Neurologists had long assumed that brain diseases that impact language abilities would manifest in essentially the same way in patients around the world. But recent discoveries have begun to question that assumption. For instance, Italian speakers with dyslexia tend to have less severe reading impairment than English or French speakers due to Italian’s simpler and more phonetic spelling.

“Clinical criteria for diagnosing disorders that affect behavior and language are still mainly based on studies of English speakers and Western cultures, which could lead to misdiagnosis if people who speak different languages or come from another cultural background express symptoms differently,” said study senior author Maria Luisa Gorno-Tempini, MD, PhD, a professor of neurology and psychiatry and the Charles Schwab Distinguished Professor in Dyslexia and Neurodevelopment at the UCSF Memory and Aging Center. “It is critical going forward that studies take language and cultural differences into account when studying brain disorders that affect higher cognitive functions — which we know are greatly impacted by culture, environment, and experience.”

The new study, published January 10, 2020 in Neurology, the medical journal of the American Academy of Neurology, focused on patients with primary progressive aphasia (PPA), a neurodegenerative disorder that affects language areas in the brain, a condition often associated with Alzheimer’s disease, frontotemporal lobar degeneration, and other dementia disorders.

The researchers recruited 20 English-speaking PPA patients from the UCSF Memory and Aging Center and 18 Italian-speaking PPA patients from San Raffaele Hospital, all of whom shared a variant of PPA characterized by difficulty producing or pronouncing words — so-called non-fluent PPA.

“We wanted to study patients with PPA to understand whether people from different language backgrounds actually experienced the disease differently, and what that might mean for how we try to help patients remain resilient to the disease,” said study lead author Elisa Canu, PhD, a neuropsychologist and researcher in the San Raffaele Scientific Institute’s Neuroimaging Research Unit, which is led by co-author Massimo Filippi, MD, full professor of neurology at the affiliated Vita-Salute San Raffaele University, and director of the neurology and neurophysiology units at the San Raffaele Hospital.

Cognitive tests and MRI brain scans revealed similar cognitive function and comparable levels of brain degeneration in the two groups. But when the researchers compared their performance on a battery of linguistic tests, they observed a key difference.

English speakers had more trouble pronouncing words — the traditional hallmark of nonfluent PPA — and tended to speak less than usual. In contrast, Italian speakers with the same disorder had fewer pronunciation difficulties but tended to produce much shorter and grammatically simpler sentences. For example, when asked to describe a drawing of a family at a lake house picnicking and flying a kite, Italian speakers with non-fluent PPA might respond (in Italian): “The man and the woman and the dog”; “Boat in the water”; “Family have picnic”; “There is a kite.”

“We think this is specifically because the consonant clusters that are so common in English pose a challenge for a degenerating speech-planning system,” said Gorno-Tempini, who directs the language neurobiology laboratory at the UCSF Memory and Aging Center, and is co-director of the UCSF Dyslexia Center and the recently launched UCSF-UC Berkeley Schwab Dyslexia and Cognitive Diversity Center. “In contrast, Italian is easier to pronounce, but has much more complex grammar, and this is how Italian speakers with PPA tend to run into trouble.”

The results are important for efforts to ensure accurate diagnoses for patients with PPA across different cultures: in the current study the Italian speakers do not match the established diagnostic criteria for nonfluent PPA as closely as the English speakers, since the criteria are based on studies of English-speaking patients.

“This means that there are probably many people around the world — including non-native English speakers in the U.S. — who are not getting the right diagnosis because their symptoms don’t match what is described in clinical manuals based on studies of native English speakers,” said Gorno-Tempini.

The researchers acknowledge that this is a small study and cannot completely exclude the possibility that differences in dementia severity, undetected anatomical differences and differences in education level between Italian and English participants could be confounding factors in the results.

Future studies in partnership with the Global Brain Health Institute (GBHI), a joint effort of UCSF and Trinity College Dublin to reduce the impact of dementia around the world, will attempt to replicate the findings in larger groups of patients, and look for further differences between speakers of even more diverse, non-Western languages, such as Chinese and Arabic.

“We hope that such studies will advance our understanding of the brain science underlying language and language disorders, raise awareness of health disparities in dementia treatment, and ultimately improve care for all patients,” Gorno-Tempini said.

The particle, tiny spheres of copper dotted with single atoms of ruthenium, is the key component in a green process for making syngas, or synthesis gas, valuable chemical feedstock that’s used to make fuels, fertilizer and many other products. Researchers from Rice, UCLA and the University of California, Santa Barbara (UCSB), describe the low-energy, low-temperature syngas production process this week in Nature Energy.

“Syngas can be made in many ways, but one of those, methane dry reforming, is increasingly important because the chemical inputs are methane and carbon dioxide, two potent and problematic greenhouse gases,” said Rice chemist and engineer Naomi Halas, a co-corresponding author on the paper.

Syngas is a mix of carbon monoxide and hydrogen gas that can be made from coal, biomass, natural gas and other sources. It’s produced at hundreds of gasification plants worldwide and is used to make fuels and chemicals worth more than $46 billion per year, according to a 2017 analysis by BCC Research.

Catalysts, materials that spur reactions between other chemicals, are critical for gasification. Gasification plants typically use steam and catalysts to break apart hydrocarbons. The hydrogen atoms pair up to form hydrogen gas, and the carbon atoms combine with oxygen in the form of carbon monoxide. In dry reforming, the oxygen atoms come from carbon dioxide rather than steam. But dry reforming hasn’t been attractive to industry because it typically requires even higher temperatures and more energy than steam-based methods, said study first author Linan Zhou, a postdoctoral researcher at Rice’s Laboratory for Nanophotonics (LANP).

Halas, who directs LANP, has worked for years to create light-activated nanoparticles that insert energy into chemical reactions with surgical precision. In 2011, her team showed it could boost the amount of short-lived, high-energy electrons called “hot carriers” that are created when light strikes metal, and in 2016 they unveiled the first of several “antenna reactors” that use hot carriers to drive catalysis.

One of these, a copper and ruthenium antenna reactor for making hydrogen from ammonia, was the subject of a 2018 Science paper by Halas, Zhou and colleagues. Zhou said the syngas catalyst uses a similar design. In each, a copper sphere about 5-10 nanometers in diameter is dotted with ruthenium islands. For the ammonia catalysts, each island contained a few dozen atoms of ruthenium, but Zhou had to shrink these to a single atom for the dry reforming catalyst.

“High efficiency is important for this reaction, but stability is even more important,” Zhou said. “If you tell a person in industry that you have a really efficient catalyst they are going to ask, ‘How long can it last?'”

Zhou said the question is important for producers, because most gasification catalysts are prone to “coking,” a buildup of surface carbon that eventually renders them useless.

“They cannot change the catalyst every day,” Zhou said. “They want something that can last.”

By isolating the active ruthenium sites where carbon is dissociated from hydrogen, Zhou reduced the chances of carbon atoms reacting with one another to form coke and increased the likelihood of them reacting with oxygen to form carbon monoxide.

“But single-atom islands are not enough,” he said. “For stability, you need both single atoms and hot electrons.”

Zhou said the team’s experimental and theoretical investigations point to hot carriers driving hydrogen away from the reactor surface.

“When hydrogen leaves the surface quickly, it’s more likely to form molecular hydrogen,” he said. “It also decreases the possibility of a reaction between hydrogen and oxygen, and leaves the oxygen to react with carbon. That’s how you can control with the hot electron to make sure it doesn’t form coke.”

Halas said the research could pave the way “for sustainable, light-driven, low-temperature, methane-reforming reactions for production of hydrogen on demand.”

“Beyond syngas, the single-atom, antenna-reactor design could be useful in designing energy-efficient catalysts for other applications,” she said.

The technology has been licensed by Syzygy Plasmonics, a Houston-based startup whose co-founders include Halas and study co-author Peter Nordlander.

Halas is Rice’s Stanley C. Moore Professor of Electrical and Computer Engineering and professor of chemistry, bioengineering, physics and astronomy, and materials science and nanoengineering. Nordlander is the Wiess Chair and Professor of Physics and Astronomy, and professor of electrical and computer engineering, and materials science and nanoengineering.

Additional co-authors include Chao Zhang, Dayne Swearer, Shu Tian, Hossein Robatjazi, Minhan Lou, Liangliang Dong and Luke Henderson, all of Rice; John Mark Martirez and Emily Carter, both of UCLA; and Jordan Finzel and Phillip Christopher of UCSB.

The research was supported by the Welch Foundation, the Air Force Office of Scientific Research (FA9550-15-1-0022) and the Department of Defense.

In a study recently published in Science Advances, an international team of scientists, including Sang-Heon Dan Shim and Thomas Sharp of Arizona State University (ASU), have completed a complex analysis of a “shocked meteorite” (one that has experienced high-pressure and high-temperature conditions through impact events) and gained new insight into Earth’s lower mantle.

Suizhou: a shocked meteorite

Shocked meteorites have provided many examples of deep mantle minerals since 1969 when high-pressure mineral Ringwoodite was discovered.

For this study, lead author Luca Bindi of the University of Florence (Italy), Shim and Sharp of ASU’s School of Earth and Space Exploration and Xiande Xie of the Guangzhou Institute of Geochemistry (China), focused their efforts on a sample of a shocked meteorite called Suizhou.

“Suizhou was an ideal meteorite for our team to analyze,” explains Shim, who specializes in using high-pressure experiments to study Earth’s mantle. “It provided our team with samples of natural high-pressure minerals like those believed to make up the Earth’s deep mantle.”

Suizhou fell in 1986 in the Hubei province in China. Immediately after the fall of this meteorite, a group of scientists were able to find and collect samples. “It was an observed fall,” explains Sharp, who specializes in studying shocked meteorites to understand shock and impact in the solar system. “So it did not suffer any chemical weathering on Earth and therefore there is no alteration of the iron.

Bridgmanite: The dominant material in the lower mantle

The Suizhou meteorite sample the researchers used for this study contains a specific silicate called “bridgmanite.” This silicate is considered the dominant material in the Earth’s lower mantle and makes up about 38 volume percent of our planet. It was first discovered in the shocked meteorite Tenham in 2014.

While it was previously thought that iron metal mainly existed in Earth’s core, about 15 years ago scientists discovered in the lab that iron in bridgmanite can undergo self-oxidation from which it can produce metallic iron.

This process, a chemical reaction called “charge disproportionation,” is where atoms re-distribute electrons among themselves and produce two or three cation forms with different oxidation states (in this case, some Fe(II) ions in bridgmanite convert to Fe(III) and Fe(0), the latter of which forms metallic iron).

The question remained, however, if this process could actually occur in nature.

Using high-resolution electron microscope imaging and spectroscopy, the researchers were able to conduct a set of complex analyses of the Suizhou meteorite sample in nanometer scale.

Through these analyses, the research team discovered metallic iron nanoparticles coexisting with bridgmanite in the shocked meteorite sample, representing the first direct evidence in nature of the iron disproportionation reaction, which so far had only been observed in high-pressure experiments.

“This discovery demonstrates that charge disproportionation can occur in natural high-pressure environments and therefore in the deep interior of the Earth,” says Shim.

The implications of this study, however, go beyond just this discovery, and may ultimately help us understand the greater question of how Earth itself was oxidized.

While we know that Earth’s upper mantle is more oxidizing than other planets and that the more oxidizing conditions of the upper mantle may be linked to the sudden rise of oxygen in the atmosphere 2.5 billion years ago, we don’t yet know how the upper mantle of the Earth became more oxidizing.

“It is possible that when materials of the lower mantle are transported to the upper mantle by convection, there would be a loss of metallic iron and the oxidized iron in bridgmanite would cause more oxidizing conditions in the upper mantle,” says Shim.

“Our discovery provides a possible explanation for the more oxidizing conditions of the Earth’s upper mantle and supports the idea that deep interior processes may have contributed to the great oxygenation event on the surface.”

SuperTIGER (Super Trans-Iron Galactic Element Recorder) is designed to measure the rare, heavy elements in cosmic rays that hold clues about their origins outside of the solar system. The effort is a collaboration among Washington University in St. Louis, Goddard Space Flight Center, California Institute of Technology Jet Propulsion Laboratory and the University of Minnesota.

The longer the balloon and instrument are up, the better.

“The significance of our observation increases with the number of events we observe essentially linearly with time, so we simply want to have as long a flight as possible to maximize the statistics of the data collected,” said Brian Rauch, research assistant professor of physics in Arts & Sciences at Washington University and principal investigator for SuperTIGER. “A day of data is a small increment of progress, and we just have to put our heads down and keep grinding away.

“SuperTIGER flights are marathons, not sprints.”

‘Fly as long as we can’

On Dec. 31, the balloon completed its first full revolution of Antarctica.

Little more than two weeks prior, Rauch and his team were celebrating a successful launch after a succession of challenging seasons on the ice.

“After three Antarctic seasons — with 19 launch attempts, two launches and one recovery of the payload from a crevasse field — it is wonderful to have SuperTIGER-2 finally reach float altitude and begin collecting scientific data. The third season is the charm!” Rauch said in a Dec. 15 news release.

NASA’s Balloon Program Office called it a “picture-perfect launch,” although the scientists suffered some technical setbacks once the instrument was in the air. There were problems with a power supply, Rauch said, and a computer failure eliminated one of the detector modules early in the flight.

“This only further emphasizes the importance for us to fly as long as we can to make up for the loss in instrument collecting power,” he said. “As it is, in this flight we may hope to collect about 40% of the statistics achieved with the first SuperTIGER flight.”

The 2012-13 SuperTIGER flight broke scientific ballooning records for longevity — staying afloat for a remarkable 55 days. The current mission will not challenge that record.

“The way the stratospheric winds are circulating this season, our flight will be terminated when the balloon comes over a suitable location at the end of our second revolution around the continent,” Rauch said.

Along for the ride

The balloon that carries SuperTIGER is also transporting four, smaller experimental devices that are “piggybacked” onto its core scientific payload. The list includes two experiments by Washington University in St. Louis researchers:

• A gamma-ray explorer developed by James H. Buckley, professor of physics in Arts & Sciences. Called APT-Lite (pictured above with Zachary Hughes, a graduate student in physics), this instrument will be followed by a bigger device called APT, currently under development.
• Another instrument developed Alex Meshik, research professor of physics, which captured stratospheric air during the balloon’s ascent. This air will be used for high-precision analyses of noble gas isotopes.

Sun never sets on SuperTIGER

“There are two SuperTIGERs (team members) still on the ice, both from Washington University,” Rauch said.

“In order to provide continuous coverage for the duration of the flight, the day is divided into monitoring shifts,” he said. “Those of us on the ice get to cover the graveyard shift for the folks in the United States.

“My routine has evolved into my getting up in the mid-afternoon, eating dinner, doing the monitoring shift in our office in Crary Lab, working in the office for another few hours or so, and then going to bed. (Graduate student in physics) Wolfgang Zober’s routine is similar, but he usually arrives, eats and gets to the office earlier than me and calls it a ‘day’ closer to the end of our shift.”

“When I’m not monitoring, I go walk on the trails, taking photos of penguins and seals,” Zober said. “I also make it a habit of socializing with other science groups to learn about other research being done here.”

There are few exceptions to the routine. The researchers did carve out a little time from their monitoring tasks to watch on Jan. 6 the launch of another balloon experiment, the BLAST-TNG mission led by researchers at University of Pennsylvania. That voyage ended only 15 hours into the flight, due to technical issues.

For the SuperTIGER team, there was no stopping for the holidays.

“I managed to convince Wolfgang to take a break on New Year’s Eve to experience IceStock while I covered the monitoring shift alone,” Rauch said.

“I did step outside just before midnight to see the New Year in.”

Carbon is the fourth-most-abundant element in the universe and is fundamental to life as we know it. It is unrivaled in its ability to form stable structures, both alone and with other elements.

A material’s properties are determined by how its atoms are bonded and the structural arrangements that these bonds create. For carbon-based materials, the type of bonding makes the difference between the hardness of diamond, which has three-dimensional “sp3” bonds, and the softness of graphite, which has two-dimensional “sp2” bonds, for example.

Despite the enormous diversity of carbon compounds, only a handful of three-dimensionally, sp3-bonded carbon-based materials are known, including diamond. The three-dimensional bonding structure makes these materials very attractive for many practical applications due to a range of properties including strength, hardness, and thermal conductivity.

“Aside from diamond and some of its analogs that incorporate additional elements, almost no other extended sp3 carbon materials have been created, despite numerous predictions of potentially synthesizable structures with this kind of bonding,” Strobel explained. “Following a chemical principle that indicates adding boron into the structure will enhance its stability, we examined another 3D-bonded class of carbon materials called clathrates, which have a lattice structure of cages that trap other types of atoms or molecules.”

Clathrates comprised of other elements and molecules are common and have been synthesized or found in nature. However, carbon-based clathrates have not been synthesized until now, despite long-standing predictions of their existence. Researchers attempted to create them for more than 50 years.

Strobel, Zhu, and their team — Carnegie’s Gustav M. Borstad, Hanyu Liu, Piotr A. Guńka, Michael Guerette, Juli-Anna Dolyniuk, Yue Meng, and Ronald Cohen, as well as Eran Greenberg and Vitali Prakapenka from the University of Chicago and Brian L. Chaloux and Albert Epshteyn from the U.S. Naval Research Laboratory — approached the problem through a combined computational and experimental approach.

“We used advanced structure searching tools to predict the first thermodynamically stable carbon-based clathrate and then synthesized the clathrate structure, which is comprised of carbon-boron cages that trap strontium atoms, under high-pressure and high-temperature conditions,” Zhu said.

The result is a 3D, carbon-based framework with diamond-like bonding that is recoverable to ambient conditions. But unlike diamond, the strontium atoms trapped in the cages make the material metallic — meaning it conducts electricity — with potential for superconductivity at notably high temperature.

What’s more, the properties of the clathrate can change depending on the types of guest atoms within the cages.

“The trapped guest atoms interact strongly with the host cages,” Strobel remarked. “Depending on the specific guest atoms present, the clathrate can be tuned from a semiconductor to a superconductor, all while maintaining robust, diamond-like bonds. Given the large number of possible substitutions, we envision an entirely new class of carbon-based materials with highly tunable properties.”

“For anyone who is into — or whose kids are into — Pokémon, this carbon-based clathrate structure is like the Eevee of materials,” joked Zhu. “Depending which element it captures, it has different abilities.”

A study published on Friday, January 10, in the online magazine PLOS ONE now shows for the first time what effect this inconspicuous deviation had in the prehistoric past. A Slovak-German research team has investigated the alignment of early Neolithic houses in Central and Eastern Europe. Scientists of the Collaborative Research Centre (CRC) “Scales of Transformation” of Kiel University (CAU) and the Slovakian Academy of Sciences were able to prove that the orientation of newly built houses deviated by a small amount from that of existing buildings and that this deviation was regularly counterclockwise.

Archaeologist Dr. Nils Müller-Scheeßel, who coordinated the study within the CRC, says: “Researchers have long assumed that early Neolithic houses stood for about a generation, i.e. 30 to 40 years, and that new houses had to be built next to existing ones at regular intervals. By means of age determination using the radiocarbon method, we can now show that the new construction was associated with a barely perceptible rotation of the house axis counterclockwise. We see “Pseudoneglect” as the most likely cause of this.”

This insight was made possible by the interpretation of one of the fastest growing archaeological data sets at present, namely the results of geophysical magnetics measurements. Differences in the earth’s magnetic field are used to visualise archaeological features lying underground. Early Neolithic house ground plans belong to the best identifiable types of features.

“In recent years, we have discovered hundreds of Early Neolithic houses in our field of work in southwestern Slovakia using geophysical prospection methods. Excavating all these houses is neither possible nor desirable for reasons of monument conservation. The possibility of using “Pseudoneglect” to bring the houses into a relative sequence without excavation and thus to break down the settlement activity of an entire small region raises our research to a completely new level,” says Mister Müller-Scheeßel enthusiastically. “Absolute dating using scientific methods must of course confirm the basic trend in every case.”

The study also refers to comparable archaeological observations at other places and times, which show that similar changes in orientation also seem to apply to more recent prehistoric periods. The significance of “Pseudoneglect” thus extends far beyond the dating of early Neolithic houses.

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Scientists aren’t sure exactly how this happens, but some think an infection may contribute to IBS by damaging the gut nervous system. A new Rockefeller study takes a close look at why neurons in the gut die and how the immune system normally protects them.

Conducted with mice, the experiments described recently in Cell offer insight on IBS and could point toward potential new treatment approaches.

Keeping inflammation in check

In a healthy gut, the immune system must strike a careful balance between responding to threats and keeping that response in check to avoid damage.

“Inflammation helps the gut ward off an infection, but too much of it can cause lasting harm,” says Daniel Mucida, an associate professor and head of the Laboratory of Mucosal Immunology. “Our work explores the complex mechanisms that prevent inflammatory responses from destroying neurons.”

To understand the effects of an infection on the nervous system, Mucida and his colleagues gave mice a weakened form of Salmonella, a bacterium that causes food poisoning, and analyzed neurons within the intestine. They found that infection induced a long-lasting reduction of neurons, an effect they attributed to the fact these cells express two genes, Nlrp6 and Caspase 11, which can contribute to a specific type of inflammatory response.

This response, in turn, can ultimately prompt the cells to undergo a form of programmed cell death. When the researchers manipulated mice to eliminate these genes specifically in neurons, they saw a decrease in the number of neurons expiring.

“This mechanism of cell death has been documented in other types of cells, but never before in neurons,” says Fanny Matheis, a graduate student in the lab. “We believe these gut neurons may be the only ones to die this way.”

Macrophages to the rescue

It’s not yet clear exactly how inflammation causes neurons to commit cell suicide, yet the scientists already have clues suggesting it might be possible to interfere with the process. The key may be a specialized set of gut immune cells, known as muscularis macrophages.

Previous work in Mucida’s lab has shown that these cells express inflammation-fighting genes and collaborate with the neurons to keep food moving through the digestive tract. If these neurons die off, as happens in an infection, a possible result is constipation — one of a number of unpleasant IBS symptoms. In their recent report, the team demonstrate how macrophages come to the neurons’ aid during an infection, ameliorating this aspect of the disorder.

Their experiments revealed that macrophages possess a certain type of receptor molecule that receives stress signals released by another set of neurons in response to an infection. Once activated, this receptor prompts the macrophage to produce molecules called polyamines, which the scientists think might interfere with the cell death process.

Getting back to normal

In other experiments, the researchers found that Salmonella infection alters the community of microbes within the guts of mice — and when they restored the animals’ intestinal flora back to normal, the neurons recovered.

“Using what we learned about the macrophages, one could think about ways to disrupt the inflammatory process that kills the neurons,” says Paul Muller, a postdoctoral fellow in the lab.

For instance, it might be possible to develop better treatments for IBS that work by boosting polyamine production, perhaps through diet, or by restoring gut microbial communities. Since short-term stress responses also appear to have a protective effect, Muller thinks it may also be helpful to target that system.

A Northwestern University research team — using mathematical modeling and optical imaging they developed themselves — has discovered how chromatin folds at the single-cell level. The researchers found chromatin is folded into a variety of tree-like domains spaced along a chromatin backbone. These small and large areas are like a mixed forest of trees growing from the forest floor. The overall structure is a 3D forest at microscale.

Chromatin is responsible for packing DNA into the cell nucleus. In humans, that’s about six feet of DNA in each cell. The new work suggests that chromatin is more structured and hierarchical in single cells than previously thought. Learning how chromatin correctly operates will help scientists understand what goes wrong with it in cancer and other diseases.

“By integrating theoretical and experimental work, we have produced a new chromatin folding picture that helps us see how the 3D genome is organized at the single-cell level,” said Igal Szleifer, the Christina Enroth-Cugell Professor of Biomedical Engineering at Northwestern’s McCormick School of Engineering. He co-led the research team with Vadim Backman.

Details of the interdisciplinary study will be published Jan. 10 in the journal Science Advances.

“If genes are the hardware, chromatin is the software,” said Backman, the Walter Dill Scott Professor of Biomedical Engineering and director of the Center for Physical Genomics and Engineering. “If the structure of chromatin changes, it can alter the processing of the information stored in the genome, but it does not alter the genes themselves. Understanding chromatin folding holds the key to understanding how cells differentiate and how cancer happens.”

Advances in genomic, imaging and information technologies are just beginning to enable scientists to better understand how chromatin works. The Northwestern researchers used a Partial Wave Spectroscopic (PWS) microscope, optical imaging developed by Backman and colleagues, to peer deep into live cells and “sense” alterations in chromatin packing. They also used electron imaging.

“Our paradigm-shifting picture of chromatin folding is an important missing piece in the holistic view of genomic structure,” said Kai Huang, the study’s first author. Huang is a postdoctoral fellow in Backman’s research group. “The results should inspire new strategies to fight cancer.”

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Materials provided by Northwestern University. Original written by Megan Fellman. Note: Content may be edited for style and length.

Divya Srivastava, M.D. Divya Srivastava, M.D. The study, published in Dermatologic Surgery, is the first to poll patient satisfaction for Mohs surgery. The findings complement previous scientific studies that found Mohs surgery is as effective as wide local excision for early melanomas, says Divya Srivastava, M.D., a UT Southwestern board-certified dermatologist and fellowship trained Mohs surgeon who led the study and has been specializing in Mohs surgery for the past decade. She says her caseload of Mohs surgeries for melanoma has doubled in that time.

“Patient satisfaction is becoming such an important part of medicine these days, so we wanted to look to see what we can do to get patients more satisfied with the care that they are getting for their skin cancer treatment. That’s a big area of interest for a lot of the subspecialties,” she says.

More people are diagnosed with skin cancer each year in the U.S. than all other cancers combined, but how they attack their cancer is wildly different. “We are working to determine what treatments garner the highest satisfaction to better inform guidelines and decision-making,” Srivastava says.

Named after the late Frederic Mohs, M.D., Mohs micrographic surgery is a highly precise excision technique in which the cancer is removed in stages, one tissue layer at a time. After each removal step, the layer is examined under a microscope to determine whether cancer remains in the patient’s skin and, if present, where exactly it is located so that the surgeon can pinpoint where to remove the remaining skin cancer. This allows for the smallest scar and best cosmetic result.

“You’re looking at 100 percent of the margin under the microscope,” Srivastava says. “You’re really tracking the cancer out so you’re giving people a great cure rate, and it’s all done under local anesthetic so it’s very safe.”

UT Southwestern researchers surveyed 42 of its patients who underwent this technique. The majority of patients were white men with a mean age of 69. The highest percentage of U.S. patients diagnosed with melanoma are white men over age 55. Three-quarters of the tumors were located on the face. The remaining were on the scalp, extremities, and neck.

This small survey suggests patients are finding that the long-term benefits of excision with 100% margin control using Mohs surgery greatly outweigh any potential perceived inconvenience. At UT Southwestern, dermatologic surgeons also provide immediate local tissue reconstruction, using advanced reconstruction techniques to diminish the appearance of scars.

Mohs surgery has a nearly 99% cure rate for early melanoma and results in minimal scarring. Patients follow up with their dermatologists every three months for two years post-surgery.

Dermatologists expect the need for Mohs surgery to increase as the baby boomer population ages. The surgery can also be used to remove basal cell carcinoma and squamous cell carcinoma, which are the two most common types of skin cancers.

“If melanoma is left untreated, it definitely has the potential to grow in the skin and even spread to lymph nodes and organs,” Srivastava says. “It can metastasize.”

People with fair skin, hair, and eyes are at the highest risk. Just a few severe sunburns in one’s lifetime also up the chance of developing skin cancer.

“Once you have one melanoma, you are at risk for more. It’s a marker that you have had lot of sun exposure in your life,” Srivastava says.

Srivastava is recognized as a national leader in the field. She authored textbook chapters and articles about dermatology. She serves in the House of Delegates in the American Medical Association and is a member of the American Academy of Dermatology, the American Society for Dermatologic Surgery, and the American College of Mohs Surgery.

Her study was funded by a $5,300 grant from the Cutting Edge Research Grant Program of the American Society for Dermatologic Surgery.