Eating protein and vegetables before carbohydrates leads to lower post-meal glucose and insulin levels in obese patients with type 2 diabetes, Weill Cornell Medical College researchers found in a new study. This finding, published June 23 in the journal Diabetes Care, might impact the way clinicians advise diabetic patients and other high-risk individuals to eat, focusing not only on how much, but also on when carbohydrates are consumed.

]"We're always looking for ways to help people with diabetes lower their blood sugar," said senior author Dr. Louis Aronne, the Sanford I. Weill Professor of Metabolic Research and a professor of clinical medicine at Weill Cornell Medical College, who is the study's principal investigator. "We rely on medicine, but diet is an important part of this process, too. Unfortunately, we've found that it's difficult to get people to change their eating habits.

"Carbohydrates raise blood sugar, but if you tell someone not to eat them — or to drastically cut back — it's hard for them to comply," added Dr. Aronne, who is also director of the Comprehensive Weight Control Center at Weill Cornell. "This study points to an easier way that patients might lower their blood sugar and insulin levels."

Patients with type 2 diabetes typically use a finger prick test to check their glucose levels throughout the day. Maintaining normal levels, specifically after meals, is of the utmost importance, because if a diabetics' blood sugar level is consistently high or frequently spikes, they risk complications of their disease, including hardening of the arteries and eventually death from heart disease.

This study looked to validate and advance previous research that showed eating vegetables or protein before carbohydrates leads to lower post-meal glucose levels. This time, though, investigators looked at a whole, typically Western meal, with a good mix of vegetables, protein, carbohydrates and fat.

They worked with 11 patients, all of who had obesity and type 2 diabetes and take an oral drug that helps control glucose levels, called metformin. To see how food order impacted post-meal glucose levels, they had the patients eat a meal, consisting of carbohydrates (ciabatta bread and orange juice), protein, vegetables and fat (chicken breast, lettuce and tomato salad with low-fat dressing and steamed broccoli with butter) twice, on separate days a week apart.

Dr. Louis Aronne. Photo credit: Carlos Rene Perez

On the day of their first meal, researchers collected a fasting glucose level in the morning, 12 hours after the patients last ate. They were then instructed to eat their carbohydrates first, followed 15 minutes later by the protein, vegetables and fat. After they finished eating, researchers checked their post-meal glucose levels via blood test at 30, 60 and 120-minute intervals. A week later, researchers again checked patients' fasting glucose levels, and then had them eat the same meal, but with the food order reversed: protein, vegetables and fat first, followed 15 minutes later by the carbohydrates. The same post-meal glucose levels were then collected.

The results showed that glucose levels were much lower at the 30, 60 and 120 minute checks — by about 29 percent, 37 percent and 17 percent, respectively — when vegetables and protein were eaten before the carbohydrates. Insulin was also significantly lower when protein and vegetables were eaten first. This finding confirms that the order in which we eat food matters, and points to a new way to effectively control post-meal glucose levels in diabetic patients.

"Based on this finding, instead of saying ‘don't eat that' to their patients, clinicians might instead say, ‘eat this before that,'" Dr. Aronne said. "While we need to do some follow-up work, based on this finding, patients with type 2 might be able to make a simple change to lower their blood sugar throughout the day, decrease how much insulin they need to take, and potentially have a long-lasting, positive impact on their health."

Demographic and lifestyle factors are largely responsible for an alarming increase of diabetes in Qatar and other countries in the Middle East and North Africa, according to a new study from Weill Cornell Medical College and Weill Cornell Medical College in Qatar.

The study, published in the December issue of Qatar Medical Journal, found that a more “westernized” lifestyle, characterized by calorie-rich diets and reduced physical activity, has made people in the region more susceptible to developing type 2 diabetes mellitus and other associated chronic conditions. Investigators say the findings underscore a need to raise awareness of diabetes, promote physical activity and emphasize the risks associated with obesity.

"The Qatar National Health Strategy has identified diabetes as one of the high-priority diseases for preventive healthcare, and for good reason," said senior author Dr. Alvin I. Mushlin, the Nanette Laitman Distinguished Professor of Public Health and a professor of healthcare policy and research and of medicine at Weill Cornell Medical College. "In addition to its direct effect on health and quality of life, diabetes is a cause of conditions such as diabetic retinopathy, kidney failure, cardiovascular disease and associated heart attacks, strokes and earlier death."

Paradoxically, the increase of diabetes and other non-communicable diseases in this region is largely tied to major improvements in economic conditions, the investigators said. There have been remarkable improvements in the health infrastructure, a lengthening of life expectancy, an increasingly aging population, and a fast pace of urbanization.

To determine the risk factors that have led increased incidence of the disease, the investigators looked at patient records for more than 450 patients — including Qatari nationals and immigrants — with type 2 diabetes who had received care from Hamad Medical Corporation Hospital's outpatient adult diabetes clinics from 2006-2008. They compared these patients to nearly 350 other patients who received care from various outpatient and inpatient clinics at the hospital.

Since more than 80 percent of the population of Qatar consists of immigrants from countries throughout the Arab world, South Asia and other regions, the researchers also conducted a sub-analysis of only Qatari nationals to see if this group had a different risk factor profile than the population at large.

"In our study, Qatari nationality was the strongest risk factor for DM, followed by higher income, obesity, no college education and no vigorous or moderate exercise," said lead author Dr. Paul J. Christos, a lecturer in healthcare policy and research in the Division of Biostatistics and Epidemiology.

"While further evaluation of DM risk factors among the Qatari population (as opposed to the resident population) is important and of interest," said study co-author Dr. Laith Abu-Raddad, an associate professor and principal investigator of the Infectious Disease Epidemiology Group at Weill Cornell Medical College in Qatar, "these findings highlight the need to focus short-term DM interventions on addressing demographic/lifestyle risk factors to achieve substantial and timely declines in DM levels."

Investigators have long sought the answer to a vexing question: What are the biological mechanisms involved in the development of type 2 diabetes? A recent study from Weill Cornell Medical College researchers suggests that the culprit may be a lack of vitamin A, which helps give rise to the cells, called beta cells, in the pancreas that produce the blood sugar-regulating hormone insulin.

The researchers found in mice models that a lack of vitamin A spurred the death of beta cells, stunting the production of insulin, which is tasked with metabolizing sugars that come from food. These findings, published Dec. 1 in The Journal of Biological Chemistry, may offer new clues into the cause of type 2 diabetes, which is characterized by insulin-resistance, and in advanced cases, inadequate numbers of insulin-producing beta cells.

When the investigators removed vitamin A from the rodents’ diet, they found that the mice began to experience massive losses of beta cells, which resulted in drops in insulin and a big increase in blood glucose. The researchers then reintroduced vitamin A into the animals’ diet and found that the number of beta cells stabilized, insulin production was higher and that blood glucose returned to normal levels.

Because patients with type 1 diabetes and those with advanced type 2 diabetes experience a loss of beta cells, there is a strong interest in developing new treatments that either preserve or replenish them. “From a therapeutic point of view, our research is a very important contribution because there are no drugs available to do this,” said first author Dr. Steven Trasino, a postdoctoral associate in the Department of Pharmacology.

Scientists have understood that vitamin A is essential for the production of insulin-producing cells during fetal development, but whether that role continued into adulthood was not known. The researchers sought to answer that question by using both normal mice and mice that had a genetically impaired ability to store vitamin A.

"While there are thousands of publications on diabetes, there hasn’t been much research on the effects of removing vitamin A from the diets of animals, acting as a model for human disease," said senior author Dr. Lorraine Gudas, chairman of the Department of Pharmacology and the Revlon Pharmaceutical Professor of Pharmacology and Toxicology at Weill Cornell. "How the removal of vitamin A causes the death of the beta cells that make insulin in the pancreas is an important question we want to answer. These beta cells in the pancreas are exquisitely sensitive to the dietary removal of vitamin A. No one has found that before."

These early-stage findings raise the question of whether vitamin A deficiency is involved in humans and animals with type 2 diabetes, either through inadequate diet or through a metabolic defect. They also spark questions about whether a synthetic analog of vitamin A could reverse the disease’s effects.

"Our study sets the platform to take these studies further into pre-clinical and clinical settings," Dr. Trasino said.

Endocrinologists and diabetes specialists consider metformin the best first-line oral drug for type 2 diabetes that lowers and stabilizes blood sugar, prevents cardiovascular events, doesn't cause weight gain and improves long-term health outcomes.

There's only one problem: An estimated 1 million Americans who are candidates for metformin aren't taking it, according to new findings from researchers at Weill Cornell Medical College and the Perelman School of Medicine at the University of Pennsylvania.

Investigators have long believed that a decades-old safety warning issued by the U.S. Food and Drug Administration that advised doctors not to prescribe it to patients who have mild to moderate kidney disease was overly conservative, and that metformin is safer than the guidelines suggest. The study, published Jan. 5 in JAMA Internal Medicine, is the first to quantify the effect the safety warning has on patient care, and, the researchers say, underscores the need for the FDA to review the drug's protocol.

"It's a public health priority to relax these warnings," said Dr. James Flory, a medical research fellow in endocrinology in the Department of Medicine who is collaborating with the Department of Healthcare Policy and Research at Weill Cornell. "It's not like the warning label isn't affecting practice. People are obeying it and ignoring this important drug that this population really needs."

There are an estimated 25 million people with diabetes in the United States, and about one in three has some degree of kidney disease — a common byproduct of diabetes. The FDA discourages doctors from prescribing metformin to people who have mild to moderate kidney disease because of concerns that the drug could cause lactic acidosis, a potentially fatal condition when lactic acid builds up in the bloodstream faster than it can be removed. The agency based its safety recommendations on the experience of phenformin, a similar drug that was implicated in fatal cases of lactic acidosis and was eventually pulled off the market in the 1970s.

Since metformin was cautiously approved for use in the United States, diabetes researchers have investigated whether it carries the same risk for lactic acidosis as phenformin. They found that such cases are extremely rare, and suggest that metformin is safe for patients who have mild to moderate kidney disease. But the FDA has not updated its recommendations to reflect these findings.

"Once you issue a safety warning, it's very hard to get it eliminated," Dr. Flory said.

To quantify current usage, the investigators in the current study examined data from 2007-2011 reported in the National Health and Nutrition Examination Survey, which uses interviews and physical exams to assess the health and nutritional status of adults and children in the United States.

They looked at the drugs patients were prescribed, and identified patients who had diabetes severe enough that metformin would normally be recommended under current guidelines and appeared not to be taking it because of their kidney disease. They estimated that 1 million people could be benefitting from metformin if policies discouraging its use in mild to moderate kidney disease were revised.

The Gene Can Increase Levels of Triglyceride Fats in Blood, Which May Contribute to Risk of Heart Disease and Other Disorders

NEW YORK (November 22, 2013) — Researchers at Weill Cornell Medical College have found that a genetic variation that is linked to increased levels of triglycerides — fats in the blood associated with disorders such as heart disease, type 2 diabetes, obesity and stroke — is far more common than previously believed and disproportionally affects people of African ancestry. Investigators say their discovery, reported in the American Journal of Cardiology, reinforces the need to screen this population for high levels of triglycerides to stave off disease.

The finding offers a clue as to why Africans and people of African descent have an increased risk of cardiovascular disease and type 2 diabetes compared to many other populations, says the study's senior author, Dr. Ronald Crystal, chairman of genetic medicine at Weill Cornell. African Americans with the variant had, on average, 52 percent higher triglyceride levels compared with blacks in the study who did not have the variant.

"The prevalence of the ApoE mutation may put large numbers of Africans and African descendants worldwide at risk for a triglyceride—linked disorder," Dr. Crystal says. "But we don't yet know the extent of that risk or its health consequences.

"Inheriting this genetic variant does not mean a person is going to get heart disease and other diseases. It increases their risk, and screening for fats in the blood — both cholesterol and triglycerides — as well as maintaining a healthy lifestyle is important," Dr. Crystal says. "There are many factors at work in these diseases. This may be one player."

The number of Africans and African descendants who may have this gene variant is significant, Dr. Crystal says. "Based on our findings, we estimate that there could be 1.7 million African Americans in the United States and 36 million sub-Saharan Africans worldwide with the variant, which increases risk of the lipid disorder and, to some unknown extent, the diseases associated with it," he says.

So Rare No One Paid Attention

The study began in Qatar, at Weill Cornell Medical College in Doha.

The gene variant the scientists studied is a single point mutation — a replacement of one of DNA segment with another — in the ApoE gene, which carries fats and other molecules through the blood.

Scientists have believed that more than 95 percent of the world's population has one of three common ApoE variants — 2, 3, or 4. The rest have one of 38 rare ApoE mutations, among them the R145C variant studied in this research. In the three decades since the variant's discovery, only 32 instances of it have been reported in the scientific literature, Dr. Crystal says.

"This ApoE variant was believed to be so extremely rare that no one paid much attention to it," he says.

Weill Cornell researchers in Qatar decided to investigate the mutation in their work evaluating the genetics of Qatari natives — people who have lived in the country for three generations or more. That population is made up of three genetic subpopulations: Arab, Persian, and sub-Saharan African. The researchers were able to look at the genomes of 228 Qatari participants.

To their surprise, investigators found that 17 percent of the African-derived genetic subgroup had the rare ApoE variant. None of the Arab or Persian participants had the mutation.

The team then expanded their study. They looked at participants in the worldwide 1000 Genomes Project (1000G), and found that while the R145C variant is rare to non-existent in populations that are not African or of African descent, it is common (occurring 5 to 12 percent of the time) among African-derived populations, especially those from sub-Sahara.

Weill Cornell Medical College researchers then looked for the variant in New York-area participants taking part in a study on smoking-related lung health. They found that R145C was rare (occurring 0.1 percent of the time) in the 1,012 Caucasians they studied, but common in the 1,266 African-American participants, 4 percent of whom carried the variant.

"This research is a good example of how studying a small population can give you insights that are very relevant to the rest of the world," Dr. Cyrstal says.

The study was supported, in part, by Weill Cornell Medical College-Qatar and the Qatar Foundation, Doha, Qatar; and the National Institutes of Health (UL1-RR024996).

Co-authors include Maen D. Abou Ziki, Yael Strulovici-Bare, Dr. Neil R. Hackett, Dr. Juan L. Rodriguez-Flores, Dr. Jason G. Mezey, Jacqueline Salit, Sharon Radisch, Dr. Charleen Hollmann, Dr. Lotfi Chouchane, Dr. Joel Malek, and Dr. Antonio M. Gotto, from Weill Cornell Medical College; and Dr. Mahmoud A. Zirie and Amin Jayyuosi from Hamad Medical Corporation in Qatar.

Weill Cornell Medical College

Weill Cornell Medical College, Cornell University's medical school located in New York City, is committed to excellence in research, teaching, patient care and the advancement of the art and science of medicine, locally, nationally and globally. Physicians and scientists of Weill Cornell Medical College are engaged in cutting-edge research from bench to bedside, aimed at unlocking mysteries of the human body in health and sickness and toward developing new treatments and prevention strategies. In its commitment to global health and education, Weill Cornell has a strong presence in places such as Qatar, Tanzania, Haiti, Brazil, Austria and Turkey. Through the historic Weill Cornell Medical College in Qatar, Cornell University is the first in the U.S. to offer a M.D. degree overseas. Weill Cornell is the birthplace of many medical advances — including the development of the Pap test for cervical cancer, the synthesis of penicillin, the first successful embryo-biopsy pregnancy and birth in the U.S., the first clinical trial of gene therapy for Parkinson's disease, and most recently, the world's first successful use of deep brain stimulation to treat a minimally conscious brain-injured patient. Weill Cornell Medical College is affiliated with NewYork-Presbyterian Hospital, where its faculty provides comprehensive patient care at NewYork-Presbyterian Hospital/Weill Cornell Medical Center. The Medical College is also affiliated with Houston Methodist. For more information, visit weill.cornell.edu.

Weill Cornell Medical College researcher Dr. Shuibing Chen's pursuit of a treatment or cure for type 2 diabetes received a boost a few weeks ago after receiving one of 51 New Innovator awards from the National Institutes of Health.

The award carries $1.5 million in funding over five years supporting Dr. Chen's research into type 2 diabetes — which affects more than 25 million Americans and consumes more than $210 billion in United States health care costs every year — and how to prevent or treat it.

"This new award is extremely important for my laboratory," said Dr. Chen, assistant professor of chemical biology in surgery and assistant professor of chemical biology in biochemistry at Weill Cornell. "Finding the cure for type 2 diabetes mellitus is the core mission of my laboratory. This innovator award recognizes the significance of this mission."

Established in 2007, the New Innovator award initiative supports investigators who are within 10 years of their terminal degree or clinical residency, but who have not yet received a research project grant or equivalent grant from the National Institutes of Health to conduct exceptionally innovative research.

Type 2 diabetes is a metabolic disorder, often caused by obesity, that's characterized by high blood glucose in the context of insulin resistance and relative insulin deficiency. While those involved in health care, as well as policymakers, are working on ways to curb the obesity epidemic, Dr. Chen is working behind the scenes to see if type 2 diabetes, once it's developed in a patient, can be reversed.

To determine that, Dr. Chen will study the role of the environment and genetic factors in the progression and regression of cellular dysfunction characteristic of type 2 diabetes in mouse models humanized through stem cells. Using these models, Dr. Chen and her team hope to identify the "tipping point," of type 2 diabetes' progression, thereby learning how to prevent or treat the chronic disease.

"The classic pathogenesis of type 2 diabetes mellitus involves insulin resistance and pancreatic β cell dysfunction," Dr. Chen said. "Pancreatic β cell dysfunction is a key step determining the progression from metabolic impairments to a disease state. We will create two novel models to monitor the progression and regression of pancreatic β cell dysfunction in real-time. By studying the mechanism controlling the progression, we will learn how to prevent type 2 diabetes mellitus. Understanding the mechanism controlling the regression of pancreatic β cell dysfunction will help us to identify novel drug target to reverse the disease state."

NEJM Study Shows Two-Year Results of a Randomized Trial Comparing Bariatric Surgery to Traditional Medical Treatment

Authors Find Effects of Bariatric Surgery on Type 2 Diabetes Are Independent of Weight Loss

NEW YORK (March 26, 2012) — In the first published study of its kind, researchers from the Catholic University/Policlinico Gemelli in Rome, Italy, and NewYork-Presbyterian/Weill Cornell Medical Center found that bariatric surgery dramatically outperforms standard medical treatment of severe type 2 diabetes.

These findings were published today in an advanced online edition of the New England Journal Medicine (NEJM).

The study's authors report that most bariatric surgery patients were able to discontinue all diabetes medications and maintain disease remission for the two-year study period, while none of those randomly assigned to receive standard medical treatment did.

"Although bariatric surgery was initially conceived as a treatment for weight loss, it is now clear that surgery is an excellent approach for the treatment of diabetes and metabolic disease," says senior author Dr. Francesco Rubino, chief of Gastrointestinal Metabolic Surgery and director of the Metabolic and Diabetes Surgery Center at NewYork-Presbyterian/Weill Cornell and associate professor of surgery at Weill Cornell Medical College.

It is particularly challenging to treat obese patients who have type 2 diabetes, because insulin therapy and other hypoglycemic medications often cause additional weight gain. In this study, most surgery patients experienced improvements in blood sugar levels, decreased total cholesterol and triglycerides, and improved HDL-cholesterol concentrations. This suggests that bariatric surgery for the treatment of diabetes may reduce a patient's cardiovascular risk.

"The unique ability of surgery to improve blood sugar levels and cholesterol levels as well as reduce weight makes it an ideal approach for obese patients with type 2 diabetes," says lead author Dr. Geltrude Mingrone, chief of the Division of Obesity and Metabolic Diseases and professor of medicine at Catholic University in Rome.

This was a randomized, controlled trial of patients aged 30 to 60.

This study evaluated remission of diabetes in 60 severely obese patients (those with a body mass index [BMI] greater than 35) with advanced diabetes. Patients were randomly assigned to three groups: one group underwent Roux-en-Y gastric bypass (RYGB); a second group had bilopancreatic diversion (BPD); and the third group received conventional individualized medication and rigorously monitored dietary and lifestyle modification.

None of the patients in the medical-therapy group has gone into remission since the start of the trial. By contrast, diabetes remission occurred and has been maintained in 95 percent of those who underwent BPD and 75 percent of those receiving RYGB. Remission is defined as fasting glucose of less than 100 mg and hemoglobin A1c (HbA1c) of less than 6.5 percent for at least one year.

The authors found that age, gender, preoperative BMI, duration of diabetes and weight-loss post surgery were not predictors of diabetes remission.

"These findings confirm that the effects of bariatric surgery on type 2 diabetes may be attributed to the mechanisms of surgery rather than the consequences of weight loss," says Dr. Mingrone. "Studying the actual mechanisms by which surgery improves diabetes may help understand the disease better" she adds.

Bariatric operations throughout the world are currently used primarily according to 1991 U.S. National Institutes of Health guidelines, which limit surgery for type 2 diabetes to individuals with a BMI greater than 35 kg m-2.

"BMI is correlated with the risk of developing diabetes in the general population; in an individual, however, BMI does not tell much about the severity of diabetes, its potential to cause complications or the mechanisms of disease," says Dr. Rubino. "The study confirms that using strict cut-off BMI levels to define eligibility for surgery in patients with diabetes is medically inappropriate and that there is an urgent need to define better criteria for patient selection," he says.

Previous experimental studies by Dr. Rubino have shown that gastrointestinal bypass operations (like RYGB and BPD) activate direct, weight-independent mechanisms of diabetes control, supporting the use of surgery as a diabetes treatment, including in less obese patients. A randomized study comparing gastric bypass surgery and best medical treatment in patients with BMI 26 to 35 is currently ongoing at NewYork-Presbyterian/Weill Cornell Medical Center.

All patients in the current study were treated in Rome. Dr. Mingrone and her team of diabetes specialists were responsible for medical treatment of patients in the study. Dr. Rubino, who also holds an adjunct academic title at Catholic University in Rome, performed the laparoscopic RYGB surgeries and a team of surgeons from the Catholic University performed the BPD procedures.

The current study is part of a broader, ongoing research collaboration between the Catholic University of Rome and Weill Cornell Medical College in New York. In March 2007, the Catholic University hosted the "Diabetes Surgery Summit" where a group of leading international scholars first recommended consideration of gastrointestinal surgery to intentionally treat type 2 diabetes ("diabetes surgery"). In the same year, NewYork-Presbyterian/Weill Cornell Medical Center established the Diabetes Surgery Center, the first academic program of its kind, as an effort to model clinical practice, education and research around the specific aim of surgically treating diabetes. The Center has since organized the first two editions of the "World Congress on Interventional Therapies for Type 2 Diabetes," which raised global awareness of diabetes surgery.

An estimated 8.3 percent of the global population has type 2 diabetes, according to World Health Organization 2010 statistics, and that number is projected to increase to 9.9 percent by 2030. As many as 23 percent of patients with morbid obesity also have type 2 diabetes. The costs associated with diabetes pose a huge burden on health care systems. Previous studies have suggested that bariatric surgery may be a cost-effective approach for obese patients with diabetes.

In spite of the potential gains, however, access to surgery for those eligible is very limited, and barriers are substantial. Less than 2 percent of eligible patients have access to bariatric/metabolic surgery in the U.S., and the figure is even lower in the rest of the world. The authors hope their study will help change the way bariatric surgery is perceived and that based on these findings, physicians will consider surgery in the treatment of diabetes.

The research was funded by the Catholic University of Rome, Italy.

Other co-authors include Alfons Pomp, from Weill Cornell Medical College, Caterina Guidone, Amerigo Iaconelli, Laura Leccesi, Guiseppe Nanni, Marco Castagneto and Giovanni Ghirlanda, all from Catholic University of Rome; and Simona Panunzi and Andrea De Gaetano, from CNR-Institute of Systems Analysis and Computer Science, BioMathLab, Rome.

The present study was supported by the Catholic University of Rome. The ongoing trial at NewYork-Presbyterian Hospital/Weill Cornell Medical Center is supported by a research grant from Covidien. Dr. Francesco Rubino is the Principle Investigator of that study. Dr. Alfons Pomp, chief of Laparoscopy and Bariatric Surgery at NewYork-Presbyterian Hospital/Weill Cornell Medical Center received consulting fees from Covidien.

NewYork-Presbyterian Hospital/Weill Cornell Medical Center

NewYork-Presbyterian Hospital/Weill Cornell Medical Center, located in New York City, is one of the leading academic medical centers in the world, comprising the teaching hospital NewYork-Presbyterian and Weill Cornell Medical College, the medical school of Cornell University. NewYork-Presbyterian/Weill Cornell provides state-of-the-art inpatient, ambulatory and preventive care in all areas of medicine, and is committed to excellence in patient care, education, research and community service. Weill Cornell physician-scientists have been responsible for many medical advances — including the development of the Pap test for cervical cancer; the synthesis of penicillin; the first successful embryo-biopsy pregnancy and birth in the U.S.; the first clinical trial for gene therapy for Parkinson's disease; the first indication of bone marrow's critical role in tumor growth; and, most recently, the world's first successful use of deep brain stimulation to treat a minimally conscious brain-injured patient. NewYork-Presbyterian Hospital also comprises NewYork-Presbyterian Hospital/Columbia University Medical Center, NewYork-Presbyterian/Morgan Stanley Children's Hospital, NewYork-Presbyterian Hospital/Westchester Division and NewYork-Presbyterian/The Allen Hospital. NewYork-Presbyterian is the #1 hospital in the New York metropolitan area and is consistently ranked among the best academic medical institutions in the nation, according to U.S.News & World Report. In its commitment to global health and education, Weill Cornell has a strong presence in places such as Qatar, Tanzania, Haiti, Brazil, Austria and Turkey. Through the historic Weill Cornell Medical College in Qatar, Cornell University is the first in the U.S. to offer a M.D. degree overseas. For more information, visit www.nyp.org and weill.cornell.edu.

Catholic University/Policlinico Gemelli

The Catholic University (Università Cattolica del Sacro Cuore -UCSC) was founded in 1921. The UCSC is the biggest private university in Europe and the biggest and one of the most distinguished Catholic universities in the world. Its main campus is located in Milan, Italy with satellite campuses in Brescia, Piacenza, Cremona, Rome, and Campobasso. The Policlinico Agostino Gemelli in Rome, serves as the teaching hospital for the medical school of the Università Cattolica del Sacro Cuore. The Gemelli University Hospital began its activities in Rome on 10 July, 1964. Today, 40 years on, the Gemelli has become one of the most important hospitals in Italy for the quality of its medical care and medical research — making Rome a true City of Health. From 1981 the Gemelli became world renowned because of its link with Pope John Paul II, who was admitted to the hospital nine times and because of this he nicknamed the hospital as Vatican III. The Gemelli University Hospital holds approximately 1,900 beds, divided between general hospitalisation, day care/surgery and rehabilitation.