Connections GYN Surgery: Pediatric Surgery: Building Bridges to Improve Care

Connections
WINTER / SPRING 2014
Q U A RT E R LY N E W S L E T T E R
DR. ARNOLD ADVINCULA
DR. STEVE ST YLIANOS
GYN Surgery:
Pediatric Surgery:
Building Bridges to Improve Care
Shaping strategies for women’s
and children’s health
Although Arnold Advincula, MD, has been Chief of the Division of
Gynecologic Surgery at CUMC for only a few short months, he’s
already got a vision. In February Dr. Advincula was appointed Vice
Chair, Women’s Health, Gynecologic Surgery, and Urogynecology
and Chief of Gynecology at the Sloane Hospital for Women at
NYPH/CUMC, in addition to his role as Division Chief. Among his
far-reaching plans are organizing and focusing the talent in the
department, building a new center for endometriosis treatment
and research, offering expanded minimally invasive surgery options, and enhancing the department’s simulation program. “My
goal is to create an organized, focused GYN service line that asks,
Where do we want to be three years to five years, 10 years from
CONTINUED ON PAGE 23
Steven Stylianos, MD, trained at Columbia University Medical
Center (CUMC) in the Department of General Surgery, spent
a portion of his faculty career here, and has deep connections
to the Division of Pediatric Surgery and its history. Last fall Dr.
Stylianos returned in the dual role of Division Chief at Columbia
University and Surgeon-in-Chief of the Morgan Stanley Children’s Hospital. Previous directors of the Division, one of the first
such programs of Pediatric Surgery in the country, include Drs.
Thomas Santulli, Peter Altman, and Charles Stolar, all of whom
have made significant contributions to the field. In reflecting on
the division’s past and future, he notes that CUMC has always
CONTINUED ON PAGE 24
1
CONTENTS
A Conversation . . . . . . . . . . . . . . 3
In the News . . . . . . . . . . . . . . . 15
Advances in Research . . . . . . . . . 4
Notable Publications . . . . . . . . . 19
Collaborations . . . . . . . . . . . . . . 7
Honors & Awards . . . . . . . . . . . 20
Robert Mellins Lecture Series . . 12
Events / Fellows . . . . . . . . . . . . 22
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WINTER / SPRING 2014
EDITORS-IN-CHIEF
Michael Weiner, MD
Department of Pediatrics
NewYork-Presbyterian News . . . 13
Cande Ananth, PhD, MPH
Message from the Editors
Beth Hanson
C
onnections is all about collaborations and relationships—
those between Pediatrics and OBGYN, and between our two
departments and other caregivers and researchers throughout
the medical center and beyond. This, our sixth issue, showcases some
of these close relationships, and how they are enabling us to provide
the most expert care to the women and children we see. You can read
about the plans of several new division chiefs: Steven Stylianos (Pediatric
Surgery; page 1), Arnold Advincula (Gynecologic Surgery; page 1), James
Riviello (Pediatric Neurology; page 9), and Steven Brooks (Pediatric
Ophthalmology; page 10), and how these new leaders plan to revitalize
their divisions. An unusual collaboration between maternal-fetal medicine
specialist and physician-scientist Joy Vink and biomechanical engineer
Kristin Myers and other members of their Collaborative Cervix Research
Group (page 7) may shed light on the reasons why some women develop
cervical insufficiency, which can lead to preterm delivery. We also include
an article on integrative oncology and The Center for Comprehensive
Wellness (page 13), where integrative treatments, supportive care, and
survivorship wellness are woven into each patient’s plan of care from day
one. Look for more news about other critical partnerships like these in
future issues of Connections.
Michael Weiner, MD
Department of Pediatrics
Cande Ananth, PhD, MPH
Department of Obstetrics and Gynecology
Co-Editors-in-Chief
Connections
Department of Obstetrics
and Gynecology
WRITERS
Rosie Foster
EDITORIAL ADVISORS
Leah Bentley
Assistant Vice President,
CUMC Office of Development
Peggy Dubner
Administrative Manager,
Department of Pediatrics
Rebecca Franck
Marketing Manager,
NewYork-Presbyterian Hospital
Alessandra Garber
Director of Development,
CUMC Office of Development
Rachel Miller, MD
Department of Pediatrics
Karen Wish
Director Marketing,
NewYork-Presbyterian Hospital
DESIGNER
Jon Kalish
Principal, KALISH
Department of Obstretrics
& Gynecology
columbiaobgyn.org
Department of Pediatrics
cumc.columbia.edu/dept/
pediatrics
NewYork-Presbyterian
Morgan Stanley
Children’s Hospital
childrensnyp.org/mschony
Pediatric Speciality
Leadership at CUMC
• James Riviello, MD
Director, Neurology
• Steven Stylianos, MD
Director, Surgery
Strengthening Care Through
Cross-Departmental Collaborations
A C onvers ation Be t w een M a ry D ’ Alton, MD
& L aw r enc e S ta n ber ry, M D , Ph D
Mary D’Alton, Chair of Obstetrics and
Gynecology, and Lawrence Stanberry, Chair
of Pediatrics, spoke recently about how new
division chiefs and programs are bolstering
care for women and children.
Dr. Stanberry: The Department of Pediatrics
has 275 faculty members, but outside of the
Department, 17 other divisions—another 130
physicians, oral surgeons, and dentists—housed
in departments such as anesthesia, urology,
ophthalmology, and so on, are involved in the
care of children. We collaborate with them
broadly.
Over the past six years, Columbia has recruited a number of really talented new division
chiefs in those sections, who are revitalizing
their specific programs. In this issue we feature
a few of those faculty: Dr. Jim Riviello, the new
Head of Child Neurology in the Department of
Neurology, Dr. Steve Stylianos the new head
of Pediatric Surgery and Pediatric Surgeon in
Chief at the Morgan Stanley Children’s Hospital,
and Dr. Steve Brooks, the new head of Pediatric
Ophthalmology. (See box for the full list of
Pediatrics specialty leadership based in other
departments.)
Among the many factors that have enabled
Columbia to attract these talented people is the
recognition that we practice in a women’s and
children’s hospital where there is remarkably
close collaboration between Pediatrics and
OBGYN services. We are unusual among major
academic medical centers in that we deliver
5,000 babies each year within the children’s
hospital, and we are equipped to care for the
most complex neonatal, pediatric, and obstetrical problems. We are fortunate that the chairs
of the departments that predominantly offer
services to adult patients (for example urology,
neurology, orthopedics, ophthalmology, etc)
have developed strong pediatric programs and
Connections
• Maria Garzon, MD
Director, Dermatology
• David Roye, MD
Director, Orthopedics
• Moira Rynn, MD
Director, Psychiatry
• Christopher S. Ahmad, MD
Director, Sports Medicine
recruited exceptional individuals to lead these
programs.
Dr. D’Alton: Dr. D’Alton: In OBGYN we work
with the more than 30 departments in the Medical Center including the divisions of Medical
Oncology, Cardiology, and GI in Medicine; the
divisions of Hepatobiliary Surgery, Colorectal,
Plastics, Surgical Oncology, and General Surgery in Surgery; and the Anesthesia; Pathology;
Radiology; Genetics; Urology; Infectious Disease; Family/Internal Medicine; and Endocrinology departments.
Our strongest collaborations are with Pediatrics, and are focused on the Prenatal Pediatric
Center and the newer Mother’s Program. At the
Prenatal Pediatric Center, we recognized many
years ago that no one specialty can best look
after the fetus—this has to be a collaboration. We
also collaborate very strongly with pediatric cardiology and pediatric cardiac surgery, because
the predominant prenatal diagnosis is congenital heart disease, and with anesthesia, because
these patients need expertise in both obstetric
and pediatric anesthesia to deal with unusual
events that can occur at delivery in babies who
could have multiple birth defects.
Our collaboration is also very strong with Pediatric Surgery and, along with the new Division
Chief, Dr. Steve Stylianos, one of our goals is to
work with a fetal surgeon. There is an enormous
opportunity for research and for programs
that provide even less invasive approaches for
fetuses down the road in that field. The major
fetal invasive therapy we now provide is twin-twin
transfusion, but spina bifida and certain forms
of congenital heart disease may be treatable in
utero, and we will be developing new approaches on both the clinical and research side.
Through our Mother Center we have reached
• Carrie Ruzal-Shapiro, MD
Director, Radiology
• Neil Feldstein, MD
Director, Neurosurgery
• Lena Sun, MD
Director, Anesthesiology
• Rosanna Abellar, MD
Director, Pediatric Pathology
• Heakyung Kim, MD
Director, Physical Medicine &
Rehabilitation
• Joseph Haddad, Jr., MD
Director, Otolaryngology
• Emile Bacha, MD
Director, Cardiac, Thoracic &
Vascular Surgery Congenital
& Pediatric Cardiac Surgery
• Steven Brooks, MD
Director, Ophthalmology
• Steven Chussid, DDS
Director, Dentistry
• Pasquale Casale, MD
Director, Urology
CONTINUED ON PAGE 21
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C O L U M B I A W O M E N ’ S A N D C H I L D R E N ’ S H E A LT H
Advances in
Research
Potential therapeutic
target found in pulmonary
hypertension
Pulmonary arterial hypertension (PAH)—high blood pressure
in the arteries in the lungs—is rare, and is more likely to arise
in people with a family history of PAH. The disease may also
arise in those with no affected family members and no apparent predisposing factors and is referred to as idiopathic PAH.
New therapies have improved the outlook for patients with PAH,
but despite progress the disease is still progressive and fatal.
In a recently published study in the New England Journal of
Medicine, geneticist Wendy Chung, MD, PhD and colleagues
analyzed possible genetic causes of the disease in members
of a family with multiple affected members. Using a genetic
test called whole-exome sequencing the researchers identified
mutations in the gene KCNK3, which encodes a member of the
superfamily of potassium channel proteins; these proteins help
regulate many fundamental cellular processes. The research
group showed that all of the mutations they identified resulted
in a loss of function of the channels through which potassium
ions cross biological membranes. Their findings suggest that
KCNK3 is involved in the development of both familial and idiopathic pulmonary arterial hypertension, and the mutations they
identified suggest a potential mechanism for a pharmacologic
intervention, one that would increase the currents through these
channels in patients with PAH.
PULMONARY ARTERIAL CHANGES SUGGESTIVE OF PULMONARY HYPERTENSION.
Chung WK, Sampson KS, Kass RS. A novel channelopathy in pulmonary
arterial hypertension. N Engl J Med. 2013 Nov 28;369(22):2162. doi:
10.1056/NEJMc1311060.
Genetic drivers in
glioblastoma identified
Glioblastoma, the most aggressive and common form of primary brain tumor, is one of the
most challenging forms of cancer to treat. In a recently published study in Nature Genetics,
Anna Lasorella, MD, and colleagues in CUMC’s Institute for Cancer Genetics used a computational tool with the goal of uncovering new driver genes for glioblastoma (GBM)—genes
that when mutated contribute to a tumor’s progression. The tool, or algorithm, (called MutComFocal) integrates two genetic hallmarks of driver cancer genes (focality of copy number variants and somatic point mutations) into a single score. The algorithm recognized
nearly all genes already known to have functional relevance in GBM, and also validated
18 new genes that occur in a fraction of GBMs, in which these two genetic hallmarks are
combined. The newly identified genes include LZTR1, which restrains the self-renewal and
growth of specific glioma cells, and CTNND2, which, when mutated, is associated with the
transformation of glioma cells into a very aggressive form. These results provide insights
into the origins and progression of glioblastoma and highlight new targets for therapy.
GLIOBLASTOMA
Frattini V, Trifonov V, Chan JM, Castano A, Lia M, Abate F, Keir ST, Ji AX, Zoppoli P, Niola F, Danussi C,
Dolgalev I, Porrati P, Pellegatta S, Heguy A, Gupta G, Pisapia DJ, Canoll P, Bruce JN, McLendon RE, Yan
H, Aldape K, Finocchiaro G, Mikkelsen T, Privé GG, Bigner DD, Lasorella A, Rabadan R, Iavarone A. The
integrated landscape of driver genomic alterations in glioblastoma. Nat Genet. 2013 Oct;45(10):1141-9.
doi: 10.1038/ng.2734. Epub 2013 Aug 5.
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C O L U M B I A W O M E N ’ S A N D C H I L D R E N ’ S H E A LT H
Advances in
Research
Tumor Suppressor Gene Mutated in ALL
Acute lymphoblastic leukemia (ALL) is the result of many genetic alterations in lymphoid progenitor cells, which together contribute to the transformation of these cells to malignancy. In a
study published recently in the journal Blood, Adolfo Ferrando, MD, PhD, leader of the Lymphoid
Development and Malignancies Program in the Herbert Irving Comprehensive Cancer Center, and
research collaborators focused in on one of these mutations. They tested the hypothesis that the
gene SH2B3 functions as a tumor suppressor, and that when mutated the gene is disabled and
ALL can arise. The researchers studied members of a family of Eastern European Ashkenazi Jewish background with a rare familial inherited disorder who all shared a genetic mutation SH2B3.
Family members with this mutation had problems including growth retardation, developmental
delay, chronic hepatitis, Hashimoto autoimmune thyroiditis, as well as B-precursor ALL. The
researchers demonstrated that, in lymphoid cells derived from study participants, cell proliferation
rates were increased, and that, in a mouse model of the mutation, leukemia developed. These results, together with similar mutations in SH2B3 found in sporadic ALL cases, demonstrate a tumor
suppressor role of SH2B3 in human leukemia.
Perez-Garcia A, Ambesi-Impiombato A, Hadler M, Rigo I, LeDuc CA, Kelly K, Jalas C, Paietta E, Racevskis J, Rowe
JM, Tallman MS, Paganin M, Basso G, Tong W, Chung WK, Ferrando AA. Genetic loss of SH2B3 in acute lymphoblastic leukemia. Blood. 2013 Oct 3;122(14):2425-32. doi: 10.1182/blood-2013-05-500850. Epub 2013 Aug 1.
A WRIGHT’S STAINED BONE MARROW ASPIRATE
SMEAR OF PATIENT WITH PRECURSOR B-CELLS
Exploring New Avenues
in GI Disorders
Meenakshi Rao, MD, PhD, and Esi Lamousé-Smith, MD, PhD, junior faculty in
Pediatric Gastroenterology, have received funding to study normal and disordered
GI function from different angles. Dr. Rao was recently awarded both a Driscoll
Children’s Fund Award and the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) Foundation’s George Ferry Young
Investigator Development Award, while Dr. Lamouse-Smith received the Harold
Amos Faculty Research Development Award from the Robert Wood Johnson
Foundation and the Columbia University Provost Diversity Award. Dr. Rao is studying the biology of the enteric nervous system (ENS) and how a cell type in the ENS,
called glia, may regulate gastrointestinal function. Glial cells form an extensive
network throughout the central nervous system (CNS), and defects in CNS glia can
lead to epilepsy, brain tumors, multiple sclerosis, and ALS. Glial cells also form an
extensive network in the gastrointestinal tract, but considerably less is known about
their normal role there. Previous studies in vitro suggest that enteric glia play a role
in epithelial wound repair, and also that they may be able to generate new neurons
in the ENS. Using mouse models that lack intestinal glia, Dr. Rao hopes to define
the normal biology of these cells in order to better understand digestive diseases
and the mechanisms of intestinal injury and repair. Dr. Lamousé-Smith’s interest is
in the role of the gastrointestinal flora in children’s health and disease—specifically
the role of the gastrointestinal flora in immune system development and function
early in life and how antibiotic use during early infancy may alter the flora. In the lab
she studies how antibiotics alter the intestinal flora of infant and juvenile mice affect their ability to fight infection or respond to immunization. She has also studied
germ-free mice (born and maintained without a gastrointestinal flora) to better understand interactions between gastrointestinal tract flora and immune function. Dr.
Lamousé-Smith is also interested in how probiotics may boost immune function and
help manage gastrointestinal disorders in children. Discoveries from the research in
her lab may have implications for understanding how to effectively use probiotics to
prevent the antibiotic-related changes of the intestinal flora that have consequences
for normal immune function.
PROBIOTIC SUPPLEMENT PILLS
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C O L U M B I A W O M E N ’ S A N D C H I L D R E N ’ S H E A LT H
Advances in
Research
Reducing Maternal Deaths Following
Cesarean Delivery
Thromboembolism—deep vein thrombosis and pulmonary embolism—is a leading cause of maternal
mortality, and is a particular concern for women who undergo cesarean delivery. A World Health
Organization review of maternal death determined embolism to be responsible for 14.9% of maternal
deaths in developed countries, while data from the United Kingdom’s Confidential Enquiries into
Maternal Death found thromboembolism to be the cause of 31.1% of deaths directly related to
pregnancy between 2003 and 2005. Many risk factors for thromboembolism are common such
as obesity, cesarean delivery during labor, and preeclampsia. Thromboprophylaxis, in particular
pneumatic compression devices applied before cesarean delivery and/or post-cesarean heparin, are
the only means identified in the US of systematically reducing maternal mortality, according to a 2008
report from the Hospital Corporation of America. Thromboprophylaxis is supported by the American
Congress of Obstetricians and Gynecologists. Alexander M. Friedman, MD, a maternal-fetal medicine
specialist, and colleagues in the Department of Obstetrics and Gynecology designed a study to
characterize contemporary practice patterns for post-cesarean thromboprophylaxis. They looked at
1,263,205 women who underwent cesarean delivery and found that although the rate of prophylaxis
increased from 8.4% in 2003 to 41.6% in 2010, the rates varied significantly by geographic region, and
that overall more than half of the women studied received no thromboembolism prophylaxis at all.
They concluded that thromboembolism has remained a leading cause of maternal death in the United
States, and that thromboprophylaxis is underused and represents a major opportunity to reduce
maternal morbidity and mortality. “Our findings support the need for clear guidelines and protocols
for thromboembolism prophylaxis,” the authors write. “Risk assessment tools that simplify decisionmaking may aid hospitals in providing uniform, high- quality care.”
They concluded that
thromboembolism
has remained a
leading cause of
maternal death in
the United States
Friedman AM, Ananth CV, Lu YS, D’Alton ME, Wright JD. Underuse of postcesarean thromboembolism prophylaxis.
Obstetrics and Gynecology 2013 Dec;122(6):1197-204.
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C O L U M B I A W O M E N ’ S A N D C H I L D R E N ’ S H E A LT H
Collaborations
Unraveling
the Knot:
Understanding
the Causes
of Cervical
Insufficiency
O
ver the course of a normal nine-monthlong pregnancy the uterus expands to
accommodate the growing fetus and its
fluid-filled amniotic sac. If the uterus could be
described as a balloon, the cervix, the cylindrical tissue connecting the vagina and uterus,
is like the balloon’s knot, keeping the uterus
tightly sealed even as the growing pregnancy
can increase the weight on this knot to more
than 10 pounds. Then the cervix miraculously
remodels, softens, and opens at time of delivery. In some women, though, the knot does
not hold long enough—the cervix shortens and
opens prematurely, and babies are born too
early. This problem, called premature cervical
shortening or cervical insufficiency (CI), causes
painless cervical dilation that increases the risk
of preterm delivery; it is relatively rare but is
thought to cause as many as 20 to 25 percent
of second-trimester miscarriages and is a significant precursor to spontaneous preterm birth.
To date, little is known about the mechanisms
that lead to this complex obstetric dilemma.
The Collaborative Cervix Research Group,
which includes CUMC specialist and an engineering professor from the Columbia School
of Engineering and Applied Science (SEAS),
along with a group of investigators here and at
other institutions are undertaking a remarkable
multidisciplinary approach to understand the
fundamental alterations that occur in cervical
tissue from women with cervical insufficiency
compared to women without cervical insufficiency. Joy Vink, MD, a Maternal-Fetal Medicine
specialist in the Department of OBGYN who
is the recipient of the American Association
of Obstetricians & Gynecologist Foundation/
Society for Maternal Fetal Medicine Award, is
researching the biochemical causes of premature cervical shortening/cervical insufficiency.
Mechanial engineer Kristin Myers, PhD, chief of
the Myers Soft Tissue Lab in SEAS, studies the
mechanical properties of the cervix and how
they can contribute to cervical insufficiency.
Connections
“To understand preterm delivery you need to
understand how the structure of the cervix
correlates to cervical function. This entails approaching this complex obstetric problem from
different perspectives and multiple disciplines,”
Dr. Vink says. “I think that is the uniqueness of
our group.”
New data on preterm births around the
world show that preterm birth rates are on the
rise in most countries. According to the March
of Dimes’ 2012 report, Born Too Soon, “preterm birth remains the single most important
cause of neonatal deaths (babies that die in
the first 28 days of life) and the second leading
cause of death in children under five.” In addition, the US is among the 10 countries with
the highest rates of preterm births. “We don’t
really understand the actual causative factors
and the pathways that are triggered to result in
a spontaneous preterm birth,” although there
are many theories, Dr. Vink says. These include
excessive stretching of the uterus (because
of twins, triplets, or too much amniotic fluid),
external factors such as infection and stress,
and genetic factors.
The cervix is composed mainly of rope-like
collagen fibers (connective tissue), smooth
muscle cells, and fibroblasts (connective tissue
cells that secrete collagen proteins). Collagen
fibers are the main component of the tissue
that keeps the cervix strong and closed as
the fetus grows during pregnancy. Sometime
before term the rope-like properties of these
fibers change and the cervix starts to soften
up so that it can dilate, shorten, and open at
delivery. Large studies have shown that if the
cervix is short, particularly if it is less than 2.5
centimeters (as measured by transvaginal ultrasound), the risk of preterm delivery increases,
explains Dr. Vink.
Current approaches to treating cervical
insufficiency are limited, she says. They include
a cerclage, a stitch that, like a purse-string, ties
the cervix closed throughout the pregnancy;
this is removed at term so women can deliver
vaginally. If the transvaginal cervical cerclage
fails, then as a last resort women undergo a
laparotomy, an incision through the abdomen,
so that physicians can put a permanent stitch
around the cervix to close it. Other interventions for a short cervix in pregnancy include
progesterone supplements or a pessary, “but
studies have not fully delineated how these
interventions work,” Dr. Vink says.
Research has been published on the
properties of other tissues including bone,
cartilage, tendon, and heart, “but literature
on the mechanics of the cervix and cervical
remodeling during pregnancy did not exist,”
Dr. Myers says. “So we had to start from
scratch.” To explore the many unknowns
about the cervix, the collaborative group is
“working on the problem along the entire
spectrum,” says Dr. Vink. “In looking at the
biochemical properties of the tissue, I’m asking
the following questions: What are the different
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C O L U M B I A W O M E N ’ S A N D C H I L D R E N ’ S H E A LT H
Collaborations
types of collagens and what are the cellular
components of the cervical tissue? What role
do the smooth muscle cells play in the cervix?
Which cells in the cervical tissue make and
remodel the collagen? And in somebody who
has cervical insufficiency, is that collagen
altered in some way so it is not as strong and if
so, what cells are causing that to happen?”
Dr. Myers is approaching the question
from a mechanics perspective: How does its
biochemistry make the cervix strong? What is
the intrinsic mechanical strength of the tissue?
“In our study, we are currently enrolling women
who are having their uterus and cervix removed
for non-cancerous reasons. Once the uterus
and cervix is removed, and before it is disposed of, we take a small sample of tissue from
the cervix so we can measure its mechanical
strength,” she says. Using these data, and
MRIs of pregnant women, her lab has created
computer simulations of a pregnant woman’s
pelvic region, including the uterus, cervix, and
surrounding tissues. “We have the anatomy
modeled on our computer and we know the
mechanical strength of the tissue because we
measured it on the bench,” she says. “Then
we can ask the model, if the baby weighs this
much, the female cervix is made out of this
kind of material which is this strong, and if the
woman stands up and we add the force of
gravity, will her cervix open or not?”
One of the big unknowns in this research
is whether cervical tissue in a woman who
is pregnant is the same as in one who is not
pregnant, because no one yet actually sampled
tissue throughout gestation and compared it.
But the group received IRB approval to obtain
cervical tissue from pregnant women last fall
and they are beginning to perform biochemical
and mechanical tests on these samples. “The
beauty of our multidisciplinary approach is that
we can correlate the structure of the tissue that
I see under the microscope to the mechanical
function of the tissue. For example, if I see that
the cervical tissue from women with CI has
certain “weaker” collagens, Dr. Myers can perform mechanical tests on the tissue to confirm
that it is actually more compliant or softer. That
is how we establish the correlation between
“structure and function,” Dr. Vink explains.
Dr. Myers adds, “and that is how Dr. Vink
and I collaborate: we are together, in parallel, building structure-function relationships
of cervical tissue during pregnancy.” And the
collaboration is beginning to result in published
Connections
KRISTIN MYERS, RIGHT, AND MEMBERS OF THE MYERS SOFT TISSUE LAB.
research: Dr. Myers’ lab has three biomechanics publications (see below), and three more
studies will be coming out in a couple of
months, Dr. Vink says.
Once they gain a better understanding of
the composition of cervical tissue and how it
is different in women with premature cervical
shortening or CI, says Dr. Vink, “then we can
start to come up with more effective therapies
for this obstetric problem. These new therapies
may include noninvasive therapies that
actually reverse either the processes that are
weakening the tissue or changing the collagen
structure with rather than using a stitch. The
ultimate goal with these new therapies is to
decrease the rate of spontaneous preterm
birth.” — Beth Hanson
One of the big unknowns
in this research is whether
cervical tissue in a woman
who is pregnant is the same as
in one who is not pregnant,
because no one yet actually
sampled tissue throughout
gestation and compared it.
Recent Publications:
Yao W, Yoshida K, Fernandez M, Vink J, Wapner
RJ, Ananth CV, Oyen ML, Myers KM. Measuring the
compressive viscoelastic mechanical properties of
human cervical tissue using indentation, Journal of the
Mechanical Behavior of Biomedical Materials, Volume
34, June 2014, Pages 18-26, ISSN 1751-6161, http://
dx.doi.org/10.1016/j.jmbbm.2014.01.016.
Yoshida K, Reeves C, Vink J, Kitajewski J, Wapner
R, Jiang H, Cremers S, Myers KM. Cervical collagen
network remodeling in normal pregnancy and
disrupted parturition in Antxr2 deficient mice. Journal
of Biomechanical Engineering, January 2014. doi:
10.1115/1.4026423 (In press).
Fernandez M, Vink J, Yoshida K, Wapner R, Myers K.
Direct Measurement of the Permeability of Human
JOY VINK, MD
Cervical Tissue. Journal of Biomechanical Engineering,
135: 021023, 2013.
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Collaborations
Pediatric
Neurology:
Building on
Success
The subspecialty of child neurology had its
origins at the Babies Hospital of Columbia
Presbyterian. It’s here that Sydney Carter, MD,
created the first pediatric neurology training program in the United States, and during his tenure
as Chief of the Division of Pediatric Neurology
he established child neurology as a recognized
subspecialty of neurology. His successor Darryl
De Vivo, MD, moved the division into a new era
of laboratory-based investigation and related
clinical research in the 1980s. Taking up the
baton, newly appointed Division Chief James
Riviello, MD has plans to expand the division,
and like his predecessors, he will retain a devotion to clinical excellence.
Dr. Riviello plans to add to the division’s current 13 faculty members significantly over the next
five years, and to add a third residency spot to the
current two per year. Richard Mayeux, MD, the
recently appointed Chairman of Neurology, had
targeted Child Neurology for growth, and brought
in Dr. Riviello in 2013. After just five months on
the job Dr. Riviello feels he has found his niche.
“Person for person, this is the best group of neurologists I’ve ever worked with,” he says.
The division’s current strengths include care
for children with neuromuscular diseases, particularly spinal muscular atrophy and muscular
dystrophy. Dr. Riviello notes that Dr. De Vivo,
Chief of the Division from 1979 to 2000, “is
one of the world’s foremost experts in pediatric
neuromuscular disease.” He hopes to build on
Dr. De Vivo’s success and further bolster the
neuromuscular disease program. His first new
recruit is pediatric neuromuscular specialist,
Jahannaz Dastgir, DO, whose expertise is using
Milestones
in Pediatric
Neurology at
CUMC
noninvasive techniques to image muscle with
ultrasound and MRI.
Hospitalists, doctors dedicated to caring
specifically for in-patients, are not only increasingly common in inpatient units, they are more
and more specialized. Neurohospitalists who care
for adults offer expertise for emergent neurologic
conditions like stroke and status epilepticus. Hospitalized children with acute neurologic disorders
also require a uniquely high level of care, and Dr.
Riviello is very interested in growing the ranks of
CUMC’s pediatric neurohospitalists. “In-patients
are sicker now than 20 years ago, and doctors
who spend just a month or two a year on the
in-patient service are not going to be as up-todate in handling acute neurological injuries or
emergencies,” he says. “We know that if you have
hospitalists on the floor the quality of the care
improves, patients’ length of stay is shortened,
resident education is better, and parent and
patient satisfaction are better. They really improve
care.” The division has hired a pediatric stroke
specialist, Sally Sultan, MD, as its first hospitalist.
In conjunction with Steven Kernie, MD, Chief
of Pediatric Critical Care Medicine, Dr. Riviello
plans to develop a pediatric neurocritical care
service, and the Morgan-Stanley Children’s
Hospital plans to have a dedicated pediatric
neuro ICU. “CUMC has a rich history in adult
neurointensive care, and the expertise on the
adult side will be very helpful for us in becoming the referral center for the area for acute
brain injuries.” He plans to staff the service with
doctors who are expert in neonatal seizures,
strokes, and other disorders.
One of the measures that will be available to
patients in the pediatric neuro ICU is continuous EEG monitoring, says Dr. Riviello, who is an
epileptologist with expertise in both the medical
and surgical treatment of patients with refractory epilepsy. This type of monitoring is used to
detect subclinical seizures—seizures that lack
any outward manifestations—but that may amplify the damage in patients who have an acute
brain injury. “If you see changes on the EEG
first—before there are any clinical changes—you
can intervene and perhaps prevent irreversible
neurological dysfunction.”
• 1933: Bernard Sachs, who
along with Warren Tay first
described Tay-Sachs disease,
became the first Chief of
Pediatric Neurology at the
Neurologic Institute.
• 1951: Sidney Carter, MD,
became Chief of Pediatric
Neurology. Dr. Carter played a
major role in establishing child
neurology as a subspecialty.
Connections
DR. JAMES RIVIELLO, SERGIEVSKY
FAMILY PROFESSOR OF NEUROLOGY
AND PEDIATRICS, DIRECTOR, DIVISION
OF CHILD NEUROLOGY
Other areas that Dr. Riviello will develop include:
• a pediatric concussion program offering
same-day evaluations and services for
children with concussions
• a neurogenetics programs to analyze
the genetic origins of neurologic disorders that affect children and to develop
treatments based on those findings
• a dedicated center for the care of patients with Tuberous Sclerosis complex,
a multisystem, genetic disorder that
can now be treated
• a learning disabilities program to augment Reet Sidhu, MD’s autism program
• a pediatric neuroimmunology and
multiple sclerosis program
Dr. Riviello concludes that, “The size of
Morgan Stanley Children’s Hospital—the full
complement of pediatric specialties and the
large volume of patients—will really enable us
develop these programs. We are well on our
way to establishing Columbia as one of the premier child neurology programs in the country.”
—Beth Hanson
• 1957: Dr. Carter was awarded
the first NIH Pediatric Neurology
Training Grant.
• 1967: the American Board of
Psychiatry and Neurology offers
subspecialty board certification in pediatric neurology; Dr.
Carter was one of the founders.
the first Sidney Carter Professor.
• 1991: The Colleen Giblin
Laboratories for Pediatric
Neurology Research are
established as the core
research facility of the Division.
• 2013: Dr. Riviello is appointed
Chief of the Division.
• 1979: Dr. Darryl C. De Vivo succeeds Dr. Carter as Director of
Child Neurology, and is named
9
WINTER / SPRING 2014
C O L U M B I A W O M E N ’ S A N D C H I L D R E N ’ S H E A LT H
Collaborations
Pediatric
Ophthalmology:
Envisioning a
Patient-Friendly,
Integrated
Service
Pediatric ophthalmology at the Columbia
University Medical Center (CUMC)/Morgan
Stanley Children’s Hospital has new facilities, a
new direction, and with the recruitment of two
new faculty members including a division chief,
the service has gained much needed momentum. New division head Steven Brooks, MD,
has several short- and long-term goals that he
hopes will not only build on Columbia’s longstanding tradition of excellence in clinical care
and research, but greatly expand its access
to patients as well. His associates, Dr. Lauren
Yeager and Dr. John Flynn, share these goals,
he adds, and together they are taking the steps
needed to transform them into a reality.
“I’m proud to be able to build on the notable
contributions that Columbia Ophthalmology
has made in the field of pediatric ophthalmology,” says Dr. Brooks. In the 1960s—before
pediatric ophthalmology was established as a
distinct specialty—Columbia ophthalmologists
Algernon Reese, MD and Robert Ellsworth, MD
created the first classification for retinoblastoma, a life-threatening pediatric cancer originating in the eye. “Dr. Reese’s and Ellsworth’s
classification system played an integral role in
patient care and scientific research for a very
long time,” Dr. Brooks notes. Philip Knapp,
MD, director of the Children’s Eye Clinic at
Columbia from 1961-75, was also an influential
thinker in the clinical management of complex
strabismus and eye muscle disorders, and
trained numerous subspecialists in the field.
The changes currently under way in pediatric ophthalmology mirror changes in the
Department of Ophthalmology as a whole.
Until 1995, the department was composed of a
group of affiliated private ophthalmology practices housed in the Edward S. Harkness Eye
Institute. These ophthalmologists had service
agreements and teaching appointments with
Columbia, but their practices were privately run.
Now the Department of Ophthalmology and
the Eye Institute are staffed largely by full time
Connections
Columbia faculty, representing the spectrum
of subspecialties. In spite of this shift toward
a full time faculty, affiliated physicians with
private practices continue to play an active and
important role in the teaching mission of the department, including pediatric ophthalmologists
Pamela Gallin, MD, Howard Eggers, MD, and
Steven Kane, MD, PhD. “The contributions of
these physicians, as well as others who donate
their time and expertise, are an extremely valuable asset to the division,” Dr. Brooks says.
To achieve his goals for the division, Dr.
Brooks notes that some re-building is a necessary first step. “The absence of a full time
pediatric ophthalmology practice at CUMC for
the past several years has left a void in patient
volume and steady referral sources,” he says,
adding, “It will take some time, some marketing, and a lot of hard work, to build things to
the robust level needed to move forward.”
The combined ophthalmic expertise
available at the Morgan Stanley Children’s
Hospital and the Edward S. Harkness Eye
Institute includes specialists in cornea, retina,
oculoplastics, glaucoma, cataract and refractive surgery, and neuro-ophthalmology. “The
strength of our division can be seen, in part,
in the close collaboration we have with other
ophthalmic specialties, which means we can
provide a much higher level of eye care for kids
with tertiary eye problems—pediatric tumors,
pediatric glaucoma, and pediatric cataract—the
kind of care that people aren’t going to easily
find elsewhere in the region,” says Dr. Brooks.
“And as part of the Morgan Stanley Children’s
Hospital, we are part of a much larger healthcare team for kids.”
Other changes are in the works. Later this
year the division will move its practice into a
new shared clinical space with pediatric ENT,
on the fifth floor of the children’s hospital. This
move will enable the division to become more
closely integrated with the hospital’s other
pediatric services in a new, modern space
specially designed for pediatric eye care. In
addition, this spring Columbia Ophthalmology
is opening a new vision center (The Robert
Burch Family Eye Center) at the LighthouseGuild Headquarters on West 65th St. This site
has been designed to provide general and
pediatric eye care in a location that’s easily
accessible for families in Midtown and on the
Upper West Side, and complements the vision
center the division currently operates at 880
Third Ave, at 53rd St.
On the research side, division members will
continue to work toward understanding the
causes of, and new treatments for, pediatric eye disease, in collaboration with other
pediatric specialties, says Dr. Brooks. An area
of particular research focus is retinopathy of
prematurity, a potentially blinding disorder affecting low birth weight premature infants. Drs.
Brooks and Flynn, and Dr. Brooks’ predeces-
DR. STEVEN BROOKS
CHIEF, PEDIATRIC OPHTHALMOLOGY
“I’m proud to be able to build
on the notable contributions
that Columbia Ophthalmology
has made in the field of
pediatric ophthalmology.”
sor, Michael Chiang, MD, have been actively
investigating and treating ROP for many years.
As part of this effort the division has an ongoing research project in the neonatal intensive
care unit, started by Dr. Chiang, aimed at
identifying possible genetic risk factors that
might contribute to ROP development and
severity. “Research into the genetic bases of
disorders will ultimately lead the way to a much
deeper understanding of them, and open up
novel approaches to treatment that will be the
hallmark of 21st century medicine,” Dr. Brooks
says. CUMC researchers are also investigating
the use of stem cells to regenerate optic nerve
and retina and individualized gene therapy to
restore normal metabolic functions to eyes that
have inborn errors of metabolism.
“It is with great enthusiasm that the Division
of Pediatric Ophthalmology embarks on its
mission of service, research, and teaching,”
says Dr. Brooks. “We look forward to building
upon Columbia’s rich history of scientific and
clinical contributions to the field pediatric
ophthalmology and meeting the challenges
ahead.” — Beth Hanson
10
WINTER / SPRING 2014
C O L U M B I A W O M E N ’ S A N D C H I L D R E N ’ S H E A LT H
Collaborations
PAUL PLANET, MD, PhD
Tracing the Origins of
a MRSA Epidemic
In the early 1990s methicillin resistant Staphylococcus aureus (MRSA), which had been
present in hospital settings since the 1950s, underwent a transformation. The bacteria
suddenly became much more transmissible between humans and appeared outside of
hospitals in the community. Over the 15 years since then MRSA has become a major
public health problem, causing severe pneumonia and blood infections, and in rare
instances death. CUMC pediatrician and infectious diseases specialist Paul Planet, MD,
PhD is featured in a new series of video shorts, part of a set of teaching materials about the
evolution of MRSA, that was developed and produced for high school students and teachers
by the American Museum of Natural History (AMNH). Dr. Planet explains how he and other
researchers used genomic sequencing to unravel the evolution of one of the most virulent
and antibiotic-resistant MRSA strains, USA300, which is responsible for several rapidly
progressive, fatal diseases. The researchers determined that USA300 likely incorporated a
segment of DNA—a gene called SPE-G—from a close relative (Staphylococcus epidermidis),
which has enabled it to live and thrive on the skin and to be more transmissible. This is just
one example of how the transfer of genes from one organism to another can have profound
effects on epidemiology and human health, Dr. Planet says. “Understanding the factors
that differentiate bacteria that are benign, or maybe even useful to us, and the bacteria that
cause disease is probably the most important thing that we can be investigating right now.”
Dr. Planet did the research for his PhD in evolutionary microbiology at the museum and he
is a Research Associate there; he helped develop the teaching materials with a group of
AMNH colleagues. The series entitled, “Bacteria Evolving: Tracing the Origins of a MRSA
Epidemic,” is part of the Museum’s collection of teaching materials, Curriculum Collections.
The four short videos are each accompanied by two articles, one for teachers and one for
students, and also include activities and datasets using the DNA Subway interactive web
site, developed by the Cold Spring Harbor Laboratory and part of the NSF-funded iPlant
Collaborative, an online bioinformatics workspace that makes high-level genome analysis
available to teachers and students.
STILLS FROM THE VIDEO SERIES
Watch video series here:
http://bit.ly/1iti4K6
Connections
11
WINTER / SPRING 2014
C O L U M B I A W O M E N ’ S A N D C H I L D R E N ’ S H E A LT H
Dr. Mellins is
remembered as one
of the founding
fathers of the
specialty of Pediatric
Pulmonology.
Annual Robert Mellins
Memorial Lecture Series
Inaugurated
The Pediatrics Department held the
first annual Robert Mellins Memorial
Lecture on January 24, 2014. Dr. Gabriel
Haddad, Professor and Chairman of
the Department of Pediatrics at the
Rady Children’s Hospital, University of
California at San Diego, was the series’
first guest speaker. He entitled his talk:
“Flying High: A Bob Mellin’s Guiding
Principle.” Dr. Lawrence Stanberry
opened the lecture with the following
remarks about Dr. Mellins and his
contributions to the department.
Welcome to the inaugural Robert B. Mellins, M.D. Lectureship. This endowed lectureship was established as a tribute to honor the memory of
an extraordinary specialist of Pediatric Pulmonology, Dr. Robert Mellins.
Born in Brooklyn, he received a BA degree from Columbia University and
a MD degree from Johns Hopkins University, and subsequently returned
to Columbia to be trained in pediatrics, cardiology and pulmonology.
Dr. Mellins became the first Director of the Division of Pediatric Pulmonary here at the College of Physicians and Surgeons and is remembered
as one of the founding fathers of the specialty of Pediatric Pulmonology.
As a career-long advocate for multidisciplinary research and patient
care, Dr. Mellins welcomed into his laboratory and clinics trainees from
disciplines as diverse as allergy, anesthesiology, engineering, health
education, psychology, and nutrition.
We remember Dr. Mellins as a devoted physician, an inspiring mentor,
and as an international authority in the field of pediatric asthma. Additionally, Bob was an accomplished musician, skier, figure skater, and
gardener, and an intellectual with deep and varied interests.
He served as the president of the American Thoracic Society, President of the Fleischner Society, as Vice President of the American Lung
Association and on the Strategic Planning Committee for the Arnold F.
Gold Foundation.
Bob received many honors including ATS Distinguished Achievement
Award and the Will Ross Medal from the American Lung Association.
In recognition of his many contributions to his academic community, he
was awarded the Distinguished Service Award at Columbia University
Medical Center and the Distinguished Alumnus Award of the College of
Physicians and Surgeons.
“Bob was a great advocate for those with lung disease, and thousands upon thousands of patients are the better for his efforts. He always
tried to help everyone that he could, and he was always gracious, warm,
and generous to friends, colleagues, students, and patients,” said Meyer
Kattan, MD, director of the Pediatric Pulmonary Division at Columbia
University Medical Center.
For more information about Dr. Mellins and his career, you can
read “Remembering Robert Mellins” in the Annals of the American
Thoracic Society: http://bit.ly/1iWZ4q9
Connections
12
WINTER / SPRING 2014
C O L U M B I A W O M E N ’ S A N D C H I L D R E N ’ S H E A LT H
ONCOLOGY DIETICIAN ALANNA CABRERA, RD WORKS WITH A PATIENT.
Center for Comprehensive Wellness
Changes Concept of “Whole-Person Care”
A walk through the pediatric hematology
and oncology outpatient clinic may
reveal some familiar sites: Children
receiving treatment. Parents speaking
with nurses. Doctors examining
patients. But look closely, and you may
see something else: A child getting a
foot massage. A teenager receiving
acupuncture. A parent learning how to
use guided imagery to relax.
These approaches are all part of the multifaceted Center for Comprehensive Wellness (CCW) at NewYork-Presbyterian Morgan Stanley Children’s
Hospital at Columbia University Medical Center. Integrative therapies
have been making their way into the care of people with cancer for
several years. What makes this program different is how integrative treatments, supportive care, and survivorship wellness are being woven into
each patient’s plan of care from day one.
Cancer therapy has been moving in the direction of “personalized
medicine,” with treatments designed to target the specific molecular
abnormalities of each patient’s tumor. Doctors are now seeing how “wellness care” can be personalized in a similar way. Treatment for children’s
cancers can be a lengthy and emotionally exhausting experience. The
CCW was created to meet the nommedical needs of patients and their
families and ease their journey with the disease.
“As we move forward with technology to better define the biology of
each patient’s cancer, we want to pay equal attention to the way we advance our ability to provide support,” says Andrew Kung, MD, PhD, Chief,
Division of Pediatric Hematology/Oncology/Stem Cell Transplantation.
“The CCW helps us deliver the compassionate care necessary to see
patients and their families through treatment. Everyone involved in each
patient’s care is working together to determine what the patient’s and
family’s needs are, and providing support tailored to meet those needs.”
Many of the components of the CCW have existed for years, but were
formally unified in 2012 to better coordinate care. “As providers, we need
to have an understanding of the emotional and educational needs of
our young patients at different points in their care, and provide services
13
JENNIFER LEVINE, MD, MSW, MS, DIRECTOR OF THE
CENTER FOR SURVIVOR WELLNESS.
ACUPUNCTURIST AND MASSAGE THERAPIST MICHELLE BOMBACIE, LAC, LMT (LEFT) AND CHRISTINE
GRIMALDI, PhD, EXERCISE PHYSIOLOGIST AND YOGA MOVEMENT THERAPIST, WITH A PATIENT.
designed to meet those needs,” says Jennifer Levine, MD, Medical
Director of the CCW.
“The blueprint for the CCW was developed from the Integrative
Therapies Program for Children with Cancer, which was the first integrative program in pediatric oncology that fused complementary therapies
within the framework of conventional care,” adds Elena J. Ladas, PhD,
RD, Assistant Professor of Nutrition in Pediatrics and the Institute of Human Nutrition and Director of CCW Operations.
The CCW’s services are provided in both the inpatient and outpatient
settings, and include:
• Integrative therapies, through a program created by Kara Kelly,
MD, Professor of Pediatrics at Columbia University College
of Physicians and Surgeons, and led by Dr. Ladas. Examples
include massage therapy, reflexology, acupuncture and acupressure, Reiki and therapeutic touch, exercise and yoga, aromatherapy, and mind-body techniques such as meditation and
guided imagery. These treatments improve the delivery of care
to patients and their families by helping to control the symptoms
and stresses of treatment.
• Nutritional counseling regarding the use of herbal and other
supplements, provided by CCW dietitians. Maintaining nutrition
status during treatment has been shown to improve quality of
life, decrease the incidence of infections, and reduce therapy-related side effects. Many families are also interested in nutritional
and herbal supplements to help manage the side effects of
therapy or to promote health. CCW dietitians provide evidencebased counseling on the use of nutritional and herbal treatments
during and after cancer therapy.
• Neuropsychological assessment and psychosocial support.
Children may undergo neuropsychological assessment before
and after therapy to gauge the effects of cancer and its treatment
on their cognitive function—information that can be used to
help tailor individualized educational plans to promote a child’s
successful return to school. Individual psychotherapy and group
counseling as well as support groups are offered to patients,
parents, and other family members.
• Child life specialists, who provide emotional support to patients
and their families and use age-appropriate therapeutic play and
education to help children understand their illness and medical
procedures.
• Social workers, who provide emotional support, advocacy, crisis intervention, and referrals to resources, and help coordinate a
safe and secure plan when it is time to leave the hospital.
• Pastoral care to provide for the religious and spiritual needs of
patients and their families.
• A long-term survivor program to monitor for late complications
of cancer treatment and to promote survivor wellness.
Thanks to vital philanthropic support from organizations such as
the Hope & Heroes Children’s Cancer Fund, the Valerie Fund (which
supports psychosocial care), the Tamarind Foundation (supporting integrative and nutrition services), and private donors, services are provided
free of charge. Other services, such as neuropsychological assessment
and survivorship visits, may be covered by insurance companies.
Research has shown that providing psychosocial support services to
families results in less depression and anxiety among family members
and patients. “We teach specific coping skills to help patients and their
families throughout treatment and survivorship,” says Stephen Sands,
PsyD, Associate Professor of Pediatrics and Psychiatry at CUMC and
Director of the Valerie Fund Psychosocial Program in the Center for
Comprehensive Wellness.
For example, facilitating open communication between patients and
parents, as well as between parents and staff, during the many aspects
of medical treatment improves quality of life for families. Additionally,
connecting survivors with the appropriate level of educational services
and psychosocial resources in their communities can improve their
return to school, intellectual functioning, and academic success.
Long-term care of survivors of childhood cancer is a growing area of
focus in oncology. As childhood cancer survival rates continue to rise,
thanks to advances in therapy, more children diagnosed with cancer
today are being cured and growing up to become productive adults.
But some therapies carry a risk of long-term health effects—such as
heart disease due to radiation therapy to the chest, or infertility due to
chemotherapy.
Through the CCW, survivors of childhood cancers treated at Morgan
Stanley Children’s Hospital can be monitored for long-term complications, receive integrative therapies and nutritional guidance, and be
educated about how to live a healthy life. Reproductive endocrinologists
are also available to provide fertility support, including fertility preservation, if desired.
The CCW is planning to expand its services to include palliative
care. Palliation involves relieving symptoms, and has been traditionally associated with end-of-life care. But today practitioners know that
helping patients and their families to feel comfortable from the moment
of diagnosis is just as important. “Being able to provide these kinds of
resources is really phenomenal,” concludes. Dr. Levine. “We are changing the way we think of ‘whole-person’ care.” — Rosie Foster
To learn more about the Center for Comprehensive Wellness at
Columbia University Medical Center, Morgan Stanley Children’s
Hospital, call (212) 305-2355.
14
In the News
US NEWS AND WORLD REPORT
NEW YORK TIMES
CBS NEW YORK
Dr. Stanberry Comments on Experimental Drug for Genital Herpes
Giving Vaccines Together Increases
Fever Risk, Dr. Stockwell Finds
Over-The-Counter DNA Tests Could
be Misunderstood, Says Dr. Chung
In people with genital herpes the experimental
drug pritelivir substantially curbed viral shedding, according to a small, preliminary study
published in the New England Journal of Medicine. Pritelivir works differently from existing
medications for genital herpes, and “it’s exciting
that there’s a new class of drugs,” Chairman
of Pediatrics and infectious disease expert
Lawrence Stanberry, MD, told US News and
World Report. “This has the potential to improve
treatment.” The three medications currently
available to treat HSV symptoms (acyclovir,
famciclovir, and valacyclovir) had a big impact
on managing genital herpes when they came
out, Dr. Stanberry said, but the drugs fall short
when it comes to preventing HSV transmission.
Researchers ultimately hope to develop drugs
that eliminate dormant HSV from nerve cells,
said Dr. Stanberry. “But we don’t have anything
like that, and [pritelivir] is not it either.”
Babies who get two common vaccines on the
same day are more likely to develop fevers than
those who don’t, CUMC researchers showed in
research published recently in JAMA Pediatrics.
Children who got shots for both the flu and
pneumococcal disease at the same time were
about three times more likely to develop fevers
on the day they were vaccinated or the day
after, compared to kids who were vaccinated
separately. But these findings are not a reason
to avoid the vaccines, according to the lead author, pediatrician Melissa S. Stockwell, MD. “We
think it’s important that children be vaccinated,”
she told The New York Times. “And when you
weigh the risks and benefits, the vast majority
of children should get the vaccines together.
It’s the best way to protect them against these
serious diseases.” Getting the vaccines at the
same visit increases the time of protection and
eliminates the problem of failing to return for the
second shot, she said.
Cheap, easy-to-use mail-order DNA tests from
companies like DNA Traits, Gene Planet, DNA
DTC, and 23 And Me promise users a glimpse
of their future health and their likelihood of
developing dozens of diseases and conditions
from arthritis to many different kinds of cancer.
Medical geneticist Wendy Chung, MD told CBS
New York that many other factors come into play
to determine whether someone will develop a
specific disease or not. “It’s not all driven by our
genes. For many different conditions it has to
do with things that happened over the course of
our lifetime,” Dr. Chung said.
http://bit.ly/1mVJCO6
http://cbsloc.al/PYOzYx
http://nyti.ms/1aUKWwu
This story also appeared on NPR MORNING
EDITION, ABC NEWS 4, FOX NEWS, MEDPAGE
TODAY and WEBMD
Connections
15
WINTER / SPRING 2014
C O L U M B I A W O M E N ’ S A N D C H I L D R E N ’ S H E A LT H
In the News
NEW YORK TIMES
NEW YORK TIMES
SALON.COM
Dr. Berkowitz Lauds William
Pollack, co-developer of Vaccine
for Rh Disease
Dr. Polin Comments on Study
Showing Tainted Breast Milk is
Often Sold Online
Abortion is Sometimes Necessary to
Save a Woman’s Life, Dr. Davis Says
William Pollack, PhD, who helped develop the
vaccine that virtually eradicated erythroblastosis
fetalis (Rh disease) in collaboration with CUMC
researchers Vincent J. Freda, MD and John G.
Gorman, MD, died late last year. The disease at
one time was the cause of 10,000 infant deaths
a year in the US. The vaccine, made from a
passive Rh-negative antibody, dispatches invading Rh-positive cells throughout the mother’s
body and preventing her immune system from
mounting a full-fledged response to the fetus.
“It was an absolutely brilliant idea,” Richard
L. Berkowitz, MD, obstetrics and gynecology
director of resident education, told the New York
Times. “A lot of people know who Jonas Salk is,
but they should know William Pollack’s name,
too. This disease was a major, major problem,
and it’s been virtually eradicated.”
A cottage industry has sprung up facilitating
the sale and donation of human breast milk
on the Internet, but a study in Pediatrics found
that breast milk bought from two popular
Web sites was often contaminated with high
levels of bacteria, including, in a few instances,
salmonella. The amounts detected in some
samples were sufficient to sicken a child. “The
study makes you worry,” Richard A. Polin, MD,
director of neonatology and perinatology, told
the New York Times. “This is a potential cause
of disease. Even with a relative, it’s probably not
a good idea to share.”
http://nyti.ms/1kn48Hg
During an interview on the campaign trail,
Wendy Davis, gubernatorial candidate in Texas,
recently suggested that a world without abortion
is something everyone wants. “The goal that we
should have is that we see zero abortions,” she
said. In response to her statement, Anne Davis,
MD, MPH, a second-trimester abortion provider
and consulting medical director at Physicians
for Reproductive Health, told Salon.com, “The
thing that makes me absolutely nuts is when
people say abortion is never necessary to save
a woman’s life. To say abortion does not save
women’s lives is false, plain and simple. And
to base policy on that kind of lie sacrifices the
health of our patients,” she said.
http://bit.ly/1lHZ2CF
http://nyti.ms/1g22wif
Connections
16
WINTER / SPRING 2014
C O L U M B I A W O M E N ’ S A N D C H I L D R E N ’ S H E A LT H
In the News
NBCNEWS.COM
NEW YORK TIMES
NEW YORK TIMES
Dr. Westhoff on Long-Acting
Contraception after Abortion
Dr. D’Alton Comments on the
case of Marlise Munoz
Dr. Planet supports global
surveillance of infectious diseases
Women who get an abortion may be interested
in long-acting forms of birth control (intrauterine
devices, contraceptive implants, and hormone
shots), but might not return for another visit
to get them, so offering women long-acting
contraception immediately after their abortion
could lower the chance of another unintended
pregnancy. “Our patients already had access
to effective contraceptives at no cost through
a community clinic; however that required
organizing an additional visit,” Carolyn Westhoff,
MD, Director of Family Planning and Preventive
Services, told NBCNEWS.com. “That might
sound easy, but for many it is hard to arrange
childcare and additional time off from work that
would permit another visit,” she said. “The result
was that many women simply didn’t make it
back.” She and colleagues undertook a study
to see what would happen if the obstacle of
an extra visit was removed, and found that the
number of subsequent pregnancies, abortions,
and live births was substantially reduced among
women offered long-acting reversible contraception right away. “Women are willing and even
eager to adopt a highly effective method when
offered,” Dr. Westhoff said.
Fort Worth, Texas woman Marlise Munoz was
brain-dead after developing a pulmonary embolism, and met the legal criteria for death in all
50 states, but Texas law prohibited the hospital
from disconnecting her from the ventilator
because she was pregnant. Munoz was tethered
to life support machines for eight weeks, despite
her husband’s and parents’ wishes, before she
was disconnected. Commenting on the effect
of a pregnancy dependent on artificial organ
maintenance on the fetus, Mary D’Alton, MD,
Chairman of Obstetrics and Gynecology told the
New York Times, “It’s extremely risky for fetal development,” but, added, “If the family is willing
and it’s something they want, it’s something I
would attempt—and have attempted… The family
will live with the impact,” she added.
In a letter to the editor of the New York Times,
pediatrician Paul Planet, MD wholeheartedly
agreed with the new initiative for global surveillance of infectious diseases recently announced
by the Obama administration. “Preventive measures and prompt responses clearly save thousands of lives,” he and a colleague wrote. “The
obvious examples come from emerging diseases
with rapid and devastating outcomes like SARS
or Ebola, but surveillance must include diseases
with less dramatic clinical courses, especially for
antibiotic resistance. Many common diseases
have the potential to become epidemics with just
a few seemingly trivial genetic changes. These
are precisely the diseases that creep up without
causing much of a stir.” Dr. Planet cited the
MRSA epidemic as an example, and “a similar
insidious rise in CRE, or carbapenem-resistant
Enterobacteriaceae. Monitoring common diseases creates new surveillance challenges, but
new technologies offer cost-effective strategies
that can be carried out now.”
http://nyti.ms/1mVKeTM
http://nyti.ms/1qkKysK
http://nbcnews.to/1g293t5
Connections
17
WINTER / SPRING 2014
C O L U M B I A W O M E N ’ S A N D C H I L D R E N ’ S H E A LT H
In the News
DNAINFO NEW YORK
CBS NEW YORK
NEW YORK DAILY NEWS
Smoke’s Danger Depends on
what has been Burned, According
to Dr. Miller
Dr. Lewin on Obesity and
Ovarian Cancer Risk
Insurance Plans Should Cover the
cost of Breast Pumps, says Dr. Ohly
A large-scale review of ovarian cancer research
by The World Cancer Research Fund has
confirmed that obesity can be a risk factor for
ovarian cancer. The Fund looked at 25 previous
studies involving 4 million women and found
that for every five additional BMI units women
had a 6 percent increased risk of developing
ovarian cancer. Being obese increases a woman’s risk because fat tissue makes estrogen,
which is known to increase ovarian cancer risk.
Gynecologic oncologist Sharyn Lewin, MD,
explained that the disease is typically detected
in its later stages. “We do not have an effective
screening mechanism for detecting ovarian
cancer at early stages so we usually, unfortunately, detect women when they are stage 3 or
4. Very advanced stages,” she told CBS New
York. “Identifying a healthy body weight and
ways to modify that with exercise, appropriate
diet, that is one risk factor that patients can really do something about,” Dr. Lewin said.
Despite a new provision in the Affordable Care
Act that requires many plans to cover lactation
devices, New York City employees’ insurance
companies do not pay for the $300 devices.
The Obamacare provision covering breast
pumps and other preventive-care services
kicked in Jan. 1, 2013, but the City is not
violating the new healthcare law because plans
already in effect before Obamacare passed
can be exempt from some of the law’s regulations. They also say nursing helps reduce a
host of health problems, including respiratory
diseases and childhood obesity. N. Tanya Ohly,
an obstetrician and gynecologist, pointed out
to the NY Daily News that that moms who can’t
get breast pumps covered by their insurance
are facing a major disadvantage. “It’s already
overwhelming to take home a newborn,” she
said. “And then to sort out the details of your insurance plan and whether you can get a breast
pump, it’s extremely aggravating.”
http://cbsloc.al/1mYUbNs
http://nydn.us/1nFL30O
Following the mid-March explosion that leveled two Park Avenue apartment buildings in
East Harlem, New York, killing seven people
and injuring more than 60, Mayor Bill de
Blasio urged residents near the site to stay
inside and avoid exposure to smoke from the
still-smoldering fire. Many area residents also
bought face masks because they were afraid
of breathing the smoke. The health dangers
of the smoke, though, “really does depend on
what burned,” allergy specialist Rachel Miller,
MD, told DNAInfo New York. “Some things burn
dirtier than others. I think the most sound thing
to do is to contact your doctor if you’re feeling
sick,” she said.
http://dnain.fo/1fAcgAi
Connections
18
WINTER / SPRING 2014
C O L U M B I A W O M E N ’ S A N D C H I L D R E N ’ S H E A LT H
Notable
Publications
Each year, members of the Departments of Obstetrics and Gynecology
and Pediatrics publish several hundred research articles in medical
journals. Below are highlights from those publications.
Piovan E, Yu J, Tosello V, Herranz D, Ambesi-Impiombato A, Da Silva AC, SanchezMartin M, Perez-Garcia A, Rigo I, Castillo M, Indraccolo S, Cross JR, de Stanchina E,
Paietta E, Racevskis J, Rowe JM, Tallman MS, Basso G, Meijerink JP, Cordon-Cardo
C, Califano A, Ferrando AA. Direct reversal of glucocorticoid resistance by AKT
inhibition in T-ALL. Cancer Cell. 2013. Doi:pii:S1535-6108(13)00463-7. 10.1016/j.
ccr.2013.10.022.
St-Jules DE, Watters CA, Brunt EM, Wilkens LR, Novotny R, Belt P, Lavine JE; Nonalcoholic Steatohepatitis Clinical Research Network. Estimation of Fish and ω-3 Fatty
Acid Intake in Pediatric Nonalcoholic Fatty Liver Disease. J Pediatr Gastroenterol
Nutr. 2013;57(5):627-33. doi: 10.1097/MPG.0b013e3182a1df77.
Zaidi S, Choi M, Wakimoto H, Ma L, Jiang J, Overton JD, Romano-Adesman A,
Bjornson RD, Breitbart RE, Brown KK, Carriero NJ, Cheung YH, Deanfield J, DePalma S, Fakhro KA, Glessner J, Hakonarson H, Italia MJ, Kaltman JR, Kaski J, Kim R,
Kline JK, Lee T, Leipzig J, Lopez A, Mane SM, Mitchell LE, Newburger JW, Parfenov
M, Pe’er I, Porter G, Roberts AE, Sachidanandam R, Sanders SJ, Seiden HS, State
MW, Subramanian S, Tikhonova IR, Wang W, Warburton D, White PS, Williams IA,
Zhao H, Seidman JG, Brueckner M, Chung WK, Gelb BD, Goldmuntz E, Seidman
CE, Lifton RP. De novo mutations in histone-modifying genes in congenital heart
disease. Nature. 2013;498(7453):220-3.
Klitzman R, Appelbaum PS, Chung W. Return of secondary genomic findings vs
patient autonomy: implications for medical care. JAMA. 2013 Jul 24;310(4):369-70.
doi: 10.1001/jama.2013.41709.
Germain M, Eyries M, Montani D, Poirier O, Girerd B, Dorfmüller P, Coulet F, Nadaud
S, Maugenre S, Guignabert C, Carpentier W, Vonk-Noordegraaf A, Lévy M, Chaouat
A, Lambert JC, Bertrand M, Dupuy AM, Letenneur L, Lathrop M, Amouyel P, de
Ravel TJ, Delcroix M, Austin ED, Robbins IM, Hemnes AR, Loyd JE, Berman-Rosenzweig E, Barst RJ, Chung WK, Simonneau G, Trégouët DA, Humbert M, Soubrier
F. Genome-wide association analysis identifies a susceptibility locus for pulmonary
arterial hypertension. Nat Genet. 2013 May;45(5):518-21. doi: 10.1038/ng.2581.
Epub 2013 Mar 17. PMID: 23502781
King B, Trimarchi T, Reavie L, Xu L, Mullenders J, Ntziachristos P, Aranda-Orgilles
B, Perez-Garcia A, Shi J, Vakoc C, Sandy P, Shen SS, Ferrando A, Aifantis I. The
ubiquitin ligase FBXW7 modulates leukemia-initiating cell activity by regulating MYC
stability. Cell. 2013 Jun 20;153(7):1552-66. doi: 10.1016/j.cell.2013.05.041.
Faith JJ, Guruge JL, Charbonneau M, Subramanian S, Seedorf H, Goodman AL,
Clemente JC, Knight R, Heath AC, Leibel RL, Rosenbaum M, Gordon JI. The longterm stability of the human gut microbiota. Science. 2013 Jul 5;341(6141):1237439.
doi: 10.1126/science.1237439. PMID: 23828941
Stockwell MS, Broder K, Larussa P, Lewis P, Fernandez N, Sharma D, Barrett A,
Sosa J, Vellozzi C. Risk of fever after pediatric trivalent inactivated influenza vaccine
and 13-Valent Pneumococcal Conjugate Vaccine. JAMA Pediatr. 2014 Jan 6. doi:
10.1001/jamapediatrics.2013.4469. [Epub ahead of print]
Society for Maternal-Fetal Medicine (SMFM), with Lynn L. Simpson, MD. Twin-twin
transfusion syndrome (SMFM Clinical Practice Guideline). American Journal of
Obstetrics and Gynecology 2013;208:3-18. (This was among the “Top 25 papers
cited” in 2013.)
Perez-Delboy A, Wright JD. Surgical management of placenta accreta: to leave or
remove the placenta? BJOG 2014;121:163-169 (with discussion 169-170).
Ananth CV, Friedman AM, Gyamfi-Bannerman C. Epidemiology of moderate preterm, late preterm and early term delivery. Clinics in Perinatology 2013;40:601-610.
Zork N, Biggio J, Tita A, Rouse D, Gyamfi-Bannerman C. Decreasing prematurity
in twin gestations: predicaments and possibilities. Obstetrics and Gynecology
2013;122:375-379.
D’Alton ME, Fuchs KM, Abuhammad A, Benacerraf B, Berkowitz R, Cuckle H,
Depp R, Goldberg J, O’Keeffe D, Platt LD, Spitz JL, Toland G, Wapner R; Nuchal
Translucency Quality Review Program. Implementation of a national nuchal translucency education and quality monitoring program. Obstetrics and Gynecology 2014
Jan;123(1):149-54
García-Pascual CM, Zimmermann RC, Ferrero H, Shawber CJ, Kitajewski J,
Simón C, Pellicer A, Gómez R. Delta-like ligand 4 regulates vascular endothelial
growth factor receptor 2-driven luteal angiogenesis through induction of a tip/stalk
phenotype in proliferating endothelial cells. Fertility and Sterility 2013;100:17681776.e1.
Vink JY, Charles-Horvath PC, Kitajewski JK, Reeves CV. Anthrax toxin receptor 2
promotes human uterine smooth muscle cell viability, migration and contractility.
American Journal of Obstetrics and Gynecology 2014;210:154.e1-8.
Douglas NC, Arora R, Chen CY, Sauer MV, Papaioannou VE. Investigating the role
of tbx4 in the female germline in mice. Biology of Reproduction 2013;89:148.
Guiahi M, Westhoff CL, Summers S, Kenton K. Training at a faith-based institution
matters for obstetrics and gynecology residents: results from a regional survey.
Journal of the Graduate Medical Education 2013;5:244-251.
Gruber Filbin M, Dabral SK, Pazyra-Murphy MF, Ramkissoon S, Kung AL, Pak E,
Chung J, Theisen MA, Sun Y, Franchetti Y, Sun Y, Shulman DS, Redjal N, Tabak
B, Beroukhim R, Wang Q, Zhao J, Dorsch M, Buonamici S, Ligon KL, Kelleher JF,
Segal RA. Coordinate activation of Shh and PI3K signaling in PTEN-deficient glioblastoma: new therapeutic opportunities. Nat Med. 2013 Nov;19(11):1518-23. doi:
10.1038/nm.3328. Epub 2013 Sep 29. PMID: 24076665
Connections
19
WINTER / SPRING 2014
C O L U M B I A W O M E N ’ S A N D C H I L D R E N ’ S H E A LT H
Honors
& Awards
Anne Armstrong-Coben, MD (Child
and Adolescent Health) has been
nominated for the 2013 Arnold P. Gold
Foundation Humanism in Medicine
Award, presented by the Association
of American Medical Colleges (AAMC)
with the support of the Arnold P. Gold
Foundation. Members of the Organization of Student Representatives at our
medical school submitted the nomination on her behalf. The recipient of the
award will be recognized during the
November 2013 AAMC Annual Meeting in Philadelphia, PA. Dr. ArmstrongCoben was also selected as a faculty
“Cloaker” for the White Coat Ceremony
for the Columbia P&S Class of 2017.
Emilio Arteaga-Solis, MD (Pulmonology) was elected to membership in the
Society for Pediatric Research.
David Bell, MD (Child and Adolescent
Health) has been invited on behalf of
the ICPD Beyond 2014 Coordination
Secretariat and the Gender, Human
Rights, and culture Branch of the Technical Division, UNFPA, to participate in
a Dialogue on Men, Masculinities and
Sexual and Reproductive Health.
Julia Glade-Bender, MD (Hematology/Oncology/SCT) was awarded a
five-year grant from Alex’s Lemonade
Stand entitled, “Columbia University
Developmental Therapeutics Program:
Striving for Excellence.” Dr. GladeBender and the Pediatric Oncology
Team at Columbia University Medical
Center were nominated for the “BEST
CARE Community Award 2014” by
The Satmar Bikur Cholim. She was
honored at an event on January 29th at
the Bais Rochel Paradise Ballroom in
Monroe, NY.
Erika Berman Rosenzweig, MD
(Cardiology) has been invited to be a
member of the Board of Trustees of the
Pulmonary Hypertension Association.
Gary M. Brittenham, MD (Hematology/Oncology/STC), in collaboration
with the Laser Research Laboratory,
University of Munich, Munich, Germany, has received grant for the project,
“ZnPP fluorometer for non-invasive
detection of iron deficiency,” from
Nestec, Ltd., Vevey, Switzerland. Dr.
Brittenham is the principal investigator
of the project.
Steve Caddle, MD (Child and Adolescent Heath) received the Humanitarian
Award from the Association pour le
Developpement de Fort-Liberte et ses
Environs (ADFE) at a gala in December
2013. The award honored him for
his time and contribution to Haiti’s
children, especially those in the city of
Fort-Liberte.
Wendy Chung, MD, PhD and Dorothy
Warburton, PhD (Clinical Genetics)
were awarded an NIH/NHLBI grant
for their project entitled, “Molecular
approaches to gene identification in
congenital heart disease.” They are
co-principal investigators of the project.
Dr. Chung has also asked to give the
2014 CUMC Dean’s Distinguished
Lecture in Clinical Sciences.
Alwyn Cohall, MD’s (Child & Adolescent Health) program Project STAY
(Services to Assist Youth) received an
award from the New York City Department of Health and Mental Hygiene in
commemoration of World AIDS Day, for
outstanding service to both high-risk
youth and those living with HIV/AIDS in
NYC. http://projectstaynyc.org/
Matt Crystal, MD and Dina Ferdman,
MD (Cardiology) are both recipients
of awards from the foundation Colin’s
Kids. Dr. Crystal’s award will fund his
work on the mechanisms of pulmonary
vein stenosis and pharmacological
mechanisms to relieve stenosis. Dr.
Ferdman’s award is for her research
involving right ventricular function in
fetuses.
Nataki Douglas, MD, PhD (Reproductive Endocrinology) was one of six
awardees of the third competition for
the Provost’s Grant Program for Junior
Faculty Who Contribute to the Diversity
Goals of the University. The awards
support new or ongoing research
and scholarship, seed funding for
innovative research, and curricular
development projects. Dr. Douglas’s
project is on the “Role of angiogenic
Notch in uterine decidualization and
placentation.” Dr. Douglas has also
been invited to participate in the Reach
for the First R01 Workshop, which
provides Columbia University faculty
who have already received NIH K,
R21,R03 awards or equivalent funding
a structured environment in which to
prepare their R01 submissions.
David Evans, PhD (Pulmonology)
been awarded a two-year grant from
the Department of Health’s Assistant
Secretary for Preparedness and
Response. The grant is for his project
entitled, “Assessing and Strengthening
Post-Storm Resilience in NYC High
Rise Public Housing.” The project’s
goal is to assess how residents of highrise public housing have responded to
the impact of Hurricane Sandy, and to
develop tools to improve residents’ preparedness for future climate events or
other building emergencies.
The North American Society for Pediatric Gastroenterology, Hepatology
and Nutrition has elected Sarah Lusman, MD to the Education Committee,
Nadia Ovchinsky, MD to the Hepatology Committee, Julie Khlevner, MD to
the Endoscopy Committee, Mercedes
Martinez, MD to the International
Committee, Esi Lamouse-Smith, MD,
PhD to the Research Committee, and
Neera Gupta, MD as Chair of the
Research Committee. Kara Margolis,
MD was selected to serve on the
Awards Committee and Joel Lavine,
MD, PhD was appointed to the Nominations Committee.
Cynthia Gyamfi-Bannerman, MD (Maternal-Fetal Medicine) has been elected
to serve on the SMFM Editorial Review
Committee. She will help coordinate
reviews for the annual SMFM edition of
the American Journal of Obstetrics and
Gynecology for 2014.
Annual Symposium of the Korean Society for Lactic Acid Bacteria in Seoul,
South Korea.
Julie Glickstein, MD (Pediatric Cardiology) and Mariellen Lane, MD (Child
and Adolescent Health) have been accepted into the Virginia Apgar Academy
of Medical Educators at Columbia University College of Physicians and Surgeons. The Academy is dedicated to
promoting, rewarding, and supporting
outstanding education for our medical
students, residents, fellows, and faculty.
Membership represents recognition of
excellence as an educator and commitment to contributing to the educational
life of our medical community.
Joel Lavine MD, PhD (GI, Hepatology
& Nutrition) was lecturer, panelist and
moderator at the FDA Advisory meeting on “Clinical Endpoints and Trial
Design for Chronic Liver Diseases,”
and was appointed to the FDA’s GI
External Advisory Board.
Kara Gross Margolis, MD (GI, Hepatology & Nutrition) was elected Councilor and member of the Governing
Board for the North American Society
for Pediatric Gastroenterology, Hepatology and Nutrition for a three-year term.
Neera Gupta, MD (GI, Hepatology &
Nutrition) received a grant from Abbott
Nutrition to fund the CUMC Pediatric
Inflammatory Bowel Disease Quarterly Series, including the 2nd Annual
CUMC Pediatric Inflammatory Bowel
Disease Research Day. Dr. Gupta was
invited to serve a second, three-year
term on the editorial board of the journal Inflammatory Bowel Diseases.
Jamie Harrington, MD (Postdoctoral
Residency fellow) is the recipient for
the American Academy of Pediatrics
research grant for her study, “Can serial echocardiography be used for early
detection of cardiac abnormalities in
children with sickle cell disease?” Her
mentors were Margaret Lee, MD from
Hematology and Usha Krishnan, MD
from Cardiology.
David Kessler, MD (Emergency
Medicine) was invited to co-chair the
simulation track for the Mediterranean
Emergency Medicine Congress in
Marseille, France and was an invited
lecturer and expert panelist at this conference on “Simulation in the Clinical
Environment.”
Usha Krishnan, MD (Cardiology) will
be delivering an invited talk on “Current Treatment option for Pulmonary
Hypertension” at the 1st European
Conference on ‘Neonatal and Paediatric Pulmonary Vascular Disease’ at the
University Medical Center Groningen,
The Netherlands in October 2014. Dr.
Krishnan was also invited to speak on
“Cardiologic considerations in infantile
Pompe disease” at the NY- Mid-Atlantic
Consortium- (NYMAC) Pompe Disease
Newborn Screening Symposium in
November.
Teresa Lee, MD (Cardiology) and
Wendy Chung, MD (Clinical Genetics) are co-investigators on a surgery
startup grant entitled, “Transcriptional
profiling of human fetal heart valve
growth.” (The PI for the project is Emile
Bacha, MD.)
Sarah Shrager Lusman, MD (GI,
Hepatology & Nutrition) was appointed
to the Training Committee of the North
American Society for Pediatric Gastroenterology, Hepatology and Nutrition
for a three-year term.
Luz Adriana Matiz, MD’s (Child
and Adolescent Health) educational
session proposal, “Integrating Community Health Workers into Pediatric
Patient Centered Medical Homes” has
been accepted as part of a special
enhanced learning session for the
Children’s Hospital Association 2014
Transforming Children’s Health Care
– Together: Care Coordination in a
Complex Environment Conference.
Rachel Miller MD (Allergy and Immunology) received a four-year RO1 from
NIH/NHLBI for the project entitled:
“Secondhand smoke and asthma:
Mechanistic outcomes of DNA methylation in T cells.” She is a co-Principal Investigator in collaboration with Dr. Kari
Nadeau at Stanford University and will
be looking at epigenetic modifications
in a cohort of monozygotic twins.
Mara Minguez, MD (Child and
Adolescent Health) was selected as the
Physician of the Year for the American
College of Nursing. This award is given
to one physician annually, through
an extensive nomination and voting
process by Nursing.
Kimberly Noble, MD, PhD (Child and
Adolescent Health) was invited to be
the inaugural speaker at the Developmental Brown Bag Series, Department of Psychology, Virginia Tech, in
September, 2013; and was also invited
to speak at the Department of Psychology, Wesleyan University in October,
and at NYU’s Institute of Human Development and Social Change. Dr. Noble
will be the PI on a new grant awarded
by the Annie E. Casey Foundation on,
“Income and Brain Development: A
Randomized Controlled Trial.”
Wyman Lai, MD (Cardiology) has been
appointed for a two-year term as the
pediatric echocardiography representative to the Board of Directors of the
National Board of Echocardiography.
Sharon Oberfield, MD (Endocrinology) was appointed to serve a threeyear term on the Editorial Board of The
Journal of Pediatrics.
Esi Lamouse-Smith, MD, PhD (GI,
Hepatology & Nutrition) was invited
by the Korean Society of Lactic Acid
Bacteria to present, “Probiotics as Immunotherapy: Lactic Acid Bacteria and
Allergic Disease in Children,” at the 3rd
Betsy Pfeffer, MD (Child and Adolescent Health) and her colleague in
Uganda, Dr. Sabrina Bakeera-Kitaka,
received the I-CATCH grant from the
American Academy of Pediatrics to
support their project, “Promoting Adolescent Medicine in Uganda.”
20
Honors
& Awards
Dr. Pfeffer also organized and presented at the Society of Adolescent Health
in Uganda (SAHU) First Clinical and
Scientific Meeting in collaboration with
the Fourth Annual Adolescent Health
Conference in Kampala, Uganda in
December, 2013. The theme was promoting adolescent health in Africa.
Meenakshi Rao, MD, PhD (GI, Hepatology & Nutrition) received the Young
Investigator Award from the North
American Society for Pediatric Gastroenterology, Hepatology and Nutrition
(NASPGHAN).
Michael Rosenbaum, MD (Molecular Genetics) and Laurel Mayer, MD
(Psychiatry) are Co-PI’s on a new
five-year NIH grant entitled, “Functional
imaging and eating behavior among
FTO genotypes in pre-obese children”
(1 R01 DK097399). Their research will
examine feeding behavior and neural
responses to food in children at varying
degrees of risk of later obesity.
Lisa Saiman, MD, MPH (Infectious
Diseases) and her Infection Prevention
and Control colleagues were awarded
a five-year grant from the NYS Department of Health entitled “Healthcare-associated Infection Prevention Project.”
Meridith Sonnett, MD (Emergency
Medicine) was honored by the Steven
and Alexandra Cohen Foundation with a
grant to establish the Alexandra and Steven Cohen Pediatric Emergency Department Division Chief’s Fund. The funds
will be used to support improvements in
patient care for patients and families in
the Pediatric Emergency Department,
and for faculty development, and scholarly and educational initiatives.
CONTINUED FROM PAGE 3
Melissa Stockwell, MD (Child and Adolescent Health) was awarded a oneyear grant from Agency for Healthcare
Research and Quality for her project,
“DEVISE: Data Exchange of Vaccine
Information between an IIS and EHR.”
Her collaborators include Sekhar Ramakrishnan and David Vawdrey from
Dept. of Biomedical Informatics.
Chantae Sullivan, MD (PGY-3;
Obstetrics and Gynecology) received
an “Award for Best New Investigator Poster Presentation” at the 2014
meeting of the Society for Gynecologic
Investigation. Dr. Sullivan was first
author of the abstract, “VEGFR-1
blockade disrupts peri-implantation
decidual macrophage recruitment and
angiogenesis in mice.”
Julie Vincent, MD (Cardiology) was
the guest speaker and panelist for the
Pediatric Cardiology fellow mentoring
session, and was moderator for abstract
presentations at the 2013 American
Academy of Pediatrics (AAP) National
Conference and Exhibition; Section on
Cardiology and Cardiac Surgery.
Yaffa Vitberg, MD’s (Emergency Medicine – senior fellow) abstract titled;
“Sonographic Assessment of Spinal
Fluid for Infant Lumbar Puncture” was
accepted for platform presentation by
the American Institute of Ultrasound
in Medicine (AIUM) Scientific Program
Committee at the 2014 AIUM Annual
Convention.
Ismee Williams, MD (Cardiology) was
awarded a NIH/NICHD grant for her
project entitled, “Early Markers of Neurodevelopmental Risk in Congenital
Heart Disease.”
Michelle DiVito Wins the Pregnancy
Foundation’s Gabbe Award
Michelle DiVito, RN, MSN, Senior
Director of Research Administration
in the Department of Obstetrics and
Gynecology, is this year’s winner of
the Pregnancy Foundation’s Steven
Gabbe Award for Service. The Award
was established in 2011 to honor
Steven Gabbe, MD, one of the world’s
leading experts on the complications
of diabetes and pregnancy, and is
given each year to an individual who
has made a considerable contribution
to the Foundation.
Ms. DiVito oversees the administrative, operational, and financial aspects
of all research in OBGYN. When Mary
D’Alton, MD, Chair of the Department
of OBGYN, was appointed Chair of
the Foundation’s Scholarly Activities
Program Committee seven years ago,
Ms. DiVito began coordinating the
out to and collaborate with virtually all of the departments to see
women who have significant medical needs. Right now cardiovascular disease in pregnancy is the number one cause of maternal
mortality, and the most common medical illness we see in mothers is also heart disease. Women with congenital heart disease
are now becoming pregnant and we collaborate very closely with
many of the cardiologists in their care. Because of the Heart Center’s unique strengths in medical and surgical care, we believe
that women with complicated heart problems will be increasingly
referred to our unit, giving us the opportunity to drive down the
risk for women with cardiovascular disease and pregnancy.
We also collaborate with colleagues in nephrology, neurology,
neurosurgery, general surgery, and gastroenterology to look after
virtually all the potential complications in pregnancy. Women with
Crohn’s disease and ulcerative colitis get pregnant and their disease
may get worse during pregnancy. A patient can present with seizure
disorders for the first time in pregnancy, or may decide to get pregnant with ongoing seizure disorders. So our collaboration is key.
And with the recruitment of Dr. Arnie Advincula as vice chair
for Women’s Health we will develop very strong programs in gynecology. (Dr. Advincula is featured in this issue on page 1.)
For a mother or a pregnancy at risk probably no single person
can provide the kind of care that is required. So we are fortunate
to practice in an institution that has expertise in all aspects of
multi-specialty care on the maternal side and the pediatric side.
And we believe this collaborative program will lead to decreased
maternal and perinatal mortality and decreased morbidity.
Dr. Stanberry: I have similar feelings. There are many places
in New York where children with non-complex illnesses can get
good care, but if their illnesses are in the least bit complex, we
are the destination they should be seeking out. We have over 400
providers and we work very well together in a collaborative and
organized manner to assure the very best care available anywhere
in the world. We could not do this if we did not have remarkable
breadth and depth in all areas from anesthesia through rehab
medicine, neurology, and surgery. One of the great strengths of
Columbia is this vast pool of talented clinicians and clinical teams
that allow us to provide care to children from our city, this region,
and quite frankly, from all over the world. And one of the strongest
and broadest collaborations at Columbia is between Pediatrics
and OBGYN. Just consider our work together in Neonatology and
Maternal-Fetal Medicine and let’s face it, we have, without question one of the finest programs in the country.
Dr. D’Alton: The collaborative programs between our two
departments and others here are too numerous to mention in
this issue, so we plan to highlight many of them in upcoming
issues of Connections.
Program. Dr. D’Alton became Chair
of the Foundation this past year and
Ms. DiVito’s role expanded. She now
assists Dr. D’Alton in managing the
details of all of the Foundation’s activities, while continuing to coordinate the
Scholarly Activities Committee.
“Since the inception of my leadership of the Pregnancy FoundationAAOGF Scholarship, Michelle has
been key to its success,” says Dr.
D’Alton. “She has organized many
of the retreats, created a database
of candidates and coordinated the
many conference calls for discussion.
She is an effective facilitator who is
recognized throughout the OBGYN
research community for her complete
commitment to research in women’s
health. It has been a pleasure for me
to see this recognition translate into
the Steven Gabbe Award.”
In her role as the senior director of
research, Ms. DiVito is responsible for
planning, administering, analyzing,
monitoring, and evaluating the Department’s sponsored and non-sponsored
research activities. She has worked in
partnership with Ronald Wapner, MD,
Vice Chair of Research, to develop a
clinical research infrastructure that is
embedded in the clinical care systems
at CUMC, as well as to develop a consortium of institutions that collaborate
in research initiatives requiring large
and diverse patient cohorts. Ms. DiVito
and Dr. Wapner have worked with
clinical and basic science investigators
in OBGYN to move the department
into the top NIH-funded OBGYN
Departments nationally.
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Upcoming
Events
Fellows Corner
APRIL 25, 2014
MAY 18, 2014
Babies Hospital Alumni
Day: The Hattie Alexander
Memorial Lecture
Columbia Children’s Gala
11:00 AM, P&S AMPHITHEATRE 1
Kathryn Edwards, MD, Sara H. Sell
and Cornelius Vanderbilt Chair in
Pediatrics and Director, Vaccine
Research Program at the Vanderbilt
University School of Medicine will
speak on, “Pertussis: What are
we going to do about increasing
disease?” Michael Katz, MD will
receive the 2014 Babies Hospital
Distinguished Alumnus Award
following the lecture. For more
information, please contact Peggy
Dubner at [email protected].
6:00 - 10:00 PM, THE METROPOLITAN OPERA, LINCOLN CENTER
The inaugural gala held by the
Children’s Board at Columbia (CBC)
will feature cocktails, dinner, and a
special performance. Gala co-chairs
Cynthia Kempner and Susan York
join Karen Kennedy, MD, Chair of the
CBC. For more information, please
contact Erin Jadney at erin.jadney@
columbia.edu.
JUNE 23RD, 2014
Hope & Heroes Golf
6:00 - 10:00 PM, BALTUSROL GOLF
CLUB, NEW JERSEY
APRIL 30, 2014
Have A Heart reception
6:00 - 8:00 PM, ALICE + OLIVIA
SHOWROOM, 450 WEST 14TH
STREET, ELEVENTH FLOOR
For more information, please
contact Erin Jadney at erin.jadney@
columbia.edu.
The 18th Annual Hope & Heroes Golf
will return to New Jersey’s legendary
Baltusrol Golf Club for the first time
in seven years. Foursomes for this
popular event typically sell out, so
email Kathryn Leiby at kl2601@cumc.
columbia.edu to join the mailing list.
MAY 18, 2014
Hope & Heroes 5th
Annual Walk
The walk will once again start at
beautiful Clinton Cove Park on the
Hudson River near 55th Street. Visit
HopeandHeroesWalk.org for more
information about how you can participate. Five years, 1000’s of steps,
one goal: a cure.
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WINTER / SPRING 2014
Dr. Dina Ferdman is a 2nd year
fellow in the Pediatric Cardiology
Division. Colin’s Kids has honored
Dr. Ferdman with the Andrew King
Research Award, a $5,000 research
grant toward her work in pediatric
cardiology. The award, presented
annually, was established to
support the Colin’s Kids’ mission
of providing critical funding to
advance medical research related
to the diagnosis, life-improving treatment, prevention and
cure of congenital heart defects. Dr. Ferdman, Postdoctoral
Clinical Fellow, will use her award to support her ongoing
research on validation of a measurement of fetal cardiac
function. It is her hope that these studies will help illuminate
detection of normal and abnormal cardiac function in various forms of congenital heart disease so that physicians
can manage patients from an earlier age and better predict
their outcomes.
Dr. Amy Brown is a 2nd year fellow
in the Pediatric Pulmonary Division.
Dr. Brown is currently working on
exciting research exploring the phototherapeutic potential of naturally
derived compounds and their implications for complementary asthma
therapy. Dr. Brown’s mentor, Dr.
Charles Emala (Department of
Anesthesia), has recently published
work that illustrates the ability of
purified ginger compounds, as well as the flavonoid Quercetin, in potentiating acute smooth muscle relaxation and
acting synergistically with beta-agonist therapy. Dr. Brown
is now extending this work to other flavonoid compounds
to characterize their effect on acute airway smooth muscle
relaxation and has found that the flavonol compound
Galangin has similar relaxation properties and this has
been demonstrated in a murine myograph model. She is
now undertaking enzymatic assays and further human
myograph studies to characterize the mechanism by which
this acute relaxation takes place. Dr. Brown’s abstract of her
preliminary findings has been accepted for poster presentation at the 2014 American Thoracic Society International
Conference in San Diego.
22
GYN Surgery
CONTINUED FROM PAGE 1
now in terms of the services we provide regionally, as well as nationally?”
Dr. Advincula says. “We have the ingredients here—the existing service
lines, personnel, and expertise—to achieve national stature for sure. We
just need to focus them, and add some new elements and new expertise
to the mix.”
With a 13-year background in minimally invasive GYN surgery, Dr.
Advincula’s interest and expertise in the field are the drivers behind
his plan to build the Center for Women’s Specialized Gynecologic
Surgery at the Sloane Hospital for Women. He and his colleagues at
the Center will provide women with team counseling and advice on the
best surgical options, and then if they choose one of those options, “we
can execute it,” he says. Dr. Advincula has special expertise in robotic
surgery for complicated conditions including fibroid removal with uterine
preservation for future fertility, advanced endometriosis surgery, complex
hysterectomy (for patients with a very large uterus, a uterus involved
with pelvic adhesions, or with comorbidities like obesity), and pelvic
reconstruction.
He says he and his team aims to offer the best outcomes for surgical procedures and management, while continuing to develop new
techniques and instrumentation for GYN surgeries, and to teach others
how to perform them as well. “I’m interested in not only providing good
clinical services but also teaching others in practice how to elevate their
surgical game,” he says. To that end, the GYN division has already established a new fellowship in minimally invasive surgery since his arrival
at CUMC.
Dr. Advincula has also announced the addition of urogynecologist
and pelvic reconstructive surgeon Rosanne Kho, MD, to the division;
she will join CUMC in June. “There is a big push nationally to bring back
vaginal surgery and vaginal hysterectomy, and that’s Dr. Kho’s forte. She
is going to add a whole new element to the department,” Dr. Advincula
says.
As part of the newly created Center for Endometriosis Treatment and
Research, specialists in reproductive endocrinology and infertility will
work with specialists in other departments including Urology, Colorectal Surgery, and Radiology, “to develop a comprehensive approach to
managing patients with this complex diagnosis,” says Dr. Advincula.
Radiologists help evaluate whether endometriosis has invaded a patient’s bowel, ureter, or bladder; and during the often complex surgeries
required to treat the condition GYN surgeons collaborate with colorectal
and urologic surgeons to perform bowel resections or remove disease
from the ureter or the bladder if needed.
“The bridges we develop with other departments will also enable us
to build a nice research infrastructure so that we can study endometriosis from those different perspectives,” Dr. Advincula adds. “Columbia is
probably one of the best places to develop a Center like this because of
the resources and talent here, and no other place in the area is offering
comprehensive treatment for women with endometriosis. These are big
surgeries and we want to provide that kind of care here.”
Dr. Advincula is building another bridge through the collaborative
work he is planning with Beth Rackow, MD, Assistant Professor of
Obstetrics and Gynecology in the Division of Reproductive Endocrinology & Infertility and Director of the Pediatric and Adolescent Gynecology
program. When they reach adolescence, girls with müllerian anomalies
begin to show signs of this abnormal development of the female genital
tract, “and you really need a collaborative effort that includes a specialist
in pediatric gynecology to treat them,” he says.
To speed the process of diagnosing gynecologic disorders and
diseases Dr. Advincula foresees collaborating with colleagues in various
departments, including radiology. “Our colleagues in radiology have
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already been in touch with me about streamlining the process so
patients can get their imaging done same day. It’s awesome when you
can figure out ways to make it easy for a patient to be seen, imaged, and
set up for what will hopefully be the best treatment option for them.”
Dr. Advincula and Dr. Kho are both involved with several national and
international organizations and societies. Dr. Advincula is president-elect
for the AAGL, the largest organization of minimally invasive gynecologic
surgeons. “A lot of the things that shape what we do as clinicians comes
from these societies, so our involvement will help us be on the front end
of developments nationally and globally,” he says. “We’re going to be
able to implement things ahead of the curve in credentialing, privileging,
techniques, and technology because we’re helping setting up the policies for future practices.”
Dr. Advincula also foresees increasing the role of surgical simulation
for members of the division using both low fidelity and high fidelity simulators, and individual simulation as well as team training. While it’s easy
to simulate the work done by the surgeon at the console of the surgical
robot, “the difficulty lies in simulating everything else for the team, and
that’s hugely important,” says Dr. Advincula. “You cannot do robotic
surgery by yourself without a support team to help with all of the other
aspects of the surgery, and that’s where the team training is critically
important. This is an area that you’re going to be hearing and seeing a
lot more about within the department over the next year.
“Arnie’s arrival brings exciting changes for our department that will
not only improve upon our current programs and services but will also
advance us as a national and international leader in minimally invasive
surgery, surgical training, and simulation,” notes OBGYN Chair Mary
D’Alton. “His vision for women’s health, with its focus on collaboration,
will enhance our continued goal to provide women with the most innovative and comprehensive care available.”
“Our division is going to cover the continuum of care for women
with GYN issues from menarche all the way beyond their reproductive
years,” Dr. Advincula says. “And when we can create cross-departmental
bridges in the hospital to provide the most comprehensive care, it’s a
win-win for everybody.” — Beth Hanson
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Pediatric Surgery
CONTINUED FROM PAGE 1
drawn very talented, multifaceted surgeons who covered all the bases of
an academic career, “performing very varied surgeries in fields ranging
from neonatal, congenital, cancer, and elective work as well as teaching
in one of the most coveted fellowship programs in the country and performing clinical or basic science research.” In the coming era under his
watch, the division will recruit the same kinds of talented, multifaceted
surgeons, he says, but ensure that each faculty member has or develops
an area of special expertise. “When we blend all of that expertise together, we’re going to have a very powerful division.”
This increasing focus on training subspecialists is an acceptance that
obtaining funding from the National Institutes of Health (NIH) is more
and more difficult every year, Dr. Stylianos says. “You can’t be a generalist and do everything, and at the same time command the respect of an
NIH. In order to procure NIH funding you should be an expert.”
The division already has a very strong regional and national reputation in bariatric surgery, chest wall defects, and congenital diaphragmatic hernia, according to Dr. Stylianos. He plans to expand division
expertise in vascular malformations; bowel problems including short
bowel rehabilitation, inflammatory bowel disease, anorectal malformations; fetal care; cancer; and critical care, he says.
Medical centers throughout the region are offering increasing subspecialization, but what makes NewYork-Presbyterian Morgan Stanley
Children’s Hospital different is that the division and hospital have the expertise to care for really sick children, says Dr. Stylianos. “Most children
get better at the other places, but seriously ill and injured children who
are really in trouble end up here.” The Children’s Hospital offers highpowered expertise in areas like extracorporeal membrane oxygenation
(ECMO)—bypass machines for children whose lungs or hearts fail—and
organ transplantation. “The courage of our practitioners to try incredibly
innovative and cutting-edge strategies really sets us apart,” Dr. Stylianos
says. “We wish we could get that word out to vulnerable families and
pediatricians earlier, before kids are on desperate measures.”
For many of the conditions they treat, CUMC’s pediatric surgeons are
moving toward increasingly minimally invasive approaches. “Members
of our division like to do more for our patients by doing less to them, and
that defines the strategies for minimally invasive surgery that we now
use in almost every condition,” says Dr. Stylianos, adding that, following
minimally invasive surgery patients recover faster, and their time away
from home and their parents and siblings is shorter.
The number of surgeries the division’s surgeons now do that use minimally invasive techniques keeps growing. Almost all surgeries done on
the abdomen and chest begin, and usually end, in a minimally invasive
fashion. In the past surgeons removed lung lesions through a very large
chest incision that resulted in a significant healing period, and patients
often had subsequent problems with their ribs and developed scoliosis.
“These surgeries are done here now with the scope, and that’s been a
huge addition to the armamentarium,” Dr. Stylianos says. The standard
approach for acute appendicitis is a three-instrument procedure, but
surgeons here do them with one instrument through the belly button.
“We’ve made minimally invasive even more minimally invasive, and we
keep pushing the envelope.”
Areas of research in the division include a collaboration between
Angela Kadenhe-Chiweshe, MD, and June Wu, MD, a pediatric plastic
surgeon and basic scientist. In their vascular malformations laboratory,
the pair is uncovering some of the biological mysteries of these lesions
and hope to develop less invasive or nonsurgical treatments, sparing
children tremendous morbidity. Pediatric surgeons are also participat-
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ing in ongoing oncology research with Darrell Yamashiro, MD, PhD, and
members of the hematology/oncology division.
As division chief, Dr. Stylianos oversees all the pediatric surgeons,
“but my other hat is Surgeon in Chief of Morgan Stanley Children’s
Hospital,” he says, “so I have administrative responsibilities for all of the
surgeons who operate on children, and that’s very, very exciting because
that allows me to work very closely with Dr. Stanberry and Dr. D’Alton
shaping the strategies for women’s and children’s health, and ensure
that our women’s and children’s environment is the best it can be.”
As an example of CUMC’s expertise, and the close collaboration
between Pediatrics and OB/GYN, Dr. Stylianos tells the following story.
“Earlier in my career here as a faculty member I led the teams that separated three sets of conjoined twins. We separated the first set, two girls,
in 1993. One of those twins delivered her first baby via C-section here
very recently, and I was in the delivery room. That’s a special thing you
could see only in a place like this, where women’s and children’s care
are integrated: a baby comes into life as a conjoined twin, is separated,
rehabilitated, and then 20 years later gives birth at the same hospital
with the same surgeon at her side and an OB community that is totally in
tune with her unique anatomy and obstetrical challenges.”
Dr. Stylianos is honored to be in the same role held by his twiceremoved predecessor Peter Altman, MD, an expert in biliary diseases of
newborns, he says. “During my first period on the faculty here I sat at the
side of my personal and professional hero, Dr. Altman. He invested so
much insight and energy into me, and now I get to sit in his chair. That’s
an amazing circle for me to have closed.” — Beth Hanson
LILLIAN SJOLUND-ENGLISH, RN; CRISTIAN ACEVEDO, ELIJAH’S FATHER; DR.
KIRSTEN CLEARY, MS. TAVARES’ OBSTETRICIAN; ROSA TAVERAS WITH HER SON,
ELIJAH; DR. STEVEN ST YLIANOS, WHO SEPARATED THE TWINS IN 1993 AND IS
NOW SURGEON-IN-CHIEF OF NYP/MSCH; CARMEN TAVERAS; DR. AMY TURITZ;
LINDSAY SPRING; NATAHALIE DAVID; HEATHER DUIGNAN, RN; AND DR. JACK
MAIDMAN, ALL FROM NYP/MSCH AND SLOANE HOSPITAL FOR WOMEN.
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