Ovarian Cancer Patients Have Lower Mortality Rates at High-Volume Hospitals

Women who have surgery for ovarian cancer have better outcomes if they are treated at high-volume hospitals, according to researchers at the Herbert Irving Comprehensive Cancer Center at NewYork-Presbyterian/Columbia University Medical Center.

The improved survival rate is not dependent on a lower rate of complications following surgery, but on the treatment of complications. Patients with a complication after surgery at a low-volume hospital are nearly 50 percent more likely to die as a result of the complication than patients seen at highvolume hospitals, according to the study.

“It is widely documented that surgical volume has an important effect on outcomes following surgery,” said Dr. Jason D. Wright, a gynecologic oncologist at NYP/Columbia and the lead author of the study published online this month in the Journal of Clinical Oncology. What the current study shows is the importance of improving the care of patients with complications from surgery.

“We also believe in the importance of adhering to quality guidelines and best practices, which may overcome these volume-based disparities,” said Dr. Dawn Hershman, associate professor of medicine and epidemiology, another of the study’s authors.

The research team reviewed data from more than 36,000 women aged 18 to 90 who underwent removal of one or both ovaries at 1,166 hospitals from 1998 to 2009.

Scientists Engineer Mouse to Develop Better Vaccines Against Typhoid Fever

Columbia University Medical Center researchers have created a genetically engineered mouse that may lead to the development of more effective vaccines against typhoid fever.

Typhoid is caused by the bacterium Salmonella typhi, which is spread through contaminated drinking water or food. While rare in the United States, it causes 200,000 deaths a year in the developing world.

The disease is treated by antibiotics, and currently there are two vaccines with efficacy rates ranging from 50 to 80 percent. Since mice are resistant to the bacteria, it has been difficult to develop new vaccines.

In the current experiment, Dr. Sankar Ghosh, chair of microbiology and immunology at CUMC, and colleagues sought to create an animal model for studying the disease.

First they identified an immune cell receptor that they had reason to believe granted the mice immunity to the bacteria. Then they created a strain of mice that lacked the receptor.

When the “knockout” mice were infected, they developed typhoidlike symptoms. Next the researchers demonstrated that the micey developed typhoidlike symptoms. Next the researchers demonstrated that the mice could be successfully immunized against S. typhi with a heat-killed vaccine.

“Vaccines are the most practical solution for preventing typhoid in the Third World,” said Ghosh. “Unfortunately, existing typhoid vaccines are only modestly effective, leaving millions of people vulnerable to infection. With our new mouse model, we have a powerful tool for investigating the disease and devising better vaccine strategies.”

The research was published last month in the online edition of Cell.

New Research Sheds Light on Childhood Neuromuscular Disease

A study by scientists at the Motor Neuron Center at Columbia University Medical Center suggests that spinal muscular atrophy (SMA), a genetic neuromuscular disease in infants and children, results primarily from problems in the motor circuits that coordinate muscle movement. Previously, researchers thought that motor neurons or muscle cells were responsible.

In a second study, researchers at the Motor Neuron Center identified the molecular pathway in SMA that leads to problems with motor function. Findings from the studies could lead to therapies for the debilitating and often fatal neuromuscular disease.

“To our knowledge, this is the first clear demonstration that defects in the function of a neuronal circuit are the cause of a neurological disease,” Dr. Brian McCabe, assistant professor of pathology and cell biology, said about the first study.

Both studies were published online Oct. 11 in the journal Cell.

SMA is a hereditary neuromuscular disease characterized by muscle atrophy and weakness. There is no treatment for SMA, which is estimated to affect as many as 10,000 to 25,000 children and adults in the United States and is the leading genetic cause of death in infants.

Based on the findings of McCabe and his colleagues, the SMA Clinical Research Center at CUMC launched a clinical trial last July of a potassium channel blocker called dalfampridine for the treatment of patients with SMA. The drug is currently marketed under the brand name Ampyra for multiple sclerosis. “This drug is unlikely to be a cure for SMA, but we hope it will benefit patient symptoms,” McCabe said.

Mailman School Study Finds Strong Ethnic Neighborhoods Can Boost Health of Seniors

A new study from the Mailman School of Public Health suggests that African-American and Mexican-American seniors are less likely to have cancer or heart disease if they live in an ethnically homogeneous community.

Contrary to earlier studies, the researchers found that “living in the barrio or ethnically dense communities isn’t always bad for your health,” said Kimberly Alvarez, a Ph.D. candidate at Mailman who conducted the study with Becca Levy, associate professor of epidemiology and psychology at the Yale School of Public Health.

The researchers used survey data from 2,367 Mexican-Americans and 2,790 African-Americans over age 65 living in communities with high percentages of residents of the same ethnic background.

Among African-Americans, those living in a county with an ethnic density of 50 percent or more were 46 percent less likely to report doctor-diagnosed heart disease and 77 percent less likely to report cancer than those who lived in a community with an ethnic density of less than 25 percent. Mexican-Americans living in a county with an ethnic density of 50 percent or more were 33 percent and 62 percent less likely to report heart disease and cancer, respectively, than those who lived in a community with an ethnic density of less than 25 percent.

Cultural factors such as respect for elders and close-knit families could help explain the phenomenon. “These networks may facilitate better health behaviors and, in turn, better health outcomes,” Alvarez said.

The study was published online last month in the American Journal of Public Health.