Registration open for third-annual neurogastronomy symposium

Registration is now open for the third annual International Society of Neurogastronomy Symposium, which will be held at UK on March 2-3, 2018.

Both day’s events offer continuing education credit.

This year’s symposium will explore the connection between brain and behavior in the context of food.

Luminaries from the worlds of science, nutrition and culinary arts will share their knowledge on a variety of topics, including the psychological influences on eating and behavior, the chemosensory properties of food and how we experience them, the role of food as medicine and the history and evolution of flavor and flavor perception.

The term neurogastronomy was coined by Dr. Gordon Shepherd, professor of neurobiology at Yale University – first in 2006 in an article in Nature and six years later in an eponymous book. While Dr. Shepherd has been interested in the concept from a research perspective, a group of neuroscientists, chefs and food scientists are enthusiastic about making it a clinical translational science, with applications in cancer, stroke, and brain injury (which can destroy the sense of taste) as well as diseases like obesity, diabetes and heart disease.

The day’s format differs from the typical symposium, featuring brief presentations modeled after the popular TED talks and punctuated with breaks for tastings and a contest where food prepared by nationally acclaimed chefs Taria Camerino and Jehangir Mehta will be judged by UK HealthCare patients with diabetes.

Here is a link to video highlights from last year’s symposium.

This year, there is an experiential event on Friday, March 2: a five-course dinner with wine pairings by world-class sommelier Francois Chartier and bourbon flavor wheel instruction by Chris Morris, Master Distiller at the Woodford Reserve, plus interdisciplinary clinical neuroscience lectures.

For more information about the symposium, including a full list of speakers and how to register, visit isneurogastronomy.org.


Next steps:

 

UK researcher using NIH grant to seek early predictors of Alzheimer’s

Olivier Thibault, a researcher in UK’s Department of Phamacology and Nutritional Science, along with researchers from four other institutions, is using a grant from the National Institutes of Health (NIH) for a collaborative project using non-invasive treatments on mice to measure early predictors of Alzheimer’s disease in hopes of finding a cure.

Alzheimer’s disease wreaks emotional havoc on patients who are robbed of their memories, their dignity and their lives. It’s financially devastating as well: care for Alzheimer’s patients is predicted to top $1 trillion by the time children born today are having children of their own.

Alzheimer’s begins its destruction decades before there are outward signs of memory loss, so some recent scientific effort has focused on recognizing the earliest signs that portend disease onset. Those telltale signs, called biomarkers, would enable patients to receive treatment for Alzheimer’s sooner, thereby delaying the disease’s devastating progress or stopping it altogether.

The biomarker treasure hunt has been difficult thus far. There’s been little to no progress toward finding one that is a “triple threat” – non-invasive, inexpensive and easily translatable to community populations. So, the NIH called for research proposals to find new ways to diagnose Alzheimer’s disease and predict its progression.

Building a research proposal

Among the grant applicants was a group of scientists from four different institutions, each with a specific scientific skillset that when put together had the resources to test the presence and reliability of one such biomarker.

“When I first saw the call for applications, I was really excited,” Thibault said. “I remembered some interesting work that came out of Bruce Berkowitz’s lab at Wayne State University and thought it might be the cornerstone of a project that met the grant’s parameters.”

That cornerstone is called Quest MRI, a dynamic process that is able to pinpoint levels of oxidative stress in specific regions of the brain over time, and in living subjects. The technique is non-invasive and usually doesn’t require expensive modifications to existing equipment.

“Almost everyone with a television set has heard about the benefits of antioxidant-rich vitamins like A, C and E, and superfoods like blueberries, green tea and dark chocolate,” Thibault said. “Well, antioxidants are the body’s defense against something called free radicals. Free radicals are natural byproducts of chemical processes in the body, and in a healthy state free radical production is offset by the work of antioxidants. But when there are too many free radicals, the balance is disrupted, and the resulting oxidative stress can increase the risk for diseases like AD.”

People write off the times when they can’t remember where they left their keys, but realizing they don’t know how to get home from the grocery store is a wake-up call that something is terribly wrong. The scientific term is “spatial disorientation,” and it’s a critical hallmark of Alzheimer’s disease.

The capacity for spatial orientation lies in a part of the brain called the hippocampus. Berkowitz and Thibault hypothesized that using Quest MRI to measure oxidative stress in the hippocampus of a live animal and compare it to that animal’s ability to remember how to navigate a maze could be proof of the existence of a biomarker for Alzheimer’s. Even better – the process uses inexpensive drugs that are already FDA-approved – making Quest MRI easily translatable to the general population.

The NIH was impressed, and awarded the foursome $2.8 million over five years to test the hypothesis.

How the collaboration works

Rounding out the project are Geoffry Murphy at the University of Michigan and Brian Bennett at Queen’s University in Canada. Bennett has developed a mouse genetically predisposed to high levels of oxidative stress, and Murphy’s mice are already afflicted with Alzheimer’s disease.

Thus begins a roughly 850-mile circuit of testing where Bennett’s oxidative stress mice are flown from Ontario to Ann Arbor, Mich., where Murphy puts them and his own Alzheimer’s mice through a maze to assess spatial navigation. Murphy himself then drives the mice to Detroit, where Berkowitz uses his Quest MRI to determine free radical production in the hippocampus. Ultimately, the mice end up in Thibault’s lab, which uses calcium imaging techniques to measure how neurons are affected over time, thereby measuring the relationship between free radical production, oxidative stress and behavioral changes in the same animal. Some of the mice actually make more than one circuit to assess cognitive and corresponding biochemical changes over time.

“The entire process provides a deeply characterized analysis of mice that may well affirm Quest MRI’s ability to identify the earliest signs of Alzheimer’s disease,” Thibault said.

Even better, says Thibault, the group foresees a bonus aspect of their research: they will also be able to test the efficacy of pharmacologic and non-pharmacologic methods to reduce free radical production in the hippocampus. Advantageous data would point to the possibility of reducing free radical production using either an antioxidant “cocktail” or a light therapy called photobiomodulation.

Either option, Thibault said, would be “the cherry on the cake.”

The mice don’t begin their journey until later this month, but Thibault and his colleagues are energized at the prospect of joining the hunt for a cure for Alzheimer’s disease.

“To be able to identify or even predict Alzheimer’s disease using Quest MRI, and then also be able to intervene using antioxidants or photobiomodulation, would be a one-two winning punch,” Thibault said.


Next steps:

  • Last year, the UK Sanders-Brown Center on Aging was redesignated as an NIH Alzheimer’s Disease Center. Learn more about this prestigious designation and what it means for our patients and their families.
  • Alzheimer’s disease usually affects people who are 65 or older. If there’s a senior in your life, be aware of these signs and symptoms of the disease.
stroke research

UK team first to offer innovative stroke care through clinical trials

The combination of a new clinical trial and a tissue bank is innovating stroke care and research at the UK. Led by a multidisciplinary team of clinicians and scientists, the two studies aim to develop new treatments using existing therapies that protect brain tissue after a stroke, and to learn more about the physiology of the event.

The MAVARIC (Magnesium and Verapamil After Recanalization in Ischemia of the Cerebrum) clinical trial leverages existing standards of care and approved drugs to improve how the brain heals following a stroke. The related BACTRAC (Blood and Clot Thrombectomy Registry and Collaboration) study is developing a tissue bank of thrombi (stroke-causing clots) and distal and peripheral blood to examine the immediate molecular changes that occur at the stroke site. Both the MAVARIC trial and the BACTRAC study are the first of their kind.

The burden of stroke is especially severe in Kentucky, where it’s the third-leading cause of death (compared to fifth nationally) and occurs at earlier ages than in the rest of the country. Globally, stroke is the leading cause of morbidity and physical incapacity.

Despite the prevalence of stroke, current standards of care include only two potential treatments. One is a drug called tPA, which, if administered quickly enough, can break up the clot that caused the stroke. This treatment, however, has a limited window of opportunity – three to four and a half hours – and can exacerbate injury if delivered too late. The second treatment option is a thrombectomy, where the clot that caused a stroke is physically removed through a catheter inserted into the blood vessel. The therapeutic window for thrombectomy is much longer, sometimes up to 24 hours.

Even with the advances of tPA and thrombectomy, which can be highly effective in removing the cause of the stroke, neither therapy treats the injury inflicted by a stroke.

“Thrombectomy has become common and widely effective, but only 60 to 70 percent of patients will be independent in three months – so there is more to be done,” said Dr. Justin Fraser, director of cerebrovascular surgery at UK and one of the principal investigators of the MAVARIC trial.

Leveraging existing drugs and modalities

In the hope of improving stroke outcomes by treating the injured area of the brain, Fraser partnered with Dr. Gregory Bix, director of the UK Center for Advanced Translational Stroke Science, to look at repurposing existing drugs that, in combination with thrombectomy, could limit brain tissue damage and promote healing in stroke survivors.

“After the clot is removed through the catheter, there’s immediate access to the site in the brain where the injury is occurring. We’re taking therapeutics that already exist and putting them into the catheter immediately after we remove the clot, so that the drug is delivered directly to the stroke-affected area of the brain,” Bix said.

Fraser and Bix began by repurposing an existing calcium channel blocker called Verapamil, which is mainly used to treat heart arrhythmias but is also FDA-approved for use to relax brain blood vessels that contract after a thrombectomy. Fraser noticed anecdotally that patients who received Verapamil during a thrombectomy had better outcomes than their imaging and symptoms would have predicted.

In a previous preclinical study and Phase I trial – the first in the world to pair thrombectomy with immediate, intra-arterial administration of a neuroprotective drug – Fraser and Bix found that intra-arteria delivery of Verapamil was safe. Furthermore, in cell culture and animal models of stroke, it was effective in preventing significant ischemia-induced injury. But they also understood that Verapamil alone wasn’t addressing the complex process of damage caused by stroke.

“There’s not going to be a single magic bullet in terms of drugs. When someone has a stroke, multiple pathways get activated and damaged. If you give a drug that addresses only one pathway, it doesn’t treat everything. So we need to try combining drugs,” Fraser said.

MAVARIC clinical trial

In the MAVARIC trial, which opened in October, Fraser and Bix are investigating whether combining magnesium with Verapamil can bestow even greater neuroprotective benefits. Magnesium has previously been studied for its potential to protect the brain after a stroke, but this trial is the first to intra-arterially deliver a neuroprotective “cocktail” to the stroke site. A total of 30 stroke patients will be enrolled; stroke size, safety, and functional and cognitive outcomes will be evaluated through randomized, blinded outcome assessment.

“By using the catheter that was inserted to remove a clot, we’re then able to deliver neuroprotective drugs directly into the brain tissue that was just reopened,” Frasier said.

The combination of Verapamil and magnesium was first validated in preclinical models before moving to a clinical trial.

“When I used these two drugs in experimental stroke models, it demonstrated very cleanly that there was a significant reduction in mean infarct volume – in other words, smaller strokes – as well as better functional outcomes. We were the first to model this completely in lab animals,” Bix said.

Because the trial uses existing FDA-approved therapeutics and modalities, the research team can conduct animal model and clinical research simultaneously, allowing them to refine the animal model as they learn more through the clinical research.

The trial also includes collaboration with Kentucky Appalachian Stroke Registry, which will enable analysis of thrombectomy and severe stroke patients who might have been candidates for the new procedure, as well as analysis of a rare but increasing stroke condition called moyamoya.

Support for the MAVARIC trial comes from the UK Multidisciplinary Value Program, which funds investigator-initiated clinical trials at UK through support from the College of Medicine, the Office of the Vice President for Research, and the Center for Clinical and Translational Science.

BACTRAC study

Leveraging thrombectomy technology even further, Fraser, Bix, and Keith Pennypacker, PhD, professor of neurology and associated director of the UK Center for Advanced Translational Stroke Science, are developing a stroke tissue bank that will greatly enhance stroke research through increased molecular understanding of the injury. The BACTRAC study is the first to collect and analyze both the stroke clots and surrounding blood. The samples are obtained as a matter of standard thrombectomy procedure and require nothing additional. The process does, however, rely on a highly collaborative process of tissue collection and informed consent that will enable inclusion of nearly every thrombectomy case at UK.

“We have a pager – we call it the Thrombectomy Pager – and when it goes off, everyone involved swarms together. One of the people who carries a pager is a researcher who will come in and process the samples on the spot. There’s centrifuge right outside the angio suite,” Frasier said.

Clot and blood samples are analyzed to examine protein, genetic and blood gas changes that occur at the stroke site. From early analysis of their first samples, the team is already noticing surprising changes in the blood and tissue where strokes occur. The observations could eventually allow for more targeted treatment of strokes.

“We’re getting the first glimpse of molecular events that are occurring due to the stroke, and some of these events are involved in signaling the immune system,” Pennypacker said. “The inflammation response is essential for the healing of the injury, but sometimes it can overreact and cause additional damage. So if we can get a handle on these molecular events, we can possibly eliminate the molecules that cause excess damage without blocking the beneficial immune molecules.”

In analyzing the first samples they collected, the team has observed calcium depletion in the blood and blood vessel distal to the clot, as well as changes in protein and RNA related to gene expression.

“We’re discovering things about stroke that no one knew six months ago – incredible changes even in single samples that could really help us understand stroke on the very acute, early side of things, which has been very difficult to study until now,” Fraser said.

Eventually, they hope, the BACTRAC study will include enough stroke cases that researchers will be able see how stroke affects people differently based on age, sex and other health conditions, such as obesity or diabetes. One limitation of current stroke research is that animal research models use predominantly young, homogeneous male mice, whereas the human population that experiences stroke is older, less healthy and much more diverse.

Such a diverse patient population is one of the main problems in finding a cure for stroke.

“In basic science animal models, we mostly use a homogeneous population, and we’ve found that they’re receptive to experimental therapies in ways that we don’t always see in humans,” Pennypacker said. “But, if we have a huge database with thousands of patients that allows us to pull out various groups and see the differences in their response to stroke, it could give insight into different treatments that work better for people based on age, sex and other health conditions.”

Initial support for the BACTRAC tissue bank comes from the UK Department of Neurology Pilot Grant Program, which funds investigator-initiated pilot studies. Further grant applications are currently underway.

Translating discoveries through team science

The multidisciplinary innovations of the MAVARIC and BACTRAC studies, which unite patient care and lab research, depend on the combined expertise of scientists, clinicians and research staff.

“There aren’t a lot of places in the U.S. that have this translational integration for stroke between basic research and clinical research,” Bix said. “What makes an academic medical center special is that we are at the cutting edge of developing new therapies. Where’s the next cure going to come from? A place like UK – an academic medical center running clinical trials it has developed itself, where people are pushing the envelope.”

To learn more these studies, visit the MAVARIC and BACTRAC clinical trial webpages.

As a designated Comprehensive Stroke Center by The Joint Commission, UK HealthCare is distinguished from other stroke centers for meeting the highest standards of care to receive and treat the most complex stroke cases.

The Multidisciplinary Value Program supports innovative, multidisciplinary clinical trials at UK. Learn more here.


Next steps:

  • Researchers are working hard to identify new treatments and strategies to improve health, but they need healthy participants and those with medical conditions to participate in clinical studies. Find out how you can participate in clinical research at UK HealthCare.
  • At the UK Comprehensive Stroke Center, we offer treatment, prevention and rehabilitation services for stroke patients. Learn more about our program.
signs of dementia

Visiting older relatives this holiday? Take time to notice memory changes

If you’re spending time with elderly friends and family members this holiday season, be aware of noticeable changes in their memory and behavior, as these can be early warning signs of dementia.

“If you haven’t seen your elderly loved one in a while, you might be more likely to notice changes in their memory and behavior that worries you,” said Dr. Gregory Jicha of the UK Sanders-Brown Center on Aging.

Here are some early warning signs of dementia that you might notice in an older friend or family member:

  • It’s normal for someone to forget a date or a name but suddenly remember it later. However, pay attention if they ask for the same information repeatedly, or struggle to recall important dates (like their own birthdate).
  • Are they having trouble following a recipe? Problem-solving skills can deteriorate in someone with dementia.
  • Do they get lost when driving to a familiar location? If they have difficulty completing familiar tasks, it might be a sign of dementia.
  • Healthy people occasionally struggle to find the right word, but using the wrong word – particularly if they call something by the wrong name – merits further scrutiny.
  • Poor judgment. Are they giving lots of money to telemarketers or charities? Pay attention to behavior related to important aspects of their life.
  • Poor hygiene.
  • Personality changes. Are they suddenly irrational, fearful or suspicious? This can be a symptom of serious memory-related problems.

Next steps:

concussions

Podcast: UK athletic trainer talks childhood concussions

UK HealthCastUK HealthCast is a new podcast series from UK HealthCare featuring in-depth interviews with our experts on a variety of health-related topics. Subscribe to UK HealthCast today wherever you listen to podcasts!

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Not all concussions in young athletes look the same.

They may appear immediately after contact in a game or practice, or they may not show up until much later. They can pass quickly or take months to heal. Although every concussion is different, they are more likely to happen in contact sports, such as football, hockey, lacrosse and soccer.

Parents, coaches and young athletes – listen below to our conversation with Peter Gray, an athletic trainer at the UK Orthopaedic Surgery & Sports Medicine and the head athletic trainer at Henry Clay High School in Lexington, to learn more about the symptoms of concussions and what you can do after a concussion occurs.


Next steps:

UK team shares Parkinson’s disease expertise on trip to China

Last summer, a group from the UK Brain Restoration Center, led by Dr. Craig van Horne, performed the first-ever deep brain stimulation (DBS) surgery for a Parkinson’s disease patient being treated at The First Affiliated Hospital of Zhengzhou University in Henan, China.

DBS surgery involves implanting a device that uses electric signals to regulate brain activity. It alleviates an array of debilitating symptoms of Parkinson’s disease such as tremors, rigidity and slowness in movement.

The UK neurosurgery group consisted of van Horne, neurosurgeon and co-director of the Brain Restoration Center; Greg Gerhardt, director of the Center for Microelectrode Technology; Ann Hanley, program director for neurorestoration at the Brain Restoration Center; and George Quintero, a research analyst and neurophysiologist from the UK College of Medicine Department of Neuroscience and UK Brain Restoration Center.

Helping build a DBS program in China

Assisted by his group, van Horne performed the groundbreaking DBS surgery in China at the renowned First Affiliated Hospital of Zhengzhou University. As the third-most populous province of China, Henan has held historical importance, having housed four Chinese capitals throughout history and often credited as the birthplace of Chinese civilization. With more than 7,000 beds, Zhengzhou University’s First Affiliated Hospital is considered the world’s largest hospital.

The surgery, which appeared on the Henan news, was intended to expand the scope of neurosurgical practice in the area. The team was fascinated by how different regions of China translated to very diverse surgical practices within the country. All agreed that the surgery was a critical learning moment; George Quintero commented that it “used all of our abilities by combining different groups’ resources and talents to achieve one goal.”

The UK group visited the Zhengzhou Hospital a day after the surgery to check on the patient. The surgery’s outcome was successful; the patient was able to walk and move more fluidly and was released from the hospital a few days later. This surgery set a precedent for many DBS surgeries to follow at the Chinese facility. The DBS program at The First Affiliated Hospital of Zhengzhou University has since grown, and DBS surgeries are now much more common. As a whole, the process highlighted a newfound optimism and cooperative spirit in tackling a source of symptoms for Parkinson’s patients.

Sharing culture and medical expertise

This landmark surgery was one major component of UK’s participation in Central China’s inaugural Sino-U.S. Neuromodulation Forum held at Zhengzhou University’s First Affiliated Hospital. The forum provided a rare opportunity for researchers, surgeons and others in the medical field from China and the U.S. to share their experiences through presentations and meetings that specifically explored DBS and neuromodulation.

The forum also facilitated a deeper understanding of Parkinson’s disease from the patient’s perspective: Ann Hanley, who is a Parkinson’s patient herself, not only shared her personal struggles in conquering obstacles presented by the disease, but also inspired doctors in this field through her creation of a Parkinson’s research fund.

Overall, both the surgery and the forum united two very different cultures of medical and surgical practices. Quintero deemed the experience an opportunity to get a Chinese perspective.

“Because diseases have worldwide impact, seeing medicine from another country’s angle is not only eye-opening, but immensely valuable,” Quintero said.

This trip, made possible with support from the UK Confucius Institute, initiated a relationship between the UK and The First Affiliated Hospital of Zhengzhou University, which will subsequently contribute to collaboration between the two universities’ research fellows.


Next steps:

How a Markey lab is helping stroke patients

When George Quintero first heard about a new clinical trial that could improve motor function in stroke patients, he knew he had to find a way to bring it to UK HealthCare.

Quintero, a research analyst for the UK Department of Neuroscience, first obtained a list of criteria to apply. The phase II trial required a physician with experience in frame-based surgery, which was easy for UK to fulfill: Dr. Craig van Horne, a neurosurgeon for the Kentucky Neuroscience Institute, has been performing this style of surgery on neurology patients for more than 20 years.

The second required element was a bit trickier. To be a treatment site for this innovative trial, the stroke team needed resources and buy-in from a stem cell lab with specific cell processing skills near the hospital.

“Originally, we thought we just needed a cell lab,” Quintero said. “We realized we didn’t have any experience in the sort of cell delivery we needed. My background is basic sciences and I have a plain cell lab, so it wouldn’t be sufficient.”

Finding the right lab

Quintero hunted for an appropriate lab across the city, beginning with UK’s Center for Clinical and Translational Science (CCTS). He combed through the work of individual investigators, and then tried to identify facilities around town that would have the means and experience to carry out the specific stem cell work needed for the trial.

After running into several dead ends, he stumbled upon the idea of bone marrow transplants, which use stem cells collected from bone marrow to repopulate the blood after aggressive treatment for blood cancers. Quintero finally had a lead: Just across the street from KNI, the UK Markey Cancer Center’s Blood and Marrow Transplantation (BMT) Program performs upward of 100 bone marrow transplants for patients each year.

Quintero reached out to Dr. Gerhard Hildebrandt, division chief of Hematology and Blood and Marrow Transplantation at UK. Although the work required was unrelated to the usual duties of the stem cell lab, Quintero says Hildebrandt was on board with the project.

“He was very excited,” Quintero said. “He thought that sort of stem cell delivery for neurological diseases would be a really advantageous thing for UK to have. So he was an early supporter of us moving forward, and he got me in touch with the group at the cell lab.”

Working together to improve patient care

Tucked away on the second floor of Albert B. Chandler Hospital, the three staff members of UK’s stem cell lab – lab manager Rita Hill and medical technologists Martha Pat Kinney and Giovi Hidalgo – quietly and efficiently go about their work of preparing stem cells for bone marrow transplant patients at the UK Markey Cancer Center.

Overseen by Dr. Roger Herzig, medical director of Markey’s Blood and Marrow Transplant Program, the lab processes stem cells for both autologous transplants – those using the patient’s own stem cells – and allogenic transplants, in which stem cells harvested from related or unrelated donors are used.

When presented the opportunity to help KNI participate in this trial, Herzig was immediately interested, having previously collaborated on other projects at UK HealthCare. Hill says the team wanted to help but had some initial reservations because of their already busy workload – to do the study, the Markey stem cell team would have to take on additional work outside of their usual service area.

“I first met Dr. Quintero and he gave us a protocol to look at, and wanted to know if we were interested,” Hill said. “We thought, ‘Yes.’ But there is a time constraint and with the BMT program rolling, we weren’t sure if we could really support it.”

For the trial to work, the stem cell team would have to work closely with Quintero and van Horne to ensure seamless patient care. The lab would receive genetically modified stem cells from the pharmaceutical company, process the cells for implantation per trial protocol, and deliver them to Quintero. Once he signed off, van Horne would initiate the procedure by drilling a small hole into the patient’s skull and injecting the stem cells into the brain. Because most of the patients in the trial would be traveling long distances just for this procedure, it was essential to have the process streamlined and efficient from start to finish.

“An idea is pretty easy to have and say, ‘Let’s do this!'” van Horne said. “But when you realize all the work that has to go into these things, it’s phenomenal.”

First, scheduling was key. Hill says Quintero and van Horne were willing to be flexible on the timing of when they could bring in patients, and they worked out a schedule that wouldn’t conflict with their normal duties for Markey.

Secondly, Hill and her team looked closely at the protocol, and noted some small elements of the process that could be improved. After several conversations, the company sponsoring the trial even adopted Hill’s suggestions and implemented them at other trial sites nationwide.

“One of the advantages of having Rita is that she has a lot of expertise in managing cell labs and the requirements of cell processing,” Quintero said. “She sort of gave some direction that the study needed, and the study welcomed that because they wanted the input from individuals to make the project better.”

Culture of collaboration

This recent trial is yet another example of what van Horne describes as “the proliferation of collaborative culture to solve human problems” across UK’s academic and healthcare campuses.

“One of the things that I think is unique about UK is there’s really a culture of collaboration,” van Horne said. “I’ve previously been in other institutions where that culture doesn’t exist… It’s not, ‘This is too much, we just can’t do this,’ but ‘Oh, that’s a great idea, let’s figure out a way to make that work.’ And everybody stepped up and pitched in and made it happen.”

“This kind of collaboration is what keeps making the research and the medicine new,” Herzig said. “And that’s what keeps me coming back to work.”

It’s not the first time the stem cell lab has stepped up to help other across the medical campus. They’ve previously assisted with stem cell research in nephrology and cardiology. Participating in these outside projects has helped the team learn more about what properties stem cells possess aside from the ability to reconstitute blood, which may prove useful in future endeavors.

“Part of the academic mission is collaboration; that allows us to tackle problems that individually we can’t do,” Herzig said. “You never know what technique you have today that you’ll be able to transfer to a different situation tomorrow. The things that we’re learning from this are probably going to be helpful in other future projects.”

Hill and her team spend most of their working time in the lab, but they do personally deliver stem cells to the bone marrow transplant patients who are preparing to undergo their infusions, giving them a brief encounter with the person who will be benefiting from their work. In addition to simply “enjoying the science” of this new project, Hill says the idea of helping even more patients provides some extra personal motivation.

“Who knows, you could have a family member or loved one later on who suffers from a stroke, and this trial could benefit them in the future,” she said. “Why wouldn’t you want to help?”


Next steps:

  • Researchers are working hard to identify new treatments and strategies to improve health, but they need healthy participants and those with medical conditions to participate in clinical studies. Find out how you can participate in clinical research at UK HealthCare.
  • At the UK Comprehensive Stroke Center, we offer treatment, prevention and rehabilitation services for stroke patients. Learn more about our program.
stroke

When it comes to a stroke, timing is everything

Dr. Michael Dobbs

Dr. Michael Dobbs

Written by Dr. Michael Dobbs, a stroke expert at the Kentucky Neuroscience Institute and the director of the UK HealthCare/Norton Healthcare Stroke Care Network

A sudden onset of blurred vision, slurred speech, or numbness or paralysis in the face, arm, or leg can be indications of a stroke.

Many people experiencing these symptoms wait to seek help, but this can be a fatal mistake: The risks of permanent damage or death increase the longer treatment is delayed. In fact, six million people die and five million more become permanently disabled because of a stroke each year.

Nationally, the number of stroke deaths has declined, but in Kentucky, strokes are increasing. Yet stroke is a largely preventable disease: keeping blood pressure, cholesterol, weight and/or diabetes in check can greatly reduce the risk.

When a stroke occurs, however, the most important factor is time.

BE-FAST

Oct. 29 was World Stroke Day – a day to reflect on a significant cause of death and disability in the U.S. and the steps you can take to help reverse that trend. Take preventive measures, know the symptoms and BE-FAST if you suspect a stroke.

Balance – Does the person have trouble walking or standing?

Eyes – Are there any changes to eyesight, such as blurry vision?

Face – Do the eyes or mouth appear to be drooping?

Arms – Does the person complain of arm weakness?

Speech – Does the person slur their speech or mix up words?

Time – If any of those signs are present, it’s time to call 911.

If you or someone you are with show any of the above symptoms, call 911. It’s better to have a false alarm than to delay any treatment.

As with any medical issue, prevention is key in avoiding a stroke. High blood pressure and cholesterol are two main risk factors. Engaging in regular physical exercise, quitting smoking, and cutting back on salty and/or fatty foods can make a big difference.

Stroke Care Network

The Stroke Care Network, a partnership between UK HealthCare and Norton Healthcare, is an affiliation of 34 regional hospitals dedicated to the highest-quality stroke care. Based on extensive research, the Stroke Care Network has developed a system of care that provides prompt diagnosis and treatment to minimize the damage a stroke can cause.

A key step in stroke diagnosis is a computerized tomography (CT) scan to find bleeding in the brain or damage to the brain cells. Since 2015, the time it takes to get a CT scan read by doctors and begin a treatment plan has decreased from 52 minutes to 39 minutes in a Stroke Care Network hospital. Clot-busting medication may reduce long-term disability, but is only available within a few hours of the first symptom.


Next steps:

UK collaboration provides improved stroke care in Eastern Kentucky

Kentucky has one of the highest rates of stroke in the nation, and in Eastern Kentucky, the burden of cardiovascular disease is especially severe. An innovative program is improving patient outcomes and saving money in the region by providing intensive, personalized support for stroke survivors and their families.

The Kentucky Care Coordination for Community Transitions program − a partnership between the UK Center of Excellence in Rural Health (CERH) in Hazard, Appalachian Regional Healthcare (ARH), and the UK College of Health Sciences − integrates a CERH community health worker with the ARH rehabilitation team to help stroke survivors transition back to their homes and to facilitate a network of community support.

Established in 2014 with pilot funding from the UK Center for Clinical and Translational Science and ARH, the project evolved into a permanent program in 2015. Just past its two-year anniversary, the program has supported nearly 150 individuals, helping them adjust to the new realities of life after a stroke, learn about chronic disease self-management, navigate complex health care and insurance systems, monitor their rehabilitation, and connect with other survivors and caregivers.

Improving health and saving money

The program has markedly improved health and well-being for participating stroke survivors, among whom there have been zero 30-day hospital readmissions and only one emergency department visit (which wasn’t stroke related). This is compared to 19 percent and 8 percent, respectively, of the matched control group of stroke survivors who chose not to join the program. The result is not only better health and quality of life for survivors and caregivers, but also a cost savings of more than $1.4 million over two years to the local healthcare system.

“We’re keeping people healthier and saving a phenomenal amount of money for the health care system,” said Patrick Kitzman, PhD, founding director of the program and professor of physical therapy in the UK College of Health Sciences. “But we also concentrate very much on the caregiver and family − we always look at the whole unit with our follow-up education and support.”

In 2016 alone, the program supported 70 individuals, including 512 encounters between the community health worker and participants and more than 1,000 provided services. Half of participants needed assistance obtaining durable medical equipment, 71 percent needed assistance obtaining essential medications, and 35 percent needed assistance obtaining health insurance.

Personal care

A critical element of the program’s success is the integration of the community health worker, Keisha Hudson, with the stroke rehabilitation team at ARH. Hudson, who is from the local community, participates in the discharge planning for participating stroke patients so that she can establish a relationship with them and their families while they’re still in the hospital and get a head start on arranging for anything they might need when they get home − shower chairs, wheelchair ramps, medical equipment, etc.

Hudson then visits patients at their home within a week of discharge and provides weekly face-to-face meetings or phone follow-up calls which tapers to bi-weekly or monthly check-ins as patients improve. Some patients, however, have stayed with the program since its beginning.

As she works with patients and families, Hudson provides health education and tracks compliance with medical visits and medication; when she notices that a patient has missed an appointment or medication, she figures out why. Sometimes the problem can be as simple as the patient lacking transportation, in which case Hudson can help them make arrangements to get to the clinic or pharmacy.

Such attention and regular communication allows Hudson to develop a personal relationship with patients and their families to the extent that she can often sense when something is “off” and intervene before a serious problem develops. While none of the patients in the transition program have been readmitted to the hospital for stroke complications within 30 days of discharge, Hudson’s attentive care has led to life-saving interventions related to patients’ other health issues; nearly 60 percent of participants have five or more co-morbid health conditions. Once, while speaking with a patient over the phone, Hudson recognized that the woman’s breathing sounded especially labored, and she told the patient to go to the hospital immediately. It turned out the woman had a dangerous level of fluid on her lungs and needed urgent treatment. While making a routine visit to check on a different patient, Hudson arrived to find them in a diabetic coma. With yet another patient, she caught an infected surgical site that required immediate attention.

Connecting with the community

Hudson also hosts a monthly stroke survivor and caregiver support group. It meets at the hospital, which allows currently hospitalized stroke survivors or their caregivers to come downstairs from the care unit and connect with the group before they go home.

“The program has evolved in the community because we’ve built trust as people hear about us through word of mouth. Some patients and caregivers have become really big advocates for us. One of the patients we’ve worked with for a while has had people in his community who’ve had strokes and he himself has referred them to us. We’ve proven to our community that we’re here to help and we’re here to stay and when we say we’re going to do something, we do it − that’s helped a lot,” Hudson said.


Next steps:

  • When it comes to preventing a stroke, simple lifestyle changes can make all the difference. Here are six things you can do to help reduce your risk of a stroke.
  • At the UK Comprehensive Stroke Center, we offer treatment, prevention and rehabilitation services for stroke patients.
Markesbery Symposium

Learn about dementia, aging at the Markesbery Symposium

Why do some people stay intellectually sharp into their 90s, while others have memory problems? Is there anything we can learn from their lifestyles that can help everyone age successfully?

These are among topics to be discussed at the UK Sanders-Brown Center on Aging’s Markesbery Symposium on Nov. 3-4. Keynote speakers are:

  • Dr. Claudia Kawas of the 90+ Study which explores the fastest-growing age group in the U.S. Kawas appeared in a 2014 “60 Minutes” episode called Living to 90 and Beyond that explored the secrets to a long and happy life.
  • Rachel Whitmer, a national expert on risk factors for dementia, including obesity and diabetes. Whitmer was also featured on “60 Minutes” in a 2016 story about an extended family in Columbia with a genetic mutation that causes Alzheimer’s disease. Studying this family might help scientists discover ways to prevent the disease in the general population.

“Typically we focus on who gets dementia and why, but we can learn just as much from the people who don’t get Alzheimer’s,” said Linda Van Eldik, director of the Sanders-Brown Center on Aging. “We are delighted to bring two national experts to Lexington to continue this discourse.”

The scientific session will be at 10 a.m. on Friday, Nov. 3 in the UK Albert B. Chandler Hospital Pavilion A Auditorium. In addition to presentations by Kawas and Whitmer, there will be a judged scientific poster session and an update on research at the Sanders-Brown Center on Aging. Click here to register for the Scientific Session or call 859-323-5474.

The Community Session goes from 8:30 a.m. to noon on Saturday, Nov. 4 at the Lexington Convention Center’s Bluegrass Ballroom, 430 W. Vine Street. It will feature an “Ask the Experts” segment where participants can ask questions of Whitmer, Kawas and researchers from the UK Sanders-Brown Center on Aging.

A free continental breakfast on Saturday will be provided courtesy of the Lexington Legends. The event is free but registration is required. Call 859-323-5474 or click here to register for the Community Session.

Watch the video below to see Dr. van Eldik preview this year’s symposium.


Next steps: