 |
 |
|
|
PHILADELPHIA INTERNATIONAL MEDICINE® NEWS BUREAU
Contact: Leonard N. Karp
lkarp@philadelphiamedicine.com
215-735-3989
For immediate release:
In this month's issue:
1. Children’s Hospital of Philadelphia Again Named Best in US
2. Jefferson Scientists Find Zinc May Help Prevent Esophageal, Oral Cancers
3. Can The Standard Course of Radiation Therapy Following Lumpectomy for Breast
Cancer Be Shortened Without Increasing Side Effects?
4. Penn Creates Three Biomedical Institutes Harnessing over $100 Million in
Research Funding
Editors note: Research by Philadelphia International Medicine physicians may lead to new ways to treat some of our most challenging diseases. Below are some examples from our hospitals.
Children’s Hospital of Philadelphia Again Named Best in US
Philadelphia – The Children’s Hospital of Philadelphia marks the kickoff of its 150th anniversary year with a celebration and announcement of a third consecutive number one ranking as the nation’s best pediatric hospital by Child magazine. The event serves as both a commemoration of the Hospital’s distinguished history and a recognition of its ongoing impact on pediatric healthcare.
In addition to the overall ranking, Child magazine also ranked Children’s Hospital’s cardiac center, neonatology, oncology and orthopaedics departments number one in the nation and emergency medicine ranked fourth.
“The Children’s Hospital of Philadelphia has always been looked upon as a leader and an institution that others can emulate. We take our responsibility as a leader in pediatric medicine very seriously,” said Steven M. Altschuler, MD, president and chief executive officer of The Children’s Hospital of Philadelphia. “As we celebrate these important milestones, we are reminded that everybody who works here has the opportunity to change the life of a child in a way that can be done in no other place.”
Throughout its 150-year history, Children’s Hospital has been the birthplace of many dramatic firsts in pediatric medicine and has fostered medical discoveries and innovations that have improved pediatric healthcare, and saved countless children’s lives. Some examples include:
-- First formal medical training for pediatric doctors
-- First neonatal surgical and pediatric intensive care unit in the nation
-- First follow-up program for long-term survivors of childhood cancer
-- First to develop the closed incubator for newborns
-- First to develop the balloon catheter for the treatment of certain heart
defects
-- First to develop vaccines for mumps, whooping cough and influenza
-- First to offer subspecialty training in pediatric emergency medicine
Advances in medical and surgical treatments pioneered at Children’s Hospital enable many children to survive once fatal childhood illnesses, like congenital heart disease, cancer and complications of prematurity. Physicians and researchers now focus on addressing the long-term outcomes and health issues affecting these children to improve the quality of life for this new generation of survivors.
Founded in 1855 with 12 beds and a dispensary on Blight St. (now Watts St.) in Philadelphia, Children’s Hospital was the first hospital in the United States dedicated exclusively to the care of children. Today, the Hospital has 430 beds.
The Child magazine ranking is the result of a comprehensive data-based study of children’s hospitals across the United States, and it is based on hard data rather than subjective opinions. Child magazine began its investigation by looking at almost 150 hospitals that are full members of the National Association of Children’s Hospitals and Related Institutions (NACHRI), and then narrowed the field to nearly 100 by tracking the evaluations the hospitals received from the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), an independent agency that examines treatment protocols, record keeping and dispensing of medication. The finalists submitted a comprehensive 167-question survey developed by Child magazine’s medical advisory board.
The Child magazine survey included questions pertaining to survival rates for childhood cancers, heart surgeries, organ transplants and premature births; staff qualifications; nurse-to-patient ratios; research funding and the number of clinical trials; the availability of playrooms, lending libraries and activities to help a child’s hospital experience seem less frightening; and family services like support groups and sleeping accommodations for parents.
Jefferson Scientists Find Zinc May Help Prevent Esophageal, Oral Cancers
Cancer researchers at Jefferson Medical College and the Kimmel Cancer Center at Thomas Jefferson University in Philadelphia have found that zinc treatment may help prevent esophageal and oral cancers in those individuals at high risk.
Oral and esophageal cancers are associated with nutritional zinc deficiency,
and a rise in the expression of the enzyme COX-2 is connected with these
cancers.
Louise Fong, PhD, assistant professor of microbiology and immunology at
Jefferson Medical College of Thomas Jefferson University, and her co-workers
have found that zinc given orally to zinc-deficient rats reverses the
development of precancerous conditions in the esophagus and tongue and reverses
the high expression of COX-2 there as well.
These findings suggest that zinc supplements may prevent the development of esophageal or oral cancers, particularly in developing countries where zinc deficiency is a problem. The researchers reported their findings January 5, 2005 in the Journal of the National Cancer Institute.
Zinc in the diet comes mostly from red meat and seafood. Whereas up to 10 percent of Americans have a zinc-deficient diet, as many as 2 billion individuals in developing countries are zinc-deficient. Epidemiological evidence show the incidence of esophageal and oral cancers is rising in recent years. As many as 13,000 Americans die from esophageal cancer each year.
Dr. Fong has been studying zinc deficiency and its connection to esophageal cancer for some 20 years, and has developed animal models of zinc deficiency and cancer susceptibility. Zinc deficiency, she says, increases cell proliferation in the esophagus and in the tongue, making both areas susceptible to carcinogens and increasing the risk of cancer development. In 2002, Dr. Fong reported that rats given a carcinogen while on a zinc-deficient diet developed esophageal cancer. Giving zinc prevented the cancer.
Dr. Fong wanted to know if zinc could regulate COX-2 expression in esophageal and tongue cancers. She and her co-workers compared COX-2 protein and gene expression in esophageal and tongue tissue in normal rats, zinc-deficient rats and in zinc-deficient rats that had received zinc. They found COX-2 expression was increased 10-to-15-fold in zinc-deficient rats. Cellular proliferation was similarly increased.
After giving zinc to the deficient rats, COX-2 expression was markedly
reduced and the precancerous cellular proliferation was reversed.
The rats lacking dietary zinc were also treated with COX-2 inhibitors, celecoxib
(Celebrex) and indomethacin. They found that the rats treated with the COX-2
inhibitors had a reduction in both COX-2 and cellular proliferation in the
esophagus.
“Zinc treatment restores many systems affected by the lack of zinc,” Dr. Fong notes. “Zinc deficiency upregulates COX-2. Zinc replenishment restores it to near normal levels.” In the future, she and her co-workers would like to determine whether zinc in combination with low amounts of celecoxib can prevent upper aerodigestive tract cancers, including esophageal and oral cancers.
Can The Standard Course of Radiation Therapy Following Lumpectomy for Breast Cancer Be Shortened Without Increasing Side Effects?
Fox Chase Cancer Center researchers have presented preliminary results of a clinical trial in which women received a two-week shorter course of radiation therapy than the current standard following a lumpectomy. The study was presented at the annual Charles A. Coltman Jr. San Antonio Breast Cancer Symposium.
Radiation therapy daily for six or seven weeks after a lumpectomy is the standard course of treatment for many women with breast cancer who have had breast-sparing surgery, called a lumpectomy.
“The length of time for radiation treatment is a major inconvenience to many women,” said Gary Freedman, MD, a radiation oncologist at Fox Chase Cancer Center and lead author of the study. “For some, it is a barrier that leads them to choose mastectomy instead of breast conservation.”
In an effort to reduce the burden of treatment on women, Freedman and his colleagues at Fox Chase Cancer Center are studying a four-week course of radiation using IMRT (intensity-modulated radiation therapy) with an incorporated boost. A boost is a higher dose of radiation given to the site of the original tumor where the lumpectomy was done. This boost usually prolongs the radiation one to two weeks. In this phase II trial, the boost is given each day during the same four weeks the breast is treated.
At the San Antonio meeting, Freedman presented data on skin toxicity, or the effect the radiation has on the skin. Thirty-eight patients have completed radiation. Researchers have collected date from 28 women six weeks after the completion of treatment. The median age of the patients in the study was 55.
The toxicity to the skin was measured using a terminology called grades. Zero is the lowest level of side effects. Grade 1 is mild redness or dryness of the skin, and grade 2 is more moderate or severe redness from radiation or moist peeling of the skin folds of the breast. Grade 3 represents more severe skin reactions.
By the end of treatment week four, six patients (16%) had a grade 0 toxicity, 26 (68%) patients had grade 1 toxicity and six (16%) patients had grade 2 toxicity. There was no grade 3 or higher skin toxicity. Six weeks after radiation, the grade 2 skin toxicity was resolved for all women.
“Our study shows that IMRT for four weeks does cause side effects to the skin, but the level is milder than expected and considered acceptable,” explained Freedman. “What’s more, these results are comparable to the side effects seen in studies of conventional six-weeks of radiation.”
Data is also being collected on tumor recurrence, cosmesis and quality of life.
“This radiation schedule may represent an alternative both to longer six- to seven-week standard whole-breast radiation and the more radically shortened one-week partial-breast treatment schedules,” Freedman said.
Fox Chase Cancer Center was founded in 1904 in Philadelphia as the nation’s first cancer hospital. In 1974, Fox Chase became one of the first institutions designated as a National Cancer Institute Comprehensive Cancer Center. Fox Chase conducts basic, clinical, population and translational research; programs of prevention, detection and treatment of cancer; and community outreach.
Penn Creates Three Biomedical Institutes Harnessing over $100 Million in Research Funding
The University of Pennsylvania established three biomedical institutes aimed at integrating research, clinical and educational missions in a new model of care that cuts across traditional academic disciplinary and departmental lines.
The new entities are the Penn Cardiovascular Institute; the Institute for Diabetes, Obesity, and Metabolism; and the Institute for Translational Medicine and Therapeutics.
The institutes will each emphasize cooperation, partnership and combination of efforts. They will draw upon scientists and physicians--and in some cases, professors from such fields as psychology and sociology--from across the University.
Michael S. Parmacek, MD, Herbert C. Rorer Professor of Medicine and chief of the Division of Cardiovascular Medicine, will direct the Cardiovascular Institute. The Institute for Diabetes, Obesity, and Metabolism will be headed by Mitchell A. Lazar, MD, PhD, Sylvan Eisman Professor of Medicine and Genetics, and chief of the Division of Endocrinology, Diabetes and Metabolism. Garret A. FitzGerald, MD, Robinette Professor of Cardiovascular Medicine and Elmer Bobst Professor of Pharmacology, will administer the Institute for Translational Medicine and Therapeutics.
All three institutes will be housed in the University’s Clinical Research Building, further encouraging the exchange of ideas, sharing of personnel and resources, and coordination of related functions, both within and across the three institutes.
“It is noteworthy that in an era of escalating specialization, these institutes will maximize the united efforts and resources of a diverse group of superb clinicians and scientists to forge strong, coordinated, and integrated approaches to disease-prevention, management, and eradication,” said Dr. Arthur H. Rubenstein, executive vice president of the University of Pennsylvania for the Health System and dean of the School of Medicine. “Penn Medicine already enjoys an exceptional measure of public trust and esteem. With the formation of these institutes, we are consciously fostering a new chapter in pioneering patient care, research, and education.”
The mission of the Penn Cardiovascular Institute is to promote patient-oriented cardiovascular research across schools, departments, and centers at Penn. Despite remarkable advances in cardiovascular science and medicine over the past fifty years, cardiovascular disease remains the number one killer of patients in the United States.
Heart failure is the most common diagnosis of hospitalized patients in the United States. In light of these statistics, the Institute will support multi-disciplinary initiatives in the areas of heart failure and transplantation/myocyte biology, atherosclerosis/acute coronary syndromes, cardiac electrophysiology/channel biology, congenital heart disease/ cardiovascular development, diabetic/metabolic cardiovascular disease, and molecular diagnostics and imaging. It will also initiate a state-of-the-art Outpatient Cardiovascular Center in the new Center for Advanced Medicine in 2008.
The aim of the Institute for Diabetes, Obesity, and Metabolism is to understand the genetic, biochemical, molecular, environmental and behavioral origins of diabetes, obesity and other metabolic diseases and reduce their incidence and severity. The Institute will be inaugurated at a time of ever-increasing prevalence of diabetes and obesity. Approximately 18 million people in the United States (6.2 percent of the population) have diabetes. Most of the increase in diabetes is related to an increase in obesity, defined as being more than 30 percent above ideal body-weight. The Institute will provide technical and administrative support and resources for clinical research and care on behalf of patients with these afflictions - from epidemiological studies to behavioral manipulations to trials of promising new medications and therapies.
The mission of the Institute for Translational Medicine and Therapeutics will be to increase the quantity and quality of translational research at Penn: the application of ideas, insights and discoveries generated through basic scientific inquiry to the treatment or prevention of human disease.
In support of this undertaking, the Institute will train current professionals and students, as well as recruit faculty with translational-research proficiency. Examples of work which will be pursued at the Institute include the integration of genomic, proteomic and lipidomic approaches to discover novel anti-inflammatory drugs; the development of innovative immunotherapeutics for cancer; original approaches to targeting drug delivery to specific sites of disease; gene therapeutics of hemophilia; cellular therapies for Alzhemier’s disease and the development of the new field of pharmacoepidemiology.
The Institute will also prepare, certify and expand the number of trial coordinators, such as nurses and other health professionals, who carry out important aspects of translational research under the aegis of physician-scientists.
In addition to helping take new insights and discoveries from the lab bench to the patients’ bedside, and ultimately to the community at-large, the outcomes and methodological approaches generated at the institutes will be integrated into the educational program of the School of Medicine.
Philadelphia International Medicine is an organization that provides medical and patient support services to international patients. It also provides continuing medical education and health care training and education to international physicians, administrators and other practitioners. As the international department of several Philadelphia-area hospitals, international patients gain access to physicians and hospitals rated among the best in the world through one telephone call to PIM. You can reach PIM by calling 1-215-735-3575; fax, 1-215-790-1267; or e-mail, physicians@philadelphiamedicine.com . You can find out more about PIM through its Website at www.philadelphiamedicine.com .