Cleveland Clinic Chose Top 10 Medical Innovations for 2015

By David S. Boyer, MD
 

Stem Cells Showed Promise for Stroke Recovery

Infusing stem cells into the brain may help boost recovery after a stroke, according to a pilot study published in Stem Cell Translational Medicine.1 The therapy used CD34+ cells, a set of stem cells in the bone marrow that give rise to blood cells and blood vessel lining cells.

Soma Banerjee, MD, of Imperial College London, and colleagues conducted the study of 5 patients who recently had a stroke, 4 of whom had suffered particularly severe strokes resulting in loss of speech and marked paralysis on 1 side of the body. The investigators drew a bone-marrow sample from each patient. They isolated the CD34+ cells and then infused them into an artery that supplies the brain. All patients were treated within 7 days of their stroke.

Patients were monitored for 6 months, and the investigators charted their ability to carry out everyday activities independently. Three of the 4 patients who had experienced a severe stroke were able to walk and look after themselves independently at the end of 6 months. All 5 were mobile and could take part in everyday tasks.

“This is the first trial to isolate stem cells from human bone marrow and inject them directly into the damaged brain area using keyhole techniques,” study author Paul Bentley, MA, MRCP, PhD, said in a news release. “Our group is currently looking at new brain scanning techniques to monitor the effects of cells once they have been injected.”

1. Banerjee S, Bentley P, Hamady M, et al. Intra-arterial immunoselected CD34+ stem cells for acute ischemic stroke [published online ahead of print August 8, 2014]. Stem Cells Transl Med. doi:10.5966/sctm.2013-0178.

Irregular Heartbeat Increased Risk for Silent Stroke

Atrial fibrillation (AF) may more than double the risk of silent cerebral infarction (SCI), according to a review published in the Annals of Internal Medicine.1

Shadi Kalantarian, MD, MPH, of Massachusetts General Hospital, Boston, and colleagues analyzed data from 11 studies that reported on the association between AF and SCI. A total of 5317 stroke-free patients (mean age, 50.0-83.6 years) with AF were included in the metaanalysis. Autopsy studies were heterogeneous and of low quality; therefore, they were excluded from the metaanalysis of the risk estimates.

When computed tomography (CT) and magnetic resonance imaging (MRI) studies were combined, AF was associated with SCIs in patients with no history of symptomatic stroke (odds ratio [OR], 2.62 [95% CI, 1.81-3.80]; P = 0.118). This association was independent of AF type (paroxysmal vs persistent). The results were not altered significantly when the analysis was restricted to studies that met at least 70% of the maximum possible quality score (OR, 3.06 [CI, 2.24-4.19]). Seventeen studies reported the prevalence of SCIs. The overall prevalence of SCI lesions on MRI and CT among patients with AF was 40% and 22%, respectively.

“AF is associated with more than a 2-fold increase in the odds for SCI,” the study authors said. “Limitations of the metaanalysis were that most studies were cross-sectional, and autopsy studies were heterogeneous and not sufficiently sensitive to detect small lesions.”

1. Kalantarian S, Ay H, Gollub RL, et al. Association between atrial fibrillation and silent cerebral infarctions: a systematic review and meta-analysis. Ann Intern Med. 2014;161(9):650-58.

PSA Testing Reduced Prostate Cancer Deaths

Prostate-specific antigen (PSA) testing may reduce prostate cancer mortality, according to results from the European Randomised Study of Screening for Prostate Cancer (ERSPC), published in Lancet.1

The ERSPC, a multicenter, randomized trial with a predefined centralized database, analysis plan, and core age group (55-69 years old), is assessing PSA testing in 8 European countries. Eligible men (50-74 years) were identified from population registries and randomly assigned by a computer to screening or no intervention. The primary outcome was prostate cancer mortality in the core age group. Analysis was by intention-to-treat; investigators performed a secondary analysis that corrected for selection bias due to nonparticipation.

Data truncated at 13 years of follow-up showed that 7408 prostate cancer cases were diagnosed in the intervention group and 6107 in the control group. The rate ratio of prostate cancer incidence between the intervention and control groups was 1.91 after 9 years, 1.66 after 11 years, and 1.57 after 13 years. The rate ratio of prostate cancer mortality was 0.85 after 9 years, 0.78 after 11 years, and 0.79 at 13 years. The absolute risk reduction of death from prostate cancer at 13 years was 0.11 per 1000 person-years, or 1.28 per 1000 men randomized, which is equivalent to 1 prostate cancer death averted per 781 men invited for screening or 1 per 27 additional prostate cancers detected. After adjustment for nonparticipation, the rate ratio of prostate cancer mortality in men screened was 0.73.

1. Schroder FH, Hugosson J, Roobol MJ, et al. Screening and prostate cancer mortality: results of the European Randomised study of Screening for Prostate Cancer (ERSPC) at 13 years of follow up [published online ahead of print August 6, 2014]. Lancet. doi:10.1016/S0140-6736(14)60525-0.

Men With Low-Risk Diets, Other Low-Risk Factors Had Reduced Risk of Myocardial Infarction

Combined low-risk diet and healthy lifestyle practices reduced the incidence of myocardial infarction (MI) in men, according to a study published in the Journal of the American College of Cardiology.1

Researchers in a population-based, prospective cohort study enrolled 20 721 Swedish men aged 45 to 79 years who had no history of cancer, cardiovascular disease, diabetes, hypertension, or high cholesterol levels. Patients were enrolled in 1997 and followed through 2009. Participants disclosed on a questionnaire if they had any of 5 low-risk factors: a healthy diet, moderate alcohol consumption (10 to 30 g/day), no smoking, being physically active for more than 40 minutes per day or more than 1 hour per week, and having a waist circumference less than 95 cm.

During the follow-up period, 1361 incidents of MI were recorded. Participants with low-risk dietary choice and moderate alcohol consumption had a relative risk of 0.65 (95% CI, 0.48-0.87) compared with those having none of the 5 low-risk factors. Patients who had all 5 low-risk factors had a relative risk of 0.14 (95% CI, 0.04-0.43) compared with those who had none of the low-risk factors.

“This combination of healthy behaviors, present in 1% of the men, could prevent 79% (95% CI, 34-93%) of the MI events on the basis of the study population,” the study authors said.

1. Åkesson A, Larsson SC, Discacciati A, Wolk A. Low-risk diet and lifestyle habits in the primary prevention of myocardial infarction in men: a population-based prospective cohort study. J Am Coll Cardiol. 2014;64(13):1299-306.

States With Highest Cervical Cancer Rates Have Lowest HPV Vaccination Rates

Some states with the highest incidence of cervical cancer had the lowest rates of vaccinating girls against the human papillomavirus (HPV), according a report by The Los Angeles Times on a health disparities conference organized by the American Association for Cancer Research.

States with the highest incidence of cervical cancer and the lowest rates of HPV vaccination included Arkansas (10.2 cases of cervical cancer per 100 000 women, 41% vaccination rate), Florida (9.4 cervical cancer cases per 100 000, 39% vaccination rate), and Mississippi (9.6 cervical cancer cases per 100 000, 40% vaccination rate). Massachusetts, the state ranking in the bottom 3 for cervical cancer rates at 6.0 per 100 000, had a vacation rate of 69%.

The national average for cervical cancer is 8.2 cases per 100 000; the national vaccination rate is 57%.

Patients were considered to have a vaccination if they had received at least 1 of the 3 vaccination doses over the 8-month period recommended by the Centers for Disease Control and Prevention. n

David S. Boyer, MD, is a clinical professor of ophthalmology at the University of Southern California Keck School of Medicine, Department of Ophthalmology, in Los Angeles. He is a member of the Retina Today Editorial Board. Dr. Boyer may be reached at +1-310-854-6201 or
vitdoc@aol.com.

 

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About Retina Today

Retina Today is a publication that delivers the latest research and clinical developments from areas such as medical retina, retinal surgery, vitreous, diabetes, retinal imaging, posterior segment oncology and ocular trauma. Each issue provides insight from well-respected specialists on cutting-edge therapies and surgical techniques that are currently in use and on the horizon.