NONPROFIT ORG. U.S. POSTAGE PAID ST. LOUIS, MO PERMIT 2535
SUMMER 2018 Targeting a killer Noninvasive therapy halts arrhythmia RANEY, CARDINAL AVIATION RANEY, KENT
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MOSER FEATURES SARA 7 Big data Putting information-based tools in doctors’ hands.
14 Radiation beam to the heart Noninvasive therapy halts arrhythmia in clinical trials.
20 Critical connections New integrated center changes care model for women and babies. COVER Early results show a new non- invasive therapy — delivered in 10 minutes or less — is halting arrhythmia when standard 26 Match Day 2018 treatments have failed. A vest (above), covered Graduating medical students learn where they will in 252 electrodes, produces a panoramic map spend their residency. of a patient’s heart. Doctors use this map to direct a radiation beam at the heart, zapping malfunctioning cells. See page 14.
181795_TOC-p1 _CC17.indd 1 5/22/18 1:00 PM Washington University School of Medicine OUTLOOK.WUSTL.EDU SUMMER 2018 MATT MILLER MATT
In a well-choreographed move Jan. 27, sta members transported babies one at a time — about 10 infants an hour — from the newborn intensive care unit (NICU) at St. Louis Children’s Hospital to the hospital’s expanded NICU. As inaugural director of the Now, a 100-foot skywalk connects Institute for Informatics, Philip R.O. the NICU with labor and delivery Payne, PhD, is charting a new path in the new Barnes-Jewish forward for big data initiatives at Parkview Tower. See page 20. Washington University. See page 7.
STAFF: DEPARTMENTS MANAGING EDITOR DEB PARKER MATT MILLER MATT DESIGNER SARA MOSER 2 Pulse ART DIRECTOR ERIC YOUNG EXECUTIVE EDITOR VIRGIL TIPTON PHOTOGRAPHER MATT MILLER 28 Alumni & CIRCULATION THERESA HOWARD
Development Published by Washington University School of Medicine, Office of Medical Public Affairs, MS 8508-29-12700, 28 Gaining mobility 660 S. Euclid Ave., St. Louis, MO 63110-1010 ©2018 30 Before Alzheimer’s PHONE (314) 286-0100 EMAIL [email protected] begins Outlook is distributed three times a year to 32 Classnotes alumni, faculty, staff, students and friends of Washington University School of Medicine. Issues are available online at outlook.wustl.edu. Sylvia, 12, tries on a medallion commemorating a professorship in her grandfather’s name, while family facebook.com/WUSTLmedicine.health members look on. Big sister Mackenzie (background, Social icon Rounded square
Only use blue and/or white.
For more details check out our Brand Guidelines. center) is joining the freshman class this fall. @WUSTLmed The family established the Daniel J. Brennan, MD, @WashUMedicine Professorship in Neurology. See page 30.
181795_TOC-p1 _CC17.indd 2 5/22/18 12:49 PM 875p-_US_C7id 2 181795_p2-6_PULSE_CC17.indd pulse 2 Changes could IDAlzheimer’s risksooner— Body P people at preclinical evidence ofAlzheimer’s. butwhosebrain scansshowintact earlier inpeoplewhosememoriesare that such disruptions also occur much sleep/wake cycle. New research indicates of sleep in one-hour increments.”hours ofsleepinone-hour hours isvery fragmented. Sleepingsolidly for of neurology. “Buttheirsleeptended to PhD, MD, S. Musiek, were the journalJAMA before clinicalsymptoms appear. can take root inthebrain 15to Washington ofMedicine University School The wasn’t“It that the people in the study The sleep-deprived,” saidfirstauthorErik findingscouldidentify help doctors research was clock disturbances that the affect riskofAlzheimer’s, adiseasethat are eople withAlzheimer’s disease different from gettingeight to known Neurology. an assistant professor clock publishedJan.29in have circadian 20years eight
be disruptions spinal fluidtesting. related proteins. And some hadscansand their cerebrospinal fluidtested for amyloid plaquesintheirbrains. had Others scansto (PET) hadpositronSome emission tomography older adultswithanaverage ageof66. circadian rhythms in189cognitively normal, people don’t getenough deep sleep. increasing whensleepisdisrupted orwhen night —decreasing during sleep and day duringthe predictably fluctuate animals, have University, inpeopleand conducted brain —aprocess linked to development ofamyloid plaquesinthe circadian disruptions accelerate the Experimental Medicine, showing that study in mice, publishedinThe The In Previous studiesat this work, theresearchers thiswork, tracked researchers aseparateconducted found that amyloid levels lookfor Alzheimer’s-related Washington years loss before memory Alzheimer’s. Journalof Alzheimer’s- may and
rhythms put at people determine whetherdisrupted circadian they were much rest theygot at internal bodyclocks, determined how by experienced significant disruptions intheir abnormal cerebrospinal fluid —all who either had abnormal brain scansor advanced age, sleepapneaorothercauses. circadian disruptions that were sleep/wake cycles, althoughseveral had preclinical Alzheimer’s. hadnormal Most of theamyloid protein that signifies disease orvice versa. among the other 50 subjects — But amongtheother50subjects Of The be the participants, 139hadnoevidence theparticipants, researchers said it’s duringtheday. rst night andhow risk
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2018 Summer
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GETTY IMAGES IMAGES GETTY Drug compound shows promise against arthritis
A new drug compound — that dials LAB down inammation and is more
selective than other compounds MBALAVIELE Researchers helped mice recover faster from stroke by clipping their whiskers, an targeting the same inammatory important sensory organ. The above images show brain mapping at eight weeks pathway — might be useful against post-stroke in mice with whiskers intact (left) and with trimmed whiskers. autoimmune disorders such as rheumatoid arthritis, according to School of Medicine research. Stroke recovery improved e protein p38 MAPK helps tissue remain healthy, but when chronically switched on, it attacks the body’s own by sensory deprivation tissues. Because this protein drives inammation in many disorders, Temporarily shutting o neuronal signals to a healthy drug companies have developed part of the brain may aid stroke recovery, according to compounds to block its signaling. new research in mice. ese compounds work for a while, Mice that had experienced strokes were more likely to but eventually the body recalibrates recover the ability to use a front paw if their whiskers were and inammation returns. clipped following a stroke. Trimming the whiskers deprives Rather than blocking the entire an area of the mouse’s brain from receiving sensory signals. pathway, the new compound, CDD- And it leaves that area of the brain more plastic — or 450, hits just one of several branches receptive to rewiring to take on new tasks. a bit downstream of the p38 MAPK “We may have to rethink how we do stroke rehabilitation,” protein. Blocking that pathway said senior author Jin-Moo Lee, MD, PhD, the Norman J. while allowing the other branches 3D CT scans of rat paws show Stupp Professor of Neurology. “Stroke rehab o en focuses on to operate freely may remedy the (from top to bottom): a normal trying to train patients to compensate for disability caused inammation recalibration problem. joint; the effects of rheuma- by the stroke, but this strategy has limited e ectiveness. Studying mice, rats and human toid arthritis; reduced damage Our ndings suggest that we may be able to stimulate cells, the researchers found that after treatment with the drug recovery by temporarily vacating some brain real estate the compound reduces levels of compound CDD-450. and making that region of the brain more plastic. One inammatory signaling molecules. e scientists further way to do that might be by immobilizing a healthy limb.” showed that it prevents the destruction of bones and e researchers triggered, in mice, a stroke in the part joints in a rat model of rheumatoid arthritis. of the brain that controls the right forepaw. en, they Developed by Conuence Discovery Technologies Inc., trimmed the whiskers in half of the mice. Immediately a er the compound is novel because it is not a global inhibitor the strokes, both groups of mice favored their le forepaws. of the protein, said Gabriel Mbalaviele, PhD, an associate But by four weeks a er the strokes, those with clipped professor of medicine and company co-founder. whiskers had begun using their right forepaws again, and CDD-450 could be taken by mouth, unlike some anti- by eight weeks, they were back to using both equally. In inammatory treatments called biologics that must be contrast, mice whose whiskers were not clipped showed injected into the bloodstream. Also, because biologics no improvement at four weeks and only partial recovery are made of short protein sequences, the immune system at eight weeks. may recognize them as foreign and eliminate them, Brain mapping revealed that, in each mouse with resulting in resistance buildup. e new inhibitor, a trimmed whiskers, the locus of forepaw control had taken small molecule, bears no resemblance to proteins. over part of the area that usually receives whisker sensation. Aclaris erapeutics Inc. recently acquired “Maybe we need to start thinking about improving Conuence and is moving toward clinical trials to test outcomes by enhancing plasticity in targeted regions of the safety of CDD-450 (now called ATI-450). the brain,” Lee said.
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181795_p2-6_PULSE_CC17.indd 3 5/21/18 6:44 PM MATT MILLER MATT Seven faculty named 2017 AAAS fellows Seven faculty members are among 396 new fellows selected by the American Association for the Advancement of Science (AAAS), the world’s largest general scientific society.
Michael G. Caparon Jr., PhD Professor of molecular microbiology Honored for his studies of disease-causing bacteria, such as those that cause strep throat, scarlet fever and urinary tract infections.
Graham A. Colditz, MD, DrPH Niess-Gain Professor of Surgery and chief of the STANDING IN SOLIDARITY Students joined in Division of Public Health Sciences the March 14 walk-out/die-in to remember the victims of the Honored for contributions to cancer epidemiology Parkland, Florida, shooting and call attention to gun violence and prevention. as a public health crisis. They also advocated for a stronger role by the Centers for Disease Control in studying the issue. John A. Cooper, MD, PhD Professor and head of the Department of Biochemistry and Molecular Biophysics Honored for contributions to the field of cell motility and the No progress seen in reducing cytoskeleton, particularly for actin assembly and function. Michael S. Diamond, MD, PhD antibiotics among outpatients Herbert S. Gasser Professor of Medicine Despite public health campaigns aimed at reducing Honored for his studies of how viruses such as unnecessary prescriptions, antibiotics continue to be West Nile, Zika, dengue and chikungunya evade the prescribed at startlingly high rates in outpatient settings, immune system and cause disease. according to a new study. e researchers analyzed de-identi ed data from Express Susan K. Dutcher, PhD Scripts Holding Co. and found that 98 million outpatient Professor of genetics and the interim director of the antibiotic prescriptions were lled by 39 million people during McDonnell Genome Institute a three-year period from 2013 to 2015. ey found no decline Honored for contributions to the field of cell biology, in the overall antibiotic prescription rate during that time. particularly for studies examining the assembly and “ is study suggests that current guidelines on prescribing function of cilia. antibiotics are not being followed,” said Michael Durkin, MD, assistant professor of medicine and co-director of the Timothy J. Eberlein, MD Antimicrobial Stewardship Program at Barnes-Jewish Hospital. Bixby Professor of Surgery and head of the Department e data tracked monthly prescription rates for all of Surgery; director of Siteman Cancer Center antibiotics, including the ve most prescribed in outpatient Honored as a pioneering, national leader in settings: azithromycin, amoxicillin, amoxicillin/clavulanate, surgery education, research and publishing, and cipro oxacin and cephalexin. in development of cancer center networks, e CDC estimates that up to 30 percent of antibiotic research programs and clinical protocols. prescriptions in outpatient settings may be unnecessary, such as those written for sore throats and sinus infections, which Michael L. Gross, PhD most o en are caused by viruses. Overuse contributes to the Professor of chemistry in Arts & Sciences and of immunology and rise of drug-resistant superbugs and excess health-care costs. pathology and of medicine in the School of Medicine e researchers are conducting further studies to understand Recognized for contributions to physical-organic, the gap between guidelines and prescribing practices. analytical, environmental and biophysical chemistry by developing and applying mass-spectrometry methods.
4 Washington University School of Medicine Summer 2018
181795_p2-6_PULSE_CC17.indd 4 5/21/18 6:44 PM MILLER MATT Wonderfully weird
Students got creepy and kooky, mysterious and spooky and altogether ooky in their performance of “The Addams Family Musical” in March. The production, a culmination of a yearlong planning process, involved students from all educational programs on the Medical Campus. This was the 13th year for the show, which is entirely student-produced. Students build sets, sew costumes, run light and sound, play in the pit orchestra, direct and act. Left: Uncle Fester, as played by Matt Mosley, a student in the Division of Biology & Biomedical Sciences.
New way to ght sepsis: Rev up immune systems Clinical trial demonstrates significant, lasting increase in key immune cells
epsis — a condition that develops The patients MACH when an infection triggers an were treated with HUY Soverwhelming immune response — a drug made of causes about 250,000 deaths annually in the interleukin-7 (IL-7), U.S. Standard treatment, involving high doses which enhances of antibiotics, often doesn’t work well and the proliferation fails to boost the body’s immune defenses. and survival of Now, a drug that revs up the immune immune cells system is showing promise in a small clinical CD4 and CD8. trial. The approach goes against the grain These cells are of earlier strategies that have relied on important because antibiotics and inflammatory medications to they recruit other tamp down the immune system. immune cells “Mortality rates from sepsis have remained to fight severe essentially the same over the last 50 years,” infections that said senior investigator Richard S. Hotchkiss, can lead to organ failure and death. Patients A small clinical trial led by Richard S. Hotchkiss, MD, MD, a professor of anesthesiology, of medicine who develop the most serious form of sepsis, shows that a drug that revs up the immune system and of surgery. “Hundreds of drugs have called septic shock, often have very low holds promise in treating sepsis. From left, Hotchkiss, been tried and have failed. It may sound counts of these key immune cells. an ICU doctor for the past 30 years, his clinical trial counterintuitive when inflammation is such The trial patients, all hospitalized and patient, Greg Porter, who recovered from sepsis, and a problem early in sepsis, but our approach is severely ill with septic shock, were randomly nurse manager Jane Blood, RN. to stimulate certain immune cells to help the assigned to one of two therapies. Seventeen patient’s system take control of the infection.” patients received the IL-7 drug, and 10 compromised immune systems. Without The trial involved 27 sepsis patients, ages received a standard treatment. Those who restoring immune function, Hotchkiss said, 33 to 82, who were treated at Barnes-Jewish received the IL-7 drug experienced a threefold many patients develop lingering infections Hospital, Vanderbilt University Medical Center to fourfold increase in CD4 and CD8 counts. and are helpless to fight any new infections. in Nashville or two medical centers in France Traditional approaches do not address A larger trial is being planned to determine — Dupuytren University Hospital in Limoges the critical problem of patients’ severely whether IL-7 can improve survival rates. and Edouard Herriot Hospital in Lyon.
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181795_p2-6_PULSE_CC17.indd 5 5/16/18 8:59 PM MILLER MATT CRISPR enhances cancer immunotherapy Last year, the Food and Drug Administration approved the rst cellular immunotherapies to treat cancer. ese therapies involve collecting a patient’s own immune cells — called T cells — and supercharging them to home in on and attack speci c blood cancers, such as hard-to-treat acute lymphoblastic leukemia and non-Hodgkin lymphoma. But so far, these T cell immunotherapies — called CAR-T EARNING A SPOT STAT, an online biomedical science cells — can’t be used if the T cells themselves are cancerous. news publication, chose 64 teams to compete in STAT Madness 2018, Even though supercharged T cells can kill cancerous T cells, they also can kill each other because they resemble one a March-Madness-esque battle designed to find the most innovative another so closely. scientific and medical research of 2017. Two School of Medicine
School of Medicine MACH teams made the bracket, and one of them made it to the “Elite scientists now have HUY Eight.” That team, led by Farshid Guilak, PhD (foreground), was used the gene-editing chosen for research aimed at rewiring stem cells to cure arthritis. technology CRISPR to engineer human T cells that can attack human T cell cancers American Academy of Arts and without succumbing to friendly re. Sciences elects Perlmutter e study in mice appears online in the John DiPersio, MD, PhD, right, works in the lab David H. Perlmutter, MD, dean of the journal Leukemia. with study co-author Armin Ghobadi, MD. School of Medicine, will join the likes of Cancerous and former President Barack Obama, actor healthy T cells have the same protein — CD7 — on their Tom Hanks and Supreme Court Justice surfaces. e team, led by senior author John F. DiPersio, Sonia M. Sotomayor as new members MD, PhD, the Virginia E. and Sam J. Golman Professor of of the American Academy of Arts and Medicine in Oncology, rst generated a novel CAR-T strategy Sciences. targeting CD7, allowing for the targeting and killing of all Perlmutter, the Spencer T. and Ann cells with CD7 on the surface. W. Olin Distinguished Professor and “But if we program T cells to target CD7, they would executive vice chancellor for medical a airs, is internationally attack the cancerous cells and each other, thus undermining recognized for his research on alpha-1 antitrypsin de ciency this approach,” DiPersio said. “To prevent this T cell (ATD), a genetic disorder in which the accumulation of a fratricide, we used CRISPR/Cas9 gene editing to remove misfolded protein in liver cells can result in severe liver failure. CD7 from healthy T cells, so they no longer carry the target.” To evaluate potential treatments for ATD, he and DiPersio and his colleagues also used CRISPR to colleagues developed a pipeline of drugs that includes one simultaneously eliminate the therapeutic T cells’ ability to in a phase II/III clinical trial. e goal is to eliminate the see healthy tissues as foreign. need for liver transplantation, the only treatment option is way, T cells from any normal donor can be used for patients with progressive liver disease due to ATD. without risk of life-threatening toxicities such as gra - Perlmutter was trained at Children’s Hospital of versus-host disease. A “matched” donor with similar Philadelphia and Boston Children’s Hospital and has immunity is not required. been on the faculties of Harvard Medical School and the is new approach also may have broad implications for University of Pittsburgh. the CAR-T eld, allowing for use of therapeutic T cells from e new class will be inducted in October in Cambridge, any healthy donor. Massachusetts, joining a list that includes Benjamin e researchers demonstrated that this approach is Franklin, Alexander Hamilton, Ralph Waldo Emerson, e ective in mice with T cell acute lymphoblastic leukemia Charles Darwin, Albert Einstein and Martin Luther King Jr. taken from patients. ey are working toward clinical trials of the gene-edited CAR-T cells.
6 Washington University School of Medicine Summer 2018
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BIG DATA Putting information-based tools in doctors’ hands
BY DEB PARKER
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The Institute for Informatics — also known as I2 — Genomic medicine. Personalized sits at the center of all big data initiatives at medicine. Precision medicine. Washington University. It provides an academic When it comes to interpreting and applying big data in health care, and professional home for informatics science, people may not agree on the best terminology. Most agree on one education and practice. thing: Big data is an abstract, intimidating concept. DNA sequencing generates millions of data points for a single individual. Clinical trials yield massive amounts of treatment information. e electronic health record (EHR) expands with every patient encounter. And wearable tness trackers and apps — which measure steps taken, food consumed, heart rate, blood pressure and sleep patterns, open up a whole new area of possibility. Big data is coming at medical professionals from all directions. Many have no idea how to e ectively leverage it for patient care. Philip R.O. Payne, PhD, is an internationally recognized leader in informatics, a eld that translates big data into actionable knowledge. As inaugural director of the university’s Institute for Informatics, he leads the way he speaks — at double speed. In 20 months of existence, the institute has made signi cant inroads at this large, decentralized university.
8 Washington University School of Medicine Summer 2018
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For Payne, the path forward is clear. Payne envisions a new landscape — where “If you ask physicians what they want, it’s doctors and researchers have the necessary tools the equivalent of a ‘patients like mine’ button on and expertise to extract meaningful information their electronic device,” he said. within vast data sets. “ ey tell us, ‘Given the patient that’s in front When many people hear the word informatics, of me right now, show me similar patients who Payne said, they associate it with interpreting the have been seen in the past six months, one year human genome, but that’s just one aspect of the or 10 years. What treatment decisions were made? institute’s work. Who had the best outcomes? Who didn’t?’ A top priority is improving EHR e ciency. “Physicians want to know, based on their e EHR requires a mental shi for some physicians wisdom and the wisdom of colleagues, how to who are used to free-form documentation of optimize outcomes for the patient in front of them.” patient encounters on paper versus a more rigid, checkbox system that perhaps even in uences medical thinking. Many clinicians nd it clunky, Information overload burdensome and disruptive. Institute team members are shadowing clinicians at the point of Provider burnout nationally is at an all-time high, care to design technologies that adapt to work ow. with doctors citing such factors as job complexity and E ciently designed systems can close the gap having too few hours in the day. By some estimates, between digesting the data and making clinical EHR upkeep requires 31 percent of physicians’ time. decisions, Payne said. “ e real challenge is not A few decades ago, doctors could stay abreast getting more data. It’s guring out what to do of medical advances by reading scholarly journals. with what we already have.” Now, it’s virtually impossible to keep up with the Recently, Payne and David H. Gutmann, MD, constant ow of information. PhD, the Donald O. Schnuck Professor and director “Human short-term memory is optimized to of the Neuro bromatosis (NF) Center at Washington remember seven pieces of information at a time, University, employed informatics to predict plus or minus two,” said Payne, also the Robert J. symptom severity in children with NF1, a genetic Terry Endowed Professor. “Informatics is essential disorder that causes brain and nerve tumors, as well to guring out how we connect the dots between as autism spectrum disorder (ASD). NF1 varies those millions of data points, contextualize them widely in severity and symptoms — from harmless and deliver them back to clinicians who may have brown spots on the skin and benign bumps to optic only 10 minutes with a patient to interpret and act gliomas and malignant cancers. Parents don’t know on that information.” which symptoms might manifest in their child.
The institute is actively training the next generation MATT MILLER MATT of informatics specialists. Here, Andrew Michelson, MD, left, a pulmonary and critical care fellow, and Sean Yu, a biomedical informatics doctoral student in the Payne-Lai lab, discuss analytical methods to predict septic shock.
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181795_p7-13_Informatics_CC18.indd 9 5/16/18 9:01 PM In a matter of hours, using computer analytics A data-driven approach, Payne said, is going and existing NF1 patient data, Gutmann and to be a key di erentiator as institutions compete Payne improved risk models that others had to provide exceptional care in an information- created following months of painstaking rich era. Within its storehouses, big data holds deliberation in conference rooms. With even the answers to pressing medical questions of our greater speci city, they outlined various NF1 time; it has the power to develop drugs faster at subtypes, their trajectories and associations with lower cost, speed diagnosis, deliver on the optic gliomas and ASD. promise of personalized, or precision, medicine, is information allows families to plan ahead, and improve quality of life. and alerts clinicians as to whether additional imaging or other interventions are warranted. “Precision medicine isn’t always about curing,” A home advantage Payne said. “We can improve quality of life by illuminating the unknown. It’s also helpful for the Harnessing this power requires an environment clinician in the exam room, who is facing imaging that’s built to rapidly translate discovery out of reports, EHR data, gene sequencing results, maybe the lab and into the clinic. a social/behavioral evaluation report — and an Washington University, in partnership with anxious child and an anxious parent. We are BJC HealthCare, stands uniquely poised to lead relying on physicians to integrate on demand and on the informatics frontier, with key strengths in make the best possible decision. at’s a source of medicine, basic science, cancer, genomics, stress for providers, who have limited time and an radiology, public health, social work, business EHR that isn’t designed very well. and engineering, among others. Nearby sits the “But if we can integrate that data and say to 200-acre Cortex Innovation Community, a those providers, ‘ is patient has an 80 percent thriving hub for bioscience research, probability of developing an optic glioma and here development and commercialization. are the outcomes for the last 10 children you saw “We have one of the best genome institutes similar to this,’ then we’ve allowed them to get and one of the most productive and most down to the really important information and impactful basic science research enterprises have a conversation with the family and not just in the world,” Payne said. “We have some of sit there clicking and pointing and typing. the smartest care providers that you will meet. “ at’s the real promise if we do all the things We have a unique living laboratory between we’re talking about.” Washington University Physicians and MILLER MATT
“ Precision medicine isn’t always about curing. We can improve quality of life by illuminating the unknown.” —Philip R.O. Payne, PhD
10 Washington University School of Medicine Summer 2018
181795_p7-13_Informatics_CC18.indd 10 5/16/18 9:02 PM BJC HealthCare, where we have a large academic referral center, plus regional hospitals and primary care practice sites in urban and rural environments. “We have all the pieces we need to study what Launching the future of health care looks like. Very few U.S. academic health centers are truly primed to take advantage of the health-care information age.” the institute Until the institute’s launch, the university had all the raw pieces, except one. Although pockets hen Philip R.O. Payne, PhD, previously chair of the of informatics strength existed — including WDepartment of Biomedical Informatics at The Ohio State leadership in the Human Genome Project, the University, signed on to become the institute’s founding director, Connectome Project and e orts to understand he brought longtime colleagues with him. the microbiome — there was no central academic and professional home for informatics science This allowed for rapid deployment in targeted areas: and practice. • Speeding pace of discovery out of the lab into human studies Every School of Medicine department chair • Building systems that improve how physicians treat patients • Using data to improve health of communities contributed funding from department reserves
to establish the Institute for Informatics, also Most faculty affiliated with the institute, which is housed in the 2 known as I . Division of General Medical Sciences, will hold dual appointments in other departments and schools. This is part of a strategy to extend the institute’s reach across the university. An informatics One patient, one record expert embedded in anesthesiology or pediatrics, for example, will collaborate on projects related to these subjects. A er putting critical team members in place, institute leaders turned their attention to their rst, most fundamental task: Getting everyone Key informatics faculty investigators within this expansive, 15-hospital system and medical school on the same page. Clinical research informatics is June, with the institute’s active Chief Research Information Officer participation, the medical school and BJC Albert M. Lai, PhD, an expert in informatics HealthCare will roll out the Epic electronic health infrastructure who specializes in solving record system on the academic campus. It already problems in the clinical domain. He oversees a has been launched in many of BJC HealthCare’s core services team of programmer analysts, software engineers, database administrators, community hospitals. Once fully implemented, data analysts and bioinformaticists. Epic will replace more than 50 standalone EHR systems that had been used by individual physician groups, specialty clinics, hospitals and Population health informatics even departments within the hospitals. Previously, Randi Foraker, PhD, MA, FAHA, who applies outpatient data generated through Washington informatics techniques to solve problems University Physicians (faculty practice plan) was in the population health domain. She also not connected to hospital inpatient data. And serves in the Institute for Public Health. some records were still paper-based. As Sam Bhayani, MD, chief medical ocer of Washington University Physicians, explains, Applied clinical informatics the medical center draws patients who live hours Po-Yin Yen, PhD, RN, an assistant professor away and who have complex problems and see at the Goldfarb School of Nursing at Barnes- multiple specialists. Jewish College, who works with frontline Bringing data into one centralized location caregivers to understand daily workflow and eliminates the need for patients to recall their improve health information technology. entire medical history, such as the date of their last tetanus shot or prescription dosages, and will reduce treatment redundancies, potentially saving money, and help eliminate harmful drug interactions. It also allows clinicians to view patients holistically and
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181795_p7-13_Informatics_CC17.indd 11 5/21/18 8:37 PM consider all factors When data becomes treatment across the continuum of care. What should emerge is a more SOURCES comprehensive picture of a person’s health care, including total cost of care. is, however, is only half of the vision. Patient information must be returned back to investigators as they consider new ways to solve complex health-care problems. Data mining within a decentralized system has been METHODS an arduous, ine cient task. “For some patients, we had very little data. All we knew is R what happened during their hospital stay,” said Chief Research Information D O cer Albert M. Lai, PhD. “If you’re a researcher trying to understand Sources C optimal care delivery, it’s basically impossible given this fragmented view.” Data is generated through the EHR, clinical studies, genome sequencing and patient- A new research paradigm reported outcomes, OUTPUT among other sources. A centralized EHR has revolutionary research implications for Washington University — Methods joining together and unlocking access to more than 6 million records of inpatient and Data is integrated in the outpatient care. Research Data Core, a centralized warehouse managed by statistical “We want to translate data into knowledge,” data analysts. Here, various Payne said. “We want to create a system where approaches can be used to what we learn from each patient informs how we analyze data — from machine treat other patients and what questions we ask in learning to visualization. the lab. In turn, we want what we learn in the lab to bene t patients more quickly. Output “Right now, we have clinical investigators seeing patients. But they go back to their labs From this analysis, decision-support IMPACT and they don’t have access to the data generated tools can be designed to assist physicians at the point of care. by their own patients, at least not to the degree These tools — such as reminders necessary to test basic hypotheses. We need to for preventive care or alerts about make that data more accessible.” potentially dangerous situations — e real forward leaps in innovation will can be deployed through laptops, come as the institute builds out a large, integrated tablets and mobile phones. database — known as the Research Data Core (RDC) — that links all data. e RDC powerhouse Impact will include the common EHR, which feeds a Precise, knowledge-based interventions continuously updated stream of patient data, plus benefit doctors, researchers, patients, data from any remaining legacy or departmental communities and policymakers. clinical systems. Plans call for the addition of genomic and biospecimen information.
12 Washington University School of Medicine Summer 2018
181795_p7-13_Informatics_CC18.indd 12 5/16/18 9:02 PM Statistical data analysts within the institute will Treatment solutions, however, are waiting manage the RDC. ese informatics professionals to be found in big data. Repurposing or using will help researchers pull data from the central new combinations of approved drugs, which already system, design studies and maintain patient have passed toxicity tests, could save valuable time. con dentiality. ey and other team members are Using an informatics concept known as available to educate, answer questions and analyze “machine learning,” computers can be and visualize data in meaningful ways. programmed to comb through clinical and rough self-service tools, researchers will be drug data, going back through decades of able to access the RDC and do some analysis at medical literature, analyzing billions of variables, their own computers. to discover meaningful patterns and new uses for Informatics leaders say a new partnership with a existing medicines. company called MDClone also has the potential to Payne, also a cancer researcher, points to fast-track research. Washington University is the rst malignant melanoma as one example. Frontline U.S. academic institution to have this technology. therapies are e ective at causing tumors to Under current federal regulations, investigators disappear, but patients oen become resistant must wait weeks or months to begin research within 12 months of the rst treatment. By projects involving real patients. For each project, using public data and computational methods, researchers must le paperwork and wait for researchers have found drugs — developed for approval from an institutional review board (IRB), other diseases — that could be combined with an administrative body that protects the rights melanoma frontline therapies to prevent or delay and welfare of human research subjects. Following resistance onset. So far, Payne’s research team has approval, researchers then must wait for a data taken this combination therapy all the way to analyst to pull the necessary data before research animal models, and they did it in about a year. can get underway. Once a therapeutic agent is ready to move to MDClone’s unique niche is its ability to create clinical trials, the RDC also should make it synthetic data — data that looks like an actual patient quicker and more e cient to identify test subjects. population, but isn’t. Data engines yield synthetic data that is statistically identical to original protected health information, but without privacy concerns. Enhancing human health “With MDClone, you could e ectively have no time delay,” Lai said. “If you think of an idea, you e dream, Payne said, is to use big data not only can pull up the data and analyze it, right then and to help the sick, but also to keep people well, to there, from the computer in your o ce, potentially intervene in the communities where they live, make discoveries on the data, with zero risk to work and play, and not just inside our hospitals. patient privacy.” An evolving EHR likely will include more data If the data looks promising, researchers can about patients’ daily activity levels, gathered follow the standard IRB steps to con rm the through smartphones and tness trackers, and result with real data. If not, Lai said, they can other health inuencers, such as water quality in just move on to the next question. the home, proximity to grocery stores and family e institute is testing MDClone’s performance support networks. via pilot research projects. Pending a successful Big data has the power to promote wellness evaluation, MDClone will become part of the by generating a picture of the whole patient — RDC infrastructure. connecting genes and environmental factors to Creating e ciencies in research saves time and social factors and outcomes. allows grant dollars to stretch farther, Payne said, “ e institutions that gure out how to bring which, in turn, will attract top U.S. researchers. all these pieces together will be the rst to begin delivering personalized, precision medicine,” Payne said. “Rather than treating people as a Speeding discovery function of averages, personalized health care that is powered by big data is about enabling Payne hopes to speed up the process of taking physicians to provide the right care at the right discoveries into clinical trials. Currently, it can time, based on the unique characteristics of the take 15 to 20 years and more than $1 billion to patient in front of them.” develop therapeutic agents for disease.
outlook.wustl.edu Outlook 13
181795_p7-13_Informatics_CC18.indd 13 5/16/18 9:02 PM Radiation beam to the heart
14 Summer 2018
181795_VT_CC17.indd 14 5/16/18 8:16 PM n the early days of his irregular heartbeat, Clarence Mankin would pass out before his Iimplanted de brillator kicked in to reboot his heart. He would wake up a bit later, dazed but alive. A er his doctor adjusted the device’s sensitivity, it would shock his heart before he fainted, which, in Doctors halt deadly rhythm some ways, was worse. Mankin could feel it coming — with noninvasive therapy the lightheadedness, the dizziness — and h e’d know to brace himself for the jolt. BY REBECCA BOYLE “It’s like a good thump in the chest. It feels like you are going to d i e ,” he said. “I’d try to grab hold of something, or nd something to sit down on, which occasionally I was able to d o.” Mankin, 74, a retired Lutheran pastor in Atlanta, Illinois, used to pride himself on walking 10,000 steps a day, which he tracked with his wrist pedometer. But when he started feeling the jolt all the time — at one point, he was having 11 episodes a day — he stopped walking. He stopped driving. He stopped leaving the couch. About 3 million Americans experience arrhythmia, in which the heart beats too fast, too slow, or too irregularly. One such form, ventricular tachycardia, is the leading cause of sudden cardiac arrest. An unlikely pairing between a School of Medicine cardiologist and a radiation oncologist, however, has led to a revolutionary treatment: Mankin is one of the earliest patients to sustain a beam of radiation directly to his heart. MOSER
outlook.wustl.edu SARA Outlook 15
181795_VT_CC17.indd 15 5/16/18 8:16 PM entricular tachycardia (VT) results Cuculich and Cli G. Robinson, MD, an associate from other cardiac problems. Mankin, professor of radiation oncology, recently had teamed Vwho served in the U.S. Army during up to provide a new type of arrhythmia treatment, the Vietnam War, had his rst heart attack at 44, one that cardiologists nationally are calling a game which he attributed to Agent Orange exposure. changer for patients with few remaining options. Injury to the heart, commonly from a heart attack, Mankin agreed to give it a try. causes some cells to die, forming scar tissue. When To undergo the procedure, he donned a specially heart cells are damaged in this way, they might designed vest covered in 252 electrodes (as compared not function correctly, causing the heart to short- to 12 for a typical electrocardiogram). circuit. is makes it beat out of sync, which means en Cuculich brie y induced VT in Mankin the heart might not be able to pump enough blood using his de brillator. is allowed him to throughout the body, and it can even stop entirely. produce a panoramic map of Mankin’s heart. Standard treatments include medications, Later, Mankin lay inside a cylindrical chamber. de brillators and a procedure known as catheter A custom mold held him in place to prevent him ablation. Patients must be sedated for this invasive from moving or breathing too deeply. Robinson procedure as doctors thread ne tubes through used the map to direct an intense, focused beam the femoral vein, up into the heart. A tiny electrode of radiation at his heart. tip, no larger than a headphone jack, selectively e high-energy particle stream is typically burns away heart cells that have gone haywire. used to blast away cancer cells, and, during normal e procedure can last from four to 10 hours, use, Robinson does everything he can to avoid and recovery can take several weeks. Although hitting the heart. But this time, his particle beam physicians have developed precise ablation intentionally zapped malfunctioning cells that techniques to ensure they destroy as many were causing Mankin’s heart to beat out of sync. To treat arrhythmia, wayward cells as they can, the treatment doesn’t On average, the procedure takes less than cardiologist Phillip S. always work. It also has a cluster of side e ects, 15 minutes. Cuculich, MD, performs from infections to bleeding problems. In a 2016 “I’ve spent my entire life as a trainee and an catheter ablation. For study, half of patients who underwent catheter attending physician thinking about ways to avoid this procedure, the patient ablation saw their tachycardias return. dosing healthy tissues,” Robinson said. “But this is must be sedated as Cuculich e same was true for Mankin. already an injured region. If you think about it as threads fine catheters en Mankin’s cardiologist referred him a diseased part, where Phil would have no problem through the femoral vein, to Phillip S. Cuculich, MD, a heart rhythm going in with a catheter to burn that area, well, we up into the heart, to burn specialist and an associate professor of medicine are doing the same thing. ere are other ways to away malfunctioning cells. at Washington University. get energy inside the body.”
Catheter Noninvasive Ablation Radiotherapy 4–10 < 10 hour procedure minute procedure
2 days 25 minutes in the hospital door-to-door 40–70% success rate TBD Success rates and % complication rates 2–12 are being evaluated
MATT MILLER MATT complications in clinical trials.
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181795_p14-19_VT_CC17.indd 16 5/22/18 12:39 PM MATT MILLER MATT
A vest covered in 252 Mankin was awake throughout the radiation REGULAR HEARTBEAT electrodes allows Phillip therapy, which took place Sept. 8 at Barnes-Jewish S. Cuculich, MD, center, to Hospital. When it was over, he sat up, swung his produce a panoramic map legs o the table, and walked out of the room. of a patient’s heart. Cliff G. He felt no pain. VENTRICULAR TACHYCARDIA Robinson, MD, right, uses On a warm January day, Mankin visited this map to direct a focused Cuculich’s o ce for a follow-up appointment. beam of radiation at the Cuculich downloaded data from his implantable heart to treat arrhythmia. de brillator, which tracks each time it gives Biomedical engineer Yoram Mankin a jolt. A er the appointment, Cuculich Rudy, PhD, invented the vest. printed out the device’s history on a piece of paper, and strode into Robinson’s o ce in the radiation More than three months later, Mankin hasn’t oncology department. had a single jolt from his de brillator. By February, “Look at this,” Cuculich said, grinning as he he was walking 5,000 steps a day. “It’s hard to thrust the small square paper into Robinson’s hand. describe. Now when I walk, I don’t feel like Robinson’s eyes widened: “Wow!” And then the something terrible is going to happen to me,” oncologist, still seated in his chair, started dancing. Mankin said. “I don’t know if this will extend e sheet of paper was marked with what my life or not, but it has made the quality of looked like a bar graph. e bottom axis was time, my life much better.” and the vertical axis depicted every instance the device was activated. Cuculich pointed out the three months prior When no other options exist to the Sept. 8 radiation treatment. It looked like a forest: A spike each day, some very tall and some Mankin is one of about two dozen patients shorter, referencing the number of jolts each day enrolled in a clinical trial led by Cuculich and from the device. en Cuculich pointed to Sept. 8, Robinson. e ENCORE-VT trial follows an and the months a er Mankin’s procedure. e initial case study from April to November 2015 forest had been cleared. e device had not activated with just ve patients, which the physicians at all. e tachycardia was gone. conducted to prove their technique would work. Cuculich and Robinson both laughed. e results were published in e New England “at is amazing,” Robinson said. Journal of Medicine in January.
outlook.wustl.edu Outlook 17
181795_p14-19_VT_CC17.indd 17 5/22/18 12:39 PM MATT MILLER MATT
Cliff G. Robinson, MD, and Like Mankin, all patients so far have had “Even if you could non-invasively image the Kim Maserang, RT (T), ventricular tachycardia that has not responded heart, we still required entry into the body with a prepare to treat a patient to standard treatments. catheter to x it,” Cuculich said. “It became clear with stereotactic radiation, In the rst clinical trial, the ve patients that the place to make an impact was to non- a very precise, high-energy collectively experienced 6,577 episodes of invasively treat it.” dose of radiation. VT in the three months before their radiation As part of the School of Medicine’s focus treatment. In the nine months a erward, they on translational research, Cuculich met with experienced four. neurosurgeon Albert H. Kim, MD, PhD, to “It has the potential to bene t a substantial discuss using ultrasound technology. Kim number of people,” said William G. Stevenson, recommended Cuculich meet with Robinson. MD, professor of medicine at Vanderbilt University For his part, Robinson was looking for new Medical School, who was not involved in the research. ways to use stereotactic radiation — a very Cuculich spent several years re ning techniques precise, high-energy dose of radiation — beyond to map the heart in four dimensions — the three cancer treatment. physical dimensions, plus time — to nail down “When we rst met to discuss this, I was the precise regions that are malfunctioning. e really concerned about how to hit a 5 mm area technique, known as electrocardiographic imaging, in a moving, beating heart,” Robinson said. was developed by Yoram Rudy, PhD, the Fred Saigh “But Phil’s rst question was, ‘How big of an area Distinguished Professor of Engineering, director of can you treat?’ And I said, ‘ is is going to be a the Washington University Cardiac Bioelectricity good friendship.’ Because as radiation oncologists, and Arrhythmia Center, and Cuculich’s mentor. we don’t treat parts of tumors. We treat the whole But a more detailed picture of heart dysfunction kit and caboodle.” was not enough, Cuculich said. Cuculich and Robinson started meeting regularly to discuss each other’s specialties and learn about their patients. Each had to relearn “ We have created an entirely non- terminology and techniques he hadn’t studied since medical school. invasive process to map and treat “ at was one of the keys to this initial success, that we came together and talked about it,” Robinson arrhythmia, and we can do it in less said. “ at this could happen is one of the unique things about being at Washington University.” than 10 minutes.”— Cliff G. Robinson, MD e physicians developed a technique that relies on multiple imaging methods. MRI, CT
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181795_VT_CC17.indd 18 5/16/18 8:17 PM and PET scans combine with the electrode Radiation therapy likely will complement, vest to produce a detailed map of the heart and rather than replace, ablation and other procedures pinpoint where arrhythmias are coming from. e cardiologists have used for many years. It provides imaging process involving patients takes several another option for VT patients who have exhausted hours, occasionally spread over multiple days. standard therapy options, including catheter “ en Cli and I sit down together and ablation, and are facing one-year survival rates collaborate over this information, and we come below 20 percent. to a conclusion about where the scar is, so we “When you get complex forms of heart are as precise as possible. We want to avoid any disease that are responsible for a lot of complex structures that are important to the heart, and circuitry, then there might be an advantage to Top: This image is a fusion keep the potentially damaging energy within the an approach that is more extensive, rather than of a CT simulation scan and scar,” Cuculich said. precise,” said Francis Marchlinski, MD, director PET/CT. The PET/CT shows To Robinson, that push and pull — how deep of cardiac electrophysiology at the University of viable heart tissue, outlined to go, how much tissue to take and how much to Pennsylvania, who was not involved in the study. in pink, as a structure to leave alone — is much like cancer treatment. Some Robinson and Cuculich are nalizing their avoid with radiation. The patients, like Mankin, have large areas that must be results from the ENCORE-VT trial, which included red line is the target area. treated. e burning tip used in catheter ablation is 18 patients along with Mankin. Early results, they The green and cyan lines only about 3.5 millimeters across, roughly the size say, are promising. mark safety margins to of a Sharpie tip. In some people, the cells that cause “We have created an entirely non-invasive account for motion (patient the heart to beat out of sync are not reachable with process to map and treat arrhythmia, and we breathing and heart beat). the tiny catheter tip. is is especially true for cells can do it in less than 10 minutes,” Robinson said. Bottom right and left show, deep within the heart muscle. e radiation beam “ is approach can fundamentally change the respectively, the coronal can penetrate deeper, targeting all the faulty cells. way we approach these heart rhythm problems.” view and sagittal view. Robinson said he was concerned some patients would be fearful of the word “radiation,” but both physicians said their patients have been less resistant than they expected, in some cases because they were desperate for any solution. Mankin said the doctors helped him understand how it would work, and why it could be so e ective. “It’s novel, but if you think about it, they’ve been using the gamma knife on cancer surgeries for years now,” he said. With such a high dose of radiation, even at a very small site, there is a risk of toxicity and ill e ects on the surrounding organs and tissues. So far, patients in the initial study and in the ongoing clinical trial have done well, Robinson said. In the initial study, patients reported no complications or pulmonary symptoms during treatment or immediately a er. Some people did experience mild in ammation in the lung adjacent to the target, but that resolved within a year, according to the study. Still, the potential long-term e ects of the radiation dose are unknown. “If this is to be used in younger, less-ill patients, the issue of collateral damage will become more relevant,” said Roy John, PhD, professor of medicine at Vanderbilt University Medical Center. He and Stevenson coauthored an editorial explaining the procedure’s potential in e New England Journal of Medicine.
outlook.wustl.edu Outlook 19
181795_p14-19_VT_CC17.indd 19 5/21/18 7:20 PM Holly and Ben Allen welcome their new baby, Max, in the Women & Infants Center.
20 Washington University School of Medicine Summer 2018
181795_p20-25_WomenInfant_CC17.indd 20 5/16/18 7:48 PM Critical connections New integrated center changes care model for women and babies
BY KRISTINA SAUERWEIN
A new center on the Washington University Medical Campus is transforming health care for women and babies in the region. e Women & Infants Center is housed within two 12-story inpatient towers recently built by BJC HealthCare: the Barnes-Jewish Parkview Tower and a St. Louis Children’s Hospital tower. A skywalk connects the labor and delivery areas in the Parkview Tower with an expanded Level IV newborn intensive care unit (NICU) in Children’s Hospital, drastically reducing the time it takes to transfer critically ill newborns. e center combines the most advanced facilities — allowing specialists to perform surgeries in the womb or manage risky deliveries — with beautiful, restful, comfortable spaces for patients. “Women and infants remain at the center’s heart. It’s as good as it gets,” said George Macones, MD, head of the Department of Obstetrics and Gynecology. Other tower oors signi cantly enhance and expand inpatient cancer care and pediatric care. e improvements stem from a three-year design planning process involving input from nearly 800 health-care workers, patients and family members. MATT MILLER MATT
outlook.wustl.edu Outlook 21
181795_p20-25_WomenInfant_CC18.indd 21 5/21/18 7:50 PM MATT MILLER PHOTOS MILLER MATT
MONITORING SYSTEM Cameras are positioned over bassinets in the OR and areas where medical staff attend to newborns. The cameras let mothers watch their new babies even when they’re not holding them. This is especially helpful for C-sections or multiple births.
OPERATING ROOM SIZE As many as 40 medical professionals can work in the largest operating room, which is designed for emergencies, for complex operations such as in-utero surgeries or for multiple births.
WOMEN’S ASSESSMENT CENTER This area allows women who COMMAND CENTER think they may be in labor In the command center, or who have an emergency nurses, doctors and other staff gynecological issue to bypass can monitor vital statistics for the emergency room. Specialists patients in labor or undergoing who handle women’s health surgery. The stations monitor issues are on call and can 18 labor and delivery rooms quickly make an assessment. and three ORs in real time.
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181795_p20-25_WomenInfant_CC18.indd 22 5/21/18 7:51 PM Caring for mom
others-to-be who deliver at the Women & Infants MCenter do so in an environment equipped with the top medical expertise and technology to treat serious conditions that may a ect a pregnant woman or fetus. Barnes-Jewish Hospital annually cares for about 700 women from eight states who need specialized obstetric care for deliveries involving multiple births, pregnancy complications, fetal abnormalities and congenital defects in utero. e labor and delivery oor has three operating rooms, including one for maternal-fetal surgeries that is state- of-the-art and spacious enough to accommodate up to 40 health-care workers. “ is is the room where we do procedures on a fetus while still in the “ It’s one stop womb,” said George Macones, MD, the for women’s Mitchell and Elaine Yanow Professor and health.” head of the Department of Obstetrics George Macones, MD and Gynecology. “Having extra space is critical. One procedure, for instance, may include physicians and nurses from obstetrics, fetal medicine and anesthesia.” Altogether, 3,300 babies were born last year at Barnes-Jewish Hospital. e center o ers 52 private obstetric rooms, in addition to 18 labor and delivery rooms. e rooms have sleeper couches for family, ample outlets for charging electronics and built-in storage stocked with supplies for diapering and feeding. Android tablets installed on over-the-bed tables make it easy for the patient to contact the doctor, order food and access the internet. e center’s care extends to all women with the new, 12-bed Women’s Assessment Center, which allows OB-GYN patients to bypass the general emergency room to receive treatment for ovarian cysts, hysterectomies and other conditions. “We take care of women in all reproductive phases,” The three new operating rooms bring Macones said. “It’s one stop for women’s health.” together advanced technology, medical efficiencies and a focus on patients.
PATIENT ROOM WOMEN’S WALK Spacious, private rooms have This hallway was created for windows overlooking Forest Park laboring women, so they won’t or rooftop gardens. The rooms are have to walk heavily trafficked divided into three zones: space areas. Glass walls let in natural for family members to visit or light, illuminating work from spend the night; a place for mom Midwestern artists. Rails and and baby to rest; and areas that benches are available for those allow clinicians to do their work. who need a hand or a break.
outlook.wustl.edu Outlook 23
181795_p20-25_WomenInfant_CC18.indd 23 5/21/18 7:51 PM MSTUDIO WEST MSTUDIO
PROTECTIVE EQUIPMENT Even basic things like how often protective gowns are restocked can make a difference in health care. Cabinets designed to hold personal protective equipment (PPE), such as gloves and gowns, are in consistent locations and require refills only once daily, minimizing noise and traffic.
COMMUNICATION TOOL Caregivers wear badges that show their location in real time and record when they enter and leave rooms. When in need of immediate assistance, they can press the badge to send an emergency alert. In rooms with TVs, the badges trigger a display of the name, title and photo of doctors and nurses to help patients know who’s who.
SKYWALK NICU MATT MILLER MATT MATT MILLER MATT MSTUDIO WEST MSTUDIO A skywalk links the Barnes-Jewish The newborn intensive care unit Parkview Tower and Children’s is designed for families. Private Hospital. Before this skywalk, rooms promote bonding and any trip between delivery rooms breastfeeding, and sleeper sofas and the NICU — for newborns or and lockers make it easy for mothers — required a quarter-mile moms and other family to visit. journey through corridors and up Mothers can pump breast milk and down elevators. Now the trip in private spaces and store it in takes seconds. in-room refrigerators.
24 Washington University School of Medicine Summer 2018
181795_p20-25_WomenInfant_CC18.indd 24 5/21/18 7:51 PM INROOM CHARTING AND CARE BOARD Nurses and doctors don’t have to trundle around a computer on a cart to record a patient’s progress. Each room has its own computer, which folds Best for baby into the wall like a Murphy bed. This in-room charting further reduces hallway traffic, keeping patient areas quieter. econds count when treating a critically ill newborn. SBefore the center opened, health-care workers transporting an infant had to walk one-fourth of a mile from labor and delivery to the NICU. Now, physicians, nurses and family members have immediate access to the baby, thanks to the 110-foot skywalk connecting the two hospitals. “We can’t a ord to waste any time a er the mother gives birth,” said F. Sessions Cole, MD, the Park J. White, MD, Professor of Pediatrics, executive vice chair of pediatrics and chief medical o cer at St. Louis Children’s Hospital. “ e skywalk allows us to treat babies immediately so we can provide the best care possible.” e expanded NICU o ers 37 private rooms, two of which accommodate “ We can’t afford multiples, bringing the total number of to waste any NICU beds to 125. e short skywalk time.” jaunt from the postpartum rooms also F. Sessions Cole, MD promotes mother-baby bonding. “We include the mom as part of the infant’s health therapy,” said Cole, director of the Division of Newborn Medicine in the Department of Pediatrics. “Babies whose moms hold and talk to them o en experience better health outcomes. For example, babies born with opioids in their system may experience less irritability and physical discomfort when moms hold them.” Intertwining mom in a baby’s health-care plan also means encouraging self-care, a feat made easier because medical appointments for postpartum mothers are in the center. “ is eliminates obstacles to health care such as transportation,” Cole said. “Many moms put all their energy The remodeled and expanded newborn intensive care unit toward their babies and neglect themselves. But a well-cared (NICU) will hold 150 beds when the expansion is complete. for mom makes for a happier baby.” The NICU design was informed by the latest neonatal care e expansion also adds 96 private patient rooms on six research, including studies on the importance of avoiding pediatric oors, addressing the need for more beds. loud noises. The ceilings and flooring reduce noise. Private rooms cut down on infection.
AUTOMATED GUIDED MATT MILLER MATT MILLER MATT NICU ECMO VEHICLE AGV The NICU is equipped to provide Robots called automated guided extracorporeal membrane vehicles, or AGVs, transport oxygenation, or ECMO, in which a supplies from the delivery dock machine oxygenates the blood of to supply rooms and haul trash infants who can’t breathe on their and other waste. AGVs have their own. Children’s is one of the few own dedicated corridors and hospitals in the Midwest with the elevators, so patients will likely expertise to use this technique. never see them.
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181795_p20-25_WomenInfant_CC18.indd 25 5/21/18 7:51 PM CALIFORNIA City of Hope RADIATION ONCOLOGY Elizabeth Germino Kaiser Permanente-San Diego FAMILY MEDICINE Tarek Salih Santa Clara Valley Medical Center RADIOLOGYDIAGNOSTIC Dalen Kuang Stanford University Programs ANATOMIC AND NEURO PATHOLOGY Angus Toland PEDIATRICS Benjamin Solomon UROLOGY Tianjia Jessie Ge
MATT MILLER PHOTOS MILLER MATT UCLA Medical Center ANESTHESIOLOGY Brannon Altenhofen INTERNAL MEDICINE Phuong Le Match Day INTERVENTIONAL RADIOLOGY INTEGRATED Shamaita Majumdar RADIOLOGYDIAGNOSTIC Randy Chang 2018 Michael Roubakha On Match Day, March 16, thousands of physicians-to-be across the U.S. learned University of California- where they will train as medical residents after graduation. Of the 119 graduating San Diego OPHTHALMOLOGY Washington University medical students, 42 will train at Barnes-Jewish Hospital Lingling Huang and four at St. Louis Children’s Hospital. Altogether, this year’s class will be University of California- San Francisco represented at hospitals in 21 states. The largest group of students — 31 — FAMILY MEDICINE will train in internal medicine, followed by 13 in diagnostic radiology. Michael Snavely NEUROLOGY Sarah Kaufman PSYCHIATRY Susan Shen 6 7 13 31 7 8 9 University of Southern Surgery- Obstetrics- Diagnostic Internal Psychiatry Orthopaedic Pediatrics General Gynecology Radiology Medicine Surgery California ORTHOPAEDIC SURGERY Ramin Lalezari THORACIC SURGERY 2 Jonathan Labin Seattle 1 Richland CONNECTICUT 1 Yale-New Haven Hospital Portland OBSTETRICS AND GYNECOLOGY 1 10 Boston Victoria Wesevich Minneapolis Milwaukee 1 New Haven Ann FLORIDA 1 1 2 Arbor 1 Bronx 2 1 Brooklyn Madison Philadelphia 5 Jackson Memorial Hospital 3 2 4 New York ORTHOPAEDIC SURGERY Cleveland Baltimore 1 Chicago 2 Michael Rizzo San 3 1 San Jose Salt Lake Columbia Indianapolis 1 Francisco City Cincinnati PaloAlto 1 1 48 GEORGIA St.Louis Winston-Salem Emory University Stanford 2 Duarte 1 1 1 2 School of Medicine Chapel Hill 7 Nashville INTERNAL MEDICINE Los Angeles Sarah Wondmeneh 1 2 San Diego Atlanta ILLINOIS Dallas 2 Northwestern McGaw/NMH/VA INTERNAL MEDICINE Seren Gedallovich Houston 3 RADIOLOGYDIAGNOSTIC Nicholas Szrama 1 Miami UIC/Mount Sinai Hospital Medical Center SURGERYGENERAL Michelle Mendiola-Pla
26 Washington University School of Medicine SummerSpring 20182017
181795_p26-27_matchday_CC17.indd 26 5/16/18 9:29 PM INDIANA INTERNAL MEDICINE New York Presbyterian University of Texas Medical School Indiana University Bilal Al-Khalil Hospital-Columbia University OBSTETRICS AND GYNECOLOGY Eleanor Christenson School of Medicine Medical Center Gregory Opara Amarilys Fernandez-Maldonado INTERNAL MEDICINE University of Texas OBSTETRICS AND GYNECOLOGY Douglas Hall Amanda Boozalis Laura Lee Southwestern Medical School Sonya Liu ORTHOPAEDIC SURGERY New York Presbyterian Hospital- PEDIATRICS Jeffrey Marinshaw Benjamin Masserano Casey Beleckas Patrick Olson Weill Cornell Medical Center INTERNAL MEDICINE RADIOLOGY DIAGNOSTIC/ MARYLAND Cliff Pruett RESEARCH Morgan Schoer Xiaodi Wu Johns Hopkins Hospital Dong Young Lee Andrea Soares New York University ANESTHESIOLOGY Stephanie Teja School of Medicine Christelle Samen UTAH Andrew Young INTERNAL MEDICINE University of Utah INTERNAL MEDICINE Shiyang Zhang Paolo Dib Nora Burdis A liated Hospitals NEUROLOGICAL SURGERY RADIOLOGYDIAGNOSTIC OTOLARYNGOLOGY Sindhoora Murthy PLASTIC SURGERY Diane Aum INTEGRATED Nicholas Scott-Wittenborn SURGERYGENERAL Ridhima Guniganti Bo Overschmidt University of Maryland Rowland Han Aaron Zuckerman Medical Center NEUROLOGY WASHINGTON OBSTETRICS AND GYNECOLOGY NORTH CAROLINA Manouela Valtcheva Kadlec Regional Medical Center Mary Dandulakis University of North Carolina OBSTETRICS AND GYNECOLOGY FAMILY MEDICINE Hospitals MASSACHUSETTS Manuela Mejia Jennifer Farley Lulu Yu ORTHOPAEDIC SURGERY/ University of Washington Beth Israel Deaconess ORTHOPAEDIC SURGERY RESEARCH A liated Hospitals Medical Center Thomas Hong Alexander Padovano INTERNAL MEDICINE Andrea Tian Wake Forest Baptist ORTHOPAEDIC SURGERY Taleef Khan Julia Berg PSYCHIATRY Medical Center SURGERYPRELIMINARY Ryan Kronen Angela Lin SURGERYGENERAL Daniel Kaufman Brigham & Women’s Hospital Dylan Powell Diana Jiang INTERNAL MEDICINE Joshua Siegel WISCONSIN Victor Kovac Emily Slat OHIO Medical College of Wisconsin Michelle Robinette Lingjin Zheng Case Western/University Hospitals A liated Hospitals Children’s Hospital-Boston RADIOLOGYDIAGNOSTIC Cleveland Medical Center PSYCHIATRY PEDIATRICS/URBAN Katerina Konstantinoff PEDIATRICS HEALTH ADVOCACYBMC Christopher Mejias William Cheng Emily Rion Sagar Mehta Adam Naylor Cleveland Clinic Foundation University of Wisconsin Massachusetts General Hospital Caroline Robb INTERNAL MEDICINE Hospital and Clinics INTERNAL MEDICINE Eric Weiner Rubabin Tooba RADIATION ONCOLOGY Monica Kasbekar Alec Wright University of Cincinnati Emily Merfeld INTERNAL MEDICINE SURGERYGENERAL Medical Center PRIMARY CARE Kenneth Newcomer Jorge Zarate Rodriguez DERMATOLOGY Radhika Jain Tyler Bauman INTERVENTIONAL SURGERYPRELIMINARY Match Day 2018 participants RADIOLOGY INTEGRATED Naveen Pokala OREGON from former School of Avik Som St. Louis Children’s Hospital Medicine classes: Oregon Health & Science SURGERYGENERAL PEDIATRICS University Anchal Bansal (2017 Avril Coley Elizabeth Daniels EMERGENCY MEDICINE graduate), Anesthesiology, SURGERYPRELIMINARY Julia Kolodziej Galen Pizzorno Barnes-Jewish Hospital Max Riley Kristen Rosano Jeannette Wong-Siegel PENNSYLVANIA Michael Lamb (2001 graduate), MICHIGAN Anesthesiology, University of St. Louis University Hospital of the University University of Michigan Texas Medical Branch, Galveston School of Medicine of Pennsylvania Hospitals-Ann Arbor DERMATOLOGY FAMILY MEDICINE Adam Letvin (2017 graduate), ANESTHESIOLOGY Gabriela Morris Rachel Springer Internal Medicine, University Shagun Mathur FAMILY MEDICINE Wills Eye Residency Program Hospitals, Columbia, Missouri INTERNAL MEDICINE Mindy Guo at Je erson Jennifer Jupitz Pitts Kunal Mathur University Hospitals-Columbia OPHTHALMOLOGY (2014 graduate), Radiology- MINNESOTA INTERNAL MEDICINE Vikram Shankar Diagnostic, University of Alexander Markov Wisconsin Hospital and University of Minnesota Washington University TENNESSEE Medical School Clinics, Madison OPHTHALMOLOGY Vanderbilt University OBSTETRICS AND GYNECOLOGY Brent Bruck Tara Rao (2017 graduate), Jessica Holttum Medical Center Internal Medicine-Primary NEW YORK INTERNAL MEDICINE Care, University of Wisconsin MISSOURI Nowrin Haque Hospital for Special Surgery Hospital and Clinics, Madison Barnes-Jewish Hospital RADIOLOGYDIAGNOSTIC ORTHOPAEDIC SURGERY Tammy Ruth (2013 graduate), CLINICAL PATHOLOGY Jessica Miller Gregory Schimizzi Pediatrics, University of Gary Grajales-Reyes Monte ore Medical TEXAS Washington Affiliated DERMATOLOGY Hospitals, Seattle Cristopher Briscoe Center/Einstein Baylor College of Medicine Stephen Erickson EMERGENCY MEDICINE INTERNAL MEDICINE Christine Yokoyama Michael Del Valle PEDIATRICS EMERGENCY MEDICINE Elizabeth Maidl Elizabeth Christiansen PEDIATRICS/MEDICAL Katherine Stanley GENETICS See more photos online: Runjun Kumar wumcnews.org/match2018
outlook.wustl.edu Outlook 27
181795_p26-27_matchday_CC17.indd 27 5/16/18 9:29 PM ALUMNI & DEVELOPMENT
ackie and Randy Baker understand the pain and loss of mobility associated with arthritis — Gaining Jand the relief of recovery. To address their arthritis, doctors at the School of Medicine’s Department of Orthopaedic Surgery replaced their mobility hips and guided them through rehabilitation. Now, New strategies to preserve with their mobility restored, the hip function, improve outcomes Bakers are passionate about bringing the gi of restoration to others. BY CHANNING SUHL Hip surgeon John Clohisy, MD, the Daniel C. and Betty B. Viehmann Distinguished Professor and chief of John Clohisy, MD Adult Reconstructive Surgery, performed the Bakers’ surgeries. Physiatrist Heidi Prather, DO, professor and chief of physical medicine and rehabilitation, advised
the Bakers on alternative methods of Heidi Prather, DO relief prior to the surgeries. rough their interactions with Clohisy and Prather, the Bakers learned about the physicians’ e orts to advance the treatment of musculoskeletal disorders. As a result, the Bakers decided to make a series of nancial gi s supporting the research. e Bakers’ gi s will help the physicians nd solutions that range from new surgical alternatives to a fundamental shi in the care model. GETTY IMAGES
28 Washington University School of Medicine Spring 2018
181795_p28-37_MAD_CC17.indd 28 5/21/18 8:01 PM Investigating arthritis “We have been impressed not only by her care for us, but Traditional treatment of advanced especially by her interest in hip arthritis has centered on improving patient outcomes joint replacement surgery. ese and well-being through procedures are very e ective for interdisciplinary approaches.” pain relief but can be associated In 2017, the couple learned with limited function and long- of Prather’s plan to create the term implant failure requiring a Living Well Center at Barnes- second, riskier revision surgery. Jewish West County Hospital, For nearly two decades, Clohisy and eagerly provided funding. and his collaborators have focused As the center works toward on pre-arthritic and early arthritic becoming a reality in 2019, hip disorders and hip joint Prather said, “ e support of replacement. e multidisciplinary St. Louisans Jackie and Randy Baker have made a series of philanthropists like the Bakers team has established a world- gifts supporting arthritis research and recovery initiatives. is crucial.” renowned clinical practice, A collaboration between the research unit and resident/fellow education programs. hospital and the School of Medicine, the proposed center Yet, there is still a critical need for additional research to will provide comprehensive, interdisciplinary medical improve understanding of hip arthritis causes. services for patients with musculoskeletal disorders. “Future strategies to cure arthritis must focus on early A team of health-care professionals will identify patients diagnosis and innovative treatments to preserve the natural at high risk for poor treatment outcomes (based on existing hip joint and prevent disease progression,” Clohisy said. medical, physical and behavioral health disorders), develop ese initiatives are aimed at early detection of hip individualized care plans for these patients and meet disease; evaluation of newer surgical alternatives that regularly to discuss their progress and any treatment barriers. correct abnormal hip anatomy leading to arthritis onset is wellness center concept is unique because it and progression; arthritic disease staging; and clinical provides health-care services, such as smoking cessation, outcomes of joint preservation procedures. nutritional counseling and exercise instruction, which Clohisy’s team is investigating biological factors that third-party payers o en do not cover. can be used for disease staging and joint prognosis. To date, circulating biomarkers and joint tissue markers associated with hip arthritis progression and disease stages “ The support of philanthropists have not been clearly de ned. As federal funds usually are not available during the early research phase, gi s from private individuals provide like the Bakers is crucial.” extremely important start-up resources. “We hope that this research will result in signi cant rough this personalized, holistic approach, the progress toward Dr. Clohisy’s vision to develop and re ne center will give patients self-care tools to positively innovative treatments to preserve natural hip joint function impact their well-being. “ e end goal is for patients to and prevent hip arthritis,” Randy Baker said. self-manage their musculoskeletal disorders and have improved overall health that is sustainable,” Prather said. “For surgical patients, the goal is improved pain outcomes Treating the whole patient and functionality with reduced risk of complications, in addition to improved health.” Prather specializes in the conservative management of Prather said she has not found another musculoskeletal musculoskeletal conditions, pre-arthritic hip disorders care model that incorporates all factors known to a ect and hip and lumbar spine connections. She is past treatment outcomes. president of the North American Spine Society — the Eventually, the pilot center may expand into a regional rst woman elected to the position — and internationally center that anyone can access. known in the eld. “By breaking down barriers to coordinated care, we e Bakers contributed in 2015 toward Prather’s hope the center will become a model for other health- musculoskeletal research. care facilities,” said Jackie Baker, “and ultimately improve “Over the years, several members of our family patient outcomes and the cost e ectiveness of the have been treated by Dr. Prather,” Jackie Baker said. health-care system.”
outlook.wustl.edu Outlook 29
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bequest by the late Daniel J. Brennan, MD, Before Ais supporting signi cant advancements in Alzheimer’s disease research at the School of Medicine. e it begins disease a ects 5.5 million Americans — a number expected to climb rapidly as people live longer. Family, researchers team up Following Brennan’s death in 2010, the estate gi to cure — or even prevent — created the Daniel J. Brennan, MD, Research Fund Alzheimer’s disease in the Charles F. and Joanne Knight Alzheimer’s
BY CHANNING SUHL Disease Research Center (Knight ADRC). In 2017, at the family’s request, a portion of the gi was used to establish the Daniel J. Brennan, MD, Professorship in Neurology, further extending its impact.
Beau Ances, MD, PhD, MSc, second from left, becomes an endowed professor. Joining in on the celebration are (from left): David H. Perlmutter, MD, executive vice chancellor for medical a airs and dean of the School of Medicine; Chancellor Mark S. Wrighton; and MILLER
Daniel J. Brennan II. MATT
30 Washington University School of Medicine Spring 2018
181795_p28-37_MAD_CC17.indd 30 5/22/18 12:37 PM Born in St. Louis, Brennan trained at Saint Louis University — earning undergraduate and medical degrees and completing a general surgery internship and residency and a plastic and reconstructive surgery residency. A gi ed plastic surgeon, Brennan practiced at St. John’s Mercy Medical Center (now Mercy) until 1997 as a member of Plastic Surgery A liates. As a longtime benefactor of medical education and research, Brennan chose Washington University School of Medicine for his estate gi because of its national leadership in Alzheimer’s disease research. Brennan’s son, Daniel J. Brennan II, said the gi re ects
the things his father valued in his own career. “My father MACH HUY dedicated most of his adult life to medicine — and caring for people,” he said. “It was his passion. To have his name John C. Morris, MD, director of the Charles F. and Joanne Knight associated with such a prestigious university, and a leader Alzheimer’s Disease Research Center, performs a neurological exam of Alzheimer’s research, ts with his desire to leave a mark. on a patient. A long-term study of adult children of Alzheimer’s It also ts with his desire for excellence.” patients aims to de ne who is likely to develop the disease.
Uncovering the progression Fulfilling a legacy
John C. Morris, MD, the Harvey A. and Dorismae Hacker According to Dan Brennan II, establishing a professorship Friedman Distinguished Professor of Neurology, leads the was an important step in ful lling his father’s wishes. Knight ADRC, located in the Department of Neurology. e “As long as I can remember, he spoke of a desire to have an center and its clinical research arm — the Memory and Aging endowed professorship in his name as part of his legacy,” Project (MAP) — are at the forefront of a worldwide eort to he said. “And I’m proud to have my daughters — Mackenzie, uncover key causal factors in Alzheimer’s disease and improve Livia, Danielle and Sylvia — involved and witness the impact early diagnosis, with a goal of nding more eective treatments, of the legacy that my father has le behind.” an eventual cure or even preventing the illness entirely. e In February, neuroimaging expert Beau Ances, MD, PhD, researchers believe that beginning preventive treatment before MSc, was installed as the inaugural Daniel J. Brennan, MD, brain damage occurs is essential to halting disease progression. Professor of Neurology. Ances is a professor of neurology, Morris leads a team focused on improving early-stage neurosciences and molecular microbiology and microbial diagnosis, identifying preclinical stages of Alzheimer’s pathogenesis at the School of Medicine and of biomedical disease by biomarker and neuroimaging studies, evaluating engineering at the School of Engineering & Applied Science. new drugs for the treatment of dementia and establishing He also is a member of the Knight ADRC and the Hope phenotypes for inherited forms of Alzheimer’s disease and Center for Neurological Disorders. other dementias. Volunteer research participants, including e Ances lab has been at the forefront of developing those who are aging normally and those with dementia, and novel neuroimaging methods to understand the timeline family members have been major contributors. ey take of change seen in both sporadic Alzheimer’s disease and part in annual assessments through the MAP and various autosomal dominant Alzheimer’s disease. e vision of the other studies, such as clinical drug trials, and provide Ances lab is to nd neuroimaging biomarkers that will allow biological and imaging specimens. for Alzheimer’s disease diagnosis and evaluate the e cacy of Morris also is the principal investigator of the Adult potential therapies. Children Study, a long-term study of adult children of While Alzheimer’s research primarily has focused on the Alzheimer’s patients — led by the School of Medicine — accumulation of the protein amyloid beta, researchers now are that aims to de ne who is likely to develop the disease and paying closer attention to another protein, tau. Long associated when, and to establish a timeline for how quickly the disease with the disease, tau is not easy to visualize through imaging will progress. e study, which began in 2005 with funding and, as a result, has not been thoroughly studied. from the National Institute on Aging of the National Using a new binding agent that makes tau protein visible Institutes of Health (NIH), already has helped identify some on positron emission tomography (PET) scans, Ances and of the molecular and structural changes in the brain that his colleagues have shown that measures of tau are better occur in the decades before a person is diagnosed with the markers of the cognitive decline characteristic of Alzheimer’s neurodegenerative disease. than measures of amyloid beta protein. is allows for a better understanding of Alzheimer’s progression.
outlook.wustl.edu Outlook 31
181795_p28-37_MAD_CC17.indd 31 5/16/18 7:21 PM CLASSNOTES
faculty in 1977. In this widely cited article, he from Washington University School of postulated that an endogenous digitalis-like Medicine, the Distinguished Achievement Find your friends. compound plays a role in the pathogenesis Award from the American Thoracic Society, Classnotes are organized first by of hypertension. The update is Blaustein’s the Kendig Award from the Academy of year of degree/training completion personal account of how he and his col- Pediatrics, The Founders Award from the leagues purified and identified endogenous and then in alphabetical order. Scientific Assembly on Pediatrics of the ouabain (EO) in human plasma. The article American Thoracic Society, and election reviews the astonishing evidence that oua- into the Colorado Pulmonary Hall of Fame. How about you? bain (first identified as a plant steroid that Share your news via the online was used as an arrow poison for centuries) S form at wumcnews.org/classnotes. is an adrenocortical hormone. EO and its 1970 Submissions will be printed in plasma membrane receptor, the sodium Richard Wahl, MD ’78, HS ’83, the a subsequent issue of Outlook pump, are a novel endocrine system that Elizabeth E. Mallinckrodt Professor of magazine as space allows. Photos influences behavior, cardiovascular func- Radiology and director of the Mallinckrodt tion, fetal development and muscle fatigue. are welcome. Institute of Radiology, Samuel I. Achilefu, Blaustein chaired the University of Maryland PhD, the Michel M. Ter-Pogossian Professor Department of Physiology from 1979-2003 of Radiology, and Pamela K. Woodward, and is still an active faculty member. His MD, professor of radiology, recently 1950S awards include the Pasarow Foundation received a five-year, $933,700 grant from Award for Cardiovascular Research, the the National Institutes of Health (NIH) for Max Heeb, MD ’53, American Heart Association Hypertension Training Opportunities in Translational who practiced general Council Novartis Award for Hypertension Imaging Education and Research (TOP- surgery for more than 45 Research and the University of Maryland TIER). This new interdisciplinary clinician- years in rural Missouri, Baltimore 2002 Faculty Research Lecturer of scientist postdoctoral program will prepare received a distinguished the Year Award. residents and fellow trainees on how to service award from the Kurt Studt, LA ’63, DE ’66, retired from bring preclinical imaging innovations to University of Missouri active dental practice after more than 50 patients and the practice of medicine. School of Medicine on years. During his career, he taught dental April 21, 2017. He is author of the book students at Washington University and “Max the Knife: The Life and Times of a S at Southern Illinois University School of 1980 Country Surgeon.” Dental Medicine. Studt is currently an Joseph Moskal, MD ’81, Roger Meyer, MD ’55, stays active with adjunct faculty member in the dental chair of the Department volunteering, supporting peace activities hygiene program of St. Louis Community of Orthopaedic Surgery with Rotary International, Peace Action with College at Forest Park. for Carilion Clinic and the Unitarians and the Physicians for Social Lynn Taussig, MD ’68, retired in the Virginia Tech Carilion Responsibility, and serves on the Oregon December from the University of Denver, School of Medicine, Health & Science University BRAINet where he served as special adviser to the has been appointed board as historian. His work with Rotary provost for life sciences for the past 12 to the Dean’s Council International’s Fellowship of Doctors as vice years. He previously served as president/ on Advancement for the Virginia Tech president is helping promote telemedicine CEO at the National Jewish Medical and Carilion School of Medicine. The council and end-of-life practices. He also enjoys a Research Center, now called National is a committee of volunteers created busy family life with four of his six children Jewish Health, and was on faculty at the to advance the stature of the medical in Portland, Ore., and looks forward to University of Arizona College of Medicine, school by providing guidance, assistance, celebrating his 90th birthday in May. where he served nine years as chair of advocacy and philanthropic investment in the Department of Pediatrics. Taussig support of the school’s strategic objectives. 1960S is proud to have initiated the Tucson Raymond Curry, MD ’82, Children’s Respiratory Study in 1979, a was recognized by the Mordecai Blaustein, major longitudinal study of asthma risk Northwestern University MD ’61, recently factors in 1,246 newborns. The study Feinberg School of published an invited continues today. One paper emanating Medicine with the 40-year update on from this study has had nearly 4,000 creation of a named an article he wrote citations. Taussig is grateful for the many professorship in medical when he was on the honors given by his peers and mentors, education, endowed by Washington University including the Alumni Achievement Award an anonymous donor in honor of his 16 years
32 Washington University School of Medicine Summer 2018
181795_p28-37_MAD_CC17.indd 32 5/16/18 7:21 PM of service to the institution as vice dean for Deborah Veis Novack, MD ’95, PhD ’95, David Jin, EN ’06, MD ’11, is a clinical education. Curry is now the senior associate participated in the Rally for Medical research fellow in gastroenterology, dean for educational affairs at the University Research in Washington, D.C., in September hepatology and endoscopy at Brigham and of Illinois College of Medicine and clinical 2017. This annual event brings together Women’s Hospital at Harvard Medical School. professor of medicine and medical education 300-plus researchers, clinicians and patient Jesse Otero, MD ’11, PhD ’11, is an at the University of Illinois at Chicago. advocates from hundreds of organizations orthopaedic surgeon at the University of Sándor J. Kovács, PhD, MD, HS ’85, to meet in the offices of senators and Iowa Hospitals and Clinics. He is married professor of medicine and of cell biology representatives to demonstrate the value with children. of medical research to all citizens. Through and physiology, was honored with a Lifetime Catherine Butler, MD ’12, is a research this type of advocacy, Congress has Achievement Award from the Barnes-Jewish nephrology fellow at the University of provided $2 billion increases in National Hospital Medical Staff Association. The award Washington. was presented at the association’s semi- Institutes of Health (NIH) funding each of Adam Rouse, EN ’04, SI ’12, MD ’12, is a annual general staff meeting, April 13, 2017. the last two years, and a similar increase is proposed for the FY2018 budget. research assistant professor in neuroscience at the University of Rochester and received Bryan Meyers, HS ’98, S a National Institutes of Health (NIH)/ 1990 chief of the general National Institute of Neurological Disorders Audrey Shillington, SW thoracic surgery and Stroke K99/00 grant in April 2017. ’87, SW ’91, GM ’93, section at Washington director of the Colorado University School of Lucy Zhang, MD ’12, State University School Medicine, has been of San Francisco, is of Social Work, assumed named chair of the an ophthalmologist responsibilities as American Board of with Peninsula associate dean for Thoracic Surgery. He will serve as chair for Ophthalmology academic affairs in the two years. Group at its Daly City and Burlington, College of Health and Human Sciences in Edward Garon, MD ’99, Calif., offices. June 2017. Shillington remains director of director of the Thoracic the social work school and is professor of Oncology Program at the Yi Wang, MD ’13, of Houston, recently epidemiology at the University of Colorado Jonsson Comprehensive was married and traveled to Italy on her School of Public Health. She was a National Cancer Center at the honeymoon and describes it as a beautiful Institute of Mental Health postdoctoral fellow University of California, and poignant experience. She is happy to and earned a master’s degree in psychiatric Los Angeles, and associate report having survived Hurricane Harvey epidemiology from Washington University professor of medicine without much damage. Wang works as a School of Medicine. She has published in in the Division of Hematology-Oncology pediatrician at Legacy Community Health. the areas of psychometrics, epidemiology, at David Geffen School of Medicine, joined Megan Cook, PT ’14, was married to prevention and intervention work aimed at LUNGevity’s scientific advisory board, a Aaron Shoppa in September 2017. She is adolescent and young adult risk behaviors. group of 19 world-renowned scientists and a physical therapist at Advocate Children’s She has been principal investigator and researchers who guide LUNGevity’s scientific Hospital in Oak Lawn, Ill. co-investigator on grants totaling more than strategy and research program. LUNGevity Jennifer Jupitz, MD $14 million, including those from the National focuses on early detection of lung cancer. ’14, is stationed at Camp Institutes of Health (NIH), the National Lejeune in North Carolina Institute on Drug Abuse and the National serving as the physician Institute on Alcohol Abuse and Alcoholism. S 2000 to a squadron in the U.S. Her current work focuses on intervention and Jimmy Kerrigan, MD ’10, is an inter- Marine Corps. She was prevention related to the changing landscape ventional cardiology fellow at Cleveland married in 2016, and in legalization of recreational marijuana use. Clinic and is married with children. she and her husband Michael Raney, MD ’94, a radiologist Vanessa Williams, LA ’06, MD ’10, is welcomed a baby boy in fall of 2017. with West County Radiological Group in an assistant professor of radiology at St. Louis, was elected secretary-treasurer the University of Kansas. She is married of the Missouri Radiological Society. with children. Bryan Gibby, PT ’95, is a certified wound Tassy Hayden, LA ’07, MD ’11, practices at specialist at St. Luke’s Elks Wound Center in Southampton Healthcare in St. Louis, a large Boise, Idaho. primary medicine group with an emphasis on caring for the LGBT community.
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OBITUARIES
David A. Bensinger, LA Berlin was diagnosed with cancer while Stephen L. Johnson, 43, DDS, former dean of in medical school. Following his diagnosis, PhD, a national leader Washington University’s his parents moved to St. Louis from in the field of zebrafish School of Dental Massachusetts to offer additional support. genomics and a Medicine, died Saturday, Berlin is survived by his wife; his parents, professor of genetics, July 22, 2017, in San Kenny Berlin, MD, and Marsha Ross-Berlin, died at his home Friday, Francisco. He was 91. DMD; a brother, Josh Berlin; a sister, Jessie Dec. 15, 2017, after a Bensinger joined Berlin; and his grandmother, Maxine Berlin. long struggle with the faculty in 1948 as an instructor of rheumatoid arthritis. He was 56. dental medicine. He became an associate Arthur Z. Eisen, MD, a Johnson guided the development of professor in 1956, was named assistant physician-scientist who zebrafish as an important research model, dean in 1967, associate dean in 1973 and founded and led the similar to fruit flies and mice. With transparent full professor in 1976. A major renovation Division of Dermatology, embryos, zebrafish are ideal for studying of the School of Dental Medicine building growth and development. died Sunday, Nov. 12, was completed under his supervision in Johnson’s zebrafish studies have shed 2017, in St. Louis after a 1972. In 1987, Bensinger was appointed light on how tissues regenerate and how short illness. He was 88. dean, serving until his retirement in 1989. organisms control the size of their organs. The Washington University Alumni Eisen founded the He was particularly interested in Association named him Alumnus of the division in 1967 and remained its director for understanding cells called melanocytes, Year in 1968, honoring his work to prevent more than 30 years. During that tenure, he which are best known for governing skin closure of the school the previous year. was the Winfred A. and Emma R. Showman pigmentation and are the cell type affected A specialist in periodontics, Bensinger Professor of Dermatology. Until his retirement in the deadliest form of skin cancer, served as president of the Midwestern last year, he remained active in clinical melanoma. Johnson developed methods to Society of Periodontists; he also served as medicine and resident education. track the fate of these cells as they develop president of the Missouri Dental Association “Dr. Eisen was one of the true giants in from the early embryo to the adult zebrafish. and was also a fellow of both the American the field of dermatology,” said Lynn Cornelius, Johnson earned a bachelor’s degree in College of Dentists and the International chemistry and molecular biology at Vanderbilt MD, director of the Division of Dermatology. College of Dentists. University, followed by a doctoral degree in “He embodied the quintessential ‘triple He is survived by his wife of 42 years, genetics from the University of Washington, threat’ throughout his illustrious career — Susanna; children and step-children Judith Seattle. He continued postdoctoral training at (William) Haynes, Scott (Vicki) Bensinger, outstanding in research, clinical medicine the University of Oregon before joining the Ruth Hartman (Gary Wolff), Emily (Avraham) and education.” Washington University faculty in 1996. Eisbruch and Sara Yashar (Mayer z”l); 11 Eisen was considered a longtime leader Johnson is survived by his sister, grandchildren and three great-grandchildren. in connective tissue research. He focused Susan C. Johnson; his brother, Lee on the genetic underpinnings of skin Johnson; and several nieces. Ari Nachum Berlin, MD, diseases and the role enzymes play in a pediatric intern at remodeling tissue, and was particularly William M. Landau, MD, St. Louis Children’s interested in the cells that synthesize a professor emeritus of Hospital and a 2017 collagenase-1 in the dermal layer of skin. neurology, died in his graduate of the School sleep Thursday, Nov. 2, He earned a bachelor’s degree from the of Medicine, died Feb. 2017, at his home in University of Buffalo in 1951, a master’s 23, 2018, in St. Louis, University City. He was 93. degree from Brown University in 1953, and after a 2 ½-year battle Landau was a with pancreatic neuroendocrine cancer. a medical degree from the University of professor of neurology He was 27. Pennsylvania in 1957. He completed an from 1954 to 2012 and served as head of Berlin grew up near Boston. He earned internship, residency and fellowship at the the Department of Neurology from 1970 to a bachelor’s degree in chemistry in 2012 University of Rochester School of Medicine 1991. He was the longest-serving faculty at Rice University. and Dentistry. member at the School of Medicine. He met his future wife, Hallie Morris, Eisen is survived by his wife of 59 years, Landau specialized in movement while both were students at the School of Mimsie Eisen; their son, Marshall (Gail) Eisen; disorders such as Parkinson’s disease, but Medicine. The couple married Jan. 7, 2017, daughters Phyllis (Alex) Kane, and Leah his interests ranged widely. With Frank and worked together for a brief time at (Steve) Pazol; and several grandchildren. Kleffner, of the Central Institute for the St. Louis Children’s Hospital. Morris, MD, Deaf, he identified and described Landau- is a fellow in newborn medicine. Kleffner syndrome, a rare disorder in which
34 Washington University School of Medicine Summer 2018
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children lose the ability to speak and Loewy was preceded in death by his Eric P. Newman, JD, respond to language. He also studied wife, Arleen Loewy, who also had worked at St. Louis businessman, how patients fared who were revived with Washington University. In addition to his scholar and philanthropist CPR after their hearts had stopped beating, son, Adam Loewy, he is survived by his — an alumnus and major and concluded that the risk of severe, daughter-in-law, Philippa (Rudolph) Loewy; benefactor to Washington debilitating brain damage was under- his long-term girlfriend, Karen Frahm; a University — died appreciated. He advocated for more limited grandson; and his daughter-in-law’s Wednesday, Nov. 15, use of the procedure. parents, Christy Twin and Larry Rudolph. 2017, at his home in The Department of Neurology established Clayton. He was 106 years old. the William & Pudge Landau Lectureship in John E. Majors, PhD, Born in St. Louis, Newman graduated Neuroscience and Society in honor of Landau professor emeritus of from John Burroughs School in 1928 and and his wife, known as Pudge, whom he biochemistry and Massachusetts Institute of Technology in married in 1947. Along with his scientific molecular biophysics, 1932. He graduated from Washington accomplishments, Landau was known for his died Wednesday, Jan. University’s School of Law in 1935. commitment to social justice. 10, 2018, of a heart Following World War II, Newman began Landau was born just a few blocks from attack. He was 69. his career at Edison Brothers Stores Inc., Washington University in 1924. He started Majors was known where he was an officer and served on the college at the University of Chicago in 1941, for key contributions to the field of board until his retirement. From 1988-2005, but the United States’ entry into World War molecular biology, particularly involving the he served as president of the Harry Edison II accelerated his college career, and after expression of genes in yeast and viruses. He Foundation. just two years, he returned to St. Louis to worked with a team led by Harold E. Varmus, One of the foremost American begin medical studies at Washington MD, and J. Michael Bishop, MD, whose numismatists, Newman wrote more than University School of Medicine. He was 18. research revealing how viruses can cause 100 books and articles, including the In addition to his daughter, Julie Landau- cancer was honored with the Nobel Prize in pioneering study “The Early Paper Money of Taylor, he is survived by three sons, David Physiology or Medicine in 1989. America” (1967), which remains a standard Landau of St. Louis, John Landau of New According to colleagues, Majors was in the field. His private collection of U.S. and Jersey and George Landau of Philadelphia; deeply committed to mentorship and Colonial American coins and paper money 11 grandchildren; and four great- training, putting students at the center of is considered one of the nation’s finest. grandchildren. his work. He served on the doctoral thesis Newman and his family extended committees of more than 100 graduate extraordinary generosity to a wide range of Arthur DeCosta Loewy, students in the Division of Biology & Washington University schools and PhD, professor of Biomedical Sciences (DBBS). In 2013, he was programs. At the School of Medicine, the anatomy and of one of 10 DBBS faculty named to “The One family helped underwrite the Eric P. neuroscience, died Hundred Club,” honoring this achievement. Newman Education Center and endow two Saturday, Dec. 2, 2017, Many of his former trainees have gone on professorships, in addition to supporting of complications related to become leaders in their fields. many other programs. to inflammatory bowel Majors earned a bachelor’s degree in Newman was preceded in death by his disease and other health physics from the University of Washington wife of 75 years, Evelyn. He is survived by issues. He was 74. in 1970 and a doctoral degree in biophysics his son, Washington University trustee Upon joining the School of Medicine from Harvard University in 1977. He trained Andrew E. Newman of St. Louis; daughter, faculty in 1975, Loewy focused his research as a postdoctoral fellow in Varmus’ lab, then Linda Newman Schapiro of New York; five on the ways the brain regulates bodily at the University of California, San Francisco grandchildren; and 10 great-grandchildren. functions such as blood pressure. He is best — contributing to the discoveries that known for discovering the anatomical basis would later earn Varmus and Bishop the John A. “Jack” Pierce, of the fight-or-flight response. Early in his Nobel Prize. MD, former director of career, he used radioactively tagged He joined the Washington University pulmonary and critical molecules to trace the pathway that faculty in 1983. After his retirement in 2011, care and emeritus connects the brain to the pacemaking he continued teaching regularly for the professor of medicine, neurons in the heart. university’s Department of Biology. died Friday, Nov. 24, Loewy earned a bachelor’s degree in Majors is survived by his sisters, Anne 2017, in St. Louis mathematics from Lawrence University in Chick and Jane Sutherland, and their families. following a long battle Appleton, Wis., followed by a doctoral with cancer. He was 92. degree in anatomy from the University of Pierce came to the university in 1967 as Wisconsin, Madison. the first director of the Division of Pulmonary
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and Critical Care Medicine. He also served as occasional scientific collaborator with her 1940S chief of pulmonary and critical care medicine husband — moved to Berkeley in 2003, Elbert H. Cason, MD ’42; Oct. ’17 at the St. Louis Veterans Affairs Medical Center. but were frequent visitors to St. Louis Roger E. Fox, MD ’49; Jan. ’18 In 1984, Pierce was named the inaugural and maintained a strong interest in Louis O. Lambiotte, MD ’45; Nov. ’17 Selma and Herman Seldin Professor of the department. Rudolph J. Maffei, MD ’48; Oct. ’17 Medicine. He became an emeritus professor He is survived by his wife. in 1993, but continued to work with medical Annetta McMahon, NU ’42; Nov. ’17 students and trainees until recently. Raymond H. “Ray” Roberta G. Middelkamp, NU ’49; Feb. ’18 Pierce created the first respiratory intensive Wittcoff, an emeritus William W. Regan, MD ’47; Oct. ’17 care unit (ICU) at what was then Barnes Washington University David E. Smith Jr., MD ’44; Nov. ’17 Hospital, which was one of the first such ICUs trustee and a member in the country. He also launched and directed of the School of 1950S one of the first National Institutes of Health Medicine’s National Allie Dunlevy, NU ’50; Aug. ’17 (NIH)-sponsored pulmonary research training Council since 2005, Joan Edwards, NU ’51; Sept. ’17 programs in the country. died Tuesday, Jan. 2, Gerald E. Hanks, MD ’59; Dec. ’17 Pierce’s research helped clarify the roles 2018, at his home in Phoenix. He was 96. Robert J. Hickok, PT ’53, HA ’71; Jan. ’18 of specific enzymes in the development Wittcoff was elected to the Board of Carl A. Hirsch, MD ’59; Dec. ’17 of emphysema. Trustees in 1974. He and his wife, Roma, also Everett L. Jung, LA ’49, MD ’55; Nov. ’17 Pierce is survived by his wife of 33 years, an emeritus trustee and School of Medicine Jo Ann Koehler, NU ’53; Jan. ’18 Susan (Ellis) Pierce; his children, Sheryl, John National Council member, have been long- Patricia Kolditz, NU ’51; Dec. ’17 Jr. (Margarita) and Robert (Dawn) Pierce; his time supporters of Washington University. Percy E. Luecke Jr., MD ’52; Oct. ’17 wife Susan’s children, Kerstin Starzer (Daryl) The Wittcoffs helped fund university Jean Matthews, PT ’55; Oct. ’17 and Nissa Fendler (Mark); 12 grandchildren; building projects, program initiatives, and four great-grandchildren. scholarships and professorships. Larry L. McCune, DE ’55; Jan. ’18 A real estate developer, philanthropist, Paul S. Meyer, DE ’55, GD ’58; Dec. ’17 Milton J. Schlesinger, civic leader and visionary, Wittcoff helped Enoch E. Morrow, DE ’53; July ’17 PhD, professor bring public television to St. Louis as a May Yamamoto Omura, NU ’51; Aug. ’17 emeritus of molecular co-founder of KETC/Channel 9. Lothar H. Pinkers, MD ’55; July ’17 microbiology, died of Wittcoff also was chair of the board Robert M. Roy, HS; Oct. ’17 heart failure Friday, of directors of Washington University Mary Lynne Ruddon, PT ’58; Nov. ’17 Oct. 27, 2017, at his Medical Center and of Jewish Hospital Olga S. Smith, OT ’55; Jan. ’18 home in Berkeley, Calif., (now Barnes-Jewish Hospital). He was after a long period of instrumental in inaugurating the 1960S illness. He was 89. Washington University Medical Center Duane E. Christian, DE ’60; Oct. ’17 Schlesinger was a professor of micro- Redevelopment Corp. In 1986, he Richard P. Jacobs, MD ’69; Jan. ’18 biology (later, molecular microbiology) from established the Raymond H. Wittcoff Leonard Jarett, MD ’62; Jan. ’18 1964 until 1999. During his tenure, he twice Professorship in Biological Chemistry at William G. Juergens Jr., MD ’61; Jan. ’18 served as acting head of his department. the School of Medicine. Azmi H. Khazin, LA ’57, MD ’61; Dec. ’17 Schlesinger wrote a definitive history of A St. Louis native, Wittcoff earned a Elizabeth C. Sowa, MD ’63; Oct. ’17 the microbiology department, starting from bachelor’s degree from the University of its inception to the present day. He was Chicago in 1942, then served as a Navy H. Goff Thompson Jr., LA ’57, MD ’61; Dec. ’17 named an emeritus professor in 1999. lieutenant in World War II. Carol F. Williams, HS ’60; Jan. ’18 His work focused on diverse aspects of In addition to his wife, Wittcoff is viral assembly and replication. “Milton was survived by his son, Mark; daughter, 1970S one of the first to use the power of defined Caroline; five stepchildren, Joel, Richard, Sharon S. Crandell, MD ’74; Oct. ’17 viral systems to probe fundamental processes Melanie, Marna and Debbie Broida; four of protein folding and modification, in grandchildren; seven stepgrandchildren; Michael Bruce Deldin, MD ’75; Dec. ’17 advance of the recombinant DNA revolution,” and one stepgreat-grandson. 1980S said Stephen M. Beverley, PhD, the Marvin A. Brennecke Professor and head of the Craig W. S. Howe, HS ’81; Jan. ’18 Department of Molecular Microbiology. For full obituaries, visit: Kevin T. McDonagh, HS ’87; Dec. ’17 Schlesinger and his wife of 62 years, wumcnews.org/obits 1990S Sondra Schlesinger, PhD — a Washington University professor emerita and an Richard Ceenan Tam, MD ’99; Jan. ’18
36 Washington University School of Medicine Summer 2018
181795_p28-37_MAD_CC17.indd 36 5/16/18 7:21 PM Medical student Iris Kuo visits with patient Jerry McCaleb.
‘ When you make a lei, MILLER PHOTOS MILLER
MATT you’re putting a piece of yourself or your spirit into it for the recipient.’
irst-year medical student Iris Kuo’s classmates were intrigued by the lovely haku lei — a Ffloral crown — Kuo wore at White Coat ceremony in the fall. Eager to share her Hawaiian culture with classmates, the Honolulu native arranged a workshop to teach them how to make the colorful crowns. But before long, the idea blossomed into something even more meaningful: an opportunity to show kindness to patients coping with cancer. Some 50 medical students, faculty, members of the Hawaii Club on the Danforth Campus, and St. Louis community members with ties to Hawaii, made the floral crowns. The crowns were delivered May 1 — Lei Day in Hawaii —to patients at Siteman Cancer Center. “It was my hope that, through the haku lei, the patients would feel Top: Kuo presents patients with oral crowns. Bottom: Maria Baggstrom, MD, left, our hope, support and aloha for a moment in their helps others make haku lei at a workshop. healing process,” Kuo said.
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181795_p28-37_MAD_CC17.indd 37 5/16/18 7:21 PM Washington University School of Medicine NONPROFIT ORG. Office of Medical Public Affairs U.S. POSTAGE MS 8508-29-12700 PAID 660 S. Euclid Ave. ST. LOUIS, MO St. Louis, MO 63110-1010 PERMIT 2535
Changing the skyline Two 12-story inpatient towers built by BJC HealthCare on the Washington University Medical Campus are enhancing patient care. One of the buildings is the Barnes-Jewish Parkview Tower, which offers roomy, modernized facilities for patients of Siteman Cancer Center and of the Women & Infants Center. The other is a St. Louis Children’s Hospital tower featuring an expanded newborn intensive care unit (NICU) and more pediatric beds. A skywalk now connects labor and delivery areas in the Parkview Tower with the Children’s Hospital NICU. Almost 800 health-care workers, patients and families contributed to the design process. RANEY, CARDINAL AVIATION RANEY, KENT
2 Washington University School of Medicine Winter 2007
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