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Our Stellar Scientific Evening

March 9th, 2017

Our Stellar Scientific Evening
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Dr. Lou Saddic, recipient of the Leonard Walts, MD Research Award with Maxime Cannesson, MD, PhD

“And the winner is – La La Land!” announced Maxime Cannesson, MD, PhD, Vice Chair for Perioperative Medicine, presenting the top award at our department’s 9th Annual Scientific Evening on March 7, at Ronald Reagan Medical Center.

Dr. Cannesson wasn’t mistaken; he was only kidding. A moment later, he presented the real “best in show” honors – the Leonard Walts, MD, Research Award – to Lou Saddic, MD, PhD, for his presentation: “Myocardial injury leads to remote transcriptome remodeling of the central nervous system in a large animal model”. Dr. Saddic studied how, in the setting of an ischemic heart, the nervous system remodels through specific changes in gene expression that promote arrhythmias.

Amid an impressive array of research presentations by UCLA Department of Anesthesiology and Perioperative Medicine residents and fellows, here are the other winners:

 
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Drs. Olcese, Umar, Cannesson, Chang (1st place resident), Bernardo (2nd place resident), and Eghbali.
 
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Dr. Chan explains his research to Drs. Mahajan & Denton
 
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Drs. Samantha Wong and Christina Nguyen
 
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Drs. Kwiecien, Maslin, and Ferrante
 
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Drs. Mahajan, Nguyen-Buckley, and Kumar
 
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Drs. Cannesson and Grocott
 
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Dr. Methangkool, Jennifer Scovotti, Dr. Cannesson
  • 1st Place Resident Award:  Marvin Chang, MD, PhD, for “A novel paradigm for a new class of anti-arrhythmic drug on targeting calcium channel gating properties”. Dr. Chang studied the prevention of early-after depolarization (EAD) of myocytes – EAD plays a key role in the genesis of arrhythmias – using roscovitine, a cancer chemotherapy agent, to modulate rather than block calcium channels.

  • 1st Place Fellow Award:  Tiffany Williams, MD, PhD, for “Effects of isoflurane on cardiac electrophysiology in a porcine model”. Dr. Williams compared healthy pigs to those 8 weeks post myocardial infarction, looking at how heightened sympathetic activity in the setting of cardiac excitability helps to explain why patients with previous heart attacks so often develop postoperative arrhythmias.

  • 2nd Place Resident Award:  Marsha Bernardo, MD, for “Investigating the cardiotoxicity of liposomal bupivacaine (Exparel) in rats: The role of Intralipid rescue”. Dr. Bernardo sought to determine the dose of liposomal bupivacaine that induces cardiotoxicity in rats, and found that Intralipid at usual rescue doses did not reliably reverse cardiac arrest.

  • 2nd Place Fellow Award:  Matthew Fischer, MD, for “Network analysis reveals DNA methylation modules that function as biomarkers for post-operative atrial fibrillation”. Dr. Fischer studied adult patients for cardiac surgery, and found that the presence of DNA methylation modules in preoperative blood samples heralded the development of post-operative atrial fibrillation, independent of traditional clinical risk factors.

Hilary Grocott, MD, served as guest judge for the evening. Dr. Grocott is Professor of Anesthesiology and Perioperative Medicine at the University of Manitoba, and Editor-in-Chief of the Canadian Journal of Anesthesia. UCLA faculty members Rajesh Kumar, PhD, Andrew Hudson, MD, MS, and Tristan Grogan, MS, joined Dr. Grocott in judging the 34 poster and oral presentations, They unanimously commended remarkable research accomplishment by the department’s residents, fellows, and their faculty mentors.

After everyone viewed the poster presentations, ten residents and fellows delivered oral slide presentations describing their work, and Dr. Cannesson moderated questions from the audience. The judges withdrew to deliberate while the group enjoyed appetizers, and then Dr. Cannesson presented the awards to the five top research projects.

Aman Mahajan, MD, PhD, our department chair, extended special thanks to Jennifer Scovotti, Naomi Mimila, and Claudia Bueno for research and administrative support of the evening, and to faculty members Judi Turner, MD, PhD, Kimberly Howard-Quijano, MD, MS, Soban Umar, MD, PhD., Rajesh Kumar, PhD, Mansoureh Eghbali, PhD, Tristan Grogan, MS, and Emily Methangkool, MD, for coordinating the event.

 

Escaping from old ideas

The next morning, Dr. Grocott delivered a thought-provoking talk at the department’s Grand Rounds on the topic, “Everything you thought was right turned out to be wrong:  Finding the truth in anesthesia research.”

Quoting British economist John Maynard Keynes, Dr. Grocott said, “The difficulty lies not so much in developing new ideas as in escaping from old ones.” We must be prepared to change our minds when the data change, he advised, as “truth” in science often evolves over time.

Why does the “truth” change? Dr. Grocott cited five chief factors:

  • Reporting bias, which skews the literature toward positive results
  • Statistical issues:  P-hacking, fragility
  • Non-reproducibility of results
  • The science really does change
  • Discovery of misconduct and fraud

Reporting bias, Dr. Grocott said, occurs with the tendency to publish papers with positive rather than negative findings. “Your enthusiasm for working on something wanes when you have a negative result”, he observed.

“P-hacking” occurs when investigators perform what Dr. Grocott called “data-dredging” without a preplanned, specific hypothesis. They repeatedly analyze data until a P < 0.05 appears, which greatly increases false discovery rates, and then they paint the story around that significant result.

The term “statistical fragility” refers to a problem of small studies, where a difference of a very few data points one way or the other may change the result dramatically. Dr. Grocott cited the example of bispectral index (BIS) studies, in which the claim of improved prevention of awareness with BIS monitoring didn’t hold up when larger studies followed initial, small-scale trials.

Sometimes we change our interpretation of even well-conducted studies as science evolves, Dr. Grocott said. He cited his own research on five-year postoperative cognitive decline after cardiac surgery, which didn’t consider the normal cognitive trajectory of aging. “Some of the cognitive loss is going to happen anyway over time,” he explained, “and probably is not caused by anesthesia and surgery.”

Dr. Grocott also pointed out that our understanding of opioid-induced hyperalgesia has increased, calling into question the routine use of fentanyl during general anesthesia. But it’s very hard to change established practices, he said, quoting Italian programmer Alberto Brandolini’s asymmetry principle: “The amount of energy needed to refute bull*&% is an order of magnitude bigger than to produce it.”

Yet Dr. Grocott still maintains faith in the future of anesthesiology research and publishing.  “Technically, the glass is always full,” he said, “even if half is water and the other half is air.”



Karen Sibert, MD

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