Health UPSTATE
U P STAT E M E D I C A L U N I V E RS I T Y
Winter 2018
MANAGING JUVENILE ARTHRITIS page 6
A SCIENTIST EXPLORES HOW TO REPAIR BRAIN DAMAGE page 12
WHAT IS MICRORNA? page 14
3 PEOPLE YOU NEED WHILE GRIEVING page 15
PREPARING FOR YOUR COLONOSCOPY page 17
HOW TO STOP THE BLEED page 19
MEDICALLY FRAGILE, MENTALLY STRONG page 5
WELCOME
Meet Ashley Brown Times 3 Three Upstate employees — all named Ashley Brown — at the gazebo at Upstate University Hospital’s Community campus in August. PHOTO BY DEBBIE REXINE
WITH UPSTATE MEDICAL UNIVERSITY being the largest employer in Onondaga County, some employees are bound to share the same name. Meet Ashley Brown, Ashley Brown and Ashley Brown.
e emergency nurse delivered her second son in August. e ICU nurse delivered her first baby, a boy, in November, and she was changing her last name to take her husband’s: Buckton.
e brunette Ashley Brown is a nurse in the emergency department at the Community campus. She shares a birth year – 1985 – and a middle name – Marie – with the redheaded Ashley Brown who works in Upstate’s dental clinic and attended Liverpool High School.
e Ashley Brown from the dental clinic has an 8-year-old daughter.
e blond Ashley Brown, born in 1987, is a charge nurse in the intensive care unit at the Community campus. She and the emergency nurse were two years apart as they attended Lafayette High School. ey both pursued nursing careers and eventually ended up at Upstate University Hospital. Both were pregnant at the time of this photo.
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e Social Security Administration reports that Ashley was most popular as a girl’s name in 2001, when 16,526 Ashleys were born in the United States. Ashley was the fourth most popular girl’s name that year, and it remained in the top 10 through 2005. e decade of the 1980s saw 352,160 Ashleys born — behind only Jessicas, Jennifers and Amandas as most popular. At least 53 Ashleys were employed at Upstate in 2017 — three with the last name Brown.●
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WELCOME
Contents 6
10
PATIENT CARE Medically fragile, mentally strong A child faces juvenile arthritis She creates during chemotherapy Relief from Meniere’s disease
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FROM OUR EXPERTS
IN OUR COMMUNITY Dialysis patients gain companionship
page 18
page 6
A scientist explores how to repair brain damage
page 12
Do you know how to stop the bleed?
page 19
page 8
Understanding microRNA
page 14
How dreams help with grief
Meet 3 pioneering female doctors
page 20
page 15
Guidelines for a good bowel prep
page 17
page 5
page 10
IN OUR LEISURE A curling fundraiser
page 22
DEPARTMENTS On the cover: Tracy Cornell is a thriving preschooler despite medical challenges. See story, page 5.
Health UPSTATE
U P STAT
E MED IC
AL UN IVE
MANAGIN JUVENILE G ARTHRITIS
RS I T Y
News you might have missed
page 4
page 6
Winter 2018
3 PEOPLE YOU NEED WHIL GRIEVING E
page 11
A SCIEN TIST EXPLORES HOW TO REPAIR BRAIN DAM AGE
page 12
WHAT IS MICRORN A?
page 14
PREPARIN G FOR YOU COLONOSC R OPY
Science Is Art Is Science back cover Focusing on prostate cancer
page 16
PHOTO BY ROBERT MESCAVAGE
HOW TO STOP THE BLEED page 19
MEDICA MENTALLLY FRAGILE, LY STRON G page 5
Health UPSTATE
Winter 2018
EXECUTIVE EDITOR Leah Caldwell Assistant Vice President, Marketing & University Communications EDITOR-IN-CHIEF WRITERS
DESIGNER
Amber Smith Leah Caldwell Jim McKeever Jim Howe Susan Keeter Amber Smith Susan Keeter
Visit us online at www.upstate.edu or phone us at 315-464-4836. For corrections, suggestions and submissions, contact Amber Smith at 315-464-4822 or smithamb@upstate.edu ADDITIONAL COPIES: 315-464-4836 Upstate Health offices are located at 250 Harrison St., Syracuse, NY 13202
Upstate Health magazine is a community outreach service of Upstate Medical University in Syracuse, N.Y. Upstate is an academic medical center with four colleges (Medicine, Nursing, Health Professions and Graduate Studies); a robust research enterprise and an extensive clinical health care system that includes Upstate University Hospital’s Downtown and Community campuses, the Upstate Cancer Center and the Upstate Golisano Children’s Hospital. Part of the State University of New York, Upstate is Onondaga County’s largest employer.
Need a referral? Contact Upstate Connect at 315-464-8668 or 800-464-8668, day or night, for appointments or referrals to the health care providers on these pages or anywhere at Upstate or for questions on any health topic.
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U P S TAT E H E A LT H
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News you may have missed
WHAT’S UP AT UPSTATE
UPSTATE RESEARCHERS, in collaboration with scientists from Penn State University, have identified a novel and accurate biomarker — from a sample of saliva — that both identifies concussion in children and predicts the length of recovery.
Results of the groundbreaking research, sponsored by Quadrant Biosciences, Inc., were presented at the Pediatric Academic Societies 2017 Meeting. e work focuses on small non-coding nucleic acid molecules in the body called microRNA. (Read more about microRNA on page 14.) Related research also looks at diagnosing autism through microRNA analysis from saliva samples. l
THE NAPPI LONGEVITY Institute at Upstate Medical University — an eight-floor, 360,000-square-foot health and wellness complex — will be built Sam and Carol Nappi at East Adams and Almond streets, across from the Upstate Cancer Center in downtown Syracuse, New York. It will house services related to brain health and neurosciences, including a focus on Alzheimer’s disease. In addition, an array of wellness services will be available there under one roof, following the philosophy that preventive health and promotion of good health can help reduce hospitalizations and emergency treatment. Upstate received a $70.6 million grant as part of the Capital Restructuring Financing Program and Essential Health Care Provider Support Program, and an additional $75 million was allocated by the state. Sam and Carol Nappi of Jamesville donated $8 million that will support its creation and special focus. It’s the largest gi ever received by the Upstate Foundation. Construction is slated to begin in 2018. UPSTATE UNIVERSITY HOSPITAL added another option for mothers-to-be seeking relief from the pain of childbirth. Nitrous oxide, also known as laughing gas, is now available at the Family Birth Center. Nitrous oxide is making a comeback in the United States, aer being overshadowed by the epidural, which uses a spinal injection to block pain. e patient breathes in the nitrous oxide through a mask that she holds. When used for labor, the mixture is half nitrous oxide and half oxygen, for a less potent mixture than what is typically used for dental procedures. Nitrous oxide has been used in Europe for years with safe outcomes for mother and child.
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THE UPSTATE CANCER CENTER joined the American Association of Cancer Institutes, which comprises 97 leading cancer research centers in North America. is group of cancer centers helps one another by sharing best practices, providing a forum for addressing common challenges and educating policy makers about the important role cancer centers play in advancing cancer discovery. More than 2,000 new patients seek care at the Upstate Cancer Center each year, resulting in 45,000 visits to the downtown campus and additional visits to satellite locations. More than 90 board-certified physicians are part of the interdisciplinary cancer team at Upstate, and all are professors in Upstate’s College of Medicine. l
UPSTATE MEDICAL UNIVERSITY joins nine other SUNY campuses and five not-for-profit organizations to establish a sustainable village and learning community in Haiti that will provide resources and services for the town of Akaye. Each campus in the collaboration was selected to bring expertise in a certain specialty to the community. Upstate, along with Stony Brook University and Nassau Community College, is part of the Health and Wellness working group. e W.K. Kellogg Foundation awarded an $800,000 grant to this project, which will develop educational, economic and social programs and other needed services on 40 acres of land donated by a Nassau Community College professor emeritus.
Learn more about happenings at Upstate at upstate.edu/news and upstate.edu/whatsup
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Medically fragile, mentally strong
PATIENT CARE
Preschooler thrives despite cardiac, neurological problems BY AMBER SMITH
IN 2013, FRIENDS OF KRISTY AND JOHN Cornell told the couple about a woman who gave birth to a baby girl in the Buffalo area. e baby was to be adopted, and she had health problems. e Cornells were foster parents, living near Binghamton. Kristy Cornell was a nurse. “I went up to visit the baby at the hospital, and I just fell in love with her,” recalls Kristy Cornell. Her husband, John, is a New York state trooper. e Cornells met baby Tracy several days aer her first heart surgery to repair the aortic arch of her heart. Tracy’s birth mother liked the couple and wanted them to adopt her. Aer a brief stay with a foster family in Buffalo — who are now Tracy’s godparents — Tracy came home to her “forever” family, which includes 21-year-old Michael, 11-year-old Molly and 5-year-old Zorion. Tracy had a second cardiac surgery when she was 1. She’s 4 now. Her pediatric cardiac surgeon, George Alfieris, MD, likely will need to operate a third time, to repair a heart valve and a narrowing of the aorta, the main artery of the body. Daniel Kveselis, MD, is Tracy’s pediatric cardiologist. Pediatric pulmonary nurse practitioner Mary Foster helps the preschooler with her asthma and environmental allergies. “I first started caring for her when she was 6 months old,” Foster says. “She used to be so scared when she came to her appointments.” Now Tracy is less anxious. By looking at her, “You would never know that she’s medically fragile. You would never know, other than the scar,” her mom says.
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Tracy Cornell with pediatric pulmonary nurse practitioner Mary Foster. PHOTO BY ROBERT MESCAVAGE
She has a scar on her chest from the surgeries. Tracy is also small for her age. In addition to the heart problems and the pulmonary issues, she has a genetic disorder that George Alfieris, MD causes the growth of tumors in her nervous system. It’s called neurofibromatosis, type 1.
Daniel Kveselis, MD
e Cornells live with many unknowns. e tumors that grow could be cancerous, cause vision problems, or be disfiguring. Or, her disease could be mild. ere’s no way to predict. So, they focus on regular life — which for Tracy means full-day pre-kindergarten, princess dresses and an obsession with Henry, the family’s 80-pound English mastiff-Lab mix. Kristy Cornell says Tracy has a million stuffed dogs and likes to pretend that she is a dog. She also likes playing with Zorion, the 5-year-old boy of whom they have custody. e minute she wakes up in the morning, she asks, “Where’s Zorion?” “She’s a redheaded, fiery little girl,” Kristy Cornell says. “She’s very strong. “I think that’s what’s gotten her through so far. “She’s just a really spunky kid. We just absolutely adore her.” ● U P S TAT E H E A LT H
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Overcoming a painful disease
PATIENT CARE
Battling juvenile arthritis is a longterm proposition for this fourthgrader BY JIM HOWE
NORA POWERS STARTED FEELING PAIN in her feet when she was 2 years old. at led to trips to her pediatrician, then a podiatrist, then an orthopedist. When she was 5, a pediatric rheumatologist diagnosed what caused her pain and also her swollen fingers: juvenile arthritis. Since its cause is unknown, it is technically called juvenile idiopathic arthritis. Nora, now 9 and in the fourth grade in the East Syracuse Minoa school district, has been seeing that rheumatologist, William Hannan, MD, ever since. Hannan and his colleague, Caitlin Sgarlat Deluca, DO, treat juvenile arthritis and related conditions at the Upstate Pediatric Rheumatology Center, the only place for specialized treatment between Rochester and Albany. “‘Arthritis means joint inflammation, and everyone thinks of it as something their parents and grandparents might get, but juvenile arthritis has been around, too. It is one of the more chronic diseases of childhood, but it doesn’t have the reputation of other chronic diseases,” Hannan says. It’s hard to diagnose, since it requires lengthy observation and a detailed evaluation that rules out other causes. e disease can go on for some time before it is identified, as in Nora’s case, and it comes in many types and degrees of severity. “e most difficult thing for families to adjust to is that this is a chronic disease,” Hannan notes. “It is a slow process. ey live through it, and it takes a while to get them really feeling good. ey’re likely to be on medications for years. at is the most difficult thing for families to deal with.” Nora has taken medications to reduce her pain and inflammation, including methotrexate, which she is now being weaned from as her symptoms are in remission.
William Hannan, MD, with Nora Powers. PHOTO BY SUSAN KAHN
Since movement is generally recommended, Nora has been as active as possible with soccer, dance and yoga for years, says her mother, April McCaslin of East Syracuse. “We noticed she used to have to take several breaks, but when the methotrexate started working, she was able to run up and down the (soccer) field without having to stop and struggle with it,” McCaslin says. Nora has permission to opt out of gym class or other school activities, but she rarely does. “When we go to the floor (for a school activity), I usually sit in a chair because it hurts my legs to sit on the floor,” Nora says, noting her chair has a cushion to make it more comfortable. She might also write a school assignment on her Chromebook computer if writing by hand is too painful. If she needs to explain her illness to people, she says, “I tell them that it hurts your joints” and notes the disease doesn’t slow her down too much. She used to have physical and occupational therapy at school but has been doing so well recently that she doesn’t have to leave class anymore, her mother says, noting that the school has gone “above and beyond” to accommodate Nora’s special needs. Since Nora doesn’t like to complain, McCaslin is ever vigilant about the disease, which can give Nora painful “flares” or leave her tired at the end of a school day. Nora also must see an eye doctor regularly to watch for a continued on page 7
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PATIENT CARE
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possible problem called inflammatory uveitis. Down the road, she will probably need extra time once she gets to middle school and has to switch rooms for each class.
She rarely uses it, but Nora has a wheelchair in case she needs to walk a long distance, such as on school field trips. Nora and her family advocate for juvenile arthritis, including sponsoring the Nora’s Flower Powers team each year since 2014 in the Arthritis Foundation’s annual Jingle Bell Run fundraiser, raising more than $18,000 in all, her mother says. Participants can walk or run, and sometimes Nora runs. The pediatric rheumatology team
On the team’s Facebook page, you can read about Nora and her mother meeting with a state senator about a health insurance bill, see their volunteer work for the Arthritis Foundation, find messages of support from Nora’s stepfather, Mason McCaslin, and many other people, and check out photos of children with signs that say, “Kids Get Arthritis, Too.”
ABOUT CHILDHOOD ARTHRITIS
Considered the most common form of juvenile arthritis, juvenile idiopathic arthritis, or JIA, begins before age 16 and involves swelling in one or more joints lasting at least six weeks.
“She looks like a perfectly normal child, so you’d never guess she was in pain,” her mother says.
JIA includes several types of arthritis and was previously known as juvenile rheumatoid arthritis. It is different in most cases from adult rheumatoid arthritis.
“Everyone would look at her and say she’s a normal 9-yearold,” Hannan agrees. As she tapers off her medication, her arthritis “may be gone or may start to come back. I wish I could predict exactly what was going to happen, but nobody can,” he says.
JIA may include muscle and so-tissue tightening, bone erosion, joint misalignment and changes in growth patterns, and the symptoms can change from day to day.
Speaking of all his juvenile arthritis patients, Hannan says, “My goal is to make them normal: to go to school, get married, have kids.” e treatments and outcomes for juvenile arthritis patients are much better now than when he started in the field in the 1980s, he notes optimistically.
Diagnosis is based on a physical exam as well as lab tests and medical history.
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Several arthritis-related diseases can also affect children, such as Kawasaki’s disease, juvenile scleroderma, juvenile lupus and fibromyalgia. SOURCE: ARTHRITIS FOUNDATION
ARE YOU GRATEFUL? A gift of gratitude is a meaningful way to both express your appreciation to special caregivers and to help patients during their time of great need. Friend in Deed, Upstate University Hospital’s annual fund, supports a variety of unmet patient needs, such as nutritional supplements for cancer patients, special pediatric needs, communication tools for the hearing impaired, and heart monitors, to name a few. To donate, visit upstatefoundation.org or contact the Upstate Foundation at 315-464-4416. To share your story, email FND@upstate.edu
Foundation
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PATIENT CARE
Talent and imagination Teen artist spends chemotherapy time drawing original characters BY SUSAN KEETER
A NEW SKETCHBOOK was the perfect gi for Julia Nguyen on Sept. 13, the day she was diagnosed with primary mediastinal large B-cell lymphoma. Over the summer, around her 16th birthday, Nguyen developed swelling in her face and felt a little off. When symptoms persisted, she had several appointments with her pediatrician. Aer X-rays and imaging scans revealed a large mass in her chest, Nguyen was admitted to the pediatric intensive care unit at the Upstate Golisano Children’s Hospital. Pediatric hematologist/oncologist Irene Cherrick, MD, met with the Nguyen family, and additional tests were done that revealed the cancer. Aer several days in intensive care, Nguyen was transferred by elevator to Upstate’s Waters Center for Children’s Cancer and Blood Disorders to begin her first course of chemotherapy.
During long days of chemotherapy, Nguyen contends with boredom by filling the sketchbook with her original characters or OCs, as they are called in her artistic circle. She favors drawing with a No. 5 mechanical pencil. It makes nice, thin lines, she explains. Occasionally she adds color with Copic-brand markers or colored pencils. e big-eyed creatures and tousled-hair beauties that occupy her sketchbook are hers alone, but Nguyen is inspired by the popular Japanese animation style, anime — “Bungou Stray Dogs,” in particular — and characters in role-playing video games such as “Hello, Charlotte.” Her mother remembers that she showed artistic talent at a young age, but Nyugen thinks that her fascination with Pokemon inspired her to start drawing in fih grade. By eighth grade, she was serious about becoming an artist. continued on page 9
Julia Nguyen, 16, with the sketchbook she was given by a cousin on the day she was diagnosed with lymphoma. Some of her sketches are reproduced here and on page 9. PHOTO BY SUSAN KAHN
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PATIENT CARE
ABOUT PRIMARY MEDIASTINAL LARGE B-CELL LYMPHOMA
Lymphoma is a cancer that starts in the cells that are part of the body’s immune system. Primary mediastinal B-cell lymphoma is a common subtype that occurs mostly in young women. It starts in the middle of the chest behind the breastbone and is fast growing but usually responds well to treatment. SOURCE: AMERICAN CANCER SOCIETY
Talent and imagination
ABOUT UPSTATE’S WILLIAM WATERS CENTER FOR CHILDREN’S CANCER AND BLOOD DISORDERS AT THE UPSTATE GOLISANO CHILDREN’S HOSPITAL
continued from page 8
Nguyen’s characters spring from her imagination and develop as she draws them. She keeps a journal in which she writes about the alternate universes that she imagines for the characters, photographs her artwork and posts it all on Instagram. Currently, Nguyen is home-schooled until she completes her chemotherapy treatments. She looks forward to returning to West Genesee High School, so she can take a drawing and painting class and rejoin the club that publishes “In the Mind’s Eye,” an arts and literary magazine.
Strokes affecting
“Julia’s ability to communicate emotion in a face is unusual for someone her age,” notes Tina Middaugh, magazine adviser and teacher at West Genesee. “She’s very talented.” ● BY AMBER SMITH
e center serves a 21-county region. Each year, approximately 65 new oncology patients are diagnosed and treated at Upstate’s Waters Center. Nguyen’s oncologist, Irene Cherrick MD, is one of eight board certified pediatric hematology/oncology physicians on staff. Melanie Comito, MD, is the director of the center which has a 44-member staff. In 2016, Upstate’s pediatric cancer and blood disorders patients received care at 6,400 appointments at the Waters’ outpatient service in the Upstate Cancer Center. e center also offers a survivor wellness program for the long-term follow-up of childhood cancer patients.
Keeping care focused on family THE UPSTATE GOLISANO Children’s Hospital has a Family Advisory Council, which periodically seeks to add new members. is group meets monthly from September to June. It has recently assisted in creating a new visitation policy for the pediatric cancer clinic, given direction and feedback in the redesign of two areas of the hospital and participated in an educational video that helps train medical residents.
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Involving parents and other caregivers on this council is an important way the children’s hospital maintains its focus on providing family-centered care, says pediatric administrator Jenny Dickinson. Members of the council are at least two years out from their child’s first visit to Golisano. Interested in volunteering? Contact Dickinson at dickinsj@upstate.edu or ● 315-464-9330. ●
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Surgical Solution
PATIENT CARE
Ear specialist helps her hearing, balance problems BY AMBER SMITH
THEY WEREN’T LIFE-THREATENING, but the symptoms that plagued Jolie Bower were so debilitating she had to stop working. She had a spinning sensation of vertigo and nausea that would come on without warning. Her head would feel like a bowling ball and her neck a toothpick. She was laid out on the floor for hours at a time. Today the Onondaga Hill Middle School health teacher is back to a job she loves – and she credits Upstate otolaryngologist Charles Woods III, MD. “I’m so fortunate that we have him here in Syracuse,” she says. “What he did for me was huge.”
Jolie Bower
Bower, of Liverpool, developed vertigo in 2006. Her primary care doctor sent her to an ear, nose and throat doctor who diagnosed Meniere’s disease and prescribed
motion sickness medicine, a low-salt diet and a medicine to help reduce the fluid from her inner ear. ose measures over the years did not relieve her symptoms. Eventually Bower took medical leave from her job and got an appointment with Woods, an Upstate otologist, an ear, nose and throat doctor who subspecializes in disorders of the ear. He is an assistant professor of otolaryngology and communication sciences at Upstate. He explains that Meniere’s can affect hearing and balance, both of which are controlled in the inner ear.
Charles Woods III, MD PHOTOS BY SUSAN KAHN
“I always tell patients I don’t like the name ‘disease’ because it’s an inner ear that’s not functioning correctly,” says Woods. “e inner ear is made up of both the hearing side of things and the balance side of things.” Patients can experience progressive hearing loss as the hair cells in the cochlea (part of the inner ear) are damaged, and they may report a feeling of fullness in the ear. Woods says that sensation comes from increased pressure within the fluid spaces of the inner ear. No one knows what causes the increased pressure, but he says it’s similar to the eye disease glaucoma. Increased fluid pressure inside the eye can lead to retinal damage, while increased fluid pressure in the inner ear can cause progressive neural damage. Tinnitus is also a common symptom, with sounds ranging from high-pitched hisses to the sound of a seashell cupping the ear. e most debilitating symptom is vertigo, a sense that the world is spinning. “If we can at least alleviate that symptom for people, the disordered ear is much more bearable,” Woods says. continued on page 11
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Surgical solutions
PATIENT CARE
continued from page 10
In Bower’s case, Woods initially operated to install a shunt in her right ear, which spared her hearing. For two years, Bower says, she felt better. “en it came back with a vengeance,” and her hearing in that ear was distorted. Woods describes a variety of treatment options ranging from steroid and antibiotic injections to the severing of the balance nerve in the inner ear. Bower opted for another surgery called a labyrinthectomy, in which her inner ear was removed. is meant she would lose her hearing in that ear, and physical therapy would be part of her recovery as she worked to retrain her brain, regain balance and recalibrate her vision. “e brain is pretty amazing in what it’s able to do,” she says. “My good side took over for my bad side.” Bower felt like she was back to normal about three months aer the surgery. She is deaf in her right ear, but Bower hopes to get a bone-
anchored hearing aid that will send sound through bone to her good ear. Woods says more than three-quarters of people with Meniere’s disease control their symptoms with a low-salt diet and diuretic medication. “Because the disease is intermittent, we’re not sure exactly how long and what period of time we need to treat people,” he says. “Oentimes, it’s at least intermittent treatment, lifelong, because the disease is not going to go away. It’s going to plague the patient, intermittently, through their life.” Patients are likely to have quiet periods of several years where they don’t need treatment. When symptoms become debilitating, Woods says it’s time to consider other treatment options. ● Reach Woods and other providers in Upstate’s Ear, Nose and Throat Clinic at 315-464-4678.
The National Stroke Association reports that African Americans are twice as likely to die from stroke as Caucasians. The statistics are staggering — African Americans are affected by stroke more often than any other group. Know your risk.
STROKE RISK FACTORS • • • • •
HIGH BLOOD PRESSURE: It's the No.1 cause of stroke. Regularly monitor your blood pressure and always take prescribed medication. DIABETES: Control your diabetes with proper diet, exercise and medication. OBESITY: Being just 20 pounds overweight significantly increases your risk of a stroke or heart disease. SMOKING: Smoking increases your risk of stroke by two to three times. MINI-STROKES (TIAS OR TRANSIENT ISCHEMIC ATTACKS): When stroke symptoms such as confusion, slurred speech or loss of balance appear and disappear, call 9-1-1. You may be able to prevent a major stroke.
A STROKE IS A BRAIN EMERGENCY. IF YOU SUSPECT A STROKE, CALL 911 AND ASK FOR UPSTATE.
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Comprehensive Stroke Center
U P S TAT E H E A LT H
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A huge mission
FROM OUR EXPERTS
Upstate scientist explores how stem cell therapy may repair brain damage from stroke, or Alzheimer’s BY AMBER SMITH
LI-RU-ZHAO’S FATHER, Jintian Zhao, was in his mid60s in 1973 when a blood clot clogged a vessel in his brain and he suffered a stroke. Doctors in China, where he lives, suggested acupuncture or physical therapy in the first six months of recovery. ey said aer six months, nothing would help. “My research challenges this notion,” says Zhao, an Upstate scientist engaged in one of the most promising new fields of medicine: stem cell factor therapy. Zhao, MD, PhD, is an associate professor of neurosurgery in Upstate’s biomedical sciences and neurosciences programs. She appreciates studying neurological diseases because so many are considered incurable. “I feel my mission is so huge,” she explains. She also loves the challenge of discovering new things. “e purpose of science is to search for the truth, to answer the questions we do not know.” Zhao began searching for stroke answers two decades ago. In the late 1990s, she worked alongside a famous stroke researcher at Lund University Wallenberg Neuroscience Center in Sweden. She focused on acute stroke research and then segued into studying stroke recovery. Zhao and her husband, Weiming Duan, MD, PhD, then relocated to the University of Minnesota, where she continued her work.
Search for answers to stroke begins One of her colleagues in Minnesota was studying the use of bone marrow stem cells for the treatment of leukemia. at gave Zhao the idea to see whether bone marrow stem cells could play a role in stroke recovery. In her study, she transplanted human bone marrow stem cells into the brains of rats afflicted by stroke. She witnessed remarkable recovery. As exiting as the results were, Zhao had to learn why and how this happened. She hypothesized that the stem cells, once injected, released factors that were responsible for rewiring the brain for permanent recovery. In 2001, her husband received a job offer at Northwestern University, in Chicago. She moved with him and continued her research, working to prove her hypothesis. She experimented with embryonic stem cells at Northwestern. Again, she saw remarkable repair from stroke. But this time, about a quarter of her test animals developed tumors. 12
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Embryonic stem cells have the ability to become any type of cell, but embryonic stem cell transplantation has a risk of generating cancerous tumors. For embryonic stem cells to be helpful to her, Zhao would have to figure a way around their propensity for tumor formation. A pair of research colleagues at Northwestern who specialized in hematology suggested she instead try using stem cell factors. “I had the same question in my mind,” Zhao admits.
A clue in human aging? Bone marrow stem cell factors are naturally-occurring substances, released by bone marrow stem cells, that are capable of stimulating cell growth and healing. As people age, they have fewer of these factors. Zhao suspects that could help explain why younger people tend to recover from stroke more fully than older people. Biotech firms sell stem cell factors as drug formulations. Two types of bone marrow stem cell factors – SCF, stem cell factor, and G-CSF, granulocyte colony stimulating factor — have been used in combination to reduce the damage from heart attacks. Researchers at that time had not looked at using these factors for stroke recovery. Zhao experimented using SCF and G-CSF individually. She also used the two factors together and discovered they were synergistic in neural network generation and in stroke recovery. at is, they work better together than either work apart. She began considering the timing.
Research for brain repair During the first six months of recovery aer a stroke, patients will have some degree of recovery without any sort of intervention, Zhao says, explaining that this spontaneous recovery is due to brain plasticity – the brain’s ability to change throughout life. Injecting SCF and G-CSF factors seems to enhance brain plasticity and enhance the formation of new neural networks, which are crucial for recovery. Aer she demonstrated the benefit of SCF and G-CSF in brain repair when the growth factors were injected at several hours or several months post-stroke, Zhao wondered whether SCF and G-CSF injected six months aer a stroke would enhance recovery. Using multiple approaches, including brain imaging in live animals, her continued on page 13
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A huge mission
FROM OUR EXPERTS
continued from page 12
research team found that SCF and G-CSF together seemed to improve motor function recovery. rough their research, she and her team located the brain cells that respond to the stem cell factor treatment. Neurons have receptors for both SCF and G-CSF. “at is the basis to suggest bone marrow stem cell factors affect brain structure and brain function,” Zhao explains.
He continues: “Recent advances in our basic knowledge of the pathways involved in tissue damage and regeneration have combined with remarkable progress in adult stem cell biology to put us at a genuine inflection point in the history of medicine. e prospect of clinical tissue repair strategies is a tangible reality.”
Live brain imaging data have shown that considerably more neural networks form in brains that receive the treatment of bone marrow stem cell factors.
Before Zhao can move her work forward with a clinical trial in humans, she must first determine exactly how the stem cell factors work and what amount is needed for effectiveness.
Turning to Alzheimer’s
So, she continues her research in search of a repair for brain damage. ●
Zhao relocated again in 2004 with her husband to Louisiana State University Health Sciences Center. When a large grant arrived for research on Alzheimer’s disease, Zhao wondered whether the work she was doing on stroke repair could also be useful in Alzheimer’s treatment. She set up experiments and soon saw that stem cell factors lead to recovery in Alzheimer’s disease, too. e amyloid plaques that accumulate between neurons and are the hallmark of Alzheimer’s were fewer in the animals that received stem cell factor injections. “is was very, very exciting,” Zhao recalls. She also saw similar results in her laboratory using stem cell factors to treat a rare type of stroke and dementia with genetic roots. “All the data put together actually validated what I was doing and made me feel more confident” that stem cell factors work for brain repair in a variety of diseases.
Understanding the potential When Zhao’s father-in-law suffered a severe stroke in 2010, her husband relocated to Beijing to care for him. Zhao accepted a position at Upstate in 2013. Here, she has conducted experiments on the use of stem cell factors to treat traumatic brain injury. ey work, in the lab, just as they worked for stroke and Alzheimer’s. Like so many other scientists in the field of stem cell research, Zhao is on the cusp of something potentially huge — but in the early stages. Stem cell-related therapies “hold significant promise for transformative and potentially curative treatments for some of humanity’s most troubling and intractable maladies,” says Food and Drug Administration Commissioner Scott Gottlieb, MD. winter 2018 l upstate.edu
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FROM OUR EXPERTS
Understanding microRNA These tiny keys could unlock treasure trove of medical knowledge BY JIM HOWE
RESEARCHERS AT UPSTATE are looking at tiny bits of genetic material that could open up new ways of understanding diseases and how the mind and body work. e material is called microRNA and is present in saliva, blood and other bodily fluids. “MicroRNA potentially could end up in every biofluid and potentially could affect every fluid … people have envisioned these microRNAs now as a whole new molecular endocrine signaling system,” says Upstate research scientist Frank Middleton, PhD, an associate professor of neuroscience and physiology, biochemistry and molecular biology, pediatrics and psychiatry and behavioral sciences. He was comparing the ways microRNA sends signals throughout the body to the way the endocrine glands send their own signals, by releasing hormones into the bloodstream to reach distant cells. MicroRNA is made by all of the body’s cells, it can enter neighboring or distant cells, and it is critical to brain development, learning and nearly every process that cells carry out, he notes. Protein production is a key activity in cells, and “MicroRNAs block proteins, and the ones involved are particularly relevant for autism,” Middleton says. He is the principal investigator of an ongoing study that is looking at measuring microRNA in children’s saliva as a quick, painless and accurate method to help diagnose autism early, so those children can get into treatment faster. continued on page 16
Frank Middleton, PhD BY WILLIAM MUELLER
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FROM OUR EXPERTS
Sweet dreams
Grieving continues even when you sleep BY AMBER SMITH
THE DISCLOSURE invariably begins with, “is may sound crazy.” at’s how psychologist Jeffrey Schweitzer, PhD, can tell a bereaved person is about to relay the story of a dream featuring his or her deceased loved one. Schweitzer, the primary psychologist at the Upstate Cancer Center, has researched the role of dreams during the bereavement process. He says dreams featuring loved ones can be helpful as a person copes with loss. For his dissertation, Schweitzer interviewed people about dreams they had aer a loved one died. In some cases, the death was anticipated; other times, the death was sudden. In all cases, the dreams were intensely vivid, highly memorable and tended to occur during periods of high emotion. One example: A woman whose father died of prostate cancer dreamed that someone knocked on her front door. She opened the door and found her father. As soon as he crossed the threshold, he turned into a baby, and the woman cradled him in her arms.
“at physical contact within the dream can enhance the experience,” Schweitzer says. is woman’s father had been the epitome of strength and stability, and much of her distress came from the loss of her pillar. For him to transform into a baby in her dream, and for her to comfort him, helped the woman learn that she would be able to be strong on her own. Were the dreams Schweitzer studied sad? Sometimes. “In most cases not,” he says. “ey produced profound, loving feelings. Feelings of comfort. Feelings of reassurance, in a sense that ‘I can have an ongoing relationship with this person,’ that they’re not gone absolutely. In the medium of dreams, we can visit with one another again.” Schweitzer did not find a way to prompt dreams to occur. “at’s part of what made the dreams so significant,” he explains. “ey just sort of seem to come out when the bereaved need them most.” ●
3 people who are needed during grief THOSE WHO ARE GRIEVING need three important people in their lives: a listener, a doer and a distracter, says bereavement counselor Susan Bachorik, from Hospice of Central New York. Here are their roles:
The listener listens without judgment.
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The doer helps the person to complete any of a variety of tasks.
And the distracter takes the person out of their grief, if only temporarily. “You can’t grieve 24 hours a day,” Bachorik says.
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Understanding microRNA
FROM OUR EXPERTS
continued from page 14
E d u c at i o n . h e a l t h c a r e . r e s e a r c h
Middleton also collaborated on a study of microRNA in saliva that identifies concussion in children and predicts the length of recovery. He worked on both studies with Steven Hicks, MD, PhD, an Upstate graduate who is now a pediatrician and researcher at Penn State Health in Hershey, Pa., and with Quadrant Biosciences, which is headquartered at Upstate. MicroRNA could also play a part in regulating the aging process and in how the body processes drugs, Middleton says, and it has been implicated in Parkinson’s, Huntington’s and Alzheimer’s diseases and amyotrophic lateral sclerosis, also known as Lou Gehrig’s disease. ●
DNA database of instructions
RNA specific instructions
protein functional product
microRNA regulators
Opportunities. Consider Upstate. Our colleges include Medicine, Nursing, Health Professions and Graduate Studies. Join us at a prospective student open house: Saturday, March 24, 2018.
DNA, RNA and microRNA In high school biology class, everyone learns about DNA, which looks like two long, twisted chains. DNA stands for deoxyribonucleic acid — a chemical compound that stores a person’s genetic information. To carry out those genetic instructions, DNA tells RNA what to do — such as instructing a cell to make protein, a key activity. RNA, or ribonucleic acid, has just one long, twisted chain. Some short segments of RNA are called microRNA. MicroRNA can block protein production and regulate a cell’s activity. Discovered in 1993, microRNA appears to control a large number of human genes and to play an important role in a range of biological processes and diseases. SOURCES: NATIONAL INSTITUTES OF HEALTH; ESSENTIAL CELL BIOLOGY, 4TH EDITION
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FROM OUR EXPERTS
Secrets of a good bowel prep IT MAY BE UNPLEASANT, but preparing properly for your colonoscopy is so important, says Upstate Gastroenterology nurse administrator Michelle Henry. Here’s what she tells patients: the prep is only for one day. You can do 1 Remember, just about anything for one day. you won’t be fasting the whole time. You 2 Technically can still have clear liquids. Broths count. So do Jell-O, and Popsicles – as long as they’re not red or purple. Coffee is also OK if you don’t add cream. No alcohol, though. goal is to empty your large intestine, so your 3 e doctor will prescribe GoLytely or a similar gastrointestinal lavage designed to stimulate your bowels. When you begin drinking this, you’ll want to stay near a bathroom. Henry says many patients like to add a lemonade mix to the solution to remove the bitter taste. your doctor’s instructions about when to start the 4 Read prep, when to stop clear liquids, and what to do about any medications or vitamins you take. Following his or her instructions precisely will improve the quality of your test. confess. Call your doctor’s office to find 5 Ifoutyouwhatmessto up, do. You don’t want your doctor to discover your mistake when he or she begins the colonoscopy; that usually means an entire second day of bowel prep and a return visit. before your colonoscopy, plan on eating a 6 Indietthelowweek in fiber. Avoid any seeds, nuts or popcorn, raw fruits or vegetables with skin, and any meat with gristle or fatty foods. uncomfortable day of prep is worth it to be 7 One screened against the third leading cause of cancerrelated deaths in women and the second leading cause of cancer-related deaths in men. Finding colon cancer early almost always means it can be treated successfully. ●
6 a.m. & 9 p.m. SUNDAYS ON WRVO winter 2018 l upstate.edu
ColoN CANCeR SCReeNiNg
e United States Preventive Services Task Force recommends screening for colorectal cancer in adults beginning at age 50 and continuing to age 75. e American Cancer Society says people at increased risk of colorectal cancer may need to start screening sooner. e colonoscopy is a test that allows a doctor to examine the entire length of the colon and rectum using a thin, flexible, lighted tube with a camera on the end. If he or she sees a polyp, it can be removed during the colonoscopy. To schedule an appointment with University Gastroenterology, call 315-464-1600.
Listen anytime on www.healthlinkonair.org or find us on iTunes 89.9 & 90.3 FM U P S TAT E H E A LT H
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IN OUR COMMUNITY
WORRIED ABOUT MEMORY LOSS? NOW ACCEPTING NEW PATIENTS
Medical students Colleen Fei, left, and Megan Harris are volunteer companions at University Dialysis Center.
Dialysis companions
PHOTO BY JIM MCKEEVER.
If you or your loved one has concerns about memory loss, we can help. Our experts assess for dementia and Alzheimer’s disease in a caring environment. The visit to the Center is different as both the patient and family members attend. The goals are to help: • extend self-sufficiency for as long as possible • preserve function • provide assessments such as memory or balance • develop a care plan that supports both the patient and caregiver. FOR AN APPOINTMENT OR MORE INFORMATION, PLEASE CALL 315-464-5166. Upstate is a NYS Center of Excellence for Alzheimer’s Disease. It serves Central New York. www.upstate.edu/aging
Center of Excellence for Alzheimer’s Disease Upstate Specialty Services at Harrison Center Suite A, 550 Harrison Street Syracuse, NY 13202
Expertise . Compassion . Hope
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Students get to know patients, another view of health care BY JIM MCKEEVER
A PROGRAM sponsored by Upstate’s Center for Civic Engagement matches student companions with patients at the University Dialysis Center, a short walk from campus. e patients — most of whom undergo treatment three days a week, four hours at a time — appreciate having a student to talk to or play games with. e students enjoy developing friendships with the patients. ey commit to weekly or bi-weekly visits of an hour or 90 minutes. “My patient was shy at first,” says Megan Harris, who is in her second year of medical school. “He’s an older man with cool life stories. Once I got him talking, I’d listen and reflect on what he was saying. “Sometimes we talk about my life, and what I may be stressing about that week. He’s always appreciative. He’ll tell me, ‘You have no idea how much better this makes it when you’re here.’” Harris typically visits at 6 to 7 a.m., before her classes. Classmate Colleen Fei makes her visits on Saturdays. Fei says most patients like talking about anything other than dialysis. Time spent listening “tells you a lot about health care outside the minutiae of medicine. e patients face other barriers besides kidney disease. ey also provide their perspective of health care — what makes a good doctor or a bad doctor.” Harris says she feels for the patients who don’t have visitors. “I wish I could talk to all of them,” she said. “I love my classmates, but it’s nice to talk to someone on the other end of health care.” ●
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IN OUR COMMUNITY
Stop the bleed
You need to know this potentially lifesaving action A PERSON CAN BLEED TO DEATH within minutes. You can potentially save a life by intervening quickly to stop blood loss. Trauma centers such as the one at Upstate University Hospital are promoting a “Stop the Bleed” campaign, an effort to educate regular people about how to help someone who is bleeding severely. e traumatic injury could happen in a car crash, from a fall during a hike or as the result of a shooting. So first, a precaution: Be aware of your surroundings and, if necessary, move yourself and the injured person to safety. Call 911. And then, in the time before medical help arrives, here are three actions you can take to help save a life:
1. Apply pressure on the wound. Remove clothing to find where the bleeding is coming from and apply firm, steady pressure to the bleeding site, preferably with both hands. You can use a commercial dressing or pack the wound with any available cloth. Continue to apply firm, steady pressure on top of the dressing.
3. If one tourniquet does not control the bleeding, a second one can be placed even closer to the torso. Marx said an effort to increase survivability aer mass shootings began in 2012 aer 20 children and six adults were gunned down at Sandy Hook Elementary School in Newtown, Conn. Fellow trauma surgeon Jacobs attended the autopsies of the victims. “ere were five or maybe William Marx, DO, chief, trauma service six children who bled to death from extremity injuries,” Marx explained. “If they had a tourniquet, Jacobs thought they would have been able to survive.”
“You need to speak to them with kindness and explain it to them and say, ‘Hold on. We’re going to stop the bleeding. We’re going to get you to care.’ at makes a huge difference,” Jacobs told the newspaper.
Tourniquets were used on the battlefield during the Civil War, although not consistently, Marx said. eir use was popular during the wars in Iraq and Afghanistan. Military body armor does a good job of protecting the trunk of the body, but to guard against bleeding to death if they were hit in an extremity, Marx said soldiers would wear uncinched tourniquets on their arms and legs. at way, if a soldier was injured, he could cinch his own tourniquet to stop the bleeding and save his own life. ●
2. For injuries of the arms or legs in which the bleeding does not stop, apply a tourniquet.
REGISTER FOR A COURSE
is can be painful for the injured person, so it’s important to talk to them, Lenworth Jacobs, MD, told e New York Times. He’s a trauma surgeon and director of the trauma institute at Hartford Hospital in Hartford, Conn.
is is a thick, beltlike strap made of rubber or plastic that can be cinched tight and locked into place. It goes two or three inches above the wound, closer to the torso. “It’s really tight, and it’s not meant to be taken off,” said William Marx, DO, chief of the trauma service at Upstate. Mark the time you apply a tourniquet. at helps doctors at the hospital decide on treatment options, he said.
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Experts from Upstate’s trauma program offer a free “Stop the Bleed” program to individuals and groups. To learn about courses or schedule an educator to come to your place of business, contact Upstate Connect at 315-464-8668. Medical professionals can sign up for a train-the-trainer course.
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IN OUR COMMUNITY
Three
trailblazers PHOTO BY DREW OSUMI
BY AMBER SMITH
THEY’RE FRIENDS WHO HAVE MENTORED ONE ANOTHER. All three have been faculty members at Upstate for decades. ey’ve all earned “distinguished service professor” honors. And they’re all women. Sharon Brangman, MD, Patricia Numann, MD, and Ruth Weinstock, MD, PhD, are the medical pioneers featured in “Triple Triumph,” a book edited by two Syracuse University professors that is being distributed to medical schools throughout the United States. Google “Triple Triumph” and “Syracuse University” to download the book for free. “None was born to wealth. However, all three grew up in families that prized and prioritized education. is make-or-break importance of their supportive families (and other caring mentors) emerges unforgettably in how they transcended barriers,” SU’s Cathryn R. Newton, PhD, and Samuel Gorovitz, PhD, write in the book. 20
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IN OUR COMMUNITY
Meet the Upstate physicians highlighted in new book
Surgeon Patricia Numann, MD
Endocrinologist Ruth Weinstock, MD, PhD
in the hamlet of Denver (Delaware county) in the Catskills.
in Queens.
Was inspired by her mother, one of the first nurse practitioners in Syracuse.
the idea that surgeons could fix people.
her cousin, who was diagnosed with type 1 diabetes when they were in high school together.
Graduated from Syracuse University in 1977 and Upstate Medical University in 1981.
Upstate in 1965, after attending the University of Rochester.
Smith College in 1974 and then became the second woman to earn the dual MD/PhD degrees at Columbia University.
in 1970.
in 1984.
to be a surgeon, after observing doctors operate.
to help people who have diabetes.
Started her career in primary care before realizing that older adults were a marginalized group with unmet needs.
providing breast surgery to women; later she developed expertise in technically challenging surgeries on the thyroid, parathyroid and adrenal glands.
seeing patients in Upstate’s diabetes clinic, which operated a half day per week in the 1980s, in a space behind the hospital cafeteria.
Now serves as division chief of geriatrics and the Center of Excellence for Alzheimer’s Disease at Upstate.
an emeritus professor. After she retired in 2007, Upstate established the Patricia J. Numann Chair of Surgery, the school’s first endowed chair named for a woman.
medical director for the Upstate Joslin Diabetes Center, which she founded, and the division chief of endocrinology, diabetes and metabolism at Upstate.
Developed the specialized geriatrics clinical practice at Upstate.
the Patricia J. Numann Breast and Endocrine Surgery Center at Upstate.
multiple research projects on new approaches for the prevention and management of diabetes mellitus and its complications.
Became president of the American Geriatrics Society.
the first female chair of the American Board of Surgery and the second female president of the American College of Surgeons.
the American Diabetes Association’s Outstanding Physician Clinician in Diabetes in 2017.
Pioneered the study of ethnogeriatrics, the influence of ethnicity and culture on the health and well-being of older adults.
support for female surgeons through the creation of the Association of Women Surgeons in 1981. Today the organization has members in 21 countries.
one of the largest randomized studies of telemedicine ever conducted, in collaboration with researchers at Columbia University.
filmmakers with a segment about her for “Icons of Surgery,” a documentary produced by the American College of Surgeons.
review grants, safety monitoring and issues related to diabetes research and patient care for the National Institute of Diabetes and Digestive and Kidney Diseases, the American Diabetes Association and other national, regional and local committees and task forces.
obtaining a patent at the age of 72 for a unique scoring system used for an e-learning course called the Fundamentals of Surgery.
her parents, for encouraging her desire to become a doctor after a school guidance counselor told her only men were doctors and that she could become a nurse.
Geriatrician Sharon Brangman, MD Grew up in New York City, until her family moved to Syracuse when she was 13.
Joined the Upstate faculty in 1989. Always wanted to bring health care to marginalized individuals.
Helped write “Doorway Thoughts: Crosscultural Healthcare for Older Adults” with the American Geriatrics Society’s Ethnogeriatrics Committee. It’s a book to help health care professionals interact with patients of ethnic, racial or religious backgrounds that differ from their own. Is proud of the geriatric medicine fellowship she founded at Upstate, which has trained more than 50 geriatricians.
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IN OUR LEISURE
Event on ice raises money for kids’ fund The Utica Curling Club was the site of an event that raised money for pediatric services at the Upstate Cancer Center.
BY AMBER SMITH
A DOZEN CURLING TEAMS, comprised of 48 novice curlers, competed in an Upstate charity invitational in November at the Utica Curling Club in Whitesboro. Upstate employees and friends created teams with names such as “Curl Power,” “e Sweeping Beauties” and “Curling Dervishes.” In the morning, they received an introduction to the sport of curling, plus practice time. ey paraded onto the ice with a bagpipe accompaniment shortly aer noon. en the games began. e event raised $900 for the Upstate Cancer Center’s “Kids with Cancer” fund – and gave participants a sample of an Olympic sport. e fund is administered by the Upstate Foundation. continued on page 23 The Sweeping Beauties curling team included pediatric oncologist Gloria Kennedy, MD, far left, and pediatric residents Meghan Jacobs, MD, Robyn Borsuk, MD, and nurse practitioner Brooke Fraser.
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Event on ice
IN OUR LEISURE
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Curling is also known as “the roaring game” because of the rumbling sound made by the granite stones on the ice. Water droplets freeze into tiny bumps on the surface, creating pebbled ice, which gives the stones a better grip and makes for more consistent curling. e Scottish island, Alisa Craig, provides the blue hone granite to make curling stones. Players advance the stone by sweeping the ice surface in the path of the stone with a curling broom, or brush. eir shoes look like athletics shoes, but the soles are different. e foot used for sliding typically has a Teflon sole, and the other has a rubbery sole for gripping the ice. Most curling leagues around the world are conducted without game officials, instead relying on players to follow the spirit of curling: that is, a curler would rather lose than win unfairly. Games begin and end with handshakes among the participants.
Douglas Rosenthal, far right, of hospital information systems, organized the fundraiser. Other participants included, from left, Steve Susco, Sue Hemingway, Tina Craig, Chris Ousby, Suzan Bzdick, John Bartosek and Susan Rosenthal. l
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e 1924 Olympics in Chamonix, France were the first to feature curling. Wheelchair curling was included for the first time in 2006 in the Paralympic Games in Turin, Italy. Curling is thought to be one of the world’s oldest team sports. It was written about in Latin in 1540. An activity being played on frozen ponds is depicted in paintings by Pieter Bruegel during that same timespan. ●
Syracuse University Head Football Coach Dino Babers, front row, second from left, visited the Upstate campus to appear in a television spot for the Upstate Cancer Center. With Babers are members of the Upstate Cancer Center team, including Jeffrey Bogart, MD, front row, right, professor and chair of radiation oncology and the center’s interim director.
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750 East Adams Street l Syracuse, NY 13210
SCIENCE IS ART IS SCIENCE IS ART 1S SCIENCE
PHOTO BY WILLIAM MUELLER
PROSTATE CANCER RESEARCH
17.414 0118 44.085M dellassk
IF DOCTORS could tell which tumors would remain indolent and which would become invasive, they could better treat men with prostate cancer. About 3 percent of men who are diagnosed with prostate cancer have an aggressive type, shown in these images from the laboratory of associate professor Leszek Kotula, MD, PhD, standing above. Kotula, together with doctoral student Disharee Das, focuses on a gene he discovered two decades ago called Abi1, which causes prostate cancer. î ˘ey want to learn how it interacts with other genes and whether it plays a role in leukemias and breast, ovarian and other cancers.