- WSU stroke experts say landmark study emphasizes early recognition of symptoms and possible superiority of combination therapy
In Headlines on July 1, 2013
Ramesh Madhavan, M.D., D.M.
Pratik Bhattacharya, M.D., M.P.H.
Kumar Rajamani, M.D., D.M.A landmark study published in the June 26 issue of the New England Journal of Medicine concluded that among patients with high-risk transient ischemic attack or minor ischemic stroke seen within 24 hours of symptom onset, treatment with clopidogrel (Plavix®) plus aspirin for 21 days, followed by clopidogrel alone for a total of 90 days, is superior to aspirin alone in reducing the risk of subsequent stroke.
The Clopidogrel in High-Risk Patients with Acute Nondisabling Cerebrovascular Events, or CHANCE study, tested the hypothesis that three months of treatment with a combination of clopidogrel and aspirin would reduce the risk of recurrent stroke, compared with aspirin alone.
“The CHANCE study is a well-designed remarkable study that demonstrates the superiority of combining the two most commonly used antiplatelet therapies for reducing the risk of future strokes,” said Ramesh Madhavan, M.D., D.M., Wayne State University School of Medicine associate professor of neurology and director of Telemedicine and the Michigan Stroke Network. “Although, a definitive study is still needed, this is a major step forward that may change how we practice.”
Dr. Madhavan is the investigator of a similarly designed ongoing study in the United States called the Platelet-Oriented Inhibition in New TIA and Minor Ischemic Stroke, or POINT, study.
In the large-scale CHANCE trial involving patients with high-risk TIA or minor ischemic stroke, the addition of clopidogrel to aspirin within 24 hours after symptom onset reduced the risk of subsequent stroke by 32 percent, as compared with aspirin alone. Combination therapy with clopidogrel and aspirin, as compared with aspirin alone, was not associated with an increased incidence of hemorrhage.
“This is an important study because it provides the potential to have a significantly improved outcome in patients who experience mild stroke. The combination of aspirin and clopidogrel was better than aspirin alone,” said Pratik Bhattacharya, M.D., M.P.H., assistant professor of WSU Neurology, who also serves as the Stroke Quality officer for the Detroit Medical Center and chief of Neurology at Sinai-Grace Hospital. “The study was conducted in China and cytochrome expression in the trial population could have influenced response to aspirin. However, an important message from the study is early recognition and treatment of stroke symptoms.”
Providing with some “chilling facts” about stroke in the United States, Kumar Rajamani, M.D., D.M., WSU associate professor and chief of Neurology at Detroit Receiving Hospital, provided some “chilling facts” about stroke in the U.S.:
* Stroke is the fourth leading cause of death, killing more than 133,000 people each year, and a leading cause of serious, long-term adult disability.
* There are an estimated 7 million stroke survivors in the U.S. over the age of 20.
* Approximately 800,000 strokes occur every year, one every 40 seconds, and taking a life approximately every four minutes.
* Stroke can happen to anyone at any time, regardless of race, sex or age.
* Approximately 55,000 more women than men have a stroke each year.
* African-Americans have almost twice the risk of first-ever stroke compared with Caucasians.
“There is absolutely no question that the sooner stroke is recognized and treated, the better the outcome,” Dr. Madhavan said. “In an increasingly aging U.S. population, early recognition of stroke is a critical message of the study, even though the investigators demonstrated that dual therapy is better than aspirin alone in the early hours following acute stroke.”
- Psychiatry event celebrates the legacy of Helene Lycaki, Ph.D.
In Headlines on June 28, 2013
The Dr. Helene Lycaki Conference Room includes this plaque honoring the former WSU faculty member.
David Rosenberg, M.D., remembers Dr. Lycaki at the dedication June 27.
James Haveman, director of the Michigan Department of Community Health, delivers a heartfelt tribute to Dr. Lycaki.
Vice Dean Bonita Stanton, M.D., speaks at the event.
From left, Diana Censoni and Michael and Athina Lycaki admire the Dr. Helen Lycaki Conference Room plaque honoring their family member and friend.
Friends, colleagues and family of the late Helene Lycaki, Ph.D., gathered June 27 to remember her and celebrate the dedication of the Dr. Helene Lycaki Conference Room on the fifth floor of the Wayne State University School of Medicine Tolan Park Medical Office Building in Detroit.
Dr. Lycaki’s brother, Michael Lycaki, and sister-in-law, Athina Lycaki, traveled to Detroit from Athens, Greece, to attend the event that honored the 30-year faculty member for her dedication to both WSU and the Michigan mental health community.
“It was a surprise for us that there was going to be such recognition,” Michael Lycaki said. “Nobody has forgotten her.”
Dr. Lycaki died in 2008 in an auto accident while attending a conference in Croatia.
The Tolan Park building became the new home of the Department of Psychiatry and Behavioral Neurosciences in March. Guests also toured the building, hearing from faculty, staff and students about the department’s groundbreaking research and its commitment to continue meeting the mental and physical health care needs of the Detroit community – a commitment many noted Dr. Lycaki would be happy to see.
“There was no greater champion and stronger advocate for ensuring equal access to mental health care and treatment for our poorest citizens. She also advocated vigorously for equal opportunities for women in medicine, science, academia and beyond,” said David Rosenberg, M.D., who was hired at WSU by Dr. Lycaki nearly two decades ago and is now chair of the department.
“She was an invaluable advisor to the university’s faculty, chairs, deans, presidents and Board of Governors. She was well known, liked and respected by the legislative community in Lansing,” he said.
Dr. Rosenberg also announced the establishment of the Lycaki-Young Fund in his remarks to the crowd, receiving audible gasps of approval. Formerly known as the Joseph Young Fund, the fund, in partnership with the state of Michigan, has helped provide vital psychiatric services to hundreds of thousands of patients in southeast Michigan during the last two decades.
“(Dr. Lycaki) was a giant in her field, a wonder to behold and a joy to be around,” said James Haveman, director of the Michigan Department of Community Health.
After earning her master’s degree from the University of Athens, Dr. Lycaki left Greece for Detroit, where she earned a doctorate degree in clinical psychology from WSU. And while a university in Texas attempted to lure her away after graduation, she stayed in Detroit “because she knew the path she would take,” Haveman said.
Dr. Lycaki served as a respected member of the School of Medicine faculty for three decades, and was named the school’s assistant dean for Health Affairs in 2001. She also played a vital role as the school’s liaison for government relations in Lansing, identifying networking opportunities linking outside resources to clinical, research and educational programs within the School the Medicine.
“She touched so many people on so many levels, from faculty to students to patients, that her legacy remains a living and breathing entity, even here in this building,” said Bonita Stanton, M.D., the School of Medicine’s vice dean of Research and a colleague and friend of Dr. Lycaki.
Dr. Lycaki, working alongside the university’s chief lobbyists, was the first woman to represent the School of Medicine to local, state and national governments. She met Haveman in that realm, and they quickly became friends. He spoke of her vibrant personality, tenacious spirit, keen intellect and ability to maneuver the political waters boldly but appropriately.
“She was one of those individuals who used the force of her personality as a change agent,” Haveman said. “She did it well and she always did it respectively.”
Dr. Rosenberg also announced plans to fundraise for the Helen Lycaki Endowed Chair in Mental Health, an endowment created to help support women pursuing careers in what he called an important, underrated and underrepresented area of medicine and psychology.
“This endowment will honor Dr. Lycaki, her rich and varied experience as an educator, clinical practitioner and scientist, and her proven leadership in medical education and administration,” he said.
- WSU scientists identify neural origins of hot flashes in menopausal women
In Headlines on June 28, 2013
Robert Freedman, Ph.D.
Vaibhav Diwadkar, Ph.D.
A new study from neuroscientists at the Wayne State University School of Medicine provides the first novel insights into the neural origins of hot flashes in menopausal women in years. The study can inform and eventually lead to new treatments for those who experience the sudden but temporary episodes of body warmth, flushing and sweating.
The paper, "Temporal Sequencing of Brain Activations During Naturally Occurring Thermoregulatory Events," by the WSU Department of Psychiatry and Behavioral Neurosciences’ Professor Robert Freedman, Ph.D., founder of the Behavioral Medicine Laboratory and a member at the C.S. Mott Center for Human Growth and Development, and his collaborator, Associate Professor Vaibhav Diwadkar, Ph.D., appears in the June issue of Cerebral Cortex, an Oxford University Press journal.
“The idea of understanding brain responses during thermoregulatory events has spawned many studies where thermal stimuli were applied to the skin. But hot flashes are unique because they are internally generated and studying them presents unique challenges,” said Dr. Freedman, the study’s principal investigator. “Our women had to lie in the MRI scanner while being heated between two body-size heating pads for up to two hours while we waited for the onset of a hot flash. They were heroic in this regard and the study could not have been conducted without their incredible level of cooperation.”
“Menopause and hot flashes that result during it are a significant women's health issue of widespread general interest,” Dr. Diwadkar added. “However, understanding of the neural origins of hot flashes has remained poor. The question has rarely been assessed with in vivo functional neuroimaging. In part, this paucity of studies reflects the technical limitations of objectively identifying hot flashes while symptomatic women are being scanned with MRI. Nothing like this has been published because this is a very difficult study to do.”
During the course of a single year, 20 healthy symptomatic postmenopausal women ages 47 to 58 who reported six or more hot flashes a day were scanned at the School of Medicine’s Vaitkevicius Imaging Center located in Harper University Hospital in Detroit.
The researchers collected skin conductance levels to identify the onset of flashes while the women were being scanned. Skin conductance is an electrical measure of sweating. The women were connected to a simple circuit passing a very small current across their chests, Dr. Diwadkar said. Changes in levels allowed researchers to identify a hot flash onset and analyze the concurrently acquired fMRI data to investigate the neural precedents and correlates of the event.
The researchers focused on regions like the brain stem because its sub regions, such as the medullary and dorsal raphe, are implicated in thermal regulation, while forebrain regions, such as the insula, have been implicated in the personal perception of how someone feels. They showed that activity in some brain areas, such as the brain stem, begins to rise before the actual onset of the hot flash.
“Frankly, evidence of fMRI-measured rise in the activity of the brain stem even before women experience a hot flash is a stunning result. When this finding is considered along with the fact that activity in the insula only rises after the experience of the hot flash, we gain some insight on the complexity of brain mechanisms that mediate basic regulatory functions,” Dr. Diwadkar said.
These results point to the plausible origins of hot flashes in specific brain regions. The researchers believe it is the first such demonstration in academic literature.
They are now evaluating the network-based interactions between the brain regions by using more complex modeling of the fMRI data. “We think that our study highlights the value of using well-designed fMRI paradigms and analyses in understanding clinically relevant questions,” Dr. Diwadkar said.
The researchers also are exploring possibilities for integrating imaging with treatment to examine whether specific pharmacotherapies for menopause might alter regional brain responses.
The study was supported by the National Institutes of Health Merit award (R37-AG05233), with additional support by a National Institute of Mental Health award (MH68680) and the state’s Joseph A. Young Sr. Fund award to the Department of Psychiatry & Behavioral Neurosciences.
- American Academy of Physical Medicine and Rehabilitation to honor WSU's Dr. Horn
In Headlines on June 28, 2013
Lawrence Horn, M.D.Lawrence Horn, M.D., M.R.M., professor and chair of the Wayne State University School of Medicine’s Department of Physical Medicine and Rehabilitation at the Detroit Medical Center - Rehabilitation Institute of Michigan, has been selected to receive the 2013 American Academy of Physical Medicine and Rehabilitation Outstanding Council Service Award - Central Nervous System Rehabilitation Council.
The award recognizes the service and volunteerism of council members who “serve its membership in ways not limited to research, education and product development.”
Dr. Horn will receive the award at the academy’s annual meeting Oct. 5 in National Harbor, Md.
“It is really a great honor to be recognized by my colleagues in neurological rehabilitation,” said Dr. Horn, who in mid-June was appointed chair of the WSU department.
He previously served as vice chair for the Neurological Rehabilitation Program Planning Committee of the American Academy of Physical Medicine and Rehabilitation.
- Molecular therapeutics advances explored during 2013 annual Research Retreat
In Headlines on June 27, 2013
Keynote speaker William Pao, M.D., Ph.D., addresses the assembly.More than 125 scientists and medical students from the Wayne State University School of Medicine, the Barbara Ann Karmanos Cancer Institute and the Henry Ford Health System explored recent and upcoming advances in molecular therapeutics during the 2013 annual Research Retreat, hosted June 19 by the institute at the School of Medicine’s Margherio Family Conference Center.
Gerold Bepler, M.D., Ph.D., associate dean of Associate Dean of Cancer Programs for the school, and president and chief executive officer of Karmanos, opened the day by welcoming attendees and noting this was the first independent retreat of the recently reorganized Molecular Therapeutics Program at Karmanos.
Larry Matherly, Ph.D., professor of pharmacology and leader of the Molecular Therapeutics Program, thanked the retreat steering committee and Julie Boerner, Ph.D., assistant professor in the Department of Oncology at Karmanos and WSU SOM, in particular for her contributions in organizing the event. Special thanks also went to KCI Research Administration, particularly Research Administrative Coordinator Michelle Case and Evano Piasentin, project administrator of Investigator Grants, for their assistance.
Keynote speaker William Pao, M.D., Ph.D., capped off the morning presentations with a discussion on “Defining Clinically Relevant Molecular Subsets of Cancer.” Dr. Pao, a lung cancer expert, is a physician-scientist and division chief of the Hematology/Oncology Department of Medicine at Vanderbilt-Ingram Cancer Center in Nashville, Tenn.
Several members of the Molecular Therapeutics Program also gave presentations, including:
Elisabeth Heath, M.D, professor of oncology, “Clinical and Translational Prostate Cancer Research: Advancing Team Science.”
Aliccia Bollig-Fischer, Ph.D., assistant professor of oncology, “Translational Genomics.”
Ana deCarvalho, Ph.D., instructor scientist II of Neurosurgery at Henry Ford Health System, “Glioblastoma Patient-Derived Mouse Xenografts are Clinically Relevant Models for the Study of Molecular Heterogeneity and Differential Response to Targeted Therapy.”
Nicholas Szerlip, M.D., assistant professor of neurosurgery, “Targeting Neuregulin and ErbB2 in Glioma Therapy.”
Patricia LoRusso, D.O., professor of oncology, “Melanoma Dream Team.”
Jeffrey Zonder, M.D., associate professor of oncology, “New Therapeutic Targets in Multiple Myeloma.”
Manohar Ratnam, Ph.D., professor of oncology, “A New Approach to Targeting the Androgen Signaling Axis in Prostate Cancer.”
Lori Pile, Ph.D., assistant professor of biological sciences, “Histone Modifying Enzymes in Cell Proliferation and Development.”
G. Andres Cisneros, Ph.D., assistant professor of chemistry, “Hypothesis Driven-SNP-Search: A New Method to Find Disease Related SNPs.”
Andrew Fribley, Ph.D., assistant professor of pediatrics, “Novel Small Molecules Activate Unfolded Protein Response Signaling and Cell Death in Head and Neck Cancer.”
A competitive poster session highlighting research from undergraduate students, graduate students and post-doctoral fellows featured 25 participants discussing their research projects with attendees and judges. Poster prizes were awarded in each of the following categories: undergraduate, graduate and post-doctoral fellow. The winners were:
Undergraduate: First prize – Adam Edmunds – laboratory of Sandeep Mittal, M.D., professor of neurosurgery.
Graduate: First prize – Daniela Buac – laboratory of Q. Ping Dou, Ph.D., professor of pharmacology, and second prize – Julie Madden Laboratory of Dr. Boerner.
Post-Doctoral Fellow: First prize – Eric Hales, Ph.D. – laboratory of Dr. Matherly.
- Dr. Chaturvedi on executive committee of study funded by NIH
In Headlines on June 27, 2013
Seemant Chaturvedi, M.D.Seemant Chaturvedi, M.D., F.A.H.A., F.A.A.N., professor of Neurology for the Wayne State University School of Medicine, is serving on the executive committee of a clinical trial recently funded by National Institutes of Health.
The Carotid Revascularization Endarterectomy Stent Trial 2, or CREST 2, aims to compare optimal medical therapy alone versus optimal medical therapy plus carotid revascularization for patients with asymptomatic narrowing of the internal carotid artery.
“This is an important study since modern medical therapy has never been evaluated relative to carotid surgery in a clinical trial,” said Dr. Chaturvedi, who also serves as director of the Wayne State University/Detroit Medical Center Stroke Program.
The study’s principal investigator is Thomas Brott, M.D., professor of neurology and director for research at the Mayo Clinic in Jacksonville, Fla.