NYU The Magazine of New York UnivePhrsity School of Medyicine siciaSPRING 2013n volume 64 • No. 3

THE COURAGE TO CUT A Journey Into the Hearts and Minds of NYU Langone’s Neurosurgeons

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Dr. Glenn Saxe on Sandy Hook Earning an MD How Molecular Autopsies Can and Childhood Trauma in Three Years Help Solve Mysterious Deaths Help Us Make Dreams Come True

EVERY ASPIRING PHYSICIAN DREAMS OF THE DAY SOMEONE WILL MAKE A GIFT ONLINE CALL HIM OR HER “DOCTOR” FOR THE FIRST TIME. But getting there Please visit www.nyu.edu/alumni. takes a lot more than hard work and dedication—it takes resources. By contributing to the NYU School of Medicine Alumni Campaign, you help To discuss special ensure that our next generation of physicians will have access to the best giving opportunities, teaching and research, along with a competitive financial assistance package. call Anthony J. Grieco, MD, Associate Dean for Alumni Relations, When you make a gift, you help us guarantee that all of our students will at 212.263.5390. have the means to complete our rigorous education. One day, you may even have the privilege of addressing them yourself as “Doctor.”

Thank you for your generosity. THE MAGAZINE OF NEW YORK UNIVERSITY SCHOOL OF MEDICINE SPRING 2013 VOLUME 64 NO. NYUPHYSICIAN 3

New York University Martin Lipton, Esq. Chairman, Board of Trustees COVER STORIES DEPARTMENTS

John Sexton The Courage to Cut 02 Message from the Dean President A journey into the hearts and minds of Because It Is Brain Surgery 08 NYU Langone’s neurosurgeons. Robert Berne 03 News from Medicine Executive Vice President Missed Connections for Health • When Leukemia Rebounds • An emerging theory of autism links social • A Strategy to Drive Leukemia Cells NYU Langone 16 isolation to faulty circuits in the brain. Out of Hiding Medical Center • One Access Point for Two Deadly Diseases A Matter of Degrees Kenneth G. Langone • Every Breath You Take A new option to earn an MD in three Chairman, • A Chemical Clue to Aging Board of Trustees 18 years aims to help some students save time and money. Robert I. Grossman, MD 14 Faculty Conversation Dean and Chief The Heart of the Matter Dr. Glenn Saxe on Sandy Hook and Executive Offi cer childhood trauma. • How molecular autopsies are solving 20 mysterious deaths— and saving lives. NYU PHYSICIAN 24 Tools of the Trade Steven B. Abramson, MD In praise of the stethoscope. Anthony J. Grieco, MD Editors, Science 26 Faculty News and Medicine • Dr. Vilcek Honored at White House Marjorie Shaffer Awards Ceremony Editor • Dr. Littman Receives Inaugural Ross Prize from Molecular Medicine Nicole Dyer • NYU Langone’s Nurses Honored for Contributing Editor Their Heroism during Hurricane Sandy Sherry Zucker Print Production 28 End Page Coordinator Dr. Abramson to Chair Medicine

Segal Savad Design Art Direction

Nancy E. Sherman Copy Editor Molecular autopsies can • help medical examiners ON THE COVER: ILLUSTRATION BY pinpoint the cause of a GREGORY MANCHESS mysterious death, identify lethal mutations that might run in families, and 2(S)A F C03 Fragment base #6 Base 108 even solve crimes. ILLUSTRATION: GETTY IMAGES ILLUSTRATION:

NYU PHYSICIAN SPRING 2013 1 MESSAGEFROMTHEDEAN&CEO

Because It Is Brain Surgery LONG BEFORE I BECAME DEAN & CEO OF NYU LANGONE MEDICAL CENTER, I began a residency in neurosurgery. Though I eventually changed course, deciding on the field of radiology, I never lost my fascination, my respect, my awe, for the mysteries and marvels of the human brain. Indeed, that passion for neuroscience steered me toward neuroradiology as a subspecialty. So while I try not to play favorites, I must admit that neurosurgery and neurosurgeons, whom I’ve consulted with closely for many years, hold a special place in my heart.

I’m immensely proud of our Department of Neurosurgery, which has a long and distinguished history, and I’m delighted to see it featured in this issue. It’s a well deserved tribute to a remarkable team of surgeons. Fifty years ago, the late Joseph Ransohoff, MD, chair of our Department of Neurosurgery from 1962 to 1992, served as medical consultant to the pioneering TV series Ben Casey, whose title character was loosely modeled after the brash, brooding surgeon. For several consecutive years, U.S. News & World Report’s Best Hospital Rankings has placed our program in neurosurgery among the top 10 in America. In the last two years, the Department has become even stronger, recruiting several outstanding neurosurgeons, some of them world-renowned for their expertise in certain subspecialties. What heartens me most about these master surgeons is their compassion and can-do attitude. As one of them puts it: “Many patients are told that their tumor is ‘inoperable,’ but then they come here and they survive.” I think you’ll enjoy this inspirational journey into their hearts and minds. •

DEAN & CEO ROBERT I. GROSSMAN, MD

NYU PHYSICIAN PHOTOGRAPH BY 2 SPRING 2013 JOHN ABBOTT NEWSFROMMEDICINE

When Leukemia Rebounds Genetic mutations linked to relapse in common childhood cancer point the way to new treatments. Julia Meyer

EVERY YEAR in the United William Carroll States, roughly 6,000 patients are diagnosed with acute lymphoblastic leukemia (ALL), a disease in which the body’s bone marrow produces a glut relapse,” he says. mutations that of lymphocytes, or white blood In the new study, led by Dr. changed the genetic cells. Improved chemotherapy Carroll and graduate student code over the course and other treatments have Julia Meyer and published of the disease. dramatically boosted the cure in the March issue of Nature Intriguingly, two rate of ALL, the most common Genetics, researchers analyzed patients harbored type of childhood cancer, to bone marrow samples from a mutation in the about 80 percent. For the 10 pediatric ALL patients for same gene, NT5C2, unfortunate 20 percent of telltale clues to the disease’s which encodes an children who relapse after a progression. After receiving enzyme that regulates some bout with the aggressive blood- samples from the Children’s DNA building blocks but can A micrograph of a white borne disease, however, the Oncology Group, the medical also degrade an important class blood cell. In acute prognosis remains dire. researchers painstakingly of drugs used in ALL therapy. lymphoblastic leukemia, white blood cells turn “There has been no progress pieced together a complete When the researchers fully malignant and flood the in curing children who relapse, sequence of ribonucleic acid, sequenced the NT5C2 gene in 61 bone marrow. in spite of giving them very or RNA, extracted from each other cases in which pediatric high doses of chemotherapy patient’s bone marrow—or ALL patients had relapsed, and bone marrow about 100 billion letters of they found five more mutations transplantation,” says William RNA in all. “It took years of that had altered the gene. therapeutics at the Dana- L. Carroll, MD, director of NYU effort analyzing samples from Experiments suggested that Farber/Children’s Hospital Langone Medical Center’s the same patient at diagnosis these seven NT5C2 mutations Cancer Center in Boston, Cancer Institute and the and relapse,” Dr. Carroll says. all made the cancer cells more says the discovery may help Julie and Edward J. Minskoff RNA is an essential resistant to chemotherapy. clinicians create personalized Professor of Pediatrics. intermediary in the cellular By identifying a specific treatment strategies.

CE Dr. Carroll’s team may now process that uses DNA disease mechanism, the “This paper identifies an be closer to changing that grim blueprints to assemble finding may help doctors abnormal enzyme that could reality with the discovery of proteins, meaning that a detect the early emergence be specifically targeted and CE SOU R 20 genetic mutations linked complete RNA sequence can of chemotherapy-resistant exploited in some patients with to relapse, including one that give researchers a view of all leukemia cells and adjust their relapsed leukemia,” Dr. Place / SC IEN may allow ALL to reemerge active genes within a patient’s strategy before the disease can says. Inhibiting the enzyme months or years after the leukemia cells. By comparing fully reassert itself. Andrew may also prove useful in initial initial diagnosis. “For the the sequences at the moment Place, MD, PhD, an instructor ALL therapies, he says, helping

CHMEISSN ER first time, we have pinpointed of diagnosis and upon relapse, in pediatrics at Harvard doctors prevent those relapses genetic mutations that lead to the team found that most Medical School and associate in their pediatric leukemia chemotherapy resistance and patients had acquired multiple director of developmental patients. —BRYN NELSON STEVE G S •

NYU PHYSICIAN SPRING 2013 3 NEWSFROMMEDICINE

A Strategy to Drive Leukemia Cells Out of Hiding Tim Cardozo Eliminating a mutated protein points the way to new Iannis Aifantis cancer therapies.

IANNIS AIFANTIS, PHD, to fight off infections and bleed blood cells. “Blood stem cells Fbw7—that is, by releasing the had been studying leukemia too easily. In about 25 percent activate only occasionally, when clamp on hematopoietic stem for years when, in 2007, he hit of cases, patients die due to we need them, like during an cells and letting them divide upon a discovery that would take irreparable damage to vital accident when we’ve lost blood,” and grow unchecked—he his research in an unexpected organs and the central nervous Dr. Aifantis explains. When hypothesized that he could direction. At the time, Dr. system. Fbw7 is mutated or removed drive leukemia-inducing stem Aifantis, professor of pathology It was while studying blood altogether, he found, the throttle cells out of dormancy and into at NYU Langone Medical Center samples from T-ALL patients is prematurely released and the crosshairs of the medication. and an Early Career Scientist that Dr. Aifantis noticed stem cells grow and divide His team’s latest research at Howard Hughes Medical something peculiar. About 25 unrestrained. In stem cells with bears out his hypothesis. In a Institute, had been teasing out percent of his samples harbored leukemia-causing mutations, the recent issue of Cancer Cell, Dr. the molecular workings of a a mutated version of a protein result is cancer. Aifantis and his team showed type of pediatric cancer known called Fbw7. In healthy people, This dramatic insight into the that deleting Fbw7 thwarts as T-cell acute lymphoblastic Fbw7 acts like a clamp on mechanics of leukemia turned cancer in mice treated with leukemia. T-ALL, as it’s called, hematopoietic stem cells, the Dr. Aifantis’s mind to a related tyrosine kinase inhibitors. A afflicts about 1,000 children precursors that give rise to every type of cancer, chronic myeloid report in the same issue by a in the United States each year, type of blood cell. With the leukemia, or CML, a disease team from Japan corroborates causing the overproduction of clamp in place, these stem cells diagnosed in about 5,000 the finding. Even more immature white blood cells. remain in a dormant state until Americans, mostly adults, encouraging, the results are not Many sufferers lose the ability it’s time for them to mature into each year. Like T-ALL, CML is confined to animals: Human a disease of excess white blood leukemia-inducing stem cells cells that leads to abnormal also failed to develop in the bleeding and infection. But absence of Fbw7 when treated unlike T-ALL, CML can be with tyrosine kinase inhibitors. treated with a class of drugs The challenge now is known as tyrosine kinase figuring out how to bring the inhibitors. “It’s the golden science out of the lab and into example of targeted therapy,” the clinic. Here, Dr. Aifantis says Dr. Aifantis. is partnering with Timothy Unfortunately, the cancer Cardozo, MD, PhD, associate often returns once patients stop professor of biochemistry and the medication. Dr. Aifantis molecular pharmacology, to believed his new understanding screen thousands of compounds CE of the Fbw7 protein could for ones that could temporarily change that. By eliminating block Fbw7 and drive cancerous stem cells out of hiding. “The CE SOU R hope is that we will one day be

able to eradicate these types of / SC IEN Mutations in a protein leukemia,” Dr. Aifantis says. called Fbw7 cause MURTI “Someone should try to find AL leukemia cells, seen here P in a micrograph, to grow a cure, even if it’s for only one and divide unrestrained. . GO patient.”• —JESSICA WAPNER DR

NYU PHYSICIAN ILLUSTRATIONS BY 4 SPRING 2013 LEANDRO CASTELAO One Access Point for Two Deadly Diseases Nathaniel Landau Victor Torres A serendipitous collaboration reveals a common link between HIV and Staph infections that could be used to treat both. Derya Unutmaz SEVENTEEN YEARS ago, experimented with immune Derya Unutmaz, MD, associate cells that Dr. Unutmaz had professor of microbiology developed during his previous and pathology and medicine, HIV research, including a and Nathaniel Landau, PhD, genetically engineered T cell professor of microbiology, that has excess copies of the helped identify a protein on the CCR5 receptor decorating its outer surface of the immune surface. When the scientists system’s T cells that HIV can exposed these cells to a purified exploit. The team discovered that Staph toxin called LukED, all the virus uses a receptor called the cells died. Cells that had CCR5 like a perch to penetrate T been completely stripped of the cells and launch an infection that receptor, however, resisted the can progress to AIDS. toxin’s effects and survived. A new collaboration with Other studies have Victor J. Torres, PhD, assistant revealed a remarkably similar professor of microbiology, has phenomenon in HIV infection: implicated the same receptor as Due to a genetic mutation, about a critical access point for a toxin 1% of Northern Europeans released by Staphylococcus completely lack the CCR5 aureus. The bacterial pathogen receptor on their T cells and is infamous as a hospital scourge are thereby protected against A micrograph of Staph real clinical advance.” that kills an estimated 100,000 infection. The NYU Langone bacteria. Staph toxins may Given the results, the CCR5 people in the U.S. every year. In a collaborators’ research suggested one day help prevent HIV receptor could become a focal infection. study published in the January 3 that the LukED toxin does point for new anti-HIV strategies issue of Nature, the collaborators indeed share a common target as well. Dr. Unutmaz, for exam- also discovered that an anti-HIV with HIV, in this case using the ple, wonders whether clinicians medication that blocks access to CCR5 receptor as a landing pad The result, says Dr. Unutmaz, could protect the body’s vulner- the vulnerable receptor might from which the toxin can lethally was remarkable. “Maraviroc able mucosal areas by ridding prevent both the virus and Staph puncture the immune cells. completely blocked the toxic them of CCR5-bearing cells that toxin from ever gaining a toehold. If removing CCR5 from T cells effects of LukED at doses would otherwise be targeted by

CE “What are the chances that warded off Staph infections, the similar to those used to inhibit the virus. His lab is also explor- a drug for HIV could possibly researchers wondered, could HIV infection.” ing the possibility of using the treat a virulent Staph infection?” simply blocking access to the Dr. Torres was equally LukED toxin to target and kill CE SOU R asks Dr. Torres, the study’s receptor have the same beneficial surprised. “While maraviroc CCR5-containing T cells that senior author, who notes that effect? To find out, they treated does not protect other immune harbor hidden reservoirs of HIV. the surprising findings could T cells with maraviroc—an anti- cells from the other leukotoxins, “These are highly speculative LLIPS / SC IEN I hold major implications for HIV medication that clings to it might give the immune approaches, of course, but it’s

. PH devising new clinical strategies. CCR5 and makes it inaccessible system the upper hand in exciting,” he says. “One break-

ID M The serendipitous discoveries to the virus—and then exposed controlling a Staph infection,” through 17 years ago may beget

DAV began when the researchers the cells to the Staph toxin. he says, “and that would be a another.” • —RENEE TWOMBLY

NYU PHYSICIAN SPRING 2013 5 NEWSFROMMEDICINE

Every Breath You Take Scientists discover a way to trace the motor neurons Jeremy Dasen central to healthy breathing.

ABOUT HALFWAY up the back natural rhythm of breathing. Neuroscience that they have of the neck, just above the fourth Harming the spinal cord discovered a genetic fingerprint Polyxeni Philippidou cervical vertebra, lies a group region where the PMC resides of PMC neurons as well as the of muscle-controlling nerve can instantly shut down two key genes that control their cells that Jeremy Dasen, PhD, breathing. But relatively development. The study was in Quebec, the researchers assistant professor of physiology little is known about what hailed as a “major milestone” in ultimately identified two genes, and neuroscience, calls “the distinguishes these neurons an accompanying commentary. Hoxa5 and Hoxc5, as the prime most important motor neurons from their neighbors and “We now have a set of controllers of proper PMC in your body.” These several how PMC neurons develop molecular markers that development. Hox genes are hundred cells, collectively and wire themselves to the distinguish PMC cells from well-known as regulators of known as the phrenic motor diaphragm in the fetus. other populations of motor animal development. column (PMC), relay a constant Scientists are now a step neurons so that we can study When the scientists pulse of signals from their closer to answering those them in detail and look for silenced Hoxa5 and Hoxc5 in bundled axons down to the questions. Dr. Dasen and his ways to selectively enhance embryonic motor neurons, the diaphragm muscles, causing the colleagues reported in the their survival,” Dr. Dasen says. PMC failed to form its usual, lungs to expand and relax in the December issue of Nature Such information could be tightly columnar organization the key to keeping these vital and failed to connect to the neurons alive in patients with diaphragm, leaving newborn amyotrophic lateral sclerosis mice unable to breathe. “Even An X-ray of the cervical (ALS), a debilitating and if you delete these genes late spine of a 46-year-old incurable disease that kills in fetal development, the woman. New research motor neurons, or in patients PMC neuron population reveals how cervical nerves along the fourth vertebra with injuries to nearby parts drops and the phrenic nerve control breathing. of the spine. doesn’t form enough branches To find out how PMC neurons on diaphragm muscles,” Dr. differ from their spinal neigh- Dasen says. In other words, bors, postdoctoral fellow Polyx- the genes play a crucial role in eni Philippidou, PhD, injected establishing and maintaining a fluorescent dye into one of the early neuronal connections the phrenic nerves, which wire needed for every breath. the PMC to the diaphragm. Dr. The study will help Dr. Dasen Philippidou then looked for the and those in his lab understand spinal neurons that lit up as the the wider circuitry of breath- tracer worked its way back up to ing as well—including neurons the PMC. After noting the char- in the brain stem that regulate acteristic pattern of gene activity breathing in response to carbon within these PMC neurons, Dr. dioxide levels, stress, and other CE Philippidou began to determine environmental factors. “Now

the genes’ specific roles. that we know something about CE SOU R Working with a complicated PMC cells,” Dr. Dasen adds, “we strain of transgenic mice, based can work our way through the partly on mice supplied by broader circuit, to try to figure collaborator Lucie Jeannotte, out how all those connections are CK G. / SC IENRRI CK G. established.” —JIM SCHNABEL PhD, at the University of Laval • WA

NYU PHYSICIAN ILLUSTRATIONS BY 6 SPRING 2013 LEANDRO CASTELAO A Chemical Clue to Aging Study shows roundworms use nitric oxide to live longer. Could humans do the same?

SCIENTISTS HAVE long “In worms, we now know puzzled over the fact that some that bacteria can use nitric bacteria can dramatically oxide not only to their own Evgeny Nudler boost the health and life advantage but also to provide spans of their hosts—the their host with a beneficial organisms in which they dwell. response, and the same thing Evgeny Nudler, PhD, the Julie could be true in a human gut,” Wilson Anderson Professor Dr. Nudler says. “It may well of Biochemistry and newly be the case that our commensal appointed Howard Hughes bacteria control some of our Medical Institute investigator, genes, at least in the gut, to recalls being particularly protect those cells against struck by research suggesting stress and aging.” that a roundworm can survive Dr. Nudler’s lab used roughly 50% longer than fluorescent labels and other its average two-week life techniques to document how expectancy simply due to the the worm hijacks nitric oxide type of bacteria it hosts. from a soil-dwelling bacterium In a study published in called Bacillus subtilis that is both February in Cell, a team led by a favored food and a common Dr. Nudler and Ivan Gusarov, colonist within its gut. Once PhD, research assistant nitric oxide penetrates the professor, traces part of that worm’s tissue, the researchers difference in roundworm discovered, it helps activate a longevity to the ability of host set of 65 genes, including some bacteria to make nitric oxide, a previously implicated in stress chemical messenger implicated resistance, immune response, The roundworm, in everything from nerve and increased life span. shown here beneath a fluorescence microscope, signaling to blood flow. The new Crucially, the chemical’s control lives longer when it hosts study, funded in part by Timur over these genes requires the certain bacteria. Artemyev, concludes that nitric presence of two regulatory oxide sends a signal to activate proteins that are evolutionarily multiple genes in the worm that conserved from worms to this finding holds several molecule produced by one may protect it from stress and humans and act like master important medical implications. organism can dramatically extend its life. switches to turn on or off the Unlike worms, we make our affect the physiology and even The worm, Caenorhabditis vast majority of the genes. own nitric oxide. However, levels life span of another organism

CE elegans, is a common stand-in for When the researchers gradually decrease over time, through direct cell signaling,” humans in studies of the aging corrected a defect that prevented a decline he speculates could Dr. Nudler says. Given the

CE SOU R process, and the discovery mutant B. subtilis from producing contribute to aging and could potential for nitric oxide– suggests how the microbiome, nitric oxide—thereby restoring be at least partially reversed generating microbes to likewise the trillions of bacterial / SC IEN the worm’s supply of the by supplemental bacteria pay big dividends in the human S colonists on and within chemical—they increased the supplying some of the missing gut, he adds, “I think it’s a

PAVE our bodies, might similarly average life span of the worm by compound. very interesting direction to

HEITI influence human health. about 15%. Dr. Nudler believes “It’s striking that a small explore.” • —BRYN NELSON

NYU PHYSICIAN SPRING 2013 7 • the coura e to

A Journey Into the Hearts and Minds of NYU Langone’s Neurosurgeons

BY THOMAS RANIERI PHOTOGRAPHS BY JOSHUA BRIGHT

NYU PHYSICIAN 8 SPRING 2013 Dr. John Golfinos, chair of the Department of Neurosurgery, at home with his daughter Phoebe. “ What makes a great neurosurgeon is his thinking. It’s not about technical skills. It’s about knowing what you can and can’t touch, what you can and can’t move. A great neurosurgeon can almost see through things.” — Dr. Anthony Frempong-Boadu •••

pleasures, joys, laughter, and jests, as well as our sorrows, pains, grief, and fears.” Chandranath Sen, MD, professor of neurosurgery and director of the Division of Skull Base Surgery, speaks of “the sacred privilege” of being a neurosurgeon. “When I first meet a patient, that person has never seen me before, yet he or she is willing to put their T’S TAKEN HOURS of painstaking chair of the Department of Neurosurgery. life in my hands. This is the weakest work—prepping, cutting, sawing, “Either I try to remove every last bit of moment in that person’s life—they are drilling, and clamping—to get here, but this tumor, or I leave some behind. Most of lost, helpless, scared to death. I have Dr. John Golfinos has finally reached the time, the tumor will keep growing. But to treat this person very gently. I never his destination: the first of two benign if you try to get it all, there’s often a cost to take the risk. It’s the patient who takes tumors he’ll be removing from the the patient. You’re constantly doing risk- the risk. He or she must have courage. I patient’s brain. During an especially benefit analysis. That’s why you have to must have conviction. Before a big case, I delicate part of the procedure, he shares know the patient as well as you can. You meditate. It gets my mind in the zone.” a piece of wisdom, born of 17 years must have a sense of what he or she would That gentleness, says Dr. Sen, must of experience as a lead surgeon, with be willing to sacrifice to extend their life. carry over into the OR. “The brain has the his assisting surgeon, a seventh-year I’m amazed at how much more aggressive consistency of Jell-O. A tumor feels like a resident. “Now, when you get to this I was just 10 years ago. As you get older, piece of meat. The nerves are like small wet part,” he says quietly, peering through all the complications and consequences noodles,” he explains. “You must peel away the eyepieces of a large overhead start to weigh on you.” the meat without disrupting the Jell-O. microscope, “you have to have the Dr. Golfinos and his colleagues in Along the way, you must be careful not to courage to cut.” the Department of Neurosurgery are damage any blood vessels, which could The courage to cut. The phrase ever mindful of their unique, profound cause a stroke, or nerves, which could cause goes to the heart of what it means to responsibility: treating blindness, deafness, paralysis, or be a neurosurgeon, and what makes the organ that, more than other problems. To succeed, you ABOVE Dr. Anthony neurosurgeons a breed apart. “Sometimes any other, makes us who Frempong-Boadu, must have the touch of a woman— you face a tough decision,” explains we are. “From the brain director of the and the heart of a lion. Once you are Dr. Golfinos, associate professor of Division of Spinal and the brain only,” noted Surgery, at his home done with the operation, the brain neurosurgery and otolaryngology and Hippocrates, “arise our in the country. must never know you were there.”

NYU PHYSICIAN 10 SPRING 2013 Is it any wonder that neurosurgeons The marvels of the human brain as little as 8 to 10 seconds, the result is speak so reverentially of this three- don’t end there, of course. An organ unconsciousness. After 30 seconds or pound mass of pinkish-gray tissue whose makeup is 75% water, it generates so, permanent brain damage may occur. about the size of a cantaloupe? “The 100,000 chemical reactions every In a single day, the brain gives rise to an brain is the most complex organ in the second and enough electrochemical estimated 70,000 thoughts, processing universe,” says Jafar Jafar, MD, professor energy to power a 10-watt lightbulb. information at a rate of up to 268 miles of neurosurgery, director of the Division The brain contains 100 billion neurons per hour. In a lifetime, it can retain one of Cerebrovascular Surgery, and (nerve cells), each connected—directly quadrillion separate bits of information. neurosurgeon-in-chief. “We still don’t or indirectly—to as many as 100,000 Such a precious object deserves high- know which part of the brain we see others. Twelve pairs of cranial nerves, level security, and the brain’s protective with. It’s an enduring mystery—one of some of which control numerous parts mechanisms are truly impressive. The many enduring mysteries.” Dr. Golfi nos of the head, and 100,000 miles of blood bony skull, or vault, is a quarter-inch puts it another way: “We can operate on vessels crisscross its terrain. Though thick at the top and even thicker at the someone’s brain while they’re awake, pain is registered in the brain, the organ base. The meninges, three layers of take out part of it, and they can talk to itself has no pain receptors and cannot membranes that line the skull, shield the us the entire time. Even though we’re feel pain. The brain demands 15% to 20% brain further. The brain is suspended in actually damaging a small part of the of the blood pumped from the heart. If cerebrospinal fl uid, which functions as a brain, the rest of it couldn’t care less.” it’s deprived of blood-borne oxygen for shock absorber, reducing the impact of

Dr. Jafar Jafar, director of the Division of Cerebrovascular Surgery, in his home library.

NYU PHYSICIAN SPRING 2013 11 “ Once you are done with the operation, the brain must never know you were there.” — Dr. Chandra Sen •••

Neurosurgery. “Before we had aneurysms and vascular malformations, the benefit of detailed imaging, spine ailments, epileptic seizures, stereotactic navigation, deep brain stimulation for Parkinson’s and electrophysiological disease, and a range of other conditions. monitoring, you had to have “Some of our new colleagues are iconic,” incredible technical mastery,” says Anthony Frempong-Boadu, MD, he explains. “That said, you associate professor of neurosurgery can’t be a klutz.” and director of the Division of Spinal Then what does separate Surgery. “We observe each other in good neurosurgeons from the OR like it’s our first time there. great ones? “The greats have The intellectual exchange has upped a real balance of confidence everyone’s game.” Dr. Jafar is so proud of and empathy,” Dr. Golfinos his newly expanded department that he says. “The hardest thing to says, “I’ve visited many departments of teach is taking ownership of neurosurgery around the world, and few the patient—realizing that this of them rival ours. Many patients are person has placed everything told that their tumor is inoperable, but they have in your hands.” then they come here and they survive.” sudden blows. Isolated from the Dr. Sen agrees: “If you exude a lack of “Our goal,” Dr. Golfinos says, “is to bloodstream by a blood-brain barrier, confidence, your entire team senses it, be the place that other neurosurgery the brain has a dutiful gatekeeper, and the team breaks down. If you get centers refer their really difficult cases admitting some nourishing elements anxious, your hand shakes, and the to because we can get the job done.” and forbidding entrance to others, situation quickly deteriorates.” For Dr. For neurosurgeons, that often requires notably toxins. Wisoff, the key is strategy. “You plan what Dr. Frempong-Boadu describes The challenge of penetrating this an operation like you plan a battle,” he as “walking the tightrope” between formidable fortress to reach the treasure says. “You know where all the pieces confidence and hubris. “Neurosurgeons that lies within has intrigued mankind lie, and you’re prepared for as many are comfortable going into the unknown,” for centuries. The first successful contingencies as possible.” Dr. Jafar sums he says. “A lot of what we do is shrouded operations to remove tumors, however, it up in a single word: tenacity. “Hating in mystery. What makes a great took place only about a century ago. to lose is what makes us a breed apart. I neurosurgeon is his thinking. It’s not Until the 1970s and 1980s, when CT chose neurosurgery because it’s difficult. about technical skills. It’s about knowing scans, overhead microscopes, high I thrive on challenges. I’m a bad loser.” what you can and can’t touch, what you intensity illumination in the OR, and NYU Langone Medical Center’s can and can’t move. A great neurosurgeon microsurgical instruments became Department of Neurosurgery has never can almost see through things.” available, a neurosurgeon’s skill relied had so many winners. In the last two For all the information and insights that largely on his keenness of vision and years, Dr. Golfinos has recruited several sophisticated imaging can provide, the steadiness of hand. While manual outstanding neurosurgeons, some of map is not the same as the territory itself, dexterity, hand-eye coordination, spatial them world-renowned for their expertise and danger, if not disaster, is sometimes perception, and tactile memory (the in subspecialties. The department only a millimeter away. “You’re often ability to return your hand to exactly now has 17 neurosurgeons serving working in a surgical field the size of a the same place it was before you moved patients at Tisch Hospital, Bellevue quarter or half dollar,” Dr. Wisoff explains. it) will always be the hallmarks of a Hospital Center, and the “If you don’t have fear,” adds Dr. neurosurgeon, “golden hands have Manhattan VA Medical Jafar, “you’re dangerous. You can ABOVE Dr. Chandra become less and less important,” says Center. Its long-standing Sen, director of the work for hours, and in the last 10 Jeffrey Wisoff, MD, associate professor reputation for excellence Division of Skull Base seconds you can ruin everything. of neurosurgery and pediatrics and encompasses surgery Surgery, after landing a Piper Archer he The most dangerous part of the director of the Division of Pediatric for brain tumors, brain flies for a hobby. operation is the last 5 minutes

NYU PHYSICIAN 12 SPRING 2013 Dr. Jeffrey Wisoff, director of the Division of Pediatric Neurosurgery, cycling near his home.

because you think you’re finished. You can’t afford to let your guard down, even for a moment. I don’t listen to music while I’m operating. The night before, I listen to Mozart. In the OR, I’m listening to the patient’s heart rate, one of many things that guide me.” The importance of total concentration is just one of the lessons Dr. Jafar tries to instill in his residents, mostly by example. Unlike many programs in neurosurgery, NYU Langone has a training period of seven years instead of six. During the last year (the second of two as chief resident), the newly minted neurosurgeon functions as the operating surgeon for more than 300 varied neurological procedures. Yet there’s death—always looms large. “Every one kids were young,” Dr. Wisoff recalls, “I one thing, says Dr. Jafar, that you can’t of my cases is my toughest case ever,” would go home and give them a big hug. teach: judgment. “For a neurosurgeon,” Dr. Sen says. “That degree of respect Then I’d sit down with my wife and have he explains, “common sense is knowing keeps you from becoming cavalier.” The a long talk.” For Dr. Sen, healing requires what your limits are. Knowing how to survival rates for benign brain tumors solitude. “When I have a disaster,” he stay out of trouble—or get yourself out have increased dramatically over the says, “I go home, I sit quietly, and I have of trouble. Knowing when to stop the years, so most of the time, notes Dr. even cried.” Dr. Jafar believes that the surgery if you have to.” Jafar, “the odds are by far in favor of the only true measure of comfort comes from Dr. Wisoff feels that the key to patient.” In children with malignant “knowing that you did your best, and that mastering the art of critical thinking brain tumors, explains Dr. Wisoff, the you’re at peace with yourself.” inside the OR is to anticipate as many cure rates are above 80%. “I followed in Neurosurgeons seem to reserve their pitfalls as possible and carefully my father’s footsteps,” he explains, “and greatest optimism for their faith in consider the options outside the OR. he taught me that to be a neurosurgeon, nature and science. “When you think “When you’re removing a malignant you have to be an optimist. ‘Maybe it’s a of the billions of cell divisions that take tumor,” he says, “you have to be subdural hematoma that we can drain place between conception and delivery,” appropriately aggressive. If you go in and cure the patient,’ he would say. Or says Dr. Wisoff, “creating the potential with a timid attitude, you’ll perform a ‘maybe it’s a benign tumor that we can for our genetic code to be misinterpreted timid operation—what we call peek and remove and cure the patient.’ Or ‘maybe or to go awry, it’s astonishing how few shriek. If that’s not right for the patient, it’s a low-grade malignancy that will problems we actually have.” Dr. Golfinos you’ve done him or her a tremendous allow us to buy the patient a lot of time.’ points to improved medications, disservice.” In the still fairly uncharted Or ‘maybe we can’t save the patient, but endovascular techniques, technology, landscape of the brain, doing what’s we can bring better quality to their life.’ ” and other advances that have “stacked right for the patient may be the greatest “Some patients have a will to live the odds in our favor.” Fifty years ago, in challenge of being a neurosurgeon, but that’s very, very strong,” Dr. Golfinos Ben Casey’s day, he reminds us, “there it’s also the most critical. “If I’m not notes, “especially if they have children was only one kind of tumor he could comfortable with a resident I’ve trained or someone else to live for.” But on those remove without killing the patient: a operating on a member of my own rare occasions when a neurosurgeon meningioma. Fifty years from now, the family,” Dr. Jafar says, “then I’ve failed.” must accept defeat—and they can recite greatest advance will be the elimination For even the best neurosurgeons, the the names of every patient they’ve ever of neurosurgery. Our specialty will possibility of failure—be it deficits or lost—the toll is a lingering one. “When my probably be obsolete.” •

NYU PHYSICIAN SPRING 2013 13 FACULTYCONVERSATION “ If Only They Could Have Been Treated When They Were Kids…” Q&A with Dr. Glenn Saxe, Chair of the Department of Child and Adolescent Psychiatry BY CLAUDIA KALB

Throughout his career, Dr. Saxe has dedicated himself to understanding the impact of traumatic events on children and adolescents and improving their care. He pioneered a unique community-based program, Trauma Systems Therapy (TST), and also helped develop the National Child Traumatic Stress Network, a nationwide program that partners academic research centers with community practice sites. In February 2013, the Child Study Center, in collaboration with the New York City Administration for Children’s Services and Bellevue Hospital, received grants totaling more than $7 million to enhance trauma services for young people. The grants built on seed funding provided by generous gifts from Michele and Timothy Barakett and the Bloomgarden-Willner Family.

How do you define childhood trauma? Trauma is when a child experiences something that threatens life and limb. Community violence, violence within families, abuse, rape, disasters, war, terrorism, significant medical illnesses—all of these fit the category of trauma. Violence in the family and a school shooting are very different events, but there’s a core similarity that defines most reactions to trauma, involving ancient, powerful survival systems in the body. When a threat occurs, a structure deep in the brain called the amygdala Dr. Glenn Saxe fires. It’s a very important structure because it prepares us to survive in the face of threat. HE SHOOTING at Sandy Hook Elementary School in Newtown, It makes your heart pound and your muscles Connecticut, last December left Americans desperate for answers. What tense, preparing you to fight or flee. Following do we tell our children after such a horrific event? Will Sandy Hook’s a trauma, it’s hard for the amygdala to settle youngest survivors ever recover? Glenn Saxe, MD, NYU Langone’s Arnold and so it’s normal to be intensely distressed Simon Professor of Child and Adolescent Psychiatry and director of and concerned about safety over days, and the Child Study Center, quickly became an expert source for reporters even weeks after trauma. In most people, this covering the tragedy. He stressed the importance of being attuned to emotional state diminishes dramatically with children’s emotional needs and answering their questions honestly, and time, but in some people it persists: Their Toffered some solace when he talked about children’s capacity to heal. “Most kids, even of this age, amygdala keeps firing, even in situations are resilient,” he told The New York Times. where there’s no real threat.

NYU PHYSICIAN PHOTOGRAPH BY 14 SPRING 2013 GLORIA BAKER What happens when those fearful emotions persist? trauma and working with them to implement What are the core components of TST? Ordinarily, other areas of the brain such as the interventions, particularly TST, for kids at risk. There are four key components of TST and we hippocampus and prefrontal cortex help inhibit The burnout rate for child welfare workers is offer these components based on our assessment the amygdala from misfiring after a trauma by very high, so we’re also working with the child of what the child needs. First, we help children bringing context and memory to the situation. welfare system to support their workforce. develop the skills to regulate their emotions The hippocampus is responsible for helping when they experience something that isn’t people understand context. After an injury, for How many children develop PTSD? really threatening, but that reminds them of example, the hippocampus will recognize that Between 15% and 40% of children who their trauma. These include coping skills, which once you’re in the hospital you’re safe. But in experience trauma will develop PTSD. Children might involve activities such as deep breathing some children this mechanism gets disordered may develop other problems as well, including or counting, and other skills to identify and and they can no longer recognize that they’re depression, aggression, and self-destructive manage their emotional states. Second, we work in a safe place. Something will remind them behaviors. The bad news is that many people with those around the child such as families of what happened and trigger those survival have been exposed to traumatic events over and schools to help the child to manage emotion systems. It might be someone using a tone of their lifetime, so a lot of people have these and to protect them from signals that may evoke voice similar to the one used by your stepfather disorders. The good news is that they’re in the threat responses. They may be unwittingly just before he raped you. You get flooded with minority. Children are resilient. emitting signals that remind a child of what painful memories and may experience yourself happened, so we help them identify a child’s back in the place and time of the trauma. You’re Where does a child’s resilience come from? triggers and diminish them. Third, we provide not under immediate threat, but you’re living We’ve found a couple of genes related to risk and psychopharmacology, which is occasionally as if you are. That’s the central problem of post- resilience to trauma, but the story is much more needed to help a child take advantage of therapy. traumatic stress disorder, or PTSD. complex than that. Many factors contribute Fourth, we use legal advocates when necessary to resilience. A child’s ability to regulate their to help improve a child’s social environment by Does trauma leave any permanent effects on the brain? emotions is particularly important. A child’s helping the family gain access to needed services. There is research that indicates kids who endure ability to say, “OK, I’m getting upset now, but chronic stress and PTSD early in life may this isn’t the end of the world. I need to get What advice would you give parents in the aftermath develop smaller brains and have lower IQs. If through it.” If you have good skills managing of a traumatic event? this is true it indicates an unspeakable tragedy: emotion and you experience a trauma, you’re As parents, your job is to make sure your children They’re starting life with a strike against them more likely to be resilient. Parents, of course, feel safe. After an acute trauma like Sandy Hook, that can influence a great many things and have a critical role helping children learn how to parents might say, “This is an awful thing that have cumulative impact. It can affect learning regulate emotion. Another key part of resilience happened, but we’re doing everything we can to and school performance. It can affect how they is community—the degree to which the people keep you safe.” Children need that reassurance. experience themselves, their effectiveness in the around the child are attuned to what he or she Parents should also answer a child’s questions world, and how others view them. is going through and offer help, and the degree honestly and authentically. The most important to which a child feels like he or she is part of a thing is for family members to be attuned to their How big is the problem of childhood trauma and how family and community and not alone. loved ones and any changes in their behavior. will your new grant help? Is the child more isolated than before? More Obviously, what happened at Sandy Hook is a What is Trauma Systems Therapy and how does it irritable? If so, that’s something to track. terrible tragedy, and our hearts break for the differ from conventional therapy? families who lost these young children. But there We believe traumatic stress is always about two How did you get interested in childhood trauma? are also many hidden cases of childhood trauma. things: a traumatized child who isn’t able to I didn’t think I was interested in trauma when Do you know how many American children last regulate his emotional and behavioral states, and I was going into psychiatric training in the late year lost their lives at the hands of their parents a social environment that isn’t sufficiently able to 1980s. Then I began seeing the devastating or other caregivers? About 1,500. And that’s just help him. We began developing TST in the late consequences of childhood trauma in my adult the tip of the iceberg: The child welfare system 1990s. Every treatment available then involved patients. I kept thinking, “If only they could have gets 6 million calls about possible child abuse the child and clinician in an office. Individual been treated when they were kids.” I see child annually. Any one call may end up as one of the therapy is a component of caring for traumatized psychiatry as a prevention field. What gives me 1500 children who die. How do they get it right? children, but what was very apparent to me and the most gratitude is working with people who What if they get it wrong? Our grant involves my team is that the action is way outside the are dealing with really complex problems, with partnering with the child welfare system and office. TST involves developing knowledge about families that are so vulnerable, and helping them building their capacity to get it right. We’re what triggers a child’s emotions and working use a set of tools that makes a very big difference. helping child welfare workers better understand within the family, the school, and wherever else If you get it right, the work is life-changing. That’s trauma, training them to screen children for it may be strategic to help. what keeps me going. •

NYU PHYSICIAN SPRING 2013 15 MISSED CONNECTIONS An emerging theory of autism links social isolation to faulty circuits in the brain BY JANE BOSVELD “ It’s exciting that we now have the tools to find the relationship between brain circuits and behavior. This relationship can guide our search for the brain mechanisms leading to autism.”

TWELVE-YEAR-OLD STEVEN RHODES (not his real to another. In people with autism, some circuits are more name) has no shortage of interests. He can hold forth on strongly connected than usual; in others, the connections Albert Einstein, the atomic bomb, Marvel Comics, and any are weaker. number of other subjects that fascinate him. The trouble One network of particular interest in autism research is is, he doesn’t know when to stop sharing. “He can talk the Default Mode Network, or DMN. It works a bit like an about Einstein for a half hour straight,” says his mother. orchestra conductor, synchronizing different brain regions “Sometimes people just walk away. He has a hard time when the mind is at rest—as during a daydream—to help reading faces.” the brain marshal a coordinated response to the external Steven’s monologues are especially disruptive in class, world. Dr. Di Martino, among others, has found a link where he often blurts out information without raising his between the DMN and autistic traits like aloofness and hand. And he resists group activities because he finds social awkwardness. Using functional MRIs, she and her them frustrating and confusing. Steven is not intentionally team have discovered that people with more ASD traits rude, his mother and teachers know. His behavior is a tend to have weaker connections between two distant brain classic symptom of autism-spectrum disorder (ASD), the regions involved in self awareness and interpreting other incurable developmental condition that he was diagnosed people’s thoughts and emotions. Thus social isolation with at age 4. appears to be rooted in neural isolation. Autism affects one in 88 children in the United States, Other types of brain scans also support this idea. up from one in 2,000 in the 1970s. Many experts attribute Using structural MRI, which reveals subtle physical at least part of this dramatic jump to a shift in the clinical abnormalities, researchers have found unusual patterns definition of autism away from a single condition to a cluster of growth in some areas of the autistic brain, including of conditions that range along a spectrum of severity. the white matter. White matter, which comprises nearly Steven’s intelligence, verbal skills, and independence land half the brain’s mass, is “the highway through which him on the more functional end of the spectrum. But like all different regions of the brain communicate,” explains Dr. ASD patients he struggles to form social bonds. Di Martino. In people who are not autistic, the white matter Despite growing awareness of ASD, why the condition develops at an even pace during gestation. But in autistic impairs social skills is still poorly understood. Adriana Di children there is a burst of white matter growth earlier than Martino, MD, Assistant Professor of Child and Adolescent expected, and the growth stops before reaching expected Psychiatry at the Child Study Center at NYU Langone levels. “Typically, developing children eventually have Medical Center, is looking to brain anatomy for answers. The more white matter than children with autism,” Di Martino brain of a child with ASD may look perfectly normal, Dr. Di notes. These differences in how white matter develops, she Martino notes. “All the specific brain regions are right where adds, contribute to the wide range of problems afflicting they’re supposed to be,” she explains. “The problem is in the people with autism. circuitry that connects them to each other.” Dr. Di Martino acknowledges that these recent insights This faulty circuitry is thought to result from changes raise more questions than they answer. For example, that occur while the brain is developing. By using how does disconnection in the brain emerge? How does it functional MRI (fMRI) scans, which measure oxygen change with age? Are specific circuits involved, or is the uptake in the brain, Dr. Di Martino and her colleagues problem widespread in the brain? Questions abound, but are mapping patterns of connectivity in the brains of fortunately the answers appear to be within reach. “It’s children with ASD and comparing them to children exciting that we now have the tools to find the relationship without the disorder. “With ASD, brain regions are poorly between brain circuits and behavior,” Dr. Di Martino synchronized,” Dr. Di Martino explains. Which neural says. “This relationship can guide our search for the brain networks malfunction, however, varies from one person mechanisms leading to autism.”•

ILLUSTRATION BY NYU PHYSICIAN LUCY READING-IKKANDA SPRING 2013 17 MEDICALEDUCATION

Dr. Steven Abramson, Dr. Melvin Rosenfeld, Dr. Vicky Harnik, and Dr. Marc Triola display images of the BioDigital Human, a 3D animated virtual dissection tool that empowers medical students to learn how and where they wish. A Matter of Degrees Starting this year, a select group of students have the option of earning an MD in three years. BY GARY GOLDENBERG

ON AN AVERAGE of once every This radical rethinking of how doctors without sacrificing quality. minute, a new scholarly article is added are made has prompted some to fear that “Our new plan is based on the premise that to the medical literature—a statistic NYU School of Medicine is on the road to medical students should be offered the ability that would seem to suggest that medical becoming a “trade school” where training to differentiate and accelerate their careers schools should lengthen their curricula is pared down to the bare minimum. if they were qualified to do so. We must keep to better prepare physicians for 21st But NYU Langone Medical Center’s in mind that you become a doctor over the century clinical practice. Yet NYU School educators believe that accelerated study, entire course of your training, not just during of Medicine is doing just the opposite. if done properly and offered to selected medical school,” says Steven Abramson, MD, Starting this year, a select group of highly qualified applicants, can be an the Frederick H. King Professor of Internal students have the option of earning an effective counterbalance to ever more Medicine and chairman of the Department of MD in three years, slicing a full year off extensive training periods, which now Medicine, senior vice president and vice dean the traditional education. average 10 years for subspecialties, for education, faculty, and academic affairs,

NYU PHYSICIAN PHOTOGRAPH BY 18 SPRING 2013 JOHN ABBOTT and professor of medicine and pathology. forgo their summer break, using that their chosen residency program, building “A four-year program for all graduates time to engage in an eight-week elective. an unprecedented bridge between made sense when postgraduate training Additional time is saved by waiving the undergraduate and graduate training. lasted two or three years. Now, residencies usual third-year 12-week clinical/research Critics argue that accelerated study will and fellowships routinely extend the concentration and eight weeks of electives. increase the likelihood of student burnout postgraduate period to six years or more, In another departure from standard and deprive students of a “maturing” year which means that many physicians don’t practice, three-year enrollees will be offered that provides time to expand their horizons. enter practice until their early or mid-30s. acceptance into a residency of their choice While Dr. Abramson acknowledges that Indeed, data from the AMA show that since at NYU Langone at the time of admission. increased burnout is a possibility, he 1975, the percentage of physicians under the This, too, will save time, since students believes it can be prevented with careful age of 35 has decreased from 28% to 15%.” routinely spend many weeks traveling monitoring and mentoring. Moreover, With this rationale in mind, Dr. around the country for residency interviews. students will have the option of switching to Abramson and his colleagues began looking In addition, says Dr. Buckvar-Keltz, “It’s the standard curriculum at any time. for ways to trim the standard four-year common for students applying in the most “The average age of incoming students is model of medical education, which has selective fields to spend 12 to 16 weeks doing older than in the past,” says Dr. Abramson. held remarkably constant since the Flexner ‘audition’ electives at outside hospitals to “Almost half come to medical school after Report of 1910, which highlighted the era’s increase their chances of matching at a taking one or two ‘gap’ years. So we have a wide disparity in physician training and preferred residency program, even though more seasoned pool of applicants, some of called on medical schools to enact higher repeating these electives has limited whom know exactly what they want to do.” admission and graduation standards. As it educational value. Our three-year students “For a certain percentage of students, turns out, NYU Langone has actually laid will save this time and expense as well.” the fourth year is a lost year,” adds Vicky the foundation for an abbreviated program “Our three-year pathway is not Harnik, PhD, assistant dean for curriculum with its Curriculum for the 21st Century, just about shortening training,” notes and assistant professor of cell biology. or C21. Instituted in 2009, C21 provides Dianna Jacob, vice president for faculty “They don’t need that time to explore students with a patient-centered and and academic affairs. “It’s really career possibilities or to mature. They’re disease-focused medical education, earlier- about redesigning medical education, anxious to get on with their training.” than-usual patient contact, and flexible, challenging the time-based model, and Fourth-year student Tara Russell (’13) individualized learning experiences. focusing on competency-based assessment agrees. “The time you are most prepared “In designing C21, we wanted a flexible across the continuum of education.” for residency is likely toward the end of curriculum, not only to accommodate The idea for a three-year MD degree is not your third year, after you have completed students, but also to allow for new new. Two other American medical schools most of your clerkships. I certainly would educational initiatives, even those we offer accelerated study, but their students are have considered the three-year option, couldn’t anticipate,” says Melvin G. limited to primary care or family practice especially since I took off three years Rosenfeld, PhD, associate dean for residencies. NYU Langone’s program is between college and medical school.” medical education and associate professor the first to allow students to choose any Hannah Kirsch (’14) likes the idea of of cell biology. “Once C21 was in place, Dr. specialty. A new informatics technology, the accelerated study, but wouldn’t have Lynn Buckvar-Keltz [associate dean of Education Data Warehouse, will be used to chosen it for herself. “I had an excellent students and clinical assistant professor track every aspect of the three-year students’ summer research experience and another of medicine] led an initiative for new dual- classroom and clinical work. “With the data elective that may not have been possible degree pathways, including an MD-MPH warehouse, we can ensure that students get had I enrolled in this program,” she says. program with NYU’s Washington Square all of the experiences they need and tailor “And I’m looking forward to exploring campus. With some creative changes, we those experiences to their chosen specialty,” other specialties—or even countries—in were able to offer this dual degree in four explains Marc Triola, MD (’98), associate my fourth year.” years instead of the usual five. At that dean for educational informatics and Slots in the new program will be offered point, it was obvious we could also offer a assistant professor of medicine. to about 10 percent of the incoming class, three-year MD pathway.” The accelerated curriculum promises and perhaps more in the years ahead. “The NYU’s new pathway features 135 weeks a number of benefits, including earlier biggest stumbling block now to expanding of instruction—20 weeks less than in entry into practice, lower overall tuition the program is that you have to declare your the traditional four-year program, but costs, and a seamless transition from specialty so early,” says Dr. Harnik. “If we still five weeks more than required for undergraduate to graduate medical can find a way in which students could enter accreditation. The time savings kick in just training. Beginning in year one, students this pathway near the end of the first year, I after year one, when three-year students will be assigned a faculty mentor from think we would have a lot more takers.” •

NYU Physician SPRING 2013 19 SC-CT-22(S)A-F_C03 Fragment base #6. Base 108 of 35 the OF THEeart MATTER When seemingly healthy individuals suddenly die, medical examiners often turn to molecular autopsies for clues. Thanks to a multiagency collaborative effort, the results are not only solving mysterious deaths but also saving lives.

BY BRYN NELSON PHOTOGRAPHS BY JOHN ABBOTT

THE SUDDEN DEATH of a 26-year-old mother of two proved deadly. initially seemed like an open-and-shut case: a tragic cocaine This case and others like it highlight the power of a so- and alcohol overdose. Beyond the toxicology results, the called molecular autopsy, a method of genetic sleuthing Office of Chief Medical Examiner of the City of New York that can determine the cause of a mysterious death, identify (OCME) could find no other contributing factors—until the potentially lethal mutations that might run in families, woman’s family raised the possibility of an inherited heart and even help solve crimes. Now, owing to the OCME’s condition. collaborative efforts, the technique is also spurring new An ensuing collaboration between the OCME’s molecular insights into how stress and drugs can compound preexisting genetics lab and the Montefiore-Einstein Center for heart conditions. GES CardioGenetics (MECC) in the Bronx uncovered a mutation Although it functions as a governmental agency, the OCME MA in one of her genes linked to a rare but dangerous heart has long-standing ties to NYU Langone Medical Center’s

ETTY I arrhythmia called long QT syndrome (LQTS) that affects an Departments of Forensic Medicine and Pathology, and

N: G estimated 1 in 7,000 people in the United States. On its own, many of its medical and research staff are on the faculty of IO cocaine was unlikely to cause the woman to collapse and die, NYU School of Medicine. The agency performs about 5,000 AT the joint investigation suggested. But in combination with a autopsies each year, a good number of them after the sudden, LLU STR

I genetic defect that altered her heart’s electric current, the drug unexpected death of a seemingly healthy New Yorker. In

NYU PHYSICIAN SPRING 2013 21 Although catastrophic failure of the immune, metabolic, or central nervous systems can contribute to sudden death, most of the potentially lethal mutations have been linked to defects in the heart, particularly a subgroup known as cardiac channelopathies. A normal heartbeat derives its steady rhythm from an electrical conduction system that begins in the heart’s right atrium, where a natural pacemaker creates electrical impulses. With every beat, these bursts of energy quickly spread to the rest of the heart through a network of fibers, causing the chambers to alternately contract and relax. At the cellular level, the electrical activity results from the regulated movement of electrically charged sodium, potassium, and calcium ions back and forth through channels in the heart cells. Aberrations in these channels, or channelopathies, can prevent them from opening or closing properly, disrupting the Dr. YingYing Tang flow and leading to dangerously irregular heartbeats.

about 100 of those cases, the cause of death remains murky despite medical examiners’ best efforts. That’s when a team led by YingYing Tang, MD, PhD, clinical assistant professor of forensic medicine and pathology at NYU Langone, steps Although catastrophic failure in.As director of the OCME’s molecular genetics lab, Dr. of the immune, metabolic, or Tang has established a testing panel for the six genes most commonly implicated in LQTS and other such diseases central nervous system can that disrupt the heart’s normal rhythms. For each of the contribute to sudden death, genes, her team uses automated DNA sequencing to detect most of the potentially lethal any mutations and then pores over published studies to determine whether those variants might cause disease. For mutations have been linked to newly discovered mutations, the lab turns to software to defects in the heart, particularly predict their potential clinical significance. Whenever Dr. Tang links the cause of death to a specific ion channels that regulate genetic aberration, the OCME notifies the decedent’s family electrical impulses. Aberrations of its findings and recommends that close relatives be tested in the cardiac ion channel can for the same mutation. “We’re used to being the end of the story, but in this case we’re the beginning,” says Barbara prevent them from opening or Sampson, MD, PhD, clinical associate professor of forensic closing properly, disrupting the medicine and pathology, and the OCME’s acting chief medical examiner. Parents mourning the loss of an infant often face flow and leading to dangerously the wrenching decision of whether or not to have another irregular heartbeats. child, while other families wonder who else might be “walking around with a time bomb,” as Dr. Sampson puts it. So far, molecular autopsies have found probable causes of death in about 10 percent to 15 percent of the unsolved cases examined by Dr. Sampson and Charles Hirsch, MD, professor These defects may not be apparent in a routine autopsy, but and chair of forensic medicine and professor of pathology, who they often show up on electrocardiograms (EKGs) as abnormal recently retired as chief medical examiner. In January 2012 patterns and in genetic analyses as DNA mutations previously Dr. Tang’s lab received a two-year grant from the Department linked to sudden deaths. LQTS type I, for example, disrupts of Justice amounting to nearly $700,000 to add the most a potassium channel that helps the heart muscle relax after advanced DNA sequencing capabilities to its tool kit. Dr. Tang each contraction, leading to a rapid and chaotic rhythm that says the additional funding should allow her lab to expand the can cause sudden death. Unfortunately for the young mother, testing panel to include more of the 50-plus genes now linked the inherited channelopathy forced her heart to rely on a to sudden unexplained deaths in infants, children, and adults. second major potassium channel that is exquisitely sensitive to

NYU PHYSICIAN 22 SPRING 2013 blockage by cocaine. That knowledge can save lives. Dr. Tang and Dr. Sampson point to their blossoming relationship with the Montefiore- Einstein Center for CardioGenetics as one example of how genetic sleuthing can open the door to lifesaving testing services and support. Thomas McDonald, MD, the center’s co-director, says the “collegial and collaborative exchange” between the groups allowed them to publish two recent case studies in the journal Pacing and Clinical Electrophysiology. Solving the cocaine-LQTS case also helped his team provide preventive care to the victim’s two children after genetic tests revealed that both had inherited the same mutation. “It’s very important because we can do things that will hopefully decrease their risk for having a heart rhythm disturbance and sudden death like their mother had,” he says. A second collaboration between Dr. Tang and Dr. McDonald underscores the difficulty of predicting how genetic mutations might affect individual patients. When a young woman suddenly collapsed and died at home several months after undergoing a gastric banding operation to help control her obesity, investigators focused on the frequent vomiting episodes reported by her family. Her symptoms heightened suspicions that she was dehydrated and running low on potassium. Meanwhile, EKG Dr. Barbara Sampson results that had gone unnoticed before her operation hinted at LQTS. The OCME’s molecular genetics lab discovered a mutation in a gene linked to the disorder, but the joint inquiry provide an explanation. “But slowly, through the use of this revealed a twist. The woman’s mother and brother harbored molecular testing,” she says, “we will whittle at this and the same mutation but lacked any symptoms, suggesting that gradually give more and more parents an answer.” the fatal arrhythmia had been triggered by the additional Dr. Tang credits Dr. Sampson and Dr. Hirsch for recognizing stress of the deceased’s dehydration and potassium loss. the importance of establishing her lab a decade ago. The One of the most difficult aspects of her work, Dr. Tang publicly financed detective work, she says, is still unique among says, is interpreting the clinical significance of previously cities in the United States and would have been prohibitively unreported genetic mutations. “It’s challenging, it’s going to expensive without the extensive infrastructure already laid continue to be challenging, and it really requires teamwork,” within the OCME’s Department of Forensic Biology. she says. With every new mutation, however, scientists are Despite the tragedies she encounters on a regular basis, adding to a collective database that may help forensic labs Dr. Tang revels in her lab’s ability to help other doctors around the world solve other unexplained deaths, including provide happier endings. In one heartbreaking case, a seven- cases of sudden infant death syndrome, or SIDS. year-old boy collapsed and died at school. After the OCME’s For years, Dr. Sampson explains, SIDS has been used as a standard autopsy tests were inconclusive, the molecular catchall label for unexplained infant deaths. “It’s long been autopsy revealed yet another mutation in a gene linked to suspected that SIDS may not be one thing but a group of things LQTS. Two of the boy’s relatives had previously died of heart that we are unable to identify from a regular autopsy,” she says. problems and his half-sister was already under the care of Since the 1994 debut of the national Back to Sleep campaign, Montefiore-Einstein cardiologists. which instructed parents to have babies sleep on their backs Unbeknownst to her doctors, the half-sister harbored the to avoid accidental suffocation, the overall SIDS rate has fallen same rare mutation, and her existing heart medication was by more than half in the U.S. But roughly one of every 2,000 particularly ill suited for the syndrome subtype. “We did infants born in America every year still dies suddenly. very fast in-house molecular testing for this case,” Dr. Tang After the loss of an infant, Dr. McDonald says, many says, recalling that the lab’s post-mortem testing spurred parents are guilt-ridden and seeking closure. “The parents the half-sister’s cardiologist to switch her medication beat themselves up because they think, ‘Is it something immediately to a more appropriate therapy. “They were very that I did or didn’t do that caused this to happen?’” he says. happy with that change,” Dr. Tang says, “because that could Dr. Sampson shares his frustration at not being able to actually be lifesaving.” •

NYU PHYSICIAN SPRING 2013 23 TOOLSOFTHETRADE

Do You Hear What I Hear? The Stethoscope Symbolizes the Enduring Task of Physicians: Listening to Patients BY THOMAS RANIERI

ONE SEPTEMBER DAY in 1816, Dr. Rene Laennec, a 35-year-old physician who had trained under several distinguished mentors, including Napoleon Bonaparte’s personal physician, was scheduled to visit a patient at the Necker Hospital in Paris. Running late, he took a shortcut through the courtyard of the Louvre, where he saw children playing with a wooden beam. As one child pressed his ear up to one end of the beam, another tapped nails into the opposite end, transmitting sound through the wood. When Dr. Laennec examined the patient, an obese young woman with heart disease, he tried to use percussion (tapping with his fi ngers) to gain information, but her many layers of insulation muffl ed the beats of her heart. He briefl y considered the ancient technique of auscultation (placing so at the risk of being branded quacks or an ear to the chest), but dismissed the charlatans. In time, it evolved into two idea as improper because of the patient’s conjoined parts: on one side, a diaphragm gender. Then, recalling his observation to hear high-pitched sounds, and on in the playground, he rolled some papers the other side, a bell to hear low-pitched into a cylinder and held one end against sounds, both connected by tubes leading the patient’s chest. Marveling at the pneumothorax, lung abscess, to the earpieces. Those who mastered its “clear and distinct” manner in which he hemorrhagic pleurisy, and pulmonary use came to regard it as indispensible, for could perceive the sounds of the heart, infarcts, and paved the way to a it enabled the physician to measure blood he fashioned a similar device from cedar, better understanding of heart sounds pressure, assess heart, lung, and bowel creating an instrument similar to an “ear and murmurs. Yet when it came to sounds, and detect a bruit (the harsh, trumpet,” or hearing aid. Thus was born his own ailments, he consistently rushing sound of blood through an artery the stethoscope (from the Greek words mischaracterized them, quite possibly that often signifi es a narrowing of that “stethos,” meaning chest, and “skopos,” to avoid confronting the reality of artery, as in arteriosclerosis). meaning view). tuberculosis, from which he died at the “A well-trained physician with a Dr. Laennec, perhaps the most brilliant age of 45. stethoscope can do much more in diagnosis diagnostician of his time, became the Like most great medical advances, than the younger generation seems to fi rst physician to distinguish reliably the stethoscope was not immediately think,” explains Martin Kahn, MD, the

among bronchiectasis, emphysema, accepted, and those who embraced it did Joel E. and Joan L. Smilow Professor of ISTOCK PHOTOGRAPH

NYU PHYSICIAN 24 SPRING 2013 Master clinicians emphasize that identifying and discerning heart sounds, so faint and fl eeting, is as much art as science—perhaps the most challenging diagnostic skill a doctor must learn.

certain sounds occur only at certain points shirt, per haps tucked neatly in to the pock- during the heartbeat, and are detectable et of a white lab coat, or clutched fi rmly only if the stethoscope is placed at just the in hand … the only tool for a spe cifi c job. right spot on the chest. “In 0.8 seconds,” Think of the things you’ve al lowed an oth er one expert explains, “you have four or per son to do and say to you, mainly be- fi ve acoustic events at the threshold of cause he or she car ried a steth o scope. We audibility. You need to be able to separate don’t check re sumes or cre den tials, don’t them, and pick them up as a pattern.” Dr. ask for ser vice re views or cer ti fi c ates. We Oppenheimer notes that “even something ex pect and ac cept the ob ject, even if it’s nev- as simple as the clean contact of the er used. But it’s al ways used. Re gard less of head of the stethoscope against the skin, phys ic al con text or at tire, the steth o scope without interference from clothing, can speaks. It says, ‘I am a doc tor,’ and in so make a big difference.” do ing it grants rights and re spons ib il it ies, In a study published in the Journal ob lig a tions and ex pect a tions. It tells us you of the American Medical Association in will do no harm. It tells us you know what 1997, researchers recruited 453 residents you are talk ing about.” in internal medicine and family practice Though the stethoscope has remained programs, played for them sound essentially unchanged over the last half sequences (recorded via stethoscope) century, it has gotten noticeably elongated Cardiology, “and there is the potential to during 12 common cardiac events, and over the last decade or two. Compared to eliminate a lot of costly and unnecessary asked them to diagnose the events. The an original length of 8 to 12 inches, some procedures that way.” Beno Oppenheimer, average identifi cation rate was about 20%, models now measure nearly 30 inches—an MD, assistant professor of medicine and which the authors termed “disturbingly arm’s length. The change, alas, is merely a director of the Surgical Intensive Care Unit low.” Subsequent studies have confi rmed sign of the times, a concession to antibiotic- at the Manhattan VA Medical Center, notes these fi ndings. resistant bacteria. an additional benefi t. “With a stethoscope,” Can medical schools train physicians What remains immutable, however, he explains, “you can monitor your to boost their auscultatory abilities? insists Howard Markel, MD, PhD, in patients continuously, which you can’t “We can and we are,” says Dr. Kahn. his essay “The Stethoscope and the Art always do with machine-based diagnostic Under the Merrin Bedside Teaching of Listening,” published in The New technology. You can’t perform numerous Faculty Development Program, Dr. Kahn England Journal of Medicine in 2006, CT scans, X-rays, or echocardiograms and other senior faculty members are is that the stethoscope symbolizes “the in one day to see if your therapeutic training younger colleagues to improve enduring task of physicians—listening to interventions are successful, but you can their bedside diagnostic skills, including our patients. Whether absentmindedly use a stethoscope 24/7 if you have to.” auscultation. “Their participation has been worn around the neck like an amulet or Master clinicians emphasize that very enthusiastic,” he reports, “and they coiled gunslinger-style in the pocket, ever identifying and discerning heart sounds, are making tremendous strides in terms of ready for the quick draw, the stethoscope so faint and fl eeting, is as much art as their skills, which they are then passing to is much more than a tool that allows science—perhaps the most challenging residents and medical students.” us to eavesdrop on the workings of the diagnostic skill a doctor must learn. “Noth ing prom ises Doc tor like a steth- body. Indeed, it embodies the essence of Distinguishing signifi cant sounds from o scope,” notes Steven Church in his essay doctoring: using science and technology in all the others requires a keen ear for subtle Auscultation. “Draped around an ex posed concert with the human skill of listening differences in pitch and rhythm. Moreover, neck or curled over a pressed, collared to determine what ails a patient.” •

NYU PHYSICIAN SPRING 2013 25 FACULTYNEWS

Vilcek joined NYU Langone at the age of 31 as an assistant professor of microbiology. LEVIN E He has devoted his entire career to the CY study of a group of natural regulators of the

immune system called cytokines, especially E N AN

a class of cytokines called interferons. Dr. PAG

Vilcek and his colleagues were the first to SITE show that there are two distinct families of

interferons: alpha interferon, used to treat S OPP O hepatitis B and C, and beta interferon, used

to treat multiple sclerosis. GR APH In the early 1980s, Dr. Vilcek took HOTO

up the study of a cytokine called TNF. ; P

The recognition that overproduction of ION AT TNF can contribute to the development of many diseases encouraged Dr. Vilcek FOU ND and Dr. Le to generate the monoclonal AL S antibody that resulted in the development MED

Jan Vilcek, MD, PhD, Honored at of Remicade®, the first anti-TNF treatment Y G approved for use in patients. The drug’s White House Awards Ceremony success has spurred the development OLO

PRESIDENT BARACK OBAMA honored One of 11 medal recipients this of other anti-TNF agents that are now ECH N T Jan Vilcek, MD, PhD, professor of year, Dr. Vilcek was recognized for his being used to treat such inflammatory microbiology at NYU Langone Medical pioneering work on interferons and for conditions as Crohn’s disease, rheumatoid CE & Center and co-inventor of the rheumatoid his role in the development of therapeutic arthritis, ankylosing spondylitis, psoriatic

arthritis drug, Remicade®, with a monoclonal antibodies. A monoclonal arthritis, psoriasis, and ulcerative colitis. AL SC IEN prestigious National Medal of Technology antibody generated by Dr. Vilcek and Dr. Vilcek, a Medical Center trustee, and Innovation during a ceremony held at his colleague Junming Le, PhD, adjunct and his wife, Marica F. Vilcek, have the White House in February. The highest associate professor of microbiology at generously given more than $120 million IONRRIS/NAT honor bestowed by the United States NYU Langone, and developed with the to NYU Langone Medical Center to MO government upon scientists, engineers, biotechnology company Centocor (now fund scholarships, research, and the . N K and inventors, the medal recognizes those Janssen Biotech, Inc.) into the drug new medical student residence hall at who have made lasting contributions to infliximab, or Remicade®, has to date NYU School of Medicine. Their ongoing RYA America’s competitiveness and quality been used to treat more than 1.6 million support is an outward display of their deep GR APH of life and helped strengthen the nation’s patients worldwide. gratitude for the many opportunities the HOTO technological workforce. A native of Bratislava, Slovakia, Dr. medical center has provided Dr. Vilcek. • P

The $50,000 award recognizes midcareer DAN R. LITTMAN, MD, PHD, scientists who have made a demonstrable impact in the understanding of human RECEIVES INAUGURAL diseases pathogenesis and/or treatment, ROSS PRIZE FROM and who hold significant promise for MOLECULAR MEDICINE making even greater contributions to the general field of molecular medicine. DAN R. LITTMAN, MD, PHD, the Helen the Skirball Institute of Biomolecular The award will be formally presented MI KE WEYMOUTH L. and Martin S. Kimmel Professor of Medicine, is the recipient of the first to Dr. Littman on June 24 at the New York Molecular Immunology, a professor of annual Ross Prize for Molecular Medicine, Academy of Sciences in Manhattan, followed GR APH microbiology, and a faculty member in issued by the Feinstein Institute’s peer- by an academic lecture by Dr. Littman and HOTO

the Molecular Pathogenesis program in reviewed journal, Molecular Medicine. several other preeminent researchers. P

NYU PHYSICIAN 26 SPRING 2013 NYU Langone’s Nurses Honored in Washington for Their Heroism During Hurricane Sandy NEAR THE END of President Barack Obama’s State of the Union address last February 12, he turned everyone’s attention to the balcony, where First Lady Michelle Obama was joined by 23 special guests. Seated between the First Lady and the vice president’s wife, Jill Biden, was Menchu de Luna Sanchez, RN, senior nurse clinician at NYU Langone Medical Center. “We were sent here to look out for our those in the KiDS Left to right: Maureen Halligan, RN, nurse fellow Americans,” President Obama told of NYU Langone clinician; Geraldine Cillo-Gillen, RN, senior nurse clinician; Claudia Roman, those assembled in the House chamber, “the Neonatal Intensive RN, senior nurse clinician; Sandra Kyong, same way they look out for one another, Care Unit. It was RN, nurse clinician; Margot Condon, RN, every single day, usually without fanfare, Sanchez who pro- senior nurse clinician; Beth Largey, RN, nurse clinician; Alison Coluccio, RN. all across this country. We should follow the posed that the saf- example of a New York City nurse named Menchu Sanchez, RN est way to evacuate Her leadership caught the attention of Menchu Sanchez. When Hurricane Sandy the infants would President Obama, who called Robert I. plunged her hospital into darkness, her be to carry them down the stairs without Grossman, MD, NYU Langone’s dean and thoughts were not with how her own home incubators. As the nurse caring for the unit’s CEO, and Kimberly Glassman, PhD, RN, was faring. They were with the 20 precious sickest baby, she went first. Nurses and phy- vice president for patient care services newborns in her care and the rescue plan sicians carried their tiny charges, held snug- and chief nursing officer, two days after she devised that kept them all safe.” ly against the skin of their chests, down nine the storm. Sanchez, who emigrated from The president was referring, of course, to flights of stairs, while manually squeezing the Philippines in the 1980s and has Monday, October 29, 2012, the night some bags to deliver oxygen to the babies’ lungs. worked at NYU Langone since 2010, was 1,000 medical and professional person- As Sanchez and her colleagues escorted one of 23 Americans invited to attend nel at NYU Langone safely evacuated 322 the newborns to other hospitals, her the State of the Union address for their patients, including the most vulnerable: Secaucus, New Jersey, home was flooding. humanitarian actions. •

A renowned immunologist and lineages and the differentiation of like rheumatoid arthritis, thought to be molecular biologist, Dr. Littman has inflammatory T helper cells. In recent influenced by imbalanced microbiota. made seminal contributions to numerous work, Dr. Littman discovered that the Dr. Littman is a Howard Hughes fields, including understanding the nuclear receptor ROR-gamma-t regulates Medical Institute investigator, a member molecular basis of immune recognition, differentiation of Th17 cells and lymphoid of the National Academy of Sciences and HIV pathogenesis, T-cell differentiation tissue inducer cells, and identified the prestigious Institute of Medicine, and and selection, and the role of commensal compounds that inhibit its activity and a fellow in both the American Academy bacteria in immune system development may be effective for autoimmune disease of Arts and Sciences and the American and regulation. therapy. He identified a commensal gut Academy of Microbiology. Dr. Littman is a leader in applying bacterium that selectively induces Th17 The Ross Prize was made possible by molecular biology and mouse genetics cells and promotes autoimmunity in mice, the generosity of Feinstein Institute board to study specification of T lymphocyte which may be relevant to human diseases members Robin and Jack Ross. •

NYU PHYSICIAN SPRING 2013 27 ENDPAGE

Dr. Abramson to Chair Medicine Appointment to Lead Largest Academic Department Follows Long Series of Leadership Posts and Caps More Than 30 Years of Service to NYU Langone

STEVEN ABRAMSON, MD, senior inflammation and arthritis, vice president and vice dean for has published more than education, faculty and academic affairs, 300 papers on these and professor of medicine and pathology, related topics, and in 2011 has been appointed chair of the was awarded the American Department of Medicine. The largest College of Rheumatology academic department of NYU School Distinguished Basic of Medicine, the department has a long Investigator Award—a merit- and distinguished history. Comprised based award presented to of twelve divisions, it is home to more one basic scientist each year than 1,200 full-time and clinical in recognition of his or her faculty members; trains hundreds of research and contributions to residents, fellows, post-doctoral fellows, the field of rheumatology. and graduate students in all areas of A member of the NYU clinical medicine; and plays a vital role Langone community for in all four years of the medical school more than 30 years, Dr. curriculum. Dr. Abramson is the fifth Abramson has distinguished chair of the Department of Medicine to himself as a clinician, serve since 1938. educator, researcher, and A summa cum laude, Phi Beta Kappa administrator. At the graduate of Dartmouth College, Dr. Hospital for Joint Diseases Abramson earned his MD from Harvard (before it merged with NYU Medical School, and was elected to the Langone), he served as Alpha Omega Alpha honor society. He Chairman of the Department arrived at NYU Langone and Bellevue of Rheumatology and Hospital for his internship in 1974, later Medicine and Physician- rose to number 7 in U.S. News & World serving as chief resident in Medicine. in-Chief. Dr. Abramson has served as Report’s annual “Best Hospitals” issue. Dr. Dr. Abramson joined our faculty in 1979, director of the Division of Rheumatology Abramson will continue to serve as vice rising to the rank of professor in 1996. He at NYU School of Medicine since 2000, dean, a role in which he guided the major has extensive experience in both basic but he will step down from that position. medical education reform that created our science and clinical research in the field of Under his leadership, the division Curriculum for the 21st Century (C21). •

Leadership team for the Department of Medicine: Dr. Steven Abramson, chair, Department of Medicine and the Frederick H. King Professor of Internal Medicine (front row, center); Dr. Ann Danoff, director, Endocrinology, Diabetes, and Metabolism (second row, far left); Dr. Caroline Blaum, the Diane and Arthur Belfer Professor of Geriatric Medicine and director, Geriatrics (second row, BBOTT second from left); Katy Wesnousky, administrator, Department of Medicine (second row, second from right); Dr. Sondra Zabar, interim director, General Internal Medicine (second row, far right); Dr. Glenn Fishman, the William Goldring Professor of Medicine and director, Division of Cardiology (third row, far left); Dr. William Rom, the Sol and Judith Bergstein Professor of Medicine and JOH N A director, Division of Pulmonary Critical Care and Sleep Medicine (third row, center); Dr. Bruce Neil Cronstein, the Dr. Paul R. Esserman

Professor of Medicine and director, Division of Translational Medicine and of the Clinical and Translational Science Institute (third GR APH row, far right); Dr. Mark Pochapin, the Sholtz/Leeds Professor of Gastroenterology and director, Division of Gastroenterology (back HOTO

row, left); Dr. Edward Skolnik, the Norman S. Wikler Professor of Medicine and director, Division of Nephrology (back row, right). P

NYU PHYSICIAN 28 SPRING 2013 Change Change Change Change Change Change Change Change Change the world…

One patient at a time. When you include a bequest in your will to NYU Langone Medical Center you help us deliver outstanding health care to the many patients and families who rely upon us to improve their lives. Superb physicians, an award-winning nursing staff and internationally ranked scientists make the difference. Join our community, and create your legacy today.

To learn more about making your planned gift to NYU Langone, please contact Marilyn Van Houten at 212.404.3653 or [email protected]. John Abbott

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