Latest news from UNC Health Care

Dedication of the UNC McAllister Heart Institute marks new era in heart research

tom_hughes — 2009-11-03T15:14:34Z

Media contact: Stephanie Crayton, (919) 966-2860, scrayton@unch.unc.edu

Embargoed until 2 p.m. Eastern time Wednesday, Nov. 4, 2009

CHAPEL HILL – Hugh “Chip” McAllister, M.D., an alumnus of the University of North Carolina at Chapel Hill School of Medicine, has made a three-part gift to establish the UNC McAllister Heart Institute.

An official ceremony celebrating the gift was held today (Nov. 4, 2009) at UNC.

Cam Patterson, M.D., MBA, UNC’s chief of cardiology and director of the Institute, says the McAllister gift, which formally changes the name of the Carolina Cardiovascular Biology Center, acknowledges the excellence in research and clinical care at UNC and will help the program expand its depth and breadth.

“Dr. McAllister’s generosity will allow our faculty to stretch themselves, to push the edge of cardiovascular research. This is truly a transformative event for UNC and for our state,” Patterson says.

“I want to support young scientists, the best in the country, in their work to understand cardiovascular disease,” McAllister says. “The mysteries of this disease will not be solved quickly, and so I want my gift to help further this research even after I'm gone.”

McAllister has given $7 million to date in outright gifts and other commitments. In addition, he has provided for the Institute in his will and made provisions for its support through his personal foundation, which will benefit the Institute for years afterward.

Cardiovascular diseases are the most common causes of death and disability in the state of North Carolina and in the United States as a whole. The mission of the UNC McAllister Heart Institute is to advance the care of patients with diseases of the heart, blood and circulation by encouraging basic, preclinical, and applied research to unravel the causes of cardiovascular disease and to provide new tools for diagnosis and treatment of patients in North Carolina and beyond.

Research programs in the Institute are organized within the center in the areas of cardiovascular physiology, cell biology and vascular development, thrombosis and hemostasis, clinical trials and translational research. There are 19 faculty laboratories, and a benefit of the McAllister gift will be the ability to attract even more world-class talent.

McAllister earned his medical degree at UNC in 1966. From then until his retirement, he built a lengthy career as a highly respected and highly accomplished leader in cardiovascular pathology.

He retired from active practice in 2000, after serving for 16 years as the founding chair of the Department of Cardiovascular Pathology at the Texas Heart Institute at St. Luke’s Episcopal Hospital in Houston. This followed his equally distinguished career in the U.S. Army Medical Corps, where he served for 13 years as chair of the Department of Cardiovascular Pathology at the Armed Forces Institute of Pathology in Washington, D.C., from 1971 to 1984.

McAllister’s roots at the UNC School of Medicine run deep. His father, Hugh A. McAllister Sr., M.D., earned his Certificate of Medicine at UNC in 1935. McAllister Sr. practiced obstetrics and gynecology in his hometown of Lumberton, N.C. for four decades before his death in 1978. He was honored with the School of Medicine’s Distinguished Service Award in 1963, while his son was working towards his medical degree at UNC.

Chip McAllister’s professional accomplishments are too numerous to provide a comprehensive listing here. Some of the more noteworthy items include:

An impressive record of scholarly publications, including four textbooks and 39 chapters in other medical books
An exhaustive atlas he compiled with co-author Dr. John Fenoglio in 1978, titled Tumors of the Cardiovascular System, which has been described as “a recognized classic in medical literature” and “a work of enduring usefulness”
The Legion of Merit of the United States of America in 1984 and the Distinguished Achievement Award from the Society for Cardiovascular Pathology in 2001 and many, many others.

McAllister is the current president of the UNC Medical Alumni Association, a member of the UNC Board of Visitors and an executive committee member of the Medical Foundation of North Carolina.

Study points to new uses, unexpected side effects of already-existing drugs

tom_hughes — 2009-11-04T14:18:28Z

Media contact: Les Lang, (919) 966-9366, llang@unch.unc.edu

Wednesday, Nov. 4, 2009

CHAPEL HILL – Scientists at the University of North Carolina at Chapel Hill School of Medicine and the University of California, San Francisco have developed and experimentally tested a technique to predict new target diseases for existing drugs.

The researchers developed a computational method that compares how similar the structures of all known drugs are to the naturally occurring binding partners -- known as ligands -- of disease targets within the cell. In a study published this week in Nature, the scientists showed that the method predicts potential new uses as well as unexpected side effects of approved drugs.

“This approach uncovered interactions between drugs and targets that we never could have predicted simply by looking at the chemical structures,” said senior study author Bryan Roth, M.D., Ph.D., professor of pharmacology and director of the National Institute of Mental Health Psychoactive Drug Screening Program at UNC. “We may now have a way to predict what side effects are likely to occur from treatment before we even put a drug into clinical testing.” Roth is also a member of the UNC Lineberger Comprehensive Cancer Center.

Many of the most successful drugs on the market today are being prescribed for ailments that are quite different from the ones they were originally designed to treat. Viagra, for instance, was once intended for coronary heart disease but now is used to combat erectile dysfunction. The discovery of surprising uses of developed drugs can sometimes be the result of serendipity, as unforeseen side effects emerge from clinical trials. In the past, researchers have tried to predict drug interactions by looking for chemical similarities among the possible targets of pharmaceutical compounds.

However, some drug targets which look very similar to one another bind very different ligands, and some targets that don't have any obvious similarity bind similar ligands, says Brian Shoichet, Ph.D., co-senior study author and professor of pharmaceutical chemistry at UCSF. “So if instead we were to organize targets by the ligands they recognize, it could reveal different patterns than traditional approaches, and illuminate new opportunities for drugs to bind to unexpected targets.”

A team of researchers led by Roth and Shoichet did just that, comparing the structures of 3,365 FDA-approved and investigational drugs against the structures of hundreds of targets, defining each target by its ligands. They then honed in on thirty of the strongest predictions, validating the actual physical interactions between the drugs and targets in wet laboratory experiments.

In one of their follow-up experiments, the scientists investigated the molecular targets of the hallucinogenic substance dimethyltrytamine (DMT), which had previously been postulated to act through a site known as the sigma-1 receptor. Using the computational approach, Roth and colleagues found that DMT had a high affinity for serotonin receptors, including the binding site for LSD, another hallucinogen.

They also showed that the substance is hallucinogenic in normal mouse models but not in ones lacking the serotonin receptor. Roth says the power of their approach is it can be used to uncover the real targets of pharmaceutical compounds quickly and efficiently, and will probably lead to a greater understanding of the many molecular targets of each drug.

“Drugs are not as selective as we once thought,” said Roth, who is also a professor in the School of Pharmacy’s medicinal chemistry and natural products division. “It turns out that the most non-selective drugs are frequently the most effective for complex diseases. Rather than ‘magic bullets,’ we need to come up with ‘magic shotguns’ that hit more than one molecular target at a time. We could use this computational approach to identify the drugs that hit the right targets and miss the wrong ones.”

Study co-authors from UNC include Vincent Setola, research associate professor; Atheir Abbas, former graduate student; Sandra J. Hufeisen, senior research assistant; Niels H. Jensen, research associate; Michael B. Kuijer, research technician; Roberto C. Matos, research technician; Thuy B. Tran, research technician; Ryan Whaley, research technician; and Richard A. Glennon. The paper’s first author is Dr. Michael Keiser, from the UCSF side of the collaboration. Also from UCSF were Drs. John Irwin, Christian Laggner and Jerome Hert, and PharmDs Kelan Thomas and Douglas Edwards.

Funding for the studies at UNC and at UCSF came from the National Institutes of Health.

No longer lost in translation: Interpreters replace pagers with iPod touch

tom_hughes — 2009-10-29T20:44:17Z

Media contact: Tom Hughes, (919) 966-6047, tahughes@med.unc.edu

Thursday, Oct. 29, 2009

CHAPEL HILL – Pagers are ubiquitous in the hospital setting. They are so familiar and common, in fact, that they are even used for comic effect on medically themed TV dramas such as “House M.D.”

But at UNC Hospitals, the Interpreter Services department has dumped both pagers and cell phones in favor of a technology they find to be much more effective in meeting their needs: the Apple iPod touch.

Juan Reyes-Alonso, who started working as an interpreter at UNC Hospitals in 2003, explains what it was like for the hospitals’ 26 interpreters to work with the pager system that was in place back then.

“All of us carried pagers, and there was just one pager phone number for all of us. So, when a doctor requested an interpreter, all of our pagers would go off at the same time. And all of us who were free at the time would call the doctor back, so the doctor might get calls from 10 different interpreters all at once. It was a mess!” said Reyes-Alonso, UNC Hospitals’ lead interpreter.

About five years ago, the interpreters dropped the pager system and started using cell phones in conjunction with a Web-based dispatch management service called ServiceHub. The service was originally designed to meet the needs of the transportation and field service industries. UNC Hospitals was ServiceHub’s first hospital client, said Hans Wynholds, chairman of the Cupertino, Calif.-based company.

Shane Rogers, director of Interpreter Services at UNC Hospitals, said the ServiceHub system was a big improvement over the pager system.

“The ServiceHub system gave us many advantages that we didn’t have before,” Rogers said. “For example, it gave people requesting interpreters a Web page for submitting their requests, and they could see whether or not an interpreter had been assigned to handle their request, and if so, which one.”

“But the cell phones we were using didn’t work as well as we had hoped. In some parts of the hospital cell phones just can’t get a signal. And sometimes the cell phone service would go down, and then we had to rely on the phone company to get it up and running again.”

A possible solution to that problem presented itself about a year ago, when UNC Hospitals began installing a WiFi system throughout the medical center. “Once the hospitals’ own wireless system was in place, we realized this could be an opportunity for us to use wireless handheld devices instead of pagers or cell phones,” Rogers said.

So, Rogers asked ServiceHub if this was possible. ServiceHub then re-wrote the mobile portion of their customized software for UNC Hospitals that enabled the interpreters to access the ServiceHub system from handheld wireless devices.


	An iPod touch screen shot from the ServiceHub system. (The names and data shown here are fictional.)

At that point, Reyes-Alonso tested the system with several wireless devices, including the iPod Touch and Web-enabled cell phones. Of the half dozen or so devices he tested, he found the iPod Touch to be the easiest to use and the most effective, Reyes-Alonso said.

All 26 interpreters began carrying an iPod Touch in early September 2009. With the iPod Touch, the interpreters are always connected, no matter where they might be inside UNC Hospitals. When an interpreter responds to a request, all the other interpreters can see that response almost instantly, so the requester doesn’t get calls from 10 interpreters all at once. In addition, many tasks that used to require a computer – such as consulting a bilingual medical dictionary – can now be done through the iPod Touch.

“The iPod Touch has greatly reduced a lot of the frustrations we used to have with our pagers and our cell phones,” Reyes-Alonso said. “I love it.”

Rogers cites additional advantages.

“Now that we’re using the hospitals’ own wireless system, if the system goes down, then we’ll be dealing with our own people to get it back up, instead of having to call the phone company and wait for them to take care of it.” Plus, Rogers said, the monthly cost to his department to lease their iPod Touches from ServiceHub is about half what it cost for the same number of cell phones.

Wynholds says UNC Hospitals was the first of its hospital clients to fully implement the mobile version of its system. Several other hospitals are now thinking about following UNC Hospitals’ example, he said.

“UNC has really embraced the technology, and they have worked hard to help us understand how to make it work effectively in the hospital environment,” he said.

“We’ve learned a lot in working with UNC over the years, and we’ve pretty much allowed the product to evolve in line with their specifications.”

Breast Cancer Research Foundation funds four at UNC Lineberger

tom_hughes — 2009-10-26T20:24:23Z

Contact: Ellen de Graffenreid, (919) 962-3405, edegraff@med.unc.edu

CHAPEL HILL, NC – Four faculty members from UNC Lineberger Comprehensive Cancer Center have been awarded yearlong grants from the Breast Cancer Research Foundation (BCRF).

Dr. Lisa Carey, medical director of the UNC Breast Center and associate professor of medicine; Dr. H. Shelton Earp, Lineberger professor and director of the UNC Lineberger Comprehensive Cancer Center; Dr. Hyman Muss, director of geriatric oncology at UNC Lineberger and professor of medicine and Dr. Charles Perou, associate professor of genetics and pathology. Each received a one-year grant designed to further promising research in the field of breast cancer.

“We are proud to be one of only a handful of university cancer centers to receive four grants from BCRF this year. The foundation and the generous people and organizations who support their research programs expect the highest degree of scientific merit and we are pleased to be well-represented in this elite group,” said Earp.

BCRF is supporting a clinical trial led by Dr. Carey, designed to understand which women benefit most and are harmed the least by chemotherapy. Carey and her colleagues are collecting genetic material from 1,000 breast cancer patients and 1,000 healthy women of similar age, race, and ethnicity before breast cancer patients are treated with chemotherapy, allowing researchers to directly measure responsiveness of their breast cancer to chemotherapy that is given. By comparing the genetic profiles in those patients who respond to chemotherapy with those who do not, the team can validate which genetic mutations are associated with differences in treatment outcomes.

Dr. Earp’s team will continue a three-part research program focused on developing a new and Improved Anti-HER2 Breast Cancer Vaccine; understanding the genetic determinants of breast cancer’s development and response to therapy; and examining the EGF Receptor family in breast cancer and the role of HER4.

The first project performed with Dr. Jon Serody is a therapeutic cancer vaccine clinical trial that combines two drugs with the vaccine in the treatment of women with high HER2-expressing metastatic breast cancer. The second project has worked with more than 1,000 women to obtain DNA samples as well as epidemiologic, clinical, therapeutic and outcome data so that researchers can better understand how complex genetic inheritance influences a woman’s predisposition to breast cancer. Finally, the researchers are studying another member of the EGF/HER2 receptor family, HER4. One variant of HER4 slows breast cancer cell growth, while the other actually stimulates growth. The team hopes to unravel the mechanisms by which those two variants, which differ by only one percent of the gene’s length, have opposite effects on breast cancer cell growth.

Dr. Muss’ new project focuses on patients aged 65 and older, assessing the costs and benefits of adjuvant chemotherapy. While this therapy has been shown to improve survival in older women with breast cancer, side effects may interfere with the quality of life and daily function. In collaboration with UNC Lineberger colleague Dr. Ned Sharpless, Muss’ team is seeking to understand the effect of adjuvant chemotherapy on a biomarker of aging called p16INKa. They will also measure the biomarker in patients treated only with surgery and those treated with adjuvant endocrine therapy to determine if the increased expression of this biomarker in some older patients is associated with their susceptibility to the age-promoting effects and associated toxicities of chemotherapy.

Dr. Perou’s team is focused on two subtypes of breast cancer that are associated with poor clinical outcomes, “Luminal B” and “Claudin-low.” The team is focused on identifying how genetic alterations cause these tumors and determining the role of stem cells in their biology. Using the genomic data for these tumor types and key clinical data, Perou’s team is building a predictive mathematical model for breast cancer patient outcomes that could assist doctors in making therapeutic decisions.
About BCRF

The Breast Cancer Research Foundation is an independent 501 (c) (3) not-for-profit organization whose mission is to achieve prevention and a cure for breast cancer in our lifetime by providing critical funding for innovative clinical and translational research at leading medical centers worldwide, and increasing public awareness about good breast health. More information is available at www.bcrfcure.org.

Clinical trial promotes new standards for colorectal cancer treatment

tom_hughes — 2009-10-27T13:43:38Z

Contact: Ellen de Graffenreid, 919-962-3405, edegraff@med.unc.edu

Monday, October 26, 2009

CHAPEL HILL, NC – In a review article published this month in The Oncologist, UNC’s Dr. Richard M. Goldberg and a team of colleagues catalogue how the data collected in a single large comparative clinical trial testing combination chemotherapy for metastatic colorectal cancer has been used not only to benefit the patients that enrolled but also patients who subsequently developed the disease.

It has also helped to refine the clinical trials process and move forward the potential for individualized therapy for patients. These benefits of this collaboration between patients, physicians across the U.S. and Canada, the National Cancer Institutes of the U.S. and Canada, and two pharmaceutical companies (Pharmacia and sanofi-aventis) are being still being realized five years after the original trial concluded.

Not only did the Phase III trial, which ran from 1997-2004, prove that combination chemotherapies adding new drugs to the standard treatment in use for 50 years are effective in treating metastatic colorectal cancer, but it also provided data for more than 25 additional scientific papers. This ongoing research has helped to improve the prognosis and change the standard of care for patients with this diagnosis.

“The history of this study shows how patients’ decisions to enroll in clinical trials can benefit thousands of others, even years down the road,” said Goldberg, who is Physician-in-Chief of the N.C. Cancer Hospital and Associate Director for Clinical Research at UNC Lineberger Comprehensive Cancer Center.

“These individuals have helped doctors and scientists change the way we treat metastatic colorectal cancer and simplify the way we run clinical trials in cancer patients.” Based on the trial the US Food and Drug Administration approved a new agent, oxaliplatin, administered with 5-fluorouracil for the indication "treatment of previously untreated patients with colorectal cancer that had spread to other organs" in 2004.

As one of the first clinical trials to monitor chemotherapy toxicity in real-time, the study allowed researchers to quickly eliminate drug combinations that were more likely to result in negative outcomes for patients. Over the course of the study, as the field of pharmacogenetics evolved, researchers were able to use the individual patients' DNA collected with a simple blood test to better pinpoint which were most likely to have severe side effects. The DNA analysis also helps doctors determine which patients derive greater benefits from a particular drug and adjust their chemotherapy to minimize risk, while maximizing the chances that their cancer would respond to therapy.

“Over time, the fact that this study collected DNA and plasma with patient permission has been important to our ability to make significant progress in understanding how patients’ genetic profiles interact with anti-cancer drugs,” said Goldberg.

Data from the study was also used to examine how patients did with a combination of surgery and drug therapy, to study how the combination drug therapy worked in patients with different risk profiles based on the type and progression of their cancer, and to assess the economic cost-benefit of combination therapies.

"The original data collected has also been combined with data from other clinical trials to examine overall survival rates and to explore differences in outcomes based on patient age and symptom profiles so that we could understand the risks and benefits when we treat older and sicker patients with the more intensive treatments" Goldberg said. "The data was also used to simplify how we follow tumor measurements and side effect profiles in clinical trials speeding the pace and reducing the cost of research."

“The history of this study demonstrates how sharing data among groups of scientists and doctors and asking questions that span scientific disciplines can help us make progress that is meaningful for patients over the relatively short time frame of approximately a decade,” he added.

Other investigators on the review study were Hanna Sanoff, MD, clinical assistant professor of medicine and Howard McLeod, PharmD, professor of pharmacy and UNC Lineberger member, Daniel J. Sargent, PhD, Erin Green and Jan Buckner, MD from the Mayo School of Medicine in Rochester, Minnesota, and Roscoe Morton, MD from the Iowa Oncology Research Association CCOP.

The original clinical trial was a partnership between the enrolled patients, the National Cancer Institutes of the US and Canada, NCI sponsored cooperative groups, industry, and investigators at academic centers, Community Clinical Oncology Programs and private practices. The review study was supported by the North Central Cancer Treatment Group (NCCTG) and NCCTG Biospecimen Resource, sanofi-aventis and Pharmacia.

Messenger RNA with FLASH

tom_hughes — 2009-10-26T16:20:05Z

Media contact: Les Lang (919) 966-9366, llang@med.unc.edu

Thursday, Oct. 22, 2009

CHAPEL HILL -- A study from the University of North Carolina at Chapel Hill has identified a key player in a molecular process essential for DNA replication within cells.

The new findings highlight a protein called FLASH, already shown to play a role in initiating apoptosis, or programmed cell death. Apoptosis is a normal biochemical response that occurs when a cell is damaged beyond repair after viral infection or accumulation of mutations that could lead to uncontrolled cellular proliferation, or cancer. Apoptosis is also crucial to the developing embryo through selective cell death, which allows proper differentiation of physical structures, such as fingers and toes.

According to senior study author Zbigniew Dominski, Ph.D., associate professor of biochemistry and biophysics at UNC, the new study demonstrates that FLASH is also required for the proper synthesis of histone messenger RNA, which gives rise to histone proteins.

Histones are the chief protein components of chromatin and act as a scaffold allowing packaging of DNA into a condensed form that fits inside the nucleus of a cell. As the DNA interacts with histones and with metabolic signals from within the cell, these proteins help regulate gene expression.

“Our study suggests for the first time that a potential link exists between the processes of histone messenger RNA formation and apoptosis,” Dominski said. “FLASH is crucial for the production of histone messenger RNA, without which the cell can’t make the histone proteins around which DNA is packaged.”

The research is described in the Oct. 23, 2009 issue of the journal Molecular Cell.

For the study, Dominski adapted a laboratory system that reproduces in the test tube what normally occurs in the cell when FLASH participates in the biochemical cleavage event that results in mature histone messenger RNA. This enabled his team to explore what might occur when FLASH was added or removed.

“We could then figure out exactly what portion of FLASH would restore the protein’s function in generating histone mRNAs and remarkably, only the first 100 or so amino acids are required. The remaining 2,000 amino acids of this large protein likely control other processes in the cell, including apoptosis and DNA replication,” he explained.

Co-author William F. Marzluff, Ph.D., is distinguished professor of biochemistry and biophysics and executive associate dean for basic research in the UNC School of Medicine. He noted that FLASH is the first component found in this protein complex “that integrates or initiates many cellular functions – DNA replication, apoptosis, histone production. Having this small piece of the puzzle makes it a lot easier to identify others.”

Other UNC coauthors include Xiao-cui Yang, laboratory technician, and Yan Yan, undergraduate student, both from the Department of Biochemistry and Biophysics and the UNC Program in Molecular Biology and Biotechnology and Brandon D. Burch, graduate student in in genetics and molecular biology.

Funding for the study came from the National Institute of General and Medical Sciences, a component of the National Institutes of Health.

Family House Diaries: Going Forward in All New Skin

tom_hughes — 2009-10-21T13:16:41Z

Media contacts: Tom Hughes, (919) 966-6047, tahughes@unch.unc.edu, or Clinton Colmenares, (919) 966-8757, ccolmena@unch.unc.edu

Written by Elizabeth Swaringen for the UNC Medical Center News Office

Wednesday, Oct. 21, 2009

CHAPEL HILL, N.C. – Finally, 20-year-old Caitlin Hughes’ acne is gone, but getting her new skin nearly killed her.

A reaction to an antibiotic of last resort – prescribed to rid the University of North Carolina junior from Charlotte of life-long acne – caused Hughes to contract Stevens-Johnson Syndrome (SJS), a rare disorder in which skin and mucous membranes react severely to medications or infection.

But Hughes’ diagnosis was even more worrisome – a severe form of SJS called Toxic Epidermal Necrolysis (TEN) – meaning that at least 30 percent of her skin was blistered, dying and shedding. Her skin sloughing progressed rapidly to ultimately involve more than 90 percent of her entire body.

The medical emergency landed Hughes in the N.C. Jaycee Burn Center at UNC Hospitals. About 50 of the nearly 800 patients admitted to the burn center annually are SJS/ TEN patients because their damaged skin and membranes mimic that of burn patients.

"This is a mysteriously devastating disease,” said Bruce A. Cairns, M.D., medical director of the N.C. Jaycee Burn Center. “Patients can present with a rash and within 24 hours nearly all of their skin can slough off. And sloughing can affect other mucosal surfaces, including the mouth, the respiratory tract, the gastrointestinal system and the eyes.”

Fortunately, TEN is relatively rare – about three in a million – but can develop as a severe reaction to a number of medications. In the most severe cases, the mortality rate from SJS/TEN can be as high as 30-50 percent.

The principal treatment is essentially supportive, Cairns said, meaning that, “We have to let the disease run its course and help support the patient during that crucial time. Sometimes it takes weeks, but many times it takes months. In Caitlin’s case, once she began to improve, she healed rapidly, and she was out of the hospital in weeks.”

Caitlin believes her near-record recovery speaks to the “developed expertise and innate compassion” of her health care team. “I’ve never seen people smiling more when they should be crying,” she said.

Caitlin had planned to spend the fall term in Chapel Hill pursuing her psychology major and continuing a research project about non-suicidal self-injury among girls. That after a six-week, eye-opening summer study abroad in genocide-ridden Rwanda.

Physically, she was in the best shape of her life, returning from Africa to work out regularly at the YMCA. She delayed the new acne regimen until after Rwanda because she thought the vaccinations required for life abroad might interfere with its effectiveness. It was a decision that saved her life.

“I would have been on the plane when the rash began, and I would have died because the rash and blisters moved with such speed,” Caitlin said.

Mid-August back in Charlotte, the rash started as three dots on Caitlin’s right wrist, spread to her stomach, into her mouth, down her throat and into her esophagus. Her vocal chords were damaged. She was hospitalized on Aug. 16, had a breathing tube placed in her throat to keep her airway open and was placed in a medically induced coma so that she was unaware of the pain of losing nearly all her skin.

Her head was shaved to manage the blisters on her scalp. Within three days of having 30 percent abrasions on both corneas, her blistered eyes healed, her sight returned and her depth perception is improving. Only her hands and feet escaped the shedding skin.

“The fact that her hands and feet were spared gave her a head start on rehabilitation because she didn’t have to relearn how to use them,” said Pam Hughes, Caitlin’s mother. “We have seen so many miracles with her, and God’s hand at work in so many ways.”

While Caitlin was hospitalized, her parents stayed at the SECU (State Employees’ Credit Union) Family House, a 40-bedroom hospital hospitality house minutes from UNC Hospitals that provides comfortable, convenient and affordable housing for adult patients undergoing treatment for critical illness and trauma and their family member caregivers.

“SECU Family House offered an excellent respite from being at the hospital all day,” Pam said. “Despite the circumstances, I am glad I was able to be with Caitlin almost non-stop for a month. We cannot say enough good things about the house and staff, most of whom are volunteers.”

Caitlin joined her mother at SECU Family House on Sept. 16 for three weeks of outpatient rehabilitation before returning to Charlotte on Oct. 9. Earlier that week, she was strong enough to participate in a Fellowship of Christian Athletes outing that involved a rigorous scavenger hunt. Caitlin’s team earned second place and best group picture honors.

“She’s always been my independent child, the fighter,” Pam said. “I now know that was God preparing her for overcoming this illness. She was in God’s hands, she got excellent medical care, and she had a strong will to survive. Her world is big, and she will be off to tackle it.”

Caitlin plans to be back in Chapel Hill as a student when the spring term begins in January. And she plans to stop by the Burn Center to see her new friends there and talk with the families of SJS patients to help ease their journey.

“Caitlin’s recovery is the kind of result we would love to have every time,” Cairns said, adding that Caitlin will continue to be followed closely for any potential long-term problems related to TEN.

“I left the hospital with a shaved head, a tracheotomy scar, a bum shoulder from some nerve damage, and all new skin which is clear and smooth,” Caitlin said. “I survived and I’ve got lots to accomplish. And when I’m 40 years old, my skin will just be 20!”

Moderate weight loss helps reduce risk of osteoarthritis in the knee

tom_hughes — 2009-10-19T16:48:41Z

Media contact: Clinton Colmenares, (919) 966-8757 or ccolmena@unch.unc.edu

Monday Oct. 19, 2009

CHAPEL HILL, N.C. – Here’s another good reason to lose even a moderate amount of weight: it could reduce your risk of developing osteoarthritis in your knees.

People who are overweight and lose just 5 percent of their weight are less likely to develop osteoarthritis of the knee, or knee OA, compared to people who gain weight, according to data from a large ongoing study by the Thurston Arthritis Research Center at the University of North Carolina at Chapel Hill School of Medicine.

“We hear a lot of messages about how obesity affects cardiovascular disease and diabetes, but arthritis is often overlooked,” says Lauren Abbate, a third-year medical student at UNC and lead investigator of the knee OA paper, presented Monday, Oct. 19, 2009, at the American College of Rheumatology scientific meeting in Philadelphia.

“OA is painful and debilitating. Effective treatments are limited and there’s not a cure. But if we can get people to lose weight we may reduce their risk and reduce the pain and disability associated with this condition,” Abbate says.

More than 27 million Americans have OA, the most common joint disease affecting middle-aged and older people. OA causes progressive damage to the joint cartilage and changes in the structures around the joint, which can include fluid accumulation, bony overgrowth and loosening and weakness of muscles and tendons, all of which may limit movement and cause pain and swelling.

Abbate and her colleagues used data from the Johnston County Osteoarthritis Project, one of the largest ongoing population-based studies of arthritis in the world. It began at Thurston in 1990 and is funded by the Centers for Disease Control and Prevention and the National Institutes of Health.

The researchers included 1,480 men and women 45 and older who were disease-free in at least one knee and followed them for approximately six years to see who developed radiographic OA – disease confirmed by X-rays; almost two-thirds were women, and more than 25 percent were African Americans.

They then divided people into categories based on weight change: people who lost 5 percent or more of their total body weight, people who maintained within 3 percent above or below their weight and those who gained at least 5 percent more than their weight.

“It was our hope that people who maintained weight would have reduced risk, but obesity is such a strong risk factor for OA, that maintaining weight showed no significant benefit,” says Abbate, who recently finished her doctoral degree in epidemiology from the UNC Gillings School of Global Public Health. She also has a master’s of science in public health from the school.

Weight loss can be difficult to achieve. But, Abbate says, people can aim for losing a certain percentage of their weight instead of shooting for an ideal number. “For someone who weighs 200 pounds, losing 5 percent just means losing 10 pounds,” she says.

Abbate’s paper was one of several research highlights at the ACR meeting for UNC’s Thurston Arthritis Research Center. Abbate and two other UNC medical students, Joshua Knight, a second-year student, and Shelby Addison, a third-year student, won research awards. Amanda Nelson, M.D., a fellow at Thurston, won a fellowship award.

“We have placed a high priority on working with medical and graduate students and being open to collaborating,” says Joanne Jordan, M.D., the center director and Herman and Louise Smith Distinguished Professor of Medicine at UNC’s School of Medicine. Jordan received the ACR’s Award of Distinction for Excellence in Investigative Mentoring.

“We take our role as the arthritis research center for the people of North Carolina very seriously,” Jordan said. “That is why we are always looking for ways to bring our research findings to the community and to learn from the community.”

Scientists demonstrate link between genetic defect and brain changes in schizophrenia

tom_hughes — 2009-10-26T20:17:06Z

Media contact: Les Lang, (919) 966-9366, llang@med.unc.edu

Friday, Oct. 16, 2009

CHAPEL HILL – For decades, scientists have thought the faulty neural wiring that predisposes individuals to behavioral disorders like autism and psychiatric diseases like schizophrenia must occur during development. Even so, no one has ever shown that a risk gene for the disease actually disrupts brain development.

Now, researchers at the University of North Carolina at Chapel Hill School of Medicine have found that the 22q11 gene deletion – a mutation that confers the highest known genetic risk for schizophrenia – is associated with changes in the development of the brain that ultimately affect how its circuit elements are assembled.

In studies conducted in mice, the researchers discovered that the genetic lesion alters the number of a critical subset of neurons that end up in the brain’s cerebral cortex – the region critical to reasoning and memory. The defect also causes another type of nerve cell – called GABAergic neurons – to be misplaced within the brain’s cortical layers, resulting in a subtle miswiring of the organ.

“For practically ever other disease, we know what cells take a hit,” said senior study author Anthony LaMantia, Ph.D., professor of cell and molecular physiology and co-director of the Silvio M. Conte Center for Research in Mental Disorders at the UNC School of Medicine. “For multiple sclerosis the myelinating oligodendrocytes in the brain falter, for Lou Gehrig’s disease the motor neurons in the brain stem degenerate. But we really had no idea what was happening in schizophrenia, or in any of the psychiatric diseases for that matter – until now.”

His study will be presented Oct. 17 at the Society for Neuroscience meeting in Chicago, by Daniel Meechan, Ph.D., post-doctoral fellow in the LaMantia laboratory and the first author of a recent paper in Proceedings of the National Academy of Sciences that details the findings.

The study lends the first clear support to the “neurodevelopmental hypothesis” – a scientific theory LaMantia calls the “Hail Mary” of schizophrenia pathologists.

For many years, researchers searched in vain for any indication that the brains of patients with schizophrenia were different from normal subjects --for some laboratory finding along the lines of the plaques and tangles characteristic of Alzheimer’s disease or the degeneration of dopamine cells that are the calling card of Parkinson’s disease. Similar degenerative change has never been identified for schizophrenia. Finally they proposed that the defects in schizophrenia must arise before the brain is fully formed, rather than after.

Then researchers began to discover regions of the genome -- many of which had neurodevelopmental functions -- that made people susceptible to schizophrenia.

In this study, LaMantia and his colleagues decided to pursue deletion of one such region on human chromosome 22, which causes DiGeorge syndrome in humans, because it is the single best-defined genetic lesion associated with schizophrenia. They tracked two subclasses of neural stem cells -- called basal and apical progenitors -- throughout early brain development in a mutant mouse with the same genetic deletion. They found that the basal progenitors divided more slowly than they should, and as a result the cells that they give rise to in the cortex were not generated in the proper numbers.

The researchers also looked at another population of cells, the GABAergic cells that are thought to essentially put the brakes on electrical activity in mature cortical circuits. The function of these cells is believed to be one of last processes to be disrupted in the schizophrenic brain. LaMantia found that these GABAergic neurons never made their way to their correct positions in the cortical layers of the brain of the mouse model of DiGeorge Syndrome .

The researchers would now like to figure out how these alterations in the circuitry of the brain affect the behavior of the mouse. They also hope that understanding the “mis-wiring” of the brain in a genetic animal model of schizophrenia would help them understand the causes of the disease in the general population.

“Now that we know what cells can be affected in schizophrenia, it opens up new avenues in thinking about the molecular mechanisms underlying this and other psychiatric illnesses,” said LaMantia. “We can even begin to look for biomarkers of the disease that can be used for better diagnosis and treatment.”

Funding for the studies led at UNC came from the National Institutes of Health and the Silvio M. Conte Center. Study co-authors from LaMantia’s laboratory at UNC include postdoctoral fellows Daniel W. Meechan, Erin S. Tucker and Thomas M. Maynard.

UNC scientists win $1.6 million stimulus award to accelerate decoding of human genome

tom_hughes — 2009-10-15T12:45:12Z

Media contact: Les Lang, (919) 966-9366 or llang@med.unc.edu

Thursday, Oct. 15, 2009

Ever since the first genome sequence was published in 2001, scientists have been working to figure out what the sequence means. An analogy is walking across a desert and finding a large book in a language you don't know, then trying to figure out what the book is saying.

“In the case of the human genome, the book is a blueprint to building cells—and ultimately—the whole human. But we don't yet understand its language,” said Morgan Giddings, Ph.D., associate professor of microbiology and immunology and of biomedical engineering at the University of North Carolina at Chapel Hill.

Giddings and UNC colleague Xian Chen, Ph.D., associate professor of biochemistry and biophysics, have been developing methods for decoding the human blueprint by studying the things the blueprint produces: proteins. They relate the proteins back to the blueprint itself, to further decode the language of the genome blueprint.

Giddings and Chen have been awarded a $1.6 million 2-year “Grand Opportunities” (GO) grant from the National Human Genome Research Institute to accelerate this research. Their effort will be part of a consortium of investigators studying the human genome blueprint, titled the “ENCyclopedia Of DNA Elements” (ENCODE). The consortium’s overall goal is to assemble a comprehensive catalog of functional elements in the human genome.

With their GO grant, Giddings and Chen will generate, analyze, and release to the public large-scale data sets that allow linking of the protein products in cells to their genomic blueprints. According to Giddings, “this will significantly promote our understanding of the language of the human genome, enhancing efforts to solve pressing human health issues like heart disease and cancer by understanding how errors in the blueprint lead to disease, and how we might fix those errors.”

Giddings is a member of the Carolina Center for Genome Sciences, and Chen is technology development director for the UNC Proteomics Core. The new grant will bring 4-6 new high-tech jobs to the Triangle.

NHGRI has awarded approximately $22 million of American Recovery and Reinvestment Act 2009 funds to support research aimed at identifying and understanding the genome’s functional elements.

Egan receives $1.47 million grant for lung transplant research

tom_hughes — 2009-10-14T14:46:13Z

Wednesday, Oct. 14, 2009

The National Heart, Lung, and Blood Institute has awarded Thomas M. Egan, M.D., M.Sc., a professor of surgery at the University of North Carolina at Chapel Hill School of Medicine, a $1.47 million, two-year grant for research on perfusion and ventilation of lungs outside the body before transplant. The research could lead to a significant increase in the number of lungs available for transplant.

Egan, a surgeon in the UNC Division of Cardiothoracic Surgery, is internationally known for his research on lung transplantation, which has been under way since he came to UNC in 1989 to start its lung transplant program.

His new grant was awarded under the NHLBI’s Translational Research Implementation Program (TRIP), a two-stage program designed to translate fundamental research ideas into proof-of-concept efficacy testing in patients. This Stage 1 grant is supported by the American Recovery & Reinvestment Act (ARRA) Grand Opportunities (GO) grants program, for large-scale research projects that the National Institutes of Health says have “a high likelihood of enabling growth and investment in biomedical research and development, public health, and health care delivery.” NHLBI is part of the National Institutes of Health.

Egan’s project will perfect a technique to perfuse and ventilate human lungs outside the body (ex vivo) to determine if they are suitable for transplant, and will demonstrate safety of transplanting human lungs after ex-vivo perfusion in a pilot clinical study.

Egan’s research has focused on use of lungs from non-heart-beating donors (patients who have died of sudden cardiac arrest outside the hospital or in the emergency room) for lung transplantation. Using animal models, Egan was the first scientist to show that lungs could be retrieved from non-heart-beating donors after death and safely transplanted. His research has shown that lungs are viable after circulation stops, because lung cells do not rely on perfusion (circulation of blood or other fluids) for cellular respiration.

A conventional transplant uses an organ from a donor who has been declared brain dead and has been kept on mechanical ventilation until circulation is stopped just before organs are donated. During transplant, the stopping and restarting of circulation to the lungs can cause ischemia-reperfusion injury, which damages cells in the lung and leads to problems with lung function after transplant. Egan has designed an ex-vivo perfusion and ventilation circuit in which lungs are placed for evaluation and possible treatment before transplant.

Egan’s project will also plan a large multi-center clinical trial to use the ex-vivo lung perfusion/ventilation system to evaluate human lungs retrieved after death from non-heart- beating donors. Widespread use of lungs retrieved from non-heart-beating donors followed by ex-vivo assessment could provide much larger numbers of human lungs for transplant that may function better and last longer than lungs currently being transplanted from conventional brain-dead organ donors.

Investigators for his project, entitled “Ex-vivo perfusion and ventilation of lungs to assess transplant suitability,” are:

Thomas M. Egan, M.D., M.Sc., Professor, Division of Cardiothoracic Surgery, UNC Department of Surgery (Principal Investigator), UNC School of Medicine
Peadar G. Noone, M.D., Associate Professor, Division of Pulmonary and Critical Care Medicine, UNC Department of Medicine, UNC School of Medicine
Paul Stewart, Ph.D., Research Associate Professor, Department of Biostatistics, UNC Gillings School of Global Public Health
Eileen Burker, Ph.D., CRC, Associate Professor, Division of Rehabilitation Counseling and Psychology, Department of Allied Health Sciences, and Adjunct Associate Professor, Department of Psychiatry, UNC School of Medicine
Benjamin E. Haithcock, M.D., Assistant Professor, Division of Cardiothoracic Surgery, UNC Department of Surgery, UNC School of Medicine
William K. Funkhouser, M.D., Ph.D., Professor, Department of Pathology and Lab Medicine, UNC School of Medicine
Katherine Birchard, M.D., Assistant Professor, Department of Radiology, UNC School of Medicine
R. Duane Davis, M.D., Ph.D., Professor, Division of Cardiothoracic Surgery, Department of Surgery, Duke University School of Medicine

UNC researcher awarded grant for anti-diarrhea vaccine study in Nicaragua

tom_hughes — 2009-10-27T14:24:18Z

Media contact: Tom Hughes, (919) 966-6047, tahughes@unch.unc.edu

For immediate use: Tuesday, Oct. 13, 2009

CHAPEL HILL – A University of North Carolina at Chapel Hill researcher has been awarded a four-year, $507,000 grant from the National Institutes of Health’s Fogarty International Center to study the effectiveness of rotavirus vaccines in the Central American nation of Nicaragua.

The grant was awarded to Sylvia Becker-Dreps, M.D., M.P.H., an assistant professor of family medicine in the UNC School of Medicine, who recently completed a National Research Service Award (NRSA) Primary Care Research Fellowship at UNC. It adds to initiatives within the UNC Center for Latino Health and the UNC Institute for Global Health & Infectious Diseases’ program in Nicaragua.

“Nicaragua was one of the first developing world nations to start universal immunization of its children against rotavirus, so the lessons learned here could be important to other developing nations,” Becker-Dreps said.

Rotaviruses are the most common infectious cause of diarrhea and cause the deaths of about 527,000 children worldwide each year. “These deaths are really the tip of the iceberg- many children have repeated diarrhea episodes and end up with malnutrition, stunted growth, and even developmental delays.”

In Nicaragua, diarrhea is the leading cause of death in children between infancy and age 5. In 2006, Nicaragua implemented universal infant rotavirus immunization with the pentavalent rotavirus vaccine, which manufactured by Merck. All Nicaraguan infants receive this live, oral vaccine at the ages of 2 months, 4 months and 6 months, as do children in the United States.

Clinical trials in the U.S. and Europe have shown the vaccine to be highly effective in reducing rotavirus diarrhea, but it is not known how well the vaccine works in developing countries like Nicaragua or in preventing less severe cases of diarrhea that may never receive care in the hospital.

Becker-Dreps’ study aims to determine the effectiveness of the vaccine in the primary care setting and in the community setting in Nicaragua. In addition, researchers will perform genotyping of rotavirus-positive samples collected in the study in order to identify if shifts in rotavirus strains are occurring as a result of the immunization program.

UNC awarded $6.2 million renewal grant by NIH Rare Diseases Research Network

tom_hughes — 2009-10-13T14:51:44Z

Media contact: Tom Hughes (919) 966-6047, tahughes@unch.unc.edu

Tuesday, Oct. 13, 2009

CHAPEL HILL – The University of North Carolina at Chapel Hill has been awarded a five-year, $6.2 million renewal grant to continue its work as part of the National Institutes of Health’s Rare Diseases Clinical Research Network (RDCRN).

"This additional funding will let us continue our discovery of rare disease-causing gene mutations, which has already culminated in a clinical genetic test, but which needs to be expanded and improved,” said Michael Knowles, M.D., a professor in the UNC School of Medicine's Division of Pulmonary and Critical Care Medicine and principal investigator for the RDCRN.

“It will also let us define early adverse clinical events in the infant and childhood studies led by Dr. Margaret Leigh and Dr. Stephanie Davis here at UNC. These advances in diagnostics and pathophysiology are likely to lead to earlier diagnosis and therapeutic interventions, and likely better clinical outcome."

Within the RDCRN, UNC is the lead institution in a study of rare genetic airways disorders, such as cystic fibrosis and primary ciliary dyskinesia. UNC also heads a multi-center group within the network, called the Genetic Diseases of Mucociliary Clearance Consortium (GDMCC). Other institutions in the consortium reporting to UNC include Washington University in St. Louis, The Children's Hospital in Denver, Colo., Children's Hospital & Regional Medical Center in Seattle, Wash., the National Institute of Allergy and Infectious Diseases (NIAID), Lucille Packer Children’s Hospital at Stanford University, and the Hospital for Sick Children in Toronto.

In addition to Knowles, UNC faculty and staff involved in the project include Margaret Leigh, M.D., professor, and Stephanie Davis, M.D., associate professor, both in the Department of Pediatrics; Susan Minnix, a nursing education clinician who is serving as national coordinator for the consortium; and Maimoona Zariwala, Ph.D., a research assistant professor in the Department of Pathology and Laboratory Medicine.

Since its creation in 2003, the RDCRN has enrolled over 5,000 patients in 37 clinical studies in rare diseases. Patient recruitment for clinical studies is a fundamental challenge in rare diseases research because there are typically so few affected patients in any one area. The RDCRN was designed to address this problem by fostering collaboration among scientists and shared access to geographically distributed research resources. Network consortia have also established training programs for clinical investigators who are interested in rare diseases research.

Officially, a rare disease is defined as a disease or condition affecting fewer than 200,000 persons in the United States. About 6,000 such disorders have been identified, impacting an estimated 25 million Americans. Few drug companies conduct research into rare diseases since there is little chance to recoup the costs of developing treatments for such small, geographically dispersed populations.

RDRCN Web site: http://rarediseasesnetwork.epi.usf.edu/
GDMCC Web site: http://rarediseasesnetwork.epi.usf.edu/gdmcc/about/index.htm

UNC study: Children can greatly reduce abdominal pain by using their imagination

tom_hughes — 2009-10-12T17:41:35Z

Media contact: Tom Hughes, (919) 966-6047, tahughes@unch.unc.edu

Monday, Oct. 12, 2009

CHAPEL HILL – Children with functional abdominal pain who used audio recordings of guided imagery at home in addition to standard medical treatment were almost three times as likely to improve their pain problem, compared to children who received standard treatment alone.

And those benefits were maintained six months after treatment ended, a new study by University of North Carolina at Chapel Hill and Duke University Medical Center researchers has found.

The study is published in the November 2009 issue of the journal Pediatrics. The lead author is Miranda van Tilburg, Ph.D., assistant professor in the Division of Gastroenterology and Hepatology in the UNC School of Medicine and a member of the UNC Center for Functional GI & Motility Disorders.

“What is especially exciting about our study is that children can clearly reduce their abdominal pain a lot on their own with guidance from audio recordings, and they get much better results that way than from medical care alone,” said van Tilburg. “Such self-administered treatment is, of course, very inexpensive and can be used in addition to other treatments, which potentially opens the door for easily enhancing treatment outcomes for a lot of children suffering from frequent stomach aches.”

The study focused on functional abdominal pain, defined as persistent pain with no identifiable underlying disease that interferes with activities. It is very common, affecting up to 20 percent of children. Prior studies have found that behavioral therapy and guided imagery (a treatment method similar to self-hypnosis) are effective, when combined with regular medical care, to reduce pain and improve quality of life. But for many children behavioral therapy is not available because it is costly, takes a lot of time and requires a highly trained therapist.

For this study, 34 children ages 6 to 15 years old who had been diagnosed with functional abdominal pain by a physician were recruited to participate by pediatric gastroenterologists at UNC Hospitals and Duke University Medical Center. All received standard medical care and 19 were randomized to receive eight weeks of guided imagery treatment. A total of 29 children finished the study; 15 in the guided imagery plus medical treatment group and 14 in the medical treatment alone group.

The guided imagery sessions, developed jointly by van Tilburg, co-investigator Olafur Palsson, Psy.D. and Marsha Turner, the study coordinator, were recorded on CDs and given to children in the study to use at home.

The treatment consisted of a series of four biweekly, 20-minute sessions and shorter 10-minute daily sessions. In session one, for example, the CD directs children to imagine floating on a cloud and relaxing progressively. The session then gives them therapeutic suggestions and imagery for reducing discomfort, such as letting a special shiny object melt into their hand and then placing their hand on their belly, spreading warmth and light from the hand inside the tummy to make a protective barrier inside that prevents anything from irritating the belly.

In the group that used guided imagery, the children reported that the CDs were easy and enjoyable to use. In that group, 73.3 percent reported that their abdominal pain was reduced by half or more by the end of the treatment course. Only 26.7 percent in the standard medical care only group achieved the same level of improvement. This increased to 58.3 percent when guided imagery treatment was offered later to the standard medical care only group. In both groups combined, these benefits persisted for six months in 62.5 percent of the children.

The study concluded that guided imagery treatment plus medical care was superior to standard medical care alone for the treatment of functional abdominal pain, and that treatment effects were sustained over a long period.

UNC co-authors of the study included Denesh K. Chitkara, M.D., adjunct research professor; William E. Whitehead, Ph.D., professor and co-director of the UNC Center for Functional GI & Motility Disorders, and Nanette Blois-Martin, pediatric nurse-practitioner.

Martin Ulshen, M.D., division chief of pediatric gastroenterology, hepatology and nutrition at Duke University Medical Center, is also a co-author.

Women urged to take charge of their eye health

tom_hughes — 2009-10-15T18:13:27Z

Wednesday, Oct. 7, 2009

This year, a group of scientists and top eye experts that comprise Women's Eye Health.org will focus their attention on gender and eye health as part of this year's World Sight Day (October 8). Ophthalmologist Dr. Mary Elizabeth Hartnett of the University of North Carolina at Chapel Hill is among experts who urge women to take charge of their eye health. "Three quarters of visual impairment is preventable or correctable. Women spend so much time caring for others, it's time we care for ourselves, beginning with our eye health." (Video produced by Courtney Potter)

Be a happy camper: Plan your emergency response in advance

tom_hughes — 2009-10-07T13:49:00Z

Media contact: Tom Hughes, (919) 966-6047, tahughes@unch.unc.edu

Written by Margot Carmichael Lester for UNC Health Care

It’s every camper’s nightmare. The turned ankle. The gash. The snake bite. Some cavalier adventurers set off with nothing more than some adhesive bandages in their packs. Others hike in an array of first aid items “just in case.” While the Boy Scout motto, “Be Prepared,” is a good one, the key, says Wes Wallace, M.D., is being correctly prepared.

“Things just happen when you’re camping, especially if people are drinking,” says Wallace, associate professor of emergency medicine in the University of North Carolina at Chapel Hill School of Medicine and an emergency physician at UNC Hospitals. “If you’re doing something that poses risk – and camping does fall in that category -- then prepare to deal with consequences.”

Once you’ve planned your trip, plan your emergency response. Wallace suggests simply asking yourself:

What are common illnesses and injuries that occur in these activities?
What are life-threatening injuries I can do something about?

Having a plan will help you stay calm should something happen, and will guide you in choosing first-aid supplies.

“You don’t want to carry pounds of plaster just to make a splint,” Wallace notes, “so you don’t need to pack something for every possible injury. But if you’ve got someone in your party who’s allergic to bee and wasp stings, for instance, you might want to take along a few epi-pens.”

Common Injuries
Here are some tips and supplies for dealing with a few common injuries:

Snake Bites: Let's settle this once and for all: you should NEVER suck venom out of a snake bite. “It doesn’t work, and it wastes time,” Wallace notes. “Instead, get out car keys and drive to the emergency room quickly, but safely. If someone’s got a dangerous envenomation, the only effective treatment is the anti-venom.”

Ankle/Knee Sprains: Do your best to compress the area and stay off it when possible. “For ankles, if you’re wearing a higher boot, leave it on to provide support and lace it tighter to provide compression,” he counsels. “If you can keep it elevated above your heart and put something cool on it, that’s great.”

Blisters: Prevention is always the best medicine. As soon as you develop a hot spot use tape or moleskin to over the area. If you do develop a blister, use one of the special blister treating products available at most drugstores. “If you have a blister and it’s clear that it’s going to burst anyway,” Wallace says, “stick a clean needle in lowest side so it drains. If it’s ripped off, definitely cover the sensitive skin up with a blister treatment product.”

Broken Bones: “The best thing you can do is try to splint the injury to immobilize it,” he asserts. Light-weight, compact aluminum splints are available at outdoor stores. If you didn’t pack a splint, lash together whatever you can find that’s rigid. “If sticks are what you’ve got that’s what you use.”

Cuts and Punctures: The most important thing to do is wash the wound out well with the cleanest water you have under pressure. If you don’t have a syringe, don’t worry. Says Wallace: “Use a clean zip-top bag, fill it with water, poke a hole in it and squeeze.”

Poison Ivy: “Unless it’s a longer trip, you’re at home when poison ivy gets you,” he laughs. “The best stuff to treat it is a steroid cream like 1- to 2-percent hydrocortisone.”

Sending Out an SOS
One of the biggest mistakes campers make is assuming they can use their cell phones to call for help should something horrible happen. “In some areas, your phone may be able to get you out of trouble,” Wallace allows. “But in the mountains or the remote back-country, there’s no access.”

While your cell may not help, your vehicle can. “Many times – especially with a snake bite or a serious injury – your car keys are the most important item in your first-aid kit,” Wallace says.

The bottom line, Wallace notes, is pretty simple. “You got yourself into this, you can get yourself out,” Wallace says. “Stay calm and do your best.”

Don’t Leave Home Without It
You can buy pre-packaged wilderness first-aid kits, but it’s easy to make up one of your own. Here is a bare-minimum list of supplies:

General: ace wrap, adhesive bandages, aloe vera gel, antibiotic ointment, antihistamines, aspirin/ibuprofen, athletic tape, gauze (rolled or pads), hydrocortisone cream, oral rehydration salts or electrolytes, pocket knife with scissors and tweezers, zip-top bags

Blisters: benzoin tincture, moleskin

Trauma: chemical hot and cold packs, latex gloves

Wounds: antibiotic ointment, surgical strips, irrigation syringe

Hunters: Don’t let buck fever be a heart hazard

tom_hughes — 2009-10-07T13:43:49Z

Media contact: Tom Hughes, (919) 966-6047, tahughes@unch.unc.edu

Wednesday, Oct. 7, 2009

Written by Margot Carmichael Lester for UNC Health Care

CHAPEL HILL – If you’re a hunter, you probably invest a lot of time getting your gun or bow ready for hunting season. But don’t forget to make time to get your heart ready, too, because the increased activity could put you – not your quarry – at risk.

For most hunters, heart-attack danger lies in excessive exertion – like walking up hills or long distances, climbing into a deer stand or running quickly. When you feel winded, it may be due to the heart being deprived of oxygen, causing the heart muscle to become injured and not pump appropriately. If you’re healthy and you slow down, you can recover easily. But if you’re not – because you have cardiovascular disease or aren’t in good shape – this situation can cause a lethal heart problem.

Flushing the Risk
The best way to avoid cardiovascular disease – including heart attacks – is to have a healthy lifestyle that includes eating well and getting regular exercise and check-ups. It’s also important to know your numbers as well as you know your hunting quotas. Here are suggested levels, according to Paula Miller, M.D., a cardiologist at the University of North Carolina at Chapel Hill School of Medicine:

Total Cholesterol: Goal is less than 200
HDL: Goal is greater than 40 and ideally greater than 60 (subtracts one risk factor if you are over 60)
LDL: Depends on risk factor profile: 0-1 risk factor = <160; 2 risk factors = less than 130 ; greater than 2 risk factors or if you have known coronary artery disease = less than 100; if you are diabetic, less than 70.
Triglycerides: Goal is less than 150
Blood Pressure: General population, less than 135/less than,85; diabetic population: less than 130/less than 80
Glucose: Less than 110 fasting blood sugar
Weight: Body mass index less than 25.5 for women, less than 26.5 for men; waist should be less than 35 inches for women and less than 40 inches for men

“If you smoke, you need to stop,” Miller advises. “And if you have hypertension – coronary artery disease, diabetes, etc. – take your medicine appropriately and follow your doctor’s instructions.”

If you don’t see your physician regularly, or you have any of these risk factors, it’s a good idea to check in with your physician before you head to the woods this season.

Start Training
It may sound silly, but a little conditioning goes a long way to avoiding heart problems on the hunt.

“Regular exercise conditions the heart and enables you to better withstand strenuous activity,” Miller says. Start slowly, working up to regular aerobic activity three times a week for at least 30 minutes. “If you can’t get regular exercise, try for a goal of 10,000 steps a day.”

Warning Signs
Paying attention to your body’s response to prolonged or bursts of activity can help you avoid a worst-case scenario. If you feel you’re struggling to keep up or develop chest pains, you should stop immediately.

“The classic symptoms are chest pain associated with shortness of breath, nausea and/or vomiting, sweating, feeling faint and possibly a feeling of doom,” Miller explains. “These generally occur with activity and get better with rest. Hunters may experience some or all of the symptoms. Many people minimize or ignore the early symptoms. You should not.”

Preventing the Worst
If you or your hunting partner experiences any of these symptoms, call 9-1-1 immediately. Keep some full-strength aspirin – 325 mg – in your gear bag, and if you/your friend isn’t allergic, chew one when the symptoms start. Proceed with as little exertion as possible.

“It is never good to hunt alone and heart attack is one of the reasons,” Miller says. “If the victim is in cardiac arrest – isn’t breathing and has no pulse – CPR should be started immediately. All hunters who may hunt in remote areas should learn basic CPR.”

Every great hunting outing starts with good preparation. This season, make sure you’re in as good shape as your gear.