Advancing the Science

Mayo Clinic Medical Science Blog – an eclectic collection of research- and research education-related stories: feature stories, mini news bites, learning opportunities, profiles and more from Mayo Clinic.

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6 days ago · The rising tide of nonalcoholic fatty liver disease

Liver disease? Me? I don’t drink. I don’t smoke. Okay, so I don’t exercise that much, and where did all these candy bar wrappers come from?

Anyway, I thought liver disease was just for alcoholics?

These are question many Americans ask when diagnosed with nonalcoholic fatty liver disease. But as its name implies, NAFLD is an umbrella term for a range of liver conditions in people who drink little or no alcohol. In NAFLD, excess fat is stored in the liver, and can lead to inflammation, scarring and potentially liver failure.

NAFLD is a significant and growing public health issue, but until now, we didn’t have a good handle on just how big this wave has grown.

Recently, Alina Allen, M.D., a gastroenterologist and population health researcher at Mayo Clinic, and colleagues, published a paper describing the incidence, as well as the life and death implications of this type of liver disease.

The researchers used the Rochester Epidemiology Project, a collaboration of clinics, hospitals, and other medical and dental facilities in Minnesota and Wisconsin that links together the medical and the dental records for people who have agreed to share their health history for the purpose of research.

The team showed that five times as many people have this type of liver disease now, as compared to 1997.

Alina Allen, M.D.

“This finding was not that surprising,” says Dr. Allen. “NAFLD is a consequence of obesity, and over the last few decades, we’ve observed a steadily rising rate of overweight people.”

She clarifies that improvements in imaging technology and increased awareness among providers may have contributed some to the increased numbers. Regardless, the team discovered that community-wide, people with NAFLD had a significantly higher risk of dying within 10 years of diagnosis, than others without NAFLD.

Dr. Allen also noted:

  • NAFLD contributes to the likely development of other diseases such as diabetes, hypertension and out of whack blood fat levels (cholesterol and triglycerides) called dyslipidemia – all known to hasten death, on their own.
  • But just NAFLD alone doubles the risk of death, and risk of cardiovascular events (for example, a heart attack).

NAFLD reduces life expectancy by about four years, which could cause us to miss a whole lot of moments with loved ones. While we may not be able to prevent the oceans from rising or falling, we can turn this tide.

“The key is maintaining a healthy weight,” Dr. Allen says, “or, for those who are overweight or obese, losing weight before the liver disease advances to cirrhosis.”

“The good news,” she says, “is that we know weight loss can reverse the unwanted consequences in the liver, such as fat, inflammation and even scar tissue. Additionally, adequate control of diabetes, hypertension and dyslipidemia have beneficial impacts on liver disease.”

Weight loss would help with those other conditions too, she notes.

If decreased health and lower life expectancy aren’t alarming enough to stop the rising tide of NAFLD cases, maybe knowing the dollars will. Dr. Allen and her colleagues also looked at the financial burden of this disease. In a related study, using the OptumLabs Data Warehouse, they showed that health care costs for patients diagnosed with NAFLD are significant – regardless of whether they have other metabolic conditions such as diabetes.

The team compared costs for more than 108,000 patients diagnosed with NAFLD, between 2010 – 2014, with those for similar patients lacking only the NAFLD diagnosis. The first years’ care added an average of $7,804 in health care costs; with follow-on care averaging $3,789 additional per year.

This garnered some attention in the news, and Dr. Allen hopes that both of these studies will contribute to patient and family awareness. They offer opportunities for life-changing conversations with health care providers, and may lead to more research to further transform health and the experience of health care. And above all, they may help stem the tide of NAFLD.

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This research was made possible by the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery. The OptumLabs Data Warehouse contains deidentified administrative claims data, including medical claims and eligibility information from a large national U.S. health insurance plan, as well as electronic health record data from a nationwide network of provider groups.

Tue, Sep 4 6:00am · Research News Roundup-August 2018

The Mayo Clinic Research News Roundup includes brief summaries and links to research news releases from the past month. It also connects readers to related resources. Read on for more information from Mayo Clinic Research.

Researchers at Mayo Clinic have identified an important new pathway by which HER2 positive breast cancers grow and have discovered that a dietary supplement called cyclocreatine may block the growth of HER2 positive breast cancer. Their findings were published today in Cell Metabolism.

Taro Hitosugi, Ph.D., a pharmacologist at Mayo Clinic, and his colleagues were hoping to find a way to help patients with HER2 positive breast cancer, in whom their cancer is or may become resistant to the typical therapy – trastuzumab. Their strategy was to develop a treatment to target tumor mitochondrial energy metabolism, which is the process cancer cells use to manipulate energy during cell metabolism in order to grow.

a person holding a pottery bowl near a river with blue clay and the person holding some of the clay in his or her hand

Image courtesy of Arizona State University

The use of mud or wet clay as a topical skin treatment or a poultice is a common practice in some cultures and the concept of using mud as medicine goes back to earliest times. Now Mayo Clinic researchers and their collaborators at Arizona State University have found that at least one type of clay may help fight disease-causing bacteria in wounds, including some treatment-resistant bacteria.

The findings appear in the International Journal of Antimicrobial Agents.

 

A research team led by Fergus Couch, Ph.D., a geneticist at Mayo Clinic, has identified specific genes associated with an increased risk for developing triple-negative breast cancer. Their research was published in the Journal of the National Cancer Institute.

“Triple-negative breast cancer is an aggressive type of cancer that cannot be treated using targeted therapies,” says Dr. Couch. “It accounts for 15 percent of breast cancer in the Caucasian population and 35 percent in the African-American population. It is also associated with a high risk of recurrence and a poor five-year survival rate. Our findings provide the basis for better risk management.”

Read more about their research findings.

Despite increased attention to opioid abuse, prescriptions have remained relatively unchanged for many U.S. patients, research led by Mayo Clinic finds. The research, published in The BMJ, shows that opioid prescription rates have remained flat for commercially insured patients over the past decade. Rates for some Medicare patients are leveling but remain above where they were 10 years ago.

“Our data suggest not much has changed in prescription opioid use since about five years ago,” says Molly Jeffery, Ph.D., lead author, who is the scientific director of the Mayo Clinic Division of Emergency Medicine Research.

Read the full news release.

A preliminary study published in the August issue of Mayo Clinic Proceedings suggests that, for some people, specific activities of gut bacteria may be responsible for their inability to lose weight, despite adherence to strict diet and exercise regimens.

“We know that some people don’t lose weight as effectively as others, despite reducing caloric consumption and increasing physical activity,” says Purna Kashyap, M.B.B.S., a Mayo Clinic gastroenterologist and co-senior author of the study. Dr. Kashyap and his colleagues wondered if there may be other factors at work that prevented these patients from responding to traditional weight-loss strategies.

Read about their findings.

Astronauts intermittently monitor their vital signs in space for experiments, partly because continuous monitoring requires multiple contact points on the body and the use of cumbersome batteries. Now, researchers at Mayo Clinic’s Florida campus are studying a device to be launched into space that is designed to use a small, inexpensive camera fitted with specialized software. This software has the potential to monitor an astronaut’s vital signs continuously and contact-free from feet away, saving precious cargo space and leaving astronauts unencumbered.

A married couple, both of who are physician-researchers at Mayo Clinic, are partnering on this project.

William D. Freeman, M.D., and Michelle Freeman, M.D., discuss the monitoring project.

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Meet our researchers and check out the research and education that after 150 years, continue to provide the underpinning for the first and largest integrated, not-for-profit medical group practice.

Find research feature stories, videos and news on Discovery’s Edge, Mayo Clinic’s online research magazine.

Mayo Clinic Radio‘s 1-minute and in-depth discussions of research and practical patient information can be found online or via your local radio station.

Information about many of the clinical trials available across Mayo Clinic is online as well.

Thu, Aug 30 6:00am · Knock, knock, the nurse practitioner is here

Burt and Ardis Ramaker were pleased with their experience in the Care Transitions Program, and thankful it helped Burt to recover at home.

When Burt Ramaker left the hospital following a successful hip replacement, he didn’t plan to go back any time soon. He and his wife Ardis imagined they would spend time at a skilled nursing facility to get him back on his feet, and then they’d be back at their waterfront cabin.

Instead, they found themselves in and out of the doctor’s office and the emergency room. Burt was on his way to being readmitted to the hospital. Patients of all ages with multiple chronic conditions are more likely than others to be readmitted to the hospital soon after discharge. However, this risk is especially high for older patients like Burt, especially if they have several chronic health conditions.

But if patients receive the right care, at the right time, and the right place, many of these readmissions could be prevented. And that was why Burt was identified for the program and his doctor recommended Burt sign up for a care management effort called the Care Transitions Program.

Newfangled house calls

At the Rochester, Minnesota, campus, the Care Transitions Program, part of Mayo Clinic’s Department of Employee and Community Health, features a new kind of house call. The program offers services to older adults with complex medical needs when they leave the hospital or skilled nursing facility. The patient-centric program features a home visit from a nurse practitioner within five days of discharge. In addition, patients receive follow-up phone calls from their care team, access to a nurse line for urgent questions or concerns, and additional house calls by the nurse practitioner when necessary.

Supervised by geriatricians – physicians specializing in elder care – the program provides individualized care and support for patients and their families.

Brenda Danielson is an advanced practice registered nurse and certified nurse practitioner at Mayo Clinic in Rochester, Minnesota.

Shortly after Burt enrolled, he and Ardis were visited by Brenda Danielson, a nurse practitioner in the program. She examined Burt, and they sat down to discuss what to do about his newly diagnosed heart failure and severe fluid build-up. Danielson wrote notes for Ardis and Burt, detailing his care plan and what had been discussed.

The Ramakers say Danielson visited monthly for several months – replacing what had been approximately weekly visits to the clinic or emergency room.

“It was great,” says Burt. “It saved me going up to the hospital a number of times, and I thought she [Danielson] was great!” He was unhappy at the nursing facility, he says, and “this program allowed me to come home.”

Danielson and others like her work with patients in the program to provide:

  • Medication reconciliation – both reducing use of high-risk medications, and lessening medication ‘misadventures’
  • Home safety assessments
  • Community resource referrals
  • Continued care for the health problem that led to the patient’s hospitalization, as well as the patient’s chronic health conditions

Burt Ramaker credits the Care Transitions Program as the reason he can step out onto his patio and fill the bird feeder, and engage in a host of other life activities.

The nurse practitioners also work with the patient to determine his or her goals for care, as well as to determine sources of social and other types of support. Together they develop strategies for:

  • Early recognition and management of health issues (before they necessitate an emergency department visit and potential readmission)
  • Patient self-management of chronic diseases
  • Advanced care planning

In Burt and Ardis’s case, Danielson also helped Ardis to understand and fill out insurance paperwork.

“I felt so comfortable asking for help,” says Ardis, “[for] any questions I had.”

Ardis says having the nurse practitioner visit, talk with them and leave detailed notes, helped her. “Knowing that I was doing it right,” she says was a comfort. And Burt got better – which they both say was their biggest benefit.

Patients like them, but do these house calls have other value?

“Bringing care to the patient is not only patient-centered, but can be beneficial to the institution,” says Rozalina McCoy, M.D., a primary care physician at Mayo Clinic who is also part of the Care Transitions Program team. But what seems like a good idea needs to be proven to add value. So the physician-researchers put it to the test.

They report that the program nearly halves unplanned readmissions within 30 days of discharge. Their research also shows better quality of life, fewer visits to the emergency department, decreased risk of death, and other potential benefits, including lower overall care costs for individuals and the health care system.

However, these observations have been broad, and the team is digging in further, to determine ways to predict and prevent readmission for as many people as possible. In addition, some types of readmission really aren’t preventable. Understanding these nuances will help Mayo Clinic provide better care for patients, and further refine the Care Transitions Program and other programs like it.

The latest piece of evidence

Patients enrolled in the program were much less likely to be readmitted than patients receiving usual care.

In their most recent study, led by Dr. McCoy, the researchers examined the program to determine its ability to reduce potentially preventable and non-preventable 30-day readmissions.

Using both a commercially available algorithm and another from the Centers for Medicare and Medicaid Services, Dr. McCoy’s team first determined which readmissions were potentially preventable. Some readmissions, she says, are either planned, or impossible to avoid, regardless of intervention.

Their study group included 365 enrollees in the Mayo Clinic Care Transitions Program, matched to a control group of patients who met enrollment criteria for, but were not enrolled, in the program.

In addition to being a primary care physician, Rozalina McCoy, M.D., is an endocrinologist, and conducts health sciences research at Mayo Clinic.

Overall, they report, patients enrolled in the program were much less likely to be readmitted than patients receiving usual care. However, when examining reasons for readmission, the team found that about two-thirds of all readmissions may still be preventable, both among patients enrolled in the Care Transitions Program and among those not enrolled. So even though the Care Transitions Program prevented more than 4 out of 10 readmissions, there is still a lot of room for further research into specific interventions for program participants.

In addition, readmissions for all causes – not just those related to the reason for the patients’ first hospital stay – seemed to be prevented, suggesting that providing intensive home-based care to high-risk patients may be an effective strategy in general, not just after a hospital admission.

“We believe timely home visits and a coordinated care program can prevent all types of hospitalizations, ED [emergency department] visits, and hospital readmissions,” says Dr. McCoy. “Perhaps not ‘all’ hospitalizations and readmissions, but certainly as we refine our ability to identify patients who are likely to have events or poor health outcomes, and then provide intensive, individualized, home-based transitional care, we expect the numbers to continue to decrease.”

Decreasing hospitalizations is great, of course, for patients and health care in general. But on an individual level, for Burt and Ardis, it means more time together, and more time fishing at the cabin.

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Dr. McCoy is a Kern Health Care Delivery Scholar in the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, which focuses on improving health care outcomes, lowering costs and enhancing patient experience. The center collaborates with Employee and Community Health to find ways to improve health and health care delivery in the local community.

 

Thu, Aug 2 6:00am · Research News Roundup-July 2018

The Mayo Clinic Research News Roundup includes brief summaries and links to research-related news releases from the past month. It also connects readers to associated resources. Read on for more information from Mayo Clinic Research.

In adults over 70, exposure to general anesthesia and surgery is associated with a subtle decline in memory and thinking skills, according to new Mayo Clinic research. The study analyzed nearly 2,000 participants in the Mayo Clinic Study of Aging and found that exposure to anesthesia after age 70 was linked to long-term changes in brain function. The results appear in the British Journal of Anaesthesia.

 

a golf ball on a putting green with someone holding a putter close by ready to tap the ballAlmost every golfer knows the feeling. Minutes after a picture-perfect drive down the fairway, a cascade of inexplicable missed putts leads to a disappointing triple bogey.

Golfers’ lapses in play sometimes are blamed on a mysterious twitching condition called “the yips.” But are yips physical or psychological? In a new Mayo Clinic study, published this month in Medicine & Science in Sports & Exercise, researchers combined multiple methods to quantify golfers’ yips and identify those with a neurological cause.

 

female research pipetting samplesThe presence of senescent or dysfunctional cells can make young mice age faster. And using senolytic drugs in elderly mice to remove these rogue cells can improve health and extend life. These findings from Mayo Clinic researchers and collaborators provide a foundation on which to move forward in this area of aging research. The results appear in Nature Medicine.

If you’d like to know more about aging research (both Mayo Clinic’s and that of other medical researchers), consider watching this upcoming PBS special: Incredible Aging: Adding Life to Your Years.

 

Mayo Clinic J. Wayne and Delores Barr Weaver Simulation Center entranceThe Mayo Clinic J. Wayne and Delores Barr Weaver Simulation Center at Mayo Clinic’s Florida campus has earned accreditation in the area of teaching and education by the Society for Simulation in Healthcare in Washington, D.C. The center is one of only 100 in the world to be recognized as having the highest quality standards in health care simulation. …

The recognition also supports the recruitment of exceptional staff; puts the center at an advantage for obtaining grant funds for research and education; and attracts future medical students, residents and fellows.

 

Research technologist removing frozen lab specimens from freezerMayo Clinic researchers are using precision genomics to search for undiscovered, inheritable genetic mutations that cause accelerated aging. In a study recently published in Mayo Clinic Proceedings, researchers conducted a study assessing 17 patients with short telomere syndromes — rare conditions that result in premature DNA and cellular deterioration. The ability to pinpoint the genetic abnormalities associated with short telomere syndromes is key to finding better ways to screen, diagnose and treat patients.

 

3-D image of damaged DNADamage to DNA is a daily occurrence but one that human cells have evolved to manage. Now, in a new paper published in Nature Structural & Molecular Biology, Mayo researchers have determined how one DNA repair protein gets to the site of DNA damage. The authors say they hope this discovery research will help identify new therapies for ovarian cancer.

 

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Find research feature stories, videos and more news on Discovery’s Edge, Mayo Clinic’s online research magazine.

Mayo Clinic Radio‘s 1-minute and in-depth discussions of research and practical patient information can be found online or via your local radio station.

Information about many of the clinical trials available across Mayo Clinic is online as well.

Much of our content is available in Spanish, and we also have news and patient resources in PortugueseMandarin Chinese and Arabic.

Mon, Jul 30 6:00am · What's new on the web?

At Mayo Clinic, research is integral to everything we do. We would be unable to offer the highest possible levels of care and continually improve the practice of medicine without research, and the education programs and processes that underpin our care.

Our research web is actually just a section of Mayo Clinic’s internet presence, but today we’re sharing some updates specifically from the research side. Click through for fresh content and updated information, and one completely redone site.

Led by Kristin Zhao, Ph.D., the Spinal Cord Injury Research Program studies recovery and rehabilitation, prevention and treatment of secondary complications, and wellness and quality of life for people with spinal cord injuries or diseases.

Dr. Zhao and her team have some interesting videos on the site, along with a wide selection of information, including specific sections describing their research into:


CCaTS is funded by the National Institute of Health’s (NIH) Clinical and Translational Science Awards (CTSA) program, and is a central hub for institutional advancement of research and education at Mayo Clinic.

The center provides tools and expert consultation to support every aspect medical research, including basic discovery science, clinical and community-engaged research, and late stage application and commercialization. In addition, CCaTS supports a national network of medical research institutions collaborating to transform how clinical and translational research is conducted nationwide.

If you visit the site, you can learn a bunch of interesting acronyms – my favorite is FuNCaTS – and also check out what’s going on across a wide variety of programs such as:


Hypoplastic left heart syndrome (HLHS) is a rare, complex heart defect that is present at birth (congenital). HLHS affects approximately 1,000 newborns every year in the United States.

In HLHS, the left side of a child’s heart — the left ventricle, ascending aorta and left heart valves — is severely underdeveloped. The result is a heart with only a single functional ventricular chamber — the right ventricle — and a small ascending aorta.

At Mayo Clinic, the Todd and Karen Wanek Family Program for Hypoplastic Left Heart Syndrome supports heart disease education and research aimed at developing therapies to repair heart tissue.

This whole site is a relaunch, and my web design colleagues tell me it’s all new and totally cool! You can judge that for yourself, but just to give you a hint of what it’s all about, watch this video:

You’ll have noticed that the world of research at Mayo Clinic is pretty broad. If you subscribe to Advancing the Science, you’ll get regular updates about Mayo Clinic research news and information – in smaller doses. See you on the web!

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Mon, Jul 9 4:43pm · A revolution in pancreatic cancer treatment

Tammy,

Thank you for reading Advancing the Science. Linked below are a couple items that cover topics related to gall bladder cancer that may be helpful.

This page from the National Cancer Institute describes pancreatic and biliary cancers: https://training.seer.cancer.gov/biliary/

You may also want to read our patient information regarding gall bladder cancer: https://www.mayoclinic.org/diseases-conditions/gallbladder-cancer/symptoms-causes/syc-20353370

Mon, Jul 9 8:32am · A revolution in pancreatic cancer treatment

Thank you for reading Advancing the Science. As you might imagine, we are unable to recount in this forum everything we are working on with respect to pancreatic cancer, but this article you a bit of insight.

As you mentioned, we are researching vaccines/vector-delivered viruses for the treatment of a variety of cancers. This video tells a bit more about that work: https://www.mayoclinic.org/diseases-conditions/cancer/multimedia/vid-20078288

For more information on more of the medical research being conducted at Mayo Clinic, please visit the website http://www.mayo.edu/research.

Thu, Jul 5 6:00am · Research News Roundup-June 2018

Each month, we publish Mayo Clinic’s Research News Roundup. This article includes brief summaries and links to news releases from the preceding month that discuss some of our latest medical research. It also connects readers to related resources.

This month’s Roundup includes a number of findings related pancreatic cancer and other gastrointestinal disorders, as well as other Mayo Clinic research.

Patients diagnosed with pancreatic cancer can develop elevated blood sugar levels up to three years before their cancer diagnosis, according to the results of a study by Mayo Clinic researchers published the journal Gastroenterology.

 

Six genes contain mutations that may be passed down in families, substantially increasing a person’s risk for pancreatic cancer. That’s according to Mayo Clinic research published in the June 19 edition of the JAMA. However, because researchers found these genetic mutations in patients with no family history of pancreatic cancer, they are recommending genetic testing for all pancreatic cancer patients as the new standard of care.

 

Genetically engineered bacteria are showing promise as a new treatment for constipation, researchers at the Mayo Clinic Center for Individualized Medicine have discovered in a mouse study. The finding is significant in part because there are few approved constipation remedies on the market. The research is published in Cell Host & Microbe.

 

A group of researchers from Mayo Clinic and Exact Sciences Corporation have completed a phase II study comparing a set of DNA markers to alpha fetoprotein as a method to test for liver cancer. The researchers presented their findings June 5 at the 2018 Digestive Disease Week conference in Washington, D.C.

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Meet our researchers and check out the research and education that after 150 years, continue to provide the underpinning for the first and largest integrated, not-for-profit medical group practice.

Find research feature stories, videos and news on Discovery’s Edge, Mayo Clinic’s online research magazine.

Mayo Clinic Radio‘s 1-minute and in-depth discussions of research and practical patient information can be found online or via your local radio station.

Information about many of the clinical trials available across Mayo Clinic is online as well.

 

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