Wake Forest Baptist Medical Center

Pumpkin Center, NC, United States

Wake Forest Baptist Medical Center

Pumpkin Center, NC, United States
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News Article | July 7, 2017
Site: www.eurekalert.org

WINSTON-SALEM, N.C. - Researchers at Wake Forest Institute for Regenerative Medicine have reached important milestones in their quest to engineer replacement tissue in the lab to treat digestive system conditions - from infants born with too-short bowels to adults with inflammatory bowel disease, colon cancer, or fecal incontinence. Reporting today in Stem Cells Translational Medicine, the research team verified the effectiveness of lab-grown anal sphincters to treat a large animal model for fecal incontinence, an important step before advancing to studies in humans. And last month in Tissue Engineering, the team reported success implanting human-engineered intestines in rodents. "Results from both projects are promising and exciting," said Khalil N. Bitar, Ph.D., AGAF, senior researcher on the projects, and professor of regenerative medicine at the institute. "Our goal is to use a patient's own cells to engineer replacement tissue in the lab for devastating conditions that affect the digestive system." Sphincter Project: The lab-engineered sphincters are designed to treat passive incontinence, the involuntary discharge of stool due to a weakened ring-like muscle known as the internal anal sphincter. The muscle can lose function due to age or can be damaged during child birth and certain types of surgery, such as cancer. Current options to repair the internal anal sphincter include grafts of skeletal muscle, injectable silicone material or implantation of mechanical devices, all of which have high complication rates and limited success. "The regenerative medicine approach has a promising potential for people affected by passive fecal incontinence," said Bitar. "These patients face embarrassment, limited social activities leading to depression and, because they are reluctant to report their condition, they often suffer without help." Bitar's team has been working to engineer replacement sphincters for more than 10 years. In 2011, the team was the first to report functional, lab-grown anal sphincters bioengineered from human cells that were implanted in immune-suppressed rodents. The current study involved 20 rabbits with fecal incontinence. Eight animals were treated with sphincters engineered from their own muscle and nerve cells, eight animals were not treated and four received a "sham" surgery. The sphincters were engineered using small biopsies from the animals' sphincter and intestinal tissue. From this tissue, smooth muscle and nerve cells were isolated and then multiplied in the lab. In a ring-shaped mold, the two types of cells were layered to build the sphincter. The entire process took about four to six weeks. In the animals receiving the sphincters, fecal continence was restored throughout a three month follow-up period, compared to the other groups, which did not improve. Measurements of sphincter pressure and tone showed that the sphincters were viable and functional and maintained both the muscle and nerve components. Currently, longer follow up of the implanted sphincters is close to completion with good results.. Intestine Project: The intestine project is aimed at helping patients with intestinal failure, which is when the small intestine malfunctions or is too short to digest food and absorb nutrients essential to health. Patients must get nutrition through a catheter or needle. The condition has a variety of causes. Infants can be born with missing or dysfunctional small intestines. In adults, surgery to remove sections of intestine due to cancer or other disease can result in a too-short bowel. Intestinal transplant is an option, but donor tissue is in short supply and the procedure has high mortality rates. "A major challenge in building replacement intestine tissue in the lab is that it is the combination of smooth muscle and nerve cells in gut tissue that moves digested food material through the gastrointestinal tract," said Bitar. Through much trial and effort, his team has learned to use the two cell types to create "sheets" of muscle pre-wired with nerves. The sheets are then wrapped around tubular molds made of chitosan, a natural material derived from shrimp shells. The material is already approved by the U.S. Food and Drug Administration for certain applications. In the current study, the tubular structures were implanted in rats in two phases. In phase one, the tubes were implanted in the omentum, which is fatty tissue in the lower abdomen, for four weeks. Rich in oxygen, this tissue promoted the formation of blood vessels to the tubes. During this phase, the muscle cells began releasing materials that would eventually replace the scaffold as it degraded. For phase two, the bioengineered tubular intestines were connected to the animals' intestines, similar to an intestine transplant. During this six-week phase, the tubes developed a cellular lining as the body's epithelial cells migrated to the area. The rats gained weight and studies showed that the replacement intestine was healthy in color and contained digested food. The researchers are excited by the results and their next step is to test the structures in larger animals. "Our results suggest that engineered human intestine could provide a viable treatment to lengthen the gut for patients with gastrointestinal disorders, or patients who lose parts of their intestines due to cancer," said Bitar. Financial support for the biosphincter project included the U.S. Armed Forces, the National Institutes of Health under the Armed Forces Institute for Regenerative Medicine (W81XWH-13-2-0052) and the National Institute of Diabetes and Digestive and Kidney Diseases (R01DK071614 and R42DK105593 to CELLF BIO LLC). Support for the intestine project came from Wake Forest School of Medicine. Co-researchers for the biosphincter project were: co-lead authors Jaime L. Bohl, M.D., and Elie Zakhem, Ph.D., Wake Forest Baptist. Researchers for the intestine project were: Elie Zakhem, Ph.D., lead author, Riccardo Tamburrini, M.D., Giuseppe Orlando, M.D., Ph.D., and Kenneth Koch, M.D., Wake Forest Baptist. Wake Forest Baptist Medical Center is a nationally recognized academic medical center in Winston-Salem, North Carolina, with an integrated enterprise including educational and research facilities, hospitals, clinics, diagnostic centers and other primary and specialty care facilities serving 24 counties in northwest North Carolina and southwest Virginia. Its divisions are Wake Forest Baptist Health, a regional clinical system with close to 175 locations, 900 physicians and 1,000 acute care beds; Wake Forest School of Medicine, an established leader in medical education and research; and Wake Forest Innovations, which accelerates the commercialization of research discoveries and specialized research capabilities of Wake Forest Baptist Medical Center and operates Wake Forest Innovation Quarter, an urban district for research, business and education. Wake Forest Baptist clinical, research and educational programs are annually ranked among the best in the country by U.S. News & World Report.


News Article | June 27, 2017
Site: www.eurekalert.org

WINSTON-SALEM, N.C. - June 27, 2017 - Moderate-intensity exercise can help even extremely obese older adults improve their ability to perform common daily activities and remain independent, according to researchers at Wake Forest Baptist Medical Center. Findings from the National Institutes of Health-funded study are published in the July issue of the journal Obesity. In the United States, obesity affects nearly 13 million adults age 65 and older. Both overall obesity and abdominal obesity are strongly associated with the development of major mobility disability (MMD), the inability to walk a quarter of a mile, according to the study's lead author, Stephen Kritchevsky, Ph.D., director of the Sticht Center for Healthy Aging and Alzheimer's Prevention at Wake Forest Baptist. Previous data on older populations had suggested that obesity may lessen the beneficial effects of physical activity on mobility. However, this research, which analyzed data from the multicenter Lifestyle Interventions and Independence for Elders (LIFE) study, showed that a structured physical activity program reduced the risk of MMD even in older adults with extreme obesity. "The inability to walk a quarter of a mile is a proxy for common daily activities, such as the inability to walk a block around the neighborhood or to walk several street blocks to go to a store," Kritchevsky said. "Having a major mobility disorder can really affect the quality of life and independence for older people, but we showed that moderate exercise was a safe and effective way to reduce that risk even in severely obese people." The LIFE study was a large clinical trial that enrolled 1,635 sedentary men and women age 70 to 89. The participants were randomized to a moderate intensity physical activity program or a health education program to test if the physical activity program would reduce the rate of MMD compared to the education program. Major mobility disability was defined as the inability to walk 400 meters (about a quarter of a mile) without sitting and without help from another person or a walker, Kritchevsky said. Participants were divided into four groups according to body mass index (BMI) - a measure of body fat based on height and weight - and waist circumference: non-obese with BMI less than 30; non-obese with high waist circumference of more than 40 inches for men and 34 inches for women; class 1 obese with BMI between 30 and 35; and class 2 obese with BMI of 35 or higher. The physical activity program focused on walking, strength, balance and flexibility training. The goal for participants was to be able to walk at moderate intensity for 30 minutes and perform 10 minutes of lower-extremity strength training with ankle weights and 10 minutes of balance training in a single session. Participants attended two center-based training sessions per week and performed at-home activities three to four times per week during the two-year study. The health education program involved in-person group workshops focused on aging-relevant topics such as nutrition, safety and legal/financial issues. Sessions included lectures and interactive discussions and five to 10 minutes of upper body stretching exercises. While there was no significant difference between obesity category and intervention effect, those in the class 2 obesity group showed the greatest benefit from the physical activity program, reducing their risk of MDD by 31 percent, Kritchevsky said. The LIFE study was the first to demonstrate that moderate intensity physical activity can significantly reduce the risk of MMD in sedentary older adults. Co-authors are: Laura Lovato, M.S., and Elizabeth P. Handing, Ph.D., Wake Forest Baptist; Steven Blair, P.E.D., University of South Carolina; Anda Botoseneau, M.D., University of Michigan; Jack M. Guralnik, M.D., University of Maryland School of Medicine; Christine Liu, M.D. Boston University School of Medicine; Abby King, Ph.D., Stanford University School of Medicine; Anthony P. Marsh, Ph.D., and W. Jack Rejeski, Ph.D., Wake Forest University; Marco Pahor, M.D., and Todd Manini, Ph.D., University of Florida College of Medicine; and Bonnie Spring, Ph.D., Northwestern University Feinberg School of Medicine. The LIFE study was funded by a National Institutes of Health/National Institute on Aging Cooperative Agreement UO1 AG22376 and a supplement from the National Heart, Lung and Blood Institute 3U01AG022376-05A2S, and sponsored in part by the Intramural Research Program, National Institute on Aging. The research was partially supported by the Claude D. Pepper Older Americans Independence Centers at the University of Florida (1 P30 AG028740), Wake Forest University (1 P30 AG21332), Tufts University (1P30AG031679), University of Pittsburgh (P30 AG024827) and Yale University (P30AG021342) and the NIH/NCRR CTSA at Stanford University (UL1 RR025744), Tufts University is also supported by the Boston Rehabilitation Outcomes Center (1R24HD065688-01A1).


News Article | June 27, 2017
Site: www.sciencedaily.com

Moderate-intensity exercise can help even extremely obese older adults improve their ability to perform common daily activities and remain independent, according to researchers at Wake Forest Baptist Medical Center. Findings from the National Institutes of Health-funded study are published in the July issue of the journal Obesity. In the United States, obesity affects nearly 13 million adults age 65 and older. Both overall obesity and abdominal obesity are strongly associated with the development of major mobility disability (MMD), the inability to walk a quarter of a mile, according to the study's lead author, Stephen Kritchevsky, Ph.D., director of the Sticht Center for Healthy Aging and Alzheimer's Prevention at Wake Forest Baptist. Previous data on older populations had suggested that obesity may lessen the beneficial effects of physical activity on mobility. However, this research, which analyzed data from the multicenter Lifestyle Interventions and Independence for Elders (LIFE) study, showed that a structured physical activity program reduced the risk of MMD even in older adults with extreme obesity. "The inability to walk a quarter of a mile is a proxy for common daily activities, such as the inability to walk a block around the neighborhood or to walk several street blocks to go to a store," Kritchevsky said. "Having a major mobility disorder can really affect the quality of life and independence for older people, but we showed that moderate exercise was a safe and effective way to reduce that risk even in severely obese people." The LIFE study was a large clinical trial that enrolled 1,635 sedentary men and women age 70 to 89. The participants were randomized to a moderate intensity physical activity program or a health education program to test if the physical activity program would reduce the rate of MMD compared to the education program. Major mobility disability was defined as the inability to walk 400 meters (about a quarter of a mile) without sitting and without help from another person or a walker, Kritchevsky said. Participants were divided into four groups according to body mass index (BMI) -- a measure of body fat based on height and weight -- and waist circumference: non-obese with BMI less than 30; non-obese with high waist circumference of more than 40 inches for men and 34 inches for women; class 1 obese with BMI between 30 and 35; and class 2 obese with BMI of 35 or higher. The physical activity program focused on walking, strength, balance and flexibility training. The goal for participants was to be able to walk at moderate intensity for 30 minutes and perform 10 minutes of lower-extremity strength training with ankle weights and 10 minutes of balance training in a single session. Participants attended two center-based training sessions per week and performed at-home activities three to four times per week during the two-year study. The health education program involved in-person group workshops focused on aging-relevant topics such as nutrition, safety and legal/financial issues. Sessions included lectures and interactive discussions and five to 10 minutes of upper body stretching exercises. While there was no significant difference between obesity category and intervention effect, those in the class 2 obesity group showed the greatest benefit from the physical activity program, reducing their risk of MDD by 31 percent, Kritchevsky said.


News Article | June 23, 2017
Site: www.prnewswire.com

Anne Lake, DNP, ONP-C, FNP-C, CCD is the Fracture Liaison Service Program Clinician and Coordinator for a nationally recognized Fracture Liaison Service at Wake Forest Baptist Medical Center in Winston Salem, NC and a current board member of the North Carolina Osteoporosis Foundation. After receiving her doctorate in nursing practice from Frontier Nursing University in 2011 with her doctoral thesis focused on the Implementation of Bone Health Protocols in Orthopedic Practice, Dr. Lake began speaking nationally on osteoporosis and the importance of Fracture Liaison Programs as a standard of care. Dr. Lake serves on the clinical advising bureau for Eli Lilly and Co. and is a speaker on best practice standards of care for the Fracture Liaison Service Quality Care program. Dr. Lake has received a Fracture Liaison Certificate from NOF and has served as a clinical advisor for NOF's partner organization, the National Bone Health Alliance. She also serves as Co-Chair of the Quality Committee and as a member of the Institute for Clinical and Economic Review committee on behalf of NOF. Dr. Lake is a published author in the Journal of Bone and Joint Surgery for Establishing a Fracture Liaison Service, An Orthopaedic Approach and has authored the Metabolic Bone Health and Pediatric sections for the Orthopaedic Nurse Practitioner review course curriculum. Mary Oates, MD is a board certified Physical Medicine and Rehabilitation specialist and a Certified Clinical Densitometrist specializing in the diagnosis and treatment of osteoporosis. Dr. Oates has been working at the Marian French and Arroyo Grande hospitals in California since 1994. Dr. Oates founded the Marian and French Hospital Osteoporosis Center and is a volunteer faculty member at Cal Poly State University in San Luis Obispo, California. Dr. Oates is actively involved with community education and outreach projects aimed at the prevention and treatment of osteoporosis and has participated in several osteoporosis pharmaceutical research studies and observational Body Composition studies using DXA for the evaluation of bone muscle and fat. Established in 1984, the National Osteoporosis Foundation is the nation's leading health organization dedicated to preventing osteoporosis and broken bones, promoting strong bones for life and reducing human suffering through programs of awareness, education, advocacy and research. For more information on the National Osteoporosis Foundation, visit www.nof.org. To view the original version on PR Newswire, visit:http://www.prnewswire.com/news-releases/the-national-osteoporosis-foundation-elects-two-new-members-to-its-board-of-trustees-300478683.html


WESTBOROUGH, Mass.--(BUSINESS WIRE)--eClinicalWorks®, a leader in healthcare IT solutions, today announces that Eagle Physicians and Associates, a multi-specialty medical group, has experienced successful interoperability using eClinicalWorks comprehensive electronic health records (EHR) for its 61 providers across 11 locations. Use of the cloud-based technology has supported Eagle Physicians in the successful exchange of patient data at the point of care. "At Eagle Physicians, we are built on an exceptional reputation for providing quality care to patients at every stage," said Dr. Robert Fried, CMIO, Family Physician of Eagle Physicians & Associates. “With the six-hospital Cone Health as the only health system in town, we needed a bidirectional exchange to share patient records at the point of service, especially to make our data available to the ED and hospitalists. eClinicalWorks was selected to assist in bridging gaps that existed in the exchange of patient data and to improve the quality of patient care. I applaud eClinicalWorks for putting significant resources into interoperability and providing it to users at no additional cost.” By implementing Carequality Interoperability Framework on the eClinicalWorks platform, Eagle Physicians and Associates has achieved improved overall efficiency in data sharing, with not only Cone Health but also other critical exchange partners like UNC-Chapel Hill Medical Center, Wake Forest Baptist Medical Center and Novant Health which are all on Epic. As a multi-specialty group, the seamless exchange of patient data has provided access to critical information and supports the organization’s patient-centered, preventative care approach. Additionally, physicians were able to find missing lab results, identify potential drug-to-drug interactions and make data available to other entities enabling streamlined care transitions. “Interoperability is essential for improving healthcare delivery,” stated Girish Navani, CEO and co-founder of eClinicalWorks. “eClinicalWorks is committed to interoperability and the exchange of patient health information. With eClinicalWorks, Eagle Physicians and Associates has experienced an improved system to deliver patient care. Immediate access to patient records has enhanced communication by providing physicians and patients access to critical information at the point of care. To date, hundreds of eClinicalWorks customers are linked to Carequality and/or CommonWell, with more connecting every day.” About Eagle Physicians & Associates Eagle Physicians & Associates is a multispecialty health care practice offering excellence in patient care through eight different medical disciplines, as well as a walk-in clinic. They are physician-owned and led and one of North Carolina’s most recognized health care providers. Eagle Physicians & Associates is a certified level three Patient-Centered Medical Home which is the highest recognition given by the National Committee for Quality Assurance. This recognition honors commitment to quality improvement and a patient-centered approach for better patient care and treatment. About eClinicalWorks eClinicalWorks® is a privately held leader in healthcare IT solutions. With more than 125,000 physicians and nurse practitioners using its solutions, customers include ACOs, physician practices, hospitals, community health centers, departments of health, and convenient care clinics. During the past eight years, 16 eClinicalWorks customers have received the prestigious HIMSS Davies Award, honoring excellence in electronic health record implementation. The company is second largest in the country for e-prescribing. Based in Westborough, Mass., eClinicalWorks has additional offices in Austin, New York City, Chicago, California, Georgia, London, India, and Dubai. For more information, please visit www.eclinicalworks.com, Facebook, Twitter or call 866-888-6929. eClinicalWorks is a trademark of eClinicalWorks, LLC. All other trademarks or service marks contained herein are the property of their respective owners.


News Article | May 25, 2017
Site: www.eurekalert.org

WINSTON-SALEM, N.C. - May 25, 2017 - Individuals whose insurance covered the cost of a comprehensive medical weight-loss program had one-year outcomes very similar to those of patients who paid for the treatment out of pocket, according to an observational study conducted at Wake Forest Baptist Medical Center. The study, published in the June issue of the journal Obesity, reviewed the electronic medical records of 943 people who enrolled in comprehensive, non-surgical weight-loss programs at Wake Forest Baptist's Weight Management Center between January 2013 and June 2015. Of these, 480 had insurance that covered the cost of the program and 463 paid the cost out of pocket. The demographics of these two groups were comparable in terms of gender and ethnicity, but participants covered by insurance on average were slightly younger, had a lower body mass index, and resided in lower per capita neighborhoods. The researchers found that there was no real difference in 12-month weight loss between the two payment groups, with those covered by insurance having a mean weight loss of 13.4 percent compared to 13.6 percent for those who self-paid. Also very similar were the percentages of those who lost 5 percent or more of their baseline weight and the average time spent in the program and the number of clinic visits made. The greatest difference between the two groups was in the dropout rates: 12.7 percent for the covered patients and 17.6 percent for the out-of-pocket payers. "There's a rather pervasive idea that patients who pay more out of pocket for a weight-loss program, who have more 'skin in the game' so to speak, will be more engaged in the treatment and consequently have better outcomes than people whose treatment is covered by insurance," said the study's lead author, Jamy Ard, M.D., co-director of the Weight Management Center at Wake Forest Baptist. "Our data suggest that bearing responsibility for the majority of the treatment cost is not required to achieve engagement and clinically meaningful weight loss in a comprehensive medical weight-loss program." Ard added that further, larger-scale research could help determine how insurance status affects both initial motivation to seek weight-loss treatment and engagement in weight-loss programs. This is especially important as we try to expand coverage for obesity treatment and stem the tide of the obesity epidemic," he said. Co-authors of the study are Matt Emery, M.D., Miranda Cook, M.P.H., Erica Hale, M.S., Annette Frain, R.D., Kristina H. Lewis, M.D., M.P.H., and Eunyong Song, Ph.D., of Wake Forest Baptist.


News Article | June 20, 2017
Site: www.technologyreview.com

What if tiny, naturally occurring bubbles emitted by cells could be harnessed as a powerful way to treat the most lethal cancers? Scientists are trying to do that for pancreatic cancer, a largely incurable disease. When they were discovered more than 30 years ago, these microscopic sacs—called exosomes—were thought to be nothing more than the cell’s waste products. But more recent research has revealed that they help cells communicate with one another by carrying valuable cargo—like proteins and RNA, a genetic messenger molecule—to other cells. Present in the bloodstream and most other bodily fluids, exosomes are released and received by nearly any type of cell. When exosomes leave cells, they travel in the body and seek out recipient cells based on the instructions encoded by their payload. Researchers think they can use this natural communication system to their advantage. Valerie LeBleu, assistant professor of cancer biology at the University of Texas MD Anderson Cancer Center, is working on genetically engineering exosomes to carry molecules that seek out pancreatic tumor cells to keep the cancer at bay. Her team extracted exosomes from human foreskin cells and modified them so that they would contain certain kinds of RNA that can turn off specific genes. They engineered the exosomes to target a gene called KRAS, which is commonly linked to pancreatic cancer. When mutated, the KRAS gene acts like an on-off switch that gets stuck in the “on” position, causing cancer cells to divide and grow. Researchers loaded the RNA into exosomes, which they then injected into mice with pancreatic cancer. The engineered exosomes were taken up by pancreatic cells with mutated KRAS. Once inside the cancer cells, the exosomes were able to switch off the gene in mice, stopping tumor growth and extending the animals’ life spans. LeBleu’s team started with pancreatic cancer because it has such a poor outlook for patients and because there are no effective therapies. But she says exosomes could be similarly designed to target different types of cancer. “This could become a type of personalized medicine,” she says. “It gives us hope for something more tailored to each cancer case, each patient progression, and each genomic landscape.” The approach, detailed earlier this month in the journal Nature, has yet to be tried in humans. A few early-stage clinical trials were launched in the mid-2000s in Europe using exosomes to treat cancer, but the therapies showed little to no benefit. Those exosomes were not genetically modified. Codiak BioSciences, based in Cambridge, Massachusetts, hopes to be the first to begin a clinical trial using engineered exosomes. The company has licensed the exosome technology from MD Anderson and is planning to begin clinical trials next year to try the technique against pancreatic cancer. Codiak BioSciences CEO Doug Williams sees exosomes as an improvement over the idea of using nanoparticles to deliver drugs to different places in the body. “Our idea is to hijack that existing naturally occurring messaging system and put messages inside or on the surface of the exosomes that we want to deliver,” Williams says. In fact, the MD Anderson team compared their engineered particles—dubbed “iExosomes”—with nanoparticles made of synthetic materials and found that the exosomes were more efficient. Wei Zhang, a cancer biology researcher at Wake Forest Baptist Medical Center, says a major benefit of exosomes loaded with RNA is that they’re native to the human body and not toxic. So if the engineered exosomes work in people, they may have fewer side effects than traditional cancer treatments like chemotherapy and radiation. Zhang says one of the biggest hurdles will be engineering the large quantity of exosomes that would be needed for human doses in clinical trials. LeBleu’s team used a billion exosomes for a single dose in mice.


News Article | June 21, 2017
Site: www.sciencedaily.com

Youth football players are exposed to more and more forceful head impacts as they move up in age- and weight-based levels of play, according to researchers at Wake Forest Baptist Medical Center. Their study, published in the June issue of the Journal of Neurotrauma, employed in-helmet sensors to record the number and location of impacts and the linear and rotational acceleration they caused to the heads of 97 players ages 9 to 13 in one youth football organization during practices and games at three different levels of competition over four seasons "By recording more than 40,000 head impacts, this study represents the largest collection of biomechanical head impact data for youth football to date," said study author Jillian Urban, Ph.D., assistant professor of biomedical engineering at Wake Forest School of Medicine, a part of Wake Forest Baptist. "Our findings clearly show a trend of head impact exposure increasing with increasing level of play." The three competition levels studied were Level A (players 11 and under weighing up to 124 pounds), Level B (players 12 and under weighing up to 139 pounds) and Level C (players 13 and under weighing up to 159 pounds). In their analysis of the data the investigators found that Level C had significantly greater linear head accelerations than Levels B and A and that both linear and rotational accelerations were significantly greater in competition as opposed to practice in Levels C and B. The researchers also found that while approximately two-thirds of all head impacts in the three levels of competition occurred during practice, the percentage of high-magnitude impacts was higher in games and the number of such impacts in games increased with the level of play. "Our results are consistent with prior studies of high school and college athletes showing that head impact exposure increases with increasing age and level of play," Urban said. "But they also show significant differences from one level to the next in a single youth organization. This strongly suggests that all youth football players should not be grouped together when studying head impact exposure and injury risk, especially since youth football leagues accommodate players ranging in age from 5 to 15. "Further studies that take into consideration the various levels of youth football could guide evidence-based intervention efforts, such as changes in practice structure and game rules, to reduce the number of high-magnitude impacts, impact frequency and the total number of impacts with the ultimate goal of improving safety in youth football."


News Article | June 21, 2017
Site: www.eurekalert.org

WINSTON-SALEM, N.C. - June 21, 2017 - Youth football players are exposed to more and more forceful head impacts as they move up in age- and weight-based levels of play, according to researchers at Wake Forest Baptist Medical Center. Their study, published in the June issue of the Journal of Neurotrauma, employed in-helmet sensors to record the number and location of impacts and the linear and rotational acceleration they caused to the heads of 97 players ages 9 to 13 in one youth football organization during practices and games at three different levels of competition over four seasons "By recording more than 40,000 head impacts, this study represents the largest collection of biomechanical head impact data for youth football to date," said study author Jillian Urban, Ph.D., assistant professor of biomedical engineering at Wake Forest School of Medicine, a part of Wake Forest Baptist. "Our findings clearly show a trend of head impact exposure increasing with increasing level of play." The three competition levels studied were Level A (players 11 and under weighing up to 124 pounds), Level B (players 12 and under weighing up to 139 pounds) and Level C (players 13 and under weighing up to 159 pounds). In their analysis of the data the investigators found that Level C had significantly greater linear head accelerations than Levels B and A and that both linear and rotational accelerations were significantly greater in competition as opposed to practice in Levels C and B. The researchers also found that while approximately two-thirds of all head impacts in the three levels of competition occurred during practice, the percentage of high-magnitude impacts was higher in games and the number of such impacts in games increased with the level of play. "Our results are consistent with prior studies of high school and college athletes showing that head impact exposure increases with increasing age and level of play," Urban said. "But they also show significant differences from one level to the next in a single youth organization. This strongly suggests that all youth football players should not be grouped together when studying head impact exposure and injury risk, especially since youth football leagues accommodate players ranging in age from 5 to 15. "Further studies that take into consideration the various levels of youth football could guide evidence-based intervention efforts, such as changes in practice structure and game rules, to reduce the number of high-magnitude impacts, impact frequency and the total number of impacts with the ultimate goal of improving safety in youth football." The research was supported by National Institute of Neurological Disorders and Stroke awards R01NS094410 and R01NS082453. Additional support was provided by National Center for Advancing Transitional Sciences grant KL2TR001421 and the Childress Institute for pediatric Trauma at Wake Forest Baptist Medical Center. Co-authors are Christopher T. Whitlow, M.D., Ph.D., Jillian E. Urban, Ph.D., Mark A. Espeland, Ph.D., Mireille E. Kelley, M.S., Logan E. Miller, M.S., and Derek A. Jones, M.S., of Wake Forest Baptist and Joseph A. Maldjian, M.D., and Elizabeth M. Davenport, Ph.D., of University of Texas Southwestern Medical Center, Dallas.


McMichael A.J.,Wake Forest Baptist Medical Center
The journal of investigative dermatology. Symposium proceedings / the Society for Investigative Dermatology, Inc. [and] European Society for Dermatological Research | Year: 2013

Alopecia areata (AA) is an autoimmune condition characterized by T cell-mediated attack of the hair follicle. The inciting antigenic stimulus is unknown. A dense perbulbar lymphocytic infiltrate and reproducible immunologic abnormalities are hallmark features of the condition. The cellular infiltrate primarily consists of activated T lymphocytes and antigen-presenting Langerhans cells. The xenon chloride excimer laser emits its total energy at the wavelength of 308 nm and therefore is regarded as a "super-narrowband" UVB light source. Excimer laser treatment is highly effective in psoriasis, another T cell-mediated disorder that shares many immunologic features with AA. The excimer laser is superior in inducing T cell apoptosis in vitro compared with narrowband UVB, with paralleled improved clinical efficacy. The excimer laser has been used successfully in patients with AA. In this context, evaluation of the potential benefit of 308-nm excimer laser therapy in the treatment of AA is clinically warranted. Herein, the use of a common treatment protocol with a specifically designed module to study the outcome of excimer laser treatment on moderate-to-severe scalp AA in adults is described.

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