By Rob Mitchum

When a doctor pulls a notepad out of his or her white coat, you might expect them to be writing down a drug prescription. But a recently completed contest thrown by the Prizker School of Medicine suggests that physician might be scrawling down a few lines of verse as well. The first annual Pritzker Poetry Contest received an overwhelming response, with more than 80 poetic submissions from Pritzker students, faculty, and residents. Those nominees were whittled down to 11 finalists, and the top entries in two categories were announced last week.

The idea to tease out the poetic side of physicians originated with Rama Jager, an assistant professor of opthamology & visual science with the University of Chicago Medicine. Jager saw a story in the New York Times about similar contests at the Yale and University College London medical schools, and thought that the concept would help students and faculty here express their feelings about their work and their relationships with patients.

With the help of medical students Rebecca Levine and Margaret Nolan and faculty advisor Shalini Reddy, the first Pritzker contest was born in February. Participants could submit a poem in either the rules-free open verse category, or (inspired by another New York Times article), the six-word poem division, a chance to express one’s feelings in highly efficient fashion.

“We wanted to have two different categories, especially since students, residents and doctors are often so busy that an open-form poem can be daunting to take on,” said Nolan, a fourth-year Pritzker student. “6-words can be easier, and yet challenging in other ways as it forces you to distill an experience or thought into so few words. It’s a really fun exercise for anyone to try, though, and we’ll hopefully experiment with other original forms in the coming years.”

The missions of the contest — to “recognize and celebrate the humanistic side of medicine at all levels of medical training and practice” and “foster continued compassion for our patients, enhancing the therapeutic doctor-patient relationship throughout our medical careers” — inspired a flood of replies [pdf]. Generous prize money, which ranged as high as $1,000 for first place in the open poem category, surely didn’t hurt too. Levine said that the final totals doubled the organizers’ original estimate, and gave the panel of 13 judges plenty to work with.

“We thought that there would be around 15 to 20 entries in each category given that this was the first year of the competition and people may not have seen our messages about the competition, have had time to write poems, or be interested in this form of expression,” said Levine, also a fourth-year with Prtizker. “When we received around 40 poems in each category, we were shocked and elated!”

The winning poems, which can be read in full and properly formatted form at the Pritzker website, are a deft blend of medical terms and emotional verse. You may not see the phrase “sinus tachycardia” appear in too many poems published in Granta, but the first prize winner in the open-poem category, H.I.E. by third-year medical student Joshua Williams, weaved that term and other pieces of physician lingo into an artful description of a two-year-old critically ill hospital patient.

You are G-tube, trach-dependent,
deaf, blind, devastated, orphaned,
forgotten,
and two years old today.

You are an incredible teacher.

Second-year Pritzker student Liese Pruitt’s Two Tiny Feet (tied for second) contrasts the bright environment of a delivery ward with a scene of mourning.

sanitized
unyieldingly,
cheerful, a place
for hellos, here
are only good-byes

And first-year Brian Thurber’s Monday Morning Rounds illustrates the all too routine struggle of providing emotional reassurance to patients whose health is declining.

It’s not fair for me to give her a false sense of
security
All the news is bad
Her numbers look worse than they did the day
before
I can’t lie to her
I can’t tell her that everything’s going to be ok
Because it’s not

It’s just not . . .

The transformation of such trying experiences into poetry can help doctors-in-training deal with their emotions and improve their bedside manner going forward, both Levine and Nolan said.

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by Rob Mitchum

An advantage and disadvantage of hypothesis-free studies looking for genes associated with various traits or diseases is that they often point to genetic candidates that don’t make immediate sense. One example of this occurrence was the 2005 discovery of an association between the gene Glo1 and anxiety-like behaviors in mice. Previously, scientists knew Glo1’s protein product, glyoxylase 1, primarily as a enzyme involved in in glycolysis — the cellular digestion of glucose. Nobody had considered that glyoxylase 1 played a role in brain function, much less behavior, leading some to question the validity of the genetic association.

“When people discover a gene, they’re always most comfortable when they discover something they already knew,” said Abraham Palmer, assistant professor of human genetics at the University of Chicago Medicine. “The alarming thing here was there was a discovery of something that nobody knew, and therefore it seemed less likely to actually be correct.”

But Palmer’s laboratory continued chasing down the Glo1/anxiety connection, and their experiments paid off in the discovery of an entirely new mechanism for anxiety disorders. Their study, published today in the Journal of Clinical Investigation, also describes a previously unrecognized inhibitory neural factor, offers a promising new target for the treatment of anxiety disorders and other psychiatric symptoms, and suggests an intriguing connection between metabolism and neurobiology.

“What’s neat is that we started with exploratory, open-ended genetic studies in mice, and we’ve now gotten into some fundamental new physiology that nobody had appreciated or put together before,” Palmer said. “Now we’re starting to reap some of the fruit from those types of genetic studies to enrich our understanding of more classical aspects of biology.”

Lead author Margaret Distler, an MD/PhD student in the Pritzker School of Medicine, started her examination of the Glo1/anxiety link by testing it in a new way. In a 2009 paper, Palmer’s group hypothesized that mice with more copies of the Glo1 gene — a genetic phenomenon known as copy number variants — were more likely to show anxious behaviors. Distler tested this theory by inserting two, eight, or ten copies of the gene into mouse lines, and measuring their anxiety with various laboratory tests, including the open field test and the light-dark box test. As predicted, more Glo1 copies equated to more anxiety-like behavior, lending more evidence to the link.

“Animals transgenic for Glo1 had different levels of anxiety-like behavior, and more copies made them more anxious,” Palmer said. “We showed that Glo1 was causally related to anxiety-like behavior, rather than merely correlated.”

The next step was to figure out how Glo1 accomplished its unexpected influence. In glycolysis, glyoxylase 1’s job is to metabolize and reduce levels of a byproduct called methylglyoxal, or MG for short. So Distler tried an experiment so simple it almost obvious: if increasing Glo1 increases anxiety, would increasing MG levels alleviate it? After injecting mice with MG, the mice were less anxious in the behavioral experiments, suggesting that the metabolic byproduct does in fact play a role in anxiety — and a relatively fast role, at that.

“Methylglyoxal changed behavior within 10 minutes of administration, which means it’s a rapid onset. It’s not changing gene expression, and it’s not having long-term downstream effects,” Distler said. “That was our first breakthrough.”

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by Rob Mitchum

The brain is a privileged organ, afforded protections denied to all the other organs of the body. Though the circulatory system functions much the same way above and below the neck, using blood to exchange nourishment for waste with cells, the exchange is conducted under much heavier security in the central nervous system. This TSA for the brain and spinal cord is known as the blood-brain barrier, and its role is protecting the fragile, irreplaceable cells of the nervous system from external disease and the body’s own immune weapons.

While we can all be thankful for the unceasing service of the blood-brain barrier (sometimes abbreviated as BBB), many scientists are interested in figuring out how it can be breached. Many neurological diseases, including multiple sclerosis and stroke, can be attributed in part to breakdowns of the BBB. Drugs designed to treat brain disease must also find a way through the BBB’s strong defenses to get to their desired targets.

That made the blood-brain barrier the perfect subject for this year’s Chicago Symposium on Translational Neuroscience, an annual gathering of neurologists and laboratory neuroscientists from the University of Chicago Medicine and other institutions. This year, the Neuro contingent was joined by UChicago’s young Institute for Molecular Engineering in presenting the conference, underscoring that the topic is very much an engineering problem: how do you build a blood-brain barrier, and how do you selectively knock it down?

The day’s first speaker, Richard Daneman of the University of California, San Francisco, explained what the field currently knows about the unique properties of the BBB. In most of the body, the capillaries of the circulatory system are “leaky,” he said, allowing many molecules to pass between the cells and the blood through the cracks between the endothelial cells that make up the blood vessel walls. But in the BBB, those cells form a tight seal, and molecules are transported into and out of the vessels by highly selective transporters instead of passive diffusion. Daneman illustrated these defenses with an experiment where blue dye is injected into an animal, which is later dissected. While organs such as the kidney or liver take on a distinct blue hue, the brain and spinal cord remain free from the dye, which cannot penetrate the barrier.

Daneman is interested in “barriergenesis,” how the BBB is constructed during development. Previously, researchers hypothesized that brain cells called astrocytes were responsible for building the BBB. But using mice and rat models, Daneman’s laboratory determined that this defense system is already in place during embryonic stages, before astrocytes first appear. Instead, Daneman’s experiments pointed to another cell group called pericytes as critical architects of the BBB. When the genes for forming pericytes were knocked out in a mouse line, the BBB did not form its tight seal…as indicated by the appearance of blue brains after a dye injection.

Now Daneman’s lab is digging into the molecular signals that construct the BBB during development and maintain its integrity throughout life. Some of those experiments involve taking the endothelial cells that form the BBB out of their native habitat to study them on the lab bench, the subject of a talk from Eric Shusta of the University of Wisconsin - Madison. Endothelial cells only make up about one-tenth of one percent of the cells in the brain, Shusta said, and don’t form the tight seals characteristic of the BBB in the lab dish unless they are co-cultured with other neural cell types.

Shusta’s laboratory has tackled these problems using the hot prospects of laboratory science: pluripotent stem cells. When researchers in his group decided to try to differentiate stem cells into BBB-like endothelial cells, Shusta said “I thought they were a little bit crazy, but the initial experiments worked.” What’s more, with neural stem cells, the researchers could also generate other nervous system cell types that might play an important role in barriergenesis. That experimental set-up can now be used to test for the cellular factors that build the BBB and as well as assess different drugs’ ability to pass through the barrier, without the constraints of having to endlessly harvest scarce endothelial cells.

“From one rat brain we can get about 6 to 12 filters, but from one vial of stem cells, we can easily get ten thousands of filters,” Shusta said. “We think that we can keep optimizing this, and hopefully make an impact in developmental and drug screening applications.”

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by Tiffani Washington

Whether it’s from a movie, celebrity hearsay or some other largely fictional account, most of us can recall a tale of someone experiencing a heart attack in the throes of passion. In reality, only about 1 percent of all heart attacks occur during sex, and far less than 1 percent of heart attack survivors die due to a sexual encounter. Still, it’s easy to see why a recovering heart attack survivor might be a bit timid rekindling romance without a doctor’s green light.

Supporting that notion, a new study finds that patients who were sexually active before suffering a heart attack were one and a half times more likely to recapture their sex lives if they received guidance on the topic before leaving the hospital.

While it’s no surprise that sexual activity tends to decline slightly for both men and women during the year following a heart attack, or acute myocardial infarction (AMI), researchers found that many patients who said they did not get medical counsel prior to hospital discharge either unnecessarily delayed or refrained from sex.

In a survey of 1,879 heart attack patients, less than a half of men and roughly a third of women recall receiving instructions about when to safely return to sexual activity before leaving the hospital. After a year of follow-up, only 41 percent of men and 24 percent of women reported having a discussion with their doctor about sex since their heart attack.

Results from the study published  in The American Journal of Cardiology are in line with early findings presented at an American Heart Association conference in 2010. Lead author, Stacy Tessler Lindau, MD, associate professor of obstetrics and gynecology at the University of Chicago Medicine, said the study underscores the need for more doctors to address sex as an important part of overall physical function, even after a life-threatening event such as a heart attack.

“Doctors need to understand the significant role they play in helping AMI patients avoid needless fear and worry about the risk of relapse or even death with return to sexual activity,” said Lindau, a renowned expert on helping women with complex illnesses maintain sexual function. “Receiving instructions, prior to hospital discharge, about resuming sex was a major predictor of whether patients resumed sexual activity in the year following AMI. For women, this was the only significant predictor. The discharging cardiologist has detailed knowledge of the patient’s condition, has provided life-saving care and is best positioned to advise on the safety of engaging in physical activity, including sex.”

Without counseling, patients are left to make their own, often flawed, assumptions about risk associated with sexual activity. Multiple studies have shown that sex puts less of a strain on the heart than people might think.

“This study may help doctors address issues that they’re traditionally reluctant to discuss,” said study author, Harlan Krumholz, MD, professor of medicine and epidemiology and public health at Yale University School of Medicine. “We’re showing that addressing sexual health may make a difference to long-term outcomes.”

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By Matt Wood

In 2006, Dale Lloyd II, a 19-year-old freshman football player at Rice University, collapsed during a conditioning workout and died the next day. His death was linked to complications from sickle cell trait, or having one of the genes that causes sickle cell disease.

At least 20 deaths of football players with sickle cell trait have been reported since 1974. As part of a settlement with Lloyd’s family in 2009, the National Collegiate Athletic Association (NCAA) agreed to screen all athletes for sickle cell trait. But does this policy make good medical sense, or does it discriminate against athletes with sickle cell trait and unnecessarily exclude them from sports? Lainie Friedman Ross, MD, PhD, the Carolyn and Matthew Bucksbaum Professor of Clinical Medical Ethics, recently surveyed pediatricians and sports medicine providers about the NCAA policy and found conflicting responses to these questions.

Sickle cell trait is most common among African Americans but can affect Caucasians as well, particularly those of Mediterranean and Middle Eastern origin. It can cause red blood cells to change shape and clog blood vessels, which can lead to heat illness, dehydration, kidney failure and exertional rhabdomyolysis, or breakdown of muscle tissue. Athletes and military trainees with sickle cell trait are especially at risk during intense conditioning at high altitudes or in extreme heat and humidity.

The idea behind the NCAA policy is that coaches would be able to take precautions during practices and games for athletes with sickle cell trait, but Ross said anybody is at risk for heat illness under those conditions.

“People who have sickle cell are at increased risk, but anybody can die from heat exhaustion,” she said. “This isn’t just unique to sickle cell trait. The whole point is we should be protecting all of our athletes and military personnel.”

The United States military has long studied this issue, and found that modifying training on hot, humid days for all recruits — not just those with sickle cell trait — eliminated the excess risk of death from heat illness and exertional rhabdomyolysis for those with sickle cell trait. Under normal conditions, athletes with sickle cell trait can participate with no restrictions, so by singling them out instead of enforcing rules on practice conditions for all athletes, the NCAA may be discriminating against them.

“Even if sickle cell trait doesn’t affect their performance, it affects how they get measured for their performance,” Ross said. “If we’re going to discriminate against these kids in practice, we’re going to discriminate against them in games too.”

In two separate surveys published in Pediatrics and the Clinical Journal of Sports Medicine, Ross and her colleagues asked pediatricians and sports medicine providers about the NCAA policy.  More than 70 percent of both groups supported targeted screening for African American athletes in all NCAA divisions. At the same time, a majority of both groups also expressed concerns about discrimination against athletes with sickle cell trait. These answers seem to contradict each other. If providers were concerned about discrimination they wouldn’t support targeted screening versus screening all athletes, or they wouldn’t support the screening policy at all.

Although initially the NCAA recommended screening all athletes, when the policy was implemented in 2010, the NCAA required screening for only Division I athletes. The final policy also allowed athletes to opt-out of screening. Both pediatricians and sports medicine providers overwhelmingly supported the opt-out policy  (75 percent of pediatricians and 88 percent of sports medicine providers), which would also seem to contradict their support for screening in the first place.

Besides the potential for unfair treatment of athletes with sickle cell trait, Ross also has concerns with the NCAA’s testing method. The official policy recommends a test called “Sickledex” which tests only for the specific sickle cell hemoglobin. However, there are a number of variants of sickle cell disease that the Sickledex test doesn’t detect.  While these variants may not pose the risk of exertional heat illness, they do have implications for having a child with a sickle cell disease variant.  By using the Sickledex, athletes who test negative may misunderstand their risks in the reproductive context.

“You’re taking 18- to 25-year-old athletes and you’re telling them that they’re sickle negative,” Ross said. “So later they decide to get married and have a family, and they tell their partner they’re sickle negative, not knowing that they were using a really bad test.”

There is a more sophisticated test available that detects all the sickle cell variants, but it costs more than $100 to administer, versus $10 for the Sickledex test. Ross believes this is the main reason driving the NCAA’s recommendation. “It’s very problematic to use a really bad test,” she said. “If we’re going to do a test, let’s do the right test so we give kids the proper information about their sickle cell status.”

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by Rob Mitchum

A common feature of pharmacies and organic grocery stores is the aisle of natural remedies, featuring bottle upon bottle of herbs, extracts, and oils that promise a wide range of medical benefits. For legal reasons, the health claims made by these products are often fuzzy, boasting of vague antioxidant or anti-inflammatory activity. But online, the compounds are touted as a cure-all for everything from the common cold to depression to cancer, despite often scarce scientific evidence to support such claims. In many cases, scientists aren’t even sure what these compounds do on a biological level, limiting their usefulness in the clinic even if an anti-disease effect could be conclusively demonstrated.

The major obstacle to determining how a natural remedy works (or doesn’t) is the difficulty in assessing the totality of its effects upon a cell, rather than just the effect on one particular factor at a time. But a technique recently invented by University of Chicago researchers to monitor the activity of hundreds of proteins at once allowed scientists to assess the anti-cancer potential of one natural remedy aisle staple: beehive propolis.

“A typical problem in bringing some of these herbal remedies into the clinic is that nobody knows how they act, nobody knows the mechanism, and therefore researchers are typically very hesitant to add them to any pharmaceutical treatment strategy,” said Richard Jones, assistant professor in the Ben May Department for Cancer Research and Institute for Genomics and Systems Biology. “Now we’ll actually be able to systematically demonstrate the parts of cell physiology that are affected by these compounds.”

Beehive propolis is a sticky resin that honeybees use to patch up holes and fill cracks in their hives. Natural remedy suppliers sell this “bee glue” in the form of capsules or liquid extract, touting its abilities to boost immunity, fight off infections, and soften skin. According to anecdotal reports, the substance has been used for centuries to treat sore throats, allergies, and burns, or for less medicinal purposes such as car wax and instrument polish.

Chih-Pin Chuu, at the time a post-doctoral researcher in Jones’ laboratory, wanted to examine whether the active compound in beehive propolis — called caffeic acid phenethyl ester, or CAPE — was effective against cancer cells. Testing concentrations of CAPE that you would expect to find in the blood after a person swallowed a propolis capsule, Chuu found the compound successfully inhibited the growth of early-stage prostate cancer cell in culture dish experiments. Subsequent experiments on mice implanted with human prostate cancer cells confirmed CAPE’s anti-cancer effect, and hinted at a mechanism.

“If you feed CAPE to mice daily, their tumors will stop growing. After several weeks, if you stop the treatment, the tumors will begin to grow again at their original pace,” Jones said of the results, published in the journal Cancer Prevention Research. “So it doesn’t kill the cancer, but it basically will indefinitely stop prostate cancer proliferation.”

That activity suggests CAPE could be a promising co-treatment alongside a chemotherapy drug that targets the cells. But if CAPE were to truly make the crossover from holistic remedy to clinical option, the scientists would also have to demonstrate how the compound freezes cancer cells in a non-proliferative state. Enter the micro-western array, the innovative proteomics technique first described in 2010 by Jones and colleagues.

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by Dianna Douglas

Forty years ago, discussing your plans to donate your organs if you were to become brain dead was considered extremely poor taste.  “People didn’t talk about death and demise in polite company,” said Allen Anderson, MD, associate professor of medicine. He’s director of the advanced heart failure program at the University of Chicago Medicine, and has seen public attitudes about organ donation gradually shift away from macabre fascination and horror in the 1970s, when the concept of brain death was still evolving. “Even after organ donation became more viable, people had a hard time talking about this,” he said.

Not anymore. As of yesterday, Facebook has added an “organ donation” status update page to every account in the U.S. and U.K. These organ donation conversations are public like never before.

Families were once likely to object to someone offering herself up as a donor. Many people feared that the hospital staff wouldn’t do enough to save a dying patient if they already had plans to harvest her organs, or that the surgery to remove the organs would inflict more pain on the patient. For a long time, becoming an organ donor upon death remained a private wish.

“Medicine has progressed and we’ve come to understand brain death. Now, organ donation is not so charged,” Anderson said. In fact, 90% of the public supports organ donation in theory. But when pressed, somewhere between 30-40% of people refuse to turn over the organs of a loved one.

“We always suggest that organ donors discuss their decision with family and loved ones,” said Michael Millis, MD, professor of surgery and section chief for transplant. These conversations serve two purposes: the family knows their wishes, and there is a domino effect when people see others doing something that they once found creepy, or something that they had never considered.

“Organ donation saves lives and eases the suffering of thousands of families,” Millis said.  “Anything that increases awareness of organ donation is helpful.”

Currently, 57% of the people in northern Illinois and northwest Indiana are registered as an organ donor. “We have a good system for getting people to register,” said David Bosch, Gift of Hope communications director. “But we need 90% registered.”

Gift of Hope arranges organ allocation in northern Illinois and northwest Indiana. Bosch still combats persistent myths about organ donation, mostly through educational events in which organ donors and organ recipients share their experiences with the community.

“We’ve had positive media stories, and will sometimes see spikes in visits to our website and donor registrations,” Bosch said. He’s hoping that the Facebook bump will be more permanent. “Most of our outreach is asking each donor to tell two friends, and asking them to tell two more friends. The Facebook attention is powerful because the audience is a billion people.”

There are currently 790 patients on the waitlist for an organ transplant at the University of Chicago Medicine. Many will get organs this year, some will get better without a transplant, and a few of them will die waiting.

The organ shortage is so severe, Anderson says, that even if every person in the country who became brain dead in a hospital gave up their organs, it wouldn’t be enough. “If you commanded every suitable donor to be utilized for donation, we would still have a shortage,” Anderson said. For example, there have only been 1,100 donors in the United States this year. But 73,000 active candidates are waiting. An average of 18 of them die every day.

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by Rob Mitchum and Matt Wood

When superstar Derrick Rose crumpled to the ground late in the Chicago Bulls game Saturday, the playoff hopes of Chicago basketball fans followed suit. Experienced sports fans saw the point guard grabbing at the front of his left knee and thought immediately of three dreaded letters: A, C, and L. Sure enough a subsequent MRI confirmed that Rose had torn his anterior cruciate ligament, an injury that would knock him out of this year’s NBA playoffs, the Olympics, and a significant chunk of the next season.

Despite the long rehabilitation time, an ACL tear is a common injury for athletes playing sports that involve frequent cutting and pivoting. J. Martin Leland, assistant professor of surgery at the University of Chicago Medicine, performs 75 to 100 ACL reconstructions each year on recreational athletes who injured themselves during basketball, soccer, lacrosse, or skiing activities. On Monday, after repairing the ACL of a cricket player, Leland sat down with ScienceLife to discuss how ACLs are torn, how they are repaired, and “the perfect storm” of factors that may have led to Rose’s injury.

Q: First of all, what is the ACL?

The ACL is one of four major ligaments in the knee that stabilize the knee. You have one ligament on the inside of the knee called the MCL or medial collateral ligament, one ligament on the outside of the knee called the LCL, or lateral collateral ligament, then two ligaments in the center of the knee: the ACL, which is right in front of the PCL, or posterior cruciate ligament.

The ACL is most important for rotational stability of the knee, so if someone has an ACL rupture, once the knee comes down and the swelling goes away, they’ll find they can walk, jog, go up stairs, no problem. Then, if they get an MRI showing an ACL tear they’re very confused: “How can I possibly have an ACL tear if I can walk without difficulty with no pain?” But the ACL is not important for walking, it’s important for rotational stability.

Q: What happens to a person’s knee right after they tear the ligament? Are they in pain?

The ACL has an artery that runs right up the center of it. So the first thing that happens is the knee typically swells up like a balloon in a matter of an hour to two hours. Normally people have difficulty putting weight on it because it just feels weird. Some people will describe a pop, other people won’t, but you’ll feel like a sharp shooting pain in the knee, and then it will be gone, and it won’t really hurt. But the knee typically tends to get very swollen within 1 to 2 hours usually, and will stay swollen for up to a week, so people tend to say they have trouble putting weight on it for anywhere between immediately after the injury and four or five days. After that they can put weight on it, but the knee is very stiff, and it takes anywhere between a week and three weeks for that swelling to go down and the stiffness to go away so that you can get range of motion again.

Q: With Rose’s injury, Bulls trainers were doing knee exams right on the court after he collapsed. Can a doctor diagnose an ACL injury that quickly?

The Lachman exam is the name of the test that’s typically done to test the ACL. It’s done with the knee at 30 degrees of flexion. Basically, you stabilize the femur, and with your hand on the tibia, you just kind of pull up. If you feel increased laxity, or the tibia pulls forward on the femur more than what’s normal, you know right off the bat that they tore their ACL.

When I watched the video, I could tell that he had ruptured his ACL without even examining him. The sportscasters couldn’t tell the instant when he injured it, they said he jumped up and was complaining of pain, so maybe it was the jump. But it was when he planted, immediately before jumping. If you watch the clip very carefully, you can see he comes in, plants, and his left knee bows in, so that the knee comes towards the right knee as well as rotates, and then he comes out of that and jumps up. That’s why he dishes the ball off, because the second the knee went in that position, he felt it pop, and felt the pain, and you can see for a split second the classic valgus instability where the one knee moves towards the other knee and ruptures the ACL.

Q: Was it unusual that Rose injured his knee without being struck by another player or running into an object?

The most common way of tearing your ACL is non contact. It was the perfect storm for Derrick Rose to rupture his ACL. He’s missed much of the season because of his prior four injuries, and he’s only been back playing for three weeks, and it was in the last minute and a half of the game. He can’t possibly be at full strength because he missed so much time, so his muscles are more weak.

He went to make that sudden stop, and normally, if he was a little bit stronger, his muscles would have fired and kept his knee still. But his muscles were fatigued and they just gave out, and once they gave out, his knee started going into that position. Basically, he was coming in and stopped with such force that normally his muscles would have kicked in and stabilized his leg, but because his muscles were weak, his knee just kept going, and then ruptured the ACL. So it was really the fact that he wasn’t at 100 percent strength, and the fact that he was fatigued at the end of a game.

When you hear about skiers rupturing the ACL, it’s almost always in the afternoon, because someone like myself who is a recreational skier is not used to 8 hours of sports participation because we work all day. In the afternoon, my muscles are tired and fatigued, and that’s when my knee gets in that bad position.

Q: Is the ACL the most fragile knee ligament, or do sports fans just hear about those injuries more often?

The most commonly injured ligament in the knee is the MCL. But the MCL when injured in isolation, it heals very well non-operatively. So some people will be in a knee brace for six weeks and then get right back out there. Professional football, if it’s a mild injury, they might not even miss a game. People are injuring their MCLs all the time but we never hear about them, because it’s not nine months until you come back, it’s anywhere between two and six weeks.

Q: Is basketball one of the worst sports for causing ACL injuries? Who’s at highest risk for the injury?

There are some studies that have been done, and it’s been shown that women who play soccer and basketball have a much higher likelihood of developing ACL ruptures, versus men or women who play other sports. It hasn’t been shown in men’s sports that basketball is any more dangerous than say football or soccer.

It’s sometimes shown that women have an even higher risk of rupturing their ACL than men. There’s a 2 to 4 times higher rupture risk in women that play soccer or basketball in comparison to male counterparts, because of different reasons. Hormones tend to stretch out ligaments and estrogen can cause increase rupture of ligaments when there’s stretching at certain times of the menstrual cycle. Women also have proportionally smaller ACLs, even accounting for the fact that women are slightly smaller than men. But there haven’t been any research to show that men who play basketball are at a higher likelihood of injury than men who, say, play soccer.

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by Rob Mitchum

Too often, art and science are treated as intellectual adversaries. Educational systems typically route students toward one pole or the other, with the artistic and scientific spheres rarely intersecting by the time one reaches the undergraduate and graduate levels. But for the last two years, the University of Chicago has paved a path between these two fields with the Arts|Science Initiative, which offers grants to collaborations that reach across the traditional boundary lines.

This year’s presentation, which took place in the “performance penthouse” of the brand-new Logan Center for the Arts on the south end of campus, featured six such partnerships formed between scientists and doctors-in-training on one side and artists, sculptors, and filmmakers on the other. The projects covered a wide span of ideas and technologies, from 3-D sculptures based on math theorems to hacked Wii controllers that allow dancers to make music as they move. In each case, the participants raved about how the collaboration allowed them to flex a different part of their mind, approaching familiar topics with a fresh set of eyes and think about new, creative ways to merge the artistic and the scientific.

Trauma Under the Microscope: Collected Perspectives on PTSD

Post-traumatic stress disorder has frequently been in the headlines lately, as tragedies such as the killing of 17 Afghan civilians by a US soldier draws attention to the high incidence of the condition in veterans of war. But the definitions of “trauma” and “PTSD” vary widely from person to person, clouding the issue of what causes the disorder and how it is diagnosed and treated. Many journalists and laypeople misuse the term, or fail to understand that PTSD is caused by a constellation of factors, not a single incident of trauma, said Nicole Baltrushes, a Pritzker School of Medicine student.

So Baltrushes collaborated with Sravana Reddy of the Computer Science program and Carmen Merport of the English Department to create an interactive website on PTSD. Starting with a print flyer, the team asked friends, family, faculty members from several disciplines and health professionals to annotate the flyer based on their understanding of the disorder and its terminology. They then took those notes, plus various multimedia links to poetry, videos, pictures, Facebook posts and other sources, and built an interactive webpage that can be added to and customized by users.

“The hope is that as more people visit the site, and as more people hear about the site, that there can be a web-based conversation that we start about what is trauma and PTSD, to broaden our understanding,” Baltrushes said. “Because as of yet, we have not the greatest understanding of what these things are, or how to even approach healing of these things on any level.”

Opening

As laboratory imaging technologies improve, science becomes more and more of a visual discipline. In the film “Opening,” Jared Clemens of the Committee on Neurobiology and Marco G. Ferrari of the Department of Visual Art make the connection between scientific videos and the world of film explicit through innovative use of split screens, montage, and audio editing. While original footage featuring neuron-esque trees on the University of Chicago campus runs in the middle of the screen, laboratory videos of actual neurons run on the left side while scenes captured from films such as Elephant Man, The Shining, and Rear Window play on the right. Meanwhile, the audio track alternates between scientific descriptions of the structure and function of the brain and movie dialogue that touches on the nature of the mind.

“This piece originated in a personal interest in the disconnect that exists between much of the public and the sciences,” Clemens said. “I wanted to explore this in a non-traditional way…the structure of the piece is an abstraction of the chaos and dynamics that exist in neural circuits, as well as the chaos that exists between the public and the sciences.”

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By Matt Wood

In a recent column in the New York Times, Nick Kristof pointed out a startling statistic: for every American soldier killed in combat this year, 25 will commit suicide. A report from the Center for a New American Security says that from 2005 to 2010, service members took their own lives at a rate of one every 36 hours, and the Department of Veterans Affairs says that 18 veterans commit suicide every day.

Further analysis of this epidemic uncovers even more troublesome data. In a recent study published in the American Journal of Public Health, a statistician from the University of Chicago Center for Health Statistics found that the youngest group of veterans, ages 17-24, were almost four times as likely to commit suicide than nonveterans.

Robert Gibbons, PhD, professor of biostatistics in the departments of Medicine and Health Studies has long been interested in statistical analysis of suicide data to uncover patterns that could point to potential intervention strategies and treatment policies. He was on the Food and Drug Administration (FDA) committee in 2004 that issued a “black box warning” about increased suicide risk in children taking antidepressants. He actually voted against the warning, citing concerns about ambiguous data, and earlier this year published his own statistical analysis of the clinical trials the FDA used for their warning and found that the drugs were quite effective in decreasing suicide risk in adults and neither increased nor decreased suicide risk in children and adolescents.

In his current work on veteran suicide, Gibbons and his colleagues tackled another statistical disagreement. The editors of the American Journal of Public Health asked him to write an editorial about two studies on the rate of suicide among veterans that showed conflicting results. He and his colleagues weren’t able to replicate the results of either study, so they decided to do their own using publicly available data.

“We realized there was just no way we were going to be able to be Solomon-like and opine about who was right or wrong,” Gibbons said. “So we decided to see if we could figure out a way to shed some light on the answer using stuff off the internet, something a 10-year-old could get.”

Those data are from the Centers for Disease Control and Prevention National Violent Death Reporting System, which provides detailed data on all violent deaths, including suicides, from 16 states from 2005 to 2008.

“It’s a very important data source that very few people know about or use, so we’re really happy to use it. It’s a great national resource,” Gibbons said. “I think what’s cool about it is that it shows you can actually learn something from data that are completely publicly available, and learn something that is probably right.”

The key difference in how Gibbons and his colleagues analyzed the data versus the two previous studies is that they looked at how the rate of suicide changed with age. Statistical analysis of epidemiological data commonly controls for age, but a more detailed stratification by age is required to tease out the effects of recent military service and the associated emotional and psychological traumas of war.

The problem with the two conflicting earlier reports was that they were based on national surveys that did not control for the time at which the veterans actively served in the military.  One study included veterans with more recent military service and identified an increased risk of suicide risk. The other study looked at veterans further removed from military service and did not find an effect.  Gibbons and his colleagues explained these differing conclusions in the editorial using their new results.

“The bottom line as it turns out there’s a really big risk of increased suicide right when you get out of your military service,” Gibbons said. The risk of suicide in the youngest group of veterans was almost four times higher than nonveterans. That number drops off after the age of 24, but remains around one and a half times higher.

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By Matt Wood

The human papillomavirus (HPV) is a strikingly common sexually transmitted disease associated with cervical cancer. More than 25 percent of women ages 14-59 are infected with HPV, but it gained greater attention in the United States in 2006 when the Food and Drug Administration (FDA) approved the first vaccine for it.

African American women and those living in low-income environments are at greatest risk for HPV infection and cervical cancer, and while some studies have looked at vaccination rates among adolescents, few have studied the unique effects of race and income level. To address this gap, a developmental psychopathologist at the University of Chicago recently studied the vaccination rates in a large, representative sample of girls 12- to 15-years old. She found that African American girls are far less likely to be vaccinated than European Americans, even when controlling for income level, exposing a significant disparity for those most at risk from HPV.

Kathryn Keenan, PhD, professor of psychiatry and behavioral neuroscience, had been working with colleagues at the University of Pittsburgh on a long-term study of the development of behavioral and emotional problems of almost 2,500 girls and their caregivers. In 2008, two years after the FDA approved the HPV vaccine, she and her colleagues took the opportunity to survey this group about initiation of the HPV vaccine.

The sample of girls in this study is unique because it is representative of the city of Pittsburgh and includes equal numbers of African Americans and European Americans. Because data had been collected annually since the study began in 2000, Keenan and her colleagues were able to identify predictors of which girls were most likely to get the vaccine.

In their latest study, published in Health Psychology, they found that about 60 percent of the girls had gotten the first of three shots for the HPV vaccine in the previous year, far below the goal of 90 percent set by the Centers for Disease Control and Prevention (CDC). African American girls were close to 40 percent less likely to have received the vaccine than European-American girls. The likelihood of vaccine uptake also increased with the level of sexual activity.

Keenan said these findings are troubling for a number of reasons. “African American women are more likely to suffer high levels of morbidity and mortality from cervical cancer than European American women,” she said. “So now we have something that in some ways should be deployed even more aggressively in that community and it’s not happening.”

The CDC recommends that all 11- or 12-year-old girls get the vaccination to protect against cervical cancer, but these recommendations have become a political issue as many parents and politicians object to the idea of protecting young children from a sexually transmitted disease. Unfortunately, this obscures the need for better education about HPV.

“Talking about sex and sexual activity when it comes to younger girls is still a huge taboo,” Keenan said. “I think we’re very uncomfortable thinking about sexual behavior in children. There are myths about how talking to children about sex gives them permission to have sex, and the data don’t support that at all.”

Keenan said that this fear overshadows the risks of HPV, because the public still has difficulty connecting it to cervical cancer. That confusion can give people the impression that there is a choice. “If you don’t have a good sense of the threat, it’s pretty easy to just say, ‘Well, it’s my choice,’” she said.  “I think we have to do a better job of making it clear that this is a real risk, and this is a real threat, because I don’t think that message is getting out.”

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By Dianna Douglas

The public health threats in Chicago aren’t just diabetes, asthma and hypertension—about 500 lives are lost every year in the city by homicide.

The University of Chicago Medicine fights the root causes of deadly violence in various ways. One recent attempt is through a partnership with CeaseFire, a group in Chicago that uses public health techniques to identify and interrupt outbreaks of violence with the same intensity as an outbreak of malaria or AIDS.

The work of CeaseFire, documented in the acclaimed 2011 film, The Interrupters, has had mixed results in lowering Chicago’s crime rate. The CeaseFire foot soldiers, called “violence interrupters,” mediate fights to try to keep them from escalating. They are hoping to change the societal norms among people who view violence as an acceptable way to solve conflict. But homicides wax and wane in the city, and the violence interrupters have had a frustrating 2012 so far, with the murder rate 60% higher than the same period last year.

The University of Chicago Medicine will host a total of 6 screenings of The Interrupters around the city this spring. Each is followed by a community discussion. The goal is to give the public some ideas on how to stop violence. Rather than seeing violence as a problem that should be addressed with crime control (more police, more incarceration), they hope that the community can view violence as a disease. The people infected by the disease need treatment and programs rather than judgment.

Below are scenes from one of these screenings and a discussion at the Rainbow PUSH coalition on April 10. Eric Whitaker, MD, MPH, executive vice president of strategic affiliations and associate dean of community-based research at the University of Chicago Medicine, served as the facilitator for the panel.

By Matt Wood

Some people use social media strictly for personal purposes. Others use it to tout their expertise on a subject or to market a business. Many use it for a little of both. The choice is usually a matter of personal preference and ambition, but for physicians using social media to discuss medical issues and communicate with others, it’s much more complicated.

BMJ recently published an article on the difficulties physicians face trying to maintain a distinction between personal and professional lives on social media, as they navigate the legal and ethical issues involved discussing medicine and interacting with the public online. I spoke to some physicians at the University of Chicago Medicine who are avid users of social media and asked them why they decided to start using social media, and how they draw the line between the personal and the professional online.

Vineet Arora, MD, associate professor of medicine, writes a blog focused on medical education called FutureDocs and runs a lively Twitter account (@FutureDocs). She’s written about why she started blogging and how social media has helped advance her career, and said in our interview, “My main reason for getting started was to stay current and learn what others were thinking about.”

This soon turned to her contributing the discussion as well. “You learn that you can also contribute to the discussion, dispel myths and connect with people who share your interests and can help you advance your thinking,” she said.

Jeffrey Matthews, MD, surgeon in chief and chairman of the Department of Surgery, echoed this sentiment about participating in the medical discussion online. “I started using Twitter (@JBMatthews) as an experiment to celebrate and publicize some of the goings on in the Department of Surgery,” he said.  “But it soon morphed into a way to also comment on interesting news stories that affect our institution, our department, the field of surgery and broader issues of science intersecting with politics.”

Social media has other professional benefits for physicians, especially those starting their careers. Andrew Nickels, MD, a resident with an interest in allergy/immunology and medical ethics, said he also started using Twitter (@EthicalAllergy) for knowledge sharing, but finds value in it as a networking tool as well. “Social media allows me to establish a network of colleagues that provide me with worthwhile content,” he said.

The biggest challenge for physicians using social media, and one that the doctors I spoke to said scares many of their colleagues away, is the risk of running afoul of HIPAA regulations by violating patient privacy or posting inappropriate content online. In March, JAMA published a research letter reporting that most medical licensing boards they surveyed had received at least one complaint about unprofessional online behavior by physicians, such as sexual misconduct, prescribing medicine without an established clinical relationship and misrepresenting credentials.

Ves Dimov, MD, an allergist/immunologist and assistant professor of pediatrics and medicine said his role as a social media user is to help other physicians use it effectively in their practice. “Everybody is aware of the risks, but we need to show them how to do it and provide examples of best practice,” he said. “Highlighting only the negatives of social media use in medicine is like teaching medical students only with “Morbidity and Mortality” conferences. We need to discuss positive outcomes too.”

With 9,000 followers,  his Twitter account (@DrVes) was ranked among the top 6 most influential people in Chicago and among the top 3 in medicine worldwide. He has written about how doctors can use social media as an extension of their natural communication skills and to provide valuable information to patients. He said the payoff to using social media outweighs risks if certain simple rules are observed. “I’ve been using social media for eight years now, and it’s been a tremendously positive experience,” he said.

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By John Easton

“Take medication on an empty stomach.” Patients dread seeing this warning on their pill bottles, knowing that it often means skipped meals and hungry rumbles in the hours before and after taking their medicine. The rationale for the empty stomach is to avoid the unpredictable effects of food on drug metabolism — depending on what you’ve eaten, different amounts of the medication can be absorbed into the bloodstream. But a new clinical trial at the University of Chicago Medicine is testing whether just the right mixture of food and drug could be more convenient for patients while saving a whole lot of money.

Abiraterone (trade named Zytiga), is a drug prescribed to men with castration-resistant prostate cancer. It also is more sensitive to food’s effects than any other marketed drug that is labeled to be taken on an empty stomach. Five times as much of the drug is taken up with a low-fat meal as on an empty stomach, and up to 10 times as much with a high-fat meal. Yet patients are told not to eat for two hours before and for one hour after taking their pills. As a result, taking Zytiga as directed means the amount of the drug absorbed by the body to fight cancer is decreased by 80 to 90 percent.

“This clinical trial is designed to assess the risks and benefits of taking this effective but costly drug with food,” said Russell Szmulewitz, assistant professor of medicine at the University of Chicago Medicine and director of the study. “Taking one pill with a meal, rather than four pills on a empty stomach, is much more convenient for patients, so it may improve compliance. It would also reduce the cost.”

The savings to patients and their insurance companies from taking lower doses of the drug would be significant, since the drug costs $5,000 a month.

“By taking one-fourth of the dose with a low-fat breakfast,” Szmulewitz said, “patients may be able to get the full medical benefit and save about $3,750 per month.”

The convenience would also appeal to patients. Many dislike having to fast for hours before and after taking their medication, which can upset an empty stomach. Since patients with advanced prostate cancer tend to be older, most take multiple medications for additional health issues, fitting each medication into a complicated daily routine. Many patients who take Zytiga wake up during the night, for example, to take the medicine, then go back to sleep, allowing them to eat soon after they wake up.

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By Matt Wood

Crohn’s disease is a form of inflammatory bowel disease that can cause painful abdominal cramps, diarrhea, fever, fatigue, loss of appetite and weight loss. These symptoms can lead to poor quality of life and cause significant stress, as people with Crohn’s limit their activities for fear of flare-ups and having an accident in public.

There is no known cure for Crohn’s disease, and treatment involves a “step up” strategy that start with first-line medications to manage symptoms. But a gastroenterologist at the University of Chicago Medicine has taken a closer look at a “top down” approach that reverses the conventional order of treatment by starting with biologic therapies.

Traditional treatment for Crohn’s patients is focused on a strategy of managing inflammatory symptoms, starting with simpler and less costly oral medications such as aminosalicylates (5-ASAs) and corticosteroids, and escalating through a series of steps to more expensive biological therapies that target specific proteins in the immune system’s inflammatory response. David Rubin, MD, associate professor of medicine, co-director of the University of Chicago Medicine’s Inflammatory Bowel Disease Center, studied the newer top-down strategy that reverses this order of treatment. He found that patients treated with biologic therapies earlier were significantly less likely to need steroids, lose response to their biologic therapy, and require surgery related to their Crohn’s disease.

“We’re essentially reversing the management strategy in Crohn’s disease,” said Rubin. He emphasized that the medications often used first for patients with Crohn’s are also the least effective and carry risks for side effects. “We’ve long discussed and debated that 5-ASAs don’t work in the majority of Crohn’s patients, and certainly don’t change any outcomes,” he said. “Steroids are ineffective long-term and are also dangerous because they have significant side effects such as infections.”

Crohn’s is a disorder in which the body’s immune system appears to have lost the ability to regulate itself and becomes overactive, causing progressive damage to the bowel structure and function.  Patients often need bowel surgery to repair this damage. Researchers have made great progress finding genetic and environmental contributors to Crohn’s disease, but the actual cause is unknown.

Rubin said that physicians have questioned the effectiveness of the step-up strategy because patients experience little relief while being treated with medications before they receive the biological therapies. During that time, they suffer from active disease, have low rates of remission and often appear to lose response to the biological therapies.

In recent years a treatment strategy that starts with the targeted biologic therapy as a first option has been explored in controlled clinical trials. The results were encouraging, and suggested that such an approach results in higher remission rates. However, it was not clear whether this top-down approach would translate to the general population of patients with Crohn’s disease, or whether such an approach would maintain the response to biologic therapy and decrease the need for surgery.

The FDA approved the first targeted biologic therapy for Crohn’s disease in 1998 and the second two in 2007 and 2008. Rubin said that because they are expensive, must be administered through injections instead of pills and are typically saved until last, physicians are hesitant to prescribe them earlier. “Patients and doctors are nervous about immune suppressive therapies. The perception in the current treatment algorithm is that the therapies saved for last must also be the most dangerous,” he said.  “But that’s the wrong thinking, and by delaying their prescription it may be a self-fulfilling prophecy because by then patients have suffered more damage to their bowels and are less likely to respond favorably.”

In the study, published in the journal Inflammatory Bowel Diseases, Rubin and his colleagues analyzed health insurance claims from a database that includes records from more than 94 commercial health plans throughout the United States. Patients eligible for the study had to be enrolled in the same health plan continuously for at least six months before the first claim related to Crohn’s, and stay enrolled for at least 12 months after the first claim for anti-TNF treatments.

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