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Archive for December, 2014

More Lung Cancer Awareness Could Lead to Better Patient Outcomes

Lung cancer is the main cause of cancer related death in the United States and world-wide. The proportion of patients with lung cancer surviving 5 years or greater is a dismal 15 percent. This statistic has not changed substantially in the past 30 years. One of the major causes of the dismal survival seen in lung cancer today is that most patients are diagnosed when the tumor is quite advanced. Lung cancer caught in an early stage is curable with surgery, but unfortunately only a minority of patients present at an early stage. If there was a way in which more patients were detected at an early stage, then outcomes for lung cancer patients would improve dramatically.

While this sounds simple in theory, the fact is that we currently do not have any way to detect lung cancer in the early stages. Most patients who have early stage lung cancer are identified serendipitously on a scan performed for something completely unrelated. The tests that we have today to diagnose lung cancer, chest X-rays, sputum analysis and Computerized Axial Tomography (CT) scans are fraught with problems.

Most patients who have early stage lung cancer are identified serendipitously on a scan performed for something completely unrelated.

Multiple studies both in the United States and abroad performed in the 1960’s and 1970’s have shown that screening for lung cancer with a chest X-ray and sputum studies actually resulted in an increased mortality, rather than increasing survival from lung cancer. There have been a number of advances in CT scan technology in the past few decades and there has been a renewed interest in using CT scans to screen for lung cancer. Current studies from Japan, Italy and United States appear promising, but use of CT scans to screen for lung cancer is not yet ready for primetime. Clearly we need to do more in order to improve the outcomes of patients with lung cancer.

A major reason for the lack of major advances in the lung cancer field is the minimal funding for lung cancer research. One reason for this may be the absence of long-term survivors who can raise lung cancer awareness in the society and also be passionate advocates for increased funding support, much like the breast cancer survivor. Another more worrisome reason is the apathy of professional organizations and funding agencies towards lung cancer. I was at a meeting a couple of years ago, when a speaker mentioned in a very tongue in cheek manner, “Finally the American Lung Association has acknowledged the fact that lung cancer is a disease of the lung!” Increased funding for research has led to dramatic improvements in results from breast cancer and so it stands to reason that the same will be true for lung cancer as well.

As a lung cancer doctor, I live on optimism. Recently there has been increasing activity among patient advocacy groups, such as The National Lung Cancer Partnership and the Bonnie J. Addario Lung Cancer Foundation trying to raise awareness of lung cancer. The daughter of one of my patients, living in Omaha, Neb. recently set up an organization called “Where is The Funding for lung cancer?” She likes to call it “WTF” for effect. If these and other efforts are successful, there is no reason why we should not be able to increase the number of lung cancer survivors in the near future.

New Heart Procedure Helps Mitral Regurgitation Patients

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For 78-year-old Viola Foley, nothing brings a bigger smile to her face than talking about family, country music or Nebraska Medicine.

“I tell everyone that the nicest doctors in the world work here,” she says. “They saved my life more than once.”

After raising nine children in Springfield, Neb., Foley underwent a liver transplant at Nebraska Medicine – Nebraska Medical Center and battled breast cancer twice.

“I was diagnosed with breast cancer six years before my liver transplant, then again four years later. It’s amazing how far I’ve come.”

Once Foley passed the 10-year mark for her transplant, she started having serious breathing problems. Walking across the living room was almost impossible. In September, she made an appointment with Nebraska Medicine cardiologist Thomas Porter, MD.

“Dr. Porter did an echocardiogram,” remembers Foley. “He discovered that my heart and liver were working against each other. One of my heart valves wasn’t opening and shutting the right way.”

In September, Foley was diagnosed with mitral regurgitation (MR), a condition that affects four million people in the United States. The heart’s mitral valve leaflets don’t close tightly, causing blood to flow backwards from the heart’s left ventricle into the left atrium. It makes the heart work harder at pushing blood through the body, leading to shortness of breath, fatigue and worsening heart failure. For many patients, open-heart mitral valve surgery is generally recommended, but for Foley, surgery wasn’t an option.

“She currently has a life threatening blood disorder that prohibits her from having any open surgical procedures,” says Michael Moulton, MD, chief of cardiothoracic surgery at Nebraska Medicine. “Her only shot was to have the MitraClip procedure, which was recently approved by the U.S. Food and Drug Administration.”

MitraClip-Inserted

The MitraClip Clip Delivery System (MitraClip CDS) is a new option for patients diagnosed with MR, who have too high a risk for surgery. The procedure consists of implant catheters and the MitraClip device, which is a permanent implant that attaches to the mitral valve leaflets, reducing the leakiness of the valve.

On October 1, Foley became the first patient to undergo the procedure at Nebraska Medicine. With the help of a catheter, Nebraska Medicine chief of interventional cardiology, Gregory Pavlides, MD, inserted the MitraClip device through a blood vessel in Foley’s groin, guiding it to her heart. The surgical team could watch in real time on the echo machine if the mitral regurgitation was appropriately reduced. Once the MitraClip device was in place, the catheter was removed.

“This procedure requires a lot of skill from interventional cardiology, imaging cardiology and anesthesia,” explains Dr. Pavlides. “Not many places in the area have the infrastructure to offer the MitraClip procedure as well as we can; based on our experience with the mitral valve and our superb imaging and cath lab skills.”

Foley’s procedure took approximately one hour and 30 minutes. She spent a little over three days in the hospital before going home. Since then, she’s regained her strength, is able to walk up and down the stairs and feed her pets without feeling fatigued. She’s excited for the next chapter in her life, which includes watching her great-grandson attend the University of Nebraska Medical Center with the hopes of becoming a cardiologist.

“I am forever grateful,” says Foley. “I wouldn’t be here today if I didn’t have this option. I’m really proud to be the first patient at Nebraska Medicine to have the MitraClip procedure. Couldn’t have asked for a better crew or a better place.”

Nebraska Medicine anticipates performing the procedure on 2-4 patients per month. To connect with a member of the Heart Center team regarding the MitraClip, call (402) 559-8888 or visit their website.

 

UNMC flow cytometer among world’s finest

by Kalani Simpson, UNMC public relations

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Philip Hexley, Ph.D.

Philip Hexley, Ph.D., research core facility director at the flow cytometry research facility, likens flow cytometry to a grocery check-out scanner. But instead of scanning bar codes for information, it uses lasers to read cells.

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A close-up of the flow cell in the new Fortessa X50 flow cytometer, a key fluidics component for single cell analysis. 

Researchers can use the technology to analyze physical and chemical properties of single cells in suspension — up to 35,000 of them per second.

“As you can imagine, this is incredibly valuable data, allowing us to get statistically significant cell numbers with robust and quantitative data,” Dr. Hexley said.

For more photos of the flow cytometer, click here.

And perhaps the world’s best instrument for doing so resides on the first floor of the Durham Research Center.

Top-line flow cytometers have the capability to capture up to 18 different pieces of information about a single cell. But UNMC’s new Fortessa X50 flow cytometer, which arrived late this last summer, uses up to nine lasers and can acquire up to 30 different pieces of information.

“Our researchers really have a fantastic opportunity to get data at a level which is not possible at any other institution,” Dr. Hexley said.

There is one other instrument on the planet — at the National Institutes of Health — with comparable capabilities, although it does not have as many lasers, making it less flexible in its capabilities.

UNMC’s one-of-a-kind new cytometer is not yet available anywhere. It is the latest in production from BD Biosciences, which, Dr. Hexley said, hopes to release this model on the commercial market sometime in the summer of 2015.

Meanwhile, UNMC is getting a state-of-the-art sneak preview, beta-testing it. This model will likely cost about $1.3 million, but because of the collaborative partnership, UNMC got it for about half that.

“We got a great deal,” Dr. Hexley said. “But BD got a good deal as well.” UNMC is helping BD further develop the hardware and software as beta testing goes on.

“It’s truly mind-blowing to have access to this technology,” Dr. Hexley said.

For more on flow cytometry opportunities at UNMC, go here or contact Dr. Hexley.

Setting the standard in Ebola care

by Elizabeth Kumru, UNMC public relations

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From left, UNMC Chancellor Jeffrey P. Gold, M.D, Shelley Schwedhelm, Angela Hewlett, M.D., Phil Smith, M.D., Ali Khan, M.D., M.P.H., John Lowe, Ph.D., and Nebraska Medicine President Brad Britigan, M.D.
The successful treatment of two men who had Ebola has turned UNMC and Nebraska Medicine into the go-to institution of the world for advice on care and protocols.

“Nebraska has set the gold standards for Ebola care,” said Philip Smith, M.D., professor of Internal Medicine, Division of Infectious Disease, and medical director of the Biocontainment Unit. “We embody everything that went right.”

“Not every institution in the U.S. had this vision and could step up and do the cutting-edge research, education and patient care to protect our citizens. That’s what an academic medical center does.”

UNMC Chancellor Jeffrey P. Gold, M.D.

Dr. Smith was part of a five-person panel of experts who spoke to more than 60 UNMC students and faculty members at a 90-minute “Ebola Explained” discussion last week.

Watch the presentation here. (A UNMC login is needed to view the discussion.)

The medical center received extensive global media attention – via television, print and social media – over the two-month period, said UNMC Chancellor Jeffrey P. Gold, M.D.

“We were in the top 10 tweets and were number three for a while – only exceeded by the National Football League,” he said before showing a video of news reports that highlighted UNMC’s heroic response.

Dr. Gold praised Dr. Smith’s foresight in building the unit.

“Not every institution in the U.S. had this vision and could step up and do the cutting-edge research, education and patient care to protect our citizens. That’s what an academic medical center does.”

Bradley Britigan, M.D., dean of the UNMC College of Medicine and president of Nebraska Medicine, served as moderator for the panel of experts that included:

•Ali Khan, M.D., M.P.H., dean, UNMC College of Public Health and former director of the Office of Public Health Preparedness and Response at the Centers for Disease Control and Prevention;
•Dr. Smith;
•Angela Hewlett, M.D., assistant professor of internal medicine-infectious diseases, and associate medical director of the Biocontainment Unit;
•John Lowe, Ph.D., assistant professor, environmental, agricultural and occupational health; associate director of research, Biocontainment Unit, director of Public Health Training and Exercise Programs, Center for Preparedness Education;
•Shelly Schwedhelm, director of the emergency department’s trauma and emergency preparedness at Nebraska Medicine.

Although some team members or family members had been shunned because they were working in the Biocontainment Unit, many experienced support and gratitude from the community. And nothing is more complimentary than imitation.

So, two experts were pleased to see three elementary school children dressed in a kid’s adaptation of the yellow biocontainment suit for Halloween.

You know you’ve reached a certain coolness factor when that happens.

Second Ebola patient released

by John Keenan, UNMC public relations

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From left, Phil Smith, M.D., medical director of the Biocontainment Unit at Nebraska Medicine-Nebraska Medical Center and professor of internal medicine/infectious diseases at UNMC, Ashoka Mukpo, and Andre Kalil, M.D., professor of internal medicine/infectious diseases at UNMC. (Photo courtesy Taylor Wilson, Nebraska Medicine)

UNMC’s second Ebola patient, Ashoka Mukpo, was released from the Biocontainment Unit Wednesday after multiple tests confirmed by the Centers for Disease Control and Prevention (CDC) that he was free of Ebola.

Although Mukpo did not attend Wednesday’s new conference, UNMC Chancellor Jeffrey P. Gold, M.D., read a prepared statement in which Mukpo called it a “joyful day.”

“After enduring weeks where it was unclear whether I would survive, I’m walking out of the hospital on my own power, free from Ebola,” the statement said. “This blessing is in no small measure a result of the world-class care I received at the Nebraska Medical Center.

See a video interview with Ashoka Mukpo here.

“When Dr. Smith and his team first received me, I was in a difficult situation and was quite sick. The professionalism and confidence of the team instantly reassured me that I was in good hands. The nursing staff was incredibly calm and handled my symptoms in a manner that clearly reflected strong training and preparedness.”

Mukpo also said the nursing staff had introduced him to “something called a ‘Runza.'”

For the complete text of Mukpo’s statement, click here.

Phil Smith, M.D., medical director of the Biocontainment Unit at Nebraska Medicine-Nebraska Medical Center and professor of internal medicine/infectious diseases at UNMC, praised the health care team, noting that Nebraska Medicine and UNMC staff continue to volunteer to work at the unit.

He praised the efforts of Shelly Schwedhelm, director of Emergency Department, Trauma and Emergency Preparedness at Nebraska Medicine, in assembling a group that has now helped two patients overcome the Ebola virus.

“Shelly has done a tremendous job of selecting and recruiting the best we have, and we have more people volunteering than we can use,” Dr. Smith said.

Schwedhelm and Angela Hewlett, M.D., associate medical director of the Biocontainment Unit and assistant professor of internal medicine/infectious diseases at UNMC, joined Dr. Smith at the press conference.

Dr. Gold said that U.S. government agencies had reached out to UNMC and Nebraska Medicine for assistance and input into ways to stop the spread of the virus both in the U.S. and Africa, and ways to educate both health care facilities and the general public in the United States.

Dr. Smith said that, until the Biocontainment Unit was asked to care for another Ebola patient, “we will use this time to try to share our knowledge as best we can with the rest of the world.”

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