Wednesday, June 19, 2013
Solace for the Children, a not-for-profit foundation based in Charlotte, N.C. will bring six Afghan children to Southern Pines, N.C. for a 6-week program that includes specialized medical care, cultural enrichment and team-building activities. Each child will live with a host family during their stay in the U.S.
One of these Afghan children, an 8-year-old girl named Maryam, will come to N.C. Children's Hospital at UNC for treatment. Maryam has a hole in her heart. She will have her first appointment with pediatric heart doctors at UNC in early July. Her course of treatment will be determined at that time.
N.C. Children's Hospital will pair Maryam with 6-year-old Hannah Saye of Pinehurst, who will be Maryam's "Heart Sister." Hannah had open heart surgery days after birth to repair a congenital heart abnormality.
Maryam's care will be paid for with donations to a fund created by the generosity of a local, retired school teacher and long-time UNC Hospitals volunteer.
]]>Wednesday, June 19, 2013
Written by Elizabeth Swaringen for UNC Health Care
CHAPEL HILL, N.C. – Kathy DeClue waited 41 years to renew her wedding vows. A successful second bone marrow transplant gave her the chance.
“At our 40th anniversary on Feb. 5, 2012, I was too sick,” said Kathy, 58, of Trinity, N.C., in Randolph County. “This February I was in the 100-day, post-transplant stay in Chapel Hill. May 4 was the first day we could get everyone together.”
On that day at 2 p.m. Kathy walked down the aisle at her church, Midway Baptist in Jamestown, N.C., on the arm of her brother, Danny Hammed, 53, and before 80 family and friends, she and her husband, Harles, 65, recommitted themselves to each other for at least another 41 years.
“Nana, you are beautiful!” shouted Ethan Rush, 7, upon first seeing Kathy in the street-length ivory dress with peach-colored lace overlay, and then processing with his siblings, Hannah, 9, and Christopher, 13, down the aisle ahead of their grandmother.
Kathy and Harles’ special words to each other flowed with genuine ease. So did the tears of those present, especially when Harles spoke.
“I promise to love you and to tell you that I love you and show you that I love you for the next 41 years,” he said, holding Kathy’s right hand. “That promise will be easy to keep because God knows I didn’t tell you or show you enough in the last 41 years. You are a strong woman, and you kept our marriage together. I can’t promise you perfection every day from here on, but I can promise that I will try.”
Kathy’s oldest brother, the Rev. Butch Hammed, 57, of Roanoke, Va., officiated. “This is an amazing day because of where she was a year ago,” he said.
On April 25, 2012, Kathy received a stem cell transplant at UNC Hospitals to treat chronic lymphocytic leukemia (CLL), a cancer of the blood cells that required aggressive medical attention.
While three of Kathy’s six siblings were perfect matches for stem cells, her youngest brother, Don Hammed, 46, of Kernersville, N.C., got the nod.
“It was a no-brainer that I would donate the cells Kathy needed,” Don said, at the reception following the ceremony. “I remember thinking they harvested more than they needed for the first transplant, but the wisdom of that is the cells were there when she needed them the second time around.
“I always felt like the transplant would work for her,” Don added. “She is a person of faith and is always so positive, regardless of the challenge before her. If we had needed to harvest more of my stem cells, we’d just do it. It wasn’t painful.”
The first transplant went well, but not well enough. As Thanksgiving neared, Kathy was failing. “I didn’t know how sick I was,” she said. “I was worried, but I tried not to let it get me down.”
“We almost lost her,” said Rose Tucker, 61, of Roanoke, Va., Kathy’s only sister. “I remember falling to my knees and praying to God ‘Please don’t take my sister, my best friend.’ I knew her team in Chapel Hill would not let her die. They are the best, and I tell anyone who will listen.”
On December 5, Kathy underwent a second stem cell transplant. Again, she was released to SECU Family House for the 100-day post-transplant stay. The 40-bedroom hospital hospitality house is the ideal home-away-from-home for patients who may have daily appointments at the hospital or need immediate medical attention.
Again, Rose joined Kathy at Family House, slipping into the familiar routine of waiting for blood test results that showed how the transplant was working. But the second time around felt different.
“I just knew it was working,” Kathy said. “I had more energy, I ate better, I talked more. And I felt like planning for the renewal of our vows. I knew it was going to happen.”
By the time she was released to return home in late March, blood tests showed that the leukemia is Kathy’s blood was down to 4 percent. A month later, it was 1 percent. (Kathy received a boost of additional stem cells on June 13 as the leukemia count grew closer to 2 percent.)
“This is just the sweetest of days, especially considering all that has happened,” said Linda Hammed, 53, Butch’s wife, who directed the ceremony, and had visited Family House while Kathy and Rose resided there.
“I was amazed at the community, the support and the love I witnessed there,” Linda said. “I think it made all the difference for Kathy.”
“Chapel Hill gave her hope, and there was always a sense that they would never give up on her,” said Linda Rush, 38, Kathy and Harles’ only daughter. “By the grace of God, she’s healed, and everything’s OK.”
(The renewal ceremony was a true family affair. In addition to those participants already mentioned, Linda Rush and Rose were matrons of honor, and Kathy and Harles’ two sons, Keith, 40, and Josh, 22, were ushers and best men.)
“I’ve never thought the disease would take her, and I expect her to live forever,” said Don. “She’s the one who took up the family tradition of getting together for a weekly meal after mom and dad died. She’s always thinking about others and doing for them.”
And what one sows, one reaps.
“We’ve talked about her illness and treatment a lot,” said Cheryl Elliott, a friend of six years and a ringleader of the reception.
“I’ve survived three cancers, gallbladder surgery and a heart attack, and I’m still going,” Cheryl said. “I believe we survive health challenges to be present for others, to be the shoulder to lean on and more. Kathy’s a very special person, and she’s still here for a reason.”
“This has been a great day,” Kathy said, reflecting on the ceremony and celebration. “We were too nervous and too shy at our wedding. I was 17, and Harles was 24 and in the Army. I never dreamed we could be as close as we are. All that we’ve been through will do that. He would say the same.”
“I do,” Harles said.
To learn more about how to be tissue typed for the National Bone Marrow Donor Registry, go to http://BeTheMatch.org.
Thursday, June 13, 2013
Clinical geneticist James Evans, MD, PhD helped to open the exhibition, Genome: Unlocking Life's Code. Portions of the exhibit include- understanding DNA; the role of genomics in health and medicine; biodiversity; medical testing and direct-to-consumer genomics; and genetic ancestry.
The exhibition, open to the general public, is a collaboration between the Smithsonian's National Museum of Natural History (NMNH) and the National Human Genome Research Institute (NHGRI) of the National Institutes of Health. Dr. Evans shares why this exhibit is important for everyone to see.
I was a technical advisor, concentrating on genomics and especially the medical aspects of it, including its promise and the challenges it raises as such things are increasingly incorporated into clinical medicine.
"We live in an age where science touches
our lives constantly and in every sphere."
We live in an age where science touches our lives constantly and in every sphere. Yet, the general public and our leaders all too often have a poor understanding of science. Given its tremendously important role in our lives it is critical that the public understand scientific concepts that shape us and influence us. Much formal science education intimidates students. Thus, there is a huge need for science to be presented to people in ways that make it approachable, understandable and for it to be done in a way that allows people to see the beauty in science. In particular, genomics is really about who we are at a fundamental level – what could be more important than understanding such things, even apart from the growing role that genomics is having in medicine?
Anyone who happens to be human and has the least interest in what makes us tick.
That we now understand how life works at its most basic level – the level of the gene and how much insight that gives us into everything from medicine to where we came from. I’d like people to walk away from the exhibit not just with knowledge but with an appreciation simply for how beautiful genetics is.
Dr. Evans is Bryson Professor of Genetics and Medicine, director of the Clinical Cancer Genetics Program of UNC Lineberger Comprehensive Cancer Center, and editor-in-chief of the journal Genetics in Medicine.
]]>Thursday, June 13, 2013
A new study by University of North Carolina School of Medicine researchers finds that visits to hospital emergency departments in North Carolina by patients with mental health disorders increased significantly from 2008 to 2010.
“Mental health disorders are a serious public health problem, and patients with mental health disorders are visiting EDs in North Carolina in growing numbers,” said Judith E. Tintinalli, MD, MS, a professor in UNC's Department of Emergency Medicine.
The study, based on an analysis of 3 years of visits to North Carolina hospital emergency departments, found that nearly 1 in 10 visits were made by patients with underlying mental health disorders. These results are reported in the June 14, 2013 issue of Morbidity and Mortality Weekly Report, published by the Centers for Disease Control and Prevention (CDC).
The study found that across the state, ED visits by patients with mental health disorders increased by 18 percent from 2008 to 2010, nearly four times the increase in the total number of ED visits in the state, and most visits (62 percent) were by those with underlying stress, anxiety, or depression. Almost one-third of ED visits by those with underlying mental health disorders resulted in hospital admission, more than twice as many as those without underlying mental health disorders. Those 65 years and older had the highest rates of stress/anxiety/depression, schizophrenia, and dementia compared to all other age groups, and one of every two elders with an underlying mental health disorder was admitted to the hospital.
“This is a predictable decision. It’s one in which both parties get something that they can claim as a victory. At this preliminary juncture, what I am pleased about is that there has been a ruling that simply isolating DNA is not sufficient for patent protection. And the reason I think that’s important is that this decision will enable the use of modern, emerging technologies for medical purposes. I think this decision puts to rest some concerns that many of us had about patent law getting in the way of medical progress and that this decision on the whole will enable progress and will not allow patents to stand in the way.
“What it will probably mean for patients is that we will have more freedom to analyze their DNA without as many concerns about patent infringements.”
Dr. Evans is the Bryson Distinguished Chair of Human Genetics at the University of North Carolina and director of the UNC Lineberger Clinical Cancer Genetics Program. He also serves as editor-in-chief of the journal Genetics in Medicine.
An expert in gene patenting and genetics policy, Evans has spoken and written nationally and internationally on the issue of direct to consumer genetic tests.
He led a program to educate federal judges about the intricacies of genetics and genetic policy as well as chairing a Federal task force that looked into the issue of gene patents. That task force, part of the Secretary’s Advisory Committee on Genetics, Health and Society, made formal recommendations to the Secretary of HHS regarding the role of gene patents in medical diagnostics.
Evans earned his medical and doctoral degrees from the University of Kansas. He completed his residency, serving as chief resident, in internal medicine at the UNC School of Medicine, and a fellowship in medical genetics at the University of Washington.
]]>Written by Nathan Clendenin for UNC Health Care
Precision, finesse and perfection are three things I know I'd want to be associated with the surgeon operating on my eye, and those words fit Dr. J. Niklas Ulrich, an ophthalmologist at UNC who specializes in vitreo-retinal surgery. He brings to the operating table years of practice, not only with the skills necessary to operate in an environment were millimeters matter, but also as an accomplished athlete.
We had our pick of golf, volleyball and tennis with Dr. Ulrich, who plays them all with excellence. But with 2-year-old twins now under his family's care, tennis is the easier option for him to play. He competes at tennis with area pros and college athletes, and his team is going to the state championship in Charlotte later this month where you'll no doubt find him smashing the ball and reaching deep for saves.
Check out this month's video and see if you don't want to grab a racket and head to the court yourself!
Tuesday, June 11, 2013
North Carolina Children’s Hospital has been ranked in seven clinical specialties in U.S. News & World Report’s 2013-14 Best Children’s Hospitals rankings, marking the sixth straight year N.C. Children’s Hospital has been recognized as one of “America’s Best Children’s Hospitals."
N.C. Children’s Hospital is recognized 11th in pulmonology, 24th in gastroenterology, 28th in neonatology, 31st in cancer, 35th in orthopaedics, 41st in endocrinology and diabetes, and 45th in nephrology.
“This is a well-deserved honor for the talented and very dedicated clinicians who are making North Carolina Children’s Hospital an increasingly well respected leader in the care of children, not just here in the Southeast but across the country,” said Wesley Burks, MD, chief physician of N.C. Children’s Hospital and chair of pediatrics at the UNC School of Medicine.
The rankings highlight the top 50 U.S. hospitals in each of these pediatric specialties: cancer, cardiology & heart surgery, diabetes & endocrinology, gastroenterology & GI surgery, neonatology, nephrology, neurology & neurosurgery, orthopedics, pulmonology, and urology. Of 179 hospitals surveyed, 87 ranked in at least one of the 10 specialties.
“N.C. Children’s Hospital deserves high praise,” said Health Rankings Editor Avery Comarow. “Ranking shows the dedication and expertise that N.C. Children’s brings to the care of children who need those qualities the most. We think it is important to identify and call attention to pediatric centers like this one.”
U.S. News introduced the Best Children’s Hospitals rankings in 2007 to help families of sick children find the best medical care available. The rankings offer families an exclusive look at quality-related information at the individual hospital level.
Each hospital’s reputation among doctors was only a small part of what U.S. News factored into its rankings. Three-quarters of each hospital’s score was determined through an analysis of patient outcomes and data on the structural resources each hospital has for pediatric care. To gather data, U.S. News used two surveys: a clinical questionnaire sent to 179 pediatric hospitals and, for the reputational assessment, a survey of 150 pediatric specialists and subspecialists in each specialty. The 1,500 physicians were asked where they would send the sickest children in their specialty, setting aside location and expense.
Survival rates, nurse staffing ratios, procedure volume, and much more can be viewed on http://health.usnews.com/best-hospitals/pediatric-rankings and will be published in the U.S. News Best Hospitals 2014 guidebook, available beginning in August.
]]>Thursday, June 6, 2013
CHAPEL HILL, N.C. - While aspirin has been shown to be effective in preventing heart attacks in men, it also increases the risk of gastrointestinal bleeding and possibly stroke, even at low doses. As such, national guidelines suggest that aspirin be used for prevention only in men at higher risk for cardiovascular events, so that the benefits of aspirin are greater than its adverse effects.
Recent data suggest that aspirin may also be effective for reducing cancer deaths. Would the possible combined health benefits of reducing heart attacks and cancer outweigh the risks of gastrointestinal bleeding and stroke for middle-aged men?
A research team, including UNC scientists, reports that including the positive effect of aspirin on cancer mortality influences the threshold for prescribing aspirin for primary prevention in men. The benefit of aspirin for cancer mortality prevention would help offset the risks and thus lower the age and increase the number of men for whom aspirin is recommended.
Their results were published in the June issue of the Journal of General Internal Medicine.
Michael Pignone, MD, MPH, study lead author, says, “We found that including a risk reduction for cancer deaths had a substantial impact on the overall benefits of aspirin, especially for early middle-aged men from 45 to 55 years of age. Based on this effect, several million men who were not previously good candidates for aspirin prevention would now become eligible.”
Dr. Pignone is professor of medicine and chief of the division of general internal medicine, and a member of UNC Lineberger Comprehensive Cancer Center.
The U.S. Preventive Services Task Force, of which Dr. Pignone is a recently appointed member, recommends aspirin for primary prevention in men “when the potential benefit of a reduction in myocardial infarctions outweighs the potential harm of an increase in gastrointestinal hemorrhage.” This recommendation was issued in 2009, before the potential benefits for cancer reduction were recognized.
Other authors are: Stephanie Earnshaw, PhD, and Cheryl McDade, Research Triangle Institute Health Solutions in Research Triangle Park, NC; and Mark Pletcher, MD, of the University of California, San Francisco.
Funding for the study was provided by Partnership for Prevention and the National Heart, Lung and Blood Institute (R21HL1122256-01) and the National Cancer Institute (K05CA 129166).
NHF established its Leadership in Research Award to recognize the outstanding achievements of researchers and physicians working to improve treatments for hemophilia and advance the field of bleeding disorders research. Dr. Monahan’s research was instrumental in building a better understanding of the potential to safely achieve increased factor IX expression using AAV vectors. The current advances in novel technologies for hemophilia and late-phases human gene therapy trials already underway for patients with factor IX deficiency were made possible through the work of Monahan and others to firmly establish the use of recombinant AAV in animal models.
Read the full announcement from the National Hemophilia Foundation here.
]]>Tuesday, June 4, 2013
CHAPEL HILL, N.C. – The American Cancer Society has awarded University of North Carolina School of Medicine researcher Dan Reuland, MD, MPH a $1.7 million Research Scholar Grant to test interventions designed to reduce colon cancer screening disparities in vulnerable patient groups, particularly Latinos.
Reuland, associate professor of medicine in the division of general medicine and clinical epidemiology, will lead a five-year, multi-site project titled “Improving Colon Cancer Screening for Diverse Populations.” Collaborators include Mike Pignone, MD, MPH, professor and chief of the general medicine division and nationally recognized expert on colon cancer screening, as well as researchers from the Mecklenburg Area Partnership for Primary-Care Research (MAPPR) and the University of New Mexico.
Colorectal cancer is the third leading cause of cancer death in the United States. Although screening can reduce colorectal cancer mortality, screening rates are low in certain vulnerable patient populations. U.S. Latinos, the nation’s largest and fastest growing racial/ethnic minority population, have particularly low screening rates. The study will focus on assessing the impact of a clinic-based intervention that includes having patients view a multimedia decision aid (in English or Spanish) before seeing their physician, as well as support from a bilingual patient “navigator” on completion of recommended colon cancer screening tests.
“There is increasing recognition that improving preventive and chronic care will require an enhanced primary care model that employs proactive, team-based approaches. These approaches will need to move beyond the model of having physicians acting as individuals delivering care in brief visits with limited care coordination or support, particularly when it comes to caring for our most vulnerable patient groups,” said Reuland. “The interventions tested in the study are pragmatic and have potential for integration into real world practice under the Patient Centered Medical Home (PCMH) model, particularly if payment for this type of systematic, team-based care can be implemented under provisions of the Affordable Care Act. This work is meant to inform clinical and policy level decisions about how to reduce disparities and promote informed decision making in vulnerable patient groups.”
The grant builds on a line of research dating back to the late 1990s when Russell Harris, MD, MPH, a professor in the UNC School of Medicine and senior investigator at the Sheps Center for Health Services Research, and others developed the original colon cancer screening decision aid. In 2009, Reuland received the American Cancer Society Cancer Control Career Development Award for Primary Care Physicians, which he used to conduct the project’s preliminary studies, including adaptation and testing of the decision aid in Spanish-speaking populations. During that award, he was mentored by Pignone, who holds a National Cancer Institute K05 Established Investigator award.
Preliminary studies were also supported by grant funding from the UNC Lineberger Comprehensive Cancer Center including its Communication for Health Applications and Interventions Core, the NIH Clinical and Translational Science Awards (CTSA) program at UNC-CH, and in-kind support from the Cecil G. Sheps Center for Health Services Research.
Reuland, Pignone and Harris are all members of the UNC Lineberger Comprehensive Cancer Center.
]]>Monday, June 3, 2013
The UNC Diabetes Care Center in Durham, N.C. is looking for volunteers to take part in a study to compare the long-term benefits and risks of four widely used diabetes drugs in combination with metformin, the most common first-line medication for treating type 2 diabetes. Beginning recruitment in June, the project is called the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness (GRADE) Study.
If metformin is not enough to help manage type 2 diabetes, a person’s doctor may add one of several other drugs to lower glucose (blood sugar). But while short-term studies have shown the efficacy of different drugs when used with metformin, there have been no long-term studies of which combination works best and has fewer side effects.The study will compare drug effects on glucose levels, adverse effects, diabetes complications and quality of life over an average of nearly five years.
“Type 2 diabetes is a progressive disease that requires the addition of more medications over time,” said Sue Kirkman, MD, the principal investigator of the study at UNC. “The GRADE study will provide important information to clinicians about the comparative effectiveness of four commonly used drug classes. UNC is honored to be one of 37 sites participating in this multi-center NIH trial. To increase our reach into the community, we will enroll and follow participants both at our Highgate clinical trials office in Durham and at UNC Diabetes Research at Eagles, located in Greensboro.”
GRADE aims to enroll about 5,000 patients. Investigators at UNC and 36 other study sites are seeking people diagnosed with type 2 diabetes within the last five years. They may be on metformin, but not on any other diabetes medication. During the study, all participants will take metformin, along with a second medication randomly assigned from among four classes of medications, all approved for use with metformin by the U.S. Food and Drug Administration.
Three of the classes of medications increase insulin levels. They are: sulfonylurea, which increases insulin levels directly; DPP-4 inhibitor, which indirectly increases insulin levels by increasing the effect of a naturally occurring intestinal hormone; and GLP-1 agonist, which increases the amount of insulin released in response to nutrients. The fourth type of medication is a long-acting insulin.
Participants will have their diabetes medications managed free of charge through the study, including at least four medical visits per year, but will receive other health care through their own providers.
“What differentiates GRADE from previous studies is that it will perform a head-to-head comprehensive comparison of the most commonly used drugs over a long period of time,” said David M. Nathan, MD, of Massachusetts General Hospital, Boston. Nathan and John Lachin, ScD, of The George Washington University, Washington, D.C., are co-principal investigators.
“In addition to determining which medications control blood glucose levels most effectively over time, we hope to examine individual factors that are associated with better or worse response to the different medications,” Nathan said. “This should provide understanding of how to personalize the treatment of diabetes.”
GRADE (ClinicalTrials.gov number: NCT01794143) is supported under NIH grant U01DK098246. Additional support in the form of donation of supplies comes from the National Diabetes Education Program, Sanofi-Aventis, Bristol-Myers Squibb, Novo Nordisk, Merck, BD Medical and Roche Diagnostics.
Learn more about the study at https://grade.bsc.gwu.edu.
For information about enrolling in the trial, contact Michelle Duclos at 919-484-0931 for the UNC Diabetes Care Center in Durham or Dawn Culmer at 919-260-8850 for the UNC Diabetes Research at Eagles in Greensboro.
Visit the UNC Diabetes Care Center website at www.uncdiabetes.org.
Monday, June 10, 2013
CHAPEL HILL – DNA is often called the blueprint of life, but the four-letter combinations that make up the genetic code are just part of the story. Built upon the DNA lies additional epigenetic information in the form of a complex ensemble of chemical tags attached to the DNA itself and on proteins that package our DNA – called histones – which ultimately control how our genetic code is accessed and used. Interestingly, histones are decorated with many types of chemical tags, and their particular combinations have been referred to as the “histone code.” But understanding how the cell interprets the code has proven challenging due to its sheer complexity and a lack of tools to study the code inside the cell.
Now research from the University of North Carolina School of Medicine has shown how a protein called UHRF1 “reads” the histone code in a specific way to perform an important cellular function. “Because the protein has been found to be defective in cancer, the finding not only lends new insight into functions downstream of the histone code but could also point the way toward novel strategies for cancer treatment and prevention,” said senior study author Brian Strahl, PhD, associate professor of biochemistry and biophysics and member of the UNC Lineberger Comprehensive Cancer Center.
The research, which appears June 1, 2013, in the journal Genes and Development, is the latest of many studies to investigate the histone code hypothesized more than ten years ago by Strahl and his former postdoctoral advisor C. David Allis. The hypothesis suggests that distinct combinations of histone modifications work together to form a code, akin to the classic genetic code, in which three-letter combinations of nucleotides make an amino acid. These histone modifications – chemical changes like phosphorylation, acetylation and methylation – generate an epigenetic language that is interpreted through the ability to recruit proteins to DNA and histones that in turn modulate cellular functions.
“This study provides important support for the histone code hypothesis, and also reiterates how difficult it will be to crack this code,” said Strahl. “It is not enough to understand how one tag works in isolation—we now have to look at all different combinations of tags on both histones and DNA to piece together the puzzle encrypting this second layer of information.”
Over the last decade, researchers have pinpointed a number of different “domains” that proteins use to interact with, or read, the histone code. Scott Rothbart, PhD, lead author and a postdoctoral research fellow in Strahl’s laboratory, previously showed that one such domain on the protein UHFR1—the tandem Tudor—helps it bind to a histone in the cell that is methylated at a specific place. Adjacent to the Tudor was another domain called a PHD finger that helped the protein also bind the unmodified end of a histone. Rothbart and Strahl wondered if these neighboring domains might function together to help UHRF1 to read the histone code and, subsequently, influence its ability to function in the cell.
To investigate this question, the researchers used a highly sophisticated peptide microarray technology developed in the Strahl lab. Just as DNA microarrays contain sections of DNA sequence spotted on glass slides, these peptide arrays contained sections of modified histone proteins. When the researchers applied the UHRF1 protein to the array, they found it bound the histone differently when it contained the linked Tudor and PHD domains than when it contained the domains in isolation. They then used biochemical techniques to show that the two domains of UHRF1 functioned together in cells—whereby each domain is making a key contribution to promote binding to the histone protein in a specific way.
One of the main functions of UHRF1 is the maintenance of a critical modification known as DNA methylation. The researchers showed that when these domains of UHRF1 were not functioning together to read the histone code, DNA methylation patterns in the cell were eventually lost.
“Abnormalities in the patterning of DNA methylation are a hallmark of many cancers,” said Rothbart. “In addition, UHRF1 has been found to be defective in a number of cancers including prostate, breast, kidney, and lung cancer. UHRF1’s function in maintaining DNA methylation seems to be reversible—if you take it out of the cell, you lose DNA methylation, but if you add it back, you restore DNA methylation. We therefore think that by using small molecules to disrupt the recognition of the histone code by UHRF1, we may be able to reprogram DNA methylation patterns in cancer cells.”
The research was supported in part by the National Institutes of Health, the Carolina Partnership and the University Cancer Research Fund, the Natural Sciences and Engineering Research Council of Canada, and the American Cancer Society.
Study co-authors from UNC were Bradley M. Dickson, PhD, postdoctoral research associate; Krzysztof Krajewski, PhD, research assistant professor; and Dmitri B. Kireev, PhD, research professor.
Thursday, May 30, 2013
The surgery, performed by Craig Buchman, MD, Professor Otolaryngology/Head and Neck Surgery, and Matthew Ewend, MD, Chair, Department of Neurosurgery, is the first of its kind performed in the United States as part of an FDA clinical trial.
The device was originally used for patients with deafness due to auditory nerve tumors, which impact hearing, but is now being considered to help restore hearing in children.
View the story on WRAL's website.
]]>Wednesday, May 29, 2013
CHAPEL HILL, N.C. - Cancer patients, physicians and insurers want to be sure that whatever therapy is recommended and provided to patients is based on evidence, preferably results from randomized clinical trials. But are there enough clinical trials data to provide this level of confidence?
A University of North Carolina School of Medicine study says not necessarily. Radiation oncologists evaluated how often patients were seen in their clinic with medical decisions to be made that were not specifically addressed by randomized controlled trials.
They determined that in a group of 393 patients who were being treated with curative intent with multiple tumor types, 47 percent of all medical decisions were made without available or applicable randomized evidence to inform clinical decision making.
The study is the only known published study to evaluate the availability of evidence in a routine clinical setting for any medical specialty. It was published in the June issue of the journal Cancer.
“Randomized controlled trials are the lynchpin of clinical care, but the results are often not applicable to an individual patient, so all care cannot be provided entirely on the basis of those trials. We’re not speaking against clinical trials. We’re just pointing out their limitations in daily cancer care,” said Joel Tepper, MD, senior author. Dr. Tepper is Hector McLean Distinguished Professor of Cancer Research, professor of radiation oncology and a member of UNC Lineberger Comprehensive Cancer Center.
Dr. Tepper said the study draws attention to several issues. “The potential negative consequences of evidence-based coverage policies may impede necessary and appropriate patient care. If the standard of adequate evidence in the form of randomized clinical trials are often not generalizable to patients, the appropriateness of using randomized data as the basis for coverage of every patient comes into question.” Observational studies, trials conducted without randomization, are an option to inform decisions when randomized trials are not available.
“Additionally, we hope that our study results suggest that well-designed observational studies and alternative clinical trial designs may play a central role in the continued development of evidence for medical decision making in select patient groups,” said Dr. Tepper. It also emphasizes the need for a robust clinical trial system that will generate more randomized trial data to inform clinical decision making.
“Our results also emphasize the importance of clinical judgment and experience in what we recommend to our patients. Tumor boards, when a patient’s case is evaluated by a number of medical specialties, can also be extremely useful,” he said.
The UNC group reviewed medical records of 393 patients evaluated for treatment in the UNC radiation oncology clinic. Patients with cancer of the breast (30 percent), head and neck (18 percent), and genitourinary (14 percent) were the most common tumor types included in the study. Patient medical decisions were classified as those with (Group 1) or without (Group 2) randomized clinical trials data. Group 1 was further divided into three groups based on the extent of fulfilling eligibility criteria for each randomized clinical trial: 1a) fulfilling all eligibility criteria; 1b) not fulfilling at least one minor eligibility criteria; and 1c) not fulfilling at least one major eligibility criteria. The availability of high level evidence varied by tumor type.
Other study authors are Smith Apisarnthanarax, MD, and Samuel Swisher-McClure, MD, University of Pennsylvania Abramson Cancer Center in Philadelphia; Randall Kimple, MD, PhD, University of Wisconsin in Madison; Stephen Harris, MD, Radiation Oncology Associates, Manchester, New Hampshire; David Morris, MD, St. Louis CyberKnife Center in St. Louis, Missouri and Wing Chiu, PhD, UNC.