The uncommon, high-risk delivery involved more than 20 physicians and other health practitioners

Read St. Petersburg Times story...

Tampa, FL (Nov. 12, 2009) -- A multidisciplinary team of USF Health and Tampa General Hospital physicians recently performed the first Ex Utero Intrapartum Treatment (EXIT) at TGH -- successfully securing an airway for a baby girl with a large benign tumor wrapped around her neck before fully delivering the 7 pound, 11 ounce infant by Cesarean section.

EXIT is an innovative procedure developed to deliver infants with severe congenital abnormalities that may make breathing after delivery difficult or impossible. During EXIT, the newborn is partially delivered in a manner similar to a C-section, but the umbilical cord supplying oxygen from mother to baby is not immediately cut. Instead, the baby is intubated -- a breathing tube is inserted through the mouth or nose into the windpipe – and delivery of the infant is completed and cord cut only after a clear airway has been established.

“The biggest challenge in this type of procedure is establishing an airway for the fetus while maintaining a steady supply of oxygen so that no neurological damage occurs,” said Valerie Whiteman, MD, lead USF obstetrician for the EXIT delivery on Oct. 1. “If you can’t successfully intubate on the first attempt, surgical intervention is required and that potentially increases the risk for both the fetus and mother.”

Dr. Valerie Whiteman, interim director of Maternal-Fetal Medicine at USF Health, led the EXIT delivery.

This challenging, uncommon procedure (only about 100 cases have been documented in the United States) required extensive, seamless coordination by the USF-TGH team of 20-plus physicians, nurses and other health professionals assembled inside and just outside the operating room.

The following were the key physicians on the EXIT delivery team:

• Maternal-Fetal Medicine -- Dr. Valerie Whiteman, USF assistant professor of obstetrics and gynecology and interim director of Maternal-Fetal Medicine, assisted by Dr. Aaron Deutsch, senior maternal fetal medicine fellow

• Anesthesia – Dr. Devanand Mangar, anesthesiologist with Gulf-to-Bay Anesthesiology and chief of staff at Tampa General Hospital, and Dr. Amrat Anand, Gulf-to-Bay anesthesiologist

• Neonatalogy - Dr. Terri Ashmeade and Dr. Laura Haubner, both USF assistant professors of pediatrics, and Dr. Lewis Rubin, professor and chief of neonatology at USF

• Pediatric Surgery - Dr. Charles Paidas, director of USF Division of Pediatric Surgery

Patty Bornick, RN, MSN, perinatal navigator for the USF Health Fetal Care Center of Tampa Bay, coordinated care for the high-risk obstetric patient, a 31-year-old woman who lives in Tampa with her husband and two other children.

Anesthesiologists delivered anesthesia to the mother and a medication to prevent contractions during intubation. Obstetricians performed the high-risk surgical delivery using a special autosuturing device to minimize maternal bleeding. Neonatologists intubated once the infant’s head and shoulders were delivered and assessed the baby after birth. The pediatric surgeon was on standby in case intubation proved difficult, so that some of the tumor could be cut away or a hole could be made in the windpipe. The infant’s heart rate was continually monitored by ultrasound for any signs of oxygen loss.

The USF-TGH team established protocols and contingency plans for the surgery and practiced with two dry runs in the operating room in August and September. During the actual EXIT procedure, intubation was successful on the first attempt.

“We were all familiar with our roles, our equipment and what steps needed to be taken when. We prepared for the best and worst case scenarios. It took teamwork, teamwork and more teamwork,” Dr. Whiteman said. “This EXIT procedure required tremendous collaboration, and the successful outcome speaks well of the partnership between TGH and USF and our extensive resources.”

“Preparing for the procedure with Dr. Laura Haubner, director of the Department of Pediatrics Center for Team Education and Multidisciplinary Simulation was vital,” said Dr. Ashmeade, the neonatologist who placed the breathing tube. “She is an expert in critical resource management and patient safety. I knew that she was aware of the entire situation in the operating room, which allowed me to concentrate solely on securing the baby’s airway.”

USF pediatric surgeon Dr. Charles Paidas has already performed one surgery to begin removing the benign tumor wrapped around the baby's neck.

The baby was discharged home from Tampa General’s neonatal intensive care unit on Oct. 12. The benign tumor, a cystic hygroma, will be resected in two stages because it is attached from the base of her skull to her tongue, and surrounds her heart, windpipe and great vessels. She underwent a first operation Oct. 30 to remove the neck portion of the hygroma. In two to three months, a second operation will remove the remainder of the tumor in her right chest.

“This was not simply a team, but a team that practiced all aspects of the planned procedure and practice makes perfect,” Dr. Paidas said.

- USF Health –
USF Health is dedicated to creating a model of health care based on understanding the full spectrum of health. It includes the University of South Florida’s colleges of medicine, nursing, and public health; the schools of biomedical sciences as well as physical therapy & rehabilitation sciences; and the USF Physicians Group. With more than $380.3 million in research grants and contracts last year, USF is one of the nation’s top 63 public research universities and one of 39 community-engaged, four-year public universities designated by the Carnegie Foundation for the Advancement of Teaching. For more information, visit www.health.usf.edu

- Tampa General Hospital -
Tampa General is a 988-bed acute care hospital on the west coast of Florida that serves as the region’s only center for level I trauma care, comprehensive burn care and adult solid organ transplants. It is the primary teaching hospital for the University of South Florida College of Medicine. TGH is also one of only 16 comprehensive stroke centers in Florida and is a state-certified spinal cord and head injury rehabilitation center.

- News release by Anne DeLotto Baier, USF Health Communications

Tampa, FL (Oc.t 28, 2009) -- You don’t have to look any further than backyard to see that there’s a regional water crisis. A three-year drought has dried up rivers and other water sources, pumping threatens wells and wetlands, and officials have imposed the toughest watering restrictions in the Tampa Bay area’s history.

A special forum at USF on Wednesday, Nov. 4, will focus on how water usage and responses to shortages here in Tampa Bay can have global environmental and health implications. The Tampa Bay chapter of Physicians for Social Responsibility and the USF College of Public Health are sponsoring “The Global Water Crisis: Solutions from Tampa Bay,” at the USF College of Public Health auditorium, 13201 Bruce B. Downs Blvd, in Tampa. Refreshments will be served at 6:30 p.m. and the event starts at 7 p.m.

The keynote speaker, Dr. Noel J. Brown, president and CEO of Friends of the United Nations, is an internationally recognized expert on global water issues and champion of environmental sustainability. Dr. Brown and others have noted the unprecedented demand on water resources can have profound implications for the world’s water supply, protection of human health and the viability of aquatic ecosystems.

A panel discuss will feature Mary Mulhern of the Tampa City Council and Karl Nurse of St. Petersburg City Council, as well as Frank Mueller-Karger, PhD, of the USF College of Marine Science, Dr. David Randle, managing director of Waves of Change, and Phil Compton, regional representative of Sierra Club Florida.

For more information go to www.psr.org/tampa.

The USF arm of the NIH trials will be performed at Genesis, Tampa General Hospial and USF clinics.

Tampa, FL (Oct. 26, 2009) -- The University of South Florida is participating in two federal studies to see whether the H1N1 vaccine can safely elicit a protective immune response in pregnant women, as well as in children and young adults, all of whom are HIV-infected.

USF will be one of 35 sites and eight sub-sites in the United States and Puerto Rico participating in the two studies, which are sponsored and funded by the National Institute of Allergy and Infectious Diseases (NIAID) and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), both part of the National Institutes of Health. Investigators plan to vaccinate about 130 HIV-infected women and 140 HIV-infected children and young adults around the country.

USF is participating in both studies as part of its role as a site of the International Maternal-Pediatric-Adolescent AIDS Clinical Trials Group (IMPAACT) network, a project of NIAID and NICHD that develops and implements multi-center HIV treatment and prevention research trials.

In the first study, on HIV-infected pregnant women, about 10 women are expected to be enrolled in the Tampa Bay area, said Dr. Karen L. Bruder, USF assistant professor of obstetrics and gynecology and the principal investigator for USF’s study site. Dr. Bruder also is medical director of the Genesis at HealthPark clinic of Tampa General Hospital.

The study is particularly important for this group of women because pregnant women already are at greater risk of suffering serious complications from the H1N1 virus, largely because their immune systems do not function at their normal levels. If a pregnant woman also is infected with HIV, her immune system is further compromised.

“She is already immuno-suppressed,” Dr. Bruder said.

Dr. Karen Bruder leads the USF study site testing whether the H1N1 vaccine protects HIV-infected pregnant women.

The study will look at how the vaccine affects the woman and her infant -- for instance, how many antibodies to the H1N1 influenza virus does the woman develop in response to the vaccine? Are those antibodies transferred to the fetus? After the baby is born, does it still have antibodies to the virus?

The study will also evaluate whether the vaccine affects the woman’s HIV viral load or the cells in the immune system that are often affected by HIV.

Women in the study will receive two doses of vaccine. The women’s response to the vaccine will be evaluated during pregnancy, at delivery, and at 3 and 6 months after delivery. The babies will be evaluated when they are 3 and 6 months old.

USF’s work in the study will be performed at Genesis, Tampa General and at USF clinics.
In the second study, at least four HIV-infected children or young adults will receive the H1N1 vaccine at the USF clinics, said Dr. Jorge Lujan-Zilbermann, associate professor of pediatrics and principal investigator for the USF site of the study.

This study will divide subjects into three age groups: ages 4 to 9, 10 to 17, and 18 to 24. As in the first study, the children and young adults will receive vaccine in two doses three weeks apart. Study subjects will be followed for seven months.

The study will examine how safe the vaccine is, how effectively it stimulates the immune system to make antibodies to the H1N1 influenza virus, and how long children and young adults maintain these antibodies in their blood after being vaccinated. The study will also look at other immune responses.

The vaccine all study subjects will receive contains inactivated virus, so it will not be possible for them to contract H1N1 influenza from the vaccine. Because of the increased vulnerability of HIV-infected pregnant women, children and youth, the trials will test whether doses of the licensed 2009 H1N1 influenza vaccine that are higher than doses being tested in other groups can safely elicit protective immune responses in these populations.

The IMPAACT sites participating in these studies will receive vaccine from Novartis Vaccines and Diagnostics of Cambridge, Mass, through the Office of the Assistant Secretary for Preparedness and Response for the U.S. Department of Health and Human Services.

For more information about NIH-sponsored clinical trials of H1N1 influenza vaccine in HIV-infected pregnant women, children and youth, see http://www3.niaid.nih.gov/news/newsreleases/2009/H1N1HIVTrials.htm and http://www3.niaid.nih.gov/news/QA/H1N1VacHIVChildYouthPregWomenqa.htm

- USF Health -

USF Health is dedicated to creating a model of health care based on understanding the full spectrum of health. It includes the University of South Florida’s colleges of medicine, nursing, and public health; the schools of biomedical sciences as well as physical therapy & rehabilitation sciences; and the USF Physicians Group. With more than $380.4 million in research grants and contracts last year, USF is one of the nation’s top 63 public research universities and one of 39 community-engaged, four-year public universities designated by the Carnegie Foundation for the Advancement of Teaching. For more information, visit www.health.usf.edu

- Story by Lisa Greene, USF Health Communications
- Photos by Eric Younghans, USF Health Communications

Research may have implications for other neurological disorders affecting balance

Tampa, FL -- An upcoming  symposium at USF Health will bring together scientists, clinicians and patients to discuss promising new research for Friedreich’s ataxia and other ataxias, a group of degenerative diseases of the nervous system that adversely affect balance, coordination and movement.

“Understanding Energy for a Cure” will be held 6:15 to 8 p.m. on Thursday, August 27, in Room 1013 at the Morsani Center for Advanced Healthcare at USF Health, 13330 USF Laurel Drive, Tampa, FL 33612. The symposium, sponsored by the Friedreich’s Ataxia Research Alliance (FARA) and the USF Ataxia Research Center (ARC), is free and open to the public.

Dr. Jeffrey Krischer, professor and director of the USF Pediatrics Epidemiology Center, will speak on “The Challenges and Promise of Rare Diseases Research.”  Dr. Krischer is the principal investigator for a major National Institutes of Health data coordinating center that supports the Rare Diseases Clinical Research Network, which is addressing the complexities of diagnosing and treating a variety of rare diseases, including ataxias.

Other speakers will be Dr. Theresa Zesiewicz, professor of neurology and director of the USF ARC; Jennifer Farmer, executive director of FARA; and Ron Bartek, president and founder of FARA.  Topics will cover new research, the care and management of ataxia, with an emphasis on Friedreich’s; and patient advocacy. Dr. Stephen Klasko, CEO for USF Health and dean of the College of Medicine, will moderate a panel discussion on the patient’s perspective of ataxia.

“Research investigating the underlying molecular mechanisms of Friedreich’s and spinocerebellar ataxia may lead not only to treatments for ataxias, but also to more effective therapies for imbalance caused by stroke, tumors and toxins,” Dr. Zesiewicz said.

The USF ARC provides care for patients suffering from imbalance and ataxia, while conducting both basic science and patient-oriented research.  The center has a special focus on Friedrich’s ataxia, a debilitating neuromuscular disease that typically strikes children and teenagers and leaves them wheelchair bound by their early 20s.

The center is currently spearheading several clinical trials in Friedreich’s and spinocerebellar ataxias, partnering with other universities and national organizations, including FARA, the National Ataxia Foundation and the Bobby Allison Ataxia Research Alliance, to bring promising medications to human testing.

For more information, please call (813) 974-5909.

About USF Health
USF Health is dedicated to creating a model of health care based on understanding the full spectrum of health. It includes the University of South Florida’s colleges of medicine, nursing, and public health; the schools of biomedical sciences as well as physical therapy & rehabilitation sciences; and the USF Physicians Group. With more than $360 million in research grants and contracts last year, USF is one of the nation’s top 63 public research universities and one of 39 community-engaged, four-year public universities designated by the Carnegie Foundation for the Advancement of Teaching.

About FARA
The Friedreich's Ataxia Research Alliance's (FARA) mission is to marshal and focus the resources and relationships needed to cure FA by raising funds for research, promoting public awareness, and aligning scientists, patients, clinicians, government agencies, pharmaceutical companies and other organizations dedicated to curing FA and related diseases.

Event week includes “Understanding Energy for a Cure” scientific symposium at USF Health

Tampa, Florida —The Friedreich’s Ataxia Research Alliance (FARA), in partnership with the University of South Florida’s Ataxia Research Center (USF ARC), is hosting its Inaugural FARA Energy Ball on August 29th at Tampa’s A La Carte Event Pavilion.  The event benefits research for Friedreich’s Ataxia (FA), a rare debilitating neuromuscular disease.  In addition to FA, a portion of funds will be contributed to USF ARC and will be targeted to support research on a broader scope of ataxias.

Tickets for the FARA Energy Ball are $250 per person or $500 per couple.  The ticket price includes admission to the Ball and to a scientific symposium titled “Understanding Energy for a Cure” (scheduled for 6:15 to 8 p.m. August 27th) hosted by the University of South Florida College of Medicine.  The interactive symposium will feature an array of keynote speakers including Dr. Stephen Klasko, CEO of USF Health and Dean of the College of Medicine, and Dr. Jeffrey Krischer, Professor and Chief, USF Department of Pediatrics Division of Biostatistics and Informatics, who will be sharing insights into energizing a cure for Friedreich’s Ataxia. Dr. Theresa Zesiewicz, Director of the USF Ataxia Research Center, will be discussing the treatment of Friedreich’s Ataxia.

The Ball will begin with a cocktail reception and silent auction at 6 p.m. and will be followed by a seated five-course dinner and live auction at 8 p.m.  Valet parking is available. 

FARA Energy Ball
Guests at the Ball will be entertained by nationally acclaimed comedian and impressionist, Gordie Brown.  Voted Nevada’s “Entertainer of the Year,” Brown has grown into a national phenomenon and is currently one of Las Vegas’ most popular shows.

According to Kathy Rothschild, co-chair of the FARA Energy Ball, the event has been supported by a substantial sponsorship base, which greatly benefits FARA as it is funded primarily by corporate and individual donors.

“We are very excited about our inaugural event that will help build awareness about Friedreich’s Ataxia.  By hosting a fun benefit, we are hopeful that it will become an annual “not to be missed” fundraiser for the Tampa Bay area,” says Rothschild.  “The amount of sponsors who have come forth to be involved through extremely generous gifts has been phenomenal.  We are grateful for their passion to find a cure."

Sponsorship levels range from $4,000 to $50,000 and sponsor packages include the Energy Experience weekend of a scientific symposium, golf, tennis, Patron Party and the Ball.  Information on sponsorship opportunities and the event can be found at http://www.cureFA.org/EnergyBall.

“This exciting collaboration between USF ARC and FARA will enable our community to lead the way in developing therapies for rare and common diseases,” says USF Health’s Dr. Klasko. “With the help of our community, we will be successful in making great progress in curing Friedreich’s Ataxia and provide powerful insights and benefits in other energy deprivation disorders.”

FARA Energy Ball Events

Thursday, August 27: “Understanding Energy for a Cure” Scientific Symposium,
 6:15 -8 p.m. USF Health Morsani Center for Advanced Health Care, University of South Florida Tampa campus

Friday, August 28:  FARA Tennis Tournament, Avila Golf and Country Club; Evening Patron Party

Saturday, August 29:  FARA Golf Tournament, TPC Tampa Bay
    FARA Energy Ball, A La Carte Event Pavilion

About Friedreich’s Ataxia (FA)
Friedreich's Ataxia (FA) is a debilitating neuromuscular disease that is caused by a lack of energy production that our cells need for proper function and survival. Over a short period of time, FA affects muscle coordination and eventually leads to a life altering loss of mobility, energy, speech and hearing, robbing children and young adults of the ability to live an active life. FA also presents serious risk of diabetes and life shortening cardiac disease. The Friedreich's Ataxia Research Alliance (FARA) provides hope for families and individuals affected by this debilitating disease. Funding is vital in this treatment era, as FARA stewards potential therapies through the final stages of research and into the hands of those affected by the disease.

About the Friedreich’s Ataxia Research Alliance’s (FARA)
The Friedreich’s Ataxia Research Alliance’s (FARA) mission is to marshal and focus the resources and relationships needed to cure FA by raising funds through research, promoting public awareness and aligning scientists, patients, clinicians, government agencies, pharmaceutical companies and other organizations dedicated to curing FA and related diseases.

About the USF Ataxia Research Center (USF ARC)
The University of South Florida’s Ataxia Research Center (USF ARC) is a translational research center focused on developing effective treatments for the ataxias. The USF ARC is currently spearheading numerous clinical therapeutic trials in both Friedreich’s and spinocerebellar ataxia and has partnered with other leading centers, organizations and industries throughout the country to bring promising compounds into human testing.

Study has implications for postoperative elderly patients at risk for Alzheimer’s disease

Tampa, FL (Aug. 11, 2009) -- A 65-year-old women goes into the hospital for routine hip surgery. Six months later, she develops memory loss and is later diagnosed with Alzheimer’s Disease. Just a coincidence? Researchers at the University of South Florida and Vanderbilt University don’t think so. They suspect that the culprit precipitating Alzheimer’s disease in the elderly women may be a routine administration of high concentrations of oxygen for several hours during, or following, surgery – a hypothesis borne out in a recent animal model study.

Dr. Gary Arendash of the Florida Alzheimer’s Disease Research Center at USF and Dr. L. Jackson Roberts II at Vanderbilt University used mice genetically altered to develop abnormal levels of the protein beta amyloid, which deposits in the brain as plaques and eventually leads to Alzheimer’s-like memory loss as the mice age. They found that young adult Alzheimer’s mice exposed to 100-percent oxygen during several 3-hour sessions demonstrated substantial memory loss not otherwise present at their age. Young adult Alzheimer’s mice exposed to normal air had no measurable memory loss, and neither did normal mice without any genetic predisposition for Alzheimer’s disease.

The authors suggest that people genetically predisposed to Alzheimer’s disease or with excessive amounts of beta amyloid in their brains are at increased risk of developing the disease earlier if they receive high concentrations of oxygen, known as hyperoxia. Their study is published online this month in NeuroReport.

“Although oxygen treatment beneficially increases the oxygen content of blood during or after major surgery, it also has several negative effects that we believe may trigger Alzheimer’s symptoms in those destined to develop the disease,” said USF neuroscientist Arendash, the study’s lead author. “Our study suggests that the combination of brain beta amyloid and exposure to high concentrations of oxygen provides a perfect storm for speeding up the onset of memory loss associated with Alzheimer’s Disease.”

USF neuroscientist Gary Arendash was the study's lead author.

While postoperative confusion and memory problems are common and usually transient in elderly patients following surgery, some patients develop permanent Alzheimer’s-like cognitive impairment that remains unexplained. Recent studies have indicated that general anesthesia administered during surgery may increase a patient’s risk of Alzheimer’s disease, but the laboratory studies did not use animals or people predisposed to develop the disease.

“Postoperative memory loss can be a fairly common and devastatingly irreversible problem in the elderly after major surgical procedures,” said Roberts, an MD who holds an endowed chair in Pharmacology at Vanderbilt University School of Medicine. “There has been much speculation as to the cause of this memory loss, but the bottom line is that no one really knows why it happens. If all it takes to prevent this is reducing the exposure of patients to unnecessarily high concentrations of oxygen in the operating room, this would be a major contribution to geriatric medicine.”

The USF-Vanderbilt study looked at 11 young adult mice genetically modified to develop memory problems as they aged, mimicking Alzheimer’s disease. After behavioral tests confirmed the mice had not yet developed memory impairment at age 3 months – about age 40 in human years – the researchers exposed half the Alzheimer’s mice to 100-percent oxygen for three hours, three times over the next several months. The protocol was intended to replicate initial and supplemental exposures of elderly patients in hospital operating rooms and recovery suites to high concentrations of oxygen. The other half of the mice were exposed to 21-percent oxygen, the concentration of oxygen in typical room air.

When researchers retested the mice after the final gas exposure, they found that Alzheimer’s mice exposed to 100-percent oxygen performed much worse on tests measuring their memory and thinking skills than the Alzheimer’s mice exposed to normal room air. In fact, the Alzheimer’s mice exposed to room air demonstrated no memory loss. Moreover, exposure of young adult mice without beta amyloid protein deposited in their brains to 100-percent oxygen did not adversely affect their memories. This is consistent with studies in humans showing that exposure of young adults to high concentrations of oxygen has no harmful effects on memory.

The researchers also demonstrated that even a single 3-hour exposure to 100-percent oxygen caused memory deficits in the Alzheimer’s mice. Furthermore, when they examined the brains of these mice, they found dramatic increases in levels of isofurans, products of oxygen-induced damage from toxic free radicals. The increase was not present in the brains of normal control mice exposed to the single hyperoxia treatment.

How might high concentrations of oxygen hasten memory impairment in those destined to develop Alzheimer’s disease? The researchers suggest the striking increase of isofurans during surgery may be one triggering mechanism, particularly in cardiac bypass surgery where very high blood oxygen levels are routinely attained and permanent memory loss often occurs months after the surgery. Secondly, exposure to high oxygen concentrations prompts abnormal swelling of brain cell terminals that transmit chemical messages from one brain cell to another and may further disrupt already frayed nerve cell connections in those at risk for Alzheimer’s. Third, high concentrations of oxygen combined with beta amyloid plaques constricts blood vessels and decreases blood flow to the brain more than either one alone.

The authors caution that the study in mice may or may not accurately reflect the effects of hyperoxia in human surgery patients.

“Nonetheless, our results call into question the wide use of unnecessarily high concentrations of oxygen during and/or following major surgery in the elderly,” Roberts said. “These oxygen concentrations often far exceed that required to maintain normal hemoglobin saturation in elderly patients undergoing surgery”.

Arendash published initial evidence in 1987 that Alzheimer’s disease starts in the brain several decades before memory loss occurs. His research focuses on developing promising therapeutics in Alzheimer’s mice that can quickly be transferred to human clinical trials. Roberts, an expert on the role of free radicals and oxidative injury in disease, has discovered novel products of free radical damage that may be associated with several age-related brain dysfunctions. Also participating in the hyperoxia study were Dr. Takashi Mori of Saitama Medical University (Japan) and Dr. Kenneth Hensley of the Oklahoma Medical Research Foundation.

The study was supported by grants within the Florida Alzheimer’s Disease Research Center, a statewide project sponsored by the National Institute on Aging, and a National Institutes of Health Merit Award to Dr. Roberts.

An estimated 10 million baby boomers will develop Alzheimer's disease in their lifetime. The disease usually begins after age 60, and risk rises with aging. The direct and indirect cost of Alzheimer's disease in the United States is a staggering $150 billion a year, according to the national Alzheimer’s Association.

- USF Health -
USF Health is dedicated to creating a model of health care based on understanding the full spectrum of health. It includes the University of South Florida’s colleges of medicine, nursing, and public health; the schools of biomedical sciences as well as physical therapy & rehabilitation sciences; and the USF Physicians Group. With more than $360 million in research grants and contracts last year, USF is one of the nation’s top 63 public research universities and one of 39 community-engaged, four-year public universities designated by the Carnegie Foundation for the Advancement of Teaching.

- Vanderbilt University Medical Center -
Vanderbilt Medical Center (VMC) is a comprehensive healthcare facility dedicated to patient care, research, and biomedical education. Its reputation for excellence in each of these areas has made Vanderbilt a major patient referral center for the Mid-South. Each year, people throughout Tennessee and the Southeast choose Vanderbilt for their health care needs, not only because of its excellence in medical science, but also because the faculty and staff are dedicated to treating patients with dignity and compassion. Vanderbilt's mission is to advance health and wellness through preeminent programs in patient care, education, and research.

L to R: Dr. Alexander Rosemurgy, Dr. Sharona Ross and Dr. Devanand Mangar

Tampa FL (July 24, 2009) -- Dr. Sharona Ross and Dr. Alexander Rosemurgy – both University of South Florida general surgeons and Dr. Devanand Mangar, anesthesiologist with Gulf-to-Bay Anesthesiology and Chief of Staff at Tampa General Hospital -- last week performed what they believe is the first single incision gallbladder removal without the use of general anesthesia.

Instead of fully sedating the patient as is traditionally practiced, they used an epidural in the thoracic area. The patient was able to converse with the medical team in the operating room. Epidurals are used for women delivering babies -- to reduce the pain during labor, but are inserted in a different part of the spine, the lumbar.

The 54 year-old patient, mother of two and grandmother of 10, returned to her Tampa home on Monday and is recovering well.

USF Health's Dr. Ross and her partners Alex Rosemurgy, MD, and Michael Albrink, MD, pioneered the first laparoscopic endoscopic single site "LESS" surgeries (one incision through the belly button) in Fall 2007 at Tampa General.

“Since the entire operation is performed through the belly button, it does not leave a visible scar like the traditional multi-port laparoscopic approach - which could be anywhere from three to six incisions”, Dr. Ross explains. “This new method benefits the patient by less post-operative pain, less blood loss, faster recovery time, fewer complications and better cosmetic results….with no visible scar.”

More than 300 physicians across the country have trained with USF/TGH and Drs. Ross, Rosemurgy and Albrink have traveled the world to teach the LESS method at conferences. To date, they have performed anti-reflux operations, appendix removals, small bowel resections, liver cysts resections, stomach tumor resections, inguinal hernia repair, removal of adrenal gland and recently the first pancreatic mass resection utilizing the LESS surgical approach - to name a few.

They have also performed combined operations in the same patient (i.e., a hysterectomy and a gallbladder removal, or a gallbladder removal and an anti-reflux procedure). They continue to refine the LESS approach to surgery, and are developing surgeries using natural orifices (vagina, anus, mouth). The physicians with the USF Digestive Disorders Center are hosting a CME LESS Course at Tampa General in November.

About USF Health
USF Health is dedicated to creating a model of health care based on understanding the full spectrum of health. It includes the University of South Florida’s colleges of medicine, nursing, and public health; the schools of biomedical sciences as well as physical therapy & rehabilitation sciences; and the USF Physicians Group. With more than $360 million in research grants and contracts last year, USF is one of the nation’s top 63 public research universities and one of 39 community-engaged, four-year public universities designated by the Carnegie Foundation for the Advancement of Teaching. For more information, visit www.health.usf.edu

About TGH
Tampa General is a 958-bed acute care hospital on the west coast of Florida that serves as the region’s only center for Level I trauma care, comprehensive burn care and adult solid organ transplants. It is the primary teaching hospital for the University of South Florida College of Medicine. TGH is also one of only eleven comprehensive stroke centers in Florida and is a state-certified spinal cord and head injury rehabilitation center. For more information, visit www.tgh.org

The study by scientists from Laval University and USF has implications for the development of future cell therapies for Parkinson's and Huntington's disease

July 20, 2009 -- Results of a new study published online this week in the Proceedings of the National Academy of Sciences question the long-term effects of transplanted cells in the brains of patients suffering from Huntington’s disease. The study, conducted by Dr. Francesca Cicchetti of Laval University in Québec, Canada, Dr. Thomas B. Freeman of the University of South Florida (USF) Department of Neurosurgery and Brain Repair, Tampa, FL, and colleagues provides the first demonstration that transplanted cells fail to offer a long-term replacement for degenerating neurons in patients with Huntington’s disease.

Huntington’s disease is a neurodegenerative disease of genetic origin that targets a particular type of neuron. The loss of these neurons is responsible for the appearance of involuntary movements as well as cognitive and psychiatric impairments. Over a decade ago, USF neurosurgeon Dr. Freeman initiated a clinical trial of neural cell transplantation in patients with Huntington’s disease in an attempt to alleviate the devastating symptoms that characterize this disease.

Some patients demonstrated some mild, transient clinical benefits that lasted for about two years. However, the loss of functional recovery after this time indicated that graft survival and functionality may be jeopardized long-term.

Study senior co-author Dr. Thomas Freeman, a professor in the USF Department of Neurosurgery and Brain Repair, is a leader in stem cell transplantation research for neurodegenerative disorders.

The post-mortem study of three cases described in PNAS is the first demonstration that 1) graft survival is indeed attenuated long-term, 2) the grafts undergo degeneration that resembles the pathology observed in Huntington’s disease, and 3) the brain’s inflammatory response could contribute to the compromised survival of grafted cells. The authors also demonstrated that cortical neurons develop Huntington’s disease synapse on the grafts, and may cause neurotoxicity to the healthy cells, inducing grafted neuronal cell death.

Last year, researchers at Rush University Medical Center, USF, and Mount Sinai School of Medicine published research in Nature Medicine showing that grafts in patients with Parkinson’s disease develop Lewy bodies -- a marker of Parkinson’s disease -- after 14 years. Those patients benefited from the grafts for about 12 years, and only about 5 to 8 percent of the transplanted cells had this finding.

“This latest study shows that grafts in patients with Huntington’s disease also undergo disease-specific neuronal degeneration,” said USF's Dr. Freeman, a senior co-author of the study. “However, the neural degeneration in the (genetically unrelated) grafts was even more severe than what was observed in the patient’s own brain. Additionally, clinical benefit, if any, only lasted about two years. These findings may be important to future therapeutic trials of stem cells for the treatment of Parkinson’s and Huntington’s diseases.”

Despite the excitement for cell transplantation therapy using embryonic or stem cells, these results raise concerns for the therapeutic potential of transplantation as a treatment option for Huntington’s disease, the study authors report. However, these observations suggest new potential mechanisms involved in the development of the disease, they conclude. A more in-depth investigation could allow the development of novel therapeutic strategies. The control of the patient’s immune and inflammatory responses holds therapeutic potential and Dr. Cicchetti and colleagues continue their research in that direction.

Dr. Francesca Cicchetti is a professor at the Department of Psychiatry/Neuroscience at Laval University and a researcher in neurobiology. She directs a research laboratory, which focuses on the understanding of neuronal degeneration and the development of treatment strategies for neurodegenerative diseases.

Dr. Thomas B. Freeman is a USF neurosurgeon at Tampa General Hospital, and director of clinical research and medical director of the Center of Excellence for Aging and Brain Repair at the University of South Florida.

This work includes the scientific contribution of the following authors: Samuel Saporta (USF Department of Neurosurgery and Brain Repair), Robert Hauser (Parkinson's Disease and Movement Disorders National Parkinson's Foundation Center of Excellence, USF), Martin Parent (Groupe de recherche sur le système nerveux central (GRSNC)), Martine Saint-Pierre (Centre de Recherche du CHUL (CHUQ)), Paul Sanberg (USF Department of Neurosurgery and Brain Repair), Xiao Li (Emory University School of Medicine), John Parker (University of Louisville Health Sciences Center), Yaping Chu (Rush University Medical Center), Elliot Mufson (Rush University Medical Center), and Jeffrey Kordower (Rush University Medical Center).

Dr. Robert Brooks

Tampa, FL (July 20, 2009) -- Dr. Robert Brooks, a nationally recognized patient safety, health informatics and policy scholar, researcher and educator, has been recruited from the Florida State University to USF Health. Dr. Brooks will build upon his well-established research and teaching record and will be professor of medicine and public health and associate vice president for health leadership at USF.

Robert Brooks, MD, MA, MBA, MPH, brings to USF an extensive and intricate working knowledge of academic medicine, curriculum development, student recruitment and advisement, health policy and practice.

“USF will tap Dr. Brooks’ distinctive and well proven academic talents. He will play a directive role in the medical student admissions process as we seek to bring diversity, competence and exceptional quality to our student body. Dr. Brooks will also be responsible for building the health leadership program at USF Health,” said Dr. Stephen Klasko, dean of medicine and CEO of USF Health. “We are exceptionally fortunate to bring Bob Brooks’ talents, knowledge and experience to USF Health.”

A former secretary of health for the state of Florida and a former Florida state legislator, Dr. Brooks has played a significant role in formulating and administering health policy.

“Dr. Brooks brings the rare combination of real scholarship and pragmatic, national leadership to our students and faculty. He will be designing and participating in health policy and leadership research and courses that will provide our public health, medical, nursing and graduate students with insight, knowledge and skills that will benefit them throughout their careers,” said Donna Petersen, ScD, dean of public health at USF.

“Bob is a gifted and dedicated teacher, a highly productive researcher, and a policy architect who has made vital contributions to health improvement in Florida. He has been a singular force in advancing patient safety, health informatics research and data-driven health policy decisions,” said Jay Wolfson, DrPH, JD, USF professor of public health and medicine.

Dr. Brooks will also work with USF’s clinical and research team to design a new system of care to more effectively manage diabetes and other chronic disorders, and to build upon the program of patient safety research with which he has previously collaborated.

USF’s recently announced partnership with the Lehigh Valley Health Network is expected to benefit from Dr. Brooks’ leadership training for medical students. In that program, students from Pennsylvania will attend USF for their first two years of medical school, then return to Lehigh Valley for their third and fourth years of clinical medical education.

At USF Health, Dr. Brooks also will serve as a professor of medicine in the Division of Infectious Diseases (Department of Internal Medicine) in the College of Medicine and as a professor in the Department of Health Policy and Management in the College of Public Health.

“I am excited to have the opportunity to join the already outstanding executive team assembled by Dean Klasko and to assist USF in its mission to train and equip world-class physicians and other health care professionals to be leaders in the 21st century,” Dr. Brooks said.

Dr. Brooks has served as the associate dean for health affairs at Florida State University, where he helped establish the first new allopathic medical school in the United States in more than 20 years. Since joining FSU in 2001, he has started five separate Centers of Excellence on Terrorism, Public Health, Patient Safety, Rural Health and Global Health.

Dr. Brooks was appointed Florida’s secretary of health in 1999. He had previously served in the Florida House of Representatives and as chief of infectious diseases at Orlando Regional Medical Center.

A Michigan native, Dr. Brooks received his B.A. and M.D. degrees from Wayne State University. He is board certified in internal medicine, infectious diseases, and preventive medicine and general public health. He also holds an MPH from the Harvard School of Public Health, an MBA from Auburn University and an MA in theology from the Reformed Theological Seminary.

- USF Health -

USF Health is dedicated to creating a model of health care based on understanding the full spectrum of health. It includes the University of South Florida’s colleges of medicine, nursing, and public health; the schools of biomedical sciences as well as physical therapy & rehabilitation sciences; and the USF Physicians Group. With more than $360 million in research grants and contracts last year, USF is one of the nation’s top 63 public research universities and one of 39 community-engaged, four-year public universities designated by the Carnegie Foundation for the Advancement of Teaching. For more information, visit www.health.usf.edu

- News release by Lisa Greene, USF Health Communications

Florida Alzheimer’s Disease Research Center studies demonstrate caffeine reverses memory impairment and markedly reduces the hallmark protein for Alzheimer’s disease in the brains and blood of Alzheimer's mice

Tampa, FL (July 6, 2009) -- Coffee drinkers may have another reason to pour that extra cup. When aged mice bred to develop symptoms of Alzheimer’s disease were given caffeine – the equivalent of five cups of coffee a day – their memory impairment was reversed, report University of South Florida researchers at the Florida Alzheimer’s Disease Research Center.

Back-to-back studies published online today in the Journal of Alzheimer’s Disease show caffeine significantly decreased abnormal levels of the protein linked to Alzheimer’s disease, both in the brains and in the blood of mice exhibiting symptoms of the disease. Both studies build upon previous research by the Florida ADRC group showing that caffeine in early adulthood prevented the onset of memory problems in mice bred to develop Alzheimer’s symptoms in old age.

“The new findings provide evidence that caffeine could be a viable ‘treatment’ for established Alzheimer’s disease, and not simply a protective strategy,” said lead author Gary Arendash, PhD, a USF neuroscientist with the Florida ADRC. “That’s important because caffeine is a safe drug for most people, it easily enters the brain, and it appears to directly affect the disease process.”

USF neuroscientist Gary Arendash, PhD, says the preclinical findings suggest caffeine could be a viable treatment for established Alzheimer's.

Based on these promising findings in mice, researchers at the Florida ADRC and Byrd Alzheimer’s Center at USF hope to begin human trials to evaluate whether caffeine can benefit people with mild cognitive impairment or early Alzheimer’s disease, said Huntington Potter, PhD, director of the Florida ADRC and an investigator for the caffeine studies. The research group has already determined that caffeine administered to elderly humans without dementia quickly affects their blood levels of β-amyloid, just as it did in the Alzheimer’s mice.

“These are some of the most promising Alzheimer’s mouse experiments ever done showing that caffeine rapidly reduces beta amyloid protein in the blood, an effect that is mirrored in the brain, and this reduction is linked to cognitive benefit,” Potter said. “Our goal is to obtain the funding needed to translate the therapeutic discoveries in mice into well-designed clinical trials.”

Arendash and his colleagues became interested in caffeine’s potential for treating Alzheimer’s several years ago, after a Portuguese study reported that people with Alzheimer’s had consumed less caffeine over the last 20 years than people without the neurodegenerative disease. Since then, several uncontrolled clinical studies have reported moderate caffeine consumption may protect against memory decline during normal aging. The highly controlled studies using Alzheimer’s mice allowed researchers to isolate the effects of caffeine on memory from other lifestyle factors such as diet and exercise, Arendash said.

Huntington Potter, PhD, director of the Florida Alzheimer's Disease Research Center, says the Byrd Alzheimer's Center at USF hopes to begin clinical trials testing caffeine treatment in people with mild cognitive impairment or early Alzheimer's.

The just-published Florida ADRC study included 55 mice genetically altered to develop memory problems mimicking Alzheimer’s disease as they aged. After behavioral tests confirmed the mice were exhibiting signs of memory impairment at age 18 to 19 months – about age 70 in human years – the researchers gave half the mice caffeine in their drinking water. The other half got plain water.

The Alzheimer’s mice received the equivalent of five 8-oz. cups of regular coffee a day. That’s the same amount of caffeine – 500 milligrams -- as contained in two cups of specialty coffees like Starbucks, or 14 cups of tea, or 20 soft drinks.

At the end of the two-month study, the caffeinated mice performed much better on tests measuring their memory and thinking skills. In fact, their memories were identical to normal aged mice without dementia. The Alzheimer’s mice drinking plain water continued to do poorly on the tests.

Caffeine treatment removed beta amyloid plaques from the brains of the Alzheimer’s mice.

In addition, the brains of the caffeinated mice showed nearly a 50-percent reduction in levels of beta amyloid, a substance forming the sticky clumps of plaques that are a hallmark of Alzheimer’s disease. Other experiments by the same investigators indicate that caffeine appears to restore memory by reducing both enzymes needed to produce beta amyloid. The researchers also suggest that caffeine suppresses inflammatory changes in the brain that lead to an overabundance of beta amyloid.

Since caffeine improved the memory of mice with pre-existing Alzheimer’s, the researchers were curious to know if it might further boost the memory of non-demented (normal) mice administered caffeine from young adulthood through old age. It did not. Control mice given regular drinking water throughout their lives performed as well on behavioral tests in old age as normal mice who received long-term caffeine treatment, Arendash said. “This suggests that caffeine will not increase memory performance above normal levels. Rather, it appears to benefit those destined to develop Alzheimer’s disease.”

Caffeinated Alzheimer's mice performed much better on tests measuring their memory and thinking skills, like finding the submerged platform (circled in photo) in this water maze. Their memories were the same as normal aged mice without dementia.

The researchers do not know if an amount lower than the 500 mg. daily caffeine intake received by the Alzheimer’s mice would be effective, Arendash said. For most individuals, however, this moderate level of caffeine intake poses no adverse health effects, according to both the National Research Council and the National Academy of Sciences. Nonetheless, Arendash said, individuals with high blood pressure or those who are pregnant should limit their daily caffeine intake.

If larger, more rigorous clinical studies confirm that caffeine staves off Alzheimer’s in humans, as it does in mice, this benefit would be substantial, Arendash said. Alzheimer’s disease attacks nearly half of Americans age 85 and older, and Alzheimer’s and other dementias triple healthcare costs for those age 65 and older, according to the Alzheimer’s Association.

In addition to the Florida ADRC, Byrd Alzheimer’s Center and Eric Pfeiffer Suncoast Alzheimer’s and Gerontology Center at USF, researchers from the Bay Pines VA Healthcare System; Saitama Medical University, Saitama, Japan; and Washington University School of Medicine, St. Louis, collaborated on the research. The studies were supported by grants to investigators in the Florida ADRC, a statewide project sponsored by the National Institute on Aging and housed at the University of South Florida’s Byrd Alzheimer’s Center.

Chuanhai Cao, PhD, was lead author of the paper reporting caffeine reduces beta amyloid in the brains and blood of Alzheimer's mice.

Journal articles cited:

1. Caffeine Reverses Cognitive Impairment and Decreases Brain Amyloid-β Levels in Aged Alzheimer’s Disease Mice; Gary W Arendash, Takashi Mori, Chuanhai Cao, Malgorzata Mamcarz, Melissa Runfeldt, Alexander Dickson, Kavon Rezai-Zadeh, Jun Tan, Bruce A Citron, Xiaoyang Lin, Valentina Echeverria, and Huntington Potter; Journal of Alzheimer’s Disease, Volume 17:3 (July 2009).

2. Caffeine Suppresses Amyloid-β Levels in Plasma and Brain of Alzheimer’s Disease Transgenic Mice; Chuanhai Cao, John R Cirrito, Xiaoyang Lin, Lilly Wang, Deborah K Verges, Alexander Dickson, Malgorzata Mamcarz, Chi Zhang, Takashi Mori, Gary W Arendash, David M Holzman, and Huntington Potter; Journal of Alzheimer’s Disease, Volume 17:3 (July 2009).

- About USF Health -

USF Health (www.health.usf.edu) is dedicated to creating a model of health care based on understanding the full spectrum of health. It includes the University of South Florida’s colleges of medicine, nursing, and public health; the schools of biomedical sciences as well as physical therapy & rehabilitation sciences; and the USF Physicians Group. With more than $360 million in research grants and contracts last year, USF is one of the nation’s top 63 public research universities and one of 39 community-engaged, four-year public universities designated by the Carnegie Foundation for the Advancement of Teaching.

- About the Journal of Alzheimer’s Disease -

The Journal of Alzheimer's Disease (http://www.j-alz.com) is an international multidisciplinary journal to facilitate progress in understanding the etiology, pathogenesis, epidemiology, genetics, behavior, treatment and psychology of Alzheimer's disease. The journal publishes research reports, reviews, short communications, book reviews, and letters-to-the-editor. Groundbreaking research that has appeared in the journal includes novel therapeutic targets, mechanisms of disease and clinical trial outcomes. The Journal of Alzheimer's Disease has an Impact Factor of 5.101 according to Thomson Reuters' 2008 Journal Citation Reports. The Journal is published by IOS Press (http://www.iospress.nl).