A surgeon at University of Louisville Hospital, part of KentuckyOne Health, recently performed an extended endoscopic skull-based surgery of the brain, a unique surgery of its kind in Kentucky.

Performed by Dr. Mary Koutourousiou, assistant professor of neurosurgery and director of the skull base program, the minimally invasive surgery was done to help restore the eyesight of a 34-year-old man who suffered from a malignant brain tumor located at the base of the skull.

Extended endoscopic skull-based surgery is performed through the nose and enables surgeons to remove brain tumors and lesions – some as large as softballs. During the procedure, which takes an average of six hours, surgeons use a specially designed endoscope to view the tumor and additional instruments to dissect it piece-by-piece through the nasal cavity.

This approach reduces risks and recovery times for the patient who would otherwise need a craniotomy, which requires temporary removal of a bone flap from the skull to access the brain and brain retraction to reach the tumor.

“The base of the skull is one of the most challenging regions of the body to access,” Koutourousiou said. “Using an endoscopic endonasal approach provides a panoramic view of the base of the skull and the patient’s tumor.”

The minimally invasive nature of the procedure leaves no visible scarring, shortens a patient’s hospital stay, reduces overall recovery times and involves less trauma to the brain and critical nerves. Hospital stays following a craniotomy could be up to 30 days, compared to three to four days following an extended endoscopic skull-based procedure.

“This approach is the future of brain surgery,” said Ken Marshall, president, University of Louisville Hospital. “There are only a handful of surgeons with fellowship training on this procedure in the country. We are proud to have one of those surgeons on our team and to be able to offer this new option for patients in the Commonwealth.”

Koutourousiou completed a clinical fellowship in endoscopic skull base surgery and open skull base surgery at the University of Pittsburgh Medical Center. She has published extensively on the endonasal approach to brain surgery.

Researchers from the University of Louisville will lead an international effort to utilize tobacco plants to develop a gel containing a specific protein that will prevent the transmission of HIV. The project is being funded by a five-year, $14.7 million grant from the National Institutes of Health.

“Our researchers are looking to solve problems that affect the world,” said James R. Ramsey, Ph.D., president of the University of Louisville. “Globally, more than 34 million people are HIV positive. The development of a low-cost method to prevent transmission of HIV certainly is something that is desperately needed and the use of tobacco plants as a method of carrying the vaccine appears to be key in the process.”

“Approximately seven years ago, UofL and Owensboro Health created a joint venture to develop a world-class plant pharmaceutical program that would have an impact globally,” said David L. Dunn, M.D., Ph.D., executive vice president for health affairs at UofL. “Today’s announcement, coupled with the announcement we made in May about the Helmsley Charitable Trust providing funding to our research into two other cancer vaccines utilizing tobacco plants, demonstrates that the vision is becoming a reality.”

Kenneth Palmer, Ph.D., professor of pharmacology and toxicology and director of the Owensboro Cancer Research Program of UofL’s James Graham Brown Cancer Center, is leading a team of researchers from the University of Pittsburgh, the Magee-Women’s Research Institute in Pittsburgh, the Centers for Disease Control and Prevention, Karolinska Institutet in Stockholm, Sweden, the University of Manitoba in Winnipeg, Canada, the University of Maryland, Baltimore and Kentucky Bioprocessing Inc. and Intrucept Biomedicine LLC in Owensboro.

The team is working with the carbohydrate combining protein Griffithsin (GRFT), which is found in red algae. In laboratory work, the protein has shown to have broad-spectrum activity against HIV. GRFT binds to the dense shield of sugars that surrounds HIV cells and prevents these cells from entering other non-HIV cells. The team plans to develop a gel containing the protein for use during sexual intercourse by people at risk for HIV transmission.

To develop the microbicide, Palmer’s team takes a synthetic copy of the protein and injects it into a tobacco mosaic virus, which carries the protein into the tobacco leaves. After 12 days, the researchers harvest the leaves and extract the mass-produced protein for development into the vaccine.

“Our goal is to optimize the delivery system of the protective agent, which in this case is a gel, and determine its safety and estimates of its efficacy, leading to a first-in-humans clinical trial,” Palmer said.

“People may question why a cancer program is conducting research into HIV prevention,” said Donald Miller, M.D., Ph.D., director of the James Graham Brown Cancer Center, a part of KentuckyOne Health. “In fact, cancer can be a result of every major disease that we know about, and HIV infection is no exception.”

Overall, the grant contains three significant projects – The Critical Path Project; Preclinical Testing Project; and Clinical Trial Project.

The critical path project involves manufacturing the microbicide active ingredient, ensuring quality of the microbicide and the formulated gel product and production for actual use. This process is in collaboration with two Owensboro-based biotechnology companies (Kentucky Bioprocessing Inc. and Intrucept Biomedicine LLC), and Lisa Rohan, Ph.D., at the University of Pittsburgh and Magee-Women’s Research Institute. Rohan has significant experience developing delivery systems for similar medications.

The preclinical testing project is a collaboration with the Centers for Disease Control and Prevention in Atlanta to use an animal model to ensure that the vaccine is safe and to determine that it actually provides protection from infection.

The clinical trial project involves developing the application to conduct a clinical trial for the Food and Drug Administration, as well as conducting the first-in-humans testing.

###

Editor’s note: Palmer is one of the founders and principal partners in Intrucept Biomedicine LLC.

More than a dozen silent auction items valued at $50 to $500 from The Outlet Shoppes of the Bluegrass will be available for bidding online beginning Friday, July 25, at 5 p.m. at www.shoppingforacure.org. Bidding online continues until 8:30 p.m. Wednesday, July 30, during the Opening Night VIP Preview Shopping Event.

The Outlet Shoppes of the Bluegrass is holding the event from 6-9 p.m. to benefit the James Graham Brown Cancer Center at the University of Louisville. The by-ticket-only VIP Preview is being held on the evening before the facility opens to the general public.

Patrons are encouraged to bring smart phones or tablets to the event to continue bidding until the silent auction closes. Among the merchants and items available are:

• Saks Fifth Avenue OFF FIFTH: $100 gift card
• Polo Ralph Lauren: 5 $100 gift cards
• Columbia: $500 gift card
• J Crew: $200 gift card
• Wilson’s Leather: ladies handbag
• Crabtree & Evelyn: $50 gift card and 2 gift sets
• Converse All Star: $100 gift card
• Auntie Anne’s: $150 in VISA gift cards and 3 At-Home Pretzel Kits
• Gold Toe, Hanes & Jockey: $250 in gift cards to Hanes Brands, $100 in gift cards to Jockey and a tote bag filled with Gold Toe socks

Patrons also will be able to beat the huge crowds expected for opening weekend and get the jump on the rest of Kentuckiana in shopping at the facility. Other retail outlets that will be open on the night of the VIP Preview include Coach, Brooks Brothers, Michael Kors, Banana Republic, Nike, Talbots, Under Armour and more. Patrons also will receive an exclusive goody bag of items that includes a free coupon book with over $300 in savings good for an entire year at many of the 80-plus retailers that make up The Outlet Shoppes of the Bluegrass.

Tickets to the event are $50 each and also can be purchased at www.shoppingforacure.org. Only patrons with tickets will be able to enter The Outlet Shoppes on VIP Preview night.

Proceeds from the VIP Preview go to the James Graham Brown Cancer Center, a part of KentuckyOne Health and the only cancer center in the region to use a unified approach to cancer care, with multidisciplinary teams of physicians working together to guide patients through diagnosis, treatment and recovery.

The Outlet Shoppes of the Bluegrass is located at 1155 Buck Creek Road, Exit 28 on Interstate 64. For additional information on the Opening Night VIP Preview or the James Graham Brown Cancer Center, contact 502-562-4642.

The president of the Institute of Medicine of the National Academies will present the 2014 Leonard Leight Lecture at the University of Louisville.

Victor J. Dzau, M.D., will speak at noon, Wednesday, Dec. 10, at Kornhauser Library Auditorium on the UofL Health Sciences Campus. Admission is free.

Dzau assumed the presidency of the IOM July 1 after having served as chancellor for health affairs at Duke University, president and CEO for Duke University Health System, and James B. Duke Professor, Duke University School of Medicine. He was elected to the IOM in 1988 and served on several leadership committees prior to being named president.

He has made a significant impact on medicine through his seminal research in cardiovascular medicine and genetics, his pioneering work in the discipline of vascular medicine, and recently his leadership in health care innovation. His work on the renin angiotensin system (RAS) – a hormonal system that regulates blood pressure and fluid balance – paved the way for the contemporary understanding of RAS in cardiovascular disease and the development of RAS inhibitors as therapeutics. Dzau also helped pioneer gene therapy for vascular disease. His most recent work provides novel insight into stem cell biology and regenerative medicine.

The Leonard Leight Lecture is presented annually by the Division of Cardiovascular Medicine in the Department of Medicine at the University of Louisville School of Medicine. For 30 years until 1996, Leight was a practicing cardiologist in Louisville and played a major role in developing cardiology services and bringing innovative treatment modalities in heart disease to Louisville.

The Leonard Leight Lecture series was established in 1994 and is made possible by gifts from Dr. and Mrs. Kurt Ackermann and Medical Center Cardiologists to the Jewish Hospital & St. Mary’s Foundation.

Craig McClain, M.D., has been named the Associate Vice President for Health Affairs/Research at the University of Louisville. McClain also serves as Distinguished University Scholar, UofL Associate Vice President for Translational Research, Director of the UofL Clinical and Translational Sciences Institute, Director of Research Affairs, Division of Gastroenterology, Hepatology and Nutrition, and Director of Gastroenterology at the Louisville VAMC.

“Dr. McClain brings a wealth of research experience to this position. I am confident that in this new position, which bridges research activities across the university and acts as a liaison between the Offices of the EVPHA and the Executive Vice President for Research and Innovation, he will continue to provide outstanding research leadership on behalf of the Health Sciences Center,” said David L. Dunn, M.D., Ph.D., executive vice president for health affairs.

McClain is a widely recognized expert in alcohol abuse, nutrition, and cytokine research, as well as hepatic drug metabolism. In 1980, he described the deleterious interactions in the liver between alcohol and acetaminophen, and he was the first to describe dysregulated cytokines in alcoholic hepatitis.

His laboratory currently focuses on nutrition and the gut: liver axis, especially as it relates to alcoholic liver disease. He has published more than 340 peer-reviewed articles and 100 book chapters/reviews, and he has mentored more than 100 medical students, residents, GI fellows, graduate students and post-doctoral fellows.

He has received multiple awards, such as the American Gastroenterology Association Foundation Research Mentoring Award, the Elizabeth Hurlock Beckman award for mentoring,  the Grace A Goldsmith Award in Nutrition, the University of Louisville Distinguished Faculty Award in Research for Basic and Applied Sciences, and teaching awards such as Outstanding Gastroenterology Education at UofL.

McClain also has been prominent nationally, serving as president of the American College of Nutrition. He also has served on several NIH and VA Study Sections. He was the first physician member of the NIH Peer Review Advisory Committee (PRAC) and currently serves on the NIAAA National External Advisory Council and on the NIH Council of Councils.

The University of Louisville James Graham Brown Cancer Center is teaming up with Lite 106.9 to give away tickets to the Opening Night VIP Preview Shopping Event at The Outlet Shoppes of the Bluegrass.

Five pairs of tickets to the preview event are being given away this week by the radio station. To win, listen to Lite 106.9 with Vicki Rogers during the noon hour for the call for entries, and then phone 502-571-1069 for a chance to win.

The Outlet Shoppes of the Bluegrass is holding the event to benefit the cancer center from 6-9 p.m., Wednesday, July 30, the evening before the facility opens to the general public.

Patrons will be able to get the jump on the rest of Kentuckiana in shopping at choice retail outlets such as Coach, Brooks Brothers, Saks Fifth Avenue Off 5^th, Michael Kors, J Crew, Banana Republic, Nike, Talbots, Under Armour and more. They also will receive a goody bag of items that includes a free coupon book with over $300 in savings good for an entire year at many of the 80-plus retailers that make up The Outlet Shoppes of the Bluegrass. VIP preview event guests will also enjoy live music, light passed hors d’oeuvres, and the opportunity to bid on silent auction packages valued at $50 to $500 donated by Shoppes merchants.

Tickets are valued at $50 each, and for those not lucky enough to win, tickets can be purchased at www.shoppingforacure.org. Only patrons with tickets will be able to enter The Outlet Shoppes on opening night.

All proceeds from the VIP Preview go to the James Graham Brown Cancer Center, a part of KentuckyOne Health and the only cancer center in the region to use a unified approach to cancer care, with multidisciplinary teams of physicians working together to guide patients through diagnosis, treatment and recovery.

The Outlet Shoppes of the Bluegrass is located at Exit 28 on Interstate 64. For additional information on the Opening Night VIP Preview or the James Graham Brown Cancer Center, contact 502-562-4642.

The next Beer with a Scientist program will shed light on the “incurable” condition of aging.

Leah Siskind, Ph.D., associate professor of pharmacology and toxicology at the University of Louisville, will present “Everyone is Aging: So Why Haven’t We Found a Scientific Cure?” from 8-9 p.m., Wednesday, July 16, at Against the Grain Brewery, 401 E. Main St.

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

The Beer with a Scientist program is now in its third month and is the brainchild of University of Louisville cancer researcher Levi Beverly, Ph.D. Once a month, the public is invited to Louisville’s Against the Grain brewpub for exactly what the title promises: beer and science.

Beverly created the monthly series as a way to connect with people who don’t have scientific backgrounds but want to know about scientific topics. “We lose sight of the fact that most people have never even met a Ph.D., never talked to one,” he said. “(However) whenever I go someplace, if I strike up a conversation at a bar and I tell someone what I do for a living, they always have questions. It leads to a whole conversation.”

Against the Grain’s Sam Cruz believes Beer with a Scientist bridges what he sees as a disconnect between scientists and the general public. “If you don’t know about something, it’s hard to care,” he said. “I think that’s why this works; what we’re doing with these talks is letting people take the time to think about these things.”

Organizers add that they 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.

University of Louisville President James R. Ramsey, Ph.D., and Donald Miller, M.D., Ph.D., director of UofL’s James Graham Brown Cancer Center, issue the following statements on the death July 2 from cancer of Asia Ludlow of Louisville:

“Asia Ludlow possessed great courage and an attitude that was so uplifting to all who came in contact with her. Her zest for life was an inspiration to all of us.

“Asia will always remain a driving force for everyone at UofL who work in the field of cancer to find the cures and preventions so that one day, no more lives are lost to this terrible disease.

“Cancer can be an all-encompassing experience, affecting every aspect of a person’s life. Asia dealt with cancer head-on with hope and optimism. The disease was in her body, never in her spirit.

“To her daughters and other loved ones, we express our deepest sympathies. As we grieve for her loss, we hope that memories of Asia will provide some comfort to all who knew and loved her.

James R. Ramsey, President

“It is with great sadness that all of us at the James Graham Brown Cancer Center, KentuckyOne Health and the University of Louisville mourn the loss of Asia Ludlow.

“Asia was a 2013 Survivor Ambassador at the Julep Ball, and the true champion that she was, she joined us again at the 2014 Julep Ball to share her story. We were honored again when she began volunteering at our M. Krista Loyd Cancer Resource Center, helping other patients with her unmatched spirit of hope and compassion.

“Asia first fought breast cancer and kept fighting as it spread throughout her body. She was strong and committed, keeping faithfully to the treatment regimen prescribed for her – but her experience reminds us again that cancer is still a formidable enemy despite all we have at our disposal to combat it.

“Her odyssey as a patient with cancer began in 2008 and ended all too soon this week in mid-2014. Her life, however, serves as a legacy to show how one person’s grace, courage and caring heart can and does make a difference for others.”

Donald Miller, M.D., Ph.D., Director, James Graham Brown Cancer Center

To see and hear Asia’s message of hope in her own words, visit the James Graham Brown Cancer Center video here, her profile on Jean West’s Medical Digest here and her interview with Urban Lifestylez here.

The University of Louisville Department of Pediatrics is reorganizing its general pediatrics division, positioning itself to respond better to the needs of the community’s children and to the changing health care enrivonment.

The division provides primary care services to children in Louisville and Campbellsville, Ky., and helps train students and residents in medicine, nursing, dentistry, psychology and social work.. In 2013, its 22 pediatricians were responsible for more than 22,000 patients. Approximately 12 percent of the children in metro Louisville sees a UofL pediatrician as their primary care provider.

“Health care reform has placed a greater emphasis on primary care, where providers can promote health and safety,” said Gerard Rabalais, M.D., MHA, chair of the UofL Department of Pediatrics. “Pediatric programs like ours may be the best place to achieve success with health care reform since we have the ‘longest runway’ to influence attitudes about prevention and healthy lifestyle.”

A number of changes are planned for the coming months.

Consolidating offices, redeploying physicians

The department created a single, expanded practice site in Downtown Louisville, moving the office formerly located on Broadway at Floyd Street a few blocks north  of the Children & Youth Project (C&Y) at 555 S. Floyd St.

C&Y will offer all of the services previously offered at the Broadway office, and the expanded downtown clinic will serve as a medical home with a wider array of on-site ancillary services: social work, psychology, dental care, home health, speech therapy, WIC nutrition services and legal counseling.

“This practice demonstrates the power of a university to bring multiple disciplines together to provide comprehensive health care for children,” Rabalais said.

Patients may see a UofL pediatrician at C&Y or one of the department’s other general pediatrics practices: the Stonestreet location at 9702 Stonestreet Road; or the Sam Swope Kosair Charities Centre at 982 Eastern Parkway.

Families who want a Spanish-speaking provider will have three office locations to choose from in Downtown Louisville, Germantown and South Louisville.

“Consolidating these two offices and deploying our physicians to different locations lays the groundwork for increasing access and building partnerships in the communities we serve,” said Gil Liu, M.D., chief of the UofL general pediatrics division. “Increasingly, we want to be able to say, ‘Our pediatricians are coming to a neighborhood near you.’”

Adding pediatric practices

This summer, the UofL Department of Pediatrics will partner with an East Louisville pediatric practice, bringing the number of general pediatricians and nurse practitioners in the department to 36.

The department will also expand its Campbellsville, Ky., practice – located at 73 Kingswood Dr. – later this summer, partnering with Taylor Regional Hospital to open a satellite office in Columbia, Ky.

Plans also are underway to provide general pediatric care in the West End of Louisville.

“We see these additions as opportunities to expand availability to patients and support community practitioners, who don’t have the resources to support multiple disciplines or the buying power and advantage in contract negotiations that we do,” Rabalais said.

Creating a network

All of the Louisville pediatric practices will soon operate as a network. That means patients will have a medical home for routine visits as well as access to urgent care at any of the other Louisville general pediatric practices. The network also will enable families to access ancillary services headquartered at C&Y and specialty care by UofL pediatric specialists.

“We think an arrangement that offers ‘one-stop shopping’ for multiple health care providers will be good for all our patients,” Dr. Liu said.

Creating additional learning opportunities for trainees

The department’s reorganization also ensures that residents, medical students and trainees from other programs will have places to learn primary care pediatrics. Historically, trainees have spent time in community pediatric practices but these practices may struggle to continue hosting students because of changes in the health care landscape.

“It is part of our educational mission to expand primary care opportunities,” Rabalais said.

Kentucky’s Horses and Hope is going international. Champion equestrian and Horses and Hope Pink Stable member Misdee Wrigley Miller will spread the message of breast cancer awareness as she competes next week in two European Equestrian World Cup qualifying events.

In 2008, the office of Kentucky First Lady Jane Beshear partnered with the Kentucky Cancer Program to create Horses and Hope. The program’s mission is to increase breast cancer awareness, education, screening and treatment referral among Kentucky’s horse industry workers and their families.

The University of Louisville and the University of Kentucky operate the Kentucky Cancer Program and staff Horses and Hope programs and events. UofL’s James Graham Brown Cancer Center, a part of KentuckyOne Health, manages the Kentucky Cancer Program for the western half of the Commonwealth.

On Thursday, July 3, Miller will compete in CAI3* horse driving competitions in Lähden and Riesenbeck, Germany, in the four-in-hand combined driving competition. Both competitions are FEI World Equestrian Game qualifying events. While there, she will spread awareness about the importance of breast cancer screening, early detection and education through the Horses and Hope program—sharing the program’s best practices and encouraging international participation.

Since 2009, she has served as a member of the Pink Stable, a committee of Kentucky horse owners, riders, trainers, farm owners and jockeys that support the Horses and Hope initiative.

“I have been grateful to serve as member of First Lady Jane Beshear's Horses and Hope Pink Stable committee, and even more honored to serve as an ambassador for this important initiative as I compete in Europe,” Miller said. “Women are traditionally care givers, especially so in the horse business; often they take care of their horses before they think of themselves. I have friends and family who have been touched by breast cancer, so I am aware of the importance of early detection. If I accomplish anything here, I want every woman, especially those with high risk, who hear my message to practice self-examination and get screened.”

Miller is a fourth-generation horsewoman and has been involved in the horse business her entire life. She is an accomplished rider and has competed as a United States team member twice in the FEI Pair Horse World Championships, was the 2013 USEF National Champion in Pairs and the 2014 USEF Reserve National Champion in 4-In Hands.

Horses and Hopehas hosted several breast cancer race days at Kentucky racetracks in the past six years, reaching nearly 1 million race track and horse show fans and educating nearly 16,000 equine employees. The program has screened close to 700 workers and detected breast cancer in two individuals, both of whom have received treatment.

The next Horses and Hope Race Day will be at Ellis Park in Henderson, Ky., on Aug. 2. For more information about Horses and Hope and all upcoming events, please visit www.horsesandhope.org.

For more information on breast cancer, please contact the Kentucky Cancer Program at UofL at http://kycancerprogram.org/kcp-west/.

A national publication for health care executives and managers has ranked the University of Louisville’s College of Business as one of the top business graduate schools for physician-executives.

UofL appears on a list Modern Healthcare compiled in May of the top graduate schools awarding advanced degrees in health care business administration in 2013-14. The ranking is based on how many full-time students are pursuing the degree at each school.

UofL placed at the 20^th spot with 45 students, just under Yale School of Management’s 48 students. Rice University’s graduate business school topped the list with 231 students.

UofL’s business school has offered an MBA degree with a health care focus since 2011. Students in the 20-month program take weekend courses preparing them for executive positions in hospital administration, senior care, health insurance, biomedicine and related areas.

For more details, see http://business.louisville.edu/wptest/images/Ranked20.pdf

Telemedicine is an effective strategy to screen for the potentially blinding disease known as retinopathy of prematurity (ROP), according to a study funded by the National Eye Institute (NEI). The investigators say that the approach, if adopted broadly, could help ease the strain on hospitals with limited access to ophthalmologists and lead to better care for infants in underserved areas of the country. NEI is a part of the National Institutes of Health.

The telemedicine strategy consisted of electronically sending photos of babies’ eyes to a distant image reading center for evaluation. Staff at the image reading center, who were trained to recognize signs of severe ROP, identified whether infants should be referred to an ophthalmologist for evaluation and potential treatment. The study tested how accurately the telemedicine approach reproduced the conclusions of ophthalmologists who examined the babies onsite.

“This study provides validation for a telemedicine approach to ROP screening and could help save thousands of infants from going blind,” said Graham E. Quinn, M.D., professor of ophthalmology at the Children's Hospital of Philadelphia and the lead investigator for the study, which is reported today in JAMA Ophthalmology.

The study was conducted by the e-ROP Cooperative Group, a collaboration that includes 12 facilities in the United States and one in Canada. The University of Louisville was the only site in Kentucky among the collaborative group. In addition to UofL, study sites were Johns Hopkins University, Boston Children’s Hospital, Vanderbilt University, Children’s Hospital of Philadelphia, Nationwide Children’s Hospital/Ohio State University Hospital, Duke University, University of Minnesota, University of Oklahoma, University of Pennsylvania, University of Texas Health Science Center at San Antonio, University of Utah and Hospital of the Foothills Medical Center (Calgary, Canada).

Some degree of ROP appears in more than half of all infants born at 30 weeks pregnancy or younger—a full-term pregnancy is 40 weeks—but only about 5 to 8 percent of cases become severe enough to require treatment. In ROP, blood vessels in the tissue in the back of the eye called the retina begin to grow abnormally, which can lead to scarring and detachment of the retina. Treatment involves destroying the abnormal blood vessels with lasers or freezing them using a technique called cryoablation. Early diagnosis and prompt treatment is the best prevention for vision loss from ROP, which is why the American Academy of Ophthalmology recommends routine screening for all babies who are born at gestational age 30 weeks or younger or who weigh less than 3.3 pounds at birth.

The study evaluated telemedicine for ROP screening during the usual care of 1,257 premature infants who were born, on average, 13 weeks early. About every nine days, each infant underwent screening by an ophthalmologist, who assessed whether referral for treatment was warranted. Those who were referred were designated as having referral-warranted ROP (RW-ROP). Either immediately before or after the exam, a non-physician staff member in the neonatal intensive care unit (NICU) took images of the infant’s retinas and uploaded them to a secure server at the University of Oklahoma, Oklahoma City. Trained non-physician image readers at the University of Pennsylvania, Philadelphia, then downloaded the photos, independently evaluated them following a standard protocol, and reported the presence or absence of RW-ROP.

Through the telemedicine approach, non-physician image readers correctly identified 90 percent of the infants deemed to have RW-ROP based on examination by an ophthalmologist. And they were correct 87 percent of the time when presented with images from infants who lacked RW-ROP. The examining ophthalmologists documented 244 infants with RW-ROP on exam. After referral, 162 infants were treated. Of these, non-physician image readers identified RW-ROP in all but three infants (98 percent).

“This is the first large clinical investigation of telemedicine to test the ability of non-physicians to recognize ROP at high risk of causing vision loss,” said Eleanor Schron, Ph.D., group leader of NEI Clinical Applications. “The results suggest that telemedicine could improve detection and treatment of ROP for millions of at-risk babies worldwide who lack immediate in-person access to an ophthalmologist,” she said.

About 450,000, or 12 percent,  of the 3.9 million babies born each year in the United States are premature. The number of preterm infants who survive has surged in middle income countries in Latin America, Asia and Eastern Europe. In these parts of the world, rates of childhood blindness from ROP are estimated at 15 to 30 percent—compared to 13 percent in the United States.

One advantage of telemedicine ROP screening is that it can be done more frequently than screening by an ophthalmologist. “It’s much easier to examine the retina when not dealing with a wiggling baby,” said Quinn said. “If a baby is too fussy or otherwise unavailable when the ophthalmologist visits the NICU, the exam may be delayed until the ophthalmologist returns—sometimes up to a week later.”

Weekly ROP screening—or even more frequently for high-risk babies—is a realistic goal for telemedicine and could help catch all cases needing treatment, according to the report. In the study, imaging was restricted to occasions when an ophthalmologist examined the baby. In practice, hospital staff could implement an imaging schedule based on the baby’s weight, age at birth and other risk factors. “With telemedicine, NICU staff can take photos at the convenience of the baby,” Quinn said.

Telemedicine for evaluating ROP offers several other advantages:

• Telemedicine may help detect RW-ROP earlier. In the study, about 43 percent of advanced ROP cases were identified by telemedicine before they were detected by an ophthalmologist—on average, about 15 days earlier.
• Telemedicine could save babies and their families the hardship and hazards of being unnecessarily transferred to larger nurseries with greater resources and more on-site ophthalmologists. “Telemedicine potentially gives every hospital access to excellent ROP screening,” Dr. Quinn said.
• Telemedicine might also bring down the costs of routine ROP screening by reducing the demands on ophthalmologists, whose time is better allocated to babies who need their attention and expertise. In a separate analysis, the study found that non-physicians and physicians had similar success in assessing photos for RW-ROP. Three physicians evaluated image sets from a random sample of 200 babies (100 with RW-ROP based on the eye exam findings; 100 without) using the standard grading protocol. On average, the physicians correctly identified about 86 percent of RW-ROP cases; the non-physicians were correct 91 percent of the time. The physicians correctly identified about 57 percent of babies without RW-ROP; non-physicians were correct 73 percent of the time.

The cost of establishing a telemedicine ROP screening program includes acquisition of a special camera for taking pictures of the retina, training of NICU personnel to take and transmit quality photos, and establishment and maintenance of an image reading center. “As we move along this road, advances in imaging and grading of images may streamline the process even more,” Dr. Quinn said.

For more information about ROP, visit http://www.nei.nih.gov/health/rop/.

To view a video about e-ROP, visit the NEI YouTube channel at http://youtu.be/7l_CqjV3NMA.

Andrea L. Behrman, Ph.D., was selected to give the Maley Lecture at the American Physical Therapy Association (APTA) in Charlotte, N.C., on June 13. The lecture honors a physical therapist that has made distinguished contributions to the profession of physical therapy in clinical practice.

Behrman is a professor in the Department of Neurological Surgery and Kentucky Spinal Cord Injury Research Center at the University of Louisville and is currently examining neuromuscular recovery in children with spinal cord injuries via both research and clinical practice. She also is a licensed physical therapist and is a Fellow of the American Physical Therapy Association.

Behrman’s lecture was titled, “I never thought that I would need to child-proof my home!” and focused on a paradigm shift for rehabilitation from the traditional view that “paralysis cannot be resolved” to an evidence-based physiological perspective that, with training, “paralysis can be resolved” and recovery is possible – to what degree has yet to be determined. As the mother whose comments inspired the lecture’s title said, “after locomotor training, my child became so mobile that I needed to child-proof my home” – something she never thought she would need to be concerned about.

Researchers have demonstrated that the spinal cord is in fact smart and that it can learn, Behrman said. By providing specific sensory input via intense training, therapists can activate the spinal circuitry and the neuromuscular system below and across the level of the injury.

Using a method known as “activity-based locomotor training,” therapists provide specific sensory information while patients are standing and walking on a treadmill with partial body weight support. Trainers also provide manual cues to promote muscle activation. Behrman demonstrated the benefits of locomotor training for developing trunk control and stepping in children who suffered a spinal cord injury when they were as young as 5 months and were paralyzed for nearly three years.

As director of the University of Louisville Kosair Charities Center for Pediatric Neurorecovery, Behrman and her fellow researchers and clinical partners work to change outcomes for children recovering from paralysis while undergoing locomotor training.

More information about Behrman’s lecture and work at UofL is available on the American Physical Therapy Association website.

Mariusz Ratajczak, M.D., Ph.D., D.Sci., has been selected to receive the prestigious Karl Landsteiner Prize from the German Society for Transfusion Medicine and Immunohematology. Ratajczak holds the Henry M. and Stella M. Hoenig Endowed Chair at the University of Louisville.

The Landsteiner Prize is given by the society to a doctor for outstanding achievements and research in the fields of transfusion and/or immunology. The prize is named after Karl Landsteiner, an Austrian biologist and physician. In addition to distinguishing the main blood groups, Landsteiner also discovered polio along with several other researchers and received the Nobel Prize in Physiology or Medicine in 1930. Landsteiner is recognized as the father of transfusion medicine. Previous recipients of the Karl Landsteiner Prize include Nobel Prize laureate Rolf Zinkernagel (Basel), Karl Blume (Seattle) and Stephanie Dimmeler (Frankfurt).

Ratajczak was honored for his outstanding achievements in the characterization of mechanisms involved in the mobilization of hematopoietic stem cells and the discovery of very small embryonic like stem cells in the adult tissue.

An internationally known specialist in the field of adult stem cell biology, his 2005 discovery of embryonic-like stem cells in adult bone marrow has potential to revolutionize the field of regenerative medicine. The discovery may lead to new treatments for heart disease, eye disease, diabetes and neurodegenerative disorders, as well as provide insight into the development of many forms of leukemia.

In addition to his endowed position, Ratajczak is a professor in the Department of Medicine and the director of the Developmental Biology Research Program and of the Research Flow and Sorting Core Facility at the University of Louisville's James Graham Brown Cancer Center.

In addition to receiving the Karl Landsteiner Prize, Ratajczak has also been invited to deliver an opening lecture on Sept. 9 during the society’s annual meeting in Dresden, Germany.

Researchers at the University of Louisville have uncovered a cadre of small molecules that tell certain proteins to kill lung cancer cells. The team, led by Chi Li, Ph.D., assistant professor of medicine, published its finding in the April 2014 issue of Molecular and Cellular Biology.

One of the characteristics of lung cancer is the dysregulation of apoptosis, or regulated cell death. Cancer cells are able to survive in the unnatural state.

Proteins from the Bcl-2 family are major regulators of apoptosis. One of them, Bax, sometimes becomes erratic and loses its ability to maintain its killer function, which leads to lung tumor development. The researchers realized that this meant Bax potentially could be part of the cure as well.

The researchers used virtual screening in their study, a process where they ran through a computer program all the possible combinations of molecules that could bind with the Bax proteins to find the best combination. After trying more than 10 million molecules, they found the right one. This Bax-activating small molecule compound kills lung cancer cells as well as inhibits the growth of lung tumors transplanted into mice.

The scientific finding of Li and his team showed it is possible to identify small molecules capable of binding and activating Bax proteins that in turn induce apoptosis in cancerous cells. In the study, published in Molecular and Cellular Biology in April of 2014, Li and his team were able to specifically induce tumor cell death while avoiding normal cell death.

The compound also shows synergy with the widely used chemotherapeutic drug carboplatin. This means that the potential application for this compound in cancer treatment is very broad.

The scientific discovery could form the basis for advanced therapeutic agents for cancer in patients, specifically lung cancer, which is especially prevalent in Kentucky.

The high mortality rate of lung cancer is partially attributed to ineffective therapeutic treatments. This makes it very important for scientists to develop new chemotherapeutic drugs for lung cancer.

Li says it could pave the way for new treatment for other types of cancer as well. “Lung cancer is a really big issue for us. We have a large mortality rate, and that’s one of the reasons we wanted to go after lung cancer,” he said. “We are in the process of trying to expand the application of our discovery onto different types of cancer.”

Li and his team will have the opportunity for that expansion very soon. The National Institutes of Health recently awarded them a grant of $1.5 million to continue their groundbreaking research.

Attention, shopaholics: Here’s your chance to be among the very first to shop The Outlet Shoppes of the Bluegrass.

The Outlet Shoppes of the Bluegrass is teaming with the University of Louisville’s James Graham Brown Cancer Center for an Opening Night VIP Preview from 6-9 p.m., Wednesday, July 30, the evening before the facility opens to the general public.

Patrons will be able to get the jump on the rest of Kentuckiana in shopping at choice retail outlets such as Coach, Brook Brothers, Saks Fifth Avenue Off 5^th, Michael Kors, J Crew, Banana Republic, Nike, Talbots, Under Armour and more. They also will receive a free coupon book with over $300 in savings at many of the 80-plus retailers that make up The Outlet Shoppes of the Bluegrass.

Cost is $50 per person with 100 percent of the proceeds going to the James Graham Brown Cancer Center, the only cancer center in the region to use a unified approach to cancer care, with multidisciplinary teams of physicians working together to guide patients through diagnosis, treatment and recovery.

“We are thrilled to partner with The Outlet Shoppes of the Bluegrass,” Michael Neumann, executive director of development for the cancer center, said. “The pairing of Kentucky’s new premier shopping center with the region’s premier cancer research and treatment center is a great fit.”

Only 3,000 tickets to the event are available and are expected to go fast, Neumann said. Tickets are sold online only at www.shoppingforacure.org. Up to 10 tickets may be purchased per transaction.

The Veritas Curat Foundation is handling ticket sales on behalf of the cancer center, and receipts will be provided via email. The email receipt serves as the ticket to the event, and to be admitted, ticket buyers must bring both a printout of the email receipt and identification that matches the name on the ticket.

A silent auction of packages donated by Shoppes retailers also will be held the night of the VIP Preview, Neumann said. Items up for auction will be posted in advance on the website starting July 28, and online bidding will be available until July 30. On-site bidding on the night of the event will be conducted via smartphone only, he added.

The Outlet Shoppes of the Bluegrass is located at Exit 28 on Interstate 64. For additional information on the Opening Night VIP Preview or the James Graham Brown Cancer Center, contact Neumann at 502-562-4642.

Advanced Cancer Therapeutics (ACT), a privately held company dedicated to bringing new anti-cancer therapies to market, announced June 4 that it has begun clinical trials of PFK-158, a small molecule therapeutic candidate that inactivates a novel cancer metabolism target never before examined in human clinical trials. The U.S. Food and Drug Administration approved Phase 1 dose escalation study is evaluating the safety, tolerability and anti-tumor activity of PFK-158 in cancer patients with solid tumors such as melanoma, lung, colon, breast and pancreatic cancer.

PFK-158 is the first 6-phosphofructo-2-kinase/fructose-2,6-biphosphatase 3 (PFKFB3) inhibitor to undergo clinical trial testing in cancer patients. The target, PFKFB3, is activated by oncogenes and the low oxygen state in cancers, stimulates glucose metabolism and is required for the growth of cancer cells as tumors in mice. PFK-158, which has been licensed by ACT from the James Graham Brown Cancer Center at the University of Louisville, inhibits the substrate binding domain of PFKFB3 causing a marked reduction in the glucose uptake and growth of multiple cancer types in mice.

PFK-158 human clinical trials began recruiting patients in May with the first clinical trial site located at the James Graham Brown Cancer Center, a part of KentuckyOne Health. Within weeks of opening the first clinical trial site, ACT was able to open the second clinical trial site at Georgetown University Medical Center in Washington, also in May.

According to Jason A. Chesney, M.D., Ph.D., deputy director of the Brown Cancer Center and a global thought leader and researcher in cancer metabolism, “PFK-158 is not only a first-in-class cancer drug but also the first to target glucose metabolism by inhibiting PFKFB3. This unique mechanism of action has resulted in efficacy against a broad spectrum of human cancers caused by common mutations as well as synergy with targeted agents that are FDA approved for several cancer types.

“As a researcher, it is incredibly rewarding to witness your group's studies move into clinical trials and potentially save the lives of cancer patients,” Chesney said.

“This is a significant milestone for ACT and it supports our dedication to develop significant treatment advancements for cancer patients with first-in-class, potential breakthrough therapeutics like PFK-158,” said Randall B. Riggs, president & CEO of ACT.

About Advanced Cancer Therapeutics (ACT):

ACT is a privately held company dedicated to advancing novel therapeutics for the prevention and treatment of cancer. ACT has successfully established a unique and innovative business model with the University of Louisville’s James Graham Brown Cancer Center whereby ACT is able to obtain exclusive worldwide licenses to novel cancer therapeutics discovered at Brown Cancer Center under preset business terms. ACT then fast-tracks these discoveries, including the selection process for partnership, commercialization and manufacture, to the pharmaceutical industry, and ultimately to the patients who need them. Led by Donald M. Miller, M.D., Ph.D., the Brown Cancer Center employs more than 50 scientists focused on the discovery and advancement of breakthrough cancer therapeutics for patients suffering from cancer. For more information, please visit www.advancedcancertherapeutics.com.

About the James Graham Brown Cancer Center:

The James Graham Brown Cancer Center is a key component of the University of Louisville Health Sciences Center. As part of the region's leading academic, research and teaching health center, the cancer center provides the latest medical advances to patients, often long before they become available in non-teaching settings. The JGBCC is a part of KentuckyOne Health and is affiliated with the Kentucky Cancer Program. It is the only cancer center in the region to use a unified approach to cancer care, with multidisciplinary teams of physicians working together to guide patients through diagnosis, treatment and recovery. For more information, visit our web site, www.browncancercenter.org.

UofL Geriatrics in the Department of Family and Geriatric Medicine at the University of Louisville is calling for nominations for the fourth annual Gold Standard Award for Optimal Aging.

The deadline to submit nominations is 5 p.m., July 15. The award will be presented Sept. 25 at the Annual UofL Geriatrics Gold Standard Award for Optimal Aging Luncheon at the Crowne Plaza Hotel, 830 Phillips Lane.

The Gold Standard Award for Optimal Aging is presented to someone 85 years old or older as of Oct. 1 who is an outstanding model for optimal aging in all areas of life.

“We are seeking people 85-plus who are making the most of whatever their later years bring and who continue to demonstrate great zest for life,” said Christian Davis Furman, M.D., vice chair for geriatric medicine. “The award is presented for optimal aging across the full spectrum of physical health, mental health, social health and spiritual health.”

The nomination process includes submitting information on the nomination form that describes why the nominee qualifies for the award. Nomination forms and information about the luncheon can be found online or obtained by calling (502) 588-4260 or emailing UofLGeriatrics@louisville.edu.

Experts in the use of comprehensive geriatric assessment for hospitalized elders and immunizations in older adults, and the author of the 2012 Beers Criteria – a guide to medication use in elders – will be featured at the 14^th Annual University of Louisville Geriatrics Healthcare Symposium.

The conference will be held Friday, Sept. 19, at the Seelbach Hilton Hotel, 500 S. Fourth St. in Downtown Louisville.

The conference is sponsored by the Division of Geriatrics in the Department of Family and Geriatric Medicine at the University of Louisville and provides information on the latest research and best practices in care for people age 65 and older. Plenary speakers include:

• Michael Malone, M.D., Center for Senior Health & Longevity, Aurora Sinai Medical Center, Milwaukee, addressing the acute care of elderly hospitalized patients.
• Kenneth Schmader, M.D., Geriatrics Division Chief, Duke University School of Medicine, Durham, N.C., providing information on immunizations for elders
• Todd Semla, Pharm.D., Feinberg School of Medicine, Northwestern University, Chicago, speaking on polypharmacy, the overuse or misuse of medications in older adults

Other sessions will be held on POLST: Physician’s Orders for Life, disease screening and prevention, caregiver burnout, injury prevention, exercise, elder abuse, dementia and enhancing independence in the older adult.

The conference is open to health care professionals and students and the public alike. CE credit will be available for physicians, nurses, social workers and other professionals working in the field of geriatrics.

For details, contact the UofL Division of Geriatrics, 502-852-3480 or awburk02@louisville.edu.

Benefactors of a fund to support patients at the James Graham Brown Cancer Center at the University of Louisville are sponsoring their second annual sand volleyball event to raise money for the fund.

In 2013, Alex and Tommy Gift established the Mary Jane Gift Quality of Life Fund at the cancer center in honor of their late mother. The fund helps patients and their families enjoy life while facing a cancer diagnosis.

To benefit the fund, the Gifts are sponsoring The Second Annual Spike It to Cancer Sand Volleyball Tournament at Baxter Jack’s sand volleyball complex, 427 Baxter Ave. on Saturday, June 7. Registration will be held from 1-2:30 p.m., and games will begin at 3 p.m.

Admission is $20 per person. Payment by cash or check will be accepted at the door, or participants can pay by credit card at the cancer center’s secure online link.

“All proceeds from this event go to the Mary Jane Gift Quality of Life Fund that pays for extras provided to our patients and caregivers,” Michael Neumann, executive director of development, said. “Additionally, The Brewery on Baxter Avenue directly across the street from Baxter Jack’s has agreed to donate a portion of all food and beverage sales to us during the event.

“These gifts go a long way in bringing cheer to our patients and their families. For example, the fund provided Thanksgiving turkeys to many of our patients and their families last November. Also, one of our physicians, Dr. Cesar Rodriguez, used funds raised by the 2013 Spike It to Cancer to give picnic baskets to 26 patients on Easter morning.”

For additional details, contact Neumann at 502-562-4642.