More children are admitted to community hospitals than children's hospitals, found DMS pediatrician David Goodman, M.D., and colleagues. According to a study presented at the Pediatric Academic Societies' meeting, 64.4% of hospitalizations for patients aged 1 to 17 were in non-children's hospitals; general hospitals cared for disproportionately high numbers of 15- to 17-year-old females, patients from low-income zip codes, and uninsured patients. Does the U.S. need more children's hospitals or more pediatric expertise at community hospitals? That's a "fundamental question that the health-care community needs to answer," said Goodman.
Diagnosing low-back pain can be difficult and problematic, acknowledged Jon Lurie, M.D., of DHMC's Spine Center in a recent paper. The major diagnostic challenge is "to distinguish the >95% [of patients] who have a benign musculoskeletal pain syndrome from the small minority with a serious, specific disease process that requires timely and specific therapy," he wrote in Best Practice & Research Clinical Rheumatology. Fortunately, Lurie offered a detailed decision guide to help physicians with this diagnostic conundrum.
How low should we go?
Lowering the threshold for what's considered abnormal in the most common prostate cancer- screening test "would be a mistake," said three DMS researchers in a paper in the Journal of the National Cancer Institute. Some doctors feel prostate-specific antigen scores as low as 2.5 should be flagged as abnormal. But doing so, wrote H. Gilbert Welch, M.D., et al., would double the number of men defined as abnormal and subject about 1.35 million more men aged 40 to 69 years to unnecessary biopsies. "It is easy to diagnose more prostate cancer," the authors wrote. "It is not easy to know who has clinically important disease."
Much ado about melanoma
Another paper by the same team, this one in the British Medical Journal, concluded that a dramatic increase in melanoma is "largely the result of increased diagnostic scrutiny and not an increase in the incidence of the disease." Welch et al. examined 15 years of Medicare data and found that "the incidence of early-stage disease has risen rapidly, whereas the incidence for late-stage disease and mortality have been relatively stable." Since it's unlikely that treatment advances exactly keep pace with the rising incidence, they argue, "overdiagnosis" is the most plausible explanation.
Two DMS researchers have revealed the insidious process by
which a molecule called Smad7 helps pancreatic cancers grow out of control. Smad7—which is present in half of human pancreatic cancers—thwarts the usual checks and balances of cell growth and allows the proliferation of cells and blood vessels that feed tumors. "It's a devilish mechanism," says Murray Korc, M.D., chair of medicine at DMS and coauthor of the Smad7 paper for the Journal of Biological Chemistry. "Smad7 not only prevents TGF-beta molecules from slowing the cancer down, but enables them to multiply at a high rate, and thus gives the cancer another growth benefit."
The FDA currently allows platelets—blood cells that aid in clotting—to be stored no more than five days before being given to patients. But new research by DMS pathologist James AuBuchon, M.D., suggests that platelets could be stored for seven days with no significant effect on outcomes, thanks to new bacterial detection methods. "Extension of platelet storage and concomitant use of a bacterial detection system would provide logistical advantages by reducing outdating and improving patient care," wrote Aubuchon in the journal Transfusion.
Picking up parental habits
"Honey, have some smokes," said a 6-yearold boy to a doll. The boy was one of 120 youngsters pretending to grocery shop as DMS researchers observed. Led by Madeline Dalton, Ph.D., the team found that children were more likely to "buy" cigarettes if their parents smoked and to "buy" alcohol if their parents drank at least monthly. "Our study is the first to demonstrate that preschool children possess social cognitive scripts of adult social life in which the use of alcohol and tobacco play central roles," Dalton et al. wrote in the Archives of Pediatric and Adolescent Medicine.
Hundreds of scientific articles on the immune system of the female reproductive tract were recently summarized by five DMS researchers in the Departments of Physiology and of Microbiology and Immunology. The goal of the summary, published in Immunological Reviews, was "to define the innate immune system in the female reproductive tract and, where possible, to define the regulatory in- fluences that occur during the menstrual cycle." It's essential that the tract's immunological processes be considered "in the design of vaccines for the protection against microbial diseases," concluded the authors.
DMS departments whose grant funding ranks among the top 20 of the nation's 125 medical schools are microbiology and immunology at 9th, genetics at 11th, and biochemistry at 15th.
Calcium may do more than build strong teeth. A DMS study showing a possible protective effect against colon polyps was presented at a meeting of the American Association for Cancer Research.
DMS microbiologist Deborah Hogan, Ph.D., was one of only 15 researchers nationwide selected as a 2005 Pew Biomedical Scholar. She studies model systems for host-pathogen interactions.
DMS geneticist Victor Ambros, Ph.D., received the 2005 Lewis S. Rosenstiel Award for Distinguished Work in Basic Medical Research, for his discovery of the first microRNA gene.
If you'd like to offer feedback about this article, we'd welcome getting your comments at DartMed@Dartmouth.edu.
This article may not be reproduced or reposted without permission. To inquire about permission, contact DartMed@Dartmouth.edu.