Utilizing MRI to Measure Blood Flow Over Atherosclerotic Plaques May Aid in Detection of Dangerous Plaques
(Boston) – Researchers from Boston University School of Medicine (BUSM) have shown...
Utilizing MRI to Measure Blood Flow Over Atherosclerotic Plaques May Aid in Detection of Dangerous Plaques
(Boston) – Researchers from Boston University School of Medicine (BUSM) have shown that using magnetic resonance imaging (MRI) to measure blood flow over atherosclerotic plaques could help identify plaques at risk for thrombosis. The findings, which appear in the March issue of Circulation Cardiovascular Imaging, offer a non-invasive application in the diagnosis and treatment of patients with atherosclerosis.
Dr. Hamilton
Atherosclerosis is a chronic disease of the human vascular system associated with lipid (cholesterol) accumulation and inflammation. It can remain silent and undetected for many years, but can cause acute cardiovascular events such as stroke or heart attack. This often occurs when a high-risk, dangerous atherosclerotic plaque disrupts at the vessel surface facing the blood, followed by partial or complete blockage of blood flow through the lumen by a thrombus. An unmet challenge of diagnostic medicine is to find such plaques before disruption occurs in order to prevent these occurrences.
While most studies have focused on the plaque within the vessel wall, the flow of blood in the vessel (hemodynamics) also is known to be important in the progression and disruption of plaques.
In this study the researchers, led by James A. Hamilton, PhD, professor of biophysics and physiology at BUSM, found that the measurement of endothelial sheer stress (ESS), which is the indirect stress from the friction of blood flow over the vascular endothelium surface, can identify plaques in the highest risk category. After performing a non-invasive MRI examination of the aorta in a preclinical model with both stable and unstable plaques, a pharmacological “trigger” was used to induce plaque disruption. Low ESS was associated with plaques that disrupted and had other “high-risk” features, such as positive remodeling, which is an outward expansion of the vessel wall that “hides” the plaque from detection by many conventional methods.
These results are consistent with previous studies that examined coronary arteries of other experimental models using invasive intravascular ultrasound method to measure features of vulnerability but without an endpoint of plaque disruption, which is the outcome of the highest risk plaques.
“Our results indicate that using non-invasive MRI assessments of ESS together with the structural characteristics of the plaque offers a comprehensive way to identify the location of “high-risk” plaque, monitor its progression and assess the effect of interventions,” said Hamilton. “Early identification of “high-risk” plaques prior to acute cardiovascular events will provide enhanced decision making and might improve patient management by allowing prompt aggressive interventions that aim to stabilize plaques.”
This research was supported by grant funding from the National Institutes of Health’s National Heart, Lung and Blood Institute (NHLBI) under grant award number 5P50HL083801.The study’s co-authors are Ning Hua, PhD, Tuan Pham, BSc, and Alkystis Phinikaridou, PhD (currently at King’s College London).
Vinci Appointed Joel and Barbara Alpert Professor and Chair BUSM Department of Pediatrics, BMC Chief of Pediatrics
Robert Vinci
Robert J. Vinci, MD, has been appointed Chief of Pediatrics at Boston Medical Center (BMC) and the Joel and Barbara Alpert Professor and Chair of the Department of Pediatrics at BU School of Medicine (BUSM).
For the past 20 years, Dr. Vinci has served as Vice Chair and Clinical Chief of the Department, providing leadership for the significant expansion of pediatric clinical services. His commitment to the community and to patients is highlighted by his central role in a number of initiatives. He co-founded the Kids Fund at BMC, which provides assistance for children’s most basic needs to give them a foundation for a healthy and bright future; led the campaign to establish a window fall prevention program for children in Boston, called Kids Can’t Fly, which has led to a dramatic decrease in the number of window fall-related injuries; and in partnership with the Massachusetts Department of Public Health, Dr. Vinci provided leadership to establish the Massachusetts Emergency Medical Services Program for Children, which created training protocols and guidelines for children in the statewide EMS system.
Dr. Vinci received his medical degree from the College of Medicine and Dentistry-Rutgers Medical School, now known as the Robert Wood Johnson Medical School. He completed his pediatric residency at the former Boston City Hospital (now BMC), serving as chief resident, in 1983. He joined the Department of Pediatrics at Boston University School of Medicine in 1984 and two years later he established the Division of Pediatric Emergency Medicine at Boston City Hospital.
An innovative leader in medical residency education throughout his career, he founded the fellowship program in Pediatric Emergency Medicine here in 1988 and has directed Pediatric residency training at BMC since 1989. In 1996, Dr. Vinci, along with Frederick H. Lovejoy, MD, established the Boston Combined Residency Program in Pediatrics, one of the nation’s leading Pediatric residency programs. He has also championed research activities, global health training and flexible training opportunities for pediatric residents. Dr. Vinci has authored more than 60 peer-reviewed papers and book chapters on the topics of pediatric emergency medicine and pediatric education.
Dr. Vinci has received numerous awards for teaching and mentoring, among them BUSM’s Leonard Tow Humanism in Medicine Award in 2010. He is a member of the National Board of Directors for the Association of Pediatric Program Directors, the American Academy of Pediatrics, the Academic Pediatric Association and the Academic Pediatric Society.
BUSM Researchers Identify Chemical Compounds that Halt Virus Replication
Could lead to the development of broad spectrum antivirals for deadly viruses
Researchers at Boston University School of Medicine (BUSM) have identified a new chemical class of compounds that have the potential to block genetically diverse viruses from replicating. The findings, published in Chemistry & Biology, could allow for the development of broad-spectrum antiviral medications to treat a number of viruses, including the highly pathogenic Ebola and Marburg viruses.
Claire Marie Filone, PhD, postdoctoral researcher at BUSM and the United States Army Medical Research Institute of Infectious Diseases (USAMRIID), is the paper’s first author and led this study under the leadership of John Connor, PhD, associate professor of microbiology at BUSM and the study’s corresponding author. John Snyder, PhD, professor of chemistry at Boston University (BU) and researchers from the Center for Chemical Methodology and Library Development at BU (CMLD-BU) were collaborators on this study.
Viruses are small disease-causing agents (pathogens) that replicate inside the cells of living organisms. A group of viruses known as nonsegmented, negative sense (NNS) ribonucleic acid (RNA) viruses cause common illnesses such as rabies, mumps and measles. These pathogens also cause more serious deadly diseases, including Ebola, Hendra and Nipah. Currently, there are no approved and effective treatments against these viruses, which, according to data from the Centers for Disease Control and Prevention, are associated with mortality rates up to 90 percent following infection.
“Identifying broad-spectrum antivirals is an important step in developing successful therapies against these and other viruses,” said Filone. The basic idea of a broad spectrum antiviral is similar to that of broad spectrum antibacterials in that they would allow one drug to serve as a common treatment for many different viral illnesses.
The compounds that inhibit the replication of genetically diverse viruses are illustrated as green molecules “blocking” spread of orange Ebola virus virions from an infected cell. Image by Filone and Connor; Ebola virus micrograph by Chris Reed at USAMRIID.
In this study, researchers identified a new chemical class of compounds that effectively blocked genetically diverse viruses from replicating by limiting RNA production by the virus in cell culture. These indoline alkaloid-type compounds inhibited a number of viruses from replicating, including Ebola.
“Because the production of viral RNA is the first step in successful replication, it appears that we have uncovered an Achilles heel to halt virus replication,” said Filone. “These compounds represent probes of a central virus function and a potential drug target for the development of effective broad-spectrum antivirals for a range of human pathogens.”
Research highlighted in this press release was funded in part by the National Institutes of Health’s National Institute of Allergy and Infectious Diseases (NIAID) under grant award numbers RO1 AI1096159-01 and K22AI-064606 (PI: Connor).
Study Reveals Potential Immune Benefits of Vitamin D Supplements in Healthy Individuals
Research from Boston University School of Medicine (BUSM) shows that improving vitamin D status by increasing its level in the blood could have a number of non-skeletal health benefits. The study, published online in PLOS ONE, reveals for the first time that improvement in the vitamin D status of healthy adults significantly impacts genes involved with a number of biologic pathways associated with cancer, cardiovascular disease (CVD), infectious diseases and autoimmune diseases. While previous studies have shown that vitamin D deficiency is associated with an increased risk for the aforementioned diseases, these results go a step further and provide direct evidence that improvement in vitamin D status plays a large role in improving immunity and lowering the risk for many diseases.
Michael Holick
Vitamin D is unique in that it can be both ingested and synthesized by the body with sun exposure. It is then converted by both the liver and kidneys to a form that the body can use. An individuals’ level of vitamin D, or their vitamin D status, is determined by measuring the level of 25-hydroxyvitamin D in the blood. Vitamin D deficiency, which is defined as a status of less than 20 nanograms per milliliter (ng/mL) of 25-hydroxyvitamin D, can cause a number of health issues, including rickets and other musculoskeletal diseases. Recently, however, data suggests that vitamin D deficiency (<20 ng/mL) and vitamin D insufficiency (between 21-29 ng/mL) is linked to cancer, autoimmune diseases, infectious diseases, type 2 diabetes and cardiovascular disease.
The randomized, double-blind, single-site pilot trial involved eight healthy men and women with an average age of 27 who were vitamin D deficient or insufficient at the start of the trial. Three participants received 400 International Units (IUs) of vitamin D per day and five received 2,000 IUs per day for a two-month period. Samples of white blood cells (immune cells) were collected at the beginning of the two-month period and again at the end. A broad gene expression analysis was conducted on these samples and more than 22,500 genes were investigated to see if their activity increased or decreased as a result of the vitamin D intake.
At the end of the pilot, the group that received 2000 IUs achieved a vitamin D status of 34 ng/mL, which is considered sufficient, while the group that received 400 IUs achieved an insufficient status of 25 ng/mL.
The results of the gene expression analysis indicated statistically significant alterations in the activity of 291 genes. Further analysis showed that the biologic functions associated with the 291 genes are related to 160 biologic pathways linked to cancer, autoimmune diseases, infectious diseases and CVD. Examining gene response elements, or sequences of DNA bases that interact with vitamin D receptors to regulate gene expression, they also identified new genes related to vitamin D status. To ensure that their observations were accurate, the researchers looked at 12 genes whose level of expression does not change, and those genes remained stable throughout the trial period.
“This study reveals the molecular fingerprints that help explain the non-skeletal health benefits of vitamin D,” said Michael F. Holick, PhD, MD, professor of medicine, physiology and biophysics at BUSM and leading vitamin D expert who served as the study’s corresponding author. “While a larger study is necessary to confirm our observations, the data demonstrates that improving vitamin D status can have a dramatic effect on gene expression in our immune cells and may help explain the role of vitamin D in reducing the risk for CVD, cancer and other diseases.”
This research was supported by a pilot grant from the National Institutes of Health’s Clinical Translational Science Institute under grant award # UL-1-RR-25711.
To view the full article, visit http://dx.plos.org/10.1371/journal.pone.0058725.
BUMC Provost, BUSM Dean Karen Antman, MD, Receives MD Anderson Cancer Center’s 2013 Kripke Legend Award
Karen Antman
The University of Texas MD Anderson Cancer Center named BUMC Provost and BUSM Dean Karen Antman, MD, as the recipient of the 2013 Margaret L. Kripke Legend Award for Promotion of Women in Cancer Medicine and Cancer Research.
A recognized expert on breast cancer, mesotheliomas and sarcomas, Antman also is widely known as a physician scientist for developing a standard treatment regimen for sarcomas, as well as for her team’s research on blood growth factors. She fought for insurance coverage of patients involved in clinical trials, which resulted in improved relationships between investigative research and the insurance industry.
“Dr. Antman’s accomplishments set a very high bar that signals to women faculty that leadership positions such as hers are obtainable,” said Elizabeth Travis, PhD, MD Anderson associate vice president of Women Faculty Programs. “Walking in Margaret Kripke’s footsteps, she’s an ideal Legend Award recipient.”
The award recognizes scientific and medical leaders who have made extraordinary efforts to hire diverse workforces, promote women to leadership roles, nominate women for awards and otherwise advance their careers. It was established in honor of University of Texas Professor Emerita Margaret Kripke, PhD, a distinguished scientist who achieved many firsts for women at MD Anderson, culminating in her appointment as executive vice president and chief academic officer. Previous winners include Nancy Hopkins, PhD, Amgen, Inc. Professor of Biology, Massachusetts Institute of Technology; Edward J. Benz, Jr., MD, president, Dana-Farber Cancer Institute and director, Dana-Farber/Harvard Cancer Center; and Janet Rowley, MD, Blum-Riese Distinguished Service Professor of Medicine, of Molecular Genetics and Cell Biology, and of Human Genetics, Section of Hematology/Oncology, University of Chicago Medical Center.
“The Kripke award is a tremendous honor,” Antman said. “Margaret Kripke is a pioneer who opened doors for me and many other women in medicine and science. As president of the American Association for Cancer Research, she gave me the first opportunity to be an AACR program chair, and I’ve always regarded her as a role model.”
To Make Health Systems More Effective, Physicians Say Time is Now for Clinician-led Innovation
Physician experts in health system issues propose a timely alternative process for harnessing and supporting physician-led innovations to rapidly address front-line health care delivery problems and improve health. Published as a Viewpoint article in the March 20th issue of the Journal of the American Medical Association (JAMA), the authors propose health systems adopt a strategy widely accepted in U.S. industries of “user-led” innovation.
User-led innovation is predicated on the idea that important enhancements to products and services are often made by users to best suit their needs. “User-led innovation is relevant to health care because clinicians and patients have an intimate view of problems and needs,” say the authors. They cite new surgical procedures, many of which originate with surgeons modifying tools and processes for better results
Barry Zuckerman
Corresponding author, Barry Zuckerman, MD, the Joel and Barbara Alpert Professor of Pediatrics, Boston University School of Medicine and pediatrician at Boston Medical Center, and the other authors Peter A. Margolis, MD, PhD, Professor of Pediatrics at the University of Cincinnati and Director of Research at the James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital; and Kedar Mate, MD, of the Department of Medicine and Institute for Healthcare Improvement, Weill Cornell Medical College, New York, suggest that traditional, clinical academic research may not be appropriate for testing these new approaches because it is difficult to adequately assess the independent impact of an innovation when it is part of a complex system as in done in randomized control trials (RCTs).
They propose a clinician-innovator model in which the user/clinician identifies the problem, develops a solution, tests it on a small scale using a quality improvement (QI) approach. Feedback is generated to help determine effectiveness and if judged to have merit will be implemented on a larger scale. Patient feedback is key to the innovation process.
“At Boston Medical Center we have developed effective clinician-led innovations in delivering pediatric care to our low-income, minority children and their families such as Reach Out and Read, Health Leads, and the Medical-Legal Partnership programs,” notes Zuckerman.
The authors also identify early-stage approaches to care delivery innovations that use technology such as bedside visual media to improve patient understanding of their disease and treatment, a computer application listing community-based services accessible by patients, and making long acting reversible contraceptives available to sexually active adolescents in the pediatric emergency department offering point of service care that provides patients with what they want and need at the time of care avoiding a referral for another visit at a later date.
“The advantages of clinician-led innovation are that work flow and clinician acceptability are built into the iterative process, and failure is associated with only a minimal amount of time or money spent,” the authors say.
Zuckerman, Margolis and Mate propose that clinician-innovation be nurtured and resources harnessed to support this work and they call upon hospitals and medical schools to promote and reward new approaches and tools to make health systems more effective and provide better care. Clinician-innovators are developing new ideas to help patients and the authors state that the time is now for an innovation incubator to help improve and advance health services delivery.
From New Hampshire to Hawaii and Canada to Texas, Class of 2013 Match for Postgraduate Training
In a very crowded Hiebert Lounge the Class of 2013 along with their friends and family awaited the stroke of noon on March 15. While Match Day happens on the same day, at the same time every year at medical schools across the country, the anticipation and excitement was fresh and infectious. With the countdown complete and cameras flashing, these doctors-in-waiting learned of their residency placements.
“It was a short three and a half years ago that the faculty welcomed you to the
study of medicine at the White Coat Ceremony, and we look forward to welcoming you to the practice of medicine at commencement,” said Dean Karen Antman. “You have matched from New Hampshire to Hawaii and Canada to Texas, and the good news is that we get to keep 15 of you here at Boston Medical Center. Congratulations on all of your hard work and achievements.”
Twenty-three percent of the class will be entering internal medicine residency, 11 percent in family medicine, and 10 percent each in pediatrics and obstetrics and gynecology. Nine percent of the class will be training in emergency medicine.
Angela Jackson, MD, acting for the first time in her capacity as associate dean for student affairs at a Match Day, told the class what a privilege it is to share such an important event in their lives. After congratulating the class, Phyllis Carr, MD, former associate dean for student affairs noted their special capacity for caring for each other and announced that the class had chosen Bill Hammond as their class speaker.
“On behalf of the 8,000 BUSM alumni across the country, I want to congratulate you on the successful completion of your medical education,” said Jean Ramsey, MD, associate dean for alumni affairs. “We look forward to welcoming you to the BUSM Alumni Association on commencement and to getting to know you better as our colleagues and fellow graduates.”
See the facebook album.
BUSM Launches Safe Opioid Prescribing Education Program for Health Care Providers
Awarded the first of its kind funding to provide FDA-mandated opioid prescribing education, Boston University School of Medicine (BUSM) has launched a program to train health care providers how to safely and effectively manage patients with chronic pain using opioid analgesics.
With approximately 100 million Americans affected by chronic pain, the appropriate prescribing of opioids is a national concern. The FDA requires that manufacturers of extended release/long-acting (ER/LA) opioid analgesics, as part of a Risk Evaluation and Mitigation Strategy (REMS), create a fund to support comprehensive prescriber education in the safe use of these medications. BUSM was the sole grantee in the first round of funding, receiving an unrestricted award of more than $1.8 million by the manufacturers of ER/LA opioid analgesics, known as the REMS Program Companies (RPC).
Offered in collaboration with the Council of Medical Specialty Societies (CMSS) and the Federation of State Medical Boards (FSMB), BUSM’s Safe and Competent Opioid Prescribing Education (SCOPE) of Pain program is based on the FDA curriculum known as the Blueprint for Prescriber Education for Extended Release and Long- Acting Opioid(ER/LA) Analgesics.
Daniel Alford
Directed by Daniel Alford, MD, associate professor of medicine at BUSM, the program’s first phase, launched on March 1, 2013, is a three-module online educational activity. It is designed to train providers how to determine appropriateness of opioid prescribing, assess risk of misuse, and monitor patients for risk and benefits of opioid treatment for pain management. The next phases of the SCOPE of Pain Continuing Medical Education program will include conferences in ten states which, in addition to the essential curriculum, will feature state-specific policy and resource panels. These panels will be recorded and archived as part of the online educational activity. There will also be train-the trainer sessions designed to develop a national cohort of SCOPE of Pain trainers, who will deliver a series of workshops at local hospitals and community health centers around the country.
Dr. Norman Kahn, Executive Vice President and CEO of the CMSS notes that “CMSS believes education designed for the prescriber community is paramount to helping clinicians safely prescribe opioids while addressing the critical public health problem faced by opioid misuse.”
Dr. Humayun J. Chaudhry, President and CEO of the FSMB, adds that “The FSMB believes educational initiatives such as this collaboration are crucial in raising awareness with physicians of the risks opioids pose, while providing a framework to ensure physicians who prescribe opioids do so responsibly and safely.”
“We are proud to have been selected to receive the first grant for such an important education initiative,” says Barry Manuel, MD, Associate Dean for Continuing Medical Education and Professor of Surgery at BUSM. “It is a testament to the quality and the comprehensive nature of the professional medical education provide by Boston University School of Medicine.”
About BUSM Continuing Medical Education (CME)
Boston University School of Medicine (BUSM) has been sponsoring Continuing Medical Education (CME) activities since 1973. In 2012, BUSM was reaccredited with Commendation by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians and reaccredited with Distinction by the American Nurses Credentialing Center (ANCC) as a provider of continuing nursing education. Within the last five years BUSM has educated more than 179,000 health care professionals.
About CMSS
Founded in 1965, CMSS was created to provide an independent forum for the discussion by medical specialists of issues of national interest and mutual concern. Today, CMSS represents thirty-nine societies with an aggregate membership of 700,000 US physicians. Its main purpose is to provide a forum for collaboration to influence policy, medical education and accreditation from a broad, cross-specialty perspective. CMSS is the unified voice for specialty societies established to improve the United States’ healthcare system and health of the public. For more information, visit CMSS at www.cmss.org.
About FSMB
The Federation of State Medical Boards (FSMB) is a national non-profit organization representing the 70 medical and osteopathic boards of the United States and its territories. The FSMB leads by promoting excellence in medical practice, licensure, and regulation as the national resource and voice on behalf of state medical and osteopathic boards in their protection of the public.
BUMC Goes Latin! Celebrate Multicultural Diversity with Students, Faculty, Staff, Patients and Musicians
On Sunday, April 7, the great variety and rhythmic wonders of Latin music will be highlighted on the BU Medical Campus. A concert featuring a select group of Berklee College of Music artists, the BUMC Band, and other guest musicians associated with the Medical Campus Arts Outreach Initiative will be performing. The program will review the origins of Latin music beginning with the music of Spain, traveling across Latin America and the Caribbean, until reaching the Latin influence in American music.
During this event two Latino physicians will be recognized for their contributions to Boston Medical Center and Boston University School of Medicine.
Admission is free on a first come first served basis. Parking for concert attendees is available at the 710 Albany Street garage. Please have your ticket validated at the concert entrance.
This event is presented by
- Boston University School of Medicine, Office of Diversity and Multicultural Affairs,
- Latino Medical Student Association
- Medical Campus Arts Outreach Initiative
Office of Financial and Business Affairs Has Moved
The Office of Financial and Business Affairs has moved to Charles River Campus, 25 Buick St, third floor. There is no longer an office at Harrison Court. “We look forward to continuing to support the BU Medical Campus from our new location,” said Director, Financial and Business Affairs Hiram Rodriguez.
Phone numbers will be changing, so please update the following:
- Hiram Rodriguez, 353-4177
- Lorraine Weiss, 353-7146
- Jannette Reese, 353-7142
Please use this address for mail and deliveries:
BUMC Financial and Business Affairs
25 Buick St., 3rd Floor
Boston, MA 02215
