Archive for 2013

Dr. Wang’s research offers hope for family with history of cancer

by Vicky Cerino, UNMC public relations



San Ming Wang. M.D. 

It’s not very often that those affected by breast cancer come face-to-face with researchers trying to find a cure for the disease.

Brandi Preston, 22, was one of five women who met in late summer with UNMC breast cancer researcher San Ming Wang, M.D.

Dr. Wang had just spoken about the latest in breast cancer research to the local members of Bright Pink, a support group chapter for those affected by familial breast cancer — those who carry a gene that can be passed down.

Ben, Bailey and Brandi Preston (Photo courtesy Preston family) 

It was an emotional experience for Dr. Wang.

“I use DNA material from patients to study, but that was the first time I had direct contact with patients,” Dr. Wang said. “I learned from them all how psychologically stressful it is to have a breast cancer gene — like carrying a time bomb.

“I feel more pressure when I think about the patient,” he said. “It’s not so simple anymore to think of my research work as just science.”

Preston said meeting Dr. Wang was fascinating.

“He is doing so much amazing research,” Preston said. “It gives me a lot of hope for the future.”

Preston is facing a decision of whether or not to have a double mastectomy.

Preston’s mother carried the BRCA1 gene, as did her grandmother, great-grandmother and great- great grandmother. (Both her great-grandmother and great-great grandmother had breast and ovarian cancer.)

Preston’s mother was diagnosed with breast cancer on Thanksgiving of 2000. Before she passed away in 2005 at the age of 40, she asked Brandi to be tested for the BRCA gene when she turned 19.

The test came back positive. Preston’s brother also is positive for the BRCA I gene.

The gene requires extra vigilance. Every six months Preston has a breast exam, a yearly breast MRI, ovarian screening and a pap smear.

“Knowledge is power,” she said. “Now that I know I have this gene, I can do something about it. I can monitor.

“After each breast exam I say, ‘Whew, no cancer, I’m good for another six months.’ But why wait until I develop it? That’s why I’m thinking of having the double mastectomy.”


Dr. Vose to be president of American Society of Clinical Oncology

Julie Vose, M.D. 

UNMC’s Julie Vose, M.D., has been elected president of the American Society of Clinical Oncology (ASCO) for a one-year term beginning in June 2015.

Dr. Vose will take office as president-elect during the ASCO annual meeting in Chicago in June 2014.

“ASCO is a very diverse and multifaceted organization with so much to offer its membership,” Dr. Vose said. “I am excited to serve the ASCO membership as president and to make a difference for oncology professionals and our patients.”

Dr. Vose cited the recent enhancements in the society’s educational offerings, quality improvement, and broadened advocacy as areas where her experience and training can add to the current ASCO activities, including CancerLinQ(TM), ASCO’s groundbreaking health information technology initiative to achieve higher quality, higher value cancer care with better outcomes for patients

Ken Cowan, M.D., Ph.D., director of the Fred & Pamela Buffett Cancer Center, called the election a great honor for Dr. Vose and UNMC.

“She is an internationally recognized leader in clinical trials in lymphoma,” he said. “As the leader of the largest organization of clinical oncologists, she will be able to have a major impact on the future directions of clinical research and clinical care in cancer.”

Dr. Vose’s election and involvement in ASCO and other national oncology organizations are a credit to UNMC as well as Dr. Vose, said James Armitage, M.D., the Joe Shapiro Professor of Internal Medicine in the UNMC Division of Oncology/Hematology.

“I’m incredibly proud of Julie and what she’s accomplished,” Dr. Armitage said. “This is the most visible and one of the most important oncology positions in the world. It reflects her excellence in clinical medicine and research.”

Dr. Vose is the Neumann M. and Mildred E. Harris Professorial Chair and chief of the oncology/hematology division in the UNMC Department of Internal Medicine, as well as the associate director of clinical research and co-chair of the lymphoma program at the Fred & Pamela Buffett Cancer Center. Since joining ASCO in 1991, she has served on the board of directors, as chair of the Cancer Education Committee and is the current chair-elect of the Integrated Media and Technology Committee, among other activities.

ASCO’s board of directors is comprised of oncology leaders who are elected to positions reflecting various specialties within the oncology field.


Med Center Physicians Leading the Way in New Cardiology Specialty

Several decades ago someone like Taylor Harms wouldn’t be a second year medical student. Someone like Taylor Harms may very well have died as a child. Advances in medicine and surgery over the years mean people like him, born with congenital heart disease are growing up to be adults.

Harms has a perspective most of his medical school classmates won’t – the perspective of a patient. And not just any patient – one who’s had open heart surgery twice.

“I first learned about my condition when I was eight years old,” Harms says. “I went to the doctor with high blood pressure and it turned out I had a narrowed aorta.”

He had surgery to repair his aorta, the body’s main blood vessel when he was eight. Harms also had a bicuspid aortic valve – a condition where one of the heart’s valves develops only two leaflets instead of three. The stress on his heart also meant that its main pumping chamber was much larger than it should have been. By July, even though Harms was feeling fine, his blood pressure was going up. His condition had worsened.

“Blood was leaking back through that valve,” explained Shane Tsai, MD, cardiologist and congenital heart disease specialist. “Instead of being ejected into the body, the blood is falling back into the heart’s main pumping chamber.”

Harms would again need open heart surgery to remove the narrowed section of his aorta and to replace his aortic valve with a mechanical valve.

“We would prefer to get someone early in the stage of their disease,” says Kim Duncan, MD, cardiovascular surgeon at The Nebraska Medical Center. “We can do a procedure and preserve cardiac function for a much longer period of time.”

Dr. Duncan performed surgery on Harms in mid-July. He replaced the aortic valve with a mechanical valve they hope will last for decades. Dr. Duncan also replaced a portion of Harms’ aorta with a synthetic blood vessel.

Dr. Tsai says patients like Harms will become more common as medical advances continue.

“As medicine and surgery has gotten better, we have more survivors,” he says. “A few decades ago, 90% of these babies may not have survived into adulthood. We now expect that 85% of children born with these heart problems will survive into adulthood.”

But just because they live to be adults does not mean they are free from heart trouble. Dr. Tsai says that’s where the medical center’s program shows its importance.

“For the first time in the U.S. there are more adults than children living with congenital heart disease. There are over one million adults with these problems,” he says. “Unfortunately there are not a lot of specialized heart centers dealing with congenital heart disease.”

There are also few physicians who specialize in pediatric and adult congenital heart disease. Because of UNMC Physicians’ collaboration with Children’s Hospital and Medical Center, Dr. Tsai says med center physicians are uniquely positioned to care for these patients throughout their lives. Drs. Tsai and Duncan see pediatric patients at Children’s and adult patients at The Nebraska Medical Center.

“We see them when they’re babies and through adulthood,” he says. “We have different interventions and surgeries we can perform and we work together as a group to decide what is best for each patient.”

Taylor Harms is recovering quickly and just started his second year of medical school at UNMC. He’s already learned a lot about what it’s like to be a patient. He has a little bit of time to decide what specialty he’ll follow as an MD.

“I’m thinking maybe cancer,” Harms says. “I think cardiology may be a little too close.”


Eyeing new discoveries in Shanghai

by Tom O’Connor, UNMC public relations


Shan Fan, M.D., and Carol Toris, Ph.D., of UNMC, with Tao Guo, M.D., associate professor of ophthalmology, Tenth People’s Hospital, Shanghai. 

SHANGHAI – Quan Dong Nguyen, M.D., is pumped.

The new chairman of ophthalmology and visual sciences, part of the UNMC delegation in China, is excited about the research that UNMC is doing with Tongji University and Tenth People’s Hospital in Shanghai.

The work, led by Carol Toris, Ph.D., professor of ophthalmology and visual sciences, is aimed at improving our understanding of glaucoma, the leading cause of irreversible blindness in the United States and worldwide. More than 60 million people in the world are living with glaucoma. It’s estimated that more than 80 million people will develop glaucoma by 2020.


From left, UNMC’s Quan Dong Nguyen, M.D., UNMC’s Carol Toris, Ph.D., Fang Wang, M.D., chair of the department of ophthalmology at Tenth People’s Hospital, and UNMC’s Shan Fan, M.D.

“It’s all about aqueous humor dynamics,” Dr. Nguyen said. Glaucoma can occur when the optic nerve is damaged, and frequently this is associated with high intraocular pressure.

That’s where aqueous humor dynamics come into play. To maintain intraocular pressure at a steady level requires a fine balance between the production, circulation and drainage of ocular aqueous humor.

Dr. Toris is one of the leading experts in the world on aqueous humor dynamics — Google the term and Dr. Toris’ name is the first to appear.

Working with Tongji University and Tenth People’s Hospital researchers led by Tao Guo, M.D., Dr. Toris, along with Shan Fan, M.D., assistant professor of ophthalmology and visual sciences and also with UNMC’s delegation to Shanghai, measure fluid flow in the eyes of volunteers.

They have studied healthy Caucasian adults, an ethnic group that is prone to a certain type of glaucoma. Now in collaboration with Tenth People’s Hospital they are studying healthy Chinese adults, an ethnic group that is prone to a different kind of glaucoma.

The team will compare data to identify differences that may help explain why people may get a particular kind of glaucoma. These findings should help determine the best treatments for the particular type of glaucoma.

“With a population of 1.35 billion, China is a fertile environment for finding research subjects,” Dr. Nguyen said.

“It’s a great collaboration,” Dr. Nguyen proclaimed. “To have all these patients done on Chinese soil is indicative of how well the project is going.”

In the next two years, Dr. Nguyen said that the Truhlsen Eye Institute at UNMC, and Tongji University and Tenth People’s Hospital hope to combine forces on several other projects, expanding to other areas of significant concerns for visual loss such as age-related macular degeneration, diabetic retinopathy, and uveitis and ocular inflammation.


UNMC designated one of three national endoscopic surgery testing centers

by Tom O’Connor

oleynikovThe University of Nebraska Medical Center is one of the first three centers in the country to be designated as a testing center for the Fundamentals of Endoscopic Surgery (FES) program.

The program is a comprehensive educational and assessment tool designed to teach and evaluate the fundamental knowledge, clinical judgment and technical skills required for basic gastrointestinal endoscopic surgery. It also teaches fundamentals of endoscopic surgery in a consistent, scientifically accepted format and to test cognitive and technical skills, while improving the quality of patient care.

“Being able to use flexible endoscopy for upper GI procedures and colonoscopies is a very important skill for surgeons,” said Dmitry Oleynikov, M.D., the Joseph and Richard Still Endowed Professor of Surgery. “Just like you have to pass a driving test to be able to drive a car, the testing center will allow us to make sure that surgeons are proficient in endoscopic procedures.”

The UNMC center was made possible in part by a donation from Paul Hodgson, M.D., establishing the Paul E. Hodgson, M.D. Innovations in Surgical Technology Fund through the University of Nebraska Foundation. Dr. Hodgson, former chairman of the UNMC Department of Surgery, died Aug. 28 at the age of 91.

Dr. Hodgson’s fund paid for half of the equipment and materials needed for the testing center. The other half of the funding will come from the Alton K. Wong, M.D., Distinguished Professorship held by pediatric surgeon Ken Azarow, M.D.

The testing center equipment is located in the Dr. Wayne and Eileen Ryan Surgical Simulation Suite in the Sorrell Center.

“Under the guidance of our chairman, Dr. David W. Mercer, and his unequivocal support of educational efforts, the department of surgery is on the path to becoming a regional and national leader in surgical education,” said Chandra Are, M.B.B.S., vice chair for education and associate professor, surgical oncology.

“Obtaining the designation as a testing center for the FES program is another milestone in satisfying the vision of our department to become an educational powerhouse.”

Being designated as a FES testing center culminates a lengthy certification process for UNMC, Dr. Oleynikov said, and is indicative of how UNMC “has become a leader in education in the region.”

Through world-class research and patient care, UNMC generates breakthroughs that make life better for people throughout Nebraska and beyond. Its education programs train more health professionals than any other institution in the state. Learn more at unmc.edu.


Dr. Joshi receives high honor from Indian government

by Elizabeth Kumru, UNMC public relations

Ashish Joshi, M.D., Ph.D. 

Ashish Joshi, M.D., Ph.D., assistant professor in the Department of Health Services Research and Administration, and the Center for Global Health and Development in the UNMC College of Public Health, was awarded the 2013 Mahatma Gandhi Pravasi Samman Award by the government of India and the Non-Resident Indians (NRI) Welfare Society of India.

He received the award last week from the Honorable Baroness Sandip Verma, junior minister of Energy and Climate Change in the United Kingdom, at the House of Lords in London in the presence of dignitaries during a function of the Global Achievers Conclave.

The Mahatma Gandhi Pravasi Samman Gold Medal recognizes people of Indian origin for their significant contributions in various fields in the country of their residence and in the service of the wider global community. Pravasi Bharatiya Divas is celebrated in India each year on Jan. 9 to mark the contribution of the overseas Indian community to the development of India. The day commemorates the return of Mahatma Gandhi from South Africa to Bombay on Jan. 9, 1915.

Dr. Joshi was chosen as one of 30 awardees from around the world for the outstanding services, achievements and contributions in the field of innovative use of information and communication technology in public health research in diverse global settings.

“I’m extremely honored and humbled to have received this award,” Dr. Joshi said.
Dr. Joshi has designed and developed innovative, accessible and affordable heath technologies to improve access, alleviate health illiteracy, reduce health disparities and enhance population outcomes among individuals living in diverse global settings.

Lifestyle diseases like obesity, diabetes and hypertension are an increasing burden worldwide. He uses such information and communication technologies as Internet, cell phone and electronic health kiosks to prevent and manage the increasing disease burden among individuals living in urban and resource-poor settings.

“I combine interactive media such as audio, video, images and animations with public health evidence to develop informatics tools that can effectively communicate risk to an individual in an easy-to-understand format so that appropriate recommendations can be given,” he said.

Dr. Silva: Investigate options for breast cancer treatment

by Kalani Simpson, UNMC public relations


VIDEO: Edibaldo Silva, M.D., Ph.D., discusses breast cancer fears
The fear of breast cancer hangs over many women like a dark cloud.


Edibaldo Silva, M.D., Ph.D., professor of surgical oncology, understands why some take immediate, even drastic, action in order to achieve peace of mind.
But Dr. Silva, who specializes in the research and treatment of breast cancer, counsels his patients to sit down with their team of health care providers first.
A week or two or three of gathering information won’t hurt your long-term prognosis, he said.

“What you see in the U.S. now is women have a lump in the breast and they find it’s cancer, and the next day they are having bilateral double mastectomy,” Dr. Silva said. “No consideration of counseling, genetic testing, none of that.”

In fact, Dr. Silva said, on average among women who have a double mastectomy in the U.S., only 29 percent ever even discuss the subject with a genetic counselor to see if they carry mutated BRCA genes which cause breast and incurable ovarian cancer.

Studies by the University of Michigan, the Mayo Clinic and others show most women are doing it out of fear.

Dr. Silva said it’s important to remember that only 5 percent of women who contract breast cancer have “bad genes.” The rest simply had “bad luck,” likely a one-time occurrence.

And their cancer is often best treated with lumpectomies and radiation, the effectiveness of which “we know is equivalent to mastectomy,” Dr. Silva said.
A possible option for many women diagnosed with breast cancer could be to start chemotherapy while simultaneously taking the time to gather information, Dr. Silva said.

First, it is actively fighting the cancer. Second, if surgery is necessary, it makes the surgery more effective and easier to complete. Third, in some cases, the cancer may be gone by the end of the chemo treatment.

“And by gone, I mean you can’t find it,” Dr. Silva said.

If you are worried that you carry the BRCA gene mutation, draw up your family tree, Dr. Silva said, and visit with a genetic counselor to see if you should get further testing.

“The odds are overwhelmingly in your favor that you are not a gene carrier,” Dr. Silva said.

But if you are among the statistically select few, it is serious.

The gene causes a 20 percent to 40 percent risk of developing incurable ovarian cancer, Dr. Silva said, and double mastectomy and eventual removal of ovaries are recommended.


Islet Cell Transplant Gives Patient Her Life Back

Facing No Other Option, Linda Elonich Agrees to Life-Changing Surgery

For seven years, Linda Elonich lived with the excruciating pain of pancreatitis attacks. The Omaha woman says it started suddenly in her sleep – pain so severe she couldn’t speak. She thought she was dying. She underwent several surgeries over the next several years, but continued attacks meant she could no longer work, travel or spend much time away from home. Her doctors brought up the idea of removing her pancreas and performing an islet cell transplant. They were cautious, but Elonich was ready.

“I said, ‘Let’s do it.’ I hurt so bad at that point, I had no fear of it. It was a chance for relief,” she recalls.

Her husband and her doctors urged caution, but a serious and extremely painful attack led them all to believe the time was right.

“The islet cell transplant is the second part of a procedure for patients who have their pancreas taken out,” explains Brian Boerner, MD, endocrinologist. “Those are patients who have no other option for treatment. As part of that, we can remove the islets, the insulin-producing cells from the pancreas and put them back into the person’s liver where they function and prevent serious diabetes.”

After a successful transplant, the liver essentially performs the function of the pancreas.

Though not the first islet cell transplant performed here, Elonich’s operation was the first done as part of the medical center’s Pancreas and Biliary Disorders Clinic.

“It went off without a hitch and went according to plan,” says Luciano Vargas, MD, the transplant surgeon who performed Elonich’s procedure.

Transplant surgeon Luciano Vargas, MD, looks on as Linda Elonich’s islet cells are infused into her liver.

The operation took most of the day. In the first part of the surgery, Dr. Vargas removed the pancreas and sent it to our Biologics Production Facility (BPF). Scientists there spent four to six hours isolating the islet cells and prepare them for re-infusion into the patient’s liver.

“The expertise at the lab is phenomenal,” Dr. Vargas says. “You can tell by how Linda is doing.”

When the cells are ready to be infused into the liver, BPF staff brings the bags of cells to the OR where the surgical team is waiting.

Elonich says she could tell a difference as soon as she woke up from surgery. After a recent check up with both Drs. Boerner and Vargas, Elonich says she has a new outlook on life.

“It’s nice to wake up in the morning. Every day is a beautiful day,” she says. She recently traveled to Arkansas to visit her 93-year-old grandmother; something that would have been impossible before the surgery.

Elonich has praise not only for the expertise at the medical center, but for the caring personalities of everyone she’s met from the clinics to the hospital.

“These people for me are life savers. Most people going to the doctor, they dread it. It’s not like that for me. They’re like family to me now; we’ve been through something so personal and life-changing together.”

Watch more of Linda’s story.


UNMC team finds early heart disease warning with simple blood test

by Charlie Litton, UNeMed

thieleGeoff Thiele, Ph.D. 

It’s a virtual certainty that everyone over 50 – more than 98 million Americans -has coronary artery disease. So do 70 percent of 40-year-olds. About half of people in their 20s and 30s probably have it too.
Yet heart disease doesn’t kill everybody.

Understanding why has been a confounding riddle for modern medicine.

An team of researchers at UNMC believe they’ve made a potentially groundbreaking discovery — a test that determines whether a patient is harboring the dangerous type of heart disease that kills one in four Americans every year.

Michael Duryee 

Unfortunately, that heart attack is too often the first indication that a patient has the lethal form of coronary artery disease. But UNMC’s new test could change that.

Geoff Thiele, Ph.D. a professor of internal medicine, and Michael Duryee, a research coordinator for the division of rheumatology and immunology, made the initial discovery. While looking for clues to help understand inflammatory conditions such as arthritis, they focused on a molecule that is a strong indicator of inflammation.

Known as MAA or malondialdehyde-acetaldehyde, the molecule also appeared to indicate the presence of coronary artery disease.

Dr. Thiele and Duryee brought in Dan Anderson, M.D., Ph.D., an assistant professor in cardiology. He has a frontline view of the battle against the world’s most prolific killer. 

Dan Anderson, M.D., Ph.D. 

“In the current realm of understanding disease, we know that inflammation is important in cardiovascular disease,” Dr. Anderson said. “But we really don’t understand a lot about why or how.”

By current measures, Anderson said, about 30 percent of people with heart disease slip through the cracks. For those people, the first indication of trouble may be a killer heart attack.

But others with the disease suffer few, if any, ill-effects. Predicting which patients will develop the more deadly form of heart disease is little more than a guess.
Then Dr. Thiele and Duryee knocked on the door.

“From a clinical diagnostic perspective, this becomes invaluable to help understand those different groups of patients,” Dr. Anderson said.

The research team and UNMC’s technology transfer office, UNeMed Corporation, are currently in preliminary discussions with several companies on how to translate the results into products that can better factor in a patient’s risk of heart attack.

The next rounds of testing will be critical to understand how accurate the test can be, particularly studies that follow individual patients over the course of five or 10 years, Duryee said.


UNMC study to test ‘breakthrough’ drug in mantle cell lymphoma patients

by Vicky Cerino 

voseJulie Vose, M.D. 

The University of Nebraska Medical Center is involved in testing a drug the Food and Drug Administration has fast-tracked towards approval because of its dramatic results in patients with mantle cell lymphoma and other cancers.

“This experimental drug, Ibruitinib, is so promising that the FDA gave it fast track designation which rarely happens,” said Julie M. Vose, M.D., chief of the division of hematology and oncology and Neumann M. and Mildred E. Harris Professor at UNMC.

“Patients who’ve been on the treatment have had remarkable results with limited side effects. We are able to offer this to patients through an expanded access program which occurs about six months before the FDA approves it.”

The new study is targeted for patients age 18 and older with mantle cell lymphoma who’ve relapsed – meaning other treatments have failed. The study, which aims to enroll as many patients as possible, is being conducted in about 50 locations across the United States and in Puerto Rico. Those eligible for the study will be provided the drug at no cost.

The FDA designated Ibruitinib as a breakthrough therapy. The designation is intended to expedite the development and review of drugs for serious or life-threatening conditions that demonstrate the drug may have substantial improvement over available therapy. The study will remain open until the medication is FDA approved, which should be by the end of the year, Dr. Vose said.

Dr. Vose, who is principal investigator of the UNMC study, said Ibruitinib works differently than other drugs for this type of cancer. The drug, developed by Pharmacyclics, Inc and Johnson & Johnson’s Janssen Pharmaceutical division, basically poisons one of the pathways that helps the cancer grow.

“It kills the lymphoma,” she said. “It has fairly limited side effects. It’s a pill rather than an intravenous delivery, and it also has potential to be used with other treatments due to the limited side effects.”

Steven “Robert” Whisnant of Morganton, N.C., and his wife, Quteen, came from North Carolina for the trial after his physicians told him there was nothing else they could do. Whisnant has had a dramatic response to the medication as have many other patients, Dr. Vose said.

“I’m thankful that there’s somebody out there trying to find different things to help people because if I hadn’t have gotten the medication, I’d have died,” Whisnant said. “So far it seems to be working. All the tumors in my neck are gone and the ones in my stomach have shrunken. It gives us hope and I’m thankful for that.”

Mantle cell lymphoma is a rare, B-cell non-Hodgkin lymphoma that most often affects men over the age of 60. The disease may be fast or slow growing. It comprises about five percent of all non-Hodgkin lymphomas.

Dr. Vose said results thus far have seen a 75 percent response rate in patients with mantle cell lymphoma whose disease has failed all other treatments.

“We have been involved in several of the first clinical trials with this particular medication,” Dr. Vose said. “We don’t think it’s a cure but it’s been found to be able to keep patients in remission longer to control their symptoms and allow them to have a good quality of life. These patients have very limited other options. This is a breakthrough and works very quickly.”

Clinical trials began on Ibruitinib a few years ago. It also is being tested at other sites for other types of lymphoma, leukemia and multiple myeloma.

Other co-investigators in the study are UNMC physicians Jim Armitage, M.D., Phil Bierman, M.D., and Greg Bociek, M.D.

For more information about the study, contact Maribeth at 402 559-9053 or mahohens@unmc.edu. For a complete list of other study locations go to clinicaltrials.gov and search “NCT01833039.” The study is funded by the drug company.

Through world-class research and patient care, UNMC generates breakthroughs that make life better for people throughout Nebraska and beyond. Its education programs train more health professionals than any other institution in the state. Learn more at unmc.edu.