Esophageal cancer, drug misuse, heart failure, stability and balance and the effects of space flight on bone cells - these are just some of the topics featured in new research studies to be presented at RCSI’s annual Research Day today.

The annual RCSI Research Day is an important date in the RCSI calendar providing its scientists with the opportunity to showcase their most recent research findings. As one of Ireland’s premier research institutions RCSI is internationally recognized for both education and research and is dedicated to improving human health through endeavour, innovation and collaboration in education, research and service.

Some of the highlights from the 2006 RCSI Research Day include:

Hiccups – public unaware of common symptoms of esophageal cancer
Persistent hiccupping is a common but previously unrecognized symptom of esophageal cancer and warrants urgent investigation, according to a new study from the Department of Surgery at Connolly Hospital in Dublin.

Researchers surveyed the presenting symptoms of 99 esophageal cancer patients prospectively and revealed that 27% had complained of persistent hiccupping, 6% complained of hiccupping as their initial reason to consult their GP and in a further 9% it was the predominant ongoing symptom.

Findings further revealed that the average age at diagnosis of esophageal cancer was 66 and that apart from persistent hiccupping the most common presenting symptoms were dysphagia or difficulty in swallowing (82%), weight loss (68%), lethargy (62%) and anorexia (56%).

In 50% of cases, tumors were located in the lower esophagus, 18% were located in the gastric cardia (the uppermost part of the stomach that connects the bottom of the esophagus to the stomach), 27% in the mid-esophagus, and 5% had tumors in the upper esophagus.

It also found that the majority of patients (67%) with persistent hiccups had tumours of the lower esophagus or cardia and 68% had adenocarinoma

The study to be presented at the 2006 RCSI Research Day states that despite the fact that the incidence of esophageal cancer is rising and it continues to be one of the most serious forms of cancer in terms of prognosis, many patients are still largely unaware of its symptoms.

High incidence of polydrug usage among methadone patients 
A significant proportion of methadone patients use cannabis on a daily basis with some also using cocaine regularly according to new research.

Findings of an extensive survey to study polydrug use in 851 methadone treated patients of the Health Service Executive (HSE), North Dublin, have concluded that cocaine abuse is emerging as a major problem among opiate users receiving methadone treatment with a great majority of these patients also using cannabis on a daily basis.

A high incidence of cocaine use was shown among the participants of the survey. Of the 77% of methadone patients with a history of cocaine use over a third (34%) reported to have used cocaine within the last month with 12% reporting daily use. The survey also showed that over 70% of the participants were receiving a medium to high daily dose of methadone.

Prevalence of cannabis use among the same patient population was also high at 83%. Of these 42% reported daily use of the drug with 19% using it once or twice a week. A worrying outcome from the study is that a significant proportion of participants with a high frequency of cocaine use was also using cannabis on a daily basis.

According to the studies carried out by researchers from the RCSI and the HSE Northern Area, the figure of cocaine use observed is “an important indicator of the level and extent of cocaine use in methadone patients and is valuable from a public health perspective in order to reassess needs, plan and evaluate education, prevention, treatment and harm-reduction services.”

The research also warns that despite its perception as a ‘safe drug’ cannabis is known to have ‘both acute and chronic health effects and does produce dependence’.

Levels of Some Aspects of Self-Care by Patients with Heart Failure are ‘worryingly low’. 
Research by the Department of Psychology at the RCSI has found that despite the fact that sudden weight gain is an early sign of cardiac congestion, only 39% of patients with heart failure reported unusual weight gain to their doctors.

Heart failure is a highly challenging condition requiring patients to follow complex medical self-care advice such as adherence to medication, dietary guidelines (reducing salt) and monitoring weight to ensure excess fluid is not retained.

Researchers surveyed 100 Irish patients with heart failure and found that while medication adherence rates were high (93% reported taking medication as prescribed), rates of daily weighing (16% ) and reporting unusual weight gain to their doctors (39% ) were ‘worringly low’, as timely treatment can avert the onset of more serious symptoms.

This research is ongoing and hopes to identify patient understanding of the reasoning behind advice in fluid and weight monitoring in order to improve this aspect of self-care.

The study is part of a larger Health Research Board (HRB) research programme – the Healthy Ageing Research Project (HARP) - being undertaken by RCSI, Trinity College Dublin (TCD), - The Economic and Social Research Institute in Ireland (ESRI) and Queens University Belfast (QUB).

Bones in space - investigating the effects of gravity on human bone forming cells 
An innovative research project on the effects of stress on bone forming cells (osteoblasts), jointly supported by RCSI and UCD Conway Institute of Biomolecular & Biomedical Research, using simulated space flight has investigated the response of osteoblasts to the amount of mechanical stress or gravity they endure.

The basis for this study was the observation that during long-duration space flight, astronauts can suffer from excessive bone loss - up to 19% of weight bearing bone - and may suffer from osteoporosis as a result.

It is well documented that cells can sense mechanical stress applied to them and bone cells are particularly sensitive to such stress. This study was designed to test the short-term effects of microgravity on osteoblasts and to further the understanding of how they operate under stress.

Researchers placed osteoblasts in a custom-made high g-tolerant watertight chamber, which were then subjected to parabolic flight on board a specially designed Airbus A300 called the Zero-G as part of the European Space Agency’s (ESA) Student Parabolic Flight Campaign. By comparing their results with those from a control experiment on the ground, the team could observe the impact of mechanical stress on the bone cells. This mechanical stress resulted from repeated exposure to periods of zero gravity and hyper gravity, induced by the airplane flying a sequence of parabolas.

Preliminary results indicate that cellular changes occurred relative to the cells’ exposure to mechanical stress. The results of this study may lead to a more in-depth knowledge of mechanotransduction (mechanisms by which cells convert mechanical stimulus such as gravity into chemical activity), which is implicated in diseases such as osteoporosis. Further investigations into the effect of mechanical stress on cells may in time lead to the development of new treatments for this disease.

The ESA Student Parabolic Flight Campaign aims to encourage talented science students into a career in space.

Shoes improve stability and balance in frail elderly women 
Frail older women who go barefoot have poorer balance leaving them more susceptible to falls than those who wear their own shoes according to a new study.

The study by researchers from the School of Physiotherapy, RCSI, and the Departments of Physiotherapy and Medicine for the Elderly in Beaumont Hospital, Dublin found that footwear significantly improved the balance of frail older women.

The causes of falls in older people include intrinsic factors and environmental hazards such as unsafe footwear. Approximately one in three older people over the age of 65 falls at least once a year, increasing to one in two in those over 80. Footwear is a potentially modifiable factor which to date has not been researched in detail.

This study, the first of its kind to look at the effects of footwear on the balance of frail older patients, surveyed a sample of 100 women with an average age of 82 attending the geriatric day hospital at Beaumont Hospital. Researchers assessed participants’ individual history of falls and their shoes were examined using a footwear assessment form. 51% of those surveyed were living alone and the majority, 80%, had a previous history of falls. Participants’ balance was tested with shoes on and off.

Findings revealed that by wearing their own shoes elderly women could significantly improve their balance compared to being barefoot, thus reducing the risk of falls. The greatest benefit of footwear was seen in those who were independently mobile with the poorest balance. Researchers called for further studies to investigate if particular types of footwear would improve balance in the elderly.