Study Directly Ties Caloric Intake to Inflammation

Sep 24, 2019 | Featured, Research

Researchers at the Icahn School of Medicine at Mount Sinai, using sophisticated, single-cell technology,have isolated the molecular underpinning that explains why short-term fasting and a low-calorie diet are beneficial to people with inflammatory and autoimmune diseases, such as atherosclerosis and rheumatoid arthritis. Until now, the connection between reduced caloric intake and improved health has been a widely held but poorly understood hypothesis that has captured the public’s attention as high-profile celebrities attest to the success of frequent fasting.

In the new study, published in the August 22, 2019, issue of Cell, the researchers, led by Miriam Merad, MD, PhD, Director of the Precision Immunology Institute at the Icahn School of Medicine at Mount Sinai, were able to describe how dietary intake actually controls the quality and quantity of monocytes—a particular group of white blood cells.

The scientists found a direct link between the amount of glucose and protein in the body and the number of circulating monocytes. These white blood cells, likened to military “reserve forces,” respond to inflammatory stimuli and also play a major role in metabolic equilibrium, growth, and other processes. When digestible carbohydrates, protein, and fat were removed from the diet, the investigators found the pool of circulating monocytes decreased. Importantly, the size of the monocyte pool that was circulating in the blood depended upon the amount of carbohydrates ingested.

The study profiled 12 healthy, normal-weight volunteers 3 hours after eating and 19 hours after fasting, as well as mice that had fasted for 4 hours.

“Monocytes are highly inflammatory immune cells that can cause serious tissue damage,” says Dr. Merad. “We have seen more of these monocytes in blood circulation as Western-style eating habits have been adopted by increasing numbers of people around the world. Now that we have a better understanding of what is driving this incidence, we can work to treat it more effectively.”

Stefan Jordan, PhD, the study’s first author and a postdoctoral fellow in the Department of Oncological Sciences at the Icahn School of Medicine at Mount Sinai, says, “There is enormous potential in investigating the anti-inflammatory effects of fasting, considering the broad spectrum of diseases that are caused by chronic inflammation. Our discoveries could lay the groundwork for novel treatments in the future.”

Indeed, chronic diseases such as type 2 diabetes, metabolic syndrome, and cardiovascular disease are believed to be mostly caused by chronic inflammation. According to a study by the RAND Corp., 60 percent of Americans had at least one chronic condition and 42 percent had multiple chronic conditions as of 2014, the last year for which this data was available. In 2018, the Milken Institute released a report that stated the most common chronic diseases cost the U.S. economy more than $1 trillion annually.

One of the study’s important findings was that short-term fasting did not compromise the body’s ability to protect itself from acute infections or repair tissue, whereas starvation for 48 hours prior to infection did compromise the body’s antimicrobial immunity and ability to repair tissue.

Another finding by Dr. Merad and her team was that by activating a key cellular pathway in the liver, AMPK, they were able to regulate the number of monocytes regardless of caloric intake.

“Targeting liver energy sensors could be an innovative strategy for the prevention and treatment of chronic inflammatory and autoimmune diseases,” says Dr. Merad.

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A Day of Remembrance for 9/11

Sep 24, 2019 | Community, Featured

Michael A. Crane, MD, MPH, right, gathered with speakers, from left, the Rev. James Hayes, MA, MDiv; the Rev. Amy Strano, MDiv; and Roberto Lucchini, MD, near a plaque outside Guggenheim Pavilion in observance of the World Trade Center attacks.

The 18th anniversary of the World Trade Center attacks was solemnly observed on Wednesday, September 11, at Stern Auditorium, in an event led by Michael A. Crane, MD, MPH, Medical Director of the World Trade Center (WTC) Clinical Center of Excellence (CCE) at the Icahn School of Medicine at Mount Sinai. More than 22,000 responders are being treated at Mount Sinai’s Center, which is the largest in the World Trade Center Health Program.

At the event, about a dozen staff teams presented videos about their roles in caring for 9/11 patients, in fields such as clinical care, billing, data management, and claims certification. “I think it’s important for us—because we work with this every day—to take a moment to feel proud of the work that we do,” Dr. Crane told the attendees. “While we will always feel the sorrow, let’s not be afraid also to celebrate the excellent work that you do.”

Speakers included Manish Arora, PhD, MPH, the Edith J. Baerwald Professor of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai; Sandra M. Lowe, MD, Assistant Professor of Psychiatry, Icahn School of Medicine, and Medical Director of Mount Sinai WTC CCE Mental Health Program; and Roberto Lucchini, MD, Professor of Environmental Medicine and Public Health, Icahn School of Medicine, and Director of the WTC CCE Data Center. Another speaker was the Rev. James Hayes, MA, MDiv, a chaplain for The Mount Sinai Hospital, who was present when the World Trade Center towers fell and spent the next year ministering at the site. “You are a blessing to every first responder and every person who spent time at Ground Zero,” Father Hayes told the attendees. “You provide us with respect and hope.”   

Mickie Brown, RN, led a session on mindfulness for staff members involved in the care of 9/11 responders. The meditation, with the theme of loving kindness, began and ended with the tone of a bell.

The event was preceded by a special mindfulness session attended by about 30 staff members of Mount Sinai’s WTC CCE. “On this day—which has left a mark in the history of our world, our country, and our personal lives—we want to honor those who have suffered and those who we have lost, and also the work we have done,” said the leader of the session, Mickie Brown, RN, Clinical Manager of Education, Mindfulness and Patient Well-Being at the Selikoff Centers for Occupational Health, home of the Mount Sinai World Trade Center Clinical Center of Excellence.

The session focused on an ancient meditation called Metta, or loving kindness, which Ms. Brown said could serve as “an antidote to anger and fear.” Participants sat in a quiet conference room and were invited to contemplate the phrases “may I be well; may I be happy; may I be free from suffering.” They were asked to gradually broaden those wishes to friends and loved ones, to strangers, to those who have done harm—to lead them toward peace and change—and finally to all beings. “Mindfulness sessions like this provide staff members with a set of evidence-based tools to maintain balance,” Ms. Brown said, “and ensure our capacity to be present to continue to serve the unique patient population that we care for.”

 

Listen to a Road to Resilience podcast on the health toll of 9/11.

Study Finds Distress Among Children in Immigrant Detention

Sep 24, 2019 | Engagement, Featured, Psychiatry, Research

The research team from the Icahn School of Medicine at Mount Sinai included, from left, Priscilla O. Agyeman, MPH, research coordinator, Division of Liver Diseases; Principal Investigator Craig L. Katz, MD; and Sarah MacLean, third-year medical student.

Mount Sinai researchers found that children being held in an immigration detention center experienced high levels of mental health distress, with 44 percent demonstrating at least one significant emotional or behavioral symptom. The report was the first large, empirical study examining the mental health of children in U.S. immigration detention, says the Principal Investigator, Craig L. Katz, MD, Clinical Professor of Psychiatry, Global Health, and Medical Education, Icahn School of Medicine at Mount Sinai.

“Perhaps our findings should not really be a surprise,” says Dr. Katz, who considers the study a valuable baseline for further research. “Kids who had been previously separated from their parents had higher rates of emotional problems, compared to those who were always detained with a parent. And the detained children overall had higher rates of distress compared to the general population in the U.S.”

The research team from Mount Sinai spent two months in summer 2018 at a detention center in the Southwestern United States. speaking to women and children, most of whom had fled Honduras, Guatemala, or El Salvador. The researchers were not allowed to use telephones or take photographs while interviewing the families in a visitation trailer. The study was published in June 2019 in the journal Social Science and Medicine.

The mothers told stories of escaping gang violence or domestic violence in their home countries, where government and police officials often turned a blind eye. The team interviewed 425 women about their eldest child, using the standard Parent-Report Strengths and Difficulties Questionnaire. Among those 425 children, 32 percent had elevated scores for emotional problems, and the rate was 49 percent for those who had previously been separated from their parent. A subset of 150 children who were age 9 or older also completed the UCLA Post-Traumatic Stress Disorder Reaction Index. Seventeen percent of those children had a probable diagnosis of PTSD, compared with 4.7 percent in the general population of U.S. children.

“Children with emotional distress showed symptoms like wanting to cry all the time; problems with conduct, such as fighting with other kids or having temper tantrums; and peer problems like not having a lot of friends or only wanting to interact with adults,” says Sarah MacLean, lead author of the study and a third-year medical student at the Icahn School of Medicine who was part of the field team. “The children with symptoms of PTSD reported having flashbacks or nightmares about a trauma, or feeling depressed or sad.”

The field research for the study was conducted by Kim A. Baranowski, PhD, Associate Director of the Mount Sinai Human Rights Program; Priscilla O. Agyeman, MPH, a research coordinator in the Division of Liver Diseases, Icahn School of Medicine; Ms. MacLean; and Joshua Walther, a fourth-year medical student at the University of Texas Health Science Center in San Antonio, Texas. Authors of the report were the field team; Dr. Katz; and Elizabeth K. Singer, MD, MPH, Assistant Professor of Emergency Medicine, and Medical Education, Icahn School of Medicine, and Director of the Mount Sinai Human Rights Program.

Dr. Katz hopes to expand on the research, which had certain limitations. The subjects were a “convenience sample,” meaning they were the families who were accessible for interviews in the center’s visitation trailer, as opposed to a randomly selected sample. Because of the setting, some mothers completed the forms in their child’s presence, which may have influenced their responses.

The study also could not pinpoint the cause of the children’s distress, whether it was detention, or the journey to the U.S. border, or the violence they faced in their home countries, says Dr. Katz, who is also an Associate Director of the Mount Sinai Human Rights Program. Regardless of the cause, the study concluded that the children “would benefit from culturally responsive and trauma-informed mental health care.” Dr. Katz says that ideally, the mothers and children would receive appropriate psychiatric support once they settle into a community. “But even if they don’t get psychiatric help, social support helps,” he says. “Making sure people have clothes, a backpack, a phone, know how to take a bus. That support is going to make an enormous different in the trajectory of their recovery.”

Despite their higher rates of emotional distress, 98 percent of the children studied had normal scores on the “prosocial” scale, which included being considerate of other’s feelings and volunteering to help others. The team found signs of hope and humanity at the center, a broad expanse of trailers surrounded by a barbed wire fence. One boy from Honduras drew a picture and shyly presented it to Ms. Agyeman, and she intends to keep it forever. “The picture gave me a bittersweet message,” she says, “that a little boy can do the things any other kid would do, laughing and playing, even in an otherwise very sad environment.”

Listen to a Road to Resilience podcast on the Immigrant Detention study.
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Complex Coronary Cases Webcast Marks Its 10th Year

Sep 24, 2019 | Featured

At the 10th anniversary webcast, from left, Sameer Mehta, MD; Samin K. Sharma, MD; Annapoorna S. Kini, MD, the founders of the series, with three distinguished guests, Ron Waksman, MD; C. Michael Gibson, MD; and Habib Samady, MD.

The 10th anniversary of Complex Coronary Cases (CCC)—a live webcast that is viewed monthly by more than 10,000 physicians in 134 countries—was recently celebrated by Samin K. Sharma, MD, Director of Clinical and Interventional Cardiology at The Mount Sinai Hospital, and Anandi Lal Sharma Professor of Medicine in Cardiology; and Annapoorna S. Kini, MD, Director of the Cardiac Catheterization Laboratory, and the Zena and Michael A. Wiener Professor of Medicine.

During the webcasts, performed on the third Tuesday of each month, viewers are guided through a complex procedure by Dr. Kini and Dr. Sharma, who are leaders in percutaneous coronary intervention (PCI), also known as angioplasty, which opens blocked arteries and restores normal blood fl ow to the heart. Participants are actively enaged and encouraged to ask questions during the webcast. “The overall goal of CCC Live Cases is to offer, to as many people as possible, unparalleled insight and training techniques in the complexities that physicians come across in the field of interventional cardiology,” Dr. Sharma said.

The anniversary webcast in June featured its 120th case, a 73-year-old man with angina and significant narrowing and calcium deposits in the right coronary artery. Dr. Kini performed a successful PCI procedure, reducing the calcific deposits by atherectomy and inserting a drug-eluting stent. The webcast was moderated by another founder of CCC Live Cases, Sameer Mehta, MD, a leading interventionalist and Chairman of the Lumen Foundation in Miami. Three other leaders in the field were guests: C. Michael Gibson, MD, Professor of Medicine at Harvard Medical School; Ron Waksman, MD, Clinical Professor of Medicine (Cardiology) at Georgetown University, and Editor-in-Chief of the journal Cardiovascular Revascularization Medicine; and Habib Samady, MD, Professor of Medicine, Emory University School of Medicine, and Chief of Interventional Cardiology, Emory University Hospitals.

Dr. Kini said, “I am very proud that, because of the global reach of this educational program, we have been able to teach interventionalists all around the world how to tackle complex cases in a simple way.” The program has expanded to offer live monthly webcasts on structural heart interventions and peripheral interventions. 

See live and archived Complex Coronary Cases.

A Highly Visible Mount Sinai Presence at US Open

Sep 23, 2019 | Community, Featured

Tennis players and tennis lovers who attended the 2019 US Open Tennis Championships in Flushing Meadows, Queens, saw a highly visible Mount Sinai presence—on the courts, and beyond—during the three-week Fan Week and Tournament experience in August and September. Icahn School of Medicine at Mount Sinai physicians, staff, and volunteers all helped to showcase the Mount Sinai Health System’s role as the event’s Official Medical Services Provider.

Physicians from the Icahn School of Medicine at Mount Sinai—including, from left, Melissa Leber, MD; Alexis Chiang Colvin, MD; James Gladstone, MD; and Carlos Benitez, MD, far right, were part of the US Open Player Medical Services team, providing medical expertise courtside. Dr. Colvin, Associate Director of Sports Medicine in the Leni and Peter W. May Department of Orthopedic Surgery, is also the Chief Medical Officer of the US Open and team physician to the US Fed Cup team. Dr. Gladstone is Chief of Sports Medicine for the Health System, and team physician to the US Davis Cup team. Dr. Benitez, Director of Musculoskeletal Imaging at Mount Sinai West and Mount Sinai St. Luke’s, oversaw radiologists who provided onsite diagnostic ultrasound and portable X-ray examinations to players. Dr. Leber is Assistant Professor of Orthopedics, and Emergency Medicine. Joining them courtside were Leesa M. Galatz, MD, Mount Sinai Professor in Orthopedics, and Chair of Orthopedic Surgery; and Michael R. Hausman, MD, Robert K. Lippman Professor of Orthopedic Surgery.

New this year—and a popular offering for patrons—were two kiosks, prominently placed on the grounds of the Billie Jean King National Tennis Center. They were staffed with Mount Sinai volunteers who handed out custom-labeled sunscreen and hand sanitizers. Over the course of three weeks, 91 volunteers distributed 58,000 1-oz bottles of branded sunscreen and 10,000 hand sanitizers to grateful fans.

On Arthur Ashe Kids’ Day, Mount Sinai hosted the “Mount Sinai Get Fit and Play” court, which offered physical and fun activities for young tennis enthusiasts, including 7-year-old Tyler Panetis, and distributed 1,300 cooling towels to those who worked up a sweat on a hot and sunny day.

Also at the US Open were 28 patients from the Department of Rehabilitation and Human Performance, who watched the US Open Wheelchair Competition, two of whom joined Richard “Woody” Wood, Outreach Program Coordinator for the Department, center, for a snapshot.

Six buses—brightly wrapped in a Mount Sinai logo and US Open banner—stood out amid the New York City traffic as they shuttled US Open players, staff, and other credential-holders between Manhattan and Flushing Meadows.

Advancing Plastic and Reconstructive Surgical Care

Sep 23, 2019 | Community, Featured

Benefactors Jay Lieberman, center, and Penny Lieberman, with from left: Michael L. Marin, MD, The Jacobson Professor of Surgery and Chair, Department of Surgery, along with Plastic and Reconstructive Surgery surgeons Lester Silver, MD; Marco A. Harmaty, MD; Philip J. Torina, MD; Peter Taub, MD; Mark R. Sultan, MD; and Alice S. Yao, MD.

The Derfner-Lieberman Family Center for Plastic and Reconstructive Surgery was officially unveiled Tuesday, July 30, at a ribbon-cutting held at the May Center for Mount Sinai Doctors. The facility was made possible through a $6 million gift from Jay Lieberman, trustee of the Derfner Foundation and member of the Department of Surgery Advisory Board.

Featuring first-of-its-kind technology, each of the nine modern private patient exam rooms is equipped with a 55-inch touchscreen Microsoft HUB computer, allowing for a more comprehensive and interactive review of presurgical planning; better visualization of anticipated surgical results following reconstructive surgery for a cancer diagnosis, an accident, or gender-affirming procedures; and a more enhanced consultation experience for the patient and the surgeon.

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