Penn Medicine News Blog Posts by Kim Menard

"Imagine the sound of this gong is like a rocket ship that can send messages up to your loved one," said drummer Josh Robinson, "take 10 seconds to think of your message, and when I ring the gong, it'll reach your loved one."

This therapeutic music class was one of the many moments held throughout last weekend's Camp Erin. The annual bereavement camp, led by experts from Penn Wissahickon Hospice's David Bradley Children's Bereavement Program, brings children and teens together from throughout the Philadelphia area who have experienced the death of a relative or close friend.

It's Monday afternoon after another warm, sunny weekend here in Philadelphia, and that familiar reddish tint of sunburn is on faces all around me. As we emerge from a particularly gloomy and cold winter,  people have been embracing every opportunity to spend time outside, but we're apparently out of practice when it comes to remembering to apply sunscreen.

Spring is the perfect time to replenish your sunscreen supply, and take a few minutes to get your skin checked. If you notice any suspicious spots, or haven't had a full-body skin screening in a year or two, now is the time.

Just in time for the summer, Penn Dermatology and the Abramson Cancer Center's annual and free skin cancer screening will be held on May 18. If you haven't signed up already, or know someone who may need to get their skin cancer checked, call 215-662-2737 to schedule an appointment, as space is limited. A large team Penn dermatologists will be screening 300 patients in 4 hours; it only takes a pro about 7 minutes to assess your skin.

David Asch and Bill Hanson interact with the latest health innovations at Penn Medicine's Connected Health Symposium.

"We wanted a chance to bring some of the best innovations from industry and from within Penn Medicine together, to share ideas, connect like-minded groups, and explore new ways we can use technology now and in the future to improve patient care and convenience and lower costs," said Bill Hanson, MD, Chief Medical Information Officer for the University of Pennsylvania Health System and professor of Anesthesiology in the Perelman School of Medicine at the University of Pennsyvania. The event was organized by the Penn Medicine Center for Innovation and moderated by David Asch, MD, MBA, Professor of Health Care Management and Executive Director of Penn Medicine's Center for Innovation, as well as Roy Rosin, MBA, Chief Innovation Officer at Penn Medicine's Center for Innovation and former Vice President for Innovation at the software company Intuit.

Last week, a fleet of community health workers fanned out to help patients in need of some extra support, as part of an ambitious new Penn Medicine program that brings relatable neighbors and peers on board to help vulnerable Penn Medicine patients navigate the medical system and address underlying causes of illness.

Poor health is only one reason why vulnerable patients bounce back to the hospital shortly after being discharged, or have a hard time managing chronic conditions, and the IMPaCT program - Individualized Management for Patient-Centered Targets - hopes to change that. IMPaCT Partners are specially-trained community health workers who share life experiences with the patients they serve. These "natural helpers," who have shared [language, ethnic and geographical] backgrounds as many of the patients they will serve, were selected for characteristics including good listening skills, non-judgmental nature, reliability, availability and knowledge of their communities.

It's hard to anticipate your next step if you've never done something before, or even seen someone go through it. The prospect of graduating - high school, college, medical school - can be daunting if you're going through it alone or unassisted, if you’re the first generation to pursue a degree, or if you’re trying to counteract the growing educational gaps between high- and low-income students. A series of Penn Medicine programs are all aimed at confronting the steep learning curve and helping smooth the way at every step - applications, financial aid, matriculation and beyond - and collectively demonstrate one professor's ongoing efforts to break down barriers along the way.

Roy Hamilton, MD, assistant professor of Neurology and director of Pipeline Initiatives for the Perelman School of Medicine's Council for Diversity and Inclusion, has cultivated a handful of education and outreach programs that extend from high school through medical school and residency. Through exposure, mentorship, and education, his efforts are helping to prepare students before they get to the next step, so they can anticipate and succeed along the way. 

Dr. Roy Hamilton (3rd from left) receives 2013 University of Pennsylvania Dr. Martin Luther King, Jr. Commemorative Award for Community Service.

For all his efforts to educate and help young people advance to next stage of their career , Dr. Hamilton recently was awarded the 2013 University's Dr. Martin Luther King, Jr. Commemorative Award for Community Service. Dr. Hamilton was selected among the many nominees for the award, which reflects exemplary work that people do across the University for members in their communities, going above and beyond their job description.

"Many students of any level with disadvantaged backgrounds don't know the game when they start playing it," said Dr. Hamilton. "We're collectively trying to help students and trainees overcome the barriers that separate them from success when they transition from one step of career to the next."

In the Penn Medicine Educational Pipeline program, students at Sayre High School in West Philadelphia go through a multi-tiered mentorship program. In partnership with Penn's Netter Center for Community Partnerships, Penn undergraduates spend the fall semester tutoring students on health and science at Sayre High School. In the spring, approximately 20 high schoolers most interested in health-related issues and medical science are invited to come to the Penn campus for an after school program in medical school lab and classrooms in an immersive experience mimicking what it's like to be at the Perelman School of Medicine. For some, it's the first time they've set foot on campus, even though they’ve grown up just blocks away. The spring semester gives an opportunity for medical students to teach the high schoolers about specific topics and systems-related material in medicine (such as the brain or gastrointestinal system), while exposing teens to what could be future steps in their education.

In the summer, a mentorship program run by the Penn Provost's office draws high school students from across the Philadelphia School District. This program was modeled in part after the Penn Medicine Educational Pipeline program and was initially started with three professional school partners from across the University, including Medicine. Now, more of Penn's professional schools each have their own programs. In this program, 12-15 students are selected to come to the Perelman School of Medicine all day throughout the summer for an immersive medical school experience. A strong shadowing portion pairs students with physicians in their particular area of interest.

For medical students in the Perelman School of Medicine, Dr. Hamilton and colleagues host an academic career seminar series that shows students the steps along various different career paths. This shows the variations in experiences, even for people on a similar path, that help the students prepare for residencies, specialties and careers in research, education and or clinical care.

"This series allows us to share what we wish we'd known when starting our medical careers, and what we would do differently during medical school to develop accordingly," explains Dr. Hamilton. "Even in the same medical specialty, a basic scientist leads a very different life than an academic clinician. We bring in faculty from variety of career paths, and show the medical students what the currency of success is for that person and field."

To celebrate February as American Heart Month, the News Blog is highlighting some of the latest heart-centric news and stories from all areas of Penn Medicine.

Imagine going through life with an extremely elevated blood pressure that cannot be controlled by medication, walking around for months and years with dangerously high risks of blindness, stroke, heart attack or even heart failure.

More than 75 million American adults are living with hypertension; nearly 1 in 3 adults, according to the CDC. Of that, up to 10 percent, or around 7 million people, have treatment-resistant hypertension, where their blood pressure remains high (over 140/90 mmHg) despite treatment with at least three or more different types of blood pressure medications (including a diuretic). 

Penn Medicine is the first in the region to begin testing a new procedure to help people whose high blood pressure can't be controlled using currently available medications.  

"Many of our patients have tried diligently to get their blood pressure under control, through medication and lifestyle changes, to no avail," said Debbie Cohen, MD, co-investigator of the study at Penn and associate professor of Medicine in the division of Renal, Electrolyte and Hypertension. "So we're trying an approach that makes physiologic sense in hopes that it will denervate the renal sympathetic  nerves and reduce blood pressure."

This procedure, called renal denervation, is being tested by an interdisciplinary team of hypertension and interventional cardiology experts at Penn. It involves inserting a catheter through an artery in the groin, which is threaded up to the renal artery, where a specific catheter using radio frequency energy is used to deactive the renal nerves. It doesn't involve a permanent implant and can be performed under conscious sedation.

"In this clinical trial, we are studying whether the procedure effectively get the patients back to their target blood pressure," said Robert L. Wilensky, MD, co-investigator of the study and professor of Medicine in Interventional Cardiology. "We've done a number of procedures at this point and are ahead of our recruitment goal, which indicates the real unmet need for people with complex hypertension."

The approach works to control the activity of nerves going in and out of the kidneys responsible for regulating the sympathetic nervous system, which plugs into the body's system to regulate blood pressure. If the nerves are overactive, hypertension can ensue.

The procedure is still being tested in a clinical trial, and is only being used in controlled research studies. Penn is actively recruiting at least 15 patients for the study and is on track to reach enrollment goals around June; results should be available a few months later. The procedure is already approved and available in Europe, Australia and New Zealand.

If the results of the current study prove positive, researchers anticipate that renal denervation may become an important approach to treatment for patients with difficult to control high blood pressure.

Whether you indulged on Turkey Day, are watching your calories, or trying to avoid an annual weight gain during the holidays, Thanksgiving can be an important time to stay in control of your health. And the day after Thanksgiving can be a great opportunity to reinvest your energy and set the stage for a happy - and healthy - holiday season.

In early November, I went to an eye-opening  town hall meeting, led by Penn's Institute for Diabetes, Obesity and Metabolism (IDOM) and Rodebaugh Diabetes Center, where obesity and diabetes experts candidly answered questions about weight, diabetes, and metabolic syndrome. The team provided useful insight into the reasons behind our individual and societal challenges with weight.

Every patient is amazing, to me, as they all have such unique stories, lives, and personalities. But Candace Gantt's story is one of the stories I talk about the most. 

On July 19th, 2005, Candace suffered a serious brain injury after being struck by a car while riding her bike.  Following an extensive hospitalization and surgeries at the Hospital of the University of Pennsylvania, she was back on her bike just 6 months after her accident.

She was one of the first patients I met when I started here in 2008 - we invited her in for a reunion with the nurses who had cared for her three years earlier during her lengthy stay in HUP’s neurocritical care unit, as inspiration for her first comeback race. She's still racing strong and using her story to raise awareness and support for brain injury research and care.

If you haven't heard her story before, you'll feel like you know her after watching this video:

On October 20th, 2012, Candace will participate in an Ironman Triathlon in Wilmington, North Carolina called Beach to Battleship to raise funds for brain injury research in Penn’s Center for Brain Injury and Repair (CBIR). This event includes a 2.4 mile open water swim, a 112 mile bike ride, and a marathon (26.2) mile run for a total of 140.6 miles of competition.  This is a grueling task that requires physical and mental strength.  

To help her strong mentally for the 13 hours she'll be racing, people can send quotes, jokes or a antidotes that she will carry on her bike and run and read one every mile. Her daughter, Carter, is collecting inspirational messages at carter.gantt@gmail.com (just put IRON WOMAN in the subject line).

Candace is no stranger to sharing her story. In addition to the stories surrounding her 2008 comeback,  she hopped off a plane and spoke with 6ABC just hours after completing the Boston Marathon last year. And on October 17, look for a story in the Philadelphia Inquirer sharing her journey.

I've never met someone as strong, dedicated and enduring as Candace, so on October 20, I know who I'll be rooting for. Go Candace!

Al D'Angelantonio, III, DPM, looks at feet as the foundation for the rest of the body. Like the structure of a house, if support isn’t there, the structure will start to fail. As such, everything from precariously high heels to unsupported flip-flops can have short- and long-term consequences on your joints, bones and quality of life.

Take high heels, for example: if the heel height is greater than 3 inches, you are putting major stress on the ball of your foot.

• If you wear heels regularly, your Achilles tendon contracts and can become difficult to stretch out.
• If you have early signs or are at high risk for bunions (when your big toe points toward your second toe and a bump appears), they will get worse with continued pressure and weight on the front toe joint.
• The mechanics of walking in heels requires muscles in front of your leg to work overtime, trying to pull the foot up and clear the ground, which will exacerbate existing hammer toes (when your second, third or fourth toe becomes permanently bent, looking like a hammer).

To prevent pain and progressive injury, Dr. D'Angelantonio recommends keeping the height under 3 inches. Or, if you want to wear very high heels, wear them in moderation. Dr. D’Angelantonio is the very first foot and ankle surgeon to pioneer a dedicated lower extremity fellowship within Plastic Surgery at the Hospital of the University of Pennsylvania. His fellowship training focuses on providing patients with both functional and aesthetic outcomes for all conditions of the foot, ankle, and lower leg.

As for flats, flip-flops and sandals, support is key. On average, we take about 10,000 steps per day (not including exercise), so imagine the impact that your body - from your feet, ankles, knees, and even your back - has to take when there’s no cushioning to absorb the impact. Like a car, you need support to keep the mechanics aligned and balanced to prevent wear and tear on your joints. If you wear the same shoes regularly, their support function will likely only last for 3 to 6 months - another excuse to go shoe shopping!

And, when switching shoes for a new season, remember that your feet expand and contract - from flattening arches caused by unsupported flip-flops, to temperature changes, water retention, and even hormones - so expect that your foot will have to adjust to different shoes.

If you have foot or ankle pain, have it checked out by a doctor. The earlier you get treated, the better. If you wait until symptoms are really bad, it usually takes a longer time to recover and can require more complex procedures.

"If you bite the bullet to deal with pain, you are going to create more problems down the line," said D'Angelantonio.

While feet are "designed to take a beating," they serve a crucial function in getting us from point A to point B and need to be supported and protected to prevent debilitating issues.

Happy shoe shopping!

Photo via Stock.xchng

The fear that athletes who suffer repeated blows to the head may end up with a preventable cause of dementia called chronic traumatic encephalopathy (CTE) is leading neurodegeneration researchers at Penn to join in a collaborative study of retired NFL players, to see if there are any clinical symptoms (such as depression, disinhibition, cognitive or motor impairment) and biomarkers present that can be measured and tracked over time. The ultimate goal is to use the clinical symptoms and biomarkers to be able to diagnose CTE during lifetime, as the only way to diagnose CTE currently is through an examination of brain tissue after death.

The study, done in collaboration with researchers at Boston University’s Center for the Study of Traumatic Encephalopathy, will evaluate 100 retired NFL players, ages 40-69, who played certain high risk positions for a particular number of years. They will be compared to male non-contact sport athletes of a similar age without any history of brain injury.

The study will not determine the risk for professional football players of developing a disease, or try to estimate the incidence or prevalence of CTE. Instead, researchers hope to develop biomarker tests for CTE and to explore the clinical presentation of this disease likely to affect athletes at all levels of play, as well as other members of our society, such as combat military personnel.The study is funded by the National Institutes of Health's National Institute of Neurological Disorders and Stroke (NINDS), National Institute on Aging (NIA), and Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD) (1R01NS078337-01A1).

Penn researchers will transfer their knowledge of neurodegenerative biomarker test development  from  their major roles in Alzheimer's disease and Parkinson's disease cognitive biomarker efforts. In 2009, the Penn team announced that a biomarker test was capable of confirming or ruling out Alzheimer’s disease; the test is now being used in research studies and similar tests are being evaluated in other conditions.

While there are only 1,800 active NFL players and 2,700 former players, studies like this can help researchers better understand how CTE manifests, and hopefully find biomarker tests to detect disease and targets for possible neurodegeneration treatments. Future studies may try to track people at high risk over time to map out characteristics and risk factors of CTE.

The NFL has issued new rules aimed at preventing injuries on the field, but the more tests available for on sidelines and at hospitals, the better.

Now that Penn Medicine's new fiscal year, for  2013, is underway, we took a look back at our last year’s worth of media activities to see how our efforts to promote the research and clinical care work by our amazing faculty and staff made an impact from July 2011 through June 2012.  

One of our key jobs is to share the latest news from Penn Medicine and its experts far and wide – that means letting the world know when our faculty publish important studies or are presenting newsworthy research at medical meetings, when Penn launches new interesting new programs, and when Penn faculty are experts on a topic that’s in the news. In the past year, here’s the data on how that work shaped up: Our now 7-person media team facilitated nearly 1,300 interviews and issued 318 press releases, blog posts, media alerts and announcements.  That’s all in approximately 255 business days!

In FY12, Penn Medicine news appeared in media that reached a total of 10.8 billion viewers and readers, resulting from nearly 18,000 news stories mentioning Penn Medicine (including syndicated stories via wire services such as the Associated Press). On average, approximately 30 million people could see – via TV, print newspapers and magazines and online news sources  – stories about Penn Medicine in the news each day.

It's becoming more and more common to find out a relative or friend has to leave his/her job to care for a loved one with Alzheimer's disease. Just yesterday, I heard about a colleague who is facing this difficult situation. In fact, the Alzheimer’s Association estimates in 2011, 15.2 million family and friends provided 17.4 billion hours of unpaid care to those with Alzheimer’s and other dementias – care valued at $210.5 billion.

Alzheimer's disease (AD) impacts the whole family, in a way very few medical conditions do, and coping with a progressively fatal disease takes a toll on everyone involved.

Hope is precious, and in the case of AD, research can hardly move fast enough to get us to a place where the disease doesn't conquer all it touches.

Knowing that it's mid-July, my optimism starts to rise. In an annual summit, AD experts will flock from across the globe to the Alzheimer’s Association International Conference (AAIC) in Vancouver this week. I'm waiting with anticipation for the next big Alzheimer's discovery to be unveiled.  

I was pleasantly surprised that AD news started pouring out the week before the big meeting. Last Wednesday, two separate studies were released and add pertinent information to the greater understanding of AD.  

The first, in the New England Journal of Medicine, found that gene carriers of the rare familial form of Alzheimer's disease start showing changes in diagnostic tests up to 25 years before symptoms would occur. This study, which may or may not correlate with what happens in the more common sporadic form of AD, establishes how early interventions may need to be made to stop the disease before it spreads through and damages the brain.  

Penn Memory Center director Steven Arnold, MD, professor of Neurology and Psychiatry in the Perelman School of Medicine at the University of Pennsylvania, told ABC News "We can learn so much from these people that would be applicable to Alzheimer's disease at large. If you can identify biomarkers early and see that there are AD changes, that is really the time where you can intervene with medicines...or perhaps lifestyle interventions," to reduce risk.

In the second study, published in Nature, researchers found a genetic mutation that actually protected people from producing a protein that contributes to AD. While it won't lead to a new genetic test to see if people carry this protective gene mutation, it does show that the production of amyloid protein, one of the pathological contributors to Alzheimer's disease, is detrimental in Alzheimer's disease progression, and pushes research forward targeting amyloid.  

In an interview with Medscape Neurology, Penn geneticist Gerard Schellenberg, PhD, professor of Pathology and Laboratory Medicine, who leads the Alzheimer's Disease Genetics Consortium, a part of the International Genomics of Alzheimer's Project (IGAP), said this study solidifies what is already known about the role of amyloid beta in AD. Although previous research showed that if amyloid goes up, there's an increased chance of AD, now, you can show that if you make amyloid go down, you get a decreased chance of the disease, he said.

“We all have extrapolated what we learned from early onset and applied it to late onset,” said Dr. Schellenberg. “This study gives us more confidence that all the stuff we use in our models and our experiments is going to apply to late−onset AD. That's something I find probably more interesting than just the fact that there is another APP mutation.”

And, at AAIC in Vancouver, we're expecting to hear updates on recent drug trials to slow the progression of the disease, and any promising new targets or approaches to combat this complex disease.  

For all the families dealing with AD on a daily basis, or those who have helped by participating with a loved one in a clinical trial, let our collective hope continue. With so many passionate people working on this, solutions are hopefully closer than ever.

I love sports. Football, hockey, wrestling, gymnastics, soccer. You name a sport, chances are, I love it. I'm counting down until the London Olympics (35 days!). As a die-hard sports fan, it's tough for me to imagine significant changes in the way sports are played, to prevent brain injuries. Can football or hockey be played without the crushing blows? As awareness over concussions has grown, society is now facing a tough question:

How can individuals and society on the whole balance the love of sports with the growing concerns over long term issues resulting from traumatic brain injuries?

Photo credit: Dan Burke Photography

In early June, Penn Medicine and Penn Athletics co-hosted an event to debate this virtues and peril of sports. Following an advance screening of the documentary Head Games - a revealing documentary about the concussion crisis in sports - a panel of experts talked about controversies in concussion diagnosis, treatment and policy.

As the film demonstrates, there's a struggle between what we know - that concussions are serious - and how that impacts our decisions to play the sports we love. There are no easy answers, even for people who have already been severely impacted by traumatic brain injuries.

While researchers are hard at work to develop tests and even treatments for concussions in athletes, the debate will continue to play out in sports. Just last week, the largest youth football organization in the United States announced that they will limit collisions and contact in practice, in an effort to reduce head injuries.

There is so much to learn, in terms of what is happening to the brain after a blow to the head, if or when someone can return safely to play, and what the long term implications may be for someone who experiences significant head injuries. If the packed house at Penn Medicine’s event was any indication, there are a lot of willing collaborators to drive the conversation forward, with a push for more research, more awareness and more discourse on the topic.

Neuro-oncologist researchers at Penn are investigating ways to help patients diagnosed with the most aggressive type of brain tumor, Glioblastoma Multiforme. Building on the Abramson Cancer Center's previous success with research designed to attempt to treat cancers using novel immunotherapies, and Penn's neuro-oncology expertise, researchers will be studying two different personalized approaches to stimulate an immune response against brain tumor cells.

In one study, the investigational immunotherapy will target peptides that are overrepresented in cancer stem cells, and will potentially train the immune system to recognize the glioblastoma tumor cells and hopefully inactivate them.

A slightly different approach will be used in the second study, where the investigational vaccine aims to incite an immune response by activating the cells that signal for help. The vaccine binds to a type of cell called antigen presenting cells, which attract attention from the immune system to recognize the malignant cells.

In both studies, newly diagnosed patients will have their own cells removed, from their tumor during an initial surgery or from their blood after surgery, by Penn Neurosurgeon Donald O'Rourke, MD, of Penn's Neuro-Oncology program and the Abramson Cancer Center. Dr. O’Rourke has previously studied other novel treatment approaches and developed non-invasive techniques to distinguish variations in tumor types.

Once the cells are obtained during surgery and post-surgically apheresis procedure, they will be re-engineered, tested and placed back into the patient. The patient's own cells are intended to recognize the tough-to-treat tumor cells and hopefully inactivate them.

If you have been recently diagnosed with glioblastoma multiforme and have not yet had surgery, please contact Neurosurgery Clinical Research trial coordinator Lisa Pritchett at 215-615-4597 or lisa.pritchett@uphs.upenn.eduto find out if you may be eligible for either of these glioblastoma research studies.

While researchers are busy identifying new biomarkers to detect disease and tailor treatments to individual needs, legal battles have been waged all the way up to the Supreme Court, trying to sort out whether a private company can own the rights to a particular biomarker.

In a new Perspective piece published today in the New England Journal of Medicine, Jason Karlawish, MD, professor of Medicine, Medical Ethics and Health Policy in the Perelman School of Medicine at the University of Pennsylvania, and co-author Aaron S. Kesselheim, MD, JD, MPH, from Brigham and Women's Hospital and Harvard Medical School, delve into a series of high profile court cases testing the limits of patent protection. 

In the months since a US Supreme Court ruling unanimously “rendered invalid two patents covering a method for determining proper drug dosage," as Nature reports, discussions have swirled about how to pay for personalized medicine.  The NEJM co-authors report that "a patentable process now needs to involve an inventive and novel application of a law of nature beyond well-understood, routine, conventional activity, previously engaged in by those in the field."

Without patents protecting such medical discoveries, some have argued that there is no way to recoup the costs of biomarker innovation. To that end, Supreme Court Justice Breyer suggested whether special market-exclusivity protection was warranted.

Instead, the authors suggest that enhanced public funding, public-private partnerships, and open-source consortia may improve biomarker discovery and development, more than a private model. According to the NEJM piece, "the Supreme Court's move to free the fundamental processes of medical diagnosis from private ownership…could ultimately enhance the public health."

As biomarkers become more and more prevalent -- helping diagnose diseases, and pairing with treatments targeted to individual needs -- there will need to be solutions to balance the needs of ensuring access to this useful information and paying for personalized medicine.

People can have a brain full of Alzheimer's disease, but not have the dementia that typically goes along with it. By the numbers, this subset of people can have many plaques and tangles in the brain, enough to qualify them for a diagnosis of Alzheimer's disease, but in reality, they don't have the memory loss or other clinical symptoms of Alzheimer's.

In most cases, people have more and more symptoms of dementia as the plaque and tangle  Alzheimer's disease lesions accumulate in the brain.  And , most people who have normal memory and thinking are found to have very few plaques or tangles.

Yet, there's this outlier group, who should, by most definitions, have dementia due to Alzheimer's disease, but they are resistant.

In a new study by researchers from the Perelman School of Medicine at the University of Pennsylvania with colleagues from Rush University, published online in Neurobiology of Aging, the team investigated why these people are resilient to Alzheimer's and found several biological factors that help distinguish the resilient group from those with dementia. They discovered that synapses are preserved in resilient cases and found an increase in the number of brain cells called astrocytes, that may provide a protective response to the "toxic" effects of plaques and tangles.

The team also identified new biochemical targets that may be associated with resilient cognitive brain aging in the subset of people who have Alzheimer's pathology, which they'll investigate further, thanks to a new grant from the National Institute on Aging.

In a disease with no known treatments or cures, this will be one more angle researchers will pursue, to thwart the diseases' advances. While research continues to progress in understanding how plaques and tangles develop and cause damage in the brain, it is also important to understand how the brain can fight this damage and preserve cognition.

Arnold SE, Louneva N, Cao K, Wang LS, Han LY, Wolk DA, Negash S, Leurgans SE, Schneider JA, Buchman AS, Wilson RS, & Bennett DA (2012). Cellular, synaptic, and biochemical features of resilient cognition in Alzheimer's disease. Neurobiology of Aging PMID: 22554416

Every moment counts for brain diseases. The saying among medical experts is that “time is brain.” The earlier you receive treatment, the better. This week, a diverse team of researchers from the Perelman School of Medicine at the University of Pennsylvania is in New Orleans at the American Academy of Neurology’s 64th Annual Meeting, sharing the latest data aimed at enhancing the speed of diagnosis and treatment, and ultimately helping people with neurologic conditions.

This morning, Michael Mullen, MD, a fellow in Neurology and Vascular Medicine, started the day with a presentation showing that the emergence of primary stroke centers certified by The Joint Commission has steadily improved the treatment of stroke patients. Previous studies, from collaborations between Penn’s Departments of Emergency Medicine and Neurology, have shown that nearly half of Americans live more than an hour away from primary stroke centers and do not have ready access to the specialized stroke care they need when blood supply to their brain has been cut off. The data presented today provides evidence supporting the efficacy and importance of primary stroke centers.

In a layer cake of research labs nestled on separate floors in a remote corner of the Hospital of the University of Pennsylvania, a new use for an existing drug was uncovered. The drug, epothilone D (EpoD), stalled after original tests as a cancer treatment, but Perelman School of Medicine researchers have found it is effective in preventing further neurological damage and improving cognitive performance in a mouse model of Alzheimer's disease (AD). Now, the drug company is starting to enroll AD patients in clinical trials to test the drug.

My colleague Karen Kreeger has written press releases about what the drug is and does, but I'm fascinated by how it came to be. It's not every day that academic researchers go so far beyond identifying a specific target by seeing an agent well into the drug development stages and discovering new uses after its initial clinical testing.

Kurt Brunden, PhD, who spearheads the drug discovery efforts at Penn's Center for Neurodegenerative Disease Research, came to Penn from the pharmaceutical industry, with hopes of progressing the basic research being conducted here and speeding it toward clinical trials. Here, he explains how the process works at Penn, and how teamwork from across the Penn campus has helped make it possible for this academic drug discovery program to be a success.

As Dr. Brunden notes, academia can play a complementary role – alongside the typical research and development might of the pharmaceutical industry -- in helping bring much-needed therapeutics into clinical trials as quickly as possible.

When I heard that Jesse Taylor, MD, assistant professor in Plastic Surgery, was using 3D computer-aided design (CAD) to plan out a surgery to restructure someone's face, I had to find out more. My father is a pattern maker by trade, and develops prototype parts and molds.  After growing up talking about some of the same 3D design tools, it’s fascinating to see how the latest technical innovations are now helping patients with facial malformations.

Dr. Taylor walked me through a recent surgery, one of the most complicated cases he's done, of a patient whose facial structure was significantly impacted by a rare genetic condition called Saethre-Chotzen syndrome (SCS).

Amyotrophic  Lateral Sclerosis (ALS) is linked to Frontotemporal Lobar Degeneration (FTLD). Parkinson's disease (PD) is linked to Alzheimer's disease (AD). Progressive Supranuclear Palsy (PSP) is caused by an abnormal accumulation of tau, a protein that plays a role in AD.

It may sound like an alphabet soup of diseases, but these intertwined diseases are changing the way we look at, and hope to treat, progressive neurodegenerative diseases attacking the brain.

For diseases historically considered in the domain of distinct neurological sub-specialties - movement disorders, neuromuscular conditions, and dementia - the steady increase in our understanding of their overlapping causes and symptoms, as well as their co-existence in the same individual, has led to a shift in how care is delivered. Physicians, nurse practitioners, therapists, and other care-team members are cross-training and collaborating more than ever.

Rachel Gross, MD, now an assistant professor of Neurology in the Perelman School of Medicine at the University of Pennsylvania, noticed the overlap as she completed advanced training in Neurology. She decided to get dual-trained in both Cognitive Neurology and Movement Disorders while completing her fellowship at Penn. "I realized that patients who suffer from diseases characterized by a movement disorder and dementia would appreciate seeing one physician who can address both their motor and cognitive issues.”

At last weekend's FTLD Caregiver Conference, hosted by the Penn FTLD Center, we saw how neurological sub-specialties are blending, overlapping, and informing each other. For instance, researchers are now considering FTLD and ALS to be on the same spectrum of disease. Some people may start with the physical stiffness seen in Lou Gehrig's disease, while someone else - with the same underlying protein markers - starts with FTLD-symptoms like behavioral outbursts or language mix-ups.

Some of the less common neurodegenerative diseases are also informing the more common diseases. Last year, we reported genetic clues on risk factors and biological causes of a rare neurodegenerative disease called progressive supranuclear palsy (PSP). Biologically, PSP is primarily caused by an abnormal accumulation of tau protein, which is well-known for its secondary role in Alzheimer's disease.

Pieces of research - genetics, biomarker tests, imaging, pathology, and clinical symptoms - are starting to come together to give us a better picture of neurodegenerative disease. The team of researchers and clinicians, at Penn and beyond, are in a race to find a cure. The more experts battling neurodegenerative diseases, the better!

If you're getting not-so-tech-savvy loved ones of any age new gadgets for  holiday gifts this year, take a page or two from the Penn Memory Center's Cognitive Fitness program lessons. They've been working one-on-one with a pilot group of participants, helping them use tech tools and other coping skills to counter memory issues. While sitting in on a recent Cognitive Fitness class, I watched as the instructors spent considerable time going over the various items the participants were learning to use, cell phones to iPads. WHYY Radio attended a recent class – get a peek inside their story.

The devices have definite perks that make them appealing gifts for seniors: e-readers are light and portable for people who do not want to carry lots of things around and make it easy to access books if transportation is problematic; iPhones and smart phones are fairly intuitive to use and great for directions or setting medication reminders; internet access allows you to find new (healthy) recipes or webchat via Skype to stay connected with loved ones far away; and email can bring photos of grandkids galore.
 
For gift-givers who have grown up surrounded by new technology, it's tough to understand how challenging it can be for tech newbies to learn to use their new devices. So, I asked the instructors for some advice.  Here's what they recommended for anyone teaching a loved one to use a new gadget -- memory issues or not.
 
1. Teach one tech tool at a time. Instead of teaching them how to use all the functions on their gadget at once, break it out into sessions. If adding contacts to a cell phone is a priority, start with that. Or, if adding a calendar appointment is a helpful tool, offer a separate lesson to walk through that process.

2. Be patient. Plan on spending a few sessions helping them learn, and space it out so they have some time to practice on their own between new sessions.

3. Write detailed instructions out. One Cognitive Fitness program participant photocopied his new remote control and annotated it, so he could have a reference guide to refer to if he couldn't recall the right button to press. Printouts of screen shots, showing people what icons to look for to check email, or what the calendar button looks like, are also helpful. 

a. If passwords are required, a handy password guide might be helpful (if stored in a secure, yet easy to find place).
b. Some people learn more if they write the instructions out themselves, in their own words and in a format that may be more intuitive for them. If they're a visual learner, drawing diagrams may work well for them.
c. Once instructions are written, the user should work through them step-by-step to make sure all steps are accounted for and identify any places at which they may get "stuck" in the process.

4. Practice makes perfect. Work with them to see if they can use the device on their own. For example, call and leave a voicemail, to see if they're able to retrieve it, send an email to make sure they can email you back, or call them via Skype to see if they can respond. It may take a couple of practice runs for more complicated instructions.

5. Build confidence. Technology can be overwhelming, so working one-on-one with a loved one can help them feel more capable and confident that they won't mess up or hit the wrong button. If they get overwhelmed, take a break and try again later, focusing on basic skills first to help them build their confidence.
 
While technology can be very beneficial, change can be unsettling. With any new process, it will take some time for your loved one to get used to making the new technology work for them.  Take the time to help your loved ones warm up to the new gadgets, and you'll both be happier.
 
Happy holidays!

Photo via www.thecapabilityproject.com

520 days ago, in June 2010, a team of six astronauts embarked on a simulated Mars mission, conducted by the State Scientific Center of the Russian Federation – Institute for Biomedical Problems (IBMP) of the Russian Academy of Sciences.

On November 4, 2011, the hatch was opened in Russia and the crew members ended their mission. But the mission continues for the Penn-led U.S. scientific team charged with monitoring the six crew members’ rest-activity cycles, performance and psychological responses.

David Dinges, PhD, chief of the division of Chronobiology and professor of Psychology in Psychiatry with the Perelman School of Medicine, and team members collected over 75,000 hours of data during the 520-day mission's three stages: 250 days for the trip to Mars, 30 days on the surface, and 240 days for the return to Earth.

Using unobtrusive miniaturized wristwatch-like devices to measure crew members' sleep-wake patterns and specially programmed computers with brief assessment tests, the team hopes determine the extent to which sleep loss, fatigue, stress, mood changes and conflicts occurred during the mission.

Dr. Dinges and colleague Mathias Basner, MD, PhD, MSc, assistant professor of Sleep and Chronobiology in Psychiatry, captured 99 percent of their intended data. Results of the study will be reported after the data has been fully analyzed.

The Penn Medicine research program was funded by the National Space Biomedical Research Institute (NSBRI) and in part by the Institute for Experimental Psychiatry Research Foundation. Dr. Dinges and Dr. Basner will be available for interviews when they return from Russia.

For more information, please see the NSBRI press release or watch the Associated Press video, below.

As Breast Cancer Awareness Month winds down, we wanted to talk about one of the last steps some of our breast reconstruction patients face: nipple reconstruction and tattooing.

Once the breast reconstruction(s) are complete, nipple reconstruction can take place several months after breast surgery and following other treatments. Patients may elect to undergo nipple reconstruction on one or both breasts using local flaps, grafts, or a combination of the two. After the reconstructed nipple has healed, nipple tattooing can re-pigment the area, to make it look more realistic.

Nipple tattooing, as I've come to find out, is a true demonstration of art's impact on healing.

We're very fortunate at Penn to have a skilled tattoo artist who specializes in 3D nipple tattoos along with tattoos for scar camouflage or cosmetic purposes - Mandy Sauler, a micropigmentation specialist in Penn's Plastic Surgery Division.

Mandy never imagined she'd find herself working as a tattoo artist in the most unlikely of places, a hospital. Her mother owns a body art shop outside Philadelphia, so Mandy grew up expecting to build a career working and teaching tattooing in her mother's shop. After spending nearly a decade as a full time tattoo artist, Mandy explored the burgeoning area of permanent cosmetics, and trained with an expert in micropigmentation, where permanent pigment is placed below the dermal layers of the skin. She earned her board certifications through the American Academy of Micropigmentation, is a member of the Society of Permanent Cosmetics and is now a busy permanent cosmetics/tattooing expert.

I asked Mandy for some tips and things to consider when investigating whether nipple tattooing is a good option. Here are some of her tips.

In honor of Breast Cancer Awareness Month, we'll be spotlighting breast cancer-related news from around Penn Medicine on our News blog every Wednesday in October. First up, we delve into Penn Medicine research providing personalized breast reconstruction options for women of all shapes and sizes.