Nephrology

Asahikawa, Japan

Nephrology

Asahikawa, Japan
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NEWTOWN SQUARE, Pa., April 21, 2017 /PRNewswire/ -- One of the world's prominent meetings in nephrology, the ISN World Congress of Nephrology is being held in Mexico City, Mexico from April 21st-25th (https://www.wcn2017.org/). Kibow has been participating at this bi-annual event since...


News Article | May 5, 2017
Site: www.eurekalert.org

(New York - May 5, 2017) - Much is known about flu viruses, but little is understood about how they reproduce inside human host cells, spreading infection. Now, a research team headed by investigators from the Icahn School of Medicine at Mount Sinai is the first to identify a mechanism by which influenza A, a family of pathogens that includes the most deadly strains of flu worldwide, hijacks cellular machinery to replicate. The study findings, published online today in Cell, also identifies a link between congenital defects in that machinery -- the RNA exosome -- and the neurodegeneration that results in people who have that rare mutation. It was by studying the cells of patients with an RNA exosome mutation, which were contributed by six collaborating medical centers, that the investigators were able to understand how influenza A hijacks the RNA exosome inside a cell's nucleus for its own purposes. "This study shows how we can discover genes linked to disease -- in this case, neurodegeneration -- by looking at the natural symbiosis between a host and a pathogen," says the study's senior investigator, Ivan Marazzi, PhD, an assistant professor in the Department of Microbiology at the Icahn School of Medicine at Mount Sinai. Influenza A is responsible in part not only for seasonal flus but also pandemics such as H1N1 and other flus that cross from mammals (such as swine) or birds into humans. "We are all a result of co-evolution with viruses, bacteria, and other microbes, but when this process is interrupted, which we call the broken symmetry hypothesis, disease can result," Dr. Marazzi says. The genes affected in these rare cases of neurodegeneration caused by a congenital RNA exosome mutation may offer future insight into more common brain disorders, such as Alzheimer's and Parkinson's diseases, he added. In the case of Influenza A, the loss of RNA exosome activity severely compromises viral infectivity, but also manifests in human neurodegeneration suggesting that viruses target essential proteins implicated in rare disease in order to ensure continual adaptation. Influenza A is an RNA virus, meaning that it reproduces itself inside the nucleus. Most viruses replicate in a cell's cytoplasm, outside the nucleus. The researchers found that once inside the nucleus, influenza A hijacks the RNA exosome, an essential protein complex that degrades RNA as a way to regulate gene expression. The flu pathogen needs extra RNA to start the replication process so it steals these molecules from the hijacked exosome, Dr. Marazzi says. "Viruses have a very intelligent way of not messing too much with our own biology," he says. "It makes use of our by-products, so rather than allowing the exosome to chew up and degrade excess RNA, it tags the exosome and steals the RNA it needs before it is destroyed. "Without an RNA exosome, a virus cannot grow, so the agreement between the virus and host is that it is ok for the virus to use some of the host RNA because the host has other ways to suppress the virus that is replicated," says the study's lead author, Alex Rialdi, MPH, a graduate assistant in Dr. Marazzi's laboratory. Co-authors include investigators from the University of California-San Francisco, Columbia University, Regeneron Pharmaceuticals and Regeneron Genetics Center, Burnham Institute for Medical Research, and the University of California-Los Angeles. The study was supported by NIH grants 2RO1AI099195 and DP2 2OD008651 (U.B.), and partially supported by HHSN272201400008C - Center for Research on Influenza Pathogenesis (CRIP) a NIAID-funded Center of Excellence for Influenza Research and Surveillance (A.G.S, H.v.B., R.A., and I.M.). Other support includes the Department of Defense W911NF-14-1-0353 (to I.M.) NIH grant 1R56AI114770-01A1 (to I. M.), NIH grant 1R01AN3663134 (I.M. and H.v.B), and NIH grant U19AI106754 FLUOMICS (I.M., R.A., S.C., N.K., A.G.S.). The Mount Sinai Health System is an integrated health system committed to providing distinguished care, conducting transformative research, and advancing biomedical education. Structured around seven hospital campuses and a single medical school, the Health System has an extensive ambulatory network and a range of inpatient and outpatient services -- from community-based facilities to tertiary and quaternary care. The System includes approximately 7,100 primary and specialty care physicians; 12 joint-venture ambulatory surgery centers; more than 140 ambulatory practices throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and 31 affiliated community health centers. Physicians are affiliated with the renowned Icahn School of Medicine at Mount Sinai, which is ranked among the highest in the nation in National Institutes of Health funding per investigator. The Mount Sinai Hospital is in the "Honor Roll" of best hospitals in America, ranked No. 15 nationally in the 2016-2017 "Best Hospitals" issue of U.S. News & World Report. The Mount Sinai Hospital is also ranked as one of the nation's top 20 hospitals in Geriatrics, Gastroenterology/GI Surgery, Cardiology/Heart Surgery, Diabetes/Endocrinology, Nephrology, Neurology/Neurosurgery, and Ear, Nose & Throat, and is in the top 50 in four other specialties. New York Eye and Ear Infirmary of Mount Sinai is ranked No. 10 nationally for Ophthalmology, while Mount Sinai Beth Israel, Mount Sinai St. Luke's, and Mount Sinai West are ranked regionally. Mount Sinai's Kravis Children's Hospital is ranked in seven out of ten pediatric specialties by U.S. News & World Report in "Best Children's Hospitals." For more information, visit http://www. , or find Mount Sinai on Facebook, Twitter and YouTube.


Shari M. Ling, MD has been selected to receive the first-ever Public Service Award from NKF, established to honor those who have dedicated their careers to public service and who have helped to shape public policies or government programs that improve outcomes for kidney patients.  Dr. Ling currently serves as the Deputy Chief Medical Officer for the Centers for Medicare and Medicaid Services (CMS) and Medical Officer in the Center for Clinical Standards and Quality (CCSQ).  In her role at CMS, she assists the CMS Chief Medical Officer in the agency's pursuit of better health care, healthier populations and smarter spending. Dr. Ling's committed focus is on the achievement of meaningful health outcomes for patients and families through the delivery of high quality, person-centered care, across all care settings. Her clinical focus and scientific interest is in the care of persons with dementia, multiple chronic conditions and functional limitations. Derek Forfang, a kidney patient and long-time kidney disease advocate, has been selected to receive the first-ever Celeste Castillo Lee Patient Engagement Award, established in honor of Celeste Castillo Lee, a longtime advocate for patient-centered care and empowerment. It is the highest honor given by NKF to a distinguished kidney patient who exemplifies NKF's mission and Celeste's legacy of putting patients at the center of all aspects of healthcare through their involvement with NKF and community partners.  Mr. Forfang, of San Pablo, California, has been an end-stage renal disease (ESRD) patient since 1999.  He received a kidney transplant and has also been on peritoneal dialysis and hemodialysis.  A regional leader of NKF's Kidney Advocacy Committee and a member of the Public Policy Committee, Derek has worked tirelessly to protect and improve care for the kidney community. Merck been selected to receive the 2017 Corporate Innovator Award which recognizes industry partners that advance the field of nephrology by addressing an unmet medical need, or improving upon an existing practice, therapeutic or technology.  Merck's innovative new treatment for hepatitis C, ZEPATIER, is the only direct anti-viral agent specifically tested and approved for use in patients with chronic kidney disease stages four and five. Paul Palevsky, MD has been selected to receive the Dr. J. Michael Lazarus Distinguished Award established to honor Dr. Lazarus for his major contributions to the clinical science and care of dialysis patients, and to recognize individuals whose research has yielded novel insights related to renal replacement therapy.  Dr. Palevsky is Professor of Medicine and Clinical and Translational Science in the Renal-Electrolyte Division at the University of Pittsburgh School of Medicine; and serves as Chief of the Renal Section at the VA Pittsburgh Healthcare System.  Dr. Palevsky's research has primarily focused on acute kidney injury and critical care nephrology. He will be presenting the Lazarus lecture on "We Don't Have to Fail at Acute Renal Failure: A Multidisciplinary Approach to Quality Improvement" on Friday, April 21st at 8:45 a.m. at the NKF Spring Clinical Meetings. Susanne Nicholas, MD, MPH, PhD has been selected to receive the Medical Advisory Board Distinguished Service Award established to recognize an individual for their educational activities and community service in promoting the mission of NKF on a local level.  Dr. Nicholas is a tenured Associate Professor of Medicine at UCLA in the Division of Nephrology where she maintains her clinical responsibilities, and the Division of Endocrinology, Diabetes and Hypertension, where she conducts research.  She is also a Clinical Hypertension Specialist.   Dr. Nicholas' research interests include understanding and identifying key factors that promote the pathogenesis of diabetic kidney disease (DKD); uncovering and validating novel biomarkers that may predict DKD progression; and quantifying renal structural changes associated with DKD in response to novel therapeutics, using stereology principles. Her research over the past 15 years has led to the identification of a novel biomarker of DKD, which is currently being validated in clinical studies. Katherine R. Tuttle, MD, FASN, FACP, FNKF, has been selected to receive the prestigious Garabed Eknoyan Award, created to recognize an individual who has promoted the mission of NKF in Making Lives Better for people with kidney disease through the exceptional contributions to key initiatives of NKF such as the Kidney Disease Outcomes Quality Initiative (KDOQI) or clinical research in the field of kidney disease.  Dr. Tuttle is the Executive Director for Research at Providence Health Care in Spokane, and serves as Co-Principal Investigator of the Institute of Translational Health Sciences, Investigator at Kidney Research Institute, and Clinical Professor of Medicine for the University of Washington.  Dr. Tuttle's major research interests include diabetic kidney disease, hypertension, renal vascular disease, nutrition in chronic kidney disease, and transitional care.  She has chaired numerous workgroups focused on diabetes and kidney disease including NKF's KDOQI Workgroup for Diabetes and Chronic Kidney Disease. Jonathan Himmelfarb, MD has been selected to receive the Donald W. Seldin Award, established to recognize excellence in clinical nephrology in the tradition of one of the foremost teachers and researchers in the field, Dr. Donald W. Seldin.  Dr. Himmelfarb is a Professor of Medicine, Director of the Kidney Research Institute, and holds the Joseph W. Eschbach, M.D. Endowed Chair in Kidney Research at the University of Washington School of Medicine.   He is the author of more than 200 peer-reviewed publications, has served on numerous grant review committees and scientific advisory boards and has held leadership positions in many national and international nephrology societies.  Dr. Himmelfarb has served on expert panels for the U.S. Food and Drug Administration, Veterans Health Administration, and Centers for Medicare & Medicaid Services. He is also a nephrologist who cares for patients with kidney disease, and an internationally recognized educator about kidney disease. Raymond R. Townsend, MD has been selected to receive the Shaul G. Massry Distinguished Lecture Award, established to honor Dr. Massry for his scientific achievements and contribution to the kidney health care community and to NKF.  Dr. Townsend is Professor of Medicine and an Associate Director of the Center for Human Phenomic Studies at the University of Pennsylvania.  He is currently a Principal Investigator evaluating the role of demographic, phenotypic, humoral and genetic factors in the progression of kidney disease and the development and progression of cardiovascular disease in patients with chronic kidney disease.  He was also the Principal Investigator of a multicenter effort evaluating the specific role of pulse wave velocity in the renal and cardiovascular consequences of chronic kidney disease.   Dr. Townsend led the work group that wrote the KDOQI Commentary on the 2012 KDIGO Guideline on this subject, and most recently co-chaired the NKF workshop on Potassium Homeostasis in Disease and Health, the report on which will soon be published in the American Journal of Kidney Disease and Journal of the American Society of Hypertension. Tilakavati Karupaiah, PhD, APD, AN has been selected to receive the Joel D. Kopple Award, an annual award honoring an individual who has made significant contributions to the field of renal nutrition.  Dr. Karupaiah is an Accredited Practicing Dietitian with Dietitian's Association of Australia, a Professor and Head of the Dietetics Program at the National University of Malaysia; and also Adjunct Associate Professor at Wayne State University, Detroit.    Dr. Karupaiah's involvement in renal nutrition began because of a lack of dietitians in this field in Malaysia, and dialysis patients needed patient-friendly information about local diets. At the National University of Malaysia, she encouraged early exposure of dietetic students to renal patient care through community engagement, outpatient counseling and practical skills on patient diet planning. Dr. Karupaiah is now targeting capacity building mentorship for developing renal dietitians in Malaysia through nutrition research. For the past 26 years, nephrology healthcare professionals from across the country have come to NKF's Spring Clinical Meetings to learn about the newest developments related to all aspects of nephrology practice, network with colleagues, and present their research findings. The NKF Spring Clinical Meetings are designed for meaningful change in the multidisciplinary healthcare teams' skills, performance, and patient health outcomes.  It is the only conference of its kind that focuses on translating science into practice for the entire healthcare team. 1 in 3 American adults is at risk for kidney disease.  26 million American adults have kidney disease—and most aren't aware of it.  Risk factors for kidney disease include diabetes, high blood pressure, family history, and age 60+.  People of African American; Hispanic; Native American; Asian; or Pacific Islander descent are at increased risk for developing the disease.  African Americans are 3 ½ times more likely, and Hispanics 1 ½ times more likely, to experience kidney failure. The National Kidney Foundation (NKF) is the largest, most comprehensive and longstanding organization dedicated to the awareness, prevention and treatment of kidney disease.  For more information about NKF visit www.kidney.org. :  Full press releases on each award recipient, including quotes for attribution, are hyperlinked by recipient's name and can also be found in the Newsroom at www.kidney.org. To view the original version on PR Newswire, visit:http://www.prnewswire.com/news-releases/national-kidney-foundation-honors-leading-researchers-clinicians-patient-advocates-and-more-at-its-26th-annual-spring-clinical-meetings-300442333.html


News Article | April 17, 2017
Site: www.prweb.com

Dr. Nizar S. Eskandar, who has lead SouthCoast Health’s Nephrology Department for almost 10 years, has a broad background of clinical experiences which sets him apart from many other nephrologists. With this experience also comes an understanding of the importance of awareness efforts like National Kidney Month. According to Dr. Eskandar, the Southeast region of United States in particular needs to focus more on its kidney health. “The Southeast United States – Georgia, South Carolina, and Alabama in particular – have higher incidence of obesity, hypertension, and diabetes. People are generally more unfit in this region, having a higher average BMI. All of these factors reflect negatively in kidney health.” More accounts of hypertension and diabetes, being two of the biggest risk factors for chronic kidney disease, lead to a higher concentration of kidney-related diseases in the region. “I think the Southeast United States needs more national attention and education through events and different forms of outreach on kidney health in general,” commented Dr. Eskandar. In the effort to raise more awareness about the importance of kidney health, Dr. Eskandar makes sure to be involved in community health fairs and other forms of local outreach. From speaking at churches, participating in school-screenings for hypertension, and promoting the importance of kidney awareness campaigns such as National Kidney Month, Dr. Eskandar hopes to prevent more cases of chronic kidney disease while providing treatment for those suffering from it. Most people overlook their kidney health when it comes to their list of health issues to keep an eye on. However, because kidney disease shows little to no symptoms in the early stages, Dr. Eskandar emphasizes the importance of getting screened regularly, especially if hypertension, diabetes, or chronic kidney disease runs in the family “If someone has multiple health issues, such as diabetes and hypertension, they need to pay attention to their kidneys as well, “ said Dr. Eskandar. “Because there are no symptoms, no physical alerts or alarms associated with failing kidneys, it’s important for everyone to stay on top of their overall health and know how it can be affecting kidney function. Other health issues, such as cardiovascular disease for example, can also negatively affect the kidneys. Along with maintaining a healthy lifestyle that includes a healthy diet and regular exercise, Dr. Eskandar said getting regular blood tests done and trying to stick to a low-salt diet are additional ways to prevent chronic kidney disease. Chronic kidney disease, in the majority of cases, can be avoided if someone keeps their health in check and maintains regular visits with a healthcare professional. “It’s important that people establish a relationship with a primary care physician in order to get associated with a nephrologist,” said Dr. Eskandar. “Diagnosing chronic kidney disease all starts in the primary care physician’s office. If patients are good about going to their yearly health examinations without skipping any appointments, the physician should be able to refer them to a nephrologist if kidney disease findings have been identified.” Dr. Eskandar says he is able to treat patients with kidney issues as a whole due to his initial experience as an internal medicine doctor. His training in primary care allows him to examine nephrology patients with a wider spectrum of knowledge and expertise. Dr. Eskandar also has experience working in the Intensive Care Unit. Being Board Certified in Internal Medicine, Nephrology, and Critical Care Medicine, “I have a well-rounded look when it comes to the patients I treat,” said Dr. Eskandar. “Whether it be from general health concerns to kidney-specific problems, I’m able to apply my experiences to help my patients in the best way possible.” In addition, Dr. Eskandar has practiced under healthcare systems from all over the world. Being from Syria, Dr. Eskandar grew up in an environment that had far less resources for healthcare compared to that of the United States. Along with the healthcare system of the U.S., he has experience with the European and Middle Eastern health systems as well. “All of that together made me have an overview and broader look into medical problems in general and nephrology in particular,” said Dr. Eskandar. “This helps me provide the best individualized care for each patient I treat.” When asked why he chose to specialize in nephrology, Dr. Eskandar said, “nephrology is a very interesting field. It is very intellectual, intuitive, and also requires a significant knowledge of physiology.” He explained that he also finds it very intriguing that there are still a lot of undiscovered facts and a lot of research to be done in this field. “There is a lot of aggressive, kidney-focused research going on currently compared to the past. Medical technology has really advanced what we understand about nephrology in the last five to ten years. Because of this pickup in research being done, I’m very excited to see what there is still to be discovered about our kidneys." Dr. Eskandar, along with the rest of the SouthCoast Health team, is dedicated to providing the best care for patients. As National Kidney Month comes to a close, make sure to keep your kidney health in mind as you strive for Total Wellness.


News Article | May 4, 2017
Site: www.eurekalert.org

(New York, NY - May 4, 2017) -- Immunotherapy, which has achieved remarkable results in late-stage lung cancer patients, can also hold great hope for newly diagnosed patients, cutting the deadly disease off before it has the chance to take hold and offering a potential cure, according to a new Mount Sinai study published today in Cell. Researchers at The Tisch Cancer Institute at Mount Sinai discovered that some of the same immune cells that allow immunotherapy to turn around some late-stage lung cancers are also present just as the disease takes hold. Before now, little was known about the immune response in early lung cancer, said Miriam Merad, MD, PhD, Professor of Oncological Sciences and of Medicine (Hematology and Medical Oncology) at The Tisch Cancer Institute at Mount Sinai. Dr. Merad and a multidisciplinary team of thoracic surgeons, pathologists, and scientists devised a comprehensive study that began when patients went into surgery to have cancerous lesions removed. The patients' lung tumor samples, samples of surrounding healthy lung tissue, and blood samples were immediately analyzed on a cellular level to map out the immune system components present. The team of researchers crafted a barcoding method that attaches cells in each sample to a different metal isotope, allowing the samples to be pooled for a simultaneous analysis of cells from all three tissue types. The scientists combined this barcoding approach with high-dimensional profiling to map the complete immune landscape to search for tumor-driven changes that would be vulnerable to targeted immunotherapy. The analysis of the samples showed that stage I lung cancer lesions already harbor immune system components that likely compromise anti-tumor T cells' ability to fend off cancer. These single-cell analyses offered unprecedented detail of tumor-driven immune changes, providing a powerful tool for the future design of immunotherapies such as checkpoint inhibitors, particularly those that target the PD-1 and PD-L1 proteins that shield cancer from the immune system; these checkpoint inhibitors have shown great promise in later-stage cancers. "Immunotherapy has mostly been used in advanced or metastatic lung cancer, but its benefit in early-stage tumors remains unknown," Dr. Merad said. "The standard treatment for early lung cancer is normally surgical removal of the lesions--sometimes with chemotherapy and radiation. Our study reveals that early lung lesions are heavily infiltrated with many different immune cells, suggesting that immunotherapy could also work on very early lesions and potentially lead to a cure by heading cancer off at the pass before it really takes root in the lungs." This new research also identified a multitude of additional immunotherapy targets to increase the number of patients that would significantly benefit from immunotherapy, which at the moment remains fairly small. This research is being used to develop immunotherapy trials with early lung cancer patients. "About 50 percent of patients with small lung cancer lesions relapse," Merad said. "And when lung cancer is advanced, chemotherapy does not have a great success rate, so knowing how to attack the cancer at an early stage could have huge impacts on the number of patients relapsing and their overall survival. Our research further corroborates the belief that immunotherapy agents are most efficient at early stages of cancer, particularly in patients who have never been treated with chemotherapy." Raja M. Flores, MD, Chair of the Department of Thoracic Surgery at Mount Sinai Health System, and his team contributed significantly to the study by identifying patients and providing their tissue samples. Mount Sinai's Human Immune Monitoring Center (HIMC) also played an integral role, by providing a platform to analyze patient samples using quality control assays and cutting-edge technology. Through the HIMC, Dr. Merad plans to build a portal to share the results of this study and of other HIMC research to collaborate with colleagues at other cancer centers in the hopes of promoting further cancer and immunology research. This study was funded by Foundation pour la Recherche Medicale DEA20150633125 and NIH grants R01, R01 CA173861, U19AI128949, U24 AI 118644, U19 AI 117873-01. The Mount Sinai Health System is an integrated health system committed to providing distinguished care, conducting transformative research, and advancing biomedical education. Structured around seven hospital campuses and a single medical school, the Health System has an extensive ambulatory network and a range of inpatient and outpatient services--from community-based facilities to tertiary and quaternary care. The System includes approximately 7,100 primary and specialty care physicians; 12 joint-venture ambulatory surgery centers; more than 140 ambulatory practices throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and 31 affiliated community health centers. Physicians are affiliated with the renowned Icahn School of Medicine at Mount Sinai, which is ranked among the highest in the nation in National Institutes of Health funding per investigator. The Mount Sinai Hospital is on the "Honor Roll" of best hospitals in America, ranked No. 15 nationally in the 2016-2017 "Best Hospitals" issue of U.S. News & World Report. The Mount Sinai Hospital is also ranked as one of the nation's top 20 hospitals in Geriatrics, Gastroenterology/GI Surgery, Cardiology/Heart Surgery, Diabetes/Endocrinology, Nephrology, Neurology/Neurosurgery, and Ear, Nose & Throat, and is in the top 50 in four other specialties. New York Eye and Ear Infirmary of Mount Sinai is ranked No. 10 nationally for Ophthalmology, while Mount Sinai Beth Israel, Mount Sinai St. Luke's, and Mount Sinai West are ranked regionally. Mount Sinai's Kravis Children's Hospital is ranked in seven out of ten pediatric specialties by U.S. News & World Report in "Best Children's Hospitals." For more information, visit http://www. or find Mount Sinai on Facebook, Twitter and YouTube.


Researchers comparing leading treatment approaches for patients with severe uveitis have discovered that systemic therapy with oral corticosteroids and immunosuppression can preserve or improve vision in the long term better than regional implant therapy can. The results, published in the May 6, 2017 issue of JAMA, should reassure physicians about the relative safety of this approach, and may lead ophthalmologists to change their treatment protocol for better and safer outcomes. Douglas Jabs, MD, MBA, Director of the Eye and Vision Research Institute, New York Eye and Ear Infirmary of Mount Sinai, and Professor of Ophthalmology and Medicine, Icahn School of Medicine at Mount Sinai, chaired an international team of researchers as they examined the long-term effects of two treatment approaches for patients with vision-threatening uveitis. Uveitis, the fifth leading cause of vision loss in the United States, is a collection of more than 30 diseases characterized by inflammation inside the eye that damages the tissues; without appropriate treatment, it will often lead to visual impairment or blindness. For more severe cases, treatment generally calls for taking oral corticosteroid and immunosuppressive medications. The alternative is regional therapy, either with repetitive corticosteroid injections or with a surgically placed fluocinolone acetonide implant that releases corticosteroid medication over three years. Since most of the more severe uveitis cases are chronic, long-term therapy is typically needed. The Multicenter Uveitis Steroid Treatment (MUST) Trial Follow-up Study followed 215 patients from the original MUST Trial for seven years. The MUST Trial and Follow-up Study were conducted at 21 medical centers across the United States, along with two sites in the United Kingdom and Australia. Patients in the Trial had been randomized to receive either systemic treatment with oral corticosteroids and immunosuppression or regional therapy with the fluocinolone acetonide implant. At the seven-year mark, the findings showed that patients taking oral medications had better vision on average, compared to those in the implant group. The results differ from the initial MUST Trial findings and from the earlier five-year results of the MUST Follow-up Study, in which the same patients had similar visual outcomes at both time points. The MUST Trial and Follow-up Study also showed that there was no significant increase in the risks of systemic side effects for the systemic therapy group compared to implant therapy, with one exception: patients in the systemic group were more likely to receive antibiotics for infections. These outcomes suggest that systemic treatment, if used properly, may be given relatively safely for up to seven years. "The implication of these data is that oral corticosteroids and immunosuppression may be a preferable initial choice for therapy of the more severe uveitides," explained Dr. Jabs. "They have better visual outcomes long-term, fewer ocular side effects, and no apparent significant increase in the risk of systemic side effects, except for the greater use of antibiotics." While the large majority of both groups maintained good vision at the end of seven years, some patients with the fluocinolone acetonide implant did worse in terms of visual acuity. Results of the follow-up study show vision loss occurred more often in the implant group due to damage from inflammatory lesions in the back of the eye, which occurred at the time of relapse of the uveitis. Even though the implant is designed to release corticosteroid medication for three years, the study found that the benefit lasted approximately five years, with relapses beginning at that time. Relapses can be treated with an implant exchange or by switching to systemic therapy. "Although both treatment approaches control the inflammation in the large majority of patients, for the first five years the implant was better than systemic therapy at controlling inflammation. Hence it has value for those patients where systemic therapy cannot control the inflammation or for those patients who cannot tolerate the oral medications," said Dr. Jabs. He notes the implant has an important role to play in the management of these diseases. "The visual loss that occurred in the implant group with relapse of the uveitis emphasizes the need of sustained control of inflammation in order to optimize visual outcomes in patients. These patients need close follow-up for reactivation of the inflammation, so that appropriate adjustments to treatment can be made." The National Eye Institute (NEI), which is part of the National Institutes of Health, supported the MUST Trial and MUST Trial Follow-up Study. The Mount Sinai Health System is an integrated health system committed to providing distinguished care, conducting transformative research, and advancing biomedical education. Structured around seven hospital campuses and a single medical school, the Health System has an extensive ambulatory network and a range of inpatient and outpatient services--from community-based facilities to tertiary and quaternary care. The System includes approximately 7,100 primary and specialty care physicians; 12 joint-venture ambulatory surgery centers; more than 140 ambulatory practices throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and 31 affiliated community health centers. Physicians are affiliated with the renowned Icahn School of Medicine at Mount Sinai, which is ranked among the highest in the nation in National Institutes of Health funding per investigator. The Mount Sinai Hospital is in the "Honor Roll" of best hospitals in America, ranked No. 15 nationally in the 2016-2017 "Best Hospitals" issue of U.S. News & World Report. The Mount Sinai Hospital is also ranked as one of the nation's top 20 hospitals in Geriatrics, Gastroenterology/GI Surgery, Cardiology/Heart Surgery, Diabetes/Endocrinology, Nephrology, Neurology/Neurosurgery, and Ear, Nose & Throat, and is in the top 50 in four other specialties. New York Eye and Ear Infirmary of Mount Sinai is ranked No. 10 nationally for Ophthalmology, while Mount Sinai Beth Israel, Mount Sinai St. Luke's, and Mount Sinai West are ranked regionally. Mount Sinai's Kravis Children's Hospital is ranked in seven out of ten pediatric specialties by U.S. News & World Report in "Best Children's Hospitals." For more information, visit http://www. , or find Mount Sinai on Facebook, Twitter and YouTube.

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