March 2016 Grand Rounds

Study Finds Relationship Between Lifetime Marijuana Use and Loss of Verbal Memory

Marijuana is the most frequently used illicit drug in the United States, according to a recent survey from the National Survey on Drug Use and Health, and new data suggest that marijuana use now could pose a serious cognitive function risk later in life.

Stefan Kertesz, MD, an associate professor with the UAB School of Medicine, is part of a recently published nationwide study reporting potential long-term consequences with implications for public health.

Impaired cognitive functioning is an acute effect of marijuana use, and there is increasing evidence that such effects may persist later in life after marijuana use has ceased. Heavy, long-term use of marijuana has been associated with cognitive impairment, particularly in learning and remembering new information.

Kertesz and other researchers found past exposure to marijuana use to be significantly associated with worse verbal memory in middle age.

Their paper used data from the Coronary Artery Risk Development in Young Adults (CARDIA) study which started in 1985, where more than 5,000 healthy adults were regularly asked about marijuana use. In contrast to studies that focus on people known to have an addiction, this study focused on community-based adults, where casual use tends to be more common than addiction. 

In the final year of the study, CARDIA participants underwent simple cognitive tests, including a word memory test. Individuals were presented with 15 words and then asked to try to remember them. After 25 minutes, they were later asked to recall the words. The tests showed that there was a significant decline in verbal memory among persons whose cumulative marijuana use exceeded the equivalent of one joint a day for five years.

“For every five years of marijuana exposure, one out of two participants would remember one word less,” Kertesz said.

Kertesz also said that it is important to realize that marijuana is more potent today than it was in the 1980s, raising the possibility that users of today’s marijuana may face cognitive consequences of greater magnitude than those reported.

“It’s crucial to recognize that young brains are not fully developed until age 22 and are at more risk from marijuana,” he said. “Parents need to be vigilant that this poses a larger risk to adolescents.”

Data from 2012 indicates that, among students in the 12th grade (ages 17-18 years), 37 percent had used marijuana within the last year, 23 percent within the last 30 days and 6.5 percent daily.


Stroke Risk Increases from Stenting in Older Patients

Vascular surgery appears to be safer than stenting for patients over 70 years of age with carotid stenosis, or a blockage of the carotid arteries in the neck, according to new findings published in the Lancet.

The international study, led by investigators at UAB, looked at the two standard methods for treating plaque buildup in the carotid arteries: a surgical procedure called carotid endarterectomy (CEA) against carotid artery stenting.

CEA is invasive surgery, opening the artery to remove plaque, whereas stenting is less invasive with a balloon used to open the blocked artery and a mesh stent placed inside.

“Stenting was hailed as a less invasive alternative to surgery, one that avoided many of the hazards and risks inherent in a surgical procedure,” said George Howard, PhD, professor in the Department of Biostatistics in the UAB School of Public Health and the study’s first author. “What we find, however, is that the risk of stroke in patients over the age of 70 is twice that with stenting than with the surgical CEA procedure.”

The study looked at data from four randomized controlled trials within the Carotid Stenosis Trialists’ Collaboration with patients with symptomatic carotid stenosis. Collectively, 4,754 patients were followed. Age was not associated with increased stroke risk for either surgery or stenting in patients under age 70. But stent patients over 70 had an increased risk, particularly in the immediate time frame of the procedure.

“These findings are very conclusive — stenting has a higher risk for stroke over carotid surgery in the older patient, over 70,” Howard said.

Howard says the stenting procedure itself seems to be causing the increased risk. “The risk appears centered on the periprocedural period, the time during and immediately after the procedure,” he said. “The risk does not appear to continue in the months or years following the procedure.”

Howard acknowledges that advances in stenting, such as the routine use of closed-cell stents, which seem to be associated with lower rates of procedural stroke and the development of novel protection systems, might allow safe stenting for elderly people in the future.

“But for now, stenting in an older population needs to be done with great caution,” he said.


Research Shows Typical American Diet can Worsen Chronic Pain

Sufferers of chronic pain are more susceptible to prolonged health issues when practicing poor diet habits, according to new research published by UAB researcher Robert Sorge, PhD and his team in the Journal of Pain.

Sorge’s study highlights the negative effects of poor diet quality with respect to recovery from hypersensitivity and susceptibility to chronic pain. The implications of the research could be significant.

“It is currently unknown whether increased pain is due to greater weight or poor diet quality, or both,” Sorge said. “This study shows us the direct link between poor diet quality and increased pain.”

Sorge’s team instigated the research looking to further explore the link between obesity and chronic pain. The two medical conditions are often comorbid, and their rates are rising.

In looking into the issue, the team focused on the effects of the Total Western Diet, in particular. TWD foods typically have fewer calories from protein and increased calories from carbohydrates and saturated and monounsaturated fats.

“They call it the Total Western Diet because it’s a common pattern in societies in our part of the world,” said Stacie Totsch, the paper’s first author and a graduate student in Sorge’s lab. “We need to be concerned about the consequences our diet has on our bodies, and not just immediately with problems like weight gain, but also with long-term complications. That’s what we set out to investigate in this study.”

Mice were fed the TWD so that researchers could investigate the functional and physiological consequences of a nutritionally poor diet in mice. After 13 weeks on the diet, the mice on the TWD showed a significant increase in fat mass and a decrease in lean mass.

Tests run on the mice also revealed increases in pro-inflammatory cytokines, signals that promote systemic inflammation, as well as increases in serum leptin, a hormone secreted by adipose tissue that acts to regulate long-term appetite and energy expenditure.

“Most obese people have increased levels of serum leptin and pro-inflammatory cytokines, so we saw the immediate health effects that the diet had on the mice,” Sorge said. “Our next step was to look at how the unhealthy effects of the TWD corresponded to chronic pain.”

When the researchers introduced chronic pain to the study, they found that hypersensitivity to heat and touch was more pronounced and was significantly prolonged in the TWD-fed mice.

“Poor diet seems to have exacerbated the normal recovery period from this mild inflammatory insult,” Sorge said. “Because poor diet heightens hypersensitivity, patients with chronic pain who regularly practice bad diet habits are likely to experience exaggerated pain responses and recovery from injury or surgery.”

Specifically, prolonged exposure to poor diet quality resulted in an altered perception of pain through acute nociceptive sensitivity, systemic inflammation and persistent pain following chronic pain induction.

“Now that we know more about the link between diet and inflammation, we can begin thinking about applications to solve the problem,” Sorge said.


Trial Combining Exercise and Metformin May Help Seniors Gain Muscle

A drug that might help older adults regrow muscle is under investigation at UAB. UAB is recruiting healthy adults age 65 and older for a study combining strength training exercise with the anti-diabetes drug metformin.

The investigators have reason to suspect that metformin might improve the effectiveness of exercise in rebuilding muscle tissue.

“Muscles atrophy as we age, and inflammation is one of the suspected causes,” said Marcas Bamman, PhD, director of the UAB Center for Exercise Medicine in the School of Medicine. “We have evidence from previous studies that metformin can play an important role in reducing inflammation in the muscles, and we are launching this study to confirm those preliminary findings.”

The key are cells called macrophages, which are some of the body’s trash collectors. Macrophages surround and digest rogue cells or cellular debris that has been identified by the body as not belonging to a healthy cell. As part of this process, macrophages promote inflammation, which stimulates the immune system to respond to the threatened area.

However, when the crisis has been managed, and it is time for the immune system to ramp down, some macrophages transition from an inflammatory to an anti-inflammatory role. Through a process called polarization, M1 macrophages, which cause inflammation, transition to M2 macrophages, which decrease inflammation and encourage tissue repair.

The team’s preliminary studies suggest metformin may promote the polarization from M1 to M2.

“Reducing inflammation in muscle of older adults should create a pro-growth environment and help these individuals build new muscle,” said Bamman, who is also a professor in the Department of Cell, Developmental and Integrative Biology. “We’re intrigued to see whether metformin’s effect on macrophages contributes to this regrowth. The overall goal is to establish a low-cost, personalized approach to prevent frailty in the elderly.”

The MASTERS trial is being conducted in collaboration with investigators at the University of Kentucky. The two institutions are looking for 100 adults 65 or older who do not have diabetes. Participants will exercise three times a week for 14 weeks with certified trainers and receive either metformin or a placebo. Participants will also get a physical examination, along with DEXA scans, CT imaging and other tests.

The study is funded by the National Institutes of Health. For more information, or to enroll in the study, go to Current Research at


Y Chromosome Responsible for More than Gender

The Y chromosome – the male genetic code – performs a broader function than testes development and may even impact cardiovascular disease, according to research led by Jeremy Prokop, PhD, a senior scientist in the Jacob Lab at the HudsonAlpha Institute for Biotechnology.

“It has long been thought that Chromosome-Y found in males is critical for male sex development, but then does very little for other biological functions,” Prokop said. “In this work we show that Chromosome-Y impacts a broad range of genetic regions. Changes to those regions could contribute to disease development such as hypertension.” The research was published online February 3 in Biology of Sex Differences.

Howard Jacob, PhD, and Jozef Lazar, MD, PhD, both faculty investigators at HudsonAlpha, are also authors of the paper.

“For years it has been known that differences between females and males are due to hormones and genes on the X and Y chromosomes,” Jacob said. “However, little is still known about how genetics contribute to the biological difference. This work shows the broad roles the sex chromosomes – particularly the Y-chromosome in males – play in biology outside of sex determination.”

For the project, the team used an animal model – rats – to sequence and examine how genetic changes on the Y-chromosome alter the biology of animals. They identified a region on the rat Y chromosome that is linked to high blood pressure. Since the human genome shares that same region, Prokop says new research could investigate whether those genes are also linked to cardiovascular disease in humans.


Brookwood Awarded Perinatal Care Certification

First Hospital in Alabama to Earn Designation, Held by Only Six Hospitals Nationwide

Brookwood Medical Center has earned Perinatal Care Certification from The Joint Commission. The certification program recognizes Joint Commission accredited hospitals committed to achieving integrated, coordinated and patient-centered care for mothers and their newborns. Brookwood is the first hospital to earn this designation in the state, and only six hospitals in the nation are currently perinatal care certified.

Brookwood underwent anonsite review to assess its compliance with certification standards for perinatal care. During the review, Joint Commission experts completed an independent evaluation of Brookwood’s perinatal health care services.


Gardendale Surgical Center Joins Brookwood Medical Center

Brookwood Medical Center has aquired the Gardendale Surgical Center as an additional outpatient facility to serve the Birmingham area.

Some of the major surgical services provided at the Gardendale location include:

• Gastroenterology

• Orthopedics

• Ophthalmology

• Pain management

• General and specialty surgical services

“Gardendale Surgical Center is a great addition to the healthcare community in Gardendale. We look forward to continue to offer patients a safe, efficient and comfortable alternative for their outpatient surgical needs,” said Price Kloess, MD, ophthalmologist at Gardendale Surgical Center.


CRMC Announces 30 Bed Expansion

The State of Alabama Department of Public Health has granted approval for Cullman Regional Medical Center to implement a three-year plan for a 30-bed expansion.

According to CRMC CEO James Clements, the expansion in necessitated by growth in admissions, which totaled seven percent in inpatient admissions and two percent in outpatient visits in 2015.

Construction for the 35,950 square feet new wing will begin in January 2017 with plans to open the unit in the fall of 2018.


St. Vincent’s East Dedicated Pain Center

St. Vincent’s East now offers patients a dedicated Chest Pain Center.

The St. Vincent’s East Chest Pain Center is designed to quickly evaluate and begin treatment on patients who present with chest pain in the Emergency Department. Patients are moved to the Chest Pain Center where a specialized team of nurses and cardiologists are able to closely monitor their symptoms and determine the best treatment plan for this sometimes life-threatening condition.

St. Vincent’s was recently named the first and only health system in the nation to hold the highest Society of Cardiovascular Patient Care’s  heart accreditations in all three areas, including Chest Pain Center. St. Vincent’s East holds the highest level available in AFib with EPS, Heart Failure, and Chest Pain Center with Primary PCI and Resuscitation.


Baptist - Brookwood Chairman Named  Hospital Trustee of the Year by Alabama Hospital Association

The Alabama Hospital Association has selected John Holcomb III, chairman of the Baptist Health System/Brookwood Medical Center joint venture’s board of directors, as its 2016 Hospital Trustee of the Year. The annual award is presented to an outstanding trustee who has made significant contributions to his or her hospital and to the health care industry.

Holcomb serves as chairman and CEO of Birmingham-based National Commerce Corp. and has had a 40-year career in the Alabama financial services industry. He played an instrumental role in Baptist’s successful negotiation of an innovative joint-venture partnership with Brookwood.

“We are so excited for the opportunity to honor Mr. Holcomb’s contributions with this prestigious award,” Keith Parrott, CEO of Baptist Health Systems/Brookwood Medical Center said.

Parrott added that, in addition to his financial expertise, Holcomb’s leadership at Baptist has benefited the health system through a strong focus on company culture and clinical processes.

Holcomb became chairman of the Baptist Health System board in 2012, after serving as vice chairman for one year. He has also been active on the governance and finance committees since joining the board in 2008.

Since 2010, Holcomb has served as chairman of National Commerce Corp., which operates 14 National Bank of Commerce locations in Alabama and Florida. Before that, he served as CEO of Birmingham-based Alabama National Bancorp., which grew to have $8 billion in assets when it was acquired in 2008.

Holcomb also serves as a board member and treasurer of the United Way of Central Alabama.


Grandview Gets Green Light for Comprehensive Cancer Center

Grandview Medical Center’s Certificate of Need for a free-standing Cancer Center, that was upheld by the Alabama Court of Civil Appeals in January, is now final. The deadline for any further appeals has expired.

“We are excited to take this important step forward with the consolidation of our cancer services at Grandview,” said Grandview’s President and Chief Executive Officer Keith Granger. “This project will allow consolidation of radiation therapy and other oncology related services into a single site, comprehensive center on Grandview’s 280 campus.”

Construction on the Cancer Center is anticipated to begin later this year.


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