The Scope E-Newsletter March 2010

Last week I attended a meeting of Deans from Graduate Regional Medical Centers from around the country as well as Canada. This body is a subgroup of the Association of American Medical Colleges (AAMC). During the three-day meeting, it became very apparent that we are indeed a unique entity. Except for one other program, all of the others have a huge focus on educating medical students, whereas our emphasis is on residents. The lone program that has almost as many residencies as the GSM does not offer fellowships and, of course, we have 11. In short, we have some excellent opportunities to distinguish ourselves as a Graduate Regional Medical Center.

This issue of The Scope really highlights our strengths, especially in the realm of professional service as evidenced by a good number of faculty gaining recognition and positions with national organizations. From a bench research perspective, Dr. Dan Kestler and Dr. Charles Bruker received an excellent grant, while Dr. David Cassada has demonstrated superb skills in clinical research. Education comes through specialized programs for residents/fellows and continuing medical education for our own physicians as well as those in the community. The number of professional presentations and publications continues to grow. In this issue, I would encourage you to check out the rather unique publication by Donna Doyle in the Journal of the American Medical Association with a poem entitled "Stroke."

As you read through The Scope, do so with pride because this is your organization!

James J. Neutens, PhD, FASHA
Dean

Daniel Kestler, PhD, Assistant Professor, Human Immunology and Cancer Program (HICP), and Charles Bruker, MD, Pathology Resident, recently received notification of a three-year grant period totaling more than $575,000 in funds from the Susan G. Komen Foundation to develop an understanding of the Odontogenic Ameloblast associated protein (ODAM) expression in breast tumors as well as patients' humoral response to this protein. This study will provide the basis for the possible direct use of ODAM-based reagents in the assessment and treatment of breast cancers within the next decade.

ODAM is a protein that was first detected by Alan Solomon, MD, Director, HICP. It is produced within a rare calcifying epithelial odontogenic tumor and is the amyloid forming protein found with this tumor. Dr. Kestler, together with other HICP researchers, expressed recombinant ODAM and made antibodies to this protein. They found using immunohistochemical methods that ODAM was expressed within specific normal tissues, such as salivary gland and airway epithelium, and also within other epithelial cancers, including those of the breast, gastrointestinal tract and lung.

HICP investigators, along with Sabina Siddiqui, MD, Surgery Resident; Dr. Bruker; and Amber Patton, DO, Pathology Resident, immunohistochemically examined a significant number of slides for ODAM expression. These were breast cancer biopsies and resections identified through the University of Tennessee Cancer Center tumor registry and obtained from the Department of Pathology. This ODAM tumor expression was compared to patient staging and other reported clinicopathological data by Drs. Bruker and Siddiqui in conjunction with UT statisticians. The findings supported a relationship between ODAM expression and clinical stage as ODAM tumor-expression appears to correspond with better survival. These findings were recently presented at a national meeting and published in the American Surgeon.

HICP investigators had also observed and reported that late-stage breast cancer patients appear to possess anti-ODAM-specific serum antibody titers relative to normal females. This may support a possible relevant immunological response to ODAM in a portion of breast cancer patients. The proposed research will further investigate ODAM expression in breast tumors along with the presence of serum antibodies to ODAM in these patients in order to clarify any diagnostic, prognostic or possible therapeutic benefits of ODAM expression in tumor tissue or patient serum antibodies to ODAM.

"We plan to verify the importance of ODAM expression in tumor tissue," Dr. Kestler said. "We also want to determine the relationship of patient anti-ODAM antibody reactivity to clinical data including disease stage, survival, recurrence and cancer status."

Dr. Kestler said his partnership with the Surgery and Pathology residency programs has presented an opportunity to apply medical and molecular perspectives to important biomedical research that often has been limited to basic or clinical science. "Through such collaboration, everyone and everything involved, scientists, clinicians and the work, are enriched and better for the interaction."

Dr. Bruker added, "This is translational research. It serves as the bridge between clinicians and the basic sciences. This type of research has been less common in the past, and discoveries have been made at the bench that physicians were not aware of. Translational research brings these results to the patient."

Leg swelling can be a common cause for vascular surgical evaluation, and iliocaval obstruction due to May-Thurner Syndrome (MTS) can be difficult to diagnose.

David Cassada, MD, Associate Professor, Surgery's Division of Vascular/Transplant Surgery, in collaboration with Mitchell Goldman, MD, Chairman, and faculty and staff in the Department of Surgery and the Vascular Research Laboratory, developed a novel, non-invasive technique for the diagnosis of MTS, a compression of the left iliac vein by the right iliac artery. Using a simple blood pressure cuff and a duplex scanner, the velocity of outflow from the leg upon blood pressure cuff release was measured and compared to normal controls in the contralateral side. A decrease in outflow velocity correlated well with the diagnosis of MTS.

Traditionally, the condition has been indicated by exercise induced swelling, pain and fluid retention, most often in young females, and has been diagnosed using invasive procedures including CT and MRI scans, followed by a venogram to duplicate the results. The radiographic scans provided positive results less than 50 percent of the time, causing MTS to be under-diagnosed.

Once MTS is diagnosed, a stent is placed in the blockage. Dr. Cassada and his team have also found that measuring maximum venous outflow velocity through the tourniquet approach post-treatment is effective in determining its success.

This technique, previously described in an article by Michael Lebow, MD, Vascular Surgery Fellow Alumnus, has received significant professional acknowledgement. Dr. Cassada recently presented his abstract for this method, co-authored by Surgery Resident Matt Jones, to the Southern Association for Vascular Surgery, and his abstract for a similar technique to be used on the arm for the planning and treatment of conditions such as central venous stenosis and thoracic outlet syndrome has been accepted for poster competition at the Society for Vascular Surgery 2010 Vascular Annual Meeting in June.

"We have proven this technique works for the leg," said Dr. Cassada. "We are still in the process of proving it works for the arm. However, using this approach on the arm will affect more people worldwide because of dialysis. Veins are destroyed over time, and this will help us plan for treatment. Measuring venous outflow velocity, if we think the central vein is obstructed, can stop us from going into the operating room and doing something that won't work."

A daughter following in her father's footsteps to become a doctor may be common, but for Christie Carringer, MD, second-year Internal Medicine Resident, to attend medical school and complete residency a year behind her father, her experience can only be described as unique.

After a 20-year career as an engineer in the Knoxville area, Michael Carringer, MD, third-year Internal Medicine Resident, decided to pursue his passion for medicine. A year later, his daughter, Dr. Christie Carringer, graduated with a bachelor's degree from the University of Tennessee and followed her father to the American University of the Caribbean. In the process of pursuing medical degrees, the Carringer family, including Dr. Michael Carringer's wife Michele and son Kent, moved to St. Maarten, Ireland, Florida, New York, California and Knoxville for rotations before re-settling in Knoxville for residency at the UT Graduate School of Medicine.

Michael said the decision to come to the Graduate School of Medicine for residency was natural. "We both completed fourth-year rotations here. We got to know the people and the program. Having travelled, there's no place like home."

Michael and Christie said they chose the field of internal medicine because they enjoy adult medicine and the variety it provides.
"With internal medicine, you don't get the same case every day. It keeps you on your toes," Michael said.

After Michael graduates this year, he will join UT Hospitalists. Christie said she also plans to be a hospitalist when she graduates next year and would not mind continuing to work with her father. She said they both like to be in the hospital environment because it is challenging and fast-paced.

The Carringers have enjoyed their unique experience and said they have gotten to spend more time together than they would have otherwise at this stage in life.

Michael said, "I instructed her when she put in her first central line. I think I was more nervous than she was."

"It went well," Christie added. "He was a good, patient teacher, and I am comfortable with the procedure today because he taught me well the first time.

"Being here together has been great. You have someone to get a second opinion from or talk medicine with. We've gotten along well, and Dad hasn't shown me any favoritism. We've both enjoyed it."

Scott Stevens, MD, Professor, Surgery, was nominated and selected to be the Southern Association for Vascular Surgery's representative to the national vascular society, the Society for Vascular Surgery. This prestigious position represents the views of southern vascular surgery to the national society and is highly regarded in the Southern region. Dr. Steven's achievement is demonstrative of the commitment of Surgery's Division of Vascular Surgery at the UT Graduate School Medicine to the furthering of quality vascular care in the region.

Oral and Maxillofacial Surgery Professors Eric Carlson, DMD, MD, FACS, Chairman; John W. Hudson, DDS; and J. Michael McCoy, DDS, examined eligible candidates for the American Board of Oral and Maxillofacial Surgery (ABOMS) in Dallas, Texas, in February. Of 86 examiners, these faculty-physicians were the only ones selected from Tennessee among four statewide OMFS programs. The objectives of the ABOMS are to elevate the standards of oral and maxillofacial surgery and to aid oral and maxillofacial surgeons in their efforts to provide optimum health care in the United States.

Stanley Kurek, DO, Associate Professor, Surgery's Division of Trauma/Critical Care Surgery, was elected to serve another term on the Board of Directors for the Eastern Association for the Surgery of Trauma. This achievement recognizes Dr. Kurek's leadership and role in the development of practice guidelines for the surgery of trauma. He and Christy Lawson, MD, Surgery Resident, presented new practice guidelines for blunt aortic injury and blunt abdominal trauma, outlying the steps and techniques that are accepted for treatment of those two injuries. Dr. Kurek also presented at the Leadership Development Workshop on leadership skills and negotiating strategies. Dr. Kurek has been instrumental in furthering the goals of EAST to establish excellence in the care of trauma victims. Past Presidents of EAST from the Graduate School of Medicine include Kimball Maull, MD; Blaine Enderson, MD; and David Reath, MD, signifying our continuing effort to insure quality trauma care.

"Stroke," a poem by Donna Doyle, Consumer and Patient Health Information Specialist and Evening Supervisor in Preston Medical Library, was published in the February 24 issue of the Journal of the American Medical Association's Poetry and Medicine column. Doyle, also a creative writer, wrote the poem in response to her husband's June 2009 stroke. According to Poet's Market, JAMA receives approximately 750 poems per year and accepts only 7 percent.

In accepting the poem, JAMA's associate editor, Charlene Breedlove, stated in a letter, "The poem brilliantly defines some uses of the word stroke before delivering readers to its final and fateful likenesses. I know readers will appreciate, as I do, the subtle shaping of alternatives and the way the felt reality is finally delivered."

Doyle has worked for the University of Tennessee for 22 years and came to Preston Medical Library in September 2008 with an interest in the Consumer and Patient Health Information Service. She became a certified Consumer and Patient Health Information Specialist in December 2008 and said her goal is to actively and empathetically listen to every consumer. Doyle has received several awards for her poetry, and her manuscript, "Heading Home," was recently selected as a finalist in Finishing Line Press's New Women's Voices competition.

Read "Stroke" online or contact Donna Doyle for more information.

Larry M. Baddour, MD, former Professor in the UTGSM Department of Medicine has recently been named Division Chief of the Department of Infectious Diseases at the Mayo Clinic in Rochester, Minnesota. His primary areas of expertise include cardiovascular infections, and skin and soft tissue infections. Dr. Baddour was a Graduate School of Medicine faculty member from 1991 until 2002.

Laurentia Nodit, MD, Assistant Professor, Pathology

Mary Kathryn O'Connor, Administrative Support Assistant III, Dean's Office

All UTGSM faculty are invited to attend the second annual Faculty Development Workshop, Friday, March 26, UT Conference Center, 8 a.m.–12 p.m., presented by the UT Graduate School of Medicine and Academy of Scholars Committee.

Faculty should register online by March 22. This workshop offers up to 4 CME credits through AMA and AAPA. Up to .4 CEUs also are available.

Two keynote presenters, Dr. Pamela Rowland of Dartmouth-Hitchcock Medical Center and Dr. Sheila Chauvin of Louisiana State University Health Science Center will address "Professionalism" and "Scholarly Research in Medical Education."

A nationally recognized communications expert, Dr. Rowland trained as a behavioral scientist and has more than 25 years of clinical experience at Brown, Tufts and Dartmouth medical schools. She evaluates faculty in clinical settings and has focused her research on physician-patient satisfaction, verbal examinations and interviewing skills.

Dr. Chavin, an equally experienced behavioral scientist, founded and directs the Academy for the Advancement of Educational Scholarship at LSU and also directs the Office of Medical Education and Research, which serves as a consulting group to faculty pursuing research projects.

After the two plenary presentations, participants will attend workshops to apply the material covered in the plenary sessions. A continental breakfast and box lunch will be provided.

For more information, visit www.tennessee.edu/cme/FacultyDevelopment2010 or call Communications and Outreach at 305-9190.

The University of Tennessee College of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The UT College of Medicine designates this educational activity for a maximum of 4 AMA PRA Category 1 Credits.

Resident Business Course Lite, a series for resident physicians and dentists to gain essential business skills, will continue at noon, March 25, in Wood Auditorium with "Residential and Commercial Real Estate Investments," presented by Tricia Andrews and Megan Stansbury, Keller Williams Realty: The Laing Team. The presentation will include tips for working with a realtor; a step-by-step guide to buying your home; and information on home-buyer tax credits, renting versus buying and commercial real estate.

View the 2010 series schedule and post-session presentations on The Pulse.

Resident Business Course Lite is sponsored by UT Graduate School of Medicine Graduate Medical and Dental Education.

Residents can now submit an abstract online to the second annual UT Graduate School of Medicine and Academy of Scholars Committee Resident Research Day via The Pulse. Abstracts for unpublished research should be submitted by April 26. Resident Research Day will be held May 26 in the College of Pharmacy third-floor auditorium.

Resident Research Day gives residents an opportunity to share their research via poster in PowerPoint format and a three-minute oral presentation. Presentations will be judged and awards will be given for first, second and third place and for best case presentation.

The UT Graduate School of Medicine and Academy of Scholars Committee will hold the first Fellow Research Day on Wednesday, June 2, in the College of Pharmacy third-floor auditorium. Fellows are invited to participate by submitting a structured abstract for unpublished research via The Pulse by Monday, May 3.

Fellow Research Day gives fellows an opportunity to share their research via poster in PowerPoint format and a three-minute oral presentation. Presentations will be judged and awards will be given for best presentations.

Plan now to attend these CME-certified activities in March and April, sponsored by the UT Graduate School of Medicine.

March 25: Surgery Grand Rounds: Physical Medicine and Rehabilitation, Morrison's Conference Center, 7-8 a.m.

March 26: Faculty Development Workshop, UT Conference Center

April 1: Surgery Grand Rounds: John W. Whittington, MD Visiting Lectureship: Topic TBA, Morrison's Conference Center, 7-8 a.m.

April 8: Surgery Grand Rounds: Topic TBA, Morrison's Conference Center, 7-8 a.m.

April 13: Internal Medicine Grand Rounds: Medical Complications of Pregnancy, Morrison's Conference Center, 8-9 a.m.

April 15: Surgery Grand Rounds: Topic TBA, Morrison's Conference Center, 7-8 a.m.

April 16: East Tennessee Dermatology Society Meeting, Knoxville Dermatology Group, Suite 209, University of Tennessee Medical Center, 4-6 p.m.

April 19: Brain and Spine Institute Neurology/Neurosurgery Quarterly Conference: Stroke, Morrison's Conference Center, 7-8 a.m.

April 22: Surgery Grand Rounds: Pediatrics, Morrison's Conference Center, 7-8 a.m.

April 29: Surgery Grand Rounds: Physiology VAC Therapy and Wound Healing, Morrison's Conference Center, 7-8 a.m.

Visit CMDE Upcoming Courses or contact Communications and Outreach for more information about these activities.

Hematology Conference Brings International Knowledge to Knoxville; 2011 Date Set

Briefings shared at the American Society of Hematology (ASH) international conference were brought to Knoxville for the Sixth Annual Hematology Conference, January 23, UT Conference Center. Renowned experts from Mayo Clinic, MD Anderson, Georgetown University and Emory University developed unique presentations combining their areas of expertise with new information they garnered from the ASH conference, and they shared this information with a group of regional hematology specialists. This continuing medical education activity offered up to 5 CME credits for participants. The hematology conference was presented by the UT Graduate School of Medicine and directed by Wahid Hanna, MD, Professor, Department of Medicine, UT Graduate School of Medicine.

Before the adjournment of the Sixth Annual Hematology Conference, January 23, 2010, organizers set the date for the 2011 conference. Mark your calendar now for the Seventh Annual Hematology Conference: January 22, 2011, UT Conference Center.

Karla Matteson, PhD, and Anton Allen, MD

Participants at the two-part, CME-certified Radiology Seminar in January learned about common mistakes made by healthcare professionals when ordering x-rays, the impact of those mistakes and what to consider when ordering radiological exams.

The seminar, "The Busy Clinician's Guide to Ordering X-Ray Exams," was led by Anton Allen, MD, Associate Professor, Head of Musculoskeletal Subsection, Radiology, and Cassy DiRuzzo, MD, Radiology Resident.

Southeastern Surgical Congress 2010 Annual Scientific Meeting, Savannah, Georgia, February 20-23

Poster Presentations
John Milligan, MD
"Endoscopy – Keeping up with the RRC"

Contributor: Brian J. Daley, MD, MBA, FACS

Sabina Siddiqui, MD
"Cytokine Response in the Multi-Trauma Patient"

Contributors: Brian Tucker, DO; Russell Langdon, MD; Blaine Enderson, MD

American Society for Parenteral and Enteral Nutrition's Clinical Nutrition Week, Las Vegas, Nevada, February 8-12

Poster Presentation
Mariah Alexander, MD
"Gastric Residual Volumes: What is Baseline?"

Contributors: Susan Brantley, RD, MS, CNSC; Ted Chang, MD; Chris Guglielmo, MD; Judson Gash, MD; and Brian J. Daley, MD, MBA, FACS

Fifth Annual Academic Surgical Congress, San Antonio, Texas, February 3-5

Oral Presentations
Deidra Mountain, PhD
"The Role of Doxycycline as an Inhibitor of Intimal Hyperplasia after Balloon Angioplasty Arterial Injury"

Contributors: James Chalk, MD; Alexander Tummers, MD; Stacy Kirkpatrick; David Cassada, MD; Scott Stevens, MD; Michael Freeman, MD; Mitchell Goldman, MD; Oscar Grandas, MD

Khanjan Nagarsheth, MD
"Splenic Artery Emobilization in Blunt Abdominal Trauma: Creating a Mathematical Model to Predict ICU Length of Stay"

Contributor: Stanley Kurek, DO

Southern Association for Vascular Surgery Meeting, Paradise Island, Bahamas, January 20-23, 2010

Co-author: Matt Jones, MD

James Chalk, MD
"Hormone Replacement Therapy Influences Intimal Hyperplasia after Vascular Injury: Role of Matrix Metalloproteinases"

Contributors: Deidra Mountain, PhD; Stacy Kirkpatrick; David Cassada, MD; Scott Stevens, MD; Michael Freeman, MD; Mitchell Goldman, MD; Oscar Grandas, MD

Scott Stevens, MD, presided over scientific sessions.

Society of Critical Care Medicine's 39th Critical Care Congress, Miami Beach, Florida, January 9-13

Brian J. Daley, MD, MBA, FACS, FCCP, CNSC led Professor Walk Rounds on Critical Care.

Lands R
The man with the angry face.
J Am Geriatr Soc. 2010 Jan;58(1):178. No abstract available.
PMID: 20122051

Wallace LS, DeVoe JE, Heintzman JD, Fryer GE
Language preference and perceptions of healthcare providers' communication and autonomy making behaviors among Hispanics.
J Immigr Minor Health. 2009 Dec;11(6):453-9. Epub 2008 Sep 24.
PMID: 18814028

Dougherty Jr JH, Cannon RL, Nicholas CR, Hall L, Hare F, Carr E, Dougherty A, Janowitz J, Arunthamakun J
The Computerized Self Test (CST): An Interactive, Internet Accessible Cognitive Screening Test For Dementia.
J Alzheimers Dis. 2010 Feb 17. [Epub ahead of print]
PMID: 20164591

Bromberg WJ, Collier BC, Diebel LN, Dwyer KM, Holevar MR, Jacobs DG, Kurek SJ, Schreiber MA, Shapiro ML, Vogel TR
Blunt Cerebrovascular Injury Practice Management Guidelines: The Eastern Association for the Surgery of Trauma.
J Trauma. 2010 Feb;68(2):471-477.
PMID: 20154559

Yao ML, Reddy MS, Yong L, Walfish I, Blevins DW, Kabalka GW
Chemoselective bromodeboronation of organotrifluoroborates using tetrabutylammonium tribromide: application in (z)-dibromoalkene syntheses.
Org Lett. 2010 Feb 19;12(4):700-3.
PMID: 20085349

Lois C, Jakoby BW, Long MJ, Hubner KF, Barker DW, Casey ME, Conti M, Panin VY, Kadrmas DJ, Townsend DW
An assessment of the impact of incorporating time-of-flight information into clinical PET/CT imaging.
J Nucl Med. 2010 Feb;51(2):237-45. Epub 2010 Jan 15.
PMID: 20080882

Leblanc CJ, Leblanc AK, Jones MM, Bartges JW, Kania SA
Evaluation of peripheral blood neutrophil function in tumor-bearing dogs.
Vet Clin Pathol. . [Epub ahead of print]
PMID: 20003028

Maples P, Franks A, Ray S, Stevens AB, Wallace LS
Development and validation of a low-literacy Chronic Obstructive Pulmonary Disease knowledge Questionnaire (COPD-Q).
Patient Educ Couns. 2009 Dec 29. [Epub ahead of print]
PMID: 20044232

Landles C, Sathasivam K, Weiss A, Woodman B, Moffitt H, Finkbeiner S, Sun B, Gafni J, Ellerby LM, Trottier Y, Richards WG, Osmand A, Paganetti P, Bates GP
Proteolysis of mutant huntingtin produces an exon 1 fragment that accumulates as an aggregated protein in neuronal nuclei in Huntingtons disease.
J Biol Chem. 2010 Jan 19. [Epub ahead of print]
PMID: 20086007

Venero CV, Venero JV, Wortham DC, Thompson PD.
Lipid-Lowering Efficacy of Red Yeast Rice in a Population Intolerant to Statins.
Am J Cardiol. 2010 Mar 1;105(5):664-666.
PMID: 20185013