News

Edward M. Schwarz, PhD presented the CMSR Strategic Plan at the 2018 Town Hall Meeting.

Are value-based payment reforms, meant to cut medical costs and improve care, hurting some patients?

Caroline Thirukumaran, a researcher at the University of Rochester Medical Center, is leading a multi-university team looking for an answer to that question.

Her project, aided by a four year $1.5 million National Institutes of Health grant, comes at a time when the U.S. medical system—rated among the world's most expensive by a 2017 Commonwealth Fund report—is in flux. Policy experts, providers and politicians are looking for ways to lower costs without sacrificing or even improving quality or access to care.

It has long been established that in the United States racial minorities have poorer outcomes, Thirukumaran says. Her research aims to see whether an alternative payment scheme designed to cut costs and improve care might be inadvertently shortchanging some of the most vulnerable patients.

The U.S. medical system has paid doctors, hospitals and other medical providers under a model called fee for service. It is a system that reimburses providers essentially the same way as some factory workers are paid, by the piece.

Two graduate students in the lab of Catherine K. Kuo, Associate Professor of Biomedical Engineering and Orthopaedics, received research awards for their poster presentations at the Orthopaedic Research Society (ORS) Tendon Section Conference in Portland, OR November 15 -- 17, 2018.

Phong Nguyen received a Poster Award for his poster, "Characterization of Tendon Cell Proliferation Rate and Development of Senescence In Vitro," as well as a Travel Award to attend the conference. Jose Suarez-Loor also received a Travel Award to attend the conference and present his poster, "A Novel Chick Embryo Model to Study Scarless Embryonic Tendon Wound Healing."

University of Rochester Medical Center urologist Ahmed Ghazi, M.D., has been awarded first place at the Falling Walls Lab Finalein Berlin, Germany. His presentation was selected from among 100 finalists from institutions from across the globe who were given the opportunity to pitch breakthrough ideas in science to a jury of academic and business leaders.

Ghazi was awarded for his presentation titled "Breaking the Wall of Surgical Errors" which describes the work of the URMC Department of Urology Simulation Innovation Laboratory and its innovative approach to building patient-specific replicas of anatomy that allow surgeons to practice complex case prior to the actual surgery.

During his presentation in Berlin, Ghazi cited the fact that an estimated 1,000 deaths 10,000 serious complications occur every year from preventable medical errors and half of these errors are due to poor performance during complex surgeries.

"To address the challenge of surgical errors, we used the aviation industry as a source of inspiration," said Ghazi. "It is one of the few high stakes industries that have reduced errors to less than one percent due to the widespread use of advanced flight simulators that allow pilots to train in a fully immersive environment."

Study analyzes bacteria in the gut to inform feeding, boost growth and development supported by the National Institutes of Health-funded Respiratory Pathogens Research Center at URMC

About half of babies born prematurely struggle to grow, putting them at risk of health problems that can last a lifetime. Despite years of research, physicians lack a method that consistently helps these infants thrive. A study suggests that the gut microbiome -- the trillions of tiny bacteria that live in the digestive tract -- could help doctors personalize nutrients and feeding patterns to help the most vulnerable babies get a stronger start to life.

Peering into Poop

From the moment we're born, the bacteria that live in and on us influence the development and function of every major system in the body. These microorganisms are essential for our health, and poopy diapers contain a treasure trove of information about the ones that live in a baby's gut. Steven Gill, Ph.D.

A team of pediatricians and microbiologists at the University of Rochester Medical Center collected stool samples from 95 preterm infants, born at an average of 29 weeks. Samples were taken weekly while the infants were treated in the neonatal intensive care unit, which ranged from a few weeks to six months.

The researchers analyzed shifts in the gut microbiome over time and the type and amount of nutrients each baby received. They found that the gut bacteria go through changes as a baby matures and identified distinct phases where particular categories of good bacteria dominate.

They also discovered that when the good bacteria thrived, the infants matured more quickly. Infants whose bacterial colonies remained stagnant saw slower rates of growth.

A Wilmot Cancer Institute study uncovers how a single gene could be at fault in acute myeloid leukemia (AML), one of the deadliest cancers. The breakthrough gives researchers renewed hope that a gene-targeted therapy could improve AML survival rates, which have not budged in recent years.

The gene, known as EVI1, rewires the entire panoply of blood-forming cells and tissues by binding to certain DNA molecules and wreaking havoc. Knowing where EVI1 locks into the genome helps scientists understand the mechanisms that drive the disease at its core.

Now, researchers can envision a new approach to treating AML, focused on blocking EVI1's ability to bind to other genes, according to the study, published in Nature Communications.

"It's not so pie-in-the-sky anymore to think we can interrupt the process within the genome that leads to leukemia," said senior author Archibald Perkins, M.D., Ph.D., professor of Pathology and Laboratory Medicine at the University of Rochester Medical Center. Co-senior author is Yi "Stanley" Zhang, Ph.D., research associate professor of Pathology and Laboratory Medicine.

Thanks to immunotherapy and other targeted approaches, treatments for many types of blood cancers have improved greatly but patients with AML have not benefitted as much. AML's five-year survival rate remains at around 25 percent. Although some leukemia patients can achieve a lasting remission with a blood and marrow transplant, the disease almost always relapses.

Scientists worldwide, including Perkins, have been studying the gene EVI1 for years, looking at its relationship to leukemia from different angles with the goal of finding a new treatment.

Wilmot investigators and co-authors Laura Calvi, M.D., and James Palis, M.D., and those who work in their labs, contributed substantially to the latest insights, Perkins said, by offering new perspectives on the hematopoietic system. They study the cells, organs, and tissues involved in blood production and the factors that may impact cancer development.

EVI1 is at the center of the investigation because when it's over-expressed — producing 10,000 to 50,000 copies compared to the low levels seen in healthy people — it changes the metabolism of immature blood cells as they become malignant. The collaboration allowed the Wilmot team to discover the importance of what happens after EVI1 is over-expressed and turned on permanently.

Hongbo Chi '98M (MS), '01M (PhD) and Ping Li '01M (MS), '03M (PhD) awarded alumni achievement award.

The Center for Musculoskeletal Research continues to be among the most represented at the Annual Meeting of the American Society for Bone and Mineral Research (ASBMR). The ASBMR Annual Meeting is a tremendous learning and networking opportunity. This year's Annual Meeting took place in Montreal, Canada from September 27th to October 1st. Several labs from the Center attended the meeting including the Ackert-Bicknell, Boyce, Eliseev, Jonason, Mesfin, Xing, and Yao labs.

Many of our trainees received the ASBMR Young Investigator Travel Award including Sarah Catheline (Jonason lab), Brianna Shares (Eliseev lab), and Jianguo Tao (Xing lab). Brianna Shares (Eliseev lab) also received a Travel Award to attend the 12th Forum on Metabolic Bone Diseases.

UR Medicine's CHAMPP team -- which includes sports medicine physicians, athletic trainers, physical therapists, and exercise physiologists -- is studying how a combination of athletic performance and life skills training can help young athletes not only perform better on the field, but also improve their longterm health and academic results. CHAMPP combines injury prevention, athletic performance training, nutrition, and academic support.

In partnership with the Eastside YMCA, Wegmans, and East and Webster high schools, UR Medicine launched a CHAMPP pilot in summer 2018. Three hours a day, three days a week, for 12 weeks, East High and Webster athletes came to the Eastside Y for athletic performance analysis and training delivered by Sports Medicine experts, along with nutrition counseling and post-workout meals prepared by Wegmans. The program collected health and performance statistics on each athlete before, during, and after the training -- and saw improvement in athletes' physical performance, as well as the factors that reduce injury and support good health.

With financial support from the Konar Foundation, Wegmans, and generous individual donors, a new session of female athletes from East and Webster has just begun their training sessions for the second round of pilot tests. In just the first weeks of the program, these athletes are seeing dramatic improvement in their strength and sports performance, as well as in their grades thanks to tutoring support they receive at each CHAMPP training day.

Gregg T. Nicandri, M.D., received the Arthroscopy Association of North America (AANA) Stephen J. Snyder Excellence in Teaching Award at the association's annual conference in Chicago in April. The award is granted to an AANA Education Instructor who demonstrates exceptional dedication and skill as a teacher.

Nicandri is an associate professor of orthopaedics and an AANA master instructor, who teaches several courses annually to residents from across the U.S. at the association's Orthopaedic Learning Center in Chicago. Nicandri designed a prototype for an arthroscopic skills training model, now known as the FAST Workstation, now used in orthopaedics residency training at academic medical centers around the country. Nicandri also developed the ASSET proficiency-based training tool, which objectively measures trainees' arthroscopic skills acquisition rather than relying on instructors' subjective observation of training outcomes.

The lab of Danielle Benoit, an associate professor of biomedical engineering, will hold its ninth annual fundraiser this weekend in support of Alex's Lemonade Stand Foundation and its efforts to cure childhood cancer. Donations are accepted online or by dropping by the lab's lemonade stand, being held from 10 a.m. to 1 p.m. Saturday June 9, at the Rochester Public Market, 280 North Union Street, or from 9 a.m. to 1 p.m. Sunday, June 10, at the Brighton Farmers Market, 1150 Winton Road South.

A Prebiotic May Alter the Obese Microbiome and Protect Against Osteoarthritis

Bacteria in the gut, known as the gut microbiome, could be the culprit behind arthritis and joint pain that plagues people who are obese, according to a new study published today in JCI Insight.

Osteoarthritis, a common side effect of obesity, is the greatest cause of disability in the US, affecting 31 million people. Sometimes called "wear and tear" arthritis, osteoarthritis in people who are obese was long assumed to simply be a consequence of undue stress on joints. But researchers at the University of Rochester Medical Center provide the first evidence that bacteria in the gut -- governed by diet -- could be the key driving force behind osteoarthritis.

The scientists found that obese mice had more harmful bacteria in their guts compared to lean mice, which caused inflammation throughout their bodies, leading to very rapid joint deterioration. While a common prebiotic supplement did not help the mice shed weight, it completely reversed the other symptoms, making the guts and joints of obese mice indistinguishable from lean mice.

What a Western, High Fat Diet Can Do

The URMC team, led by Michael Zuscik, Ph.D., associate professor of Orthopaedics in the Center for Musculoskeletal Research (CMSR), Robert Mooney, Ph.D., professor of Pathology and Laboratory Medicine, and Steven Gill, Ph.D., associate professor of Microbiology and Immunology, fed mice a high fat diet akin to a Western 'cheeseburger and milkshake' diet.

Just 12 weeks of the high fat diet made mice obese and diabetic, nearly doubling their body fat percentage compared to mice fed a low fat, healthy diet. Their colons were dominated by pro-inflammatory bacteria, and almost completely lacked certain beneficial, probiotic bacteria, like the common yogurt additive Bifidobacteria.

The changes in the gut microbiomes of the mice coincided with signs of body-wide inflammation, including in their knees where the researchers induced osteoarthritis with a meniscal tear, a common athletic injury known to cause osteoarthritis. Compared to lean mice, osteoarthritis progressed much more quickly in the obese mice, with nearly all of their cartilage disappearing within 12 weeks of the tear.

"Cartilage is both a cushion and lubricant, supporting friction-free joint movements," said Zuscik. "When you lose that, it's bone on bone, rock on rock. It's the end of the line and you have to replace the whole joint. Preventing that from happening is what we, as osteoarthritis researchers, strive to do -- to keep that cartilage."

Tendons, which connect muscle to bone, are commonly injured and often require surgical repair. More than 300,000 tendon repair procedures are performed each year in the United States alone.

However, tendons heal with excessive scar tissue, which decreases strength and range of motion and leads to poor outcomes, including decreased quality of life, chronic pain, and disability.

These complications become more severe in Type II Diabetes patients, who are up to five times more likely to experience a tendon tear or rupture than non-diabetics.

"Our understanding of the mechanisms that govern increased fibrotic healing in diabetic tendon remains limited," says Alayna Loiselle, an assistant professor of orthopaedics, "and this gap in knowledge has resulted in few therapeutic targets to improve clinical outcomes."

She has received a 5-year, $1.694 million grant from the National Institute of Arthritis and Musculoskeletal and Skin Diseases to study the protein S100a4 as a key driver of scar-mediated tendon healing.