Pediatric researchers at UT Southwestern Medical Center have identified a key component of the pathogenesis of bronchopulmonary dysplasia (BPD), a devastating and sometimes fatal lung disease that affects premature infants. Their findings clarify what prompts the inflammatory response that results in BPD, which previously had been unclear.
The study determined how the NLRP3 inflammasome activates the protein Interleukin 1 beta, which in turn triggers inflammation and development of BPD.
In an animal model of BPD, researchers also tested two FDA-approved drugs that either block the effect of or decrease the production of Interleukin 1 beta and found that these treatments allowed more normal lung development.
Bronchopulmonary dysplasia, a common chronic lung disease in premature infants, develops as a result of the ventilation and oxygen necessary for these infants to survive. Infants born before 30 weeks gestation have immature lungs that lack surfactant, a substance comprised of phospholipids and proteins that is needed for lungs to properly function. This causes premature infants to develop respiratory distress syndrome, requiring the aid of mechanical ventilation. The infants’ exposure to elevated oxygen levels during ventilation activates the process of inflammation that leads to BPD.
‘The same ventilation that ultimately saves their lives, damages their lungs,’ said Dr. Rashmin Savani, Professor and Chief of Neonatal-Perinatal Medicine. ‘Our findings suggest that if we target premature infants born at less than 28 weeks gestation from three to 10 days after birth with this therapy, we might be able to drastically reduce or even eliminate the development of BPD.’ Dr. Savani also holds the William Buchanan Chair in Pediatrics.
Next steps include testing the therapeutic intervention strategies outlined in this study in larger animal models, potentially followed by a Phase 1 clinical trial.

UT Southwestern Medical Center http://tinyurl.com/j2yjrtz

‘OB Nest’: Just the name may bring warm feelings to parents and prospective parents. However, at Mayo Clinic, it’s much more than a name. It’s a new way that Mayo Clinic is providing prenatal care. And, families say they are thrilled with the process.
Current prenatal care for a pregnancy consists of 12-14 visits with an obstetrician. However, often these visits are just brief check-ins to make sure a pregnancy is progressing well. Previous research has looked at ways to give providers more time for high-risk patients, and save time and office visits for women with low-risk pregnancies. While these studies have shown that fewer visits are safe, patients reported less satisfaction overall.
Seeking to identify ways to improve patient experience and perceived value, Mayo Clinic researchers decided to test a new way of providing prenatal care, dubbed ‘OB Nest.’
With the changes to the care experience provided within OB Nest, the researchers found that not only did patient satisfaction improve, but also this improved satisfaction came with fewer office visits.
‘Traditionally, pregnancy is treated as a sickness,’ says Yvonne Butler Tobah, M.D., a Mayo Clinic obstetrician and lead author of this study. ‘We wanted our care to reflect the normal, life-bringing event that it is, and [we] looked for a way to transform prenatal care into a wellness, patient-oriented experience.’
The Department of Obstetrics and Gynecology, in collaboration with the Center for Innovation, worked with patients and staff to collect and prioritize ideas to improve the way pregnant women and their families experience prenatal care. Along with the department, the Care Experience Program, which is part of the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, took this information and these ideas and designed evidence-based practice improvements for prenatal care.
OB Nest study participants – all of whom were experiencing low-risk pregnancies – entered the programme with a specific nurse identified as their lead contact. They received eight scheduled office visits (More were optional.) and home monitoring equipment for fetal heart rate and maternal blood pressure. In addition, they could take part in an online care community with other OB Nest participants and nurses from the OB Nest care team.
‘My schedule is very hectic,’ says Seri Carney, M.D., a mom who participated in the OB Nest study during pregnancy with her second child. ‘It was really nice to only have to go in for my appointments every other month. My husband and I didn’t have to worry as often about arranging our work schedules for the appointments.’
‘We could listen to the heartbeat whenever we wanted,’ says Dr. Carney. ‘Our daughter was 4 at the time, and doing it at home meant that she could get involved, too. That was really fun. It also felt like it made me more aware of the movements and heartbeat of my baby.’
In her third trimester, when Dr. Carney noticed her baby’s heartbeat was a little low, she was able to email her care team. They reacted right away and got Carney in for a stress test. All was fine, and within a few weeks, she and her family welcomed baby Luisa Jane.
The OB Nest research project is part of Mayo Clinic’s healthcare delivery research efforts, and aligns with the Institute for Healthcare Improvement Triple Aim.
‘This fulfills the holy grail of what patients expect today,’ says Abimbola Famuyide, M.B.B.S., chair of the Department of Obstetrics and Gynecology, and study principal investigator. ‘How can we continue to improve patient experience and clinical outcomes, while, at the same time, keep costs down?’
‘Improving the patient experience, in the case of OB Nest, includes empowering expectant women to truly engage in, and take control of, their care,’ says Dr. Famuyide. He and his team learned that having one nurse as the centre point for each woman’s care and concerns provided them the comfort of easy connection. Concurrently, fewer office visits saved healthcare provider resources, while reducing patient burden.
This practice transforming research is leading to permanent changes in the way women receive prenatal care across Mayo Clinic. It is part of the goal of the Mayo Model of Community Care, to deliver wellness-focused, high-value healthcare – improving access, convenience and patient satisfaction, while lowering costs.

Mayo Clinichttp://tinyurl.com/jsjgz2t

Most filters – whether for water or a furnace – eventually need to be removed or replaced to avoid complications.

Blood clot filters, which are implanted in the veins of people at risk of developing blood clots in their legs, require a similar precaution.

Complications have been found to arise when the filters, even those intended to be permanent, are left in longer than three to six months. These complications may include part of the filter breaking off and traveling to the heart and lungs, abdominal pain, filter tilt, and the filter tearing or creating a blockage in the veins of the abdomen (inferior vena cava) or in the legs. The chance of complications increases the longer the filter has been in place. Blood clot filters, also known as inferior vena cava (IVC) filters, potentially are dangerous and require specialized techniques to remove them.

Interventional radiologists at Rush University Medical Center have pioneered methods to remove filters that previously couldn’t be removed for various reasons.

‘We have both the standard retrieval methods as well as the most advanced tools to remove any type of filter, and we have the medical expertise to treat any complications from the filter being implanted,’ says Osman Ahmed, MD, primary author and interventional radiologist at Rush University Medical Center and Rush Oak Park Hospital.

The techniques involve a careful method of catching or ‘snaring’ the filter to hold it in place and then covering it to prevent parts of it breaking free. The team also uses tools such as alligator forceps and excimer laser in removing filters.

Thanks to these methods, the Rush team has achieved a 100 percent retrieval rate over the past five years, including difficult-to-remove filters from patients who have been referred to Rush from other hospitals.

The minimally invasive procedure is performed on an outpatient basis using twilight (conscious) sedation in the interventional radiology suite, which is similar to an operating room but also includes special imaging equipment. More advanced retrievals are performed using general anaesthesia due to the time it may take to remove the filter.

The filter removal is performed through a small incision in the neck or groin (the maximum size is around 5 mm) and the filter is removed using X-ray guidance to manipulate wires, catheters, and other devices necessary to remove the filter, which can be up to 29 mm in length.

The Rush team lead by Bulent Arslan, MD, and Ulku Turba, MD, developed these techniques to remove IVC filters, which are implanted in the inferior vena cava, a large vein just below the kidneys, in order to trap blood clots before they travel to the heart and lungs and cause permanent damage.

Rush University Medical Center www.newswise.com/articles/pioneers-in-ivc-filter-removal

Titanium is the leading material for artificial knee and hip joints because it’s strong, wear-resistant and nontoxic, but an unexpected discovery by Rice University physicists shows that the gold standard for artifi cial joints can be improved with the addition of some actual gold.
‘It is about 3-4 times harder than most steels,’ said Emilia Morosan, the lead scientist on a new study in Science Advances that describes the properties of a 3-to-1 mixture of titanium and gold with a specific atomic structure that imparts hardness. ‘It’s four times harder than pure titanium, which is what’s currently being used in most dental implants and replacement joints.’
Morosan, a physicist who specializes in the design and synthesis of compounds with exotic electronic and magnetic properties, said the new study is ‘a first for me in a number of ways. This compound is not difficult to make, and it’s not a new material.’ In fact, the atomic structure of the material – its atoms are tightly packed in a ‘cubic’ crystalline structure that’s oft en associated with hardness – was previously known. It’s not even clear that Morosan and former graduate student Eteri Svanidze, the study’s lead co-author, were the first to make a pure sample of the ultrahard ‘beta’ form of the compound. But due to a couple of lucky breaks, they and their co-authors are the fi rst to document the material’s remarkable properties.
‘This began from my core research,’ said Morosan, professor of physics and astronomy, of chemistry and of materials science and nano-engineering at Rice. ‘We published a study not long ago on titanium-gold, a 1-to-1 ratio compound that was a magnetic material made from nonmagnetic elements. One of the things that we do when we make a new compound is try to grind it into powder for X-ray purposes. This helps with identifying the composition, the purity, the crystal structure and other structural properties. ‘When we tried to grind up titanium-gold, we couldn’t,’ she recalled. ‘I even bought a diamond (coated) mortar and pestle, and we still couldn’t grind it up.’
What the team didn’t know at the time was that making titanium- 3-gold at relatively high temperature produces an almost pure crystalline form of the beta version of the alloy – the crystal structure that’s four times harder than titanium. At lower temperatures, the atoms tend to arrange in another cubic structure – the alpha form of titanium-3-gold. The alpha structure is about as hard as regular titanium. It appears that labs that had previously measured the hardness of titanium-3-gold had measured samples that largely consisted of the alpha arrangement of atoms.
The team measured the hardness of the beta form of the crystal in conjunction with colleagues at Texas A&M University’s Turbomachinery Laboratory and at the National High Magnetic Field Laboratory at Florida State University; Morosan and Svanidze also performed other comparisons with titanium. For biomedical implants, for example, two key measures are biocompatibility and wear resistance. Because titanium and gold by themselves are among the most biocompatible metals and are oft en used in medical implants, the team believed titanium-3-gold would be comparable. In fact, tests by colleagues at the University of Texas MD Anderson Cancer Center in Houston determined that the new alloy was even more biocompatible than pure titanium. The story proved much the same for wear resistance: Titanium-3-gold also outperformed pure titanium.

Rice University http://tinyurl.com/jto5exc