Medical Bulletin | Minnesota Medical Foundation

Retraining the brain

2013-04-29T19:55:27Z

U plasticity lab helps kids and adults recover from stroke and other disabling conditions

By Susan Perry

On a chilly Minnesota evening last December, 16-year-old Tiffany Cowan sat uncomplainingly in Room 242 of the University of Minnesota’s Masonic Memorial Building as two graduate students from the University’s Brain Plasticity Laboratory carefully attached a series of wires to her scalp and right arm.

Cowan, with the consent of her parents, had volunteered to participate in one of the lab’s studies, which was examining the safety of using transcranial direct current stimulation (tDCS) as a treatment for children with congenital stroke. tDCS is a type of painless, noninvasive brain stimulation that delivers a low (battery-powered) and persistent current to specific areas of the brain through small electrodes. experimental studies have suggested that it may help adult stroke victims regain some function of their limbs. This is among the first to investigate whether it may help children, too.

Tiffany, who suffered a stroke either before or during birth, has limited use of the right side of her body. Although the lithe, blonde teenager leads an active life, including playing the violin (like nearly all violinists, she bows with her right hand and does the more demanding finger work with her left), she’s eager to participate in research that might enable her to have more muscle control of her stroke-damaged hand.

She’d particularly like to write with that hand.

Lead researcher Bernadette Gillick, P.T., Ph.D., hovered maternally around Tiffany as the graduate students prepared the young woman for the tDCS stimulation. Gillick spoke to Tiffany constantly, putting her at ease as she explained everything the graduate students were doing.

“You’re my eleventh subject in this study,” she quipped. “That’s why your nickname is C-11.”

Tiffany smiled.

Eventually, all the electrodes were secured on the correct areas of Tiffany’s capped head, and the actual experiment began. The graduate students switched on the tDCS machine, being careful to hide the device’s controls from both Tiffany and Gillick. This was a double-blinded controlled study, which meant that half the children were being randomly assigned to a “control” group that received a pretend, or sham, treatment. To ensure the integrity of the study’s results, it was important that the children and Gillick, who would be interpreting the data, didn’t know which child was in which group.

“How do you feel?” Gillick asked.

Tiffany smiled again. “Fine,” she answered. “It just feels a bit like my hair is being pulled.”

Exploring new territory

Understanding how the brain reorganizes itself after a stroke or other brain injury is the overall mission of the Brain Plasticity Laboratory. Located in the Children’s Rehabilitation Center on the University’s East Bank campus, the decade-old lab is engaged in a variety of fascinating — and often unique — research using various brain stimulation, rehabilitation, and imaging techniques. Findings from this research are not only enabling scientists to gain deeper insight into how the injured brain restructures itself, but they are also pointing to promising new therapies that may help children and adults recover lost function after such an injury.

“There are only a couple of other labs that I’m aware of around the country that are doing some of the things that we’re doing here,” says James Carey, P.T., Ph.D., who codirects the lab with Gillick and Teresa Kimberley, P.T., Ph.D. In fact, he adds, the Brain Plasticity Laboratory may be the only one using a special dual type of brain-priming technique in its studies.

There’s urgency to this area of research. Stroke affects about 795,000 American adults each year, according to the U.S. Centers for Disease Control and Prevention. It’s the leading cause of serious long-term disability in the nation, and it costs the country an estimated $54 billion annually in health care services and lost productivity.

Focal dystonia, another major focus of the lab’s research, also has a devastating effect on many people’s quality of life. Tens of thousands of Americans have this neurological movement disorder, which causes specific sets of frequently used muscles, such as those in the hands, feet, or throat, to involuntarily contract and form unnatural positions. Current treatments are often short-lived and ineffective. Read more about focal dystonia.

“If we could develop a reliable, effective intervention for these conditions,” says Kimberley, “we would have a profound effect on many people’s lives.”

Retraining the brain

The term plasticity (which comes from the Greek word plaistikos, meaning “to form”) refers to the brain’s ability to change its structure and function as a result of new learning and experiences. Until the 1960s, scientists believed that after childhood the brain became a static organ, unable to create new pathways among its 100 billion cells, or neurons. But thanks in large part to advances in brain imaging technology, it’s now known that the brain is constantly reorganizing those pathways. In fact, the adult human brain is even capable of creating new neurons, a process called neurogenesis.

The knowledge that the brain can be retrained to regain lost function has led to the development of a wide range of plasticity-based behavioral therapies. Today, patients who have experienced a stroke or other brain injury are prescribed rigorous and repetitive physical exercises or tasks in order to “rewire” their damaged brain. For stroke patients, this rehabilitative therapy usually begins 24 to 48 hours after the stroke.

“Traditional therapies are effective,” says Carey. “They do help. But given the magnitude of the stroke lesions in some people, they may just not be enough.”

A newer idea, he explains, is to use tDCS or a similar technology called repetitive transcranial magnetic stimulation (rTMS) to “prime” the brain so it will be more receptive to the effects of behavioral therapy.

“If we can adjust the brain to be more responsive to behavioral therapy, we might get better results,” Carey says.

Other laboratories in the United States and elsewhere are also investigating the uses of brain stimulation as an adjunct to traditional stroke therapies, but the University’s Brain Plasticity Laboratory is taking that concept one step further.

“We’re doing priming of the priming,” explains Carey.

The battle of the hemispheres

To understand how brain-stimulation priming helps stroke patients, you have to first understand how a stroke injures the brain and how, in a somewhat surprising way, the brain responds to that injury. The most common type of stroke damages the brain by interrupting blood flow to the neurons. Without oxygen in the blood, the cells in the immediate region of the stroke begin to die within a few minutes.

Strokes tend to occur on one side, or hemisphere, of the brain’s cerebrum, the largest part of the brain. Located in the top and front section of the skull, the cerebrum is responsible for movement, speech, thinking, memory, the regulation of emotions, and other functions. The hemispheres, which are connected by a thick band of nerve fibers called the corpus callosum, specialize in different functions. When it comes to movement, each hemisphere controls the muscles on the opposite side of the body.

The goal of all stroke rehabilitation therapy is to restore function to the weak side of the body. Achieving this outcome is challenging — and not only because of the damage in the stroke hemisphere. After a stroke, the cells in the nonstroke hemisphere respond in a way that compounds the problem: They become more “excitable.” This exaggerated excitability inhibits healthy cells in the stroke hemisphere from rewiring themselves to regain lost muscle function.

“It’s maladaptive,” explains Carey. “Some have called it a double disablement. As if the stroke weren’t bad enough, the patient gets a disablement from the extra inhibition coming from the other hemisphere.”

Double priming the brain

The University’s Brain Plasticity Laboratory, along with a handful of other labs around the world, has demonstrated in experimental studies that rTMs and tDCS brain stimulation can suppress the inhibitory behavior of the non-stroke side of the brain, thus “priming” the stroke side to be more receptive to behavioral therapies. The University’s lab is unique, however, in having also discovered that low-frequency (inhibitory) stimulation of the non-stroke hemisphere appears to work even better when it is preceded by high-frequency (excitatory) stimulation.

Currently, the Brain Plasticity Laboratory is the only research group in the United States to have received Food and Drug Administration approval to conduct studies involving this “priming of the priming” technique. Initial clinical trials completed by the lab have been promising, showing a distinct trend toward improved function in adult stroke patients who receive the double-priming treatment.

Children and stroke

Recently, the lab has expanded its focus to include research on pediatric stroke. Although thought of mainly as an adult illness, stroke is a leading cause of death and disability in children as well. Each year, about 11 of every 100,000 U.S. children under the age of 19 — including about one of every 4,000 newborn babies — experience a stroke, according to the American Stroke Association. The major causes of stroke in children are congenital heart problems, infections, blood disorders (such as sickle cell anemia), and diseases of blood vessels in the brain.

Children show a tendency to advance faster than adults undergoing stroke rehabilitation therapies. Scientists believe children’s brains may have greater plasticity, enhancing their ability to create new neural pathways in response to injury. But 50 to 80 percent of children with a history of stroke enter adulthood with a permanent disability. The most common is total or partial hemiplegia — paralysis on one side of the body.

Clinical studies

Last summer, the Brain Plasticity Laboratory completed a pediatric study that combined rTMS with behavioral therapy. For the study, which was conducted in conjunction with the Gillette Children’s Specialty Healthcare Hospital in St. Paul and funded by a $1 million challenge grant from the National Institutes of Health, the lab recruited 19 children ages 8 to 16. All had hemiplegia as a result of a stroke.

For 13 days the children received treatment, which alternated daily between rTMS stimulation of the nonstroke side of their brain and one-on-one sessions with a physical therapist. Half of the children received real rTMS stimulation; the other half received sham treatment. (Neither the researchers nor the children knew which treatment the children were receiving until the study was completed.) Throughout the study the children wore a cast on their “good” arm to force them to use only their stroke-affected arm for everyday tasks as well as for the physical therapy exercises.

Both groups of children showed some functional improvement at the end of the study, but those who received the real rTMS stimulation performed significantly better than the other group — and those added gains came with no adverse effects.

“The big question is, can we translate the results that we observed here in our research laboratory to the clinical setting,” says Gillick. “Because that’s ultimately where this is supposed to go. The goal is to improve the lives of those who live with the consequences of stroke.”

Gillick’s current pediatric study — the one Tiffany joined — is using tDCS technology for brain stimulation. Although both technologies can alter brain-cell excitability in the cerebrum, tDCS is less expensive and more portable. That’s because tDCS delivers current directly to the brain, whereas rTMS uses magnetic fields to produce its low-dose electric currents.

“We have just completed the interim analysis and have been approved to continue the study to completion of 20 subjects,” says Gillick. If promising results are found — and she believes they will be — then the next step will be an intervention study combining tdCs with behavioral rehabilitation.

Gillick’s long-term goal is to determine whether this combination of brain stimulation and physical therapy would be even more effective when used soon after a child experiences a stroke. “If we could get closer to around the time of the actual event, we might have a greater impact,” she says.

‘Sign me up’

A week after her initial participation in the tDCS safety study, Tiffany Cowan returned to the Masonic Memorial Building to be hooked up to the brainstimulation machine for a second and final time.

First, though, she asked if she could have a moment to talk with Gillick.

“She literally sat me down,” recalls Gillick, “and said, ‘Ok. you’re going to have another study, right? And you’re going to be actually treating people in that study, right? I want to participate in that study, so sign me up.’”

That conversation underlines the importance of the Brain Plasticity Laboratory’s research, says Gillick — and the great need for more effective treatments for people who have experienced a stroke or other brain injury.

“Tiffany returned for her follow-up excited about the next phase of the study,” Gillick says. “I’m excited, too.”

Web extras

Video: Brain Plasticity Lab

Learn more about brain stimulation and hand training.

Slideshow: In the lab

See a slideshow of Bernadette Gillick, P.T., Ph.D., and research study participant Tiffany Cowan in the lab.

Companion story: Easing the symptoms of focal dystonia

Guitarist Dean Harrington participates in U of M brain-stimulation studies targeting focal dystonia. Read more.

Star Tribune: New stroke therapy shows promise on kids

Using non-invasive electronic stimulation, coupled with occupational therapy, researchers say they are hoping kids can increase hand function. Read more at the Star Tribune.

Learn more

If you are interested in learning more about Dr. Gillick’s research studies, please contact study coordinator at 612-626-6415 or brown029@umn.edu.

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Help the University of Minnesota save lives, inspire hope, and prepare the world’s future health care leaders. Make a gift today.

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Urban engagement

2013-04-29T19:54:57Z

MetroPAP immerses students in inner-city medicine, where relationship-building is lesson No. 1

By Susan Maas

Brian Park, a third-year medical student at the time, had seen the patient, a morbidly obese woman with COPD and recurrent pneumonia, for three months. But he didn’t have the context he needed to understand her health struggles — until he saw her home, a very small house where she lived with at least three generations of her family, as well as several friends who tended to come and go.

“There’s something really intimate about inviting someone into your home. We looked in her fridge, and it became clear why her BMI was so high,” says Park. “Why does she keep coming in? Why isn’t she taking all of her medications? That kind of learning doesn’t really come in one week or two weeks or four weeks,” he says.

Park’s participation in MetroPAP, an innovative University of Minnesota program that trains medical students to work in urban, medically underserved communities for nine months, allowed him to get to know his patient well, gain her trust, and discover the insights he needed to understand her health challenges.

MetroPAP — short for Metropolitan Physician Associate Program — is now in its third year and is the only program of its kind in the nation.

Proven approach, new setting

The program was inspired by the U’s internationally renowned Rural Physician Associate Program (RPAP). Launched in 1971, RPAP places third-year medical students in rural communities for nine-month rotations. So far, it has helped train more than 1,300 aspiring physicians to practice primary care in rural areas.

But Kathleen Brooks, M.D., M.B.A., M.P.A., director of RPAP, was concerned by the dearth of primary care doctors in urban communities, too.

“We thought, ‘wouldn’t it be interesting to take this educational model and apply it to urban underserved settings?’” says Brooks. “What would that look like?” So in 2008, then-Medical School dean Deborah Powell, M.D., challenged her to design a pilot program to find out.

Brooks — along with MetroPAP cofounders Michael Wootten, M.D., and Shailendra Prasad, M.D., M.P.H. — sought ideas from other institutions around the world.

Finding nothing like what they had in mind, they followed the RPAP model to create MetroPAP, starting small, with just two participants each year (next year it will have three, compared with 40 for RPAP). The two programs have the same core requirements for clerkships and the same basic requirements in terms of final exams, explains Brooks, who now directs both MetroPAP and RPAP.

As with RPAP, interested students apply to MetroPAP in the winter of their second year of medical school. “It tends to be students who really have a passion for underserved medicine and students who are really interested in primary care,” Brooks says.

Current MetroPAP student Vanessa Ozomaro says she’s thrilled — and undaunted — by the chance to help shape a one-of-a-kind work in progress. This winter she participated in a new six-week psychiatry rotation that joins surgery, emergency medicine, family medicine, and a two-part elective at Broadway Family Medicine Clinic in North Minneapolis and north Memorial Medical Center in nearby Robbinsdale.

A rich way to learn

MetroPAP students genuinely want to get to know their patients and mentors. “Students see it as an educational opportunity to have continuity with patients and preceptors and the health care team over nine months,” says Brooks. “I think it’s appealing, just intuitively, as a rich way to learn clinical medicine.”

While RPAP often tends to attract students from rural areas, MetroPAP has drawn students from both urban and suburban areas. Park, for example, is from the northern Twin Cities suburb of Shoreview. Ozomaro, the daughter of a nurse who is a Nigerian immigrant, grew up in St. Paul and says her urban high school had “a very diverse” environment.

“A lot of my friends had immigrant backgrounds, east African or Hmong, and we often had conversations about their experiences with the health care system,” Ozomaro says. That upbringing convinced her that it’s important for patients to be comfortable with and able to communicate with their physicians.

“I never had an African, or an African American, physician see me. I always felt like there were a lot of people who didn’t look like me, in medical [settings] and in the sciences generally.”

MetroPAP students share a deep commitment to social justice and to developing the humanistic side of medicine, says Prasad, assistant professor of family medicine. “RPAP has shown us a different way. In medical school, you get to a point where you start looking at things in a very reductionist way: You look at the heart. You look at the lungs. Here, the focus is on the context of the patient and the family and the community — the big picture.”

There’s also ample opportunity to develop procedural skills. “Objectively, in terms of clinical competency, this program is great, too,” says Park, who is taking a break from medical school to earn his master’s degree in public health. “I was able to do a lot more procedures — knee injections, circumcisions, things that come with a bit of liability. They treat you more like an intern.”

That’s by design, Prasad says. “You are treated like part of the family.

“[MetroPAP] students participate in our research meetings. We call it the percolator; they come and sit with us in the percolator and bring their ideas. And they’re part of our noncurricular activities, too — going to a baseball game, being part of our book club. We don’t force them to. It’s just natural.”

MetroPAP’s future is now

MetroPAP is built around mentorship, adds Prasad. The eager support of faculty preceptors and residents is essential. “When you look at why medical students choose disciplines, one common predictor usually is strong mentorship, strong role models. we tend to shape ourselves after folks we admire.”

Park, for one, plans to keep the trend going. “Developing strong relationships with mentors in MetroPAP gives me a framework for how I want to be a mentor to future [physicians],” he says.

“Any idea I had, they told me to run with it. I want to be involved in medical education and to help shape what it looks like.”

For now, say Brooks and Prasad, among the biggest challenges facing MetroPAP is figuring out how to expand it and make it replicable for other institutions.

“Is this an educational model we can expand, and if so, to what degree?” Brooks asks. The program’s capacity was initially limited both by design (“It’s easier to course-correct if you only have a couple of students,” she says) and by the availability of community sites. The faculty is working with the Central Avenue Neighborhood Health Source Consortium to find more participating clinics.

The time is right for MetroPAP, says Prasad: “I feel a synergy there.”

Participating faculty and students say MetroPAP reflects, as Brooks puts it, “a changing overall perspective on medical education.”

“We’re slowly doing away with the thinking that empirical knowledge is paramount to everything else,” says Park. “Scientific competency is just one tool in the toolbox. It’s about a bigger process: How do I go about building relationships in my community?”

Gradually, attentively, one patient at a time.

Susan Maas is a freelance writer who lives in Minneapolis.

To make a gift to support medical education at the University of Minnesota, visit www.give.umn.edu/giveto/meded.

Web extras

Video

Learn more about Vanessa Ozomaro’s community health project.

Community impact

A crucial component of MetroPAP is the chance to do a community health assessment, a project built around identifying and solving a problem or meeting a need in the community the student is serving. It’s not merely an academic exercise, says Shailendra Prasad, M.D., M.P.H., program cofounder and assistant professor of family medicine and community health. Students are expected to look, listen, and work with the community to make meaningful change.

Prasad points to one project that led to a lasting connection between Broadway Family Medicine Clinic in North Minneapolis and The Bridge for Youth, a resource and advocacy organization serving homeless teens.

MetroPAP student Vanessa Ozomaro lights up when she describes her idea: She’s meeting with representatives of local anti-human-trafficking organizations to connect women in prostitution, and those trying to transition out of it, with accessible health care.

“I want to identify barriers to their receiving health care, reasons why they may come to the clinic, and the type of interactions they may have had with physicians in the past,” Ozomaro says. “I want to really find out what their needs are.”

Watch a video of Vanessa and learn more about her community health project.

Building bonds

MetroPAP brings medical students and patients together in a way that traditional rotations can’t, says Ben Pederson, one of two students who blazed the MetroPAP trail in its inaugural year, 2010-11.

He tells this story to prove his point:

“I met this 60-year-old woman who would come in for stress reduction and body work; she’d been coming to Broadway [Family Medicine Clinic in North Minneapolis] for many years. I saw her at a couple different sessions, and we really got along.

“Well, she found a breast lump. I was able to go to that [diagnostic] visit and, later, to go when she was referred to the breast cancer clinic at North Memorial. She had a tumor that needed to be operated on. It’s a devastating diagnosis for anyone, but she had a very limited support network. I was able to be there with her. Every pre-op visit she had, I was there. We were able to talk about her diagnosis, talk about these complex decisions.”

When the time came for her operation, “I scrubbed in on her surgery. I was first assist, and I was able to see her in the hospital after. I think it really meant a lot to her, and it certainly meant a lot to me,” Pederson says. “I saw her for a few followup appointments after her surgery, and she’s doing well.

“People with cancer really struggle to find continuity with their providers. That’s a big part of what a good family physician can do: help patients feel comfortable and at home. It was a fantastic experience for me.”

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Help the University of Minnesota save lives, inspire hope, and prepare the world’s future health care leaders. Make a gift today.

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Big-time interest in nanomedicine

2013-04-29T19:53:19Z

U of M researchers are tapping tiny particles’ huge potential in a new realm

By Miranda Taylor

At the University of Minnesota’s new AeroCore Center, researchers are thinking big by exploring the potential of particles one-billionth of a meter in size. The center has brought together researchers from the College of Pharmacy, Masonic Cancer Center, College of Science and Engineering, and Medical School to develop a new way to eradicate lung cancer cells: inhalation of nanoparticles.

The initiative is one of many University-wide and nationwide projects advancing nanotechnology — the science of manipulating materials on an atomic or molecular scale. Broadly speaking, it’s showing up in medicine, energy, information systems, including sensors, and even in everyday products such as paints, sunscreens, and self-cleaning glass.

“The movement to put nano into medicine is a growing one,” says Stephen Campbell, Ph.D., electrical and computer engineering professor and director of the University’s Nanofabrication Center, which helps the University and companies across the country develop nanotechnology-based products.

Increasingly, he says, nanoscale drugs and devices are being used to detect and treat medical conditions. And, as the lung cancer study suggests, these tiny particles have huge potential.

Nanomedicine and cancer

According to the Centers for Disease Control and Prevention, lung cancer is the leading cause of cancer-related death among both men and women, accounting for 28 percent of all U.S. cancer deaths expected this year.

At the AeroCore Inhalation Testing Research Facility, University researchers are combining nanoparticles with hyperthermia, the process of raising heat levels to a point that threatens cell survival, to kill cancerous cells that have formed in the lungs. By heating iron oxide nanoparticles to temperatures higher than 98.6 degrees Fahrenheit, they have been able to kill cancer cells in preliminary mouse-model trials.

To get the nanoparticles into the lungs, the researchers developed an aerosol inhalant that, with just a few deep breaths from the patient, carries iron oxide nanoparticles to diseased sites in the lungs.

Then, in a motion resembling a magician’s trick, the wave of a magnet outside the body, over the area where a tumor has formed, causes the iron oxide particles to become agitated — and hot enough to kill many of the cancerous cells around them.

From there, cells in the body called macrophages remove the dead cancer cells and iron oxide particles. Over time, any remaining particles are converted into iron salts that the body can absorb or clear.

The next step in the research is to improve the technique to the point where it can completely clear a site of cancer, says the project’s leader, Jayanth Panyam, Ph.D., codirector of the Department of Defense-funded AeroCore Center.

“We have not yet successfully eliminated 100 percent of the cancerous cells in an area,” says Panyam, who is also an associate professor in the College of Pharmacy and a member of the Masonic Cancer Center, University of Minnesota. “Without all of the cancer cells gone, the cancer will continue to come back. but what we have now does serve to help eliminate a significant portion of the cancer.”

And that’s big progress.

A growing field

Nationally, nearly 250 nanomedicine products are being used or tested in humans, according to a study published in the January 2013 issue of Nanomedicine: Nanotechnology, Biology, and Medicine.

But the field is still in an early stage, says the study’s lead author, Michael Etheridge, a Ph.D. candidate in mechanical engineering in the University’s Institute for Engineering in Medicine. So far, the identified applications “are only scratching the surface of the potential available,” he told the Huffington Post in February.

“Nanomedicine products have exciting potential in so many different applications, ranging from cancer treatment or diagnosis, imaging, infectious diseases, immunologic diseases, or possibly facilitating transplantation,” says the study’s senior author, Jeffrey McCullough, M.D., a professor of laboratory medicine and pathology in the University’s Medical School and a former director of the Institute for Engineering in Medicine. “There is no question that nanomedicine products will be important in medical advances over the next decade.”

Collaboration is key

Collaboration within and beyond the University’s walls has proven essential for nanotechnology research and development. Experts from such wide-ranging fields as biomedical engineering, pharmaceuticals, head and neck surgery, and veterinary medicine are connecting over nanotechnology’s potential.

That means a person who wants to understand how to fix a problem has to find someone who has the technology to help.

“The developers behind nanotechnology don’t always understand how their discovery can be applied elsewhere,” says the Nanofabrication Center’s Campbell. “That’s not to mention the challenges of finding someone who may be interested but works for another institution or speaks another language.”

To help connect the right people, the University supports a variety of interdisciplinary workshops, conferences, and centers. A joint program of the Institute on the Environment and Medical Devices Center, for example, provides start-up funding, resources, and a network for nanotechnology projects that cross collegiate boundaries.

Increasingly, researchers are coming together with the understanding that it’s the small stuff that matters.

Miranda Taylor is a communications associate with the University’s Academic Health Center.

To learn more about nanotechnology at the University of Minnesota, visit www.nano.umn.edu.

Exploring what nano can do

University of Minnesota researchers from multiple disciplines are discovering what nanomedicine can do. Here are a few examples:

Shai Ashkenazi, Ph.D., assistant professor of biomedical engineering
Developing less invasive imaging probes including a thin, flexible ultrasound device to provide a clearer picture inside the body
Allison Hubel, Ph.D., associate professor of mechanical engineering and Masonic Cancer Center member
Creating synthetic corneal tissue that mimics natural tissue
William Kennedy, M.D., professor of neurology
Quantifying cognitive function via nanotech-enabled sensors
Jayanth Panyam, Ph.D., associate professor of pharmaceutics and Masonic Cancer Center member
Investigating effectiveness of nanoparticles in destroying lung cancer cells
Amy Skubitz, Ph.D., professor of laboratory medicine and pathology and Masonic Cancer Center member
Seeking to detect ovarian cancer earlier and identify recurrences
T. Andrew Taton, Ph.D., associate professor of chemistry and Masonic Cancer Center member
Creating a cancer vaccine using proteincoated nanoparticles

You can make a difference

Help the University of Minnesota save lives, inspire hope, and prepare the world’s future health care leaders. Make a gift today.

Because with your support, anything is possible.

Where stress, diabetes, and culture converge

2013-04-29T19:52:10Z

A UMD study explores the link between stress and high diabetes rates among Native Americans of the Midwest

By Gene Rebeck

Sociologist Melissa Walls, Ph.D., wants to make something clear: She’s not the story behind the $2.8 million National Institutes of Health research grant that she, a Medical School, Duluth colleague, and two other researchers were awarded last fall.

The story, as she sees it, is about adults her team will be working with to examine the ties between stress and type 2 diabetes among Native Americans — the population with the highest diabetes rate in the world.

“I consider them co-investigators,” says Walls, who is leading the five-year study. “They are equal partners.”

Walls, who studies the social aspects of disease among indigenous people, is Ojibwe herself, with many relatives on the Bois Forte reservation on Lake Vermilion in northern Minnesota. Bois Forte is one of the five Midwestern indigenous communities participating in the study. (Walls shares the names of participating communities only when they ask to be named publicly.)

The longitudinal study will follow a cohort of 250 people for four years, periodically monitoring their self-reported stress levels and measuring their blood sugar and cortisol levels. Chronically elevated levels of cortisol, a stress hormone, can increase blood sugar and inhibit the effects of insulin, leading to or compounding diabetes.

Improving Native Americans’ health

Walls, a University of Minnesota, Duluth graduate, earned a Ph.D. in sociology at the University of Nebraska, Lincoln. She returned to Duluth in 2007 as an assistant professor in the sociology department, where she earned grants for studying American Indian health. The work connected her with research partners in the Medical School, and she joined its faculty in 2011. “It was a natural fit,” Walls notes, given that improving Native American health is among the school’s priorities.

Collaborating with Walls on the current study are professor Mustafa al’Absi, Ph.D., director of the Duluth Medical Research Institute at UMD and an expert on the biological and physiological mechanisms of stress; sociologist Les Whitbeck, Ph.D., Walls’s mentor at Nebraska; and Kelley Sittner Hartshorn, Ph.D., from Oklahoma State University.

The project grew out of a diabetes study called mino giizhigad (“good day” in Ojibwe). On that study, Walls worked with Doris Isham, a diabetes nurse at Bois Forte. Isham told her that although her patients conscientiously took their medications and gave themselves shots, they were far less likely to exercise or eat healthier diets. It was almost as if they were giving up. “To me,” Walls says, “it sounded like depression or apathy.”

That insight led her to consider how stress affects type 2 diabetes in American Indian communities. Type 2 diabetes is the fourth-leading cause of death among indigenous Americans and a major contributor to cardiovascular disease, the No. 1 killer in this population. American Indians and Alaska Natives are more than twice as likely as other Americans to have diabetes.

While many studies have looked at type 2 diabetes among U.S. indigenous people, little has been written about the connection between diabetes and stress. “We know that stress and diabetes are related — [stress] impacts your ability to control diabetes, your health behaviors,” says Walls, who wants to learn more about how stress affects treatment compliance and disease progression.

Dealing with stress—past and present

Her goal is to develop treatment protocols for indigenous people that take into account their culture and history. This population copes with a disproportionate number of stressors, says Walls, naming several: economic disadvantage, unemployment, community violence, discrimination, and the long-term effects of historical traumas.

Walls is particularly interested in the last one — how catastrophic experiences in a group’s past affect its current members’ emotional and physical health. For indigenous people, she says, particularly those who live on reservations, historical trauma is bound up with cultural loss. What happened in the past, she argues, is related to contemporary stressors.

Her mentor, Whitbeck, codeveloped a “historical-loss scale” based on such questions as how often participants think about loss of land, language, tradition, and other aspects of their culture. “In some cases, 25 percent of our sample was thinking of these certain losses more than daily,” says Walls, describing a previous study she and Whitbeck conducted.

To get a true sense of the stressors indigenous people struggle with requires a deep engagement with them and their way of life, says Walls. In the current study, she and her team will be working with research councils in each community. The councils, which will include at least one member with type 2 diabetes, a tribal elder, and a service provider working with type 2 patients, will help develop questionnaires, recruit participants, and collect data. This inclusive approach, Walls says, “acknowledges the community as an equal partner in the research process.”

Bois Forte elder and community leader Stan Day has worked with Walls in the past and will serve on the community research council. “It’s a special thing for me to work for my people in any capacity that I can,” says Day. “I also have diabetes. It’s a double concern.” like Walls, he believes that the loss of land and culture is still affecting his people. “It’s something we have to heal from,” he says.

Walls hopes her team’s results aid that healing. “This is a basic research grant, but our long-term goal is always translating that basic research into something that’s actually usable and tangible. every little bit we do brings awareness.”

By Gene Rebeck, a freelance writer based in Duluth.

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Easing the symptoms of focal dystonia

2013-04-29T19:51:53Z

Twenty years ago, while studying classical guitar at the University of Minnesota, Dean Harrington lost the fine motor control in the “plucking” fingers of his right hand. Soon he also found that he could no longer type efficiently on a computer and that his right forefinger would spontaneously click the mouse at inappropriate times.

He had developed focal dystonia, a neurological movement disorder that causes muscles to involuntarily contract and twist into unnatural positions. It typically affects a single group of muscles, usually those that a person repeatedly uses for a specific purpose—the muscles, for example, in a pianist’s hand, a trumpeter’s lips, a golfer’s forearm, a surgeon’s wrist, or a football placekicker’s leg. Many people in a variety of professions, including well-known musicians, athletes, writers, and illustrators, have been forced to forsake their careers after developing the condition.

Harrington found the computer problem was annoying, but easy to fix: He resorted to one-finger typing. But the effect of the focal dystonia on his guitar playing was devastating. Harrington had to give up classical guitar. Fortunately, he could still play with a flat pick, a technique that uses a different set of muscles. He switched to performing jazz.

In the ensuing years, Harrington tried all sorts of treatments for his hand dystonia, including acupuncture and various behavioral and massage therapies. Nothing worked. Harrington has enjoyed a full and busy career as a jazz musician (he performs with the popular gypsy jazz band Mill City Hot Club—see video above right), but he never completely gave up on returning to classical guitar. So when he heard about the focal dystonia research being conducted at the University of Minnesota’s Brain Plasticity Laboratory, he volunteered. So far, he has participated in three of the lab’s brain-stimulation studies, including one last year that involved a combination of repetitive transcranial magnetic stimulation (rTMS) and physical therapy.

Neuroplasticity ‘gone bad’

The aim of the lab’s focal dystonia research is to alter brain-cell excitability in a way that helps the brain “rewire” itself to regain lost function. “Focal dystonia is thought to be the result of neuroplasticity gone bad,” explains Teresa Kimberley, P.T., Ph.D., codirector of the Brain Plasticity Laboratory. “People who develop focal dystonia seem to have lost the inhibitory mechanisms in their brain that come in and stop the neuroplastic response.”

Individuals with focal dystonia “literally wake up one morning to discover that their muscles are doing weird things,” she says. And the problem is usually very task-specific. An illustrator may discover, for example, that the muscles in his drawing hand no longer let him hold a pencil. But he can do just about anything else with the fingers of that hand— button a shirt, for example, or eat with chopsticks.

“There’s nothing really wrong with their muscular-skeletal system,” explains Kimberley. “Their muscle biopsies are normal. Their nerve conduction velocities are normal. Their strength is normal. Their range of motion is normal.”

For that reason, focal dystonia is often mistakenly diagnosed as a psychological disorder. “Many people have dreadful stories of being told that they were just crazy,” says Kimberley. “Others were told they had Parkinson’s disease or [multiple sclerosis] or even carpal tunnel syndrome, and then they would have surgery, which would make it worse. Often it takes years to get a correct diagnosis.”

Focal dystonia may be “all in the head,” but not in a psychological way. Brain imaging has shown that the condition arises from faulty, over-excited neural connections in the sensorimotor area of the cerebral cortex, the thin layer of neurons that cover the cerebrum. Because of those over-excited neurons, the brain tells the wrong muscles to contract.

Enhancing therapy

Current treatments for focal dystonia include botulinum toxin (Botox) injections and sensorimotor retraining therapy, a somewhat tedious process in which the brain is retrained to pick up the correct sensory cues from the affected muscles. But neither is a cure, and many people with the condition who undergo these treatments fail to see their symptoms improve.

At the Brain Plasticity Laboratory, Kimberley and her colleagues are exploring a promising new avenue of treatment. In experimental studies, they have found that priming the affected cells in the brain with rTMS can inhibit their excitability, making the brain more receptive to retraining.

“rTMS alone is not going to be a magic bullet that somehow miraculously changes people,” says Kimberley. “But it could be that the technology could be harnessed as an adjunct, enhancing the rehabilitation.”

Subtle improvement

Harrington knew the Brain Plasticity Laboratory’s studies were in their earliest stages and that there was no guarantee that they would have any impact on his focal dystonia. Still, he’s noticed some subtle changes in his symptoms, particularly since his participation in the latest study last summer.

“My typing has improved,” he says. “It’s not fast, but I’m not typing any more with one finger.”

He has even returned, if only tentatively, to playing classical guitar. “I’m approaching it like a beginner,” he stresses. “I’m going in really, really slow.” It’s too soon, he says, to know if he will be able to perform that style of guitar with any regularity. But for the first time in 20 years, he feels hopeful.

By Susan Perry

Web extra

Video:
Dean Harrington’s Mill City Hot Club

View a video of Dean Harrington playing with his band.

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Students without borders

2013-04-29T19:50:50Z

The University’s Global Future Physician seminar takes premed students across the world to reflect on the state of health and health care today

At the University of Minnesota, a select group of students is swapping textbooks for English-Kannada dictionaries and boning up on Udupi cuisine for a premed course called the Global Future Physician (GFP), which plays out not in the classroom but amid the cacophony of Mysore, India, and across the tribal lands of the Indian state of Karnataka.

The goal of the course seems straightforward — expose students to the inner workings of a medical system in a vastly different land — but there’s a deeper challenge for the students selected to make the trip.

“We want each student to grow in personal awareness,” says Tricia Todd, M.P.H., assistant director of the University’s Health Careers Center and cofounder of the GFP seminar. “If you come back from India and haven’t learned anything about yourself, you’ve missed the point.”

The setting for the seminar is the Vivekananda Institute of Indian Studies, an outgrowth of the Swami Vivekananda Youth Movement (SYVM) that was started almost 30 years ago by a group of medical students from the Mysore Medical College. Those students, committed to the idea of “building a new civil society in India,” grew SVYM from a volunteer team that handed out medicine samples to the poor and opened tribal schools for kids in old cow sheds, to a thriving organization that today includes hospitals, clinics, schools, and more.

The backstory

The three-week seminar in India is the culmination of the Future Physician Series, classes designed to help University undergraduate or postbaccalaureate students decide whether medicine might be the career for them.

Rita Chakrabarti was among the still unsure. “I thought I wanted to go to medical school,” says Chakrabarti, a postbaccalaureate student at the University, “But I wasn’t quite convinced, so I enrolled in the Future Physician classes. Fantastic experience! Those classes helped me make the decision that medical school is something I really want.”

Future Physician students hear from practicing doctors, discuss topics such as medical ethics and primary versus specialized care, and spend time volunteering in a medical setting. Only 25 students are chosen to take the global seminar each year.

Destination: Mysore

Shailendra Prasad, M.D., M.P.H., was among the medical students who helped found SVYM in the early ’80s. Today, he is an assistant professor of Family Medicine and Community Health at the University of Minnesota — and, ultimately, the link that helped pull the pieces of Global Future Physician together.

“We wanted to give future M.D.s exposure to the social determinants of health — things like gender, socioeconomic status, education — and explore how they affect medical delivery,” says Prasad. “It’s easier to get that perspective in India because things are more stark.”

Prasad’s close connections with SVYM smoothed the way for an inaugural GFP trip to India, in January 2012.

“When we got to Mysore, they took us straight to the market in the city center,” recalls David Droullard, who was a University senior when he was chosen to participate in that first GFP trip. “It was chaotic, overwhelming — and a cunning choice by the trip leaders. The market is almost a microcosm of the diversity of India, and it really set the stage for our three weeks of learning,” says Droullard, who is now a first-year medical student at Columbia University.

And learn they did. Lectures from medical doctors and educators, visits to rural clinics and schools, and daily debriefing sessions with the faculty leaders filled each day.

“We were seeing not just the ‘what,’” explains Droullard, “but the ‘why’ behind it. In some ways, I learned more in my three weeks in India than I did in my entire junior year abroad.”

Watch, listen, learn

The entire faculty team — Todd and Prasad, who developed the program and led last year’s trip, and this year’s faculty leaders, Laura Wellington, M.D., and Keri Bergeson, M.D. — share one very clear notion: Untrained students should not go abroad to work in medical clinics.

“Other mission trips often target premed students,” says Todd, “offering them the chance to get hands-on experience in a foreign clinic. But this is an ethical issue: you shouldn’t practice medicine, anywhere, without a license.”

Wellington, a faculty physician at North Memorial Medical Center, agrees that, instead of “doing” when they’re not ready, students are better off examining global medicine issues.

“What is our role, as Westerners, as health care workers in a global community?” she asks. “What can we bring to share with their communities? What can we learn and bring back to our own communities? These are questions that are so important for anyone thinking about studying medicine to ponder.”

Returning to Minnesota at the end of January after this year’s trip, Chakrabarti was reeling from her whirlwind experience.

“My big takeaway,” she says, “was becoming aware of the social determinants of health and how they affect every single patient you will ever see as a doctor.”

By Barbara Knox, a Minneapolis-based writer and editor and frequent contributor to the Medical Bulletin.

Web extra

Slideshow: Students without borders

U premed students travel to India to study social factors affecting medical care delivery. See the slideshow.

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Help the University of Minnesota save lives, inspire hope, and prepare the world’s future health care leaders. Make a gift today.

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Alumni Spotlight | Christopher Wenner, M.D.

2013-04-29T19:49:25Z

A new-generation country doctor

Family physician Christopher Wenner, M.D., is also his own nurse, receptionist, accountant, and janitor. And that’s how he likes it.

Three years ago, the 1999 Medical School alumnus got fed up with the constant hurry he faced in his job with a large practice group and decided to become a solo practitioner in Cold Spring, Minn., his hometown.

“I see it as an avenue for me to practice medicine in a fashion that I feel is most fitting with family medicine — spending time with my patients, getting to know them as individuals,” Wenner says.

In his no-frills solo practice today, seeing just two patients per day covers his costs. He normally schedules 30-minute appointments, but it’s OK if they run long. He can do home visits when it’s more convenient for his patients. And, yes, he cleans his own exam rooms between appointments.

But the flexibility and autonomy that come with being his own boss are completely worth it, Wenner says.

“It’s being able to practice how I see fit, [doing] what’s best for my patients, what’s best for my practice, what’s best for myself,” he says. “When things need to get changed, it’s a committee of one.”

Making an old model new again

Wenner, who matriculated from the Medical School, Duluth campus, had always planned to go into family practice. “I really fell into that [Duluth] model and embraced it,” he says.

But as part of a group practice, he was pumping through appointments with 30 to 40 patients per day and felt like he didn’t have enough time to adequately address everyone’s concerns. So he decided to make a radical change and go out on his own.

Wenner admits that he faced a steep learning curve while he figured out how to run a medical business in the 2000s. In the 1950s, doctors could get by with a stack of 3-by-5-inch notecards as patient records, he says, but today with mandatory electronic medical records, “it’s exceedingly complex.”

The first six months were rough. He didn’t take a salary. He’d see one person one day and no one the next. At times he wondered whether his decision to go solo was a good one.

“Going from a regular paycheck to nothing — it’s quite an abrupt realization,” he says. “But I knew that I had a good model, and I knew that I was lean.”

Back on track

Three years later, Wenner feels like he’s on stable ground. In November he moved his office from a rented space in a strip mall to a renovated bank building on Main Street that he and his wife, Jennifer, own. He sees about 10 patients per day.

And now he employs an office assistant to help him with scheduling and billing, though Wenner still does technical work like blood draws himself. He says that’s often a good thing.

“Right now I find that it’s a nice way to end the visit — with some small talk,” he says. “The more time I’m able to spend with my patient, the better the visit is.”

Wenner finds that he’s spending more time with his family, too. His office is just three blocks from his home, and he gets home for dinner with his wife and three young children almost every night.

Wenner says it’s a privilege to be back in his hometown, practicing medicine the way he thinks it should be done. Sometimes that means being able to say, “There’s no charge for today’s visit,” or blocking off an afternoon to spend time with a patient in hospice, he says.

“Those are the things that keep me energized and very happy doing what I’m doing.”

By Nicole Endres, managing editor of the Medical Bulletin.

Web extras

Slideshow: A new-generation country doctor

Glimpse a day in the life of solo practitioner and Medical School alumnus Christopher Wenner, M.D.

A real family practice

At Wenner family gatherings, there’s no shortage of medical opinions.

Family physician Christopher Wenner, M.D., Medical School Class of 1999, is the oldest of four children. his sister Michelle Chestovich, M.D., Medical School Class of 2001, is a family physician in St. Paul. Another sister, Rachel Wenner Ruzanic, M.D., Medical School Class of 2007, practices dermatology in St. Cloud (and is married to emergency physician Ted Ruzanic, M.D., Medical School Class of 2005). And his youngest sister, Gretchen Butler, will be pursuing a radiology residency at the University after graduating from Creighton University School of Medicine in May.

Their father, Joseph H. Wenner, D.D.S., graduated from the University’s School of Dentistry, and their mother, Mary Legatt Wenner, has a master’s degree from the School of Public Health.

Their grandfather, Waldemar T. Wenner, M.D., Medical School Class of 1925, was an ophthalmologist, and their uncle Waldemar H. Wenner, M.D., Medical School Class of 1958, was a pediatrician.

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Scholarship Winner | Andrea Stember

2013-04-29T19:48:49Z

Scholarships allow a champion pole-vaulter to set a high bar in medical school, too

Andrea Stember knows how to seize an opportunity. When an ankle injury curtailed her budding career as a teenage gymnast, the Bemidji resident decided to take up pole-vaulting. Astonishingly, she managed to break the school record on her first try.

“It was not a lofty goal,” Stember jokes. “The record wasn’t all that impressive.” Still, her initial success spurred her to put some serious effort into the sport — practicing for hours, attending training camps — and she eventually won the state pole-vault championships three years in a row.

“I worked hard to get better at it,” she says. “If you set your mind to it, you can accomplish it.”

Hard work is important, but Stember, now a 27-year-old medical student at the University of Minnesota, also acknowledges the help she’s received from other people on life’s path. Her coach played a vital role in her success as a vaulter, and generous scholarship support has made her enrollment at the U and her medical studies possible.

Confronting challenges

Stember grew up in northern Minnesota, in a family of five that grappled with medical issues almost daily. Her oldest brother was born with a host of complex health problems, including serious immune deficiencies and type 1 diabetes. When the family wasn’t hunting, canoeing, gathering wild rice, tapping trees for maple syrup, or traveling to trapping conventions (where Stember participated in tomahawk-throwing competitions), they were often attending medical appointments. Stember remembers tagging along — her toy doctor’s case in hand — as they visited innumerable clinics and hospitals.

Those visits made an impression on Stember. “My brother’s doctors were sometimes annoyed if my mother had one too many questions or my father didn’t understand something that the doctor had said,” she recalls. “So I try to keep that in mind when I interact with people: When a doctor says something, it’s like a foreign language to someone who doesn’t know medicine. I need to … remind myself that my whole reason for being there is to care for the patient — and that may include caring for his or her family, too.”

New drug treatments, multiple surgeries, organ transplants, and a positive attitude have kept Stember’s brother alive over the years. But caring for him has been both an emotional and financial drain on the family. When Stember turned 17 and decided to pursue a college education, her parents — her father is a construction worker and her mother a paraprofessional for the Bemidji school district — could offer little financial help. Her summer job cleaning cabins didn’t pay enough to cover tuition, either.

Reaching new heights

To Stember’s surprise, pole-vaulting provided the answer: “Through a lot of blood, sweat, and tears, and many hours on the track, I was recruited out of high school,” Stember says. “Had it not been for the scholarships offered to me, I would have not even considered attending the U, and I would have missed out on an incredible undergraduate experience.” Ultimately, she received a full academic scholarship that supported her as a sophomore, junior, and senior.

In 2008, Stember completed her undergraduate degree, majoring in biology, society, and the environment. She planned to go on to medical school, but again required financial assistance. Now in her fourth year of medical school, Stember is grateful for the support of four different scholarships, including the 2012 Samuel J. Ravitch Scholarship.

“It definitely eases the burden and the stress,” she observes. “Financial stress doesn’t go away. The tests come and go, and you can cross those off the list, but the [expenses] continue to pile up.”

This summer, Stember will begin her emergency medicine residency at the Denver Health Medical Center.

But she’s already putting her technical knowledge and bedside manner into practice. last spring, her brother underwent a pancreas transplant, and Stember found her family turning to her for answers.

Being immersed in the situation as both a family member and a doctor-tobe reinforced the notion that practicing medicine requires empathy, as well as technical knowledge. “It reminded me that when a family is in a stressful situation, the things you say as a doctor don’t necessarily stick,” Stember says. “you have to take all that into account.”

By Joel Hoekstra, a Minneapolis-based writer and editor

Web extras

Slideshow: Scholarship recipient reaches new heights

Scholarship recipient and champion pole-vaulter Andrea Stember sets a high bar in Medical School. View a photo slideshow featuring Stember’s extracurricular activities.

Make a gift

To make a gift, visit
www.give.umn.edu/giveto/meded.

Continuing their legacy

Many Medical School alumni continue to have a lasting impact — even years and years after their deaths — by having created endowed scholarships for medical students.

Andrea Stember, for instance, has benefited from the Samuel J. Ravitch (Class of 1926) Scholarship, the B. A. Dyar (Class of 1905) and Robert Dyar (Class of 1934) Memorial Scholarship, and the Dr. Harry F. (Class of 1947) and Grace E. Burich Scholarship. (Stember also has received the David A. Dunshee Scholarship, established by the former medical student’s family in his memory.)

Gifts to endowed scholarship funds truly keep on giving. The principal gift amount is invested and continues to grow over time, while the interest it accrues is paid out annually as a scholarship to help defray the rising costs of medical school for an outstanding student.

To learn more about creating an endowed scholarship fund at the University of Minnesota Medical School, contact Teri McIntyre at 612-625-5976 or mcintyre@umn.edu.

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Help the University of Minnesota save lives, inspire hope, and prepare the world’s future health care leaders. Make a gift today.

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Ahead of the curve

2013-04-29T19:47:49Z

The Medical School celebrates 125 years of innovative education

The hopeful student wishing to join the first medical school class at the University of Minnesota in 1888 needed little more than a high school diploma to apply. There were no national standards for medical education at the time, and the requirements for admission and subsequent graduation were regularly debated and varied between institutions.

Much has changed for the University of Minnesota Medical School — founded in 1888 as the College of Medicine and Surgery — in its 125-year existence, particularly in education.

The school’s first students trained for three academic years of six months each, enjoying summers off, before becoming doctors. They were young and roguish, playing tricks on their professors by introducing a cadaver to a faculty meeting, crowdsurfing a fellow student during class, or rioting after an unpopular lecture. The growing presence of women (there were just two in the first class) is thought to have helped to tone down this rowdy behavior.

The College of Medicine and Surgery went on to set much higher admissions standards and become a national leader in medical education. In fact, by 1910 when the seminal Flexner Report was released, Minnesota was credited as being “perhaps the first state in the union that may fairly be considered to have solved the most perplexing problems with medical education and practice.”

Elliot Memorial Hospital, the first of Minnesota’s university hospitals, was built on campus the following year. The Medical School later partnered with Mayo Clinic in Rochester, Minn., to offer the first graduate-level program for physicians. In 1917 the program issued the first-ever graduate degree in a clinical specialty.

Realizing the value of mentorship and wanting to give adequate attention to each student, by 1922 the Medical School had successfully limited class sizes, ahead of many of its peers. In 1923 the school received twice as many applications as there were spaces, and that was considered selective. Interest in attending medical school has grown considerably since then: in 2012 the Medical School accepted only 5 percent of applicants to fill 230 spaces on its Twin Cities and Duluth campuses.

In its 125-year history, the Medical School has pioneered and advanced many areas of education and will continue to do so in the future. For example, it launched the nationally lauded Rural Physician Associate Program in 1971 and is now wrapping up the third year of a metro model. Also, the school will be involved in the Academic Health Center’s new Coordinating Center for Interprofessional Education and Collaborative Practice, a national initiative to find the best ways to prepare health professional students to work in today’s fast-changing health care environment.

Timeline

1888-1913 First 25 years

The University of Minnesota College of Medicine and Surgery, as it was originally named, is founded in 1888. The first graduating class of 23 students includes two women. The first black student, Walter B. Holmes, graduates in 1895. Medical education as a whole is just beginning to take shape in America. The College of Medicine and Surgery becomes the Medical School in 1913.

1913-1938 Second 25 years

With Mayo Clinic, the Medical School offers the first medical graduate school program in the nation. It awards the first-ever graduate degree for a clinical specialty on May 24, 1917. Class size is limited in the 1920s to better support student learning. Faculty members begin to approach learning and research with a distinct vision of interdisciplinary partnership. Owen Wangensteen, M.D., Ph.D., takes the reins of the Surgery Department in 1930 and encourages faculty to pursue bold new ideas.

1938-1963 Third 25 years

The University is home to huge leaps in surgical advancement, including the world’s first successful open-heart surgery in 1952. A successful kidney transplant is conducted at the University of Minnesota between twins in 1963. C. Walton Lillehei, M.D., Ph.D., and Earl Bakken (who later cofounded Medtronic, Inc.) make possible the world’s first portable, battery-operated cardiac pacemaker in 1957. K-rations, cortisone, the heart-lung machine, and the blood pump are invented.

1963-1988 Fourth 25 years

The world’s first successful bone marrow, pancreas, heart-lung, and simultaneous kidney-pancreas transplants are performed at the University of Minnesota. B. J. Kennedy, M.D., pioneers the field of medical oncology. The Medical School’s Duluth campus admits its first class in 1972. The University becomes the first in the world to use artificial blood in a patient. Microbiologist Russell Johnson, Ph.D., creates a vaccine for Lyme disease.

1988-2013 Fifth 25 years

With AT&T Bell labs, the University develops functional magnetic resonance imaging, which shows the brain in action. Karen Hsiao Ashe, M.D, Ph.D., develops the first genetically engineered mouse exhibiting Alzheimer’s disease symptoms. A University research team is the first to create a beating animal heart in the laboratory. Jakub Tolar, M.D., Ph.D., and John Wagner, M.D., are the first to use bone marrow transplantation to treat epidermolysis bullosa, a devastating skin disease, in children.

By Sarah Morean, the Medical School’s communication’s manager

Web extras

Medical School: Celebrating 125 years

Learn more about Medical School innovations at z.umn.edu/med125.

Medical School by the numbers

  
     
    1888
    2013
  

    Acceptance
rate
    50%(1923)
    5% 
  

    Graduating
class
    23
    225
  

    Women in
the class
    8%
    47%
  

    Months in
Medical School
    18
    40+
  

Connect

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In the big leagues

2013-04-29T19:46:40Z

His life has been bookmarked by the Minnesota Twins.

When Jon Hallberg, M.D., was born in 1965, the Twins made their first World series appearance. He was a senior in college and a fourth-year medical student, respectively, when they won the World series in 1987 and 1991.

It’s only fitting that Hallberg, a member of the Medical school Class of 1992 and now an assistant professor in the Department of Family Medicine and Community Health, today serves as the team’s club physician and its Employee Assistance Program provider.

That means he’s on call 24/7 for the nearly 200 players in the Twins organization — from the instructional league to the pros. He’s the only family physician in this role in all of Major League baseball.

“I’m an educator, a referral source, an ear,” Hallberg says.

Hallberg counsels players dealing with depression, anxiety, addiction, and other psychological conditions — like suddenly losing the ability to throw the ball from one base to another — “any and all psychosocial issues that come up that might affect their ability to play ball,” he says.

As part of his official duties with the team, Hallberg also joins the players at training camp in Fort Myers, Fla., for a week each March to give presentations on such topics as over-the-counter supplement use and proper documentation of “therapeutic use exemptions” for legit medications that might cause a positive drug test, he says. (Stimulants for treating attention deficit hyperactivity disorder fit into this category.)

This spring marked Hallberg’s 17th trip to training camp with the team. He stops by the Twins clubhouse once per home stand, too, to check in with the guys.

“It seems cheesy to say it, but the Twins have kind of become a family,” he says. “They treat people like family.”

And though he’s plenty busy as medical director of the Mill City Clinic and with his weekly medical segments on MPR, Hallberg says the little things about the game itself also have kept him involved with the team.

Hallberg appreciates the finely manicured fields, the generations of people who attend games together, the smells of the ballpark, and the game’s inseparable connection to radio. But what really appeals to him is the lack of a clock.

“Since I spend so much time as a physician ‘on the clock,’ seeing patients every 20 minutes or so, always running behind,” Hallberg says, “I find that the last thing I need is to be reminded of, while watching a game, how little time is left.”

Web extras

Slideshow: In the big leagues

Medical School alumnus Jon Hallberg, M.D., helps keep Minnesota Twins in tip-top shape at spring training—and beyond. Check out the Minnesota Twins’ spring training facility in Fort Myers, Fla.

Diagnose, stitch, fix for the home team

Family physician Jon Hallberg, M.D., is just one University of Minnesota Medical School alumnus keeping Minnesota Twins players in tip-top shape:

John A. Steubs, M.D., Medical School Class of 1979, directs medical services for the team.
Tom Jetzer, M.D., Medical School Class of 1974, is one of three internal medicine physicians with the Twins.
Another internal medicine doctor with the team, Vijay Eyunni, M.D., M.P.H., earned his public health degree at the University in 1988.

You can make a difference

Help the University of Minnesota save lives, inspire hope, and prepare the world’s future health care leaders. Make a gift today.

Because with your support, anything is possible.

University mourns loss of cancer pioneers

2013-04-29T19:45:52Z

John H. Kersey, M.D.

The Masonic Cancer Center, University of Minnesota lost one of its most prominent and influential physician-scientists March 10 with the sudden death of John Kersey, M.D. He was 74.

A native Minnesotan and graduate of the Medical School (Class of 1964), Kersey dedicated his life to developing new treatments for childhood cancer. He founded the University’s blood and marrow transplant program and what is now called the Masonic Cancer Center, which became a National Cancer Institute-designated Comprehensive Cancer Center under his watch in 1998.

Kersey also led the team that performed the world’s first successful bone marrow transplant for malignant lymphoma in 1975. That patient is alive and well today.

“John was the driving force that helped the University of Minnesota become internationally recognized for excellence in cancer treatment and research,” says Medical School Dean Aaron Friedman, M.D. “His enthusiasm for his work was contagious, and his passion for bringing people together to solve problems changed the way cancer research is conducted.”

Colleagues say that Kersey’s generosity as a friend and collaborator also set him apart.

“The world has been positively changed by John’s scientific, educational, and clinical contributions,” says Douglas Yee, M.D., who succeeded Kersey as director of the Masonic Cancer Center in 2007. “John provided mentorship and guidance to researchers around the world who will now carry on his legacy.”

Kersey is survived by his wife, Anne; 3 children; and 4 grandchildren.

To make a gift to the John H. Kersey Chair in Cancer Research in his memory, visit www.give.umn.edu/giveto/kerseychair.

John R. Ohlfest, Ph.D.

John Ohlfest, Ph.D., a University of Minnesota alumnus and pioneering researcher who dedicated his career to developing novel therapies for brain cancer, died of malignant melanoma on Jan. 21. He was 35.

Ohlfest, who earned his Ph.D. at the University in 2004, joined the faculty in 2005 and led the Neurosurgery Gene Therapy Program. The inaugural holder of the Hedberg Family/Children’s Cancer Research Fund Endowed Chair in Brain Tumor Research, he explored multiple strategies for tackling brain tumors. His focus was on creating customized vaccines that would stimulate a patient’s own immune cells to destroy the tumor stem cells responsible for tumor growth.

“Dr. Ohlfest was one of the true leaders in cancer research,” says Aaron Friedman, M.D., dean of the Medical School. “Everyone he came in contact with walked away invigorated about the possibilities of science.”

In recent years, Ohlfest’s work on brain tumors in dogs gained national prominence and helped pave the way for clinical trials in people.

“Brain tumors come back with extreme fury,” Ohlfest said in 2011. “Our work is never enough — not until this is cured.”

John Ohlfest is survived by his wife, Karen; 2 children; his parents; sister; and extended family. The Ohlfest Memorial Education Fund has been established in his honor through Wells Fargo for his children. To donate, visit any Wells Fargo branch and ask to make a contribution.

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Help the University of Minnesota save lives, inspire hope, and prepare the world’s future health care leaders. Make a gift today.

Because with your support, anything is possible.

Loan forgiveness offers primary care incentives

2013-04-29T19:44:50Z

Fourth-year medical student Sarah Ristvedt is from a rural community in western Minnesota, but from a young age, she knew she wouldn’t follow the family tradition of hog farming. Instead, she wanted to become a doctor and return home to practice.

She was quick to apply to the Rural Physician Associate Program (RPAP) while attending the University of Minnesota Medical School, Duluth campus. With RPAP, she participated in a nine-month clinical experience last year in a community of fewer than 2,500 people. It’s 25 miles from her hometown of Beardsley, and there’s nowhere she’d rather be.

“My attending physicians were mostly specialists and would ask why I was going into primary care, saying I should think about lifestyle,” says Ristvedt. “[I am] choosing a specialty that isn’t going to make as much money as others.”

But to her, rural Minnesota is where she feels most connected, and where she knows she can make a big difference. She plans to stick with her plan, even though she will graduate this year $200,000 in debt.

Repaying that debt won’t be easy on a rural, primary-care doctor’s salary, and that can dissuade others from choosing Ristvedt’s path. That’s why the University has included a $1.5 million legislative proposal for a student loan forgiveness program that would offer debt relief to health professional students who make a three-year commitment to practice in an underserved Minnesota community.

Such debt relief, agrees Ristvedt, could serve as a powerful recruitment tool, attracting new practitioners to an area they had not previously believed they could afford to serve.

Learn more

U.S. News & World Report ranked the University of Minnesota Medical School 5th in rural medicine, 7th, in primary care, and 10th in family medicine nationally. See the rankings.

You can make a difference

Help the University of Minnesota save lives, inspire hope, and prepare the world’s future health care leaders. Make a gift today.

Because with your support, anything is possible.

Couple creates their own loan-forgiveness fund

2013-04-29T19:43:25Z

Margaret Hustad-Perrin, M.D., is concerned about the increasingly specialized future of medicine.

“Fewer and fewer people are choosing to go into primary care,” says the recently retired pediatrician and 1976 Medical School alumna.

Some studies have indicated that medical students are being steered away from primary care fields such as family medicine, internal medicine, and pediatrics at least partly because they offer less earning potential than subspecialties. With the way the medical system is set up today, Hustad-Perrin says, “physicians tend to be better compensated for doing procedures than for spending more time with patients.”

So to encourage students who are passionate about primary care to stick with it, she and her husband, David Perrin, M.S.W., have set aside $1 million in their estate plan to create a loanforgiveness fund for those who plan to pursue primary-care pediatrics, primarycare internal medicine, family medicine, medicine-pediatrics, or psychiatry.

Whereas a traditional scholarship would provide the financial support regardless of changes in the recipients’ career paths, loans through this fund will be forgiven at a prorated amount — about 20 percent for each of five years — as the recipients continue their careers in primary care.

“To the small degree we can make it possible,” Perrin says, “we want to make sure that money does not sway the decision.”

You can make a difference

Help the University of Minnesota save lives, inspire hope, and prepare the world’s future health care leaders. Make a gift today.

Because with your support, anything is possible.

The MNDrive to excellence

2013-04-29T19:42:25Z

Parkinson’s. Alzheimer’s. Schizophrenia. Stroke. Depression. These and a host of other debilitating neurological diseases afflict one in five Americans, at a staggering economic and social cost. But University of Minnesota neuroscientists expect to reduce that burden with advances in neuromodulation — treatments, such as deep brain stimulation, that change the activity of brain circuits.

Both the University and the state’s medical devices industry are leaders in this booming field — with Minnesota companies generating $2.2 billion in neuromodulationrelated revenue in 2011. And the state will continue to lead the way if an ambitious University initiative is approved by the legislature. The initiative, called MNDrive (Minnesota Discovery, Research, and Innovation economy), asks the state to invest $18 million in neuromodulation and three other key industries: food security, robotics, and bioremediation — the use of microorganisms to clean up hazardous wastes.

The aim: advance Minnesota’s economy, position the state as a leader in highgrowth industries, and improve Minnesotans’ quality of life.

Read more at z.umn.edu/cod.

You can make a difference

Help the University of Minnesota save lives, inspire hope, and prepare the world’s future health care leaders. Make a gift today.

Because with your support, anything is possible.

MERC cuts threaten medical training

2013-04-29T19:41:50Z

Minnesota hospitals and clinics may be forced to scale back their training programs because of 2011 state legislation that severely reduces funding to Medical education and research Costs (MERC). The cuts adversely affect University of Minnesota Medical School students and residents, partner hospitals, and, ultimately, access to health care in Minnesota.

The state program compensates hospitals, clinics, and other health care providers for a portion of the costs of clinical training for health professional students and residents.

Now, budget cuts threaten to dismantle MERC and the education it funds. Facing a budget deficit in 2011, the legislature cut MERCfunding for hospitals and clinics by more than 50 percent to $31.5 million, and eliminated direct payments ($5.35 million in 2010) to the University and University of Minnesota Medical Center, Fairview.

These cuts will have real consequences. Partner hospitals have told the University that they will soon have to reduce the number of students and residents they train. Meanwhile, Minnesota is facing a health professional shortage as the need for care grows with our aging population. Nationwide, we will need nearly 63,000 more physicians in 2015 and twice that in 2025—making recruiting from elsewhere difficult and costly.

Students and health care providers are not the only ones affected; families across the state depend on access to quality health care, and access to quality health care is critical to job and business growth in our communities.

The Minnesota legislature is now in session. The University, along with its partner hospitals, is urging the legislature to adopt Gov. Mark Dayton’s recommendation to restore MERC to 2011 funding levels.

In addition, the University is requesting that its direct appropriation, used to fund training at community health and dental clinics in the Twin Cities, Willmar, and Hibbing, also be restored.

You can help. Please contact your legislators and urge them to restore MERC funding. A strong Minnesota depends on healthy communities, which, in turn, depend on well-trained health care providers. About two-thirds of doctors who train in Minnesota stay and practice here.

Contact your legislators

Contact the HOUSE.

Contact the SENATE.

You can make a difference

Help the University of Minnesota save lives, inspire hope, and prepare the world’s future health care leaders. Make a gift today.

Because with your support, anything is possible.

After anticipation, relief!

2013-04-29T19:40:54Z

A sense of anticipation filled the McNamara Alumni Center March 15 as 225 fourth-year medical students waited to receive the envelopes containing a glimpse of their futures: the results of their residency matches.

On Match Day 2013, 46.7 percent of the Medical School’s graduating class learned that they’d be joining primary care residency programs. Family medicine (18.2 percent), internal medicine (16 percent), and pediatrics (8.9 percent) were the most popular fields, followed by general surgery (7.1 percent) and emergency medicine (5.8 percent).

Web extras

Slideshow: Meeting their match

See a slideshow of Medical School students celebrating Match Day on March 15, 2013.

Match Day 2013 - Health Talk

Find more stats and see how students reacted to Match Day 2013.

You can make a difference

Help the University of Minnesota save lives, inspire hope, and prepare the world’s future health care leaders. Make a gift today.

Because with your support, anything is possible.

Join us for the 2013 Alumni Celebration, September 19-21

2013-04-29T19:39:10Z

Reunite and celebrate with your fellow alumni this fall. All Medical School alumni, including the reunion classes of 1948, 1953, 1958, 1963, 1973, 1983, 1988, 1993, and 2003, are invited back to campus for the 2013 Alumni Celebration, September 19-21.

Don’t miss the chance to:

pay tribute to esteemed alumni at the Alumni Awards Banquet
find out what’s new at the Medical School at the Medical Education Forum
meet medical students at the Scholarship Luncheon
catch up with old friends at the reunion class dinners
cheer on the Gophers as they take on San Jose State at TCF Bank Stadium

Invitations and registration materials will be mailed in July. In the meantime, please visit www.give.umn.edu/alumni/reunions to find a complete schedule of events and more.

Honor an outstanding alumnus

The Medical Alumni Society is seeking nominations for the 2013 alumni awards. Visit www.give.umn.edu/alumni/awards for award criteria, nomination requirements, and a list of past recipients. Nominations are due by May 24.

How you can help

Alumni are needed to contact classmates, join the reunion planning committee, or serve as reunion giving volunteers. To learn more about these opportunities, contact Katrina Roth at roth0103@umn.edu, 612-625-0336, or 800-775-2187.

You can make a difference

Help the University of Minnesota save lives, inspire hope, and prepare the world’s future health care leaders. Make a gift today.

Because with your support, anything is possible.

New research building takes shape for June grand opening

2013-04-29T19:38:29Z

Construction crews have been hard at work this spring as they put the finishing touches on the newest building in the university of Minnesota’s burgeoning Biomedical Discovery District.

The Cancer and Cardiovascular Research Building encompasses 280,000 square feet of state-of-the-art research space and will serve as the gateway to the Biomedical Discovery District, the result of a $292 million funding program approved by the state of Minnesota in 2008.

Together, the district’s five buildings will bring together more than 1,000 investigators and personnel in 700,000 square feet of space — larger than 12 football fields — to discover next-generation therapies for a number of medical conditions. the district is expected to attract up to $40 million in new annual research funding.

The cancer researchers housed in the new Cancer and Cardiovascular Research Building will study chemical biology with a focus on the role of chemical carcinogens in causing cancer. Others will build new models to find better cancer treatments. Heart researchers housed there will study cardiac regeneration and development, muscular dystrophy, congenital heart medicine, and genomics.

A ribbon-cutting ceremony at the Cancer and Cardiovascular Research Building is slated for June 14. Faculty members whose labs are moving to the new building will occupy the space beginning in July.

Web extras

Slideshow: The new Cancer and Cardiovascular Research Building

See a slideshow of how the newest Biomedical Discovery District building took shape during different stages of construction.

Cancer and Cardiovascular Research Building

You can make a difference

Help the University of Minnesota save lives, inspire hope, and prepare the world’s future health care leaders. Make a gift today.

Because with your support, anything is possible.

U team discovers enzyme behind breast cancer mutations

2013-04-29T19:37:56Z

A Masonic Cancer Center, University of Minnesota research team has uncovered a human enzyme responsible for causing DNA mutations found in most breast cancers. The discovery of this enzyme — called APOBEC3B — may change the way breast cancer is diagnosed and treated.

“Hopefully, [the discovery] will allow cancer researchers to develop new treatment approaches that can prevent these mutations before they become harmful,” says lead researcher Reuben Harris, Ph.D., associate professor of biochemistry, molecular biology, and biophysics and a member of the Masonic Cancer Center.

Previous HIV research conducted by Harris’s lab on APOBEC3 enzymes eventually led to the discovery that APOBEC3B is overexpressed in breast cancer cell lines and tumors.

“DNA mutations are absolutely essential for cancer development,” says Harris. “Our experiments showed the APOBEC3B enzyme causes mutations in the genome of breast cancer cells. From this, we were able to reasonably conclude that the APOBEC3B is a key influencer in breast cancer.”

If further studies confirm that finding, a simple blood test could result in early detection, says Harris, who is also looking for ways to block APOBEC3B from causing mutations.

The findings were published in the Feb. 6 online edition of Nature.

You can make a difference

Help the University of Minnesota save lives, inspire hope, and prepare the world’s future health care leaders. Make a gift today.

Because with your support, anything is possible.

U scientists develop 'calcium sponge' to combat heart failure

2013-04-29T19:36:36Z

University of Minnesota researchers have developed a “calcium sponge” that could one day be used to combat diastolic heart failure, a common killer of men and women nationwide.

In diastolic heart failure, cardiac cells’ calcium levels rise to the peak needed for the squeezing action of the heart, but then they don’t drop quickly enough for an efficient relaxation period.

To solve that problem, scientists in the Department of Integrative Biology and Physiology and the Lillehei Heart Institute used molecular genetic engineering to produce an optimized protein called Parve101Q, which soaks up excess calcium, allowing the heart to relax properly after a contraction.

The next step will be determining the best method of delivering the protein.

“Heart disease and heart failure rates are growing, especially as our population ages,” says Joseph Metzger, Ph.D., chair of the Department of Integrative Biology and Physiology. We hope this type of discovery may one day help pave the way to a better way to treat patients.”

The study’s results were reported in the Feb. 10 online edition of Nature Medicine.

You can make a difference

Help the University of Minnesota save lives, inspire hope, and prepare the world’s future health care leaders. Make a gift today.

Because with your support, anything is possible.

	1888	2013
Acceptance rate	50% (1923)	5%
Graduating class	23	225
Women in the class	8%	47%
Months in Medical School	18	40+

Medical Bulletin | Minnesota Medical Foundation

Retraining the brain

U plasticity lab helps kids and adults recover from stroke and other disabling conditions

By Susan Perry

Exploring new territory

Retraining the brain

The battle of the hemispheres

Double priming the brain

Children and stroke

Clinical studies

‘Sign me up’

Web extras

Learn more

Urban engagement

MetroPAP immerses students in inner-city medicine, where relationship-building is lesson No. 1

By Susan Maas

Proven approach, new setting

A rich way to learn

MetroPAP’s future is now

Web extras

Video

Community impact

Building bonds

Big-time interest in nanomedicine

U of M researchers are tapping tiny particles’ huge potential in a new realm

By Miranda Taylor

Nanomedicine and cancer

A growing field

Collaboration is key

Exploring what nano can do

Where stress, diabetes, and culture converge

A UMD study explores the link between stress and high diabetes rates among Native Americans of the Midwest

By Gene Rebeck

Improving Native Americans’ health

Dealing with stress—past and present

Easing the symptoms of focal dystonia

Neuroplasticity ‘gone bad’

Enhancing therapy

Subtle improvement

Web extra

Students without borders

The University’s Global Future Physician seminar takes premed students across the world to reflect on the state of health and health care today

The backstory

Destination: Mysore

Watch, listen, learn

Web extra

Alumni Spotlight | Christopher Wenner, M.D.

A new-generation country doctor

Making an old model new again

Back on track

Web extras

A real family practice

Scholarship Winner | Andrea Stember

Scholarships allow a champion pole-vaulter to set a high bar in medical school, too

Confronting challenges

Reaching new heights

Web extras

Make a gift

Continuing their legacy

Ahead of the curve

The Medical School celebrates 125 years of innovative education

Timeline

1888-1913 First 25 years

1913-1938 Second 25 years

1938-1963 Third 25 years

1963-1988 Fourth 25 years

1988-2013 Fifth 25 years

Web extras

Medical School by the numbers

Acceptancerate

50%

(1923)

5%

Graduatingclass

23

225

Women inthe class

8%

47%

Months inMedical School

Acceptance
rate

Graduating
class

Women in
the class

Months in
Medical School