For Scoliosis, a Big Leap in Care NYU LANGONE’S INNOVATIVE FIX for a CURVED SPINE IS DRAWING YOUNG ATHLETES WORLDWIDE

To Serve. To Teach. To Discover SUMMER 2021

Frontiers The Golden Age of Psychedelic Medicine PAGE 20

Perlmutter Cancer Center When Melanoma Invades the Eye PAGE 4

New Doctors Meet Brooklyn’s Top Robotic Lung Surgeon PAGE 8

SPECIAL REPORT: New Milestones in Our Pandemic Response

For Scoliosis, a Big Leap in Care NYU LANGONE’S INNOVATIVE FIX FOR A CURVED SPINE IS DRAWING YOUNG ATHLETES WORLDWIDE. DANCER JENNA MORIELLO IS ONE OF THEM. PAGE 14 2 NYU LANGONE HEALTH NEWS

Plastic Surgery A New Face, Two New Hands, and Another Major Milestone

When NYU Langone Health per- ˆ, the -year-old from Clark, dures had never been done simulta- we capitalized on their expertise, formed its third successful face NJ, was driving home aer working neously with a successful outcome. assembling a comprehensive hand transplant last August, the patient, the night shift as a product tester. In one case, the patient subsequent- transplant team.” Joseph DiMeo, got a new lease on When he fell asleep at the wheel, his ly died from an infection, and in the Aer DiMeo was formally accept- life—not only from the new face car crashed, rolled over, and burst other, the transplanted hands had ed for the donor wait list on October that reintroduced him to the world, into flames. DiMeo was pulled to to be removed when they failed to , , the surgical team began a but also from the new pair of hands safety by a good Samaritan before thrive. period of rigorous rehearsals. Dr. that restored his independence. The the vehicle exploded. The accident In DiMeo’s case, the risks would Rodriguez and ­ other transplant procedure, the first successful face le DiMeo with third-degree burns be no less daunting. Not only would surgeons practiced every step of each and double hand transplant ever per- over ˆ% of his body, disfiguring his Dr. Rodriguez and his surgical team procedure on cadavers, first in NYU formed, marked the launch of a new face and hands. transplant the donor’s full face, but Langone’s surgical skills laboratory Hand Transplant Program at NYU DiMeo endured more than  they would also amputate both of and then in an operating room with Langone, and another milestone in skin gra surgeries. His fingertips DiMeo’s hands, replacing them at the entire OR team of ˆ clinicians the institution’s expanding portfolio were amputated, and scarring left midforearm with those of the donor. and sta‰. of pioneering procedures. In partic- the remaining parts of his fingers In all, they would need to connect A major challenge would be at- ular, the program now o‰ers people fused together, forcing him to grasp two bones,  tendons, five veins, taching limbs from a donor whose with severe hand deformities an al- objects as if he were wearing mit- two major arteries, and three domi- anatomy is uniquely di‰erent. “This ternative to prosthetic arms, notes tens. A plastic surgeon at a medical nant nerves. makes it very di‘cult to join the two Eduardo D. Rodriguez, ¢£, ££¤, center in New Jersey, realizing that NYU Langone was well posi- sets of structures because the length the Helen L. Kimmel Professor of no additional conventional surgery tioned to tackle the challenges of and diameter of the bones and ten- Reconstructive Plastic Surgery and would improve DiMeo’s function- hand transplantation. For more dons are not identical,” notes Sheel chair of the Hansjörg Wyss Depart- ality, referred his patient to Dr. Ro- than half a century, its surgical spe- Sharma, MD, clinical associate pro- ment of Plastic Surgery. “Many of driguez, director of NYU Langone’s cialists at the Replantation Center at fessor of plastic surgery, who led these people are limited by the cur- Face Transplant Program. When Dr. NYC Health + Hospitals/Bellevue, a the team of eight specialists who rent technology of prostheses, which Rodriguez met DiMeo and his par- Level I Trauma Center, have refined worked in concert on the limbs of are functionally imperfect,” he says. ents, John and Rose, he recognized the microsurgical skills needed to both donor and recipient. “It’s also In DiMeo’s case, artificial arms both a challenge and an opportunity. reattach severed body parts. “These challenging to weave the tendons of were not a viable option due to the While some ­ face transplants and plastic and orthopedic surgeons are the donor into those of the recipient extent of the injuries he sustained  hand transplants had been per- very experienced with these tech- to achieve the proper tension for during an accident. On July §, formed worldwide, the two proce- niques,” says Dr. Rodriguez, “so the pulley system that controls the IMAGERIGHT: CHRISTIE RAMIAH FOR THE HANSJÖRG WYSS DEPARTMENT OF PLASTIC SURGERY

Photograph by ELLIOT GOLDSTEIN SUMMER 2021 3

During a 23-hour surgery, Joseph DiMeo made medical history as the first recipient of a successful face and double hand transplant. Praising the OR team of 15 fellow transplant surgeons and 80 clinicians and staff, Dr. Eduardo Rodriguez described the collaboration as “the most beautifully choreographed dance you could ever imagine.”

movement of the hand.” DiMeo is recovering so well that To ensure that bones would be his doctors consider him six months aligned perfectly, the team used ahead of where they expected him ¨-£ computerized surgical planning to be. “He lis heavier weights than and ¨-£–printed customized cutting I can,” says Dr. Sharma. They attri- guides. A meticulous system was bute much of this progress to their also needed to match the networks patient’s commitment. “Joe does of nerves, blood vessels, and tendons everything we ask for and more,” from the donor with those of the re- says Dr. Rodriguez, “and our hand cipient. “The inside of a limb looks therapists from Rusk Rehabilitation like an exposed telephone cable,” are very creative with exercises that says Dr. Rodriguez. “We tagged all improve his fine motor skills.” Even- the elements to be transplanted with tually, DiMeo’s new hands will allow preprinted labels to ensure that we him to regain his freedom and even paired them properly.” start driving again. “It’s great that As in all transplants, the surgeons Joe has a new face, but he also loves sought to complete the operation his new hands,” says Dr. Rodriguez. as quickly as possible to limit the “Every time I see him on his smart- amount of time the donor’s tissue phone, it’s impressive to see his fin- is not nourished with blood. “Since gers typing on the tiny keypad.” Joe is right-hand dominant, the first transplant I wanted to see was his Joseph DiMeo (right), five months right hand,” explains Dr. Rodriguez. after surgery. When Dr. Eduardo Rodriguez evaluated the prospec- “Once that was going well, then we tive donor, he was happy to see that went ahead with the le-hand pro- his height, weight, and skin color cedure and finally progressed to the were a close match to DiMeo’s. face transplant.” The entire oper- FOR INFORMATION ABOUT face ation was completed in ¨ hours,  and hand transplantation, visit hours less than NYU Langone’s two nyulangone.org/facetrans-

IMAGERIGHT: CHRISTIE RAMIAH FOR THE HANSJÖRG WYSS DEPARTMENT OF PLASTIC SURGERY previous face transplants. plant or call 646-501-4481. 4 NYU LANGONE HEALTH NEWS

Complex Cases When Melanoma Invades the

May 25, 2021: After a year of surgical interventions at NYU Langone Health, Colleen Regan is now free of melanoma. The vision in her affected eye is 20/30. SUMMER 2021 5

“Melanoma in the eye is rare and amelanotic melanoma is rarer still. The location alone makes it extraordinarily complex.” Irina Belinsky, MD

Last March, just as New York City in their lifetime. Fewer than ­% of a malignancy “rolling out like an was entering lockdown, Colleen those cases will be amelanotic, or invisible carpet.” The melanoma, Regan was confronting a health without pigment. The rare cancer is it turned out, had spread along the crisis of her own. A few days before no deadlier than conventional mela- skin of her entire lower eyelid, onto hospitals were forced to cancel elec- noma, but fewer people survive be- the mucous membrane (conjuncti- tive surgeries to free up beds for the cause it’s oen overlooked or misdi- va) that lines the inside of the eyelid surge of ¬¯°±£ patients, Regan had agnosed. and white part of the eye, and even been diagnosed with a rare type of Dr. Liebman’s ability to discern the skin of her upper eyelid. Worse melanoma, a deadly skin cancer. She what others had missed reflects still, it extended into her tear canal, wondered how she would manage NYU Langone’s long-standing ex- the conduit for tears flowing from her illness amid a pandemic that pertise in melanoma research and the eye to the sinus. “That was a big made something as simple as leaving care. Its dermatologists developed problem because if the cancer cells the house a potentially life-threaten- one of the first skin cancer treat - spread beyond the canal, the chance ing event. ment programs in New York City of surgically clearing the cancer One year earlier, Regan, then more than ¨ years ago and even would be slim, and Colleen’s overall ­ˆ, noticed an itchy blemish be- established the main criteria for de- prognosis would be poor,” says Dr. neath her right eye, a seemingly tecting melanoma, popularized with Belinsky. “It was a very sneaky mel- innocuous pink spot. She consulted the mnemonic ª«¬£® (see page ). anoma that got into all of the little two dermatologists, both of whom “Dr. Liebman was the first doctor nooks and crannies.” dismissed the scaly patch as a skin who listened to me,” recalls Regan. There was no doubt that Regan infection and prescribed topical an- “She’s the only one who would do a would need more surgery. The only tibiotics. But when the itching per- biopsy.” question was how to do it amidst the sisted, Regan grew increasingly con- Within a few days, Regan was sit- shutdown. By late March, national cerned. She knew she couldn’t wait ting across from eye surgeon Irina guidelines had recommended post- for the pandemic to pass to find out Belinsky, ¢£, an oculoplastic spe- poning surgeries for three months, the cause, so she consulted a third cialist and director of ocular oncolo- including those for melanoma. But dermatologist, Tracey Liebman, ¢£. gy at NYU Langone’s Department of Dr. Belinsky knew Regan couldn’t Dr. Liebman saw things differ- Ophthalmology. Like Dr. Liebman, afford the delay. She successfully ently. The pink coloring beneath Dr. Belinsky brought specialized petitioned for an exemption and Regan’s eye made her suspect a rare knowledge to the case. She is one of created a plan to work around the type of skin cancer called amelanotic a few surgeons in the nation dually staffing limitations. “Olga Whyte, melanoma. “It’s easy to miss because trained in oculoplastic surgery and our ophthalmology nurse, came in it doesn’t have the pigment or other ocular oncology. With her elite ex- every other day with little notice, features that patients might typically pertise, she was accustomed to dif- as the positive biopsy results kept associate with melanoma,” explains ficult cases, but Regan’s was unlike coming in, to assist me with ongo- Dr. Liebman, assistant professor anything she had ever encountered. ing procedures,” recalls Dr. Belin- of dermatology in NYU Langone “Melanoma of the eye is rare,” notes sky. “I personally walked the tissue Health’s Ronald O. Perelman De- Dr. Belinsky, “and amelanotic mela- specimens down the street to the partment of Dermatology. “It can noma is rarer still. The location alone pathology lab.” She would sit shoul- be pinkish.” makes it extraordinarily complex.” der-to-shoulder with dermatologist On March , a biopsy confirmed During multiple exploratory pro- Shane Meehan, MD, director of Dr. Liebman’s suspicion. About one cedures to determine the extent of NYU Langone’s dermatopathology in ­ people will develop melanoma the cancer, Dr. Belinsky discovered section, peering down a microscope

Photograph by BRAD TRENT 6 NYU LANGONE HEALTH NEWS

Colleen Regan with her family on Staten Island, where she lives. at Regan’s tissue samples. After several procedures, the cancer was still encroaching. So Dr. Belinsky consulted Perlmutter Cancer Center’s Tumor Board, a multidisciplinary group of physi- cians who convene to troubleshoot challenging cases. Dr. Belinsky re- members asking herself, “Is my pa- tient going to lose her eye so we can clear the cancer? Is continuing with surgery the right thing, or should we think about other treatments, like radiation or topical chemotherapy?” Dr. Belinsky’s methodical ap- proach quickly earned her patient’s trust. “Dr. Belinsky had enough confidence to consult with other specialists,” Regan says. “She’s that intelligent. I was afraid, but being in her care made it so much easier.” Ultimately, Dr. Belinsky pressed on with a surgical approach. She treated the surface of Regan’s eye with cryotherapy and removed the tear canal. Then, she teamed up with colleague John Carucci, ¢£, µh£, director of dermatologic surgery, to remove any remaining cancer from the surrounding skin. Regan would go on to have a series of major reconstructive sur- geries to rebuild the periocular tissue and eyelids, all at the peak of the pandemic. “In ocular oncology, our goals are THE ABCDEs OF to preserve life first, save the eye, and if at all possible, save vision,” says MELANOMA DETECTION Dr. Belinsky. “For now, our team has achieved all three goals for Colleen, More than 30 years ago, dermatologists at NYU Langone Health and we will continue to fight for her. developed the criteria for detecting melanoma, popularized in the She’s an unforgettable patient. She mnemonic ABCDE. NYU Langone’s melanoma surgeons at Perlmut- does everything we ask of her. She’s ter Cancer Center specialize in removing the cancer while preserv - strong and never loses her positivity.” ing appearance and function; our medical oncologists provide the Today, Regan is back to work as a latest targeted treatments, including genetically engineered inject- legal assistant. In her downtime, she able therapies; and our researchers and clinicians study all aspects rides her bike and enjoys taking long of the melanoma disease process. walks, grateful that she can still take A = asymmetry, where half the mole is unlike the other. in the scenic views. “What NYU Langone has done for me has been B = border, where the mole is irregularly shaped, scalloped, unbelievable,” she says. “They saved or poorly defined. my life.” C = color, where there is variation from one area to another or different shades of tan, brown, black, and sometimes white, red, or blue.

TO FIND A DOCTOR who D = diameter, where a mole is wider than a pencil eraser. treats melanoma, visit nyulangone.org/melanoma E = evolving, where a mole changes in size, shape, or call 212-731-6000. or color over time. WILDPIXEL WILDPIXEL SUMMER 2021 7

“In ocular oncology, our goals are to preserve life Ÿrst, save the eye, and if at all possible, save vision. For now, our team has achieved all three goals for Colleen, and we will continue to Ÿght for her.” Irina Belinsky, MD, surgeon and director of ocular oncology WILDPIXEL WILDPIXEL

Photograph by BRAD TRENT 8 NYU LANGONE HEALTH NEWS

Robotics: Part 1 Saving Time, Saving Lives A Brooklyn Breakthrough: Robotic Diagnosis and Surgery for Lung Cancer, All in One Day

Maria Rodriguez, ¹, has been a “Removing lung cancer as early as to identify patients who should be LUNG CANCER: pack-a-day smoker since she was a possible is critical to prevent it from scanned annually based on their teenager, so her primary care phy- spreading,” says Dr. Mercado. smoking history and additional risk THE PROBLEM sician orders an annual lung cancer Brooklyn patients like Rodri- factors, including a family history of BROOKLYN CAN’T screening. This year, the low-dose guez who require lung cancer sur- lung cancer and exposure to asbestos. ¬º scan revealed a small nodule. Nor- gery are in expert hands. Dr. Geraci The initiative has expanded to other FUHGEDDABOUD mally, the finding would lead to fur- was trained by two of the most ac- NYU Langone Family Health Cen- ther imaging tests or a needle biopsy. complished robotic surgeons in the ters in Brooklyn and NYU Langone The need for lung cancer Instead, Rodriguez, who lives country, Robert Cerfolio, ¢£, ¢«ª, Levit Medical in Midwood, with screening is compelling. in the Bensonhurst section of Brook- director of clinical thoracic surgery plans to add additional practices in Nationwide, lung cancer lyn, skipped these steps thanks to a and chief of hospital operations at Brooklyn, as well as in Queens, Man- is projected to kill 131,880 novel tag-team robotic approach NYU Langone, and Michael Zervos, hattan, and Long Island. people in 2021, twice the being pioneered by NYU Langone ¢£, chief of thoracic surgery at NYU Early detection is vital for robot- number of mortalities from Health’s Lung Cancer Center, part Langone’s Manhattan campus. To- ic surgery, generally a viable option any other cancer. In Brook- lyn, lung cancer is the single of Perlmutter Cancer Center. gether, they have completed more only for stage  and stage  tumors. largest cause of cancer death. In March, Rodriguez was than ¨,­ robotic thoracic surger- It boosts the e‰ectiveness of other The most populous borough wheeled into an ¯» at NYU Langone ies. “They’ve been at the forefront of lung cancer treatments, as well. At has New York City’s highest Hospital–Brooklyn and sedated. robotic surgery for years and were a Perlmutter Cancer Center, a Na- annual lung cancer incidence There, Jorge Mercado, ¢£, associate big reason why I came to NYU Lan- tional Cancer Institute–designated and second-highest rate (after section chief of pulmonary, critical gone,” says Dr. Geraci. Comprehensive Cancer Center, Staten Island). Abraham Cha- care, and sleep medicine, inserted a The robotic surgical system Dr. these treatments include radiation choua, MD, medical director first-of-its-kind robotic scope called Geraci uses, like those at other therapy, chemotherapy, and clinical of the Lung Cancer Center the Monarch through her mouth and NYU Langone locations, offers a trials for patients whose mutations at Perlmutter Cancer Center, airways. Using a handheld controller, minimally invasive approach for are likely to respond to investiga- notes that a high percentage Dr. Mercado maneuvered the long, removing lung cancers. With a ¨-D tional therapies. Brooklyn patients of his Brooklyn patients are flexible camera deep into her lungs. camera providing visual guidance have access to all of these services diagnosed with advanced The scope’s robotic features, which for the surgeon, who operates from through Perlmutter Cancer Center– lung cancer, “and that speaks afford unprecedented control, al- a nearby console, tiny surgical in- Sunset Park, an airy, ­,-square- to a lack of screening.” Lung lowed Dr. Mercado to safely travel struments mounted on robotic arms foot facility that opened two blocks cancer typically causes no further into the fragile airways, permit precise movements. In addi- from NYU Langone Hospital– symptoms in its early stag- where he identified and biopsied tion to reduced scarring and a short- Brooklyn in . “We are o‰ering es and has spread to other the suspicious mass. Pathologist er recovery time compared with comprehensive lung cancer care organs by the time it’s diag- Deepthi Hoskoppal, ¢£, mean- conventional surgery, “the robotic and giving more patients access to nosed. Only a tiny fraction of while, evaluated the sample in the method has clear advantages for re- it,” says Dr. Chachoua. “No other those eligible for screening ¯» rather than transporting it to the moving a small segment rather than hospital in Brooklyn has a robust actually receive it, despite the fact that, according to a major pathology lab. Within minutes, Dr. an entire lobe,” says Dr. Geraci. screening program like the one study, annual scans reduce Hoskoppal identified the cancer- Robotic diagnostic and surgical we’re building,” he notes. lung cancer deaths among this ous cells, and Dr. Mercado injected procedures are only half the story Maria Rodriguez is a shining ex- cohort by 20%. The five-year a contrast marker to aid in locating of Perlmutter Cancer Center’s ample of the di‰erence stepped-up survival rate for localized the cancer during surgery. The team heightened emphasis on treating early detection and treatment can non–small-cell lung cancer is then exchanged the robotic scope for lung cancer in Brooklyn (see text at make. Two decades ago, she lost her 63%, but that figure drops to a robotic surgical system. Thoracic right). “Our mission is to provide older sister, also a smoker, at age § 7% for patients diagnosed at surgeon Travis Geraci, ¢£, assistant access to underserved, underrep- to lung cancer, just a month after stage 4, according to the Na- professor of cardiothoracic surgery, resented communities,” says Abra- diagnosis. “She didn’t get screen- tional Cancer Institute. New identified the area with the cancer ham Chachoua, ¢£, the Jay and ings, and by the time they found the recommendations from the and removed a small segment of the Isabel Fine Professor of Oncology cancer, she was at stage §,” recalls US Preventive Services Task lung. Rodriguez was discharged two and medical director of the Lung Rodriguez. By contrast, Rodriguez’s Force will nearly double the days later, effectively cured of her Cancer Center. scan revealed a suspicious lesion number of patients advised to stage  malignancy. “I was relieved With that in mind, the Lung early on, and a team of doctors at have yearly scans, lowering they caught it and that I don’t require Cancer Center launched a screening NYU Langone was able to remove it the recommended screening further treatment,” she says. initiative at the Sunset Park Family quickly. “I’m grateful to Dr. Geraci age from age 55 to 50 and Diagnosing and treating ear- Health Center last August. The pro- and Dr. Mercado,” says Rodriguez. reducing the smoking history ly-stage lung cancer in one day is a gram leverages Epic, NYU Langone’s “This procedure saves patients time, guideline from 30 years to 20 first—for Brooklyn and for Perlmut- electronic health record system, and it will save lives.” years. ter Cancer Center. The same-day approach spares patients weeks of TO FIND A DOCTOR who treats lung cancer, visit nyulangone.org/lungcancercenter or call 212-731-5662. worry between appointments. More important, it saves precious time.

Photograph by JONATHAN KOZOWYK It takes three: Robotic lung surgeon Travis Geraci, MD, pathologist Deepthi Hoskoppal, MD, and pulm- onologist Jorge Mercado, MD, team up at NYU Lan- gone Hospital–Brooklyn to diagnose and remove early-stage lung cancer.

“Removing lung cancer as early as possible is critical to prevent it from spreading.” Jorge Mercado, MD, NYU Langone Hospital-Brooklyn 10 NYU LANGONE HEALTH NEWS

Robotics: Part 2 Moving Mountains A Month After Robotic Mitral Valve Repair, an FDNY Fire ghter Feels (and Is) on Top of the World

Barton Fendelman has never been only e‰ective treatment for severe one to give up on a goal. So when Firefighter Barton forms like Fendelman’s is to repair the New York City firefighter, now Fendelman takes in the or replace the errant valve. Two- view atop Mt. Kilimanjaro ­ and retired, came to see Didier just one month after thirds of surgical candidates for this Loulmet, ¢£, NYU Langone undergoing a robotic condition are men, and a majority Health’s director of robotic cardiac mitral valve repair. are in their ­s or ¹s, though Dr. surgery and chief of cardiac sur- Loulmet has done surgical repairs gery, he mentioned his plan to climb on patients as young as ˆ and as old Mount Kilimanjaro, the highest as ˆ. “Health is the biggest factor, peak in Africa, in two months. not age,” says Dr. Loulmet, explain- Dr. Loulmet was, to say the least, ing that some patients are too sick surprised. Fendelman, referred by to endure an open procedure that NYU Langone cardiologist Manuel requires surgeons to stop the heart Morlote, ¢£, had been diagnosed and use a heart-lung bypass ma - with mitral valve regurgitation, a chine. Overall, less than ­% of pa - condition in which the valve fails tients receiving robotic mitral valve to close, causing some blood to flow repair will develop recurrent mitral backward into the heart’s upper valve regurgitation over a period of chamber. In severe cases like Fen-  years. delman’s, it can lead to congestive Fendelman’s ¨½-hour proce- heart failure. Without surgery, Fen- dure was straightforward. Seated delman was at risk for heart failure, at the console and guided by the but he was determined and, per- high-definition binocular display, haps, in denial. “I asked, ‘Can this Dr. Loulmet made an incision in the wait until aer my trip?’ ” he recalls. le atrium to reach the mitral valve, It couldn’t, but Dr. Loulmet, removed the damaged portion of the a pioneer in robotic mitral valve leaflet, and repaired the valve with repair surgery, didn’t rule out his the remaining tissue. Finally, he im- patient’s summit quest. Though planted a device around the mitral he has performed the repair using valve, known as an annuloplasty open and minimally invasive tech- band, to correct and reinforce the niques, Dr. Loulmet favors the valve’s shape. robotic approach because it is the Fendelman was discharged two most precise and least invasive, re- days later, feeling sore but other- sulting in a shorter hospital stay and wise symptom free. He progressed quicker recovery period. “The visu- quickly, and at his follow-up visit, alization system gives the surgeon Dr. Loulmet cautiously cleared him  times greater magnification and for the climb. a ¨-£ view,” says Dr. Loulmet. The One month aer his surgery, Fen- tiny instruments, inserted through “To climb Kilimanjaro so soon after conventional delman departed for Tanzania, where five pencil-size incisions on the surgery would’ve been impossible. Robotic repair lets he met up with his tour group for right side of the heart, endow the you recover quickly and move on with your life.” the week-long expedition. The final surgeon with a greater range of leg to the ,¨§-foot summit was Didier Loulmet, MD motion and finer dexterity. a challenge but, he says, well worth it. The robotic system requires a “It was a beautiful, cloudless day,” he seasoned hand at the helm, and Dr. says. “Being that high with nothing Loulmet has experience few other Program team has been chosen by vanced approach,” says Aubrey Gal- else around me was unforgettable.” surgeons can match. He assisted the Society of Thoracic Surgeons to loway, ¢£, chair of cardiothoracic The vast majority of the ­-plus Alain Carpentier, ¢£, on the world’s train other experienced cardiac sur- surgery at NYU Langone. patients Dr. Loulmet operates on ro- first robotic mitral valve repair in geons in robotic mitral valve repair. Mitral valve regurgitation is the botically each year are simply happy ˆ in Paris, and during the past  “Dr. Loulmet sets the stan - most common form of valve disease. to return to good health. Still, Fen- years, he and fellow cardiothoracic dard for the elite top-tier surgeons It often results from simple wear delman’s dramatic example points surgeon Eugene Grossi, ¢£, who internationally who are able to do and tear. Although some cases can to the benefits of the technique. operates together with Dr. Loulmet, complex valve repairs with this ad- be controlled with medication, the “To climb Kilimanjaro so soon aer have completed nearly , robotic conventional surgery would’ve been mitral valve repairs at NYU Lan- TO FIND A DOCTOR who treats mitral valve disease, visit nyulangone.org/ impossible,” says Dr. Loulmet. “Ro- mitralvalveprogram or call 212-263-3940. gone, with a success rate of nearly botic repair lets you recover quickly

%. The Robotic Cardiac Surgery and move on with your life.” COURTESY OF BARTON FENDELMAN

Photograph by JONATHAN KOZOWYK Experience matters: Robotic car- diothoracic surgeon Didier Loul- met, MD, assisted on the world’s first robotic mitral valve repair and has completed nearly 1,000 more at NYU Langone Health with a success rate of almost 100%. NYU LANGONE HEALTH NEWS

Better Dermatology Shining a Spotlight on Skin Conditions Commonly Overlooked When They Aˆect People of Color

When Daniel Gutierrez, MD, be- Black patients. Dr. Adotama’s gan medical school, he planned to research focuses on healthcare become a primary care physician. disparities and outcomes in hair Then he learned that the field of disorders; he offers a variety of dermatology is the least ethnically remedies for treatable hair-loss diverse specialty in all of medi- disorders among Black patients. cine, and he reconsidered. “My Meanwhile, Dr. Parameswaran has mentors thought I could make a created a clinic for an inflamma- much bigger impact in dermatol- tory skin disease called hidrad- ogy, treating underserved patient enitis suppurativa, which causes populations,” recalls Dr. Gutierrez. painful boils in the armpits and Dr. Gutierrez, the son of a genital area and is more prominent migrant worker from Mexico, has among young Black women. She long aspired to bring better care is studying the effect of three in- to those hit hardest by healthcare vestigational drugs that may prove disparities. Now an instructor in beneficial in treating the disease, the Ronald O. Perelman Depart- under the direction of principal ment of Dermatology, he’s quickly investigator Kristen Lo Sicco, MD, making an impact in his field. director of NYU Langone’s Skin Just months after completing his and Cancer Unit. residency at NYU Langone Health While every NYU Langone der- last year, Dr. Gutierrez joined matologist is more than capable of forces with NYU Langone derma- treating these conditions, Dr. Guti- tologists Nayoung Lee, MD, Prince errez points to two broader ben- Adotama, MD, and Anupama efits of the burgeoning program. Parameswaran, MD, to establish a First, the team will attune resi- new initiative focused on diagnos- dents and fellows to the nuances ing and treating dermatological of how common skin conditions conditions that disproportion- manifest in patients of color, since ately affect those with black and images in medical textbooks tend brown skin. The program, called to show how they look only on Skin of Color, emphasizes medical white skin. For instance, psoriasis, therapies, clinical research, and an overgrowth of skin cells that educational training of residents. causes itching and scaly flareups, “It was a great idea that was usually appears red or pink on only missing the motivated clini- fair-skinned people but is more cians who wanted to implement likely to be violet or dark brown on it,” says Seth Orlow, MD, PhD, those with black skin. chair of the Ronald O. Perelman Beyond this, the team plans Department of Dermatology. to bring more patients of color The four young doctors treat to their NYU Langone practices the full spectrum of skin problems, through outreach efforts, as well though each has a special interest as word of mouth. All four phy - in a condition impacting patients sicians have skin of color—Dr. with pigmented skin. Dr. Gutier- Gutierrez is Hispanic, Dr. Adotama rez’s focus is vitiligo, which results is Black, Dr. Lee was born in South in spotty white patches that can Korea, and Dr. Parameswaran is of be minimized with topical medica- Indian descent—and believe that tions and light treatments, known their backgrounds will help attract as phototherapy. Dr. Lee, a skin those who may be hesitant to cancer surgeon, is the principal seek out a dermatologist. “When investigator of a study to deter- you have cultural concordance, mine whether laser-assisted drug patients have more confidence in delivery is effective at eliminating your care, and that improves out- prominent raised scars, called comes,” says Dr. Gutierrez. keloids, that predominantly affect

TO FIND A DOCTOR who treats skin conditions in people of color, visit nyulangone.org/dermassociates or call 212-263-5015. DRB IMAGES SUMMER 2021 13

Center of Attention

NEW YORK’S LARGEST CLINIC FOR HYPERTROPHIC CARDIOMYOPATHY

The Need Every week, cardiologist Mark Sherrid, MD, sees new patients whose chronic symptoms—shortness The MRI of a patient with hypertro- of breath, chest tightness, and periodic blackouts—had previously been misdiagnosed. They had been told phic cardiomyopathy (above left) they were suffering from conditions like exercise-induced asthma, panic attacks, depression, coronary artery shows a thickened wall between the disease, or mitral valve prolapse, yet the treatments, predictably, weren’t working. Finally, an observant cardi- heart’s chambers, called the ven- tricular septum (VS), that obstructs ologist helps these patients learn the truth: they have a genetic heart disease affecting one in 500 people that blood flow from the left ventricle causes the wall between the heart’s chambers to thicken, restricting the flow of blood. The condition, called (LV) to the aorta. Above right, a hypertrophic cardiomyopathy, or HCM, can be disabling and potentially fatal. “HCM is the great masquerader healthy ventricular septum. of cardiology, because it looks like a lot of other conditions,” says Dr. Sherrid, director of NYU Langone Health’s Hypertrophic Cardiomyopathy Program, “and it can end a patient’s life at a tragically young age.”

The Draw Cardiologists generally refer patients with HCM to a center that specializes in the disease. Many in the tristate area wind up in the office of Dr. Sherrid, who has contributed to its improved prognosis during the past two decades. “HCM used to have a high mortality rate, but in recent years, it’s become remarkably treat- able, in most cases with a normal life expectancy,” says Dr. Sherrid. Since their arrival at NYU Langone in 2015, he and surgical director Daniel Swistel, MD, have built the largest program in New York State, accredited as a Center of Excellence by the Hypertrophic Cardiomyopathy Association. Dr. Sherrid, in parallel with cardiologist Daniele Massera, MD, assistant professor of medicine at NYU Grossman School of Medicine, sees 350 new patients each year and follows 3,000 men and women ranging from 18 to their early 90s. “People routinely tell us that our care has transformed their quality of life,” Dr. Sherrid says.

The Approach Since obstruction in the heart is often latent, and the characteristic murmur may be absent at rest, Dr. Sherrid often asks new patients to trigger it by eating a meal and then walking briskly on a treadmill right before undergoing an ultrasound of the heart. This diagnostic strategy helps point to medications that, in a majority of cases, reduce symptoms significantly. Magnetic resonance imaging can help identify patients at lifelong risk for sudden death. Patients whose HCM triggers an irregular heart rhythm are candidates for an implantable device, called a defibrillator, which emits an electric shock when needed to restore a normal heart- beat. Those with severe obstruction may require surgery to thin out the wall between the heart’s chambers, called the septum, to increase blood flow to the body’s central artery, the aorta. Dr. Swistel has performed more than 600 of these complex repairs, among the most of any surgeon nationally, with about 95% of patients showing improvement. Regardless of the treatment, Dr. Sherrid emphasizes the importance of moderate exer - cise and weight management, as early results from an NYU Langone study show that losing weight improves symptoms and may reduce heart wall thickness.

The News NYU Langone has been at the forefront of surgical innovations for HCM. Dr. Swistel pioneered the technique of removing a portion of the mitral valve, which tends to become elongated in patients with the disease, further hindering the flow of blood. He and fellow HCM surgeon Deane Smith, MD, assistant professor of cardiothoracic surgery, are testing an investigational ultrasound probe to assess heart wall thickness in real time during septal reduction surgery and ensure that the optimal amount of tissue is removed. The program is TO FIND A DOCTOR who treats hypertrophic cardiomyopathy, enrolling patients in a phase 3 study of a novel medication to relieve obstruction, and Dr. Sherrid is leading a visit nyulangone.org/hcm or phase 1 clinical trial for another drug that has shown early promise. “It’s a very exciting time in our field, with call 646-501-0568. advances that are helping patients with HCM live longer, healthier lives,” says Dr. Sherrid. 14 Cover Story Treating Young Athletes Standing Tall: A New Surgical Alternative for Scoliosis

Jenna Moriello tried her best to draw Spain. As chance had it, Dr. Rodri- attention away from the dramatic guez-Olaverri, renowned for treating curve in her spine, but the malfor- adolescent athletes with spinal defor- mation was hard to hide in a dancer’s mities, had just accepted a position at skintight bodysuit. By her freshman NYU Langone Health as director of year at the Union County Academy Early Onset Scoliosis. for Performing Arts high school in The pandemic delayed Dr. Rodri- Linden, New Jersey, her condition, guez-Olaverri’s arrival, but he met called scoliosis, was worsening, the Moriellos in the spring of , causing far more than emotional dis- reviewed Jenna’s case, and recom- tress; the chronic back pain forced mended the procedure. “Fusion her to continually compensate for surgery would have stopped Jenna’s her misalignment. An X-ray in No- dancing career,” says Dr. Rodri - vember  revealed a curvature of guez-Olaverri. “If I can give her four nearly  degrees; anything over ­ more years of doing what she loves, degrees is considered severe. “My that’s wonderful.” spine was shaped like an S,” says A pioneer in his field, Dr. Rodri- Jenna, now ¹. “I started to look for guez-Olaverri tested many versions it in photographs and videos of me of °«º. Despite design improve- dancing. It didn’t help that I was in a ments, there remains a one-in-five leotard in front of a mirror every day. chance that the cord, pulled taut, That made me insecure.” will tear within two years. To reduce The corrective brace Jenna wore that risk, he uses two sets, side-by- at night, a remedy that prevents the side, reducing the breakage rate to condition from progressing in many less than ­%. He is one of only two of the ¹ to  million Americans surgeons globally to use computer- with the condition, primarily girls ized tomography imaging to facilitate and women, wasn’t working. With placement of the titanium screws Jenna hiding her body in oversized during the six-hour procedure. clothes, and with the risk that her When Jenna le Hassenfeld Chil- curvature could ultimately impede dren’s Hospital at NYU Langone in her lung function, her mother, Dan- June , five days after surgery, ielle, knew that surgery couldn’t her curvature measured a negligible wait much longer. However, she  degrees. She spent the summer was afraid of the standard proce- adjusting to her new alignment. In dure, fusing two or more vertebrae “Fusion surgery would have stopped Jenna’s September, she returned to dancing together to straighten the spine, be- dancing career. If I can give her four more years without restrictions. “I felt surpris- cause it limits a patient’s flexibility. of doing what she loves, that’s wonderful.” ingly normal,” she says. “I worried about the impact of such Juan Carlos Rodriguez-Olaverri, MD, PhD By this spring, Jenna had grown a surgery on a §-year-old, especially an inch—helping to straighten a dancer,” Danielle says. her spine further—and Dr. Rodri- While she weighed the pros and guez-Olaverri had completed ­ °«º cons, Danielle heard through a Face- surgeries at NYU Langone, a great book group about a surgical alterna- majority on children and teenagers tive recently approved by the ãª, who traveled from other states or na- called vertebral body tethering, or tions to see him. He delights in the °«º. The novel approach restrains post-procedure videos they share: one side of the spine with a flexi- figure skaters able to resume jumps, ble polymer cord threaded through gymnasts doing flips, and baseball screws attached to the side of a‰ect- players back on the field in as little ed vertebrae, allowing the opposing as four to six weeks. “We’re helping side to straighten naturally as a child these patients continue to be com- grows. Unlike a fusion rod, the tether petitive athletes,” he says. “You can doesn’t reduce mobility. Finding no always do fusion later on.” local providers who o‰ered it, Dan- ielle reached out to a leading practi- TO FIND A DOCTOR who treats scoliosis in children, visit nyu- tioner of the technique, Juan Carlos langone.org/scoliosisinchil- Rodriguez-Olaverri, ¢£, µh£, at the dren or call 646-929-7970.

Centro Médico Teknon in Barcelona, PHOTOGRAPHSTHIS PAGE AND COVER COURTESY OF DSM PRODUCTIONS SUMMER 2021 15

Before After

Images of Jenna Moriello’s spine before and after surgery show how the flexible cord, threaded through screws on her vertebrae, reduced her extreme curvature. PHOTOGRAPHSTHIS PAGE AND COVER COURTESY OF DSM PRODUCTIONS 16 NYU LANGONE HEALTH NEWS

Telemedicine

12A Dozen Doctors,+ 22 Days,22 =2 and Two Lives Saved

“Twenty years ago, people used to say that emergency departments were a safety net for patients. But COVID-19 has made telemedicine another safety net for people who are afraid to come into hospitals or doctor o¨ces.” Leslie Miller, MD

Like many people, Tammy Fried was her lungs. Sensing that her condi- the integrity of the blood vessels, bleeding,” he says, “we can employ skeptical about the value of a virtual tion was deteriorating, Dr. Miller interventional radiologist Beatriz high-end mechanical and imaging visit with a doctor. When she awak- explained the need for a ¬º scan to Escobar, ¢£, was able to identify technology to stop it, avoiding major ened one morning in May  with help diagnose a potential vascular the precise source of the bleeding. A surgery.” a nosebleed and bloody cough, she abnormality. “You need to go to the fistula, or abnormal connection be- Her bleeding issue resolved, Fried was concerned about her symptoms Emergency Department,” she told tween two blood vessels that are nor- and her baby faced a new threat. She but wondered what a doctor could Fried. “The sooner, the better.” mally excluded from one another, had had developed a severe form of pre- possibly do for her over the phone. Soon after Fried arrived at the formed between the bronchial and eclampsia, a life-threatening con- Still, Fried, then seven months preg- Ronald O. Perelman Center for pulmonary arteries. Upon bursting, it dition that affects multiple organ nant, was reluctant to make a trip to Emergency Services at Tisch Hos- had caused blood to leak into Fried’s systems, including the mother’s the Emergency Department amid pital, she was coughing up an alarm- lungs—slowly at first, and then with liver and kidneys. When it became the pandemic. So instead, she made ing amount of blood. Concerned greater force. Through a pinhole inci- clear that Fried’s organ damage was an appointment with NYU Langone that an underlying disorder was sion in the groin, Dr. Escobar thread- worsening, maternal fetal medi- Health’s Virtual Urgent Care service, causing Fried to hemorrhage, doc- ed a catheter to the bronchial artery, cine specialist Sara Brubaker, ¢£, as thousands of patients had done tors ordered a ¬º scan, expedited but she was unable to block it off recommended delivery, which throughout the spring surge. by emergency medicine physician because one of the microwires dam- reverses the complications of the ill- Fried, a tax attorney who lives on Tina Wu, ¢£. The scan didn’t show aged blood vessels, which sometimes ness. Though Fried was frail from  Manhattan’s Upper West Side, soon evidence of a life-threatening blood occurs during the procedure. “This days of hospitalization, ˆ spent on a found out just how valuable NYU clot known as a pulmonary embo- is a very unusual place for a fistula ventilator, her baby was strong at just Langone’s telemedicine service lism, nor did it identify the cause to form,” notes Dr. Sista, “and it can ¨ weeks of gestation. On May ¹, could be. Her outreach marked the of the bleeding. The same was true be very challenging to gently guide a five days aer being weaned o‰ seda- first step of a long, complex medi- for an endoscopy of Fried’s airway, wire through a tortuous vessel.” tion, Fried gave birth via cesarean de- cal journey in which a team of NYU which ruled out a severe nosebleed Fried continued to cough up small livery to a ¨-pound ­-ounce boy. “To Langone specialists drew upon their as the culprit. With Fried stabilized amounts of blood over the next few hear the baby cry,” she says, “was like wide-ranging expertise and keen de- in the Emergency Department, Dr. days, which were suctioned out by hearing the angels sing. It felt like ev- cision-making to save her life. Wu transferred her to the intensive the intensive care team. When the erything was going to be okay.” Aer It all began with Leslie Miller, care unit. There, she was sedated and vessels healed several days later, Dr.  weeks in the neonatal intensive ¢£, an emergency medicine phy- intubated, and a bronchoscopy was Sista, the interventional radiologist care unit, “Miracle Max,” as his par- sician with ¨ years of experience, performed to remove blood from her on duty, was able to successfully ents referred to him, went home to who fielded Fried’s Virtual Urgent lungs and identify the location of the block off the artery by plugging it meet his three-year-old brother, Jack. Care visit last May. “With pregnan- bleeding. with metallic coils, which prevent- “Twenty years ago, people used cy, one of the things you have to “By isolating the source of the ed blood from spilling into Fried’s to say that emergency departments be very concerned about is sponta- bleeding, the bronchoscopy helped lungs. Dr. Sista describes this embo- were a safety net for patients,” notes neous bleeding,” explains Dr. Miller, us correlate what we would see on an lization technique as one of the most Dr. Miller. “But ¬¯°±£- has made an emergency medicine physician. angiogram,” explains Akhilesh Sista, advanced procedures performed by telemedicine another safety net for It’s not unusual for people to cough ¢£, chief of the Division of Vascular interventional radiologists, placing people who are afraid to come into up blood due to pneumonia, bron- Interventional Radiology. Using the NYU Langone at the forefront of hospitals or doctor offices.” When chitis, or other respiratory con - angiogram’s series of X-rays to view the field. “Anytime there’s internal Fried made a full recovery, she sent ditions, she notes. But Dr. Miller Dr. Miller a note to thank her for the could hear Fried’s cough sounding TO SCHEDULE A VIRTUAL URGENT CARE VISIT, go to nyulangone.org/vir- expert care she provided during their tualurgentcare. Or navigate to the “virtual urgent care” section of the progressively wetter, suggesting NYU Langone Health app. video visit. “You saved my life,” she an increasing amount of blood in wrote.

Photograph by TONY LUONG SUMMER 2021 17 1,000 %

Meeting in person for the first time, Dr. Leslie Miller offers a warm embrace for the two lives she helped save: Tammy Fried and her son, Max.

The rise in Virtual Urgent Care video visits since the start of the pandemic in January 2020 ■

Tammy Fried’s reluctance to visit an emergency department during the spring surge is one that has been shared by many New York- ers throughout the pandemic. Since January 2020, some 88,000 patients have taken advantage of NYU Langone’s Virtual Urgent Care service, compared to about 9,000 during the previous two years combined. The soaring increase reflects the value of tele- medicine during a public health crisis, and it suggests that in many cases, virtual healthcare is here to stay. Of those patients who consult one of NYU Langone’s 200 specialists in emergency medi- cine—the average wait time for an appointment is only two to three minutes—about 7% are referred to one of NYU Langone’s Emergency Departments because they require in-person care. But Tammy Fried belongs to a much smaller elite group. “In a typical year,” notes Viraj Lakdawala, MD, clinical associate professor of emergency medicine and medical director of Virtual Urgent Care, “only one or two patients we refer to the Emergency Department require a lifesaving intervention.” 18 NYU LANGONE HEALTH NEWS

Milestones All Heart, No Question 1. Our Transplant Team Saved a Patient’s Life by Implanting an Arti cial Heart—and Then a Real One

“When we decide to do something, we make things happen quickly. We have a remarkable team, one of the best in the world.” Nader Moazami, MD

It’s been over five decades since the the body’s major organs. By the time first artificial heart was implanted Gaskins was transferred to NYU in a human. That device, handmade Langone from a referring hospital in from plastic and connected to a §- New Jersey, he was in cardiogenic pound air compressor, kept a §Â-year- shock, a life-threatening condition in old patient alive for three days until it which the heart can no longer pump was replaced by a donor heart. enough blood to meet the body’s The technology has evolved sig- needs. He had been on chronic dial- nificantly, but the artificial heart is ysis, his liver function was declining still seen as a bridge to transplanta- quickly, and he had early-stage bone tion and reserved for patients who marrow cancer. are too sick to receive a real heart. NYU Langone acted quickly, se- Because the four- to six-hour open curing a SynCardia cc Total Arti- surgery required to implant the ficial Heart (ºªÇ) within a week and device is more complex than a heart training a team of §¨ clinical special- transplant, with poorer overall out- ists on the device in just two days. comes, not many centers are willing “NYU Langone isn’t an ocean liner to take on the challenge. In fact, only you can’t turn,” says Dr. Moazami. about  artificial hearts are im- “When we decide to do something, planted worldwide in a typical year. we make things happen quickly. We At NYU Langone Health, how- have a remarkable team, one of the ever, the thinking is di‰erent. The best in the world.” Transplant Institute finds donor Having worked with the manu- hearts faster than any other center facturer on investigational studies for in the Northeast, due in part to its the ºªÇ while at another institution, innovative protocol for accepting Dr. Moazami was comfortable lead- and later treating otherwise healthy ing the procedure. With the patient organs infected with hepatitis C. on a heart-lung machine, Dr. Moaza- Moreover, with the highest one-year mi and Deane Smith, ¢£, associate survival rate among heart transplant director of heart transplantation and patients in the Northeast and the mechanical circulatory support, re- best outcomes among multiorgan moved both lower heart chambers transplants in the US, it has been and the four valves, positioned the named the top heart transplant pro- device, sutured it into place, and gram twice in a row based on data connected tubes to the chambers of published by the Scientific Registry the original heart and the aorta. The of Transplant Recipients. So taking artificial heart attaches to a tube that on patients whose only hope of sur- extends through the chest wall to an vival is an artificial heart is a natural external pneumatic driver that does erwise be candidates in other cen- The Total Artificial Heart is extension of its mission. the pumping and monitoring. ters,” says Aubrey Galloway, ¢£, the designed to increase blood “When everybody else says no, Though designed as a temporary Henry H. Arnhold Chair and Profes- flow and speed the recovery of vital organs to make the patients can always rely on NYU solution, the device has supported sor of Cardiothoracic Surgery. patient a stronger transplant Langone to look at the most complex some patients unable to get a trans- The surgery sets up the Trans- candidate. The only device cases,” says Nader Moazami, ¢£, plant for more than four years. One plant Institute to participate in trials of its kind approved by the chief of heart and lung transplanta- month after surgery, Gaskins was for other artificial heart devices cur- FDA, about 1,500 have been implanted worldwide since tion and mechanical circulatory sup- well enough to walk the halls at the rently in development and further 2004. port. “We’re not afraid to say yes.” Kimmel Pavilion, and on June , he bolsters its reputation. “He would The Transplant Institute’s inau- underwent a heart-kidney transplant not have received this care and treat- FOR MORE INFORMATION gural artificial-heart implantation, at NYU Langone. Gaskins will likely ment at any place other than NYU about NYU Langone’s Heart on March ¨, was, in Dr. Moazami’s require chemotherapy to combat his Langone,” says Robert Montgomery, Transplant Program, visit nyu- words, “as complex as it gets.” The amyloidosis—the next step on his ¢£, chair of surgery and director of langone.org/hearttransplant patient, Floyd Gaskins, ­­, a pastor path to recovery. the NYU Langone Transplant Insti- or call 833-344-3278. For doctors who treat pediatric from Vauxhall, New Jersey, has am- “This represents a critical, life- tute. “This cements us as a top center cardiac conditions, visit nyu- yloidosis, a rare disease caused by the saving option for patients who need that can do anything and everything langone.org/pediatricheart

buildup of a protein that damages a heart transplant but might not oth- for patients in heart failure.” or call 212-263-5989. IMAGE COURTESY OF SYNCARDIA SUMMER 2021 19

2. And Our Pediatric Cardiac Surgeons Saved This Baby—and Hundreds More Each Year—Thanks to Outcomes That Exceed the National Average 99%

NYU Langone’s overall risk-adjusted survival rate for pediatric cardiac sur- gery, compared with a national rate of 97.2%

Soon after a routine 20-week ultrasound, Jes- sie Taormina, 34, then a nurse at NYU Langone At a follow-up visit in 2019, Hospital–Brooklyn, learned with her husband, Sammie Taormina Nicolo, that their baby had a rare congenital con- shared a smile with dition known as hypoplastic left heart syndrome his doctors, cardiol- (HLHS). Dubbed “half a heart syndrome,” it leaves ogist Dr. Achi Ludo- the left side of the heart so underdeveloped that mirsky and cardiac surgeon Dr. Ralph it struggles to pump blood to the rest of the body. Mosca. Thirty years ago, the survival rate of the approx - imately 960 babies born in the US annually with HLHS was less than 5%. Today, thanks to a series of three reconstructive surgeries, the five-year survival rate has increased to 70%, with 90% long-term survival of children who reach their first birthday. Jessie was deeply relieved to learn that NYU Langone Health has one of the most successful programs in the country for this condition, led by one of the top pediatric cardiac surgeons. Ralph S. Mosca, MD, chief of the Division of Pediatric and Adult Congenital Cardiac Surgery, helped define the modern-day surgical standard of care in the 1990s. The cardiac surgery program he heads at Hassenfeld Children’s Hospital, which treats the most complex forms of congenital heart disease and performs nearly 250 operations annually, has the highest risk-adjusted survival rate of any hos- pital in New York State for pediatric patients. That impressive outcome report was recently issued by the state’s Department of Health, which takes into account the complexity of care at the time of surgery, as well as the number of children treated for the condition at the institution. In addition, Hassenfeld Children’s Hospital outperforms the national average for clinical out- comes, complication rates, and length of hospital stay, according to the Society of Thoracic Sur- geons (STS). The latest data from STS shows that NYU Langone’s survival rates for pediatric cardi- ac surgery exceed the national average in several categories. The institution’s overall survival rate is 99%, compared with a national rate of 97.2%. For neonates, the survival rate is 96.2%, com- pared with a national average of 92%. For infants up to age 1, the survival rate is 99.5%, compared with a national average of 97.4%. In September 2018, Sammie Taormina became one of those success stories. Seventeen days after he was born at Tisch Hospital, Sammie had his first operation. It went smoothly, as did the second surgery in March 2019 and the third last September. Once Sammie fully recovered, he was cleared to do all the climbing, running, and jumping he wished. Today, the Taorminas look like any other relaxed young family, with a chub- by-cheeked toddler who, along with his new baby

IMAGE COURTESY OF SYNCARDIA brother, Russell, charm everyone they meet.

Photograph by TONY LUONG 20 NYU LANGONE HEALTH NEWS

5 THINGS YOU SHOULD KNOW ABOUT Psychedelic The Explainer Medicine

1 2 3 4 5

It isn’t new. The benefits Science is NYU Langone Don’t skip can be underway to researchers the therapy In the 1950s, enduring. explain why. are leading sessions. scientists be- the way. gan exploring Psychedelic treat- “How a single The Center for the therapeutic ment typically experience can Excessive alcohol Psychedelic Med- potential of psy- includes one to produce lasting use is the fourth icine is squarely chedelic drugs to three sessions in changes is some- leading cause focused on de- treat people with which medication thing we’re still of preventable veloping safe, ef- addictions, as is administered, trying to unpack,” death in the US. fective therapies well as terminally combined with says Dr. Bogen- “Alcohol abuse for hard-to-treat ill patients. There a number of schutz.” Based was a main focus psychiatric dis- was big interest non-drug therapy partly on brain of the first wave orders. Michael in their clinical sessions. Volun- imaging studies, of psychedelic Bogenschutz, potential, but the teers are carefully he believes that science, so it was MD, the Center’s widespread abuse screened and psilocybin en- a logical place for director, is lead- IN EARLY 2021, NYU Langone of LSD during the prepared for the hances the brain’s me to start my ing clinical trials Health launched the Center 1960s led to the treatment ses- ability to adapt research,” says on psilocybin for for Psychedelic Medicine criminalization sions. Two thera- and reorganize Dr. Bogenschutz. mitigating depen- of psychedel- pists (one a psy- its structure and One of the clinical dence on alcohol to investigate the use of ics. Research on chiatrist) conduct activity. By dis- trials he’s leading and opioids, and hallucinogens, drugs that can psychedelics in the therapy and rupting ingrained assesses the ef- MDMA for PTSD. produce radical changes in the US resumed support the pa- negative patterns, fectiveness of psi- Stephen Ross, consciousness, for the treatment in the early 1990s, tient through any psychedelics locybin, coupled MD, the Center’s of psychiatric conditions such and the initial episodes of fear may allow new with psychother- associate director, as substance-use disorders, the studies from this or anxiety. After a patterns of brain apy, in reducing is leading trials leading preventable cause of second wave have dose of psilocybin activity and be- the amount of al- on psilocybin for death and disability in the US. gained attention is administered havior to emerge. cohol participants major depressive The Center, the first of its kind due to impressive orally, the patient Studies show that consume. With 95 disorder, LSD for in New York City and one of only clinical outcomes spends several psilocybin can randomized par- advanced can- and safety within hours reclined on produce intense, ticipants, it’s the cer pain treated a handful nationwide, builds on controlled trials. a couch, wearing meaningful expe- largest clinical tri- with opioids, and years of trailblazing research Based on these eye shades and riences marked al ever conducted cannabidiol for on addiction, depression, post- early results, the listening to music by a sense of with psilocybin, chronic nerve traumatic stress disorder, and Food and Drug on headphones oneness and and one of the root pain. Sarah cancer-related distress. Administration to help maintain transcendence. largest ever with Mennenga, PhD, This body of work has made has fast-tracked an inward focus. Dr. Bogenschutz a psychedelic is leading pre- NYU Langone a major force studies on During MDMA thinks of these drug. “Behaviorial clinical studies on behind the emerging renaissance psilocybin for medication episodes as hav- patterns become the effects of LSD in psychedelic-medicine research. major depres- sessions, there is ing an effect that deeply ingrained and BOL-148, a In a controlled setting and amid sive disorder and typically more in- is the opposite in a person’s re- nonpsychoactive MDMA for PTSD. teraction between of the effect of action to stress,” drug similar to ongoing psychotherapy, most Recently, the the participant traumatic expe- Dr. Bogenschutz LSD, on alcohol clinical-trial participants are need for effec- and the thera- riences causing says. “We hope use behavior in administered pharmaceutical- tive therapies pists. Dr. Bogen- PTSD. In that to learn who mice. Findings grade drugs like psilocybin, has gained even schutz says he’s disorder, a single responds best to on the safety of the psychoactive ingredient in greater urgency most surprised by traumatic event these treatments, these drugs in a “magic mushrooms,” or MDMA, due to the opioid how transforma- seared into mem- and how they controlled clinical a psychoactive drug known more epidemic and tive and durable ory can cause can make last- setting have been colloquially as Ecstasy. the psychosocial the effects of the dramatic, per- ing changes. A very reassuring. Here, psychiatrist Michael impact of the therapy can be. “If sistent changes in larger, multi-site But professional Bogenschutz, MD, who leads the pandemic. “It’s a single treatment brain function and trial is now being supervision is taken a while for can leave a pa- behavior. “Maybe planned with the the key, says Dr. Center, offers insights into this a second wave of tient problem-free what we’re seeing ultimate goal of Bogenschutz. renewed field. research to gain for six months, with psilocybin,” FDA approval “I’m hopeful that credibility,” notes that’s highly pre- he says, “is an for psilocybin the evidence will Dr. Bogenschutz. dictive of contin- experience so as a treatment be so compel- “But even skep- ued success.” powerfully pos- for alcohol use ling that one day tical scientists itive that it can disorder. these treatments TO FIND A DOCTOR who treats ad- are beginning to have an enduring will become diction, visit nyulangone.org/ad- give these drugs a positive effect on widely available diction or call 646-929-7950. For fresh look.” one’s brain and through trained doctors who treat post-traumatic psyche.” therapists,” he stress disorder, visit nyulangone. adds.

org/ptsd or call 646-929-7950. ROBINOLIMB BY ILLUSTRATION SUMMER 2021 21

Education Big Discoveries Boost NYU Grossman School of Medicine’s National Rank for Research to the #2 Spot

Some important scientific advances emerge from an urgent quest, such as those made by dozens of NYU Langone New research suggests that an Health clinician-researchers and basic scientists who have spent more than a year refocusing their work on ¤ª»¤-¬o°-, interconnected series of fluid-filled the virus that causes ¬¯°±£- (see page  of Special Report). Others come about through sheer serendipity, such as the compartments throughout the body form a kind of superhighway ˆ discovery by Neil D. Theise, ¢£, professor of pathology, that widespread layers of the human body, long thought distinct from blood and lymphatic to be solid connective tissues, actually contain fluid-filled spaces that Dr. Theise has dubbed the interstitium (see illustra- vessels that may play a role in the tion). If accepted by scientific consensus, this previously unknown network would be designated the body’s ˆth organ. spread of cancer. “I had been looking at the interstitium for ¨ years and never really noticed it before,” says Dr. Theise. “But now that we’re viewing living tissue at the microscopic level, this has enabled us to stumble onto this, and I don’t think there’s anything that doesn’t get changed by it.” Earlier this year, Dr. Theise and colleagues published research suggesting that this interconnected series of compartments—a kind of anatomical “highway”—may potentially play a role in the spread of cancer cells. Whether such breakthroughs arise from intense multidisciplinary collaboration or chance that favors the prepared mind, they explain why NYU Grossman School of Medicine was recently ranked number  in the nation for research in U.S. News & World Report’s  Best Graduate Schools rankings, a jump from number § on last year’s list. The listing for medical schools is based on faculty resources, the academic success of entering students, and qualitative assessments by participating schools and their residency directors. The research rankings include two measures of productivity: total federal research activity and average federal research activity per faculty member. “While we are pleased to receive this accolade, the importance of our work far exceeds any ranking from any single organization,” notes Robert I. Grossman, ¢£, Dean and ¬®¯ of NYU Grossman School of Medicine. “We recognize

ILLUSTRATION KAITLIN BY SOBIESIAK FOR NYU LANGONE HEALTH this survey for what it is: a source of feedback to help us identify areas of strength and opportunity.” 22 NYU LANGONE HEALTH NEWS

“Patients with advanced heart failure have a life expectancy of less than one year. On average, an LVAD pump adds Ÿve years of life and, just as important, provides a higher quality of life.” Sunil Abrol, MD, cardiothoracic surgeon, NYU Langone Hospital-Long Island

Photograph by JONATHAN KOZOWYK SUMMER 2021 23

Milestones In Cardiac Surgery, a Life-Saving First at NYU Langone Hospital-Long Island

The math is simple yet painful: Some with his wife, Mary. Another patient life-extending device at a convenient Since his LVAD implantation, ¹, people in the ɤ have end- received an È°ª£ in April, and many location. Those patients for whom an Sal Cangialosi, 75, (opposite) feels well enough to garden and stage heart failure, the most severe more implants are planned at the hos- È°ª£ serves as a temporary bridge to take walks with his wife, Mary. form of the disease, but each year pital. “Patients with advanced heart transplantation can now get the bulk less than % receive a life-saving failure have a life expectancy of less of their before-and-aer care in Min- heart transplant. While the nation- than one year,” says Dr. Abrol. “On eola while receiving a new heart once wide shortage of donor organs helps average, this device adds five years of a match is confirmed at NYU Lan- explain the sad statistic, so does life and, just as important, provides a gone’s Transplant Institute, named the fact that many patients with the higher quality of life.” the nation’s top heart transplant pro- life-threatening condition are too To Shaline Rao, ¢£, director of gram based on data from the Scientif- sick and at too high a risk to under- the Heart Failure Advanced Care ic Registry of Transplant Recipients. go a transplant. But for some, like Sal Center at NYU Langone Hospital– “A lot of these patients are frail, and Cangialosi, ­, a retired construction Long Island, the milestone represents traveling to the city is burdensome for worker from Franklin Square, New the natural expansion of a program them and their family,” says Dr. Rao. York, there is another option: a left ranked  nationally in cardiology and “The launch of the È°ª£ Program ventricular assist device, or È°ª£, a heart surgery by U.S. News & World on Long Island gives them access to battery-operated mechanical pump Report. Long Island patients with complex heart failure care close to that helps the heart deliver oxy- heart failure now have access to the home.” gen-rich blood to the rest of the body. On March ¨, Cangialosi, who was su‰ering from severe shortness of breath, even at rest, became the first patient to be implanted with an È°ª£ device at NYU Langone Hospi- tal–Long Island. The four-hour proce- dure was performed by cardiothoracic surgeon Sunil Abrol, ¢£, the hospi- tal’s director of the Mechanical Circu- latory Assist and È°ª£ Program, and Nader Moazami, ¢£, professor of car- diothoracic surgery and chief of Heart and Lung Transplantation and Me- chanical Circulatory Support at NYU Langone Health. After placing the patient on a heart-lung machine, the surgeons, using real-time imaging for guidance, implanted the device just below the heart and attached tubes to the le ventricle and the body’s main artery, the aorta. Then they connected a cable to the external controller and ON THE EAST END OF LONG ISLAND, CLOSE“TO“HOME power source, worn by the patient on a belt. Once activated, the È°ª£ OUTPATIENT CARE IS NOW EVEN CLOSER began suctioning blood from the le ventricle and delivering it to the aorta, In late summer 2020, as NYU Langone Health’s ambulatory care practices were starting to fully reopen after the pandemic had paused their operations, patient volume in sever - thus lightening the load on the over- al outpatient sites on the East End of Long Island rose by more than 10% over the previous burdened heart. year. The reason? The region, long a popular summer destination for many New Yorkers, has Cangialosi was discharged nine become a more permanent residential option for those who have shifted to working from days later, spent a week at NYU Lan- home during the pandemic. NYU Langone has responded to the area’s changing demograph- gone’s Rusk Rehabilitation, and then ic by launching two new multispecialty practices, which join three existing practices in this returned home. By early May he was part of Suffolk County. NYU Langone Medical Associates–Riverhead ➀ offers care in internal back to gardening and taking walks medicine, endocrinology, urology, pulmonology, and podiatry. (Additionally, on-site oncolo- gy services are available at Perlmutter Cancer Center at NYU Langone Arena Oncology–Riv - TO FIND A DOCTOR who treats erhead.) The second new practice, NYU Langone Medical Associates–Bridgehampton ➁, has heart failure, visit nyulangone. specialists in internal medicine, pediatrics, and cardiology. “These new sites have been in the To Ÿnd a doctor org/heartfailurecenter or call on the East End of 646-501-0119. works for years, but we’re expanding our footprint and commitment on Long Island to serve a Long Island, visit growing population of patients seeking high-quality healthcare services close to home,” says nyulangone.org/ Andrew Rubin, senior vice president for clinical affairs and ambulatory care. eastend. 550 First Avenue New York, NY 10016

All NYU Langone Health hospitals received an A-rating from Leapfrog. We are the only hospital system in the New York metropolitan area with straight A’s.

Kenneth G. Langone CHAIR, BOARD OF TRUSTEES 3 For more information about NYU Langone Health, Robert I. Grossman, MD DEAN AND CEO visit us online at nyulangone.org. Kathy Lewis EXECUTIVE VICE PRESIDENT, COMMUNICATIONS AND MARKETING Tell Us! We want to hear from you. Submit your Nicole Dyer DIRECTOR OF PUBLICATIONS comments, story ideas, and subscription requests to Thomas A. Ranieri, David Sparrow SENIOR EDITORS [email protected]. Modus Operandi Design CREATIVE DIRECTION Copyright © 2021 NYU Langone Health. All rights reserved. To Serve. To Teach. To Discover STILL SUMMER 2021 SAVING LIVES: A SPECIAL REPORT

“Our researchers have a profound sense of what it means to do something for the community and for the world.” LUDOVIC DESVIGNES, PHD, DIRECTOR OF NYU LANGONE’S HIGH CONTAINMENT LABORATORY PAGE 6 2 NYU LANGONE HEALTH NEWS

Leadership “ I Was One of the First People in the World to Get the P†zer Vaccine. Here’s What I’ve Learned.”

A CONVERSATION WITH AISHA LANGFORD, PHD, MPH

When Aisha Langford, h, from back in Michigan saw on some potential personal benefit  , wrote her doctoral dis- the news that NYU Langone while also contributing to the sertation on improving minori- was launching a vaccine trial for global e‘ort to find a vaccine for ty participation in clinical trials  ­-€‚ and texted me to see this devastating disease?” It was some years ago at the Universi- if I knew about the trial. I was a privilege to participate. ty of Michigan, she had little not aware of the trial but learned inkling that one day she would more about it on NYU Lan - DID YOUR FAMILY not only enroll in a trial herself, gone’s Clinical Research Stud- AND FRIENDS EXPRESS CONCERN? but it would also be a study of ies web page (clinicaltrials.med. historic importance. When a nyu.edu). Before that, a good I got di‘erent reactions a£er I friend contracted  ­-€‚ friend got very sick from  ­- o¤cially enrolled in the trial. My during New York City’s spring €‚. He lives alone and had to call mom said, “That makes sense. ‡ˆ‡ˆ surge, she was compelled an ambulance because he was You’ve been talking about clini- to put her research into prac - struggling to breathe. He was cal trial participation for years.” tice. “I wanted to help people hospitalized for four days and My brother said, “Why are you avoid  ­-€‚,” she says. An still has some health challeng- doing this? Are you crazy?” My assistant professor of popula- es. I can’t imagine being by significant other said, “Gosh, tion health, Dr. Langford re- yourself when you’re that sick. we should have talked about searches how enhancing health I felt very blessed that I hadn’t this. What if you get hurt?” My communication can improve gotten  ­-€‚, but I started dad said, “That’s really brave. individual decision-making and thinking, “If there’s going to be We’re proud of you.” I under- reduce health disparities. Her a vaccine, I want to be one of the stand all of their views. They e‘orts aim to boost recruitment first to get it.” care about me, so volunteering and retention for clinical trials. for a clinical trial for something She also advises NYU Lan - DID YOU HAVE ANY FEAR totally new sounded scary to gone’s Vaccine Center on strat- OR RESERVATIONS ABOUT some of them. TAKING AN EXPERIMENTAL egies for improving community VACCINE? outreach and diversity. In June HOW DID YOU FEEL AFTER ‡ˆ‡ˆ, Dr. Langford enrolled in I was one of Ÿ¡ participants at BEING VACCINATED? Pfizer’s Phase € Vaccine Clinical NYU Langone’s site for the After my second vaccine shot Trial at NYU Langone Health. Pfizer Phase € Vaccine Clini- on July ‡‡, ‡ˆ‡ˆ, I had a low She received her first shot on cal Trial, and we were literally fever and was tired for a couple July €, ‡ˆ‡ˆ, becoming one of among the first humans to get of days. Partly because of that the first people to receive the this vaccine. The consent form reaction, I sensed that I had re- experimental vaccine. Here, was ‡ˆ pages long. So, yes, I was ceived the active vaccine rather she shares her insights. a little bit concerned, but I’m fa- than a placebo. Those mild side miliar with science and believe effects actually made me feel WAS THERE A PARTICULAR in getting vaccines as a way to excited because my immune MOMENT WHEN YOU protect health. So I was more fo- system was responding. When DECIDED TO ENROLL IN NYU cused on the potential benefits. I NYU Langone began offering LANGONE’S CLINICAL TRIAL was also curious about the clin- its employees the vaccines that FOR AN EXPERIMENTAL COVID19 VACCINE? ical trial process and what the were ¦§-approved for emergen- participant experience would cy use authorization, I inquired In early May of ‡ˆ‡ˆ, my pastor entail. I thought, “Why not have with the clinical trial study team

Photograph by TONY LUONG; Cover photograph by JONATHAN KOZOWYK SUMMER 2021 3

With a master’s degree in epidemiology and behavioral science and a doctorate in health education and health behavior, Dr. Aisha Langford has long championed public health. “We need to think more about social determi- nants of health,” she says. 4 NYU LANGONE HEALTH NEWS

“Hesitation can be a good thing. It means people need more information and want to have their questions answered. From there, they can make informed decisions about getting vaccinated.” Dr. Aisha Langford

about whether I had received the active vaccine, and learned that I had. Of the three groups in the trial, my group received a slightly smaller dose than the one later approved by the ¦§ for emergency use authorization. So I chose to get an optional boost- er shot through the clinical trial, which I received on March €ª, ‡ˆ‡€. I’m being followed for two years to monitor the e¤cacy and durability of the vaccine. My par- ticipation will end in July ‡ˆ‡‡.

YOU’VE SAID THAT IT’S ONLY NATURAL FOR PEOPLE TO BE “ON THE FENCE” ABOUT THE COVID19 VACCINE? WHY IS THAT?

It’s understandable for people to be cautious. Although the vac- cines were based on good science and collaboration, I don’t think health professionals communi- cated that very clearly early on. Historically, medical innovation has been slow. So people didn’t understand how we got the vac- cines so fast when we still don’t have cures or vaccines for other conditions. But hesitation can be a good thing. It means people need more information and want to have their questions answered. From there, they can make in- formed decisions about getting vaccinated.

WHAT’S THE BEST WAY TO APPROACH SOMEONE WHO IS VACCINE HESITANT? Ask questions to find out why they’re hesitant. Some people have an underlying medical con- dition and want to know if the vaccines were tested in people with that same condition. Others don’t get recommended vaccines like the flu shot because they don’t think getting the illness is a big deal. Other people think

Photograph by TONY LUONG SUMMER 2021 5

Know Your Pandemic Lingo Adenoviral Vectors

they’re going to get a big bill, es- pecially if they don’t have health insurance. It’s important to pro- vide the information and support people’s need to feel more confi- dent about getting vaccinated. For health professionals, it’s crit- ical to listen and acknowledge Want to beat a virus? Enlist another virus. concerns. That’s the thinking behind most of the COVID-19 vaccines distributed globally today. AstraZeneca, Johnson & Johnson, VACCINE HESITANCY CanSino in China, and Russian scientists have all developed HAS HISTORICALLY BEEN vaccines that rely on adenoviruses, a family of pathogens more HIGHER IN THE BLACK commonly blamed for cold-like symptoms and conjunctivitis COMMUNITY COMPARED WITH OTHER GROUPS. (pinkeye). By stripping out adenovirus genes that allow the virus HAVE RECENT ADVOCACY to reproduce, scientists can transform it into a delivery vehicle, EFFORTS MADE AN or “vector,” and equip it with instructions for making a small, IMPACT? but critical, part of the SARS-CoV-2 virus called the spike pro- The media have focused on tein. Once these genetic blueprints are ferried inside human Blacks and Hispanics, but vac- cells, the spike protein is mass produced to trigger an immune cine confidence and willingness response. In e”ect, it tricks the body into •ghting o” a COVID- to get vaccinated is actually im- 19 infection it doesn’t really have. “Adenoviruses have evolved proving in every group. Black to infect human cells very well and to deliver their cargo,” says adults account for the biggest in- Daniel Sterman, MD, director of the Division of Pulmonary, Criti- crease in those willing to get the cal Care, and Sleep Medicine at NYU Langone Health. “That  ­-€‚ vaccines. This success cargo could be an anti-cancer therapeutic or a protein the body will develop an immune response to, like the spike protein in the is due in part to intense e‘orts COVID-19 vaccine.” by many Black churches, com- First developed in the 1980s, adenovirus vectors have been munity-based organizations, and used in clinical trials to test gene therapy and vaccines against medical professionals to build HIV, malaria, tuberculosis, and other diseases. With the excep- vaccine confidence. We need tion of successful Ebola and rabies vaccines, all of these e”orts to keep providing opportunities have sputtered. Nonetheless, researchers are optimistic about for people to ask questions, find the new wave of COVID-19 vaccines. Unlike the mRNA vaccines trusted sources of information, made by P•zer and Moderna, the adenovirus-based vaccines and access high-quality health can be stored at room temperature. And in many cases, they care. To come out on the other require just one shot instead of two. One of the potential draw - side of this pandemic, it will be backs is that some people may have preexisting immunity to important for everyone to con- the adenoviral vector itself and therefore generate a weaker, sider getting vaccinated. Vac- less protective immune response. Scientists are also studying cines are one of the greatest tools whether an overly robust immune response might be associated we have to minimize the burden with a very rare but serious side e”ect: blood clotting. of preventable diseases. Vaccines aside, adenoviruses also play a starring role in an exciting new therapy for lung cancer. As part of a Phase II clin- ical trial testing a new therapeutic approach against advanced non-small cell lung cancer, Dr. Sterman and colleagues are using an adenoviral vector to deliver a “suicide” gene encoded with an enzyme directly into tumors. When activated, it can e”ectively kill o” the cancer cells. The researchers believe an in¢ammatory response triggered by the adenoviral vector may enhance the immune reaction to the introduced gene and boost the therapy’s TO MAKE AN APPOINTMENT for a COVID-19 vacci- e”ectiveness. With the COVID-19 vaccines taking center stage, nation, visit nyulangone. Dr. Sterman says he will be watching closely for new insights

org/covid19vaccine. that can help him re•ne his own anti-cancer strategy. ILLUSTRATION KOTO¥FEJA BY 6 NYU LANGONE HEALTH NEWS

Photograph by JONATHAN KOZOWYK SUMMER 2021 7

Research

Inside a High-Containment Lab: The Gear, the Safety, the Science

Dr. Ludovic Desvignes leads NYU Langone’s high-containment facility, where scientists work in “space suits” to protect them from infection.

Continued on page 11 8 NYU LANGONE HEALTH NEWS

Microbiologist Ken- neth Stapleford, PhD, (left), used NYU Lan- gone’s BSL-3 labora- tory to analyze blood samples from recov- ered healthcare work- ers to assess their level of protection THE HIGHER THE RISK, THE HARDIER THE LAB: against COVID-19 re- FOUR LEVELS OF BIOSAFETY FACILITIES infection. In the lab of microbiologist Meike Laboratories where biological agents are studied are classi•ed Dittmann, PhD, Maren by the level of containment they require for safety. There are four De Vries, PhD (right), levels of biosafety labs, ranging from those that house low-risk performs an assay to pathogens, biosafety level 1 (BSL-1), to the highest risk microbes, quantify infectious viral particles and biosafety level 4 (BSL-4). isolate viral clones. Biosafety Level 1 (BSL-1) For research with agents that usually don’t cause disease in healthy adults, and pose minimal potential hazard to laboratory personnel and the community. Examples include a nonpathogenic strain of E. coli. Biosafety Level 2 (BSL-2) For research with agents that can cause mild disease in healthy humans or are di§cult to contract through inhalation, and present moderate potential risk to laboratory personnel and the community. Examples include herpes simplex virus, rhinoviruses, RSV, Staphy- lococcus aureus, and Salmonella. Access is restricted and appropri- ate personal protective equipment is required. Biosafety Level 3 (BSL-3) For research with agents that can cause serious or potentially lethal disease through inhalation, and pose a signi•cant potential risk to laboratory personnel and the community. Examples include Myco- bacterium tuberculosis, SARS-CoV-2, Bacillus anthracis (anthrax), and West Nile virus. Access to a BSL-3 laboratory is restricted, and the lab is equipped with self-closing, interlocking doors, sealed windows, devices to decontaminate infectious waste, a HEPA-•l- tered ventilation system, and directional air ¢ow that draws air into the laboratory from clean areas. Work is performed in biosafety cabinets, and extensive personal protective equipment is required, including disposable gloves, a powered air purifying respirator (PAPR), and a full body suit. Biosafety Level 4 (BSL-4) For research with agents that can cause life-threatening disease to humans, with no vaccines or treatments available. Such agents pose a high risk of infection through inhalation and constitute a high risk to laboratory personnel and the community. Examples include Ebola virus and smallpox virus. In addition to the design speci•ca - tions and safety precautions required by a BSL-3 lab, a BSL-4 lab is located in a separate building or in an isolated and restricted zone, with dedicated supply and exhaust ventilation. Work is performed in a Class III biosafety cabinet (“glovebox”) and wearing a full body, tear-resistant, air-supplied positive pressure protective suit. Upon entry, a complete change of clothing is required; upon exit, shower- ing and decontamination of all materials are required. SUMMER 2021 9 DR. LUDOVIC DESVIGNES; OPPOSITE PAGE: KARSTEN MORAN 10 NYU LANGONE HEALTH NEWS

HOW TO ENTER AND EXIT A HIGH-CON- TAINMENT LAB

STEP 1: Enter the anteroom through self-closing double doors. A directional air¢ow system draws in air and sweeps it into the facility to protect the surroundings from any acci- dental spill.

STEP 2: Zip yourself into a full- body, waterproof Tyvek suit, complete with booties.

STEP 3: Don two pairs of latex gloves and a protective sleeve over each arm.

STEP 4: Place a powered air-pu- rifying respirator over your head. It •ts like an astronaut’s helmet and connects to your suit via a protective shroud. This contraption allows you to breathe •ltered air within your suit.

STEP 5: Once inside the lab, work with the virus inside a biosafety cabinet, a large hood with controlled air circulation. All of the facility’s air vents out of the building several times per hour through an extensive HEPA-•ltration system on the roof. A fully integrated alarm system, which can send warn- ings through sirens, ¢ashing lights, emails, and text mes- sages, monitors the air supply, pressure, and exhaust fans. For decontamination, use a pow- erful disinfectant to quickly inactivate the virus after exper- iments and sterilize all waste with a large pass-through autoclave (the decontaminated and autoclaved waste is then collected as regulated medical waste and incinerated o”-site).

STEP 6: Every time you •nish your experiments for the day, follow the same cadence to make sure your work remains in the ABSL-3 facility. O” comes the outer pair of gloves, dis- carded along with the sleeves in a biohazard waste container. Then discard the Tyvek suit, and remaining gloves as well; the special respirator can be reused after it’s been thor- oughly disinfected.

Photographs by JONATHAN KOZOWYK SUMMER 2021 11

Before entering an ABSL-3 lab, Ludovic Desvignes, PhD, (opposite page), dons a full- body Tyvek suit, one of several pieces of gear that protect against airborne pathogens. “There’s always someone who knows who is in the lab at any given time and when they leave,” he says. At right: To help prevent accidents, warning signs and reminders are posted and an eye sink is nearby for potential splashes.

Continued from page 7 12 NYU LANGONE HEALTH NEWS SUMMER 2021 13

NINE MAJOR COVID19 STUDIES, COURTESY OF OUR HIGHCONTAINMENT LAB

DECEMBER 22 cipal investigator Meike Dittmann, by additional and larger studies, virus had high levels of in¢ammato- Can a Free-Floating ACE2 PhD, assistant professor of micro- could alter vaccine guidelines and ry immune proteins, which exacer- Inhibitor Block the Growth of biology, tested a potential new make additional doses available to bate symptoms and might be tied SARS-CoV-2? therapy that targets an enzyme other patients. to “long haul” symptoms that linger essential for SARS-CoV-2 infection for many months after infection. The •rst step in a coronavirus and multiplication. Publishing the MARCH 10 infection occurs when the virus MAY 9 results in Journal of Virology, Dr. Are Recovered Patients latches onto a protein called ACE2 Dittmann and team found that their Immune to Reinfection? How Does COVID Cause a that lines the surface of cells in the experimental drug, called PF- Cytokine Storm? lungs. With this in mind, virologist 00835231, is at least as e”ective Patients who have recovered Nathaniel Landau, PhD, professor as remdesivir, the only antiviral from COVID-19 often test positive A coronavirus infection can un- of microbiology, engineered a approved to treat patients infected for viral antibodies, but are they leash a rush of immune-stimulating free-¢oating version of the ACE2 with COVID-19, when tested in a protected from reinfection? To •nd proteins called cytokines, caus- protein to serve as a decoy that model of the human airway epi- the answer, the teams of principal ing ¢uid buildup in the lungs that binds to the virus before it reaches thelium. investigators Kenneth Staple- severely impairs breathing. Jun lung cells. Dr. Landau and team ford, PhD, assistant professor of Wang, PhD, assistant professor found that their ACE2 imitator was FEBRUARY 26 microbiology, and Shohei Koide, of pathology, discovered that this highly e”ective at inhibiting viral PhD, analyzed blood samples from damaging response is not caused How Does Viral Load in the entry into cells and blocking the Lower Airways Re‘ect Patient 101 recovered healthcare work- by the spike protein’s entry into replication of SARS-CoV-2 both Outcomes? ers for three types of antibodies: lung cells, as previously thought, in vitro and in a mouse model. The Few studies have been completed IgG, IgM, and IgA. The results, but rather by the way it interacts study’s •ndings, published in Cell on the lower airways in patients published in Scientic Reports, with surface proteins in immune Reports, may point to future thera- with COVID due to the risk of viral suggest that patients who produce cells. Based on the •ndings, pub- peutics to treat and protect against transmission to healthcare provid- a broader spectrum of antibodies lished in the journal Immunity, he COVID-19. ers. Leopoldo Segal, MD, associate can more e”ectively neutralize the and team members generated an SARS-CoV-2 virus than those who experimental therapeutic derived FEBRUARY 5 professor of medicine, and clini- cians and researchers at NYU Lan- produce individual isotopes. from antibodies that blocks the How Does the Spike Protein virus from attaching to proteins in gone obtained bacterial and fungal APRIL 21 Fool the Immune System? culture data from 589 critically both lung and immune cells. The Do Vaccinations Evoke the research team plans to test the To better understand how human ill patients requiring mechanical ventilation; they also performed Same Immune Response As potential treatment in patients with antibodies naturally •ght coronavi- COVID? severe cases of COVID-19. rus, Shohei Koide, PhD, professor bronchoscopies on some of these patients to quantify the viral load of biochemistry and molecular A SARS-CoV-2 infection and the MAY 12 pharmacology, designed variants and immune response within their P•zer-BioNTech vaccine can both Is a New Monoclonal Antibody of the virus’s famous spike protein, lower airways. The team found stimulate robust immune respons- that those patients whose samples Eœective at Reducing COVID which binds to human cells, sub- es that shield against subsequent Symptoms? jected them to blood samples from revealed a high SARS-CoV-2 viral infection. In a recent study, Sergei 94 COVID-recovered patients, burden and a poor antibody re- Koralov, PhD, associate professor Monoclonal antibodies, laborato- and generated synthetic versions sponse had the highest mortality of pathology, analyzed 120,000 ry-produced molecules that either of human antibodies targeting the rate. immune cells from volunteers to enhance or mimic the immune compare the two. His team’s •nd- system’s response to invading variants in test tubes. In a study MARCH 9 published in Journal of Molecular ings revealed that while both in- cells, have shown promise as a way Biology, the researchers showed Do Recovered COVID-19 fection and vaccination lead to the to combat in¢ammatory diseases, that only a small fraction of both Patients Need a Booster Shot? production of many di”erent types including the coronavirus. Meike of immune cells to •ght COVID, Dittmann, PhD, and researchers natural and synthetic antibodies People previously infected with the blood of vaccinated people had from NYU Langone’s Vaccine targeted a vulnerable region of the SARS-CoV-2 still require the three times as many memory CD8T Center tested an experimental spike protein important for neutral- protection provided by a COVID- cells, which can attack the virus monoclonal antibody designed to izing the virus. Their •ndings hold 19 vaccine, but they may not need directly, suggesting their protec- neutralize COVID’s signature spike important implications for future two. An exploratory study led by tion could last longer. Beyond this, protein. The results, published in vaccine design. Mark Mulligan, MD, director of vaccinated patients had far fewer Science Translational Medicine, NYU Langone’s Vaccine Center, FEBRUARY 23 immune cells tied to body-wide showed signi•cant protection from found that recovered patients in¢ammation in COVID patients. By infection and demonstrated the Is a New Antiviral An Eœective who receive their •rst dose of the contrast, those infected with the potential for reduced viral trans- Alternative to Remdesivir? P•zer-BioNTech vaccine produce mission, results that support the antibodies equal to or greater than With a dire need for e”ective an- use of the drug for the prevention uninfected people who receive tiviral treatments for patients with and treatment of the virus. acute COVID-19 symptoms, prin- both doses. Moreover, the sci- entists found that a booster shot among recovered patients did not improve their antibody levels further. The •ndings, if con•rmed

Photograph by JONATHAN KOZOWYK 14 NYU LANGONE HEALTH NEWS

Heroes to the Front

A True Sense of Security

“Empathy is probably the most important aspect of our job. Our o§cers may be the •rst and last people visitors meet.” John Grosse, assistant director of security at NYU Langone Hospital–Long Island

“We normally fly under the radar, doing our jobs quietly, out of the spotlight,” says Robert Zick, senior director of security at NYU Langone Health’s main campus in Manhattan. But throughout the  ­-€‚ pandemic, the Security teams at all four campuses have played a critical and prominent role. Joining others on the front lines, they have been called upon to protect patients, sta‘, and vis- itors in ways they never would have imagined—from creating hun- dreds of urgently needed ­ badges for temporary sta‘ to informing family members that they were unable to visit their loved ones for safety reasons. “Empathy is probably the most important aspect of our job,” explains John Grosse, assistant director of security at NYU Langone Hospital–Long Island. “Our o¤cers may be the first and the last people visitors meet. We have to be understanding.” Here, several members of NYU Langone’s Security team share their perspectives on how the pandemic touched them personally and professionally.

Photographs by JONATHAN KOZOWYK SUMMER 2021 15 16 NYU LANGONE HEALTH NEWS

“When someone comes to the hospital, I want them to feel that they’re coming to a warm place where everyone is concerned about their well-being.”

Mark Berry Security Team Members at NYU Langone’s Manhattan Campus: 198 Years of Service: 22

Last spring, when the virus hit, I got a call from my father’s friend, who is like an uncle to me. I hadn’t seen him in many years, but he knew I worked at NYU Langone. He was an inpatient with COVID-19, and he was calling to ask if someone could bring him a phone charger. So I got a charger to him, but I couldn’t visit him. It reminded me how real COVID-19 is—that it can happen to anybody. The pandemic has made me realize how important everyone’s job actually is. Everyone’s responsibili- ties are important. The person who mops the ¢oors is keeping patients safe, too, because he’s preventing germs from spreading. We protect people and property, of course, but our responsibilities are now on a totally di”erent level. I see my role in more personal terms now. When someone comes to the hospital, I want them to feel that they’re coming to a warm place where everyone is concerned about their well-being. Even though I’m not providing medical care, I’m a re¢ection of the hospital where they get treated.” SUMMER 2021 17

“In a situation like this, you realize how tight-knit you really are. We’re just links in the chain, but every link has held strong.”

Javier Crespo Security Team Members at NYU Langone Orthopedic Hospital: 21 Years of Service: 15

“An elderly gentleman came by several times with breakfast for his wife, asking if we could bring it up to her. We had to explain that the hospital’s policy prohibited us from accepting food for patients. I’m sure it was di§cult for him to get here, so to have to turn him away was tough. I put myself in his shoes. Because some patients at NYU Langone Orthopedic Hospital are in the recovery phase of COVID-19, many family members assume that they can •nally see their loved ones, but the visitation policy is the same. They would say to us, “Can you give them this letter?” or “Can you tell them I love them?” Now, I realize that just being here is a big part of our service to patients, visitors, and the entire community. I’ve learned not to take anything for granted, and to share my feelings toward loved ones and even coworkers, because they’re part of my extended family. We leave here every day and come back the next. But in a situation like this, you realize how tight-knit you really are. We’re just links in the chain, but every link has held strong. 18 NYU LANGONE HEALTH NEWS

“Being a frontline worker makes you proud to work at a hospital during these di§cult times.”

Ines Vieira Security Team Members at NYU Langone Hospital–Long Island: 59 Years of Service: 4

People would come by just to say thank you, because while everybody was being told to stay home, we came out to do our job. One time, I heard a knock at the window. It was a neighborhood resident holding up a poster that read: “Thank you, hospital employees, for everything you are doing.” When I looked up, she pointed to me and gave a thumbs-up. That brought a smile to my face. I used to think of us as security o§cers, but now I feel that we’re so much more. Being a frontline worker makes you proud to work at a hospital during these di§cult times. I live in Mineola, so NYU Langone Hospital–Long Island is my go-to hospital. I’ve wanted to be here as much as possible, even o”ering to work extra shifts. In everything we do, we try to make a di”erence, to go above and beyond the call of duty. I’ve always been grateful for having a job, but being able to work through the pandemic and help people has made me that much more thankful for everything. It’s made me more humble.” SUMMER 2021 19

“Paychecks come and go, but a life is only once. You just hope that at the end of your shift, you’ve made a di”erence.”

Carlos Gonzales Security Team Members at NYU Langone Hospital–Brooklyn: 61 Years of Service: 4

“I spotted my best friend from high school in the Emergency Department one day. Even with our masks on, we recognized each other. I could tell something was wrong. “My mother is here, and she’s COVID- 19 positive,” he said. He just broke down, and a part of me broke down, too. We said a prayer. I felt like we were meant to be together at that time. During the surge, we were in the hospital more than we were in our homes. We all came together— even stronger. Paychecks come and go, but a life is only once. I would make phone calls for people trying to contact their family members. You just hope that at the end of your shift, you’ve made a di”erence. As a security o§cer, you have to listen to people, even if they repeat themselves. They’re confused. They’re emotional. They’re lost. More than anything, they just need to be heard. 20 NYU LANGONE HEALTH NEWS

Burning Questions Pandemic Armor WHAT CAUSES A Standby “LONG COVID”? Respirator Does a Stand-up Job

At the height of the spring surge in March 2020, the worldwide demand for disposable N95 respirators, which a”ord a high level of protection against airborne pathogens, had created such a frenzy among healthcare institutions that Michael Phillips, MD, NYU Langone Health’s chief hospital epidemiologist, resigned himself to a painful reality. “I don’t expect that N95s are going to be readily available anytime soon,” he acknowledged. With its own reserves dwindling, NYU Langone’s Supply Chain Management team reached out to 3M, its The  ­ pandemic may be on the wane in the United States, but primary supplier of N95s. The company o”ered an al- the impact of the disease, which has killed some ³ˆˆ,ˆˆˆ Americans, ternative respirator that provides equivalent protection: isn’t going away anytime soon. Studies show that up to one-third of its 6000 Series Half Facepiece Elastomeric Respirator. nonhospitalized patients who were infected with the novel corona- A reusable device made of silicone, it’s known in health- virus still had a range of symptoms three months later, including care as a P100. The mask is named for its particulate fatigue, shortness of breath, “brain fog,” sleep disorders, fevers, gas- •lter, which has the highest level of e§ciency: 100%. trointestinal issues, anxiety, and depression. The •lter needs to be changed only once a year, unless To boost the understanding and treatment of these debilitating af- the cartridge that houses it gets contaminated, dam- tere‘ects, known as “long  ­,” the National Institutes of Health aged, or clogged. (´­ ) is investing $€.€¶ billion in research initiatives that were funded The respirator of choice in construction and industry, by Congress last December. NYU Langone Health will play a critical the P100 was found in only a handful of hospitals across role in the project, known as Post-Acute Sequelae of ·§¸·-o -‡ In- the country until March of last year, when the FDA fection, or §·. The institution has been awarded up to $¶‡ million authorized the use of elastomeric respirators in health- and was named the project’s Clinical Science Core, charged with care. Competition for the device became so •erce leading and integrating the research activities of clinical sites around that 3M was forced to limit its allocations, but Supply the country. Chain purchased a supply early on, building a robust NYU Langone researchers, who have advanced the knowledge inventory. The P100 was piloted at NYU Langone Hos- pital–Long Island, where the device served as a primary and treatment of  ­ during the past €¶-plus months, will lead respirator for several months. “Clinicians really took to studies on the chronic effects of the infection in diverse patient it,” recalls Richard Kraft, director of logistics, inventory, groups, known as the ·§¸·-o -‡ Recovery Cohort. §· will lever- and distribution. “It’s much more comfortable than an age the databases of electronic health records to examine how many N95, provides a tighter seal, and comes with a nylon people are a‘ected in the long term, what treatments contribute to storage bag that makes people feel that they have their recovery, and why some patients are vulnerable to these symptoms own personal respiratory protection at all times.” while others aren’t. Biological specimens will be examined to learn On July 17, 2020, at all four of its hospitals, NYU how the brain, heart, and other organs are impacted by the still-mys- Langone started •t-testing the P100 for clinicians who terious virus. provide patient care. More than 7,000 employees have “We are grateful to the ´­ for their support of this important been •tted so far. “We started by focusing on high-vol- mission, which is to better understand the long-term effects of ume users of N95s,” explains Marta Figueroa, PhD,  ­-€‚ infection and to find new ways to avert a potentially pro- senior director of environmental health and safety, who found public health crisis,” says Stuart Katz, , the Helen L. and partnered with Occupational Health and Safety and Martin S. Kimmel Professor of Advanced Cardiac Therapeutics, di- other departments, “and now they are an option for rector of NYU Langone Health’s Heart Failure Program, and prin- anyone who has been •t-tested for an N95.” The P100 cipal investigator for the PASC Clinical Science Core. is considered an equivalent alternative to the N95, so The PASC Clinical Science Core will be led by Dr. Katz; Leora clinicians can use it if the type of N95 for which they’ve Horwitz, , director of the Center for Healthcare Innovation and been •tted is unavailable. Sta” is trained to disinfect the Delivery Science; and Andrea Troxel, ·c, director of the Division respirator with germicidal wipes. Because the device of Biostatistics. “These leaders were the first to acknowledge the ex- has an exhalation valve, it’s not suitable for sterile pro- pertise and technical skills made by countless NYU Langone collab- cedures. orators in support of an initiative of this magnitude and importance Thanks to its reusable service, a single P100 can do to the health of our patients,” says Dafna Bar-Sagi, h, the Saul J. the work of hundreds of N95s. “This respirator gives us Farber Professor of Biochemistry and Molecular Pharmacology, and not only peace of mind, but a true readiness to address chief scientific o¤cer at NYU Langone. a shortage of N95s,” says Dr. Figueroa. “No matter what happens, we’re able to take care of our patients and

■ For more information on “long COVID,” visit recovercovid.org PHOTOGRAPHY JONATHAN BY KOZOWYK ensure the protection of our sta”.”

Photograph by DEVON JARVIS

22 NYU LANGONE HEALTH NEWS

Innovative Education Video Consults with Medical Students Help COVID Patients Safely Go Home—and Stay There

During the peak of the first wave of the pandemic last spring, Vic- toria Terentiev, , a fourth- year resident specializing in emergency medicine at NYU Langone Hospital–Brooklyn, noticed a curious pattern: Many of the patients diagnosed with  ­-€‚ in the Emergency De- partment (¼) whose symptoms were mild enough to recover at home were bouncing back to the ¼ within a few days. In most instances, they were no sicker upon their return. Rather, they had grown increasingly anxious about their infection and how to shield the family members who live with them. The sheer volume of patients—up to ½ˆˆ people had visited the hospital’s ¼ daily, about one-third more than before the surge—required clinicians to review their dis- charge instructions with them in a few minutes and move on. “Patients with  ­-€‚ have lots of questions and require a longer duration of counsel- ing,” says Dr. Terentiev. Her solution? Tap students at NYU Grossman School of Medicine for assistance. Nancy Conroy, , associate chief of service for NYU Langone Hospital–Brook- lyn’s Emergency Department, was intrigued by the idea of having medical students coun- seling patients in the ¼ before their discharge, but there was a logistical challenge: the stu- dents were prohibited from all clinical units during the spring surge. Audrey Tse, , clinical assistant professor of emergen- cy medicine, came up with a workaround, suggesting that students instead consult with patients virtually, using iPads the hospital had been given to facilitate communication be- tween physicians and the fami-

Photograph by TONY LUONG SUMMER 2021 23

“Patients with COVID-19 have a lot of questions and require a longer duration of counseling.” Dr. Victoria Terentiev

During a recent simulation, to conduct video chats, access Victoria Terentiev, MD, clinicians’ notes, and for the introduces a mock patient to Ÿ½% of patients at NYU Langone Christopher Kuhner, one of 20 students at NYU Gross- Hospital–Brooklyn with  ­- man School of Medicine €‚ whose primary language is tapped to remotely counsel one other than English, connect COVID-19 patients on how to with a translator. In turn, Kuhner recover at home. and Ross trained other students at NYU Grossman School of Medicine, now ranked as the #‡ medical school in the nation by U.S. News & World Report’s ‡ˆ‡‡ Best Medical Schools: Research. Since its launch last May, virtual discharge counseling has been an unqualified suc- cess. Prior to discharge, patients spend an average of ‡ˆ minutes speaking remotely with medical students, freeing up emergency medicine doctors and nurses lies of hospitalized patients. to attend to other sick patients. Christopher Caspers, , “We knew there was a lot of un- vice chair of clinical operations certainty among patients, and for the Ronald O. Perelman De- these calm one-on-one sessions partment of Emergency Med- made sure they truly understood icine, championed the project, what they were being told,” says and Ian Wittman, , chief of Dr. Conroy. service for the ¼ at NYU Lan- With all their  ­-€‚ ques- gone Hospital–Brooklyn, signed tions addressed, the rate of pa- off. “It was an innovative idea tients returning to the ¼ has with minimal risks that met ev- dropped by more than half, eryone’s needs—patients, clini- from ¡.€% to ½.ª%. cians, and med students,” says The program has since Dr. Caspers. Linda Tewksbury, expanded to the ¼ at NYU , associate dean for student Langone Health–Cobble Hill affairs, meanwhile, helped re- and to the Ronald O. Perelman cruit ‡ˆ third- and fourth-year Center for Emergency Services students. Dr. Terentiev and Dr. at Tisch Hospital. What’s more, Conroy, for their part, created as  ­-€‚ cases eased over a €ˆ-page script highlighting the summer, €‡ other common what discharged patients need diagnoses were added to the to know, from the expected discharge counseling roster, in- symptoms and recommended cluding back pain, headaches, fever reducers, to proper hy- urinary tract infections, and giene practices and symptoms diabetes, each with an accom- that might necessitate a return panying script to guide the stu- visit. “We used simple language dents. patients could understand,” “We think this approach im- says Dr. Terentiev. She tutored proves care, and we’re excited medical students Christopher about building on it,” Dr. Wit- Kuhner and Joshua Ross in how tman says. 24 NYU LANGONE HEALTH NEWS

Operation Vaccination How We Delivered Over 156,000 Doses in Five Months ...

… Across 21 Locations

December €Ÿ, ‡ˆ‡ˆ, is a date electronic health record system, and updates via MyChart, NYU guessed how many slots would etched in the memory of Samuel for data that can inform quality Langone’s patient portal. “We open for patients—and ended up Levine, NYU Langone Health’s and safety measures. In the case provided clear instructions on canceling hundreds of appoint- director of operations and re- of vaccines, digital patient re- how to make an appointment,” ments. NYU Langone never had sourcing. Nine months to the cords simplified the process of says Levine. Regular communi- to call o‘ even one. The state’s day a£er  ­-€‚ was declared prioritizing employees and pa- cation enhanced the institution’s notification for a Monday de- a pandemic, the institution tients. “We sliced and diced the relationships with the New York livery could come as late as the began administering the Pfizer data multiple ways and grouped State and New York City De- night before, so Rubin; the oper- vaccine to employees under the patients more specifically than partments of Health, as well. ations team; Nicole Dittmar, as- ¦§’s emergency use authori- New York State guidelines Danielle Dropkin, associate di- sistant vice president, ambulato- zation. For Levine, it was more did,” says Rubin. That was a big rector of strategy, planning, and ry operations and optimization; than a milestone. “Some staff benefit during the early days of business development, made Suzanne Howard, vice president had tears of joy and relief,” he the rollout, when the vaccine sure government o¤cials knew for ­Â clinical systems and in- recalls. “There was a sense that supply was limited and the most how NYU Langone planned to tegration; and Maureen Hickey, we’ve all been through so much, vulnerable patients, including administer every dose, leading director for EpicCare Ambu- and getting vaccinated is the be- the elderly and cancer patients, to Tisch Hospital becoming the latory, spent many weekends ginning of the end.” were given priority. first hospital in New York City ensuring that eligible patients Indeed, vaccination has been to receive its vaccine shipments. could book spots on time. The the true turning point in the user-friendly MyChart plat- pandemic, with the Pfizer and II. Clear Communication form simplified patients’ selec- Moderna vaccines proving at NYU Langone notified its €.¶ III. Scheduling Made Easy tion of a time and location on a least ‚Ÿ% effective at prevent- million patients when they With the number of available smartphone or computer. “Our ing hospitalization among fully would be eligible, sending out vaccines shifting from week vaccine process was uniquely vaccinated adults. However, the more than ¶ million emails, texts, to week, some area hospitals reliable, coherent, and well or- ¶‡ shots given that day to sta‘ ganized,” says Rubin. working on  ­ units—as well as the €¶³,ˆˆˆ first doses given to patients and employ- IV. Sweat Equity ees by early May at ‡€ NYU A hospital system is only as Langone locations in Manhat- good as the people who run it, tan, Brooklyn, Queens, Long and here NYU Langone rose to Island, and West Palm Beach, the challenge. Administrators Florida—would not have been helped older patients navigate so seamless without the tireless tablet check-ins at vaccination e‘orts of the vaccination team, locations and assisted teachers, including physicians, nurses, police officers, and firefighters and the departments of Medical in creating MyChart accounts. Center Information Technol- Nurses administered up to €¶ ogy, Ambulatory Operations, vaccinations per hour. When- Emergency Management, and ever an extra dose was dis - Communications and Market- covered—NYU Langone was ing. “People worked ‡Ÿ/ª to among the first sites to draw make sure we were set to go,” an extra dose from vials of the says Andrew Rubin, senior vice Pfizer vaccine—practices called president for clinical a‘airs and patients in search of a last-min- ambulatory care. Rubin points ute taker, fulfilling the mission to four strategies that ensured of not wasting a single dose. “I NYU Langone’s success. would go through the hospital lobby looking for candidates,” I. Data at the Ready NYU Langone’s Vaccine Team comprises more than says Levine. “If they met the cri- For more than a decade, NYU 500 employees. teria, I’d bring them for registra-

Langone has mined Epic, its tion. We always found people.” LUONG TONY

Infographic by CATALOGTREE SUMMER 2021 25

102,392 20,917 18,951 14,592 NYU LANGONE NYU LANGONE NYU LANGONE PRESTON TISCH HOSPITAL MEDICAL ASSOCIATES LAKE SUCCESS ROBERT TISCH – EAST MEADOW MEDICAL CENTER FOR MEN'S HEALTH 6

4 5 13,884 1 NYU LANGONE ASTORIA MEDICAL ASSOCIATES 7

12,427 9,111 8,848 NYU LANGONE NYU LANGONE NYU LANGONE AMBULATORY AMBULATORY AMBULATORY 8 CARE REGO PARK CARE WEST SIDE CARE BAY RIDGE 11 12

43,842 22,059 NYU LANGONE NYU LANGONE HOSPITAL – BROOKLYN HOSPITAL–LONG ISLAND 12,238 10,932 NYU LANGONE NYU LANGONE HUNTINGTON AT TRINITY 7,766 MEDICAL GROUP JOAN H. TISCH CENTER FOR 15 16 WOMEN'S HEALTH 2 3 9 10 13

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17 6,151 20 NYU LANGONE 14 LEVIT MEDICAL 21 18

3,949 2,065 1,712 1,094 650 584 485 15 NYU LANGONE 16 SUNSET TERRACE 17 NYU LANGONE 18 NYU LANGONE 19 NYU LANGONE 20 NYU LANGONE 21 NYU LANGONE AMBULATORY FAMILY HEALTH CENTER ORTHOPEDIC MEDICAL ASSOCIATES MEDICAL ASSOCIATES MEDICAL ASSOCIATES GREENPOINT CARE BROOKLYN AT NYU LANGONE HOSPITAL – WEST PALM BEACH – RIVERHEAD – CHELSEA

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DECEMBER JANUARY FEBRUARY MARCH APRIL MAY TONY LUONG TONY 26 NYU LANGONE HEALTH NEWS

Transplantation This Is What COVID Does to the Lungs. Any Questions? “There’s no normal part of this lung. The virus has completely destroyed it.” Dr. Navneet Narula

Stroke, weakened blood vessels, transplant—because the dam- heart damage, neurological aged lungs must be painstaking- deficits— ­-€‚ is linked to ly separated from the chest wall, a long list of complications. Yet the diaphragm, and surround- perhaps nowhere in the body is ing tissue, explains Stephanie the virus’s potentially devastat- Chang, , surgical director of ing impact more dramatically the Lung Transplant Program. illustrated than in the lungs. “The rate of lung transplan- This dissected sample of a once- tation for  ­-€‚ is going to healthy lung ravaged beyond increase,” Dr. Chang predicts, repair by the virus is vivid “because of the traumatic proof. It was taken on March €€, lung changes among patients ‡ˆ‡€, following a double-lung with severe cases of the virus, transplant performed at NYU whether it’s short-term or five Langone Health—the third years from now.” lung transplant on a  ­-€‚ NYU Langone is well equip- patient at the Transplant Insti- ped for the trend. It has com- tute since December €ˆ, when pleted more than €ˆˆ lung trans- NYU Langone became the first plants since early ‡ˆ€¡, a national medical center in New York record for the first three years of City to complete a transplant of a program. Most of those cases this type. were for pulmonary fibrosis, a A series of whitish spots in progressive disease that causes the upper and lower lobes indi- lung scarring; emphysema, cate widespread scarring around which occurs when the air sacs the air sacs, which impedes the are systemically damaged; and transfer of oxygen to the blood- cystic fibrosis, an inherited dis- stream. The lung’s outer surface ease that causes thick mucus is rough and inflamed, limiting to form in the lungs, blocking the organ’s ability to expand and scarring the airways. The upon inhalation. Although not program has the shortest wait visible in this image, the re - time for a donor organ and the moved lungs were dotted with highest one-year survival rate in A virus-ravaged lung removed from a 47-year-old the Northeast, according to data air-filled cysts, or pneumato- patient shows severely scarred air sacs (white). celes, that commonly occur in from the Scientific Registry of patients who su‘er acute respi- Transplant Patients. ratory distress and are often a was severe enough to require not just two weeks a£er the surgery, “We work diligently to get marker of dead tissue. “There’s only a ventilator, but also a form was discharged, feeling healthy our patients evaluated and listed no normal part of this lung,” of life support called extracor- and grateful. “He is doing fan- promptly,” says Dr. Angel. “Our says Navneet Narula, , pro- poreal membrane oxygenation, tastic,” says Luis Angel, MD, excellent survival rate results fessor of pathology at NYU or ¼ . It serves as a mechan- professor of medicine and med- from our selection process, our Grossman School of Medicine. ical gas exchanger that pumps ical director of NYU Langone’s donor management, and the “The virus has completely de- oxygen into the blood while fil- Lung Transplant Program, who e‘orts of our multidisciplinary stroyed it.” tering out excess ‡, a function marveled as his patient confi- team to monitor patients, some The patient, Robert Fernan- his lungs were no longer able dently strolled the halls of the of whom are extremely sick, dez Guevara, a Ÿª-year-old man to perform. The interventions Rusk Rehabilitation unit at Tisch very closely.” from the Bronx, was infected saved Guevara, who was in the Hospital. during the peak of the first wave hospital for nearly seven months, A double-lung transplant for FOR INFORMATION about last spring and admitted to NYU but his only hope of long-term  ­-€‚ is daunting but ulti- lung transplantation, visit nyulangone.org/ Langone on April ‡, ‡ˆ‡ˆ, with survival was a new pair of lungs. mately curative. The operation lungtransplant or call shortness of breath, a cough, He was placed on the wait list for can take up to €ˆ hours—rough- 866-838-5864. fever, and fatigue. His condition an organ donor in January and, ly twice as long as a typical lung PATHOLOGY IMAGE COURTESY NAVNEET NARULA, MD

Photograph by ADAM WATT SUMMER 2021 27

Pulmonologist Dr. Luis Angel and surgeon Dr. Stephanie Chang visit their patient, Robert Fernandez Guevara (center), in late March following his successful double lung transplant. PATHOLOGY IMAGE COURTESY NAVNEET NARULA, MD “ I have a purpose and a passion, and that keeps me going.”

DEBORAH PRIESTER, THE 750TH PATIENT WITH COVID¥19 DIS ¥ CHARGED FROM NYU LANGONE HOSPITAL²LONG ISLAND

Photograph by JONATHAN KOZOWYK … And Stronger Than Ever.

(CONTINUED FROM FRONT PAGE) up to $52 million to lead and integrate clinical sites around the country studying cohorts that represent all sectors of our society. One of our many patients who have expe- rienced “long COVID” is Deborah Priester, who, on April 21, 2020, was honored as the 750th patient with COVID-19 to be discharged from NYU Langone Hospital–Long Island. During the past year-plus, she has experienced anxiety that sometimes impacts her sleep. She has also suffered from a loss of taste and a reduced appetite that has result- ed in unwanted weight loss. Still, Priester, who responded well to treatment and re- turned home after six days in the hospital, has navigated the challenges of recovery with aplomb. After receiving her final COVID-19 vaccine on April 6, she attends church again (and says her faith has only grown), works out regularly, and has even returned part-time as a special education teacher for preschoolers. “I have a purpose and a passion, and that keeps me going,” she says. I know just how you feel, Deborah. So do we. I’ve often noted that because the pandemic has challenged us like nothing else we’ve ever encountered, we would need to summon all of our resolve and inner strength to prevail. What I never anticipated, however, was that it would summon so much more from everyone in our community. The scope and scale of the ingenuity, resourcefulness, and compassion I’ve witnessed makes me prouder than ever to serve at the helm of this extraordinary institution.

Robert I. Grossman, MD, Dean and CEO From the Dean & CEO We’re Here …

Sir William Osler, MD, the father of modern medi- cine, was fond of saying that “medicine is a science of uncertainty and an art of probability.” From the earliest days of this improbable pandemic, uncertainty, unpredictability, and a vast number of unknowns have defined its very nature. Yet throughout this long, intense ordeal, the one thing I’ve been unshakably certain of is that NYU Langone Health would not only weather this crisis, but emerge even stronger for having done so. I vowed from the start that we would do whatever it took to save lives and defeat COVID-19, and we’ve fulfilled that promise on many fronts. Our four hospitals have cared for thousands of patients with COVID-19. Our clinicians have devised novel treat- ment protocols that have produced some of the best clinical outcomes for this disease in New York City. Our researchers have collaborated on dozens of studies that have illuminated our understanding of COVID-19. Our institution has played a critical role in landmark clinical trials for two vaccines. All of this has been possible because we have shown ourselves to be extremely agile, innovative, and communal in our efforts—virtues that will serve us well as we face future challenges. As one key measure of the stature we’ve earned and of how much stronger we have indeed become, in May the National Institutes of Health selected NYU Langone Health as the home of the Clinical Science Core for a $1.15 billion investment in understanding and treating chronic aftereffects of acute COVID-19 (see page 20). As the nerve center of this nationwide initiative, NYU Langone will receive (CONTINUED ON BACK PAGE)