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JANUARY 2005: Exercise and Metabolic Syndrome Managing Problem Deliveries ... Singapore Center Moves ... Measuring MI Damage Separated Twin Returns Home ... Eliminating Bloodstream Infections Hopkins' New MS Center.

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"My counterparts around the country are surprised I'm so focused on safety initiatives. Many believe technology will solve the problem. Yet information technology is complex to implement, expensive and often proprietary. My guess is that IT can help eliminate about one-third of the mistakes; the rest will be up to those who staff our hospitals."

Edward Miller, M.D., Dean & CEO, Johns Hopkins Medicine


Exercise Combats Metabolic Syndrome in Older Adults

People ages 55 to 75 who follow a moderate program of physical exercise can significantly offset the deadly mix of risk factors for heart disease and diabetes known as metabolic syndrome, according to a Hopkins study.

The researchers found that while exercise improved overall fitness, the 23% fewer cases reported were more strongly linked to reductions in total and abdominal body fat and increases in muscle leanness.
"Older people are very prone to have the metabolic syndrome," said lead study investigator and exercise physiologist Kerry Stewart, Ed.D. "While each component of metabolic syndrome increases disease risk by itself, when combined, they represent an even greater risk for developing heart disease, diabetes and stroke." The study appears in the American Journal of Preventive Medicine, available online Dec. 30.

New Way to Manage Problem Deliveries

Using a Hopkins-designed birthing simulator, obstetricians have identified what may be the least forceful way to deliver a baby whose shoulders are stuck in the birth canal. Results are reported in the Jan. 4 issue of the American Journal of Obstetrics and Gynecology.

Shoulder dystocia, in which the baby's shoulders won't move past the mother's bony pelvis during delivery, occurs in about 5% of births. Of these, up to 25% of deliveries may result in an injury to the baby's brachial plexus, and as many as 10% of infants may sustain permanent damage.

An obstetrician can perform one of several maneuvers to manipulate the position of either the mother or the baby when shoulder dystocia occurs. The Hopkins study found that turning the baby so its spine faces the mother's belly (a technique known as anterior Rubin's maneuver) requires less force than either turning the baby so its spine faces the mother's spine, or moving the mother's legs back to try to reduce the force of the baby's shoulders against the mother's pelvis.


A More Accurate Measure of MI Damage

In animal studies, Hopkins researchers have used MRI to measure with 94% accuracy the size and amount of heart muscle damaged by a myocardial infarct. If confirmed in humans, the development could standardize how physicians gauge the severity of a heart attack and a patient's chances for recovery.

The researchers, whose findings appeared in the Journal of the American College of Cardiology online Dec. 21, hope to apply this information to determine more accurate dosing regimens for stem cell therapies currently under development.

"Current methods for measuring the size of an infarct and assessing how much damage was done are highly subjective and arbitrary," said study author and cardiologist Joo Lima, M.D. "A person who has suffered damage to more than 30% of the left ventricle is twice as likely to die within a year from the injury than someone who has suffered less damage, and bigger infarcts often require more aggressive drug therapy or, in the most severe cases, surgery to repair heart tissue or prevent further damage."

CLINICAL (continued)...

Click here to read about the separation
surgerySeparated Conjoined Twin Returns to Germany

Lea Block, who underwent surgery at Hopkins in September to separate her from her conjoined twin sister, Tabea, left Baltimore December 6 with her parents to return to their home in Germany. Her departure comes almost 3 months after the marathon operation performed by a team led by neurosurgeon Benjamin Carson. Tabea died of major complications associated with the surgery.

Lea, now 16 months old and in good health, was discharged November 6 but remained in Baltimore to receive follow up care, including physical therapy. According to Dr. Carson, Lea is very alert and interactive and is expected to grow into a healthy young girl who will lead an independent life. She is feeding herself and like other children her age, engages in baby babble and is currently teething.

Further rehabilitative care will focus on improving the movement on Lea's left side of her body, which has experienced some weakness since the surgery. In addition, there may be compromises in her visual function which will be carefully evaluated in the upcoming months.

Hopkins Center in Singapore to Relocate

The Johns Hopkins-National University Hospital International Medical Centre, currently at NUH, will relocate to Tan Tock Seng Hospital in Singapore in the coming months, renamed as Johns Hopkins Singapore International Medical Centre. The move will allow the 4-year-old center to continue its rapid growth and bring advanced oncology services to the island nation as it strives to become a regional medical hub.


Simple Intervention Nearly Eliminates Bloodstream Infections

Thousands of patients die each year because of catheter-related bloodstream infections, but doctors and nurses who implement simple and inexpensive interventions can cut the number of deaths to nearly zero, say Hopkins researchers.

The simple interventions, which include streamlining the catheter insertion process, training doctors and nurses, and a safety checklist, are believed to have prevented over 40 infections, eight deaths and saved $2 million in additional health care costs during the four-year study led by anesthesiologist Sean Berenholtz.

The same interventions have been applied in over 100 ICUs nationwide with equally dramatic results, says Berenholtz.


Hopkins' New MS Center

The new Johns Hopkins Multiple Sclerosis Center has opened with an offering of clinical trials unlike any in the institution's history.

"With nine neurologists and staff, we can tailor current therapies to patients," says neurologist Peter Calabresi, who heads the center. "But, now, we've begun conducting large international trials that follow from laboratory discoveries." Soon, he says, "we'll start smaller translational ones even closer to the edge."

Until now, Hopkins' approach to MS has clearly advanced what's known of the disease. "Real" MS has been winnowed out from look-alikes, for example. Scientists have described the immune basis of the disease and eliminated trendy but wrong ideas of its cause, saving wasted years of research.

Now new high-tech approaches are enhancing the earlier finds, pinpointing targets worthy of trials. Calabresi, new to Hopkins, has worked a decade to show, for example, how white blood cells--memory T cells--designed to attack the immune system slip from blood vessels into the nervous system. He has identified a protein that is key to T cell migration and promoted a therapeutic antibody against it.

"The data in a Phase II trial of 220 patients were stunning! After once-a-month IV of the antibody, patients had a 90% reduction in active lesions and essentially no side effects!," he reports.

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