Research News Tip Sheet: Story Ideas From Johns Hopkins Medicine

During the COVID-19 pandemic, Johns Hopkins Medicine Media Relations is focused on disseminating current, accurate and useful information to the public via the media. As part of that effort, we are distributing our “COVID-19 Tip Sheet: Story Ideas from Johns Hopkins” every other Tuesday.

We also want you to continue having access to the latest Johns Hopkins Medicine research achievements and clinical advances, so we are issuing a second tip sheet covering topics not related to COVID-19 or the SARS-CoV-2 virus. “Research News Tip Sheet: Story Ideas from Johns Hopkins Medicine” alternates Tuesdays with the COVID-19 Tip Sheet.

Stories in this tip sheet associated with journal publications provide a link to the paper. Interviews with the researchers featured may be arranged by contacting the media representatives listed.

AI AND DEEP LEARNING CAN ANALYZE ‘RASH SELFIES’ FOR BETTER LYME DISEASE DETECTION

Johns Hopkins Medicine and Johns Hopkins Applied Research Laboratory (APL) researchers have shown that cell phone images of rashes taken by patients can be  evaluated using artificial intelligence (AI) and deep learning (DL) technologies to more accurately detect and identify the erythema migrans (EM) skin redness associated with acute Lyme disease. This can enable more reliable screening, more accurate diagnosis and earlier treatment, helping avoid the serious potential neurologic, rheumatologic and cardiac complications of advanced Lyme disease.

A report on the findings was published in the October 2020 issue of the journal Computers in Biology and Medicine.

APL scientists developed and tested several deep learning computer models to accurately pick out EM from other dermatological conditions and normal skin. The DL models were “trained” to discern the appearance of EM using images of non-EM rashes and normal skin available in the public domain, and clinical photos of patients with EM provided by the Johns Hopkins University Lyme Disease Research Center and the Lyme Disease Biobank, part of the Johns Hopkins University School of Medicine’s Division of Rheumatology.

There are more than 300,000 new cases of Lyme disease annually in the United States and treatment is most effective if it is caught early. Misdiagnosis, especially in the disease’s initial stages, is common because of several challenges. Blood tests detecting the presence of antibodies to Borrelia burgdorferi, the cause of Lyme disease, are often unreliable. Tests to directly identify the pathogen in lab cultures, by genetic analysis of blood or from a skin biopsy, can be problematic and aren’t readily available to clinicians. Using the EM rash as a screening method also is difficult because to the unaided eye, the rash can be easily confused with skin inflammations resulting from other illnesses.

To address the EM recognition problem, the Johns Hopkins Medicine researchers applied an AI and DL approach to analyzing cell phone images of rashes from patients suspected of having Lyme disease.

Evaluating the public domain images, the computer-enhanced image analysis system had an accuracy ranging from 72%, when choosing between EM and other rashes, to 94% when picking out EM from normal skin. For clinical images from patients already diagnosed with Lyme disease, the system could positively identify an EM rash 86% of the time. 

“Being able to analyze the rash images using artificial intelligence and deep learning enables us to more accurately diagnose that a patient has Lyme disease, determine the stage of the illness and establish a more appropriate treatment plan,” says John Aucott, M.D., director of the Johns Hopkins Lyme Disease Clinical Research Center. “So in the near future, if you notice a round, red skin rash, you can take a picture of it as soon as possible to share with your physician. That way, even if the rash disappears and you still have Lyme disease symptoms, your physician can make the correct diagnosis using our analysis technique.”

Now that the researchers have shown the potential of their EM rash digital analysis as a prescreening diagnostic tool for Lyme disease, they plan to further test and refine the technology in upcoming studies.

JOHNS HOPKINS CHILDREN’S CENTER OPENS CRITICAL CARE UNIT FOR THE TINIEST HEART PATIENTS

Caring for infants with heart disease is nothing new to Johns Hopkins Medicine. In November 1944, Johns Hopkins surgeons performed the first “blue baby” procedure on an 18-month-old girl with a heart defect that prevented blood from reaching her lungs to be replenished with oxygen for the rest of the body. Surgeon Alfred Blalock, with assistance from technician Vivien Thomas, implanted a shunt that he and pediatric cardiologist Helen Taussig had developed. With her blood flow restored, the baby turned pink and the modern era of pediatric cardiac surgery began.

Nearly 76 years later, the Blalock-Taussig-Thomas Pediatric and Congenital Heart Center at Johns Hopkins Children’s Center — named in honor of the three pioneers — has dedicated a new pediatric cardiac intensive care unit (PCICU) to provide state-of-the-art, specialized and highly focused care for tiny patients struggling with serious heart conditions from the moment of their first breath.

“Building this cardiac critical care program is an opportunity, when coupled with the already established systems, programs and — importantly — the people at Johns Hopkins Medicine, that will enable us to provide a level of medical care and a patient-family experience that is truly unique in this region and the country,” says Darren Klugman, M.D., director of pediatric cardiac critical care at Johns Hopkins.

Klugman says the PCICU will be staffed by board-certified, subspecialty-trained intensivists and cardiologists who will partner with surgeons to deliver high-quality care. The team also will include respiratory therapists, nurses and nurse practitioners trained in pediatric and cardiac critical care.

The high quality, comprehensive and multidisciplinary cardiac care services in the new PCICU include:

• Coordinated care beginning at fetal diagnosis
• A dedicated cardiac anesthesia team
• Heart transplantation
• Cardiac extracorporeal membrane oxygenation (ECMO), which uses a device that takes over the function of the heart and lungs, giving them time to rest
• A cardiac imaging program, including computerized tomography (CT) and magnetic resonance imaging (MRI) capabilities
• Temporary and permanent ventricular assist devices (VADs), mechanical devices that support or replace a weakened or faulty heart ventricle
• An electrophysiology ablation and pacemaker program that treats irregular heartbeats known as arrhythmias
• Preoperative and postoperative management

While one-year survival for infants with critical congenital heart defects has been improving over time, mortality rates remain high. Advanced surgical approaches enabling early intervention, Klugman explains, along with specialized cardiac critical care of these children, has translated into better treatment results. Research shows that PCICU care has many advantages over traditional ICU cardiac care, including shorter ventilator stays, improved continuity of care and more seamless coordinated multidisciplinary care, which is necessary to ensure high quality outcomes.

An internationally known researcher in congenital heart disease quality and outcomes, Klugman will lead efforts to advance outcomes in the PCICU and optimize practice through scientific inquiry and quality improvement.

“One of the things that attracted me to Johns Hopkins Medicine was the enormous research infrastructure and resources that exist within our system,” says Klugman. “All of the dedicated subspecialty care, research and education here will enable us to ask important questions, to understand the differences among our patients, and participate in research and clinical care advances to improve our outcomes. Without question, our singular goal is to continue to advance the care we provide through research, science and practice to improve outcomes beyond where they are today.”

For more information on the Johns Hopkins Children’s Center PCICU, go to www.hopkinsmedicine.org/heart_vascular_institute/specialty_areas/pediatric-and-congenital-heart-center/critical-care.html.

PSYCHOLOGISTS: STOP USING TERM ‘IMPULSIVITY’ TO DESCRIBE BEHAVIOR OR PERSONALITY TRAITS

When a word is too frequently used as a catch-all term, its definition becomes too broad and it can stop meaning anything concrete. That’s why Johns Hopkins Medicine researchers suggest that the descriptive term “impulsivity” has become so overgeneralized that it’s no longer useful to describe mental conditions such as substance use disorders, attention deficit/hyperactivity disorder (ADHD) and others listed in the psychiatry bible, the Diagnostic and Statistical Manual of Mental Disorders (DSM).

In a new theoretical analysis published on Sept. 24, 2020, in Psychological Review, the researchers say disorders cluster with certain kinds of impulsive behaviors that are individually very distinct for helping to define an illness or condition. They argue that lumping everything together muddles clarity and understanding in the fields of psychology, psychiatry and neuroscience. Rather, they say, researchers should stop using the catch-all term “impulsivity,” and refer to more specific and validated types of behaviors and traits as is done for dozens of other concepts in psychology.

A major reason that different behaviors or traits have been lumped together as "impulsivity" is that clinical disorders, such as substance use disorders, are linked with more than one kind of characteristic.

“There are many ways to be bad at basketball: a person is too short, they can’t dribble, can’t do free-throws, they are selfish and don’t pass the ball, or can’t take instructions from a coach,” says study co-author Matthew Johnson, Ph.D., professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine. “It doesn’t mean that height is the same thing as selfishness. Similarly, there are many ways that someone with a mental health disorder can do poorly in life.”

Impatience, lack of attention to remaining on a task, risk taking or having a hair-trigger response have all been considered types of impulsivity. However, past research has shown that each of these behaviors occurs through different processes in the brain, and they have distinct mechanisms linked to different clinical conditions. For example, the DSM defines impulsive behavior in different ways for disorders such as ADHD and antisocial personality disorder.

According to Johnson and study co-author Justin Strickland, Ph.D., a postdoctoral fellow at Johns Hopkins Medicine, these various behaviors or traits are not “types” of impulsivity, but are stand-alone scientific categories that shouldn’t be lumped together as aspects of a single trait.

REDETT NAMED DIRECTOR OF PLASTIC AND RECONSTRUCTIVE SURGERY AT JOHNS HOPKINS MEDICINE

Richard Redett, M.D., has been appointed director of the Department of Plastic and Reconstructive Surgery (P&RS) at the Johns Hopkins University School of Medicine. An internationally recognized physician, Redett has served as the department’s interim director since February 2019.

During his tenure as interim director, the department expanded its research portfolio, strengthened multidisciplinary clinical programs, enhanced its residency and fellowship programs, and further developed clinical and research collaborations with other Johns Hopkins Medicine departments. P&RS is recognized for its innovative surgical procedures — including hand, upper extremity and penis transplantations — as well as a soon-to-be-launched uterus transplant program.  

The basic science and translational research program in P&RS includes activities in vascularized composite allotransplantation (transplantation of multiple tissues such as muscle, bone, nerve and skin as a functional unit — e.g., a hand or face), organ preservation, neurocranial implant technologies and peripheral nerve regeneration.

Redett is a graduate of Emory University and Dartmouth College’s school of medicine. He completed an internship and residency in general surgery at The Johns Hopkins Hospital, and a residency in plastic and reconstructive surgery in the Johns Hopkins/University of Maryland combined plastic surgery residency program. He also was a pediatric plastic surgery fellow at the Hospital for Sick Children in Toronto.

Redett specializes in cleft lip and palate surgery, facial paralysis, brachial plexus injuries, and pediatric burn reconstruction. He also is the director of the Cleft Lip and Craniofacial Center at the Johns Hopkins University School of Medicine, and led the team that in March 2018 performed the world’s first total penis and scrotum transplant.