News Briefs

Rao receives AGA award

Satish S.C. Rao, MD, PhD, professor of internal medicine, has been selected by the American Gastroenterology Association (AGA) to receive a Distinguished Educator Award at its national meeting on May 21 in Washington D.C. Rao will receive the award to honor his outstanding contributions to the field of gastroenterology and to recognize his exceptional teaching ability.

Rao came to the UI Carver College of Medicine in 1991 as an assistant professor. He was promoted to associate professor in 1997 and full professor in 2002. He is also the director of the neurogastroenterology and GI motility and anorectal manometry and biofeedback program and directs the annual Iowa Symposium on GI Motility. His research interests are in neurogastroenterology and motility. He has developed a new system for studying ambulatory colonic motility in humans, and pioneered several techniques for studying and treating anorectal dysfunction, particularly in patients with constipation and incontinence.

Rao has been recognized for his work with numerous honors and awards, including an AGA Distinguished Clinician Award in 2003 and an AGA Masters Award for Outstanding Clinical Research in Gastroenterology in 2006.

U.S. News ranks CCOM programs

U.S. News & World Report once again gives high rankings to research and education at the UI Carver College of Medicine.

In particular, the 2008 edition of “America’s Best Graduate Schools” ranks the Carver College’s Physician Assistant Program No. 1 and the specialty of rural medicine No. 4 among both public and private institutions. These are new rankings for 2007. The College’s Physical Therapy Graduate Program was previously ranked No. 5 nationally, which still stands.

Several College programs also are newly ranked among the top 15 public institutions: Internal Medicine (No. 10), Family Medicine (No. 13) and Primary Care (No. 14). In addition, the College is ranked 13th in the nation for medical research among public institutions.

“These rankings are a clear indicator of the College’s continued national prominence in medical education and research,” said Peter Densen, MD, executive dean of the College. “Our highly ranked programs are shining examples of the excellence that underpins our academic enterprise, a key cornerstone of our ability to deliver compassionate and cutting-edge care to our patients and the state.”

Following are all ranked College specialties and programs. The ranking number provided at the front end of each entry is the ranking as compared to other public universities. The overall ranking, comparing UI colleges and programs to all public and private universities, is listed at the end of the entry in parentheses.

Rankings with an asterisk (*) are new for the 2008 issue of “America’s Best Graduate Schools.” All others were made in previous years but still stand.

*1 Physician Assistant, master’s/doctorate (1)

3 Physical Therapy, master’s/doctorate (5)

*4 Medical Specialty- Rural Medicine (4)

*10 Medical Specialty- Internal Medicine (24)

*13 Medical Specialty- Family Medicine (15)

*13 Carver College of Medicine- Research - Public (30)

*14 Carver College of Medicine- Primary Care (18)

“Blue-Light” therapy and cancer

The addition of photodynamic, or “blue-light,” therapy at UIHC is helping dermatologists ward off skin cancer in patients with actinic keratoses.

Also known as solar keratoses, these scaly bumps range in size from pinhead to one inch and appear primarily in sun-exposed areas on the face, ears, head, lips and back of the hands and forearms. If left untreated, an estimated 10 percent of these precancerous lesions may eventually evolve into a type of skin cancer called squamous cell carcinoma.

The hospital has treated about a dozen patients since acquiring the technology in the spring, said Vincent Liu, MD, clinical assistant professor of dermatology in the UI Carver College of Medicine.

“Photodynamic, or blue-light, therapy for actinic keratosis can help treat and reduce the number of precancers, hopefully reduce the number of full-fledged skin cancers and possibly help in photo-rejuvenation,” Liu said.

Pioneered in Europe, the therapy works by applying a light-sensitizing chemical solution to the skin area needing treatment and then exposes the area to blue light. The photosensitive chemicals, which have been absorbed into the skin, react with the particular wavelength of blue light to generate reactive oxygen radicals that destroy the potentially precancerous or cancerous skin cells.

Liu said researchers are interested in exploring whether photodynamic therapy can be used to treat other skin conditions, including acne and acne-related conditions.

Class size to increase

Beginning this fall, the UI Carver College of Medicine will admit more first-year students under a recently finalized plan. The class of 2011, which will arrive on campus in August, will number 148 compared with the current class size of 142.

The Association of American Medical Colleges has called on U.S. medical schools to increase enrollment by up to 30 percent by 2015. The association predicts an overall shortage of physicians by 2020, predicated partly on an expected rise in demand for medical services by aging baby boomers.

The College can increase its medical classes by six students “without significantly impacting the quality of education and without significantly increased investment in facilities, teaching demands or dilution of the clinical experience,” said a task force empaneled by Dr. Jean Robillard, (’74 F), UI vice president for medical affairs and dean of medicine. Task force members surveyed clerkship and curriculum directors, faculty and medical students in reaching its conclusions. They assessed the potential impact of a class size increase on facilities, teaching resources and quality of applicants accepted for admission. The medical class size has been 142 since 2002.

Children’s Hospital changes name

The Children’s Hospital of Iowa within University of Iowa Hospitals and Clinics officially changed its name to University of Iowa Children’s Hospital in order to emphasize its long history as a part of the University.

Michael Artman, MD, physician-in-chief at University of Iowa Children’s Hospital, said that a market survey conducted during the summer 2006 found that the link between Children’s Hospital of Iowa and the UI was not clear to respondents.

“More than half of the survey’s respondents told us that they thought University of Iowa Children’s Hospital was, in fact, our name already,” Artman said. “We carefully considered that feedback and decided that the new version will more clearly demonstrate that our hospital is part of the University of Iowa.”

Autism researchers report finding

Thomas Wassink, MD, (’97 R, ’98 F, ’99 F), associate professor of psychiatry, and Val Sheffield, MD, PhD, professor of pediatrics and a specialist with University of Iowa Children’s Hospital, announced preliminary results from the largest genome scan ever conducted in autism research.

The research consortium discovered a previously unidentified region of chromosome 11, and neurexin 1, a member of a family of genes believed to be important in neuronal contact and communication. The neurexin finding highlights a special group of neurons, called glutamate neurons, and the genes affecting their development and function, suggesting they play a critical role in autism spectrum disorders.

This research was performed by more than 120 scientists from over 50 institutions representing 19 nations who formed a first-of-its-kind autism genetics consortium, the Autism Genome Project.

“This is exciting news because we have now narrowed the search area on the human genome. The neurexin finding, in particular, has emerged from contributions made by the Iowa autism research team, and we are spearheading the neurexin follow-up work. We have a much better idea about where to look for factors that might make a child susceptible to developing an autistic disorder,” Wassink said. “Now we can move forward to more precisely pinpoint those genes, which may eventually help us develop better treatments for the disorder.”

Building on their previous success, the researchers will now apply state-of-art “gene-chip” technologies to scan the genome for association with new genetic markers, as well as sub-microscopic copy number variations (CNVs) along chromosomes in autism.

PA graduates excel at exam

The UI Carver College of Medicine Physician Assistant (PA) Program recently distinguished itself as one of the nation’s best when its 2006 graduates scored among the highest out of all PA programs in the country on their national certification examinations.

The 23 students from the class of 2006 achieved a 100 percent pass rate on the examination, compared to a national average pass rate of 92 percent.

This achievement makes 11 consecutive years without a single graduate from the UI program failing this examination. This year’s perfect pass rate placed the UI above the 98th percentile—the highest percentile reported this year—of 130 PA programs with more than five graduates taking the exam for the first time.

From 1974 through 2006, the UI program has a first-time pass rate of more than 99 percent, compared to a national average of 86 percent for the same period. More than 60 percent of the didactic coursework completed by PA students is taken with second-year UI medical students, making the PA program unique among other institutions with physician assistant programs.

“The strength of our curriculum certainly has been a key to our students’ success on the certification exam,” said David Asprey, (’87 BS, ’93 MA, ’99 MD), director of the PA Program. “We are proud of the tradition of excellence that our program has attained and equally pleased to know that our graduates are well prepared to enter the profession and provide high quality medical care to the citizens of Iowa and our nation.”

What makes arctic animals’ biological clocks tick?

How do animals living in 24 hours of light during the Arctic summer know when to sleep and when to be active? Answering this question may improve our understanding of biological clocks—the internal, genetically programmed cycle of rest and activity that affects the behavior, metabolism and physiology of all animals, including humans. A better understanding may also help solve problems, such as shift-work fatigue, jet lag and even seasonal affective disorder, often associated with disruption of the biological clock.

G. Edgar Folk, PhD, emeritus professor of molecular physiology and biophysics at the UI Carver College of Medicine, has spent a lifetime pursuing these questions and finding answers that have helped build the field of biological clock research.

Folk notes that humans have a natural circadian rhythm of close to, but not exactly, 24 hours. All biological clocks are adjustable and respond to environmental cues such as sunrise or sunset, which continuously reset the clock and keep us on a regular 24-hour schedule.

However, previous research, including studies in Folk’s lab, has shown that lab rats kept in continuous light develop a 26-hour cycle of rest and activity, meaning their peak of activity travels around our usual daily 24-hour clock. This phenomenon is called the “Aschoff Effect” after a German scientist who first recorded it in the 1960s. Folk some time ago set out to determine if this effect was also seen in wild animals during the continuous light of the Arctic summer.

“In continuous light in the lab, the animal’s clock changes depending on the intensity of the light,” Folk explained. “We thought that would also happen in the Arctic. Much to our surprise, the Arctic animals maintained a very crisp 24-hour period of activity.”

Working at Folk’s permanent Arctic field lab at Barrow, Alaska, the research team studied two types of Arctic rodent: nocturnal porcupines and day-living ground squirrels.

Heart rates—a good measure of metabolism and activity—from four porcupines and direct observation of nine squirrels’ activity showed that both creatures retained a 24-hour rhythm of behavior, just as they would if they were living under a normal day/night situation.

“We postulate that animals are conscious of where the sun is in the sky and that the nearness of the sun to the horizon could be a clue to animals, and even plants, to keep on a 24-hour schedule.”

Buckwalter receives award

Joseph A. Buckwalter IV (’69 BA, ’72 MS, ’74 MD, ’79R), professor and head of the UI Carver College of Medicine Department of Orthopaedics and Rehabilitation, received the Orthopaedic Research Society/American Orthopaedic Association Alfred R. Shands Jr. Award.

“I am pleased and honored to receive the Alfred R. Shands Award. The work that led to this award was made possible by the unique opportunities I have had at The University of Iowa, and the encouragement and support I have received from the faculty, residents and staff in the Department of Orthopaedics,” said Buckwalter.

The award was given in recognition of his lifelong contributions of knowledge to orthopaedics, and for his efforts in helping to expand upon new ideas in the field of musculoskeletal disease.

Smoking ups chances of cleft lip

A fetus that lacks both copies of a gene involved in detoxifying cigarette smoke and whose mother smokes during pregnancy has a substantially increased risk of developing a cleft lip and/or palate, according a University of Iowa-led international study.

About 25 percent of babies of European ancestry and up to 60 percent of those of Asian ancestry lack both copies of the gene, which is called GSTT1. The finding is believed to mark the first time a gene-environment interaction in clefting has been documented at the molecular level.

“If a pregnant woman smokes 15 cigarettes or more per day, and her fetus doesn’t have any working copies of the GSTT1 gene, then the chances of the fetus developing a cleft increase nearly 20 fold,” said Jeff Murray, MD, the study’s senior author and professor of pediatrics in the UI Carver College of Medicine, with joint appointments in pediatric dentistry in the College of Dentistry, biology in the College of Liberal Arts and Sciences, and epidemiology in the College of Public Health.

Without the functioning gene, a fetus cannot remove the toxins that may be transferred across the placenta when the mother smokes.

Murray said the bulk of the research was carried out by Min Shi, (’02 MS, ’04 MS, ’05 PhD), a former UI graduate student in biology who is now a researcher at the National Institute of Environmental Health Sciences.

The UI teamed with colleagues in Denmark to assemble a list of 16 genes of interest, each of which encode proteins that plug into various pathways involved in detoxifying chemicals.

Using an existing database of 1,244 children with clefts, as well as their parents and siblings, the scientists analyzed 5,000 DNA samples. Data from participating families in Denmark and Iowa helped the team independently confirm the findings. The Iowa data was gathered through the Iowa Registry for Congenital and Inherited Disorders.

Protein may promote migraines

Andrew Russo, PhD, professor of molecular physiology and biophysics in the UI Carver College of Medicine, found through a recent study an explanation for why some people get migraine headaches while others do not. The researchers found that too much of a small protein called RAMP1 appears to “turn up the volume” of a nerve cell receptor’s response to a neuropeptide thought to cause migraines.

The neuropeptide is called CGRP (calcitonin gene-related peptide) and studies have shown that it plays a key role in migraine headaches. In particular, CGRP levels are elevated in the blood during a migraine, and drugs that either reduce the levels of CGRP or block its action significantly reduce the pain of migraine headaches. Also, if CGRP is injected into people who are susceptible to migraines, they get a severe headache or a full migraine.

“We have shown that this RAMP protein is a key regulator for the action of CGRP,” said Russo. “Our study suggests that people who get migraines may have higher levels of RAMP1 than people who don’t get migraines.”
The research team included Zhongming Zhang, PhD, postdoctoral fellow, Christina Winborn, graduate student, and Blanca Marquez de Prado, PhD, postdoctoral fellow. Russo also noted that Donna Hammond, PhD, professor and interim head of pharmacology and professor of anesthesia, was instrumental in measuring the neuronal-induced inflammation in the mouse model.

NICU earns excellence status

The University of Iowa Children’s Hospital received designation as a member of the United Resource Networks Neonatal Centers of Excellence network, reflecting national recognition of the neonatology care it provides.
“This is yet another confirmation for the families of patients who require neonatal care that they are being treated by the nation’s experts,” said Michael Artman, MD, professor and head of pediatrics and physician-in-chief at University of Iowa Children’s Hospital. “Our faculty and staff provide unsurpassed care for these tiny patients and their families, and all Iowans can be proud of their skill, dedication and compassion.”

The Centers of Excellence network program evaluates and recognizes specific hospital, program and surgeon capabilities, including quality processes; adherence to evidence-based approaches; compliance with nationally recognized guidelines published by clinical societies and their broad capabilities in the continually evolving field of organ and tissue transplantation.

Testing for substance abuse

Genetic tests using blood samples already are used to diagnose some diseases and even personalize treatment. Now it is possible to develop similar tests that reveal a person’s potential to become dependent on nicotine or marijuana or have antisocial personality disorder.

These tests would not dictate who becomes substance dependent or will have behavioral problems, as genes do not function in isolation, but are influenced by other genes and environmental factors, said the study’s lead author Robert Philibert, (’89 MD/PhD, ’93 R), professor of psychiatry in the UI Carver College of Medicine.

Meds help improve post-stroke complex thinking

Antidepressant treatment appears to help stroke survivors with the kind of complex mental abilities often referred to as “thinking outside the box.” Sergio Paradiso, MD, PhD, (’01 R), assistant professor of psychiatry at the UI Carver College of Medicine, and the study’s corresponding author, found that people diagnosed with stroke who often have a decline in ‘executive functions’, that is, those mental abilities that enable us to respond appropriately to unfamiliar or complex situations, and support several cognitive, emotional and social capacities, showed improvement after receiving a 12-week treatment with antidepressants.

Antidepressant treatment already is known to improve mood in depressed post-stroke patients, but such therapy had not been examined on executive function in people with clinically diagnosed stroke.

The study began with 47 patients who had a stroke during the previous six months. These individuals were divided into three groups and randomly assigned (with the exception of those with certain medical conditions) to take the antidepressant fluoxetine (Prozac), the antidepressant nortriptyline (Aventyl or Pamelor) or a placebo (inactive substance).

Their executive functions were assessed using standard neuropsychological tasks at the end of 12 weeks of treatment, and again two years after the study had started. A total of 36 patients completed all the evaluations.

No significant differences were found between the antidepressant and placebo groups at the end of treatment. However, 21 months after the treatment ended, the placebo group showed continued worsening of the executive functions, whereas the group treated with antidepressants had clear and significant improvement, regardless of how their depressive symptoms changed.

The investigators hypothesize that antidepressants may foster recovery of neural tissue not directly destroyed by the stroke, yet because the effects are slow to appear, it can take months.