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Biomaterial particles educate immune system to accept transplanted islets

Team of researchers, including those from UofL, open potentially new pathway for treating type 1 diabetes
Biomaterial particles educate immune system to accept transplanted islets

Haval Shirwan, Ph.D., the Dr. Michael and Joan Hamilton Endowed Chair in Autoimmune Disease at the University of Louisville School of Medicine and director of the Molecular Immunomodulation Program at the Institute for Cellular Therapeutics at UofL.

By instructing key immune system cells to accept transplanted insulin-producing islets, a team of researchers including those from the University of Louisville have opened a potentially new pathway for treating type 1 diabetes. If the approach is  successful in humans, it could allow people with type 1 diabetes to be treated without the long-term complications of immune system suppression.

The technique, reported this week in the journal Nature Materials, uses synthetic hydrogel particles (microgels) to present a protein known as the Fas ligand (FasL) to immune system T-effector cells along with the pancreatic islets being transplanted. The FasL protein “educates” the effector cells – which serve as immune system watchdogs – causing them to accept the graft without rejection for at least 200 days in an animal model.

The FasL-presenting particles are simply mixed with the living islets before being transplanted into the mice, which suffer from chemically-induced diabetes. The researchers believe the FasL-presenting hydrogels would not need to be personalized, potentially allowing an “off-the-shelf” therapy for the transplanted islets.

Researchers from the University of Louisville, Georgia Institute of Technology and the University of Michigan collaborated on the work, which was supported by the Juvenile Diabetes Research Foundation and the National Institutes of Health.

“We have been able to demonstrate that we can create a biomaterial that interrupts the body’s desire to reject the transplant, while not requiring the recipient to remain on continuous standard immunosuppression,” said Haval Shirwan, Ph.D., the Dr. Michael and Joan Hamilton Endowed Chair in Autoimmune Disease at the University of Louisville School of Medicine and director of the Molecular Immunomodulation Program at the Institute for Cellular Therapeutics at UofL.

“We anticipate that further study will demonstrate potential use for many transplant types, including bone marrow and solid organs,” he said.

In the United States, some 1.25 million persons have type 1 diabetes, which is different from the more common type 2 diabetes. Type 1 diabetes is caused by immune system destruction of the pancreatic islet cells that produce insulin in response to glucose levels. Current treatment involves frequent injection of insulin to replace what the islets no longer produce. There is no long-term cure for the disease, though persons with type 1 diabetes have been treated experimentally with islet cell transplants – which almost always fail after a few years even with strong suppression of the immune system.

“Drugs that allow the transplantation of the islet cells are toxic to them,” said Andrés García, the Rae S. and Frank H. Neely Chair and Regents' Professor in Georgia Tech’s George W. Woodruff School of Mechanical Engineering. “Clinical trials with transplantation of islets showed effectiveness, but after a few years, the grafts were rejected. There is a lot of hope for this treatment, but we just can’t get consistent improvement.”

Among the problems, García said, is toxicity to the islet cells from the immune system suppression, which also makes patients more susceptible to other adverse effects such as infections and tumors. Other researchers are exploring techniques to protect the islets from attack, but have so far not been successful.

The research reported in Nature Materials takes a totally different approach. By presenting the FasL protein – which is a central regulator of immune system cells – the researchers can prevent the immune system from attacking the cells. Once they are educated at the time of transplantation, the cells appear to retain their acceptance of the transplanted islet cells long after the FasL has disappeared.

“At the time of transplantation, we take the islets that are harvested from cadavers and simply mix them with our particles in the operating room and deliver them to the animal,” García explained. “We do not have to modify the islets or suppress the immune system. After treatment, the animals can function normally and are cured from the diabetes while retaining their full immune system operation.”

The hydrogels can be prepared up to two weeks ahead of the transplant, and can be used with any islet cells. “The key technical advance is the ability to make this material that induces immune acceptance that can simply be mixed with the islets and delivered. We can make the biomaterial in our lab and ship them to where the transplantation will be done, potentially making it an off-the-shelf therapeutic.”

In the experimental mice, the islets were implanted into the kidneys and into an abdominal fat pad. If the treatment is ultimately used in humans, the islets and biomaterial would likely be placed laparoscopically into the omentum, a tissue with significant vasculature that is similar to the fat pad in mice. Garcia’s lab has previously shown that it can stimulate blood vessel growth into islet cells transplanted into this tissue in mice.

In future work, the researchers want to see if the graft acceptance can be retained in more complex immune systems, and for longer periods of time. By reducing damage to the cadaver islets, the new technique may be able to expand the number of patients that can treated with available donor cells.

García’s lab uses polymer hydrogel particles that are about 150 microns in diameter, about the same size as the islet cells. They engineer the particles to capture the FasL – a novel recombinant protein developed by Shirwan and Esma S. Yolcu, associate professor of microbiology and immunology at the University of Louisville – on the particle surface, where it can be seen by the effector cells.

Thousands of women diagnosed with breast cancer might not need chemotherapy, study shows

UofL doctor says study of women with most common type confirms what many had believed
Thousands of women diagnosed with breast cancer might not need chemotherapy, study shows

Elizabeth Riley, M.D., FACP, a breast cancer expert at UofL’s Brown Cancer Center and deputy director of the center.

Thousands of women diagnosed with the most common type of breast cancer can now skip chemotherapy and still have the same outcome, according to a new study presented this week.

The long-awaited study, presented at the American Society of Clinical Oncology meeting over the weekend in Chicago, confirmed what many breast cancer specialists, including those at the James Graham Brown Cancer Center at the University of Louisville, had already believed.

For women with this common type of cancer - early stage estrogen-receptor positive - anti-estrogen treatment alone provide the same benefit as chemotherapy, without the harsh and sometimes devastating side effects. Chemotherapy can cause hair loss, a weakened immune system and heart problems, among other issues. Breast cancer is the most common cancer in women worldwide.

“The name of the study is TAILORx, which is perfect, because what this means is that for a large group, treatment can be truly tailored to a woman’s circumstances,” said Elizabeth Riley, M.D., FACP, a breast cancer expert at UofL’s Brown Cancer Center and deputy director of the center. “We now have solid data that chemotherapy is not needed for many in this group and helps validate what many specialists already knew.

“For years, physicians made treatment decisions solely based on a woman’s stage of breast cancer. TAILORx now confirms the biology of the tumor may be more important. This study should reassure a woman with very early stage, estrogen-driven breast cancer that chemotherapy can be avoided without increasing her risk of breast cancer,” Riley said.

The study, published Sunday in the New England Journal of Medicine, analyzed how well a widely used genetic test called the Oncotype DX Breast Recurrence Score assessed the risk of breast cancer returning. The Oncotype DX test looks at 21 genes linked with a likelihood of recurrence. The test has a range between 0 and 100, and determines whether these genes are turned off or on, or are over expressed.

The study’s lead author, Joseph Sparano M.D., associate director for clinical research at the Albert Einstein Cancer Center and Montefiore Health System in New York City, said the data confirms women can be spared “unnecessary treatment if the test indicates chemotherapy is not likely to provide benefit.”

Riley noted there are multiple types of breast cancer, with multiple genes involved in the growth of tumors. She said those patients who will benefit from the study’s findings are estrogen sensitive, test negative for HER2 (human epidermal growth factor receptor 2), a gene that can play a role in the development of breast cancer, and have early-stage tumors below 5 centimeters that have not spread to lymph nodes.

They also have what is considered an intermediate score on the OncotypeDX test, one between 11 and 25.

Riley said that past research has shown women with scores between 0 and 10 could safely forego chemotherapy, while those with scores over 25 were best treated with a combination of chemotherapy and anti-estrogen hormonal treatment, as the cancer recurrence risk in this group was high.

“There have been clear guidelines on treatment for woman with a high or low score OncotypeDX score. It was the group in the intermediate range, from 11 to 25, that the degree of benefit of chemotherapy was not well established,” Riley said.

The study followed over 10,000 women diagnosed with breast cancer between 2006 and 2010. Of those, 6,711 had intermedia scores between 11 and 25. That group was split into two: one receiving hormone therapy and chemotherapy, and the other only hormone therapy.

The women were followed for an average of nine years, and researchers found the outcome in recurrence and survival was virtually the same.

“If you are seen by a doctor tomorrow and have a low to intermediate score on the test, you should expect not to be offered chemotherapy, unless you are under the age of 50,” Riley said.

That is the caveat, she said. Breast cancer in younger women is biologically different, and typically comes with a poorer prognosis. In premenopausal women and those younger than 50, the TAILORx results suggested that hormonal therapy alone may not be enough and chemotherapy may still be needed, she said.

While these patients should discuss their options with their doctor, they would be likely candidates for the more aggressive combination therapy, she said.

“In that case, the treatment decisions are going to depend on more than just the test, such as a thorough analysis of a patient’s particular tumor type. We can’t say that everyone under 50 needs chemotherapy, but future studies may be necessary to interpret the test in this age group,” Riley said.

Breast cancer in younger women is a focus of Riley’s. At the Brown Cancer Center, she also leads the HER Breast Cancer Program, which addresses the challenges this group faces with regional experts in the management of breast cancer in young women. The program also addresses the impact of treatment on fertility, the patient’s young children, and her career. HER stands for Hope, Empower and Restore.

A new era in medical care for children begins

The Novak Center for Children’s Health represents paradigm shift in pediatric care
A new era in medical care for children begins

David and Wendy Novak, left, and their family stand with the architect's rendering of the Novak Center for Children's Health in July 2017.

A new era in medical care for children will begin this June when the Novak Center for Children’s Health at the University of Louisville opens to patients and their families.

A preview of the new 176,000-square-foot facility was held Thursday evening (May 31) for supporters and friends of the university, including the building’s namesakes, David and Wendy Novak, their family and their foundation, the Lift-A-Life Foundation.

The retired CEO of Louisville-based Yum! Brands, David Novak headed the lineup of dignitaries launching the building’s debut, including University of Louisville Board of Trustees Chair David Grissom, UofL President Neeli Bendapudi, Ph.D., and UofL Executive Vice President for Health Affairs Gregory Postel, M.D. Honored among the group were the Novaks’ daughter, Ashley Novak Butler, for her leadership with the project along with others who played a role it: Tony and Lisa Christensen, the WHAS Crusade for Children, Bruce Henderson and Henderson Services, Lynnie Meyer and Emmett Ramser of Norton Healthcare, and the former vice president of advancement at UofL and current Kosair Charities President Keith Inman.

 David Novak lauded the facility for creating the environment where a new paradigm of health care for children will be fostered. The Novak Center will house all general, specialty and subspecialty pediatrics services in a single eight-story building, meaning patients and their families will be able to have all their needs handled in one convenient location.

An anticipated 135,000 patient visits will occur annually in the new center – now one of the largest and most technically advanced pediatric outpatient centers in the United States.

David Novak noted the vision of the center: “UofL has the world-class minds; it needed a world-class center. It is so gratifying to be here tonight and see that we are on the cusp of opening a building that has the potential to impact generations to come.”

“This magnificent facility promises to change how health care is delivered to our children with no child turned away from that care,” Grissom said. “Its design for efficiency of care was not by accident; a number of UofL staff spent a tremendous amount of time exploring the best practices from throughout the nation and took the best of those to implement here in Louisville.”

Bendapudi reminded the crowd that implementing such change takes ongoing support. “Progress cannot occur without generous support from our community,” she said. “We could not be able to improve how health care is delivered to every child who comes to our door if it were not for the generosity of supporters such as the Novak family and the Lift-a-Life Foundation.”

Postel outlined many of the building’s features: “For too long, we have required our children and their families to move from building to building, office to office, to see all the providers who meet their health care needs. This facility changes that,” with:

  • All pediatric providers in a single building to ensure a multidisciplinary approach in providing care
  • Innovative clinical and research programs that not only provide the latest advances in treatments and cures but also create and develop them
  • An environment that enables staff to explore new initiatives, including holistic life style approaches to diseases and conditions that impact children
  • A site where both basic and clinical research will be carried out and will help UofL attract new researchers as faculty
  • Enhancement of the education provided to medical students, residents and fellows, giving them first-hand experience with interdisciplinary learning they can take directly into the patient exam room

The total patient experience was at the forefront of the facility’s design, Postel said. “In addition to the excellence in patient care provided here, we looked at the ‘softer’ touches – light-up benches along the skybridge (connecting the building to the parking garage); using colors to identify floors so that no matter what language people speak, they can find the right floor; coding the floors with animals representing regional and Kentucky wildlife to pique children’s interest; and much more.”

Designed in kid-friendly colors, the facility features several public areas with soft seating and interactive screens to entertain children while they wait to see providers. But the waiting shouldn’t be long, say UofL Department of Pediatrics providers: The latest in technological advances, the Real Time Locator System, will help move patients and providers to their appointments without lengthy wait times.

Also included in the facility will be the Wendy Novak Diabetes Center, created in 2015 with support from the Novaks and currently housed in the Children’s Hospital Foundation Building. The Wendy Novak Diabetes Center provides comprehensive diabetes care as well as access to clinical research trials that sometimes are patients’ only chance at diseases management and survival.

The services of the Wendy Novak Center will be augmented in the new facility with the addition of an up-to-date kitchen. “We are going to bring in the world-class chefs we have in Louisville to teach families how to prepare menus and foods that are diabetic-friendly and can actually improve lives,” Novak said. “Some these chefs have diabetes themselves so they can speak and teach from first-hand experience.”

The Novak Center for Children’s Health will be staffed by faculty physicians practicing with UofL Physicians and will open for patient appointments in June. To learn more about the scope of pediatric health care at UofL, visit www.UofLPhysicians.org.

The Novak Center for Children's Health is located at 411 E. Chestnut St. Budget to construct the new facility was $79 million. Messer was construction manager for the project.

Pediatric diabetes educator reminds that summertime is perfect time to adopt healthy habits

Pediatric diabetes educator reminds that summertime is perfect time to adopt healthy habits

Kick Starter and hocolate Peanut Butter, Banana & Strawberry Smoothies can help you begin to establish health habits this summer.

With Memorial Day around the corner, even adults can begin to have a “school’s out” attitude and let healthy habits fall by the wayside. As temperatures rise, children enjoy their freedom and plans are being made for vacations, Diabetes Educator Whitney Cessna, M.S., R.D.N., L.D.N,, reminds both grown-ups and kids alike that staying in shape is a priority all year long.

“Summer can be the perfect time to improve your health without even noticing you are doing so,” said Cessna, who practices with University of Louisville Physicians-Pediatric Endocrinology and at the Wendy Novak Diabetes Center, managed jointly by UofL and Norton Children’s Hospital. “Making several small changes in your routine can reap big health benefits.”

Cessna has put together a few of her personal tips to make the most out of your summer, all while being healthy at the same time:

  • Drink at least 64 ounces of water a day. This is important to stay hydrated whether at the pool, on the golf course or sitting outside soaking up that sunshine. Hydration is also key for any physical activity, and especially when drinking alcohol.
  • Make half your plate vegetables. They are lower in carbs, higher in fiber and contain essential vitamins and nutrients that help reduce certain chronic risk factors and diseases. Veggies such as cucumbers, asparagus, avocados, zucchini and leafy greens are high in fiber and over time will help decrease bloating.
  • Exercise. If you can find more time to exercise, do it. Exercising in the extreme heat should be kept to a minimum, but that doesn’t mean you can’t take your workouts to the gym or do some circuits in the luxury of your home in the air conditioning.
  • Go light on the alcohol. Summer is the best time to skip those hard liquor drinks you’ve been consuming all winter. Choose lighter options lower in calories and carbohydrates. If you are going to be outside for several hours, cut back on alcohol. When you drink it in the sun, it dehydrates you further, causing you to urinate and sweat more. Although you may crave more of that crisp, cold beverage, alcohol fails to replenish those water stores, potentially causing dehydration.
  • Get plenty of sleep. Sleep plays an important role in physical health and mental health. According to the National Heart, Lung, and Blood Institute, sleep deficiency may lead to an increased risk of heart disease, kidney disease, high blood pressure, stroke and diabetes.
  • Give your diet a boost of berry.  Strawberries, blackberries, raspberries and blueberries are some of Cessna’s year-round favorites, but more so in the summer when they are available fresh at stores and farmers markets. Berries are full of antioxidants, which help prevent tissue damage and reduce risk of age-related illnesses. Berries are perfect for a breakfast fruit bowl, as a snack by the pool or blended into a delicious and nutritious smoothie such as these:

Kick Starter Smoothie

Ingredients:

  • ½ cup blueberries
  • ½ frozen banana
  • 1 peeled carrot
  • 1 tbsp. flax seed
  • 1 cup almond milk
  • 1 cup ice
  • 2 tbsp. oats
  • ½ packet of Breakfast Essentials powder (any flavor, but chocolate would go perfect!)

Directions:

  • Peel a carrot and place in blender with ice. Pulse a few times to get carrots semi blended.
  • Add in other ingredients until smooth and enjoy.

Chocolate Peanut Butter, Banana & Strawberry Smoothie

Ingredients:

  • 1 cup almond milk
  • ½ avocado
  • ½ frozen banana
  • 2 strawberries
  • 1 scoop of Protein Superfood Chocolate Peanut Butter powder, whey protein or a plant-based protein if not able to tolerate whey, or Breakfast Essentials powder
  • ¼ tsp. cinnamon
  • 1 cup ice
  • 3 tbsp. cocoa powder or ½ packet of Breakfast Essentials powder
  • 3 tbsp. peanut butter or PB2 powder, a good alternative to peanut butter

Directions:

Blend all ingredients in blender until a creamy, smooth consistency is reached.

 

 

UofL pediatricians emphasize that tick-borne diseases exist but are rare in Kentucky

UofL pediatricians emphasize that tick-borne diseases exist but are rare in Kentucky

Victoria Statler, left, and Gary Marshall

Kentucky parents concerned about tick-borne diseases can relax a bit, say pediatricians with the University of Louisville Department of Pediatrics. While ticks and tick bites are common here, the diseases that ticks carry and transmit are rare – so much so that the Centers for Disease Control and Prevention do not recommend routinely giving preventive antibiotics to people who have had a tick bite and are otherwise well.

Recent media reports have indicated concern about ticks in New Jersey that can transmit SFTS – severe fever with thrombocytopenia syndrome. Thrombocytopenia is a decrease in blood platelets, which are cells that help form clots.

However, the tick carrying SFTS is not found in Kentucky, so physicians and public health officials are less concerned about this condition in the Commonwealth. The same is true about the tick that carries Lyme disease, the deer tick with the species name Ixodes scapularis. This tick is much less common in Kentucky than it is in coastal New England, where Lyme disease is frequently seen, Marshall said. The immature forms of ticks common to Kentucky, such as the dog tick (Dermacentor variabilis) and the lone star tick (Ambylomma americanum) can be mistaken for the tiny deer tick.

“You do not need to bring your child to the doctor if he or she has an attached tick but is otherwise well,” said Gary S. Marshall, M.D., who practices with UofL Physicians – Pediatric Infectious Diseases. “You should remove the tick and watch for signs of illness such as fever, headache, nausea, rash or sensitivity to light; if these conditions occur, then bring your child in to see your pediatrician immediately.”

Victoria A. Statler, M.D., also with UofL Physicians – Pediatric Infectious Diseases, concurs. “While tick bites are common during the warmer months in Kentucky, tick-borne diseases are rare,” she said. “The vast majority of bites never result in any disease.”

The CDC notes there is no need to panic if you find a tick attached to your child. There are several tick removal devices on the market, but a plain set of fine-tipped tweezers will remove a tick quite effectively. The CDC offers these steps to safely remove a tick:

  1. Use fine-tipped tweezers to grasp the tick as close to the skin's surface as possible.
  2. Pull upward with steady, even pressure. Don't twist or jerk the tick; this can cause the mouth-parts to break off and remain in the skin. If this happens, remove the mouth-parts with tweezers. If you are unable to remove the mouth easily with clean tweezers, leave it alone and let the skin heal.
  3. After removing the tick, thoroughly clean the bite area and your hands with rubbing alcohol, an iodine scrub or soap and water.
  4. Dispose of a live tick by submersing it in alcohol, placing it in a sealed bag/container, wrapping it tightly in tape, or flushing it down the toilet. Never crush a tick with your fingers.

Do see your doctor if symptoms occur, said Statler. “If you have fever and any combination of rash, headache, light sensitivity, muscle aches and pains or nausea during tick season, see a doctor, whether you’ve had a tick bite or not,” she said.

To make an appointment with UofL Physicians - Pediatric Infectious Diseases, call 502-588-2348. After 5 p.m. on weekdays and on weekends, call Norton Children's Hospital at 502-629-6000.

 

 

 

 

 

 

 

 

UofL neurologist uses acupuncture to help patients

Way to treat migraines, headaches without medication
UofL neurologist uses acupuncture to help patients

Elizabeth S. Doll, M.D.

Elizabeth S. Doll, M.D., completed years of medical training to become a child neurologist. But what most people don’t know is she also spent hundreds of hours at Harvard University, training in the art of acupuncture.

“I’ve always been interested in integrative and alternative medicines,” said Doll, who cares for patients at University of Louisville Physicians – Child Neurology and Norton Children’s Hospital. “Even with all the advancements in modern medicine, we still can learn a lot from ancient treatments.”

She’s recently combined her love of neurology and acupuncture. She offers acupuncture as a way to help with migraines and severe headaches in teens and children as young as 6 years old.

“Research shows that acupuncture, when done properly, is a great, noninvasive way to treat headaches and other pain conditions, often without the use of medicines,” Doll said. “Many patients I treat in the hospital see relief quickly.”

Doll said when most people think of acupuncture, they picture someone lying down with hundreds of needles all over their body. That’s not the treatment she provides.

“My treatments are about 45 minutes and involve roughly 10 to 15 needles,” she said. “Those needles are usually placed at acupuncture points in distant areas, like the ears and feet."

How can needles treat headaches?

“It’s about opening up pathways throughout the body,” Doll said. “You’d be amazed to see how different body parts are connected.”

She admits that most patients and families are skeptical or fearful at first, but once they try it, they become believers.

“People have a fear of needles, but it really doesn’t hurt,” Doll said. “And patients end up liking it when they feel the results.”

Doll said acupuncture isn’t going to replace modern treatments and medications, but rather it’s a good way to supplement care, especially in the hospital setting.

“It’s not a miracle cure,” she said. “Acupuncture can relieve pain quickly, but medicines and other forms of treatment are still important. Acupuncture can be effective long-term, but periodic treatments outside the hospital setting are needed.”

For those with severe headaches, acupuncture can make a big difference.

"I recently had a patient in the hospital and we were treating her with IV medication for her migraine,” Doll said. “After performing acupuncture, she didn’t need any more medications and went home the next day.”

To make an appointment with Dr. Elizabeth Doll, call 502-588-3650.


Reprinted by permission from Norton Children's Hospital.

Racers run, walk or roll in 5K to Cure Paralysis for UofL pediatric spinal cord injury program

Racers run, walk or roll in 5K to Cure Paralysis for UofL pediatric spinal cord injury program

Todd Crawford, Center, with participants in the 5K to Cure Paralysis in 2015

Runners, walkers, wheelchair participants, families and pets are invited to participate in the 11th annual 5K to Cure Paralysis at Louisville Waterfront Park on June 2. A portion of proceeds from the race, sponsored by the Todd Crawford Foundation, will benefit spinal cord injury research at the University of Louisville.

Crawford was 22 years old and had just graduated from college when he suffered a spinal cord injury that left him paralyzed. His family and friends organized fundraisers to help during his physical rehabilitation. Crawford went on to earn an MBA from UofL and is president of Crawford Designs. In 2006, he established the Todd Crawford Foundation and began to raise funds to support spinal cord injury and paralysis research.

 “We have a large group of wonderful people who come to our events and support our mission. For this, we are continually grateful,” Crawford said.

Racers may register online. Race-day registration begins at 9 a.m. on Saturday, June 2 at Louisville Waterfront Park and the race starts at 10 a.m. Entry is $25 for adults and kids under 12 race free.

One of the chief beneficiaries of the foundation has been the Kosair Charities Center for Pediatric NeuroRecovery at UofL. Directed by Andrea Behrman, Ph.D., P.T., the center innovates treatments and provides therapy for children with spinal cord injuries using locomotor training, an activity-based rehabilitation approach that has led to progress in sitting, standing and stepping. The children are treated at Frazier Rehab Institute in Louisville, a part of KentuckyOne Health. 

In addition to pediatric neurorecovery, the foundation also supports the work of individual researchers at the Kentucky Spinal Cord Injury Research Center (KSCIRC) at UofL through the Crawford Scholars program. Scholarships for 2018 allowed researchers Darryn Atkinson, Ph.D., and Goutam Singh, Ph.D., to present research at national conferences, and funded advanced training in neuroimaging for doctoral candidate Luis Alvarado.

“The generous support of the Crawford Foundation allowed me to encounter this transformative experience at a crucial point of my training and has without a doubt helped shape the trajectory of my scientific career,” Alvarado said.

About The Kentucky Spinal Cord Injury Research Center

The Kentucky Spinal Cord Injury Research Center (KSCIRC), opened in 2001, provides the opportunity for basic scientists, physicians, neurosurgeons and physical therapists to work collaboratively with the common goal of curing paralysis. Through close association with clinical colleagues in the UofL Department of Neurological Surgery, KSCIRC is in a unique position to conduct research designed to ultimately lead to effective treatments for spinal cord injury. This continuum of research has facilitated a “bench-to-bedside” and “bedside-to-bench” approach, where basic science questions are examined from a translational perspective, and findings in the clinical setting enlighten or guide future basic scientific studies.


Pediatric cardiology chief named by UofL

Pediatric cardiology chief named by UofL

Brian Holland, M.D.

A United States Army Medical Corps veteran with eight years of experience at the University of Louisville Department of Pediatrics has been named division chief of pediatric cardiology.

Brian Holland, M.D., has been serving as interim chief since 2017 and practices with UofL Physicians-Pediatric Cardiology.  The UofL Board of Trustees approved his appointment in March.

“Dr. Holland relentlessly pursues quality improvement initiatives, research projects and growth opportunities to enhance and improve pediatric cardiovascular services, both in UofL pediatric clinics and at Norton Children’s Hospital,” said UofL Department of Pediatrics Chair Charles Woods, M.D.

Holland is board-certified by the American Academy of Pediatrics, American College of Cardiology and American Society of Echocardiography. He joined UofL as a pediatric cardiologist in 2010. In 2015, he became the medical director for echocardiography, which is the use of ultrasound to obtain images of the structure and function of the heart. He also is chief of cardiology at Norton Children’s Hospital.

Holland specializes in fetal, transthoracic and transesophageal echocardiography. Fetal echocardiography uses ultrasound to find details of heart defects before birth. Transthoracic echocardiography looks through the patient’s chest wall to see the heart, while transesophageal echocardiography uses a device that passes through the mouth into the esophagus to obtain images.

Holland attended the University of Pennsylvania where he graduated summa cum laude with a degree in bioengineering and then received his M.D. degree from the Medical College of Georgia in Augusta, where he was awarded membership in Alpha Omega Alpha Honor Medical Society.

Following his graduation from medical school, Holland served seven years with the U.S. Army Medical Corps. While in the Medical Corps, he completed an internship and residency in pediatrics at Tripler Army Medical Center in Honolulu and served as a pediatrician in Germany. He also earned the Bronze Star for exceptional service while deployed as a U.S. Army physician during Operation Enduring Freedom in Afghanistan.

After finishing his military service, Holland completed a three-year fellowship in pediatric cardiology at New York-Presbyterian, the training hospitals of Columbia University and Cornell University, before coming to UofL.

Pediatric emergency medicine chief selected for leadership initiative

Becomes 20th from UofL selected for Executive Leadership in Academic Medicine program
Pediatric emergency medicine chief selected for leadership initiative

Michelle Stevenson, M.D.

Michelle D. Stevenson, M.D., M.S., has been selected to the Hedwig van Ameringen Executive Leadership in Academic Medicine (ELAM) Program. The chief of the Division of Pediatric Emergency Medicine and a professor in the Department of Pediatrics at the University of Louisville, Stevenson is the 20th faculty member chosen for the program from UofL and will join the 2018-2019 ELAM class.

ELAM is a yearlong fellowship for women faculty in schools of medicine, dentistry and public health. It provides leadership training with extensive coaching, networking and mentoring opportunities aimed at expanding the national pool of qualified women candidates for executive positions in the academic health sciences. Currently, more than 1,000 ELAM alumnae hold leadership positions at 257 academic health organizations in the United States and Canada.

Stevenson is board-certified in pediatric emergency medicine and in general pediatrics and is a fellow of the American Academy of Pediatrics. She practices with UofL Physicians – Pediatric Emergency Medicine and is on the medical staff of Norton Children’s Hospital.

She came to UofL in 2008 as research director and assistant professor in pediatric emergency medicine. Previously, she held academic appointments at Northeastern Ohio Universities College of Medicine and at the University of Cincinnati and was on staff of Cincinnati Children’s Hospital Medical Center and Children’s Hospital Medical Center of Akron.

She has earned competitive research funding virtually continuously since 2002. Currently, she has grant awards totaling nearly $1 million through 2023 and conducts health outcomes research through the executive committee of the Child and Adolescent Health Research Design and Support unit of the Department of Pediatrics.

Stevenson currently serves as associate editor of Academic Emergency Medicine and is an editorial board member for American Academy of Pediatrics Grand Rounds. She is lead or co-author of almost 50 peer-reviewed articles and four book chapters, and has presented or co-presented 75 oral or poster presentations at medical meetings throughout her career.

She is the recipient of numerous awards for teaching and mentoring medical students, residents and fellows and most recently, received the Outstanding Peer Mentor Award and Top 10 Faculty Peer Clinician-Teacher Excellence Award for Established Faculty from the UofL Department of Pediatrics in 2016. She also is a previous winner of the Celebrating Better Care Award and the Good Samaritan Award, both from Norton Healthcare.

Stevenson earned a bachelor’s degree in biochemistry from Indiana University and her M.D. degree from the University of Kentucky. She completed a residency in pediatrics at UofL followed by a fellowship in pediatric emergency medicine at Cincinnati Children’s Hospital Medical Center. She then augmented her education with a master’s degree in epidemiology from the University of Cincinnati.

For more information on the ELAM program, visit the program’s website. A complete list of ELAM alumnae selected while they were with UofL is shown below:

University of Louisville AlumnaeHedwig van Ameringen Executive Leadership in Academic Medicine Program

Kathy B. Baumgartner, Ph.D. (2008-2009): Associate Professor of Epidemiology and Population Health, University of Louisville School of Public Health and Information Sciences

Kimberly A. Boland, M.D. (2017-2018): Assistant Dean of Resident Education and Work Environment, Department of Graduate Medical Education, University of Louisville School of Medicine

Anees B. Chagpar, M.D., M.Sc., M.P.H. (2009-2010): Academic Advisory Dean, School of Medicine; Director, Multidisciplinary Breast Program; Associate Professor of Surgery; University of Louisville School of Medicine

Mary Thoesen Coleman, M.D., Ph.D. (2002-2003): Associate Professor of Family and Community Medicine; Vice Chair for Clinical Affairs, Department of Family and Community Medicine; University of Louisville School of Medicine

Lourdes C. Corman, M.D. (1996-1997): Professor and Vice Chair of Medicine; Chief, Division of Medical Education; University of Louisville School of Medicine

Connie L. Drisko, DDS (2001-2002): Professor of Periodontics, Assistant Dean for Research, University of Louisville School of Dentistry

Kelli Bullard Dunn, M.D. (2012-2013), Vice Dean, Community Engagement and Diversity, Professor of Surgery, University of Louisville School of Medicine

Susan Galandiuk, M.D. (2001-2002), Professor of Surgery, University of Louisville School of Medicine

Toni M. Ganzel, M.D., M.B.A. (2003-2004): Interim Dean, School of Medicine; Professor of Surgery, and Otolaryngology; University of Louisville School of Medicine

Diane Harper, M.D. (2015-2016): Rowntree Professor and Endowed Chair of Family and Geriatric Medicine, Department of Family and Geriatric Medicine, University of Louisville School of Medicine

Amy Laura Holthouser, M.D. (2016-2017): Associate Dean, Medical Education, Associate Professor of Pediatrics, University of Louisville School of Medicine

V. Faye Jones, M.D., Ph.D., M.S.P.H. (2007-2008): Associate Dean for Academic Affairs, Professor of Pediatrics, University of Louisville School of Medicine

Linda F. Lucas, M.D. (1999-2000): Associate Professor of Anesthesiology, University of Louisville School of Medicine

Sharmila Makhija, M.D., M.B.A. (2012-2013): Chair, Department of Obstetrics, Gynecology and Women's Health; Donald E. Baxter Endowed Chair in Obstetrics and Gynecology; Professor of Gynecologic Oncology; University of Louisville School of Medicine

Barbara J. McLaughlin, Ph.D. (2000-2001): Professor of Ophthalmology, Associate Dean for Research, University of Louisville School of Medicine 

Melanie R. Peterson, D.M.D., M.B.A. (2008-2009): Associate Professor of Dentistry, University of Louisville School of Dentistry 

Laura F. Schweitzer, Ph.D. (1998-1999): Professor, Department of Anatomical Sciences and Neurobiology; Associate Dean of Faculty Affairs; Associate Dean of Student Affairs; University of Louisville School of Medicine

M. Ann Shaw, M.D. (2013-2014): Vice Dean, Undergraduate Medical Education; Professor of Medicine; University of Louisville School of Medicine

Michelle Stevenson, M.D. (2018-2019); Professor of Pediatrics; Division Chief, Emergency Medicine; University of Louisville School of Medicine

Jill Suttles, Ph.D. (2010-2011): Professor of Microbiology and Immunology, University of Louisville School of Medicine

 

 

 

Let there be light

Distinctive glass makes Novak Center for Children's Health pedway bright and efficient
Let there be light

Workers harnessed to the scaffolding of a cherry picker are three stories above ground as they install glass in the pedway of the Novak Center for Children's Health.

As construction continues on the University of Louisville Physicians Novak Center for Children’s Health at the University of Louisville’s Health Sciences Center, a distinctive feature is now complete: the third-floor pedestrian bridge – the “pedway” – that links the new building to the UofL Physicians Health Care Outpatient Center and to the Chestnut Street Garage.

With soaring glass walls, the pedway provides a light-filled conduit between buildings. It is composed of 138 rectangular pieces of glass, each digitally printed with its own individual grid pattern of gray blocks, said Edwin Penna, project manager with Koch Corp. of Louisville, the company installing the glass. Workers are harnessed to a “cherry picker” – a crane with an attached scaffold – and rise three stories above the ground to install the panes into metal frames. No two panes are exactly alike, and seen from a distance, the panes of glass collectively compose an abstract design.

Each pane is approximately 63 inches wide and 1 inch thick, and they vary in height from 47 inches to 120 inches tall, Penna said. After ceramic paint is digitally applied, the glass is fired in a kiln so the design becomes part of the panes. A low-emissivity or “low-e” coating is then applied. Low-e glass emits a lower level of radiant heat than non-coated glass without shading it, making it more energy efficient while still allowing light to shine through.

The glass product is known as Digital DistinctionsTM and is manufactured by Viracon of Minneapolis, Minn. It is just one of a multitude of innovative products being incorporated into the Novak Center, making it both esthetically pleasing and environmentally friendly.

The first new health care delivery facility constructed in the Louisville Medical Center in nearly a decade, the Novak Center for Children’s Health is a 176,000-square-foot building that will be home to the general, specialty and subspecialty pediatrics programs at UofL. This includes faculty physicians from UofL’s Department of Pediatrics as well as other faculty from the UofL School of Medicine, including those in neurology, oncology-hematology, cardiology, surgery, ophthalmology and more. Faculty physicians at UofL practice with UofL Physicians.

Messer is construction manager for the Novak Center, which is on track for a summer opening. Photos of the pedway glass installation are available here.

 

UofL names Endowed Chair in Pediatric Clinical and Translational Research

UofL names Endowed Chair in Pediatric Clinical and Translational Research

Kyle Brothers, M.D., Ph.D.

A researcher who examines the intersection of ethics and policy decisions with human genetics and also studies the translation of technology into clinical care has been promoted to Endowed Chair in Pediatric Clinical and Translational Research at the University of Louisville Department of Pediatrics.

The appointment of Kyle Brothers, M.D., Ph.D., to the newly created position was approved by the UofL Board of Trustees at its March meeting.

Brothers is a board-certified pediatrician who practices with UofL Pediatrics – Downtown and is on staff at Norton Children’s Hospital where he chairs the Hospital Ethics Committee. He came to UofL in 2012 and also is affiliated with UofL’s Institute for Bioethics, Health Policy and Law. He previously was at Vanderbilt University School of Medicine.

Brothers serves with several national groups involved in research, most notably the Clinical Sequencing Evidence-Generating Research Consortium, a multi-site research program funded jointly by the National Human Genome Research Institute and National Cancer Institute that conducts translational research to evaluate the integration of genome and exome sequencing into clinical care. He also serves on the Social Issues Committee of the American Society of Human Genetics.  

His own research efforts have been funded virtually continuously since 2007, and he currently is involved in NIH-sponsored research projects that are funded at a total of approximately $7 million.

Brothers is a reviewer for 25 professional journals, including Science, PLOS One, Pediatrics, Genetics in Medicine, American Journal of Medical Genetics and others. He is a major author on 17 peer-reviewed articles and co-author on another 19. His inclusion in oral and poster presentations numbers 89.

Earlier this year, Brothers won a Department of Pediatrics Mid-Career Faculty Award, and he won a department Faculty Peer Clinician-Teacher Excellence Award three consecutive times, in 2016, 2015 and 2014. In 2011, he won the Scholars Abstract Award at the national Clinical and Translational Research and Education Meeting.

Brothers earned a bachelor’s degree with a double major in religion and biochemistry and molecular biology from Centre College in Danville, Ky., and his M.D. degree from UofL. He completed his internship and residency in pediatrics at the Monroe Carell Jr. Children’s Hospital at Vanderbilt and later earned a Ph.D. degree in the Program in Ethics and Society at Vanderbilt’s Graduate Department of Religion.

 

Healthy eating during a Derby party? You can bet on it

UofL Physicians-Pediatric Endocrinology diabetes educator provides healthy and delicious recipes
Healthy eating during a Derby party? You can bet on it

Healthy and delicious choices like these cucumber and avocado sandwiches, healthy chicken fingers and bite-sized Derby pies will be the hit of any Derby party.

The extravagance of the Kentucky Derby is clearly on display each year through the rich diversity of the food and drink served both at the track and at the multitude of Derby parties held throughout the Bluegrass State. That extravagance, however, doesn’t mean sacrificing good health and sensible eating, said Whitney Cessna, M.S., R.D.N., L.D.N, diabetes educator at University of Louisville Physicians-Pediatric Endocrinology and at the Wendy Novak Diabetes Center, managed jointly by UofL and Norton Children’s Hospital.

“The Kentucky Derby might be my favorite event of the year,” Cessna said. “The entire week is nothing short of extravagance, full of events with exquisite cuisine. So it is important to remember to not overdo it on portions and remember everything in moderation is okay.”

Here are a tips, ideas and recipes Cessna recommends for indulging without over-indulging during the Derby:

Don’t skip meals:During Derby time, mint juleps and oak lilies are a must. When drinking, however, you might forget to eat because beverages can be just as filling as food. Also, the hustle and bustle of all the events during Derby season can leave less time for meals. Food is important to keep your body energized throughout the day. Pack snacks in a clear plastic bag and put in your purse or car to tide you over until you hit the buffet line.

Don’t overdo it on junk food: As difficult as it may seem, try to eat small, healthy portions throughout the day. Whether at Churchill Downs or someone’s home for a party, remind yourself to snack on fruits and vegetables such as carrot or celery sticks, strawberries, cantaloupe and the like, or foods rich in protein to satisfy those hunger cravings. “A tip I’ve learned,” Cessna said, “is as long as you bring food in a clear plastic bag, Churchill Downs will allow you to bring it into the track.” An added benefit: Bringing your own snacks helps save money you can use to bet on the winning horse.

Stay hydrated:Alcohol and highly salted food dehydrates your body very quickly, especially in the sunshine. Hydrate your body with water by alternating it with your other beverages, or drink water every hour to avoid dehydration and other heat-related conditions.

Remember: They key word to always keep in mind when going to parties where you know food will be in abundance is moderation. Be mindful of portion size and balance healthy choices with the higher-fat, higher-calorie ones.

Whether you need healthy ideas for your Derby party or ideas on what to select at the Millionaire’s Row buffet, Cessna offers the following recipes:

Cucumber and Avocado Sandwich

Yields: 2 sandwiches

Serving size: ½ to 1 sandwich

Total carbs per serving: 32 grams per sandwich, 16 per ½ sandwich

Ingredients:

  • 4 slices Dave’s Killer Bread (The 21 Whole Grains and Seeds option is recommended)
  • 4 oz. herbed goat cheese, at room temperature
  • Romaine lettuce leaves, washed and dried
  • 1 large cucumber, sliced in circular pieces
  • 1 avocado
  • 1 lemon, freshly squeezed
  • ½ cup alfalfa sprouts
  • Salt and pepper to taste

Directions:

  • Spread a little bit of the goat cheese on bread slices. Take one slice of bread and top with lettuce, cucumber and avocado slices.
  • Drizzle or squeeze a little lemon juice over the cucumbers and avocados. Add some sprouts and season with salt & pepper, to taste.
  • Place a piece of bread, goat cheese side down on top of the other slice of deliciousness. Cut in half and serve.

Healthy Chicken Fingers

Yields: 4 servings

Serving size: 2-3 tenders

Total carbs per serving: 17 g

Ingredients:

  • 1/3 cup all-purpose wheat flour or in case of gluten intolerance, gluten-free flour
  • 2 eggs, or in case of egg allergy, substitute with 1 tablespoon of ground flaxseed to 3 tablespoons warm water per egg; mix and let stand for 1 minute before using
  • Salt & pepper
  • 1 1/3 cup Panko breadcrumbs (whole wheat is recommended)
  • 1 tsp. sweet paprika
  • 1/8 tsp. garlic powder
  • 5 tsp. EVOO (olive oil)
  • 1 pound boneless, skinless chicken tenders

Directions:

  • Preheat oven to 400˚F. Coat pan with cooking spray.
  • Mix flour with a pinch of salt in a bowl. In a separate bowl, beat eggs or substitute and set next to flour.
  • Stir breadcrumbs, paprika, garlic powder and another pinch of salt in a third bowl. Drizzle oil over breadcrumb mixture and then mix thoroughly with a fork until all of the oil and spices coat breadcrumbs. Set aside.
  • Use one hand for wet ingredients and one hand for dry ingredients while dipping the tenders. Dip chicken tenders one at a time in flour mixture, coating each side. Dip into eggs, or egg substitute mixture, coating all over. Then coat with breadcrumb mixture on each side. Drench all tenders and place on baking sheet evenly.
  • Bake until tenders have reached an internal cooking temperate of 165˚F, or about 22 to 25 minutes.
  • Enjoy with any dipping sauce of your choice

 Bite-Sized Derby Pies

Yields: 12 servings

Serving size: 1 mini pie

Total carbs per serving: 18 g

Ingredients:

  • 2 packages of refrigerated piecrusts, whole-wheat recomended
  • ¾ cup chopped walnuts or pecans
  • 12 pecan halves for topping pies
  • ½ cup semisweet chocolate morsels
  • ½ cup firmly packed brown sugar
  • Pinch of nutmeg
  • ¼ cup bourbon, or for non-alcoholic version, ¼ cup water
  • 1 egg
  • 2 tbsp. unsalted butter
  • 1 tsp. vanilla extract
  • ½ tsp. salt

Directions:

  • Preheat oven to 350˚F. Spray a mini muffin pan with nonstick spray.
  • Lay out the piecrusts and using any small circular cup, cut 6 rounds from each dough, so you get a total of 12.
  • Place dough in each muffin pan. Press it flat into bottom of tins and around sides
  • For filling: melt butter in small bowl in microwave. Allow to cool slightly for a few minutes.
  • Whisk brown sugar, egg, vanilla, nutmeg and bourbon together in a bowl. Add in melted butter and whisk together. Stir in pecans or walnuts.
  • Sprinkle each pie with chocolate chips and a pecan half for each individual pie. Top with a pinch of salt.
  • Bake pies for 20-24 minutes until piecrusts are slightly brown.

 

Derby fans: Know these signs to help potential sex trafficking victims

Derby fans: Know these signs to help potential sex trafficking victims

Amidst the fun and excitement of the Kentucky Derby each year, signs of a dark world arise – the dark world of sex trafficking, particularly of children and teens.

It is a practice that always increases during high-profile events such as the Derby, say providers with the University of Louisville’s Kosair Charities Division of Pediatric Forensic Medicine. But armed with knowledge on what to look for, bystanders at the Derby may be able to help sex trafficked youngsters get help.

“The average age of sex trafficked victims ranges from 14 to 17, most are female, and we know that incidences of sex trafficking triple during the Kentucky Derby,” said Emily Neal, R.N., a forensic nurse specialist with the Kosair Charities Division of Forensic Pediatric Medicine.

“It is directly a case of supply and demand,” said Jennifer Green, M.D., child abuse pediatrics fellow in the UofL Department of Pediatrics. “The more people there are who are willing to purchase other people, the greater the number of people there are who are available to be purchased.”

Green and Neal provide these recommendations on what bystanders can do to recognize potential sex trafficked victims during Derby season:

  • Signs to watch for include young people who may appear overly sexualized for their age, do not possess or have control of their documentation such as driver’s licenses or passports, and who are in the presence of an older, usually male adult, who is controlling them and their behavior.
  • Sexually trafficked victims may have tattoos to “brand” them, such as bar codes or the names of someone other than themselves.
  • They could be wearing clothes that are inappropriate for their age, are too revealing or are not climate appropriate.
  • They could be staying confined to one area, seemingly to “work” that area for customers.
  • They could have signs of trauma: bruises, lesions, black eyes or other marks that raise concern.
  • They could have two or more cell phones in their possession, taking calls from all of them.

If Derby fans see someone they suspect may be a sex trafficked victim, Green and Neal emphasize getting professional help.

“The first step is to call the National Human Trafficking Resource Center Hotline, 1-888-373-7888,” Neal said. “The center will stay on the phone with you to help you get local resources, such as law enforcement, to intervene.”

“If you see direct signs of abuse to a child or are concerned about a child’s safety, involve law enforcement officers immediately and indicate your concerns clearly,” Green added.

 

 

 

Researchers find expert panel reliable, accurate in identifying injuries in young children as abusive, accidental

Findings from UofL School of Public Health and Information Sciences published this month in the Journal of Pediatrics
Researchers find expert panel reliable, accurate in identifying injuries in young children as abusive, accidental

Doug Lorenz, Ph.D.

When a child is brought to a pediatric emergency department with an injury, it can be difficult for physicians to precisely identify whether the injury is the result of abuse or an accident. One approach is to employ the opinion of a panel of pediatric injury experts.

In a study led by University of Louisville biostatistician Doug Lorenz, Ph.D., associate professor, School of Public Health and Information Sciences, the reliability and accuracy of a nine-member expert panel was measured in determining the likelihood of abuse in more than 2,000 cases. The results of the study that published recently in the Journal of Pediatrics found nearly perfect reliability and accuracy of the panel both individually and as a composite.

“Decision rules for identifying  injuries from abuse are valuable for settings such as pediatric emergency departments - in these cases, reliability and accuracy of human judgement is needed since victims of child abuse are at high risk of future abuse and death,” Lorenz said.

Each panelist received de-identified case information, including current and past data of the patient’s visit to a pediatric emergency department. The panelists independently rated the likelihood of abuse on a 5-level classification scale as “definite abuse,” “likely abuse,” “indeterminate,” “likely accident,” and “definite accident”. Each individual also provided a “yes” or “no” answer to a question on whether to report the case to state child protective services.
The study examined injuries involving children less than 4-years-old who visited pediatric emergency departments between 2011 and 2016 at five children’s hospitals in the United States. The expert panel included four child abuse pediatricians, four emergency medicine physicians and one bioengineer with expertise in pediatric injury.

At least two panelists reviewed each of the 2,166 cases. There was unanimous agreement in 852 cases (39-percent). An additional 1,048 cases (48-percent) exhibited partial agreement, where all panelists provided classifications of abuse (definite or likely) or accident (definite or likely). There were 44 instances (2-percent) of abuse-accident disagreement, none of which were in the definite category. In the remaining 222 cases (10-perecent), all panelists gave classifications of indeterminate.

The study tested the accuracy of the expert panel based on 584 of the 2,166 cases that could be more definitively classified as abuse or accidental based on other information learned after the child’s visit to the emergency department. This included video of an event, a third party account, a confession of abuse or criminal conviction of abuse, to name a few examples. Individual panelists accurately classified between 95 and 98-percent of the abuse cases and between 99 and 100-percent of the accident cases.

“We have demonstrated the reliability and accuracy of the expert panel approach, and suggest this method provides a suitable set of criteria for the future evaluation of clinical decision rules for identifying child abuse,” Lorenz said.

Lorenz collaborated with other UofL colleagues in the School of Medicine Department of Pediatrics and J.B. Speed School of Engineering. The study also involved researchers at the Northwestern University, University of Pittsburg, University of Utah, University of Washington and Yale University.
 

 

'Match Madness' once again a success for UofL Internal Medicine residency programs

Internal Medicine, Combined Med-Peds residency groups both fill their available spots with another set of strong incoming classes
'Match Madness' once again a success for UofL Internal Medicine residency programs

UofL fourth-year medical students celebrate Match Day 2018, when they found out where they will continue the residency portion of their medical education.


VIEW A PHOTO GALLERY FROM UofL MATCH DAY

Who said the madness of March was confined to the basketball court?

March 16 was Match Day for University of Louisville medical students, and others nationwide, as they opened their envelopes from the National Residency Match Program to find where they had been matched for their future training as residents.

"I would like to welcome an excellent group of young doctors to the internal medicine residency program," Jennifer Koch, M.D., FACP, Director of the UofL Internal Medicine Residency Program said. "We are honored to train this accomplished and diverse class of interns."

Conducted annually by the NRMP, The Match uses a computerized algorithm designed to the best results by aligning the preferences of applicants with the preferences of residency programs. The results are used to fill thousands of training positions available in the United States.

The UofL Internal Medicine Residency Program successfully filled all of its 24 categorical and 12 preliminary positions.

In addition the Combined Internal Medicine-Pediatrics Residency Program, under the direction of Laura Workman, M.D., added five new members.

Our incoming Class of 2021 includes:

Categorical Residents

  • Agastaya Nelur - Seth G.S. Medical College
  • Thomas Bierman - University of Louisville
  • James Bradley - University of Louisville
  • Wenjing Cai - Indiana University
  • Aaditya Chandramouli - Indiana University
  • Rishi Charate - University of Missouri-Kansas City
  • Sirmad Chaudhary - East Tennessee State University
  • Scott Diamond - Nova Southeastern College of Osteopathic Medicine
  • Mohamed Elmasry - Ohio University Heritage College of Osteopathic Medicine
  • Khusboo Gala - Grant Government Medical College
  • Katherine George - Nova Southeastern College of Osteopathic Medicine
  • Margaux Hetzman - Central Michigan University
  • Parth Jadav - University of Louisville
  • Yiran Jiang - Indiana University
  • Bokhodir Mamedov - University of Louisville
  • Leondrus McIver - Morehouse School of Medicine
  • Kyle Mills - University of Pikeville
  • Cody Moore - Indiana University
  • Chris Moser - Alabama College of Osteopathic Medicine
  • Sahil Patel - Drexel University
  • Gayatri Suresh Kumar - University of Arkansas
  • Ashley Twyman - Louisiana State University Shreveport
  • Pradheep Vermula - The Ohio State University
  • James Vernace - Lake Erie College of Osteopathic Medicine

 

Preliminary Residents

  • Ali Cohen - University of Iowa
  • Michael Del Busto - University of Cincinnati
  • Bryan Edwards - Indiana University
  • Collin Gamble - University of Louisville
  • Brian Gordon - University of Louisville
  • Dagan Kaht - University of Louisville
  • Aleksander Krazinski - Medical College of South Carolina
  • Samantha Sears - University of Louisville
  • Laura Taylor - George Washington University
  • Graham Trent - University of Maryland
  • Razvan Turcu - University of Louisville
  • Mengmeng Zheng - Indiana University

 

Combined Med-Peds Residents

  • Ariel Carpenter - University of Missouri
  • Caitlin McKenzie - Loyola University Chicago
  • Adam Neff - University of Louisville
  • Jonathan Phillips - Kansas City University
  • Kasey Reed - University of Louisville

March Madness doesn’t have to mean losing control over eating

March Madness doesn’t have to mean losing control over eating

Alternatives such as pretzels in place of high-fat chips, mini instead of full-size meatballs and the use of non-fat Greek yogurt in dips can help you be a champion of healthy snacking during March Madness.

New Year’s resolutions made in January to eat healthy don’t have to be sabotaged during March Madness, said Whitney Cessna, M.S., R.D.N., L.D.N, diabetes educator at University of Louisville Physicians-Pediatric Endocrinology. With a little information on how to practice good habits for snacking, you can be a champion at healthy eating.

“I recommend the practice of what we call ‘mindful eating,’” said Cessna, who provides services with the Wendy Novak Diabetes Center managed jointly by UofL and Norton Children’s Hospital. “Whether it’s the craziness of the ballgame itself or the stress of hosting a watch party, overeating can easily happen, and you should be mindful of that.”

Here are a few simple guidelines Cessna recommends to practice mindful eating during March Madness:

  • Listen to your body and stop eating when you are full. It takes about 20 minutes for the satiation signal to reach the brain, which is why we often overeat unconsciously.
  • When your stomach is growling or if you feel like your energy is low…eat. Don’t ignore the signals your body gives you or you could overeat later.
  • Eat with others at the same time to help prevent wandering around and eating at random times and places.
  • When it’s time to eat, just eat. Try not to be on your cell phone or engaging in other activities. This can cause overconsumption.
  • As much as possible, eat foods that are healthy and full of nutrients.
  • Try baking, not frying when preparing cheese sticks, wings or other game-time favorites to cut down on calories.
  • Serving size matters; serve mini corn dogs, mini meatballs or hamburger sliders when indulging in higher carb/fat foods.
  • Seek out crunchy alternatives; instead of potato chips, try carrots, celery or low-fat pretzels.
  • Use skim or reduced fat products when possible when making recipes with cream cheese or shredded cheese. Avoid regular mayo and use avocado mayo instead.
  • If making ranch or taco dip, use non-fat plain Greek yogurt.
  • If eating or making dips, serve with pita bread or baked chips rather than higher-fat fried chips.

Cessna offers the following recipes to help March Madness party planners provide healthy alternatives:

 

Black Bean & Corn Quinoa Salad

Serving size: ½ cup      Carbs in serving: 15 g

Ingredients:

  • 1 cup quinoa
  • ½ cup black beans, rinsed and drained
  • 1 Roma tomato
  • 1 tbsp. red onion, chopped
  • 1/3 cup frozen corn
  • 2 tbsp. fresh lemon juice
  • 1 tbsp. cilantro, chopped

Directions:

  • Cook quinoa according to package directions
  • In a large bowl, add all ingredients and mix until thoroughly combined
  • Serve immediately or chill in refrigerator and serve later on.

 

Wonton Taco Cups

Serving Size: 3 cups     Carbs in serving: 28 g

Ingredients:

  • 24 wonton wrappers
  • 1 lb. 85/15 or 90/10 ground beef
  • 1 packet of taco seasoning
  • Toppings of choice: shredded lettuce, salsa, shredded cheese, plain Greek yogurt (instead of sour cream), avocado, cilantro

Directions:

  • Preheat oven to 375˚ F.
  • Cook ground beef in skillet over medium heat until done. Drain. Stir in taco seasoning and cook according to package directions.
  • Spray a 12-cup muffin pan with cooking spray. Gently push wonton wrappers down in the cups. Add a second wonton wrapper on top of each cup, rotated slightly where the corners of both wrappers show.
  • Distribute ground beef mixture evenly between the 12 cups
  • Bake for 10-12 minutes or until edges are golden brown
  • Top with taco toppings of your choice and serve

 

Crockpot Buffalo Chicken Celery Sticks (Low Carb)

Ingredients:

  • 1 lb boneless, skinless chicken breasts
  • ¾ cup plain, Greek yogurt
  • ¼ cup hot sauce of your choice
  • ¼ - ½ diced onion (*optional)
  • 1 clove of garlic, minced
  • ¼ tsp. garlic powder
  • 1 bunch celery (8-10 medium stalks cut into 2-3 inch pieces)
  • Blue cheese, crumbled

Directions:

  • Add chicken breasts to bottom of crockpot/slow cooker
  • Combine yogurt, hot sauce, onion, garlic, and garlic powder in a bowl.
  • Cook on high for 3-4 hours or until chicken is cooked through.
  • Transfer chicken to a medium bowl and shred with 2 forks.
  • Fill celery sticks with chicken filling (1-2 tbsp. each)
  • Top with crumbled blue cheese, if desired

 

Chicken Salad with Apple Slices

Ingredients:

  • 1, 9 oz. pkg chicken breast strips, cooked
  • 3 apples
  • 1 tsp apple cider vinegar
  • ½ cup celery, chopped
  • ¼ cup dried cranberries
  • 2 tbsp. light cream cheese spread with veggies
  • 2 tbsp. avocado mayo
  • Salt & pepper, to taste

Directions:

  • In a bowl, combine cream cheese, mayo, vinegar, and pepper. Stir in chicken breasts, celery, and dried cranberries.
  • Slice apples into small, round circular, thin pieces.
  • Serve chicken salad on top

 

Zucchini Pizza Bites

Ingredients:

  • ¼ cup mini pepperoni
  • 3 zucchini
  • 1/3 cup marinara sauce
  • 1 tbsp. Italian seasoning
  • Salt & pepper, to taste
  • 1 tbsp. EVOO (olive oil)
  • ½ cup low-fat mozzarella

Directions:

  • Preheat oven to broil
  • Heat EVOO in large skillet over medium high heat. In small batches, add zucchini and cook, flipping just one time until golden brown on each side. Should be about 1-2 minutes. Season with salt & pepper, to taste.
  • Place zucchini rounds on a baking sheet. Top each zucchini round with a little marinara, mozzarella, and pepperoni minis. Sprinkle with Italian seasoning.
  • Put in oven and make until cheese has melted, about 1-2 minutes, and serve.

 

University of Louisville and Jewish Hospital Trager Transplant Center achieve 500th heart transplant

Celebration commemorates milestone
University of Louisville and Jewish Hospital Trager Transplant Center achieve 500th heart transplant

UofL's Mark Slaughter, M.D., performed the 500th heart transplant for the UofL and Jewish Hospital transplant team.

The University of Louisville and the Jewish Hospital Trager Transplant Center marked an important milestone on Wednesday – the 500th heart transplant performed at the hospital since the heart transplant program began there nearly 35 years ago.

“As we end American Heart Month, it’s the perfect time to share this wonderful news,” said Mark Slaughter, M.D., surgical director of heart transplant for University of Louisville Physicians and Jewish Hospital, and professor and chair, Department of Cardiovascular and Thoracic Surgery, UofL School of Medicine.

Dr. Slaughter performed the 500th transplant on Wednesday, Feb. 21, on a 59-year-old man who had a left ventricular assist device implanted to support his heart until the donor heart was available for transplant. An LVAD is a surgically implanted mechanical pump attached to the heart.

The first heart transplant at the hospital, which was also the first heart transplant in Kentucky, took place on Aug. 24, 1984, performed by the University of Louisville’s Laman Gray Jr., M.D. The state and region waited in suspense as 40-year-old Alice Brandenburg received a new heart. The surgery, which took seven hours, was groundbreaking at the time. The UofL and Jewish Hospital transplant team is one of the leading providers of organ transplantation in the country.

“Jewish Hospital is a place where miracles happen every day and patients’ lives are changed forever,” said Ronald Waldridge II, M.D., president of Jewish Hospital. “Five-hundred hearts is much more than a milestone. It represents the life-changing impact on our patients, their families and the entire region. Together, with UofL, Jewish Hospital’s Trager Transplant Center is investing in research, technology and advance procedures to increase access to transplant services.”

On Wednesday, doctors and heart transplant recipients gathered at the Jewish Hospital Rudd Heart and Lung Center to celebrate the 500th milestone and the many lives that have been saved over the years thanks to heart transplantation. 

“The 500th heart transplant is a reminder of the commitment by Jewish Hospital and the University of Louisville to provide advanced therapies for patients with advanced heart failure,” said Dr. Slaughter. “We’ve come a long way since Dr. Gray broke ground with that first heart transplant more than 30 years ago. Every day, we continue to advance the science of heart transplantation here at UofL and Jewish Hospital. I’m excited about the future of this program, and I’m confident that we’ll mark a lot more milestones over the next 30 years.”

For Dr. Gray, Wednesday’s celebration marked decades of dedication to the heart transplant program.

“After performing the first heart transplant, it means a lot to me to see the 500th and where we are today,” said Dr. Gray.

Gray continues to research new ways to help patients with heart disease at UofL’s Cardiovascular Innovation Institute, a center focused on bio-adaptive heart innovations, including the integration of heart-assist device, biodfeedback sensors and related technologies. In 2001, Gray and the Trager-UofL surgical team implanted the first fully implantable replacement heart, the AbioCor™.

Today, patients like Jeffrey McMahan continue to benefit from the heart transplant program. McMahan was the center’s 479th heart transplant, and he attended the celebration on Wednesday along with other recipients.

Before his heart transplant, McMahan, 61, was no stranger to the procedure – it had helped save many of his family members. The Memphis, Indiana, resident had four family members receive heart transplants - two by University of Louisville surgeons at Jewish Hospital. In 2015, McMahan learned he, too, needed one.

“I was serving in the military at Fort Knox when I developed a cough,” said McMahan. “It finally got bad enough that doctors flew me to Jewish Hospital, where I was diagnosed with a cardiomyopathy, a condition where the heart muscle is weakened. I learned that I would need a transplant in the next 10 years, but that timeframe quickly changed to 10 months after my condition worsened.”

On Aug. 15, 2015, McMahan was added to the organ donor transplant list. A month later, he received the transplant that forever changed his life.

“I wouldn’t have lived without the transplant,” McMahan said. “It means a lot to be here to celebrate the 500th. I’m forever thankful to the transplant team that helped save my life and gave me more time with family.”

It has been an exciting year for the Jewish Hospital Trager Transplant Center and University of Louisville team. In December 2017, the center – a joint program with the UofL School of Medicine and KentuckyOne Health – broke its all-time record for number of organs transplanted in the center’s 53-year history, with 175 organs transplanted in a year. The center also achieved several other milestones in 2017, including its 5,000th transplanted organ, its 3,000th kidney transplant and its 900th liver transplant. In addition to Kentucky’s first heart transplant, the program is known for performing Kentucky’s first adult pancreas, heart-lung and liver transplants.

But the 500th heart transplant and other milestones wouldn’t have been reached without organ donors, noted David Lewis, director of Transplant Services at the Jewish Hospital Trager Transplant Center.

“We often encourage people to sign up as organ donors to help save lives. The need for organ donors is unfortunately greater than the number of people who donate, so each day, an average of 20 people pass away while waiting for a transplant in the United States,” Lewis said. “Knowing that we have helped save 500 people in need of a new heart is a wonderful feeling, and it would not be possible without the donors and their families.”

For information on the Jewish Hospital Trager Transplant Center, visit www.kentuckyonehealth.org/transplant-care.

For video of the first heart transplant at Jewish Hospital, visit https://youtu.be/b8AFYN-TsDY.

$550,000 goal set for raiseRED Dance Marathon

Annual event helps fight pediatric cancer and blood disorders
$550,000 goal set for raiseRED Dance Marathon

raiseRED generated more than $459,000 in 2017 to fight pediatric cancer and blood disorders, and organizers intend to raise almost $100,000 more at the 2018 event on Feb. 23.

It’s time to shake it for a good cause. The University of Louisville student group raiseRED kicks off its 18-hour dance marathon Feb. 23 to fight pediatric cancer and blood disorders.

About 1,000 dancers will try to raise $550,000, about $100,000 more than the record-breaking amount the group collected last year.   

Patrick McSweeney, a freshman engineering student, is well on his way. Thanks to a viral video McSweeney made detailing his own battle with cancer, he’s already raised $20,000.

McSweeney, who is 18, was diagnosed with acute lymphoblastic leukemia, or ALL, when he was 5 years old. He learned last month that he has relapsed for the sixth time. He delayed his next cancer treatment in Philadelphia by a week so he could attend raiseRED and help others.

“I want to turn this negative situation of relapsing into a positive,” he said. “I want to help others, so that no one else experiences what I’ve been through, no one has to relapse six times. One time is enough. They can be cancer free after one time.”

The dance marathon kicks off at 6 p.m. Feb. 23 in the Swain Student Activities Center. The night is a mix of dancing, testimonials by patients and special guests to keep the dancers energized and focused on how their participation makes a difference.

The public is invited to take part in the Community Celebration from 10:30 a.m.-noon Feb. 24, which culminates in the grand reveal of the total number of dollars raised.

All funds from raiseRED go to research and patient care at the UofL Division of Pediatric Hematology, Oncology and Stem Cell Transplantation.

Learn more at raisered.org. To make a donation, go toraisered.org/donate.

Dr. Julio Ramirez Presents at Department of Medicine Grand Rounds

February 15, 2018 - "Clinical Research: From Idea to Publication"
Dr. Julio Ramirez Presents at Department of Medicine Grand Rounds

Julio A. Ramirez, M.D., FACP, Professor of Medicine/Associate Professor of Microbiology and Immunology; Chief, Division of Infectious Diseases; Director, Infectious Diseases Fellowship Training Program and Founding Director, Global Health Initiative at The University of Louisville, presented "Clinical Research: From Idea to Publication" at University of Louisville Department of Medicine Grand Rounds on February 15, 2018. The talk focused on performing an overview of clinical study designs, describing the planning and performing of a clinical study, reviewing the process for statistical and clinical analysis, and presenting the structure of a Clinical Research Coordinating Center.

A recording of the presentation may be viewed at the following link: UofL Dept. of Medicine Grand Rounds: Dr. Julio Ramirez

It’s Heart Month. We know smoking is bad. So why don’t we quit?

New UofL treatment program addresses why our relationship with tobacco is ‘complicated’
It’s Heart Month. We know smoking is bad. So why don’t we quit?

The University of Louisville’s Rachel Keith, Ph.D., APRN, is a specialist in cardiovascular medicine and tobacco treatment and runs the new UofL Physicians Tobacco Treatment Clinic.

Smoking harms nearly every organ in the body. It causes about 1 in every 5 deaths in the United States each year, and is the main preventable cause of death and illness. We know the harmful effects of tobacco, so why is it so hard for people to quit?

“The benefits of not smoking, in particular to the heart, are huge. And with February being American Heart Month, it’s a good time to think about quitting,” said the University of Louisville’s Rachel Keith, Ph.D., APRN, a specialist in cardiovascular medicine and tobacco treatment. “But it’s a lot more than just halting a bad habit. That’s why we can say our relationship with tobacco is, ‘complicated.’”

Keith, who runs the new UofL Physicians Tobacco Treatment Clinic, said there are “strange dynamics” with tobacco.

“Smoking cessation is hard in general,” she said. “Helping patients to quit smoking often involves a lot of talking and figuring things out.

“We have to really get at WHY they smoke. Perhaps their grandmother died at age 100 even though she smoked, so they don’t believe there’s a connection. Or, she got them smoking and that’s their connection to her now that she’s gone.”

She said many people who come to the clinic have smoked for 30 or 40 years, and they are hesitant to quit. “That’s because it’s almost a part of them. In their view, you are taking away something they don’t know how to replace.”

She said she encourages patients to try different things and look for healthier alternatives when they have the urge for a cigarette.

“But when I ask them, ‘What are some other things you like to do for 10-15 minutes?,’ a whole lot of people can’t name those things. Many don’t have anything else. We try to help them find them, whether it’s a hobby or something like taking a walk,” she said.

But again, it’s complicated.

“A lot of patients feel sick, so they think they can’t get out and walk, even though they know it will be easier when they quit. There’s just a lot that goes into smoking, culturally and hormonally.”

People “can’t see the immediate effects of quitting, but they can quickly gain the rewards of smoking, because it’s almost instant. The body actually gets hard-wired to anticipate the effects from tobacco.”

That’s why the new clinic approaches all the factors that make it hard for people to stop, making it Louisville’s only comprehensive tobacco treatment program.

Keith meets with patients and develops a personal, individualized approach that best suits each patient’s needs. During sessions, Keith and patients discuss the benefits of stopping smoking, medication options, and different skills, such as mindfulness and relaxation, to help overcome anxiety.

Medications to treat withdrawal symptoms are paired with the cognitive-behavioral therapy to help patients sustain attempts to quit. Any medical issues also are addressed. One treatment Keith is studying is how to increase people’s motivation with virtual reality therapy, where an immersive session allows patients to imagine what life will be like once they’ve quit.

“The good news is, this type of program has been proven over and over as the most effective method for long-term cessation,” Keith said. “But until we opened, it was hard to find one in this area to get into.”

She said those who try to quit on their own have about a 6 percent chance of succeeding. If they work with a health provider, their chances improve to 10 percent to 15 percent. But with the comprehensive program, patients see a success rate of 30 percent and above.

“Those who have come through the program have done really well,” she said. “Almost everyone who comes through has quit.”

It generally takes about six sessions, usually once a week or every other week, to complete. Afterward, patients return on a more limited basis, and Keith follows up by phone.

Anyone who wants to quit smoking can come to the clinic, and many insurance plans will cover the program at little or no cost to the patient. It is located in Suite 310 of the UofL Physicians Health Care Outpatient Center, 401 E. Chestnut St.

To make an appointment, call 502-588-4600.