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LOS ANGELES (Nov. 15, 2024) —
Study: Virtual Reality Helps IBS Patients
In an ongoing clinical trial, Cedars-Sinai gives VR headsets and the IBS VR app to patients, who get access to new virtual “treatment rooms” every few days. In the treatment rooms, patients learn relaxation strategies and other tactics to help manage their IBS symptoms.
“We want to raise awareness of the opportunity to think beyond the pill and particularly think about VR,” said Brennan Spiegel, MD, MSHS, director of Health Services Research at Cedars-Sinai and senior author of the study. “IBS is a gut-brain interaction disorder, and we know that calming the nervous system using cognitive behavioral therapy helps keep the gut calm. We want to add IBS VR to the cognitive behavioral therapy toolbox, particularly because IBS VR is more easily accessible to all patients. We are bringing the clinic to the patient.”
The app-based treatment will now undergo testing funded by a $1 million, three-year grant from the National Institutes of Health.
Cancer: Improving Drug-Radiotherapy Clinical Trials
Several major oncology groups, led by Cedars-Sinai Cancer investigators, have published a white paper in The Lancet Oncology recommending clinical trial designs that can improve testing of new drug-radiotherapy combinations and speed the regulatory approval of these treatments for cancer patients.
Numerous laboratory studies have shown that drug-radiotherapy combinations increase the effectiveness of cancer therapy, but clinical trials in humans have been less successful. Only one new non-chemotherapeutic drug has been approved by the Food and Drug Administration for concurrent treatment with radiation.
“One of the biggest reasons for this is that early-phase clinical trials investigating these combinations are challenging to design and implement,” said Zachary Zumsteg, MD, associate professor of Radiation Oncology and Biomedical Sciences at Cedars-Sinai and first author of the paper. “Since many side effects of radiotherapy occur after treatment is completed, it can take longer to determine the appropriate dose of treatment. Testing of drug-radiation therapy combinations often occurs in patients receiving first-line therapy, leading to less tolerance of unexpected side effects. And because radiotherapy affects each organ differently, new drug-radiotherapy combinations must be tested separately for cancers arising in different parts of the body.”
To address these challenges, investigators suggest designing trials that use mathematical models with real-time toxicity data to calculate appropriate doses for each patient, allowing for continuous patient enrollment and making trials more efficient. They also advocate testing multiple drug-radiotherapy combinations simultaneously to limit the number of patients receiving any specific drug-radiotherapy combination at a given time. They note that these trial designs require substantial infrastructure and expertise, making them best suited for implementation in large cooperative group clinical trial networks.
If widely adopted, the authors suggest that these clinical trial designs are more likely to lead to the development of additional safe and effective cancer treatments.
Good Nutrition Prior to Heart Surgery Could Result in Faster Recovery
Older patients with poor nutrition prior to undergoing elective cardiac surgery are more likely than older patients with good nutrition to die within 30 days after surgery, according to a new study by Cedars-Sinai investigators. The findings, published in Anesthesia & Analgesia, suggest doctors could use a tool called the Geriatric Nutritional Risk Index to identify patients who would benefit from changes to their diet.
“This study adds to a growing body of research showing good nutrition is associated with better outcomes after surgery,” said Abirami Kumaresan, MD, assistant professor of Anesthesiology and Cardiac Surgery at Cedars-Sinai and first author of the study. “Doctors and clinical care teams have an opportunity to help patients modify their risk with conversations centered on improvements in diet.”
Investigators reviewed data from patients 65 and older who underwent nonurgent coronary artery bypass grafting or a valve repair or replacement procedure in a single center between July 2011 and March 2022. After adjusting for several factors, the investigators found that low scores on the Geriatric Nutritional Risk Index were associated with 4.8-fold greater odds of in-hospital mortality, 8.7-fold greater odds of 30-day mortality, and 3.7-fold greater odds of needing extended hospital care.
For all patients, the postoperative in-hospital mortality rate was 1.4% and 30-day mortality rate was 5.5%.
Using AI to Analyze Cardiovascular Plaques
Artery-clogging plaque can lead to a heart attack, and artificial intelligence (AI) may help physicians advise patients about their risk, according to a new Cedars-Sinai study.
The study, published in Circulation: Cardiovascular Imaging, details how investigators trained a deep-learning program to look for patterns in a commonly used heart test called computed tomography angiography. The results showed that plaque volumes increased with age and were higher in male patients. Women presented with lower plaque volumes compared to men of the same age. Patients in higher percentiles for plaque volume (which takes into account these differences in age and gender) were more likely to experience a heart attack.
Patients typically have a computed tomography angiography for chest pain. The AI software can measure plaque in the coronary arteries and also provide a percentile score for a patient’s age and gender.
When plaque builds up in the arteries, it can lead to a condition called atherosclerosis, in which arteries harden and narrow. If blood supply to the heart is reduced, a heart attack may result. The condition also can lead to heart failure, stroke and loss of limbs.
“The use of AI to measure coronary plaques will significantly influence clinical practice,” said Damini Dey, PhD, professor of Biomedical Sciences at Cedars-Sinai and corresponding author of the study. “In addition to telling a patient their total plaque volume, it may be easier to understand their heart attack risk from plaque volumes relative to other patients of similar age and sex.”
‘Persistent Cells’ Are Key to Long-Term and Working Memory
The same brain cells that help us keep a phone number in mind long enough to dial it also contribute to storing that number in long-term memory, according to a new study from Cedars-Sinai investigators. The findings, published in the peer-reviewed journal Neuron, could provide a new target for treating memory disorders.
These cells are located in the hippocampus, the brain area affected in the earliest stages of Alzheimer’s disease, the earliest symptoms of which are working memory deficits.
“Working and long-term memory are different types of memory that were previously thought to be supported by different parts of the brain,” said Ueli Rutishauser, PhD, director of Neural Science and Medicine and professor of Neurology, Neurosurgery and Biomedical Sciences at Cedars-Sinai and senior author of the study. “Based on this study and our previous work, we have concluded that the hippocampus, long known to support long-term memory, is often essential for working memory as well. In fact, neurons in the hippocampus that we have named ‘persistently active cells’ are critical for both types of memory. Protecting or restoring these cells could help in treating the devastating effects of memory disorders.”
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