March 28, 2014 Emory Surgery newsletter Department of Surgery of the Emory University School of Medicine


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Dr. Craig Coopersmith appointed the new vice-chair of research of the Department of Surgery

Craig Coopersmith in the Emory University Hospital ICU.
Craig Coopersmith in the Emory University Hospital ICU.

Dr. Craig Coopersmith will succeed Dr. Allan Kirk as the new vice-chair of research for the Department of Surgery. Dr. Kirk will be leaving Emory in May to chair the Department of Surgery of the Duke University School of Medicine.

As an academic surgeon in the area of surgical critical care, Dr. Coopersmith has established himself as one of the top investigators of sepsis and shock in the country. He is also highly committed to fostering the next wave of surgeon-scientists, and regularly mentors general surgery residents in his lab.

"The rigor and attention to detail that Craig Coopersmith applies to his own research will be a perfect fit for his tenure as vice-chair," says Dr. John Sweeney, interim chair of the Emory Department of Surgery. "Craig is a critical thinker and an outstanding mentor to junior faculty and trainees."

Dr. Coopersmith is associate director of the Emory Critical Care Center and director of the Surgical/Transplant Intensive Care Unit of Emory University Hospital. Before he came to Emory in 2009, he directed the surgical critical care fellowship and general surgery resident research program at Washington University School of Medicine and co-directed the surgical intensive care unit at Barnes-Jewish Hospital. During his years at Washington University, he worked closely with Dr. Timothy Buchman, the esteemed critical care surgeon/scientist who is director of the Emory Critical Care Center.

Dr. Coopersmith is president-elect of the Society of Critical Care Medicine, the world's largest multi-professional ICU organization, and a member of the American Society for Clinical Investigation, one of the nation's most respected medical honor societies which recognizes physician-scientists who translate findings in the laboratory to the advancement of clinical practice. He serves on the editorial boards of Critical Care Medicine, Shock, Journal of the American College of Surgeons, and the Journal of Surgical Research.

Dr. Coopersmith's current research activity includes an NIH T32 critical care training grant and two NIH R01 grants, one of which is a collaborative study of the interplay between cancer and sepsis with Emory transplant immunologist Dr. Mandy Ford.

"I am truly honored to be afforded the opportunity to play a leadership role in research in the Department of Surgery," says Dr. Coopersmith. "My goal is to catalyze new applications and collaborations in the department to ultimately impact our patients at the bedside. To that end, I understand the necessity of being available to the entire department to act as a resource in research-related activities, especially to junior investigators who are developing their research careers. I have experienced first hand how much superior mentorship can contribute to making research a successful component of an academic career, and will do my best to help mentor researchers and future leaders in our department."

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Linda Cendales
Dr. Cendales' interest in hand transplantation was piqued during her observations of patients with severe rheumatoid arthritis in Mexico City, where she went to medical school. “I wondered if an alternative option would provide better results,” she says. “These patients were already on immunosuppressant drugs, so that wouldn’t be an additional risk factor for them.”

History in the making: Dr. Linda Cendales' Emory years

Linda Cendales with hand transplant patient Linda Lu shortly after she received her new hand in March 2011.
Linda Cendales with hand transplant patient Linda Lu shortly after Ms. Lu
received her new hand in March 2011.

Before Dr. Linda Cendales came to Emory in 2007, the phrase "vascularized composite allotransplantation," or VCA, was mysterious and perplexing to most. However, by the time she led the multi-disciplinary team that performed Emory's first hand transplant in 2011, VCA had become generally recognized as a bold new surgical discipline that held great promise. Dr. Cendales had much to do with that shift, and when she leaves Atlanta at the end of March to establish and lead the VCA program at Duke University School of Medicine, Emory will remain a significant location in the series of advancements she brought to this nexus of transplantation and reconstructive surgery.

"Dr. Cendales pioneered vascularized composite allotransplantation at Emory," says Dr. Grant Carlson, chief of the Emory division of plastic and reconstructive surgery. "She developed a program founded in her basic science research and her own world class technical expertise as a hand surgeon. It was an incredible achievement to successfully transplant a hand three years after starting the program."

Early in her career, Dr. Cendales understood that the then-nascent area of VCA—a procedure involving the transplantation of multiple tissues such as skin, muscle, bone, nerves, and tendons as a functional unit, such as a limb—would involve reconciling the complexities of immunology, reconstructive surgery, orthopaedics, and surgical technical science. She became the only person in the United States with formal training in hand, microsurgery, and transplant surgery, and began to make inroads in developing the practice and science of VCA. As a clinical fellow in hand and microsurgery at Christine M. Kleinert Institute in Louisville, KY, she was involved in the performance of the first hand transplant in the U.S. in 1999. While doing a transplant surgery fellowship at the NIH four years later, she led the group that devised the first classification scheme for VCA rejection.

Once she settled into her dual faculty appointment in the Emory divisions of plastic and reconstructive surgery and transplantation, Dr. Cendales began serving as director of the Vascularized Composite Allotransplantation and Microsurgery Laboratory of the Emory Transplant Center. With the assistance of a grant from the Department of Defense (DoD), she and her research team initiated Georgia's first clinical trial of VCA in hand transplantation in 2008. The DoD saw VCA as a means of benefitting soldiers who suffer traumatic amputation during combat. At the time, the Atlanta VA Medical Center in collaboration with Emory had the only VA-approved limb transplant program within the VA system in the country.

After an intensive period of preparation, planning, and coordination of a wide variety of transplant and other healthcare professionals, Dr. Cendales led the multi-disciplinary team that performed Emory's first hand transplant in March 2011. The procedure was also the first in the Southeast and only the 14th such transplant in the country. The patient, a 21-year-old college student at the time, is doing well and can now perform activities with both hands such as cooking and driving.

"The patient had been without a hand since she was four months old, and to see her at the first press conference with her new hand was wonderful and moving," says Dr. Thomas Pearson, executive director of the Emory Transplant Center and a transplant consultant on the procedure. "You could see that Dr. Cendales, whose exceptional surgical skills and determined management of the team were major factors in the success of the procedure, was most gratified by the happiness and new lease on life that her team had brought to this patient."

Following the transplant, Dr. Cendales resumed investigating the biology of VCA rejection and testing anti-rejection therapy. In 2012, she received additional funding from the DoD to evaluate the use of belatacept as an immunosuppressant in hand transplant patients. Co-developed by Emory School of Medicine Dean Dr. Christian Larsen, Dr. Pearson, and several other investigators at Emory and Bristol-Myers Squibb, belatacept is considered a less-toxic alternative to the standard immunosuppressants that had been prescribed for most kidney transplant patients. The study will continue at Duke under Dr. Cendales' supervision, and will measure the degree that belatacept lowers the risks of rejection, alleviates the negative side effects of other immunosuppressants, and improves the benefits of limb reconstruction through transplantation.

"Emory gave me an environment to simultaneously provide advanced care to patients, study and develop vascularized composite allotransplantation in the laboratory, and translate that knowledge to the clinic," says Dr. Cendales. "My time here has been valuable, and further strengthened my commitment to continue developing this field to improve the quality of life of patients and to contribute to the advancement of novel therapies."

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Charles Staley
Charles Staley

Dr. Charles Staley named local Co-PI of new NCI clinical trials network

Winship Cancer Institute of Emory University has been selected as a Lead Academic Participating Site for the National Cancer Institute's new National Clinical Trials Network (NCTN). Dr. Charles Staley, chief of the division of surgical oncology of the Emory Department of Surgery and associate director for clinical operations at Winship, will serve as Co-PI of the Winship outpost of the network with Emory medical oncology chief Dr. Suresh Ramalingam and Emory radiation oncologist Dr. Jonathan Beitler.

Effective March 1, 2014, the NCTN began serving as NCI's primary infrastructure to conduct phase II and III cancer clinical trials, and is expected to enroll over 17,000 patients per year with a variety of cancer types and from diverse backgrounds. After a peer-review application process for membership in the NCTN, Winship was one of only five centers in the Southeast to be chosen, and is included with a total of 30 American cancer centers that received the designation. The distinction includes a five-year award.

The NCTN trials will be managed by five network groups, one of which will be co-led by Dr. Walter Curran, Jr., executive director of Winship, and Dr. Deborah Bruner, associate director for outcomes research at Winship.

The three Co-PIs will use the grant to support efforts to optimize the design and conduct of Winship's trials as well as to support patient enrollment in NCTN trials. "This grant acknowledges our leadership in national clinical trials and allows us to continue to offer the most up to date and novel cancer treatments to the patients of Georgia and the Southeast," says Dr. Staley.

Dr. Staley is a recognized translational cancer researcher who conducts innovative clinical trials in gastrointestinal cancers. He has investigated gene therapy for metastatic colon cancer, radiofrequency ablation with intra-arterial chemotherapy for patients with colorectal liver metastases, and neoadjuvant chemoradiation with the goal of maximizing sphincter preservation in the treatment of rectal cancer. In the area of translational science, Dr. Staley and such colleagues as Dr. Lily Yang are exploring methods of using nanotechnology to diagnose and treat pancreatic and breast cancer.

In 2013, 760 patients were enrolled in 250 Winship clinical trials that were testing new therapies. In the last seven years, 75-percent of new cancer treatments approved by the FDA have been tested in clinical trials available at Winship.

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Brian Kogon
Brian Kogon

Dr. Brian Kogon to co-direct new Emory, CHOA Comprehensive Congenital Heart Center

Under the newly formed Congenital Heart Center of Georgia (CHCG), launched by Children's Healthcare of Atlanta (CHOA) and Emory Healthcare, the cardiac team at Children's Healthcare of Atlanta Sibley Heart Center will collaborate with Emory's Adult Congenital Heart Center team to assist their patients with congenital heart defects (CHD) in making seamless transitions from pediatric to adult care. As one of the largest programs of its type in the United States and the first in Georgia, the CHCG will be a comprehensive service for children and adults with CHD that provides a continuum of lifesaving care from before birth through adulthood.

The CHCG will be co-directed by Dr. Brian Kogon, surgical director of Emory's Adult Congenital Heart Center (ACHC); cardiologist Dr. Wendy Book, medical director of the ACHC; and Dr. Robert Campbell, chief of cardiac services, Children's Healthcare of Atlanta Sibley Heart Center (SHC).

Dr. Kogon has led the surgical arm of the ACHC since 2005 and is considered a leading authority on pediatric and adult congenital heart disease. In 2012, he was a member of the multi-disciplinary team that performed patient Stephanie Lindstrom's triple organ transplant, a first for the state of Georgia, and performed the heart transplant portion of the multiple procedure with his Emory colleague Dr. David Vega.

While little research has been done to quantify the problem in the U.S., studies have shown that approximately 40 percent of CHD patients in Canada and Europe stop seeing heart specialists between the ages of 13 and 21 years old. It is suspected that the same problem exists in the states. Specialists suspect that many former patients are lulled into complacency by the lessening of childhood symptoms that comes from competent pediatric care, and wrongly assume that their condition has been cured. In fact, current guidelines recommend lifelong care and observation for these patients.

The cooperation of the Emory Healthcare and CHOA services under the banner of CHCG will allow patients to be closely tracked throughout the course of their lives, regardless of age or pediatric versus adult status. CHCG also plans to educate patients about the importance of consistent monitoring and continued care so that they may live longer, more productive, and healthier lives.

"With a system like this in place, the left hand will know what the right hand is doing and we won't lose track of people," says Dr. Kogon. "At all stages of a patient's life and condition, we will be able to offer the latest treatments and access to the most progressive clinical trials."

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Emory islet cell transplant patients celebrate 10 years of freedom from diabetes

Dr. Nicole Turgeon; Rob Allen, islet cell transplant recipient; Laura Cochran, islet cell transplant recipient; Dr. Christian Larsen.
Dr. Nicole Turgeon; Rob Allen and Laura Cochran, islet cell transplant
recipients; Dr. Christian Larsen (from left to right).

On March 13, Rob Allen, Laura Cochran, and the Emory Transplant Center (ETC) celebrated Mr. Allen and Ms. Cochran's 10th year of being diabetes free following a novel transplant of donor pancreatic islet cells. "I feel free. I feel normal," says Ms. Cochran.

Mr. Allen and Ms. Cochran suffered from severe Type 1 diabetes, an autoimmune disease in which the pancreas ceases to produce insulin, a hormone that allows people to get energy from food. Type 1 diabetics must take insulin every day to survive. Fortunately, Mr. Allen and Ms. Cochran were candidates for a clinical trial at Emory where donor pancreatic islet cells were being transplanted to restore insulin production in people with Type 1 diabetes.

"Through a small incision in the abdomen, we placed an IV into the vein going to the liver," says kidney and pancreas transplant surgeon and Emory School of Medicine Dean Dr. Christian Larsen. "Then using a slow-drip method, we infused hundreds of thousands of donor islet cells into the patient. Those islets made their way from the liver to the pancreas to restore insulin production."

The two patients both received two transplants from two different organ donors over the course of several months. After the second transplant, they no longer needed daily insulin injections. They have been insulin-free since 2004.

"The best part about the islet cell transplants is not having to worry daily about my blood glucose levels getting out of control," says Mr. Allen. "It has been an amazing thing."

A total of 19 patients have received islet cell transplants in four different clinical trials at Emory. Researchers are awaiting FDA approval of islet cell transplants so the surgery will no longer be experimental. At that point, surgeons can perform these transplants on patients who meet criteria.

"Islet cell transplantation offers patients with debilitating Type 1 diabetes hope and freedom from fear," says Dr. Nicole Turgeon, director of ETC's clinical islet transplant program and Co-PI for Emory's islet transplant clinical trials. "We are very proud to be a part of the trials to obtain FDA approval so islet cell transplantation can be offered as standard of care."

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Robert Guyton
Robert Guyton

Dr. Robert Guyton inducted into Emory’s Millipub Club

The Millipub Club recognizes Emory faculty who have published papers that have been cited at least 1,000 times in the literature. Dr. Robert Guyton has been inducted into the organization on the basis of the following article, which had received 1,026 citations as of March 28, 2014:

“Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery.” Leon MB, Smith CR, Mack M, Miller DC, Moses JW, Svensson LG, Tuzcu EM, Webb JG, Fontana GP, Makkar RR, Brown DL, Block PC, Guyton RA, Pichard AD, Bavaria JE, Herrmann HC, Douglas PS, Petersen JL, Akin JJ, Anderson WN, Wang D, Pocock S; PARTNER Trial Investigators. New England Journal of Medicine. 2010 Oct 21;363(17):1597-607.

In 2007, Dr. Guyton joined fellow Emory CT surgeon-scientist Dr. Vinod Thourani and Emory cardiologists Dr. Vasilis Babaliaros and Dr. Peter Block as one of the local surgical co-PIs of the multi-center PARTNER I trial of transcatheter aortic valve replacement (TAVR). The FDA clinical trial evaluated the use of TAVR, a non-invasive method of replacing diseased aortic heart valves, in patients suffering from severe aortic stenosis that were too frail or sick to withstand the traditional open-heart surgical approach.

The cited article reported the results of comparing TAVR to such standard therapies as balloon aortic valvuloplasty, and concluded that the reduced mortality among patients treated with TAVR as opposed to traditional methods was significant. These results, combined with additional results reported by the PARTNER group in 2011, contributed to the FDA’s 2011 approval of the SAPIEN transfemoral transcatheter heart valve for use in patients considered inoperable by traditional surgical technique.

The annual Millipub induction event will be held in September or October 2014. While overseen by the SOM, membership in the MilliPub Club is open to any qualifying Emory faculty member.

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Geoffrey Gurtner
Geoffrey Gurtner

13th Annual Emory Surgery Research Symposium

The 13th Annual Department of Surgery Research Symposium of the Emory University School of Medicine will commence at surgical grand rounds in the EUH auditorium on Thursday, April 17, at 7:00 a.m. "The Art of the Practical: Translating Scientific Discovery into the Real World" will be presented by distinguished visiting professor Geoffrey C. Gurtner, MD, Johnson & Johnson Professor of Surgery and Professor, by courtesy, of Materials Science and Engineering, Stanford University School of Medicine, and director of the breast and aesthetic surgery service, Stanford Medicine.

Prior to his position at Stanford, Dr. Gurtner was the program director of plastic surgery and an associate professor of surgery and cell biology at NYU School of Medicine. He has served on the editorial board of Annals of Plastic Surgery and was an associate editor for the 7th edition of Grabb & Smith’s Plastic Surgery, one of the most widely read textbooks in the field.

Dr. Gunter's lab is focused on understanding the mechanism of new blood vessel growth following injury and how pathways of tissue regeneration and fibrosis interact in wound healing, with the long-term goal of creating complex tissues for organ replacement ex vivo. His work is regularly funded by the NIH and other entities and he has various patents issued and pending.

The symposium will resume at 1:00 p.m. in Cox Hall Ballroom, 3rd floor, and will showcase the research of the Department of Surgery’s medical students, postdocs, residents, and fellows. "Seventeen oral presentations and 24 posters will be featured," says Lisa Carlson, director of academic affairs for the Department of Surgery. "We had an overwhelming response to the abstract call this year and are expecting a great symposium."

The schedule is as follows:

1:00-3:00 p.m. Basic Science Session
3:00-4:15 p.m. Poster Session, SOM Commons Lobby
4:15-6:30 p.m. Clinical Session

First and second place cash awards for oral presentations in both clinical and basic science categories will be presented, as well as awards for the top poster in each category. Dr. Gurtner will assist in ranking the posters and presentations, and all winners will be invited to dinner with faculty immediately following the symposium.

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Rohit Mittal
Rohit Mittal
John Lyons
John Lyons

Rohit Mittal, John Lyons, and Zhe Liang receive Shock Society travel awards

Dr. Rohit Mittal and Dr. John Lyons, general surgery residents on research sabbatical in Dr. Craig Coopersmith and Dr. Mandy Ford’s labs, and Dr. Zhe Liang (photo unavailable), the manager of Dr. Coopersmith’s lab, have received travel awards of $1000 from the Shock Society, the leading shock and sepsis basic science society in the country.

Shock Society travel awards are based on scientific merit, and only 40 are distributed each year. The awards will allow Drs. Mittal, Lyons, and Liang to attend and participate in the 37th Annual Conference on Shock in Charlotte, NC, June 7-10, 2014.

Drs. Mittal and Lyons are working with Drs. Coopersmith and Ford on their investigations of the effect of cancer on sepsis. Dr. Mittal is examining the impact of 2B4, a novel lymphocyte co-inhibitor molecule, in the pathogenesis of sepsis, a disease that kills between 230,000 and 370,000 people in the United States annually. Dr. Lyons is performing experiments of multiple models of sepsis with diverse tumor lines to determine if results can be generalized or if they must be separated into specific responses to types of sepsis or types of cancer. Dr. Liang is studying gut permeability in sepsis.

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SSO 2014 program

Emory makes strong showing at SSO 2014 Annual Meeting

Exemplifying the scope of Emory’s cancer research, Emory surgical oncology faculty, lab support staff, and trainees presented six posters and five oral abstracts at the 67th Annual Cancer Symposium of the Society of Surgical Oncology, held in Phoenix, AZ, March 12-15. One of the oral presentations and five of the posters were credited to members of the U.S. Gastric Cancer Collaborative (UGCC), a joint research effort of Emory, Stanford University, University of Wisconsin, Ohio State University, Washington University in St. Louis, Johns Hopkins University, and Wake Forest University.

The non-faculty presenters and coauthors included Dr. Malcolm Hart Squires, a general surgery resident doing a research sabbatical with faculty mentors Dr. Shishir Maithel and Dr. David Kooby; lead research specialist Folashade Adeshuko; and 4th year medical students Joanna Etra and Clara Farley. Faculty presenters included Drs. Grant Carlson, Keith Delman, and Shishir Maithel.

“Is It Time to Abandon the 5cm Margin Rule During Resection of Distal Gastric Adenocarcinoma? A Multi-Institution Study of the U.S. Gastric Cancer Collaborative” received the meeting’s Best Clinical Research Poster Award. The poster was credited to the UGCC and presented by Dr. Squires.

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Save the Date: Emory Surgery Faculty Boot Camp Seminar

April 16, 2014, 3:00 p.m. – 8:00 p.m., H Wing Education Classroom, EUH

This boot camp/overview event for the 2014 faculty development seminar series is open to all faculty, though faculty who are relatively new to the Department of Surgery are strongly encouraged to attend, as the series is dedicated to equipping faculty with the tools to be successful. The primary components of faculty life will be introduced via snapshot summaries delivered by seasoned faculty and staff. Agenda items will include promotions, education, research, clinic operations, quality, and communications resources (download the agenda here). Dinner will be provided. In the months that follow, separate seminars will be held that concentrate on a single facet of what it takes to build a solid academic-research-clinical portfolio.

Those who plan to attend should RSVP to

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Upcoming events

7th Annual Ira Ferguson Lectureship
Preparation of Residents for Independent Practice: Challenges, Opportunities, and New Directions

Presented by Ajit K. Sachdeva, MD
– Founding Director, Division of Education, American College of Surgeons
– Adjunct Professor of Surgery, Feinberg School of Medicine, Northwestern University, Chicago
7:00 a.m. – 8:00 a.m., April 3, 2014 EUH auditorium
Cystic Neoplasms of the Pancreas
Presented by Sameer Patel, MD
– Chief Resident, Department of Surgery, Emory University School of Medicine
7:00 a.m. – 8:00 a.m., April 10, 2014 EUH auditorium
2014 Emory Surgery Faculty & Resident Picnic & BBQ 12:00 p.m. – 4:00 p.m., April 12, 2014

W. D. Thompson Park, 1760 Mason Mill Road, Decatur, GA 30033

Event flyer

13th Annual Department of Surgery Research Symposium
The Art of the Practical: Translating Scientific Discovery into the Real World

Presented by Geoffrey C. Gurtner, MD
– Johnson & Johnson Professor of Surgery and Professor, by courtesy, of Materials Science and Engineering, Stanford University School of Medicine
– Director, Breast & Aesthetic Surgery, Stanford Medicine
7:00 a.m. – 8:00 a.m., April 17, 2014 EUH auditorium
EUH Perioperative Services Performance Day
A quarterly review and analysis of surgical services performance among anesthesia, surgery, and OR staff of Emory University Hospital.
7:00 a.m. – 8:00 a.m., April 24, 2014 EUH auditorium
Department of Surgery Faculty Meeting 5:30 p.m. – 7:00 p.m., April 29, 2014 TEC B6300
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