Whitney McKnight

CHICAGO – The driving force behind anxiety is avoidance, according to Barbara Rothbaum, Ph.D., an expert in exposure therapy and a presenter at this year’s annual conference of the Anxiety and Depression Association of America.

"What we think maintains [a person’s] anxiety is avoidance of what they’re scared of," says Dr. Rothbaum in this video. "We help people confront what they’re scared of, in a therapeutic manner."

Particularly in posttraumatic stress disorder, there are two drivers holding anxiety in place, which when addressed by repeatedly immersing a patient in a virtual re-creation of the traumatic event, are relieved so the person can find peace. Many patients say, "It doesn’t haunt me anymore," according to Dr. Rothbaum, professor in the department of psychiatry and behavioral sciences and director of the trauma and anxiety recovery program at Emory University, Atlanta.

In this video, Dr. Rothbaum explores what drives anxiety and how the therapeutic, virtual re-creations of painful memories is helping patients with PTSD accept that although certain things will always be "sad," they need not negate joy and pleasure in life.

[email protected]

On Twitter @whitneymcknight

CHICAGO – The driving force behind anxiety is avoidance, according to Barbara Rothbaum, Ph.D., an expert in exposure therapy and a presenter at this year’s annual conference of the Anxiety and Depression Association of America.

"What we think maintains [a person’s] anxiety is avoidance of what they’re scared of," says Dr. Rothbaum in this video. "We help people confront what they’re scared of, in a therapeutic manner."

Particularly in posttraumatic stress disorder, there are two drivers holding anxiety in place, which when addressed by repeatedly immersing a patient in a virtual re-creation of the traumatic event, are relieved so the person can find peace. Many patients say, "It doesn’t haunt me anymore," according to Dr. Rothbaum, professor in the department of psychiatry and behavioral sciences and director of the trauma and anxiety recovery program at Emory University, Atlanta.

In this video, Dr. Rothbaum explores what drives anxiety and how the therapeutic, virtual re-creations of painful memories is helping patients with PTSD accept that although certain things will always be "sad," they need not negate joy and pleasure in life.

[email protected]

On Twitter @whitneymcknight

CHICAGO – The driving force behind anxiety is avoidance, according to Barbara Rothbaum, Ph.D., an expert in exposure therapy and a presenter at this year’s annual conference of the Anxiety and Depression Association of America.

"What we think maintains [a person’s] anxiety is avoidance of what they’re scared of," says Dr. Rothbaum in this video. "We help people confront what they’re scared of, in a therapeutic manner."

Particularly in posttraumatic stress disorder, there are two drivers holding anxiety in place, which when addressed by repeatedly immersing a patient in a virtual re-creation of the traumatic event, are relieved so the person can find peace. Many patients say, "It doesn’t haunt me anymore," according to Dr. Rothbaum, professor in the department of psychiatry and behavioral sciences and director of the trauma and anxiety recovery program at Emory University, Atlanta.

In this video, Dr. Rothbaum explores what drives anxiety and how the therapeutic, virtual re-creations of painful memories is helping patients with PTSD accept that although certain things will always be "sad," they need not negate joy and pleasure in life.

[email protected]

On Twitter @whitneymcknight

CHICAGO – Because not everyone has immediate access to treatment for suicidal depression, Thomas Joiner, Ph.D., codirector of the Military Suicide Research Consortium in Tallahassee, Fla., is helping develop virtual adjunct psychotherapies to help de-escalate acute suicide until first-line therapy can be administered.

"We are trying to locate really simple but effective interventions for suicide in service members – but we think it’s going to be generalizable beyond the military – take those risk factors from a level that is worrisome and in some cases catastrophic and make them more manageable so that other treatments have a chance to take hold and to do their work," Dr. Joiner said in an interview after his presentation given at the scientific session of the annual conference of the Anxiety and Depression Association of America.

The technology for these interventions is basic and "available to most people," according to Dr. Joiner, and includes at least one smartphone app that reminds people experiencing suicidal ideation that they matter to others and that their death would adversely affect people they love.

[email protected]

On Twitter @whitneymcknight

CHICAGO – Because not everyone has immediate access to treatment for suicidal depression, Thomas Joiner, Ph.D., codirector of the Military Suicide Research Consortium in Tallahassee, Fla., is helping develop virtual adjunct psychotherapies to help de-escalate acute suicide until first-line therapy can be administered.

"We are trying to locate really simple but effective interventions for suicide in service members – but we think it’s going to be generalizable beyond the military – take those risk factors from a level that is worrisome and in some cases catastrophic and make them more manageable so that other treatments have a chance to take hold and to do their work," Dr. Joiner said in an interview after his presentation given at the scientific session of the annual conference of the Anxiety and Depression Association of America.

The technology for these interventions is basic and "available to most people," according to Dr. Joiner, and includes at least one smartphone app that reminds people experiencing suicidal ideation that they matter to others and that their death would adversely affect people they love.

[email protected]

On Twitter @whitneymcknight

CHICAGO – Because not everyone has immediate access to treatment for suicidal depression, Thomas Joiner, Ph.D., codirector of the Military Suicide Research Consortium in Tallahassee, Fla., is helping develop virtual adjunct psychotherapies to help de-escalate acute suicide until first-line therapy can be administered.

"We are trying to locate really simple but effective interventions for suicide in service members – but we think it’s going to be generalizable beyond the military – take those risk factors from a level that is worrisome and in some cases catastrophic and make them more manageable so that other treatments have a chance to take hold and to do their work," Dr. Joiner said in an interview after his presentation given at the scientific session of the annual conference of the Anxiety and Depression Association of America.

The technology for these interventions is basic and "available to most people," according to Dr. Joiner, and includes at least one smartphone app that reminds people experiencing suicidal ideation that they matter to others and that their death would adversely affect people they love.

[email protected]

On Twitter @whitneymcknight

ARUBA – Patients with actinic keratoses are a fixture in most dermatology practices, but is your practice up to date on the full range of treatments available?

At the Caribbean Dermatology Symposium, Dr. David Pariser presented a quick run-down of current, new, and up-and-coming treatments for AKs, including, but not limited to, cryosurgery and imiquimod.

Also, he discusses his experience with field therapy to treat AKs.

"The damage that occurred that caused the actinic keratosis in one specific spot has also occurred in adjacent areas," that can’t be detected visually, he said.

Dr. Pariser is a professor of clinical dermatology at Eastern Virginia Medical School in Norfolk, and a physician in a private group practice in Virginia.

[email protected]

On Twitter @whitneymcknight

ARUBA – Patients with actinic keratoses are a fixture in most dermatology practices, but is your practice up to date on the full range of treatments available?

At the Caribbean Dermatology Symposium, Dr. David Pariser presented a quick run-down of current, new, and up-and-coming treatments for AKs, including, but not limited to, cryosurgery and imiquimod.

Also, he discusses his experience with field therapy to treat AKs.

"The damage that occurred that caused the actinic keratosis in one specific spot has also occurred in adjacent areas," that can’t be detected visually, he said.

Dr. Pariser is a professor of clinical dermatology at Eastern Virginia Medical School in Norfolk, and a physician in a private group practice in Virginia.

[email protected]

On Twitter @whitneymcknight

ARUBA – Patients with actinic keratoses are a fixture in most dermatology practices, but is your practice up to date on the full range of treatments available?

At the Caribbean Dermatology Symposium, Dr. David Pariser presented a quick run-down of current, new, and up-and-coming treatments for AKs, including, but not limited to, cryosurgery and imiquimod.

Also, he discusses his experience with field therapy to treat AKs.

"The damage that occurred that caused the actinic keratosis in one specific spot has also occurred in adjacent areas," that can’t be detected visually, he said.

Dr. Pariser is a professor of clinical dermatology at Eastern Virginia Medical School in Norfolk, and a physician in a private group practice in Virginia.

[email protected]

On Twitter @whitneymcknight

ARUBA – Patients with actinic keratoses are a fixture in most dermatology practices, but is your practice up to date on the full range of treatments available?

At the Caribbean Dermatology Symposium, Dr. David Pariser presented a quick run-down of current, new, and up-and-coming treatments for AKs, including, but not limited to, cryosurgery and imiquimod.

Also, he discusses his experience with field therapy to treat AKs.

"The damage that occurred that caused the actinic keratosis in one specific spot has also occurred in adjacent areas," that can’t be detected visually, he said.

Dr. Pariser is a professor of clinical dermatology at Eastern Virginia Medical School in Norfolk, and a physician in a private group practice in Virginia.

[email protected]

On Twitter @whitneymcknight

ARUBA – Patients with actinic keratoses are a fixture in most dermatology practices, but is your practice up to date on the full range of treatments available?

At the Caribbean Dermatology Symposium, Dr. David Pariser presented a quick run-down of current, new, and up-and-coming treatments for AKs, including, but not limited to, cryosurgery and imiquimod.

Also, he discusses his experience with field therapy to treat AKs.

"The damage that occurred that caused the actinic keratosis in one specific spot has also occurred in adjacent areas," that can’t be detected visually, he said.

Dr. Pariser is a professor of clinical dermatology at Eastern Virginia Medical School in Norfolk, and a physician in a private group practice in Virginia.

[email protected]

On Twitter @whitneymcknight

ARUBA – Patients with actinic keratoses are a fixture in most dermatology practices, but is your practice up to date on the full range of treatments available?

At the Caribbean Dermatology Symposium, Dr. David Pariser presented a quick run-down of current, new, and up-and-coming treatments for AKs, including, but not limited to, cryosurgery and imiquimod.

Also, he discusses his experience with field therapy to treat AKs.

"The damage that occurred that caused the actinic keratosis in one specific spot has also occurred in adjacent areas," that can’t be detected visually, he said.

Dr. Pariser is a professor of clinical dermatology at Eastern Virginia Medical School in Norfolk, and a physician in a private group practice in Virginia.

[email protected]

On Twitter @whitneymcknight

CHICAGO – In a study of 100 people who attempted suicide, researchers found the persons all had elevated levels of proinflammatory cytokines in their blood, according to a presentation made at this year’s annual conference of the Anxiety and Depression Association of America.

Now the study’s lead investigator, Dr. Lena C. Brundin of the department of translational science & molecular medicine at Michigan State University, Grand Rapids, seeks to replicate her findings across a larger population with varying degrees of suicidal ideation, to see whether specific biomarkers can be identified to determine which patients are at elevated risk and develop targeted therapies for inflammation to reduce that risk.

In an interview, Dr. Brundin explains her hypothesis for the mechanisms of this neuroinflammatory response: that metabolites in the kynurenine pathway adversely affect glutamate neurotransmission (kynurenic acid is an antagonist of the glutamatergic N-methyl-D-aspartate [NMDA] receptor), creating "very profound and strong effects" on the brain, and possibly contributing to suicidal ideation.

[email protected]On Twitter @whitneymcknight

CHICAGO – In a study of 100 people who attempted suicide, researchers found the persons all had elevated levels of proinflammatory cytokines in their blood, according to a presentation made at this year’s annual conference of the Anxiety and Depression Association of America.

Now the study’s lead investigator, Dr. Lena C. Brundin of the department of translational science & molecular medicine at Michigan State University, Grand Rapids, seeks to replicate her findings across a larger population with varying degrees of suicidal ideation, to see whether specific biomarkers can be identified to determine which patients are at elevated risk and develop targeted therapies for inflammation to reduce that risk.

In an interview, Dr. Brundin explains her hypothesis for the mechanisms of this neuroinflammatory response: that metabolites in the kynurenine pathway adversely affect glutamate neurotransmission (kynurenic acid is an antagonist of the glutamatergic N-methyl-D-aspartate [NMDA] receptor), creating "very profound and strong effects" on the brain, and possibly contributing to suicidal ideation.

[email protected]On Twitter @whitneymcknight

CHICAGO – In a study of 100 people who attempted suicide, researchers found the persons all had elevated levels of proinflammatory cytokines in their blood, according to a presentation made at this year’s annual conference of the Anxiety and Depression Association of America.

Now the study’s lead investigator, Dr. Lena C. Brundin of the department of translational science & molecular medicine at Michigan State University, Grand Rapids, seeks to replicate her findings across a larger population with varying degrees of suicidal ideation, to see whether specific biomarkers can be identified to determine which patients are at elevated risk and develop targeted therapies for inflammation to reduce that risk.

In an interview, Dr. Brundin explains her hypothesis for the mechanisms of this neuroinflammatory response: that metabolites in the kynurenine pathway adversely affect glutamate neurotransmission (kynurenic acid is an antagonist of the glutamatergic N-methyl-D-aspartate [NMDA] receptor), creating "very profound and strong effects" on the brain, and possibly contributing to suicidal ideation.

[email protected]On Twitter @whitneymcknight

Throughout history the diagnosis "posttraumatic stress disorder" has been called many things and been defined by a variety of presentations.

In this interview, Col. Elspeth Cameron Ritchie, U.S. Army retired, and an Army psychiatrist, examines how the term PTSD came to be and the elements of existentialism that are inherent within it.

[email protected]

On Twitter @whitneymcknight

Throughout history the diagnosis "posttraumatic stress disorder" has been called many things and been defined by a variety of presentations.

In this interview, Col. Elspeth Cameron Ritchie, U.S. Army retired, and an Army psychiatrist, examines how the term PTSD came to be and the elements of existentialism that are inherent within it.

[email protected]

On Twitter @whitneymcknight

Throughout history the diagnosis "posttraumatic stress disorder" has been called many things and been defined by a variety of presentations.

In this interview, Col. Elspeth Cameron Ritchie, U.S. Army retired, and an Army psychiatrist, examines how the term PTSD came to be and the elements of existentialism that are inherent within it.

[email protected]

On Twitter @whitneymcknight

The first treatment guidelines developed for pulmonary hypertension in sickle cell disease are now available from the American Thoracic Society.

Because more effective treatments have extended the lives of patients with the disease, their risk of mortality from pulmonary hypertension and elevated tricuspid regurgitant jet velocity has increased. Until now, however, there has been no standardized approach for identifying and managing these conditions.

The guidelines are published in the March 15 issue of the American Journal of Respiratory Critical Care Medicine (doi: 10.1164/rccm.201401-0065ST).

The multidisciplinary committee that wrote the guidelines defined mortality risk as a tricuspid regurgitant velocity (TRV) of at least 2.5 m/second; an N-terminal pro-brain natriuretic peptide (NT-pro-BNP) level of at least 160 pg/mL; or pulmonary hypertension (PH) confirmed by a right heart catheterization (RHC).

Patients with elevated mortality risk should be treated with hydroxyurea as first-line therapy. Chronic transfusion therapy for patients who are not candidates for or responsive to hydroxyurea is noted as a "weak recommendation."

For those with RHC-confirmed pulmonary hypertension, venous thromboembolism, and no additional risk factors for hemorrhage, indefinite – not limited – anticoagulant therapy is recommended.

For patients with either an elevated TRV or an elevated NT-pro-BNP level, the guidelines strongly recommend against pulmonary hypertensive–specific therapies such as prostanoid, endothelin-receptor antagonist, and phosphodiesterase-5 inhibitor therapy.

The same guidance was given for patients who have RHC-confirmed PH.

While the guidelines recommend against targeted therapies for RHC-confirmed pulmonary hypertension, a trial of either a prostanoid or an endothelin-receptor antagonist is recommended for patients with confirmed PH and elevated pulmonary vascular resistance, normal pulmonary capillary wedge pressure, and related symptoms. These patients should not be given phosphodiesterase-5 inhibitor therapy as first-line treatment.

The lack of both large-scale clinical trials in this population and integrated standards of care limit the guidelines’ effect, Dr. Elizabeth S. Klings, who chaired the guidelines committee, noted in a written statement.

"Management of [these patients] will ultimately be a collaborative effort including adult and pediatric pulmonologists, cardiologists, and hematologists," added Dr. Klings of the department of medicine at Boston University.

Dr. Klings receives support from NIH grant R21HL107993.

Dr. Susan Millard, FCCP, comments: The guidelines are a breath of fresh air. I feel they are very well thought out. More research needs to be done on the therapies for pulmonary hypertension, but the authors of these guidelines admit that there is a paucity of data in this area.

In addition, more collaboration is needed between our pulmonary, hematology, oncology, and cardiology specialties. Pulmonologists do not perform right heart catheterizations, but when we ask cardiologists about pulmonary hypertension concerns, we regularly get shot down by the ones who feel that echocardiograms are sufficient to look for this problem. Yet when we want help managing these patients, they don’t want to do that either because it is pulmonary hypertension. You need a dedicated group of people locally to workup these patients.

There are not many experienced pulmonary hypertension centers easily accessible for both adult and pediatric patient referrals. It is difficult, for example, to refer patients out of state and get it approved by insurance companies.

Dr. Susan Millard is a pediatric pulmonologist, Helen DeVos Children’s Hospital, Grand Rapids, Mich.; and CHEST board member.

[email protected]

The first treatment guidelines developed for pulmonary hypertension in sickle cell disease are now available from the American Thoracic Society.

Because more effective treatments have extended the lives of patients with the disease, their risk of mortality from pulmonary hypertension and elevated tricuspid regurgitant jet velocity has increased. Until now, however, there has been no standardized approach for identifying and managing these conditions.

The guidelines are published in the March 15 issue of the American Journal of Respiratory Critical Care Medicine (doi: 10.1164/rccm.201401-0065ST).

The multidisciplinary committee that wrote the guidelines defined mortality risk as a tricuspid regurgitant velocity (TRV) of at least 2.5 m/second; an N-terminal pro-brain natriuretic peptide (NT-pro-BNP) level of at least 160 pg/mL; or pulmonary hypertension (PH) confirmed by a right heart catheterization (RHC).

Patients with elevated mortality risk should be treated with hydroxyurea as first-line therapy. Chronic transfusion therapy for patients who are not candidates for or responsive to hydroxyurea is noted as a "weak recommendation."

For those with RHC-confirmed pulmonary hypertension, venous thromboembolism, and no additional risk factors for hemorrhage, indefinite – not limited – anticoagulant therapy is recommended.

For patients with either an elevated TRV or an elevated NT-pro-BNP level, the guidelines strongly recommend against pulmonary hypertensive–specific therapies such as prostanoid, endothelin-receptor antagonist, and phosphodiesterase-5 inhibitor therapy.

The same guidance was given for patients who have RHC-confirmed PH.

While the guidelines recommend against targeted therapies for RHC-confirmed pulmonary hypertension, a trial of either a prostanoid or an endothelin-receptor antagonist is recommended for patients with confirmed PH and elevated pulmonary vascular resistance, normal pulmonary capillary wedge pressure, and related symptoms. These patients should not be given phosphodiesterase-5 inhibitor therapy as first-line treatment.

The lack of both large-scale clinical trials in this population and integrated standards of care limit the guidelines’ effect, Dr. Elizabeth S. Klings, who chaired the guidelines committee, noted in a written statement.

"Management of [these patients] will ultimately be a collaborative effort including adult and pediatric pulmonologists, cardiologists, and hematologists," added Dr. Klings of the department of medicine at Boston University.

Dr. Klings receives support from NIH grant R21HL107993.

Dr. Susan Millard, FCCP, comments: The guidelines are a breath of fresh air. I feel they are very well thought out. More research needs to be done on the therapies for pulmonary hypertension, but the authors of these guidelines admit that there is a paucity of data in this area.

In addition, more collaboration is needed between our pulmonary, hematology, oncology, and cardiology specialties. Pulmonologists do not perform right heart catheterizations, but when we ask cardiologists about pulmonary hypertension concerns, we regularly get shot down by the ones who feel that echocardiograms are sufficient to look for this problem. Yet when we want help managing these patients, they don’t want to do that either because it is pulmonary hypertension. You need a dedicated group of people locally to workup these patients.

There are not many experienced pulmonary hypertension centers easily accessible for both adult and pediatric patient referrals. It is difficult, for example, to refer patients out of state and get it approved by insurance companies.

Dr. Susan Millard is a pediatric pulmonologist, Helen DeVos Children’s Hospital, Grand Rapids, Mich.; and CHEST board member.

[email protected]

The first treatment guidelines developed for pulmonary hypertension in sickle cell disease are now available from the American Thoracic Society.

Because more effective treatments have extended the lives of patients with the disease, their risk of mortality from pulmonary hypertension and elevated tricuspid regurgitant jet velocity has increased. Until now, however, there has been no standardized approach for identifying and managing these conditions.

The guidelines are published in the March 15 issue of the American Journal of Respiratory Critical Care Medicine (doi: 10.1164/rccm.201401-0065ST).

The multidisciplinary committee that wrote the guidelines defined mortality risk as a tricuspid regurgitant velocity (TRV) of at least 2.5 m/second; an N-terminal pro-brain natriuretic peptide (NT-pro-BNP) level of at least 160 pg/mL; or pulmonary hypertension (PH) confirmed by a right heart catheterization (RHC).

Patients with elevated mortality risk should be treated with hydroxyurea as first-line therapy. Chronic transfusion therapy for patients who are not candidates for or responsive to hydroxyurea is noted as a "weak recommendation."

For those with RHC-confirmed pulmonary hypertension, venous thromboembolism, and no additional risk factors for hemorrhage, indefinite – not limited – anticoagulant therapy is recommended.

For patients with either an elevated TRV or an elevated NT-pro-BNP level, the guidelines strongly recommend against pulmonary hypertensive–specific therapies such as prostanoid, endothelin-receptor antagonist, and phosphodiesterase-5 inhibitor therapy.

The same guidance was given for patients who have RHC-confirmed PH.

While the guidelines recommend against targeted therapies for RHC-confirmed pulmonary hypertension, a trial of either a prostanoid or an endothelin-receptor antagonist is recommended for patients with confirmed PH and elevated pulmonary vascular resistance, normal pulmonary capillary wedge pressure, and related symptoms. These patients should not be given phosphodiesterase-5 inhibitor therapy as first-line treatment.

The lack of both large-scale clinical trials in this population and integrated standards of care limit the guidelines’ effect, Dr. Elizabeth S. Klings, who chaired the guidelines committee, noted in a written statement.

"Management of [these patients] will ultimately be a collaborative effort including adult and pediatric pulmonologists, cardiologists, and hematologists," added Dr. Klings of the department of medicine at Boston University.

Dr. Klings receives support from NIH grant R21HL107993.

Dr. Susan Millard, FCCP, comments: The guidelines are a breath of fresh air. I feel they are very well thought out. More research needs to be done on the therapies for pulmonary hypertension, but the authors of these guidelines admit that there is a paucity of data in this area.

In addition, more collaboration is needed between our pulmonary, hematology, oncology, and cardiology specialties. Pulmonologists do not perform right heart catheterizations, but when we ask cardiologists about pulmonary hypertension concerns, we regularly get shot down by the ones who feel that echocardiograms are sufficient to look for this problem. Yet when we want help managing these patients, they don’t want to do that either because it is pulmonary hypertension. You need a dedicated group of people locally to workup these patients.

There are not many experienced pulmonary hypertension centers easily accessible for both adult and pediatric patient referrals. It is difficult, for example, to refer patients out of state and get it approved by insurance companies.

Dr. Susan Millard is a pediatric pulmonologist, Helen DeVos Children’s Hospital, Grand Rapids, Mich.; and CHEST board member.

[email protected]

Researchers have successfully engineered human tissue from autologous tissue for the reconstruction of nasal alar lobules in one first-in-human trial while investigators in separate study were able to engineer and implant vaginas in young women with congenital aplagia.

The results move human tissue engineering closer to one day becoming mainstream health care, according to an editorial accompanying the two studies published in the Lancet.

© Ivan Martin

"Progression from first-in-human experiences in only a few patients ... to a full integration into health systems involves many steps, and is often an uphill struggle," according to Dr. Martin A. Birchall, professor of laryngology at University College London, and Alexander M. Seifalian, Ph.D., professor of nanotechnology and regenerative medicine at the same institution, in an editorial on both studies (Lancet 2014 April 11 [doi: 10.1016/S0140-6736(14)60533-X]). However, because the human tissue engineering field is not unique in its need for larger trials and long-term follow-up to show efficacy in larger patient cohorts, further progress might be facilitated by the fact that "many countries now have large translational income streams, engaged biotech companies, and streamlined regulatory processes that might lower these barriers."

The two studies achieve three important milestones in the field of human tissue engineering, according to Dr. Birchall and Dr. Seifalian. They provide evidence that when biological scaffolds with or without cells are placed in the body, native tissue will grow in its place rather than scar tissue. And this can be achieved in pediatric populations.

The third – and possibly most important – milestone is that implanting large-scale engineered tissue is possible, since in situ angiogenesis was found to be adequate in the vaginal vaults constructed and implanted in the second study, wrote Dr. Birchall and Dr. Seifalian. The findings help to "edge tissue engineering towards the mainstream of organ and tissue replacement needs," they said.

For the nasal reconstruction study, researchers used nasal septum cartilage cells from each of the five study participants to grow and shape cartilage grafts, which were then implanted in the respective patients whose alar lobule had been badly damaged by treatment for nonmelanoma skin cancer, according to Dr. Ilario Fulco and his associates in the departments of surgery and regenerative medicine at the University of Basel in Switzerland (Lancet 2014 April 11 [doi: 10.1016/S0140-6736(14)60544-4]).

Growth factor was used to expand the cells over the course of 2 weeks before they were seeded onto collagen membranes and cultured for another 2 weeks, until they grew into cartilage that was 40 times larger than the original biopsy. The cartilage was then shaped to fit the defect and was implanted.

At 1-year follow-up, all five reconstruction recipients reported they were satisfied with their ability to breathe, were happy with the look of their nose, and had not experienced any relevant adverse events.

"The engineered cartilage had clinical results comparable to the gold standard cartilage graft surgery," said Dr. Fulco. "This new technique could help the body accept the new tissue more easily, and improve the stability and functionality of the nostril."

Wake Forest Institute for Regenerative Medicine

Currently, for this kind of reconstruction, grafts are made using cartilage excised from the nasal septum, ear, or rib, which is painful and requires additional surgery, often fraught with complications.

The second study dealt with four female patients, who had congenital vaginal aplagia. The investigators fashioned vaginal vaults from smooth muscle and vaginal epithelial cells taken from the patients’ own vulvar tissues and grown on vagina-shaped biodegradable scaffolds. The engineered vaults then were transplanted into each of the young women, who were aged 13-18 years at the time of surgery, according to Dr. Atlántida M. Raya-Rivera, a professor of bioengineering at the Metropolitan Autonomous University, Mexico City, and her associates.

At 8 years’ follow-up, all the vaginas were determined to be structurally and functionally normal. At that time, all four women reported that they were sexually active; were satisfied with their desire, arousal, lubrication, and orgasm; and did not experience pain during intercourse.

"Yearly tissue biopsy samples show that the reconstructed tissue is histologically and functionally similar to normal vaginal tissue," noted Dr. Raya-Rivera. The results mean that this method is a "viable" alternative to current vaginal reconstructive techniques because it requires only a small tissue sample and can help avoid the complications inherent when using nonvaginal tissue such as from the large intestine or skin; the complications include infections or grafts that shrink, she noted (Lancet 2014 April 11 [doi: 10.1016/S0140-6736(14)60542-0]).

Wake Forest Institute for Regenerative Medicine

"With the syndrome these women have, both the uterus and vagina can be missing or malformed. In this study, two of the patients were born with uteri, and there is potential for them to have children," Dr. Raya-Rivera said in an interview.

In both studies, the authors wrote respectively that further "fundamental studies" and "clinical experience" are warranted. Dr. Birchall and Dr. Seifalian concluded that the two studies show that "disruptive innovation might be nigh."

Funding for the study led by Dr. Fulco was provided by the department of surgery, University Hospital Basel, and Krebsliga bedier Basel; funding for the study led by Dr. Raya-Rivera was provided by Wake Forest University and Hospital Infantil de Mexico Federico Gomez. None of the researchers associated with the studies or the commentary reported having any relevant disclosures.

[email protected]

On Twitter @whitneymcknight

Researchers have successfully engineered human tissue from autologous tissue for the reconstruction of nasal alar lobules in one first-in-human trial while investigators in separate study were able to engineer and implant vaginas in young women with congenital aplagia.

The results move human tissue engineering closer to one day becoming mainstream health care, according to an editorial accompanying the two studies published in the Lancet.

© Ivan Martin

"Progression from first-in-human experiences in only a few patients ... to a full integration into health systems involves many steps, and is often an uphill struggle," according to Dr. Martin A. Birchall, professor of laryngology at University College London, and Alexander M. Seifalian, Ph.D., professor of nanotechnology and regenerative medicine at the same institution, in an editorial on both studies (Lancet 2014 April 11 [doi: 10.1016/S0140-6736(14)60533-X]). However, because the human tissue engineering field is not unique in its need for larger trials and long-term follow-up to show efficacy in larger patient cohorts, further progress might be facilitated by the fact that "many countries now have large translational income streams, engaged biotech companies, and streamlined regulatory processes that might lower these barriers."

The two studies achieve three important milestones in the field of human tissue engineering, according to Dr. Birchall and Dr. Seifalian. They provide evidence that when biological scaffolds with or without cells are placed in the body, native tissue will grow in its place rather than scar tissue. And this can be achieved in pediatric populations.

The third – and possibly most important – milestone is that implanting large-scale engineered tissue is possible, since in situ angiogenesis was found to be adequate in the vaginal vaults constructed and implanted in the second study, wrote Dr. Birchall and Dr. Seifalian. The findings help to "edge tissue engineering towards the mainstream of organ and tissue replacement needs," they said.

For the nasal reconstruction study, researchers used nasal septum cartilage cells from each of the five study participants to grow and shape cartilage grafts, which were then implanted in the respective patients whose alar lobule had been badly damaged by treatment for nonmelanoma skin cancer, according to Dr. Ilario Fulco and his associates in the departments of surgery and regenerative medicine at the University of Basel in Switzerland (Lancet 2014 April 11 [doi: 10.1016/S0140-6736(14)60544-4]).

Growth factor was used to expand the cells over the course of 2 weeks before they were seeded onto collagen membranes and cultured for another 2 weeks, until they grew into cartilage that was 40 times larger than the original biopsy. The cartilage was then shaped to fit the defect and was implanted.

At 1-year follow-up, all five reconstruction recipients reported they were satisfied with their ability to breathe, were happy with the look of their nose, and had not experienced any relevant adverse events.

"The engineered cartilage had clinical results comparable to the gold standard cartilage graft surgery," said Dr. Fulco. "This new technique could help the body accept the new tissue more easily, and improve the stability and functionality of the nostril."

Wake Forest Institute for Regenerative Medicine

Currently, for this kind of reconstruction, grafts are made using cartilage excised from the nasal septum, ear, or rib, which is painful and requires additional surgery, often fraught with complications.

The second study dealt with four female patients, who had congenital vaginal aplagia. The investigators fashioned vaginal vaults from smooth muscle and vaginal epithelial cells taken from the patients’ own vulvar tissues and grown on vagina-shaped biodegradable scaffolds. The engineered vaults then were transplanted into each of the young women, who were aged 13-18 years at the time of surgery, according to Dr. Atlántida M. Raya-Rivera, a professor of bioengineering at the Metropolitan Autonomous University, Mexico City, and her associates.

At 8 years’ follow-up, all the vaginas were determined to be structurally and functionally normal. At that time, all four women reported that they were sexually active; were satisfied with their desire, arousal, lubrication, and orgasm; and did not experience pain during intercourse.

"Yearly tissue biopsy samples show that the reconstructed tissue is histologically and functionally similar to normal vaginal tissue," noted Dr. Raya-Rivera. The results mean that this method is a "viable" alternative to current vaginal reconstructive techniques because it requires only a small tissue sample and can help avoid the complications inherent when using nonvaginal tissue such as from the large intestine or skin; the complications include infections or grafts that shrink, she noted (Lancet 2014 April 11 [doi: 10.1016/S0140-6736(14)60542-0]).

Wake Forest Institute for Regenerative Medicine

"With the syndrome these women have, both the uterus and vagina can be missing or malformed. In this study, two of the patients were born with uteri, and there is potential for them to have children," Dr. Raya-Rivera said in an interview.

In both studies, the authors wrote respectively that further "fundamental studies" and "clinical experience" are warranted. Dr. Birchall and Dr. Seifalian concluded that the two studies show that "disruptive innovation might be nigh."

Funding for the study led by Dr. Fulco was provided by the department of surgery, University Hospital Basel, and Krebsliga bedier Basel; funding for the study led by Dr. Raya-Rivera was provided by Wake Forest University and Hospital Infantil de Mexico Federico Gomez. None of the researchers associated with the studies or the commentary reported having any relevant disclosures.

[email protected]

On Twitter @whitneymcknight

Researchers have successfully engineered human tissue from autologous tissue for the reconstruction of nasal alar lobules in one first-in-human trial while investigators in separate study were able to engineer and implant vaginas in young women with congenital aplagia.

The results move human tissue engineering closer to one day becoming mainstream health care, according to an editorial accompanying the two studies published in the Lancet.

© Ivan Martin

"Progression from first-in-human experiences in only a few patients ... to a full integration into health systems involves many steps, and is often an uphill struggle," according to Dr. Martin A. Birchall, professor of laryngology at University College London, and Alexander M. Seifalian, Ph.D., professor of nanotechnology and regenerative medicine at the same institution, in an editorial on both studies (Lancet 2014 April 11 [doi: 10.1016/S0140-6736(14)60533-X]). However, because the human tissue engineering field is not unique in its need for larger trials and long-term follow-up to show efficacy in larger patient cohorts, further progress might be facilitated by the fact that "many countries now have large translational income streams, engaged biotech companies, and streamlined regulatory processes that might lower these barriers."

The two studies achieve three important milestones in the field of human tissue engineering, according to Dr. Birchall and Dr. Seifalian. They provide evidence that when biological scaffolds with or without cells are placed in the body, native tissue will grow in its place rather than scar tissue. And this can be achieved in pediatric populations.

The third – and possibly most important – milestone is that implanting large-scale engineered tissue is possible, since in situ angiogenesis was found to be adequate in the vaginal vaults constructed and implanted in the second study, wrote Dr. Birchall and Dr. Seifalian. The findings help to "edge tissue engineering towards the mainstream of organ and tissue replacement needs," they said.

For the nasal reconstruction study, researchers used nasal septum cartilage cells from each of the five study participants to grow and shape cartilage grafts, which were then implanted in the respective patients whose alar lobule had been badly damaged by treatment for nonmelanoma skin cancer, according to Dr. Ilario Fulco and his associates in the departments of surgery and regenerative medicine at the University of Basel in Switzerland (Lancet 2014 April 11 [doi: 10.1016/S0140-6736(14)60544-4]).

Growth factor was used to expand the cells over the course of 2 weeks before they were seeded onto collagen membranes and cultured for another 2 weeks, until they grew into cartilage that was 40 times larger than the original biopsy. The cartilage was then shaped to fit the defect and was implanted.

At 1-year follow-up, all five reconstruction recipients reported they were satisfied with their ability to breathe, were happy with the look of their nose, and had not experienced any relevant adverse events.

"The engineered cartilage had clinical results comparable to the gold standard cartilage graft surgery," said Dr. Fulco. "This new technique could help the body accept the new tissue more easily, and improve the stability and functionality of the nostril."

Wake Forest Institute for Regenerative Medicine

Currently, for this kind of reconstruction, grafts are made using cartilage excised from the nasal septum, ear, or rib, which is painful and requires additional surgery, often fraught with complications.

The second study dealt with four female patients, who had congenital vaginal aplagia. The investigators fashioned vaginal vaults from smooth muscle and vaginal epithelial cells taken from the patients’ own vulvar tissues and grown on vagina-shaped biodegradable scaffolds. The engineered vaults then were transplanted into each of the young women, who were aged 13-18 years at the time of surgery, according to Dr. Atlántida M. Raya-Rivera, a professor of bioengineering at the Metropolitan Autonomous University, Mexico City, and her associates.

At 8 years’ follow-up, all the vaginas were determined to be structurally and functionally normal. At that time, all four women reported that they were sexually active; were satisfied with their desire, arousal, lubrication, and orgasm; and did not experience pain during intercourse.

"Yearly tissue biopsy samples show that the reconstructed tissue is histologically and functionally similar to normal vaginal tissue," noted Dr. Raya-Rivera. The results mean that this method is a "viable" alternative to current vaginal reconstructive techniques because it requires only a small tissue sample and can help avoid the complications inherent when using nonvaginal tissue such as from the large intestine or skin; the complications include infections or grafts that shrink, she noted (Lancet 2014 April 11 [doi: 10.1016/S0140-6736(14)60542-0]).

Wake Forest Institute for Regenerative Medicine

"With the syndrome these women have, both the uterus and vagina can be missing or malformed. In this study, two of the patients were born with uteri, and there is potential for them to have children," Dr. Raya-Rivera said in an interview.

In both studies, the authors wrote respectively that further "fundamental studies" and "clinical experience" are warranted. Dr. Birchall and Dr. Seifalian concluded that the two studies show that "disruptive innovation might be nigh."

Funding for the study led by Dr. Fulco was provided by the department of surgery, University Hospital Basel, and Krebsliga bedier Basel; funding for the study led by Dr. Raya-Rivera was provided by Wake Forest University and Hospital Infantil de Mexico Federico Gomez. None of the researchers associated with the studies or the commentary reported having any relevant disclosures.

[email protected]

On Twitter @whitneymcknight

Ingenol mebutate gel for the treatment of actinic keratosis is an effective adjunct therapy to cryosurgery, and the absence of attendant serious local reactions can increase compliance, based on data from more than 100 patients.

"By the time you do see a reaction, because the treatment time is only 2 or 3 days, the patient is done applying it, so the compliance is increased," Dr. Miriam S. Bettencourt, a community-based dermatologist in Las Vegas.

Dr. Bettencourt conducted her chart review of 135 patients "out of curiosity," she said in an interview. She found that at follow-ups of 1-4 months, nearly 100% of patients who received ingenol mebutate gel as an adjunctive therapy with cryosurgery for AK on the face had clearance rates of at least 75%. In addition, clearance of at least 75% was seen in 89% of patients treated on the scalp and 84% of patients treated on the forearms and/or hands. Most of the patients were male (88%), ranging in age from 39 to 85 years, with a median age of 70 years.

"One of the questions I had was, in a clinical practice, whether [the gel] mimics the clinical trial results that showed only a mild to moderate reaction," said Dr. Bettencourt. Common side affects of topical AK treatments include erythema, flaking, scaling, and crusting. In more extreme cases, vesicular pustulation is possible.

"I found that patients really didn’t complain of pain," said Dr. Bettencourt. "Most local skin reactions were resolved within a week." She prescribed moisturizers for patients whose reactions were moderate.

The findings were published in the March issue of the Journal of Drugs in Dermatology (J. Drugs Dermatol. 2014:13:269-73).

The results negate the common tenet that the more severe the reaction to the topical, the deeper the healing of the AK, said Dr. Bettencourt. "The degree of reaction does not correlate with the level of improvement. We used to think so, but that’s not true." The results show that the reaction can be "tolerable" and short lived despite dramatic results, she said.

The gel was approved by the Food and Drug Administration for use in the United States in early 2012 under the name Picato (LEO Pharmaceuticals). Unlike other topicals that must be applied over the course of weeks, the gel is applied for 2 or 3 days, with side effects lasting much of that time.

In addition to increased compliance, Dr. Bettencourt said she also measured whether her off-label "creativity" such as prescribing higher concentrations for the scalp and instructing patients to spread the gel over larger areas, yielded worthwhile results.

"I found that, especially for the face, you can spread the medication without jeopardizing the efficacy," said Dr. Bettencourt. However, when the gel is applied to the scalp, "You lose a little bit of the efficacy, because that’s a lot to cover using the prescribed three tubes, but you still get good results."

In addition, Dr. Bettencourt said that the gel offers cosmetic advantages over other treatments such as the topical imiquimod or photodynamic therapy because there is no hypo- or hyperpigmentation. And, because there is no photosensitivity associated with the gel, Dr. Bettencourt said she can offer it year-round.

She still prescribes other topicals, however, because not all patients’ insurance plans cover the gel. Medicare, does cover the gel, she noted, but only if the patient has a supplemental insurance policy.

While the study was unsponsored, and Dr. Bettencourt had no financial conflicts to disclose, she noted that she has shared her data with LEO Pharmaceuticals, the gel’s manufacturer. "They were thrilled, and helped me to put the results together," she said.

[email protected]

On Twitter @whitneymcknight

Ingenol mebutate gel for the treatment of actinic keratosis is an effective adjunct therapy to cryosurgery, and the absence of attendant serious local reactions can increase compliance, based on data from more than 100 patients.

"By the time you do see a reaction, because the treatment time is only 2 or 3 days, the patient is done applying it, so the compliance is increased," Dr. Miriam S. Bettencourt, a community-based dermatologist in Las Vegas.

Dr. Bettencourt conducted her chart review of 135 patients "out of curiosity," she said in an interview. She found that at follow-ups of 1-4 months, nearly 100% of patients who received ingenol mebutate gel as an adjunctive therapy with cryosurgery for AK on the face had clearance rates of at least 75%. In addition, clearance of at least 75% was seen in 89% of patients treated on the scalp and 84% of patients treated on the forearms and/or hands. Most of the patients were male (88%), ranging in age from 39 to 85 years, with a median age of 70 years.

"One of the questions I had was, in a clinical practice, whether [the gel] mimics the clinical trial results that showed only a mild to moderate reaction," said Dr. Bettencourt. Common side affects of topical AK treatments include erythema, flaking, scaling, and crusting. In more extreme cases, vesicular pustulation is possible.

"I found that patients really didn’t complain of pain," said Dr. Bettencourt. "Most local skin reactions were resolved within a week." She prescribed moisturizers for patients whose reactions were moderate.

The findings were published in the March issue of the Journal of Drugs in Dermatology (J. Drugs Dermatol. 2014:13:269-73).

The results negate the common tenet that the more severe the reaction to the topical, the deeper the healing of the AK, said Dr. Bettencourt. "The degree of reaction does not correlate with the level of improvement. We used to think so, but that’s not true." The results show that the reaction can be "tolerable" and short lived despite dramatic results, she said.

The gel was approved by the Food and Drug Administration for use in the United States in early 2012 under the name Picato (LEO Pharmaceuticals). Unlike other topicals that must be applied over the course of weeks, the gel is applied for 2 or 3 days, with side effects lasting much of that time.

In addition to increased compliance, Dr. Bettencourt said she also measured whether her off-label "creativity" such as prescribing higher concentrations for the scalp and instructing patients to spread the gel over larger areas, yielded worthwhile results.

"I found that, especially for the face, you can spread the medication without jeopardizing the efficacy," said Dr. Bettencourt. However, when the gel is applied to the scalp, "You lose a little bit of the efficacy, because that’s a lot to cover using the prescribed three tubes, but you still get good results."

In addition, Dr. Bettencourt said that the gel offers cosmetic advantages over other treatments such as the topical imiquimod or photodynamic therapy because there is no hypo- or hyperpigmentation. And, because there is no photosensitivity associated with the gel, Dr. Bettencourt said she can offer it year-round.

She still prescribes other topicals, however, because not all patients’ insurance plans cover the gel. Medicare, does cover the gel, she noted, but only if the patient has a supplemental insurance policy.

While the study was unsponsored, and Dr. Bettencourt had no financial conflicts to disclose, she noted that she has shared her data with LEO Pharmaceuticals, the gel’s manufacturer. "They were thrilled, and helped me to put the results together," she said.

[email protected]

On Twitter @whitneymcknight

Ingenol mebutate gel for the treatment of actinic keratosis is an effective adjunct therapy to cryosurgery, and the absence of attendant serious local reactions can increase compliance, based on data from more than 100 patients.

"By the time you do see a reaction, because the treatment time is only 2 or 3 days, the patient is done applying it, so the compliance is increased," Dr. Miriam S. Bettencourt, a community-based dermatologist in Las Vegas.

Dr. Bettencourt conducted her chart review of 135 patients "out of curiosity," she said in an interview. She found that at follow-ups of 1-4 months, nearly 100% of patients who received ingenol mebutate gel as an adjunctive therapy with cryosurgery for AK on the face had clearance rates of at least 75%. In addition, clearance of at least 75% was seen in 89% of patients treated on the scalp and 84% of patients treated on the forearms and/or hands. Most of the patients were male (88%), ranging in age from 39 to 85 years, with a median age of 70 years.

"One of the questions I had was, in a clinical practice, whether [the gel] mimics the clinical trial results that showed only a mild to moderate reaction," said Dr. Bettencourt. Common side affects of topical AK treatments include erythema, flaking, scaling, and crusting. In more extreme cases, vesicular pustulation is possible.

"I found that patients really didn’t complain of pain," said Dr. Bettencourt. "Most local skin reactions were resolved within a week." She prescribed moisturizers for patients whose reactions were moderate.

The findings were published in the March issue of the Journal of Drugs in Dermatology (J. Drugs Dermatol. 2014:13:269-73).

The results negate the common tenet that the more severe the reaction to the topical, the deeper the healing of the AK, said Dr. Bettencourt. "The degree of reaction does not correlate with the level of improvement. We used to think so, but that’s not true." The results show that the reaction can be "tolerable" and short lived despite dramatic results, she said.

The gel was approved by the Food and Drug Administration for use in the United States in early 2012 under the name Picato (LEO Pharmaceuticals). Unlike other topicals that must be applied over the course of weeks, the gel is applied for 2 or 3 days, with side effects lasting much of that time.

In addition to increased compliance, Dr. Bettencourt said she also measured whether her off-label "creativity" such as prescribing higher concentrations for the scalp and instructing patients to spread the gel over larger areas, yielded worthwhile results.

"I found that, especially for the face, you can spread the medication without jeopardizing the efficacy," said Dr. Bettencourt. However, when the gel is applied to the scalp, "You lose a little bit of the efficacy, because that’s a lot to cover using the prescribed three tubes, but you still get good results."

In addition, Dr. Bettencourt said that the gel offers cosmetic advantages over other treatments such as the topical imiquimod or photodynamic therapy because there is no hypo- or hyperpigmentation. And, because there is no photosensitivity associated with the gel, Dr. Bettencourt said she can offer it year-round.

She still prescribes other topicals, however, because not all patients’ insurance plans cover the gel. Medicare, does cover the gel, she noted, but only if the patient has a supplemental insurance policy.

While the study was unsponsored, and Dr. Bettencourt had no financial conflicts to disclose, she noted that she has shared her data with LEO Pharmaceuticals, the gel’s manufacturer. "They were thrilled, and helped me to put the results together," she said.

[email protected]

On Twitter @whitneymcknight

WASHINGTON – Payers will cover obesity treatment, people will suffer less from cardiometabolic disease, and the economy will be less burdened by the costs of untreated complications and lost productivity related to obesity. That’s the vision of Dr. Jeffrey I. Mechanick and his colleagues at the American Association of Clinical Endocrinologists and the American College of Endocrinology, who’ve jointly released a consensus statement on obesity treatment.

In a video interview, AACE president Dr. Mechanick, discusses why payers haven’t covered obesity treatment as a matter of course in the past, but why they may going forward, and how a growing impatience with a fractured approach to obesity care spurred the AACE and ACE to create a cross-disciplinary conference that also included members of the nonmedical professions involved in obesity care.

"By limiting the conference just to the biomedical model, we wouldn’t have access to this type of information," Dr. Mechanick also of the Icahn School of Medicine at Mount Sinai, New York, said in a press conference at the meeting. "We learned that different stakeholders require different levels of evidence."

The value of measuring body mass index is a controversial topic in obesity treatment. Dr. Mechanick explains why BMI will still be part of the developing ACCE/ACE standards of care and how it will be incorporated with other factors.

[email protected]

WASHINGTON – Payers will cover obesity treatment, people will suffer less from cardiometabolic disease, and the economy will be less burdened by the costs of untreated complications and lost productivity related to obesity. That’s the vision of Dr. Jeffrey I. Mechanick and his colleagues at the American Association of Clinical Endocrinologists and the American College of Endocrinology, who’ve jointly released a consensus statement on obesity treatment.

In a video interview, AACE president Dr. Mechanick, discusses why payers haven’t covered obesity treatment as a matter of course in the past, but why they may going forward, and how a growing impatience with a fractured approach to obesity care spurred the AACE and ACE to create a cross-disciplinary conference that also included members of the nonmedical professions involved in obesity care.

"By limiting the conference just to the biomedical model, we wouldn’t have access to this type of information," Dr. Mechanick also of the Icahn School of Medicine at Mount Sinai, New York, said in a press conference at the meeting. "We learned that different stakeholders require different levels of evidence."

The value of measuring body mass index is a controversial topic in obesity treatment. Dr. Mechanick explains why BMI will still be part of the developing ACCE/ACE standards of care and how it will be incorporated with other factors.

[email protected]

WASHINGTON – Payers will cover obesity treatment, people will suffer less from cardiometabolic disease, and the economy will be less burdened by the costs of untreated complications and lost productivity related to obesity. That’s the vision of Dr. Jeffrey I. Mechanick and his colleagues at the American Association of Clinical Endocrinologists and the American College of Endocrinology, who’ve jointly released a consensus statement on obesity treatment.

In a video interview, AACE president Dr. Mechanick, discusses why payers haven’t covered obesity treatment as a matter of course in the past, but why they may going forward, and how a growing impatience with a fractured approach to obesity care spurred the AACE and ACE to create a cross-disciplinary conference that also included members of the nonmedical professions involved in obesity care.

"By limiting the conference just to the biomedical model, we wouldn’t have access to this type of information," Dr. Mechanick also of the Icahn School of Medicine at Mount Sinai, New York, said in a press conference at the meeting. "We learned that different stakeholders require different levels of evidence."

The value of measuring body mass index is a controversial topic in obesity treatment. Dr. Mechanick explains why BMI will still be part of the developing ACCE/ACE standards of care and how it will be incorporated with other factors.

[email protected]