From 2022 to 2024, any alcohol use declined by nearly 2%, while heavy drinking declined more than 8%. The decline marks the first confirmed reduction in alcohol consumption observed since the onset of the COVID-19 pandemic.

"It’s encouraging to see alcohol use decline for the first time since the start of the pandemic,” said Brian P. Lee, MD, MAS, a hepatologist and liver transplant specialist with Keck Medicine and principal investigator of the study. “However, use remains above pre-pandemic levels and certain groups continue to have concerning trends.”

Why older adults remain a concern

One of the study’s most notable findings was the variation among age groups. While younger adults reduced alcohol consumption, adults ages 50-64 continued to drink at rates higher than before the pandemic. From 2018 to 2024, any alcohol use in this age group increased by nearly 4%, while heavy drinking increased by more than 36%.

According to Lee, the increase among older adults is particularly concerning because the risk of alcohol-related conditions such as liver disease, certain cancers and cardiovascular disease increases with age. Older adults are more likely to develop these conditions even when consuming the same amount of alcohol as younger adults.

"The encouraging national decline should not overshadow the fact that some groups continue to be at increased risk," Lee said. "Heavy drinking among ages 50-64 is up by more than a third since 2018, a concerning trend because this age group faces some of the greatest risks of harm from alcohol, including cirrhosis and alcohol-related cancers.”

According to the Centers for Disease Control and Prevention, excessive alcohol consumption is one of the leading preventable causes of illness and death in the United States. Alcohol accounts for approximately half of all liver-related deaths, and alcohol-associated cirrhosis has become the leading cause of liver transplants, according to Lee.

Differences among subgroups

Because of the large sample size, researchers identified meaningful differences among some demographic groups. Men generally experienced a larger decline in any alcohol use than women (2.4% vs. 1.1%). However, women experienced a larger decline in heavy alcohol use than men (9% vs. 7.7%).

The largest decline in any alcohol use occurred among Gen Z adults, whose consumption dropped over 5%, while millennials experienced the greatest decrease in heavy drinking, with a 17% drop between 2022 and 2024.

The study did not examine why younger adults reduced drinking, though researchers noted that changing social attitudes toward alcohol has been proposed as one possible explanation.

“These findings suggest that alcohol prevention efforts need to become more tailored to specific populations,” Lee said. “Different groups are showing different patterns of alcohol use, and understanding those differences could help us develop more effective prevention and treatment strategies.”

How researchers conducted the study

Researchers analyzed National Health Interview Survey data from 114,352 U.S. adults between 2018 and 2024. Respondents were categorized based on whether they consumed alcohol and whether they met the National Institute on Alcohol Abuse and Alcoholism criteria for heavy drinking. Heavy drinking is defined as five or more drinks per day or 15 or more drinks per week for men, and four or more drinks per day or eight or more per week for women within the 12 months before the survey.

The findings build on a November 2024 study by Lee that found alcohol use increased during the COVID-19 pandemic and continued to increase for the following two years.

Researchers sought to further examine findings from a 2025 Gallup poll that suggested alcohol consumption was declining among U.S. adults. Using data from more than 100,000 respondents, Lee’s study was able to assess drinking patterns and explore trends across demographic groups. Survey methods allowed participants to complete the questionnaire privately online rather than by telephone.

“The decline in alcohol use is a positive development, but we cannot assume alcohol-related harms will decline automatically,” said Lee. “Continued attention to screening, prevention and treatment will be critical, particularly among groups where alcohol use remains elevated.”

Additional study authors include Jennifer Dodge, MPH, associate professor of research medicine and population and public health science at the Keck School of Medicine of USC and Divya Ayyala-Somayajula, MD, of Thomas Jefferson University in Philadelphia.

However, a new Keck Medicine of USC study published today in eBioMedicine suggests that increasing omega-3 levels via supplements has little effect on brain health despite showing evidence that the nutrients directly reach the brain. 

The two-year, placebo-controlled, double-blinded study of older adults with an elevated risk of developing Alzheimer’s showed that high doses of omega-3s did not improve memory, cognitive function or brain cell loss in areas of the brain related to Alzheimer’s. 

“We all wish there was a silver bullet for preventing Alzheimer’s, but our findings showed that fish oil supplements do not appear to protect brain health,” said Hussein Naji Yassine, MD, director of the USC Center for Personalized Brain Health and lead investigator of the study. “While omega-3s play an important role in forming brain cell connections needed for cognition, our results do not support fish oil supplements as a preventive measure against Alzheimer’s.” 

How the study was conducted 

Researchers recruited 365 adults, ages 55 to 80 who rarely ate fish, which is rich in omega-3s, and who study authors considered at risk for Alzheimer’s. About half (47%) carried an APOE4 gene, the strongest genetic risk factor for late-onset Alzheimer’s. Participants were randomly chosen to receive either daily fish oil supplements or a placebo. The supplements contained 2,000 mg of docosahexaenoic acid (DHA), a key omega-3 involved in brain function. 

Researchers were first interested to learn whether the omega-3 in the supplement was able to reach the brain.  

They measured DHA levels in cerebrospinal fluid, which surrounds the brain, and found an average 17% increase of DHA levels in patients’ brains after six months, confirming the omega-3 reached its intended target. 

Next, researchers tested participants’ memory and cognitive abilities at the beginning of the study and again two years later. Study participants who took DHA supplements did no better on the tests than those who took a placebo. Brain scans also showed that supplements did not prevent shrinkage of the hippocampus, a brain region important for memory that is often used as a marker of brain aging and Alzheimer’s risk. 

Looking beyond supplements 

Now, Yassine and his team are focused on solving why omega-3 supplements can reach the brain but not affect brain health. Based on their previous research, they believe omega-3s may work better as a part of a Mediterranean-style diet, which is naturally rich in omega-3s and linked with lower Alzheimer’s risk, than in a standalone supplement. 

“We’re focused on better understanding how the brain processes omega-3s and whether factors, such as poor health, dietary pattern, genetic risk and age, may change the brain’s ability to effectively absorb and use omega-3s,” said Yassine. “We are working to develop medications that may help the brain better utilize these nutrients to preserve cognitive function.”  

Holistic lifestyle remains the best prevention  

While out of scope of the study, the researchers stress that overall healthy living — rather than relying on fish oil supplements alone —is the best way to protect brain health.  

“Staying healthy throughout life remains the most powerful tool we have for reducing Alzheimer’s risk, including regular exercise, quality sleep and a balanced diet,” said Yassine. “Living a healthy lifestyle is the brain’s equivalent of getting regular car maintenance and high-quality oil changes. The brain is more likely to lose greater function if health issues in other parts of the body go unaddressed, in the same way that car engines stop working if regular maintenance is skipped.” 

Other USC authors for the study include Lina D’Orazio, PhD, a clinical psychologist and neuropsychology specialist with Keck Medicine; Lon Schneider, PhD, a professor of psychiatry and behavioral sciences at the Keck School of Medicine of USC; Michael Harrington, MD, a professor of research neurology at the Keck School; and Meredith Braskie, PhD, an assistant professor of neurology at the Keck School. 

Medical experts have typically calculated obesity using body mass index (BMI), a calculation based on a person’s height and weight.

In the last year and a half, however, some practitioners have shifted away from screening for obesity through BMI and have instead adopted a newer measure known as clinical obesity, which identifies obesity based on fat around the abdomen coupled with weight-related health issues.

A new study from Keck Medicine of USC, published today in the Annals of Internal Medicine, quantifies how often BMI may miss cases of obesity. The research shows that one quarter of people considered to have a normal (healthy) BMI meet the standard of clinical obesity. And 50% of those deemed overweight by their BMI would be reclassified as obese.

“Many people assume that if their BMI says they are not obese, they don’t have to worry about the many health problems linked to obesity,” said Brian P. Lee, MD, MAS, a hepatologist and liver transplant specialist with Keck Medicine and principal investigator of the study. “Our findings show that millions of Americans may already have obesity-related health impacts and may be missing needed health interventions.”

Those with normal or overweight BMIs do not currently qualify for pharmacologic or surgical treatments for obesity, and physicians may not necessarily flag them as needing lifestyle modifications that could improve their health, added Lee.

Old definition of obesity versus new

BMI classifies people into four categories based on their weight to height ratio: a BMI under 18.5 is considered underweight; a BMI between 18.5-25 is considered normal, or healthy; a BMI between 25-29.9 is considered overweight; and a BMI of 30 or over is categorized as obese.

“BMI is problematic because it does not specifically measure body fat and instead reflects total body weight, which includes muscle and bone,” said Lee. “So a muscular person can have a very high BMI but not have excess fat, while someone without much muscle can have a normal BMI but have excess fat causing health problems.”

Clinical obesity, a term developed in 2025 by the Lancet Diabetes and Endocrinology Commission, an international group of obesity experts, specifically examines fat around the waist, known as adipose fat, and is a more accurate way of determining obesity and obesity-linked health problems, said Lee.

Adipose fat accumulates deep in the abdomen, causing dangerous inflammation to the body’s organs, unlike under-the-skin or subcutaneous fat, which is found in other parts of the body.

Clinicians determine clinical obesity through three measurements: a person’s waist circumference, their waist-to-hip ratio and their waist-to-height ratio.

Click here to learn more about these measurements

If a person is found to have extra fat by at least two of the three measurements and has evidence of organ, tissue or other health issues associated with extra fat, such as heart disease or chronic hip or knee pain, they are considered clinically obese, said Lee.

Obesity can lead to many illnesses, including heart disease, diabetes, high blood pressure, high cholesterol, liver disease and certain cancers, making it one of the leading causes of preventable death in the country.

Toward better long-term health

For the study, researchers used data from the National Health and Nutrition Examination Survey, a nationally representative survey of health and nutrition. They included data from some 5,600 adults with an average age of 49 who had been tested for both BMI and hip and waist circumferences.

When they compared BMI results with clinical obesity status, they reached the conclusion that approximately 26% of people with a normal BMI and 50% of people with an overweight BMI qualified as clinically obese.

In the future, Lee hopes that more physicians will diagnose obesity using the clinical obesity definition rather than BMI to better inform people of any health risks they may be facing.

“The good news is that obesity can be treated,” said Lee. “Whether through lifestyle changes, medication or both, we have effective ways to reduce excess body fat and lower the risk of future health problems. The earlier we identify people at risk, the better chance we have of improving long-term health and quality of life.”

New research suggests otherwise, according to a Keck Medicine of USC study published today in Clinical Gastroenterology and Hepatology. 

Researchers discovered that people with metabolic dysfunction–associated steatotic liver disease (MASLD), the most common liver condition in the country affecting one-in-three adults, face significantly higher risk of liver fibrosis, or harmful scarring of the liver, if they engage in episodic heavy drinking. Episodic heavy drinking is four or more drinks in one day for women and five or more drinks in one day for men, at least once a month.  

Those who consume large amounts of alcohol in a single day at least once per month are three times more likely to develop advanced liver fibrosis than individuals who spread out the same total alcohol intake over time, according to the findings. 

Younger adults and men were more likely to report episodic heavy drinking, and the more drinks consumed at one time, the more liver fibrosis people tended to have. 

“This study is a huge wake-up call because traditionally, physicians have tended to look at the total amount of alcohol consumed, not how it is consumed, when determining the risk to the liver,” said Brian P. Lee, MD, MAS, a hepatologist and liver transplant specialist with Keck Medicine and principal investigator of the study. “Our research suggests that the public needs to be much more aware of the danger of occasional heavy drinking and should avoid it even if they drink moderately the rest of the time.”  

How the study was conducted 

Lee and his colleagues used data from the nationally representative National Health and Nutrition Examination Survey, a long-running health survey of the United States population. They included data from more than 8,000 adults, collected between 2017 and 2023. In particular, they looked at the link between episodic heavy drinking and advanced liver fibrosis to understand how drinking patterns — not just total drinks — may cause harm even to moderate drinkers, which is considered seven drinks a week for women and 14 or less for men.  

The research team focused on MASLD because of its prevalence among Americans. MASLD affects people with excess weight, obesity or other metabolic conditions, such as Type 2 diabetes, high blood pressure or high cholesterol, and is on the rise. Additionally, while MASLD is not defined as alcohol-related, Lee and his colleagues wanted to explore if alcohol did in fact play some role in the condition. 

More than one-half of the adults included in the study reported episodic heavy drinking and almost 16% of patients with MASLD were episodic heavy drinkers. 

The researchers compared people with MASLD with the same age, sex and average weekly alcohol consumption, segmenting some as episodic heavy drinkers and others as non-episodic heavy drinkers, to reach their conclusion that episodic heavy drinkers with MASLD had nearly three times higher odds of experiencing advanced liver fibrosis.  

Lee speculates that episodic heavy drinking can harm the liver both directly and indirectly. Drinking large amounts of alcohol at once can overwhelm the liver and increase inflammation, which leads to scarring and damage. People with MASLD may be particularly at risk, as Lee’s previous research has shown that obesity, high blood pressure and other conditions associated with MASLD can more than double liver disease risk. 

Alcohol-related liver disease has more than doubled in the last two decades, according to Lee. He believes this trend is driven by pandemic-era surges in drinking and an increase in people with risk factors for MASLD, like obesity and diabetes.  

“Although this study focused on patients with MASLD, these findings may also be pertinent to a broader patient population,” said Lee. “With more than half of adults reporting some episodic heavy drinking, this issue deserves further attention from both physicians and researchers to help better understand, prevent and treat liver disease.” 

LOS ANGELES — Keck Medicine of USC radiologists use computed tomography (CT) scanners to diagnose and treat patients’ diseases and injuries.

Recently, however, this advanced technology was put to a far more novel use: examining the bodies of two ancient Egyptian mummies.

Radiologists conducted full-body CT scans of two Egyptian priests, Nes-Min, circa 330 BCE, and Nes-Hor, circa 190 BCE, whose bodies had been preserved for more than 2,200 years.

The mummies, along with 3D digital models and 3D prints of select parts of their bodies, will be on display at “Mummies of the World: The Exhibition,” an upcoming exhibit at the California Science Center opening Feb. 7.

Each mummy was scanned inside the bottom half of its sarcophagus, which weighed approximately 200 pounds each. The mummies were wrapped in linen shrouds, blackened with age. The older mummy, Nes-Min, was draped in a garment of heavily beaded net over his torso and wore several strands of colorful beads.

A state-of-the-art, 320 slice CT scanner revealed small details of their bodies that humanized the men, including facial features such as eyelids and their lower lips. The images also held clues about their health, life experiences and lifespans that resonate with people today.

Scans reveal healed injuries, dental issues and other modern-day ailments

Analysis of the scans showed that the elder of the mummies, Nes-Min, probably suffered from an aching lower back like many modern humans. His spine showed a collapsed lumbar or lower back vertebrae likely due to natural aging and wear and tear.

He was buried with several artifacts, representing several scarab beetles and a fish.

Nes-Hor’s scan revealed dental issues and a severely deteriorated hip, and that he was older at the time of death than Nes-Min.

"These scans provide a treasure trove of information made possible by Keck Medicine’s access to the latest in high-level scanning, coupled with the team’s expertise,” said Summer Decker, PhD, who leads 3D imaging for Keck Medicine and serves as director of the USC Center for Innovation in Medical Visualization with the Keck School of Medicine of USC.

“These mummies were scanned previously, but due to advancements in scanning technology, the results are much more detailed and extensive than ever before,” said Decker, who oversaw the mummy scans and visualization analysis. “The high-resolution images have revealed things that were previously unknown and helped create a picture of what their lives were like.”

After scanning the mummies, Decker and her colleague, Jonathan Ford, PhD, used the scans to create 3D digital models of the men. They also printed out life-size reproductions of the men’s spines, skulls and hips, as well as artifacts found with Nes-Min, using medical-grade 3D printers.

“Mummies have long been a mystery. Seeing beneath the surface to reveal the specific lived experience of individuals is incredibly exciting,” said anthropologist Diane Perlov, PhD, senior vice president for special projects at the California Science Center. “This modern scientific technology offers us a powerful window into the world of ancient people and past civilizations that might otherwise be lost.”

Keck Medicine’s 3D technology brings organs to life

Keck Medicine’s 3D visualization and printing technologies used on the mummies allow for surgeons to turn medical imaging, such as a CT or MRI scan, into physical reproductions of a patient’s liver, heart, pelvis or other structure.

The scans first create hundreds of detailed 3D cross-sectional images (or “slices”), then 3D visualization experts digitally “stack” the images together to form 3D digital models. These models can then be analyzed, measured or used to print on high-resolution medical-grade 3D printers, meaning that the prints can be used in surgery and are safe to touch and potentially be implanted in a patient.

Surgeons then use these prints to better visualize and understand a patient’s complex medical condition or practice the best surgical solution before entering the operating room.

“Through 3D visualization, modeling and printing, clinicians like surgeons can accurately measure hard-to-detect tumors, examine the intricate structure of a patient’s heart or liver or determine how best to repair a shoulder or hip,” said Decker. “They walk into the operating room with a much better idea of what they are facing and how they will approach surgery. With these advanced technologies, we can create custom treatments and solutions for our patients, which may lead to improved outcomes.”

Patients may also benefit from holding a replica of their own organ in their hand, Decker continued. “They gain a new understanding of what their condition is and how it will be treated,” she said.

Keck Medicine has access to almost two dozen 3D printers housed in the USC Center for Innovation in Medical Visualization.

About the exhibit

“Mummies of the World: The Exhibition” first debuted at the California Science Center in 2010. After touring the globe, the exhibition returns to Los Angeles for its closing venue with a new selection of mummies never seen before in Los Angeles.

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Download photos and b-roll package below.

Click here to discover the difference between X-rays, CT scans, MRIs and more.

MASLD occurs when fat builds up in the liver and is associated with one or more of five conditions: obesity, Type 2 diabetes, high blood pressure, high blood sugar and low HDL cholesterol, known as “good” cholesterol. These conditions are characterized as cardiometabolic risk factors because they affect the heart or metabolism.  

MASLD can lead to serious illness, such as advanced liver, heart and kidney disease, but little research has been done to examine if certain cardiometabolic risk factors for those with MASLD are more associated with death than others.  

The deadliest cardiometabolic risk factors  

Now, a new study from Keck Medicine of USC published in Clinical Gastroenterology and Hepatology reveals that three of the cardiometabolic risk factors carry the greatest risk of death for those with MASLD: high blood pressure, pre-diabetes or Type 2 diabetes, and low HDL, which raise the risk of death by 40%, 25% and 15%, respectively.  

These results were independent of how many or which combination of cardiometabolic risk factors patients had, and held steady despite individuals’ gender, sex, race or ethnicity.  

“MASLD is a complicated disease, and this study sheds new light on where doctors may want to focus their efforts when treating patients,” said Norah A. Terrault, MD, a hepatologist with Keck Medicine and a senior author of the study. “Knowing which aspects of MASLD might lead to poorer outcomes can help us offer patients the best possible care.”  

Researchers were especially surprised to discover that high blood pressure was associated with a higher chance of death than diabetes, said Matthew Dukewich, MD, PharmD, MS, a USC transplant hepatology fellow and lead author of the study. “Until now, it was commonly thought that diabetes was the most pressing health problem for MASLD patients, which is a key insight.” 

The study also found that obesity, the most common cardiometabolic risk factor of MASLD,  can substantially raise the risk of mortality depending on a patient’s body mass index (BMI), which is a formula used to estimate body fat percentage based on an individual’s height and weight. The higher a patient’s BMI, the higher the association with death. 

Additionally, the study adds to the growing body of research that patients with more cardiometabolic risk factors have poorer outcomes. The study found that the risk of death in MASLD patients increased by 15% for each additional cardiometabolic risk factor present. 

How the study was conducted  

Researchers used data from the National Health and Nutrition Examination Survey (NHANES), which collected health information about children and adults in the United States from 1988-2018, the most current year for which data was available for their study. Out of 134,515 participants 20 years or older, some 21,000 patients qualified as having MASLD.  

The study authors tracked all-cause mortality rates by individual cardiometabolic risk factors to reach their conclusions.  

Looking ahead, the study authors hope to conduct further studies examining patients’ genetic background, dietary habits and alcohol use in relation to MASLD outcomes to provide more comprehensive risk profiles. “The more we can understand about the drivers of the disease, the more we can identify those most in need of interventions and prioritize our resources for enhanced outcomes,” said Terrault.  

Liyun Yuan, MD, a transplant hepatologist with Keck Medicine, is also a study author. 

“Alcohol-related liver disease is the main cause of liver-related death and these results are a major wakeup call to the dangers of drinking,” said Brian P. Lee, MD, MAS, a hepatologist and liver transplant specialist with Keck Medicine and lead author of the study.  

The study also sheds light on the demographics of American drinkers, uncovering that four groups make up a greater share of heavy drinkers than they did 20 years ago — women, adults 45 and older, those living in poverty and people with metabolic syndrome, a cluster of conditions that together raise the risk of coronary heart disease, diabetes and stroke. Previous studies have already associated these groups with a higher risk of liver disease when exposed to alcohol.  

“These findings — the first comprehensive look at the demographics of heavy drinking and their relation to liver disease since the 1990s — provide important new information about which population groups may need more intervention to curb alcohol use and may also explain the rise in liver disease over the years,” said Lee.  

Additionally, the study showed that the average drinking rate in America was unchanged over the last 20 years before the COVID-19 pandemic, suggesting that factors beyond alcohol quantity, such as changing health and demographic profiles, may be contributing to the rise in liver disease.  

“Our results show that the makeup of the American public with heavy alcohol consumption has changed compared to 20 years ago,” said Lee.  

Lee and his fellow researchers analyzed data from the National Health and Nutrition Examination Survey, which assesses the health and nutritional status of adults and children in the United States, from 1999-2020, the most recent year for which complete data was available.  

They tracked the total increase in significant liver disease — a stage of liver disease when the liver forms scar tissue that impairs liver function that is often caused by heavy drinking. The study examined the demographic and health profiles of adults 20 or older who drank heavily. According to the Centers for Disease Control and Prevention, heavy drinking is considered eight drinks per week for women and 15 for men. 

Lee believes that the study results will provide physicians with necessary updates to better treat patients and hopes they will lead to more screenings and interventions for high-risk populations.  

Jennifer Dodge, MPH, associate professor of research medicine and population and public health sciences with the Keck School of Medicine of USC, was also a study author.  

The study was supported by a grant from the National Institute on Alcohol Abuse and Alcoholism, grant number K23AA029752.  

These findings build on Lee’s previous work, including a February 2025 study that found heavy drinkers with diabetes, high blood pressure or increased waist size had double the risk of advanced liver disease, and a November 2024 study revealing that heavy drinking rose during the COVID-19 pandemic peak and continued for two years afterward. 

A new study from the USC Caruso Department of Otolaryngology – Head and Neck Surgery, part of Keck Medicine of USC, published today in JAMA Otolaryngology – Head & Neck Surgery, is the first to link hearing aids and cochlear implants, surgically implanted devices that help those with profound hearing loss perceive sound, to improved social lives among adults with hearing loss. 

“We found that adults with hearing loss who used hearing aids or cochlear implants were more socially engaged and felt less isolated compared to those who didn’t use them,” said Janet Choi, MD, MPH, an otolaryngologist with Keck Medicine and lead researcher of the study. “This suggests that hearing devices may help prevent the social disconnection and broader health consequences that can follow untreated hearing loss.” 

Hearing loss affects an estimated 40 million American adults, yet many go untreated. When left unaddressed, hearing loss can make communication difficult, leading people to withdraw from conversations and social activities, according to Choi.  

Previous research has shown that over time, social withdrawal can reduce mental stimulation and increase the risk of loneliness, anxiety, depression, cognitive decline and dementia. It has also linked chronic social isolation to biological and neurological changes, including increased brain inflammation and alterations in brain structure.  

“Understanding the link between hearing loss, hearing device use and social isolation is crucial,” said Choi. “Until this study, it has been unclear whether hearing devices could help reverse the isolation.”   

Choi and her fellow researchers conducted a comprehensive, systematic review and meta-analysis of 65 previously published studies, encompassing over five thousand participants, on how hearing aids and cochlear implants affect three key measures: social quality of life, perceived social handicap, which refers to the limitations and frustrations hearing loss can create in social situations, and loneliness.  

The researchers found that adults using hearing devices feel more socially connected and less limited in social situations. They are better able to engage in group conversations and feel more at ease in noisy or challenging listening environments. Participants also reported feeling less socially handicapped by their hearing loss, with fewer barriers and frustrations during interactions and an improved ability to stay engaged without feeling excluded. This increased confidence can help users connect more easily with family, friends and colleagues, leading to stronger feelings of belonging and reduced social anxiety. The study also suggested hearing devices may reduce loneliness, although further research is needed in this area, according to Choi. 

Those with cochlear implants reported the most improvement in their social quality of life. This is likely because cochlear implants offer greater hearing restoration than hearing aids, especially for individuals with more severe hearing loss. As a result, they may experience more noticeable improvements in social engagement once their hearing is restored. 

While it was outside the scope of the study to measure how better social lives relate to improved cognitive outcomes, Choi believes there may be a connection, as previous research has found managing hearing loss may be key to reducing the risk of cognitive decline and dementia. “While our study didn’t directly measure cognitive outcomes, the improvements we saw in communication and social engagement suggest that by restoring clearer communication, hearing devices may help preserve cognitive health by keeping the brain more actively involved and people more connected,” Choi said. 

This research follows a January 2024 study by Choi showing that adults with hearing loss who use hearing aids have an almost 25% lower risk of mortality, suggesting that treating hearing loss can improve lifespan as well as social quality of life.  

“These new findings add to a growing body of research showing that hearing health is deeply connected to overall well-being,” said Choi. “We hope this encourages more people to seek treatment and helps clinicians start conversations with patients about how hearing devices can improve their quality of life.” 

However, the majority of American adults are unaware that HPV can cause throat cancer and are not taking advantage of the one proven method for prevention — the HPV vaccine.  

These are the conclusions of two recent studies from the USC Head and Neck Center, part of Keck Medicine of USC and the USC Caruso Department of Otolaryngology – Head and Neck Surgery, that examined public knowledge of the link between HPV and throat cancer and HPV vaccination rates among adults, respectively.  

The research suggests that less than one-third of Americans associate HPV with throat cancer and less than 7% of adults eligible for the vaccine have completed the full course of the HPV vaccine, which is three doses for adults.  

“This data is very worrisome because knowledge is the first step toward disease prevention,” said Daniel Kwon, MD, a head and neck surgeon with Keck Medicine and lead author of a study examining trends in HPV vaccination rates for adults. “The public is missing crucial information about the link between throat cancer and HPV, as well as the fact that vaccines may prevent HPV-related throat cancer.”  

The need for greater HPV-related throat cancer awareness  

Each year, some 43 million Americans are infected with HPV, and most sexually active adults will contract HPV at some time in their lives. Most HPV infections are asymptomatic and resolve on their own. However, in some cases, the infection can lead to cancer, including throat cancer.  

In 2006, an HPV vaccine was made available to females ages 9-26, then expanded to males ages 9-26 in 2009. In 2018, the vaccine was expanded to adults ages 27-45. While HPV vaccination for this older group may provide less benefit because most have already been exposed to HPV, there still may be benefits of vaccination, according to the Centers for Disease Control and Prevention (CDC).   

To determine public awareness of HPV-related throat cancer, Dr. Kwon and fellow researchers compared data between the 2018 and 2020 iterations of the National Cancer Institute Health Information National Trends Survey, which tracks Americans’ knowledge about cancer and health information related to cancer.  

They focused on adults ages 27-45, who were newly eligible for the vaccine in 2018, to see how much of an impact the expansion of eligibility had on knowledge of HPV and throat cancer.  

Study authors compared data from 3,504 adults in the 2018 survey with data from 3,865 adults in the 2020 survey assessing people's knowledge of HPV, the vaccine, the link between HPV and throat cancer and changes in awareness between 2018 and 2020.  

While they found that most respondents were aware of HPV in both years studied, they were disappointed to discover that knowledge of the connection between HPV and throat cancer remained poor. In 2018, 27% of respondents reported they were aware of the link between HPV and throat cancer; in 2020, that number barely moved upward to 29.5%.  

“These results are particularly disheartening because since the vaccine eligibility was expanded in 2018, health advocates have issued many guidelines and recommendations about HPV and throat cancer,” said Kwon. “Clearly, more efforts are needed to educate the public about this risk.”  

Cervical cancer used to be the most widespread HPV-related cancer, but cervical cancer rates have declined through concerted efforts of the health care industry, according to Kwon. “HPV-related cervical cancer cases have decreased in large part due to successful HPV awareness campaigns targeting women,” he said. He also notes that women get screenings for cervical cancer through regular Pap smears, but there is no screening available for throat cancer.  

He emphasized the need for more education about the risk of HPV and throat cancer in men, as throat cancer affects men at a higher rate than women, he added. 

Investigating HPV vaccination rates 

In a second study, researchers from the USC Head and Neck Center examined HPV vaccination rates among a nationally representative cohort of more than 26,000 adults ages 30-44 who completed questions on HPV vaccination from 2018-2022 through the Behavioral Risk Factor Surveillance System survey, a nationwide telephone survey conducted by the CDC. 

The authors discovered that only 6.5% of those surveyed were fully vaccinated, and only 15.8% had completed any HPV vaccination.  

Many factors play into the low HPV vaccination rate, according to the lead author of the study, Niels Kokot, MD, a head and neck surgeon with Keck Medicine. He cites not only a lack of general knowledge of the link between HPV and cancer, but also a lack of advertising about the HPV vaccine in comparison to other well-publicized campaigns such as for the flu or COVID-19 vaccines and growing vaccine hesitancy in the United States.  

Socioeconomic status, race, education level, access to health care, sexual orientation and gender also play roles in who is getting vaccinated, he added, with men, Asian Americans, African Americans, Hispanics and those not having a personal health care provider among those less likely to be vaccinated.  

Kokot hopes these findings will help spur greater public education on the HPV vaccine. He also recommends that any eligible adult who has not yet been vaccinated talk to a health care provider about vaccinations. “Every patient’s circumstances are different, and the subject is worth a discussion to see if an individual would benefit from the vaccine,” he said.  

Besides cervical and throat cancer, HPV can also cause anal, penile, vaginal and vulvar cancers. Learn more about HPV and cancer here.  

The study also reports that the number of suicide deaths in the AYA male cancer survivor group (ages 15-39) increased three-fold during the 21-year-study period. In 2021, one in 65 deaths among the group was attributed to suicide. Suicide deaths have also increased for other cancer survivor groups, but the gap in suicide rates between young men and other populations significantly widened over time.

Cancer is becoming more common among young people, and cancer survivors are more likely to struggle with anxiety, depression and thoughts of suicide, according to the American Cancer Society and the National Comprehensive Cancer Network. This study, one of the first to examine suicide rates by gender for AYA patients with cancer, characterized the increasing suicide rate among this population as alarming.

Researchers used data from the National Cancer Institute’s Surveillance, Epidemiology and End Results Program to assess some 4.5 million deaths among cancer survivors between 2000-2021. A cancer survivor is defined as anyone who has ever been diagnosed with cancer, no matter where they are in the course of their disease. 

They then divided the data according to three age groups: ages 15-39, 40-59, and sixty-plus, and further divided each group by males or females.

The study found that in 2000, 4.9 deaths per 1,000 deaths of male AYA cancer patients were caused by suicide and the suicide rates for all other age/gender cancer patient groups ranged from 0.4 to 3.1 per 1,000 deaths.

Nearly two decades later in 2021, the number of suicide deaths per 1,000 deaths for male AYA cancer patients mushroomed to 15.4. While the rates of suicide deaths for all other age/gender cancer patient groups also increased, the rates were much lower than that of the male AYA cancer patients, ranging from 0.6 to 7.4 per 1,000 deaths.

In other findings, researchers determined that thyroid cancer, testicular cancer and melanomas of the skin were the three most common cancer diagnoses leading to suicide among male AYA cancer patients. According to the American Cancer Society, these three cancers are among those with the highest five-year-survival rates. Researchers did not have access to certain information about the patients, such as mental health status before cancer diagnosis, the reason or method of suicide death, patients’ cancer prognoses, and status of the cancer, such as disease recurrence or remission, at the time of death.

However, despite these limitations, the study authors believe that their findings warrant a call for attention focused on the suicide rate of AYA patients, specifically males. They recommend that AYA cancer patients be provided with more long-term support and resources that could potentially reverse this trend. 

Resources 

Keck Medicine provides support for its young cancer patients through The Adolescent and Young Adult Program at USC, which offers cancer patients ages 15-39 supportive care, advocacy, support groups, events and other resources to improve their health outcomes and quality of life.

National resources for young cancer survivors include: 

• Guidelines and support for AYA patients from the National Comprehensive Cancer Network
• Resources for AYA patients from The American Cancer Society

For anyone with thoughts of suicide, the National Institute of Mental Health’s suicide prevention resources and suicide lifeline can help.

This is especially true for patients with diabetic foot ulcers (open sores), which affects one-third of people with diabetes. Approximately 20% of those who develop a diabetic foot ulcer will require a lower-extremity amputation, according to the American Diabetes Association.  

When physicians debride, or clean out, a wound, they remove as much bacteria as possible. However, they face one key limitation — not all bacteria can be seen by the human eye, and some may be missed during the debridement. 

New Keck Medicine of USC research published in Advances in Wound Care suggests there may be a more effective method to detect bacteria during wound debridement. Autofluorescence (AF) imaging, where a handheld device “lights up” bacteria previously invisible to the human eye, uses violet light to illuminate molecules in the cell walls of any bacteria. Different types of bacteria turn different colors, allowing physicians to immediately determine how much and which types of bacteria are in the wound. 

“We’re hopeful this new technology can help surgeons improve their accuracy when pinpointing and consequently removing bacteria from wounds and therefore improve patient outcomes, particularly for those with diabetic foot wounds,” said David G. Armstrong, DPM, PhD, a podiatric surgeon and limb preservation specialist with Keck Medicine and senior author of the study. “The early detection and removal of bacteria from a wound is vital to preventing avoidable amputations.”    

The research, a literature review of 25 studies examining the effectiveness of AF imaging in treating diabetic patients with foot ulcers, reveals that AF imaging can identify bacteria in wounds in approximately 9 in 10 patients that traditional clinical assessments miss.  

Traditionally, physicians debride wounds, then send tissue samples to the lab to identify specific types of bacteria present in the wound and determine the best treatment protocol based on those findings, such as starting the patient on antibiotics or providing a special type of wound dressing. This process can take days, during which time an infection can set in, said Armstrong.  

With AF imaging physicians are able to make medical decisions during the wound debridement, rather than waiting for lab results to initiate treatment.  

Another benefit to the technology is that if bacteria is caught early, the patient may avoid being prescribed antibiotics, which in wound care can be prolonged, thus avoiding possible antibiotic resistance. 

“This real-time intervention may allow for faster, more effective treatment for wounds,” said Armstrong.  

Keck Medicine physicians are already using the technology to successfully treat patients with chronic wounds, including diabetic foot ulcers.  

“I look forward to more research in this area as we hope to see AF imaging become the standard of care for wound care in the near future,” said Armstrong.  

The study is partially supported by the National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Award Number 1R01124789-01A1 and the National Science Foundation (NSF) Center to Stream Healthcare in Place (#C2SHiP) CNS Award Number 2052578.  

A large, multicenter study published in JAMA Otolaryngology – Head & Neck Surgery revealed that adults with cannabis dependence, known as cannabis use disorder, are 3.5 to 5 times more likely to develop head and neck cancer than those who do not use the substance. 

“This is one of the first studies — and the largest that we know of to date — to associate head and neck cancer with cannabis use,” said Niels Kokot, MD, a head and neck surgeon with the USC Head and Neck Center and senior author of the study. “The detection of this risk factor is important because head and neck cancer may be preventable once people know which behaviors increase their risk.”  

Kokot is also a professor of otolaryngology – head and neck surgery at the Keck School of Medicine of USC. 

Head and neck cancer, the sixth most common cancer in the world, includes several cancers, including cancer of the mouth, pharynx, larynx, oropharynx (tongue and tonsils and back wall of the throat) and adjacent salivary glands.  

The researchers, including lead study author Tyler Gallagher, an MD/MPH candidate at the Keck School, discovered that those with cannabis use disorder had higher rates of all types of head and neck cancers. They also found that the prevalence of head and neck cancer among those with cannabis use disorder was independent of other factors, such as age, gender and ethnicity. Alcohol and tobacco use, which have been associated with head and neck cancer, also did not play a role in the findings. 

Kokot and his fellow researchers hypothesize that the primary reason cannabis raises the risk of head and neck cancer is because of the damaging effect of the smoke. Cannabis is primarily consumed through inhalation (even though the study did not distinguish between methods of consumption). Additionally, research has shown that tobacco smoke contains numerous chemicals that cause DNA damage and inflammation to the area, which, if unchecked, can lead to cancer, and they speculate that cannabis smoke may cause similar harm.  

In fact, there is some evidence, Kokot theorizes, that the smoke from cannabis may even be worse than tobacco smoke.  

“Cannabis smoking is typically unfiltered and involves deeper inhalation compared to tobacco,” he said. “Additionally, cannabis burns at a higher temperature than tobacco, increasing the risk of cancer-causing inflammation.”  

Kokot would like to see further research examining the link between cannabis and head and neck cancer. In the meantime, he hopes this study will help people make more informed choices and raise awareness about the link between head and neck cancer and cannabis use. 

To reach their conclusions, the researchers compiled 20 years of data through a health research network of 64 health care organizations that accounted for more than 90 million individuals. They tracked cancer cases from one to five years of cannabis use.   

Those who don’t use hearing aids but should may want to make wearing them one of their New Year’s resolutions, according to a new study from Keck Medicine of USC published today in The Lancet Healthy Longevity.  

“We found that adults with hearing loss who regularly used hearing aids had a 24% lower risk of mortality than those who never wore them,” said Janet Choi, MD, MPH, an otolaryngologist with Keck Medicine and lead researcher of the study. “These results are exciting because they suggest that hearing aids may play a protective role in people’s health and prevent early death.”  

Previous research has shown that untreated hearing loss can result in a reduced life span (as well as other poor outcomes such as social isolation, depression and dementia). However, until now, there has been very little research examining if the use of hearing aids can reduce the risk of death. The study represents the most comprehensive analysis to date on the relationship between hearing loss, hearing aid use and mortality in the United States, according to Choi, who is also an assistant professor of clinical otolaryngology – head and neck surgery with the USC Caruso Department of Otolaryngology 
– Head and Neck Surgery at the Keck School of Medicine of USC.

Choi and her fellow researchers used data compiled by the National Health and Nutrition Examination Survey between 1999-2012 to identify almost 10,000 adults 20 years and older who had completed audiometry evaluations, a test used to measure hearing ability, and who filled out questionnaires about their hearing aid use. Researchers followed their mortality status over an average follow-up period of 10 years after their evaluations.  

A total of 1,863 adults were identified as having hearing loss. Of these, 237 were regular hearing aid users, which were characterized as those who reported wearing the aids at least once a week, five hours a week or half the time, and 1,483 were identified as never-users of the devices. Subjects who reported wearing the devices less than once a month or less frequently were categorized as non-regular users. 

Researchers found that the almost 25% difference in mortality risk between regular hearing aid users and never-users remained steady, regardless of variables such as the degree of hearing loss (from mild to severe); age, ethnicity, income, education and other demographics; and medical history. There was no difference in mortality risk between non-regular users and never users, indicating that occasional hearing aid use may not provide any life-extending benefit.  

While the study did not examine why hearing aids may help those who need them live longer, Choi points to recent research linking hearing aid use with lowered levels of depression and dementia. She speculates that the improvements in mental health and cognition that come with improved hearing can promote better overall health, which may improve life span.  

Choi hopes this study will encourage more people to wear hearing aids, even though she acknowledges that factors, including cost, stigma and difficulty finding devices that fit and function well, are barriers to use.  

Choi can personally relate to these challenges. She was born with hearing loss in her left ear, but did not wear a hearing device until her 30s. It then took her several years to find ones that worked effectively for her.  

She is currently working on an AI-driven database that categorizes hearing aid choices and tailors them to individual patient needs. She also advocates for larger studies to further understand the link between regular hearing aid use and a lower mortality risk and to promote hearing care. 

What explains the different outcomes?  

The answer may lie in a condition known as metabolic syndrome, a cluster of conditions that together raise the risk of coronary heart disease, diabetes, stroke and other serious health problems. This syndrome, characterized by symptoms such as abdominal fat, high blood pressure, high cholesterol and high blood sugar, affects more than one in three Americans.  

A new study from Keck Medicine of USC published in the Annals of Internal Medicine shows that heavy alcohol use may be dramatically more damaging to the liver for people with metabolic syndrome.  

“Our research suggests that metabolic syndrome and alcohol interact in such a way that they multiply the effect of alcohol on the liver, more than doubling the risk of advanced liver disease among heavy drinkers,” said Brian P. Lee, MD, MAS, a hepatologist and liver transplant specialist with Keck Medicine who is the lead author on the study. “Drinking is harmful to the liver, but especially so for this segment of the population.”  

In the study, heavy alcohol use was defined as two drinks (a total of 12 fluid ounces) a day for women and three drinks (a total of 18 fluid ounces) per day for men.  

Lee and his colleagues were motivated to research a connection between advanced liver disease, alcohol use and metabolic syndrome after noticing that between 2009-2018, deaths from alcohol-associated liver disease surged in the United States by more than 30% while alcohol use, including heavy drinking, remained stable or declined.  

During the last 20 years, the number of Americans with metabolic syndrome increased significantly. Previous research has shown that metabolic syndrome can cause liver abnormalities.  

“We therefore hypothesized that metabolic syndrome could be an important contributor to this unexplained surge in advanced liver disease,” said Lee.  

For the study, Lee and his fellow researchers used data from the National Health and Nutrition Examination Survey, which assesses the health and nutritional status of adults and children in the United States, pulling together samples representing the U.S. population 20 years or older between 1999 and 2018. 

While the data revealed a slight increase in advanced liver disease with heavy alcohol use without metabolic syndrome, the greatest increase in advanced liver disease was found in those with combined heavy alcohol use and metabolic syndrome. 

Lee believes that the increased risk of liver damage from drinking is a result of an increase in the amount of fat in the liver. A healthy liver contains less than five percent fat; any more than that can lead to inflammation and cirrhosis (scarring) of the liver, liver cancer and liver failure.  

“Both metabolic syndrome and drinking increase liver fat, and we think that the combination of the two accelerates the accumulation of fat in the liver and fuels inflammation, resulting in a greater chance of liver disease,” said Lee.  

He hopes the study will encourage physicians who screen and diagnose patients with metabolic syndrome to also ask about alcohol use and look for liver disease.  

“Our study indicates that these conditions may often coexist, and it is in patients’ best interest to address both issues,” he said. “It’s also important for people with metabolic syndrome to realize they may be at an increased likelihood of advanced liver disease, and to monitor their drinking accordingly,” he added.  

The other authors of the study are Jennifer Dodge, MPH, assistant professor of research medicine and population and public health sciences with the Keck School of Medicine of USC;  Wendy Mack, PhD, professor of population and public health sciences with the Keck School of Medicine; Adam Leventhal, PhD, professor of population and public health sciences with the Keck School of Medicine and director of the USC Institute for Addiction Science and Norah Terrault, MD, MPH, a Keck Medicine gastroenterologist and division chief of gastroenterology and liver diseases with the Keck School of Medicine. 

Urologists with Keck Medicine of USC have launched a clinical trial to perform the world’s first human bladder transplant.

The trial is actively screening potential participants for this first-ever type of transplantation.

During the procedure, the patient’s diseased bladder will be removed and replaced with a healthy bladder from a deceased donor.

“Transplantation is a lifesaving treatment option for conditions affecting many major organs, and transplanting a bladder could be a historic step in improving lives,” said Inderbir Gill, MD, founding executive director for USC Urology, part of Keck Medicine. Gill is also the principal investigator of the clinical trial and leading the transplantation efforts. “We could be on the verge of a medical advance that has the potential to revolutionize how we treat terminally compromised bladders.”

Hundreds of millions of people around the globe experience varying degrees of bladder disease and dysfunction. Some patients with these conditions may require a bladder reconstruction, a surgical procedure wherein the bladder is removed, and a new bladder is made from the patient’s own intestines. However, the procedure carries a high risk of early and delayed adverse side effects, and not every patient is a candidate for this surgery.

“The intention of this clinical trial is to develop a new treatment option for a certain subset of patients with debilitating bladder conditions that can severely hamper quality of life and ultimately, even shorten life,” said Nima Nassiri, MD, urologic surgeon and researcher with the Keck School of Medicine of USC and Gill’s collaborator on the clinical trial. “We have worked diligently to expand the boundaries of what is considered possible for severely compromised patients who traditionally have had few options.”

Bladder transplants have not been done previously, in part because of the complicated vascular structure of the pelvic area and the technical complexity of the procedure. Gill, Nassiri and their colleagues have spent the past few years developing and practicing numerous research procedures to prepare for the first-in-human bladder transplant, which will be done completely using robotic surgery.

Robotic surgery is an advanced form of minimally invasive surgery in which surgeons use a high-definition, three-dimensional camera to guide a robot to perform surgery using smaller, more precise incisions with more dexterity than is possible using hand-held surgical tools.

Under Gill’s direction, USC Urology has established itself as a pioneer and world leader in robotic, minimally invasive techniques for kidney, bladder and prostate cancer surgery, and achieved important milestones leveraging machine learning and artificial intelligence to optimize patient outcomes.

Keck Medicine’s USC Transplant Institute, which has a robust and nationally recognized kidney, liver, heart and lung transplant program, further provided Keck Medicine with the needed resources and skills to pioneer the first bladder transplant.

As part of the research and development stage, Gill, Nassiri and colleagues successfully completed many practice transplantation surgeries, including the first-ever robotic bladder retrievals and successful robotic transplantations in five recently deceased donors with cardiac function maintained on ventilator support.

The procurement, surgery and post-surgical monitoring during transplantation were aligned with current clinical and research standards. OneLegacy Foundation, an organ procurement organization serving Southern California, provided clinical trial funding and, with the generous agreement of donor families, enabled bladder donations that made the trial possible.

Nassiri and Gill are presenting their surgical research update April 30 at the annual meeting of the American Urologic Association, the world’s leading association for urology professionals.

Gill, in addition to directing USC Urology, is chairman and Distinguished Professor of the Catherine and Joseph Aresty Department of Urology and the Shirley & Donald Skinner Chair in Urologic Oncologic Surgery at the Keck School.

Photo caption: The Keck Medicine of USC surgical team evaluates the integrity of a bladder during the research and development stage of bladder transplantation.

Diabetes is a chronic condition where the body does not produce or effectively use insulin. A lack of insulin leads to raised blood glucose (sugar) levels, which can cause heart disease and stroke, kidney disease, nerve damage and other severe complications.

Keck Medicine of USC has launched a Phase 2 clinical trial investigating the effectiveness of a new outpatient, nonsurgical endoscopic procedure in stabilizing blood glucose levels for patients. 

“Currently, the only treatment for diabetes not managed with lifestyle changes are oral medications or, in the case of advanced disease, insulin injections, both of which can be costly or have side effects,” said Luke Putnam, MD, lead investigator of the clinical trial and a gastrointestinal surgeon with Keck Medicine. “If this therapy is proven effective, it could eliminate the need for medication or insulin, or potentially prevent disease progression so it does not lead to organ failure and other debilitating conditions.”

This innovative procedure is designed for patients before they require insulin and targets the duodenum, the first part of the small intestine that works with the pancreas to regulate insulin and blood glucose levels.

Recent data suggests the duodenum plays an important role in glucose regulation, and in patients with Type 2 diabetes, the cells lining the duodenum become damaged.

The clinical trial is testing a device inserted via an endoscope into the duodenum that ablates (removes) the poorly functioning cells through precise, controlled electrical pulses.

The study researchers hypothesize that ablating the damaged cells will promote the regrowth of healthy cells, which will better regulate blood glucose levels.

The procedure takes about an hour and is done under general anesthetic. Patients are discharged the same day and can continue normal activities a few days later.

“Previous studies have shown that ablation of cells in the duodenum is effective in controlling blood sugar levels, so we are optimistic this study will produce successful results,” said Putnam.

Clinical trial participant Mark Canning, a 60-year-old Los Angeles resident who was diagnosed with Type 2 diabetes in 2015, is seeing progress controlling his blood glucose since undergoing the procedure in January. “My blood sugar levels are falling, and I am feeling very encouraged,” he said.

The clinical trial is currently enrolling new patients. To qualify for the study, patients must be between the ages of 22-65 and have a history of Type 2 diabetes between three to 10 years. Participants can be on oral medications but not insulin.

Those interested in participating in the study should contact Christian Romero at christian.romero@med.usc.edu.

John Lipham, MD*, a gastrointestinal surgeon with Keck Medicine, is co-investigator of the study.

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Download b-roll below of clinical trial participant Mark Canning undergoing an outpatient, nonsurgical endoscopic procedure that may help patients stabilize blood glucose levels.

* Lipham has a financial interest in the company sponsoring this study. He is a consultant for the sponsoring company, Endogenex, Inc. The nature of this conflict and the management of the conflict of interest have been reviewed by the USC Conflict of Interest Review Committee.

Atherosclerosis, the accumulation of plaque in arteries, is a leading cause of death in the U.S., and almost always occurs in women after menopause. Cognitive concerns such as memory loss, dementia and Alzheimer’s disease are dramatically more common in postmenopausal than premenopausal women.

Now, Keck Medicine of USC has launched a clinical trial to study the effect of a novel hormone replacement therapy on postmenopausal cardiovascular disease and cognitive decline.

“Data supports the concept that estrogen, a hormone that the ovaries stop producing after menopause, protects both the heart and brain from damage,” said Howard N. Hodis, MD, director of the USC Atherosclerosis Research Unit, internal medicine specialist with Keck Medicine and lead researcher of the study. “Our study seeks to determine whether estrogen-containing hormone therapy can prevent or slow atherosclerosis progression and cognitive impairment in women after menopause.”

A key aspect of the study is that it is designed for women who are postmenopausal for six years or less.

“We have studied previous data and conducted clinical trials showing that the timing of when a woman starts hormone therapy is crucial,” said Hodis, who is also a professor of medicine and population and public health sciences at the Keck School of Medicine of USC. “There appears to be a limited window of time wherein women benefit from hormone replacement therapy. Beyond six years of menopause, prevention appears to be too late.”

Improving standard hormone replacement therapies

The hormone therapy being studied has been approved by the Food and Drug Administration since 2013 and consists of estrogen paired with a non-hormone drug known as bazedoxifene.

Traditional hormone replacement therapy combines estrogen with progesterone, or more commonly with progestin, a synthetic progesterone. Estrogen alone can cause the lining of the uterus to thicken, causing bleeding and other health issues, which the progesterone or progestin prevents.

However, progestin/progesterone combined with estrogen has been associated with cancer risks. Bazedoxifene prevents the uterine lining from thickening while appearing not to present the same risks, said Hodis.

Trial eligibility and protocols

The clinical trial, titled Advancing Postmenopausal Preventive Therapy, is open to healthy women six years or less post-menopause, who have a uterus, are 45-59 years of age and do not have cardiovascular disease. Upon enrollment, trial participants:

• Receive an ultrasound of their neck artery that is used as a non-invasive baseline measure of atherosclerosis.
• Undergo several tests to gauge their baseline cognitive function and memory.

Every six months, participants have an ultrasound of the neck artery to monitor any progression of atherosclerosis. They also have electrocardiograms to check for different heart conditions, which are done yearly.

At the end of the study, which lasts approximately three years, women retake the cognitive and memory tests so researchers can determine whether there has been any change since enrollment.

The clinical trial is a double-blinded, placebo-controlled trial, meaning neither participants nor the researchers know who is receiving hormone replacement or a placebo. When the clinical trial is completed, researchers will compare results between the therapy and placebo recipients, and participants will be informed which option they received.

So far, some 260 women are participating in the trial; researchers are looking for 100 more women to enroll. Those interested in participating should contact the USC Atherosclerosis Research Unit at (323) 442-2257 or visit aru.usc.edu.

“Our ultimate goal is to help women and their physicians make informed decisions to promote good health post-menopause,” said Hodis.

The trial is funded by the National Institute on Aging (grant R01-AG058691), part of the U.S. National Institutes of Health (NIH). 

Donna Shoupe, MD, a reproductive endocrinologist specialist with Keck Medicine and professor of obstetrics and gynecology at the Keck School of Medicine and Wendy J. Mack, PhD, a professor of population and public health sciences with the Keck School of Medicine, are co-investigators of the clinical trial.

A study from Keck Medicine of USC published today in Clinical Gastroenterology and Hepatology gives people extra motivation to reduce fast-food consumption.

The study found that eating fast food is associated with nonalcoholic fatty liver disease, a potentially life-threatening condition in which fat builds up in the liver.

Researchers discovered that people with obesity or diabetes who consume 20% or more of their daily calories from fast food have severely elevated levels of fat in their liver compared to those who consume less or no fast food. And the general population has moderate increases of liver fat when one-fifth or more of their diet is fast food.

“Healthy livers contain a small amount of fat, usually less than 5%, and even a moderate increase in fat can lead to nonalcoholic fatty liver disease,” said Ani Kardashian, MD, a hepatologist with Keck Medicine and lead author of the study. “The severe rise in liver fat in those with obesity or diabetes is especially striking, and probably due to the fact that these conditions cause a greater susceptibility for fat to build up in the liver.”

While previous research has shown a link between fast food and obesity and diabetes, this is one of the first studies to demonstrate the negative impact of fast food on liver health, according to Kardashian.

The findings also reveal that a relatively modest amount of fast food, which is high in carbohydrates and fat, can hurt the liver. “If people eat one meal a day at a fast-food restaurant, they may think they aren’t doing harm,” said Kardashian. “However, if that one meal equals at least one-fifth of their daily calories, they are putting their livers at risk.”

Nonalcoholic fatty liver disease, also known as liver steatosis, can lead to cirrhosis, or scarring of the liver, which can cause liver cancer or failure. Liver steatosis affects over 30% of the U.S. population.

Kardashian and colleagues analyzed the most recent data from the nation’s largest annual nutritional survey, the 2017-2018 National Health and Nutrition Examination Survey, to determine the impact of fast-food consumption on liver steatosis.

The study characterized fast food as meals, including pizza, from either a drive-through restaurant or one without wait staff.

The researchers evaluated the fatty liver measurement of approximately 4,000 adults whose fatty liver measurements were included in the survey and compared these measurements to their fast-food consumption.

Of those surveyed, 52% consumed some fast food. Of these, 29% consumed one-fifth or more daily calories from fast food. Only this 29% of survey subjects experienced a rise in liver fat levels.

The association between liver steatosis and a 20% diet of fast food held steady for both the general population and those with obesity or diabetes even after data was adjusted for multiple other factors such as age, sex, race, ethnicity, alcohol use and physical activity.

“Our findings are particularly alarming as fast-food consumption has gone up in the last 50 years, regardless of socioeconomic status,” said Kardashian. “We’ve also seen a substantial surge in fast-food dining during the COVID-19 pandemic, which is probably related to the decline in full-service restaurant dining and rising rates of food insecurity. We worry that the number of those with fatty livers has gone up even more since the time of the survey.”

She hopes the study will encourage health care providers to offer patients more nutrition education, especially to those with obesity or diabetes who are at higher risk of developing a fatty liver from fast food. Currently, the only way to treat liver steatosis is through an improved diet.

Jennifer Dodge, MPH, assistant professor of research medicine and population and public health sciences at the Keck School of Medicine of USC and Norah Terrault, MD, MPH, a Keck Medicine gastroenterologist and division chief of gastroenterology and liver diseases at the Keck School, were also authors on the study.

Keck Hospital of USC performs some 300 liver and kidney transplants each year, and provides ongoing care to thousands of post-transplant patients on an outpatient basis. During the peak of the COVID-19 surge in Los Angeles, Keck Medicine of USC physicians implemented a new protocol to monitor and manage the care of liver and kidney transplant recipients who developed COVID-19, including monoclonal antibody therapy for eligible patients.

Now, a new study shows that as a result of these efforts, the number of hospitalizations and deaths for patients managed with the new protocol dropped by 18%. For those who received the drug therapy, the number of hospitalizations were halved, and deaths reduced to zero.

“We took a very proactive approach in managing our at-risk patients that resulted in significantly improved outcomes,” said Aaron Ahearn, MD, PhD, a liver, kidney and pancreas transplant surgeon with Keck Medicine, who also is the principal investigator and corresponding author of the study.

Quick response to an urgent problem

Early in the pandemic, Keck Medicine physicians realized that COVID-19 was much more lethal for transplant recipients than the general population. By December 2020, the height of the Los Angeles outbreak, they were treating 20 or more COVID-positive liver or kidney transplant recipients per week, many of them gravely ill.

“We were overwhelmed with cases and realized we needed to do something quickly to help these patients,” said Ahearn.

Ahearn and his colleagues assembled a multidisciplinary team consisting of transplant, infectious disease, nephrology, hepatology and family medicine specialists to devise a new patient protocol that included:

• Creating a database to track COVID-19 outcomes.
• Educating staff on identifying and monitoring COVID-19 symptoms.
• Creating a triage system to determine the severity of the disease and appropriate level of care.
• Providing telehealth visits by internal and family medicine doctors.
• Giving all recent transplant recipients a home pulse oximetry monitor to track their oxygen levels.

Additionally, eligible patients who tested positive for COVID-19 were offered monoclonal antibody therapy, which the U.S. Food and Drug Administration had approved in November 2020 for emergency use to treat COVID-19. Monoclonal antibodies have been found to be effective for treating mild to moderate COVID-19 disease soon after infection.

Patients who tested positive for COVID-19 within the previous 10 days with symptoms not severe enough to be hospitalized were eligible for the drug therapy. All patients who met this criterion were offered a single outpatient infusion of one of two monoclonal antibody therapies.

How the study was conducted

For the study, the physicians conducted a retrospective review of all liver and kidney transplant recipients who tested positive for COVID-19 and were seen at Keck Hospital from Feb. 1, 2020 to Feb. 28, 2021, a total of 226 patients. They reviewed patient demographics, COVID-19 treatments, hospitalizations and survival rates.

When comparing the outcomes of all patients before and after the protocol was implemented, the study authors found the total rate of hospitalization dropped from 54% to 35% and deaths from 20% to 9%.

They also discovered that the protocol was even more effective for patients who were identified early in their disease course and were therefore eligible for monoclonal antibody therapy.

A total of 34 (17 liver or combined liver/kidney transplant recipients and 17 kidney transplant recipients) received the drug therapy. For this group, COVID-related hospitalizations fell from 32% to 15% and death from 13% to zero.

Additionally, none of the patients had a major adverse reaction to the therapies.

Ahearn believes these results have important implications for the continued treatment of liver and kidney transplant recipients in the age of COVID-19.

“While all patients benefitted from our change in protocol, those who received the monoclonal antibodies benefitted the most,” he said. “Our study strongly suggests that these therapies can reduce disease progression in liver and kidney transplant recipients with COVID-19 and should be considered for all patients.”

Other authors in the study include Thin Thin Maw, MD, a nephrologist with Keck Medicine; Rishi Mehta, MD, a clinical assistant professor of medicine (clinician educator) at the Keck School of Medicine of USC and the associate medical director of inpatient operations at the Keck School; Juliet Emamaullee, MD, PhD, a transplant surgeon with Keck Medicine; Jim Kim, MD, a kidney and pancreas transplant surgeon with Keck Medicine; Emily Blodget, MD, MPH, an infectious disease specialist with Keck Medicine; Jeffrey Kahn, MD, a hepatologist with Keck Medicine; Linda Sher, MD, a hepatobiliary and pancreatic surgeon with Keck Medicine; and Yuri Genyk, MD, a hepatobiliary and pancreatic surgeon with Keck Medicine and division chief of hepatobiliary, pancreas and abdominal transplant surgery at the Keck School.

The trial is currently recruiting breast cancer patients whose cancer has metastasized (spread to other areas of the body) and whose tumors show increased levels of a protein called human epidermal growth factor receptor 2 (HER2). Participants must also have experienced resistance or disease progression while on treatment plans containing T-DM1, and/or T-DXd, and/or tucatinib, which are typically prescribed for HER2-positive breast cancer patients.

About 20% of breast cancers are HER2 positive. The HER2 protein promotes cancer cell growth, which can make HER2-positive breast cancer more aggressive and difficult to treat, despite the availability of therapeutic options specific to this type of cancer.

Chemotherapy may be used in combination with targeted therapies, but can cause difficult side effects because the drug is administered throughout the body rather than just to the areas affected by cancer.

“At USC Norris, we treat a large volume of patients with HER2-positive, metastatic breast cancer and we’ve found that resistance to existing therapies is a major issue,” said Janice Lu, MD, PhD, a medical oncologist with Keck Medicine, medical director of the USC comprehensive breast oncology program and global lead principal investigator of the trial. “We are excited to lead this effort in assessing a possible alternative solution for breast cancer patients, and hope to expand our ability to provide effective personalized care.”

Michael Press, MD, PhD, a pathologist with Keck Medicine, member of USC Norris and the director of the Breast Cancer Analysis Lab at the Keck School of Medicine of USC, will lead the study’s pathological evaluation.

ARX788 is an antibody drug conjugate, which is a type of therapy that combines a monoclonal antibody with a potent dose of medication, allowing for precise, targeted drug delivery that could potentially lessen side effects. ARX788 is designed with an anti-HER2 monoclonal antibody that identifies HER2-positive tumor cells to deliver a powerful dose of Amberstatin269, which destroys cancer cells and prevents new cells from forming.

Results from two phase 1 clinical trials demonstrated promising anti-tumor activity in patients who had previously received aggressive treatment plans, showing an overall response rate of 74% and a disease control rate of up to 100%, depending on dosing. ARX788 was well-tolerated, with most adverse events being mild or moderate.

“If this drug is effective, it could provide a hopeful alternative to patients with a difficult prognosis and help them maintain a quality of life in ways that chemotherapy cannot,” said Lu, who is also a member of USC Norris.

The trial is currently recruiting participants at more than 20 sites across the United States and Australia, with plans to open 150 sites worldwide, including Europe and Asia.

Those interested in enrolling at the USC Norris site can contact (323) 865-BRST (323-865-2778). To learn more about USC Norris breast cancer research, treatment and prevention please visit the USC Breast Center.

The trial is sponsored by Ambrx, which manufactures ARX788. Those wishing to learn more about the trial can email breast03trialinquiry@ambrx.com.

This study will be presented at the San Antonio Breast Cancer Symposium on Dec. 7-10, 2021 as an ongoing trial.

A new study from USC Norris Comprehensive Cancer Center, part of Keck Medicine of USC, suggests that the region cancer spreads to in the brain may not be random, but rather, is dependent on where the cancer originated in the body.

“We discovered that different types of cancer are more likely to show up in specific parts of the brain once they metastasize, indicating the location of tumors follow a distinct pattern,” said Gabriel Zada, MD, a brain and tumor neurosurgeon with Keck Medicine of USC and senior author of the study. He is also a member of USC Norris and director of the USC Brain Tumor Center.

Zada and colleagues analyzed the location of brain tumors caused by five common types of cancer – melanoma (a type of skin cancer), lung, breast, renal (kidney) and colorectal. They discovered that lung cancer and melanoma showed a higher likelihood for the metastasis to be at the frontal and temporal lobes (which sit behind the ears). Breast, renal and colon cancers had a higher propensity to spread to the back of the brain, such as the cerebellum and brainstem.

The findings are important not only because they may predict where a specific cancer may spread in the brain, but because they also have implications for how brain tumors grow.

“It may be that cancer cells have the ability to adapt to regional microenvironments in the brain that allow them to colonize and progress, while other areas of the brain are inhospitable to the same cells,” said Josh Neman, PhD, assistant professor of neurological surgery and physiology and neuroscience at the Keck School of Medicine of USC, scientific director of the USC Brain Tumor Center and lead author of the study. He is also a member of USC Norris.

To reach their conclusions, the researchers collected data from patients with metastatic brain cancer treated using stereotactic radiosurgery (SRS), a minimally invasive, targeted form of radiosurgery used to treat brain tumors and other lesions. The SRS allows surgeons to define the coordinates of a tumor in the brain with precise accuracy.

The researchers used the SRS coordinates from 970 patients with approximately 3,200 brain metastatic tumors arising from skin, lung, breast, kidney or colon cancers treated at Keck Medical Center of USC from 1994-2015. They created two predictive mathematical models to analyze the exact locations of brain metastases based on the primary cancer origins.

One model showed that distinct regions of the brain were relatively susceptible to certain types of cancer; another provided the probability of each cancer metastasizing in certain brain regions. Both models resulted in the approximate same results as to which areas of the brain were most likely to develop cancer-specific tumors.

The researchers believe the results of the study could be useful in the eventual prevention and treatment of brain tumors.

“If we can understand what factors either facilitate or block the process of metastasis, such as certain chemicals or neurotransmitters in the brain, there might be a way to intervene and prevent a cancer from metastasizing in the first place or treat it once it has spread,” Neman said. “In fact, we are already conducting studies to learn why certain areas of the brain are not receptive to certain cancer cells in hopes of developing better targeted therapies for patients.”

Zada and Neman are currently using the data from this study to participate in an international trial involving multiple sites to further study the patterns of brain metastasis based on primary cancer type.

“We are excited to see what new information this larger study will yield in our efforts to better understand and treat this complication of so many common cancers,” said Zada.

“Our registered nurses are an invaluable part of our organization,” said Marty Sargeant, interim CEO and chief operating officer of Keck Hospital and USC Norris. “We are excited to move forward with a contract that reflects our commitment to our caregivers and supports our mission to provide exceptional patient care.”

The new contract will continue through June 2025 and includes industry-leading wages, staffing enhancements and other key benefits that are important to represented employees and the health system.

“Our ability to attract and retain the most highly skilled, compassionate nurses is a key component of our success,” said Annette Sy, DNP, RN, NE-BC, chief nursing executive of Keck Medical Center of USC. “We are proud to provide our nurses with the support and environment that allows them to thrive.”

Keck Medicine is committed to the highest standards of patient safety and world-class care. This year, the medical center was ranked among the top hospitals nationwide on U.S. News & World Report’s 2021-22 Best Hospitals rankings and among the top three hospitals in Los Angeles and top five in California. The medical center was also nationally recognized among the top 50 hospitals in 12 medical specialties. Recently, Keck Hospital received its fourth consecutive hospital safety grade “A” from The Leapfrog Group, as well as the 2020 Patient Safety Honor Roll Award from the California Health and Human Services Agency, Hospital Quality Institute and Cal Hospital Compare.

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For more information about Keck Medicine of USC, please visit news.KeckMedicine.org. 

Traditionally, stroke patients try to regain motor function through physical rehabilitation, where patients re-learn pre-stroke skills, such as eating motions and grasping. However, most patients eventually plateau and stop improving over time.

Now, results of a clinical trial published in The Lancet gives patients new hope in their recovery.

Patients who received a novel treatment that combines vagus nerve stimulation (VNS) and rehabilitation showed improvement in upper body motor impairment compared to those who received sham (inactive form of) stimulation and rehabilitation. Considered a natural antenna to the brain, the vagus nerve runs from the chest and abdomen to the brainstem and regulates many of the body’s functions.

“This is incredibly exciting news for everyone involved in stroke rehabilitation and functional restoration and represents a unique intersection between neurosurgery and neurorehabilitation,” said Charles Liu, MD, PhD, the lead neurosurgeon of the study and director of the USC Neurorestoration Center of Keck Medicine of USC. “These study results are the first of their kind, and open up new possibilities for stroke patients, allowing them to reclaim more arm function even years after having a stroke.”

In this international, multi-center clinical trial, 53 participants with moderate to severe arm weakness nine months to 10 years post-stroke, received rehabilitation paired with VNS. Fifty-five patients within the same parameters received a sham stimulation. The trial was randomized and triple blind.

Those receiving the nerve stimulation had a wire inserted into their neck that wrapped around the vagus nerve. The wire was then connected to a pulse generator device implanted in the chest. Those receiving the sham received placebo implants.

After the surgical procedure, all patients received six weeks of in-clinic therapy, which included tasks such as reaching and grasping, simulated eating and opening and closing containers. After the in-clinic period, patients continued treatment with a course of daily home therapy.

When the two patient groups were compared, those receiving the nerve stimulation scored higher on several standardized measures of upper arm functionality.

“Not only were the results clinically meaningful, the fact that these patients were at least nine months post-stroke and in some instances years out, points to the possibility that meaningful improvements can be achieved even years after a stroke,” said Liu, who also serves as chief of innovation and research and chair of neurosurgery and orthopedics at Rancho Los Amigos National Rehabilitation Center.

The device is thought to work by triggering the release of brain neuromodulators – which regulate the body’s responses – to strengthen motor circuits in the brain associated with movement, enabling the brain to effectively relearn tasks. VNS is already used widely for the treatment of epilepsy and plays an increasing role in the treatment of severe depression.

“For too long, stroke patients have faced limited options for recovery,” said Liu. “This new treatment signifies a breakthrough that could be life-changing for many stroke patients and also represents an approach that will certainly be explored for many other functional restoration applications in the future.”

The VNS system utilized for the study is owned by MicroTransponder Inc., a medical device development company, who sponsored the study.

Lead authors on the study include Jesse Dawson, MD, College of Medical, Veterinary and Life Sciences, University of Glasgow in Scotland; Teresa J. Kimberley, PhD, Massachusetts General Hospital; and Navzer Engineer, MD, PhD, of MicroTransponder Inc.

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For more information about Keck Medicine of USC, please visit news.KeckMedicine.org.

In good news for older men, a new study from Keck Medicine of USC published in Urology shows that men over 50 who undergo a vasectomy reversal had the same rate of pregnancy with their partners as their younger counterparts. Contrary to what one might expect, the man’s age was not a factor.

“These results are exciting for men looking to start families later in life who have had a vasectomy,” said Mary Samplaski, MD, a male infertility specialist with Keck Medicine and the lead investigator of the study. “This research is especially timely because anecdotally, fertility doctors are seeing an increase in the number of men interested in vasectomy reversals as couples focus on family planning during the COVID-19 pandemic.”

For couples wanting to pursue a pregnancy after a vasectomy, two main options exist: vasectomy reversal and sperm extraction with in vitro fertilization (IVF). “IVF can come with unique risks, such as psychological distress and multiple births, plus typically costs more than a reversal, making the reversal the best choice for some couples,” said Samplaski.

Approximately 20% of American men who undergo a vasectomy will want to father children in the future, and some 6% will request a reversal, research shows. But up until now, little data has existed regarding the effect of paternal age on reversal outcomes.

In the study, Samplaski and colleagues analyzed the results of some 3,000 men over 50 and 350 men under 50 who underwent a vasectomy reversal at two separate locations, one of which was Keck Hospital of USC. The surgeries were performed by a single high-volume surgeon. The mean age for the over-50 group was 54, and for the under-50 group, 39.

Of the younger cohort, 33.4% of couples achieved pregnancy; in the older male population, 26.1%. However, the study also looked at several other factors, such as how many years ago the man received the vasectomy, the age of the female partner and if the man smoked. When the woman was under 35 and/or the man had the vasectomy less than 10 years ago, the odds of getting pregnant were higher. Smoking decreased the odds.

“When we did a statistical analysis, and examined all these other factors involved, the data showed that age had no bearing on success,” said Samplaski. “Male age was not an independent factor.”

For example, one reason older men were statistically less successful than younger ones in reaching pregnancy was because men with advanced age tend to have older female partners.

Looking forward, Samplaski hopes that men of a certain age will not be discouraged from having a vasectomy reversal. “The bottom line is, men over 50 can have successful outcomes in achieving pregnancy after a vasectomy reversal, and it should be considered a very viable option,” she said.

As part of a nationwide effort to discover more about the effects of this kind of therapy, Keck Medicine of USC is enrolling outpatient volunteers in a national phase 3 clinical trial to test the efficacy and safety of another monoclonal antibody drug known as LY-CoV555 for mild to moderate COVID-19.

Monoclonal antibodies are synthetic versions of the antibodies the body naturally produces when exposed to SARS-CoV-2, the virus that causes COVID-19. When given during the early stages of COVID-19, these antibodies may prevent the virus from replicating and spreading.

“The monoclonal antibody LY-CoV555 has shown some efficacy in early studies in preventing patients with mild to moderate COVID-19 from being hospitalized. So far, it is the only treatment to do so,” said Saahir Khan, MD, PhD, co-principal investigator of the trial site and an infectious disease specialist with Keck Medicine. He is also a clinical assistant professor of medicine (clinician educator) at the Keck School of Medicine of USC.

Michael Dube, MD, an infectious disease specialist with Keck Medicine and interim chief of the Division of Infectious Diseases with the Keck School, is the co-principal investigator of the study.

Those participating in the randomized, double-blind trial will be enrolled at the Keck Medicine COVID-19 medical evaluation tent and will receive a one-time infusion of either the drug or a placebo at the tent. Participants will keep a symptom diary for the first 28 days after the infusion, and their progress will be tracked for a total of 24 weeks either through in-person or virtual visits.

To qualify for the study, participants must:

• Be 18 or older.
• Be showing symptoms of COVID-19 but not have been hospitalized for the disease.
• Have tested positive for SARS-CoV-2 infection within seven days of enrollment and started experiencing symptoms within 10 days of enrollment.

The study aims for half of participants to have risk factors for developing a severe case of COVID-19, including those 55 or over or who have a preexisting condition such as diabetes, asthma or hypertension.

Keck Medicine will enroll patients who have tested positive for COVID-19 at all Keck Medicine hospitals and ambulatory locations, including Keck Hospital of USC, USC Norris Cancer Hospital and USC Verdugo Hills Hospital, as well as Los Angeles County + USC Medical Center and neighboring outpatient clinics.

Those interested in participating in the study can learn more or volunteer here.

This trial is part of a larger study, “ACTIV-2: A Study for Outpatients With COVID-19,” examining the safety and effectiveness of different drugs in treating COVID-19 in outpatients. ACTIV, which stands for Accelerating COVID-19 Therapeutic Interventions and Vaccines, brings private organizations and public agencies together to coordinate research strategies and speed the development of the most promising treatments and vaccines for the coronavirus.

The study is sponsored by the National Institute of Allergy and Infectious Diseases and the AIDS Clinical Trials Group. The monoclonal antibody drug LY-CoV555 is manufactured by Eli Lily.

Keck Medicine of USC is enrolling individuals in an international phase 3 clinical trial to examine the safety and effectiveness of deep brain stimulation to treat Alzheimer’s. The study uses electrical impulses to stimulate the region of the brain known as the fornix, which is associated with memory and learning.

“Deep brain stimulation has successfully treated conditions such as Parkinson’s disease by improving motor skills, and we are now investigating if this therapy can stabilize or improve cognitive function,” says Darrin Lee, MD, PhD, a neurosurgeon with Keck Medicine of USC and the site’s principal investigator of the study. “Based on the results of earlier phases of this clinical trial, the treatment offers a potential benefit for patients with mild Alzheimer’s.”

This randomized, double-blind study will last four years. Subjects will first take a standardized assessment test for Alzheimer’s to be used as a baseline measure of cognitive ability throughout the study.

Next, researchers will implant electrodes into subjects’ brains that connect to a battery pack, similar to a heart pacemaker, placed underneath the collarbone.

For the first year of the study, subjects will be given either low-frequency stimulation to the brain, high-frequency stimulation or a placebo — no stimulation.

“For those with Alzheimer’s disease, certain parts of the brain become atrophied,” Lee says. “We are testing to see if stimulating the brain’s fornix can reawaken brain activity in this area and stop the progression of the disease.”

During the first year, subjects will be given subsequent cognitive tests to check if their memory or learning skills have held steady or improved. At the end of the year, study researchers will examine data to determine which level of stimulation had the most impact on these skills.

For the next three years of the trial, all subjects in the study will receive what researchers have determined is the optimal frequency of deep brain stimulation, even those originally receiving the placebo. Patients will continue to be given cognitive assessments throughout the four-year period.

To qualify for the trial, patients must be 65 or older, have been diagnosed with mild Alzheimer’s and take Alzheimer’s medication, and have a caregiver or family member who can accompany them to doctor visits.

The clinical trial involves approximately 200 patients at some 20 sites in the United States, Canada and Germany. Keck Medicine plans to enroll 8-15 patients.

Those interested in enrolling in the clinical trial with Keck Medicine can contact Amanda Romano at amanda.romano@med.usc.edu or 213-393-5640.

Keck Medicine co-investigators of the trial include psychiatrist Carlos Manuel Figueroa, MD, and neurologist Elizabeth Joe, MD.

Deep brain stimulation has been approved by the U.S. Food and Drug Administration since 1997 and has proven to be safe.

The trial is sponsored by Functional Neuromodulation, Inc.

Learn more about the clinical trial here.

A new study from USC Urology with Keck Medicine of USC demonstrates that focal (or targeted) high-intensity focused ultrasound (HIFU) ablation of the prostate is an effective alternative to surgery or radiation, with encouraging outcomes and shortened recovery time.

Focal HIFU ablation is an outpatient procedure that uses a focused ultrasound beam to raise the temperature inside the prostate to approximately 90 degrees Celsius (194 degrees Fahrenheit) to destroy targeted areas of prostate tissue. The procedure takes around two hours and the patients are often discharged home the same day.

The study, published in The Journal of Urology, followed 100 men in the United States who underwent a HIFU procedure for prostate cancer between 2015-2019. This is the first and largest study examining the outcomes of focal HIFU ablation as a primary treatment for prostate cancer in the United States.

During follow-up, 91% of HIFU patients successfully avoided radical treatment. Also, 73% of patients did not experience treatment failure, which the researchers defined as clinically significant cancer recurrence, metastases or mortality, or the need for additional hormone therapy, chemotherapy, surgery or radiation.

The results demonstrated that focal HIFU carries a low risk of complication and can help preserve quality of life. In fact, all patients remained continent and there was no significant decrease in sexual function. There also were no serious adverse events or major complications. Minor complications, including difficulties with urination and urinary tract infection, occurred in a small proportion of the patients, and were addressed without major interventions. Patients were typically discharged the same day as their procedure and resumed regular activities shortly thereafter.

“This positive data empowers urologists to use focal HIFU ablation to effectively address prostate cancer without the intrinsic side effects of radical treatments,” says Andre Abreu, MD, urologic surgeon with Keck Medicine and first author of the study. Abreu is also an assistant professor of clinical urology and radiology at the Keck School of Medicine of USC. “We hope this study encourages prostate cancer patients to talk to their doctor about all potential treatment options to ensure that they receive a personalized care plan that addresses their individual needs.”

Urologists worldwide have used HIFU ablation to treat prostate cancer patients for many years; however, the technology was only approved by the Food and Drug Administration (FDA) for prostate tissue ablation in 2015. Keck Medicine was among the first U.S. institutions to use this technology following the FDA approval.

“USC Urology is dedicated to refining cancer care through collaboration and innovation,” says Inderbir S. Gill, MD, founding and executive director of USC Urology and senior author of the study.

“Throughout screening, diagnosis and treatment, it is important to balance accuracy and efficacy. Our physicians will continue working toward better methods to personalize that balance for every prostate cancer patient,” continues Gill, who is also Distinguished Professor and chair of the Catherine and Joseph Aresty Department of Urology, Shirley and Donald Skinner Chair in Urologic Cancer Surgery and associate dean for clinical innovation at the Keck School.

In 2010, USC Urology launched a focal therapy and image-guided surgery program to develop more accurate methods to diagnose and treat prostate cancer. Since the program’s inception, USC Urology has increased its annual image-guided prostate biopsies six-fold, with the vast majority of these procedures using a combination of MRI and ultrasound imaging. Additionally, USC Urology physicians are skilled in the most innovative therapies, including focal HIFU, cryoablation and robotic prostatectomy.

USC Urology physicians also collaborate with Keck Medicine radiologists and pathologists to create tailored, multidisciplinary treatment plans for each prostate cancer patient.

This year, U.S. News and World Report ranked Keck Medicine No. 9 in the country for Urology.

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For more information about Keck Medicine of USC, please visit news.KeckMedicine.org.

The phase 3 clinical trial, which is also funded by the US Biomedical Advanced Research and Development Authority and the National Institute of Allergy and Infectious Diseases, aims to register 30,000 adult volunteers nationally: Keck Medicine plans on enrolling 500 of them.

“Participating in this trial is a historic moment that has great significance not only in the United States but for the entire world,” says the co-investigator of the study Edward Jones-Lopez, MD, MS, an infectious disease specialist at Keck Medicine. “It is an honor to have been selected as one of the trial sites, and we look forward to being part of the solution in the search for a vaccine for COVID-19.”
 

Prioritizing access for at-risk populations

Keck Medicine is enrolling participants at the greatest risk of contracting the coronavirus, such as those from the Latino and Black communities, those older than 65 and factory workers.

“We want to help those who could benefit the most,” says co-investigator Michael Dube, MD, an infectious disease specialist at Keck Medicine and interim chief of thedivision of infectious diseases at the Keck School of Medicine of USC.

The clinical trial will operate out of two locations: Keck Hospital of USC and a satellite location in Vernon, California, five miles south of downtown Los Angeles. The researchers, with the support of local health officials, selected Vernon because the city has a high concentration of factories and warehouses, including meat-packing plants. Many meat-packing houses have experienced high infection rates throughout the country during the pandemic.
 

Study protocol and background

The trial is a randomized, blind, placebo-controlled study. Two-thirds of the subjects will receive the vaccine in the form of two shots one month apart. The other third will receive a placebo injection.

Those receiving the vaccine will be asked to keep a symptom diary and receive periodic follow-up in-person and over the phone. Any subject who develops symptoms of COVID-19 will be seen and evaluated as needed. Researchers will measure the rate of symptomatic infection between the group receiving the vaccine and the placebo.

“At the end of the study, if the vaccine proves effective, those who received the placebo will have the option to be vaccinated,” Dube says.

The vaccine was developed by the University of Oxford in partnership with AstraZeneca, a global biopharmaceutical company. An earlier Phase 1/2 trial of more than 1,000 participants found that the vaccine induced a strong immune response to COVID-19, producing antibodies to fight infection, with most participants experiencing only mild side effects, such as fatigue and headaches. Early animal-model research yielded a similar immune response.

The vaccine is made from a weakened version of the common cold virus called an adenovirus that has been genetically modified to contain the coronavirus spike protein, a protein that binds to and infects the cells, explains Jones-Lopez. Once the protein is introduced into the body, the vaccine theoretically works by priming the immune system to attack the COVID-19 virus if it later infects the body.
 

Participating in the clinical trial

To volunteer for the study, individuals must be 18 or older who are at high risk of COVID-19 infection and able to comply with study procedures. Participants may have preexisting health conditions, however, must be in stable condition with no hospitalization or worsening of the disease three months before enrollment. People over the age of 65 years are encouraged to participate in this study.

To volunteer for this trial or other federally supported coronavirus vaccine trials either currently underway or planned for the future, please visit the COVID-19 Prevention Network.

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For more information about Keck Medicine of USC, please visit news.KeckMedicine.org.

However, once lung transplant recipients leave the hospital, they may experience complications, such as an infection or organ rejection, that can result in unplanned hospital readmissions and other poor outcomes.

One of the many challenges patients face is managing their health from home and adhering to medication schedules.

To provide another layer of support for lung transplant recipients, the Keck Medicine of USC lung transplant team launched a two-year observational pilot study to monitor patients post-discharge using Bluetooth-enabled devices and computer tablets. The devices measured blood pressure, heart rate, weight, blood glucose, oxygen saturation and pulmonary function.

The researchers discovered that monitored patients had 44% fewer hospital readmissions and spent 54% fewer days in the hospital when they were readmitted.

“This study is significant because it is the first to use Bluetooth technology to comprehensively monitor transplant patients,” says Felicia Schenkel, MSN, lung transplant manager and lead author of the study. “Lung transplant recipients are a high-risk patient population, and we’re happy to see that this program worked so well to improve patients’ lives.”

The study appeared in the American Journal of Transplantation.

Twenty-eight lung transplant patients received the two-year remote tracking and 28 matched control patients did not. With the exception of remote monitoring, all patients received the same level of post-surgical care, which included regular in-person visits and lung function check-ups. The two groups of patients were also similar in respect to demographics, diagnosis and pre-transplant clinical characteristics.

Monitored patients used computer tablets to report symptoms, track appointments and medication compliance, conduct videoconferences with staff and access educational videos along with other materials.

Patients were asked to measure their vital signs and report symptoms daily for the first three months and after that time, three times a week. The results were sent in real time to the transplant team and triggered alerts if out of normal range.

Patients with high compliance rates on reporting vital signs and symptoms received incentives such as badges and humorous memes. Patients with marginal compliance received encouraging reminders and periodic calls from the transplant team.

At the end of the two years, the tracked patients were readmitted to the hospital 66 times versus 112 for the control group. They were less likely to be admitted for infections and non-organ rejection/non-infection causes such as shortness of breath or hypertension. They also had a lower but not statistically significant readmission for organ rejection and for death.

In addition, when monitored patients were readmitted to the hospital, they spent an average of 12 fewer days per patient per year compared to the control group (approximately 10 days versus 22). Hospital costs were also dramatically cut by 48%, translating to a $132,000 reduction in hospital charges per patient per year.

The at-home tracking worked for two reasons, according to Schenkel. “With constant monitoring, we were able to react to data sooner and take intervening steps before a patient’s condition worsened,” she says. “In addition, because we incentivized data reporting, patients were more likely to check in with us about their health and report symptoms.”

Post-surgical remote monitoring is now standard protocol for all lung transplant recipients at Keck Medicine. The department averages between 30 – 40 lung transplants per year.

In the future, study authors hope other medical teams will follow their lead.

“Real-time remote monitoring of patients is not only beneficial to lung transplant patients but can easily be transferred to other types of transplant or critical care patients,” Schenkel says. “This program should be a model for how telemedicine can be used in the future, especially as the need for remote monitoring technology has increased due to the COVID-19 pandemic.”

Other Keck Medicine authors of the study include Mark L. Barr, MD, co-director of the USC Transplant Institute; Sivagini Ganesh, MD, MPH, medical director of the lung transplant program; Maria Bembi, RN, lung transplant coordinator; Roya Sadeghi, RN, lung transplant coordinator; Jeremy O’Connor, MSW, LCSW, cardiothoracic transplant social worker; Marian Duong, RD, cardiothoracic transplant dietitian; Jaynita Patel, MS, RD, clinical dietitian; and Tammie Possemato, project manager.

The Bluetooth devices were provided by ActiCare Health.

The medication activates the kappa opioid receptor (KOR), which binds to opioid-like compounds in the central and peripheral nervous systems to alleviate pain, resulting in targeted pain relief with a reduced risk of addiction.

Previous research shows that some opioids that selectively activate only KORs relieve pain locally at the site of injury without crossing the blood brain barrier and inducing substance dependency, whereas commonly prescribed opioids that target other receptors in the brain are more addictive.

In this study, lead author Alexander Weber, MD, sports medicine physician and orthopaedic surgeon with Keck Medicine, and corresponding author Denis Evseenko, MD, PhD, vice chair for research and associate professor of orthopaedic surgery at the Keck School of Medicine of USC, locally administered a kappa opioid into arthritic mice knees and measured the progression of the disease in their joints.

The researchers confirmed that the medication effectively alleviated pain, however findings also suggest that the medication prevented the loss of cartilage, the connective tissue between the joins that pads bones, and slowed the progression of osteoarthritis.

“Arthritis affects nearly a quarter of adults in the United States, many of whom take addictive opioids to manage their pain. The implications of this study may someday alter how we provide orthopaedic care to significantly reduce the number of patients experiencing long-term pain and addiction,” says Weber.

More research is needed to advance toward human clinical trials, which are paramount as treatment and pain management options for osteoarthritis are limited.

“We hope that the findings of our study will lay the foundations for clinical research to further current understandings of the relationship between kappa opioids and osteoarthritis in humans to improve clinical care and quality of life,” says Evseenko.

This study was supported by the National Institutes of Health under award numbers RO1-AR-071724 and RO1-AG-058624, and by the Department of Defense under award number W81XWH-13-1-0465.

The new center, named in honor of Brown’s parents, will focus on accelerating the development of groundbreaking cancer treatments.

“The importance of conducting research to develop more effective and less toxic cancer therapies cannot be overestimated,” says Caryn Lerman, PhD, director of the USC Norris Comprehensive Cancer Center and associate dean for cancer programs at the Keck School. “This gift will enable us to leverage the talent of USC Norris scientists and dedicated clinicians and ensure that our groundbreaking discoveries move not from bench to bookshelf, but from bench to bedside, transforming cancer care and survivorship for all people.”

Brown, who will celebrate his 90^th birthday in August, is a previous donor to USC Norris and graduated from USC with a Bachelor of Science degree in 1959.

“I have been fortunate to do well in business, and now through my efforts as trustee of the Rosalie and Harold Rae Brown Charitable Foundation, want to give back to a cause that is not only personally important to me, but addresses a great need in society, finding a cure for cancer,” says Brown. “Honoring my parents and creating the Rosalie and Harold Rae Brown Center for Cancer Drug Discovery at USC Norris is a rewarding and fitting legacy.”

This gift will have an immediate impact by supporting the development of new clinical trials that build on USC Norris discoveries of the underlying causes of cancer and disease progression. Initial projects will be sharply focused on cancers that disproportionately affect members of the community for whom there are dramatic ethnic and racial disparities, such as breast cancer, prostate cancer and colorectal cancer.

“This generous gift will help position USC Norris and the Keck School at the forefront of innovative cancer research and treatment,” says Laura Mosqueda, MD, dean of the Keck School. “It will significantly enhance our mission of finding cures and offering renewed hope for all who are impacted by cancer.”

Researchers at the Keck School of Medicine of USC compared Pinktober and Movember, two monthlong cancer outreach campaigns with similar online popularity based on six years of search traffic data. They analyzed patterns of Google Trends search data for specific keywords associated with each campaign and the health behaviors that should result from increased awareness. For example, the Pinktober keywords included “Pinktober,” “Breast Cancer” and “Mammography,” while Movember keywords included terms like “Movember,” “Mustaches,” and “PSA Test OR PSA.”

The researchers found that while the peaks in breast cancer related web searches corresponded with peaks for the Pinktober campaign throughout October, the volume of web-searches for prostate cancer did not appear to be influenced by the timing of the “Movember” campaign in November.

“Between the pink ribbons and mustaches, both these campaigns have very visual elements that can reinforce their online visibility,” says Giovanni Cacciamani, MD, assistant professor of research urology at the Keck School and principal investigator of the study. “However, a successful health awareness campaign will need to go beyond reach and virality to ensure that the public understands the call to action.”

Cacciamani emphasized that the data does not necessarily reflect poorly on the Movember movement, which encourages men to grow out their mustaches in November to raise awareness for men’s health issues like prostate and testicular cancers, mental health and suicide prevention. Since its founding in 2003, the campaign has raised more than $700 million in funding.

The varied effectiveness of the two campaigns may be attributed to the target audience. The Pinktober campaign to raise awareness for breast cancer and the need for regular screening is targeted to women, who may be more likely to turn to the internet for health information. In contrast, Movember is most popular among younger to middle-aged men and lends itself to social media mustache selfies, while prostate cancer primarily affects a generation of men who may not be as active on these platforms.

Another possible explanation for the differences in search traffic could be that in 2012, the United States Preventive Services Task Force (USPSTF) recommended against routine prostate-specific antigen testing for prostate cancer. Although the USPSTF has since updated their guidelines to encourage men ages 55-69 to speak to their doctor about the frequency of screening, Movember has seen a decrease in registered participants and donations since 2012.

Cacciamani and his team continue to analyze Google traffic for insights into how patients use the internet to obtain health care information.

“The pernicious trap of fake news is always around the corner,” says Inderbir S. Gill, MD, chair and Distinguished Professor of Urology in the Catherine & Joseph Aresty Department of Urology and executive director of USC Urology. Gill is also the senior author of the study. “Understanding patients’ internet search patterns can help the medical community combat misinformation and encourage healthier habits,” concluded Gill, who is also the Shirley and Donald Skinner Chair in Urologic Cancer Surgery at the Keck School.

• Homelessness: Patient’s history of homelessness
• Outreach: Who else is providing services
• Utilization: How patient uses health care, social services and judicial system
• Salary: Kinds of financial resources
• Eat: Sources of food and access to it
• Drink: Sources of clean water and access to it
• Bathroom: Access to toilet
• Encampment: Sleeping environment
• Daily routine: How to minimize competing priorities
• Substance use: History of usage

This acronym is designed to spur clinicians to ask questions they may not have been trained to ask, which can reveal issues that directly impact a patient’s health.

“Developing an effective treatment plan depends on a complete and accurate patient history,” said Brett Feldman, MSPAS, PA-C, clinical assistant professor of family medicine and director of street medicine at the Keck School. The street medicine program administers care to homeless individuals in Los Angeles County, which is home to nearly 45,000 unsheltered individuals. “Even patients in traditional clinic settings omit information, sometimes unintentionally, that could be relevant to a diagnosis, so it’s important for outreach teams to have a means of understanding each homeless individual’s unique situation,” he added.
 
Understanding the people behind the numbers

• In the 2019 Greater Los Angeles Homeless Count, volunteers found 58,936 people experiencing homelessness in Los Angeles County — a 12% increase over the last year. Countywide, 75% (44,214 people) were unsheltered.
• The City of Los Angeles counted 36,300 homeless people, a 16% increase from last year. Of those, 27,221 were unsheltered.
• In Los Angeles County, the number of people experiencing chronic homelessness, defined as being homeless for 12 consecutive months or on at least four separate occasions in the last three years totaling at least 12 months, increased 17%, from 14,075 in 2018 to 16,529 in 2019. Of these, 1,991 had some form of shelter, but 14,537 were unsheltered.

— Wendy Wolfson

“Current wearable low vision technologies using virtual reality are limited and can be difficult to use or require patients to undergo extensive training,” said Mark Humayun, MD, PhD, director of the USC Dr. Allen and Charlotte Ginsburg Institute for Biomedical Therapeutics, co-director of the USC Roski Eye Institute and University Professor of Ophthalmology at the Keck School.

“Using a different approach — employing assistive technology to enhance, not replace, natural senses — our team adapted AR glasses that project bright colors onto patients’ retinas, corresponding to nearby obstacles,” Humayun said.

Patients with retinitis pigmentosa wore adapted AR glasses as they navigated through an obstacle course based on a U.S. Food and Drug Administration–validated functional test. Using video of each test, researchers recorded the number of times patients collided with obstacles, as well as the time taken to complete the course. Patients averaged 50% fewer collisions with the adapted AR glasses.

Patients also were asked to grasp a wooden peg against a black background — located behind four other wooden pegs — without touching the front items. Patients demonstrated a 70% increase in grasp performance with the AR glasses.

“Patients with retinitis pigmentosa have decreased peripheral vision and trouble seeing in low light, which makes it difficult to identify obstacles and grasp objects. They often require mobility aids to navigate, especially in dark environments,” said Anastasios N. Angelopoulos, study project lead in Humayun’s research laboratory at the Keck School.

“Through the use of AR, we aim to improve the quality of life for low vision patients by increasing their confidence in performing basic tasks, ultimately allowing them to live more independent lives,” Angelopoulos said.
 
How the AR system works
The AR system overlays objects within a 6-foot wireframe with four bright, distinct colors. In doing so, the glasses provide visual color cues that help people with constricted peripheral vision interpret complex environments, such as avoiding obstacles in dimly lit environments.

To accomplish this, researchers used a process called simultaneous location and mapping, allowing the AR glasses to fully render the 3-D structure of a room in real time. The glasses then translated this information into a semitransparent colored visual overlay, which highlighted potential obstacles with bright colors to help patients with spatial understanding and depth perception. This technology can work on commercially available devices.

According to Humayun, while major cost and technical issues remain, this type of assistive technology could eventually become more practical for everyday use in the near future.

— Wendy Wolfson

USC CBC researchers provided free and unlimited Lyft rides for three months to 150 older patients with chronic disease to see if better access to transportation could improve their access to medical centers and reduce their social isolation. The researchers also wanted to know its overall impact on their health.

Ninety-three percent of patients used the Lyft rides to access medical care and a significant number learned to use smartphone apps and a telephone concierge service to do so. While visiting their doctors counted for a third of all rides (31%), the seniors used the remaining rides to get to fitness, social and leisure activities, and reported that this improved their perceived quality-of-daily-life (92%).

“Access to transportation is more than getting from point A to point B; it encompasses multiple human facets of life,” says Leslie Saxon, MD, executive director of the USC Center for Body Computing and principal investigator of the study. “This research underscores how ride-sharing platforms can provide a significant benefit to the well-being of older adults, empowering them to become active participants in their own care as well as in other areas of their lives.”

The researchers concluded that while older adults can be willing, even enthusiastic novel technology adopters who are motivated to overcome barriers disrupting their own health, they needed education and support to be successful.

In the study, 150 English-speaking Keck Medicine of USC patients over the age of 60 (63% female and 54% Caucasian) with chronic diseases were screened for psychological factors and to ensure that access to transportation was a factor in missed appointments. The patients lived an average of 20 miles away from Keck Medical Center of USC and over 45% relied on others for transportation.

The patients were offered free rides to both medical and non-medical destinations for three months and received personalized training in summoning a ride from a ride-sharing app. They also had the option to schedule rides via the Lyft phone concierge platform. Each participant was assigned a wrist-worn daily activity tracker.

The majority of older adults reported that cost was the primary barrier preventing them from continuing to use the ride shares after the study concluded, as the average cost of a month of unlimited rides in Los Angeles is $500. “Because study participants expressed challenges with the costs associated with ride-sharing, our next steps will be to compare the long-term costs of using these apps for health care needs versus the opportunity costs of inconsistent access to transportation,” Saxon says. “Our findings on the benefits to seniors could incentivize similar programs on a larger scale by cities and insurance companies.”

The study was supported by a $1 million grant from the AARP Foundation as part of a broader collaboration with United Healthcare to address the needs of seniors. Lyft provided the rides and transportation data as well as the app and telephone concierge platform.

“Access to reliable, affordable transportation is essential for older adults,” says Lisa Marsh Ryerson, president of AARP Foundation. “When older adults can’t get to medical appointments or social activities, the negative effect on well-being — whether from untreated medical conditions or lack of social interaction — is enormous. This study highlights the vital connection between good transportation and good health in our communities, especially for seniors who can no longer drive.”

This research was supported by the AARP Foundation. No funding support was contributed by Lyft.

— Wendy Wolfson

Using a unique source of frontline data — instances of elder abuse reported to the National Center on Elder Abuse (NCEA) resource line, Keck School researchers were able to identify the most common types of elder abuse reported and profile the alleged perpetrators. The NCEA resource line is a source for individuals seeking information regarding how to identify or report elder abuse.

Of the nearly 2,000 calls logged for the study, more than 42% (818 calls) alleged abuse. Financial abuse was the most commonly reported at nearly 55% (449 calls).

Family members were the most frequently identified perpetrators of alleged abuse at nearly 48% of calls in which relationship could be determined. The most common abuse perpetrated by family was financial abuse (61.8%), followed by emotional abuse (35%), neglect (20.1%), physical abuse (12%) and sexual abuse (0.3%). Of the calls that alleged abuse by a family member, more than 32% reported more than one abuse type.

“We expected to find that financial abuse was the most common abuse reported,” said Gali Weissberger, PhD, lead author of the study, and postdoctoral scholar in the Han Research Lab at the Keck School. “But despite the high rates of financial exploitation perpetrated by scammers targeting older adults, we found that family members were the most commonly alleged perpetrators of financial abuse. In fact, across all abuse types, with the exception of sexual abuse and self-neglect, abuse by a family member was the most commonly reported.”

Elder abuse affects an estimated one in 10 older adults annually, but is often underreported. Aside from its physical, psychological and social impact on victims, their families and society, elder abuse attributes to more than $5.3 billion in U.S. annual health care costs.

“This is the first study to characterize elder abuse from calls made to the NCEA resource line, which serves as a public access point for people seeking information and resources about elder abuse,” said Duke Han, PhD, associate professor of family medicine at the Keck School and corresponding author of the study. “Our findings highlight the importance of resource lines for those seeking information on elder abuse, as many calls were made to understand whether certain situations reflected abuse.”

The researchers coded nearly 2,000 calls, emails or messages logged on the NCEA hotline between August 2014 and June 2017, reviewing for any mention of abuse. They categorized type of abuse alleged, whether multiple types of abuse occurred and who perpetrated the alleged abuse.
The researchers added that it is important to incorporate diverse data sources when collecting information regarding alleged abuse. The study was limited by selection bias, as the data was from individuals proactively calling the NCEA line.

“The results highlight the importance of developing effective strategies to prevent future abuse,” Weissberger said. “Our next step is to conduct more studies targeting high-risk individuals and to better understand additional risk factors.”

— Wendy Wolfson

Clinical trials provide researchers with insight into how people are likely to respond to medical interventions, including surgery. Factors such as age, weight, genetics, ethnic origin and geographic location all play a role in how a person may react to different treatments. For that reason, representation of diverse patient populations in clinical trials enables researchers to better address public health concerns.

“Nearly half of Los Angeles residents are Hispanic, making the Keck School uniquely positioned to recruit a large, underrepresented population in cardiac surgery trials,” said principal investigator Michael Bowdish, MD, MS, associate professor of surgery and preventive medicine at the Keck School. “By increasing patient diversity in cardiac surgery clinical trials, we are better suited to address cardiovascular disease, the No. 1 cause of mortality in the United States.”

The Keck School, through relationships with the Los Angeles County Department of Health Services, will recruit potential patients from areas with a large Hispanic presence, according to Bowdish. Potential patients also will be identified through the Southern California Clinical and Translational Science Institute (SC CTSI), which provides outreach and education to more than 30 predominantly Hispanic community health organizations in Los Angeles.

“Addressing the cardiovascular needs of our community is top priority,” said Vaughn A. Starnes, MD, chair and Distinguished Professor of Surgery and H. Russell Smith Foundation Chair for Stem Cell and Cardiovascular Thoracic Research at the Keck School. “This prestigious award provides us with valuable resources to discover novel and innovative therapies to improve the health of our Los Angeles community and beyond.”
The Keck School will collaborate with Saint Luke's Mid America Heart Institute in Kansas City, Missouri, as Linked Clinical Research Centers. This expands the patient pool for gathering and assessing data, enabling researchers to achieve stronger and more definitive research results, according to Bowdish.

In addition, the implementation science training program, under the leadership of Cecilia Patino-Sutton, MD, PhD, MEd, associate professor of preventive medicine at the Keck School, will explore novel ways to translate findings from clinical research in cardiac surgery into clinical practice. The program also will leverage collaborative relationships between the Keck School, SC CTSI, the USC Gehr Family Center for Health Systems Science, and the USC Leonard D. Schaeffer Center for Health Policy and Economics, as well as the Mid America Heart Institute Cardiovascular Research Fellowship.

Keck Medicine of USC has been an active member of the CTSN since 2010. The CTSN includes more than 40 major academic medical centers across the United States and Canada, and more than 20 hospitals in Europe.

“Many supplements on the market merely contain vitamins and minerals, but don’t do anything to improve testosterone,” Samplaski said. “Often, people can be vulnerable to the marketing component of these products, making it difficult to tease out what is myth and what is reality.”

Testosterone is the primary male sex hormone and the reason why men produce sperm and have Adam’s apples. It’s also why men develop more “masculine” features like bulging muscles, a deep voice, broad shoulders and a hairy chest. After age 30, most men experience a gradual decline in testosterone, sometimes causing these features to diminish or new symptoms to occur, like erectile dysfunction. In an attempt to turn back the hands of time, some men will turn to T boosters.

Using a structured review approach, Samplaski and a team of researchers explored the active ingredients and advertised claims of 50 T boosting supplements. Their findings were published as an original article in The World Journal of Men’s Health.

Researchers performed a Google search with the search term “Testosterone Booster,” thus mimicking a typical internet research for someone looking to increase testosterone levels, and then selected the first 50 products that came up in their search. Then, the team reviewed published scientific literature on testosterone and the 109 components found in the supplements. Zinc, fenugreek extract and vitamin B6 were three of the most common components in the supplements.

The team also compared the content for each supplement with the Food and Drug Administration’s (FDA) Recommended Daily Allowance (RDA) and the upper tolerable intake level (UL) as set by the Institute of Medicine of the National Academy of Sciences.

Of the 150 supplements, researchers came across 16 general claims to benefit patients, including claims to “boost T or free T”, “build body lean mass or muscle mass”, or “increase sex drive or libido.”

While 90% of the T booster supplements claimed to boost testosterone, researchers found that less than 25% of the supplements had data to support their claims. Many also contained high doses of vitamins and minerals, occasionally more than the tolerable limit.

Unlike drugs, supplements are not intended to treat, diagnose, prevent, or cure diseases, according to the FDA. As such, Samplaski would like to see more regulation around testosterone-boosting supplements to protect consumers. She also would like to explore disseminating handouts to her patients with more accurate information in the hopes that it encourages patients to seek a medical professional for low testosterone issues.

While no one can escape the effects of aging, Samplaski said there is something men can do to address their concerns. “The safest and most effective way for men to boost low testosterone levels is to talk with a medical professional or a nutritionist.”

— Elyse Blye

Researchers at the USC Norris Comprehensive Cancer Center found that identifying a metastatic colorectal cancer patient’s Consensus Molecular Subtype (CMS) could help oncologists determine the most effective course of treatment. CMS also had prognostic value, meaning each subgroup was indicative of a patient’s overall survival, regardless of therapy. The results are from the multi-center Phase III CALGB/SWOG 80405 trial and published in the Journal of Clinical Oncology.

CMS categorizes colorectal cancer into four distinct, biologically characterized subgroups based on how mutations in the tumor behave. The subgroups were created using data from several research teams around the world that had previously analyzed tumors of colorectal cancer patients who were treated with surgery and adjuvant chemotherapy. Although CMS classification is not based on clinical outcomes, there seemed to be patterns in how different subtypes responded to treatment.

“We wanted to understand the importance of CMS for patients with metastatic disease who are treated with the two most important first-line therapies,” said Heinz-Josef Lenz, MD, professor of medicine at the Keck School of Medicine of USC and J. Terrence Lanni Chair in Gastrointestinal Cancer Research at USC Norris. Lenz was the lead author on the study. “We anticipated that CMS had prognostic value, but we were impressed at how strongly CMS was associated with outcomes.”

The study compared the efficacy of two different therapies (chemotherapy and cetuximab versus bevacizumab) on 581 metastatic colorectal cancer patients categorized by CMS. The data showed a strong association between a patient’s CMS subtype and both overall survival and progression-free survival. For example, patients in CMS2 had a median overall survival of 40 months compared to 15 months for patients in CMS1.
CMS also was predictive of overall survival among patients on either treatment, with patients in certain subtypes faring better on one therapy over the other. Survival for CMS1 patients on bevacizumab was twice that of those on cetuximab, whereas survival for CMS2 patients on cetuximab was six months longer than for bevacizumab.

“This study establishes the clinical utility of CMS in treating colorectal cancer,” Lenz said. “It also provides the basis for more research to uncover additional clinically significant predictive signatures within these subtypes that might better personalize patient care.”

Currently, it is not possible to order patient subtyping, though multiple efforts are underway to develop an assay approved for clinical use. Lenz estimates that this could happen in a matter of months. Until then, he and his colleagues continue to analyze data from more than 44,000 samples of blood, tissue and plasma in one of the largest, most comprehensive research efforts to characterize DNA, RNA and germline DNA in colon cancer.

“This is only one study of many more to come that will help us understand this disease at the molecular level so we can provide better care for patients,” Lenz said.

CALGB/SWOG 80405 is sponsored by the National Cancer Institute. Primary study contributors included teams led by Alan Venook, MD, from the University of California, San Francisco; Federico Innocenti, MD, PhD, from the University of North Carolina, Chapel Hill; Omar Kabbarah, PhD, from Genentech; and Fang–Shu Ou, PhD, from Alliance for Clinical Trials in Oncology at Mayo Clinic. Genentech also funded the study.

— Wendy Wolfson

Simple measures such as giving patients pillboxes for their medications, helping patients’ family members understand their medication regimen and having patients attend weekly education sessions about managing the disease through lifestyle changes are all ways that patients could improve medication adherence.

The study also points toward specific challenges that underserved Latinos may be facing. Such challenges include having difficulty understanding what their medications are for, keeping track of their medications and feeling that they may take too many medications. Cohorts in this study took an average of 6.5 prescribed medications daily.

“Obtaining patients’ perspectives is key to finding solutions that help improve their medication adherence and health outcomes,” said Andrea Bañuelos Mota, the study’s first and corresponding author. “Not only do our findings suggest several potential approaches to intervention for Latinos with diabetes, but they could also pave the way for the development of future evidence-based guidelines.” Bañuelos Mota is currently enrolled in the Keck School’s Doctor of Medicine/Master of Public Health (MD/MPH) degree program.

Published in the Journal of General Internal Medicine (JGIM) on June 4, the cross-sectional study involved conducting surveys of 120 patients from across four safety net clinics in Los Angeles. Patients were at least 18 years old, self-identified as Latino/Hispanic/Chicano, were diagnosed with diabetes for more than six months, and were taking multiple diabetes medications. Furthermore, the study’s dependent variable was patients with “controlled diabetes” (i.e., having a hemoglobin A1c level of less than 7.5%) versus patients with “uncontrolled diabetes” (i.e., having a hemoglobin A1c level equal to or greater than 7.5%).

“This study is exemplary of excellent primary care research and brings awareness to the language and literacy barriers faced by our immigrant communities, which health care providers must address to deliver quality medical care,” said Jo Marie Reilly, MD, MPH, professor of clinical family medicine (educational scholar). Reilly leads the Keck School’s Primary Care Initiative, a program created to promote careers in primary care and the one through which this study was established.

Conceived and led entirely by a team of five medical students — including Andrea Bañuelos Mota, Emilio Ernesto Feliz Sala, Jennifer M. Perdomo, Joel Alejandro Solis and Walter M. Solorzano — the study also marks an achievement for the Keck School initiative. “JGIM is one of the highest ranked general internal medicine journals, so it is particularly impressive that a student group got a paper accepted,” said Michael Hochman, MD, MPH, a faculty mentor on the project with Reilly. Hochman is an associate professor of clinical medicine and serves as director of the USC Gehr Family Center for Health Systems Science.

— Elyse Blye

• Patient history, from the perspective of both the patient and another trusted source
• The patient’s physical appearance before clean-up or treatment is initiated
• A head-to-toe evaluation for injuries
• All injuries, including minor ones
• Any evidence that might disprove abuse or neglect (pertinent negatives)

“The need to protect our older loved ones from elder abuse is great,” said Alexis Coulourides Kogan, PhD, assistant professor of family medicine at the Keck School and co-author of the study. “But focusing solely on the reason for a patient’s visit seldom tells the whole story, even when you look at the medical chart. If documentation of physical findings is poor, then we may be missing the big picture.”

Study participants also noted the value of photographs and body diagrams to supplement written documentation, the time challenges of thorough documentation in a busy clinical setting and the need to integrate the tool into existing electronic medical records.

“It may be more work for a clinician to use an injury documentation tool, but we believe the value far surpasses the burden placed on physicians,” Kogan explained. “If there is suspected elder abuse, these records can potentially help prosecutors achieve justice and protection for older adults or exonerate innocent caregivers.”
Next, the researchers plan to seek funding to test the Geriatric Injury Documentation Tool in clinical settings.

“Our results not only offer a unique molecular atlas of human skeletal development, but also define a strategy for joint cartilage repair,” said Evseenko, who is the study’s corresponding author and an associate professor of orthopaedic surgery, and stem cell biology and regenerative medicine at the Keck School.

In a series of experiments, Gabriel B. Ferguson, PhD, postdoctoral scholar – research associate, Ben Van Handel, PhD, postdoctoral scholar – research associate, and colleagues compared the gene activity of developing human cartilage cells with several other cell types.
First, they compared the cartilage cells to four other types of developing human cells: the precursors to bone, muscle, tendon and ligament. As the cartilage matured, the genes specific to cartilage became increasingly active, while genes related to the other cell types became repressed.
Next, the scientists compared these developing human cartilage cells to equivalent cells from mice. The team found many broad similarities in gene activity.

The researchers also carried out a detailed comparison of ordinary human cartilage cells and stem cell-derived human cartilage cells, taking into account genetics, genetic regulation and function. The researchers demonstrated that stem cell–derived cartilage does not fully develop in the Petri dish but rather retains the genetic hallmarks typical of fetal cartilage. However, if the scientists transplanted stem cell-derived human cartilage at a particular stage of development into an arthritic rat, the cartilage would lose its fetal hallmarks and fully mature — regenerating the critical superficial zone.

Additional authors include: Maxwell Bay, Siyoung Lee, Ruzanna Shkhyan, Nicholas W. Banks, Mila Scheinberg, Biagio Saitta, Joseph Elphingstone and Michael Bonaguidi from USC; Petko Fiziev, April Pyle, Nicholas M. Bernthal, Hanna KA Mikkola and Jason Ernst from UCLA; Tonis Org from UCLA and the University of Tartu in Estonia; Ling Wu from InVitro Cell Research; and A. Noelle Larson, Scott M. Riester and Andre J. van Wijnen from the Mayo Clinic.
— Cristy Lytal

V. Wendy Setiawan (Photo/Ricardo Carrasco III)

“There are very few studies on diabetes and pancreatic cancer that include Latinos and African Americans,” said the study’s lead author V. Wendy Setiawan, PhD, associate professor of preventive medicine at the Keck School. “Both groups have a high rate of diabetes and African Americans, in particular, have a higher risk of developing pancreatic cancer relative to other racial/ethnic groups. Because most people with pancreatic cancer are diagnosed at a late stage, the five-year survival rate is low — about 8 percent. Identifying people who are at high risk early on could potentially save their lives.”

Symptoms of pancreatic cancer typically present when the disease is in its later stages and no screening methods currently exist.

Using prospective data from approximately 49,000 African Americans and Latinos, the researchers found that people who were diagnosed with diabetes between the ages of 65 and 85 were more likely to develop pancreatic cancer within three years as compared with people without diabetes. The data showed that Latinos were four times more likely to develop pancreatic cancer within three years of a diabetes diagnosis, and African Americans were three times more likely.

The research team also looked at whether late-onset diabetes was associated with breast, prostate or colorectal cancer, and no association was found.

“What we found is that, yes, diabetes is associated with pancreatic cancer in African Americans and Latinos, but we also discovered that there is a different type of diabetes here, a late-onset diabetes that’s associated with developing pancreatic cancer within 36 months. The evidence suggests that late-onset diabetes may be an early sign of pancreatic cancer,” Setiawan said.

Late-onset diabetes may be a useful marker for pancreatic cancer, she added, providing an opportunity to screen high-risk groups with new tools such as liquid biopsy, which is a test that looks for cancer cells or DNA from cancer cells in the blood.

“Pancreatic cancer is a rare disease, but if you are diagnosed with late-onset diabetes, have a conversation with your clinician about your individual risk,” Setiawan said. “Early intervention could improve survival.”

— Erica Rheinschild

They discovered that two things happen after exposure to a loud noise: sensory hair cells, which are the cells that detect sound and convert it to neural signals, die, and the inner ear fills with excess fluid, leading to the death of neurons.

“That buildup of fluid pressure in the inner ear is something you might notice if you go to a loud concert,” said the study’s corresponding author John Oghalai, MD, chair and professor of the USC Tina and Rick Caruso Department of Otolaryngology – Head and Neck Surgery and holder of the Leon J. Tiber and David S. Alpert Chair in Medicine. “When you leave the concert, your ears might feel full and you might have ringing in your ears. We were able to see that this buildup of fluid correlates with neuron loss.”
Both neurons and sensory hair cells play critical roles in hearing.

“The death of sensory hair cells leads to hearing loss. But even if some sensory hair cells remain and still work, if they’re not connected to a neuron, then the brain won’t hear the sound,” Oghalai said.

The researchers found that sensory hair cell death occurred immediately after exposure to loud noise and was irreversible. Neuron damage, however, had a delayed onset, opening a window of opportunity for treatment.
 
A simple solution
The buildup of fluid in the inner ear occurred over a period of a few hours after loud noise exposure and contained high concentrations of potassium. To reverse the effects of the potassium and reduce the fluid buildup, salt- and sugar-based solutions were injected into the middle ear, just through the eardrum, three hours after noise exposure. The researchers found that treatment with these solutions prevented 45–64 percent of neuron loss, suggesting that the treatment may offer a way to preserve hearing function.
The treatment could have several potential applications, Oghalai explained.
“I can envision soldiers carrying a small bottle of this solution with them and using it to prevent hearing damage after exposure to blast pressure from a roadside bomb,” he said. “It might also have potential as a treatment for other diseases of the inner ear that are associated with fluid buildup, such as Meniere’s disease.”

Oghalai and his team plan to conduct further research on the exact sequence of steps between fluid buildup in the inner ear and neuron death, followed by clinical trials of their potential treatment for noise-induced hearing loss.
— Erica Rheinschild

“Osteoarthritis is a looming public health problem with few solutions on the horizon,” said grant recipient Denis Evseenko, MD, PhD, associate professor of orthopaedic surgery, stem cell biology and regenerative medicine at the Keck School. “With these concurrent research efforts, we hope to translate our foundational knowledge about joint cartilage development into clinical therapies that would improve millions of lives.”

Osteoarthritis, caused by injuries and everyday wear and tear, is the most common joint disorder in the United States. Its prevalence is steadily growing due to longer life spans and increased obesity rates. It is estimated that by 2032, nearly 30 percent of people age 45 and older will be diagnosed with the disease. There is no cure for osteoarthritis, though pain medication can help improve quality of life. Those severely affected by the disease may opt for joint replacement surgery, but the procedure can be cost-prohibitive and may require revision surgery after a number of years.
 
Arthritis research at USC delves into degrading cartilage
Evseenko hypothesizes that genetic and pharmacologic manipulation of the body’s glycoprotein 130 (gp130) receptor molecule could decrease the effects of arthritis by slowing cartilage degradation, or perhaps even building new cartilage.

Gp130 is a complex receptor responsible for processing the body’s signals to grow cartilage in the embryo and cause chronic inflammation in adults. One method for targeting gp130 is using drug candidates similar in structure to the small molecule, “Regulator of Cartilage Growth and Differentiation 423” (RCGD 423).

RCGD 423 was discovered in Evseenko’s laboratory, and his recent research suggests targeting gp130 with RCGD 423 spurs cartilage growth while lowering inflammation associated with osteoarthritis. If the pre-clinical research data holds true, he hopes to launch clinical trials for an injectable therapy to delay the progression of arthritis among those in early stages of the disease.

— Mary Dacuma