Transactions of the American Clinical and Climatological Association最新文献

The author, Dr. A. Wesley Burks, reflects on his life's work to improve the lives of his patients.

Adrenocortical carcinoma (ACC) is an orphan cancer with 35% five-year survival that has been unchanged for last five decades. Patients often present with severe hypercortisolism or with mass effects. The only Food and Drug Administration (FDA)-approved drug for ACC is mitotane, an insecticide derivative, which provides only limited additional months of survival, but with toxicities. Little progress in the field has occurred due to a lack of preclinical models. We recently developed new human ACC in vitro and in vivo research models. We produced the first two new ACC cell lines for the field, CU-ACC1 and CU-ACC2, which we have distributed for global collaborations. In addition, we developed 10 ACC patient-derived xenograft (PDX) and two humanized ACC-PDX models to test new therapeutics and examine the mechanism of mitotane action in combination with immunotherapy. These new preclinical models allow us to identify novel targets and test new therapeutics for our patients with adrenal cancer.

Acute kidney injury (AKI) is common during hospitalization and is associated with long-term risk of readmissions and chronic kidney disease (CKD). Preclinical studies and novel urine biomarkers have demonstrated that subclinical inflammation and repair continue for several months after AKI. We conducted three clinical and translational studies to alleviate long-term sequelae after AKI. First, we assessed repair in deceased donor kidneys which can assist with organ allocation and reduce discard. In an ongoing study, organ procurement organizations are measuring repair biomarkers via lateral flow devices to assess organ quality and adding it to their workflow. Second, we performed research biopsies during AKI to interrogate kidney tissue with novel transcriptomic and proteomic techniques to advance therapeutic development. Third, we initiated pragmatic clinical trials to reduce readmissions after an episode of AKI by providing nurse navigator and pharmacist support to optimize blood pressure, fluid, and medication management.

The rapid and unprecedented climate changes driven by human-induced greenhouse gas emissions present a critical challenge for society today. However, the link between climate change and health remains inadequately explored in both literature and policy discussions. Thousands of individuals die each year in the United States due to climate-related factors, including extreme temperatures, severe weather, air pollution, and vector-borne diseases, and these health impacts disproportionately affect already vulnerable populations. Climate change is not just an environmental concern but also an imminent threat to individual and population health, as well as a major challenge to health equity. Moreover, the health sector significantly contributes to greenhouse gas emissions. Recognizing their roles as health care providers and contributors to the climate crisis, clinicians and health professionals have a moral obligation to emphasize the profound significance of climate impacts on human health and equity. This lecture provides an overview of efforts by the U.S. National Academy of Medicine and others to address the intersection of climate change and health, with an aim to raise awareness about the immediate threats to patient health and to build a proactive path forward for the health sector. The health sector must unite to collectively tackle these challenges, safeguard patient well-being, and promote the common good in the face of climate-induced health crises.

The Healthcare Innovation Lab, established by BJC HealthCare and Washington University School of Medicine, has catalyzed care delivery innovations since 2017. Focusing on digital health to enhance care delivery and patient outcomes, the Lab emphasizes predictive analytics, digital point-of-care tools, and remote patient monitoring. The Lab identifies innovative ideas that align with the health system mission and deliver empiric value to its patients and care teams. Since its inception, the Lab has vetted 507 ideas, piloting 98, with a success rate of 40%. Examples include a predictive model to improve palliative care referrals and goal-of-care discussions, a digital approach to non-emergent medical transportation that enhances access and equity, and a COVID-19 home monitoring program that proved essential during the pandemic. These initiatives underscore the importance of integrating digital technology with health care, balancing innovation with practical application, and using a data-informed approach to innovation selection and assessment.