Drug release in a cancer cell

Credit: PNAS

Researchers have discovered that a solvent used as a drug delivery vehicle has antimyeloma properties.

The team found that N-methyl-2-pyrrolidone (NMP)—long-regarded a basic, stable, and inactive solvent—affects the growth and survival of multiple myeloma (MM) cells and stimulates the immune system to kill these tumors.

Jake Shortt, MBChB, PhD, of the Peter MacCallum Cancer Centre in Melbourne, Australia, described these findings in Cell Reports.

“[W]e found NMP effectively ‘reprograms’ myeloma cells by targeting a class of gene-regulating proteins,” Dr Shortt said. “This reprogramming reawakens thousands of genes that have been silenced in the cancer cells, immediately stopping the myeloma cells from growing, while activating the immune system to respond to the cancer.”

The researchers were surprised by this discovery because they had been using NMP as a vehicle to deliver drugs in mouse models of MM.

“In a routine experiment in 2010, Dr Shortt noticed our preclinical models of myeloma were responding to the control dose of NMP, which was surprising, as this control dose contained none of the novel cancer agents we were actually testing,” said study author Ricky Johnstone, PhD, also of the Peter MacCallum Cancer Centre.

Specifically, the researchers were using NMP as a drug delivery vehicle in mice transplanted with Vk*MYC MM tumors. And they consistently observed antitumor activity in vehicle-only control mice.

The team saw responses to NMP in mice transplanted with multiple, independently derived myelomas; namely, delayed paraprotein progression and improved survival in aggressive clones and sustained regressions in more indolent disease.

Further investigation revealed that NMP is an acetylated lysine mimetic and bromodomain ligand. And NMP shares molecular targets with lenalidomide, including cMYC and IRF4.

Unlike lenalidomide, NMP showed CRBN-independent activity. NMP induced similar growth arrest in CRBN-knockdown MM cells and lenalidomide-resistant MM cells.

Based on these findings, the researchers are planning a phase 1 trial of NMP, which is due to start later this year. The team noted that, because safe levels of NMP in humans are already well-established, the study is in the advanced planning stage.

“We’re at an advantage with this trial because we can immediately start at dosage levels within those recommended under occupational health and safety guidelines,” said David Ritchie, MBChB, PhD, a professor at the Peter MacCallum Cancer Centre and chief investigator of the phase 1 trial.

“It is extremely exciting to have this new insight into NMP, which is comparatively cost-effective and plentiful, compared to novel treatments developed by pharmaceutical companies, and hopefully holds promise for new or improved treatments in other cancer types.”

Drug release in a cancer cell

Credit: PNAS

Researchers have discovered that a solvent used as a drug delivery vehicle has antimyeloma properties.

The team found that N-methyl-2-pyrrolidone (NMP)—long-regarded a basic, stable, and inactive solvent—affects the growth and survival of multiple myeloma (MM) cells and stimulates the immune system to kill these tumors.

Jake Shortt, MBChB, PhD, of the Peter MacCallum Cancer Centre in Melbourne, Australia, described these findings in Cell Reports.

“[W]e found NMP effectively ‘reprograms’ myeloma cells by targeting a class of gene-regulating proteins,” Dr Shortt said. “This reprogramming reawakens thousands of genes that have been silenced in the cancer cells, immediately stopping the myeloma cells from growing, while activating the immune system to respond to the cancer.”

The researchers were surprised by this discovery because they had been using NMP as a vehicle to deliver drugs in mouse models of MM.

“In a routine experiment in 2010, Dr Shortt noticed our preclinical models of myeloma were responding to the control dose of NMP, which was surprising, as this control dose contained none of the novel cancer agents we were actually testing,” said study author Ricky Johnstone, PhD, also of the Peter MacCallum Cancer Centre.

Specifically, the researchers were using NMP as a drug delivery vehicle in mice transplanted with Vk*MYC MM tumors. And they consistently observed antitumor activity in vehicle-only control mice.

The team saw responses to NMP in mice transplanted with multiple, independently derived myelomas; namely, delayed paraprotein progression and improved survival in aggressive clones and sustained regressions in more indolent disease.

Further investigation revealed that NMP is an acetylated lysine mimetic and bromodomain ligand. And NMP shares molecular targets with lenalidomide, including cMYC and IRF4.

Unlike lenalidomide, NMP showed CRBN-independent activity. NMP induced similar growth arrest in CRBN-knockdown MM cells and lenalidomide-resistant MM cells.

Based on these findings, the researchers are planning a phase 1 trial of NMP, which is due to start later this year. The team noted that, because safe levels of NMP in humans are already well-established, the study is in the advanced planning stage.

“We’re at an advantage with this trial because we can immediately start at dosage levels within those recommended under occupational health and safety guidelines,” said David Ritchie, MBChB, PhD, a professor at the Peter MacCallum Cancer Centre and chief investigator of the phase 1 trial.

“It is extremely exciting to have this new insight into NMP, which is comparatively cost-effective and plentiful, compared to novel treatments developed by pharmaceutical companies, and hopefully holds promise for new or improved treatments in other cancer types.”

Drug release in a cancer cell

Credit: PNAS

Researchers have discovered that a solvent used as a drug delivery vehicle has antimyeloma properties.

The team found that N-methyl-2-pyrrolidone (NMP)—long-regarded a basic, stable, and inactive solvent—affects the growth and survival of multiple myeloma (MM) cells and stimulates the immune system to kill these tumors.

Jake Shortt, MBChB, PhD, of the Peter MacCallum Cancer Centre in Melbourne, Australia, described these findings in Cell Reports.

“[W]e found NMP effectively ‘reprograms’ myeloma cells by targeting a class of gene-regulating proteins,” Dr Shortt said. “This reprogramming reawakens thousands of genes that have been silenced in the cancer cells, immediately stopping the myeloma cells from growing, while activating the immune system to respond to the cancer.”

The researchers were surprised by this discovery because they had been using NMP as a vehicle to deliver drugs in mouse models of MM.

“In a routine experiment in 2010, Dr Shortt noticed our preclinical models of myeloma were responding to the control dose of NMP, which was surprising, as this control dose contained none of the novel cancer agents we were actually testing,” said study author Ricky Johnstone, PhD, also of the Peter MacCallum Cancer Centre.

Specifically, the researchers were using NMP as a drug delivery vehicle in mice transplanted with Vk*MYC MM tumors. And they consistently observed antitumor activity in vehicle-only control mice.

The team saw responses to NMP in mice transplanted with multiple, independently derived myelomas; namely, delayed paraprotein progression and improved survival in aggressive clones and sustained regressions in more indolent disease.

Further investigation revealed that NMP is an acetylated lysine mimetic and bromodomain ligand. And NMP shares molecular targets with lenalidomide, including cMYC and IRF4.

Unlike lenalidomide, NMP showed CRBN-independent activity. NMP induced similar growth arrest in CRBN-knockdown MM cells and lenalidomide-resistant MM cells.

Based on these findings, the researchers are planning a phase 1 trial of NMP, which is due to start later this year. The team noted that, because safe levels of NMP in humans are already well-established, the study is in the advanced planning stage.

“We’re at an advantage with this trial because we can immediately start at dosage levels within those recommended under occupational health and safety guidelines,” said David Ritchie, MBChB, PhD, a professor at the Peter MacCallum Cancer Centre and chief investigator of the phase 1 trial.

“It is extremely exciting to have this new insight into NMP, which is comparatively cost-effective and plentiful, compared to novel treatments developed by pharmaceutical companies, and hopefully holds promise for new or improved treatments in other cancer types.”

Lab mouse

Investigators have developed a technique that allowed them to track single tumor circulating in the blood of mice.

The method, described in Chemistry & Biology, involves photoswitchable fluorescent proteins that change color in response to light.

When one laser light hits the circulating tumor cells, they appear to be fluorescent green. A second laser makes the cells appear fluorescent red.

To label cells, the investigators use a violet laser beam aimed at small blood vessels.

The fluorescence from each cell is collected, detected, and reproduced on a computer monitor as real-time signal traces, allowing the team to count and track individual cells in the bloodstream.

“This technology allows for the labeling of just one circulating pathological cell among billions of other normal blood cells by ultrafast changing color of photosensitive proteins inside the cell in response to laser light,” said study author Ekaterina Galanzha, PhD, of the University of Arkansas for Medical Sciences in Little Rock.

In tumor-bearing mice, the investigators could monitor the real-time dynamics of circulating cancer cells released from a primary tumor.

They could also image the various final destinations of individual circulating cells and observe how these cells travel through circulation and colonize healthy tissue, existing sites of metastasis, or the site of the primary tumor.

“Therefore, the approach may give oncologists knowledge on how to intervene and stop circulating cancer cell dissemination that might prevent the development of metastasis,” Dr Galanzha said.

The investigators believe the approach might also prove useful for other areas of medicine—for example, tracking bacteria during infections or immune-related cells during the development of autoimmune disease.

Lab mouse

Investigators have developed a technique that allowed them to track single tumor circulating in the blood of mice.

The method, described in Chemistry & Biology, involves photoswitchable fluorescent proteins that change color in response to light.

When one laser light hits the circulating tumor cells, they appear to be fluorescent green. A second laser makes the cells appear fluorescent red.

To label cells, the investigators use a violet laser beam aimed at small blood vessels.

The fluorescence from each cell is collected, detected, and reproduced on a computer monitor as real-time signal traces, allowing the team to count and track individual cells in the bloodstream.

“This technology allows for the labeling of just one circulating pathological cell among billions of other normal blood cells by ultrafast changing color of photosensitive proteins inside the cell in response to laser light,” said study author Ekaterina Galanzha, PhD, of the University of Arkansas for Medical Sciences in Little Rock.

In tumor-bearing mice, the investigators could monitor the real-time dynamics of circulating cancer cells released from a primary tumor.

They could also image the various final destinations of individual circulating cells and observe how these cells travel through circulation and colonize healthy tissue, existing sites of metastasis, or the site of the primary tumor.

“Therefore, the approach may give oncologists knowledge on how to intervene and stop circulating cancer cell dissemination that might prevent the development of metastasis,” Dr Galanzha said.

The investigators believe the approach might also prove useful for other areas of medicine—for example, tracking bacteria during infections or immune-related cells during the development of autoimmune disease.

Lab mouse

Investigators have developed a technique that allowed them to track single tumor circulating in the blood of mice.

The method, described in Chemistry & Biology, involves photoswitchable fluorescent proteins that change color in response to light.

When one laser light hits the circulating tumor cells, they appear to be fluorescent green. A second laser makes the cells appear fluorescent red.

To label cells, the investigators use a violet laser beam aimed at small blood vessels.

The fluorescence from each cell is collected, detected, and reproduced on a computer monitor as real-time signal traces, allowing the team to count and track individual cells in the bloodstream.

“This technology allows for the labeling of just one circulating pathological cell among billions of other normal blood cells by ultrafast changing color of photosensitive proteins inside the cell in response to laser light,” said study author Ekaterina Galanzha, PhD, of the University of Arkansas for Medical Sciences in Little Rock.

In tumor-bearing mice, the investigators could monitor the real-time dynamics of circulating cancer cells released from a primary tumor.

They could also image the various final destinations of individual circulating cells and observe how these cells travel through circulation and colonize healthy tissue, existing sites of metastasis, or the site of the primary tumor.

“Therefore, the approach may give oncologists knowledge on how to intervene and stop circulating cancer cell dissemination that might prevent the development of metastasis,” Dr Galanzha said.

The investigators believe the approach might also prove useful for other areas of medicine—for example, tracking bacteria during infections or immune-related cells during the development of autoimmune disease.

Blood for transfusion

Credit: Elise Amendola

Results of a large study showed that black patients were more likely than white patients to receive perioperative blood transfusions for 2 of 3 common surgical procedures.

Researchers evaluated transfusion practices in these 2 racial groups for coronary artery bypass surgery (CABG), total hip replacement (THR), and colectomy.

And they found that black patients undergoing CABG or THR had a significantly higher incidence of transfusion than white patients undergoing these procedures.

Feng Qian, PhD, of the University at Albany School of Public Health, and his colleagues reported these findings in BMC Health Services Research.

The team examined the use of perioperative red blood cell transfusion using patient data from the University Health System Consortium, a network of academic medical centers and affiliated hospitals. The data included hospitalizations occurring from 2009 to 2011.

The researchers’ final sample included 42,933 patients who underwent THR (37,888 white and 5045 black), 25,849 patients who underwent CABG (23,113 white and 2736 black), and 8255 patients who underwent colectomy (6861 white and 1394 black).

Black patients tended to be younger than white patients, with the overall age ranging from 48 to 73 years. Blacks were also less well-insured than whites and more likely to have comorbidities such as diabetes, renal failure, and anemia.

Dr Qian and his colleagues adjusted for these differences in their analysis, as well as for patient gender, admission status, and severity of illness.

The analysis revealed that black patients undergoing CABG had a 41% higher incidence of perioperative transfusion than white patients (P=0.002).

For THR, the incidence of transfusion was 39% higher among blacks than whites (P<0.001). And for colectomy, the incidence was 8% higher among blacks than whites (P=0.40).

The researchers then performed an analysis adjusted for the aforementioned factors as well as for hospital-fixed effects.

This revealed that black patients undergoing CABG had a 42% higher incidence of transfusion than whites (P<0.001). Blacks undergoing THR had a 43% higher incidence of transfusion (P<0.001). And blacks undergoing colectomy had a 1% higher incidence of transfusion (P=0.92)

The researchers noted that, although blood transfusion is widely employed in surgery, the practice is associated with adverse outcomes. So overuse of transfusions may pose serious health risks, specifically in black patients undergoing CABG and THR.

Dr Qian added that recognizing racial disparities related to the use of perioperative red blood cell transfusion may help reduce potentially unnecessary transfusions in minority patients.

Blood for transfusion

Credit: Elise Amendola

Results of a large study showed that black patients were more likely than white patients to receive perioperative blood transfusions for 2 of 3 common surgical procedures.

Researchers evaluated transfusion practices in these 2 racial groups for coronary artery bypass surgery (CABG), total hip replacement (THR), and colectomy.

And they found that black patients undergoing CABG or THR had a significantly higher incidence of transfusion than white patients undergoing these procedures.

Feng Qian, PhD, of the University at Albany School of Public Health, and his colleagues reported these findings in BMC Health Services Research.

The team examined the use of perioperative red blood cell transfusion using patient data from the University Health System Consortium, a network of academic medical centers and affiliated hospitals. The data included hospitalizations occurring from 2009 to 2011.

The researchers’ final sample included 42,933 patients who underwent THR (37,888 white and 5045 black), 25,849 patients who underwent CABG (23,113 white and 2736 black), and 8255 patients who underwent colectomy (6861 white and 1394 black).

Black patients tended to be younger than white patients, with the overall age ranging from 48 to 73 years. Blacks were also less well-insured than whites and more likely to have comorbidities such as diabetes, renal failure, and anemia.

Dr Qian and his colleagues adjusted for these differences in their analysis, as well as for patient gender, admission status, and severity of illness.

The analysis revealed that black patients undergoing CABG had a 41% higher incidence of perioperative transfusion than white patients (P=0.002).

For THR, the incidence of transfusion was 39% higher among blacks than whites (P<0.001). And for colectomy, the incidence was 8% higher among blacks than whites (P=0.40).

The researchers then performed an analysis adjusted for the aforementioned factors as well as for hospital-fixed effects.

This revealed that black patients undergoing CABG had a 42% higher incidence of transfusion than whites (P<0.001). Blacks undergoing THR had a 43% higher incidence of transfusion (P<0.001). And blacks undergoing colectomy had a 1% higher incidence of transfusion (P=0.92)

The researchers noted that, although blood transfusion is widely employed in surgery, the practice is associated with adverse outcomes. So overuse of transfusions may pose serious health risks, specifically in black patients undergoing CABG and THR.

Dr Qian added that recognizing racial disparities related to the use of perioperative red blood cell transfusion may help reduce potentially unnecessary transfusions in minority patients.

Blood for transfusion

Credit: Elise Amendola

Results of a large study showed that black patients were more likely than white patients to receive perioperative blood transfusions for 2 of 3 common surgical procedures.

Researchers evaluated transfusion practices in these 2 racial groups for coronary artery bypass surgery (CABG), total hip replacement (THR), and colectomy.

And they found that black patients undergoing CABG or THR had a significantly higher incidence of transfusion than white patients undergoing these procedures.

Feng Qian, PhD, of the University at Albany School of Public Health, and his colleagues reported these findings in BMC Health Services Research.

The team examined the use of perioperative red blood cell transfusion using patient data from the University Health System Consortium, a network of academic medical centers and affiliated hospitals. The data included hospitalizations occurring from 2009 to 2011.

The researchers’ final sample included 42,933 patients who underwent THR (37,888 white and 5045 black), 25,849 patients who underwent CABG (23,113 white and 2736 black), and 8255 patients who underwent colectomy (6861 white and 1394 black).

Black patients tended to be younger than white patients, with the overall age ranging from 48 to 73 years. Blacks were also less well-insured than whites and more likely to have comorbidities such as diabetes, renal failure, and anemia.

Dr Qian and his colleagues adjusted for these differences in their analysis, as well as for patient gender, admission status, and severity of illness.

The analysis revealed that black patients undergoing CABG had a 41% higher incidence of perioperative transfusion than white patients (P=0.002).

For THR, the incidence of transfusion was 39% higher among blacks than whites (P<0.001). And for colectomy, the incidence was 8% higher among blacks than whites (P=0.40).

The researchers then performed an analysis adjusted for the aforementioned factors as well as for hospital-fixed effects.

This revealed that black patients undergoing CABG had a 42% higher incidence of transfusion than whites (P<0.001). Blacks undergoing THR had a 43% higher incidence of transfusion (P<0.001). And blacks undergoing colectomy had a 1% higher incidence of transfusion (P=0.92)

The researchers noted that, although blood transfusion is widely employed in surgery, the practice is associated with adverse outcomes. So overuse of transfusions may pose serious health risks, specifically in black patients undergoing CABG and THR.

Dr Qian added that recognizing racial disparities related to the use of perioperative red blood cell transfusion may help reduce potentially unnecessary transfusions in minority patients.

Blood for transfusion

Credit: UAB Hospital

Reinfusing the blood a patient loses during cardiopulmonary bypass surgery confers benefits over transfusing the patient with banked blood, results of a small study suggest.

Investigators noted that both the surgery and red blood cell (RBC) storage are associated with changes in RBCs that can adversely affect oxygen delivery.

However, their study revealed minimal effects on RBC structure and function among patients who received their own recycled blood during surgery.

On the other hand, patients who received banked RBCs along with their own blood experienced a dose-dependent decrease in RBC cell membrane deformability that could persist beyond 3 days.

Steven Frank, MD, of the Johns Hopkins University School of Medicine in Baltimore, Maryland, and his colleagues reported these findings in Anesthesia & Analgesia.

The team studied 32 patients undergoing cardiopulmonary bypass, categorizing them by their transfusion status: those who received their own RBCs (n=12), those who received their own blood plus fewer than 5 units of banked blood (n=10), and those who received their own RBCs plus 5 or more units of stored blood (n=10).

All patients had blood samples drawn before, during, and for 3 days after surgery. The investigators examined samples for blood cell membrane stiffness and flexibility.

In patients who received only their own recycled blood, their cells behaved normally right away, as if they had never been outside the body.

But the more banked blood a patient received, the less flexible their entire population of RBCs. Three days after surgery, RBCs in the group that received the largest number of transfused units still had not recovered their full function.

“We now have more evidence that fresh blood cells are of a higher quality than what comes from a blood bank,” Dr Frank said.

“If banked blood, which is stored for up to 6 weeks, is now shown to be of a lower quality, it makes more sense to use recycled blood that has only been outside the body for 1 or 2 hours. It’s always been the case that patients feel better about getting their own blood, and recycling is also more cost-effective.”

The investigators used a cell saver machine to collect the material a patient lost during surgery. They then rinsed away the unneeded fat and tissue, centrifuged and separated the red cells, and returned them to the patient.

Dr Frank and his colleagues noted that disposable parts of the cell saver, which can be used to process multiple units of blood, cost around $120, compared to $240 for each unit of banked blood. Additionally, recycling blood reduces a patient’s risk of contracting infections and experiencing transfusion-related adverse reactions.

Dr Frank pointed out, however, that cell saver machines are not appropriate for all operations, and not all hospitals have access to round-the-clock perfusionists to run them. For heart surgeries, a perfusionist is already in the operating room to run the heart-lung bypass machine.

Dr Frank also noted that many operations are considered to be a low risk for blood loss, in which case, the cell saver is unnecessary. Nevertheless, he advocates wider use of recycled blood.

“In any patient where you expect to give 1 unit of red blood cells or more, it’s cost-effective and beneficial to recycle,” he said.

Blood for transfusion

Credit: UAB Hospital

Reinfusing the blood a patient loses during cardiopulmonary bypass surgery confers benefits over transfusing the patient with banked blood, results of a small study suggest.

Investigators noted that both the surgery and red blood cell (RBC) storage are associated with changes in RBCs that can adversely affect oxygen delivery.

However, their study revealed minimal effects on RBC structure and function among patients who received their own recycled blood during surgery.

On the other hand, patients who received banked RBCs along with their own blood experienced a dose-dependent decrease in RBC cell membrane deformability that could persist beyond 3 days.

Steven Frank, MD, of the Johns Hopkins University School of Medicine in Baltimore, Maryland, and his colleagues reported these findings in Anesthesia & Analgesia.

The team studied 32 patients undergoing cardiopulmonary bypass, categorizing them by their transfusion status: those who received their own RBCs (n=12), those who received their own blood plus fewer than 5 units of banked blood (n=10), and those who received their own RBCs plus 5 or more units of stored blood (n=10).

All patients had blood samples drawn before, during, and for 3 days after surgery. The investigators examined samples for blood cell membrane stiffness and flexibility.

In patients who received only their own recycled blood, their cells behaved normally right away, as if they had never been outside the body.

But the more banked blood a patient received, the less flexible their entire population of RBCs. Three days after surgery, RBCs in the group that received the largest number of transfused units still had not recovered their full function.

“We now have more evidence that fresh blood cells are of a higher quality than what comes from a blood bank,” Dr Frank said.

“If banked blood, which is stored for up to 6 weeks, is now shown to be of a lower quality, it makes more sense to use recycled blood that has only been outside the body for 1 or 2 hours. It’s always been the case that patients feel better about getting their own blood, and recycling is also more cost-effective.”

The investigators used a cell saver machine to collect the material a patient lost during surgery. They then rinsed away the unneeded fat and tissue, centrifuged and separated the red cells, and returned them to the patient.

Dr Frank and his colleagues noted that disposable parts of the cell saver, which can be used to process multiple units of blood, cost around $120, compared to $240 for each unit of banked blood. Additionally, recycling blood reduces a patient’s risk of contracting infections and experiencing transfusion-related adverse reactions.

Dr Frank pointed out, however, that cell saver machines are not appropriate for all operations, and not all hospitals have access to round-the-clock perfusionists to run them. For heart surgeries, a perfusionist is already in the operating room to run the heart-lung bypass machine.

Dr Frank also noted that many operations are considered to be a low risk for blood loss, in which case, the cell saver is unnecessary. Nevertheless, he advocates wider use of recycled blood.

“In any patient where you expect to give 1 unit of red blood cells or more, it’s cost-effective and beneficial to recycle,” he said.

Blood for transfusion

Credit: UAB Hospital

Reinfusing the blood a patient loses during cardiopulmonary bypass surgery confers benefits over transfusing the patient with banked blood, results of a small study suggest.

Investigators noted that both the surgery and red blood cell (RBC) storage are associated with changes in RBCs that can adversely affect oxygen delivery.

However, their study revealed minimal effects on RBC structure and function among patients who received their own recycled blood during surgery.

On the other hand, patients who received banked RBCs along with their own blood experienced a dose-dependent decrease in RBC cell membrane deformability that could persist beyond 3 days.

Steven Frank, MD, of the Johns Hopkins University School of Medicine in Baltimore, Maryland, and his colleagues reported these findings in Anesthesia & Analgesia.

The team studied 32 patients undergoing cardiopulmonary bypass, categorizing them by their transfusion status: those who received their own RBCs (n=12), those who received their own blood plus fewer than 5 units of banked blood (n=10), and those who received their own RBCs plus 5 or more units of stored blood (n=10).

All patients had blood samples drawn before, during, and for 3 days after surgery. The investigators examined samples for blood cell membrane stiffness and flexibility.

In patients who received only their own recycled blood, their cells behaved normally right away, as if they had never been outside the body.

But the more banked blood a patient received, the less flexible their entire population of RBCs. Three days after surgery, RBCs in the group that received the largest number of transfused units still had not recovered their full function.

“We now have more evidence that fresh blood cells are of a higher quality than what comes from a blood bank,” Dr Frank said.

“If banked blood, which is stored for up to 6 weeks, is now shown to be of a lower quality, it makes more sense to use recycled blood that has only been outside the body for 1 or 2 hours. It’s always been the case that patients feel better about getting their own blood, and recycling is also more cost-effective.”

The investigators used a cell saver machine to collect the material a patient lost during surgery. They then rinsed away the unneeded fat and tissue, centrifuged and separated the red cells, and returned them to the patient.

Dr Frank and his colleagues noted that disposable parts of the cell saver, which can be used to process multiple units of blood, cost around $120, compared to $240 for each unit of banked blood. Additionally, recycling blood reduces a patient’s risk of contracting infections and experiencing transfusion-related adverse reactions.

Dr Frank pointed out, however, that cell saver machines are not appropriate for all operations, and not all hospitals have access to round-the-clock perfusionists to run them. For heart surgeries, a perfusionist is already in the operating room to run the heart-lung bypass machine.

Dr Frank also noted that many operations are considered to be a low risk for blood loss, in which case, the cell saver is unnecessary. Nevertheless, he advocates wider use of recycled blood.

“In any patient where you expect to give 1 unit of red blood cells or more, it’s cost-effective and beneficial to recycle,” he said.

Thrombus

Credit: Andre E.X. Brown

The US Food and Drug Administration (FDA) has approved the antiplatelet agent vorapaxar (Zontivity) to reduce the risk of thrombotic cardiovascular events in patients with a history of myocardial infarction or peripheral arterial disease.

Results of a large study suggested the drug can be effective as prophylaxis but may also increase the risk of bleeding.

Vorapaxar’s label has a black box warning describing this risk, which includes intracranial hemorrhage and fatal bleeding.

The warning also states that vorapaxar should not be given to patients with a history of stroke, transient ischemic attack, intracranial hemorrhage, or active pathological bleeding.

The drug will be dispensed with an FDA-approved patient medication guide that provides instructions for its use and important safety information.

Vorapaxar tablets are intended to be given once daily, along with aspirin and/or clopidogrel, according to their indications or the standard of care.

“In patients who have had a heart attack or who have peripheral arterial disease, this drug will lower the risk of heart attack, stroke, and cardiovascular death,” said Ellis Unger, MD, director of the Office of Drug Evaluation in the FDA’s Center for Drug Evaluation and Research.

“In the study that supported the drug’s approval, [vorapaxar] lowered this risk from 9.5% to 7.9% over a 3-year period—about 0.5% per year.”

The study, which was published in NEJM, included 26,449 patients with a history of myocardial infarction (n=17,779), ischemic stroke (n=4883), or peripheral arterial disease (n=3787).

The patients were randomized to receive vorapaxar at 2.5 mg daily or matching placebo, in addition to standard antiplatelet therapy.

The study’s primary efficacy endpoint was the composite of death from cardiovascular causes, myocardial infarction, or stroke. At 3 years, 1028 patients (9.3%) in the vorapaxar group and 1176 patients (10.5%) in the placebo group reached the primary endpoint.

Both moderate and severe bleeding events were significantly higher in patients on vorapaxar than in the placebo group. Bleeding occurred in 4.2% and 2.5% of patients, respectively. And intracranial hemorrhage occurred in 1.0% and 0.5%, respectively.

The risk of intracranial bleeding was highest among patients with a history of stroke, so these patients were taken off of vorapaxar early.

Vorapaxar is made by Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., of Whitehouse Station, New Jersey. For more information on the drug, see the full prescribing information.

Thrombus

Credit: Andre E.X. Brown

The US Food and Drug Administration (FDA) has approved the antiplatelet agent vorapaxar (Zontivity) to reduce the risk of thrombotic cardiovascular events in patients with a history of myocardial infarction or peripheral arterial disease.

Results of a large study suggested the drug can be effective as prophylaxis but may also increase the risk of bleeding.

Vorapaxar’s label has a black box warning describing this risk, which includes intracranial hemorrhage and fatal bleeding.

The warning also states that vorapaxar should not be given to patients with a history of stroke, transient ischemic attack, intracranial hemorrhage, or active pathological bleeding.

The drug will be dispensed with an FDA-approved patient medication guide that provides instructions for its use and important safety information.

Vorapaxar tablets are intended to be given once daily, along with aspirin and/or clopidogrel, according to their indications or the standard of care.

“In patients who have had a heart attack or who have peripheral arterial disease, this drug will lower the risk of heart attack, stroke, and cardiovascular death,” said Ellis Unger, MD, director of the Office of Drug Evaluation in the FDA’s Center for Drug Evaluation and Research.

“In the study that supported the drug’s approval, [vorapaxar] lowered this risk from 9.5% to 7.9% over a 3-year period—about 0.5% per year.”

The study, which was published in NEJM, included 26,449 patients with a history of myocardial infarction (n=17,779), ischemic stroke (n=4883), or peripheral arterial disease (n=3787).

The patients were randomized to receive vorapaxar at 2.5 mg daily or matching placebo, in addition to standard antiplatelet therapy.

The study’s primary efficacy endpoint was the composite of death from cardiovascular causes, myocardial infarction, or stroke. At 3 years, 1028 patients (9.3%) in the vorapaxar group and 1176 patients (10.5%) in the placebo group reached the primary endpoint.

Both moderate and severe bleeding events were significantly higher in patients on vorapaxar than in the placebo group. Bleeding occurred in 4.2% and 2.5% of patients, respectively. And intracranial hemorrhage occurred in 1.0% and 0.5%, respectively.

The risk of intracranial bleeding was highest among patients with a history of stroke, so these patients were taken off of vorapaxar early.

Vorapaxar is made by Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., of Whitehouse Station, New Jersey. For more information on the drug, see the full prescribing information.

Thrombus

Credit: Andre E.X. Brown

The US Food and Drug Administration (FDA) has approved the antiplatelet agent vorapaxar (Zontivity) to reduce the risk of thrombotic cardiovascular events in patients with a history of myocardial infarction or peripheral arterial disease.

Results of a large study suggested the drug can be effective as prophylaxis but may also increase the risk of bleeding.

Vorapaxar’s label has a black box warning describing this risk, which includes intracranial hemorrhage and fatal bleeding.

The warning also states that vorapaxar should not be given to patients with a history of stroke, transient ischemic attack, intracranial hemorrhage, or active pathological bleeding.

The drug will be dispensed with an FDA-approved patient medication guide that provides instructions for its use and important safety information.

Vorapaxar tablets are intended to be given once daily, along with aspirin and/or clopidogrel, according to their indications or the standard of care.

“In patients who have had a heart attack or who have peripheral arterial disease, this drug will lower the risk of heart attack, stroke, and cardiovascular death,” said Ellis Unger, MD, director of the Office of Drug Evaluation in the FDA’s Center for Drug Evaluation and Research.

“In the study that supported the drug’s approval, [vorapaxar] lowered this risk from 9.5% to 7.9% over a 3-year period—about 0.5% per year.”

The study, which was published in NEJM, included 26,449 patients with a history of myocardial infarction (n=17,779), ischemic stroke (n=4883), or peripheral arterial disease (n=3787).

The patients were randomized to receive vorapaxar at 2.5 mg daily or matching placebo, in addition to standard antiplatelet therapy.

The study’s primary efficacy endpoint was the composite of death from cardiovascular causes, myocardial infarction, or stroke. At 3 years, 1028 patients (9.3%) in the vorapaxar group and 1176 patients (10.5%) in the placebo group reached the primary endpoint.

Both moderate and severe bleeding events were significantly higher in patients on vorapaxar than in the placebo group. Bleeding occurred in 4.2% and 2.5% of patients, respectively. And intracranial hemorrhage occurred in 1.0% and 0.5%, respectively.

The risk of intracranial bleeding was highest among patients with a history of stroke, so these patients were taken off of vorapaxar early.

Vorapaxar is made by Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., of Whitehouse Station, New Jersey. For more information on the drug, see the full prescribing information.

Researcher in the lab

Credit: NIH

A group of researchers who tried, and failed, to replicate the STAP cell phenomenon have detailed their work in F1000Research.

Kenneth Ka Ho Lee, PhD, of the Chinese University of Hong Kong, and his colleagues attempted to create STAP (stimulus-triggered acquisition of pluripotency) cells using the method described in a recent Nature paper.

The paper’s authors had reported they could induce pluripotency in somatic cells by bathing them in acid.

However, not long after the paper and a related letter were published, members of the scientific community voiced concerns about the publications—such as suspicions of plagiarism and the possibility of doctored images—and began to question the findings.

Then, an investigation by the Japanese research institute RIKEN (where many of the researchers are employed) suggested that at least some of the paper’s authors were guilty of misconduct and/or negligence.

However, the study’s lead author, Haruko Obokata, PhD, has maintained that, despite errors in the paper, STAP cells can be created.

Dr Lee’s experiments suggest otherwise—or at least that the cells cannot be created using the methods outlined in the Nature paper.

Dr Lee and his colleagues reported that carefully replicating the original acid-treatment method does not induce pluripotency in 2 types of mouse somatic cells.

Using both white blood cells isolated from the spleen of neonatal mice—the same cells used in the original study—and lung fibroblasts, the team was unable to replicate the original findings.

They’ve published a full account of this work in F1000Research. The journal also employs open peer review by invited experts, which occurs after publication and is published in full online alongside the paper.

Dr Lee’s study will now undergo this process, and readers interested to see referees’ views as they come in can follow the paper by clicking “Track” on the published article.

Researcher in the lab

Credit: NIH

A group of researchers who tried, and failed, to replicate the STAP cell phenomenon have detailed their work in F1000Research.

Kenneth Ka Ho Lee, PhD, of the Chinese University of Hong Kong, and his colleagues attempted to create STAP (stimulus-triggered acquisition of pluripotency) cells using the method described in a recent Nature paper.

The paper’s authors had reported they could induce pluripotency in somatic cells by bathing them in acid.

However, not long after the paper and a related letter were published, members of the scientific community voiced concerns about the publications—such as suspicions of plagiarism and the possibility of doctored images—and began to question the findings.

Then, an investigation by the Japanese research institute RIKEN (where many of the researchers are employed) suggested that at least some of the paper’s authors were guilty of misconduct and/or negligence.

However, the study’s lead author, Haruko Obokata, PhD, has maintained that, despite errors in the paper, STAP cells can be created.

Dr Lee’s experiments suggest otherwise—or at least that the cells cannot be created using the methods outlined in the Nature paper.

Dr Lee and his colleagues reported that carefully replicating the original acid-treatment method does not induce pluripotency in 2 types of mouse somatic cells.

Using both white blood cells isolated from the spleen of neonatal mice—the same cells used in the original study—and lung fibroblasts, the team was unable to replicate the original findings.

They’ve published a full account of this work in F1000Research. The journal also employs open peer review by invited experts, which occurs after publication and is published in full online alongside the paper.

Dr Lee’s study will now undergo this process, and readers interested to see referees’ views as they come in can follow the paper by clicking “Track” on the published article.

Researcher in the lab

Credit: NIH

A group of researchers who tried, and failed, to replicate the STAP cell phenomenon have detailed their work in F1000Research.

Kenneth Ka Ho Lee, PhD, of the Chinese University of Hong Kong, and his colleagues attempted to create STAP (stimulus-triggered acquisition of pluripotency) cells using the method described in a recent Nature paper.

The paper’s authors had reported they could induce pluripotency in somatic cells by bathing them in acid.

However, not long after the paper and a related letter were published, members of the scientific community voiced concerns about the publications—such as suspicions of plagiarism and the possibility of doctored images—and began to question the findings.

Then, an investigation by the Japanese research institute RIKEN (where many of the researchers are employed) suggested that at least some of the paper’s authors were guilty of misconduct and/or negligence.

However, the study’s lead author, Haruko Obokata, PhD, has maintained that, despite errors in the paper, STAP cells can be created.

Dr Lee’s experiments suggest otherwise—or at least that the cells cannot be created using the methods outlined in the Nature paper.

Dr Lee and his colleagues reported that carefully replicating the original acid-treatment method does not induce pluripotency in 2 types of mouse somatic cells.

Using both white blood cells isolated from the spleen of neonatal mice—the same cells used in the original study—and lung fibroblasts, the team was unable to replicate the original findings.

They’ve published a full account of this work in F1000Research. The journal also employs open peer review by invited experts, which occurs after publication and is published in full online alongside the paper.

Dr Lee’s study will now undergo this process, and readers interested to see referees’ views as they come in can follow the paper by clicking “Track” on the published article.

RIKEN President Ryoji Noyori

Credit: RIKEN

The Japanese research institute RIKEN has announced that it will not re-investigate the allegations of misconduct levelled against the researcher who claimed to have discovered a new method for inducing pluripotency in somatic cells.

In January, Haruko Obokata, PhD, and her colleagues reported the creation of stimulus-triggered acquisition of pluripotency (STAP) cells.

The team said they could induce pluripotency by exposing somatic cells to a low-pH environment.

But members of the scientific community voiced concerns about the research, so RIKEN launched an investigation.

In April, the investigative committee concluded that Dr Obokata and some of her colleagues were guilty of misconduct and/or negligence.

Dr Obokata appealed the findings, but the committee has decided another investigation is not warranted. RIKEN has also called for a retraction of the Nature paper in which the committee found evidence of misconduct.

Another RIKEN committee has already met to discuss possible disciplinary action for Dr Obokata and some of her colleagues. Potential punishments range from pay cuts to temporary suspension to disciplinary discharge.

In the meantime, a group headed by Shinichi Aizawa, PhD, special advisor to RIKEN, is attempting to verify the results of the STAP experiments and determine if the STAP phenomenon is, in fact, real.

As the events of this case unfolded, another possible case of misconduct surfaced at RIKEN.

The institute recently announced that Shunsuke Ishii, PhD, chairperson of the committee investigating misconduct in the STAP papers, had resigned from the committee amid concerns about one of his own papers.

RIKEN replaced Dr Ishii with Jun Watanabe, a lawyer already on the committee. And the institute has launched an investigation into Dr Ishii’s work.

Furthermore, RIKEN’s office for internal reform, headed by President Ryoji Noyori, PhD, has commissioned a committee of outside experts to deliberate and recommend measures to prevent research misconduct in the future.

RIKEN President Ryoji Noyori

Credit: RIKEN

The Japanese research institute RIKEN has announced that it will not re-investigate the allegations of misconduct levelled against the researcher who claimed to have discovered a new method for inducing pluripotency in somatic cells.

In January, Haruko Obokata, PhD, and her colleagues reported the creation of stimulus-triggered acquisition of pluripotency (STAP) cells.

The team said they could induce pluripotency by exposing somatic cells to a low-pH environment.

But members of the scientific community voiced concerns about the research, so RIKEN launched an investigation.

In April, the investigative committee concluded that Dr Obokata and some of her colleagues were guilty of misconduct and/or negligence.

Dr Obokata appealed the findings, but the committee has decided another investigation is not warranted. RIKEN has also called for a retraction of the Nature paper in which the committee found evidence of misconduct.

Another RIKEN committee has already met to discuss possible disciplinary action for Dr Obokata and some of her colleagues. Potential punishments range from pay cuts to temporary suspension to disciplinary discharge.

In the meantime, a group headed by Shinichi Aizawa, PhD, special advisor to RIKEN, is attempting to verify the results of the STAP experiments and determine if the STAP phenomenon is, in fact, real.

As the events of this case unfolded, another possible case of misconduct surfaced at RIKEN.

The institute recently announced that Shunsuke Ishii, PhD, chairperson of the committee investigating misconduct in the STAP papers, had resigned from the committee amid concerns about one of his own papers.

RIKEN replaced Dr Ishii with Jun Watanabe, a lawyer already on the committee. And the institute has launched an investigation into Dr Ishii’s work.

Furthermore, RIKEN’s office for internal reform, headed by President Ryoji Noyori, PhD, has commissioned a committee of outside experts to deliberate and recommend measures to prevent research misconduct in the future.

RIKEN President Ryoji Noyori

Credit: RIKEN

The Japanese research institute RIKEN has announced that it will not re-investigate the allegations of misconduct levelled against the researcher who claimed to have discovered a new method for inducing pluripotency in somatic cells.

In January, Haruko Obokata, PhD, and her colleagues reported the creation of stimulus-triggered acquisition of pluripotency (STAP) cells.

The team said they could induce pluripotency by exposing somatic cells to a low-pH environment.

But members of the scientific community voiced concerns about the research, so RIKEN launched an investigation.

In April, the investigative committee concluded that Dr Obokata and some of her colleagues were guilty of misconduct and/or negligence.

Dr Obokata appealed the findings, but the committee has decided another investigation is not warranted. RIKEN has also called for a retraction of the Nature paper in which the committee found evidence of misconduct.

Another RIKEN committee has already met to discuss possible disciplinary action for Dr Obokata and some of her colleagues. Potential punishments range from pay cuts to temporary suspension to disciplinary discharge.

In the meantime, a group headed by Shinichi Aizawa, PhD, special advisor to RIKEN, is attempting to verify the results of the STAP experiments and determine if the STAP phenomenon is, in fact, real.

As the events of this case unfolded, another possible case of misconduct surfaced at RIKEN.

The institute recently announced that Shunsuke Ishii, PhD, chairperson of the committee investigating misconduct in the STAP papers, had resigned from the committee amid concerns about one of his own papers.

RIKEN replaced Dr Ishii with Jun Watanabe, a lawyer already on the committee. And the institute has launched an investigation into Dr Ishii’s work.

Furthermore, RIKEN’s office for internal reform, headed by President Ryoji Noyori, PhD, has commissioned a committee of outside experts to deliberate and recommend measures to prevent research misconduct in the future.

The Diagnosis: Carotenemia

Laboratory parameters including thyroid function testing as well as total protein and bilirubin levels were within reference range. Testing revealed multiple food allergies to almonds, oranges, cashews, garlic, peanuts, and cantaloupe. The patient was treated with a dietary expansion based on his allergy testing.

ß-Carotene converts to vitamin A in the intestine and acts as a lipochrome. Lack of conversion can be noted as an inborn error of metabolism.¹ Many green, yellow, and orange fruits and vegetables contain ß-carotene, including carrots, sweet potatoes, squash, green beans, papayas, and pumpkins.^1-3 ß-Carotene also is used as a vitamin supplement⁴ or therapeutic agent in photosensitive disorders such as genetic porphyrias.⁵

ß-Carotene can accumulate in the stratum corneum and impart a yellow color to the skin when the circulating levels are high; this coloration is termed carotenemia.^1,4 Carotenemia is common in infants and young children who have diets rich in green and orange vegetable purees.⁶ Carotenemia limited to thick areas of the skin, such as the palms and soles, can be seen in adults who eat large amounts of carrots; generalized carotenemia is rare.^1,4

Carotenemia is a benign condition of excess cutaneous buildup of ß-carotene through excessive intake of carotene-rich foods^1-4 or nutritional supplements⁷ or through association with anorexia, liver disease, renal disease, hypothyroidism, or diabetes mellitus.^1,4,8,9 Carotene deposits usually are most notable in areas with thick stratum corneum, such as the nasolabial folds, palms, and soles, as opposed to areas such as the conjunctivae and mucosa.^1,4

Carotenemia may mimic jaundice and should be differentiated through scleral examination for icterus and bilirubin levels. Carotene levels can be tested but generally are unnecessary. Carotenemia can be seen in liver or renal disease and can exacerbate the yellow coloration seen in jaundiced individuals.^1,4,9

Because it is a benign condition, the pathology usually is limited to skin discoloration, as seen in our patient. Although this condition can be reversed with a modified diet, our patient had multiple food allergies that further restricted his vegetarian diet, thereby limiting the modifications that he was willing to make to his diet.

The Diagnosis: Carotenemia

Laboratory parameters including thyroid function testing as well as total protein and bilirubin levels were within reference range. Testing revealed multiple food allergies to almonds, oranges, cashews, garlic, peanuts, and cantaloupe. The patient was treated with a dietary expansion based on his allergy testing.

ß-Carotene converts to vitamin A in the intestine and acts as a lipochrome. Lack of conversion can be noted as an inborn error of metabolism.¹ Many green, yellow, and orange fruits and vegetables contain ß-carotene, including carrots, sweet potatoes, squash, green beans, papayas, and pumpkins.^1-3 ß-Carotene also is used as a vitamin supplement⁴ or therapeutic agent in photosensitive disorders such as genetic porphyrias.⁵

ß-Carotene can accumulate in the stratum corneum and impart a yellow color to the skin when the circulating levels are high; this coloration is termed carotenemia.^1,4 Carotenemia is common in infants and young children who have diets rich in green and orange vegetable purees.⁶ Carotenemia limited to thick areas of the skin, such as the palms and soles, can be seen in adults who eat large amounts of carrots; generalized carotenemia is rare.^1,4

Carotenemia is a benign condition of excess cutaneous buildup of ß-carotene through excessive intake of carotene-rich foods^1-4 or nutritional supplements⁷ or through association with anorexia, liver disease, renal disease, hypothyroidism, or diabetes mellitus.^1,4,8,9 Carotene deposits usually are most notable in areas with thick stratum corneum, such as the nasolabial folds, palms, and soles, as opposed to areas such as the conjunctivae and mucosa.^1,4

Carotenemia may mimic jaundice and should be differentiated through scleral examination for icterus and bilirubin levels. Carotene levels can be tested but generally are unnecessary. Carotenemia can be seen in liver or renal disease and can exacerbate the yellow coloration seen in jaundiced individuals.^1,4,9

Because it is a benign condition, the pathology usually is limited to skin discoloration, as seen in our patient. Although this condition can be reversed with a modified diet, our patient had multiple food allergies that further restricted his vegetarian diet, thereby limiting the modifications that he was willing to make to his diet.

The Diagnosis: Carotenemia

Laboratory parameters including thyroid function testing as well as total protein and bilirubin levels were within reference range. Testing revealed multiple food allergies to almonds, oranges, cashews, garlic, peanuts, and cantaloupe. The patient was treated with a dietary expansion based on his allergy testing.

ß-Carotene converts to vitamin A in the intestine and acts as a lipochrome. Lack of conversion can be noted as an inborn error of metabolism.¹ Many green, yellow, and orange fruits and vegetables contain ß-carotene, including carrots, sweet potatoes, squash, green beans, papayas, and pumpkins.^1-3 ß-Carotene also is used as a vitamin supplement⁴ or therapeutic agent in photosensitive disorders such as genetic porphyrias.⁵

ß-Carotene can accumulate in the stratum corneum and impart a yellow color to the skin when the circulating levels are high; this coloration is termed carotenemia.^1,4 Carotenemia is common in infants and young children who have diets rich in green and orange vegetable purees.⁶ Carotenemia limited to thick areas of the skin, such as the palms and soles, can be seen in adults who eat large amounts of carrots; generalized carotenemia is rare.^1,4

Carotenemia is a benign condition of excess cutaneous buildup of ß-carotene through excessive intake of carotene-rich foods^1-4 or nutritional supplements⁷ or through association with anorexia, liver disease, renal disease, hypothyroidism, or diabetes mellitus.^1,4,8,9 Carotene deposits usually are most notable in areas with thick stratum corneum, such as the nasolabial folds, palms, and soles, as opposed to areas such as the conjunctivae and mucosa.^1,4

Carotenemia may mimic jaundice and should be differentiated through scleral examination for icterus and bilirubin levels. Carotene levels can be tested but generally are unnecessary. Carotenemia can be seen in liver or renal disease and can exacerbate the yellow coloration seen in jaundiced individuals.^1,4,9

Because it is a benign condition, the pathology usually is limited to skin discoloration, as seen in our patient. Although this condition can be reversed with a modified diet, our patient had multiple food allergies that further restricted his vegetarian diet, thereby limiting the modifications that he was willing to make to his diet.

Scenario: The Chief Executive Officer (CEO) of a large hospital comes into the Chief Medical Officer's (CMO) office after a hospital board retreat meeting on strategy for faster physician integration. His marching orders include allowing daytime coverage but restricting after-hours house staff coverage only for patients of physicians who are fully employed by the health system. The CEO knows this will create an uproar but wants the CMO to get "buy-in" from all physicians on the medical staff. He shares the 5-year financial projections and insists that viability of the institution is at stake. The relatively new CMO not only realizes the challenge represented but also recognizes a great personal opportunity. From her efforts in the past 2 years, she has garnered a reputation for honesty and integrity. Relying on her education in leadership, communications, and negotiations, she formulates a strategy to achieve the CEO's directive.

Problem: "Getting buy-in" has become an unwelcome phrase for many physicians. The general implication is that hospital administration wants salaried physicians or other leaders to persuade the "troops" to agree to something for which a decision has already been made. Persuading others is often an art and not a show of strength, and furthermore, not always rational. The art involves putting yourself in the other person's shoes and asking yourself: "Would I buy this if the idea was offered to me?" If not, leaders first need to convince themselves of the benefits of the intended proposal. If it is always about you and your victories, you will acquire a reputation of being a self-serving leader and lose followers when you need them. Once a leader has convinced himself/herself, pushing hard against a timeline does not always work. Sometimes, being too aggressive can have the opposite reaction.

Solution: Physicians are scientists and, therefore, are influenced by data and empiric arguments. Most proposals advanced by hospitals involve finances to some degree. The problem is that most physicians do not have expertise in analyzing financial data. Thus, physician leaders must make the facts easily understandable and not use book-based accounting terms in attempts to impress physician groups. This may result in a reinforcement of the bias that everyone in administration is concerned only with money. Leaders must make the financial application easy to understand, possibly with charts or graphs, and seek to educate in the process.

Even though the proposal may be factual and well reasoned, the medical staff sometimes has not had time to process the pros and cons or separate their own parochial interests from those of the institution. Persuasion does indeed involve emotion at times but must be used wisely and at the right time when reason and rational arguments have hit home first. That is not to say that everyone in the audience will be convinced of the brilliance of your argument but it may persuade enough people to come over to your side. When emotion is used and timed correctly, it creates excitement and tends to spread through the audience so it completes the "sale."

If there is not enough support, it is best to let things rest and work on those who are opposed to the proposal as a knee-jerk response or based upon misperception. The leader needs to have established a reputation for honesty, integrity, and listening. A physician leader speaking on behalf of the institution may have already been deemed as having gone over to the "dark side" of administration and thus, sacrificed integrity. A successful physician leader will discuss the downsides of a proposal as well as inherent risks of the endeavor. If this is done, the opposition tends to then start looking at the positives you have presented.

Conclusion: Although presenting data to physicians is vital to getting their "buy-in" for an idea or proposal, the physician leader must build a reputation of honesty, integrity, and being a good listener. Convincing physician audiences almost always takes more time than hospital administrators think it should. Facts help to put the idea on a sound footing as well as a clear and rational explanation brings attention to the proposal. But genuine emotion displayed at the right time creates excitement and can lead to closing the deal.

Scenario: The Chief Executive Officer (CEO) of a large hospital comes into the Chief Medical Officer's (CMO) office after a hospital board retreat meeting on strategy for faster physician integration. His marching orders include allowing daytime coverage but restricting after-hours house staff coverage only for patients of physicians who are fully employed by the health system. The CEO knows this will create an uproar but wants the CMO to get "buy-in" from all physicians on the medical staff. He shares the 5-year financial projections and insists that viability of the institution is at stake. The relatively new CMO not only realizes the challenge represented but also recognizes a great personal opportunity. From her efforts in the past 2 years, she has garnered a reputation for honesty and integrity. Relying on her education in leadership, communications, and negotiations, she formulates a strategy to achieve the CEO's directive.

Problem: "Getting buy-in" has become an unwelcome phrase for many physicians. The general implication is that hospital administration wants salaried physicians or other leaders to persuade the "troops" to agree to something for which a decision has already been made. Persuading others is often an art and not a show of strength, and furthermore, not always rational. The art involves putting yourself in the other person's shoes and asking yourself: "Would I buy this if the idea was offered to me?" If not, leaders first need to convince themselves of the benefits of the intended proposal. If it is always about you and your victories, you will acquire a reputation of being a self-serving leader and lose followers when you need them. Once a leader has convinced himself/herself, pushing hard against a timeline does not always work. Sometimes, being too aggressive can have the opposite reaction.

Solution: Physicians are scientists and, therefore, are influenced by data and empiric arguments. Most proposals advanced by hospitals involve finances to some degree. The problem is that most physicians do not have expertise in analyzing financial data. Thus, physician leaders must make the facts easily understandable and not use book-based accounting terms in attempts to impress physician groups. This may result in a reinforcement of the bias that everyone in administration is concerned only with money. Leaders must make the financial application easy to understand, possibly with charts or graphs, and seek to educate in the process.

Even though the proposal may be factual and well reasoned, the medical staff sometimes has not had time to process the pros and cons or separate their own parochial interests from those of the institution. Persuasion does indeed involve emotion at times but must be used wisely and at the right time when reason and rational arguments have hit home first. That is not to say that everyone in the audience will be convinced of the brilliance of your argument but it may persuade enough people to come over to your side. When emotion is used and timed correctly, it creates excitement and tends to spread through the audience so it completes the "sale."

If there is not enough support, it is best to let things rest and work on those who are opposed to the proposal as a knee-jerk response or based upon misperception. The leader needs to have established a reputation for honesty, integrity, and listening. A physician leader speaking on behalf of the institution may have already been deemed as having gone over to the "dark side" of administration and thus, sacrificed integrity. A successful physician leader will discuss the downsides of a proposal as well as inherent risks of the endeavor. If this is done, the opposition tends to then start looking at the positives you have presented.

Conclusion: Although presenting data to physicians is vital to getting their "buy-in" for an idea or proposal, the physician leader must build a reputation of honesty, integrity, and being a good listener. Convincing physician audiences almost always takes more time than hospital administrators think it should. Facts help to put the idea on a sound footing as well as a clear and rational explanation brings attention to the proposal. But genuine emotion displayed at the right time creates excitement and can lead to closing the deal.

Scenario: The Chief Executive Officer (CEO) of a large hospital comes into the Chief Medical Officer's (CMO) office after a hospital board retreat meeting on strategy for faster physician integration. His marching orders include allowing daytime coverage but restricting after-hours house staff coverage only for patients of physicians who are fully employed by the health system. The CEO knows this will create an uproar but wants the CMO to get "buy-in" from all physicians on the medical staff. He shares the 5-year financial projections and insists that viability of the institution is at stake. The relatively new CMO not only realizes the challenge represented but also recognizes a great personal opportunity. From her efforts in the past 2 years, she has garnered a reputation for honesty and integrity. Relying on her education in leadership, communications, and negotiations, she formulates a strategy to achieve the CEO's directive.

Problem: "Getting buy-in" has become an unwelcome phrase for many physicians. The general implication is that hospital administration wants salaried physicians or other leaders to persuade the "troops" to agree to something for which a decision has already been made. Persuading others is often an art and not a show of strength, and furthermore, not always rational. The art involves putting yourself in the other person's shoes and asking yourself: "Would I buy this if the idea was offered to me?" If not, leaders first need to convince themselves of the benefits of the intended proposal. If it is always about you and your victories, you will acquire a reputation of being a self-serving leader and lose followers when you need them. Once a leader has convinced himself/herself, pushing hard against a timeline does not always work. Sometimes, being too aggressive can have the opposite reaction.

Solution: Physicians are scientists and, therefore, are influenced by data and empiric arguments. Most proposals advanced by hospitals involve finances to some degree. The problem is that most physicians do not have expertise in analyzing financial data. Thus, physician leaders must make the facts easily understandable and not use book-based accounting terms in attempts to impress physician groups. This may result in a reinforcement of the bias that everyone in administration is concerned only with money. Leaders must make the financial application easy to understand, possibly with charts or graphs, and seek to educate in the process.

Even though the proposal may be factual and well reasoned, the medical staff sometimes has not had time to process the pros and cons or separate their own parochial interests from those of the institution. Persuasion does indeed involve emotion at times but must be used wisely and at the right time when reason and rational arguments have hit home first. That is not to say that everyone in the audience will be convinced of the brilliance of your argument but it may persuade enough people to come over to your side. When emotion is used and timed correctly, it creates excitement and tends to spread through the audience so it completes the "sale."

If there is not enough support, it is best to let things rest and work on those who are opposed to the proposal as a knee-jerk response or based upon misperception. The leader needs to have established a reputation for honesty, integrity, and listening. A physician leader speaking on behalf of the institution may have already been deemed as having gone over to the "dark side" of administration and thus, sacrificed integrity. A successful physician leader will discuss the downsides of a proposal as well as inherent risks of the endeavor. If this is done, the opposition tends to then start looking at the positives you have presented.

Conclusion: Although presenting data to physicians is vital to getting their "buy-in" for an idea or proposal, the physician leader must build a reputation of honesty, integrity, and being a good listener. Convincing physician audiences almost always takes more time than hospital administrators think it should. Facts help to put the idea on a sound footing as well as a clear and rational explanation brings attention to the proposal. But genuine emotion displayed at the right time creates excitement and can lead to closing the deal.

Nearing 40 years of continued service to its membership, the Peripheral Vascular Surgery Society at its annual meeting elected a change in the society name to reflect the modern practice of its 1,000+ active and senior members. Originally founded in 1976, the society was designated as the Peripheral Vascular Surgery Club and later on invoked the PVSS. Now outdated, "peripheral" was once used to differentiate the emerging field of vascular surgery from "central" cardiovascular surgery. As evidenced by hundreds of VESS registrants at the most recent meeting and plenary sessions in Steamboat Springs, January 29–February 2, the membership has actively engaged and researched projects and outcomes across the spectrum of all vascular territories using the best of modern vascular and endovascular techniques.

Indeed, the VESS reflects our appropriate American Board Certifications, many division and practice names, as well as common journals in which the membership are often published and contribute. General knowledge of the role of vascular surgery in public health is increasing through a variety of mechanisms, and the importance of the marriage of endovascular surgery to traditional perceptions of vascular surgery has both timely and strategic implications for VESS going forward. The process of VESS name was researched since 2008 and carried forth with support of the past 26 PVSS presidents. An opinion poll was taken from the membership, and among respondents, the Vascular and Endovascular Surgery Society was the leading choice by an overwhelming margin. At our recent winter meeting, the membership voted overwhelmingly for the VESS moniker.

Our academic program at the winter meeting was very successful this year with 50 papers presented from institutions across the country and abroad. The topics discussed covered the entire scope of vascular and endovascular surgery including readmission rates after abdominal aortic aneurysm repair, hospital length of stay after carotid endarterectomy as a surrogate for quality, and methods for maintenance of end-stage dialysis access. The program also included case presentations that described new techniques for visceral vessel debranching and the management of large acquired arteriovenous fistulas. The plenary sessions promoted discussion and gave a forum for fellows and residents to present their work.

Building on the enthusiasm of a great winter program, the VESS inauguration has met great support, as Past PVSS President Chuck Anderson, M.D., commented, "Our specialty has evolved dramatically since the early meetings of the Peripheral Vascular Surgery Club. The original goal was to recognize the group of "new" surgeons that were fellowship trained in a "new" specialty and provide a forum for continued education and advocacy. The new name more appropriately reflects the evolution of the specialty and our mission remains the same." Jeb Hallett, M.D., a past PVSS president, echoes the sentiment: "Keep your focus on our mission for young surgeons!"

Without a doubt, VESS will continue in its mission to provide a forum for development of the young vascular and endovascular surgeon, with continued support for its spring meeting in conjunction with the Vascular Annual Meeting. The VESS Winter Meeting will remain the major venue for all its members with novel programs for residents and fellows, an exciting slate of plenary sessions and interchange, inspirational presidential addresses, and the unique and entertaining venues for its annual celebratory dinner.

James H. Black III, M.D., VESS Councilor-at-Large

Nearing 40 years of continued service to its membership, the Peripheral Vascular Surgery Society at its annual meeting elected a change in the society name to reflect the modern practice of its 1,000+ active and senior members. Originally founded in 1976, the society was designated as the Peripheral Vascular Surgery Club and later on invoked the PVSS. Now outdated, "peripheral" was once used to differentiate the emerging field of vascular surgery from "central" cardiovascular surgery. As evidenced by hundreds of VESS registrants at the most recent meeting and plenary sessions in Steamboat Springs, January 29–February 2, the membership has actively engaged and researched projects and outcomes across the spectrum of all vascular territories using the best of modern vascular and endovascular techniques.

Indeed, the VESS reflects our appropriate American Board Certifications, many division and practice names, as well as common journals in which the membership are often published and contribute. General knowledge of the role of vascular surgery in public health is increasing through a variety of mechanisms, and the importance of the marriage of endovascular surgery to traditional perceptions of vascular surgery has both timely and strategic implications for VESS going forward. The process of VESS name was researched since 2008 and carried forth with support of the past 26 PVSS presidents. An opinion poll was taken from the membership, and among respondents, the Vascular and Endovascular Surgery Society was the leading choice by an overwhelming margin. At our recent winter meeting, the membership voted overwhelmingly for the VESS moniker.

Our academic program at the winter meeting was very successful this year with 50 papers presented from institutions across the country and abroad. The topics discussed covered the entire scope of vascular and endovascular surgery including readmission rates after abdominal aortic aneurysm repair, hospital length of stay after carotid endarterectomy as a surrogate for quality, and methods for maintenance of end-stage dialysis access. The program also included case presentations that described new techniques for visceral vessel debranching and the management of large acquired arteriovenous fistulas. The plenary sessions promoted discussion and gave a forum for fellows and residents to present their work.

Building on the enthusiasm of a great winter program, the VESS inauguration has met great support, as Past PVSS President Chuck Anderson, M.D., commented, "Our specialty has evolved dramatically since the early meetings of the Peripheral Vascular Surgery Club. The original goal was to recognize the group of "new" surgeons that were fellowship trained in a "new" specialty and provide a forum for continued education and advocacy. The new name more appropriately reflects the evolution of the specialty and our mission remains the same." Jeb Hallett, M.D., a past PVSS president, echoes the sentiment: "Keep your focus on our mission for young surgeons!"

Without a doubt, VESS will continue in its mission to provide a forum for development of the young vascular and endovascular surgeon, with continued support for its spring meeting in conjunction with the Vascular Annual Meeting. The VESS Winter Meeting will remain the major venue for all its members with novel programs for residents and fellows, an exciting slate of plenary sessions and interchange, inspirational presidential addresses, and the unique and entertaining venues for its annual celebratory dinner.

James H. Black III, M.D., VESS Councilor-at-Large

Nearing 40 years of continued service to its membership, the Peripheral Vascular Surgery Society at its annual meeting elected a change in the society name to reflect the modern practice of its 1,000+ active and senior members. Originally founded in 1976, the society was designated as the Peripheral Vascular Surgery Club and later on invoked the PVSS. Now outdated, "peripheral" was once used to differentiate the emerging field of vascular surgery from "central" cardiovascular surgery. As evidenced by hundreds of VESS registrants at the most recent meeting and plenary sessions in Steamboat Springs, January 29–February 2, the membership has actively engaged and researched projects and outcomes across the spectrum of all vascular territories using the best of modern vascular and endovascular techniques.

Indeed, the VESS reflects our appropriate American Board Certifications, many division and practice names, as well as common journals in which the membership are often published and contribute. General knowledge of the role of vascular surgery in public health is increasing through a variety of mechanisms, and the importance of the marriage of endovascular surgery to traditional perceptions of vascular surgery has both timely and strategic implications for VESS going forward. The process of VESS name was researched since 2008 and carried forth with support of the past 26 PVSS presidents. An opinion poll was taken from the membership, and among respondents, the Vascular and Endovascular Surgery Society was the leading choice by an overwhelming margin. At our recent winter meeting, the membership voted overwhelmingly for the VESS moniker.

Our academic program at the winter meeting was very successful this year with 50 papers presented from institutions across the country and abroad. The topics discussed covered the entire scope of vascular and endovascular surgery including readmission rates after abdominal aortic aneurysm repair, hospital length of stay after carotid endarterectomy as a surrogate for quality, and methods for maintenance of end-stage dialysis access. The program also included case presentations that described new techniques for visceral vessel debranching and the management of large acquired arteriovenous fistulas. The plenary sessions promoted discussion and gave a forum for fellows and residents to present their work.

Building on the enthusiasm of a great winter program, the VESS inauguration has met great support, as Past PVSS President Chuck Anderson, M.D., commented, "Our specialty has evolved dramatically since the early meetings of the Peripheral Vascular Surgery Club. The original goal was to recognize the group of "new" surgeons that were fellowship trained in a "new" specialty and provide a forum for continued education and advocacy. The new name more appropriately reflects the evolution of the specialty and our mission remains the same." Jeb Hallett, M.D., a past PVSS president, echoes the sentiment: "Keep your focus on our mission for young surgeons!"

Without a doubt, VESS will continue in its mission to provide a forum for development of the young vascular and endovascular surgeon, with continued support for its spring meeting in conjunction with the Vascular Annual Meeting. The VESS Winter Meeting will remain the major venue for all its members with novel programs for residents and fellows, an exciting slate of plenary sessions and interchange, inspirational presidential addresses, and the unique and entertaining venues for its annual celebratory dinner.

James H. Black III, M.D., VESS Councilor-at-Large