Jan. 15, 2016

Sean L. Francis, currently the interim chair of the Department of Obstetrics, Gynecology and Women’s Health at the University of Louisville, has been named to the post permanently. The appointment was approved by the UofL Board of Trustees at its Jan. 14 meeting.

“Dr. Francis brings a patient-centered approach to care that enables him to partner with our patients to identify the best treatment options and infuses that approach in his work leading the department, its residents and students,” said Toni M. Ganzel, M.D., dean of the UofL School of Medcine.

Francis was named interim chair in February 2015. He came to UofL in 2012 as associate professor and chief of the divisions of Female Pelvic Medicine and Reconstructive Surgery (FPMR) and Minimally Invasive and Gynecologic Surgery. He also is FPMR fellowship director and practices with University of Louisville Physicians-Urogynecology. Prior to his tenure at UofL, he was on the faculty of the Medical College of Georgia in Augusta.

Francis is board-certified in both obstetrics and gynecology and FBMR and completed a fellowship at the Mayo Clinic Scottsdale’s Department of Gynecology, Urogynecology and Pelvic Reconstructive Surgery.

He has been named to “Top Doctors in America,” “Best Doctors in America,” “Top Doctors in Louisville” and “Top Surgeons in Louisville.” The author or co-author of chapters in two reference manuals and 20 journal articles, Francis has made 47 oral, video and poster presentations at professional meetings in the United States, Canada and Wales.

He is a past winner of the Faculty Award for Excellence in Resident Education by the Council on Resident Education in Obstetrics and Gynecology of the American College of Obstetrics and Gynecology; the Association of Professors of Obstetrics and Gynecology Award for Excellence in Undergraduate Teaching; and the American Association of Gynecologic Laparoscopists’ Special Excellence in Endoscopic Procedures Award.

Francis earned a bachelor’s of science degree, cum laude, in biology from Morehouse College, Atlanta, Ga., and his medical degree from Case Western Reserve University in Cleveland, Ohio. He completed a residency in internal medicine at Case Western’s Mount Sinai Hospital and another in obstetrics and gynecology at the Medical College of Georgia.

Most of us have experienced it, or have a loved one who has: You enter a room, intending to retrieve something – and cannot remember what it was you wanted. Or you exit the shopping mall, only to discover you have forgotten exactly where you parked your car.

Annoying? Yes. Signs of dementia or Alzheimer’s disease? Maybe. Or maybe not.

Ben Schoenbachler, M.D., associate professor in the Department of Psychiatry and Behavioral Sciences at the University of Louisville, will help sort out the differences between temporary forgetfulness and symptoms of age-related memory disorders at a “Building Hope” lecture and question-and-answer session sponsored by the UofL Depression Center.

Schoenbachler’s “Memory, Aging and Alzheimer’s Q&A” will begin at 7 p.m., Tuesday, Jan. 12, in Room 251 of Second Presbyterian Church, 3701 Old Brownsboro Rd. Admission is free.

Results from a 2015 survey conducted by Trinity College Dublin found that more than 75 percent of people can’t distinguish between signs of Alzheimer’s and the usual forgetfulness that comes with aging. Schoenbachler’s presentation will help participants learn more about those differences.

Schoenbachler is a native of Louisville who earned his bachelor’s degree in zoology and his medical degree from the University of Kentucky and completed combined residency training in neurology and psychiatry at Tulane University. His clinical focus is primarily on cognitive and behavioral complications of brain injury and neurodegenerative disorders.

The University of Louisville Depression Center is Kentuckiana’s leading resource for depression and bipolar disorder treatment, research and education. It is a charter member of the National Network of Depression Centers, a consortium of leading depression centers that develops and fosters connections among members to advance scientific discovery and provide stigma-free, evidence-based care to patients with depressive and bipolar illnesses.

For more information, contact the Depression Center at 502-588-4450.

Norton Healthcare and the University of Louisville today announced they have reached agreements which end more than five years of negotiations and more than two years of litigation. The University of Louisville Physicians group and the Commonwealth of Kentucky are also parties to the agreements.

“This is great news for the Louisville community and the Commonwealth,” said Donald H. Robinson, chair of the Norton Healthcare board of trustees. “The agreements clear up critical land lease and ownership issues as well as bringing operational security to Norton while assuring stable financial support to the UofL School of Medicine in pediatrics. The real winners here are the families who depend on our children’s hospital for their child’s care.”

“We reached fair and mutually beneficial agreements that extend our long-time relationship for providing the highest level of pediatric care to the children of the Commonwealth and beyond,” said Larry Benz, chair of the UofL board of trustees. “Both organizations are passionate about fulfilling their missions in this regard. We are now focused on how our organizations will combine our strengths to make Kosair Children’s Hospital a top tier pediatric hospital in the United States.”

The agreements include an amendment to the 1981 land lease between Norton and the Commonwealth for the children’s hospital property which results in a permanent solution, one that secures Norton’s ownership and control of the hospital, confirmed by the Commonwealth and UofL. It also makes it possible for Norton to continue plans for more than $35 million in additional capital improvements to its children’s hospital over the next five years. Those plans had been held up due to the litigation.

An amendment to the 2008 academic affiliation agreement currently in place between Norton and UofL sets an initial eight-year term with automatic annual renewals thereafter. UofL will be Norton’s primary academic partner for pediatrics with at least 90 percent of the Norton’s residency positions at the children’s hospital being made available to UofL.

UofL guarantees that its pediatric residents will utilize the children’s hospital as UofL’s primary hospital training site and that the majority of its pediatric hospital admissions will be made to the children’s hospital.  Both Norton and UofL will appoint three representatives each to a new Pediatric Academic Medical Center Committee (PAMCC), charged with overseeing and making recommendations for the affiliation relationship. Norton can still pursue other third party relationships and programs, such as the previously announced intent to collaborate with UK Children’s Hospital, as long as its commitments to UofL are fulfilled. UofL agrees to participate in collaborative pediatric care joint programs with Norton and UK and/or others.

Under the terms of the agreement, UofL will receive $272 million over eight years. Norton has extended its current total of $30 million in annual funding (through separate individual contracts as is currently done) for UofL academic support and physician services over the next eight years, with an additional $3 million annually for additional pediatric care investments. Those investments are to be recommended by the PAMCC and approved by Norton. UofL will participate in independent audits to facilitate full transparency regarding how Norton’s financial support is used. UofL also will receive a one-time payment of $8 million to resolve any and all financial disputes from the past.

“We thank the administration of Gov. Bevin for its leadership in finalizing the land lease amendments and assuring we can move forward with our planned $35 million additional investments by Norton in our Children’s Hospital,” said Stephen A. Williams, CEO, Norton Healthcare. “We also sincerely thank UofL Board Chairman Larry Benz for his great leadership in helping accomplish these agreements. The combined agreements stabilize the relationship between Norton and UofL in pediatrics and facilitate additional investments in pediatric care, while also allowing for appropriate collaboration with UK and other providers across the state to advance pediatric care in Kentucky.”

“This agreement allows both organizations to continue fulfilling their missions of caring for the children of the Commonwealth; UofL through the education and training of future health care providers and conducting cutting-edge research and Norton as the primary site for the provision of the highest levels of health care possible,” said Dr. James Ramsey, president of the University of Louisville. “The Bevin administration’s quick attention and assistance is a demonstration of his desire for ensuring the future of the Commonwealth.”

All three of the agreements were effective immediately upon ratification over the last few days by the boards of Norton, University of Louisville, University of Louisville Physicians, and the Commonwealth.

The resident physicians at the University of Louisville School of Medicine, along with the school’s faculty, staff and medical students, are making the holidays a little brighter for underprivileged children in the Louisville community. In just one week, they collected 570 toys for Toys for Tots.

UofL’s House Staff Council, the representative body for resident and fellow physicians, issued a request on December 10 for new, unwrapped toys for its annual holiday service project. The group was inspired by Mayor Greg Fischer’s call to set a world record for the most toys collected in a 12-hour period during Holiday in the City.

As of December 16, the residents, fellows and program faculty had collected 500 toys.

“The initiative took hold more than we had even imagined,” said Matthew Bertke, M.D., president of the House Staff Council. “The response shows the kind of charitable spirit and sense of community we have in the house staff. Although young physicians are busy with patient care, we also are invested in our community.”

John Roberts, M.D., UofL’s vice dean for graduate medical education and continuing medical education, supported the request by offering a luncheon for the departments with the highest percentage of residents participating. Four programs earned the luncheon, having greater than 150 percent participation:  Psychiatry (430 percent), Neurology/Child Neurology (246 percent), Pediatrics (193 percent - the largest number of gifts at 166) and Emergency Medicine (161 percent).

The school’s faculty, staff and medical students then joined in the project, adding an additional 70 toys for a total of 570 from the UofL School of Medicine.

“Among the qualities of a good physician are empathy and compassion. It is inspiring to see how generously our young physicians, faculty, staff and students responded in order to brighten the holidays for our community’s children,” said Toni Ganzel, M.D., dean of the UofL School of Medicine.

The U.S. Marine Corps Reserve Toys for Tots Program collects new, unwrapped toys during October, November and December each year, and distributes those toys as Christmas gifts to less fortunate children in the community in which the campaign is conducted.

December 21, 2015

For the January 2016 edition of Beer with a Scientist, Timothy Dowling, Ph.D., will explain how the discovery of water on Mars sheds light on our own environment.

“In 2015, NASA announced the discovery of liquid water on present-day Mars. We’ll take a look at what the many rovers and orbiters have turned up about the past, present and future of the Red Planet, and why liquid water is so important,” Dowling said. “The discoveries on Mars are revealing how essentially every detail of the Earth’s system is beneficial to life, and we will discuss habitability and the future of space exploration.”

Plus, Dowling will separate fact from fiction in the recent movie, “The Martian.”

Dowling is a professor of atmospheric science in UofL’s Department of Physics and Astronomy. He studies planetary atmospheres and specializes in atmospheric dynamics and thermodynamics.

The program begins at 8 p.m. on Wednesday, Jan. 13 at Against the Grain Brewery, 401 E. Main St. A 30-minute presentation will be followed by an informal Q&A session.

The Beer with a Scientist program began in 2014 and is the brainchild of UofL cancer researcher Levi Beverly, Ph.D. Once a month, the public is invited to enjoy exactly what the title promises:  beer and science.

Admission is free. Purchase of beer, other beverages or menu items is not required but is encouraged.

Organizers add that they also encourage Beer with a Scientist patrons to drink responsibly.

For more information and to suggest future Beer with a Scientist topics, follow Louisville Underground Science on Facebook.

January 5, 2015

University of Louisville professor of pharmacology and toxicology John Pierce Wise Sr., Ph.D., will be honored by the Society of Toxicology with a 2016 Education Award in March, 2016.

Wise is being recognized for teaching and training the next generation of toxicologists on a variety of educational levels both in the classroom and in the field. He has taught high school students and their teachers, undergraduate students, graduate students and junior faculty members. Wise has participated in K–12 outreach and lifelong learning programs attended by older students. Wise and his wife, Sandra Wise, Ph.D., joined the faculty at the UofL School of Medicine earlier this year.

“The Department of Pharmacology and Toxicology was thrilled to recruit Dr. John Wise Sr., his wife and research collaborator Dr. Sandra Wise, and other members of his research team to the University of Louisville,” said David W. Hein, Ph.D., chair of UofL’s Department of Pharmacology and Toxicology. “Professor Wise's research program transforms the excitement of a world class research laboratory experience to graduate, professional, post-graduate and undergraduate students. The very prestigious Education Award from the Society of Toxicology reflects the international impact of his research program and training accomplishments.”

In addition to on-campus instruction and lab work, Wise spends a good deal of time working in the field, testing wildlife for toxic exposures. He, his wife and their adult children spent three summers working aboard a sailboat in the Gulf of Mexico, obtaining tissue samples from whales to test for toxins resulting from the 2010 explosion of the Deepwater Horizon oil well. Most recently, he has been collecting tissue samples from alligators around the Kennedy Space Center in Florida and investigating sea turtle populations on Puerto Rico’s Vieques Island. Prior to his arrival at UofL, Wise was a professor of toxicology at the University of Southern Maine in Portland.

“Whether it is our work in the tiny, microscopic world of a cell or out in the wild with some of the most amazing creatures on earth, being a scientist is always a thrill and a privilege, and the most important part of being a scientist is to share all of these discoveries with others and to be an educator,” Wise said. “We all thirst to know more, to understand more. We seek to be amazed and inspired by the world. For me, engaging others in my scientific quests, teaching them and learning from them, is a central part of being a scientist.”

The Society of Toxicology (SOT) is a professional and scholarly organization of more than 7,800 scientists from academic institutions, government and industry. The SOT Education Award recognizes an individual who teaches and trains toxicologists and who has made significant contributions to education in the field of toxicology. The award will be presented to Wise at the 2016 SOT Annual Meeting and ToxExpo in New Orleans, March 13–17, in the form of a plaque and stipend. Wise is one of more than two dozen scientists from across the United States and abroad who will be honored at the event.

December 15, 2015

The Institute for Sustainable Health & Optimal Aging at the University of Louisville is seeking nominations for the 2016 Gold Standard for Optimal Aging Award. Nominations for this annual award are open now through Feb. 1, 2016.

The Gold Standard for Optimal Aging Award celebrates and honors older adults who embody the Institute’s vision for a world where all older adults lead engaged and flourishing lives. This award recognizes older adults who are 85 years or older and who are outstanding models of optimal aging in the following four categories: physical, social, spiritual and creative. There is no geographical limitation for nominations.

The award will be presented at a luncheon on May 10, 2016 at the Crowne Plaza, 830 Phillips Lane. WAVE3 News Anchor Dawne Gee will be the keynote speaker for this year’s award luncheon.

Lunch reservations are $35 per person and $350 for a table of 10. Sponsorships in a variety of opportunities also are currently being accepted by the Institute at (502) 852-5629.

Registration and nomination available at: louisville.edu/medicine/departments/familymedicine/geriatrics. For information, call 502-852-5629 or email OptimalAging@louisville.edu.

Lorrel Brown, M.D., assistant professor of cardiology at the University of Louisville School of Medicine, is working to improve the way staff respond when a hospital patient experiences cardiac arrest. Brown has received a grant to develop and evaluate a new protocol to improve communication and fine tune the staff team that responds to these patient emergencies at University of Louisville Hospital (ULH), a part of KentuckyOne Health.

When a patient suffers a cardiac arrest in the hospital, staff members call a “code blue” to summon necessary medical personnel to attend to the patient. Existing procedures for code blue events at ULH may bring 30 to 40 people to the patient’s room, which can create an inefficient situation for responders. Brown’s plan would train a streamlined group of about 15 people who have the most appropriate skill sets for the event to respond to a code blue announcement.

“This will lead to an appropriate use of resources. When 40 people are in the room, it is too crowded and people are not functioning at the height of their effectiveness,” said Brown, a cardiology and critical care specialist with UofL Physicians. “We want people who are highly trained and responding often so they know what they are doing.”

To determine the best team of responders, Brown has collaborated with an inter-professional group that includes physicians in neurology, internal medicine, intensive care, surgery, anesthesia and cardiology, along with respiratory therapists, nurses and pharmacists. She is collecting data on the current system and will evaluate the process before and after the new procedures are implemented.

Brown will introduce the new procedures by conducting unannounced code blue simulations in the hospital and familiarize all hospital personnel in the new system for several months before it is implemented. Under the new procedure, a UofL Hospital Code Team Leader will wear a special lanyard to visually identify the team leader for all staff members. Attached to the lanyard will be a card that lists the individuals who should be involved in the response.

“This will require a culture change,” Brown said. “Whoever is the leader wears the lanyard so everyone can see who’s in charge. It is not a novel approach, but what is novel is that we are studying the impact of this change by collecting data and evaluating the process before and after the new plan is implemented.”

Instructing medical staff on procedures for cardiac arrest is familiar territory for Brown, UofL’s associate director of cardiovascular medicine fellowships. For the past year, she has been training medical residents and other staff members to work together during code blue events by conducting drills in which teams of resident physicians, pharmacists, nurses and respiratory therapists engage in simulated cardiac arrest events. This allows each of the personnel to focus on their specialized training and to reinforce teamwork. [Click for photo gallery of code blue simulation drills]

“When we train people to respond to cardiac arrest, it is usually in silos – nurses train with nurses, residents train with residents, and so on,” Brown said. “In the real world, various people with distinct skills respond to a cardiac arrest who haven’t worked together before. It can be stressful, especially if they don’t know one another. Team training utilizes the skill sets of each individual to the best advantage of the patient.”

Brown received a two-year medical education and research grant from the Southern Group of Educational Affairs, a regional division of the Association of American Medical Colleges, to define, implement and evaluate the new procedures for the hospital staff. The grant extends through August of 2017.

“The goal of this project is to improve communication in the delivery of high-quality care in a low-frequency, high-stakes situation, and to clearly identify the code blue team leader,” Brown said. “This streamlined group of responders will facilitate clear communication, rapid delivery of life-saving care and inter-disciplinary cooperation.”

December 15, 2015

Refugee resettlement may be a hotly debated issue on the presidential campaign trail but the health care of refugees is both a service provided by and a benefit provided to the University of Louisville Global Health Initiative.

Ruth Carrico, Ph.D., and Rahel Bosson, M.D. will address the “The State of Refugee Health in Kentucky: From Flight to Resettlement” at noon, Thursday, Dec. 10, in room 103 of UofL’s School of Public Health and Information Sciences, 485 E. Gray St. Admission is free.

Carrico, a registered nurse and family nurse practitioner, and Bosson are among the staff who practice in UofL’s refugee health care and vaccine clinics that see approximately 3,000 refugees annually. These services are provided through a partnership with the Kentucky Office for Refugees, Catholic Charities Inc. and Kentucky Refugee Ministries.

While Syrian refugees are currently most discussed in news reports, the UofL clinic is the medical home for people seeking resettlement in Louisville from approximately 30 countries and who speak more than 20 languages.

Perhaps not surprisingly, most of the refugees come from a country with which the United States has recently relaxed sanctions and resumed diplomatic relations: Cuba.

“Most of our refugee patients today come from Cuba,” Carrico said. “The next largest groups are Iraqis, the Butanese and Somalis.”

The wide variety of nationalities is illustrated by the most prevalent condition seen in each group, Bosson said. “Women from Cuba most often have reproductive health concerns,” she said, “while PTSD is prevalent among people from the Middle East. In the Somali population, non-active tuberculosis is most often what we see.

“But we also  provide and facilitate care in  virtually every other health specialty – dentistry, vision, oncology, cardiovascular care, mental health services and vaccines – we arrange it all.”

The health care providers focus on exactly that – health care – not politics. The refugee patients need the services provided by the clinic, and in turn, the care provided is integrated in the health sciences schools’ education and training process. The care is interprofessional with medicine, nursing, dentistry and public health faculty and students partnering with faculty and students from engineering, business, arts and sciences and law.

“Before they can come to the United States, refugees are required to have an overseas medical exam,” Carrico said. “When they arrive, there is an eight-month window for them to make major strides toward self-sufficiency.

“Health is part of that self-sufficiency; how can you work and support yourself if you are sick? We can wait for health issues to occur and see them present in the emergency room,” Carrico said, “or we can care for them upfront. Preventive care is always less expensive and produces the best outcomes.”

The providers work with staff at the two resettlement agencies in Louisville to coordinate care for the newly arriving refugees, allowing a global health experience for faculty, staff and students.

“The care we provide in turn gives our resident physicians and medical, nursing and public health students important education and training in conditions not always seen in Louisville,” Bosson said. “Combined with interactions from students across the entire university, these experiences are unique to education and training at UofL and can be found in few other places across the United States.”

Added Carrico, “Many of our residents and students want a global health experience as part of their training; we provide it right here in Louisville.”

For information about the refugee clinic at UofL, call 502-852-3324.

In today’s issue of Nature Communications, University of Louisville scientists reveal research that increases the understanding of the mechanisms regulating adult stem cells required for skeletal muscle regeneration. Sajedah M. Hindi, Ph.D., of UofL’s Department of Anatomical Sciences and Neurobiology, and Yuji Ogura, Ph.D., now of Japan, and other researchers show that the protein kinase TAK1 (transforming growth factor-ß-activated kinase 1) is vital in regulating the survival and proliferation of satellite stem cells. These cells are responsible for regenerating adult skeletal muscles in response to damage from disease or injury.

Specialized stem cells known as satellite cells reside in the skeletal muscles of adults in an inactive or quiescent state. When muscle injury occurs, a chain of signals prompts the satellite cells to awaken and generate new muscle cells to repair the injury. As part of this process, the satellite cells self-renew in order to replenish the pool of satellite cells for future muscle repair.

In the article, the authors reveal that when the protein TAK1 is reduced, satellite stem cells do not vigorously self-renew and many eventually die. Alternately, when TAK1 is increased, the satellite cells prosper. These results lead the authors to conclude that TAK1 is required for satellite cell proliferation and survival for regeneration of adult skeletal muscle.

This publication complements research published just last week in the Journal of Clinical Investigation by Hindi and Ashok Kumar, Ph.D., a professor and distinguished university scholar in UofL’s Department of Anatomical Sciences and Neurobiology, that describes the role of another protein, TRAF6 (TNF receptor-associated factor 6), in ensuring the vitality of the satellite stem cells. TAK1 and TRAF6 support distinct functions that regulate satellite cell survival and functionality. In the JCI article, Hindi and Kumar show that TRAF6 is critical for the satellite cells to retain their stem properties and prevents them from undergoing premature differentiation.

Kumar, also the corresponding author on the Nature Communications publication, believes the research in both of these publications may lead to multifaceted therapies for muscular dystrophy, cancer cachexia and other muscle-wasting conditions, including aging.

“In one disease state the muscle stem cells are undergoing premature differentiation. In that situation, TRAF6 is very important in preventing premature differentiation so the satellite cells maintain their stemness,” Kumar said. “But in some disease conditions, the overall cell population is reduced. If the cells are dying, we need to look at the protein TAK1 and if we put this protein back, determine whether it improves satellite cell survival.”

Hindi, a post-doctoral fellow at UofL, and Ogura are the primary authors of the Nature Communications publication. Ogura was a post-doctoral fellow in UofL’s Department of Anatomical Sciences and Neurobiology from 2012-2014 and now is an assistant professor at St. Marianna University School of Medicine in Japan. Co-authors include Kumar, Guangyan Xiong, Ph.D., of UofL, Shuichi Sato, Ph.D., now an assistant professor at the University of Louisiana at Lafayette, and Shizuo Akira of Japan.

Research reported in this press release was supported by the National Institute of Health grants R01AR059810, R01AR068313, and R01AG029623 to Ashok Kumar.

December 9, 2015

More than 65 percent of youth in the juvenile justice system in the United States meet the criteria for a disability, a rate three times higher than that of the general population. Research also shows that the more serious and prolonged a youth's interaction with the justice system becomes, the more likely he or she is to die prematurely.

Juvenile justice reform, therefore, is not only a law enforcement concern, it is a public health concern, said Matthew C. Aalsma, Ph.D., associate professor of pediatrics and psychology and director of the Juvenile Forensic Psychology Clinic at Indiana University.

Aalsma will deliver the 15^th Annual Doctor Elliott Podoll Adolescent Medicine Lecture, sponsored by the University of Louisville Department of Pediatrics. The lecture will be at 8 a.m., Friday, Dec. 11, at Wade Mountz Auditorium, second floor of Norton Hospital, 200 E. Chestnut St. Admission is free.

Youth involved in the justice system “are a vulnerable population due to their high rates of mental illness, physical health problems and early mortality,” Aalsma said. “Juvenile justice reform that decreases the reliance on incarceration and improves behavioral health and medical services are very important public health initiatives.”

Trained as a pediatric psychologist, Aalsma focuses on research with vulnerable populations, including youth in the mental health and juvenile justice systems. His current research agenda includes exploring system-wide and individual efforts to improve the utilization of mental and physical health care for children and adolescents.

As director of the Juvenile Forensic Psychology Clinic, Aalsma oversees the provision of comprehensive psychologic assessments for court-involved youth. “The clinic provides thorough and fair assessments for vulnerable populations and trains psychology Ph.D. students in conducting juvenile forensic assessments,” he said.

The Podoll lectureship was established by the family of the late Elliott Podoll, M.D., a longtime Louisville pediatrician and clinical faculty member at the University of Louisville and a local pioneer in the provision of appropriate health care services for adolescents. The yearly lectureship brings an expert in the field of adolescent medicine to UofL in the spirit of what Podoll cared about: an increased awareness and development of the skills necessary to improve the lives of young people in the region.

For additional information, contact the UofL Department of Pediatrics at 502-852-8600.

Researchers at the University of Louisville have discovered a mechanism involved in skeletal muscle repair that may enable clinicians to boost the effectiveness of adult stem cell therapies for diseases such as muscular dystrophy. The research, published today in the Journal of Clinical Investigation, describes the role of TNF receptor-associated factor 6 (TRAF6), an adaptor protein and E3 ubiquitin ligase, in ensuring the vitality of stem cells that regenerate muscle tissue.

Specialized stem cells known as satellite cells reside in skeletal muscle in an inactive state. When muscle injury occurs, a complex chain of signals prompts the satellite cells to awaken and generate new muscle cells to repair the injury. Previous research had shown that Pax7 (a paired-box transcription factor) is essential to this regeneration. When Pax7 is missing or reduced, the satellite cells undergo premature differentiation, or lose their stem properties and their ability to regenerate injured muscles.

In their research, authors Sajedah M. Hindi, Ph.D., and Ashok Kumar, Ph.D., discovered that removing TRAF6 depletes Pax7, resulting in reduced muscle regeneration in both normal and Duchenne muscular dystrophy (DMD) mouse models. Hindi, a post-doctoral fellow, and Kumar, professor and distinguished university scholar in UofL’s Department of Anatomical Sciences and Neurobiology, believe this is because TRAF6 is upstream from Pax7 in the signaling process involved in muscle repair and orchestrates multiple signals controlling the muscle regeneration process.

“We have discovered a pathway by which the Pax7 and myogenic potential of satellite cells is regulated. The protein TRAF6 is a very important adaptor protein that is involved in multiple signaling pathways and its functions are important to maintain the stemness of satellite cells in adults,” Kumar said.

“In normal conditions, skeletal muscle is a self-healing tissue and can recover promptly from most trauma because of the satellite cells. But in disease conditions like muscular dystrophies, satellite cells can’t keep up with repeated cycles of injury and are ultimately exhausted or functionally impaired,” Hindi said. “Our next step is to see if this functional impairment is partially due to lack of TRAF6 signaling in satellite cells. If so, we are thinking we can take a patient’s stem cells, restore the TRAF6 activity, put them back and boost their regenerative potential.”

Kumar and Hindi believe their research ultimately will lead to improved treatments for muscle wasting diseases such as muscular dystrophy, ALS, cancer cachexia, diabetes, heart disease and others.

“Right now the problem in donor stem cell therapy is that we inject the stem cells into the patient but most of the stem cells don’t proliferate very well, so they repair very little part of the muscle,” Kumar said. “But if you have stem cells that are over expressing this protein TRAF6, they may proliferate longer and they may repair the muscle much more effectively.”

Research reported in this press release was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases and the National Institute on Aging of the National Institutes of Health under award numbers R01AR059810, R01AR068313, R01AG029623 and F31AG046950.

IMAGES: TRAF6 ^fl/fl (top) are control injured muscle whereas TRAF6^scko (bottom) are from satellite cell-specific TRAF6- knockout mice which show drastic deficit in muscle regeneration due to lack of TRAF6.

November 30, 2015

For the December edition of Beer with a Scientist, Steve Yanoviak, Ph.D., associate professor and the Tom Wallace Endowed Chair of Conservation at the University of Louisville, will share stories of his adventures in the tropical rainforest.

Yanoviak has been conducting research in the tropical rainforest canopy for more than two decades. In his discussion, "How to Fall From Trees,” he will highlight some of the amazing discoveries he and his colleagues have made regarding the behavior and ecology of insects that live in the treetops. He will share videos of swimming ants and skydiving insects and spiders, and a story about zombie ants. His presentation will conclude with a brief look at the next phase of his research, which explores the effects of lightning on tropical trees.

The program begins at 8 p.m. on Wednesday, December 9 at Against the Grain Brewery, 401 E. Main St. A 30-minute presentation will be followed by an informal Q&A session.

The Beer with a Scientist program began in 2014 and is the brainchild of UofL cancer researcher Levi Beverly, Ph.D. Once a month, the public is invited to enjoy exactly what the title promises:  beer and science.

Admission is free. Purchase of beer, other beverages or menu items is not required but is encouraged.

Organizers add that they also encourage Beer with a Scientist patrons to drink responsibly.

For more information and to suggest future Beer with a Scientist topics, follow Louisville Underground Science on Facebook.

December 1, 2015

Specialists with University of Louisville Physicians have announced they performed a surgery to separate 7-week-old conjoined twin girls on Nov. 11 at Kosair Children’s Hospital. Since the surgery, the girls have been under close watch of experts in the hospital’s “Just for Kids” Critical Care Center. They are currently still on ventilators but have been getting stronger by the day. Their long-term prognosis is not yet known, but indicators are favorable for continued improvement.

“In any situation where you have so complex a surgery, there is always a long road to recovery,” said Erle H. Austin III, M.D., pediatric surgeon with UofL Physicians and the UofL School of Medicine's Department of Cardiovascular Surgery. “We are cautiously optimistic, as one or both may require additional surgeries in the future.” Austin also is chief of cardiovascular surgery at Kosair Children’s Hospital.

“God was definitely watching over the girls and the medical team on the day of the surgery,” said the babies’ mother. “We are so thankful to God and everyone at Kosair Children’s Hospital for getting them this far.

“We are also thankful to the hospital chaplain, who prayed with us before the delivery and the day of the surgery.”

The twins were born at Norton Hospital and had been under close watch of UofL Physicians’ neonatologists in the Kosair Children’s Hospital Level IV neonatal intensive care unit.

The twins were defined as thoraco-omphalopagus, which means their bodies were joined at the chest and abdominal cavity. Their livers were joined and they shared some of the same heart structures.

Conjoined twins occur in approximately one out of 200,000 live births. Forty to 60 percent are stillborn, and about 35 percent survive only one day. The overall survival rate of conjoined twins is between 5 percent and 25 percent.

The surgical team waited as long as possible prior to performing the separation surgery. The decision to operate was made after the twins began to need increased breathing support. They also were not growing as they should. One of the infants was more fragile than the other, and survival was in question. The separation procedure was risky for both.

While originally expected to last about 12 hours, the procedure went smoothly and was completed in approximately eight hours. To prepare, the surgical team had undergone multiple drills using dolls.

The UofL Physicians' medical team involved in the procedure included two cardiovascular surgeons, a transplant surgeon, a plastic surgeon, two pediatric surgeons, a pediatric surgery fellow and a cardiologist. Other specialists included two additional plastic surgeons, three anesthesiologists, a radiologist, extracorporeal membrane oxygenation specialists, advanced surgical nurses, surgical technologists, biomedical and engineering specialists, information systems technologists, respiratory therapists and blood bank team members. In all, more than 45 people were involved in the planning and surgery. More have been involved in the babies’ care throughout their stay.

A woman who survived a rare childhood cancer successfully underwent a first-of-its-kind procedure with University of Louisville Physicians to help restore her appearance.

Jarrod Little, M.D., a plastic and reconstructive surgeon with UofL Physicians, used fat grafted from Janna Coleman’s identical twin, Jessie, to reshape Janna’s face from the damaging effects of radiation and chemotherapy. While fat grafting has been done for years, there are no instances in medical literature of it taking place from one person to another, and never before on identical twins. While tissue from twins has been used for organ transplants, soft tissue procedures between twins are rare, Little said.

The surgery took place at University of Louisville Hospital, part of KentuckyOne Health, over about three hours on Thursday, Nov. 19, and was a success.

“It will make a huge difference for her,” Little said. “She looks like a new person. I’m very happy with the results.”

Janna, 28, was diagnosed with an aggressive rhabdomyosarcoma at the age of 7. Childhood rhabdomyosarcoma is a disease in which malignant cells form in muscle tissue, and Janna’s formed behind her jaw. She was successfully treated, but the surgery, radiation and chemotherapy to her head and neck left lasting effects, damaging her pituitary gland, which disrupted her growth, most noticeably around her face. He jawbone never grew to an adult size.

While Janna is an identical twin, her sister, Jessie, did not have the same condition. Though they once looked so much alike even their father had trouble telling them apart, after her treatment Janna no longer looked as much like her sister.

“The cancer was the easy part; the aftermath is what’s been hard,” Janna said.

Janna went through more than 10 reconstructive surgeries over the years to help, but without much success. After moving to Louisville and working as an oncology nurse, she heard of Little and went to him to see if there was anything else that could be done.

With the jawbone in Janna's face damaged and stunted from radiation, Little determined reconstruction of her jaw was not an option. Fat grafting to help re-shape her face was, but Janna did not have enough fat, and was unable to gain weight because of her development issues.

But when Little learned Janna was an identical twin, he came up with the idea to take fat from Jessie and transplant it into Janna’s face. The procedure also was unique in that many people with Janna’s condition and location of her tumor do not survive to adulthood.

By increasing volume to the face and repairing some of the damaged tissues, the goal of the procedure was to give Janna’s face a more natural volume and contour so the size of the jaw bone will not be as noticeable, Little said.

Fat also was a good option for Janna because it has a high concentration of stem cells, which are beneficial because they can form into new types of cells. When they are introduced to a new area, they can regenerate surrounding soft tissue. And with the twins having a nearly 100 percent genetic match, the probability of success was high.

“I just want to look like my sister and more like a twin,” Janna said. "It is hard being her twin. She's gorgeous.”

To donate fat, Jessie had to make an effort to gain weight. For months, the normally health-conscious Jessie ate high-calorie foods – including ice cream, pizza and fast food – to develop enough fat that could be removed by liposuction for Janna.

“She’s my sister, my twin,” Jessie said before the surgery. “Of course I’m going to do anything I can to help.”

“I want her to be more confident in herself and be proud to say we're twins and not be shy about it because we're exactly alike.”

It will take several months to assess the full effects of the procedure. One or two more sessions may be needed before the reconstruction is complete.

While Janna’s portion of the procedure was covered by insurance, Jessie’s was not, so UofL Hospital donated her costs.

If a baseball player waits until he sees the ball arrive in front of him to swing his bat, he will miss miserably. By the time the batter sees the ball’s position, plans his swing and moves the bat, the ball will be firmly in the catcher’s mitt.

This time lag is known as sensorimotor delay. University of Louisville researcher Bart Borghuis, Ph.D., has increased our understanding of how people and animals deal with this delay in day-to-day interactions by analyzing the hunting skills of salamanders. His article, “The Role of Motion Extrapolation in Amphibian Prey Capture,” is published in today’s issue of The Journal of Neuroscience.

A skilled baseball player compensates for sensorimotor delay by predicting when the ball will cross the plate and starting his swing in time to meet it. Borghuis’ research reveals the salamander also predicts the future location of its prey as it catches moving fruit flies by projecting its long, sticky tongue.

The sensorimotor delay is caused by the time it takes for the visual image to be processed by the retina, time to plan the motor action and time to activate the motion. When a salamander hopes to catch a moving fly, in the time it takes to make the strike – about 230 milliseconds – the fly will have moved from the location it was in when the salamander launched its attack. If the salamander sends its tongue to the location where it sees the fly, by the time the tongue gets there, the fly will be gone. Despite this delay, salamanders are efficient hunters, catching their prey more than 90 percent of the time in Borghuis’ experiments.

Why are salamanders so effective in their attacks?

Borghuis, assistant professor in the Department of Anatomical Sciences and Neurobiology at UofL, and Anthony Leonardo, Ph.D., of the Howard Hughes Medical Institute, used high speed videography to capture 270 instances of salamanders striking at flies. Through analysis of the videos, Borghuis developed an algorithm that predicted where the salamander’s tongue would strike based on the fly’s path.

The algorithm mimics the salamanders’ process using extrapolation to anticipate the prey’s position in the future based on its bearing and velocity. The salamanders’ tongue strikes were consistent with the algorithm, and were consistently successful – unless the fly changed course between the time the salamander initiated the attack and the time of the actual strike.

In successful strikes, the salamander caught the fly by sending its tongue tip to the position where the fly was when the tongue arrived. When the salamanders missed, the salamander’s tongue struck the location where the fly would have been had it continued on the same path it had been following. However, in these cases, the fly had changed direction after the salamander launched its attack.

“The misses confirmed the model,” Borghuis said. “This is the first demonstration that the salamanders were making a prediction.”

The tongue struck where the fly never had been, yet would have been had the fly continued its previous course of motion. Thus the salamander was predicting where the fly would be at the time the tongue reached it based on the fly’s direction and speed.

“This information adds to a small set of clear examples of how vertebrates – including humans – use prediction for dealing with delays in motor processing,” Borghuis said. “Now that we know how the salamander does this, we can further investigate the neuromechanisms that make this happen.”

VIDEO

The videos above show the researchers’ trajectory duplicating the salamander’s prediction of the location of the fly at the point of impact with the tongue. In the first video, the salamander successfully predicts the path and catches the fly. In the second video, the fly alters its direction after the salamander launches its strike, so the tongue misses the fly, hitting instead the location where the fly would have been had it not changed its course. The final video is a 4000 fps video showing a salamander striking a fruit fly. In real time, this motion would take about 1/5 of a second or 180 milliseconds.

November 18, 2015

University of Louisville researcher Lynnette Montgomery, Ph.D., has received the 2015 Fritz Krauth Memorial Fellowship Award from the Paralyzed Veterans of America (PVA), for submitting the top scholarship application to the organization for the year. Earlier this year, Montgomery was awarded a two-year, $100,000 scholarship from the PVA for research she is conducting in the lab of Charles Hubscher, Ph.D., in the Department of Anatomical Sciences and Neurobiology.

Montgomery, one of eight researchers who received grants from the PVA Research Foundation in 2015, is studying how activity-based rehabilitation can improve bladder function after spinal cord injury (SCI). Often, following SCI, the bladder produces excessive urine, a condition known as polyuria. This can lead to a high number of catheterizations, each of which increases the possibility of urinary complications.

Preliminary work in Hubscher’s lab has shown that the hormone vasopressin decreases following spinal cord injury, causing an increase in the production of urine. Montgomery is working with rodent models to understand the mechanisms behind vasopressin reduction and hopes to determine whether exercise and medication aimed at increasing vasopressin levels will alleviate polyuria following SCI.

“It’s an exciting area of research and it is very under studied,” Montgomery said. “Bladder control is one of the top quality-of-life issues for spinal cord injury patients. If a patient has to use a catheter four times a day instead of six, or is able to sleep through the night instead of waking for catheterization, it makes a big difference in quality of life.”

The Krauth Fellowship is named for Fritz Krauth, a Navy veteran who incurred a spinal cord injury as a naval aviator. Prior to his death in 2002, Krauth provided a gift to PVA to support research initiatives through the PVA Research Foundation. The foundation provides grants that will lead to improved understanding and treatment of spinal cord injury and disease. The researcher submitting the top fellowship application to the PVA each year is honored with the Fritz Krauth Memorial Fellowship Award.

“Paralyzed Veterans of America is dedicated to advancing research for spinal cord injury and dysfunction and supporting leading medical experts such as Dr. Montgomery. Her breakthrough findings will improve the life of veterans and every person living with SCI. It will also ensure they have the means to pursue a life undefined by disability,” said Sherman Gillums, Jr., deputy executive director of PVA.

A native of Australia, Montgomery came to the University of Louisville in 2013 to join Hubscher’s lab. Hubscher was recently awarded continued funding from the Department of Defense.

“The translational research studies being conducted in our laboratory address the areas of highest priority and utmost importance for the spinal cord injured population, bladder and sexual function,” Hubscher said. “The award from the Paralyzed Veterans of America and continued funding from the Department of Defense will allow us to address multiple questions regarding potential underlying mechanisms for the benefits of activity-based rehabilitation on urogenital function after spinal cord injury.”

About Paralyzed Veterans of America

Paralyzed Veterans of America is a congressionally chartered veterans service organization dedicated solely for the benefit and representation of veterans with spinal cord injury or disease. For nearly 70 years, PVA has ensured that veterans have received the benefits earned through their service to our nation, monitored their care in VA spinal cord injury units and funded research and education in the search for a cure and improved care for individuals with paralysis. In addition, PVA develops career services, works to ensure accessibility in public buildings, provides health and rehabilitation opportunities through sports and recreation, and advocates for veterans and all people with disabilities.

November 16, 2015

Educators from the University of Louisville School of Medicine are sharing two successful programs with medical educators from around the nation today at the 2015 Association of American Medical Colleges (AAMC) Medical Education Meeting. Two teams are delivering presentations at the Baltimore event, and an educational grant will be announced for an interdisciplinary training program for internal medicine residents.

“The recent curriculum revision at the UofL School of Medicine has been a catalyst for multiple innovative approaches to medical education. We are committed to developing best practices in medical education and translating those practices to meet the needs of our immediate community by improving patient care,” said Monica Ann Shaw, M.D., M.A., vice dean for undergraduate medical education for the UofL School of Medicine. “I am very proud of the momentum we are gaining in educational scholarship and am proud of my colleagues and the University of Louisville’s presence at this national conference."

Members of UofL’s Interdisciplinary Curriculum for Oncology Palliative Care Education (iCOPE) Council will detail the program for training medical, nursing, social work and chaplaincy students in interprofessional palliative care education. Presenters Shaw, Leslee Martin, M.A., director of medical education, and Susan Sawning, M.S.S.W., director of medical education research, will share the details of iCOPE, developed with a grant from the National Cancer Institute. Surveys of 758 students reveal the program significantly improves the students’ palliative care knowledge, skills and self-efficacy related to working in teams.

In another session, Olivia Mittel, M.D., and Carrie Bohnert, M.P.A., are presenting a program that helps medical students learn to identify and assist victims of human trafficking. Mittel, assistant dean of student affairs, and Bohnert, director of the standardized patient program, developed a training unit for medical students that utilized a standardized patient encounter and an online learning module to teach the students to identify victims of human sex trafficking, communicate with suspected victims and refer victims to safety. This program addresses the fact that although 400,000 Americans are at risk for exploitation each year, only 10 percent of doctors will recognize trafficking victims.

Finally, Lorrel Brown, M.D., associate director of UofL’s Cardiovascular Medicine Fellowship Program, has been awarded a grant from the Southern Group on Educational Affairs for her curriculum that improves resuscitation effectiveness through team simulations. The program, called “Code Blue,” brings together internal medicine residents, nurses, respiratory therapists and pharmacy residents to learn as a team to respond more effectively in actual “code blue” events. The grant will be announced during the conference.

November 12, 2015

Among the most important issues facing health care are social barriers to care. To ensure future health professionals are equipped with the understanding to reduce health inequities, the University of Louisville Health Sciences Center Office of Diversity and Inclusion will hold its 10^th annual Patricia Allen Cultural Competency Day on Tuesday, November 10. Nearly 700 students will participate in “Health Equity through Interprofessional Practice,”a day-long workshop that includes discussions on Poverty and Accessing Health Care, LGBT Health, Immigrant and Refugee Populations and Cultural Barriers in Health Care.

Students from UofL Schools of Medicine, Nursing, Dentistry, Public Health and Kent School of Social Work, as well as the Sullivan University School of Pharmacy and nurses with Passport Health Plan will take part in the program, to be held at the Kentucky Center for African American Heritage (KCAAH).

Vivian Lasley-Bibbs, the acting director for the Office of Health Equity in the Kentucky Department for Public Health, will open the event with a keynote address on the increasing racial, ethnic, cultural and linguistic diversity in the American population and the need for health-care practitioners to understand the socio-cultural background of their patients in order to deliver high quality health care.

“This is the 10^th year for this conference reflecting the Health Sciences Center’s commitment to health equity for all. In addition to this important milestone, the program has expanded to include almost 700 students from multiple health disciplines,” said V. Faye Jones, M.D., Ph.D., assistant vice president for health affairs – diversity initiatives. “We all have a role in achieving health equity, and this year’s program allows students to learn with and from each other in the community setting of the Kentucky Center for African American Heritage.”

Attendees will be assigned to interprofessional teams that rotate together among 75-minute breakout sessions covering each topic. This format, which differs from previous years, will ensure that all attendees are exposed to each topic and will accommodate the large number of participants. The interprofessional teams, which mix students and residents from dentistry, speech pathology, pharmacy, social work, public health and medicine, allow the students to experience the topics from the unique perspectives of each field.

UofL’s Cultural Competency Day was first held in 2006, the result of efforts by Jones and Patricia Allen, administrative associate for the Area Health Education Center (AHEC) program office at UofL, to improve cultural understanding of UofL Health Sciences Center students. Approximately 150 students attended the event its first year. The event is named for Allen, who helped lay the groundwork and planning for the event.

November 9, 2015

A third-year resident in the University of Louisville Department of Psychiatry and Behavioral Sciences has been awarded the Jeanne Spurlock, M.D. Congressional Fellowship of the American Psychiatric Association and the association’s related organization, the American Psychiatric Foundation.

Daniel T. Jackson, M.D., is serving in the Capitol Hill office of U.S. Rep. James McDermott, M.D. (D-Wash.) for the 10 months of the fellowship beginning in September. The award is offered to only one individual each year and provides the opportunity to represent the profession of psychiatry in Congress, working with federal policy makers to shape public policy.

“My work with Rep. McDermott – who is a psychiatrist himself – focuses on mental health issues including the Mental Health Reform Act of 2015 in the Senate and the Helping Families in Mental Health Crisis Act of 2015 in the House,” Jackson said. “We hope to see action on one or both bills in the coming months.”

Both bills propose to reform current mental health law to make available needed psychiatric, psychological and supportive services to individuals with mental illness and families in mental health crisis. The bills focus on providing more programs and resources to help those suffering from mental disorders.

Jackson is a two-time graduate of UofL, earning his medical degree in 2013 and a bachelor of arts degree cum laude in psychology with concentration in the natural sciences in 2007. He entered the residency program in July 2013.

As a resident, he lectures on substance abuse topics to third- and fourth-year medical students and sits on the UofL Psychiatry Residency Admission Committee. He also is a member of the American Psychiatric Association, Kentucky Psychiatric Medical Association, Kentucky Medical Association and Greater Louisville Medical Society.

He also has undertaken public policy advocacy work as a resident, attending the Advocacy Leadership Conference in Washington last year. There, he joined with others in the health care profession to recommend for increased federal investment through the National Institutes of Health, Substance Abuse and Mental Health Services Administration and Indian Health Service. He has lobbied for passage of the Ensuring Veteran’s Resiliency Act and helped efforts that were successful in reforming Medicare’s physician payment formula.