A new pediatric oncology research laboratory, supported by a three-year, $3 million grant from the Pediatric Cancer Research Foundation of Irvine, Calif., officially opened last month in Babies Hospital South. The 2,000-square-foot lab, where 20 researchers work, is a joint effort of P&S and the Children's Hospital of NewYork-Presbyterian.
Dr. Mitchell S. Cairo, principal investigator for the grant, assistant professor of pediatrics at P&S, head of the pediatric cancer research program at Children's Hospital, and director of the new laboratory, says the facility will investigate the genetics of childhood lymphomas and will develop new diagnostic tools and treatments in immunology and hematology.
One focus of the research is on experimental hematopoiesis or blood cell production. Dr. Cairo and his colleagues have been working to mitigate obstacles hampering stem cell transplantation. Leukemia patients need new stem and immune cells because the chemotherapy that destroys the cancer in the bone marrow also kills the blood production and immune cells. But it is difficult for most childhood leukemia patients to find suitable donors in their families. So doctors have used umbilical cord blood from donors unrelated to the patient to transplant stem and immune cells.
However, current cord blood transplantation procedures use the entire sample in one infusion, making a second infusion impossible. Sometimes a second infusion is necessary if the leukemia returns after the first chemotherapy and cord blood infusion treatment. Even if enough cord blood were left over for a second transplant, the human body might reject the second transplant.
To begin to address these problems, the researchers developed an ex vivo procedure to multiply or expand the cord blood sample to enable a second treatment if a patient's leukemia returns. Using cytokines and antibodies, the cord blood immune and stem cells are multiplied, activated, and frozen for later use. Dr. Cairo and his colleagues recently published the details of this method in an in vitro system in the March issue of Experimental Hematology.
Ultimately, Dr. Cairo would like to use this method of expanding cord blood stem and immune cells in patients. His lab also has been investigating a reduced intensity chemotherapy treatment followed by a smaller than usual initial transplant of donor blood cells. This mini-transplant may help prevent rejection of the donor blood when given to a patient the second time.
In recent years, research studies and popular press stories have touted ways that religious activity leads to better health. Now, two Columbia Health Sciences investigators show that little scientific evidence exists to support the idea that a person's health is improved by religious activity.
In the new research, Dr. Richard Sloan, professor of behavioral medicine at P&S, and Dr. Emilia Bagiella, assistant professor of clinical biostatistics in the Mailman School of Public Health, first surveyed the medical literature for religious terminology to assess the extent of this area of research inquiry.
A search of Medline for papers involving religion found 266 papers published in 2000. The researchers read all 266 abstracts and found only 17 percent were relevant to claims of health benefits associated with religious participation. They had expected to find more studies analyzing the link.
They also assessed the quality of two major review articles linking religion and health and analyzed articles cited in the reviews that addressed cardiovascular disease and hypertension. They found numerous methodological problems in the articles cited. And they found the authors of the review articles made mistakes in interpreting the findings of the articles. Ultimately, only a few of the nearly 100 articles from the reviews showed a health advantage from religious activity. The research was reported in the March issue of the Annals of Behavioral Medicine.
The conclusions might be important in medical education, Dr. Sloan says, because more than half of U.S. medical schools now offer courses on religion, spirituality, and health. Such courses should avoid making claims about health benefits from religious involvement because that evidence is extremely weak, he says.
The researchers are continuing to study the relationship between religion and health by analyzing data from the National Institute on Aging on 14,000 elderly people. They are examining whether an association exists between religious service attendance and decreased mortality.
To swallow food, muscle contractions at the back of the mouth, in the throat, and in the esophagus must be coordinated to deliver food to the stomach. But a third of stroke patients and many Parkinson's patients have swallowing problems that send food past the vocal cords and into the trachea, where the food can cause choking, or into the lungs, where the food can cause pneumonia.
Researchers at P&S have shown that the ability to feel food move down the throat is key in coordinating muscle contractions and preventing food from entering the trachea. Their findings challenge the current paradigm among swallowing researchers who say sensory stimulation in the pathway is not necessary and that swallowing problems arise if the muscles don't perform their function in the correct temporal sequence. The P&S research appeared in the February issue of Laryngoscope.
Led by Dr. Jonathan Aviv, professor of otolaryngology/head and neck surgery, the researchers directed a puff of air at the back of the throat of 122 patients with swallowing difficulties. If patients feel the air puff, they react by closing the vocal cords, which closes off the trachea and prevents food from going down the wrong way. After assessing the patient's sensation in the throat, researchers gave each patient applesauce and water to see if any food or liquid got past the vocal cords.
Of the 46 patients who did not react to the air puff, 85 percent inhaled applesauce into the trachea and 100 percent inhaled water, compared with 8 percent and 34 percent, respectively, among patients with an air puff reaction.
The researchers also found that patients without throat sensations had weak muscular contractions in the throat, suggesting that a loss of sensation changes throat contractions, impairing the patient's ability to prevent food from entering the trachea.
Dr. Aviv says the study shows that the standard of care for patients with swallowing problems needs to change. Currently, most patients are given barium-coated food to swallow while the physician watches the progress of the food with fluoroscopic imaging.
But this puts patients with a sensory deficit at risk of choking or pneumonia, Dr. Aviv says. We suggest that physicians should assess airway protection first before giving a potential foreign body to the patient.