News Article | May 1, 2017
In this Sunday, April 30, 2017 photo, a sign warns beach goers at San Onofre State Beach after a woman was attacked by a shark in the area Saturday, along the Camp Pendleton Marine base in San Diego County, Calif. The beach remained closed Sunday. (Laylan Connelly/The Orange County Register via AP) CAMP PENDLETON, Calif. (AP) — A woman who lost part of her right leg in a shark attack while wading at a popular Southern California beach was listed in critical condition Monday at a hospital. Leeanne Ericson was rescued Saturday by a handful of Camp Pendleton beachgoers, including one who used a tourniquet fashioned from a surfboard leash to stanch the bleeding. She was flown to Scripps Memorial Hospital in La Jolla, where hospital spokeswoman Janice Collins said she was critical condition but declined to release further details. "All of the back of her leg was kind of missing," Thomas Williams, one of several witnesses who pulled the woman ashore, told the Orange County Register. He said a veteran surfer, Hunter Robinson, suggested using a surfboard leash to stanch the bleeding until Camp Pendleton Marine Corps Base emergency personnel arrived. The shark attacked at a beach known as Church on the northern tip of the base. Ericson is a single mother of three young children, according to a GoFundMe page to raise money for her recovery. The page, which had raised a little more than $23,000 by Monday afternoon, was created by Christine McKnerney Leidle, who did not immediately respond to email messages. Members of Ericson's family could not be immediately reached. Authorities immediately shut down a three-mile stretch (4.8 kilometers) of shoreline extending from a mile (0.6 kilometers) north of Church to nearby San Onofre and San Clemente state beaches. The area was expected to be reopened Wednesday to swimmers and surfers. "If we do have additional sightings, aggressive shark behavior or something that warrants extending the closing beyond Wednesday we would certainly reassess, but right now we haven't had anything," said Todd Lewis, superintendent for the central sector of California State Parks, Orange Coast District. It didn't appear anyone recorded video of the attack, and it wasn't known if the shark was a great white, although several have been seen in the area over the past year. While shark sightings are not uncommon along the California coast, attacks are rare and fatalities even more so. The last shark attack in the area that Lewis could recall involved Maria Korcsmaros, who was training for an ironman competition when she was bitten last May off the coast of nearby Newport Beach. A shark chewed into her sides, ribs and liver but she recovered and swam in a triathlete competition in San Diego last October. In two separate incidents in February, fisherman reeled in what were believed to be great white sharks, one onto the Huntington Beach Pier and the other onto the sand. Both were quickly returned to the ocean, as required by law. Watch TV shows, movies and more on Yahoo View, available on iOS and Android.
News Article | May 1, 2017
FILE PHOTO: An emergency sign points to the entrance to Scripps Memorial Hospital in La Jolla, California, U.S. March 23, 2017. REUTERS/Mike Blake/File Photo WASHINGTON (Reuters) - Top aides to President Donald Trump on Monday predicted the House of Representatives would move this week to overhaul the U.S. healthcare system, though Republicans remained divided on how to protect sick Americans from insurance price hikes. The White House is eager to move forward on legislation to repeal and replace the Affordable Care Act, commonly called Obamacare, to make good on a key campaign promise. Republicans tried but failed to pass a replacement bill in March in an embarrassing setback for the Trump Administration. Lawmakers are considering a bill that would allow states to opt out of Obamacare protections for people with pre-existing medical conditions - provisions that force insurers to charge sick people and healthy people the same rates. It was unclear when or if a vote would be scheduled. Trump told Fox News Channel that he would not set a deadline for the vote, and indicated he was open to improvements. "We’re either going to have a great plan or I’m not signing it," he said in the interview. In a separate interview with Bloomberg News, Trump insisted that the new bill would maintain protections for pre-existing conditions. "I want it to be good for sick people. It’s not in its final form right now," he told Bloomberg. "It will be every bit as good on pre-existing conditions as Obamacare." Ten major patient advocacy groups said they opposed the reworked healthcare bill, including the American Heart Association and American Diabetes Association. Other major medical groups such as the American Medical Association have also expressed concerns over coverage losses and unaffordable insurance for those with pre-existing conditions. Republican lawmakers have struggled to unite around legislation, with moderates and conservatives within the caucus divided over key provisions. Once a plan passes the Republican-controlled House, it is expected to face a tough fight in the Senate, where Republicans have a narrower majority and where some party senators have expressed misgivings about the House bill. White House Chief of Staff Reince Priebus and White House economic adviser Gary Cohn on Monday said in separate interviews with CBS' "This Morning" that they thought there were enough votes to pass the bill this week. House Republican leaders were more cautious. As of Monday afternoon, no vote had been scheduled and backers of the healthcare proposal had not released legislative language. Representative Cathy McMorris Rodgers, chair of the House Republican conference, said Republican members needed time to understand new tweaks to the bill. "We are having those member-to-members conversations right now," McMorris Rodgers told Fox News. Vice President Mike Pence made his way to Capitol Hill late on Monday to make the case to members who are on the fence, a Republican aide said on condition of anonymity, noting leaders are believed to be within five or six votes of having enough support to pass the bill. The Freedom Caucus, which brought down the previous effort to pass a healthcare bill, has endorsed the new measure. The Republican aide told Reuters all but one or two members of the group will support the reworked plan. "This bill doesn’t get all the way there but it’s a good step and is ... the best we can get out of the House right now," Representative Jim Jordan, chairman of the group, told CNN. But several moderate Republicans were either undecided or opposed the bill for fear that it would not protect those with pre-existing conditions and cause millions to lose health insurance. Representative Charlie Dent, a moderate Republican from Pennsylvania, said he still had problems with the latest plan and suspected there were not enough votes to pass it. "Too many Americans are going to be without coverage," Dent told MSNBC, adding that the plan could make things even worse for vulnerable Americans.
News Article | May 7, 2017
In Southern California, great white sharks have begun to arrive after spending the winter off Baja California. Recently, one of the sharks bit a chunk out of a mother's leg as she swam off San Onofre State Beach. The woman, 35-year-old Leanne Ericson of Vista, remains in critical condition and has undergone two of several surgeries scheduled for her injuries, The San Diego Union-Tribune reported. She lost a lot of blood and was temporarily in an induced coma. "We are grateful for all of the concern, prayers and good wishes we have received in recent days from the many friends and strangers who have reached out to us from across the country, and indeed, the world," read a statement from Ericson's family, released to the Union-Tribune through Scripps Memorial Hospital La Jolla. "The situation could have been far graver had it not been for the number of emergency response personnel and others who provided the care she needed and saved her life." Chris Lowe, a biology professor and director of the Shark Lab at California State, Long Beach, said the shark that attacked Ericson on Saturday was likely not a full-grown adult and mistook her for food. Typically, young great whites will feed on fish and rays. "They have to learn to feed on their own and they're naive," Lowe said. "They don't know how to chase down big prey." Adult great whites feed on sea lions and other marine life off islands such as Catalina and San Nicholas, Lowe said. Although it's not exactly known where the mothers give birth, their babies immediately head toward the shore once they're born. The sharks are normally off Southern California's shores between May and October. But last year, warm waters triggered by El Nino conditions kept the sharks here longer into the winter and drew them back earlier in the spring. Some of the 2- and 3-year-old sharks are here again earlier this year, Lowe said, though he's not sure why. "Maybe it just wasn't cold enough to move those migrations. We just don't know what's going on this year," Lowe said. But that's not the only shark mystery this year. In San Francisco Bay, a huge die-off of leopard sharks and bat rays has sparked concerns among marine life experts. For weeks now, dead leopard sharks - newborns and mature adults - have been washing up on beaches from San Mateo to Bolinas. Officials with the Pelagic Shark Research Foundation in Monterey believe years of debris, trash and chemical waste pent up in Bay Area storm drains and waterways have finally been washed into the bay because of this winter's epic storms and are killing the creatures that live there. Tide gates inside the bay that close during high tide to prevent flooding during a storm can also trap sharks and bat rays in the bay, where they're then exposed to, and unable to escape, toxic runoff. "This is an issue of San Francisco Bay sharks and associated wildlife being exposed to toxic watershed ... due to Tide Gate entrapment and subsequent discharges into the San Francisco Bay," the center wrote on Facebook last week. At the peak of the die-off, dozens of dead sharks were found daily along the coastline, the foundation said. The number of dead sharks has begun to drop in the last week. In Southern California, however, the shark population is thriving. On Thursday, Orange County Sheriff's Sgt. Steve Marble said deputies with the harbor patrol in Dana Point spotted a group of four 6- to 8-foot great whites at the surf line. Other popular areas for sharks this year include Ventura, Santa Monica and Belmont Shores, Lowe said. "We've learned that these baby white sharks are temperature-sensitive and they don't like temperatures above 80 degrees. They have this sweet spot, and Southern California is the perfect place from late spring to mid-fall," Lowe said. "Then Baja becomes the sweet spot." Lowe's researchers recently tracked a 1-year-old shark that stayed around Huntington Beach for 30 days, then moved up to Santa Monica in a matter of hours. It stayed there for a month. Despite the public panic a shark attack can create, Lowe says the coastline is safe if you look at statistics. "It's horribly unfortunate these things happen, but the reality is people are going to go out surfing and it's not something that happens every day," he said. "Accidents do happen and that's what we think these are. There's no indication these sharks have any penchant for eating people. "Otherwise, Huntington Beach would be a one-stop shop for sharks in the Pacific," he joked. When young sharks have attacked, it has typically been when swimmers have been alone, farther out in the water and along remote stretches of beach not crowded with hundreds or thousands of other people. Explore further: More great white sharks appear to be visiting off Cape Cod
News Article | February 23, 2017
LA JOLLA, CA - February 22, 2017 - The MagnaSafe Registry, a new multicenter study led by scientists at The Scripps Research Institute (TSRI), has demonstrated that appropriately screened and monitored patients with standard or non-MRI-conditional pacemakers and defibrillators can undergo MRI at a field strength of 1.5 tesla without harm. These devices are not presently approved by the U.S. Food and Drug Administration (FDA) for MRI scanning. The researchers observed no patient deaths, device or lead failures, losses of pacing function or ventricular arrhythmias in 1,500 patients who underwent MRI using a specific protocol for device interrogation, device programming, patient monitoring and follow-up designed to reduce the risk of patient harm from MRI effects. The research will be published as an Original Article in the February 23, 2017 issue of The New England Journal of Medicine. The use of MRI poses potential safety concerns for patients with an implanted cardiac device. These concerns are a result of the potential for magnetic field-induced cardiac lead heating, which could result in cardiac injury and damage to an implanted device. As a result, it has long been recommended that patients with a pacemaker or defibrillator not undergo MRI scanning, even when MRIs are considered the most appropriate diagnostic imaging method for their care. Despite the development of devices designed to reduce the potential risks associated with MRI, a large number of patients have devices that have not been shown to meet these criteria and are considered "non-MRI-conditional." At least half these patients are predicted to have the need for MRI after a device has been implanted. Researchers established the MagnaSafe Registry to determine the frequency of cardiac device-related events among patients with non-MRI-conditional devices, as well as to define a simplified protocol for screening, monitoring and device programming before MRI. "Given the great clinical demand for MRI for patients with a standard pacemaker or defibrillator, we wanted to determine the risk," said study leader Dr. Robert Russo, an adjunct professor at TSRI and director of The La Jolla Cardiovascular Research Institute. In the MagnaSafe Registry, researchers at 19 U.S. institutions tested 1,000 cases with a non-MRI-conditional pacemaker (one not approved for use in an MRI) and 500 cases of patients with a non-MRI-conditional implantable cardioverter defibrillator (ICD), a device that can shock the heart in response to a potentially fatal cardiac rhythm. They scanned regions other than the chest, such as the brain, spine or extremities--where MRI is traditionally the best option for imaging. The researchers tested the devices at an MRI field strength of 1.5 tesla, a standard strength for MRI scanners and reprogrammed some devices according to a prespecified protocol for the MRI examination. "If the patient was not dependent upon their pacemaker, the device was turned off," explained Russo. "If they could not tolerate having the device turned off, it was set to a pacing mode that did not sense cardiac activity. The reason was that the pacemaker could sense the electrical activity (radiofrequency energy) from the MRI scanner and the function of the device could be inhibited, which could be catastrophic if you depend upon your pacemaker for your heartbeat." Russo and his co-investigators did observe adverse effects in a small group of patients. Six patients had a brief period of atrial fibrillation, and in six additional cases pacemaker partial reset (a loss of stored patient information) was noted. But in no cases did the researchers observe device failure or a failure in the leads that connect the device to the heart when the protocol was followed. "One ICD generator could not be interrogated after MRI and required immediate replacement; the device had not been appropriately programmed per protocol before the MRI," explained Russo. These findings led the researchers to conclude that "device removal and replacement seem unlikely to be safer than proceeding with scanning for patients with a pacemaker or an ICD who require a nonthoracic MRI," provided a protocol similar to the MagnaSafe protocol was followed. "Patients with a standard or non-MRI-conditional pacemaker can undergo clinically indicated MRI without harm if a protocol such as the 'MagnaSafe' protocol used in this study is followed and patients are screened and monitored as described," said Russo. The researchers also noted that their results may not be predictive of findings with all device and lead combinations, higher MRI field strengths, patients younger than 18 years of age and MRI examinations of the chest or cardiac resynchronization devices (those designed to increase the function of a failing heart). The researchers plan to follow up by studying the risk for patients in need of a chest scan at scanner field strength of 1.5 tesla, as well as an MRI of any anatomic area at a higher field strength (3.0 tesla). The study, "Assessing the Risks Associated with MRI in Patients with a Pacemaker or Defibrillator," also included authors from the University of California, San Diego; Scripps Memorial Hospital; the University of California, Los Angeles; Providence St. Joseph Medical Center; the University of Arizona; Intermountain Medical Center; Inova Heart and Vascular Institute; Allegheny General Hospital; Abington Memorial Hospital; Yale University School of Medicine; Providence Heart Institute; Oklahoma Heart Institute; the University of Mississippi Medical Center; the Medical College of Wisconsin; Bassett Medical Center; Carnegie Hill Radiology; Methodist DeBakey Heart and Vascular Center and Baptist Health. The study was supported by grants from St. Jude Medical, Biotronik, Boston Scientific and the Hewitt Foundation for Medical Research, and by philanthropic gifts from Mr. and Mrs. Richard H. Deihl, Evelyn F. and Louis S. Grubb, Roscoe E. Hazard, Jr. and the Shultz Steel Company. The Scripps Research Institute (TSRI) is one of the world's largest independent, not-for-profit organizations focusing on research in the biomedical sciences. TSRI is internationally recognized for its contributions to science and health, including its role in laying the foundation for new treatments for cancer, rheumatoid arthritis, hemophilia, and other diseases. An institution that evolved from the Scripps Metabolic Clinic founded by philanthropist Ellen Browning Scripps in 1924, the institute now employs more than 2,500 people on its campuses in La Jolla, CA, and Jupiter, FL, where its renowned scientists--including two Nobel laureates and 20 members of the National Academies of Science, Engineering or Medicine--work toward their next discoveries. The institute's graduate program, which awards PhD degrees in biology and chemistry, ranks among the top ten of its kind in the nation. In October 2016, TSRI announced a strategic affiliation with the California Institute for Biomedical Research (Calibr), representing a renewed commitment to the discovery and development of new medicines to address unmet medical needs. For more information, see http://www. .
News Article | November 28, 2016
Medical researchers have discovered and exploited genetic mutations that are expressed only in precancerous or malignant cells. However, in making a formal diagnosis of cancer, these genetic mutations can be especially hard to pinpoint within the body and, thus far, have not been used as a primary method of diagnosing cancer. Instead, different types of imaging tests—including X-rays, PET scans, mammography and ultrasound—have been used to identify cancerous masses. But while imaging scans can locate masses in the body, they cannot identify microscopic cancers or be used to classify the cellular composition of a tumor.1 Traditionally, tissue biopsies have been used as a method of gathering genetic material for analysis. They are very invasive to the patient, and some may refuse to have the procedure performed due to the pain and anxiety associated with sample collection. The analysis of each biopsy sample is also a labor-intensive process that involves the possibility of human error. In some cases, it simply isn’t feasible to obtain tissue samples from specific locations in the body, such as the brain. Furthermore, once a biopsy sample is taken, the delay until diagnostic results are available is often very long, with an average wait time of 27 days.1 Now, NuView Life Sciences (NVLS) is at the forefront of a developing technology sector within the medical industry. Liquid biopsies focus on identifying biomarkers from tumor cells that are present in body fluids, and this type of biopsy is becoming more important as medical care shifts to a precision medicine mindset. One report forecasts that the non-invasive cancer diagnostics market, which is primarily driven by liquid biopsy technology currently in use or in development, will grow by as much as 44% between 2015 and 2030. The early diagnosis of prostate, breast, colorectal and lung cancer is primarily what’s driving this market growth. These four types of cancer are expected to account for over 70% of the liquid biopsy market in 2030.2 By 2030, the global liquid biopsy market is expected to reach 5,958.3 million.3 NVLS is working to change the way cancer is diagnosed by developing its precision medicine NV-VPAC1 platform technology. NVLS’ chairman and CEO, Paul Crowe, explained, “We’re working towards using NV-VPAC1 in liquid biopsies, which is much less invasive, painful, and less costly overall compared to traditional surgical biopsy methods. Because cancer cells are identified by certain biomarkers that result from genetic mutations, NV-VPAC1 is being tested in in vitro diagnostic scenarios to confirm cancerous mutations in prostate cells contained in voided urine specimens.” Liquid biopsies are more than just less invasive. These types of biopsies are able to gather more information about specific types of cancer and tumor cellular compositions than traditional biopsies, and there are fewer post-biopsy complications experienced by patients when using this new diagnostic method. There are also substantial cost savings to be had in using liquid biopsies, and these savings are shared not only by the patient, but also by third-party payers and the healthcare system as a whole. Since NVLS is developing a liquid biopsy method using NV-VPAC1 technology, the company is already becoming a leader in non-invasive, precision medicine-based diagnostics. “We believe that NV-VPAC1 could eventually be used to screen for cancer in other biological fluids, such as bloodserum, cerebral spinal fluid and saliva. After all, liquid biopsy technology has the potential to completely change the cancer diagnostics industry, and we want that change to be part of that change,” said Crowe. About NuView Life Sciences: Founded in 2005, NuView Life Sciences is a biotechnology company located in Park City, Utah, working to reform the way cancer is diagnosed and treated in today’s healthcare system. NuView is focused on creating precision cancer diagnostics and therapeutics to improve patient outcomes—while reducing healthcare costs—through the development and clinical application of its exclusive peptide analog technology, NV-VPAC1. Led by a team of industry experts with decades of combined experience in healthcare and medical imaging technologies, NuView is poised to change how we look for and respond to cancer. To learn more about NuView Life Sciences, please visit http://nuviewinfo.com/site/3/. About Paul Crowe: Paul Crowe is a veteran healthcare industry leader who has already helped develop several successful start-up and early-stage healthcare companies, bringing diagnostic ultrasound, nuclear magnetic resonance (NMR/MRI), mobile positron emission tomography (PET), and gamma knife radio surgery technology to domestic and international markets. He currently serves on the board of NuView Life Sciences, Radiosurgical Centers of San Diego, at Scripps Memorial Hospital. Sources: 1. The Promise of Liquid Biopsy Technology. Novella Clinical. http://novellaclinical.com/resource/liquid-biopsy/ 2. Non-invasive Cancer Diagnostics Market, 2015—2030. PR Newswire. http://www.prnewswire.com/news-releases/non-invasive-cancer-diagnostics-market-2015-2030-300361188.html 3. Liquid Biopsy Market Size & Forecast by Application, By Sample Type, By Biomarker Type, By Technology and Trend Analysis from 2013 to 2030. PR Newswire. http://www.prnewswire.com/news-releases/liquid-biopsy-market-size--forecast-by-application-by-sample-type-by-biomarker-type-by-technology-and-trend-analysis-from-2013-to-2030-300351275.html
News Article | October 28, 2016
It’s estimated that the U.S. spends approximately $7.9 billion annually on negative prostate and breast cancer biopsies. Diagnosing and treating malignant cancer is an invasive and prohibitively expensive process. While there are currently a variety of diagnostic methods available,(1) many of these methods lack accuracy and specificity in diagnosing the nature, invasiveness or localization of the disease state. Current treatment protocols are highly invasive procedures. Biopsies are typically performed after a suspicious mammogram or an elevated PSA are observed by the physician, often causing a referral for a biopsy which are uncomfortable and drive up medical costs. Furthermore, these biopsies often result in diagnoses of benign cancers that may not require treatment. Paul Crowe, Chairman and Chief Executive Officer of NuView Life Sciences, explained, “The earlier we can detect cancer, the higher probability of successful treatment, and importantly, improved patient outcomes. Our goal is to provide the healthcare industry with NuView’s state of the art technology in early non-invasive detection, NuView’s novel technology and application will expedite the identification and treatment of many types of malignant cancers rapidly. This technology will also help patients by reducing the stress and anxiety they feel while waiting for a confirmation of their cancer diagnosis. It will make the entire process faster and more accurate, and will help lower medical costs for both patients and third-party payers.” Positron Emission Tomography (PET) scans have been used to diagnose different types of cancers since the 1970s, but there are limitations to their accuracy and reliability. The scans can be influenced by various internal and external factors, like metabolism, and it can take several hours to several days for traditional imaging agents to accumulate in cancer cells in levels great enough to be detected.(2) Moreover, some traditional imaging methods are not as accurate in locating certain types of cancer inside denser tissues, and smaller lesions may not be detected at all.(5) Nuview’s mission is to provide early detection, new application and improved quality of life for those affected through NuView’s personalized treatment characterization. NuView’s research focuses on identifying a cancer cells over-expression of a unique class of receptors in malignant cells. NuView’s research team has identified a receptor family, Vasoactive Intestinal Peptide (VIP), a prevalent neuro-peptide with two subtype receptors, VPAC1 and VPAC2. By taking advantage of the known overexpression of VIP receptors on the surface of cancerous cells, and the ability to create a unique biomarker to bind a certain part of the receptor, NuView’s research team can now quantify rapid, non-invasive tests for early detection of many cancer forms. Importantly, Nuview’s non-invasive, in-vitro examination is also applicable to healthcare facilities that already have in use, Positron emission tomography–magnetic resonance imaging (PET-MRI). Crowe said, “What does all this tell us? It tells us for the first time in cancer research and treatment we have a plan that focuses on patient quality of life. Beginning with a non-invasive test for cancer, followed by minimally evasive localization imagining (PET-MRI), and finally, NuView’s HTOB system will for the first time asses the lowest minimum treatment required to provide a high-quality of life for those affected.” With all the money spent on negative tests for prostate and breast cancer, Crowe noted, “It doesn’t have to be this way. We’ve been able to successfully use NV-VPAC1 within urine (liquid biopsy) screening tests to identify malignant prostate genital urinary cancers. Our results have been accurate in diagnosing cancer in 100% of affected men, and no false positives were reported in healthy, normal men involved in our research. It’s an incredible result of which we’re particularly proud.” Since research and testing using NuView’s exclusive imaging agent have already been so successful in clinical feasibility studies which have been published in peer-reviewed journals, the company now plans to begin Phase II clinical trials in 2017. Founded in 2005, NuView Life Sciences is a biotechnology company located in Park City, Utah, working to reform the way cancer is diagnosed and treated in our modern healthcare system. NuView is focused on creating precision cancer diagnostics and therapeutics to improve patient outcomes while reducing healthcare costs through the development and clinical application of its exclusive peptide analog technology, NV-VPAC1. Led by a team of industry experts with decades of combined experience in healthcare and medical imaging technologies, NuView is poised to change how we look for and respond to cancer. To learn more about NuView Life Sciences, please visit http://nuviewinfo.com/site/3/. Paul Crowe is a veteran healthcare industry leader who has already helped develop several successful start-up and early-stage healthcare companies, bringing diagnostic ultrasound, nuclear magnetic resonance (NMR/MRI), mobile positron emission tomography (PET), and gamma knife radio surgery technology to market. He currently serves on the Board of Radio Surgical Centers of San Diego, located at Scripps Memorial Hospital. Sources: 1. Diagnostics. Cancer Treatment Centers of America. 2016. 2. Positron Emission Tomography—Computed Tomography (PET/CT). RadiologyInfo.org For Patients. June 11, 2015. 3. SEER Stat Fact Sheets: Prostate Cancer. National Cancer Institute, Surveillance, Epidemiology, and End Results Program. 2016. 4. New Nuclear-Imaging Tests Show Promise in Locating Cancer. The Wall Street Journal. September 25, 2016. 5. Metabolic PET Imaging in Cancer Detection and Therapy Response. Seminars in Oncology.
Shurman J.,Scripps Memorial Hospital |
Koob G.F.,Scripps Research Institute |
Gutstein H.B.,University of Texas M. D. Anderson Cancer Center
Pain Medicine | Year: 2010
Objective. Opioids have relieved more human suffering than any other medication, but their use is still fraught with significant concerns of misuse, abuse, and addiction. This theoretical article explores the hypothesis that opioid misuse in the context of pain management produces a hypersensitivity to emotional distress, termed hyperkatifeia. Results. In the misuse of opioids, neural substrates that mediate positive emotional states (brain reward systems) are compromised, and substrates mediating negative emotional states (brain stress systems) are enhanced. A reflection and early marker of such a nonhomeostatic state may be the development of opioid-induced hyperkatifeia, defined as the increased intensity of the constellation of negative emotional/motivational symptoms and signs observed during withdrawal from drugs of abuse (derived from the Greek "katifeia" for dejection or negative emotional state) and is most likely to occur in subjects in whom the opioid produces a break with homeostasis and less likely to occur when the opioid is restoring homeostasis, such as in effective pain treatment. When the opioid appropriately relieves pain, opponent processes are not engaged. However, if the opioid is administered in excess of need because of overdose, pharmacokinetic variables, or treating an individual without pain, then the body will react to that perturbation by engaging opponent processes in the domains of both pain (hyperalgesia) and negative emotional states (hyperkatifeia). Conclusions. Repeated engagement of opponent processes without time for the brain's emotional systems to reestablish homeostasis will further drive changes in emotional processes that may produce opioid abuse or addiction, particularly in individuals with genetic or environmental vulnerability. © 2010 American Academy of Pain Medicine.
Feng X.D.,Shanghai Eastern Hospital |
Wang X.N.,ShanXi Cardiovascular Hospital |
Yuan X.H.,Changzhi Peace Hospital |
Wang W.,Scripps Memorial Hospital
Journal of Thoracic and Cardiovascular Surgery | Year: 2014
Objective Postoperative atrial fibrillation (POAF) is the most frequent complication arising after cardiac surgery, occurring in 30% of cases. Amiodarone is the most effective drug for prophylaxis and treatment. However, because of significant extracardiac side effects, only high-risk patients are eligible for prophylactic amiodarone therapy. We performed a randomized prospective study of 100 patients undergoing cardiac surgery with epicardial application of amiodarone-releasing hydrogel to determine the effectiveness of preventing POAF. Methods After institutional review board approval, 100 patients, from January 2012 to July 2013, who had undergone cardiac surgery, were randomized to 2 equal groups. The study group received poly-based hydrogel with amiodarone sprayed diffusely over the epicardium. The control group underwent the procedure without the spray. Continuous telemetry monitored for POAF, and amiodarone levels in the atria, plasma, and tissue were measured postoperatively. Daily electrocardiographic parameters were measured until postoperative day 14. Results The incidence of POAF was significantly less in the study group, with 4 of 50 patients (8%) incurring atrial fibrillation compared with 13 of 50 patients (26%) in the control group (P <.01). The mean amiodarone concentrations in the atria (12.06 ± 3.1) were significantly greater than those in the extracardiac tissues (1.32 ± 0.9; P <.01). The plasma amiodarone levels remained below the detection limit (<8 μg/mL) during the 14 days of follow-up. Bradycardia was observed less in the study group (76 ± 29) than in the control group (93 ± 18; P <.01). Conclusions Epicardial application of amiodarone-releasing adhesive hydrogel is a less invasive, well-tolerated, quick, and effective therapeutic option for preventing POAF at minimal risk of extracardiac adverse side effects. © 2014 by The American Association for Thoracic Surgery.
Chaffoo R.A.K.,University of California at San Diego |
Chaffoo R.A.K.,Scripps Memorial Hospital
Facial Plastic Surgery Clinics of North America | Year: 2013
Rhytidectomy remains a challenging surgical procedure for even the most experienced aesthetic plastic surgeons. The challenges are compounded by complications that are inherent to this procedure and place added pressure on the doctor-patient relationship. Expectations for both parties are high and the margin for error nil. This article presents a personal approach to the avoidance and management of complications associated with facelift surgery. It presents the author's personal approach as a plastic surgeon in the practice of aesthetic plastic surgery over the past 25years. Clinical pearls are provided to obtain optimum results in rhytidectomy and limit associated sequelae. © 2013 Elsevier Inc.
Higgins S.L.,Scripps Memorial Hospital
Future Cardiology | Year: 2013
A number of substantial improvements to the 60-year-old concept of the Holter monitor have recently been developed. One promising advance is the Zio® Patch (iRhythm Technologies, Inc., CA, USA), a small 2 × 5-inch patch, which can continuously record up to 14 days of a single ECG channel of cardiac rhythm without the need for removal during exercise, sleeping or bathing. Its ease-of-use, which enables optimal long-term monitoring, has been established in the ambulatory setting, although some insurance carriers have been reluctant to reimburse appropriately for this advance, an issue characteristic of other heart monitors, treated as 'loss-leaders.' In this article, in addition to discussing possible reasons for this reluctance, a novel model for direct-to-consumer marketing of heart monitoring, outside of the traditional health insurance reimbursement model, is also presented. Additional current and future advances in heart rhythm recording are also discussed. Such potentially revolutionary opportunities have only recently become possible as a result of technologic advances. © 2013 Future Medicine Ltd.