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Children's National News - Spring 2012



Anthony Sandler, MD, Named Senior Vice President of the Joseph E. Robert, Jr., Center for Surgical Care

Anthony Sandler, MD, the Diane and Norman Bernstein Chair of Pediatric Surgery, has been named the Senior Vice President of the Joseph E. Robert, Jr., Center for Surgical Care at Children’s National Medical Center. Dr. Sandler has served as Acting Director of the center since September 2011, when Kurt D. Newman, MD, the prior Senior Vice President of the center, was chosen to lead Children’s National as President and CEO.

Dr. Sandler is internationally known for his work on childhood solid tumors and operative repair of certain congenital anomalies of the gastrointestinal tract. Dr. Sandler’s research interests focus on solid tumors of childhood in which he has developed markers for determining the risk of tumor recurrence. His current research in tumor immunology investigates immunotherapeutic strategies for tumors, and is supported by from multiple resources, including the National Institutes of Health.

He joined Children’s faculty in 2006 as Chief of the Division of General and Thoracic Surgery. He came to Children’s National from the University of Iowa where he held the Robert and Helene Soper Chair in Surgery and was professor and Chief of the Division of Pediatric Surgery.

Dr. Sandler’s research team with the Sheikh Zayed Institute for Pediatric Surgical Innovation is focused on the formulation and application of novel tumor vaccine therapies, especially around targeted activation of host immunity. Dr. Sandler has published more than 70 peer-reviewed manuscripts in clinical and scientific medical journals. He also has received multiple awards including several for Outstanding Teaching of Surgical Residents and was awarded the Joel Rosyln Young Investigator Award from the Association for Academic Surgeons.

View more information on the Joseph E. Robert, Jr., Center for Surgical Care.




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Unique Training Program in Transfusion Medicine and Hematology Established


Naomi L.C. Luban, MD

 


Lori Luchtman-Jones, MD

Naomi L.C. Luban, MD, and Lori Luchtman-Jones, MD, have secured funding from the National Heart, Lung, and Blood Institute (NHLBI) at the National Institutes of Health (NIH) for a new pediatric transfusion medicine and hematology research program with the Children’s Research Institute at Children’s National. The program will prepare candidates for academic leadership and research careers.

The program, the Pediatric Hematology and Transfusion Medicine Multidisciplinary Research Training Award, encourages diversity among trainees and will draw upon the strengths of the partnering organizations, including a wide range of senior mentors, as well as an infrastructure to support trainee research from the Clinical and Translational Science Institute at Children’s National (CTSI-CN). The center is a Clinical and Translational Science Awards Institution, a consortium that is funded by the National Center for Advancing Translational Sciences, part of the National Institutes of Health.

The program also leverages faculty and resources from several institutions and agencies, including George Washington University, the NIH, American Red Cross, the U.S. Food and Drug Administration, and Howard University School of Medicine. This collaboration is deemed a unique and innovative approach to filling a gap in the number of researchers and pediatric subspecialists in hematology and transfusion medicine.

“There is a serious need for multidisciplinary approaches to addressing important clinical questions in these fields,” said Dr. Luban, Chief of Laboratory Medicine at Children’s National and director of the new program. “This highly collaborative and inter-institutional program focuses on advancing clinical and translational scholarship in the diagnosis and clinical management of hematological, cardiovascular, and pulmonary disorders, transfusion and transplantation. It also addresses the lack of well-trained clinical and translational investigators in pediatric subspecialty fields.”

Applications from pediatricians (U.S. citizens or permanent residents) who are enrolled in a relevant fellowship will be accepted in May for a July 1, 2012, start. Each trainee in this two-year program will complete a Master’s degree in Clinical and Translational Science at the George Washington University School of Medicine and Health Sciences and will devise and implement a research project under the mentorship of a senior investigator and multidisciplinary mentorship team.

Learn more about the Hematology Division at Children’s National.

Learn more about Transfusion Medicine Research at Children’s National.



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Children’s National Researchers Gain Better Understanding of White Matter Protectection in Infants Receiving Heart Surgery

A collaborative team of researchers at Children’s National are making progress in understanding how to protect infants needing cardiac surgery from white matter injury, which impacts the nervous system. The synergistic team from the Children’s National Heart Institute and Center for Neuroscience Research at Children’s Research Institute was led by Nobuyuki Ishibashi, MD, Joseph Scafidi, DO, Richard Jonas, MD, and Vittorio Gallo, PhD. The study, published online in the January edition of Circulation, identifies the stages of white matter development, as well as the areas and cells of the brain that are impacted by the amount of oxygen and any inflammation in infants with complex cardiac issues that affect brain oxygenation and cause swelling.

The most common neurological deficits seen in children with congenital heart defects requiring cardiac surgery are fine and gross motor deficits, which are consistent with white matter injury. The study, using a porcine cardiopulmonary bypass (CPB) model, monitored how the regions of white matter responded to CPB at 1, 3, and 7 weeks of age. In some groups, observation involved CPB with a lack of oxygen (hypoxia) and inflammation. The results found that white matter injury was dependent on the area’s stage of maturity. Additionally where there was hypoxia and inflammation, the team saw a halt in the progression of white matter development, or oligodendroctye cell maturation and lineage, which is known to lead to neurological deficits. Four weeks after surgery with CPB that induced hypoxia and inflammation, the team determined that white matter cells were no longer growing and maturing, a finding consistent with the neurological deficits in complex congenital heart disease patients, who are at higher risk of ischemia and inflammation that often occur after frequent hypoxia.

“Being able to identify the stage in which certain cells are more vulnerable to disruptions brings us much closer to understanding the mechanisms of white matter injury and could eventually help us create strategies and treatment methods to protect those cells in young patients who will need to undergo cardiopulmonary bypass,” stated Nobuyuki Ishibashi, MD, lead author of the study and Laboratory Director of Cardiac Surgery. “This study also provides evidence that CPB surgery must be managed precisely to avoid inducing further hypoxia and inflammation in these already fragile patients.”

Oligodendrocyte cells are the type of brain cells that make up white matter and serve as the primary messaging “network” that conducts signals rapidly between gray matter areas. Without it, the brain does not function properly. Myelination, or growth of white matter, in humans begins in utero at around 5 months of gestation and continues throughout the first two decades of life. This process involves the maturation of oligodendrocyte cells through different stages; if there is a disruption, for example from a lack of oxygen or inflammation, these cells and the subsequent stages, or lineage, can’t develop the way that they should, resulting in neurological deficits.

“Interestingly, the white matter response we saw in the group that experienced hypoxia and inflammation is very similar to what you see in patients with complex congenital heart disease,” stated Richard Jonas, MD, Chief of Cardiac Surgery. “If we can start to understand the mechanics of white matter development and how a lack of oxygen and inflammation affects the brain, we will be able to contribute to the treatment strategies for patients with congenital heart disease.” Congenital heart disease is the leading birth defect, affecting almost one in every 100 infants each year. For successful white matter development in congenital heart disease patients, it is imperative to understand how CHD and its treatments affect the growth and repair of white matter.

Director of the Center for Neuroscience Research, Vittorio Gallo, PhD, commented, “This study provides us with further evidence of the critical time windows that exist in white matter development and the importance of understanding the mechanisms of white matter development so that we might possibly ease white matter damage in patients.”

Myelination, white matter growth and repair, and the study of complex mechanisms of prenatal brain development are a key focus of the Center for Neuroscience Research at Children’s National, which also houses the White Matter Diseases Program, one of the largest clinical programs in the country for treating children with disorders that cause the brain’s white matter to degenerate. Congenital heart disease and other cardiac conditions are the main priority of the Children’s National Heart Institute, an international leader in providing comprehensive care for infants, children, and adults.


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Children’s National Adds Robotic Surgery for Urology to Surgical Specialties

Children’s National has added robotic surgery as a minimally invasive option for some pediatric urologic procedures. The team, led by international robotic surgery expert Craig Peters, MD, and a trained team of surgical support staff, will use the daVinci Surgical System to provide an additional minimally invasive surgical option for children requiring several common urologic surgical procedures.

Children’s National is the region’s only team to use a surgical robotic system solely in pediatric procedures. While surgical robotics are common for adult procedures like prostate surgery, the application of this system in children’s hospitals has, to date, been limited to pediatric urology.

“Early results show promise as a minimally invasive surgical option for children for pediatric urology,” said Dr. Peters, urologist and Chief of the Division of Surgical Innovation, Technology, and Translation, who has applied surgical robotics techniques for the last 10 years. “Our hope at the Sheikh Zayed Institute is that our team of engineers, scientists, and expert pediatric surgeons will allow us to develop innovative uses for robotic surgery to minimize pain and recovery for children needing surgery.”

Both the hiring of Dr. Peters and the addition of the daVinci Surgical System to Children’s National were made possible through the clinical and research efforts of the Joseph E. Robert, Jr., Center for Surgical Care and the Sheikh Zayed Institute for Pediatric Surgical Innovation, which share a significant interest in developing more precise, less invasive, and pain-free surgery for children. The team will begin with pediatric urologic procedures and conduct research on how the precision of this system will benefit other procedures, including general surgery procedures.

“The arrival of this robotic surgery system is another logical step toward improving surgical care for children,” said Peter Kim, MD, PhD, Vice President of the Sheikh Zayed Institute and Associate Surgeon in Chief at Children’s National. “Our efforts to enhance these technologies and emphasize training through simulation will ensure that more precise, less painful methods and devices become sustainable for future generations of children needing surgery, and eventually may make surgery without any incisions possible.”

In addition to the clinical robotic system, Children’s National also will add a robot for training and research, which will be housed in the bioengineering laboratory at the Sheikh Zayed Institute. This research-based robot will be used to train more surgeons on the system and allow doctors and engineers to create new tools that surgeons can use with the surgical system to perform additional procedures on other areas of the body.


Read an article in the Spring 2012 issue of Medical Currents about Minimally Invasive Surgery in Children.

Children’s National Division of Urology

Sheikh Zayed Institute for Pediatric Surgical Innovation Blog



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Children’s National Health Network Presents: Future of Pediatrics 2012: “PRACTICAL PEDIATRICS FOR PRACTICAL PEDIATRICIANS”: Partners in Care.

RSVP Today!
Join Children’s National Alumni at the Future of Pediatrics 2012 meeting.

Two days-Twice the CME!

Wednesday, June 13 – Thursday, June 14, 2012
Location: Bethesda North Marriott Hotel & Conference Center (at White Flint Metro)

Register now!

RSVP: www.ChildrensNational.org/CNHN

Watch CME sessions from past conferences.



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Publications

Abnormal Cardiac Strain in Children and Young Adults with HIV Acquired in Early Life.
Sims A, Frank L, Cross R, Clauss S, Dimock D, Purdy J, Mikhail I, Hazra R, Hadigan C, Sable C.
J Am Soc Echocardiogr. 2012 Apr 26. [Epub ahead of print]
PMID: 22542272 [PubMed - as supplied by publisher]
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Acute evaluation of pediatric patients with minor traumatic brain injury.
Tavarez MM, Atabaki SM, Teach SJ.
Curr Opin Pediatr. 2012 Apr 20. [Epub ahead of print]
PMID: 22525719 [PubMed - as supplied by publisher]
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Implementation of proteomic biomarkers: making it work.
Mischak H, Ioannidis JP, Argiles A, Attwood TK, Bongcam-Rudloff E, Broenstrup M, Charonis A, Chrousos GP, Delles C, Dominiczak A, Dylag T, Ehrich J, Egido J, Findeisen P, Jankowski J, Johnson RW, Julien BA, Lankisch T, Leung HY, Maahs D, Magni F, Manns MP, Manolis E, Mayer G, Navis G, Novak J, Ortiz A, Persson F, Peter K, Riese HH, Rossing P, Sattar N, Spasovski G, Thongboonkerd V, Vanholder R, Schanstra JP, Vlahou A.
Eur J Clin Invest. 2012 Mar 27. doi: 10.1111/j.1365-2362.2012.02674.x. [Epub ahead of print]
PMID: 22519700 [PubMed - as supplied by publisher]
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High Prevalence of Respiratory Ciliary Dysfunction in Congenital Heart Disease Patients with Heterotaxy.
Nakhleh N, Francis R, Giese RA, Tian X, Li Y, Zariwala MA, Yagi H, Khalifa O, Kureshi S, Chatterjee B, Sabol SL, Swisher M, Connelly PS, Daniels MP, Srinivasan A, Kuehl K, Kravitz N, Burns K, Sami I, Omran H, Barmada M, Olivier K, Chawla KK, Leigh M, Jonas R, Knowles M, Leatherbury L, Lo CW.
Circulation. 2012 Apr 12. [Epub ahead of print]
PMID: 22499950 [PubMed - as supplied by publisher]
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Retrospective comparative analysis of metabolic control and early complications in familial and sporadic type 1 diabetes patients.
Lebenthal Y, Shalitin S, Yackobovitch-Gavan M, Phillip M, Lazar L.
J Diabetes Complications. 2012 Apr 18. [Epub ahead of print]
PMID: 22520402 [PubMed - as supplied by publisher]
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Biologically targeted therapeutics in pediatric brain tumors.
Nageswara Rao AA, Scafidi J, Wells EM, Packer RJ.
Pediatr Neurol. 2012 Apr;46(4):203-11.
PMID: 22490764 [PubMed - in process]
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Biomarkers of Brain Injury in Neonatal Encephalopathy Treated with Hypothermia.
Massaro AN, Chang T, Kadom N, Tsuchida T, Scafidi J, Glass P, McCarter R, Baumgart S, Vezina G, Nelson KB.
J Pediatr. 2012 Apr 10. [Epub ahead of print]
PMID: 22494878 [PubMed - as supplied by publisher]
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Cognitive profiles of neurofibromatosis type 1 patients with minor brain malformations.
Acosta MT, Walsh KS, Kardel PG, Kutteruf RE, Bhatt RR, Bouton TC, Vezina LG, Packer RJ.
Pediatr Neurol. 2012 Apr;46(4):231-4.
PMID: 22490768 [PubMed - in process]
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A calm before the exome storm: Coming together of dSMA and CMT2.
Hoffman EP, Talbot K.
Neurology. 2012 Mar 28. [Epub ahead of print]
PMID: 22459684 [PubMed - as supplied by publisher]
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Validation and use of the Children's Hope Scale-revised PTPB edition (CHS-PTPB): high initial youth hope and elevated baseline symptomatology predict poor treatment outcomes.
Dew-Reeves SE, Athay MM, Kelley SD.
Adm Policy Ment Health. 2012 Mar;39(1-2):60-70.
PMID: 22407561[PubMed - in process]
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