Recent trends in National Institutes of Health funding for surgery: 2003 to 2013

Background

The purpose of this study is to compare the compositions of federally funded surgical research between 2003 and 2013, and to assess differences in funding trends between surgery and other medical specialties.

Data Sources

The National Institutes of Health (NIH) Research Portfolio Online Reporting Tool database was queried for grants within core surgical disciplines during 2003 and 2013. Funding was categorized by award type, methodology, and discipline. Application success rates for surgery and 5 nonsurgical departments were trended over time.

Conclusions

Inflation-adjusted NIH funding for surgical research decreased 19% from $270M in 2003 to $219M in 2013, with a shift from R-awards to U-awards. Proportional funding to outcomes research almost tripled, while translational research diminished. Nonsurgical departments have increased NIH application volume over the last 10 years; however, surgery’s application volume has been stagnant. To preserve surgery’s role in innovative research, new efforts are needed to incentivize an increase in application volume.     

Drugs: An update

Pediatric regional anesthesia is now well-established and has an important place for peri- and postoperative pain control in children. We also need drugs safe and effective for epidural administration; ropivacaine and levobupivacaine seem to offer a wider safety margin in comparison with the old drugs and are able to provide a valid pain control. Various adjuvants can be used in order to potentiate the analgesic duration; clonidine and ketamine are probably among the best drugs. Copyright 2002, Elsevier Science (USA). All rights reserved.     

Onco-hypertension: An Emerging Specialty

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Osteoporosis: New-Generation Drugs

A new understanding in the pathophysiology of bone led to the development of a fully human monoclonal antibody directed against RANK ligand (RANKL). Denosumab inhibits the interaction of RANKL with its receptor RANK, thereby suppressing osteoclast differentiation, function and survival. In this respect, denosumab mimics osteoprotegerin, the endogenous antagonist of RANKL. Recently, denosumab has been approved by the European Medicines Agency (EMEA) for the treatment of postmenopausal osteoporosis (PMO) and treatment-induced bone loss in breast and prostate cancer patients undergoing hormone ablation. Oncologic indications affecting bone are promising, but still under clinical evaluation. In clinical trials for PMO, denosumab has shown significant increases in bone mineral density (BMD) at various skeletal sites, decreases in bone turnover markers, and reductions in fracture risk. In head-tohead studies, denosumab proved to be superior to alendronate with regard to the increase in BMD. Considering clinical trial data, the risk-benefit profile of denosumab seems to be favorable since the rates of adverse events, serious adverse events, infections, malignancies and deaths were not higher compared to the control arms. In PMO, denosumab is applied subcutaneously as a 60-mg dose twice yearly. This administration scheme and route might have a high acceptance by patients and physicians.     

LUTS and Sleep Disorders: Emerging Risk Factor

Lower urinary tract symptoms (LUTS) are commonly associated with benign prostatic hyperplasia (BPH) and represent significant bother among aging men. Bothersome LUTS secondary to BPH, including nocturia, significantly impact men??s general health-related quality of life (QoL) as do sleep disturbances. However, very few studies have examined the relationship between the severity of BPH-related urinary symptoms and sleep disturbances. This review analyzes the recent studies that report the association between the bother and severity of LUTS secondary to BPH and the severity of sleep disturbance. In addition, we address the relationship between treating LUTS and the influence that it has on treating the sleep disorders.     

Emerging endocrine disrupters: perfluoroalkylated substances

In recent years, polyfluorinated chemicals (PFCs) have increasingly been used as surfactants in various industry- and consumer products, because of their unique properties as repellents of dirt, water and oils. The most well-known PFCs are perfluorooctane sulfonic acid (PFOS), perfluorooctanoic acid (PFOA) and their derivatives belonging to the group of perfluoroalkylated substances. The PFCs are very persistent in the environment, and some of them have been discovered as global pollutants of air, water, soil and wildlife and even found in remote polar areas. Bioaccumulation occurs also in humans, and everybody in our society has traces of these PFCs in their blood and internal organs such as the liver, kidneys, spleen, gall bladder and testes. In the blood, PFOS and PFOA are bound to serum proteins. The acute toxicity of the polyfluorinated substances is moderate but some substances can induce peroxisome proliferation in rat livers and may change the fluidity of cell membranes. Some of these PFCs, such as PFOS and PFOA, are potential developmental toxicants and are suspected endocrine disruptors with effects on sex hormone levels resulting in lower testosterone levels and higher oestradiol level. Other PFCs have oestrogenic effects in cell cultures. The industrial production of PFOS and its derivatives stopped in 2000, and the European Union has banned most uses from the summer of 2008. However, hundreds of related chemicals: homologues with shorter or longer alkyl chain, PFOA and telomers, which potentially may degrade to perfluoroalkanoic (carboxylic) acids, are not regulated.     

Angiomyolipoma: Emerging concepts in management

The ability to diagnose angiomyolipoma accurately with radiographic techniques has increased greatly. If the clinical circumstances and the radiographic features are characteristic, we no longer believe that histologic confirmation is necessary, even in the absence of stigmata of tuberous sclerosis. Also, the role of surgery in the management of complications has been reduced because of the increased effectiveness of embolization techniques.     

Spinal Cord Injury-Induced Osteoporosis: Pathogenesis and Emerging Therapies

Spinal cord injury causes rapid, severe osteoporosis with increased fracture risk. Mechanical unloading after paralysis results in increased osteocyte expression of sclerostin, suppressed bone formation, and indirect stimulation of bone resorption. At this time, there are no clinical guidelines to prevent bone loss after SCI, and fractures are common. More research is required to define the pathophysiology and epidemiology of SCI-induced osteoporosis. This review summarizes emerging therapeutics including anti-sclerostin antibodies, mechanical loading of the lower extremity with electrical stimulation, and mechanical stimulation via vibration therapy.     

Diabetes and benign prostatic hyperplasia: Emerging clinical connections

Benign prostatic hyperplasia (BPH) and associated lower urinary tract symptoms (LUTS) are highly prevalent in older men and represent a substantial challenge to public health. Increasing epidemiologic evidence suggests that diabetes significantly increases the risks of BPH and LUTS. Plausible pathophysiologic mechanisms to potentially explain these associations include increased sympathetic tone, stimulation of prostate growth by insulin and related trophic factors, alterations in sex steroid hormone expression, and induction of systemic inflammation and oxidative stress. This article presents a comprehensive overview of the current understanding of clinical and epidemiologic research on diabetes and BPH/LUTS, describes hypothesized pathophysiologic mechanisms linking these conditions, and recommends future directions for research and clinical care.