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Feed for "Health + Behavior" newsUCLA RESEARCH ALERTFINDINGS

UCLA researchers have discovered that timing is everything when it comes to preventing a specific gene mutation in mice from developing rare and fast-growing cancerous tumors, which also affects young children. This mutation can also cause a benign tumor condition in humans in adulthood.

The scientists found that when one tumor suppressor gene is turned off or inactivated during early stages of a developing mouse embryo, it induces the formation of a malignant tumor. The research demonstrates that this type of malignant tumor will not form if the gene is inactivated during later stages of nerve development. However, when combined with the inactivation of a second tumor suppressor, non-cancerous tumors develop in older mice.

The research, led by Dr. Marco Giovannini, a member of UCLA’s Jonsson Comprehensive Cancer Center and senior author of the study, is the first of its kind to analyze the functional role of mutations in a mouse model with both tumor suppressor genes known as SMARCB1 and NF2.

BACKGROUND

A tumor predisposition syndrome is a genetic disorder in which inherited genetic mutations predispose the affected individuals to the development of multiple tumors. People who carry SMARCB1 gene mutations are predisposed to either rhabdoid tumor predisposition syndrome or familial schwannomatosis syndrome, but the mechanisms causing one or the other disease are still unknown.

The rhabdoid tumor predisposition syndrome affects infants and toddlers who develop malignant, highly aggressive tumors mainly in the brain, spinal cord, kidney and other soft tissues. Treatment for rhabdoid tumors involves surgery and chemotherapy, but patients have a poor prognosis.

Adults with SMARCB1 gene mutations are at higher risk of developing familial schwannomatosis, typically developing non-cancerous schwannoma tumors, which can affect any nerves inside the human body. Symptoms can include painful lumps or tingling and numbness that are treated with surgery. 

METHOD

Giovannini and his colleagues used genetically modified mice to induce different gene mutations during development of rhabdoid and schwannoma tumors. The researchers also found that malignant tumors in this mouse model had very similar molecular features to human rhabdoid tumors.

IMPACT

The study’s findings will be used to refine and develop new therapies and treatments, which could benefit young children and adults with these tumor syndromes.

AUTHORS

Giovannini is a professor-in-residence in the department of head and neck surgery at the David Geffen School of Medicine at UCLA and first author Jeremie Vitte is an assistant researcher in the department of head and neck surgery at the medical school. Co-authors are Dr. Giovanni Coppola, associate professor in residence, and Fuying Gao, a data analyst in the department of psychiatry and biobehavioral sciences and in the Semel Institute for Neuroscience and Human Behavior at the medical school. Dr. Alexander Judkins, vice chair in the department of pathology at USC’s Keck School of Medicine, also contributed to this study.

JOURNAL

The study is published online in the journal Nature Communications.

FUNDING

The research is supported by the United States Department of Defense and the Children’s Tumor Foundation.

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20176/Mouse+brain+rhaboid+tumor.jpgMouse brain rhabdoid tumorImage of a mouse brain shows a rhabdoid tumor (the darker area at right).

A mouse brain with a rhabdoid (malignant tumor, shown in blue) 

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20176/Mouse+brain+rhaboid+tumor.jpgMouse brain rhabdoid tumor

A mouse brain with a rhabdoid (malignant tumor, shown in blue) 

ReggieKumar310-206-2805reggiekumar@mednet.ucla.eduFindings from the research, led by UCLA’s Dr. Marco Giovannini, will be used to refine and develop new therapies and treatments, which could benefit young children and adults with these syndromes.Reggie Kumarhttp://newsroom.ucla.edu/releases/study-provides-insight-into-link-between-two-rare-tumor-syndromesMon, 21 Aug 2017 15:06:00 GMTUCLA physician says key mutation can be easily detected through blood or saliva analysis UCLA Health Dr. Christopher Childers

Of the nearly 4 million women in the United States who have had either breast cancer or ovarian cancer, at least 1.5 million have a high risk of carrying certain types of genetic mutations that could increase their risk for additional cancers in the future.

And although the mutations, including those that affect the BRCA1 and BRCA2 genes, can be identified through a simple blood or saliva test, more than 80 percent of those women have not taken the test or even discussed it with a health care provider, according to a new study from the UCLA Fielding School of Public Health.

The study is published online August 18 in the peer-reviewed Journal of Clinical Oncology.

“Many of these women have inherited genetic changes that put them and their family members at risk for future cancers,” said Dr. Christopher Childers, a resident physician in the department of surgery at the David Geffen School of Medicine at UCLA and the study’s lead author. “Identifying a mutation is often important for surgical decision-making and cancer therapy, but its importance extends further than that. If individuals are aware that they have these mutations, they can take steps to lower their future cancer risk.”

Childers said people who know they have the mutations would be advised to undergo more frequent and specialized screening (such as breast MRI), consider preventive medications, undergo risk-reducing surgery or make lifestyle modifications (including improving diet and exercise habits, and stopping smoking).

Testing for BRCA1 and BRCA2 mutations, which are still the leading risk factors for inherited breast and ovarian cancer, has been available since the mid-1990s. But scientists now know that mutations in several other genes can increase the risk for breast and ovarian cancers; those mutations can also be detected by contemporary genetic tests.

The researchers examined data from the 2005, 2010 and 2015 National Health Interview Surveys, which are conducted by the Centers for Disease Control and Prevention. Then, drawing from the National Cancer Center Network’s guidelines for managing care for people with cancer, the scientists identified five criteria to determine women for whom the genetic test would be most beneficial:

  • Women who have had ovarian cancer.
  • Women who have had breast cancer, if:
    • they were diagnosed at age 45 or younger;
    • they were diagnosed at age 50 years or younger, and have a mother, sister or daughter who has had breast cancer;
    • they have a mother, sister or daughter who had breast cancer when they were 50 or younger; or
    • they have a mother, sister or daughter who has had ovarian cancer.

Of 47,218 women whose records were reviewed, 2.7 percent had had breast cancer. Among those who met at least one of these four criteria, 29 percent had discussed the genetic test with a health care provider, 20.2 percent were advised to undergo the test, and only 15.3 percent had taken it.

Some 0.4 percent of women in the survey had had ovarian cancer. Of them, 15.1 percent discussed the genetic test with a health care provider, 13.1 percent were advised to undergo the test and just 10.5 percent had taken it.

Based on those figures, the UCLA researchers estimated that 1.2 million to 1.3 million women in the U.S. who would be most likely to benefit from the test have not taken it.

“Many women are not receiving vital information that can aid with cancer prevention and early detection for them and their family,” said co-author Kimberly Childers, a genetic counselor and regional manager of the Providence Health and Services Southern California’s clinical genetics and genomics program. “Thus, we have identified an incredible unmet need for genetic testing across the country.” 

The paper suggests some reasons that so few women have undergone the test, including that NCCN guidelines have changed over the years, and the relatively small number of board-certified genetic counselors who specialize in cancer testing. (The researchers also note that genetic counselors are unevenly distributed throughout the country, with 500 in California but only five each in Wyoming, Alaska, Missouri and Mississippi.)

“Also, when women change doctors, their new physicians may not be aware of their histories or of the new eligibility guidelines,” said James Macinko, professor of health policy and management and of community health sciences at the Fielding School, and the study’s senior author.

The study has some limitations, including that data was self-reported and not verified by medical records, and that subjects may not have accurately remembered whether they discussed or took the genetic test.

Childers received postdoctoral scholarship funding from the Agency for Healthcare Research and Quality.

Dr. Melinda Maggard-Gibbons, professor of surgery at the Geffen School of Medicine, was a co-author of the study.

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20177/Christopher+Childers+UCLA+Health.jpgDr. Christopher ChildersDr. Christopher Childers

Dr. Christopher Childers, a resident physician in the department of surgery at the David Geffen School of Medicine at UCLA

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20177/Christopher+Childers+UCLA+Health.jpgDr. Christopher Childers

Dr. Christopher Childers, a resident physician in the department of surgery at the David Geffen School of Medicine at UCLA

EnriqueRivero310-267-7120erivero@mednet.ucla.eduUCLA’s Christopher Childers says the relevant genetic mutations can be easily detected through blood or saliva analysis.Enrique Riverohttp://newsroom.ucla.edu/releases/few-women-with-history-of-breast-cancer-and-ovarian-cancer-take-a-recommended-genetic-testFri, 18 Aug 2017 20:00:00 GMTUCLA RESEARCH ALERTFINDINGS

Women who have gone through menopause and who have been using a vaginal form of estrogen therapy do not have a higher risk of cardiovascular disease and cancer than women who have not been using any type of estrogen.

Among women with an intact uterus, the risks of stroke, invasive breast cancer, colorectal cancer, endometrial cancer and pulmonary embolism/deep vein thrombosis were not significantly different between vaginal estrogen users and nonusers. The risks of coronary heart disease, fracture and premature death were lower in users than non-users. The risks of coronary heart disease, stroke, cancer and pulmonary embolism/deep vein thrombosis for women who had undergone hysterectomies were not significantly different in users of vaginal estrogen compared to nonusers. 

BACKGROUND

Randomized trials and other studies have shown that women who take estrogen therapy in the form of a pill may have an increased risk of blood clots, stroke and if the estrogen is used together with progestogen pills, invasive breast cancer. Some women take a vaginal form of estrogen, and it has not been known whether that treatment carries risks similar to the tablet form.   

METHOD

The researchers examined data from participants in the Women’s Health Initiative Observational Study who were recruited at 40 U.S. clinical centers and were ages 50 to 79 when they began the study.

IMPACT

This study, the first to examine potential adverse health effects in users of vaginal estrogen compared with non-users, suggests that vaginal estrogen therapy is a safe treatment for genitourinary symptoms such as burning, discomfort, and pain during intercourse associated with menopause.

AUTHORS

The paper’s authors are Dr. Carolyn Crandall of UCLA; Kathleen Hovey of the State University of New York at Buffalo; Christopher Andrews of the University of Michigan; Dr. Rowan Chlebowski of City of Hope; Marcia Stefanick of Stanford University; Dr. Dorothy Lane of the State University of New York at Stony Brook; Dr. Jan Shifren and Dr. JoAnn Manson of Harvard University; Chu Chen of the Fred Hutchinson Cancer Research Center; Andrew Kaunitz of the University of Florida; and Jane Cauley of the University of Pittsburgh.

JOURNAL

The study was published today in the peer-reviewed journal Menopause.

FUNDING

The research was supported by the Women’s Health Initiative, which is funded by the National Heart, Lung, and Blood Institute, the National Institutes of Health and the U.S. Department of Health and Human Services.

DISCLOSURES

Kaunitz serves as a consultant for: Allergan, AMAG, Pfizer and Shionogi. He receives research grants from TherapeuticsMD, with funds paid to the University of Florida. He also receives royalties from UpToDate.

Chlebowski serves as consultant for Amgen, Genentech, Novartis, Astra-Zeneca and Pfizer. He also is on speaker’s panel for Genentech and Novartis.

Shifren serves as a research consultant to the New England Research Institutes.

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20177/Womens+Health+Initiative+logo.jpgWomens Health Initiative logo

Womens Health Initiative logo

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20177/Womens+Health+Initiative+logo.jpgWomens Health Initiative logo

Womens Health Initiative logo

EnriqueRivero310-267-7120erivero@mednet.ucla.eduUCLA-led study is the first to examine potential adverse health effects in users of vaginal estrogen compared with non-users.Enrique Riverohttp://newsroom.ucla.edu/releases/vaginal-estrogens-do-not-raise-risk-of-cancer-other-adverse-health-effectsWed, 16 Aug 2017 04:01:00 GMTInjectable gel holds promise as wound-healing material for strokes

A research team led by UCLA biomolecular engineers and doctors has demonstrated a therapeutic material that could one day promote better tissue regeneration following a wound or a stroke.

During the body’s typical healing process, when tissues like skin are damaged the body grows replacement cells. Integrins are class of proteins that are important in the cellular processes critical to creating new tissue. One of the processes is cell adhesion, when new cells “stick” to the materials between cells, called the extracellular matrix. Another is cell migration, where at the cell’s surface, integrins help “pull” the cell along through the extracellular matrix to move cells into place. However, these processes do not occur in brain tissue that has been damaged during a stroke. This is why scientists are trying to develop therapeutic materials that could promote this form of healing.

The injectable gel-like material, which is called a hydrogel, that the UCLA researchers developed helps this repair process by forming a scaffold inside the wound that acts as like an artificial extracellular matrix, and the new tissue grows around that.

Using an injectable gel isn’t new, but previous gel scaffolds resulted in weak blood vessels in the newly formed tissue. The new findings, published in Nature Materials, show that when the scaffold contains a specific integrin-binding molecule, the new blood vessels that are formed are stronger.

“The injectable gel scaffold is sort of like a garden trellis that plants use to grow on,” said Tatiana Segura, professor of chemical and biomolecular engineering, bioengineering and dermatology, who led the research. “By itself that’s good as incoming new tissue has something to support its growth. This new material is similar to a trellis with very specific fertilizer to help the plant grow healthy and strong.”

Even combining gels with a protein that promotes blood vessel formation, such as vascular endothelial growth factor, known as VEGF, the blood vessels in the new tissue inside the scaffold tend be leaky and also tend to clump too close together.

To overcome this, the researchers looked deeper at how integrin-binding molecules interacted with the gel and how these molecules influenced blood vessel growth.

They tested two types of scaffolds with different integrin-binding molecules. Both scaffolds also contained the VEGF protein. They found that one of the scaffolds — which bound with the integrin known as “α3/α5β1” — worked really well. It directed a higher quality of repair and of regeneration of blood vessels. In addition, they found that the α3/α5β1 binding scaffolds also guided the shape of the blood vessel, a process called morphogenic signaling.

The other integrin-binding scaffold they tested still had problems with leaky and clumping blood vessels.

“Beyond just the structural support for new tissue and blood vessels, the addition of specific integrin binding molecules for α3/α5β1, tells surrounding tissue to grow blood vessels that are strong and well-defined as opposed to other one we tested, where new blood vessels were prone to leaks and clumping too close together,” Segura said.

The lead author on the research was Shuoran Li, a 2017 UCLA doctoral graduate who was advised by Segura. Collaborators also include Dr. Thomas Carmichael, a neurologist and neuroscientist at the David Geffen School of Medicine at UCLA and Thomas Barker, a professor of biomedical engineering at the University of Virginia.

In this recent work, the researchers demonstrated that integrin binding can dictate blood vessel structure in vitro with the α3/α5β1-binding scaffold resulting in extensive networks that link up with existing blood vessel branches. Then the researchers used the same α3/α5β1-scaffolds in mice and saw blood vessels formed that were less leaky following stroke.

The next step, the researchers said, would be using integrin-binding molecules with other hydrogel technologies that have shown promise for long-term functional recovery after stroke, but in which newly grown blood vessels were not robust.

“Currently there is no therapy that promotes brain repair and recovery after stroke,” Carmichael said. “All of the therapies in stroke focus on the initial blockage in brain blood vessels that lead to stroke. This means that stroke is the most common cause of adult disability. This research is exciting because it shows a viable way to transform the dead and scarred tissue in stroke by growing new and well-formed blood vessels into the area of stroke.”

Lina Nih, a UCLA post-doctoral scholar and member of Segura’s lab, was also an author of the paper. Additional authors include UCLA researchers from the departments of chemistry and biochemistry, mechanical and aerospace engineering, and electrical engineering. Other authors are from Georgia Tech; Huazhong University of Science and Technology, China; and NovuMind Inc. in Santa Clara, California.

The research was supported by the National Institutes of Health.

Segura and collaborators have worked on biomaterials for tissue repair including, an injectable gel (distinct from this current research) and more recently, work that showed the gel could reduce inflammation and promote the migration of neural progenitor cells to the stroke site.

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20177/nV+star+edit-with-preferred-integrin-binding-molecule-mouse.jpgBlood vessels with preferred integrinA fluorescence-enhanced microscope image showing healthy-looking blood vessel growth following stroke, in a mouse.

A fluorescence-enhanced microscope image showing healthy-looking blood vessels growth following stroke, in a mouse.

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20177/nV+star+edit-with-preferred-integrin-binding-molecule-mouse.jpgBlood vessels with preferred integrin

A fluorescence-enhanced microscope image showing healthy-looking blood vessels growth following stroke, in a mouse.

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20177/nV+4G+edit-with-NON-preferred-integrin-binding-molecule-mouse.jpgBlood vessels with non-preferred integrin

A fluorescence-enhanced microscope image showing poor blood vessel grown following stroke, in a mouse model.

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20177/60x_RGD+1000uM+well3+2+match+3D-INVITRO.jpgEndothelial cells with preferred integrin

Endothelial cells (blood vessel cells) growing in a gel matrix with preferred integrin binding molecules.

AmyAkmal310-429-8689aakmal@support.ucla.eduThe injectable hydrogel works by forming a scaffold inside a wound that new tissue can grow around.Matthew Chinhttp://newsroom.ucla.edu/releases/ucla-researchers-demonstrate-new-material-that-could-aid-bodys-cellular-repair-processMon, 14 Aug 2017 21:45:00 GMTThe research may lead to new drugs that could promote hair growth for people with baldness or alopecia, which is hair loss linked to such factors such as hormonal imbalance, stress, aging or chemotherapy. Hologram technology developed at UCLA could lead to improved diagnoses of chronic diseases in remote areas

A new system developed by UCLA researchers could make it easier and less expensive to diagnose chronic diseases, particularly in remote areas without expensive lab equipment.

The technology uses extremely simple optical hardware and a lens-free microscope, as well as sophisticated algorithms that help reconstruct the images of tissue samples. It could make much-needed diagnostic testing available and affordable for people in developing countries and remote areas that lack the expensive lab equipment currently used to perform tissue biopsies.

The system for making biological samples transparent, also known as “tissue clearing,” and then imaging them using a lens-free microscope is described in an article published today in Science Advances, a journal of the American Association for the Advancement of Science. It was developed by a team led by Aydogan Ozcan, the UCLA Chancellor’s Professor of Electrical and Computer Engineering and Bioengineering and associate director of the California NanoSystems Institute; and Rajan Kulkarni, an assistant professor of medicine and dermatology at the David Geffen School of Medicine at UCLA, and a member of CNSI.

Tissue biopsy is widely considered the gold standard for detecting diseases like cancer and inflammatory conditions. But the test is relatively expensive and complex, and it requires the use of sophisticated facilities — a serious challenge in regions with limited resources.

In a standard biopsy, tissue is cut into thin slices, around one-tenth of the thickness of a human hair and stained with dyes, so that medical professonals can use a microscope to detect abnormalities and diseased cells. One challenge of that approach — beyond the time and cost involved — is that only a small number of tissue samples can be analyzed at a time.

“Although technological advances have allowed physicians to remotely access medical data to perform diagnoses, there is still an urgent need for a reliable, inexpensive means for disease imaging and identification — particularly in low-resource settings — for pathology, biomedical research and related applications,” Ozcan said.

The researchers prepared tissue samples using a technique called Clarity, which makes tissue transparent, or “clears” it, using a chemical process that removes fat and leaves behind proteins and DNA. The method typically requires fluorescent dyes, which can be costly, to stain the tissue samples, but one drawback of those dyes is that the staining tends to degrade over time, making it harder for scientists to gather information from it.

Instead, the UCLA researchers used colored, light-absorbing dyes which, according to Kulkarni, can be used with regular microscopy tools without any noticeable signal loss over time.

And instead of utilizing a machine that’s typically used for biopsy testing (a traditional microscope can cost more than $50,000), the UCLA scientists developed a new device made of components that collectively cost just a few hundred dollars: a holographic lens-free microscope that’s capable of producing 3-D pictures with one-tenth the image data that conventional scanning optical microscopes need to do the same thing.

The UCLA method also allowed the scientists to use tissue samples that were 0.2 millimeters thick, more than 20 times thicker than a typical sample — a critical benefit of the new system because producing thinner tissue slices is difficult without sophisticated equipment. This also enables scientists to study a larger sample volume, which could help them to detect abnormalities earlier than they otherwise would.

Here’s how the test works: First, the cleared tissue is placed in a small container on a silicon chip that contains millions of photo detectors — the same type of chip that’s found in mobile phone cameras. When light is shined on the tissue sample, low-resolution shadows from the tissue sample fall on the chip. Those shadows, created by the interference of light scattered by the sample, form holograms of the tissue sample.

Next, the researchers enhance the resolution and enable 3-D imaging by shifting the sample relative to the image sensor and capturing the same holographic shadow, allowing them to digitally view different cross-sections, or digital slices, of the tissue sample.

“Through computation and algorithms, we converted a standard 10-megapixel imager, like those commonly used in mobile phones, into a  few-hundred-megapixel microscope that can digitally image through different slices of a thick tissue sample,” said Yibo Zhang, the study’s first author and a graduate student in Ozcan’s lab.

Other members of the research team were Sam Yang, Hongda Wang, Da Teng and Yair Rivenson, all of the Ozcan Research Group; and Yoonjung Shun, Kevin Sung and Harrison Chen of Kulkarni’s lab.

Ozcan’s work is supported by the Presidential Early Career Award for Scientists and Engineers, the Army Research Office, the National Science Foundation, the Office of Naval Research, the National Institutes of Health, the Howard Hughes Medical Institute, the Vodafone Americas Foundation and the Mary Kay Foundation. Kulkarni’s work is supported by the UCLA Clinical and Translational Sciences Institute. 

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20177/Holographic+microscope+image.jpgHolographic microscope imageRendering of a lens-free holographic microscope that uses a silicon chip and computer algorithms to create 3-D images of tissue samples.

Rendering of a lens-free holographic microscope that uses a silicon chip and computer algorithms to create 3-D images of “cleared” tissue samples.

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20177/Holographic+microscope+image.jpgHolographic microscope image

Rendering of a lens-free holographic microscope that uses a silicon chip and computer algorithms to create 3-D images of “cleared” tissue samples.

MeghanSteele Horan310-206-5488meghan.horan@ucla.eduHologram technology developed at UCLA could lead to easier and less costly diagnoses of chronic diseases in remote areas and developing countries.Meghan Steele Horanhttp://newsroom.ucla.edu/releases/system-creates-3-d-images-of-tissue-samples-without-conventional-lensesFri, 11 Aug 2017 18:42:00 GMTTeitell, a renowned molecular immunologist and biochemist, was chosen after a national search and assumed leadership on Aug. 8.UCLA scientists report the first evidence that a gene outside the brain controls the ability to rebound from sleep deprivation. Free, six-week program offers students from historically disadvantaged backgrounds classes, training and mentoring

For many college students, the summer break means basking at the beach, traveling to exotic locales or just hanging out with friends. But this summer meant something quite different to a dedicated group of college students from disadvantaged backgrounds. Thanks to a free program offered by the David Geffen School of Medicine at UCLA, these students took part in a six-week summer program to further their dreams of becoming health care professionals.

“I was ecstatic about this opportunity and couldn’t wait to get involved,” said Nahun Flores, a 29-year-old who attends Chaffey College in Rancho Cucamonga, about 60 miles east of UCLA. Flores was one of 80 participants from underrepresented minorities and underprivileged backgrounds who have an interest in medicine, dentistry, nursing and other health professions who took advantage of the Summer Health Professions Education Program, known as SHPEP, for college sophomores, juniors and community college students.

A native of Nicaragua, Flores said he is grateful for the opportunity to participate in the program, which was administered at the Geffen School of Medicine and 12 other U.S. sites, thanks to a generous grant from the Robert Wood Johnson Foundation.

“When we migrated to the U.S.,” Flores said, “we had access to health care; however we encountered many challenges because of health disparities. Facing those challenges and going through those experiences has impacted my character and made me realize that I need to become a doctor so I can help out and make a difference in our community. I am a U.S. citizen now and I feel the need to give back. These people, my community, are my motivation and the burning fire in my heart that gets me going every day to pursue a career in medicine.”

Dr. Clarence Braddock, vice dean of education for the medical school and principal investigator for SHPEP, says the UCLA summer program also focuses on students “who are the first family member to go to college, who don’t have family role models or mentors, or who are otherwise socio-economically disadvantaged.”

The program exposes students to real-world health problems, lectures, patient experiences, small-group discussions and they must also complete a research project. Students also take classes in the basic sciences and math needed for health care professionals, as well as financial planning workshops. They learn study skills and receive coaching on how to interview, fill out applications and touch on important life skills. Upon completion of the program, the participants better understand the urgent need for health care professionals in medically underserved communities and of the educational pathways that lead to providing medical, dental, and nursing services to underserved populations.

“At the David Geffen School of Medicine at UCLA, we aspire to be a positive force for improving diversity in our profession,” Braddock said. “We seek to cultivate the brightest pool of applicants to our medical school to be more representative of minorities and people from disadvantaged backgrounds. This is one of the many ways we try to produce a more diverse physician workforce that meets the needs of our communities.”

“Many of the participants have seen family members struggle to get access to quality care, either because of cultural, socioeconomic or language barriers,” Braddock said. “Exploring these issues often makes them want to be part of the solution.”

Flores noted that the lack of health care he and his family experiences since he was a child is the reason he wants to become a physician. His goal is to open health centers in San Bernardino and Los Angeles counties for those who are unable to get medical attention due to health disparity reasons.

As Flores was nearing completion of the program, he said he was encouraged by the diversity of the medical school’s leaders and how they served as role models.

“What makes it special is that they have been in our shoes and are now doing great things including being involved with the program,” he said. “This is extremely inspiring for me as it exudes hope that the dream can come true for anyone coming from disadvantaged backgrounds. It simply sends the statement that the future is in our hands. Your hard work will pay off.”

One of those role models for the students is Braddock.

“Students have told me how empowering it was to hear that I grew up in a community not too different from where they’re growing up and went to a big public high school like they did, and that I struggled with my own self-doubt along the way,” Braddock said. “And yet I've become a physician and vice dean at a top medical school, so maybe they can too.”

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20177/Flores+and+Braddock.jpgFlores and BraddockNahun Flores, right, with Dr. Clarence Braddock, vice dean of education at the David Geffen School of Medicine at UCLA, was encouraged by the diversity of the medical school’s leaders.

Nahun Flores and Dr. Clarence Braddock. Flores was a student in the 2017 Summer Health Professions Education Program, known as SHPEP, at UCLA. Braddock is vice dean of education for the David Geffen School of Medicine at UCLA and principal investigator for SHPEP.

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20177/Flores+and+Braddock.jpgFlores and Braddock

Nahun Flores and Dr. Clarence Braddock. Flores was a student in the 2017 Summer Health Professions Education Program, known as SHPEP, at UCLA. Braddock is vice dean of education for the David Geffen School of Medicine at UCLA and principal investigator for SHPEP.

ElaineSchmidt310-267-8323eschmidt@mednet.ucla.eduThe free, six-week program offers students from historically disadvantaged backgrounds classes, training and mentoring.Roxanne Mosterhttp://newsroom.ucla.edu/stories/summer-program-at-ucla-helps-build-more-diverse-pipeline-for-health-care-fieldWed, 09 Aug 2017 17:11:00 GMTU.S. News and World Report lists UCLA medical centers among country’s best for 28th consecutive year

UCLA Health hospitals in Westwood and Santa Monica placed No. 1 in Los Angeles, No. 2 in California and No. 7 in the nation in the 2017–18 U.S. News and World Report rankings.

“UCLA Health is proud to be recognized for providing world-class treatment to patients from greater Los Angeles, across the state and around the globe,” said Johnese Spisso, president of UCLA Health, CEO of UCLA Hospital System and associate vice chancellor of UCLA Health Sciences. “Our long-standing commitment to excellence ensures that our patients and their families receive the most compassionate, comprehensive care possible from every member of our team.”

The annual rankings evaluate more than 4,500 medical centers nationwide in 16 medical specialties and nine relatively common procedures and conditions. The survey’s national honor roll names only 20 medical centers; UCLA Health has appeared on the honor roll for 28 consecutive years.

“Being among the best in the country requires continually striving to enhance all aspects of patient care,” said Dr. John Mazziotta, vice chancellor for UCLA Health Sciences and CEO of UCLA Health. “I commend the dedication of everyone at our hospitals, clinics and the David Geffen School of Medicine at UCLA.”

The medical specialty rankings assessed performance in 16 disciplines, recognizing hospitals that excel at treating patients who require more complex care. The methodology utilizes extensive publicly reported data such as patient outcomes, nurse staffing and hospital volume to measure quality, safety, efficiency, reputation and delivery of a wide range of care. Evaluation of 12 of the specialties was data-driven, focusing on performance in three primary dimensions of health care: structure, reputation and outcomes. The remaining four specialties were evaluated on hospital reputation only, determined by a survey of specialists.  

UCLA received top 10 rankings in eight specialties: ear, nose and throat (2); geriatrics (4); urology (4); ophthalmology at the UCLA Stein and Doheny Eye Institutes (5); nephrology (6); rheumatology (6); psychiatry at the Resnick Neuropsychiatric Hospital at UCLA (8) and pulmonology (10).

Only about 3 percent of 4,500 evaluated hospitals were ranked in even at least one specialty.

The nine relatively common procedures evaluated were: abdominal aortic aneurysm repair, aortic valve surgery, care for chronic obstructive pulmonary disease, colon cancer surgery, care for congestive heart failure, heart bypass surgery, hip replacement, knee replacement and lung cancer surgery.

“The top 20 hospitals that were highlighted on this year’s honor roll have delivered outstanding care and offer deep expertise spanning multiple specialties,” Ben Harder, chief of health analysis at U.S. News, said in a statement.

UCLA Health includes four hospitals on two campuses — Ronald Reagan UCLA Medical Center; UCLA Medical Center, Santa Monica; UCLA Mattel Children’s Hospital; and Resnick Neuropsychiatric Hospital at UCLA — and more than 160 primary and specialty care offices throughout Southern California. It also includes the David Geffen School of Medicine at UCLA.

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20177/AA051337_1.jpgUCLA surgeonsUCLA received top 10 rankings in eight specialties; only about 3 percent of the hospitals evaluated were ranked in even a single one.

A surgical team at Ronald Reagan UCLA Medical Center.

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20177/AA051337_1.jpgUCLA surgeons

A surgical team at Ronald Reagan UCLA Medical Center.

PhilHampton310-267-7014phampton@mednet.ucla.eduThe survey’s honor roll names only 20 medical centers; UCLA Health has appeared on that list for 28 consecutive years. Phil Hamptonhttp://newsroom.ucla.edu/releases/ucla-health-hospitals-place-no-1-in-los-angeles-no-7-in-national-rankingTue, 08 Aug 2017 04:15:00 GMTNew agency aims to improve patient outcomes and experience

AccentCare Inc. and UCLA Health are creating a jointly owned home health services agency, AccentCare UCLA Health, to serve patients in Los Angeles and surrounding communities. The new agency is designed to provide a comprehensive continuum of care after patients have been discharged from the hospital to facilitate efficient provider network communication, improved safety and faster healing.

Under the agreement, UCLA Health will be responsible for clinical oversight of post-acute services provided by the new joint venture agency, while AccentCare will provide day-to-day operational management, including patient intake, staffing and home health services such as physical therapy, medical social work and skilled nursing.

“We are excited to begin this valuable partnership with UCLA Health’s award-winning team,” said Steve Rodgers, the CEO of AccentCare. “Patients will benefit from the health system’s extended reach and our commitment to achieving comprehensive care and exceptional health outcomes.”

The formation of the new post-acute care agency aligns with the shared strategic vision of AccentCare and UCLA Health to develop innovative approaches to manage and deliver health care. The partnership will further extend AccentCare’s reach in California and is similar to partnerships that AccentCare has formed, or is pursuing, within its 11 states of operation.

“UCLA Health is committed to ensuring that our patients have access to a complete continuum of high-quality care, even after they leave our hospitals,” said Johnese Spisso, president of UCLA Health, CEO of UCLA Hospital System and associate vice chancellor of UCLA Health Sciences. “This new service will help improve the overall patient experience as they transition home.”

The venture will enhance UCLA Health’s ability to improve patient outcomes by providing patients with post-acute services that link to their UCLA Health physicians, providing optimal clinical oversight. The partnership will also position UCLA Health to better serve diverse populations of people with chronic diseases.

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20125/236236_Ronald_Reagan_UCLA_Medical_Center.jpgRonald Reagan UCLA Medical CenterRonald Reagan UCLA Medical Center

Ronald Reagan UCLA Medical Center.

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20125/236236_Ronald_Reagan_UCLA_Medical_Center.jpgRonald Reagan UCLA Medical Center

Ronald Reagan UCLA Medical Center.

TamiDennis310-267-7007tdennis@mednet.ucla.eduThe new agency is designed to improve care for people after they have been discharged from the hospital.UCLA Healthhttp://newsroom.ucla.edu/releases/ucla-health-and-accentcare-create-joint-venture-for-post-acute-care-servicesMon, 07 Aug 2017 15:30:00 GMTSoftware developed by UCLA urologist helps men avoid decisions they might regret

Like many men diagnosed with prostate cancer, Bill Pickett faced a tough question when he came to UCLA for treatment: how to fight it?

Prostate cancer is one of the more curable cancers — it has a 96 percent survival rate 15 years after diagnosis, according to the American Cancer Society. The options men have after a diagnosis have different side effects and trade-offs. So choosing, for example, between radiation therapy or surgery, can be complicated for a person.

“When you’re diagnosed with prostate cancer, you realize that each treatment can have very different side effects,” said Pickett, who lives in Los Angeles and came to UCLA for treatment in summer 2016. “You really have to think about what's most important and about which treatment is best for you.”

Recent research in the Journal of Clinical Oncology shows that as many as 15 percent of prostate cancer patients later regret their treatment choice.

Such difficulties led Dr. Christopher Saigal, vice chair of urology at UCLA, to develop a tool to simplify the choices for men and reduce what he calls “decisional conflict,” when patients experience stress about which treatment — and consequent risks — to choose.

The tool, an online computer program called WiserCare, asks men with prostate cancer to answer questions about personal values and goals and based on those answers provides a ranking of suggested treatments.

The program works by using algorithms that incorporate medical evidence and modeling to quantify the relative strengths of what a patient says he values. For example, has he answered that having the longest life possible is less important than avoiding a side effect like decreased sexual function? The software then suggests treatment options, which the men can weigh to decide which treatment option is best for them.

“As doctors, we want to offer a patient-centered plan that gives patients the power to leverage all the clinical evidence we have and choose a treatment that fits with their personal preferences,” Saigal said.

Pickett is one of the more than 300 men at UCLA who have used the tool. It's currently available to all prostate cancer patients at UCLA and is being adopted at a growing number of institutions, including Johns Hopkins and Northshore University. After completing the questionnaire online, Pickett decided that a new clinical trial would be the right choice for him.

“By the time I was done using the tool, I knew which treatment I wanted to have,” Pickett said.

The trial involved taking oral drugs and subcutaneous injections in hopes of making the surgery to remove the prostate gland — known as a prostatectomy — more successful. Pickett underwent surgery at the end of January and now has no signs of the cancer in his body. He continues to be closely monitored for any cancer recurrence using the prostate-specific antigen test.

While the common side effects of a prostatectomy include incontinence and decreased sexual function, physicians suggest different exercises patients can use to get better control of bodily functions like urine flow. Pickett is using a variety of methods — including Kegel exercises to strengthen the pelvic floor muscles — to manage the side effects of his surgery.

“With my treatment, I just wanted the best chance at success,” Pickett said. “I've been doing well post-surgery, and my side effects have been getting better each day.”

Prostate cancer is one of many diagnoses that highlights the benefits of personalized medicine. While Pickett, 66, decided a clinical trial followed by a prostatectomy was best for his situation, Saigal said that other men with different preferences choose different treatments. Personalized tools like the one Saigal created aim to give patients the greatest chance at success — whatever that may mean to them.

“There is so much data out there now on this diagnosis that patients can be overwhelmed,” Saigal said. “Software programs like these help patients to unlock the power of those data and apply them to their personal situation.”

Saigal is measuring the impact of the software on patient decision quality and said his team has found improvements in patient satisfaction, increased knowledge about prostate cancer and reductions in feelings of uncertainty after making a treatment decision.

“As doctors, we need to put a greater emphasis on patient preferences when guiding them through their treatment,” he said. “It's important for patients to be as involved as they can be when it comes to decisions about their own health.”

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20176/IMG_3005.JPGChristopher Saigal and Bill PickettAfter being diagnosed with prostate cancer, Bill Pickett used a computer program developed by Dr. Christopher Saigal, left, to help choose a treatment option.

Dr. Christopher Saigal with prostate cancer patient Bill Pickett. 

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20176/IMG_3005.JPGChristopher Saigal and Bill Pickett

Dr. Christopher Saigal with prostate cancer patient Bill Pickett. 

RyanHatoum310-267-8304rhatoum@mednet.ucla.eduSoftware developed by a UCLA urologist helps men avoid decisions they might regret.Ryan Hatoumhttp://newsroom.ucla.edu/stories/faced-with-many-options-men-with-prostate-cancer-get-help-choosing-the-right-treatmentsFri, 04 Aug 2017 01:22:00 GMTPolicy brief looks at centers in four U.S. regions, including Los Angeles

Community health centers, the leading providers of primary health care to the nation’s poor and uninsured populations, need strong partnerships and effective strategies to strengthen the current health care safety net, and to prepare for what may happen in the future, according to a new policy brief by the UCLA Center for Health Policy Research.

The brief looks at a selection of Federally Qualified Health Centers, referred to as community health centers, in Atlanta, Houston, Los Angeles and New York state that collaborate with other regional centers, local hospitals and health departments to improve and expand care, or work with legislators and advocacy groups to push for changes in health policy.

Their proactive strategy is a blueprint for community health centers nationwide, given the current administration’s proposed plans to cut billions of dollars in federal Medicaid benefits to vulnerable Americans, said Steven Wallace, associate director at the UCLA Center for Health Policy Research and co-author of the report.

“These centers are working to do their best in the current environment,” Wallace said. “But all centers will also need a robust Plan B if resources provided by the Affordable Care Act are stripped away.”

The brief, based on findings from UCLA’s REmaining Uninsured Access to Community Health Centers project, looks at specific strategies community health centers in the four regions undertook to increase capacity and improve service after the Affordable Care Act was enacted. Among the findings:

  • Streamlining referrals in Atlanta: One center set up a shared electronic medical records system with a local public hospital to more easily admit patients to the hospital and improve post-hospital care; the hospital granted admitting privileges to the center’s physicians.
  • Pooling regional resources in Houston: Four centers collaborated to strengthen regional service, with center directors regularly meeting to share ideas and resources. The centers’ partners set up and funded shared pharmacy services and a position for a shared psychiatrist that no single center could support alone.
  • Collaborating with Los Angeles County policymakers: The Los Angeles County Board of Supervisors in 2014 signed a contract with 204 centers in the county to establish a no-cost, primary care program for low-income uninsured county residents who did not qualify for other public health insurance, without regard to citizenship status. Supervisors authorized a $61 million annual budget for the centers to serve as many as 146,000 people.
  • Advocating for health policy change in New York state: Community health centers in New York state speak out on behalf of their patients both directly and indirectly. Examples include having leadership staff participate in local councils and committees, encouraging patients to attend local government meetings, and engaging with law enforcement agencies to change practices to protect center patients. Center leaders in the state said they maintain contact with local, state and federal policymakers as well as stakeholders involved in transportation, immigration, housing and other policy areas that have health implications.

“We found community health centers are being more than just practical when forming new partnerships,” said Maria-Elena Young, graduate student researcher at the UCLA Center for Health Policy Research and lead author of the brief. “They’re taking creative and innovative steps and thinking outside of the box to improve the safety net.”

Having a shared mission, understanding the political environment, incubating partnerships, and highlighting the benefits of aligning with community health centers were all factors that led to the success of each partnership strategy, according to the policy brief.

Authors recommend a series of steps that other community health centers can take to develop partnerships, such as having the centers include partnership-fostering as part of their long-term strategic plan; formalizing such partnerships; asking foundations to provide small grants to centers to build new collaborations; educating local hospitals on the value centers’ primary care services bring in lowering hospital readmission rates; and providing funding for staff dedicated to developing community partnerships and advancing advocacy efforts.

The policy brief is supported by the Commonwealth Fund.

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20176/hands-iStock.com-Jacob+Ammentorp+Lund.jpgDiverse hands

Diverse hands

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20176/hands-iStock.com-Jacob+Ammentorp+Lund.jpgDiverse hands

Diverse hands

VenetiaLai310-794-6963venetialai@ucla.eduA policy brief by the UCLA Center for Health Policy Research looks at facilities in four U.S. regions, including Los Angeles. Venetia Laihttp://newsroom.ucla.edu/releases/ucla-policy-brief-looks-at-community-health-centers-in-four-u-s-regions-including-l-aMon, 31 Jul 2017 20:39:00 GMTRazmik Ghukasyan is committed to establishing close doctor-patient relationships

When Razmik Ghukasyan received his acceptance letter to the David Geffen School of Medicine at UCLA, he and his family were ecstatic. But their celebration was cut short days later when his uncle was diagnosed with advanced pancreatic cancer.

During his first year of medical school, Ghukasyan frequently accompanied his uncle, Partev Kolanjian, to oncology appointments at another hospital. He was disturbed by the impersonal way his uncle’s doctors treated him, which differed sharply from what Ghukasyan was learning at UCLA about the importance of a compassionate doctor-patient relationship.

“In school, I was taught to develop a relationship with a patient, even when there is no hope,” Ghukasyan recalled. Everyone at UCLA is instructed that even simple things, like addressing patients as “Mr.” or “Ms.” and explaining in detail what procedures are happening and how long they’ll take, matter.

“Some of my uncle’s oncologists would not even look him in the eyes or acknowledge his concerns,” Ghukasyan said. “His experience gave me a lot of insight into the patient’s perspective and illustrated how important it is to personally connect with my patients and respond to their questions with respect.”

Discouraged by his doctors’ lack of support, his uncle began exploring alternative therapies. The 48-year-old died eight months after his diagnosis, leaving behind a wife and two young children.

His death deeply affected Ghukasyan, ultimately shaping his future career. This month, the 27-year-old recent medical school graduate began a surgical residency at UCLA, where he plans to focus on surgical oncology with an emphasis on pancreatic disease.

“After witnessing pancreatic cancer’s impact on my family,” he said, “I am determined to find more targeted, effective ways to prevent and treat this very aggressive and deadly disease.”

Ghukasyan and his family are no strangers to adversity. Growing up in Armenia, Ghukasyan lived with his parents and extended family in the small town of Ejmiatsin. His family owned a factory in the Soviet Union, but lost their livelihood and savings after Armenia’s independence from the Soviet Union in 1991.

The Armenian economy plunged into chaos; war raged on the Azerbaijan border; supplies of food, medicine and clean water dwindled; and a Turkish blockade created a severe energy crisis. Armenian history books refer to this period as “the dark and cold years.”

“My brother and I slept in layers of clothes at night to beat the freezing winters, and kept our coats on at school because the classroom was so cold,” Ghukasyan said.

Trained as an economist, Ghukasyan’s father resorted to farming to feed the family. He began growing wheat so his mother and wife could grind the flour by hand and bake bread. By raising chickens for eggs and planting vegetables on their land, the family managed to eke out enough food for 10 people.

Everything changed when Ghukasyan turned 14.

“After trying for 10 years, my family won the green-card lottery and we immigrated to America in 2004,” he said. “None of us spoke or understood English, and we had limited finances.”

The family rented an apartment in North Hollywood, where his aunt and uncle had settled earlier. Entering Van Nuys High School as a sophomore, Ghukasyan was the only non-Spanish speaker in his English-as-a-Second-Language class.

“Six months after I arrived in the U.S., I started volunteering at Valley Presbyterian Hospital,” Ghukasyan said. “As the hospital began to feel like my new home, I recognized my desire to become a doctor.”

Driven by his aspiration to enter medical school, he quickly progressed from ESL classes to Advanced Placement. While math and science came easily, honors English and American literature did not.

“The first book we read was ‘The Scarlet Letter’ and I didn’t understand a word of it,” he admitted, laughing. “I pulled a C in the end, but it was the hardest grade I ever earned.”

Intent on entering UCLA, Ghukasyan caught up on the high-school curriculum during his senior year. When the university rejected his application, he still didn’t give up. Graduating high school with a 4.0 grade-point average, he persevered through two years at Los Angeles Valley College before transferring to UCLA as a junior.

At last, his hard work and discipline paid off. Ghukasyan graduated summa cum laude and finally realized his dream to enter medical school. Not only did the David Geffen School of Medicine at UCLA offer him admission, it also awarded Ghukasyan a Leader of Tomorrow scholarship covering all four years of his educational expenses.

“The scholarship inspired me to become a true leader in the innovation of health care delivery,” he explained. “That’s why I decided to complete a joint degree program in medicine and business.”

In June, he graduated from UCLA with a medical degree and a master’s in business administration from the Anderson School of Management.

In between patients, studying and classes, Ghukasyan also managed to squeeze in a social life. He met his fiancee, Dr. Lily Saringulian, during college and proposed to her last year. She is currently pursuing a pediatric residency at UCLA, and the two will marry in November.

As he launches his seven-year residency, Ghukasyan’s thoughts return frequently to his late uncle’s battle with cancer.

“Never will I be the type of doctor who tells my patients ‘there’s nothing we can do,’” he said. “I want to make an impact by contributing to the study and treatment of pancreatic tumors. Even when, statistically, there is no reason to hope, I will continue to advocate for my patients.”

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20176/Razmik+aunt+uncle+cousins_2010.jpgRazmik Ghukasyan Christmas 2010Razmik Ghukasya, standing in center, celebrating Christmas with his late uncle, aunt and cousins.

Dr. Razmik Ghukasyan celebrating Christmas with his late uncle, aunt and cousins.   

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20176/Razmik+aunt+uncle+cousins_2010.jpgRazmik Ghukasyan Christmas 2010

Dr. Razmik Ghukasyan celebrating Christmas with his late uncle, aunt and cousins.   

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20176/Razmik+and+brother.jpgGhukasyan brothers in Armenia

Razmik Ghukasyan and his younger brother, Levon, bundled up against Armenia’s freezing winters.  

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20176/Razmik+family+-1992.jpgGhukasyan family

Razmik Ghukasyan with his parents and younger brother in 1992. 

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20176/Razmik+and+fiance.jpgRazmik Ghukasyan Commencement Day

Ghukasyan and his fiancee, Dr. Lily Saringulian, a pediatric resident at UCLA, at his graduation from medical school in June.   

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20176/Razmik+and+family+2017.jpgRazmik Ghukasyan and family

Razmik Ghukasyan and his family celebrating his hard-won medical degree and MBA. 

ElaineSchmidt310-267-8323eschmidt@mednet.ucla.eduNew UCLA resident Razmik Ghukasyan is pursuing a career in surgical oncology with an emphasis on establishing close doctor-patient relationships.Elaine Schmidthttp://newsroom.ucla.edu/stories/to-honor-his-uncles-memory-young-doctor-will-offer-hope-to-cancer-patientsFri, 28 Jul 2017 16:23:00 GMTUCLA RESEARCH ALERTFINDINGS

When it comes to assessing the risk of estrogen therapy for menopause, how the therapy is delivered — taking a pill versus wearing a patch on one’s skin — doesn’t affect risk or benefit, researchers at UCLA and elsewhere have found. But with the commonly used conjugated equine estrogen, plus progestogen, the dosage does. Higher doses, especially over time, are associated with greater risk of problems, including heart disease and some types of cancer, especially among obese women.

BACKGROUND

The Women’s Health Initiative established the potential of estrogen therapy to increase or decrease the risk of stroke, breast cancer and heart attack, but research had never compared the risks and benefits of various formulations of estrogen treatments or delivery methods.

METHOD

The researchers used data from about half the participants in the Women’s Health Initiative Observational Study, which enlisted more than 93,000 postmenopausal women between the ages of 50 to 79 and tracked their health over an average of eight years.

In this new study, the team examined data from 45,112 participants in the WHIOS to gauge how various types of estrogen pills, different delivery methods (patch versus pill) and different doses of oral conjugated equine estrogen affected women’s health. With an average follow-up of 5 1/2 years per patient the researchers measured rates of adverse effects such as coronary heart disease, breast cancer, stroke, pulmonary embolism, hip fracture, colorectal cancer, endometrial cancer and death.

They found that women taking oral equine estrogen at daily doses below 0.625 mg in combination with progestogen had a lower risk of an adverse effect compared with women taking higher dosages (0.625 mg per day or more) of the same combination. Further, the risk at a daily 0.625 mg dose, was greater after five or more years of use than it was if taken for less than five years. 

In women who had undergone a hysterectomy, the risk of an adverse effect was the same whether they were taking oral conjugated equine estrogen therapy less than 0.625 mg per day, estradiol pills or estradiol patches regardless of length of use, compared with women taking oral equine estrogen at 0.625 mg per day for less than five years.

The researchers found no difference in health risk among women taking a combination of oral conjugated equine estrogen plus progestogen compared to estradiol pills plus progestogen; equine estrogen/progestogen compared to estradiol patches/progestogen; and estradiol pills/progestogen compared to estradiol patches/progestogen. This was also true of women who had undergone a hysterectomy who took estrogen alone.

IMPACT

The researchers believe that no previous U.S. study on the subject has relied on data from such a large number of women who were followed over a substantial period of time. These results could help physicians guide women on the best hormone therapy to take during menopause.

AUTHORS

The lead author of the study is Dr. Carolyn Crandall, professor of medicine at the David Geffen School of Medicine at UCLA. Other authors are Kathleen Hovey and Jean Wactawski-Wende of the University at Buffalo; Christopher Andrews of the University of Michigan; Jane Cauley of the University of Pittsburgh; Marcia Stefanick of Stanford University; Dr. Chrisandra Shufelt of Cedars-Sinai Heart Institute; Ross Prentice of the Fred Hutchinson Cancer Research Center; Dr. Andrew Kaunitz of the University of Florida; Dr. Charles Eaton of Brown University; and Dr. JoAnn Manson of Harvard University.

JOURNAL

The study was published in the peer-reviewed journal Menopause

FUNDING

The Women’s Health Initiative program is funded by the National Heart, Lung, and Blood Institute, National Institutes of Health, and U.S. Department of Health and Human Services.

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20176/Dr.+Carolyn+Crandall.jpgDr. Carolyn Crandall

Dr. Carolyn Crandall, professor of medicine at the David Geffen School of Medicine at UCLA.

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20176/Dr.+Carolyn+Crandall.jpgDr. Carolyn Crandall

Dr. Carolyn Crandall, professor of medicine at the David Geffen School of Medicine at UCLA.

EnriqueRivero310-267-7120erivero@mednet.ucla.eduUCLA researchers found that with estrogen therapy for menopause, taking a pill versus wearing a patch on one’s skin doesn’t affect risk or benefit.Enrique Riverohttp://newsroom.ucla.edu/releases/in-assessing-risk-of-menopausal-hormone-therapy-dose-not-form-mattersThu, 27 Jul 2017 00:06:00 GMTUCLA's Dr. Emeran Mayer has spent four decades studying how the two interact

Just past midnight on Sept. 26, 1983, Lt. Colonel Stanislav Petrov, a member of the Soviet Air Defense Forces serving as the command-center duty officer for a nuclear early-warning system, faced a decision with unimaginable consequences.

Cold War tensions were running hot. The Soviet Union had recently shot down Korean Air Lines Flight 007, killing all 269 passengers and crew aboard the Boeing 747. The Soviets claimed the plane was on a spy mission and represented a deliberate provocation by the United States.

Now, in a bunker outside of Moscow where Petrov was stationed, alarm bells blared as Soviet satellites detected five U.S. ballistic missiles heading toward the USSR. Was this a real nuclear attack warranting retaliation? Or was it a false alarm? Gazing at a screen that flashed “launch” “launch” “launch,” Petrov had only minutes to decide.

Thirty years later, Petrov reflected on his fateful decision to ignore the signal coming from the satellite detection system — which, of course, had turned out to be erroneous. But at the time, when he couldn’t know that for sure, Petrov said he ultimately made the decision based on “a funny feeling in my gut.”

In his book “The Mind-Gut Connection: How the Hidden Conversation Within Our Bodies Impacts Our Mood, Our Choices, and Our Overall Health” (Harper Collins, 2016), Dr. Emeran Mayer retells Petrov’s story, and he notes how many historic and present-day decision-makers have cited unspecified feelings in their gut as tipping the balance on a difficult call.

To many of us, these “gut feelings” leading to “gut decisions” represent instincts with no basis in reasoned thought. But Dr. Mayer, professor of medicine, physiology and psychiatry and biobehavioral sciences and director of the UCLA Oppenheimer Center for Neurobiology of Stress and Resilience, has other ideas. Acting on his own inclinations developed as a medical student, he has spent the last 40 years building a scientific case for the inextricable link between the brain and the gut, often calling into question the conventional medical wisdom.

“The gut,” Dr. Mayer says, “converses with the brain like no other organ. When people talk about going with their gut feelings on an important decision, what they’re referring to is an intuitive knowledge based on the close relationship between our emotions and the sensations and feelings in the gastrointestinal (GI) tract.”

These gut sensations go in both directions. “When you eat too much or have certain fatty foods, the changes in your gut can affect your mental state,” Dr. Mayer notes. “And when you feel ‘butterflies’ or a rumbling in your stomach when you’re nervous, or knots in your stomach when you’re angry, your mental state is affecting your gut.”

Illustration by Jon Lee The gut and the brain are closely linked through bidirectional signaling pathways that include nerves, hormones and inflammatory molecules.

Dr. Mayer and the growing number of colleagues at UCLA and around the world who are interested in the mind-gut connection have been buoyed by the emerging evidence coming from studies of the gut microbiome — the 100-trillion-or-so bacteria and other microbes that make their home in our intestines. Research (mostly in the laboratory, but some in humans) suggests that emotions can affect the gut microbiota, and that, conversely, certain gut microbes can be mind-altering.

Yes, the gut has its essential roles to play in digestion and metabolism. But as Dr. Mayer suggested in an interview with Scientific American in 2010: “The system is way too complicated to have evolved only to make sure things move out of your colon.”

Dr. Mayer is convinced that the brain-gut axis isn’t a linear system, as it is often still viewed, but a circular-feedback loop operating through multiple communication channels. One of the most common channels is via activation of the vagus nerve, which extends from the gut lining to the brain stem. But interactions also can occur between the brain and the immune system (the gut hosts the majority of the body’s immune cells) and between the brain and the endocrine system. When the communication channels go awry for one of a variety of reasons — including poor diet, stress or illness — the result can be physical-health problems such as digestive disorders and obesity or mental-health issues such as anxiety or depression. It’s no coincidence, Dr. Mayer notes, that most patients with anxiety or depression also have abnormal gastrointestinal function.

Dr. Mayer’s influence in shedding light on the mind-gut connection extends well beyond his own work; he has consulted with researchers looking at the relationship from a variety of vantage points. “Emeran has a unique ability to communicate across different levels of analysis — from the cellular to the physiological to the psychological to the behavioral,” says Nancy Zucker, director of the Center for Eating Disorders at Duke University. “That enables researchers to better see the clinical and translational implications of our studies.”

Zucker has sought Dr. Mayer’s counsel on studies of the impact of gut-brain interactions on people with eating disorders and has collaborated with his group in studies of patients with anorexia nervosa. She is pursuing the hypothesis that a hypersensitivity to gut sensations fuels the disorder. “The widely accepted narrative is that these are individuals with a biological vulnerability, and the environment brings it out,” Zucker says. “We believe that this vulnerability starts below the neck, and that it is neurological.”

Well before the current “decade of the microbiome,” Dr. Michael Gershon broke new ground with his book "The Second Brain" (Harper, 1998), referring to the collection of approximately 100 million neurons in the gut that constitute the enteric nervous system and act both independently and interdependently with the brain in our head. While it’s no help in matters of philosophy, poetry and other forms of deep thought, Dr. Gershon noted, this second brain and how it interacts with the first one is a key factor in our physical and mental well-being.

The gut remains an underappreciated organ even by many scientists and physicians — perhaps because it isn’t pleasant to look at or think about, suggests Dr. Gershon, who continues to serve as chairman of the Department of Anatomy and Cell Biology at Columbia University.

“What Emeran Mayer and others are finding is that there is a whole world of microorganisms that live in the gut,” he says, “and that they are not just evil bacteria but are companions in life.”

To read the entire story, go to U Magazine’s spring 2017 issue

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20175/170302_DrMayer_028-ret.jpgDr. Emeran MayerDr. Emeran Mayer has built a scientific case for the inextricable link between the brain and the gut, and their influence on our emotional and physical states.

Dr. Emeran Mayer is professor of medicine, physiology and psychiatry and biobehavioral sciences and director of the UCLA Oppenheimer Center for Neurobiology of Stress and Resilience, 

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20175/170302_DrMayer_028-ret.jpgDr. Emeran Mayer

Dr. Emeran Mayer is professor of medicine, physiology and psychiatry and biobehavioral sciences and director of the UCLA Oppenheimer Center for Neurobiology of Stress and Resilience, 

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20175/Features1Pic6.jpgIllustration of the gut-brain dialogue

The gut and the brain are closely linked through bidirectional signaling pathways that include nerves, hormones and inflammatory molecules. 
 

EnriqueRivero310-267-7120erivero@mednet.ucla.eduDr. Mayer and a growing number of colleagues at UCLA and around the world who are interested in the mind-gut connection have been buoyed by the emerging evidence coming from studies of the gut microbiome.Dan Gordonhttp://newsroom.ucla.edu/stories/understanding-the-constant-dialogue-that-goes-on-between-our-gut-and-our-brainWed, 26 Jul 2017 00:47:00 GMTUCLA RESEARCH ALERTFINDINGS

UCLA researchers have discovered that children with autism have a tell-tale difference on brain tests compared with other children. Specifically, the researchers found that the lower a child’s peak alpha frequency — a number reflecting the frequency of certain brain waves — the lower their non-verbal IQ was. This is the first study to highlight peak alpha frequency as a promising biomarker to not only differentiate children with autism from typically developing children, but also to detect the variability in cognitive function among children with autism. 

BACKGROUND

Autism spectrum disorder affects an estimated one in 68 children in the United States, causing a wide range of symptoms. While some individuals with the disorder have average or above-average reasoning, memory, attention and language skills, others have intellectual disabilities. Researchers have worked to understand the root of these cognitive differences in the brain and why autism spectrum disorder symptoms are so diverse.

An electroencephalogram, or EEG, is a test that detects electrical activity in a person’s brain using small electrodes that are placed on the scalp. It measures different aspects of brain activity including peak alpha frequency, which can be detected using a single electrode in as little as 40 seconds and has previously been linked to cognition in healthy individuals.

METHOD

The researchers performed EEGs on 97 children ages 2 to 11; 59 had diagnoses of autism spectrum disorder and 38 did not have the disorder. The EEGs were taken while the children were awake and relaxed in dark, quiet rooms. Correlations among age, verbal IQ, non-verbal IQ and peak alpha frequency were then studied.

IMPACT

The discovery that peak alpha frequency relates directly to non-verbal IQ in children with the disorder suggests a link between the brain’s functioning and the severity of the condition. Moreover, it means that researchers may be able to use the test as a biomarker in the future, to help study whether an autism treatment is effective in restoring peak alpha frequency to normal levels, for instance.

More work is needed to understand whether peak alpha frequency can be used to predict the development of autism spectrum disorder in young children before symptoms emerge.

AUTHORS

The authors of the study are Shafali Spurling Jeste, UCLA associate professor in psychiatry, neurology and pediatrics and a lead investigator of the UCLA Center for Autism Research and Treatment; Abigail Dickinson and Charlotte DiStefano, postdoctoral fellows at the UCLA Center for Autism Research and Treatment; and Damla Senturk, associate professor of biostatistics at UCLA.

JOURNAL

The study was published online in the European Journal of Neuroscience.

FUNDING

The study was funded by Autism Speaks (Meixner Postdoctoral Fellowship in Translational Research), the National Institutes of Mental Health (K23MH094517), the National Institute of General Medical Sciences (R01 GM111378-01A1) and the National Institute of Health (ACE 2P50HD055784-06).

LeighHopper310-267-7149 LHopper@mednet.ucla.eduThis research highlights a promising biomarker to reveal the variability in cognitive function among children with the disorder. Sarah C.P. Williamshttp://newsroom.ucla.edu/releases/brain-activity-test-detects-autism-severity-ucla-study-findsTue, 25 Jul 2017 14:33:00 GMTUCLA professor co-authored new report showing that more than half of people succeed in discontinuing usage of drugs

Despite numerous obstacles and severe withdrawal effects, long-term users of psychiatric drugs can stop taking them if they choose, and mental health care professionals could be more helpful to such individuals, according to a new study.

While 1 in 6 Americans take a psychiatric medication for serious mental illness, there is little research on people’s experiences coming off the drugs. In the first large-scale study in the United States on this subject, Live and Learn, Inc., in partnership with researchers at the UCLA Luskin School of Public Affairs, UC San Francisco and New York University, began to fill this knowledge gap. Study findings are now available online in Psychiatric Services, a journal published by the American Psychiatric Association.

Surveying 250 long-term users of psychiatric medications who had a diagnosis of serious mental illness and chose to discontinue use, the study found that more than half succeeded in discontinuing usage, despite having little professional support while experiencing severe withdrawal symptoms including insomnia, crying and diarrhea. The majority of survey respondents cited the main reason they attempted to quit centered on health risks of long-term use and side effects.

Of the study’s respondents, 54 percent managed to stay off psychiatric medication for at least one year, with few reporting relapse or re-hospitalization. Eighty-two percent of those who discontinued use reported being “satisfied” with their choice.

“People stop taking their psychiatric medications whether or not they find the drugs helpful, and they do so at all stages of the medication experience — days, weeks, months, or years after taking them,” said David Cohen, professor and Marjorie Crump Chair in Social Welfare at UCLA Luskin and a co-author of the study.  “This study is novel because it asks questions about stopping to take medications from the consumer’s point of view.”

Many industry-funded studies have asked patients why they stop taking their medications, but typically with a view to increase compliance, according to Cohen. By contrast, this study asks consumers what they experienced while coming off drugs, who helped them make and carry out their decision, and whether they were satisfied with their attempted or completed discontinuation.

“Over 70 percent of our study sample had taken medication for more than a decade; however, these individuals reported having little to rely on when discontinuing except the internet and social support in order to endure withdrawal. Limiting access to care through cuts to health and psychosocial services can only make that situation worse,” says principal investigator Laysha Ostrow, founder and CEO of Live and Learn, a California-based social enterprise that provides research, technical assistance and knowledge translation services to behavioral health systems. “Most were working with a provider at the time but did not find them helpful in the process. However, even though it was often complicated and difficult, the majority who were able to come off medication completely were satisfied with their decision to do so.”

Cohen said that there are still plenty of challenges for researchers who are examining this topic.

“There’s a lot of work to do to understand how people come off medications and how to help them do so safely, especially when they're taking several psychiatric medications simultaneously,” he said. “This study didn’t use a probability sample. Though it very carefully selected the 250 respondents, most with over 10 years’ history of taking medications, it should be a priority to confirm or modify these findings with a probability sample.”

The study was funded through a grant by the Foundation for Excellence in Mental Health Care.

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20176/addiction-71573_1280.jpgPillsThe majority of respondents cited the main reasons they attempted to quit psychiatric drugs were health risks of long-term use and side effects.

Pills.

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20176/addiction-71573_1280.jpgPills

Pills.

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20176/Cohen+-+1.jpgDavid Cohen

David Cohen, Marjorie Crump Chair in Social Welfare at the UCLA Luskin School of Public Affairs.

GeorgeFoulsham310-206-0159gfoulsham@luskin.ucla.eduUCLA professor of social welfare co-authored new report showing that more than half of people succeed in discontinuing usage of psychiatric medications.George Foulshamhttp://newsroom.ucla.edu/stories/new-study-examines-effects-of-stopping-psychiatric-medicationWed, 19 Jul 2017 17:19:00 GMTUCLA RESEARCH ALERTFINDINGS

Researchers found in a review of data from three large studies that a minimally invasive treatment to treat peripheral artery disease offers a safe alternative to standard surgery.

BACKGROUND

Peripheral artery disease is a common circulatory problem in which the arteries become narrow from plaque buildup and blood flow to the limbs is reduced. The condition affects from 8 to 12 million Americans. The most common symptom is leg pain that occurs while walking or climbing but goes away with rest. For many patients, treatment includes lifestyle changes or medication. Those with severe plaque buildup may need vascular surgery or a minimally invasive procedure to clear the blockage.

METHOD

The goal of this study was to analyze outcomes of patients treated with a minimally invasive, nonsurgical procedure using the orbital atherectomy system, which helps restore blood flow in the common femoral artery by using a rotating device to sand down the plaque into microparticles that the bloodstream flushes away.

The study reviewed data from three large, multi-center, non-randomized registries (called CONFIRM I, II and III) of 3,135 patients with severely calcified peripheral arterial disease who were treated with the orbital atherectomy system from October 2009 to June 2011.

Further studies are needed to compare orbital atherectomy with the surgical option called endarterectomy and to evaluate longer-term outcomes.

IMPACT

Although endarterectomy has been considered the standard of care for more than 50 years, the ideal treatment for these patients remains unknown. For some patients, such as older people or those with multiple health issues, surgery is considered too risky. This study shows that the orbital atherectomy treatment can offer patients a safe and effective alternative to surgery.

AUTHORS

The authors of the study are Dr. Michael Lee and Dr. Daniel Heikali of UCLA; Dr. Jihad Mustapha of Metro Health Hospital in Wyoming, Mich.; Dr. George Adams of Rex Healthcare in Raleigh, N.C.; and Dr. Ehtisham Mahmud of UC San Diego.

JOURNAL

This study was published by the peer-reviewed journal Vascular Medicine.

FUNDING

This research was funded Cardiovascular Systems Inc., the makers of the orbital atherectomy device.

DISCLOSURES

​Drs. Lee, Mustapha and Adams received funding from Cardiovascular Systems. The remaining authors disclose no conflicts.

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20176/DB+Peripheral+Device+4.jpgOrbital atherectomy system device Orbital atherectomy system device

Orbital atherectomy system device 

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20176/DB+Peripheral+Device+4.jpgOrbital atherectomy system device

Orbital atherectomy system device 

AmyAlbin310-267-7095aalbin@mednet.ucla.eduThis study shows that the orbital atherectomy procedure can offer individuals with peripheral artery disease an effective alternative to standard surgery.Amy Albin http://newsroom.ucla.edu/releases/less-invasive-treatment-for-blocked-artery-in-the-leg-is-safe-study-review-finds-2637672Wed, 19 Jul 2017 16:49:00 GMTUCLA was among the first medical centers to use exome sequencing

When Audrey Lapidus’ 10-month old son, Calvin, didn’t reach normal milestones like rolling over or crawling, she knew something was wrong.

“He was certainly different from our first child,” said Lapidus, of Los Angeles. “He had a lot of gastrointestinal issues and we were taking him to the doctor quite a bit.”

Four specialists saw Calvin and batteries of tests proved inconclusive. Still, Lapidus persisted.

“I was pushing for even more testing, and our geneticist at UCLA said, ‘If you can wait one more month, we’re going to be launching a brand new test called exome sequencing,’” she said. “We were lucky to be in the right place at the right time and get the information we did.”

In 2012, Calvin Lapidus became the first patient to undergo exome sequencing at UCLA. He was subsequently diagnosed with a rare genetic condition known as Pitt-Hopkins syndrome, which is most commonly characterized by developmental delays, possible breathing problems, seizures and gastrointestinal problems.

Though there is no cure for Pitt-Hopkins, finally having a diagnosis allowed Calvin to begin therapy. “The diagnosis gave us a point to move forward from, rather than just existing in that scary no-man’s land where we knew nothing,” Lapidus said.

“Unfortunately, there are a lot of people living in that no-man’s land, desperate for any type of answers to their medical conditions,” said Dr. Stanley Nelson, professor of human genetics and pathology and laboratory medicine at the David Geffen School of Medicine at UCLA. “Many families suffer for years without so much as a name for their condition.”

 

What exome sequencing allows doctors to do is to analyze more than 20,000 genes at once, with one simple blood test.

In the past, genetic testing was done one gene at a time, which is time-consuming and expensive.

“Rather than testing one sequential gene after another, exome sequencing saves time, money and effort,” said Dr. Julian Martinez-Agosto, a pediatrician and researcher at the Resnick Neuropsychiatric Hospital at UCLA.

The exome consists of all the genome’s “exons,” which are the coding portion of genes. Clinical exome sequencing is a test for identifying disease-causing DNA variants within the 1 percent of the genome which codes for proteins, the exons, or flanks the regions which code for proteins.

To date, mutations in the protein-coding parts of genes accounts for nearly 85 percent of all mutations known to cause genetic diseases, so surveying just this portion of the genome is an efficient and powerful diagnostic tool. Exome sequencing can help detect rare disorders like spinocerebellar ataxia, which progressively diminishes a person’s movements, and suggest the likelihood of more common conditions like autism spectrum disorder and epilepsy.

More than 4,000 adults and children have undergone exome testing at UCLA since 2012. Of difficult to solve cases, more than 30 percent are solved through this process, which is a dramatic improvement over prior technologies. Thus, Nelson and his team support wider use of genome-sequencing techniques and better insurance coverage, which would further benefit patients and resolve diagnostically difficult cases at much younger ages.

Since her son’s diagnosis, Lapidus helped found the Pitt-Hopkins Syndrome Research Foundation. “Having Calvin’s diagnosis gave us a roadmap of where to start, where to go and what’s realistic as far as therapies and treatments,” she said. “None of that would have been possible without that test.”

Next, experts at UCLA are testing the relative merits of broader whole genome sequencing to analyze all 6 billion bases that make up a person’s genome. The team is exploring integration of this DNA sequencing with state-of-the-art RNA or gene expression analysis to improve the diagnostic rate.

The entire human genome was first sequenced in 1990 at a cost of $2.7 billion. Today, doctors can perform the same test at a tiny fraction of that cost, and believe that sequencing whole genomes of individuals could vastly improve disease diagnoses and medical care.

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20176/Audrey+and+Calvin+Lapidus.jpgAudrey and Calvin LapidusAfter undergoing batteries of tests without a conclusive diagnosis, Calvin Lapidus underwent exome sequencing at UCLA, which enabled doctors to identify his rare condition, known as Pitt-Hopkins syndrome.

Audrey Lapidus works with her son, Calvin, at their home in Los Angeles.

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20176/Audrey+and+Calvin+Lapidus.jpgAudrey and Calvin Lapidus

Audrey Lapidus works with her son, Calvin, at their home in Los Angeles.

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20176/Audrey+Lapidus+and+Calvin.jpgAudrey Lapidus and Calvin

Audrey Lapidus and her son Calvin, of Los Angeles, talk with Dr. Stanley Nelson, Professor and Vice Chair of Human Genetics and Professor of Psychiatry at the David Geffen School of Medicine at UCLA. Nelson helped diagnose Calvin’s rare and perplexing medical condition, known as Pitt-Hopkins Syndrome, after testing him with exome sequencing, which can analyze more than 20,000 human genes from a single blood sample.

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20176/Dr+Stanley+Nelson.jpgDr. Stanley Nelson

Dr. Stanley Nelson, professor of human genetics and professor of psychiatry at the David Geffen School of Medicine at UCLA, helped champion the use of exome sequencing in the clinical setting. With the ability to analyze more than 20,000 genes in a single test, exome sequencing can help doctors diagnose rare diseases faster and more efficiently than traditional genetic testing, which only analyzes one gene at a time.

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20176/Exome+lab.jpgExome lab

Dr. Julian Martinez-Agosto, right, looks at genetic data with a fellow researcher at UCLA Health. Next-generation genetic testing at UCLA, known as exome sequencing, allows doctors to better and more quickly diagnose rare and complex diseases by analyzing more than 20,000 genes at once.

DavidOlmos310-267-8276dolmos@mednet.ucla.eduUCLA was among the first medical centers to use exome sequencing, which can analyze more than 20,000 genes at once.UCLA Health Sciences Media Relationshttp://newsroom.ucla.edu/stories/ucla-genetic-sequencing-unravels-rare-disease-mysteriesTue, 18 Jul 2017 16:27:00 GMTDoes milk really do a body good? Should you cut carbs? A UCLA expert on nutrition has the answers UCLA Broadcast Studio  

As a nutritional epidemiologist devoted to prevention, Karin Michels has spent much of her career studying how health can be optimized through a proper diet.

“People think it all comes down to their genes, but there is so much we can control by not smoking or being overweight, eating right and exercising at least moderately,” says Michels, professor and chair of the epidemiology department in the UCLA Fielding School of Public Health.

What constitutes healthy eating? Michels, who frequently gives public talks on the topic, has found there are many widely held misconceptions that lead to misguided dietary decisions.

Based on the feedback she receives from her public talks, Michels believes many physicians fail to adequately counsel their patients on proper nutrition. “Public health has an opportunity and an obligation to educate people about how to optimize their diet,” she says. “Many of the risk factors for disease people can’t control, but the diet is something we can change. We all eat, and what we eat involves choices. We need to make sure people understand which choices are best for their health.”

Below are some of the most common myths she seeks to dispel.

Myth: Cut the carbs

On the low-carbohydrate diet, which has gained popularity in recent years, Michels’ advice: Don’t change the proportion of carbs you consume, but instead lower the refined carbohydrates and sugars while upping the intake of whole grain (not to be confused with multigrain, which usually means more than one type of refined flour). Quinoa, oats, rice and pasta are good sources of carbs as long as they’re made of whole grains, she says. And there is no good reason to avoid gluten unless you’re intolerant — by doing so, you’re missing out on important nutrients and fiber that come from grain.

Myth: A low-fat diet is optimal

Many believe limiting fat consumption is good for the heart. In fact, Michels says, the average American diet includes about a third of calories from fat, and it should stay that way. “What we do want to modify is the type of fat we consume,” she explains. That means steering toward unsaturated fats and away from saturated and trans fats. It’s the unsaturated fats — including those found in olive and canola oils and in foods such as fish, nuts and avocados — that raise the body’s HDL (“good”) cholesterol, while the saturated fats from animal and dairy products and the artificial trans fats found in margarines, cookies and many things crispy will bump up the LDL (“bad”) cholesterol. (A word of caution: Coconut oil, which many assume to be healthy, is laden with saturated fat.)

UCLA Karin Michels

Myth: We should eat like our ancestors

The Paleo diet goes in another direction — advocating that we follow the path of our hunter-gatherer ancestors in eating lots of energy-dense red meats, while excluding grains. “We are nothing like our ancestors — instead of running around all day, most of us sit in front of our computers,” Michels says. Rather than following any of the aforementioned dietary trends, she adds, the best approach is a balanced diet that limits or avoids red and processed meats, which were classified as carcinogens in 2015 by the World Health Organization’s International Agency for Research on Cancer.

Myth: Red meat is a good source of iron

Michels often hears the argument that red meat is important to avoid an iron deficiency. What many don’t realize, she says, is that the iron from red meat is very different from the iron that comes from vegetable sources, legumes and whole grains.

“The red-meat iron actually promotes cardiovascular disease,” Michels explains. “The plant iron found in beans and green leafy vegetables is much healthier. Unfortunately, it is more difficult to absorb, so we need to consume more of it or help absorption by consuming vitamin C-rich foods at the same time.”

Myth: A well-balanced diet provides all essential nutrients

Michels is frequently asked about the value of supplements. The only one she strongly recommends is vitamin D. “Two-thirds of the U.S. population — especially those living in colder climates — is vitamin D-deficient, and many don’t realize it,” she says. While certain foods contain the nutrient, it’s nearly impossible to get enough from the diet — and when we use sunscreen to protect ourselves against skin cancer, we’re also blocking the best source of vitamin D production in the body. The easiest way out of the dilemma is to take vitamin D supplements.

Myth: Alcohol should be avoided

Some assume that alcohol is unhealthy, but the verdict is actually mixed. “Alcohol cleans out your coronary arteries, so if you have a strong family history of coronary artery disease, it may help you,” Michels says. “On the other hand, you have to balance that against the fact that alcohol increases the risk of many cancers. For most people, we recommend limiting alcohol consumption to one beverage a day.”

Myth: Coffee is unhealthy

Coffee, too, gets a bad rap, but Michels says it lowers the risk of many common diseases, including diabetes, colorectal cancer and aggressive prostate cancer subtypes.

Myth: It’s advisable to load up on calcium

Calcium is often promoted to strengthen the bones, but Michels says most people get plenty in a balanced diet, and vitamin D warrants more focus for bone health. The two subgroups with an increased calcium need are children and postmenopausal women, the latter as a protection against osteoporosis. But even for that population, Michels says, the increase can come from a dietary uptick in calcium-containing foods or small doses of supplements; too much may raise the risk of coronary artery disease.

Myth: Milk does the body good

Milk is widely assumed to be healthy, but Michels says it’s not — at least not the type that comes from cows (plant alternatives such as almond and soy milk are better). “Cow’s milk is not designed for humans — its composition is completely different from that of human mother’s milk,” Michels says. Part of the problem, she explains, is that in the interest of efficiency, cows are artificially inseminated to remain in a constant state of simultaneous pregnancy and lactation. That means significant doses of the pregnancy hormones estrogen and progesterone make their way into milk products sold to consumers, which raises the risk for several cancers.

This story appears in the UCLA Public Health Magazine’s spring/summer 2017 issue.

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20175/milk.jpgBuying milkMilk might not always be as healthy for everyone as we used to think.

Man buys milk in a supermarket.

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20175/milk.jpgBuying milk

Man buys milk in a supermarket.

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20175/Photo+Dr.+Michels+1.jpgKarin Michels

Karin Michels is professor and chair of the UCLA Fielding School of Public Health’s Department of Epidemiology.

CarlaDenly310-825-6738cdenly@support.ucla.eduAs a nutritional epidemiologist devoted to prevention, Karin Michels has spent much of her career studying how health can be optimized through a proper diet. UCLA Newsroomhttp://newsroom.ucla.edu/stories/separating-food-facts-from-fictionThu, 13 Jul 2017 17:53:00 GMTUCLA researchers upend long-standing idea that the star-shaped brain cells can’t be differentiated from each other

From afar, the billions of stars in our galaxy look indistinguishable, just as the billions of star-shaped astrocytes in our brains appear the same as each other. But UCLA researchers have now revealed that astrocytes, a type of brain cell that supports and protects neurons, aren’t all the same. While stars might be categorized by their size, age and heat, the supportive brain cells vary when it comes to shape, molecular machinery and functioning.

The findings, published today in the journal Neuron, should make it easier for researchers to study how astrocytes relate to disease, or to develop drugs that aim to target small subsets of astrocytes, said Baljit Khakh, a UCLA professor of physiology and neurobiology and the study’s senior author.

“For 50 years, the textbooks have said that astrocytes everywhere in the brain are largely identical,” Khakh said. “We’ve now discovered that astrocytes in different circuits in the brain are different, and we’ve developed a comprehensive toolkit to explore astrocyte biology and diversity.”

Unlike neurons, astrocytes in the brain don’t directly process information, store memories or control the body’s movements. Instead, astrocytes — which have been described as glue-like — are known to compose the blood-brain barrier, give the brain structure, carry nutrients to neurons, and regulate the concentration of certain molecules between neurons. They also play a key role in helping the brain repair itself after traumatic injuries, strokes or infections. And studies have suggested links between impaired astrocytes and diseases of the nervous system, including Huntington’s, ALS, multiple sclerosis and Alzheimer’s.

“Essentially all brain diseases likely contain an astrocytic component,” Khakh said. “But it hasn’t been explored much because there just haven’t been good enough methods to study the astrocytes.”

To test the long-held theory that astrocytes throughout the brain have the same properties and functions, Khakh and his colleagues looked at astrocytes in two areas of mouse brains. The two areas — the dorsolateral striatum and the hippocampus CA1 stratum radiatum — are known to be quite different in their functions and the types of neurons they contain. The dorsolateral striatum is involved in controlling movement, while the hippocampus helps establish long-term memories. The scientists performed dozens of in-depth tests on the astrocytes from each area of the brain.

Khakh’s team found that the astrocytes in the striatum and hippocampus had differences that affected how they functioned and how they interacted with neurons. The cells varied between the two brain circuits when it came to how they interacted with neurons and conducted chemicals across their membranes. Moreover, the astrocytes in the striatum had different genes turned on than astrocytes from the hippocampus. 

In the past, most researchers dismissed the idea that drugs could selectively target small sets of astrocytes to try to treat brain diseases, because of the assumption that a drug targeting astrocytes would impact the whole brain. “But we’re seeing differences between astrocytes in different areas, and I suspect there are differences far greater than what we’ve seen so far,” Khakh said. The new observation means that it may be possible for drugs to work on just a small subset of astrocytes, selected by their molecular characteristics.

“Deepening our understanding of astrocyte biology in the healthy brain enables us to examine what happens to these cells in neuropsychiatric disorders and potentially intervene in astrocytes in a specific brain region for therapeutic benefit,” said Hua Chai, a UCLA graduate student and co-first author of the new paper.

“Our work suggests that differences in astrocyte functions between circuits may be one of the main reasons why in some neurological diseases, there are brain regions that are more susceptible than others,” added Blanca Diaz-Castro, a postdoctoral research fellow in the Khakh lab and co-first author of the paper.

The team has further questions about the astrocytes in the striatum and hippocampus and plans to start analyzing astrocytes from other areas of the brain.

The study’s other authors are Eiji Shigetomi, Christopher Octeau, Xinzhu Yu and Thomas Vondriska of the UCLA department of physiology; Emma Monte of the UCLA department of anesthesiology; Whitaker Cohn and Julian Whitelegge of the UCLA Pasarow Mass Spectrometry Laboratory and UCLA Brain Research Institute; Pradeep Rajendran of the UCLA Cardiac Arrhythmia Center and Neurocardiology Research Center for Excellence; and Giovanni Coppola of the UCLA department of neurology, department of psychiatry and biobehavioral sciences, and Center for Neurobehavioral Genetics.

This work and the researchers involved were supported mainly by the National Institutes of Health and the American Heart Association.

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20176/astrocyte-yellow2.jpgAstrocyteThousands of branches and branchlets emanate from an astrocyte’s cell body, which is the dense portion in the middle of the image.

Thousands of branches and branchlets emanate from an astrocyte’s cell body, which is the dense portion in the middle of the image. 

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20176/astrocyte-yellow2.jpgAstrocyte

Thousands of branches and branchlets emanate from an astrocyte’s cell body, which is the dense portion in the middle of the image. 

DavidOlmos310-267-8276dolmos@mednet.ucla.eduUCLA researchers upend a long-standing idea that the star-shaped brain cells cannot be differentiated from each other. The results should make it easier for researchers to study how astrocytes relate to disease. Sarah C.P. Williamshttp://newsroom.ucla.edu/releases/not-all-astrocytes-in-the-brain-are-the-same-study-findsThu, 13 Jul 2017 16:53:00 GMTUCLA RESEARCH ALERTFINDINGS

UCLA researchers have found that people with schizophrenia were able to more accurately determine whether two auditory tones matched or differed, after receiving a type of electrical brain stimulation. Being able to distinguish tones is essential for verbal communication.

BACKGROUND

People with schizophrenia have difficulty discriminating between tones of differing frequencies. This is thought to impair their ability to interpret tone of voice, resulting in social difficulties. Transcranial direct current stimulation, or tDCS, is a non-invasive neural stimulation technique that passes a weak electrical current (equivalent to a nine-volt battery) through the brain, changing the ability of neurons to respond to stimuli. Scientists wanted to find out if tDCS — which comes in two active varieties, anodal or cathodal — could boost auditory processing in people with schizophrenia.

METHOD

In 12 people with schizophrenia, researchers applied tDCS via electrodes on the scalp to the auditory cortex, the part of the brain that processes auditory information. The participants received anodal stimulation, cathodal stimulation or a placebo stimulation for 20 minutes. Immediately following stimulation, subjects listened to pairs of tones and were asked whether they sounded identical or different. Cathodal stimulation was associated with significant improved tone discrimination ability. Researchers’ next step is to see if the findings can be replicated in a larger group and to test how long the effects of tDCS last.

IMPACT

The technique could present an inexpensive strategy for improving the lives of people with schizophrenia in ways currently unaddressed by medication.

AUTHORS

The study’s first author is Dr. Walter Dunn, and the senior author is Michael Green, both of the West Los Angeles VA Medical Center and the UCLA Semel Institute for Neuroscience and Human Behavior. Other authors are Jonathan Wynn, Dr. Allan Wu, Dr. Marco Iacoboni and Gerhard Hellemann, all of UCLA; and Yuri Rassovsky of Bar-Ilan University, Israel.

JOURNAL

The study was published in the Journal of Neural Transmission.

FUNDING

The study was supported by the Veterans Administration Desert Pacific Veterans Integrated Service Network 22 Mental Illness Research, Education and Clinical Center.

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20176/Walter+Dunn.jpgDr. Walter DunnDr. Walter Dunn

Dr. Walter Dunn, psychiatrist and member of the UCLA Semel Institute for Neuroscience and Human Behavior and also part of the West Los Angeles VA Medical Center.

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20176/Walter+Dunn.jpgDr. Walter Dunn

Dr. Walter Dunn, psychiatrist and member of the UCLA Semel Institute for Neuroscience and Human Behavior and also part of the West Los Angeles VA Medical Center.

LeighHopper310-267-7149 LHopper@mednet.ucla.eduPeople with the disease were able to better identify auditory tones, an essential skill for interpreting tone of voice in communication.Leigh Hopperhttp://newsroom.ucla.edu/releases/electrical-stimulation-of-brain-may-help-people-with-schizophrenia-communicate-betterWed, 12 Jul 2017 20:35:00 GMTUCLA RESEARCH ALERTFINDINGS

People with schizophrenia have trouble remembering the details of social interactions in all phases of the illness, researchers report. However, in the early stages of schizophrenia, patients can remember more about these interactions if given hints about context. This finding suggests a potential strategy for memory training.

BACKGROUND

Episodic memory is the way we remember life events, big and small. What did I have for lunch? Where do I know that person from? It’s key for social functioning: Poor episodic memory, a common feature of schizophrenia, limits the ability to form relationships with others.

METHOD

Researchers wanted to see if social, episodic memory worsens over the course of the illness. They recruited three groups: people at high risk for psychosis, people who had one episode of psychosis and people with chronic schizophrenia. Without telling their subjects they were taking part in a memory test, researchers showed the participants 24 film clips, depicting friends talking, a car mechanic speaking to a customer and other ordinary scenes. Participants then viewed photographs of 24 people featured in the film clips, and photos of 24 people who were not. Researchers asked which faces just seemed familiar and which faces elicited detailed memories about the specific situations depicted in the film clips.

All three groups were able to identify faces from the film clips, but all demonstrated poor episodic memory in their ability to recall the social situations that matched the faces.

In the second phase of the study, researchers showed pictures again and asked the participants to select which of four sentences described the situation in which the face appeared. The participants who were at risk for developing schizophrenia had no trouble with this task; those who had experienced an episode of psychosis or who had chronic schizophrenia showed impairment.

IMPACT

Researchers said the study provides several insights: 1. The difference among groups in the sentence-selection task indicates that a subtle change in social memory occurs with the onset of psychosis; once the illness starts, the picture cues aren’t helpful. 2. Awareness of the importance of providing context as a way to improve social memory in the earliest phase of schizophrenia could be important for family members and caregivers. 3. Impaired social episodic memory may be an early symptom of schizophrenia.

AUTHORS

The study’s authors are Junghee Lee, first author, and Michael Green, senior author, of the UCLA Semel Institute for Neuroscience and Human Behavior and the West Los Angeles VA Medical Center; Keith Nuechterlein, Barbara Knowlton, Carrie Bearden, Alan Fiske, Livon Ghermezi, Jacqueline Hayata, Gerhard Hellemann, William Horan, Robert Kern, Kenneth Subotnik, Catherine Sugar, Joseph Ventura and Cindy Yee, all of UCLA; Tyrone Cannon of Yale University; and Kimmy Kee of California State University Channel Islands.

JOURNAL

The study was published in the July 6 Schizophrenia Bulletin.

FUNDING

The study was funded by the National Institute of Mental Health (P50MH066286).

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20176/junghee.jpgJunghee LeeFirst author Junghee Lee

Junghee Lee

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20176/junghee.jpgJunghee Lee

Junghee Lee

LeighHopper310-267-7149 LHopper@mednet.ucla.eduResearchers report that in the early stages of schizophrenia, patients can remember more about the interactions if given hints about context. This finding suggests a potential strategy for memory training. Leigh Hopperhttp://newsroom.ucla.edu/releases/memory-of-social-interactions-impaired-in-all-phases-of-schizophreniaTue, 11 Jul 2017 20:25:00 GMT
Updated: 18 hours 53 min ago