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Former VP Joe Biden honored at annual Stars of Stony Brook Gala

by Heidi Sutton - May 4, 2017

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Samuel L. Stanley Jr, Joe Biden, Samuel L. Stanley Jr, Richard L. Gelfond — Honoree US Vice President Joe Biden (center) stands with Samuel L. Stanley Jr., President, Stony Brook University, Former and James H. Simons, Chair Emeritus, Stony Brook Fountation and IMAX CEO Richard L. Gelfond during the 2017 Stars of Stony Brook Gala at Chelsea Piers April 19, 2017, in New York, NY. (Mark Von Holden/AP Images for Stony Brook University)

Stony Brook University recognized the 47th vice president of the United States of America, the Honorable Joseph R. Biden Jr., at its 18th annual Stars of Stony Brook Gala on April 19 at Pier Sixty at Chelsea Piers in New York City. The former vice president was recognized for his outstanding career and dedication to the fight against cancer.

“Cancer touches us all in some way and at some point,” said Biden. “Everywhere I go, people share their stories of heartbreak and hope. And every day, I’m reminded that our work to end cancer as we know it is bigger than just a single person. It carries the hopes and dreams of millions of people who are praying that we succeed, praying for hope, praying for time — not someday, but now.”

As vice president, Biden led the White House Cancer Moonshot, with the mission to double the rate of progress in preventing and fighting the disease. Under his leadership, the White House Cancer Moonshot Task Force catalyzed novel, innovative and impactful collaborations among 20 government agencies, departments and White House offices and over 70 private sector collaborations designed to achieve a decades’ worth of progress in the prevention, diagnosis and treatment of cancer in just five years.

In addition, Biden helped lead the effort to pass the 21st Century Cures Act that provides $1.8 billion over seven years for the Cancer Moonshot’s scientific priorities.

“We are privileged to have the opportunity to honor former Vice President Biden,” said Stony Brook University President Samuel L. Stanley. “The Cancer Moonshot has the potential to transform cancer research and prevention around the world. This critical initiative is a reflection of the work our researchers and doctors are doing in Stony Brook Cancer Center labs — using insight, innovation and strategic collaborations to push the boundaries of what we know about how best to diagnose, treat and ultimately prevent the disease that is responsible for more than 8 million deaths a year worldwide.”

Research and discovery are at the heart of the Stony Brook ethos and the university’s Cancer Center is a shining example of its commitment to combating the malady. Stony Brook doctors are on the forefront of the next generation in cancer care.

The Cancer Center will relocate next year to the new 254,000 square-foot Medical and Research Translation facility (MART), which was designed to enable scientists and physicians to work side by side to advance cancer research and imaging diagnostic and will be the home to the new Bahl Center for Metabolomics and Imaging. Stony Brook researchers are receiving worldwide attention for their pioneering research into the genesis and behavior of cancer cells at the molecular level, which will one day help detect, treat, and eliminate the disease altogether.

Every spring the Stony Brook Foundation hosts the Stars of Stony Brook Gala to benefit student scholarships and a select academic program. Since its inception in 2000, the event has raised more than $42 million. A portion of the net proceeds from this year’s gala will support the Stony Brook Cancer Center.

Biden joins a distinguished roster of scholars, politicians, celebrities and luminaries who have been honored by the gala for their outstanding and relentless commitment to society, including Nobel Laureate CN Yang; actors Julie Andrews, Alan Alda and Ed Harris; founder of Renaissance Technologies Jim Simons; CA Technologies founder Charles Wang; and world-renowned conservationists Richard Leakey and Patricia Wright.

SBU’s Escobar-Hoyos wins $600K for pancreatic cancer research

by Daniel Dunaief - April 29, 2017

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escobarsbshroyerleach — Escobar-Hoyos, center, holds her recent award, with Kenneth Shroyer, the chairman of the Department of Pathology at Stony Brook on the left and Steven Leach, the director of the David M. Rubenstein Center for Pancreatic Cancer Research on the right. Photo by Cindy Leiton

By Daniel Dunaief

While winter storm Niko in February closed schools and businesses and brought considerable precipitation to the region, it also coincided with great news for Luisa Escobar-Hoyos, who earned her doctorate from Stony Brook University.

Escobar-Hoyos, who is a part-time research assistant professor in the Department of Pathology at Stony Brook University and a postdoctoral fellow at Memorial Sloan Kettering Cancer Center, received word that she was the sole researcher selected in the country to receive the prestigious $600,000 Pancreatic Cancer Action Network–American Association for Cancer Research Pathway to Leadership Award.

When she heard the news, Escobar-Hoyos said she was “filled with excitement.” After she spoke with her husband Nicolas Hernandez and her current mentor at MSKCC, Steven Leach, the director of the David M. Rubenstein Center for Pancreatic Cancer Research, she called her parents in her native Colombia.

Her mother, Luz Hoyos, understood her excitement not only as a parent but as a cancer researcher herself. “My interest in cancer research started because of my mom,” Escobar-Hoyos said. Observing her example and “the excitement and the impact she has on her students and young scientists working with her, I could see myself” following in her footsteps.

The researcher said her joy at winning the award has blended with “a sense of responsibility” to the growing community of patients and their families who have developed a deadly disease that is projected to become the second leading cause of cancer-related death by 2020, according to the Pancreatic Cancer Action Network, moving past colorectal cancer.

The Pancreatic Cancer Action Network has awarded $35 million in funding to 142 scientists across the country from 2003 to 2016, many of whom have continued to improve an understanding of this insidious form of cancer.

David Tuveson, the current director of the Cancer Center at Cold Spring Harbor Laboratory, received funds from PanCan to develop the first genetically engineered mouse model that mimics human disease. Jiyoung Ahn, the associate director of the NYU Cancer Institute, used the funds to discover that two species of oral bacteria are associated with an over 50 percent increased risk of pancreatic cancer.

Over the first decade since PanCan started awarding these grants, the recipients have been able to convert each dollar granted into $8.28 in further pancreatic cancer research funding.

In her research, Escobar-Hoyos suggests that alternative splicing, or splitting up messenger RNA at different locations to create different versions of the same protein, plays an important part in the start and progress of pancreatic cancer. “Her preliminary data suggest that alternative splicing could be associated with poorer survival and resistance to treatment,” Lynn Matrisian, the chief science officer at PanCan, explained in an email. “The completion of her project will enhance our understanding of this molecular modification and how it impacts pancreatic cancer cell growth, survival and the progression to more advanced stages of this disease.”

Escobar-Hoyos explained that she will evaluate how mutations in transcriptional regulators and mRNA splicing factors influence gene expression and alternative splicing of mRNAs to promote the disease and aggression of the most common form of pancreatic cancer. Later, she will evaluate how splicing regulators and alternatively spliced genes enriched in pancreatic ductal adenocarcinoma contribute to tumor maintenance and resistance to therapy.

Escobar-Hoyos will receive $75,000 in each of the first two years of the award to pay for a salary or a technician, during a mentored phase of the award. After those two years, she will receive $150,000 for three years, when PanCan expects her to be in an independent research position.

Escobar-Hoyos said her graduate research at Stony Brook focused on ways to understand the biological differences between patients diagnosed with the same cancer type. She helped discover the way a keratin protein called K17 entered the nucleus and brought another protein into the cytoplasm, making one type of tumor more aggressive.

While Escobar-Hoyos works full time at Memorial Sloan Kettering, she continues to play an active role in Kenneth Shroyer’s lab, where she conducted experiments for her doctorate. She is the co-director of the Pathology Translational Research Laboratory, leading studies that are focused on pancreatic cancer biomarkers. The chair in the Department of Pathology, Shroyer extended an offer for her to continue to address the research questions her work addressed after she started her postdoctoral fellowship.

“When you do research projects and you develop them from the beginning, they are like babies and you really want to see how they evolve,” Escobar-Hoyos said. Numerous projects are devoted to different aspects of K17, she said.

Shroyer said Escobar-Hoyos had already been the first author on two landmark studies related to the discovery and validation of K17 even before her work with pancreatic cancer. “She has also conducted highly significant new research” that she is currently developing “that I believe will transform the field of pancreatic cancer research,” Shroyer wrote in an email.

Shroyer hopes to recruit Escobar-Hoyos to return to Stony Brook when she completes her fellowship to a full-time position as a tenure track assistant professor. “Based on her achievements in basic research and her passion to translate her findings to improve the care of patients with pancreatic cancer, I have no doubt she is one of the most promising young pancreatic cancer research scientists of her generation,” he continued.

Yusuf Hannun, the director of the Stony Brook Cancer Center, said Escobar-Hoyos’s work provided a new and important angle with considerable promise in understanding pancreatic cancer. “She is a tremendous example of success for junior investigators,” Hannun wrote in an email.

Escobar-Hoyos said she is hoping, a year or two from now, to transition to becoming an independent scientist and principal investigator, ideally at an academic institution. “Because of my strong ties with Stony Brook and all the effort the institution is investing in pancreatic research” SBU is currently her first choice.

Escobar-Hoyos is pleased that she was able to give back to the Pancreatic Cancer Action Network when she and a team of other friends and family helped raise about $4,000 as a part of a PurpleStride 5K walk in Prospect Park earlier this month.“I was paying forward what this foundation has done for me in my career,” she said.

Matrisian said dedicated scientists offer hope to patients and their families. “Researchers like Escobar-Hoyos spark scientific breakthroughs that may create treatments and ultimately, improve the lives of patients,” she suggested.

Medical Compass: Evaluating thyroid nodules

by David Dunaief - April 29, 2017

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Implications for thyroid removal are lifelong

By David Dunaief, M.D.

It is very interesting that the amount of coverage by the lay press concerning thyroid nodules does not reflect the number of people who actually have them. More than 50 percent of people have thyroid nodules detectable by high-resolution ultrasound (1); however, news coverage for general, nonphysician audiences is infrequent.

You can understand how coverage should be more in the forefront. Fortunately, most nodules are benign. A small percent, 4 to 6.5 percent, are malignant, and the number varies depending on the study (2). Thyroid nodules are being diagnosed more often incidentally on radiologic exams, such as CT scans of the chest, MRI scans, PET scans and ultrasounds of the carotid arteries in the neck (3).

There is a conundrum of what to do with a thyroid nodule, especially when it is found incidentally. It depends on the size. If it is over 1 centimeter, usually it is biopsied by fine needle aspiration (FNA) (4). This is the cutoff point for thyroid nodules found with a radiologic exam. Most are asymptomatic. However, if there are symptoms, these might include difficulty swallowing, difficulty breathing, hoarseness, pain in the lower portion of the neck and a goiter (5).

FNA biopsy is becoming more common. In a study evaluating several databases, there was a greater than 100 percent increase in thyroid FNAs performed over a five-year period from 2006 to 2011 (6). This resulted in a 31 percent increase in thyroidectomies, surgeries to remove the thyroid partially or completely.

However, the number of thyroid cancers diagnosed with the surgery did not rise in this same period. To make matters even more confusing, from 2001 to 2013, the number of thyroid cancers increased by 200 percent. In the study authors call for more detailed guidelines, which are lacking for thyroid nodules. Though the number of cancers diagnosed has increased, the mortality rate has remained relatively stable over several decades at about 1,500 patients per year (7). Thyroid nodules in this study were least likely to be cancerous when the initial diagnosis was by incidental radiologic exam.

Treating borderline results

As much as 25 percent of FNA biopsies are indeterminate. We are going to look at two modalities to differentiate between benign and malignant thyroid nodules when FNA results are equivocal: a PET scan and a molecular genetics test. A meta-analysis (a group of six studies) of PET scan results showed that it was least effective in resolving an unclear FNA biopsy. The PET scan was able to rule out patients who did not have malignancies significantly but did not do a good job of identifying those who did have cancer (8).

On the other hand, a molecular-based test was able to potentially determine whether an indeterminate thyroid nodule by FNA was malignant or benign (9). This test was a combination of microRNA gene expression classifier with the genetic mutation panel. I know the test combination sounds confusing, but the important takeaway is that it was more effective than previous molecular tests in clarifying whether a patient had a benign or cancerous nodule.

Unlike in the PET scan study above, the researchers were able to not only rule out the majority of malignancies but also to rule them in. It was not perfect, but the percent of negative predictive value (ruled out) was 94 percent, and the positive predictive value (ruled in) was 74 percent. The combination test improved the predictive results of previous molecular tests by 65 to 69 percent. This is important to help decide whether or not the patient needs surgery to remove at least part of the thyroid. The trial used hospital-based patients, but follow-up studies need to include community-based practices.

Is a negative FNA definitive?

We know that FNA is the gold standard for determining whether patients have malignant or benign thyroid nodules. However, a negative result on FNA is not always definitive for a benign thyroid nodule. When this occurs, it is referred to as a false negative result. In a retrospective (looking back at events) study, from the Longitudinal Health Insurance Database in Taiwan, 62 percent of thyroid nodules that were cancerous were diagnosed with one biopsy, and 82 percent were found within the year after that biopsy (10). However, about 17 percent of patients needed more than two FNA biopsies, and 19 percent were diagnosed after one year with cancerous thyroid nodules.

Significance of calcification on ultrasound

Microcalcifications in the nodule can be detected on ultrasound. The significance of this may be that patients with microcalcifications are more likely to have malignant thyroid nodules than those without them, according to a small prospective study involving 170 patients (11). This does not mean necessarily that a patient has malignancy with calcifications, but there is a higher risk. The results demonstrated that more than half of the malignant thyroid nodules, 61 percent, had microcalcifications.

Good news

As I mentioned above, most thyroid nodules are benign. The results of one study go even further, showing that most asymptomatic benign nodules do not progress in size significantly after five years (12). This was a prospective (forward-looking) study involving 992 patients with between one and four benign thyroid nodules diagnosed cytologically (by looking at the cells) or by ultrasound. The factors that did contribute to growth of about 11 percent of the nodules were age (<45 years old had more growth than >60 years old), multiple nodules, greater nodule volume at baseline and being male.

The authors’ suggestion is that the current paradigm might be altered and that after the follow-up scan, the next ultrasound scan might be five years later instead of three years. However, they did discover thyroid cancer in 0.3 percent after five years.

Thyroid function may contribute to risk

In considering risk factors, it’s important to note that those who had a normal thyroid stimulating hormone (TSH) were less likely to have a malignant thyroid nodule than those who had a high TSH, implying hypothyroidism. There was an almost 30 percent prevalence of cancer in the nodule if the TSH was greater than >5.5 mU/L (13).

The bottom line is that there is an urgent need for new guidelines regarding thyroid nodules. Fortunately, most nodules are benign and asymptomatic, but the number of cancerous nodules found is growing. We are getting better at diagnosing nodules. Why the death rate remains the same year over year for decades may have to do with the slow rate at which most thyroid cancers progress, especially two of the most common forms, follicular and papillary.

References: (1) AACE 2013 Abstract 1048. (2) Thyroid. 2005;15(7):708. (3) uptodate.com. (4) AACE 2013 Abstract 1048. (5) thyroid.org. (6) AAES 2013 Annual Meeting. Abstract 36. (7) AACE 2013 Abstract 1048. (8) Cancer. 2011;117(20):4582-4594. (9) J Clin Endocrinol Metab. Online May 12, 2015. (10) PLoS One. 2015;10(5):e0127354. (11) Head Neck. 2008 Sep;30(9):1206-1210. (12) JAMA. 2015;313(9):926-935. (13) J Clin Endocrinol Metab. 2006;91(11):4295.

Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com or consult your personal physician.

Port Jefferson Chamber of Commerce hosts annual Health & Wellness Fest

by Alex Petroski - April 27, 2017

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“Eat well, live well” was the tagline for the Greater Port Jefferson Chamber of Commerce annual Health & Wellness Fest, which was held April 22 at Earl L. Vandermeulen High School in Port Jefferson. Attendees were instructed on how to do both by vendors set up at tables in the school’s gymnasium, featuring representatives from Stony Brook Medicine, John T. Mather Memorial Hospital, St. Charles Hospital and many others.

“It’s been growing every year, and in the last two years, we were so fortunate as to have St. Charles Hospital provide us with the healthy snacks, and that’s really helped us boost the attendance,” Chamber President Jim Karras said in an interview during the event.

Chamber director of operations Barbara Ransome was also pleased with the number of vendors who turned out to offer advice to interested community members.

“We had no extra tables this year,” she said. “We had over 80 tables this year…I think there were like 45 individual vendors…All of our local nonprofits, we don’t charge them, so we feel like this is giving back to our community.”

Karras said he is proud of what the chamber has built with the annual event.

“There’s a lot of health and wellness events in the area, but I think we’re the only one that has the three major hospitals sponsoring them,” he said. “That makes a big difference.”

Ransome thanked the district for their hospitality.

“We want to put a shout out to our school,” she said. “Fred Koelbel, who is the superintendent of buildings here for the Port Jefferson School District, and for them to allow us to use this great facility, we have elevated this event.”

Other vendors included Jefferson’s Ferry lifecare community, L.I. Botanical Wellness, Save-A-Pet, Paws of War, Port Jefferson Hearing and many more.

Hundreds flock to Cedar Beach to walk for hope

by TBR Staff - April 24, 2017

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As the number of drug-related overdoses on the Long Island grows, one parent refuses to bury his head in the sand.

On the one-year anniversary of his son’s fatal heroin overdose, William Reitzig wasn’t in bed grieving. Instead, the Miller Place parent was on stage at Cedar Beach in Mount Sinai asking hundreds of community members to hug one another.

“Hug your loved ones like I hugged my son every day … My hope is that you leave here today with the same mission as my wife and I — that with love and compassion, we have the power to overcome the perils of drug addiction.”

—Michael Reitzig

“Hug your loved ones like I hugged my son every day … don’t let a minute go by without saying ‘I love you,’” Reitzig said to a crowd of emotional parents, extended family members, friends and strangers. “My hope is that you leave here today with the same mission as my wife and I — that with love and compassion, we have the power to overcome the perils of drug addiction.”

That mission resonated throughout Hope Walk for Addiction, an April 22 fundraising event created by Reitzig and co-sponsored by Brookhaven Town and Hope House Ministries — a nonprofit based in Port Jefferson that supports people suffering the disease of addiction.

Reitzig, whose 25-year-old son Billy struggled for years with opioid pills and ultimately died after a one-time use of heroin last April, kickstarted “a war on addiction” by raising awareness, educating about addiction, raising money to help those struggling and unite the community.

“This is [really] for the community — it’s not about me, it’s not about my son, it’s to try and make a difference moving forward,” Reitzig said. “I can’t do anything about the past at this point, but going forward we can all chip in … we’re all in the same boat. Today is about all the families that struggle every day with this disease getting together because this is no longer acceptable and we need to do something.”

The large crowd, mostly loved ones of those battling addiction or those who died from it, collectively walked Cedar Beach’s Nature Pathway in memory of those who overdosed. About a dozen names could be seen on signs along the scenic trail.

“I don’t think people realize how many people are depressed and they don’t know how to handle that and so people self-medicate and that’s part of the issue. Ninety-one young people die every day [from this] and that’s unconscionable.”

—Francis Pizzarelli

Local leaders, self-help experts and bands occupied the stage to address the issue that brought everyone together. Various sponsors, including WALK 97.5 and St. Charles Hospital in Port Jefferson, were set up at tables taking donations and educating others, and representatives from the Suffolk County Sheriff’s Office gave seminars on how to use Narcan, a life-saving nasal spray that can revert the effects of an overdose.

More than 500 people registered for the event, and all proceeds — totaling more than $34,000 at the end of the day — went to Hope House, which currently doesn’t have enough space for the overwhelming amount of people who need its services.

Father Francis Pizzarelli, founder of Hope House, counseled Billy while he was rehabilitating in the facility’s outpatient treatment program for a few months, and ultimately presided over his funeral.

Reitzig worked closely with Pizzarelli, and Councilwoman Jane Bonner (C-Rocky Point), to make the Hope Walk a reality.

“Billy was a loving and caring guy, but like a lot of people today, he had his demons and struggled with that,” Pizzarelli said. “I don’t think people realize how many people are depressed and they don’t know how to handle that and so people self-medicate and that’s part of the issue. Ninety-one young people die every day [from this] and that’s unconscionable. [William] elected to say ‘we’re not going to let this continue, we’re going to do something about it and we’re going to protect the quality of life of all our younger and older people addicted to heroin.’”

This is a time to come together as a community, Pizzarelli added, and celebrate the hope Reitzig embodies.

“We need to help stop the stigmatized feeling that comes with addiction. The users feel alone as it is, they don’t feel proud of themselves. They are good people that made one bad decision.”

—Sue Meyers

“I don’t think I’ve met more resilient, strong, dedicated and passionate people in my whole life as I have in William and his family,” Bonner said. “He’s changing the future of so many people by doing this. We’re losing a generation to addiction and this is an opportunity to lift each other up and strip the layers of shame back. It’s all around us and no community is safe from it.”

Patty Eiserman, of Sound Beach, wore a shirt bearing the face of her nephew David Smallwood, who died in 2013 when he was just 22. She said her goal is to educate children as young as possible so they don’t start using.

“I don’t want to say it’s impossible to get them clean,” she said, “but it’s very, very hard.”

Manorville resident Melanie Ross, whose brother died last year after a 10-year battle with addiction, said the situation ravaged the family. It was the first time she’d attended an even like this.

Sue Meyers, a Setauket resident, said she was walking for her son, Michael Moschetto, a Ward Melville graduate who died in December at 28.

“It’s in his name, but I’m also here to help show support for other people and donate as much money as I have in my pockets,” Meyers said. “We need to help stop the stigmatized feeling that comes with addiction. The users feel alone as it is, they don’t feel proud of themselves. They are good people that made one bad decision. I think events like this really give people hope and a sense of direction.”

A lesson in sugar, not so sweet (part two: metabolic stressor)

by TBR Staff - April 24, 2017

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It’s time to connect sugars to metabolic dysfunction. As a quick reminder, sugar is a paired unit made up of glucose and fructose. These are the same two sugars (a term that can be used generically for the various related calorie-bearing sweeteners) that comprise high fructose corn syrup. Also notable is that starch is composed of long chains of glucose. Consuming too much of any or all of these substances puts stress on your body in numerous ways. Our individual metabolic vulnerabilities fall prey to this stress, as some individuals may develop diabetes and others cardiovascular disease, etc. This lesson will focus on the stress that too much glucose can place on your metabolism.

Since your body can use glucose for energy, we are quick to accept this “blood sugar” as a good thing. We are equally inclined to believe the marketing that encourages us to buy more (sport drinks, pasta, etc.) especially if we also believe the claims that dietary fat is unhealthy. It turns out, however, high blood levels of glucose (more than two teaspoons) can be lethal. Consuming a typical sugary beverage (or a bagel) threatens to introduce five to 10 times that amount.

Luckily, your body is equipped to protect itself from such assaults and in the case of a glucose “rush,” it calls upon cells buried within your pancreas to produce insulin. Insulin works like a verbal command to your fat cells, directing them to remove glucose from your blood before it can reach dangerous levels. The more glucose consumed, the more insulin produced and the more your fat cells are called into action. (Notably and ironically, high insulin levels actually reduce the ability of your muscle cells to absorb this energy, leaving them, and you, still hungry.)

These verbal directions, when repeated frequently throughout the day, become tiresome to your fat cells, which develop a sort of hearing loss described by the medical community as “insulin insensitivity.” Progressively more insulin than before will be required to get the job done, crossing the line to a pre-diabetic state. Eventually, the cells become unable to “hear” the insulin commands (insulin resistance), a condition known as diabetes.

If that is not concerning enough, insulin also functions as an inflammatory signal to your body. Inflammation, a topic of its own, is a critical component of our health maintenance. It should work in concert with our natural repair mechanisms. But when out of balance, it inhibits our recovery from even normal wear and tear. One may develop arthritis, cardiovascular disease, and/or require extended recovery times for illness and injury.

Recent research places the blame for heart attacks on the inflammation that can develop along the walls of your arteries. Ironically, the cholesterol that was once thought to be the culprit is now seen as evidence of your body’s attempts to repair this inflammation.

Similarly, obesity, once viewed as a pre-cursor to diabetes, is now known to be just one symptom of glucose management malfunction that may occur as diabetes progresses. The acronym TOFI (Thin on the Outside, Fat on the Inside) has been coined to describe individuals who appear healthy, but have metabolic dysfunction that is dangerously real.

Our society has yet to learn the difference between looks and health. Many thin individuals are unknowingly pre-diabetic or at risk for heart disease. Even the acronym TOFI continues to promote the stereotype that fat is unhealthy. And yet, there are plenty of active, overweight individuals who are metabolically healthier than many of the thin people who judge them.

Whether absorbed from starchy foods or literally half of table sugar, glucose represents both an energy source and a cause of disease, depending on the amount and frequency of its consumption. Knowing how your body metabolizes glucose is an important step in being able to make better food and beverage choices for a healthier life. Choose well, live well. “Chow for now!”

Chris Zenyuh is a science teacher at Harborfields High School and has been teaching for
30 years.

Advanced specialty care center opens in Commack

by TBR Staff - April 20, 2017

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Advanced4w — Kenneth Kaushansky speaks at the opening ceremony of the establishment. Photo by Kevin Redding

On April 18, Stony Brook Medicine officially extended its reach to residents in western Suffolk County, with a ribbon cutting for a new, state-of-the-art medical center that provides 30 specialty services under one roof.

Advanced Specialty Care in Commack, which opened to the public last month, serves as a “one-stop shopping” destination for the health care needs of patients no matter where they are located. The center itself sits near the Sunken Meadow Parkway, the Northern State Parkway and the Long Island Expressway.

The variety of specialties includes internal medicine, pediatrics, dermatology, urology, neurosurgery and radiology. A complete imaging center is on site to provide X-rays, mammograms, ultrasounds, bone densitometry, and CT and MRI scans. Stony Brook doctors, including primary and specialty care internists, gynecologists, orthopedists and surgeons of all kinds, make up the staff.

“But this facility is more than just a multi-specialty clinic,” Kenneth Kaushansky, M.D., senior vice president for health sciences and dean of Stony Brook University School of Medicine said, addressing a crowd of Stony Brook Medicine and university staff, elected officials and community members.

According to Kaushansky, one of the leaders behind the 120,000-square-foot center, patients who come to the center have easy access to “the power of Stony Brook medicine.”

“As part of Suffolk County’s only academic medical center,” he said “Advanced Specialty Care connects consumers to Stony Brook Medicine’s cutting-edge research, clinical trials and advanced technology. This is what truly distinguishes it from other physician practices in the area. You not only have access to Stony Brook primary care physicians and specialists, but also to the best ideas in medicine.”

He also said the Commack facility will soon be the new home of Stony Brook’s World Trade Center Health Program, a service that offers comprehensive, integrative health care for World Trade Center responders dealing with 9/11-related illnesses.

Samuel Stanley, M.D., Stony Brook University president, said the center signifies another Stony Brook step toward creating an aspiring, integrated health care network, focused on providing quality and value, for all of Long Island and beyond.

“Every day, we take ambitious ideas from the minds of our expert researchers who are working in medical laboratories, driven by their boundless curiosity, and bring those ideas to life at the patient’s bedside to continuously redefine health care in the 21st century,” Stanley said. “Through our leadership role in health care reform, we are driving forward with new initiatives to improve health, reduce costs and eliminate the unnecessary care for our patients.”

Among the elected officials in attendance were Suffolk County Legislators Kara Hahn (D-Setauket), Leslie Kennedy (R-Nesconset) and Rob Trotta (R-Fort Salonga); Brookhaven Town Councilwoman Valerie Cartright (D-Port Jefferson); and New York State Assemblymen Mike Fitzpatrick (R-Saint James) and Andy Raia (R-East Northport.)

Stanley said they were vital to what Stony Brook Medicine does, by helping with the budget and supporting Medicare and Medicaid for the state, among other important contributions.

Fitzpatrick and Raia presented an official New York State assembly citation to the center and its faculty.

“I just wanted to say thank you to Stony Brook for taking medicine to the next level by opening this beautiful facility here in Commack,” Fitzpatrick said. “Stony Brook is growing and is offering new services and treatment and wellness to people beyond just the Three Village area. Stony Brook represents excellence.”

Margaret McGovern, M.D., professor and chair of the department of pediatrics at the university’s School of Medicine and physician-in-chief at Stony Brook Children’s Hospital, said this is truly the “power of Stony Brook medicine, closer to you.”

“We’re extending the reach of Stony Brook Medicine,” she said, “offering medical expertise in a new and growing
market.”

She also commended Kaushansky for making the center possible.

“Ambitious ideas require exceptional leadership and imaginative solutions, and this project required both,” McGovern said. “I want to thank Ken Kaushansky, especially, for his vision and confidence in moving this project forward. By working together across traditional boundaries, we are achieving a new vision for the future of Stony Brook Medicine.”

Huntington official urges residents to be smart with their skin

by Victoria Espinoza - April 20, 2017

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Councilwoman uses personal experience with skin cancer as motivation to spread awareness

Councilwoman-Berland-with-Sunscreen-Dispenserw — Councilwoman Susan Berland stands with the free sunscreen dispenser now at Crab Meadow Beach in Northport. File photo from A.J. Carter

For one Huntington Town councilwoman, warning residents about the dangers of the sun isn’t just a work obligation — it’s personal.

Councilwoman Susan Berland (D) has been dealing with the effects of spending summers under the sun’s rays for nearly a decade, and it has motivated her to host “Melanoma Prevention: Avoiding the Dangers of Tanning,” an event open to the public Tuesday, April 25, at 7 p.m. at Town Hall, 100 Main St.

“I think it’s important for any parent whose kid wants to tan to learn spending too much time out in the sun is dangerous,” Berland said in a phone interview. “Hopefully this sways people from making bad decisions.”

Berland said she had her first run-in with skin cancer seven or eight years ago, when she discovered she had an irregular mole on her lower back that was precancerous. These moles, also known as dysplastic nevi, increase the risk of a patient developing melanoma in a mole elsewhere on the body.

“When I was in high school, I was one of the girls wearing Hawaiian Tropic [sunscreen] zero [SPF] and using tinfoil at the beach getting fried,” Berland said. “I did a lot of damage. Nobody knew, you just always thought you looked so much better with a tan.”

When she had kids, she said she was focused on making sure her children were protected with sunscreen, and would often “run out of steam,” by the time it got to her skin.

Berland, like many other people, learned of a “base tan,” a once-popular idea to get before vacations, where the thought was getting a starter level for a tan on your skin would help protect it from getting burnt when on tropical vacations. Many science and health organizations, including medical research group Mayo Clinic, have come out against base tans in recent years, saying they do not protect skin anymore than sunscreen and can actually cause more damage long term.

“I didn’t get fried anymore, and I really thought I was doing the right thing and getting a healthy tan,” Berland said. “Turns out there’s really no such thing as that.”

The councilwoman said she’s had six procedures so far — the most recent in March — to remove dangerous parts of her skin, and she goes for full-body checks every three months.

“I always hope to leave the doctor’s office as I came in but that hasn’t been the case yet,” she said. “The pain is just not worth it — it’s just not.”

In some cases she said skin abnormalities had to be removed with liquid nitrogen. “On a scale from one to 10, that’s about a seven, but in some cases I had to have the procedure on my lip and that is like a 50,” she said of the pain associated with the treatment. “And that is why I am doing this. People are not paying close enough attention. I am a total convert now, I lay under an umbrella at the beach and wear SPF 50.”

Berland said she hopes people will realize how serious skin protection is during the event, where Meghan Rothschild, a cancer survivor and spokesperson for the Melanoma Foundation of New England will be speaking about her fight against cancer and how to prevent melanoma, the deadliest form of skin cancer and the second most-common cancer in children, teens and young adults aged 15-29. New York State Attorney General Eric Schneiderman (D) will also be attending the event, and echoed the dangers of tanning.

“To many people, indoor tanning seems like a harmless activity — it’s not,” Schneiderman said. “Each session increases your risk of skin cancer and contributes to premature aging, eye damage, allergic reactions and more. There are many myths and misconceptions concerning the safety of tanning, many of them perpetrated by the indoor tanning salon industry. If you engage in indoor tanning or are thinking about it, it’s important to make sure you know the significant associated health risks.”

Berland said she would tell young children considering going to a tanning booth to get their tan out of a bottle.

“Spray tans or makeup, if you don’t like it you can wash it off and start again,” she said. “But in a booth there is nothing you can do to reverse the damage. It’s just not worth it. The pain you go through, the anxiety of wondering when the next spot will be found on your body. You’re playing Russian roulette with your body.”

Medical Compass: Preventing skin cancer

by David Dunaief - April 19, 2017

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Diet choices and vitamin B3 have surprising effects

By David Dunaief

Warmer weather is finally upon us, we now have long, sunny days and, soon, the beach. However, longer sun exposure does increase the risk of skin cancer. Melanoma is the most serious skin cancer, but fortunately it is not the most common. Basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (SCC) are more prevalent, in that order. Here, we will focus on these two types.

The incidences of these skin cancers are very difficult to pin down because they are not readily reported. However, most of us either know someone who has had these types of skin cancer or have had them ourselves. There were roughly 3.5 million nonmelanoma skin cancer treatments in the U.S. in 2006, with the number of treatments increasing 77 percent from 1992 to 2006 (1). SCC and BCC outcomes diverge, with the former having a higher risk of metastases compared to the latter, which tends to grow much slower (2).

These skin cancers may present in different ways. BCC may have a bump that is pearly, waxy, light-colored or pink or flesh-colored or brown. It may bleed, ooze and crust, but may not heal, and can be sunken in the middle (3). SCC has the appearance of a growing nodule. It may also be scaly or crusty and may have flat reddish patches. It may be a sore that also may not heal. It is found on sun-exposed areas, more commonly the forehead, hands, lower lip and nose (3). Interestingly, SCC develops over years of gradual UV sun exposure, while BCC develops more like melanoma through intense multiple sporadic burns (4).

The more well-known risks for these types of skin cancer include sun exposure (UV radiation), light skin, age, ethnicity and tanning beds (2). But there are other risk factors, such as manicures. There are also ways to reduce risk with sunscreen reapplied every two hours, depending on what you are doing, but also NSAIDs (nonsteroidal anti-inflammatory drugs) and even vitamin B3. Let’s look at the research.

Beyond skin cancer

Though nonmelanoma skin cancers (NMSCs) have far less potential to be deadly, compared to melanoma, there are other risks associated with them. In the CLUE II cohort study of over 19,000 participants, results show something very disturbing: A personal history of NMSC can lead to other types of cancer throughout the body (5). The increased risk of another type of cancer beyond NMSC is 103 percent in those with BCC and 97 percent in those with SCC, both compared to those who did not have a personal history of NMSC.

Tanning beds — No surprise

We know that tanning beds may be a cause for concern. Now the FDA has changed the classification of tanning beds from low to moderate risk and requires a warning that they should not be used by those under the age of 18 (6). The catch is that this does not have teeth; if tanning salons ignore the new rules, there is no punishment.

However, in a prospective (forward-looking) study, results show that people’s responses to warnings depended on how the warnings were framed (7). Compared to the text-only FDA warning requirement, graphic warnings that emphasized the risks of skin cancer were more likely to help people stop using tanning beds, whereas graphic warnings that demonstrated the positive benefits of not using these devices had no effects. So you may have to scare the daylights out of those in their teens and early twenties.

A recent study showed that drying lamps used after a manicure could lead to skin cancer.

Manicure risk, really?

I am told women and some men love manicures. Manicures cannot possibly be dangerous, right? Not so fast. It is not the actual manicure itself, but rather the drying process that poses a risk. In a prospective study, results show that drying lamps used after a manicure may increase the risk of DNA damage to the skin, which could lead to skin cancer, though the risk is small per visit (8).

There were a lot of variables. The shortest number of visits to increase the risk of skin cancer was eight, but the intensity of the UVA irradiance varied considerably in 17 different salons. The median number of months it took to have carcinogenic potential with exposure was around 35, or roughly three years. The authors recommend either gloves or suntan lotion when using these devices, although both seem to be somewhat impractical with wet nails. It’s best to let your nails dry naturally.

Vitamin B3 to the rescue

Many vitamins tend to disappoint when it comes to prevention. Well, hold on to your hat. This may not be the case for vitamin B3. In the Australian ONTRAC study, the results showed that vitamin B3 reduced the risk of developing NMSC by 23 percent, compared to those who took a placebo (9). Even better was the fact that SCC was reduced by 30 percent.

The most interesting part about this study is that these results were in high-risk individuals who had a personal history of NMSC. The participants were given B3 (nicotinamide 500 mg) twice daily for one year.

After the patients discontinued taking B3, the benefits dissipated within six months. The study was on the small side, including 386 patients with two or more skin cancer lesions in the last five years, with a mean of eight lesions. The side effects were minimal and did not include the flushing (usually neck and facial redness) or headaches seen with higher levels of niacin, another derivative. The caveat is that this study was done in Australia, which has more intense sunlight. We need to repeat the study in the U.S. Nicotinamide is not expensive, and it has few side effects.

NSAIDs as beneficial?

Results have been mixed previously in terms of NSAIDs and skin cancer prevention. However, a more recent meta-analysis (nine studies of varying quality, with six studies considered higher quality) showed that especially nonaspirin NSAIDs reduced the risk of SCC by 15 percent compared to those who did not use them (10).

Diet — The good and the bad

In terms of diet studies, there have been mixed positive and neutral results, especially when it comes to low-fat diets. These are notoriously difficult to run because the low-fat group rarely remains low fat. However, in a prospective dietary study, results showed that effects on skin cancer varied depending on the foods. For those who were in the highest tertile of meat and fat consumption, compared to those in the lowest tertile, there was a threefold increased risk of a squamous cell cancer in those who had a personal history of SCC (11). But what is even more interesting is that those who were in the highest tertile of vegetable consumption, especially green leafy vegetables, experienced a 54 percent reduction in skin cancer, compared to those in the lowest consumption tertile.

Thus, know that there are modifiable risk factors that reduce the risk of nonmelanoma skin cancer and don’t negatively impact your enjoyment of summer. There may be easy solutions to help prevent recurrent skin cancer, as well, that involve both medication and lifestyle modifications.

References: (1) Arch Dermatol. 2010;146(3):283. (2) uptodate.com. (3) nih.gov. (4) Br J Cancer. 2006;94(5):743. (5) J Natl Cancer Inst. 2008;100(17):1215-1222. (6) federalregister.gov. (7) Am J Public Health. Online June 11, 2015. (8) JAMA Dermatol. 2014;150(7):775-776. (9) ASCO 2015 Annual Meeting: Abstract 9000. (10) J Invest Dermatol. 2015;135(4):975-983. (11) Am J Clin Nutr. 2007;85(5):1401.

Long Island team explores ancient gene link to ALS

by Daniel Dunaief - April 19, 2017

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sbcshldubnauhammell — Ride For Life presents CSHL with $300,000 for ALS research: from left, CSHL Director of Annual Giving and Donor Relations Karen Orzel, CSHL Assistant Professor Molly Hammell, Ride for Life Founder Chris Pendergast, Stony Brook Associate Professor Josh Dubnau and Ride for Life board member Frank Verdone. Photo by Jessa Giordano, Cold Spring Harbor Laboratory

By Daniel Dunaief

The past can come back to haunt us, even in the world of genetics. Over the course of millions of years, plants and animals have battled against viruses, some of which inserted their genes into the host. Through those genetic struggles, explained Molly Hammell, an assistant professor at Cold Spring Harbor Laboratory, cells develop “elaborate ways to fight back,” even as they continue to make copies of these pieces of DNA.

Sometimes, when our defenses break down, these retrotransposons, or jumping genes, can become active again. Indeed, that appears to be the case in a fly model of amyotrophic lateral sclerosis, also known as ALS or Lou Gehrig’s disease.

Working on a fruit fly model of ALS, Joshua Dubnau, an associate professor at Stony Brook University, Lisa Krug, who earned her doctorate at Cold Spring Harbor Laboratory and is now working at Kallyope in New York, and Hammell showed that these ancient genetic invaders play an important role in the disease amid activation by a protein often linked to ALS called TDP-43.

A recent study, published in PLOS Genetics, “really proves that retroviral reactivation (as a consequence of TDP-activity) is … central to either causing or accelerating neuronal cell death when TDP-43 inclusions are present,” explained Hammell in an email. If TDP-43 plays the same role for humans, this would suggest that targeting this protein or the jumping genes, it activates could lead to potential treatment for ALS.

These collaborators showed that an aggregation of this protein turned on jumping genes. These genes can make copies of themselves and insert themselves in other parts of the genetic code. In this case, TDP-43 expression disrupts the normal immune-like system that silences retrotransposons such as gypsy, which is a particular type of jumping gene in the fruit fly.

When gypsy was activated, the fruit fly exhibited many of the features of ALS, including protein pathology, problems with movement, shortened life span and cell death or glia and neurons in the brain. The scientists were also able to turn gypsy off, which improved the health and extended the life span of the fly.

Mimicking this protein results in broad activation of several retrotransposons. If this also occurs in people, the disease may activate a retrotransposon that is the human analog to gypsy, called HERV-K, as well as other retrotransposons. The study also suggests that DNA damage caused by retrotransposons may active a cell suicide mechanism. Finally, this effort showed a means by which the protein disrupts the normal immune surveillance that keeps retrotransposons quiet.

To be sure, Dubnau cautioned that animal models of a disease may not translate when returning to people. Researchers need to look at more patients at all the retrotransposons in the human genome to monitor its prevalence, Dubnau suggested. If the link between retrotransposon activation and the development of ALS is as evident in humans as it is in the fruit fly, scientists may take an approach similar to that which they took to battle the human immuno-deficiency virus, or HIV. Retrotransposons have an RNA genome that needs to be copied to DNA. This, Dubnau explained, is the step in the process where researchers attacked the virus.

In a small subset of HIV patients who have motor neuron symptoms that are similar to ALS, Avi Nath, a senior investigator at the National Institutes of Health discovered that treating patients with the typical HIV medication cocktail helped relieve their ALS symptoms as well.

“What is not known is whether, for some reason, this subset of patients had an ALS syndrome caused by HIV or they were curing them” by treating HIV, Dubnau said. Nath is currently involved in one of two clinical trials to see if HIV medications help ALS patients. The next step for Dubnau and Hammell is to screen the tissue of numerous ALS patients after their death to see if their retrotransposons were elevated.

In addition to NIH funding, the scientists received financial support from Ride for Life, which is a not-for-profit organization started in 1997 that raises funds for research to find a cure for ALS, supports patients and their families through patient services and raises awareness of ALS. Every May, Ride for Life conducts a 12-day, 100-mile patient wheelchair ride across Long Island. Dubnau and Hammell, who received a $300,000 grant from Ride for Life in 2015, said they have been inspired by Ride for Life founder Chris Pendergast.

Meeting Pendergast “has had a big impact,” Dubnau said. “He’s a force of nature. He’s an incredibly strong and intelligent person.” Receiving funds from Ride for Life created a sense of personal obligation to Pendergast and many other people who “had raised that money through sweat and effort.”

Without funding from the Ride for Life Foundation, “We would not have the resources to obtain these samples and do the sequencing experiments necessary to prove that this is a clinically relevant phenomenon in a large number of ALS patients,” Hammell said.

Through an email, Pendergast explained that Ride for Life chose to fund the work by Dubnau and Hammell because the research met several criteria, including that it might lead to new strategies to treat ALS and the research was on Long Island, which is a “powerful affirmation for our generous donors.”

Pendergast emphasized the importance of funding basic ALS research. “We need to know why it develops, how it progresses [and] how it can be diagnosed and monitored,” he urged.

A resident of Huntington, Dubnau and his wife Nicole Maher, who works at the Nature Conservancy as a climate scientist, have a nine-year-old daughter, Caitlin. Reflecting both of her parents’ professional interests, Caitlin is going to a statewide science fair, where she is presenting her work on how temperature affects the life span of insects.

As for his research, Dubnau hopes a further exploration of TDP-43 might reveal an important step in the progression of ALS. He hopes this discovery may suggest a strategy researchers and clinicians can take that might “stop the cascade of events” in ALS.

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