Dr. Levy Co-Authors Manuscript in NEJM

Jerrold H. Levy, MD, FAHA, FCCMCardiac surgery with the use of cardiopulmonary bypass is a common procedure, with more than one million operations performed in the United States and Europe each year. Studies show that 3 to 14 percent of patients who undergo this type of procedure experience a complication known as the low cardiac output syndrome; prevention of this syndrome is an important therapeutic objective for the improvement of outcomes in this patient population.

Duke Anesthesiology’s Dr. Jerrold Levy co-authored an article published on March 19, 2017 in the New England Journal of Medicine, titled “Levosimendan in Patients with Left Ventricular Dysfunction Undergoing Cardiac Surgery.”

Levosimendan is an inotropic agent that has been shown in small studies to prevent or treat the low cardiac output syndrome after cardiac surgery. In a multicenter, randomized, placebo-controlled, phase 3 trial, investigators evaluated the efficacy and safety of levosimendan in patients with a left ventricular ejection fraction of 35 percent or less who were undergoing cardiac surgery with the use of cardiopulmonary bypass.

The authors concluded that prophylactic levosimendan did not result in a rate of the short-term composite end point of death, renal-replacement therapy, perioperative myocardial infarction, or use of a mechanical cardiac assist device that was lower than the rate with placebo among patients with a reduced left ventricular ejection fraction who were undergoing cardiac surgery with the use of cardiopulmonary bypass.

This study was presented at the Late Breaking Clinical Trials Session of the American College of Cardiology on March 19, 2017.

Chris KeithDr. Levy Co-Authors Manuscript in NEJM
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A Breath of Fresh Air for Eucalyptus Research

Left to Right: The researchers who work in Dr. Jordt’s lab: Maya Kaelberer, BS; Satya Achanta, DVM, PhD; Dr. Sven-Eric Jordt; Anabel Caceres, PhD; and Boyi Liu, MD

Left to Right: The researchers who work in Dr. Jordt’s lab: Maya Kaelberer, BS; Satya Achanta, DVM, PhD; Dr. Sven-Eric Jordt; Anabel Caceres, PhD; and Boyi Liu, MD

A new study by Dr. Sven-Eric Jordt’s Chemical Sensing, Pain and Inflammation Research Laboratory at Duke Anesthesiology identifies the mechanism through which eucalyptol, the active ingredient in eucalyptus oil, suppresses inflammation.

Eucalyptol, a cooling natural product, is licensed as an over-the-counter treatment in some countries, either as a pill, in lozenges, as an oil for inhalation, or as a cream for pain treatment. Eucalyptol is also found in sage, rosemary and tea tree oil, all used for treatment of inflammation. Clinical trials suggested that eucalyptol is effective as a supportive treatment in bronchitis and chronic obstructive pulmonary disorder, a lung disease caused by smoking. However, eucalyptol’s mechanism of action has remained unclear, and studies in mice and rats required much higher amounts of eucalyptol to be effective than in the human studies.

This study, titled “TRPM8 mediates the anti-inflammatory effects of eucalyptol,” is published in the February 2017 issue of the British Journal of Pharmacology. It identifies a target for eucalyptol and explains why eucalyptol might be more effective in humans.

“We identified TRPM8 as eucalyptol’s target to treat skin and lung inflammation” says Dr. Jordt. “TRPM8 is a sensor for cooling in temperature-sensing nerves in the body. Eucalyptol mimics the sensation of cooling that is known to have anti-inflammatory effects. We also found that TRPM8 in humans is more sensitive to eucalyptol than in the mouse or rat. This may explain why lower amounts of eucalyptol were effective in the published human trials.”

This Duke study provides a rationale for additional human studies testing this widely-used natural product in other inflammatory conditions, and for the development of novel eucalyptol-based drugs. Duke Anesthesiology researchers, Ana Caceres, Boyi Liu, Sairam Jabba and Satya Achanta, contributed to the study. Dr. Jordt is an associate professor in anesthesiology and a faculty member of the department’s newly established Center for Translational Pain Medicine. His research interests focus on the mechanisms that enable humans and animals to sense touch, pain and irritation.

Chris KeithA Breath of Fresh Air for Eucalyptus Research
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Acupuncture Proves to be Integrative Therapy for Bell’s Palsy

Jongbae Jay Park, PhD, LAcBell’s palsy is a nerve disorder that causes sudden paralysis of unilateral facial muscles. Studies show that 70 percent of those affected will completely recover, but 15 percent will go on to experience permanent damage. This prolonged paralysis and asymmetry can affect psychological and social behaviors which can undermine patients’ quality of life.

Duke Anesthesiology’s Dr. Jongbae Jay Park is a co-author of a newly published study in the February 2017 issue of Complementary Therapies in Clinical Practice, titled “A close look at an integrative treatment package for Bell’s palsy in Korea.”

As the study notes, Bell’s palsy patients experience significantly higher degrees of distress and report that they feel helpless when doctors don’t acknowledge problems other than facial disfigurement. While clinical guidelines in conventional medicine don’t yet recommend acupuncture treatment for Bell’s palsy due to poor study design and reporting, acupuncture is one of the most sought after treatments for this condition in many Asian countries.

The authors conclude that the lack of awareness, dearth of knowledge in patient needs, and shortage of treatment options available during the recuperation months increase the need and significance of an integrative treatment program for a well-rounded overall recovery. While rigorous research is warranted, they highly suggest that it is worth applying integrative medicine, such as acupuncture, to Bell’s palsy patients.

Dr. Park is the director of acupuncture and Asian medicine for Duke Anesthesiology’s Center for Translational Pain Medicine and a pain specialist at Duke Innovative Pain Therapies, located in Raleigh, North Carolina. Learn more about this first-of-its-kind pain practice in Duke Anesthesiology’s 2016 edition of BluePrint magazine.

Chris KeithAcupuncture Proves to be Integrative Therapy for Bell’s Palsy
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