Updated on Jun 30, 2022 | Community, Featured, Global Health
Ram Roth, MD, a board certified anesthesiologist at Mount Sinai Queens, generally posts about anesthesiology, anesthesiologists’ advice to patients, and the surgical services offered at Mount Sinai Queens. This time, Dr. Roth is reporting from Liberia, the West African nation where a group from Mount Sinai recently provided much-needed medical care, surgical care, and education.
I’m sitting in the dark with two surgeons, a medical student, the director of events, and another anesthesiologist from within the Mount Sinai Health System. The lights in the compound just went out. We have no idea when they will come back on. Where are we and why are we sitting in the dark? Liberia. The country of about 4.3 million people was heavily hit by the 2014-2015 Ebola outbreak. (more…)
Updated on Jun 30, 2022 | Community, Featured
In a Q&A with Cardiovascular Business, Donna Mendes, MD, a vascular surgeon at Mount Sinai St. Luke’s and Mount Sinai West, talks about diversity at Mount Sinai, how the industry has become more diverse over the years, and why all providers should make it a priority.
Read the Q&A
Updated on Jun 30, 2022 | Featured, Research
From left: Martin John Walsh, PhD; and Stuart Sealfon, MD
Empirical evidence shows that exercise improves and prevents a large number of diseases, but the scientific basis and molecular mechanisms responsible for these beneficial effects are largely unknown. Two researchers at the Icahn School of Medicine at Mount Sinai have been awarded $15.5 million by the National Institutes of Health (NIH) Common Fund—designated as the Physical Activity Genomics, Epigenomics/transcriptomics Site (PAGES)—to advance this knowledge by mapping the molecular signals between different parts of the body during physical activity.
Stuart Sealfon, MD, the Sara B. and Seth M. Glickenhaus Professor of Neurology, Director of the Center for Advanced Research on Diagnostic Assays, and Chairman Emeritus of the Department of Neurology; and Martin John Walsh, PhD, Director for the Center of RNA Biology and Medicine, and a Professor of Pharmacological Sciences, Genetics and Genomic Sciences, and Pediatrics, will employ the latest genomic technologies in their investigation. They are part of a $170 million NIH program called the Molecular Transducers of Physical Activity Consortium (MoTrPAC), which involves more than two dozen academic research institutions around the country.
Using various genomic, epigenomic, transcriptomic, proteomic, and metabolomic technologies, Drs. Sealfon and Walsh, together with MoTrPAC, will analyze tissue and blood from 3,000 individuals in diverse racial, ethnic, gender, and age groups, and fitness levels. The samples will identify exercise-related chemical messengers and molecular responses that can provide the scientific basis for developing more effective individualized prescriptions of exercise, as well as the development of new drug therapies.
Where exercise has been studied, the benefits are measured in results such as less body fat, and lower cholesterol, sugar levels, and blood pressure. At molecular dimensions, the links between exercise and health remain mysterious.
“How is physical activity preventing or improving various cancers?” Dr. Sealfon asks. “We really don’t know the mechanisms.” The same holds true for Parkinson’s and Alzheimer’s diseases, depression, and other illnesses that have been shown in clinical studies to respond to exercise.
Based on their future findings, Drs. Sealfon and Walsh can foresee the creation of medications that mimic the signals released by exercising—so-called exercise mimetics—that would be particularly beneficial for patients with disorders that prevent or restrain their movement. According to NIH Director Francis S. Collins, MD, PhD, the current availability of advanced technology has made it possible to launch this bold new study. “This is the right time to take that technology forward,” he said. “We can now contemplate doing something that even a year ago would have been pretty hard to imagine.”
Physicians nowadays prescribe exercise routinely with particular attention to heart disease, weight control, and stress-related ailments. But, ultimately, the goal is to help them prescribe exercise on an individual basis. Such specificity would be based upon a clear understanding of the physical activity needed to assist each patient, rather than a one-size-fits-all approach.
The information gathered by all of the research sites involved in the consortium will be stored in a publicly accessible database that scientists can use to study almost every organ and tissue in the body.
Says Dennis S. Charney, MD, Anne and Joel Ehrenkranz Dean, Icahn School of Medicine at Mount Sinai, and President for Academic Affairs, Mount Sinai Health System: “To fully understand and subsequently transform clinical medicine’s use of physical activity for health management, a large-scale effort like this is imperative. Receiving this award is a testament to our outstanding faculty and our investment in genomics and systems biology research, which have positioned us to be able to contribute to this groundbreaking translational endeavor.”
Updated on Jun 30, 2022 | Featured, Research
Patients with more activity (the purple area throughout the image at right) in the brain’s center for stress and fear were more likely to have a heart attack or stroke, compared to patients with less activity (at left).
A Mount Sinai researcher has played a key role in tracing—for the first time—the mechanisms that link stress to cardiovascular events, like heart attack or stroke. Zahi A. Fayad, PhD, Director of the Translational and Molecular Imaging Institute at the Icahn School of Medicine at Mount Sinai, was co-senior author of a paper on the research, which was published January 12, 2017, in The Lancet. The work will be expanded in a five-year project, funded by a new $7 million grant from the National Institutes of Health (NIH).
The research found that people who had more activity in an area of the brain that regulates the body’s response to stress and fear, called the amygdala, were more likely to have a heart attack or stroke than those with less activity. The findings “provide more evidence of a heart-brain connection,” Dr. Fayad says. “It may seem obvious, but until now the evidence had not been shown. We had not seen the mechanistic link.”
The Lancet paper was based on two complementary studies. One study was led by the first author of the paper, Ahmed A. Tawakol, MD, Co-Director of the Cardiac MR PET CT Program at Massachusetts General Hospital in Boston. The study analyzed data from 293 people who from 2005 to 2008 underwent positron emission tomography–computed tomography (PET/CT) brain imaging, primarily for cancer screening, using a radiopharmaceutical called FDG that measures activity in the brain, vascular system, and bone marrow. Researchers found that over the next four years, 22 of the patients had cardiovascular events. In that group, many patients had initially shown a high level of activity in the amygdala and a greater amount of inflammation in the aorta, and in the bone marrow, where new blood cells are made. The latter two factors can contribute to atherosclerosis, the hardening and narrowing of the arteries, which increases the risk for heart disease. This pathway—from emotional stress to increased white blood cells to inflammation to atherosclerosis—has been identified in animals, but until now, not in humans.
Zahi A. Fayad, PhD
The second study, conducted by Dr. Fayad’s team at the Translational and Molecular Imaging Institute, examined 13 people who were being treated for post-traumatic stress disorder at Mount Sinai’s Mood and Anxiety Disorders Program. These patients completed a questionnaire about their perceived stress levels and underwent FDG-PET/MR scans. The team found that the patients’ stress levels were linked to increased activity in the amygdala, as well as increased inflammation in the blood vessels.
In the new project, Dr. Fayad—as overall principal investigator—will work with Dr. Tawakol; the leaders of the Mood and Anxiety Disorders Program, Dennis S. Charney, MD, Anne and Joel Ehrenkranz Dean, Icahn School of Medicine at Mount Sinai, and President for Academic Affairs, Mount Sinai Health System; and Program Director James Murrough, MD, Assistant Professor of Psychiatry, and Neuroscience; and others at Mount Sinai.
The project is seeking to study three groups of patients: 80 who are being treated for PTSD; 80 who are “resilient,” with past exposure to trauma but a low perceived level of stress; and 80 who have not been exposed to trauma. It will explore the possibility that alleviating stress could not just improve patients’ psychological sense of well-being, but also improve their physical atherosclerotic health. “In the future, chronic stress can be treated as a risk factor for cardiovascular disease,” Dr. Fayad says, “so we can screen for it and manage it like other risk factors.”
A patient with high activity in the amygdala also showed inflammation in the aorta (top right) and bone marrow in the spinal column (bottom right). Another patient with low activity in the amygdala showed little or no inflammation in the aorta (top left) and bone marrow (bottom left).
Updated on Jun 30, 2022 | Featured, Research
Joshua B. Bederson, MD, with a 3D model and an interactive simulation of the skull of a patient with a large epidermoid tumor—tools he used in planning the patient’s surgery.
The Mount Sinai Health System recently launched the Medical Modeling Core, a collaboration led by the Department of Neurosurgery, where Mount Sinai clinicians can order 3D and virtual models that can be used to explain procedures to patients, plan surgeries, and even conduct trial runs.
“Our simulation, prototyping, and 3D printing resources developed here at Mount Sinai are rare for a medical institution,” says Joshua B. Bederson, MD, Professor and Chair of Neurosurgery for the Mount Sinai Health System, and Clinical Director of the Neurosurgery Simulation Core at the Icahn School of Medicine at Mount Sinai. “In conjunction with simulation, they also play an important role in the patient-consultation process.”
The team is led by Anthony B. Costa, PhD, Assistant Professor in the Department of Neurosurgery, Scientific Director of the Neurosurgery Simulation Core, and Director of the Medical Modeling Core. Dr. Costa has developed digital tools to expedite the process of turning radiological data into 3D models and interactive, virtual modeling. The work is done rapidly—“in days, as opposed to weeks,” Dr. Costa says—and at a significantly lower cost than outside vendors. Recent models include brain tumors with surrounding vasculature and cranial nerves, spine modeling for the correction of severe scoliosis, and pelvic models for the planning of total hip replacement.
“When patients come in and are told they require a surgical procedure, it is often difficult for them to have a clear picture of what is going on in their own body,” Dr. Costa says. And 3D printing enables patients to pick up a model of the area affected, as the physician explains their condition and how the surgical procedure will work. “This offers patients confidence about what is about to happen to them,” Dr. Costa says. “We have found this to be a very successful approach.”
Mount Sinai clinicians and researchers who are interested in Medical Modeling Core services may visit icahn.mssm.edu/medicalmodeling or contact holly.oemke@mountsinai.org.
Updated on Jun 30, 2022 | Featured
From left: Peter McCann, MD; Leesa M. Galatz, MD; and Steven F. Harwin, MD
Mount Sinai West and Mount Sinai Beth Israel have earned The Joint Commission’s Advanced Certification for Total Hip and Total Knee Replacement, joining an elite group of institutions nationwide that have earned this highest recognition for quality and safety.
The Joint Commission established Advanced Certification for Total Hip and Total Knee Replacement in 2016 in response to growing demand, due to an aging population and expanding clinical indications for the procedure, along with an increased focus by physicians on helping patients manage pain, improve their quality of life, and return to everyday activities. The Advanced Certification is for two years.
Each year, nearly 700,000 total hip and knee replacements are performed in the United States. The surgery is among the most common performed, and the number of procedures is expected to quadruple by 2030, according to The Joint Commission.
Evan L. Flatow, MD
“This achievement points out our quality and exceptional orthopedic care,” says Leesa M. Galatz, MD, Mount Sinai Professor of Orthopaedics at the Icahn School of Medicine at Mount Sinai and Chair of the Leni and Peter W. May Department of Orthopaedic Surgery. “We are dedicated to giving patients top-level orthopedic care throughout the Mount Sinai Health System.”
The Joint Commission conducted site visits at Mount Sinai West and Mount Sinai Beth Israel that focused on all aspects of the total hip and knee replacement process, including pre-admission testing, operating room holding, the operating room, post-anesthesia care, services in the inpatient rehabilitation unit, and home care arrangements.
To prepare for the visits, the hospitals implemented a vast collaborative effort involving physicians, nursing, physician assistants, social workers, and staff from rehabilitation medicine, the quality improvement subcommittee, food and nutrition, and environmental services.
Michael J. Bronson, MD
“Mount Sinai West staff demonstrated exemplary teamwork to showcase our commitment to providing the highest level of care,” says Evan L. Flatow, MD, President, Mount Sinai West, and Bernard J. Lasker Professor of Orthopaedic Surgery. “We congratulate all involved in this remarkable achievement and look forward to continuously improving patient safety and quality of care.”
Michael J. Bronson, MD, Chair, Orthopaedic Surgery at Mount Sinai West and Mount Sinai St. Luke’s, says the certification “shows that Mount Sinai West provides an exceedingly high level of care in every parameter of joint replacement when it comes to positive outcomes, low complication rates, and high patient satisfaction.”
“The quality of hip and knee replacement surgeries can vary greatly among hospitals, and our exceptional performance will help us differentiate our program,” says Steven F. Harwin, MD, who was Chief of Adult Reconstruction and Total Joint Replacement at Mount Sinai Beth Israel when The Joint Commission conducted the review. Dr. Harwin, Professor of Orthopaedic Surgery, recently joined the Department of Orthopaedic Surgery at Mount Sinai West.
For example, last year at Mount Sinai West and Mount Sinai Beth Israel, the infection rate for total hip replacement and total knee replacement—a key concern for patients—was below the national average.
“The Joint Commission recognizes the outstanding quality of care provided by our entire team of caregivers, from nurses in the operating room to physical therapists, internists, and orthopedic surgeons,” adds Peter McCann, MD, Chair of the Department of Orthopaedic Surgery at Mount Sinai Beth Israel and Professor of Orthopaedics.
