Pulse Magazine Summer 2014

pulse Volume 12 Number 2

Summer 2014

Surgery’s superstar Anne Mosenthal is one of a handful of women in the U.S. leading an academic surgery department.

PLUS:

Minimally Invasive Brain Repair Medical Mission to Ghana NJMS Researchers Garner Millions in Grants

Message from the Dean

O

n a sun-drenched morning back in May, 170 Rutgers New Jersey Medical School graduates filed into the New Jersey Performing Arts Center in Newark to collect their hard-earned medical degrees during our annual Convocation ceremony. As newly minted doctors, these remarkable individuals and their families savored every moment of this happy day. We, too, celebrated this milestone in our students’ lives, as well as a couple of our own.

After all, 2014 marked the 60th anniversary of our school’s founding and the first Convocation ceremony since our historic merger with Rutgers, The State University of New Jersey.

Since New Jersey Medical School’s inception, our institution has become recognized as a place where world-renowned scientists and clinicians convene to do their important lifesaving work. Certainly, our status in the medical and academic communities would not be what it is today if not for the numerous collaborative relationships that we have built throughout the years—not only here at New Jersey Medical School, but throughout the Rutgers community and beyond. From contributing to Rutgers Biomedical and Health Sciences’ ongoing strategic planning process to forging alliances with national groups like the Association of American Medical Colleges, the National Institutes of Health, and the American Medical Association, we understand how important collaborative efforts are to our success. In recognition of these vital partnerships, we are devoting this issue of Pulse to highlighting some of the collaborations that help to make us great.

Throughout our 60-year history, we at New Jersey Medical School have worked persistently to carry out meaningful work that makes a difference in the lives of others. We are proud of what we have accomplished throughout the years and know that, together, we will continue to leave our mark, not only on the fields of science and health care, but on society at large.

In health,

Robert L. Johnson, MD, FAAP’72 The Sharon and Joseph L. Muscarelle Endowed Dean Rutgers New Jersey Medical School

pulse Dean Rutgers New Jersey Medical School

Robert L. Johnson, MD, FAAP’72 Chief Operating Officer

Walter L. Douglas, Jr. Senior Marketing and Communications Coordinator

Genene W. Morris Business Coordinator

Iveth P. Mosquera

VOLUME 12 NUMBER 2 Senior Editor, Pulse

Mary Ann Littell Contributing Writers

Maryann Brinley Kaylyn Kendall Dines Jennifer S. Doktorski LaCarla Donaldson Rob Forman Eve Jacobs Cynthia McChesney Genene W. Morris Carole Walker Photo Editor

Doris Cortes-Delgado Design

Sherer Graphic Design

SUMMER 2014

R U T G E R S , T H E S TAT E U N I V E R S I T Y O F N E W J E R S E Y

President NJMS Alumni Association

Paul Bolanowski, MD ’65 ALUMNI FOCUS

Director

Dianne Mink Administrative Assistant

Emily Birkitt

Keep in Touch

Pulse is published twice a year by New Jersey Medical School. We welcome letters to the editor and suggestions for future articles. Send all correspondence to: Iveth P. Mosquera Business Coordinator New Jersey Medical School Medical Science Building, Room C -595 185 South Orange Avenue Newark, NJ 07103 or via email to mosqueip@njms.rutgers.edu

pulse SUMMER 2014

FYI

2 Notable, Quotable 5 News by the Numbers A C LO SER L OOK

6 8 9 10

At At At At

Brain Injury Research: To Heal Injured Brains an Enigmatic Disease: What Is Sarcoidosis Anyway? the Miracle of Cochlear Implants: Music to His Ears a Unique Integrative Medicine Rotation: The Bigger Fix

N JMS / GSBS PEOPLE‌ DO YOU KNOW ?

12 13 14 15 16 18 20

Jonathan Keith: Falling in Love With Surgery Arjun Raj: Just How Brilliant Is He? Sourav Sinha: Getting a Cancer Drug to Patients Ana Natale-Pereira: Never Lose Hope Theresa L. Chang, Veronique Dartois, Marila Gennaro: Award-Winning Women Keith and Scott Pasichow: A Tale of Two Brothers Kevin Clarke: Surgical Care Mission Returns to Ghana

FE ATURES

22 A Pipeline to Recovery Brain aneurysms and strokes are often deadly. But these NJMS neurosurgeons are not only skilled at treating brain attacks (strokes), but are among the few specialists trained to repair brain aneurysms with minimally invasive techniques.

26 The Newest Virus Buster An NJMS researcher discovers a new type of interferon with the potential to become a blockbuster drug and wins a sizable grant to help move his finding forward.

30 Woman at the Top There are only six women who chair academic surgery departments in the entire country and one of them, Anne Mosenthal, is right here at NJMS. Has the going been tough at times? Oh yes, she says. Was it worth it? Absolutely.

A LUMNI F OCUS

33 34 36 37

38 39 40

Message from the Alumni Association President Alumni Reunion Weekend Elizabeth Alger’s Amazing Adventure Gerard Malanga: Non-Surgical Solutions to Sports, Spine, and Orthopaedic Injuries Yvonne Farnacio: A Career That Fits Class Notes, In Memoriam Bringing Health Care to the Homeless

COVER PHOTO BY JOHN EMERSON

‘‘’’

Quotable

Notable

FYI Global TB institute Celebrates 20 Years of Excellence The Rutgers Global Tuberculosis Institute at

NJMS recently celebrated its 20th anniversary

“This was our first Match Day celebration since joining Rutgers and, as usual, it was an exciting and joy-filled day. Getting to this point in their journey through medical school was no small feat for our students. I am exceedingly proud of them and commend them on their achievements.”

ROBERT L. JOHNSON, MD’72, THE SHARON AND JOSEPH L. MUSCARELLE ENDOWED DEAN OF NJMS

with Dean Robert L. Johnson, MD; Marc Klapholz, MD, chair of the Department of Medicine; and Arturo Brito, MD, MPH, deputy

The Arnold P. Gold

Petros Levounis, MD, MA, chair of the Depart-

commissioner of NJ Public Health Services, who

Foundation donated

ment of Psychiatry, received the 2014 Schonfeld

welcomed faculty, students and guests. Douglas

$1,000 to the

Award from the New York Society for Adolescent

Eveleigh, PhD, professor of biochemistry and

Humanism in Medical

Psychiatry. As a Schonfeld awardee, he delivered

microbiology, Barry Kreiswirth, PhD, professor at

School — Bridging the

a lecture titled “Emerging Drugs of Abuse: From

the Public Health Research Institute, Lee Reich-

Years Project at its

Ecstasy to Bath Salts, Synthetic Cannabinoids,

man, MD, MPH, clinical professor and executive

annual luncheon held

and Beyond” at the New York Academy of

director, Global Tuberculosis Institute, and David

this spring. The project was established through

Alland, MD, associate dean of clinical research

a grant received from the foundation, which

and professor of medicine, made presentations

promotes humanism as an integral part of quality

on current TB research and developments in

patient care and physician wellness.

diagnosis of TB. Brian Strom, MD, MPH, Chancellor of Rutgers Biomedical & Health Sciences, gave the closing remarks.

Left to right: Drs. Arturo Brito, Brian Strom, Lee Reichman, Robert Johnson, and Marc Klapholz

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Aaron Hajart, MS, senior director of administration in the Department of Neurological Surgery, was elected to a two-year term on the inaugural Board of Directors of the American College of Neuroscience Administrators.

Medicine.

James Oleske, MD, MPH, professor of pediatrics, was honored as Pediatrician of the Year by the New Jersey Chapter of the American Academy of Pediatrics.

David Chu, MD, associate professor of ophthalmology and visual science,

David Livingston, MD, Wesley J. Howe Pro-

was honored with

fessor of Surgery and chief of the Division of

the Lions Eye Bank

Trauma and Surgical Critical Care, was appointed

of New Jersey’s

president of the Western Trauma Association for

Man of Vision

2013 – 2014. The WTA is the only multispecialty

Award for his

trauma organization in the U.S. He is also direc-

excellent surgical

tor of the New Jersey Trauma Center at Univer-

and leadership

sity Hospital in Newark and medical director of

skills in the field of

the Northstar Aeromedical Program.

ophthalmology.

Trauma Team on TV When the ambulance comes screaming through the city to the trauma center door, delivering a patient with a bullet in his abdomen, TV cameras that capture the medical staff’s every move are often less than welcome. Not so for the NJMS docs and their patients featured on the second season of ABC’s documentary series, NY Med, which launched at 10 p.m. on June 26, and continues for eight consecutive Thursday evenings.

Brazeau Named ELAM Fellow Chantal Brazeau, MD, interim chair of Rutgers New Jersey Medical School’s Department of Family Medicine, has been named a fellow of The Hedwig van Ameringen Executive Leader-

Confidence, courage and composure are all

This season of NY Med features two hospitals:

qualities demonstrated by this NJ trauma team.

New York Presbyterian Hospital on the Upper

They know that they are always required to

East Side of Manhattan and University Hospital,

perform flawlessly on command— cameras or no

Newark, the primary teaching facility of Rutgers

cameras. The rapid-fire responses required to

New Jersey Medical School. The NJMS faculty

mend often life-threatening patient injuries create

members featured in the series (see above)

a natural drama unequalled by the most polished

deserve special documentary-actor-awards. At the

made-for-TV script. In episode 1, a young man

most critical times, they never lose their human-

is shot, and his family and friends wait agonized

ity — or their cool. These are no actors — that’s ob-

moments for the trauma surgeon to emerge with

vious. But they are experts you could count on if

news about his condition. (He survives.)

the going got tough. Watch them and feel proud.

ship in Academic Medicine® (ELAM) Program, a core program of the Institute for Women’s Health and Leadership at Drexel University College of Medicine in Philadelphia.

Brazeau joins a select class of 54 women from medical schools throughout the country in the only program in North America dedicated to preparing women for senior leadership roles in academic health science institutions.

The one-year, part-time program combines three weeklong in-residence sessions with a distancelearning component. During that time, fellows are supported by their dean or other senior official within their institution for continuity and mentorship.

Brazeau will join a community of more than 800 alumni — all highly accomplished women serving in a variety of leadership positions around the world, including department chairs, research center directors, deans and college presidents, as well as chief executives in health care and accrediting organizations.

Teams Square off in Charity Hockey Game Rutgers Biomedical and Health Sciences presented the 2014 Winter Classic Charity Hockey Game featuring New Jersey Medical School’s Medwings vs. the School of Dental Medicine’s Bitewings.

Dean Robert L. Johnson, MD, and RSDM’s Dean Cecile Feldman, DMD, started the game with a ceremonial puck drop. The Medwings won 7 – 3. The event raised $14,500 for the Sean Hanna Foundation, which benefits pediatric cancer patients and their families. In the past two years, this fundraiser has raised $22,000 for charities.

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Trauma surgeon, gunshot wound specialist, teacher, soldier, writer, role model, mentor, father and

A man of action

grandfather: Kenneth Swan was all

Kenneth G. Swan, a professor of surgery

that and more.

at NJMS for more than 40 years, died on March 22. He was a trauma, vascular and thoracic surgeon and played a pivotal role in developing the trauma center at University

the rank of lieutenant colonel and became

two textbooks and published more than 300

Hospital in Newark after returning from ac-

director of the division of surgery. In 1973,

articles on trauma, shock, physiology, and

tive service in Vietnam.

he left active duty to join the NJMS faculty.

medical history.

Swan graduated from Harvard in 1956;

Swan was a reservist for most of the ’80s

Swan served as chief of the NJMS

earned his medical degree from Cornell

and ’90s, and in 1991, was recalled to ac-

Section of General Surgery for more than

University Medical College in 1960; and

tive duty in Saudi Arabia during Operation

two decades, as well as director of surgery

completed his residency in general surgery

Desert Storm. He became a colonel and was

at University Hospital. NJMS recently

at New York Hospital and a fellowship in

awarded the Legion of Merit when he retired

honored Swan with a Lifetime Achievement

gastrointestinal physiology at UCLA.

from the Army in 1998. He was a flight

Award and the Distinguished Faculty Award.

surgeon, combat medic, master parachutist,

—L A CARLA DONALDSON

In 1968, Swan entered the Army as captain, Medical Corps, and was sent to

U.S. Army War College graduate and was Air

Vietnam for one year, where he developed

Assault and Special Forces qualified.

expertise in treating gunshot wounds. He

Trauma surgery was Swan’s passion. He

was then assigned to the Walter Reed Army

treated thousands of victims of gun violence

Institute of Research in Washington, DC,

in New Jersey using skills he developed treat-

where he spent the next four years, rose to

ing gunshot wounds in Vietnam. He wrote

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Many people have expressed interest in making donations in Swan’s honor. Gifts to the Dr. Kenneth G. Swan Fund at the Rutgers University Foundation will be designated to support medical student education at the NJMS Department of Surgery. To contribute visit www.support.rutgers.edu.

NJMS NEWS BY THE NUMBERS

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$1,580,485

An estimated 4 in 10 U.S. adults suffer from chronic pain. Many can be helped by neuromodulation therapy, the use of implantable devices that alter nervous system activity through electrical stimulation. Specializing in this therapy is neurosurgeon Antonios Mammis, MD, director of the new NJMS Center for Functional Neurosurgery and Neuromodulation. Targets for stimulation include the spinal cord for certain types of intractable pain, including complex regional pain syndrome, facial pain syndromes, and failed back surgery. Mammis also specializes in deep brain stimulation (DBS) to treat movement disorders, including Parkinson’s disease. To make an appointment, contact the center at 973-972-2323.

William Gause, PhD, professor of medicine, director of the Center for Immunity and Inflammation, and senior associate dean for research, was awarded a four-year grant from the NIH–National Institute of Allergy and Infectious Diseases for “Innate Type II Immune Mechanisms of Resistance.”

170 Approximately 95 percent of the 170member Class of 2014 who participated in Match Day received assignments to residency programs in competitive specialties such as plastic surgery, neurosurgery, otolaryngology, and dermatology. The national average was 94 percent. Of those students who matched, 47 will stay in the state.

510 That’s the number of students who attended a recruitment fair hosted by NJMS and Rutgers School of Dental Medicine in July. The fair was part of the 25th anniversary celebration of the Summer Medical and Dental Education Program (SMDEP). This program is for undergraduates interested in health careers.

$727,237 In year two of a five-year grant from the NIH– National Institute of Allergy and Infectious Diseases, Yuri Bushkin, PhD, adjunct professor of medicine at the Public Health Research Institute of NJMS, along with team members Marila Gennaro, MD, and Sanjay Tyagi, PhD, are being funded for a project titled “Rapid Analysis of Single T Cell Immunity Signatures in Tuberculosis.”

S E C T I O N C O M P I L E D B Y C A R O L E WA L K E R

$1,391,252 The National Institute of Neurological Disorders and Stroke awarded this amount to Tibor Rohacs, MD, PhD, associate professor of pharmacology and physiology, for “Lipid Regulation of Transient Receptor Potential Channels.”

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a closer look at brain injury research

Steve Levison, PhD, and Frances Calderon, PhD

of the brain.” He is looking at whether LIF can also activate the resident stem cells in the brain during the acute period of recovery from a concussive injury and “whether these stem cells can produce new neurons and glia, which would be really exciting.”

Having benefitted from grant support, including the most recent NJCBIR award of $537,500, Levison has generated sufficient new data to support a major proposal to the National Institutes of Health. In addition, “Because several labs in the Newark region obtain funding from NJCBIR, we have created a collaborative TBI research interest group that meets monthly,” he says. “We keep each other on the cutting edge.”

Feeding the Brain

To Heal Injured Brains Ten years ago, state legislators put their heads together and established the New Jersey Commission on Brain Injury Research (NJCBIR) to promote more effective treatments and cures for traumatic brain injuries (TBI). Four NJMS scientists received grants from the commission for their collaborative work.

BY MARYANN BRINLEY

Re-Growing Baby-Brains

As a developmental neurobiologist, Steve Levison says he has “always been interested in understanding the forces that regulate the development of the brain.” A professor of neuroscience in the Department of Neurology and Neurosciences and director of the Laboratory for Regenerative Neurobiology, Levison has spent 15 years researching 6

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how neonatal stroke affects brain development and how to restore the brain’s proper growth. Recently, his team discovered a cytokine known as LIF that is important in both brain development and as a protective response after injury. The scientists hypothesize that LIF acts “like a cellular emergency life support system, able to protect cells from damage in both the gray and white matter

Frances Calderon was so astonished by the research she participated in on the neuroprotective effect of dietary DHA on neurons that she changed her own diet and resolved to investigate the capabilities of these omega-3 fatty acids in improving human health.

“When I learned that DHA deficiency impairs memory and brain function, I wanted to understand how that happens and study the molecular mechanisms,” she explains.

It was a Eureka moment when she saw the upsurge in proteins that modulate signaling transduction in an adult brain being fed a diet rich in omega-3. DHA and its derivative NPD1 are now at the core of Calderon’s traumatic brain injury studies funded by $539,733 from the NJCBIR. Neural stem cells have been investigated to repair damaged brains but these grafted cells often do not survive. Calderon, who is studying animal models in the Nutritional Neuroscience Lab at NJMS, has changed this by adding DHA. Her goal is to develop a model of neural repair and regeneration.

Calderon, who earned her PhD at the Pontifical Catholic University of Chile, believes that this research will lead to effective treatments for TBI. Clinical approaches often fail now because of drug toxicity or side effects. “Omega-3 fatty acids are natural neuroprotectants,” she explains.

Fish oil capsules are readily available but ANDREW HANENBERG

DHA and EPA can also be found in fatty fish like salmon. Another type of omega-3 fatty acids in our diets is alpha-linolenic acid (ALA), which is found in some vegetable oils, such as soybean and canola, in flaxseeds, and in walnuts. However, the body converts only a small amount of ALA to EPA and DHA. She adds, “The so-called ‘western diet’ is so deficient in omega-3 fatty acids that I am wondering how many brain diseases might be treated or prevented by exploiting its capabilities.”

Jean Lengenfelder, PhD, and James Sumowski, PhD

Aerobic Exercise To Improve Memory

A recent case study by James Sumowski, Victoria Leavitt, and colleagues at the Kessler Foundation demonstrated for the first time that aerobic exercise training can increase the brain’s hippocampal volume and activity, and can enhance memory in the neurologically impaired. That research was conducted with a group of multiple sclerosis (MS) patients.

TBI can also result in memory problems, so Sumowski, an assistant professor in the NJMS Department of Physical Medicine and Rehabilitation (PM&R), has turned his attention here. “There has never been an aerobic exercise trial in TBI patients that looked at hippocampal volume and memory,” he says.

In the current randomized pilot trial of 36 subjects, funded by a $170,296 grant from NJCBIR, one group of TBI patients is assigned to 30 minutes of aerobic exercise (stationary cycling) three times a week for three

months and a control group is given stretching exercises on a similar schedule. Based on studies in the scientific literature and results of their own MS trial, Sumowski and Leavitt expect aerobic exercise (but not stretching) to increase hippocampal volume and improve memory in the TBI patients. The hippocampus plays a critical role in how we form new memories and retain old ones. The brain has two hippocampi, one in each cerebral hemisphere. The good news is: “You can grow your hippocampus,” Sumowski says.

He is also looking at “functional connectivity” or how remote regions of the brain talk to each other. “In our MS study, greater connectivity was observed between hippocampal regions after just 12 weeks of aerobic training. Along with the improvement in memory, we think that aerobic exercise can mean improved health, productivity, independence and quality of life for those with TBI,” Sumowski states.

Understanding the Emotional Disconnect

One of the grant-winning studies evaluates the effects of aerobic exercise training to enhance memory in patients with traumatic brain injury.

JOAN BANKS

As assistant director of neuropsychology at the Neuropsychology and Neuroscience Laboratory at Kessler Foundation Research Center, Jean Lengenfelder has found that

after a traumatic brain injury, individuals often have problems with social and emotional functioning that result in “difficulties in social relationships, poor social participation, impaired empathy, and a high degree of caregiver stress. People with TBI are not able to recognize facial affect,” she says. Her study, funded by a $397,941 grant from NJCBIR, documents the prevalence of emotional processing deficits in TBI and identifies the neural networks engaged in such tasks.

“We knew these impairments existed but we did not know why they occurred in TBI or how they could be treated. This study set out to answer those questions,” she explains.

Lengenfelder, who is also an assistant professor of PM&R at NJMS, hypothesizes that diffuse axonal injury in TBI is responsible for damaging the connections in the brain essential for emotional processing.

Using three different types of neuro-imaging, she has examined the extent to which this emotional processing damage is being caused by structural and functional problems. “The identification of impairments in the neural network of emotional processing in TBI is essential to be able to design and monitor effective treatment strategies,” she states. ● RUTGERS NEW JERSEY MEDICAL SCHOOL

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a closer look at an enigmatic disease

What is Sarcoidosis Anyway?

A team of experts launches an interdisciplinary center to diagnose and treat a puzzling disease that is often misdiagnosed.

W

hen Larry Frohman performs a neuro-ophthalmic exam, it may turn up evidence of sarcoidosis. This disease, estimated to affect more than one million people worldwide, most often shows up in the lungs first. However, “about 20 percent of patients will have ocular involvement and 5 to 10 percent will have neurologic involvement during the course of the disease,” the eye expert states.

Frohman says he sees a “disproportionate number of sick, sometimes undiagnosed sarcoid patients who come through the ophthalmology department as the initial point of contact.” Some have aggressive forms of the disease requiring therapy beyond the standard treatment regimens. “This disease mimics other diseases so it’s not easy to diagnose,” he states.

A professor at the Institute of Ophthalmology and Visual Science at Rutgers New

BY MARYANN BRINLEY

Jersey Medical School (NJMS), Frohman says his patients complain of symptoms such as eye pain, double vision, and loss of vision, which, if left untreated or inadequately treated, can eventually cause blindness. The ophthalmologist has teamed up with pulmonologist Andrew Berman, MD, to found a new center— called the NJMS Sarcoidosis Center— dedicated to the diagnosis and treatment of the disease.

“Up to 90 percent of sarcoidosis patients have lung involvement,” says Berman, an associate professor of clinical medicine at NJMS and co-director of the center. “Patients are often referred by other physicians for swollen lymph nodes in the chest, a dry cough, shortness of breath, or unexplained weight loss or fever.” According to the American Lung Association, 20 to 30 percent of people with pulmonary sarcoidosis end up with permanent lung damage. The disease’s

Larry Frohman, MD, and Andrew Berman, MD

varied manifestations include involvement of the skin, lymph nodes, liver, heart, muscles and bones, and the nervous system, including the brain and visual system.

The term sarcoidosis comes from the Greek word “sarkodes,” meaning fleshy, and “osis,” a Greek suffix meaning condition.

This refers to the skin lesions that can form on various parts of the body and are often the disease’s most noticeable manifestation.

The incidence of sarcoidosis is higher in African Americans and northern Europeans, particularly Scandinavians. Those between ages 20 and 40 are most at risk, and women are affected slightly more often than men.

The typical pathology, granulomas (small, nodular aggregations of inflammatory cells), can form in multiple organs, producing the symptoms of the disease. Berman says, “We don’t know what causes this condition. However, we do know how to diagnose it and how to treat it with medications, generally corticosteroids, that reduce the inflammation.”

Three years ago when Berman, who has had an interest in sarcoidosis for some time, arrived at NJMS to direct the medical school’s Division of Pulmonary and Critical Care Medicine/Allergy and Immunologic Diseases, Frohman found a partner as interested in this disease as he is. Giving comprehensive and coordinated care to hundreds of sarcoidosis patients being seen by NJMS faculty physicians had been problematic in the past.

Working together, Berman and Frohman assembled a team of experts from more than 10 different specialties who have experience and knowledge about the disease to co-manage what can be difficult, complicated cases.

These specialties include adult and pediatric pulmonary medicine; neuro-ophthalmology, uveitis and other ophthalmic subspecialties; cardiothoracic surgery; cardiology; allergyimmunology; neurology; ear, nose and throat; and oral medicine.

“This way, a patient is able to see a number of doctors who are both used to working together and experienced with the disease,” Continued on page 11

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JOHN EMERSON

a closer look at the miracle of cochlear implants

Robert Jyung, MD (inset), opens up a new world of hearing for cochlear implant patient Jesse Solano.

Music to His Ears

BY MERRY SUE BAUM

L

ike most 12-year-olds, Jesse Solano is part of today’s “wired” world. He has a computer, a smart phone and a tablet loaded with apps. But unlike your average teen, he also has two cochlear implants that he says, “have rocked my world.”

The Elizabeth, NJ, resident was born with significant hearing loss, and at age 2 needed hearing aids in both ears. He managed to get by for the next eight years, but among the routine things he couldn’t do were playing sports, going to the movies, and talking on the phone. By the time he was 10, Jesse could barely hear at all. That’s when he got his first cochlear implant. “Suddenly, I could hear the birds sing,” he says. “I didn’t know that birds made noise.” Jesse made

JOHN EMERSON

a video about his experience that is posted on YouTube at http://www.youtube.com/ watch?v=uclqk3sZac0.

Normal ears process sound through a perfectly timed chain of events. Part of that process relies on movement in the fluid of the cochlea, which sets tiny hair cells in motion. Someone with sensorial hearing loss, like Jesse, has damage to the cochlea. Hearing aids only amplify sound, but cochlear implants directly stimulate the inner ear with electricity, since the inner ear can no longer process even amplified sound. The implants work by capturing sound vibrations with a microphone outside the ear, and sending them to a receiver implanted under the skin behind the ear. The receiver takes the coded

electrical signals and delivers them to the array of electrodes that have been surgically inserted in the cochlea. These signals are transmitted to the brain by the auditory nerve, which interprets them as sound.

Robert Jyung, assistant professor of otolaryngology, head and neck surgery at Rutgers New Jersey Medical School (NJMS), says the surgery usually takes two to three hours and patients go home the same day.

That is just the first step on the road to hearing, however. Jyung, who is also director of otology/neurotology at University Hospital, the primary teaching hospital for NJMS, explains that a person with a cochlear implant hears differently from someone with normal hearing. “People with implants report that the words sound electronic,” he says. “It takes time for the brain to adjust.” New implant patients are encouraged to listen to television news broadcasts or books on tape to learn to decipher the exact sounds of words. The patient has to meet with an audiologist to have the device adjusted. Using a computer, the audiologist sets the threshold for the softest sound the patient can detect and the loudest sound the patient can comfortably tolerate for each of the 22 electrodes that were surgically placed in the cochlea.

“This is an ingenious device,” says Jyung.

“The pioneers in the field endured a great deal of skepticism and opposition.” The latest implants are waterproof, have Bluetooth capability, and remote controls, and can be synced with smart phones and iPods.

Researchers have even developed a hybrid implant combining elements of an acoustic hearing aid with the cochlear implant.

Jyung feels fortunate to do the work he does. “There is such joy in helping to put people back in the hearing and speaking world,” he says.

The Cochlear Implant Center of New Jersey is located at University Hospital. The Center does about 30 implants each year and has a success rate of nearly 100 percent. Lisa Bell, MA, CCC-A, is the Center’s audiology director. ● To contact the Cochlear Implant Center of New Jersey, call 973-972-2548.

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a closer look at a unique integrative medicine rotation

The Bigger Fix Meditation, stress reduction, yoga, acupuncture, massage therapy, mindbody medicine, music therapy, nutritional healing. These remedies, and others, may soon earn a place — next to drugs and surgery — on your doctor’s prescription pad.

BY EVE JACOBS

C

onventional medicine is changing and two Rutgers schools are leading the way to a broader definition of what constitutes good patient care. Rutgers New Jersey Medical School (NJMS) and Rutgers School of Health Related Professions (SHRP) teamed up to create a novel eight-week rotation for second-year residents in preventive medicine/public health that introduces them to some of the therapies now dubbed “alternative” and “complementary” and to the practitioners of those therapies. The

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unique program is supported by a $150,000 grant, awarded to NJMS and SHRP in September 2012 as part of IMPriME, the National Coordinating Center for Preventive Medicine/Integrative Medicine programs, funded by the Health Resources and Services Administration.

The program’s creators —Polly Thomas, co-director of the residency program and an associate professor at NJMS, and Gwen Mahon, an associate dean and associate professor at SHRP— are helping to change the

status quo in the medical world. Recognizing that physicians often have trouble communicating with other health care providers, and vice versa, they set about analyzing the whys and wherefores. A lack of familiarity with each other’s work and existing hierarchies in the health care world that restrict interaction climbed to the top of their list. In fact, Thomas and Mahon found that they themselves felt some of these same constraints when sitting down to discuss their plans.

“Respect. It’s largely about respect,” says Mahon. “Familiarity is key to eradicating barriers and fostering respect.”

In a first step toward change, a fivemember team developed a survey, which was distributed in 2012 to faculty members of NJMS, SHRP, the School of Nursing and Rutgers School of Dental Medicine to assess their knowledge and attitudes toward complementary and alternative medicine (CAM). About 300 surveys were completed.

In addition to Thomas and Mahon, team members included: Virginia Cowen, assistant professor of primary care at SHRP; Susan Gould Fogerite, associate professor of primary care at SHRP; and Marian Passannante, PhD, chair of the School of Public Health’s Department of Quantitative Methods and an NJMS associate professor in the Department of Preventive Medicine and Community Health.

Survey results indicated that faculty are interested in integrative medicine and would like to incorporate aspects of it into their practice. Many have had some training in the use of nutrition, diet, exercise, and physical activity in patient care. The survey also indicated that physicians and dentists are less likely to refer patients for integrative medicine services than other health care providers.

Mahon, who was born in Ireland, and raised in Ireland, Toronto and Vancouver, and whose family moved frequently while she was growing up, was taught by her father to “reach for the moon” and “not to fear change.” She brings that mindset to her work. Trained as a cancer researcher, she nevertheless likes to work outside the lab, where the “experiments” are broader in scope and STEPHANIE CARTER

Clinic in New Brunswick, where physician often more impactful. She sees health care as assistants are the primary caregivers; the an area where a willingness to think outside Oral Health Nutrition Clinic in Newark; the box can translate into big dividends for the Center for Well Being at Morristown large groups.

Medical Center; and Atlantic Health System The new rotation is also a reflection of Integrative Medicine. The residents must Thomas’s chief interests — encouraging lifealso complete a research project. style changes to promote health and prevent “This is a new field,” says Mahon. “There disease, building teams of physicians and is no model yet other experts to for including intecare for patients grative medicine in contrast to the in preventive current segmentmedicine residened system, and cy programs.” making changes At the end of at the population, the day, the team rather than the that launched individual, level. the new rotaThe preventive tion wants to medicine/public build bridges health residency among health care that she heads specialists and tip up with Wilthe system toward liam Halperin, preventive care.

MD, chair of the The grant gives Department of The integrative medicine rotation team (left to right): Virginia Cowen, PhD, Susan Gould Fogerite, PhD, Gwen Mahon, PhD, and the team credibility Preventive MediPolly Thomas, MD and allows them to cine and Combe part of a large munity Health, is consortium that is wrestling with this issue the only one in New Jersey and accepts just on a national scale. “This is more complione or two applicants each year. Most of the cated than it sounds,” says Mahon. “We are applicants are interested in working for a local, state, or federal agency such as the CDC; tackling a host of questions.”

It is necessary to have strong evidence that working directly with patients to provide CAM therapies work and are safe in order to preventive medicine services; and doing include them in a treatment plan, but how is public health research. that evidence best obtained? Do CAM pracIn the eight-week integrative medicine titioners need to be licensed and educational rotation, residents observe and work closely programs accredited? Who should lead the with professionals in such specialties as new health care teams? If the physician is the physical therapy, occupational therapy, and leader, are there ways to create an environpsychiatric rehabilitation. They also attend ment of inclusion where others can comfortwellness centers and clinics that provide an ably bring their thoughts to the table? array of health care services — including “For primary care providers, integrative alternative and complementary care — under and preventive care are traditional and essenone roof. “Relationships are formed betial,” says Thomas. “But they need knowltween these physicians and other health care edge about when and where to refer patients providers and a level of respect is built,” says for services they cannot provide.” ● Mahon. “It’s a start.”

Among the sites hosting physicians in Read about Yvonne Farnacio, one of the first NJMS the program are the student-run physical residents to participate in the integrative medicine rotatherapy clinic at SHRP in Newark; St. John’s tion, on page 38.

K E I T H B R AT C H E R

Sarcoidosis Continued from page 8

Berman says. “We are also planning a support group where patients can interact with each other and a facilitator. This disease has so many unanswered questions.”

Among the center’s missions is outreach to community physicians who only see sarcoidosis patients occasionally. “It would be hard for any one physician to comfortably manage this disease with its many varied manifestations. We have collective expertise to assess multi-organ involvement and can provide treatment without delay,” Berman continues.

In addition to treating the disease, Frohman and Berman teach, research, and publish on sarcoidosis nationally and internationally. But their primary goal remains helping patients transition from having an unexplained systemic inflammatory illness with severe manifestations to getting a correct diagnosis and therapy that will keep them healthy and out of the hospital. ●

1-855-4-SARCOID The Rutgers NJMS Sarcoidosis Center can assist you or your patients with comprehensive care. Physicians and staff are available to answer calls or coordinate visits to allow for ophthalmology and pulmonary evaluations as well as lung function testing on the same day.

To reach co-directors: call Larry Frohman at 973-972-2026 or email him at frohman@njms.rutgers.edu or call Andrew Berman at 973-972-LUNG (5864) or email him at bermanar@njms.rutgers.edu.

You can also call the Sarcoidosis Hotline at 1-855-4-SARCOID.

RUTGERS NEW JERSEY MEDICAL SCHOOL

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njms people…do you know?

said, ‘I like to think of plastic surgery as the specialty of skin and its contents.’”

Keith joined NJMS last fall, after completing his residency at Pitt — a period that included a stint in Belgium as the recipient of the Stephen S. Kroll Fellowship in microsurgery at the University Hospital of Ghent.

“That was a real honor,” Keith says. “I worked with Dr. Phillip Blondeel, an internationally recognized pioneer of this very specific kind of breast reconstruction surgery, where you take fat and skin from a woman’s abdomen, sparing the fascia, the muscle, and the nerves that make the muscle work, and use that to reconstruct the breast.”

The Kroll fellowship also included work with perforator surgery, a technique, Keith explains, that involves taking “tissue and its blood supply without taking any of the surrounding structures. A lot of the tissues are supplied by blood vessels that come through the muscle, and people need those muscles.”

He adds, “The fellowship was about learning how to make a breast artistically. It is beyond what you learn in residency.”

Keith says he’s excited to be part of the new Breast Reconstruction Program at NJMS. “We’re just getting it off the ground,” he says. “We’ve done a few cases using the techniques I learned in Belgium.

We’re trying to set up a program so that every patient has access to this treatment, whether they have insurance or not.”

In fact, Keith says, one of the reasons he came to NJMS was “to provide a service that a lot of people in New Jersey just aren’t getting. Either they have the wrong kind of insurance, or they don’t have enough. These are big surgeries. They’re not something you can do easily in private practice.”

It was his passion for teaching, Keith says, that led him to choose academia over private practice. “To be part of an academic resource like Rutgers, and to teach residents and medical students — that’s what I really want to do.

Plus, I get to work with skilled partners who have great training. They can help me, I can help them, and we can work together.” ●

J O N ATHAN KEI TH

Falling in Love With Surgery

BY TY BALDWIN

J

onathan Keith, MD, didn’t exactly plan on becoming a plastic surgeon. In fact, Keith, who recently joined New Jersey Medical School (NJMS) as an assistant professor in the Division of Plastic and Reconstructive Surgery, hated biology in high school. “I wanted to be a chef,” he says. “I was thinking about going to culinary school instead of college. But my dad said, ‘Well…you could think about college.’”

Ultimately, Keith enrolled at the University of Maryland, with a major in government and politics. “But then I had a really great professor for Biology 101,” Keith says. “He

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drew these elaborate pictures of photosynthesis. My notebook was filled with drawings of the inside of a cell.” By the end of the year, he had changed his major to neurobiology and physiology.

Keith graduated in December 2001, and having made his peace with biology, was to begin medical school at the University of Pittsburgh the following fall. He worked that spring at the Walter Reade Army Institute for Research, and then, during his last summer before medical school, did what many aspiring doctors would like to do: headed to Los Angeles with his girlfriend (now his wife) to work as an extra.

“I was in an episode of NYPD Blue and also in a movie with Teri Hatcher,” he says.

“I didn’t get that many jobs. I was mostly just hanging out, but it was fun to do something different.”

At Pittsburgh, Keith planned a career as a urologist. But a research project he did with a plastic surgery resident (“just for the experience”) caught the eye of the department chair, who urged Keith to consider the field. “He spent half an hour telling me what plastic surgery was about,” Keith says.

“I still remember his description of it. He

To contact Dr. Jonathan Keith, call 973-972-5377.

ANDREW HANENBERG

njms people…do you know?

AR J U N R AJ

Just How Brilliant Is Arjun Raj?

BY MARYANN BRINLEY

E

ach year Popular Science magazine chooses the “Brilliant Ten” from among young scientists and engineers all over the world, looking for individuals who are “dramatically reshaping their fields and the future.” To be singled out for the recent class of stars came as a surprise to Arjun Raj, PhD, a former researcher at the Public Health Research Institute (PHRI) at New Jersey Medical School (NJMS), who is now analyzing “what makes cells tick” at the University of Pennsylvania.

For his mentor Sanjay Tyagi, PhD, an NJMS professor of medicine at PHRI, the magazine’s choice was hardly surprising.

Almost from the beginning of working together, the professor was amazed by the grad student. “Even though they have not met him in person, my lab’s next generation of graduate students, and even my own son, know all about Arjun because I admire his intellectual abilities and continuously present him as an ideal. I have no doubt that he will be a future science star,” Tyagi says.

Raj, who had been studying abstract

mathematics at New York University when he came to PHRI, was interested in applying his theoretical math skills to biology. Tyagi explains how unusual this is. “The cultures of theoreticians and experimentalists are so different that usually theoreticians can’t be experimentalists. But that rare mixture coexists in this individual. Even though Arjun had never touched a pipette before, he soon became a guru in lab techniques. In fact, a technique he developed here, single molecule fluorescence in situ hybridization (sm-FISH) is now used around the world.” This innovation is the basis for a commercial product that continues to bring royalties to Tyagi’s lab, and Raj’s published paper on the topic has been cited hundreds of times.

For Raj, the years spent with this advisor were “truly a magical time. Doing my graduate work there was the singular experience that has made me the researcher I am today.”

He describes his PHRI mentor as brilliant and creative, as well as kind, generous and unassuming. “I remember once being bummed and stressed about my research before walking into his office and slumping in a chair,” says Raj. “But after 15 minutes of talking, I bounced out of there with energy and optimism and the work became exciting all over again. Only a person true of heart can imbue someone with that spirit. That is Sanjay to the core.”

What brought Raj to the attention of Popular Science, however, was not just a new lab technique, but also a new understanding of the inner workings of cells. Though each cell in your body has the same DNA, how a cell’s genes are arranged and expressed (and how frequently) is critical. To see closely what’s happening inside, Raj bathes cells with fluorescent DNA probes, which line up like Christmas lights along a roof, noted Popular Science.

“Our work shows how the organization of genes affects their function,” Raj reports.

“It’s like asking what the effects of rearranging the recipes in a recipe book might be.

This organization of genes matters, often in unexpected ways.” Gene activity determines whether a cell is healthy or sick as well as its

life span. “What I find exhilarating is that we just don’t know what we’re going to see.”

Ever the proud advisor, Tyagi explains, “For the first time, Raj showed that mammalian cells express their genes in randomly initiated bursts that are punctuated by brief (and random) periods of inactivity.” Raj gleaned this dynamic view from static microscopic snapshots of RNA molecules (which carry the genetic information from DNA), through a powerful mathematical analysis.

What he has created is a new field of research allowing cell biologists to see the subtle gene activities.

Tyagi remembers how Raj wrote a powerful program to string together the idle computers at PHRI so that during the night they would “shift through terabytes of microscopic images and produce quantitative information about gene activities by morning.” In fact, when Raj left, the lab was at a loss.

“With him, I had entered the fascinating world of quantitative biology that I couldn’t navigate in his absence,” says Tyagi. The professor had to learn programming on his own to continue the work of his student.

Since graduating in 2000 from the University of California, Berkeley, with a bachelor’s in both physics and mathematics and earning his PhD from NYU in 2006, Raj has received the National Institutes of Health Director’s New Innovator Award in 2011 and other prizes have been piling up, including a $2,400,000 NIH grant now funding the work in his lab on RNA and cancer biology.

Raj, like his mentor, remains modest to his core. Call him “brilliant,” and he responds with humor. Yes, family and friends were proud of the Popular Science designation but he laughs about how his mother first saw the article in a dentist’s office and how lab mates joked about the magazine’s cartoon image of him. “One guy started waving it around before I could grab it.” He admits, “I certainly didn’t expect to be on anyone’s radar.” In fact, he says, “My only hope is to be the same sort of mentor to the people in my lab that Sanjay was and continues to be for me.” ● RUTGERS NEW JERSEY MEDICAL SCHOOL

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gsbs people…do you know?

SO U RAV SI NHA

Getting a Cancer Drug to Patients Rutgers biomed student strives to market a promising new treatment

BY ROB FORMAN

W

hat if an experimental treatment for an aggressive breast cancer had the potential to save women’s lives, but nobody could use it because there was no money to develop and test it? With funding sources for research and development more scarce than in the past, it is not an unusual situation.

It’s a problem that Sourav Sinha, a Master’s degree candidate at Rutgers Graduate School of Biomedical Sciences, is tackling head-on.

Sinha leads a team that won first place in its category this past March in the Breast Cancer Startup Challenge, a worldwide competition sponsored by the Avon Foundation, the Center for Advancing Innovation and the National Cancer Institute. Competitors were asked to take a drug that shows promise in the laboratory — a powerful toxin created and patented by scientists at the National Institutes of Health — and develop a business plan to guide its development for potential use in patients. With the competition won, Sinha and his team have now begun work on moving that plan forward.

Bringing a drug to market is a much more daunting process than people might realize.

“We have this unique opportunity to get a powerful treatment to breast cancer patients who need it,” says Sinha, who aspires to be a physician-researcher. “This is a new, exciting avenue through which my team and I can make a meaningful contribution to health.”

This drug is designed to kill individual cells altered by the HER-2-positive gene mutation that is responsible for as many as 25 percent of all breast cancers. “The toxin is in a very early stage of development right now,” says Sinha, “but if it works it will be huge.”

That is where the need for a business plan comes in. The drug’s inventors have shown 14

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it kills cancer cells in the lab, but in order for it to work in people, an intricate transport system is also needed to carry the toxin through patients’ bodies and deliver it to diseased cells, while bypassing surrounding healthy cells.

Choosing the right mechanism requires an extensive knowledge of biochemistry. But it also demands business sense: to negotiate financial agreements with biotech companies that have the expertise to construct the delivery system. Specialized components include synthetic antibodies that are specifically engineered to seek out HER-2-positive cancer cells, as well as “linkers” that would fuse the toxin to the antibodies — as a space capsule might be attached to a booster rocket — until just the moment when, inside the cell, the toxin detonates.

If the product ultimately works, these

companies will see a share of what could be substantial profits. Sinha and his team are approaching venture capitalists and large foundations — which they hope to convince to put up the capital needed to fund both the manufacturing process and the allimportant clinical trials.

And attacking HER-2-positive breast cancer may be just the start. If, as Sinha expects, the toxin can also be combined with different antibodies that seek out other cancers, Sinha says the drug has “nearly endless” cancer fighting potential.

“He’s an impressive young man,” says Joseph Bertino, chief scientific officer at the Rutgers Cancer Institute of New Jersey and a professor of medicine and pharmacology at Rutgers Robert Wood Johnson Medical School. Bertino, whose own research focuses on targeted cancer therapies, is one of several Rutgers faculty members who have advised Sinha. “He has collaborators lined up,” Bertino adds, “and I think he has a real shot at it.” Sinha and his team have formed a company, OncoLinx LLC, to help advance their plans. The $5,000 prize they received for winning the Challenge will help fund the company’s operations.

Sinha’s foray into the business side of drug development is a sign of rapidly changing times. In the past, nearly all who earned doctorates in the biomedical sciences stayed in academia. But now, Bertino notes, “some of our best scientists are working with biotech companies and big pharma. It’s important for them to understand what industry is all about, so we at Rutgers are trying to make sure it’s part of their education.” ● This article originally appeared in Rutgers Today.

ROB FORMAN

njms people…do you know?

AN A NATALE- PEREI R A

Never Lose Hope

BY JENNIFER SALVATO DOKTORSKI

A

heart failure patient and frequent visitor to the emergency room (ER) at University Hospital was homeless, could not speak English, and lacked identification documents when he was referred to the Healthcare Outreach, Prevention, and Education (HOPE) Center about a year ago.

Working with Jeannie Garmon, the center’s health educator, and the medical team, the patient learned to understand his medication regimen, changed his eating habits, and began a modest exercise regimen.

Garmon also worked with the patient to complete his Social Security and immigration forms and contacted a shelter manager to help with his housing needs. As a result, his number of trips to the ER was significantly reduced —one of the primary goals of

The HOPE team, left to right: David Landry, Ana Natale-Pereira, MD’96, Jeannie Garmon, and Isaura Otero

ANDREW HANENBERG

HOPE, a collaborative program of Rutgers New Jersey Medical School (NJMS) and the University Hospital Ambulatory Care Center.

“The HOPE Center works with very sick patients who are confused about the health care system and lack the necessary skills to navigate it. We show patients that a team of people is working to help them feel better, and that gives them hope,” says Ana NatalePereira, an associate professor of medicine at NJMS and the center’s leader.

Natale-Pereira completed her internal medicine residency at NJMS and stayed on as a faculty member to focus on the underserved. “I believe in the mission of caring for our unique and very challenged, diverse community,” she says.

The HOPE Center is one of many such programs in which Natale-Pereira has been involved. Established in April 2012 with financial support from The Healthcare Foundation of New Jersey, it was born out of the need to address a gap in patient health education and excessive use of the ER for primary care services. It does that by reaching chronically ill patients who, for various reasons —limited access to care, transportation barriers, behavioral issues, trust issues —

have disconnected from primary care. The center, which exists “virtually” within the Ambulatory Care Center Medical practice, operates under the Division of General Internal Medicine at NJMS, delivering a comprehensive model of primary care.

“This is not a new concept. Many programs utilize comprehensive models of care, but our patient populations are particularly challenged and unique in their health care needs,” says Natale-Pereira, who is also principal investigator of the center’s grant from The Healthcare Foundation of New Jersey.

For example, before the center’s existence, another patient, who suffered from back pain and cardiac issues, visited the ER almost monthly. As a HOPE Center participant, he reconnected with primary care and received assistance in filling out paperwork for health insurance and Social Security benefits. Since then, he has returned to the ER only once.

Garmon, who oversees the day-to-day operations and organizes student participation, says: “I am truly proud of our work.

Every patient that we connect back to care, every patient that we empower with education to understand and manage their medical conditions, is a potential life we save.” Isaura Otero, who supports patient recruitment, and David Landry, whose communication skills and patient education experience benefit patients, are vital members of the team.

“We have 73 patients enrolled in the program,” says Natale-Pereira. “To date, 11 have not been back for emergency services, and 60 patients have reduced ER visits by 30 percent.” Natale-Pereira says that residents and doctors often refer patients who have multiple chronic conditions and are frequent users of the ER. Medical students are eager to deliver healthy eating education sessions and excited about the great service-learning opportunities.

“It takes an enormous effort to change behavior in patients, providers, and the system as a whole,” says Natale-Pereira. “By embedding the center into both the clinical and educational missions of our institution, we can expand on this concept and target a larger cohort of patients in need.” ● RUTGERS NEW JERSEY MEDICAL SCHOOL

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njms people…do you know?

A

T HER ESA L. CH AN G , M A R I LA G E NNA R O , A ND VÉ R ON IQU E DARTOIS

Award-Winning Women National Institutes of Health grants are never easy to win. The competition for research money is fierce. Ask anyone who has labored over a submission. But three NJMS faculty members make it look easy to the tune of $11.5 million from the NIH. And there is more on the way.

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BY MARYANN BRINLEY

lthough women continue to be underrepresented in science, women researchers at the Public Health Research Institute (PHRI) have made the science world sit up and take notice. In fact, Theresa L. Chang, PhD, Véronique Dartois, PhD, and Marila Gennaro, MD, have secured $11.5 million in new National Institutes of Health (NIH) research grants. PHRI has always made research excellence its top priority and excellent describes the work of these three researchers, states David Perlin, PhD, director of PHRI at Rutgers New Jersey Medical School (NJMS).

Born in Taiwan, Theresa Chang, NJMS associate professor of microbiology and molecular genetics, began to study the role of innate immunity in HIV transmission in 2002 when she was an assistant professor at Mount Sinai School of Medicine. She joined PHRI in 2010. Since then, she has been working on the role of mucosal immunity and the microbiome in the setting of sexually transmitted infections and hormone changes associated with an increase in HIV transmission. She received NIH funding for this work. She has also examined human peritoneal macrophages as potential reservoirs for HIV. Approximately 34 million people are living with HIV worldwide and there were an estimated 2.5 million new HIV infections across the globe in 2011, according to the World Health Organization (WHO). Sexual transmission is the predominant mode of infection. Because early immune responses during acute infection may determine HIV disease progression, Chang believes that understanding innate immune responses to HIV infection is crucial for developing effective prevention strategies.

The new five-year grant of $2,785,332 will fund a study of the role of Depo-Provera in the spread of HIV. Chang and Zhiheng Pei from New York University are the principal investigators. Depo-Provera, an injectable birth control method commonly used in Africa as well as the U.S., has been shown to increase the risk of acquiring HIV. If use of the hormonal contraceptive increases HIV K E I T H B R AT C H E R

Major Grant Will Support Research to Develop New Antibiotics The National Institute of Allergy and Infectious

acquisition or transmission, it would have profound implications for family planning policies.

Chang and her colleagues will study her hypothesis that injectable Depo-Provera alters immune responses and cervicovaginal and colonic microbiomes, leading to increased HIV acquisition and transmission.

Véronique Dartois is Belgian but arrived at PHRI in 2012 by way of Singapore, where she had spent seven years with the Novartis Institute of Tropical Diseases. Her $3,138,294 NIH grant will allow her to further pursue research in tuberculosis (TB).

“TB kills one person every 20 seconds, ” she says.

The drug she is investigating, pyrazinamide, is a commonly prescribed TB medication, especially for patients with drugsensitive or drug-resistant disease, which often occurs in conjunction with HIV. It has a unique ability to shorten treatment of active TB and latent infection but its pharmacological mechanisms are poorly understood. Dartois surmises that TB lesions, which are at the root of bacterial persistence because they can reside in remote infection sites, could be key. She will test the idea that pyrazinamide reaches and kills persistent populations residing in the lungs where most drugs fail to go.

“For the successful treatment of pulmonary tuberculosis, drugs need to penetrate complex lung lesions and permeate the mycobacterial cell wall in order to reach their intracellular targets,” she explains. “Most currently used anti-tuberculosis drugs were introduced into clinical use without considering the pharmacokinetic and pharmacodynamic properties that influence drug distribution,” or how far a drug reaches and how long it is effective in the body.

With a state of the art mass spectrometry platform in her lab, Dartois is able to visualize drugs and metabolites in biological tissues. Her team can measure the levels of the anti-TB agents in various lesion types and across lung tissue and plasma to see where and how long a drug is working to sterilize infection. The results of her research could ROB FORMAN

Diseases (NIAID) of the National Institutes of Health (NIH) has selected infectious disease expert David Perlin, PhD, executive director of PHRI, to lead a major research effort aimed at developing new forms of antibiotics to regain the upper hand over deadly bacteria that have become resistant to current treatments.

With a five-year grant of up to $26 million, Perlin will participate in the Centers of Excellence for Translational Research (CETR), a public-private partnership that brings together prominent scientists from Rutgers as well as other institutions.

When modern antibiotics were introduced in the 1940s to help control deadly bacterial disease, they were greeted as wonder drugs. Now, bacteria have adapted and become resistant to many of those drugs.

According to the Centers for Disease Control and Prevention, more than two million people are sickened every year in the U.S. with antibiotic-resistant infections resulting in at least 23,000 deaths. With few new drugs being developed, many serious infections have become largely untreatable.

Senior leaders of the research team assembled by Perlin include: Sean Brady, PhD, from The Rockefeller University in New York City; David Alland, MD, and Joel Freundlich, PhD, from NJMS; and Richard Ebright, PhD, from Rutgers’ Waksman Institute of Microbiology. The global biopharmaceutical company Cubist is the first industry member of the consortium. The recently formed Institute for Infectious and Inflammatory Diseases at NJMS will also play a key role in the partnership. — ROB FORMAN

guide a more rational approach to designing treatment regimens that ensure drug exposure at the site of an infection, not just in cases of TB but in other diseases.

“This technology can be expanded to a large variety of medications used for an array of diseases,” she states. “It holds great promise for the molecular imaging of many biochemical and pathological changes.”

Dartois has another large, newly funded NIH grant to examine other TB drugs.

Marila Gennaro, a native of Palermo, Italy, started focusing on TB in the mid1980s when New York City was experiencing a resurgence of the disease. “At the time, there were only a handful of labs across the country working in mycobacteria,” she remembers. The spread of TB was being spurred by co-infection with HIV, which was just emerging. Her most recent grant of $5,523,914 will move the goal of an accurate, speedy, blood-based diagnostic test for TB forward.

“TB is a global health problem,” she states. “It’s one of the great killers of people but if diagnosed early, you’re able to help.

What greater gratification can there be for a scientist?” Gennaro and fellow PHRI faculty members Yuri Bushkin, PhD, Richard Pine, PhD, and Sanjay Tyagi, PhD, aim to take this test into preclinical development.

“This test has the unparalleled potential to distinguish between latent TB infection and active pulmonary TB,” she states. What also makes the project exciting is that this technology may someday be applied to detect other infectious and even non-infectious diseases.

“In my view, the new test will phase out current testing, which has been around for more than 100 years,” comments Perlin.

“Marila has worked nearly two decades to understand the body’s response to TB infection and this innovative technology is a huge leap forward. It will be used to screen tens of millions of people each year.” ● RUTGERS NEW JERSEY MEDICAL SCHOOL

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njms people…do you know?

K EIT H AND SCOTT PA S I C HO W

A Tale of Two Brothers Fighting cancer, supporting each other, and making the journey to becoming physicians

BY MARY ANN LITTELL

Left to right: NJMS student Scott Pasichow with his brother Keith, a pediatric oncologist

T

wo boys grow up in suburban New Jersey. They go to school, watch TV, play sports, and tussle over the small stuff.

The family takes its abundant good health for granted…until one of the brothers is diagnosed with cancer. To hear this news at any age is one of the most difficult things a person can face. But when you’re only 15?

When cancer struck Keith Pasichow in 1996, “it was the worst day of my life,” he says. His brother Scott, who was then 10 years old, agrees: “All I knew was that my grandfather died from cancer. Now I was afraid my brother was going to die.”

Keith’s memories of cancer are still fresh: the intense pain, the fear that he would lose his leg—where the large, malignant tumor was located—and even worse, the fear that

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he would lose his life. Back then, there were far fewer tools in the cancer arsenal, and a much greater risk of dying.

He fought hard and survived. But his recovery was difficult. He underwent treatment so rigorous that it kept him home from high school his entire sophomore year. Now 18 years post cancer, his story has a happy outcome. Ironically— or perhaps not—he’s become a pediatric oncologist, choosing the specialty that saved his life. Not to be left out, his brother Scott is also on his way to becoming a physician, currently in his third year at New Jersey Medical School (NJMS).

The brothers are convinced that Keith’s battle with cancer influenced them both to go into medicine. “We were a close-knit family, but my brother’s cancer brought us

even closer,” says Scott. “We were so focused on his illness. It was a huge part of our lives.”

Keith’s cancer began with a sore, swollen leg. At first the family thought it was muscle spasms. His doctor did tests but couldn’t find anything wrong. Keith, who loved acting and the theater, went to performing arts camp that summer, where his leg continued to ache and swell. There were visits to the nurse and phone calls home, but he soldiered on and finished out the session.

When he came home, his worried mother brought him back to the pediatrician, then to a pediatric orthopedist. After two days of tests and scans, Keith was referred to the Rutgers Cancer Institute of New Jersey.

There, a biopsy confirmed that he had osteosarcoma, the most common type of cancer that develops in bone. Most osteosarcomas occur in children and young adults and frequently develop in the bones around the knee — the location of Keith’s tumor.

Keith’s dreams for the future were put on hold as he underwent a year of difficult treatment. First came 3½ months of chemotherapy, then he had surgery to remove most of his femur—the long thigh bone — and many muscles in the thigh. He had a cadaver bone graft, but it failed to fully heal and fuse with the remaining bone. In a second surgery, his fibula, a bone in the lower leg, was moved to his upper leg. The surgery was successful but he continued to have pain and a severe limp.

He had to learn to walk again.

“It was a tough period and I remember being severely depressed my entire sophomore year,” Keith says. “Amputation was discussed as an option — either the entire leg or a portion of it. I had a tremendous fear of the unknown.”

Scott recalls the family spending days in the hospital with Keith. “That’s when I began developing an interest in medicine,” says Scott. “I had so many questions. Why did my brother get sick? How does disease start?”

While Keith slowly recovered, life was fairly normal for Scott. An enthusiastic but not particularly proficient athlete, he tried out for his school basketball team and didn’t make the cut. The coach suggested that he K E I T H B R AT C H E R

pursue his love of sports via another route: the school’s student athletic trainer program.

Students received instruction in first aid and fitness, then served as student athletic trainers to the sports teams. “I loved it,” says Scott. “It combined my interests in sports and medicine and made me think about athletic training as a career. It also got me interested in emergency medicine.”

At 16, Scott joined the East Brunswick Rescue Squad. “My mom wasn’t thrilled, but I told her at least I wasn’t running into burning buildings,” he laughs. Along the way, he became certified as an emergency medical technician.

Graduating from high school, Keith stayed close to home, attending Muhlenberg College in Pennsylvania. By now he knew he wanted to become an oncologist, but he didn’t have the energy to tackle a rigorous pre-med curriculum. “I still had pain and was taking medication,” he says.

“Many people who care about me, including my parents, advised me not to take on too much. So I majored in my other love, theater.”

Scott went to Penn State for a year, then transferred to Rutgers, earning a degree in exercise science and sport studies. “This major prepares you to for a career in sports

medicine and rehabilitation, but by the end of college I was I thinking about medicine as a career,” he says. As an undergraduate he joined the Rutgers EMS and went on ambulance runs on campus, at Rutgers sporting events, and in the community.

By his senior year Keith was able to take some pre-med courses. After graduating, he finished his pre-med courses at Rutgers, took the MCATS, and did well. He applied to medical school and enrolled in Mount Sinai School of Medicine, graduating in 2010. Following a residency in pediatrics, he’s currently in the first year of a three-year fellowship program at Columbia University training in pediatric oncology, hematology, and bone marrow transplantation. He plans to pursue further training in palliative care and neuro-oncology. He’s also pursuing a master’s in public health.

Keith’s bout with cancer gives him a special bond with his young patients. A persistent limp causes him some difficulty walking, so he uses a motorized scooter and forearm crutch to get around the hospital.

“I feel joy and pride in being a physician and helping children go through what I went through,” he says. “But it’s more difficult than I ever anticipated. It brings back memories, and I feel emotions I didn’t realize

Scott Pasichow skates with the NJMS Medwings. “Very few medical schools have hockey teams, and we actually have two,” he says.

I still had.” When he tells his patients he too had cancer, many don’t react. “They’re more interested in the scooter, so I give them rides,” he says. “But their parents listen. I suppose my story gives them hope that their children will be as fortunate as I was.”

“Being in medicine is something we share and we talk about it a lot,” says Scott Pasichow.

“Medical school is very challenging, and my brother helped me learn how to get through it.”

Scott followed in his brother’s footsteps, entering NJMS in 2010. He plans to specialize in emergency medicine. “It’s fast-paced and challenging,” he says. “You have to know about every medical specialty and be able to make quick decisions at a critical juncture. I thrive under pressure.” He also is an MPH candidate at the Rutgers School of Public Health.

He’s still into sports and skates on the NJMS hockey team, the Medwings. “It’s a lot of fun,” he says. “Very few medical schools have hockey teams, and we actually have two. They’re made up of students and faculty and play in different leagues. Once a year we play against each other as a charity fundraiser.”

Both brothers say the five-year age difference doesn’t seem as large as it did when they were kids. “Being in medicine is something we share and we talk about it a lot,” says Scott. “Medical school is very challenging, and my brother helped me learn how to get through it.”

“My brother has always been there for me,” says Keith. “He helped me get through cancer, so how could I not help him?” ● RUTGERS NEW JERSEY MEDICAL SCHOOL

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njms people…do you know?

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K EV IN CLARKE

Surgical Care Mission Returns to Ghana The trip was a true collaboration, including physicians and staff from NJMS, University Hospital, and Newark Beth Israel Medical Center.

BY KAYLYN KENDALL DINES

T

he international surgical care mission to Ghana didn’t get off to a good start for a team of 17 health professionals. After a 12hour flight, the van taking them to a guest house broke down, leaving them stranded on the side of the road.

When they finally checked in, the surgeons, anesthesiologist, nurses and support staff didn’t stay for long. The lights in their rooms flickered off and on and the water slowed to a drip, forcing them to pack up and find lodging elsewhere. These setbacks didn’t get in the way of their 10-day journey to treat nearly 100 Ghanaian patients at Tetteh Quarshie Memorial Hospital in Mampong-Akuapem.

“We pride ourselves on being prepared.

As surgeons, you plan for everything,” said Kevin Clarke, MD, an assistant professor of clinical medicine in the Department of Surgery at New Jersey Medical School (NJMS). “You try to anticipate every situation, but invariably things always happen that you don’t expect.”

Clarke was the team leader for the International Surgical Health Initiative’s (ISHI) second mission to Ghana. He believes preparation was the team’s linchpin for success when performing about 50 pediatric and adult operations over five days ranging from hernias and hysterectomies to soft tissue mass removal. This mission went smoothly once they got settled. Breaks were rarely plugged into their daily 10-hour shift at the 123-bed regional hospital, serving a population of 120,000.

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ISHI was founded in 2009 as a humanitarian, non-profit organization by Ziad Sifri, MD, associate professor of clinical medicine in the NJMS Department of Surgery, and Asha Bale, MD, an attending surgeon at Palisades Medical Center in North Bergen.

Through ISHI, these Executive Team members gave credentialed volunteers the chance to provide surgical care to medically underserved families worldwide. Based in Colonia, NJ, and Quebec, Canada, ISHI’s volunteers delivered donated medical supplies, medications, and equipment during missions in Ghana, the Philippines, Guatemala, Haiti, Sierra Leone, and Peru.

NJMS general surgery resident Joyce Alexander Bonitz, MD’09, who earned an undergraduate degree from Rutgers, felt it was a privilege to travel with the team for a second time. A natural curiosity drew Bonitz to her first ISHI mission to the Philippines in January 2013, about six months after marrying her medical school sweetheart, Paul Bonitz, MD’12, a current NJMS urology resident. Then, eight months after that mission, she put a research project on hold to travel to Ghana with ISHI. “You’re sacrificing for 10 days, but it’s totally worth it because it makes you realize and appreciate everything that you have.”

Clarke, who completed a general surgery residency at University Hospital in Newark before completing a surgical oncology fellowship at the City of Hope National Cancer Center in California, said, “Pictures are worth a thousand words.” ●

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1. Kevin Clarke closing a surgical incision.

2. Left to right: Felicity Amponsah, RN, and NJMS general surgery resident Joyce Bonitz interviewing a patient.

3. The group in front of the Tetteh Quarshie Memorial Hospital in Mampong, Ghana.

4. The surgical team: Kevin Clarke, local surgeon Dr. Charles Asiedu, Bo Protyniak, MD (Newark Beth Israel Medical Center), Joyce Bonitz, Kamalakar Ayyagari, MD (also from Newark Beth Israel).

5. Meeting with the Nana (tribal chief of the Aburi region) Hon Otoobour Djan Kwasi.

6. Leslie Osei-Tutu, MD, anesthesiologist and former NJMS anesthesiology resident, with University Hospital OR nurse Hannah Asare-Boateng, RN, overseeing a patient during a surgical procedure.

7. Surgeon Kamalakar Ayyagari being assisted by Bo Protyniak and Pushpa Goel, RN, on a hernia operation.

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STEPHANIE BURROUGHS AND KEVIN CLARKE

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Chirag D. Gandhi, MD’00, associate professor of neurological surgery, with patient Marjorie Carle.

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a pipeline to

r e c o v e ry

BY MARY ANN LITTELL

M

eeting Marjorie Carle for the first time, you might not guess she’s 80. While her silver hair hints at her age, she walks with the quick step of a much younger person.

She’s got a busy schedule, spending her days driving, shopping and caring for her 86-year-old husband Bill, who suffers from dementia, in their home in a retirement community in Lakewood, NJ. “I’m blessed to be in pretty good health,” she says. “But last year I wasn’t feeling so great. ” Her problems began in early 2013 with earaches and debilitating headaches, which quickly progressed to soreness all across her face. It was trigeminal pain, a term used to describe serious, acute pain that affects the trigeminal nerve, which carries sensation from the face to the brain. Over time, the pain spread to her jaw and neck. Her left eye drooped and she began seeing double. “Now I was afraid to drive,” she says. “What was I going to do?”

Over the next few months she made the rounds of physicians. First she went to an ear, nose and throat specialist, but he saw no sign of infection or any other potential cause of the earaches. She next saw a dentist, who found nothing wrong with her teeth or jaw, and then an ophthalmologist, who sent her for an MRI. These results were sent to her primary care physician, who called with alarming news: she had a large aneurysm in her brain, behind her left eye.

JOHN EMERSON

An aneurysm is a weak area in the wall of a blood vessel that causes it to balloon out. This weakening can be present from birth or caused by disease or injury. Aneurysms are not always dangerous, but they can leak or rupture, bleeding into the brain and causing stroke, brain damage, or even death.

Carle’s physician said she needed to see a neurosurgeon as soon as possible. He’d heard good things about the endovascular surgery program at University Hospital, the primary teaching hospital for NJMS, and referred her to Chirag Gandhi. He is one of two physicians in the Department of Neurological Surgery at NJMS who is trained in minimally invasive endovascular surgery. (The other is department chair Charles Prestigiacomo, MD.) Traditionally, aneurysms have been repaired in open craniotomy procedures, which require cutting through the bones of the skull to reach the brain. Clips are then placed on the aneurysm to close it.

While open procedures are still used, in the past 10 years minimally invasive endovascular techniques have been developed to repair arteries in the neck or brain. This type of surgery involves the introduction of catheters into a large blood vessel, typically the femoral artery. Using angiography, an imaging technique that visualizes blood vessels, the catheters navigate through arteries to the treatment site, where a stent can be positioned. Endovascular techniques offer the opportunity RUTGERS NEW JERSEY MEDICAL SCHOOL

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An aneurysm is a weak area in the wall of a blood vessel that causes it to balloon out.

While aneurysms are not always dangerous, they can leak or rupture, bleeding into the brain and causing stroke, brain damage or even death.

for a less invasive procedure with faster healing. They are particularly beneficial to elderly patients who might not survive the rigors of brain surgery.

“Endovascular surgery is a small percentage of neurosurgery, perhaps 5 percent,” says Gandhi. “There are only about 30 neurosurgeons doing these procedures in New Jersey.”

Standard stents and coils, tinier than the tip of a pencil, are used to treat small, garden-variety aneurysms. The coils fill the aneurysm while the stent stabilizes the artery and holds the coils in place. But what happens when a physician finds an aneurysm that is very large, has an exceptionally wide neck, or is situated on the curve of an artery? “For these complex aneurysms, we use a Pipeline stent, like this one,” says Gandhi, holding a small jumble of coiled mesh in his palm. While it doesn’t look very high-tech, the device, recently approved by the FDA, is an ingenious lifesaver, and Gandhi was one of the first neurosurgeons in New Jersey to use it.

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The Pipeline’s design features a braided netting which diverts blood flow from the aneurysm while still allowing it to flow freely through the artery. The stent is threaded through the carotid artery and positioned across the neck of the aneurysm. The blood already in the aneurysm clots, stabilizing it.

“I used the Pipeline stent on Marjorie Carle’s aneurysm because it was particularly large, and it has produced great results in other similar cases,” Gandhi says.

Carle would agree. “Before the surgery Dr. Gandhi showed me the aneurysm on my angiogram,” she says. “I could see right away how large it was. He said I’d possibly had it for a long time, but it had to be treated right away.”

She underwent the procedure on May 31, 2013, at University Hospital. Gandhi threaded a catheter up her femoral artery to the location of the aneurysm, where he first took additional angiogram pictures that showed that the aneurysm had grown even larger in the previous two weeks. He positioned and then deployed the Pipeline stent. The procedure took two hours. “I had no pain at all,” she reports.

“In fact, I couldn’t believe I’d just had surgery. The incision in my groin was remarkably tiny.” She stayed in the hospital intensive care unit overnight and went home the next day.

Immediately following the surgery she noticed a dramatic improvement in how she felt, except for some headaches. Gandhi says headaches following this surgery are fairly common and resolve over time. Carle is being followed with regular MRIs and angiograms to be sure the aneurysm remains closed. The chance of recurrence is small, says the surgeon.

A year later, Marjorie Carle is back to driving, cooking, caring for her husband, and doing everything she did before the aneurysm intruded. She considers Gandhi one of the most important people in her life.

“How happy and thankful I am that I met him,” she says. “Otherwise I might not be alive.” ● JOHN EMERSON

Endovascular Stroke Treatment

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s a detective with the Essex County Prosecutor’s Office, Roberta Harper has faced her share of criminals, but nothing in her life laid her as low as the major stroke she had in 2012. A member of the Special Victims Unit, responsible for investigating sexual assaults, elder and child abuse, and other serious crimes, she was on duty the morning of November 20. “It was a Tuesday,” she recalls. “Apart from all the demands of work, I was having a Sweet Sixteen party for my daughter in a week. That morning I woke up with a horrible backache, worse than labor pains. But I disregarded it because my back frequently acts up when I’m stressed.”

She considered staying home but decided against it. It was her supervisor’s birthday and the unit had organized a small celebration.

She drove to work, parked her car in the lot, and entered the building with a co-worker, a clinical psychologist. Coincidentally, a security guard was also nearby, securing a chain across the gate of the parking lot. He held the building’s door open for the two women. “Usually I walk into that building alone, but for some reason that morning there were people around,” she says.

As she walked up the flight of stairs to her office, Harper began feeling sick. “I told the security guard I didn’t feel well. I was dizzy — like I was on a roller coaster,” she recalls, her eyes filling with tears. “My body temperature rose until I was in a sweat. I was so hot! I heard a droning sound, like an alarm. Then my hearing shut down.”

The security guard raced to Harper’s side and helped her sit on the stairs. Then he went to get Alicia Seary, the unit’s sexual assault nurse examiner. “I later learned that she had left the building just a short time earlier to attend an all-day seminar, but returned to retrieve something she forgot,” says Harper.

The nurse sat next to Harper and asked some simple questions: did she know her name and where she was? When she didn’t get answers, she quickly called for an ambulance.

“It was truly a miracle that my colleagues were there with me that day,” says Harper. She remembers the nurse telling her that she was experiencing total locked-in syndrome, a condition in which a patient is aware and awake but cannot move, speak or see. This syndrome can be caused by a stroke affecting the brain stem.

Harper was rushed to University Hospital’s (UH) Emergency Department, where Chirag Gandhi and the Brain Attack Team waited.

This multidisciplinary team of stroke specialists is on site 24/7. Part of the Stroke Center at University Hospital’s Neurological Institute of New Jersey, they take their name from an expression commonly used to describe stroke: a brain attack.

Harper had a basilar occlusion — a clot in her basilar artery, which supplies the brain with oxygen-rich blood. “It was a massive stroke,” says Gandhi. “The clot was preventing blood and oxygen from reaching the brain. When she came in here she was hours away from dying.”

She was taken into surgery, where Gandhi threaded a catheter K E I T H B R AT C H E R

through her femoral artery to the location of the blockage. He administered the powerful blood thinner tPA (tissue Plasminogen Activator) through the catheter directly to the clot. A standard treatment for stroke, tPA breaks up clots that block blood flow. To be effective, it must be administered within three hours of the stroke. He also used a new generation of devices designed to remove large parts of the clot with a vacuum suction, called Prenumbra mechanical thrombectomy.

Fortunately, the quick action taken by Harper’s colleagues got her to the hospital within this short window.

During her hospital stay, Harper underwent physical therapy.

“When I stood up for the first time, I stumbled, and after taking only a few steps, I was exhausted,” she recalls. “But by my third physical therapy session, I could walk, open a door and climb upstairs. My eyesight and hearing were also fine.” After a week in the hospital, Harper went home. She did not need any outpatient physical therapy.

Remarkably, she went ahead with her daughter’s Sweet Sixteen. “I took it easy,” she laughs. “It went well. We had a lot to celebrate!”

After several months of recuperation, Harper has made a full recovery. She went back to work in August 2013. “There are a lot of things I am thankful and grateful for in my survival,” she notes. “I’m fortunate that my colleagues were nearby and that the ambulance came quickly, and most of all, that I was cared for by Dr. Gandhi, the Brain Attack Team, and the staff at University Hospital.” ●

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The

Newest

Virus Buster

BY EVE JACOBS

A six million dollar grant ($5,959,585 to be precise) is nothing to sneeze at in today’s research world — especially when it comes at a pivotal time in the development of a new drug. NJMS faculty members Sergei Kotenko and Joan Durbin, working with a biotech partner, pooled their research discoveries and scientific knowhow to win this award from the National Institute of Allergy and Infectious Disease. The grant was awarded under the funding opportunity called “Partnerships for Development of Therapeutics and Diagnostics for Biodefense,” which encourages collaboration between laboratory researchers in academia and an industry-partner to develop drugs, vaccines, technologies and diagnostics to respond to threats presented by bioterrorism and emerging infectious diseases. The funding came at a perfect time for this group.

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Left to right: Sergei Kotenko, PhD, Russell Durbin, PhD, and Joan Durbin, MD, PhD

Just ask Vince Smeraglia, executive director of Rutgers’ Office of Technology Commercialization. He was so impressed by Kotenko’s research that he asked him to present his findings at a New JerseyPennsylvania conference of biotech companies. Not only did Kotenko win the award for best poster presentation, but a biotech company showed immediate interest in developing interferon (IFN)-lambda3, a discovery “with the potential to become a blockbuster drug,” according to Smeraglia.

Interferon alpha and beta are well-known superheroes in the battle against certain hard-to-combat viruses, like hepatitis B and C, and cancers, such as leukemia, lymphoma and melanoma. Interferon beta is also used to treat multiple sclerosis, an autoimmune disease. Interferon was discovered more than 50 years ago, but first became commercially available in 1986. (Commercially available interferon is predominantly manufactured using recombinant DNA technology.) But it took a scientist long-schooled and practiced in this field to look for and find a new type with new properties —when few researchers believed there were any more types of interferon to be discovered.

Kotenko, a professor of biochemistry and molecular biology at Rutgers New Jersey Medical School (NJMS) and a researcher with a decades-long portfolio in interferon research, was awarded a patent —in partnership with the university — for IFN-lambda3 in 2010. His research team, collaborating with investigator Grant Gallagher, PhD, identified three novel, closely related interferons, named them IFN-lambda (IFNlambda1, IFN-lambda2 and IFN-lambda3), and discovered that “this 28

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new type of interferon signals through a different receptor complex than interferon alpha and beta, yet its antiviral action is similar.”

“Interferon lambda has strong antiviral activity, like interferon alpha,” Kotenko explains. “But interferon alpha acts on all cells of the body, resulting in serious side effects.” The researcher says IFN-lambda has been shown to cause fewer and milder side effects and is produced in the body mainly in mucosal and epithelial tissue (which covers the body and organs, lines the body’s cavities and forms glands).

“This is where you need the most antiviral protection because this is where most viruses enter the body,” he states.

Interferon works by boosting the body’s innate immune response to infectious agents and cancers. “In animal studies, this interferon also has strong anti-tumor properties,” he says.

The work is moving along rapidly. It is now the beginning of year two of the five-year grant. Smeraglia says in order to make the protein more usable as a medicine, IFN-lambda3 needs to be modified and produced according to good manufacturing practice (GMP) guidelines for drug production established by the FDA. The team is concentrating on that aspect now.

Kotenko’s finding is big. IFN-lambda1 was discovered by two groups at the same time and is currently being developed by Bristol Myers Squibb. The researcher says: “IFN-lambda3 has the strongest antiviral potency amongst IFN-lambda. Also, the interferon produced by recombinant technology mimics the IFN-lambda3 produced by the body. Our product may be better.”

JOHN EMERSON

Kotenko’s NJMS group continues to investigate the many interesting aspects of interferon lambdas. “Some of the biology is not well known,” he explains. “As we work, more questions and research directions emerge.”

High on the researcher’s list of exciting prospects is the potential for IFN-lambda3 to play a role in biodefense. “We want to find out how well it protects against respiratory and gastrointestinal viruses,” he says.

“It may work as a preventative against respiratory viruses such as SARS

and pathogenic flu viruses and could also be effective as a treatment after infection with a virus.”

IFN-lambda3 may be a new player on the pharma scene, but its potential is huge.

In fact, it could be the next “wonder drug”— perhaps even serving as a prophylactic to flu during the flu season. Meanwhile its inventor continues to humbly toil in the NJMS labs each day, working to find out just how far-reaching IFN-lambda3’s medicinal effects might be. ●

Is There a Silver Lining to the Devastation of Superstorm Sandy?

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ost New Jerseyans have nothing good to say about Superstorm Sandy. But Sergei Kotenko is among the few who do.

The force of Sandy drove a brilliant scientist to his door and changed his research team for the better.

Joan Durbin, an experimental pathologist with an MD/PhD from Rutgers Robert Wood Johnson Medical School and Rutgers Graduate School of Biomedical Sciences, and her husband Russell, a virologist who often partners with her on research, were firmly ensconced at New York University when Superstorm Sandy hit this area on October 29, 2012. “Our labs were hit very hard,” says Durbin. “We lost our mouse strains and all our cell lines. Years of work were destroyed. It was tough.”

Life did not return to normal in their building after the storm subsided. Researchers scattered—looking for suitable space to continue their work. The Durbins came to RBHS Newark, where they first moved into temporary quarters and then were invited to stay. They accepted.

“There is a big emphasis on immunity to pathogens of all kinds here, particularly respiratory pathogens. I have worked on respiratory pathogens for a long time and knew a lot of the people from meetings. I have a big group of colleagues here,” she says.

There was one colleague in particular whom she wanted to know better. “I had read about Sergei Kotenko’s discovery and knew his finding was huge,” she says.

In fact, Durbin herself had done years of research on alpha interferon. She was interested in the question of why influenza causes such a strong interferon response, but respiratory syncytial virus (RSV), an infection that most often strikes children but can also infect adults, does not. “There’s no vaccination for this disease.

It’s a big problem. We wanted to know why RSV is so good at evading or inactivating the interferon response,” she says.

She was anxious to meet, and possibly work with, Kotenko; and when that meeting happened, it proved fortuitous. Their

JOHN EMERSON

shared interest in the unique role of lambda interferon in lung and epithelial cells cemented a partnership that has already yielded a major grant and may soon win another.

“There are so many questions to be answered,” says Durbin.

“Lambda interferons probably have a unique role in the portals of the body. They have to turn on quickly and turn off quickly. What is their role in regulating immune responses?”

It is the basic biology of lambda interferons that intrigues her.

“Lambda is induced where alpha can’t be,” she says. “But why does the body need two interferon systems with distinct functions? These interferons are so important that the body did it twice.”

Durbin’s enthusiasms are many. She has funding to develop a vaccine against RSV, which she hopes can also serve to protect against otitis media, or middle ear infections, a major source of misery for many children. Otitis media is often the result of viral plus bacterial infections, she says. She is excited about working with Kotenko and gaining a better handle on the anti-proliferative effects that interferon has on many cell types.

But Durbin is also a pathologist and in that role she helps researchers get specimens that are useful. “I see myself as a resource in experimental pathology,” she says, “and, in return, I get to work with people outside of my sphere.”

Her hospital work also means that she continues to be involved with clinical disease. “It reminds me that there is so much that is inexplicable in the human condition,” she comments.

“A researcher’s work is hypothesis driven. You see something you don’t understand, you devise a theory and you test it,” she says. “As a physician, you can’t make an assumption. You proceed along a certain methodology and come up with a hypothesis at the end.

When you work at an intersection of the two, it’s great!”

And in her new professional life at NJMS, lambda interferon is never far from her thoughts. “There are some powerful antivirals, but our bodies develop resistance very quickly. Interferon lambda is natural and it doesn’t make you as sick as alpha,” she says. “If only we could develop lambda 3 into a broad-based antiviral, then the world would be a much better place to live.” ●

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Anne Mosenthal, MD

Woman at the

TOP

By Eve Jacobs Effecting positive change as a surgeon, teacher, researcher and leader. Serving as a role model for future surgeons — female and male. Providing comfort and direction at the bedside of critically ill patients and their families. Flying in the face of old established traditions that no longer work. And, of course, teaching future surgeons the art and science of surgery. That’s what Anne Mosenthal is about. She says hard work and supportive and amazing partners are the reasons she has excelled.

It’s 2014 and there are still only six women surgery chairs in all 141 medical schools in the U.S. Anne Mosenthal is one of them. As the recently named head of the Department of Surgery at Rutgers New Jersey Medical School (NJMS), she is a living, breathing example of the changing face of this specialty. Was her goal to climb the steep ladder to the very top of a male-dominated field? Absolutely not, she says. “I set out to become a trauma, critical care surgeon.” Is she happy to be there? Oh yes, she smiles.

Mosenthal exudes quiet determination and focus, but she’s nothing like the archtypical hospital surgeon of bygone days. “The old ways of a single man at the top of a department or operating room just don’t work anymore,” she says emphatically. “It’s about building a strong team.”

That is exactly what she has set out to do in her leadership role at JOHN EMERSON

NJMS and as a member of the highly touted University Hospital Level 1 Trauma Center surgical team that has earned a remarkable reputation for saving those torn up by guns and near-fatal car wrecks. This woman of action, a 1985 graduate of Dartmouth Medical School, says there were just 15 women in her class of 65, and “less than a handful of them chose surgery.”

“Surgery is not for women,” she remembers being told. “Well, maybe plastics.” But plastic surgery did not interest Mosenthal at all.

She wanted the pace and demands of “taking care of really sick and critically injured patients” and she wanted an academic career as well.

“When I was a medical student, my sense was that women in surgery were pariahs, that they were taken less seriously than men, but I was determined to defy the stereotypes,” she states.

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And defy she did — with eyes wide open. She applied to be a surgery resident but remembers worrying if a “quiet, unassuming person,” like her, would be accepted by “the classic surgical personality of the time — confident, arrogant, never in doubt, usually right.” Lucky for her, the University of Massachusetts Medical Center, where she was accepted into a general surgery residency, “was very tough, but it was very tough for everybody.”

She amends her statement a little: “It wasn’t professionally harder for women, but it was personally harder. Many of the men were married, and some had children, but very few of the women were married and none had children.” With no limits on hours and “on call” required every other night, Mosenthal says a social life was next to impossible.

Three of her fellow female surgery residents dropped out, leaving just two women in her year. “It would have been much harder if we didn’t have each other,” she says. The department had just one female faculty member at the time.

“When I was a medical student, my sense was that women in surgery were pariahs, that they were taken less seriously than men,” says Mosenthal.

“I was determined to defy the stereotypes.”

Mosenthal finished her residency in 1990 and fellowships in critical care and surgical endoscopy in 1992, and was recruited to NJMS in that year by founding chair of the Department of Surgery, Benjamin Rush, MD. She describes him as a visionary, ahead of his time in recruiting talented women and minorities into the department long before other medical schools.

Life was busy. Not only were the surgeries long and challenging, and the teaching responsibilities demanding, but by this time Mosenthal, now in her 30s, was married to surgeon Peter Rice, MD, and they were thinking of starting a family.

“It’s hard for women in surgery, particularly in the surgical specialties,” she says. “The training is so long and women are just not ready to give up their childbearing years.” She comments that there is an ongoing perception of surgery being more brutal than the other specialties, but “what is true is that the training for all surgical specialties is more demanding in terms of time.”

When her own children came along in the mid- to late-’90s, the pace of her life became even more dizzying. “There were many times 32

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that I was gone from home for 36 hours at a time. If it hadn’t been for my husband, who provided a lot of child care and took care of everything when I wasn’t there, I would not have made it,” she states.

“This kind of partnership is rarely talked about, but it is such a crucial element of success for women in demanding professions,” she says.

Professional camaraderie during the working years is difficult to find for women surgeons, comments Mosenthal. “There are way fewer women than men who are colleagues who have a home life and children.”

Over the years, she developed that camaraderie with fellow trauma surgeons, primarily men. But it was her professional partnership with Patricia Murphy— an advanced practice nurse with a doctorate in ethics and bereavement — and their creation of a palliative and endof-life care program that took her career in a new and personally satisfying direction. Launched in 2000, the program answered a huge unmet need of critically ill patients and their families and helped to define Mosenthal as a pioneer and a surgeon whose humanity would consistently be front and center.

“I have always liked to converse with patients and answer their questions, but I felt unprepared to handle bereavement and the sudden life changes of trauma patients and their families,” she says. “In reality, 13 percent of our trauma patients admitted to the surgical ICU will die, many with unknown pain and suffering at the end of life, and many with families in crisis.”

“Other patients will go on to have significant disability and impaired quality of life,” she continues. “We saw that components of palliative care — such as relief of pain and symptoms, good communication, bereavement support and appropriate withdrawal of life support — are essential to the care of trauma patients.”

“This has become one of the great services we offer here,” Mosenthal says, “and it is one of my greatest contributions.”

The program — adopted in hospitals throughout the country— helped to propel her into a leadership position locally and nationally. In 2011, she was asked by NJMS Dean Robert Johnson to lead the strategic planning process for the medical school, a “very exciting effort” that lasted a year and a half and “taught me the power of building a team.

We had a lot of different people on the team and a lot of opinions, and our charge was to bring it all together,” she says.

Whether taking care of patients or working with a health care team, Mosenthal’s style is participative and inclusive, and she strives to be “direct, transparent, honest and fair. ” This trauma surgeon calls surgery “the most intimate relationship.

Patients put all their trust in the surgeon.”

“There have been studies showing that women interact differently with patients — they listen more and it’s better for the patients,” she states. “Women bring that to the practice of surgery.”

“And women are better at relationships,” she says. “The critical mass of women who have gone through medical school in the last number of years has already changed the practice of medicine. Surgery is bound to follow suit.” ●

ALUMNI FOCUS

news of special interest to njms and gsbs graduates

Message from the

Alumni Association President

PAUL BOLANOWSKI, MD’65 ALUMNI ASSOCIATION PRESIDENT

Dear fellow alumni,

I

wrote my first letter to you shortly after the integration with Rutgers University that occurred on July 1, 2013. Since then, while discussions continue with the Dean’s Office and the Rutgers University Foundation regarding our future relationship with them, the NJMS Alumni Association has maintained its dedication and commitment to the work that we have supported for the past 30 years.

We continue to fulfill our mission and concentrate our efforts on our primary focus, which is the support of our medical students through scholarships and sponsorship of student programs. Over the past few years, despite economically challenging times, we are proud that the Association has successfully supported an average of $150,000 in scholarship awards that benefit more than 100 students each year. I extend my sincere thanks to our alumni who have generously ANDREW HANENBERG

supported the scholarship program in the past and continue to do so now. It is these committed alumni who deserve the credit for our accomplished history of providing support to our medical students and to the university.

In addition to being president, I also have the pleasure of serving as chair of the Alumni Association Scholarship Committee. When I read and review the student scholarship applications and essays, I am always impressed by the caliber of students we have at NJMS. Many of them not only excel academically and match in some of the most competitive and desirable residency programs, but also actively participate in many SHARE (Student Health Advocacy Resources and Education) service groups that facilitate learning opportunities in community health and educational outreach programs in Newark and surrounding areas.

One of the SHARE groups that the Association supports is the Student Family Health Care Center (SFHCC). Involvement in this group is an opportunity for the students, under the supervision of faculty, to learn from one another and provide free health care to underserved members of the Newark community. Upon graduation, our students are thankful to have received a quality medical education that not only prepares them for their residency and beyond, but also teaches humanism in medicine and the importance of serving the community.

This year our scholarship program boasts 49 Endowed Scholarships and 33 Named Scholarships, in addition to the International Study Scholarships for first- and fourth-year students and Summer Student Research Grants that are also awarded annually. With the rapidly rising costs of education, I would like to encourage all alumni to join me in the support of our scholarship program and Annual Fund, and help us make a difference

in our students’ lives. No matter how big or small your donations may be, each one counts and enables the association to assist and impact our much deserving student body as they pursue their dreams of becoming physicians.

I am always available to talk and encourage alumni to contact me, or the Alumni Office staff, with questions about our scholarship program or to become involved in the Alumni Association in another way. I can be reached through the Alumni Office at 973-972-6864. ●

LIFETIME MEMBERSHIP

Scholarship Opportunity

The Alumni Association of New Jersey Medical School is proud to announce the creation of The Alumni Association of the New Jersey Medical School Lifetime Member Endowed Scholarship. This scholarship was made possible through the generosity and commitment of our Alumni Association Lifetime dues members. This is a permanent scholarship that will provide financial support, through Alumni Association Scholarships, to Rutgers New Jersey Medical School students for perpetuity.

Alumni Association Scholarships are awarded annually to medical students in recognition of academic achievement and community service. The Alumni Association invites New Jersey Medical School alumni to support this permanent scholarship with a $1,000 membership payment. To add your name to the 196 initial supporters, or for more information, please contact Dianne Mink or Emily Birkitt in the Alumni Office at 973-972-6864.

RUTGERS NEW JERSEY MEDICAL SCHOOL

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ALUMNI EVENTS NJMS Alumni Association Celebrates

Golden 50th Reunion Weekend Members of the class of 1964

On the weekend of May 2 – 4, the Alumni Association had the pleasure of celebrating a Golden 50th anniversary class — the class of 1964, which began with 76 medical students. In 25 years, class size more than doubled. The class of 1989, which gathered as well to celebrate their milestone 25th anniversary, graduated 157 doctors. Alumni traveled from near and far to celebrate and reconnect with friends and colleagues.

Two alumni lectures, a luncheon and campus tours kicked off the weekend on May 2. Glenn Fennelly, MD’87, chair of the Department of Pediatrics at Rutgers New Jersey Medical School, delivered the 25th Annual Stuart S. Stevenson Memorial Lecture for Pediatric Grand Rounds; and the 46th Annual Harold Jeghers, MD, Memorial Lecture was given by Steven Dubinett, MD’80, chief of the Division of Pulmonary and Critical Care at UCLA’s David Geffen School of Medicine.

A personalized tour of the Montclair Art Museum was the featured activity on Saturday afternoon. Saturday night’s Gala Dinner started off with an elegant display of wines and pairings and the rare opportunity to taste and learn about wines from various 34

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regions. Guests enjoyed dinner, dancing, and lots of reminiscing.

The Alumni Association has taken pride in honoring alumni, faculty and friends for their contributions to the medical school since 1971. This year’s recipient of the Distinguished Professor Award is Dorian Wilson, MD’82. This annual award recognizes an NJMS professor for outstanding dedication to teaching New Jersey Medical School students. As a physician, he has shown great respect, sensitivity, and commitment to his patients, and as director of the Center for Humanism in Medicine at NJMS, he conveys to students the importance of caring for the entire patient.

Wilson’s parents and son Brennis were pres-

ent to see him receive this special honor.

Joseph Benevenia, MD’84, chair of the Department of Orthopaedics, received the Charles L. Brown Award. This award, dedicated to the memory of the first dean of the medical school, is given to an individual who has made outstanding contributions to NJMS and who has demonstrated the high ideals exemplifying the medical profession.

His family, friends and colleagues joined in the celebration as he was honored for his dedication to teaching and patient care.

The Honorary Alumnus Award, the highest honor given to a non-alum, was presented to Purnima and Shailesh Shah in recognition of their generous support of medical students through establishment of an endowed scholarship. This permanent scholarship benefits NJMS students as they pursue their dreams of practicing medicine and making a difference in their communities. The Shah’s children, Kushyup, Ravi, and Radhika, all aspire to become doctors and earn their degrees at NJMS. Ravi and Kushyup are current students and will be graduating in 2015 and 2016. Radhika will join her brothers at NJMS this fall, after she receives her pharmacy degree at the University of the Sciences in Philadelphia.

More recent graduates and future alumni were also on hand to celebrate the honorees, meet graduates of years past and learn what life has been like for practicing physicians.

Alumni President Paul Bolanowski, MD’65, looks forward with great anticipation to celebrating his 50th reunion. Please join him in his effort to bring as many of his classmates together as possible. He welcomes your ideas and participation and hopes to hear from you. To contact him, call the Alumni Office at 973-972-6864. ●

Members of the class of 1964

Dr. Joseph Benevenia receiving his award from Dr. Paul Bolanowski

Dr. Dorian Wilson with parents Wilbur and Owena Wilson

The Shah family

Residents, guests, and future alum Bonnie Buechel’17, seated center

PETER BYRON

RUTGERS NEW JERSEY MEDICAL SCHOOL

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ALUMNI PROFILES EL IZ A BETH ALG ER, M D ’6 4

Alger’s Amazing Adventure

BY MARYANN BRINLEY

T

he distance from Newark, NJ, to Doha, Qatar, is 6,678 miles but Elizabeth Alger, MD’64, made it with ease flying every two weeks for three months in 2004. In fact, that was the summer she officially retired from NJMS. It was hardly a time of relaxation or withdrawal from the professional adventures that had kept her engaged and excited for 45 years.

“You go from New Jersey Medical School to the Middle East when you are lucky enough to have your phone ring with the of-

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fer of an amazing opportunity,” she explains.

The invitation from Weill Cornell Medical College to help set up the only American medical degree program offered abroad came via a headhunter. She didn’t dare hang up.

“At that point, I had been out of the dean’s office for three years.” She had been associate dean of education for 20 years, where she coordinated the initiative to revise the curriculum and update teaching methods. “I finally had some time for myself,” she recalls.

Curriculum consultations spent in far-flung

places like Egypt, Thailand, Uganda, and Indonesia had given her a taste for international travel. But the thought of moving overseas at age 65 was another matter.

Her destination for the next six years? Not a piece of geographic or professional cake by far. Not only was she pressed for time on this project — the school had to be up and running in less than three months — but the position itself also had its challenges. Qatar is a desert peninsula of 5,000 square miles where economic activity had centered on camel breeding, fishing and pearl diving until the 20th century, when the discovery of oil and gas reserves put it at the top of the list of the world’s highest per capita countries. She would soon be living in a 4,500-square-foot villa on a lagoon and flying business class.

She is often asked if she had to wear a long, black abaya and head scarf or shayla. “No,” she replies, “just modest western clothes.

The abaya is considered national dress and is worn with a great sense of style, often with embroidered cuffs and matching designer shoes and handbags.” While she would be making other cultural adjustments, “The Qataris were extraordinarily polite, warm and hospitable.”

In spite of the rush and the distance from home, Alger was excited about the possibilities. “This was a start-up with a broad job description that included student affairs and faculty development. They were things I had done. I also had a lot of respect for the Cornell curriculum and faculty. Such good people to work with. It was just amazing how so much of what I had learned and experienced in my career at NJMS would translate to Qatar.”

She was so determined to make this new position work that at first she juggled two jobs, flying back and forth between Newark and Doha that first summer. It was June and “the first medical school class in Doha was scheduled to start in August. I had to interview and select prospective students who came from throughout the Middle East along with getting everything else set up.”

Continued on page 39

ANDREW HANENBERG

G ER AR D MALAN G A, MD ’8 7

Non-Surgical Solutions to Sports, Spine and Orthopaedic Injuries

BY TY BALDWIN

G

erard Malanga, MD’87, chose his career in medicine after a chance accident at the Jersey shore that could have left him paralyzed. He was a junior in college at the time. “While bodysurfing, I dove through a wave and hit a sandbar with my head,” he recalls. “I broke my neck and was transiently quadriplegic. Some parts came back more quickly than others, but I didn’t move my right hand for about three weeks.”

That accident was a transformational experience for Malanga, who is a clinical professor of physical medicine and rehabilitation at NJMS and a founder and partner of New Jersey Sports Medicine and New

COURTESY OF GERARD MALANGA

Jersey Regenerative Institute (both in Cedar Knolls, NJ). “I could have drowned or been permanently paralyzed,” he says. “It’s just the grace of God that spared me a lot of things.”

Malanga grew up in Montclair, NJ, the son of Italian immigrants who’d come to the U.S. from farming villages just south of Naples. He always enjoyed the sciences and as a high school student, considered a medical career, but it was just one option among many. After his accident, however, Malanga made his decision. He returned for his senior year at Villanova University and matriculated at NJMS the following fall.

“Initially, I had thought I would go into pediatrics,” he says. “But I wasn’t sure. I was interested in neurology and also liked some aspects of orthopaedics. One of my classmates was interested in physical medicine and rehabilitation, and he told me about it and gave me some information. At that time, the field was not well-known, but when I learned more about it, I knew that’s what I wanted to do.”

After graduating from medical school, Malanga did a year-long internship at Morristown Memorial Hospital, returning to NJMS for a three-year residency in physical medicine and rehabilitation. A fellowship in sports medicine at the Mayo Clinic led to his joining the staff there, and he stayed in Minnesota for the next three years.

One of Malanga’s former mentors recruited him to return to NJMS and the Kessler Institute for Rehabilitation (an NJMS affiliate) in 1996. He’s currently a

clinical professor of physical medicine and rehabilitation at NJMS. “I wanted to come back to New Jersey to practice and teach,” he says. “It’s something I really enjoy.”

Atlas of Ultrasound-Guided Musculoskeletal Injections, Malanga’s most recent book, was published earlier this year.

“Historically, physicians have injected a variety of areas — joints, tendons, ligaments,” he says. “We’ve always done it by feeling around and thinking we know where we are. But the research shows that, doing it that way, we miss our target up to 30 or 40 percent of the time.”

Over the last five years, ultrasound technology has greatly improved. Visual imagery has been enhanced, and the machines themselves are smaller and more affordable, so that now they’re more readily available in physicians’ offices.

“With ultrasound, you’re able to actually watch the needle go exactly where you want to place your medication,” Malanga explains.

“It enables you to be highly precise, to make sure you get the medicine where you want it, and not where you don’t. This textbook is the first to include all these different procedures.”

The most common sports injuries, Malanga says, are to the tendons. “The treatment for such injuries has changed dramatically over the past few years and is still changing. We used to inject cortisone. We’d do that just based on touching a spot and putting a needle into it.”

But recent research has shown that cortisone can be harmful to tendons. “Now we’re able to use people’s own growth factors — something called platelet-rich plasma — and, with ultrasound guidance, we can inject problem areas and deliver these growth factors precisely where they’re needed to reduce pain and inflammation and help heal the tendon.” From Olympic and professional athletes all the way down to weekend warriors, “these treatments have become real game-changers for patients at all levels.” ● RUTGERS NEW JERSEY MEDICAL SCHOOL

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ALUMNI PROFILES

Y V O N NE FAR NACI O , M D ’0 9

A Career That Fits

BY EVE JACOBS

Y

vonne Farnacio was a high school and college science star who rolled into medical school with no worries. She positively excelled at the basic sciences in her first two years at Rutgers New Jersey Medical School (NJMS) and sailed through Step 1 of the Boards (United States Medical Licensing Examination) that students generally take at the end of year two. But not one of the clinical specialties in her third- and fourth-year rotations called to her. She was lost.

“I almost quit medical school in my fourth year,” she remembers. Instead, she turned for advice to her friends and immediate family (all nurses — mother, father, sister and brother) and they all told her to apply for a residency in internal medicine, where she would have a lot of options. She did that and was accepted at Rutgers Robert Wood Johnson Medical School (RWJMS) in New Brunswick for a one-year internship.

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It was during that year that she first learned about the preventive medicine/public health residency at NJMS. She applied and was accepted; and started the program in July 2012. It proved to be a good fit. “I am very interested in chronic disease and injury management, particularly prevention— but I didn’t know this residency program or specialty even existed,” she says. “Our medical system is not structured to prevent disease.” She completed the residency program in June 2014.

Farnacio was the third resident to choose an eight-week integrative medicine rotation jointly offered by NJMS and the Rutgers School of Health Related Professions as part of her NJMS residency program. “I didn’t know what integrative medicine was when I started,” she states. “What I learned is that it’s not yoga or acupuncture or what we typically think of as alternative medicine. It’s about

working with patients and their caregivers to deliver a full range of therapies — psychological, social, physical, preventative. It’s really an approach to patient care that is different from what most physicians are accustomed to.”

She points out that some physicians are so focused on physical symptoms that they may miss some things that a patient is trying to tell them. “And patients are shy to discuss what’s really going on in their lives — and what other therapies they are trying. Most people in the U.S. use some nontraditional care,” she says.

Farnacio advocates incorporating emotional and social well being, values and patient perspectives into the health care treatment plan. “If a patient wants to use an alternative or complementary therapy, physicians need to try to understand that,” she comments.

The integrative medicine rotation will change the way she practices medicine — she is quite sure. “When I meet patients, I’ll first ask what matters to them,” she muses. “For instance, you can’t just tell an overweight person to lose weight. It won’t usually work.

Now, I would try to incorporate patient values into motivating behavior changes. If the person is very family-minded, I might suggest that weight loss could translate into more years to spend with grandchildren.”

She points out that preventive medicine doctors are the lowest paid, but have the most job satisfaction and are the least likely to burn out. For Farnacio, the opportunity to spend the time to get closer to her patients is pivotal to her choice of specialties.

“In occupational medicine, I think that will be possible,” she says. “I also like the detective work — being out in the field investigating a disease cluster or outbreak.”

Farnacio started a two-year fellowship in occupational medicine — a subset of preventive medicine — at RWJMS in July. Occupational medicine focuses on preventing, evaluating, and treating health issues caused by the workplace environment.

“I didn’t think I could fit into the health care environment and the role of being a doctor,” she concludes, “but now I do.” ● K E I T H B R AT C H E R

CLASS NOTES Elizabeth Alger Continued from page 36

The most pressing task was replicating the Cornell New York curriculum hour for hour, activity for activity. The clinical skills lab had to be renovated and a standardized patient program set up. The pathology professor tackled the enormous job of scanning hundreds of microscope slides so students could access them by computer. “We also had to arrange for lectures to be sent by streaming video or for faculty to visit from New York.

It was such a scramble but the nicest thing about it was that everyone was so committed to making the program work. I didn’t need to beg for anything to get done and the speed with which it all happened was amazing.” They started with 18 students and class sizes are now in the mid-40s.

When the Qatari students were ready for clinical training in a hospital at the end of year two of med school, Alger realized that local physicians weren’t experienced in American teaching methods. She reached out to Stanford because it had the best clinical faculty training program. “I looked at their model and wrote to the director explaining what had to be done and fast.” In her letter, Alger asked, “How would you like to train six of us here in Qatar for a month?” The reply: Of course.

Doing workshops with physicians at the hospital was great fun. “They had a wonderful sense of humor and there were lots of laughs during the role-play scenarios,” she recalls. Few of the hospital physicians are Qatari although that will change as the Cornell graduates join their ranks. Most doctors in Qatar come from elsewhere in the Middle East and having done postgraduate training in the United Kingdom or the U.S., English is the common language. Some are longtime residents of Qatar while others, like Alger herself, are on short-term contracts. “The different backgrounds of the people I worked with made the time there so much richer.”

Friendships were close between Alger and

her colleagues, Ibrahim and Samar, who ran the clinical teaching workshops. When she and two Qataris went to Stanford in 2008 for a refresher course, the three made an overnight road trip to Yosemite National Park. “Ibrahim took over driving and after a stop for junk food, he turned the radio dial until he found a country music station.”

Later, Alger learned that he had done his fellowship in Texas. And when they returned to Doha, Alger was invited later to the wedding of Samar’s niece, which offered her “a glimpse into a highly privileged lifestyle.”

The last time the three met was in 2010 but they still exchange greetings at holidays.

“They wish me Merry Christmas and I wish them a Blessed Eid,” she says.

At age 75, Alger is still a wise presence on the Newark campus where she teaches as a clinical professor of medicine. Looking back on her adventures, she says, “You can’t call medicine just a career. It’s a stepping stone to so many other possibilities, to anything.”

For her, Qatar was the high point. “It was uniquely rewarding and offered so much.” ●

1960s William Boutelle, MD’67, writes that he retired from the position of Chief of Staff at the Northampton, MA Veterans Administration Medical Center in 2005. He has since been working as a general psychiatrist at ServiceNet in Northampton and as a geriatric psychiatrist for New England Geriatrics.

James F. Mayhew, MD’69, who practices in Jackson, MS, is double board certified in anesthesiology and pediatrics, and just recently became a Lifetime Member of the Alumni Association–NJMS. Charles F. Mess, MD’64, and wife Marilyn, of Olney, MD, traveled to NJ to celebrate the 50th Anniversary and wrote us to say that they had a truly great time.

James Phelan, MD’68, continues to teach Advanced Trauma Life Support and has an adjunct professorship at the University of Texas Medical Branch at Galveston, TX, teaching Aerospace Otolaryngology.

Leo M. Pisculli, MD’60, writes that he is still practicing at the age of 80.

1970s Serena Friedman, MD’75, and husband Michael are the parents of four daughters and are producing wine at the Four Sisters Ranch in Paso Robles, CA. They also lecture on the health benefits of wine.

1990s Join the Alumni Association of

New Jersey Medical School General Dues

$75.00

Resident in Training

$15.00

Lifetime Membership

$1,000.00

Visit njms.rutgers.edu/alumni, click on Alumni and Alumni Association and then Online Dues Payment to pay your dues online.

The Lifetime Membership is being offered to our alumni as a means to perpetuate the goals of the Alumni Association and enable its members to sustain their support in a more meaningful way.

All categories of membership will afford you the opportunity to keep connected with us. You will continue to receive all membership benefits, including Pulse magazine, information about upcoming events and reunions, and on-site library privileges.

Alumni Association of NJMS, 185 South Orange Avenue, MSB–B504, Newark, NJ 07101–1709.

Photos are welcome. You can also send your news via e-mail to: njmsalum@njms.rutgers.edu or fax us at 973-972-2251.

Carla Martin, MD’97, is a med-peds physician at the Blackstone Valley Community Health Center in Pawtucket, RI, working with the underserved. She has 6-year-old twin sons and a 9-year-old daughter.

2000s Imran Khan, MD’04, PhD, has been promoted to medical director at Janssen Research & Development LLC, of Johnson & Johnson, in Raritan, NJ. Dr. Khan is also an admissions interviewer for NJMS.

IN MEMORIAM Ken B. Carnevale, MD’94, passed away in November 2013. He practiced ophthalmology with Ophthalmic Consultants of Long Island and was an assistant clinical professor of ophthalmology at the New York Presbyterian Hospital in Manhattan. As a student at NJMS, he was elected to the Alpha Omega Alpha Honor Medical Society. He is survived by his wife, Sima, and two daughters.

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focus on philanthropy

Bringing Health Care to the Homeless

BY CYNTHIA M C CHESNEY

I

n 1984, a small group of Episcopal churches from Newark and the suburbs joined together to help found The Apostle’s House, a shelter dedicated to the needs of homeless women and their children. (It has since developed into a full social services agency.) Thirty years later, one of those churches, Christ Church in Short Hills, is beginning a unique collaboration with Rutgers New Jersey Medical School (NJMS) and other community partners to make it possible to provide homeless women and children with on-site primary and preventive health care services at the shelter. Named “The House Calls Project,” it will operate as a satellite of the medical school’s Student Family Health Care Center (SFHCC).

The idea originated about a year ago when Josephine Orrico, then a second-year NJMS medical student and volunteer at The Apostle’s House, chatted with a fourth-year student who had helped set up and organize a satellite clinic at Fairmont Health Services, a homeless shelter.

Orrico, who volunteered at The Apostle’s House as part of the NJMS Humanism Center’s studentoutreach activities, realized that with some work, a similar satellite could be set 40

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From left to right: Josephine Orrico, NJMS Class of 2015, Reverend Tim Mulder of Christ Church, Cynthia McChesney, formerly of Rutgers University Foundation, and Judy Bennett, executive director of The Apostle’s House, in one of the newly refurbished patient rooms. Orrico and Bennett are holding tiles created by children from both the shelter and the church that are part of the church’s fundraising efforts for this program.

up at The Apostle’s House — and in this case it could serve pediatric patients, as well as their mothers. Orrico took her idea to Cynthia McChesney, formerly of the Rutgers University Foundation, and together they started to plan.

A few months later, Orrico and McChesney, together with Judy Bennett, executive director of The Apostle’s House, went to Christ Church in Short Hills to present the plan after the Sunday service. Some of the parishioners had been part of the shelter’s founding 30 years before, so there was already some interest. But when the group heard about Orrico’s idea from the student herself, the excitement grew.

Several members of the church made donations that same day.

Within a few weeks, the church— through a commitment of outreach grants and proceeds from a rummage sale — had pledged more than $25,000 to help get the

program started. Before long, other community supporters appeared, all attracted by the vision of medical school students providing primary and preventative health care services to homeless mothers and their children. One of those community groups, the Carpenter’s Club — a group of expert craftsmen and craftswomen — volunteered their time to do all of the renovations, from painting to carpentry, for free.

Renovations were recently completed, and later this summer, the first “House Calls” will begin. “This was a wonderful way for our church to help change lives in Newark by providing seed money to get this program started,” says Dr. Timothy Mulder, rector of Christ Church, “and it’s so exciting to see what can be created when different groups work together toward a common purpose.”

Fundraising in support of this outreach program to the homeless continues and is necessary in order to fund ongoing physician supervision. To donate to the house calls program, go to http://support.rutgers.edu/ housecalls or contact Dale Evanson at 973-972-9474. ●

ThE paTh is slighTly DiffErEnT. ThE gOal is ExaCTly ThE samE. New Jersey Medical School is now part of one of the nation’s largest research universities, a move that enhances the school’s core mission of innovation and excellence in education, discovery, patient care, and community service.

When you give to the medical school, you can still designate your gift to support the same programs and initiatives. And now your contributions, which are channeled through the Rutgers University Foundation, also support Our Rutgers, Our Future, the university’s historic $1 billion fundraising campaign.

Contact Dale Evanson at 973-972-9474, Or visit support.rutgers.edu/rbhs to learn more.

185 South Orange Avenue Newark, New Jersey 07103 http://njms.rutgers.edu

Match Day 2014

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