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USC experts available to comment on appetite control, cancer and flu season




chair of maternal-fetal health at the Diabetes and Obesity Research Institute at the Keck School of Medicine of USC. She is an expert in obesity, sugar consumption and appetite regulation. She can address the brain's response to fructose and glucose ingestion, specifically brain regions that regulate appetite and reward processing. “Fructose consumption has increased dramatically over the last few decades, paralleling the rise in obesity rates. Compared to glucose, the main type of sugar in our bloodstream and the brain's source of fuel, fructose is processed differently by the body,” said Page. "Our research shows that when compared to glucose, the brain doesn't get the 'fullness' signal it needs to stop eating, which leaves us feeling hungry and could contribute to overeating." She can be reached at (323) 442-2804 or kpage@usc.edu.

Cancer

Stephen B. Gruber, M.D., Ph.D., M.P.H., is a professor of medicine at the Keck School of Medicine of USC and director of the USC Norris Comprehensive Cancer Center. His research focuses on the causes of cancer, clinical cancer genetics and translational research in cancer prevention. He can address current cancer trends found in the Annual Report to the Nation on the Status of Cancer, which is published in the Journal of the National Cancer Institute. He can be contacted through the USC Health Sciences Public Relations & Marketing Office at (323) 442-2823 or lridgewa@usc.edu.

Flu Season

Sharon E. Orrange, M.D., is an assistant professor of clinical medicine at the Keck School of Medicine of USC. An expert in internal medicine and primary care, she can address influenza vaccinations as well as flu season activity. “The dominant influenza strain this year is influenza A (H3N2,) which has been associated with more severe flu seasons,” said Orrange. "The good news is that this year’s flu vaccine is a 90 percent match for the specimens that have been sent to the CDC and about 112 million Americans have been vaccinated this season." She can be reached at (323)-442-5100 or orrange@usc.edu.

ABOUT KECK MEDICINE OF USC
Keck Medicine of USC encompasses the University of Southern California's medical school and clinical enterprise. It consists of the Keck School of Medicine of USC and the Keck Medical Center of USC.
Appetite Control

Kathleen Page, M.D., is an assistant professor of medicine and
Depressed stroke survivors may face triple the risk of death

 
 

Southern California (USC)-led study released today that will be presented at the American Academy of Neurology’s 65th Annual Meeting in San Diego, March 16 to 23, 2013.








medical officer at USC-affiliated Rancho Los Amigos National Rehabilitation Center, noted that similar associations have been found regarding depression and heart attack, but less is known about the association between stroke, depression and death.

The research included 10,550 people between the ages of 25 and 74 followed for 21 years. Of those, 73 had a stroke but did not develop depression; 48 had stroke and depression; 8,138 did not have a stroke or depression and 2,291 did not have a stroke but had depression.

After considering factors such as age, gender, race, education, income level and marital status, the risk of dying from any cause was three times higher in individuals who had stroke and depression compared to those who had not had a stroke and were not depressed. The risk of dying from stroke was four times higher among those who had a stroke and were depressed compared to people who had not had a stroke and were not depressed.

“Our research highlights the importance of screening for and treating depression in people who have experienced a stroke,” said Towfighi. “Given how common depression is after stroke, and the potential consequences of having depression, looking for signs and symptoms and addressing them may be key.”
People who are depressed after a stroke may have a tripled risk of dying early and four times the risk of death from stroke than people who have not experienced a stroke or depression, according to a University of
“Up to one in three people who have a stroke develop depression,” said study author Amytis Towfighi, M.D., assistant professor of neurology at the Keck School of Medicine of USC and a member of the American Academy of Neurology. “This is something family members can help watch for that could potentially save their loved one.”

Towfighi, who is chair of the Department of Neurology and associate chief
Smoking intensity and cancer markers predict seriousness of bladder cancer

 

study published early online in Cancer, a peer-reviewed journal of the American Cancer Society. The study also found that a panel of bladder cancer markers can predict which particular cases are at the highest risk for a fatal outcome.







Anirban P. Mitra,
M.D., Ph.D.
The researchers found that the bladder cancers that developed in individuals who smoked intensely were more likely to be deadly than bladder cancers that developed in those who never smoked, or who smoked less. The study also revealed that changes in particular proteins are often present in bladder cancers that have become deadly.

“We have identified a panel of nine molecular markers that can robustly and reproducibly predict bladder cancer prognosis independent of standard clinical criteria and smoking history,” said Mitra. Patients with alterations in six to nine markers had a very poor outcome, raising the hypothesis that these individuals could have benefited from more aggressive treatments.

Because the number of changes in these proteins was directly proportional to patients’ health outcomes in a progressive fashion, the findings confirm the theory that an accumulation of changes is more important than individual changes in determining the characteristics of a given cancer. The link between smoking intensity and prognosis found in this study points to the incrementally harmful effects of smoking.

“The study’s findings are extremely clinically relevant as bladder cancer is one of the most expensive malignancies to treat,” said Cote, who is director of the Genitourinary Malignancies Program at UM’s Sylvester Comprehensive Cancer Center. “Personalized patient management is urgently needed for this disease as current clinical stratification cannot predict outcomes of individual patients.”
Smoking not only causes bladder cancer — it also affects its course, in that people who smoke more have greater likelihood of developing more aggressive and deadly disease. That is one of the conclusions of a new
Researchers have known that smoking is one of the most common causes of bladder cancer, but they’ve wondered whether it also affects how the disease progresses. To investigate, Richard J. Cote, M.D., formerly of the University of Southern California (USC) and now with the University of Miami (UM) Miller School of Medicine, and Anirban P. Mitra, M.D., Ph.D., of the Keck School of Medicine of USC, led a team that analyzed bladder tumors and smoking history in 212 multi-ethnic patients recruited through the Los Angeles County Cancer Surveillance Program between 1987 and 1996.
USC experts available to comment on bladder cancer causes, brain injury and the flu season



pathology at the Keck School of Medicine of USC. His research focuses on the causation and progression of genitourinary cancers, with an emphasis on urinary bladder cancer. He can address new research that links increased smoking to the progression of deadly bladder cancers. "Our study revealed a unique panel of nine markers that can potentially predict outcomes of bladder cancer patients after surgery, independent of standard clinical parameters and smoking history," said Mitra. "The panel can therefore identify early on those patients who may require more aggressive treatments like chemotherapy in addition to surgery." He can be reached at (213) 926-2437 or amitra@usc.edu.

Brain Injury

Gabriel Zada, M.D., is an assistant clinical professor of neurosurgery at the Keck School of Medicine of USC and director of Cranial Base Endoscopic Surgery at the USC Norris Comprehensive Cancer Center. He is an expert in traumatic brain injury, pituitary tumors and advanced cranial base surgery. He can comment on the severity and effects of brain damage incurred from head trauma. "A considerable amount of emerging evidence supports the idea that some professional athletes with repetitive traumatic brain injury have a propensity for developing chronic traumatic encephalopathy, or CTE," said Zada. "We are still actively researching and learning about the potentially severe cognitive and neuropsychiatric consequences of this degenerative condition." He can be reached at (323) 226-7421 or gzada@usc.edu.

Flu Season

Sharon E. Orrange, M.D., is an assistant professor of clinical medicine at the Keck School of Medicine of USC. An expert in internal medicine and primary care, she can address influenza vaccinations as well as flu season activity. “The dominant influenza strain this year is influenza A (H3N2), which has been associated with more severe flu seasons,” said Orrange. "The good news is that this year’s flu vaccine is a 90 percent match for the specimens that have been sent to the CDC and about 112 million Americans have been vaccinated this season." She can be reached at (323)-442-5100 or orrange@usc.edu.

ABOUT KECK MEDICINE OF USC

Keck Medicine of USC encompasses the University of Southern California's medical school and clinical enterprise. It consists of the Keck School of Medicine of USC and the Keck Medical Center of USC.
Bladder Cancer Causes

Anirban P. Mitra, M.D., Ph.D., is a senior research associate of
Childhood obesity linked to more immediate health problems
than previously thought



study focuses on the condition's immediate consequences and shows that obese youngsters are at far greater risk than had been supposed.    

Compared to kids who are not overweight, obese children are at nearly twice the risk of having three or more reported medical, mental or developmental conditions, the UCLA researchers found. Overweight children had a 1.3 times higher risk.

"This study paints a comprehensive picture of childhood obesity, and we were surprised to see just how many conditions were associated with childhood obesity," said lead author Dr. Neal Halfon, a professor of pediatrics, public health and public policy at UCLA, where he directs the Center for Healthier Children, Families and Communities. "The findings should serve as a wake-up call to physicians, parents and teachers, who should be better informed of the risk for other health conditions associated with childhood obesity so that they can target interventions that can result in better health outcomes."   

With the dramatic rise in childhood obesity over the past two decades, there has been a parallel rise in the prevalence of other childhood-onset health conditions, such as attention deficit–hyperactivity disorder, asthma and learning disabilities. But previous studies on the topic have been limited due to a narrow focus on a specific region of the county, a small sample size or a single condition.  

The new UCLA research, a large population-based study of children in the United States, provides the first comprehensive national profile of associations between weight status and a broad set of associated health conditions, or co-morbidities, that kids suffer from during childhood.

Overall, the researchers found, obese children were more likely than those who were classified as not overweight to have reported poorer health; more disability; a greater tendency toward emotional and behavioral problems; higher rates of grade repetition, missed school days and other school problems; ADHD; conduct disorder; depression; learning disabilities; developmental delays; bone, joint and muscle problems; asthma; allergies; headaches; and ear infections.

For the study, the researchers used the 2007 National Survey of Children's Health, analyzing data on nearly 43,300 children between the ages 10 and 17. They assessed associations between weight status and 21 indicators of general health, psychosocial functioning and specific health disorders, adjusting for sociodemographic factors.

Of the children in the study, 15 percent were considered overweight (a body mass index between the 85th and 95th percentiles), and 16 percent were obese (a BMI in the 95th percentile or higher).

The study, which is currently available online, will be published in the January–February print issue of the journal Academic Pediatrics.

The UCLA researchers speculate that the ongoing shift in chronic childhood conditions is likely related to decades of underappreciated changes in the social and physical environments in which children live, learn and play. They propose that obesity-prevention efforts should target these social and environmental influences and that kids should be screened and managed for the co-morbid conditions.

The researchers add that while the strength of the current study lies in its large population base, future studies need to examine better longitudinal data to tease out causal relationships that cannot be inferred from a cross-sectional study.

"Obesity might be causing the co-morbidity, or perhaps the co-morbidity is causing obesity — or both might be caused by some other unmeasured third factor," Halfon said. "For example, exposure to toxic stress might change the neuroregulatory processes that affect impulse control seen in ADHD, as well as leptin sensitivity, which can contribute to weight gain. An understanding of the association of obesity with other co-morbidities may provide important information about causal pathways to obesity and more effective ways to prevent it."

Halfon's co-authors on the study included Kandyce Larson and Dr. Wendy Slusser, both of UCLA. 

The study was supported by funding from the Maternal and Child Health Bureau of the Health Resource Services Administration.

The authors have no financial ties to disclose.

For more information on the UCLA Center for Healthier Children, Families and Communities, please visit www.healthychild.ucla.edu.  

For more news, visit the UCLA Newsroom and follow us on Twitter.
While a great deal of research on childhood obesity has spotlighted the long-term health problems that emerge in adulthood, a new UCLA 
Right target, but missing the bulls-eye for Alzheimer’s
UCLA researchers discover new point of attack for drug therapy



          



For decades now, researchers have been trying, with limited success, to develop drugs that prevent this clumping. Such drugs require a "target" — a structure they can bind to, thereby preventing the toxic actions of Abeta.  

Now, a new study out of UCLA suggests that while researchers may have the right target in Abeta, they may be missing the bull's-eye. Reporting in the Jan. 23 issue of the Journal of Molecular Biology, UCLA neurology professor David Teplow and colleagues focused on a particular segment of a toxic form of Abeta and discovered a unique hairpin-like structure that facilitates clumping.  

"Every 68 seconds, someone in this country is diagnosed with Alzheimer's," said Teplow, the study's senior author and principal investigator of the NIH-sponsored Alzheimer's Disease Research Center at UCLA. "Alzheimer's disease is the only one of the top 10 causes of death in America that cannot be prevented, cured or even slowed down once it begins. Most of the drugs that have been developed have either failed or only provide modest improvement of the symptoms. So finding a better pathway for these potential therapeutics is critical."  

The Abeta protein is composed of a sequence of amino acids, much like "a pearl necklace composed of 20 different combinations of different colors of pearl," Teplow said. One form of Abeta, Abeta40, has 40 amino acids, while a second form, Abeta42, has two extra amino acids at one end.

Abeta42 has long been thought to be the toxic form of Abeta, but until now, no one has understood how the simple addition of two amino acids made it so much more toxic then Abeta40.  

In his lab, Teplow and his colleagues used computer simulations in which they looked at the structure of the Abeta proteins in a virtual world. The researchers first created a virtual Abeta peptide that only contained the last 12 amino acids of the entire 42–amino-acid-long Abeta42 protein. Then, said Teplow, "we just let the molecule move around in a virtual world, letting the laws of physics determine how each atom of the peptide was attracted to or repulsed by other atoms."  

By taking thousands of snapshots of the various molecular structures the peptides created, the researchers determined which structures formed more frequently than others. From those, they then physically created mutant Abeta peptides using chemical synthesis.  

"We studied these mutant peptides and found that the structure that made ‘Abeta42 Abeta42’ was a hairpin-like turn at the very end of the peptide of the whole Abeta protein," Teplow said.  

The hairpin turn structure was not previously known in the detail revealed by the researchers, "so we feel our experiments were novel," he said. "Our lab is the first to show that it is this specific turn that accounts for the special ability of Abeta42 to aggregate into clumps that we think kills neurons. Abeta40, the Abeta protein with two less amino acids at the end of the protein, did not do the same thing."  

Hopefully, the work of the Teplow laboratory presents what may the most relevant target yet for the development of drugs to fight Alzheimer's disease, the researchers said.  

Other authors on the study included Robin Roychaudhuri, Mingfeng Yang, Atul Deshpande, Gregory M. Cole and Sally Frautschy, all of UCLA, and Aleksey Lomakin and George B. Benedek of the Massachusetts Institute of Technology.  

Funding for the study was provided by grants from the State of California Alzheimer's Disease Research Fund, a UCLA Faculty Research Grant, the National Institutes of Health (AG027818, NS038328) and the James Easton Consortium for Alzheimer's Drug Discovery and Biomarkers.  

The Mary S. Easton Center for Alzheimer's Disease Research at UCLA is part of the UCLA Department of Neurology, which encompasses more than 20 disease-related research programs, along with large clinical and teaching programs. These programs cover brain mapping and neuroimaging, movement disorders, Alzheimer's disease, multiple sclerosis, neurogenetics, nerve and muscle disorders, epilepsy, neuro-oncology, neurotology, neuropsychology, headaches and migraines, neurorehabilitation, and neurovascular disorders.

The department ranked first among its peers nationwide in National Institutes of Health funding (2002–09). 
Alzheimer's disease is the most common cause of late-life dementia. The disorder is thought to be caused by a protein known as the amyloid-beta protein, or Abeta, which clumps together in the brain, forming plaques that are thought to destroy neurons. This destruction starts early, too, and can presage clinical signs of the disease by up to 20 years. 
For the Second Time, Children’s Hospital Los Angeles Receives the Prestigious “Magnet® Recognition” for Nursing Excellence
Only 6.6 percent of hospitals in US have achieved Magnet status






“Earning Magnet recognition the first time in 2008 was a milestone in the history of Children’s Hospital Los Angeles,” Cordova says. “To have achieved Magnet status a second time confirms the unwavering dedication of our nurses and our nursing leadership and their commitment to providing the best in patient care. It demonstrates why we are ranked among the top children’s hospitals in the United States, if not the world.”

The Magnet Recognition Program® was developed by the ANCC, the world's largest and most prestigious nurse credentialing organization, to recognize health care organizations that demonstrate quality patient care, nursing excellence and innovations in professional nursing practice. According to the ANCC, Magnet designation benefits consumers by identifying hospitals with superior nursing care and quality patient outcomes. It is the highest honor a health care organization can receive for professional nursing practice.

Only a select group of 395 hospitals out of almost 6,000 U.S. health care organizations have achieved Magnet status, recognizing only the very best hospitals across the country. In California, Children’s Hospital is one of only 28 recognized Magnet organizations.

Hospitals must reapply for Magnet recognition every four years and Children’s Hospital received word Jan. 16 from the Commission on Magnet leadership that it had achieved Magnet redesignation for another four years. A rigorous four-year application process that was overseen by the leadership of Children's Hospital Los Angeles Vice President for Patient Care Services and Chief Nursing Officer  Mary Dee Hacker (Glendale, Ca.), MBA, RN, NEA-BC, FAAN and Suzanne Taylor (Simi Valley, Ca.), MSN, RN-BC, EMT, the hospital's director of Clinical Education and Professional Development, preceded the Magnet recognition redesignation.

For the second time, Children’s Hospital Los Angeles receives the prestigious “Magnet® Recognition” for Nursing Excellence.

“The entire organization demonstrates incredible professional commitment daily,” Hacker says. “Everybody cares about our patients; everybody cares about our patient families and every single person working here strives to be better.”

In 2008, the Commission on Magnet introduced a new vision, and a new conceptual model that required an organization’s nursing force to prove that they are leaders in five key areas: Transformational Leadership; Structural Empowerment; Exemplary Professional Practice; New Knowledge, Innovations and Improvements and Empirical Outcomes.

The Magnet commission reported that Children’s Hospital exceeded many of the high Magnet standards and stood out as an example to hospitals across the U.S. in several areas, including the hospital’s transformational nursing leadership practices, its current and long-term strategic priorities in a changing medical market and the organization-wide adaptation to a new hospital building, the Marion and John E. Anderson Pavilion. In addition, the commission cited many practices and programs that exceeded its stringent standards, including: daily interdisciplinary rounds with patients and families; efficient medication administration; outreach programs for homeless youth; children’s reading and library programs; spinal education for scoliosis patients; teleconferencing interpreter services; and bedside technology to enhance patient care and parent-nurse communication.

“Our nurses are indefatigable,” Hacker says. “They provide the highest quality of care built on a foundation of evidence-based best practices, and they have achieved the goal of becoming leaders in research and education. Our nurses work as college professors, lecture at national and international conferences and have been published in professional journals and textbooks.”

Margaux Chan (La Crescenta, Ca.), RN, BSN, CPN, and Susan G. Crandall (Azusa, Ca.), RN, BSN, CCRN, the hospital’s Magnet Program co-managers, coordinated the Magnet application process, which involved the efforts of more than 100 nurses and staff in the creation of a document of more than 4,000 pages, detailing the hospital’s nursing practices, standards, governance and leadership.

Cheers erupted on Jan. 16 just before noon when the Magnet commission delivered the great news in a phone call to more than 300 Children’s Hospital physicians, nurses and staff who were waiting in anticipation in the hospital’s John Stauffer Conference Room. “The Magnet redesignation verifies and validates the excellence of Children’s Hospital Los Angeles,” Hacker told the boisterous crowd moments after receiving the news. “We cannot thank the commission enough for this honor.”

About Children’s Hospital Los Angeles: Children's Hospital Los Angeles has been named the best children’s hospital in California and among the top five in the nation for clinical excellence with its selection to the prestigious U.S. News & World Report Honor Roll. Children’s Hospital is home to The Saban Research Institute, one of the largest and most productive pediatric research facilities in the United States. Children’s Hospital is also one of America's premier teaching hospitals through its affiliation since 1932 with the Keck School of Medicine of the University of Southern California.

For more information, visit CHLA.org. Follow us on Twitter, Facebook, YouTube and LinkedIn, or visit our blog: WeAreChildrens.org. 
For the second time in four years, The American Nurses Credentialing Center (ANCC) bestowed Magnet® recognition for nursing excellence on Children’s Hospital Los Angeles, according to an announcement today by Richard D. Cordova, FACHE, president and CEO of Children’s Hospital Los Angeles.
USC experts available to comment on heart health awareness
and mental health policy



for the division of cardiovascular medicine at the Keck School of Medicine of USC. Her areas of expertise include women's health and cardiology consultation for organ transplantation. In recognition of National Wear Red Day on Feb. 1, Van Herle can address heart health awareness for women. "Only 1 in 5 American women recognize heart disease as their biggest health risk. Currently, 43 million women in the U.S. are affected by heart disease," said Van Herle. "Despite these sobering statistics, 80 percent of cardiovascular diseases and strokes can be prevented and treated with the appropriate education, assessment of risk factors and recognition of symptoms." Contact her at (323) 442-6130 or helga.vanherle@med.usc.edu.

Mental Health Policy

Anand Pandya, M.D., recently joined the Keck School of Medicine of USC as an associate professor of clinical psychiatry and vice-chair of clinical affairs. He is an expert in mental health policy and disaster psychiatry. He can discuss the mental health directives recently issued under President Obama's administration. "The Presidential initiatives addressing gun violence have great promise," said Pandya. "The mental health community has long been advocating for the administration to finalize mental health parity rules and ensure coverage of mental health care under the Affordable Care Act, so it is reassuring that the President sees this as a priority. However, only time will tell whether these good intentions will translate into action." Contact him at (323) 442-4000 or anandpan@med.usc.edu.

ABOUT KECK MEDICINE OF USC: Keck Medicine of USC encompasses the University of Southern California's medical school and clinical enterprise. It consists of the Keck School of Medicine of USC and the Keck Medical Center of USC.
Heart Health Awareness

Helga Van Herle, M.D., Ph.D., is an associate professor of clinical medicine
UCLA to play key role in worldwide effort to map human brain
Laboratory of Neuro Imaging to use expertise to piece together brain's 'puzzle'



a massive, unprecedented effort to understand the human brain.  

The European-led Human Brain Project (HBP), announced Jan. 28, will pull together all the world's existing knowledge about the brain and reconstruct it, piece by piece, in super-computer–based models and simulations. The 10-year, 1.19 billion–euro ($1.6 billion) effort is backed by the European Commission and will begin with 87 partners in 27 countries.  

UCLA's LONI has long been at the forefront in developing computational algorithms and scientific approaches for the comprehensive and quantitative mapping of brain structure and function. As a result, the laboratory is perfectly positioned to play a similar role as part of the HBP.  

"This is an ambitious and worldwide collaborative effort to understand the human brain and the diseases that attack it," said Arthur Toga, LONI's director and a professor of neurology at UCLA. "Our role will be to focus on harmonizing all of the data that will be pouring into our computers. The trick will be to find a way to aggregate all this information in order for it to be useful. We will be receiving brain images and all the data that goes with it, both recent data as well as images that were done years ago. 

"Combining disparate data is difficult," he added, "so sophisticated new computer algorithms will be needed."  

LONI's portion of the HPB funding will be approximately $10.8 million. In addition to UCLA, other U.S. institutions involved in the project are Yale University, the University of Tennessee and the Seattle-based Allen Institute for Brain Science.

The HBP will provide new tools to help scientists understand the brain and its fundamental mechanisms and to apply this knowledge in future medicine and computing.  

Central to the project is information and computing technology. The HBP will develop information and computing technology platforms for neuroinformatics, brain simulation and super-computing that will make it possible to combine neuroscience data from all over the world, to integrate the data in unifying models and simulations of the brain, to check the models against data from biology, and to make the data available to the world scientific community.  

The ultimate goal is to allow neuroscientists to connect the dots leading from genes, molecules and cells to human cognition and behavior.  

Combining such data is LONI's expertise. Since the 1990s, the lab has been building universal brain atlases, each describing sub-populations with similar characteristics in health and disease. The algorithms written and constantly updated by LONI take millions of brain images and modify them to make a certain number of brains look "the same" in order to describe, for example, a specific population, such as right-handed females, or to show the early stages of Alzheimer's disease.  

"Thus, we are well positioned to contribute to these important and challenging goals," Toga said.  

The Laboratory of Neuro Imaging at UCLA, which seeks to improve understanding of the brain in health and disease, is a leader in the development of advanced computational algorithms and scientific approaches for the comprehensive and quantitative mapping of brain structure and function. It is part of the UCLA Department of Neurology, which encompasses more than a dozen research, clinical and teaching programs. The department ranks in the top two among its peers nationwide in National Institutes of Health funding.  

For more news, visit the UCLA Newsroom and follow us on Twitter.
UCLA's Laboratory of Neuro Imaging (LONI) has entered into a partnership with academic centers from Europe and around the world in
USC scientists design mouse with more human-like immune response




more cost-effective development of next-generation drugs to treat human diseases like cancer, diabetes and tuberculosis.

Medical researchers have long used mice and rats to help formulate new drugs and vaccines, in part because their genetic and biological characteristics closely parallel human physiology. But mice are not humans, and many experimental drugs that work extraordinarily well in rodents fail miserably when tested in people. One such drug, α-galactosylceramide (α-GalCer), essentially wipes out cancerous tumors in mice by activating the body’s immune system; for reasons not entirely clear, the drug does not trigger the same response in people with cancer.

Scientists hypothesize that the failure to translate is due to subtle differences between the CD1d molecules in mice and humans and how they respond to tumors and infection. CD1d molecules are found on certain cells that trigger the body’s innate immune response. In a study to be published by the Proceedings of the National Academy of Sciences the week of Feb. 4, USC researchers describe how they genetically engineered mice to express CD1d molecules that look more like those in humans and in more similar proportions. More importantly, the humanized CD1d molecules effectively trigger natural killer T (NKT) cells—a recently discovered type of white blood cell that attacks tumors and infection—in live animals when exposed to α-GalCer.

“It’s the best model we have in the field,” said Weiming Yuan, Ph.D., assistant professor of molecular microbiology and immunology at the Keck School of Medicine of USC and principal investigator of the study. “We’ve basically set a platform to fast-track the identification of immunotherapies that can kill cancer and also make vaccines stronger.”

Once activated, NKT cells react in a matter of hours whereas other T cells may take days. This rapid response makes them difficult to study, but also an ideal target for drug-makers. Yuan’s humanized mouse allows scientists to more accurately test the viability of those NKT cell-targeting drugs before going to human clinical trials.

“Before, it would have been a guess as to whether the drug would work in people. Now, the chance of success goes from 1 out of 100 to 1 out of 5,” Yuan said.

Yuan and colleagues have yet to demonstrate the effects of inserting a more human-like version of the final component of the CD1d/NKT system, the T cell receptor. More experiments are necessary to determine why α-GalCer is ineffective in treating people with cancer and to develop novel α-GalCer derivatives that work with the human immune system.

Co-authors include Xiangshu Wen, Seil Kim and Agnieszka Lawrenczyk of the Keck School of Medicine; Ping Rao of the UCLA Immunogenetics Center and Department of Pathology; Leandro J. Carreño and Steven A. Porcelli of the Albert Einstein College of Medicine at Yeshiva University; and Peter Cresswell of the Yale University School of Medicine. The research was supported by the National Institutes of Health (R01 AI091987, R01 AI059167, R01 AI045889), the Harry Lloyd Charitable Trust, the Margaret Early Medical Research Trust, and the Howard Hughes Medical Institute.

Article cited:
Wen, X., Rao, P., Carreño, L.J., Kim, S., Lawrenczyk, A., Porcelli, S., Cresswell, P. & Yuan, W. (2013). Human CD1d knock-in mouse model demonstrates potent antitumor potential of human CD1d-restricted invariant natural killer T cells. Proceedings of the National Academy of Sciences. Published online Feb. 4, 2013. doi:10.1073/pnas.1300200110
Medical scientists at the University of Southern California (USC) have bred a first-of-its-kind mouse model that possesses an immune response system more like a human’s. The discovery makes way for quicker and
USC experts available to comment on Beijing's air pollution crisis and wise consumer health care



2012, he published a study in the

Journal of the American Medical Association that linked improved heart health to a short-term decrease in air pollution levels during the Beijing Olympics. He can comment on the health effects of poor air quality in China and other geographic areas. "The public and the Chinese government should mind the results of our study on air quality and the Beijing Olympics," Zhang said. "Achieving short-term economic profits by using dirty fossil fuels like coal and low-quality petroleum ultimately makes society pay a higher price—not only in today’s smog but also tomorrow’s climate change-related disasters." Contact him at (323) 442-1099 or junfengz@usc.edu.

Wise Consumer Health Care: Michael R. Cousineau, DrPH, is a research associate professor of preventive medicine at the Keck School of Medicine of USC. His expertise includes health care policy and reform for underserved populations. In recognition of wise health care consumer month, he can discuss useful resources for understanding health policies and expenses. "Many people do not learn about the terms and conditions of their own health insurance policies until they are injured or sick. This is the wrong time to try to understand limits of coverage or out-of-pocket expenses," said Cousineau. "Every year, make it a point to pull out your policies and check that conditions meet your family's needs. Call your broker or health plan representative if you have questions." He can be contacted through the USC Health Sciences Public Relations & Marketing Office at (323) 442-2823 or lridgewa@usc.edu.

ABOUT KECK MEDICINE OF USC: Keck Medicine of USC encompasses the University of Southern California's medical school and clinical enterprise. It consists of the Keck School of Medicine of USC and the Keck Medical Center of USC.
Beijing's Air Pollution Crisis: Junfeng “Jim” Zhang, Ph.D., is professor of environmental and global health at the Keck School of Medicine of USC.  In
USC recruits two renowned neurosurgeons to bolster multidisciplinary
spine care center



disciplinary, academic-based spine center at the Keck Medical Center of USC.

John C. Liu, M.D., and Frank Acosta, M.D., previously practicing at Cedars-Sinai Medical Center, join other neurosurgical and orthopaedic spine experts at USC and begin seeing patients on Feb. 1, 2013.

Liu, a recognized leader and considered a pioneer in minimally invasive surgical techniques for the spine, has been named professor of neurosurgery and director of the spine division at the Keck School of Medicine of USC. Acosta, a fellowship-trained neurosurgeon in complex spine deformity, has been named associate professor of neurosurgery at the Keck School. Both are experts in the clinical care of complicated spinal disorders and join USC from the Cedars-Sinai Spine Center.

“At the Keck Medical Center of USC, we are committed to ensuring that our patients have access to the best doctors,” said Tom Jackiewicz, senior vice president and CEO for USC Health. “Both Dr. Liu and Dr. Acosta are tremendous additions to the medical center’s comprehensive spine program.”

Liu, a board certified neurosurgeon, had been vice chairman of spine services and co-medical director of the spine center at Cedars-Sinai since January 2011. Prior to Cedars, Liu was director of spinal surgery at Northwestern University in Chicago. One of the country’s preeminent specialists in intricate and minimally invasive spine surgery, Liu is leading research to study innovative technologies and techniques for the treatment of conditions such as spinal deformities, scoliosis and spinal cord injuries.

“The opportunity to join a team of doctors as distinguished as those at USC and help them build a premier academic spine center was difficult to turn down,” said Liu. “I am honored to have this opportunity.”

Acosta, who has published more than 70 peer-reviewed articles, led a clinical practice at Cedars-Sinai that focused on complex spinal reconstruction and spinal deformities. His research, which concentrates on the diagnosis and treatment of spinal disorders, has been funded by National Institutes of Health, Harvard Medical School and Howard Hughes Medical Institute grants and fellowships.

“I am very much looking forward to joining the USC family,” Acosta said. “I think the team approach that we will take in both the clinical and basic research settings will not only make USC's spine program one of the best in the nation, but will ultimately improve the lives of patients suffering from spinal problems who seek treatment at USC.”

The Keck Medical Center of USC hosts physicians and surgeons with expertise in a range of neurological diseases and disorders, including minimally invasive surgical techniques, diagnostic tests and medicine.

“The neurosurgery and neurology programs at Keck Hospital of USC and USC Norris Cancer Hospital are second to none,” said Scott Evans, CEO of the USC hospitals. “Our approach to patient care is comprehensive and we are privileged to be able to call upon Dr. Liu and Dr. Acosta’s expertise in diagnosing and treating the most complex of spinal disorders.”

Spinal diseases that change the structure of the spine or damage the vertebrae often cause pain and can limit movement. Treatment varies by disease, but USC has assembled a cadre of specialists to provide complete care for the patient with spinal problems.

“Collaborating with the doctors in USC’s Department of Orthopaedic Surgery, we are building the leading spinal surgery program on the West Coast,” said Steven Giannotta, M.D., chair of the Department of Neurological Surgery. “Dr. Liu and Dr. Acosta, along with Dr. Patrick Hsieh and Dr. Thomas Chen, are integral in setting that initiative into motion.”

A lieutenant colonel of the United States Army Reserves, Liu has earned several honors including the Global War on Terrorism Service Medal, the Brooke Army Medical Center Commanding General Award for Excellence and the Army Achievement Medal for Meritorious Service. He earned his medical degree from the University of California, Los Angeles, and completed a surgical internship, a residency in neurological surgery and a fellowship in complex spine surgery and minimally invasive surgery at the Northwestern University Feinberg School of Medicine.

Acosta earned his bachelor’s degree in chemistry magna cum laude from Harvard College and his medical degree from Harvard Medical School. He completed an internship and neurosurgical residency at the University of California, San Francisco, and a fellowship in complex and reconstructive spine surgery at Northwestern University.

The spinal surgery program at the Keck Medical Center of USC is led by Patrick Hsieh, M.D., associate professor of neurological surgery; Thomas Chen, M.D., Ph.D., professor of neurological surgery and pathology; and Mark J. Spoonamore, M.D., assistant professor of clinical orthopaedic surgery. Keck Hospital of USC is consistently ranked among the nation’s top hospitals for neurosurgery and orthopaedics care by U.S. News & World Report.

ABOUT THE KECK MEDICAL CENTER OF USC: The Keck Medical Center of USC is one of only two university-owned academic medical centers in the Los Angeles area. It consists of Keck Hospital of USC (formerly USC University Hospital) and USC Norris Cancer Hospital, the private hospitals of the University of Southern California. The two world-class, USC-owned hospitals are staffed by more than 500 physicians who are faculty at the renowned Keck School of Medicine of USC.
The University of Southern California announces the recruitment of two esteemed spine surgeons who will play critical roles in expanding a multi-
USC research finds certain contraceptive may pose risk of type 2 diabetes for obese women




slight negative impact on metabolic markers, raising the risk for type 2 diabetes.

• Contraceptive implants under the skin increase the risk more than uterine implants.

•  Longer and larger studies are needed to see if metabolic changes are temporary or long-term.

A first-of-its-kind study by researchers at the Keck School of Medicine of the University of Southern California (USC) indicates that healthy, obese, reproductive-age women who use long-acting reversible contraception (LARC) containing the hormone progestin, have a slightly increased risk for developing type 2 diabetes when compared to those who use non-hormonal contraception.

The research concludes that progestin-releasing LARC appears to be safe for use by such women but needs further investigation.

Nicole M. Bender, assistant professor of clinical obstetrics and gynecology at the Keck School, was the principal investigator for the study “Effects of progestin-only long-acting contraception on metabolic markers in obese women,” which appeared online in the journal Contraception on Jan. 2, 2013.

“Contraceptive studies often only look at normal-weight women,” said Penina Segall-Gutierrez, co-investigator of the study and an assistant professor of clinical obstetrics and gynecology and family medicine at the Keck School. “Studies such as this are necessary because, today, one-third of women in the U.S. are overweight and one-third are obese. All women, including overweight and obese women, need to have access to safe and effective contraception.”

Obese women are at increased risk for pregnancy-related complications and are sometimes warned by their doctors not to use contraceptives containing estrogen, such as the pill, patch and vaginal ring.

“[Those choices] raise the risk for blood clots,” Segall-Gutierrez said. “So they need other, viable alternatives. The implanted LARC devices last three to 10 years, are easily reversible, and women don’t have to remember to do anything with them, in contrast to the birth-control pill.”

The six-month study observed the metabolic markers in three groups of obese women: a control group using non-hormonal birth control methods, including condoms, the copper IUD, and female or male sterilization; a second group with a progestin-releasing LARC device implanted in the uterus (IUD); and a third group with a progestin-releasing LARC device implanted under the skin.

“All three methods were found to be safe and effective, and they did not create changes in blood pressure, weight, or cholesterol,” Segall-Gutierrez said. “However, there was a 10 percent increase in fasting blood-glucose levels among the skin implant users, compared to a 5 percent increase among the IUD users and a 2 percent decrease among those using non-hormonal methods. The effects on sensitivity to insulin showed a similar trend. It is unknown if these effects would continue if the devices were used and studied for a longer period of time.”

Segall-Gutierrez and her Keck research partners have studied the metabolic effects of other birth-control methods as well. In 2012, they reported findings that obese women receiving a progestin birth-control shot every three months may be at increased risk for developing type 2 diabetes.

“Overall, we’re finding that methods such as the progestin injection and the progestin skin implant, which both have higher circulating progestin, may have an increased risk for metabolic changes compared to methods like the IUD, which only has a local effect ─ in the uterus,” she said.

Segall-Gutierrez added that the progestin-releasing IUD has other benefits. It is approved by the U.S. Food and Drug Administration for treatment of heavy menstrual bleeding, which often affects obese women. The IUD also protects against endometrial cancer, which disproportionately affects obese women.

“Choosing a birth-control method requires consideration of many factors, including the patient’s lifestyle and willingness to use the method, desire for future fertility, and risk for a host of diseases ─ diabetes and endometrial cancer being two of them for obese women,” she said. “We would like to expand our most recent study by looking at more participants over a longer period of time to see if the metabolic effects we observed in the progestin-releasing implants persist or are only temporary.”

In addition to Bender and Segall-Gutierrez, the research team includes Sandy Oliver Lopez Najera, Frank Z. Stanczyk, Martin Montoro and Daniel R. Mishell.

The research was funded by an anonymous donor who has made other gifts related to gynecologic research at the school.

Bender, N.M., Segall-Gutierrez, P., Oliver Lopez Najera, S., Stanczyk, F.Z., Montoro, M., Mishell, D.R. (2013) Effects of progestin-only long-acting contraception on metabolic markers in obese women. Contraception. Published online Jan. 4, 2013.
Highlights of this news release:

• Six-month study finds that progestin-releasing contraceptives show a
UCLA Study Shows Promise, Offers Hope for Brain Hemorrhage Patients
Minimally Invasive Intraoperative CT Scan Guided Endoscopic Surgery (ICES) May Benefit Patients Deemed Hopeless Cases until Now






“These exciting results offer a glimmer of hope for a condition that most doctors have traditionally considered hopeless,” said principal investigator Dr. Paul Vespa, professor of neurosurgery at the David Geffen School of Medicine at UCLA and director of the neurocritical care program at Ronald Reagan UCLA Medical Center. “That is a big deal in medicine.”

Stroke is the leading cause of death and long-term disability in America. During a stroke, bleeding becomes toxic and deadly in the brain. Brain hemorrhage that causes a stroke is a devastating, critical condition with a mortality rate of 75 percent. If the patient manages to survive, he or she could face a life of long-term severe disability. Nearly 800,000 Americans suffer from strokes every year.  

In the past, brain surgery involving a large incision to remove the blood further traumatized the brain and failed to improve the outcome of the patient’s quality of life.  As a result, open surgery is uncommon for bleeding in the brain. 

The study led by Vespa and Dr. Neil Martin, chairman of neurosurgery at the David Geffen School of Medicine at UCLA, in conjunction with Johns Hopkins University, set out to determine the safety and effectiveness of removing blood using a keyhole incision smaller than the size of a dime. The endoscope, a tiny probe with a light and video camera on the tip, was used to navigate with GPS-like precision. The image-guided system displays CT scans of the brain on monitors that allow the surgeons to immediately pinpoint and remove the blood. 

“Endoscopic surgery has the key advantage to get the blood out all at once, immediately alleviate the pressure on the brain and set the stage for ultimate recovery,” said Martin. 

Based upon the study findings, the procedure appears to be safe with no further bleeding or harm to the patient. On average, 71 percent of the blood was immediately removed. The procedure was performed at seven major medical centers with 24 enrolled patients. Eighteen of the patients underwent the endoscopic surgery while six received standard medical treatment.  After six months post-op, the neurological outcomes for patients were better and mortality rates lower for the endoscopic surgery patients compared to the second group. 

The team of neurosurgeons at UCLA determined that the ICES study appears to be a safe and potentially helpful surgical procedure for brain hemorrhage and will continue to be investigated in a more definitive clinical trial in the near future. 

The UCLA Department of Neurosurgery is committed to providing the most comprehensive patient care through innovative clinical programs in minimally invasive brain and spinal surgery; neuroendoscopy; neuro-oncology for adult and pediatric brain tumors; cerebrovascular surgery; stereotactic radiosurgery for brain and spinal disorders; surgery for movement disorders such as Parkinson’s disease; and epilepsy surgery. For 21 consecutive years, the department has been ranked among the top neurosurgery programs in the nation by U.S. News & World Report, including No. 1 in Los Angeles and No. 2 on the West Coast.
At the International Stroke Conference today in Honolulu, UCLA neurosurgeons announced the results of a potentially groundbreaking, multi-center, randomized, controlled phase II clinical trial.  The study was conducted at multiple medical centers to determine whether minimally invasive endoscopic surgery appears to have safer and more effective outcomes compared to standard medical treatment for brain hemorrhage.
CUSC researchers discover genetic clues that may lead to better understanding of human organ development and birth defects




understanding of how organs and birth defects form in humans.

A team of researchers at the Eli and Edythe Broad Center for Regenerative Medicine and Stem Cell Research at USC has for the first time determined the role of two important molecular signaling pathways that help control the number and position of repeated units of cells that pattern the head and face.

Two members of a “Wnt” signaling pathway are instrumental in forming pharyngeal pouches that organize the structure of the head and face. Problems with forming the pouches can result in birth defects, including the rare DiGeorge syndrome, which causes an array of symptoms including an abnormal facial appearance, cleft palate, congenital heart disease, and loss of the thyroid and thymus.

The research, “Wnt-Dependent Epithelial Transitions Drive Pharyngeal Pouch Formation,” was published Feb. 11, 2013 in Developmental Cell. Principal author is Chong Pyo Choe, research associate at the Keck School of Medicine of USC.
Using cutting-edge time-lapse photography, University of Southern California (USC) researchers have discovered clues to the development of the head at the cellular level, which could point scientists to a better
USC experts available to comment on family health and heart health awareness



Medicine of USC. He is an expert in primary care, preventive care and management of chronic conditions. With his recent involvement in Too Small to Fail, a national movement focused on improving the lives and health of children, he can comment on the health challenges of America's children. "At least 25 percent of children in the U.S. live with chronic disease and 18 percent are diagnosed with a developmental disability before they reach junior high," said Prestwich. "If not diagnosed and treated effectively, these children will not perform well in school or in life." Contact him at (310) 567-4644 (cell) or prestwic@med.usc.edu.

Heart Health Awareness
Helga Van Herle, M.D., Ph.D., is an associate professor of clinical medicine for the division of cardiovascular medicine at the Keck School of Medicine of USC. Her areas of expertise include women's health and cardiology consultation for organ transplantation. She can address heart health awareness for women. "Only 1 in 5 American women recognize heart disease as their biggest health risk. Currently, 43 million women in the U.S. are affected by heart disease," said Van Herle. "Despite these sobering statistics, 80 percent of cardiovascular diseases and strokes can be prevented and treated with the appropriate education, assessment of risk factors and recognition of symptoms." Contact her at (323) 442-6130 or helga.vanherle@med.usc.edu.

ABOUT KECK MEDICINE OF USC: Keck Medicine of USC encompasses the University of Southern California's medical school and clinical enterprise. It consists of the Keck School of Medicine of USC and the Keck Medical Center of USC.
Family Health
Brian Prestwich, Ph.D., is an assistant professor and chief medical officer for the department of family medicine at the Keck School of
UCLA study suggests link between untreated depression and response to shingles vaccine
Study has implications for the impact of mental health and depression treatment on vaccine responses







zoster, or shingles, vaccine. 

Shingles is a painful, blistering skin rash that can last for months or even years. It’s caused by the varicella-zoster virus, the same virus that causes chickenpox. It’s thought to strike more than a million people older than 60 each year in the U.S. Every year, health officials urge people 50 and older to get vaccinated against the herpes zoster virus. The vaccine boosts cell-mediated immunity to the virus and can decrease the incidence and severity of the condition.

But in a two-year study, Irwin, who is also the director of the UCLA Cousins Center for Psychoneuroimmunology at the UCLA Semel Institute, and colleagues, measured the immune response to shingles vaccination among 40 subjects aged 60 or older who suffered from a major depressive disorder, then compared these responses to similar levels in 52 control patients matched by age and gender. Measurements were taken at the beginning of the study, and then at six weeks, one year, and two years after the patients received either the shingles vaccine or a placebo.

Depressed patients not being treated with antidepressants showed a weaker immune response to the varicella-zoster virus, and thus were less able to respond to the shingles vaccine. These findings were compared to patients who either were not depressed, or were suffering from depression but receiving treatment with antidepressants.

The findings suggest that patients with untreated depression were “poorly protected by the shingles vaccination,” said Irwin.

Surprisingly, when the depression was being treated, responses to the vaccine were normalized even when the depression treatment had not been effective in lessening depression symptoms. “Among depressed elderly, treatment with an antidepressant medication such as a selective serotonin uptake inhibitor might increase the protective effects of zoster vaccine,” said Irwin.

Larger studies are needed to evaluate the possible relationship between untreated depression and the risk of shingles, the study noted, along with further research to establish what mechanisms are responsible for patients’ reduced immune response. And there is a clinical side as well, said Irwin. “Efforts are also needed to identify and diagnose depressed elderly patients who might benefit from either a more potent vaccine or a multi-dose vaccination schedule.”

The findings also have important public health implications beyond the prevention of shingles, possible extending to other infectious diseases, said Irwin. Because this study measured immune system T-cells that were specific to the varicella-zoster virus, the association may extend to memory T-cells specific for antigens of other pathogens that cause disease in older adults, such as influenza. If so, he said, this suggests that untreated depression may identify a subgroup of elderly likely to respond poorly to other vaccines. “While we know that psychological stress is associated with a weakened immune response to influenza vaccines in older adults,” said Irwin, “few studies have examined the association between depression and infectious disease risk, or disease-relevant immunologic endpoints, such as vaccine responses,” he said.

There were multiple authors on the study. Other UCLA authors were Richard Olmstead and Carmen Carrillo. Please see the study for other authors and conflict of interest statements. 

Funding for the study was provided by the National Institute of Mental Health at the National Institutes of Health (R01-MH 55253) and in part by the Department of Veterans Affairs; a grant from Merck & Co., Inc. National Institute of Health grants R01-AG034588; R01-AG026364; R01-CA119159; R01-HL079955; R01 HL095799; P30-AG028748; UCLA CTSI UL1TR000124; the Cousins Center for Psychoneuroimmunology; and the James R. and Jesse V. Scott Fund for Shingles Research.

The Cousins Center for Psychoneuroimmunology encompasses an interdisciplinary network of scientists working to advance the understanding of psychoneuroimmunology by linking basic and clinical research programs and by translating findings into clinical practice. The center is affiliated with the Semel Institute for Neuroscience and Human Behavior and the David Geffen School of Medicine at UCLA.
Can an individual’s state of mind effect how well a vaccine may work? In the case of seniors and shingles, the answer is yes.

Reporting in the current online edition of the journal Clinical Infectious Diseases, Dr. Michael Irwin, a UCLA professor of psychiatry and first author of the study, showed a link between untreated depression in older adults and decreased effectiveness of the herpes
February is Heart Month - A Few Lifestyle Tips for a Healthy Heart



The term “heart disease” refers to several types of heart conditions. The most common type is coronary heart disease (also called coronary artery disease), which occurs when a substance called plaque builds up in the arteries that supply blood to the heart. Coronary heart disease can cause heart attack, angina, heart failure, and arrhythmias.

The good news is that heart disease is preventable and controllable, and we want to share some heart health tips with you (information courtesy of the Centers for Disease Control (CDC)).

Be Heart Smart

Some health conditions and lifestyle factors can put people at a higher risk for developing heart disease. You can help prevent heart disease by making healthy choices and managing any medical conditions you may have.

•Eat a healthy diet. Choosing healthful meal and snack options can help you avoid heart disease and its complications. Be sure to eat plenty of fresh fruits and vegetables—adults should have at least 5 servings each day. Eating foods low in saturated fat, trans fat, and cholesterol and high in fiber can help prevent high cholesterol. Limiting salt or sodium in your diet also can lower your blood pressure.

•Maintain a healthy weight. Being overweight or obese can increase your risk for heart disease. To determine whether your weight is in a healthy range, doctors often calculate a number called the body mass index (BMI). Doctors sometimes also use waist and hip measurements to measure a person's body fat.

•Exercise regularly. Physical activity can help you maintain a healthy weight and lower cholesterol and blood pressure. The Surgeon General recommends that adults should engage in moderate-intensity exercise for at least 30 minutes on most days of the week.

•Monitor your blood pressure. High blood pressure often has no symptoms, so be sure to have it checked on a regular basis. You can check your blood pressure at home, at a pharmacy, or at a doctor's office.
•Don't smoke. Cigarette smoking greatly increases your risk for heart disease. If you don't smoke, don't start. If you do smoke, quit as soon as possible. Your doctor can suggest ways to help you quit.

•Limit alcohol use. Avoid drinking too much alcohol, which can increase your blood pressure. Men should stick to no more than two drinks per day, and women to no more than one.

•Have your cholesterol checked. Your health care provider should test your cholesterol levels at least once every 5 years. Talk with your doctor about this simple blood test.

•Manage your diabetes. If you have diabetes, monitor your blood sugar levels closely, and talk with your doctor about treatment options.

•Take your medicine. If you're taking medication to treat high blood pressure, high cholesterol, or diabetes, follow your doctor's instructions carefully. Always ask questions if you don't understand something.  Every year, approximately 715,000 Americans have a heart attack. About 600,000 people die from heart disease in the United States each year—that’s 1 out of every 4 deaths.

Know the Signs and Symptoms of Heart Attack
1.Chest discomfort that is intermittent or lasts more than a few minutes
2.Uncomfortable pressure, squeezing, fullness or pain in the chest area
3.Unexplainable pain or other areas of the body (both arms, the back, neck, jaw or stomach)
4.Shortness of breath with or without chest discomfort
5.Breaking out in cold sweat
6.Nausea
7.Lightheadedness
(In accordance with American Heart Association guidelines)  If you experience any of these symptoms, call 9-1-1- immediately

Our Heart and Vascular Center offers a full spectrum of services, including screening and diagnostic tests, advanced medical and surgical treatments, and cardiac rehabilitation and education programs.

Our Women's Heart Center is here to help women take control of their heart health and minimize their risk for heart disease through screenings, education and behavior modification.
Many of us are not aware, but heart disease is the leading cause of death for both men and women in the United States.
UCLA study finds endocrine disorder is most common cause of elevated calcium levels
Hyperparathyroidism occurs most often in older African American women






bone loss, depression and fatigue that may go undetected for years, is most often seen in African American women over the age of 50, the researchers discovered.  

The study, currently online in the Journal of Clinical Endocrinology and Metabolism, is one of the first to examine a large, racially and ethnically diverse population — in this case, one that was 65 percent non-white. Previous studies had focused on smaller, primarily Caucasian populations.  

The four parathyroid glands, which are located in the neck, next to the thyroid, regulate the body's calcium levels. When one is dysfunctional, it can cause major imbalances — for example, by releasing calcium from the bones and into the bloodstream. Over time, calcium loss from bones often leads to osteoporosis and fractures, and excessive calcium levels in the blood can cause kidney stones and worsening kidney function. 

The UCLA researchers determined that hyperparathyroidism is the leading cause of high blood-calcium levels and is responsible for nearly 90 percent of all cases.   

"The findings suggest that hyperparathyroidism is the predominant cause of high calcium levels, so if patients find they have high calcium, they should also have their parathyroid hormone level checked," said the study's lead author, Dr. Michael W. Yeh, an associate professor of surgery and endocrinology at the David Geffen School of Medicine at UCLA.

Hyperparathyroidism, which affects approximately 1 percent of the population, can be detected by measuring parathyroid hormone levels to determine if they are elevated or abnormal.  

For the study, researchers utilized a patient database from Kaiser Permanente Southern California that included information on 3.5 million individuals, a population roughly the size of Ohio. Using data from lab results, the research team identified 15,234 cases of chronic high-calcium levels. Of those cases, 13,327 patients (87 percent) were found to have hyperparathyroidism.  

The incidence of hyperparathyroidism — reported as the number of cases per 100,000 people per year — was found to be highest among African Americans (92 women and 46 men), followed by Caucasians (81 women and 29 men), Asians (52 women, 28 men) and Hispanics (49 women and 17 men).   

The research team also found that with advancing age, the incidence of hyperparathyroidism (per 100,000 people per year) increased and that more women were affected:   

·         Under age 50: 12 to 24 cases for both genders

·         Ages 50–59: 80 women and 36 men

·         Ages 70–79: 196 women and 95 men 

"It was surprising to find the highest incidence in black women over age 50," Yeh said. "We had traditionally thought of the disorder as affecting mostly Caucasian women."  

However, since black women tend to have stronger bones and fewer fractures, more study is needed to see how the disorder is manifested in this patient group. African American women's physiology may be different and more protective of calcium and bone, Yeh said.  

Yeh also noted that further study of the disorder may result in new, more targeted treatment guidelines based on racial differences. African American women, for instance, may require less vitamin D than is commonly prescribed to protect bone health, he said.  

In the study, the researchers also found that the prevalence of hyperparathyroidism has tripled in the last 10 years, increasing from 76 women to 233 (out of 100,000) and from 30 men to 85.  

The researchers noted that the growing prevalence is likely due to increased calcium testing, annual lab tests to monitor patients with symptoms and the low rate of surgery to treat the disorder. Previous research has shown that only 28 percent of patients with hyperparathyroidism undergo surgery to remove the overactive parathyroid gland — the most reliable way to correct the disorder.

"Women can suffer for years with hyperparathyroidism and not know they have it, which is especially critical in midlife, when bone health is so important," Yeh said. "Appropriate management of the disorder is essential. Surgery should be considered in the majority of people with primary hyperparathyroidism."  

The next step, Yeh said, is further study of this patient population to examine the long-term impact of the condition on bone health and the effectiveness of different management strategies on outcomes.  

"We are aiming to better understand how hyperparathyroidism affects people of different racial backgrounds," he said.   

The study was funded with support from the Earl Gales Family Foundation, the National Institute on Aging and the American Geriatrics Society.  

Additional authors include Philip H.G. Ituarte, Ph.D., Stacie Nishimoto and Dr. Avital Harari of the section of endocrine surgery at the David Geffen School of Medicine at UCLA; Hui Cynthia Zhou, In-Lu Amy Liu and Annette L. Adams, Ph.D., of the department of research and evaluation at Kaiser Permanente Southern California; and Dr. Philip I. Haigh of the department of surgery at Kaiser Permanente Los Angeles Medical Center.  

For more news, visit the UCLA Newsroom and follow us on Twitter.
Unusually high calcium levels in the blood can almost always be traced to primary hyperparathyroidism, an undertreated, underreported condition that affects mainly women and the elderly, according to a new study by UCLA researchers. 

The condition, which results from overactive parathyroid glands and includes symptoms of
What's the Difference Between a Pharmacist and a Pharmacy Technician?




often provide instructions, answer questions and may even work the cash register.

However, if you're thinking about a career as either a pharmacist or a pharmacy technician, you'll quickly discover there are many differences between the two professions. Big differences. Here are some of the most important ones:

Education -- Pharmacy technicians can usually complete their training in about a year. Pharmacists must usually invest at least six years in a college education.

Knowledge -- Pharmacy technicians need to know the routine, day-to-day particulars of their job. This usually includes taking orders, filling prescriptions, preparing labels, etc. They also should have some knowledge of how the most popular prescription drugs work and interact. In addition to this practical knowledge, pharmacists study biology, chemistry and biochemistry, among other advanced subjects.

Duties -- A pharmacy technician's typical day can include accepting prescriptions, talking with doctors' offices, filling orders, preparing labels, and dispensing prescription drugs. They may also stock shelves, pay bills, process payments and perform other administrative duties. Pharmacists check completed orders to make sure they are correct, prepare any customized medications, and advise patients on a drug's proper use. They may also advise physicians on the proper medications to treat a patient's condition and issue warnings when they foresee the danger of possible drug interactions.

Responsibilities -- Pharmacy technicians are responsible for the quality of the work they perform. Pharmacists, on the other hand, are responsible for the quality of their technicians' work as well as for the overall professionalism of their pharmacy's operations.

Salaries -- According to the U.S. Bureau of Labor Statistics (BLS), pharmacy technicians in the United States have a median annual income of $28,900. Entry-level pharmacy technicians make about $20,300 per year. Experienced pharmacy techs make about $41,900 per year. Salaries are significantly higher in California. There, the mean annual income for pharmacy technicians is $37,800. Entry-level pharmacy technicians earn about $27,400 while senior pharmacy techs earn about $49,000 per year.* Nationally, pharmacists have a mean annual income of $113,400. Entry-level salaries are about $84,500, while experience professionals can take home about $144,100 per year. Again, salaries are higher in California. The mean income of California-based pharmacists is $128,900. Annual salaries start at around $96,000 and can go as high as $148,400.**

Growth -- Nationally, the BLS projects job prospects for pharmacy technicians to increase 32 percent between 2010 and 2020, 28 percent in California.* For pharmacists, the BLS projects growth of 25 percent nationally and 16 percent in California over the same 10-year period.**

Train to be a Pharmacy Technician at Everest College in Los Angeles

If you'd like to work in a pharmacy but don't want to invest the time, money and energy necessary to become a full-fledged pharmacist, then a pharmacy technician career may appeal to you. If you live in the Los Angeles area, you can get the training you need to become a certified pharmacy technician at the West Los Angeles campus of Everest College.

This eight-month program provides you with the academic background and hands-on experience you need to take the Pharmacy Technician Certification Board (PTCB) exam and compete successfully for entry-level pharmacy technician job opportunities in the Los Angeles area.

Courses include:

■Pharmacy of the Endocrine/Lymphatic Systems
■Aspects of Retail Pharmacy
■Pharmacology of the Nervous Systems
■Infection Control, Medication Errors and Alternative Medicine
■Pharmacology of the Urinary and Reproductive System
■Pharmacy Operations
■Pharmacology of the Urinary and Reproductive System
■Circulatory and Skeletal System
Career Services

Upon graduation, you can get further support from Everest's Career Services specialists. They can help you write a winning resume, practice effective interviewing techniques, assemble a professional wardrobe and, most import of all, identify, contact and set up interviews with potential employers.

About Everest's West Los Angeles Campus: Everest College's West Los Angeles campus is conveniently located at 3000 S. Robertson Blvd., just north of the Santa Monica (I-10) Freeway in Los Angeles (90034). In addition to its Pharmacy Technician program, the campus also offers diploma programs that can be completed in less than a year in Business Office Administration, Business Sales and Customer Service, Criminal Justice, Criminal Justice-Private and Homeland Security, Criminal Justice-Social and Youth Services, Dental Assistant, Massage Therapy, Medical Administrative Assistant, Medical Assistant, Medical Insurance Billing and Coding and Paralegal.
What's the difference between a pharmacist and a pharmacy technician? If you're a customer, both jobs may look pretty much the same. Both people work behind the counter. Both handle and dispense prescription drugs. Both
Keck Medical Center of USC to provide medical care services for
2013 ASICS LA Marathon




place on Sunday, March 17. As part of a multi-year agreement, Keck Medical Center of USC doctors and staff will oversee care and treatment to runners along the course from start to finish.

Keck Medical Center physicians will supervise medical staff and supplies at mobile medical tents at strategic locations along the course, at the finish line, post-finish area and the family reunion area. The USC team will also provide training to the nurses, paramedics, EMTs and athletic training volunteers who will be staffing the marathon on race day.

Glenn T. Ault, M.D., associate dean of the Keck School of Medicine of USC, will serve as the Medical Commissioner of the 2013 ASICS LA Marathon. In that role, Ault will manage the hundreds of medical personnel along the route and serve as the marathon’s medical spokesperson to news media. Last year Dr. Ault was a frequent media spokesman in the days leading up to the race, when the potential for wet weather led race officials to give comprehensive tips to runners for keeping themselves safe and dry regardless of conditions.

“Last year, Dr. Ault and his team at the Keck Medical Center of USC were a tremendous resource for our runners, our staff and our volunteers,” said Nick Curl, chief operating officer of LA MARATHON LLC. “We are thrilled to have Keck back as one of our world‐class partners, and we look forward to another successful race with outstanding medical care.”

USC is a world-renowned private research institution enrolling more international students than any other U.S. university and operating an integrated academic medical center that serves more than a million patients each year.

“The University of Southern California is honored to once again partner with the ASICS LA Marathon, a landmark event of the city,” said Tom Jackiewicz, CEO for USC Health. “We are committed to the health and well-being of the Los Angeles community and Keck Medical Center of USC physicians and staff will provide the best first-responder care to marathon participants, as well as any medical supplies that may be needed.”

In addition to 10 medical stations on the course, the marathon will also promote a healthy experience for runners by having water stations every mile, and stations with electrolyte fluids located every two miles along the route, beginning at mile three.

ABOUT THE KECK MEDICAL CENTER OF USC: The Keck Medical Center of USC is one of only two university-owned academic medical centers in the Los Angeles area. It consists of Keck Hospital of USC (formerly USC University Hospital) and USC Norris Cancer Hospital, the private hospitals of the University of Southern California. The two USC-owned hospitals are staffed by more than 500 physicians who are faculty at the Keck School of Medicine of USC.

ABOUT THE ASICS LA MARATHON: We inspire athletes and connect communities. With thousands of volunteers, tens of thousands of participants, and hundreds of thousands of spectators, the ASICS LA Marathon is one of the largest organized road races in the country. The Stadium to the Sea course, which starts at Dodger Stadium and finishes by the Santa Monica Pier, is considered one of the most scenic in the world. The race has been named Best Big City Race by Runner’s World and Best Marathon in the West by Competitor Magazine.
Building on a successful partnership in 2012, the Keck Medical Center of the University of Southern California (USC) will once again serve as the official medical team for the 2013 ASICS LA Marathon, which takes
UCLA study could explain why some people get zits and others don't
Two strains of acne bacteria linked to pimples, another to healthy skin





                          
that acne bacteria contain "bad" strains associated with pimples and "good" strains that may protect the skin.

The findings, published in the Feb. 28 edition of the Journal of Investigative Dermatology, could lead to a myriad of new therapies to prevent and treat the disfiguring skin disorder.   

"We learned that not all acne bacteria trigger pimples — one strain actually may help keep skin healthy," explained lead author Huiying Li, an assistant professor of molecular and medical pharmacology at the David Geffen School of Medicine at UCLA. "We hope to apply our findings to develop new strategies that stop blemishes before they start, and enable dermatologists to customize treatment to each patient's unique cocktail of skin bacteria." 

The scientists looked at a tiny microbe with a big name: Propionibacterium acnes, bacteria that thrive in the oily depths of our pores. When the bacteria aggravate the immune system, they cause the swollen, red bumps associated with acne.  

Using over-the-counter pore-cleansing strips, LA BioMed and UCLA researchers lifted P. acnes bacteria from the noses of 49 pimply and 52 clear-skinned volunteers. After extracting the microbial DNA from the strips, Li's laboratory tracked a genetic marker to identify the bacterial strains in each volunteer's pores and recorded whether the person suffered from acne. 

Next, Li's lab cultured the bacteria from the strips to isolate more than 1,000 strains. Washington University scientists sequenced the genomes of 66 of the P. acnes strains, enabling UCLA co-first author Shuta Tomida to zero in on genes unique to each strain. 

"We were interested to learn that the bacterial strains looked very different when taken from diseased skin, compared to healthy skin," said co-author Dr. Noah Craft, a dermatologist and director of the Center for Immunotherapeutics Research at LA BioMed at Harbor–UCLA Medical Center. "Two unique strains of P. acnes appeared in one out of five volunteers with acne but rarely occurred in clear-skinned people."  

The biggest discovery was still to come.  

"We were extremely excited to uncover a third strain of P. acnes that's common in healthy skin yet rarely found when acne is present," said Li, who is also a member of UCLA's Crump Institute for Molecular Imaging. "We suspect that this strain contains a natural defense mechanism that enables it to recognize attackers and destroy them before they infect the bacterial cell."  

Offering new hope to acne sufferers, the researchers believe that increasing the body's friendly strain of P. acnes through the use of a simple cream or lotion may help calm spotty complexions.  

"This P. acnes strain may protect the skin, much like yogurt's live bacteria help defend the gut from harmful bugs," Li said. "Our next step will be to investigate whether a probiotic cream can block bad bacteria from invading the skin and prevent pimples before they start."   

Additional studies will focus on exploring new drugs that kill bad strains of P. acnes while preserving the good ones; the use of viruses to kill acne-related bacteria; and a simple skin test to predict whether a person will develop aggressive acne in the future. 

"Our research underscores the importance of strain-level analysis of the world of human microbes to define the role of bacteria in health and disease," said co-author George Weinstock, associate director of the Genome Institute and professor of genetics at Washington University in St. Louis. "This type of analysis has a much higher resolution than prior studies that relied on bacterial cultures or only made distinctions between bacterial species."  

Acne affects 80 percent of Americans at some point in their lives, yet scientists know little about what causes the disorder and have made limited progress in developing new strategies for treating it. Dermatologists' arsenal of anti-acne tools — benzoyl peroxide, antibiotics and Accutane (isotretinoin) — hasn't expanded in decades. Most severe cases of acne don't respond to antibiotics, and Accutane can produce serious side effects.

The research was supported by a grant (UH2AR057503) from the National Institutes of Health's Human Microbiome Project through the National Institute of Arthritis and Musculoskeletal and Skin Diseases.   

Co-authors include co-first author Sorel Fitz-Gibbon, Bor-Han Chiu, Lin Nguyen, Christine Du, Dr. Minghsun Liu, David Elashoff, Dr. Jenny Kim, Anya Loncaric, Dr. Robert Modlin and Jeff F. Miller of UCLA; Erica Sodergren of Washington University; and Dr. Marie Erfe of LA BioMed.  

For more news, visit the UCLA Newsroom and follow us on Twitter.
The bacteria that cause acne live on everyone's skin, yet one in five people is lucky enough to develop only an occasional pimple over a lifetime. What's their secret?  

In a boon for teenagers everywhere, a UCLA study conducted with researchers at Washington University in St. Louis and the Los Angeles Biomedical Research Institute has discovered
Alzheimer’s risk gene discovered by screening brain’s connections
UCLA researchers find signs of disease decades before illness strikes






connections, which we rely on to support thinking, emotion, and memory. With no known cure, the 20 million Alzheimer’s sufferers worldwide lack an effective treatment, and we are all at risk - our risk of developing Alzheimer's doubles every five years after age 65.

The researchers discovered a common abnormality in our genetic code that increases our risk for Alzheimer’s. To find the gene, they used a new method that screens the brain’s connections, the wiring or circuitry that communicates information in the brain. Switching off these Alzheimer risk genes – first discovered 20 years ago –could stop the disorder in its tracks, or delay its onset by many years.   

The research appears in the March 4th online edition of the Proceedings of the National Academy of Sciences.

“We found a change in our genetic code that boosts our risk for Alzheimer’s disease,” said Paul Thompson, senior author of the study, a UCLA professor of neurology, and a member of the UCLA Laboratory of Neuro Imaging. “If you have this variant in your DNA, your brain connections are weaker. As you get older, faulty brain connections increase your risk of dementia.”  

The researchers screened over a thousand people’s DNA, to find, said Thompson, the common “spelling errors” in the genetic code that might heighten risk for disease later in life. In another first, each person received a “connectome scan” as well–a special type of brain scan that measures water diffusion in the brain, which allows it to map the strength of the brain’s connections. 

Hundreds of computers, calculating for months, sifted through more than 4,000 brain connections and the entire genetic code, comparing connection patterns in people with different genetic variations. In people whose genetic code differed in one specific gene called SPON1, weaker brain connections were found between brain centers controlling reasoning and emotion. The rogue gene also affects how senile plaques build up in the brain – one of the main causes of Alzheimer’s. 

The new study is the first of its kind to use “connectome” scans, which reveal the brain’s circuitry and how information is routed around the brain, to discover risk factors for disease. It combines these connectivity scans with extensive genomic screening, to pinpoint what causes faulty wiring in the brain. 

“Much of your risk for disease is written in your DNA, so the genome is a good place to look for new drug targets,” said Thompson, who founded a research network in 2009 – known as Project ENIGMA – to pool brain scans and DNA from 26,000 people worldwide. “If we scan your brain and DNA today, we can discover dangerous genes that will undermine your ability to think and plan, and make you ill in the future. If we find these genes now, there is a better chance of new drugs that can switch them off before you or your family get ill.” Developing new therapeutics for Alzheimer’s is a hot area for pharmaceutical research, he said.  

The researchers also found that the SPON1 gene can also be manipulated to develop new treatments for the devastating disease. When the rogue gene was altered in mice, it led to cognitive improvements and fewer plaques built up in the brain. Alzheimer’s patients show an accumulation of these senile plaques – made of a sticky substance called amyloid – which kills brain cells, causing irreversible memory loss and personality changes. 

Screening genomes has led to many new drug targets in the treatment of cancer, heart disease, arthritis, and brain disorders such as epilepsy. But the UCLA team’s approach – screening genomes and brain scans from the same people – promises a faster and more efficient search. “With a brain scan that takes half an hour and a DNA scan from a saliva sample, we can search your genes for factors that help or harm your brain’s connections,” said Thompson. “This opens up a new landscape of discovery in medical science.”

Other UCLA authors on the paper included Neda Jahanshad, Priya Rajagopalan, Xue Hua, Derrek P. Hibar, Talia M. Nir, and Arthur W. Toga. The project had multiple funding sources including the National Institutes of Health, grant R01 HD050735; please see paper for other authors and additional funding.

The Laboratory of Neuro Imaging, which seeks to improve understanding of the brain in health and disease, is a leader in the development of advanced computational algorithms and scientific approaches for the comprehensive and quantitative mapping of brain structure and function. It is part of the UCLA Department of Neurology, which encompasses more than a dozen research, clinical and teaching programs. . The department ranks in the top two among its peers nationwide in National Institutes of Health funding. For more information, see http://www.neurology.ucla.edu/
Scientists at UCLA have discovered a new genetic risk factor for Alzheimer’s disease by screening people’s DNA, then using an advanced kind of brain scan to visualize the brain’s connections.

Alzheimer’s disease – the commonest cause of dementia in the elderly – erodes those
Keck School of Medicine of USC students discover where they will complete residency training after graduation at Match Day ceremony




WHEN:
8 – 9:15 a.m., Friday, March 15, 2013
• 8 a.m. – Student Registration
• 8:45 a.m. – Welcome and Class Announcements
• 8:50 a.m. – Match Facts
• 8:55 a.m. – Champagne Toast
• 9 a.m. – Match Envelope Distribution

WHERE:
Pappas Quad, USC Health Sciences campus
1975 Zonal Ave.
Los Angeles, CA 90033
Complimentary media parking may be arranged at least 24 hours in advance.

WHO:
153 participating medical students including
• Andrew J. Gausepohl, a commissioned U.S. Air Force officer from San Diego who hopes to practice emergency medicine in Los Angeles alongside his fiancée, also an emergency medicine resident
• Veronica Ramirez, a first-generation Mexican-American medical student from San Diego who hopes to practice primary care medicine in the San Francisco Bay area
Carmen Puliafito, M.D., MBA, dean of the Keck School of Medicine
Donna Elliott, M.D., Ed.D., associate dean for student affairs at the Keck School of Medicine
Henri R. Ford, M.D., MHA, vice dean for medical education at the Keck School of Medicine
Family and friends of students

VISUALS:
A range of emotions is on full display as graduating medical students rush to open the envelopes that determine the rest of their careers.

WHY:
A rite of passage for U.S. medical students, Match Day ceremonies are held at medical schools simultaneously across the country, marking the first opportunity for students to learn where they have been “matched” to work after graduation. Earlier in the year, graduating students rank their choices for residency programs at teaching hospitals and universities; residency programs also rank their preferred applicants based on grades, interviews and recommendations. The lists are combined and individual matches are made using a computer algorithm. The matches are binding.

ABOUT THE KECK SCHOOL OF MEDICINE OF USC: The Keck School of Medicine of USC is among the nation’s leaders in innovative clinical care, research and education. Located on the university’s 31-acre Health Sciences campus three miles northeast of downtown Los Angeles, the Keck School is adjacent to the Los Angeles County+USC Medical Center, one of the largest teaching hospitals in the United States. The school’s faculty and residents serve more than 1 million patients each year at Keck Hospital of USC, USC Norris Cancer Hospital, Children’s Hospital Los Angeles, LAC+USC Medical Center and additional USC-affiliated hospitals throughout Southern California.
WHAT:
The University of Southern California (USC) holds its annual Match Day ceremony for fourth-year M.D. students of the Keck School of Medicine.
USC expert available to comment on brain injury awareness



Keck School of Medicine of USC and director of Cranial Base Endoscopic Surgery at the USC Norris Comprehensive Cancer Center. He is an expert in traumatic brain injury, pituitary tumors and advanced cranial base surgery. He can address the significance of recognizing Brain Injury Awareness Month in March. "Traumatic brain injury (TBI) is a major cause of death and disability worldwide, particularly for military personnel, athletes and the younger population," said Zada. “That being said, TBI awareness is extremely important in order to improve both prevention and treatment. Nearly 1.7 million people in the U.S. sustain and seek medical attention for TBI each year." He can be reached at (323) 226-7421 or gzada@usc.edu.

ABOUT KECK MEDICINE OF USC: Keck Medicine of USC encompasses the University of Southern California's medical school and clinical enterprise. It consists of the Keck School of Medicine of USC and the Keck Medical Center of USC.
Brain Injury Awareness

Gabriel Zada, M.D., is an assistant clinical professor of neurosurgery at the
Keck School of Medicine of USC students discover where they will complete residency training after graduation at Match Day ceremony




WHEN:
8 – 9:15 a.m., Friday, March 15, 2013
• 8 a.m. – Student Registration
• 8:45 a.m. – Welcome and Class Announcements
• 8:50 a.m. – Match Facts
• 8:55 a.m. – Champagne Toast
• 9 a.m. – Match Envelope Distribution

WHERE:
Pappas Quad, USC Health Sciences campus
1975 Zonal Ave.
Los Angeles, CA 90033
Complimentary media parking may be arranged at least 24 hours in advance.

WHO:
153 participating medical students including
• Andrew J. Gausepohl, a commissioned U.S. Air Force officer from San Diego who hopes to practice emergency medicine in Los Angeles alongside his fiancée, also an emergency medicine resident
• Veronica Ramirez, a first-generation Mexican-American medical student from San Diego who hopes to practice primary care medicine in the San Francisco Bay area
Carmen Puliafito, M.D., MBA, dean of the Keck School of Medicine
Donna Elliott, M.D., Ed.D., associate dean for student affairs at the Keck School of Medicine
Henri R. Ford, M.D., MHA, vice dean for medical education at the Keck School of Medicine
Family and friends of students

VISUALS:
A range of emotions is on full display as graduating medical students rush to open the envelopes that determine the rest of their careers.

WHY:
A rite of passage for U.S. medical students, Match Day ceremonies are held at medical schools simultaneously across the country, marking the first opportunity for students to learn where they have been “matched” to work after graduation. Earlier in the year, graduating students rank their choices for residency programs at teaching hospitals and universities; residency programs also rank their preferred applicants based on grades, interviews and recommendations. The lists are combined and individual matches are made using a computer algorithm. The matches are binding.

ABOUT THE KECK SCHOOL OF MEDICINE OF USC: The Keck School of Medicine of USC is among the nation’s leaders in innovative clinical care, research and education. Located on the university’s 31-acre Health Sciences campus three miles northeast of downtown Los Angeles, the Keck School is adjacent to the Los Angeles County+USC Medical Center, one of the largest teaching hospitals in the United States. The school’s faculty and residents serve more than 1 million patients each year at Keck Hospital of USC, USC Norris Cancer Hospital, Children’s Hospital Los Angeles, LAC+USC Medical Center and additional USC-affiliated hospitals throughout Southern California
WHAT:
The University of Southern California (USC) holds its annual Match Day ceremony for fourth-year M.D. students of the Keck School of Medicine.
UCLA Stroke Center awarded 'comprehensive stroke center' certification
Designation recognizes center's commitment to quality care for patients



Association. The center, part of UCLA Health and the UCLA Department of Neurology, is one of the first 10 stroke centers in the nation to receive the prestigious designation. 

The certification, which confirms that the UCLA Stroke Center has met the highest national standards for safety and quality of care, further enhances the center's national reputation as an innovator in clinical care.  

"This is a true team effort, reflecting the efforts of over 200 physicians, nurses, therapists, pharmacists and technologists at the UCLA Stroke Center and spanning all of UCLA Health." said Dr. Jeffrey Saver, the center's director and a professor of neurology at the David Geffen School of Medicine at UCLA. "It is a reflection of our team's sustained, collective commitment to saving the lives of our stroke patients."  

The Joint Commission, an independent, not-for-profit organization that accredits and certifies more than 19,000 health care organizations and programs in the United States, conducted a rigorous on-site review at UCLA, collecting data and evaluating the center's performance based on the commission's requirements for the certification designation.  

The commission now certifies two levels of stroke care, "primary" and "comprehensive." Comprehensive stroke centers offer the highest level of care, including neuro-intensive care units, complex neurosurgical interventions, and advanced brain and blood-vessel imaging.  

Since the UCLA Stroke Center was established in 1994, it has offered stroke patients state-of-the-art facilities and highly skilled specialists, 24 hours a day, 365 days a year. As part of a major academic institution, the center also has been a world leader in researching and implementing new ways to improve stroke survival and recovery.  

For example, nearly a decade ago, center researchers invented the MERCI Retriever — a mechanical device that removed stroke-causing clots from the brain. The center supplanted the MERCI device last February with the SOLITAIRE Flow Restoration Device, which dramatically outperformed the standard mechanical treatment. SOLITAIRE proved to be so superior that the U.S. Food and Drug Administration ended its clinical trial nearly a year earlier than planned due to SOLITAIRE's significantly better outcomes.  

The UCLA Stroke Center was also an innovator with the establishment, in 2009, of its Telestroke Network Partner Program, which gives emergency departments at community hospitals across California the opportunity for direct, immediate, around-the-clock video consultations with UCLA stroke neurology experts. Within 15 minutes of being contacted, a neurologist can be interviewing and counseling a patient and family and performing a stroke-specific neurologic exam through a two-way video connection. The UCLA stroke specialist can view any local diagnostic images online as well.  

The commission's certification shows that UCLA has achieved the highest standard of stroke care by ensuring that patients receive treatment according to nationally accepted standards and recommendations.    

"The dual mission of the UCLA Stroke Center is to provide the best possible care for every patient with cerebrovascular disease and to innovate new methods to diagnose, treat and cure stroke," said Dr. Neil Martin, chair of the UCLA Department of Neurosurgery and a member of the UCLA Stroke Center's steering committee. "We look forward to serving the Los Angeles community as a certified comprehensive stroke center."  

The UCLA Stroke Center, recognized as one of the world's leading centers for the management of cerebral vascular disease, treats simple and complex vascular disorders by incorporating recent developments in emergency medicine, stroke neurology, microneurosurgery, interventional neuroradiology, stereotactic radiology, neurointensive care, neuroanesthesiology and rehabilitation neurology. The program is unique in its ability to integrate clinical and research activities across multiple disciplines and departments. 
The UCLA Stroke Center has been certified as a comprehensive stroke center by the Joint Commission and the American Heart Association/American Stroke
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USC experts available to comment on colorectal cancer awareness



National Colorectal Cancer Awareness Month in March, this source alert includes experts who can address various aspects of colorectal cancer including new research, screening and surgery.

Research
Heinz-Josef Lenz, M.D., is director for clinical research and co-leader of the Gastrointestinal Cancers Program at the USC Norris Comprehensive Cancer Center and associate professor of medicine and preventive medicine at the Keck School of Medicine of USC. He is an expert in clinical trials, cancer predisposition and drug development research. He can address new personalized therapies and treatment options for colorectal cancer patients. “Our challenge is to better understand how cancer cells vary and how gene expression affects treatment efficacy," said Lenz. "With new research, we hope to develop drugs that target the root-like cells of colorectal cancer and stimulate responses to chemotherapy.” He can be reached at (323) 865-3967 or lenz@med.usc.edu.

Screening and Treatment
Anthony J. Senagore, M.D., is a professor and division chief of colorectal surgery at the Keck School of Medicine of USC. He is an expert in minimally invasive colorectal surgery. He can discuss the importance of screening and different types of surgical treatment and therapies for colorectal cancer. "Screening colonoscopy remains the single most important and least used tool in preventative medicine in the United States," said Senagore. "Patients and primary care physicians need to understand the importance of this option for a healthier and longer life. The majority of colon cancer can be managed surgically by minimally invasive techniques requiring small incisions and only two to three days in the hospital. Patients should ask their surgeons about the availability of these exciting new techniques." He can be reached at (323) 865-3690 or anthony.senagore@med.usc.edu.

ABOUT KECK MEDICINE OF USC: Keck Medicine of USC encompasses the University of Southern California's medical school and clinical enterprise. It consists of the Keck School of Medicine of USC and the Keck Medical Center of USC.
According to the Centers for Disease Control and Prevention, 140,000 Americans are diagnosed with colorectal cancer each year. In recognition of
UCLA Researchers Create Tomatoes that Mimic Actions of Good Cholesterol

          

Published in the April issue of the Journal of Lipid Research and featured on the cover, their early study found that mice that were fed these tomatoes in freeze-dried, ground form had less inflammation and plaque build-up in their arteries.  

"This is one of the first examples of a peptide that acts like the main protein in good cholesterol and can be delivered by simply eating the plant," said senior author Dr. Alan M. Fogelman, executive chair of the department of medicine and director of the atherosclerosis research unit at the David Geffen School of Medicine at UCLA. "There was no need to isolate or purify the peptide — it was fully active after the plant was eaten."  

After the tomatoes were eaten, the peptide surprisingly was found to be active in the small intestine but not in the blood, suggesting that targeting the small intestine may be a new strategy to prevent diet-induced atherosclerosis, the plaque-based disease of the arteries that can lead to heart attacks and strokes.  

Specifically for the study, the team genetically engineered tomatoes to produce 6F, a small peptide that mimics the action of apoA-1, the chief protein in high-density lipoprotein (HDL or "good" cholesterol). Scientists fed the tomatoes to mice that lacked the ability to remove low-density lipoprotein (LDL or "bad" cholesterol) from their blood and readily developed inflammation and atherosclerosis when consuming a high-fat diet.  

The researchers found that mice that ate the peptide-enhanced tomatoes, which accounted for 2.2 percent of their Western-style, high-fat diet, had significantly lower levels of inflammation; higher paraoxonase activity, an antioxidant enzyme associated with good cholesterol; higher levels of good cholesterol; decreased lysophosphatidic acid, a tumor- promoter that accelerates plaque build-up in the arteries in animal models; and less atherosclerotic plaque.  

Several hours after the mice finished eating, the intact peptide was found in the small intestine, but no intact peptide was found in the blood. According to researchers, this strongly suggests that the peptide acted in the small intestine and was then degraded to natural amino acids before being absorbed into the blood, as is the case with the other peptides and proteins in the tomato.  

"It seems likely that the mechanism of action of the peptide-enhanced tomatoes involves altering lipid metabolism in the intestine, which positively impacts cholesterol," said the study's corresponding author, Srinavasa T. Reddy, a UCLA professor of medicine and of molecular and medical pharmacology.  

Previous studies performed by Fogelman's lab and other researchers around the world in animal models of disease have suggested that a large number of conditions with an inflammatory component — not just atherosclerosis — might benefit from treatment with an apoA-1 mimetic peptide, including Alzheimer's disease, ovarian and colon cancer, diabetes, asthma, and other disorders.   

The immune system normally triggers an inflammatory response to an acute event such as injury or infection, which is part of the natural course of healing. But with many chronic diseases, inflammation becomes an abnormal, ongoing process with long-lasting deleterious effects in the body.  

If the work in animal models applies to humans, said Fogelman, who is also the Castera Professor of Medicine at UCLA, consuming forms of genetically modified foods that contain apoA-1–related peptides could potentially help improve these conditions.  

The peptide would be considered a drug if given by injection or in a purified pill form, but when it is a part of the fruit of a plant, it may be no different from a safety standpoint than the food in which it is contained — and it may be better tolerated than a drug, Fogelman said. He noted that one possibility could be the development of the peptide into a nutritional supplement.  

The current study and findings resulted from years of detective work in searching for an apoA-1 peptide that could be practically produced. Peptides prior to the current 6F version have required additions that can only be made by chemical synthesis. The 6F peptide does not require these additions and can therefore be produced by genetically engineering plants.  

The team chose a fruit — the tomato — that could be eaten without requiring cooking that might break down the peptide. The researchers were able to successfully genetically express the peptide in tomato plants, and the ripened fruit was then freeze-dried and ground into powder for use in the study.

"This is one of the first examples in translational research using an edible plant as a delivery vehicle for a new approach to cholesterol," said Judith Gasson, a professor of medicine and biological chemistry, director of UCLA's Jonsson Comprehensive Cancer Center and senior associate dean for research at the Geffen School of Medicine. "We will be closely watching this novel research to see if these early studies lead to human trials."  

In addition, Gasson noted that this early finding and future studies may yield important and fundamental knowledge about the role of the intestine in diet-induced inflammation and atherosclerosis.   

The study was supported in part by U.S. Public Health Service Research Grants HL-30568 and HL-34343 and by the Laubisch, Castera and M.K. Grey funds at UCLA. Studies on the determination of 6F in intestinal contents and plasma were partially funded by a Network Grant from the Leducq Foundation.  

All of the intellectual property is owned by the UC Regents and managed by the UCLA Office of Intellectual Property and Industry Sponsored Research. The technology is currently licensed exclusively to Bruin Pharma Inc. Authors Alan M. Fogelman, Mohamad Navab and Srinivasa T. Reddy are pincipals in Bruin Pharma. Fogelman is an officer in the start-up company. Other disclosures are available in the manuscript.  

Other authors included Arnab Chattopadhyay, Mohamed Navab, Greg Hough, David Meriwether, Victor Grijalva, James R. Springstead, Ryan Namiri-Kalantari, Brian J. Van Lenten and Alan C. Wagner of the department of medicine at the David Geffen School of Medicine at UCLA; Robin Farias-Eisener, Feng Gao and Feng Su of the department of obstetrics and gynecology at the Geffen School of Medicine; and Mayakonda N. Palgnachari and G.M. Anantharamaiah of department of medicine at the University of Alabama, Birmingham.  

For more news, visit the UCLA Newsroom and follow us on Twitter.
UCLA researchers have genetically engineered tomatoes to produce a peptide that mimics the actions of good cholesterol when consumed. 
Results of large, multi-site trial to determine how to prevent future strokes are encouraging but not definite
UCLA’s Dr. Jeffrey Saver one of the studies four PIs



The results of a major, multicenter clinical trial to determine the best treatment for younger patients who have strokes potentially due to a hole in the upper chambers of the heart provided suggestive but not definitive evidence of benefit for a new heart hole closure device. 

The trial sought to determine the best treatment to prevent further strokes--whether closing the hole with a button device, along with anti-clotting medicines, or just anti-clotting medicines alone.

The trial was called the Recurrent Stroke Comparing PFO Closure to Established Current Standard of Care Treatment (RESPECT). UCLA was one of the 69 performance sites. Over eight years, the study enrolled 980 relatively young patients between 18 and 60 years of age (average age 46) who had had a cryptogenic ischemic stroke (a stroke of unknown origin) and a patent foramen ovaleor or PFO (hole in the wall of the heart); 49 percent of patients had large strokes as their qualifying stroke event. Up to 10 percent of all strokes in the United States occur in patients in whom a PFO is the only identified potential cause.

Patients were followed for an average of approximately 2.5 years; in the main analysis, patients assigned to receive the button device showed a trend toward having fewer recurrent strokes than those receiving standard care with anti-clotting medications (9 versus 16), but the difference did not meet statistical tests for being definite. Further analyses conducted in the subset of patients who adhered to their assigned treatments provided additional evidence of device benefit. 

IMPACT:

The trial, said Dr. Jeffrey Saver, professor of neurology and one of four national principal investigators of the study, showed that both device and medication treatments work well to prevent recurrent strokes in patients with PFOs, “which is good news for patients and doctors. It will be important to continue to follow the patients in this study and to combine the results of this trial with others, to confirm the indications of added benefit of device closure,” he said. 

”Closure device therapy may be a useful strategy for selected patients with a history of cryptogenic stroke and PFO,” said Saver. “This population is generally younger than the average stroke patient, and otherwise are facing a lifetime of potentially riskier medications without this procedure,” he added.

“Results of the RESPECT trial together with results from another study called the PC-Trial, demonstrated that patients who received the device did show a benefit,” said Dr. Jonathan Tobis, director of Interventional Cardiology and the RESPECT lead investigator at the UCLA site. He notes that closing this hole in the heart has also been studied as possibly helping with other health issues such as migraine.  

“We’re still learning about the impact when this hole in the heart does not naturally close like it is supposed to.” 

UCLA INVESTIGATORS:

Dr. Jeffrey Saver, director of the UCLA Stroke Center;

Dr. Jonathan Tobis, director of Interventional Cardiology and a UCLA professor of medicine, and the RESPECT lead investigator at the UCLA site.

AUTHORS:

Dr. Saver was an author on the paper.


JOURNAL:

The New England Journal of Medicine


FUNDING:

Funding was provided by St. Jude Medical
FINDINGS:
First Do No Harm – UCLA Researchers Find Patient-Centered Care at End of Life Results in Happier Patients who Live Longer in Less Pain



that don’t improve outcomes and drive up healthcare costs.

Researchers from UCLA Urology have found that patient-centered care at end-of-life – ensuring a dying person’s wishes are known and followed – results in happier, less depressed patients who are in less pain and survive longer.

This type of care also helps to keep healthcare costs down for patients with advanced cancers and other diseases that can’t be effectively treated by eliminating aggressive measures that the patients might not want.

“You can improve care while reducing cost by making sure that everything you do is centered on what the patients want, what his or her specific goals are and tailor a treatment plan to ensure we provide the specific care he or she wants,” said Dr. Jonathan Bergman, a Robert Wood Johnson Clinical Scholar at UCLA.

The perspective piece appears March 20, 2013 in the peer-reviewed journal JAMA Surgery.

Medical care during the final stages of life often is poorly coordinated and inattentive to a patient’s preferences, the perspective states. End-of-life care also consumes the lion’s share of healthcare dollars. A 2004 study found that 30 percent of Medicare resources are expended on the 5 percent of beneficiaries who die every year, and one-third of costs in life’s last year are accounted for during the final month.

Studies also have found that patient-centered care can reduce costs in the last week of life by 36 percent and death, when it comes, is less likely to occur in an intensive care unit.

UCLA researchers are testing the patient-centered care model on cancer patients being treated at the West Los Angeles Veterans Affairs Medical Center. One of the first things done with these critically ill patients is to determine their goals in a multidisciplinary environment, integrating a palliative care specialist at the outset. The physician and specialist see the patient on the same day to coordinate their care.

“Unfortunately, the opposite is usually what happens. They come in with incurable diseases and there’s no discussion of prognosis and goals of care,” Bergman said. “Then a lot of very aggressive treatments can occur due to inertia. Patients are placed in an intensive care unit with oxygen and feeding tubes, and that’s not always in line with their goals.”

Patients who want aggressive care should, of course, receive it, Bergman said. But the UCLA research team is finding that there are many who don’t that and they just haven’t been queried about their needs.

To change this, the perspective suggests that one of the first things that needs to happen is educating residents about patient-centered care. Physicians will be better prepared to practice in the 21st century, and to maximize patient outcomes, if they are guided toward appropriate care for their patients in life’s final stages, Bergman said.

Secondly, changes should be considered to Medicare, which pays for the majority of care at the end of life. However, meaningful policy discussions on this issue have proven elusive, and recent suggested changes have been characterized as creating “death panels,” causing policy makers to shy away from such decision making, Bergman said.

“Given the disproportionate cost of care at the very end of life, the issue should be revisited,” the perspective states. “Addressing goals of care, not to deny aggressive care to those who want it, but to ensure that we deliver aggressive care only to those who do, reduces costs and improves outcomes.”

Lastly, UCLA researchers suggest that hospital scorecards be changed to reflect this new care model. The Joint Commission, which accredits hospitals, has an annual report on quality and safety that ranks hospitals using evidence-based processes known to be linked to patient outcomes. However, none of the 44 accountability measures or the six non-accountability measures in the report address end-of-life care or assessment of patient preferences.

“Adding such measures to the report would improve practice as well as inform patient-centered care by empowering individuals to make educated decisions,” Bergman said. “Better care in life’s final stages should and can be led by physicians, who have accepted the mission of skillfully – and thoughtfully – caring for patients at every step of life’s journey.”
New doctors take an oath to first do no harm, but physicians often go too far in their quest to keep that oath – exposing patients to aggressive treatments
Expert available to comment on new MS drug



an oral agent, it reduces relapse rates, and in one trial, slowed progression of the disease. 

If you seek expert, outside comment on the drug’s approval, Dr. Barbara Giesser, professor of neurology and medical director of the Marilyn Hilton MS Achievement Center at UCLA, is available. In an email to me, she noted--

“It is the third oral agent approved for MS; I will most likely  initially offer it as an alternative to people who are not doing well on current injectable therapy and in whom we would consider switching. The active ingredient in it has been used in Germany for almost 20 years to treat psoriasis, and it appears to have a pretty good safety record in that population.”
The FDA has just approved  Tecfidera (Biogen) for the treatment of relapsing-remitting multiple sclerosis (MS). Three benefits, according to my experts:  It is