sutures newsletter

PRODUCED BY AND FOR MEMBERS OF THE DEPARTMENT OF SURGERY June 2016 | Archived Issues

Vrahas Appointed Founding Chair of Orthopaedics

Vrahas

Mark Vrahas, MD, has been appointed the founding chair of Cedars-Sinai's new Department of Orthopaedics. He assumes the post Aug. 8. Vrahas arrives with an international reputation for clinical excellence and a strong record of building and leading highly effective orthopedic trauma programs.


» Read more

Romanoff Maintained Relentless Focus on Patient Safety

Romanoff Neil

After more than two decades, Neil Romanoff, MD, vice president for Medical Affairs and associate chief medical officer, is stepping down at the end of the month. The executive helped transform the culture and the way it measures and manages Cedars-Sinai's safety and quality.


» Read more

Letter from Chief of Staff: Updating Online Profiles

In an effort to enhance efficient communication and ensure that patients are admitted to correct providers, physicians are being asked to update their online profiles with current information and preferences.

» Read more

Two Minutes With …

Chung Rex

This question-and-answer feature will help you get to know some of the physicians in the Cedars-Sinai Department of Surgery. This month's installment features Rex Chung, MD.



» Read more

Father of Three Thanks Circle of Friends

Circle of Friends Awards

James Liotta can name three good reasons why he's grateful to Cedars-Sinai – Gemma, Hannah and James. They're his children. "It's because of you that my three children are alive today," Liotta said to more than 300 Cedars-Sinai employees at the Circle of Friends recognition event Monday, May 23, in Harvey Morse Auditorium.

» Read more

FDA Cautions Against Zecuity Patches, High Doses of Loperamide, and Aspirin Overuse

Pharmacy Focus

The U.S. Food and Drug Administration is warning about heart problems associated with taking higher than recommended doses of the common over-the-counter and prescription diarrhea medicine loperamide. Also, the FDA has temporarily suspended sales of Zecuity patches for migraine headaches over concerns of burning and scarring. And the agency warned about the risks of serious bleeding that can result from taking too much aspirin, which is contained in over-the-counter products for stomach upset.

» Read more

Case Against Social Media Triumphs in Debate

Great Debate

The gloves came off in a war of wit and words over the proper role of social media in medicine at the 13th annual Dr. Leon Morgenstern Great Debates in Clinical Medicine Resident Competition. Cedars-Sinai resident physician Ryan Spurrier, MD, triumphed in the clash of ideas.

» Read more

Goals of the Anesthesia Pre-Procedure Evaluation Center

The Pre-Procedure Testing Program underwent a redesign to better meet the needs of pre-procedure patients, their surgical teams and referring physicians. In June 2013, its name was changed to the Anesthesia Pre-Procedure Evaluation Center and it opened a one-stop shop in the state-of-the-art Advanced Health Sciences Pavilion, Plaza Level.

» Read more

Metabolic Plasticity in Breast Cancer

Metabolic

The holy grail of breast cancer research is to understand how a transformed cell survives within a normal mammary epithelium amid the prevailing regulatory checkpoints and protective mechanisms in a normal tissue environment.


» Read more

Gewertz Lectures About Innovation and Leadership

Gewertz

Bruce L. Gewertz, MD, surgeon-in-chief and chair of the Department of Surgery, delivered four lectures across the country in May. The topics were: sustaining fulfillment in work and life, managing carotid artery disease, leadership lessons for work and life, and fostering innovation in healthcare.

» Read more

Reminder About Block Utilization, Operating Room Access

To help improve block utilization and operating room access, here is a reminder about the process related to block utilization credit when applicable.

» Read more

The Campaign for Cedars-Sinai Begins Public Phase

Cedars-Sinai is conducting its most ambitious fundraising effort in the history of the institution – the Campaign for Cedars-Sinai – with a goal of raising $600 million by 2018. This July marks the beginning of the public phase of the campaign, when the organization will begin sharing its goals and mission with the community at large.

» Read more

CS-Link Tip: Creating and Editing Lists

cs-link logo

Physicians often need to find a patient in the hospital, and CS-Link can make this task easier and more efficient. The idea is to create a patient list with the help of the toolbar.

» Read more

Circle of Friends Honorees for May

The Circle of Friends program honored 201 people in May. Circle of Friends allows grateful patients to make a donation in honor of the physicians, nurses, caregivers and others who have made a difference during their time at Cedars-Sinai.

» Read more

Vrahas Appointed Founding Chair of Orthopaedics

Vrahas

Mark Vrahas, MD

Mark Vrahas, MD, has been appointed the founding chair of Cedars-Sinai's new Department of Orthopaedics. He assumes the post Aug. 8.

Vrahas arrives at Cedars-Sinai with an international reputation for clinical excellence and a strong record of building and leading highly effective orthopedic trauma programs. He is currently the Robert W. Lovett Professor of Orthopaedic Surgery at Harvard Medical School and vice-chair for Population Health & OR Operations at Massachusetts General Hospital's Department of Orthopaedic Surgery. Also, he is chief of Partners Orthopaedic Trauma Program at Mass General and Brigham and Women's Hospital in Boston.

"Dr. Vrahas was chosen after a rigorous national search and exemplifies the finest clinical, academic and administrative role model for leading this newly established department with vision and skill," said Shlomo Melmed, MD, executive vice president of Academic Affairs and dean of the medical faculty. "We look forward to the opportunity of a flourishing orthopedics program under his proven national leadership."

The founder of the Harvard Orthopedic Trauma Initiative, Vrahas led efforts to foster collaboration among orthopedic trauma services at all Harvard-affiliated teaching hospitals — Mass General, Brigham and Women's, Beth Israel Deaconess Medical Center and Boston Children's Hospital.

Vrahas is widely recognized as an expert in orthopedic trauma, and pelvic and acetabular surgery. He lectures around the world, publishes extensively and serves as an editorial board member for leading orthopedic journals. He has successfully mentored dozens of residents and fellows in orthopedic trauma surgery and research.

Vrahas completed medical school and residency at the University of Pittsburgh, followed by fellowships in biomechanics research at the University of Iowa and in orthopedic trauma and adult reconstruction at the University of Toronto. He was chief of Orthopaedic Trauma at Charity Hospital in New Orleans before arriving in Boston in 1999.

Romanoff Maintained Relentless Focus on Patient Safety

In most large workplaces, stepping onto an elevator means riding a few floors with social awkwardness. Avoiding eye contact. Staring down at a mobile device. Silence.

Few of the compartments are known for their practical content, much less advancing the art of healing — unless they are at Cedars-Sinai. For the past decade, medical center elevator doors have been plastered with colorful floor-to-ceiling messages exhorting passengers, as in one memorable campaign, to save lives by cleaning their hands.

Romanoff Neil

Neil Romanoff, MD

You can thank Neil Romanoff, MD, vice president for Medical Affairs and associate chief medical officer, for making a short trip with strangers educational. After 25 years at Cedars-Sinai, the longtime health care executive is retiring June 30.

"People were always willing to try new things here," said Romanoff, who was inspired by seeing movie ads on elevator doors at a local mall. "You can come back with an idea and you could easily work in a place where someone might say, 'That's ridiculous. That's a shopping center.' But people here said, 'Wow, that's an opportunity to get people to wash their hands.'"

The elevator messaging, an inventive approach soon copied by other hospitals, stands as one of myriad contributions Romanoff has made during a career marked by precision, dedication and vision. In addition to being a calm and steady leader during a time of great change in healthcare, the Cedars-Sinai executive is perhaps best known for spearheading a major cultural shift in attitude and practice toward quality and safety.

"Neil really developed a corporate awareness, passion and accountability for our work in the clinical sphere," said Michael Langberg, MD, chief medical officer at Cedars-Sinai. "His legacy will forever be the organization's commitment to the highest possible safety and quality for our patients. He embodies that."

Before Romanoff arrived in the early 1990s, like much of the healthcare industry, Cedars-Sinai had no quality council, no safety officer and no widely accepted methodology for measuring quality and safety. That all changed under Romanoff, who helped lead a drive to treat improvement as a science.

"People didn't really like the concept that this could be seen as making widgets," said Romanoff, who led the way in creating the Cedars-Sinai Resource and Outcomes Management Department. "But by the same token, there are a series of inputs that go through a process and something comes out of that.

"You had to design a process for that to happen," he added. "It wasn't just going to happen because people tried harder."

His knowledge and expertise were sought after far beyond Cedars-Sinai. A couple of examples: In April 2012, he presented at the International Forum on Quality and Safety in Healthcare in Paris. His talk on "What Will Go Wrong Next?" highlighted a defect-analysis methodology developed at Cedars-Sinai along with Institute for Healthcare Improvement faculty. In December 2014, he presented at the Institute for Healthcare Improvement's national forum on "It Takes a Village: Lessons Learned Along the Journey Toward Reducing 30-Day Readmissions."

Colleagues describe him as collegial, hard working, open-minded, but a stickler for detail and follow-up. He's the kind of executive who can emerge from a 90-minute meeting and describe it as "fun" — and mean it.

"He could always be relied upon to be the one person in any conversation at any level to remind everyone why we are all here," said Rekha Murthy, MD, who has worked with Romanoff for more than two decades and will become vice president for Medical Affairs and associate chief medical officer on July 1. "That is, to do the best for our patients and not to be satisfied with the status quo."

Those qualities have come into play in a couple of noteworthy safety campaigns. A prevailing view in healthcare was that a certain number of hospital acquired infections was unavoidable. But Romanoff argued there shouldn't be any — and "zero is the greatest number" soon became a common phrase around the medical center.

"The old mentality was that 95 percent was an A and a great score," said Romanoff. "But here if you get a 95, that means five patients didn't get something right done to them and that had to change."

Another effort Romanoff championed was identifying seemingly innocuous daily tasks that could sometimes build into a critical mass and derail a safety process. The idea was called normalized deviation, in which workers unwittingly tolerate as acceptable what should be regarded as a problem.

The trick is spotting the potentially corrosive activity. To do so, Romanoff dispatched teams across dozens of units in the medical center to uncover these trends and suggest ways to eliminate them.

"Neil himself would go to floor after floor, unit after unit, having conversations, and it was amazing to watch," recalled Langberg. "There would often be this 'a-ha' moment when people would suddenly realize that some annoying problem was keeping them from their work."

Retirement is never an easy decision, but Romanoff felt it was just time for him.

"Change is good for an organization," he said. "Rekha is wonderful, and she's going to be bring a new perspective."

What will he miss about the job?

"The people," he said. "This is my second family."

He did identify a couple of things he won't miss. One is waking up at 5:30 a.m. The other is a state of perpetual readiness.

He compared it to a selling point for older television sets, which were marketed for their "instant on" ability. Hit the switch and the viewer didn't have to wait for the gradual appearance of a picture, but received a bright, clear one in seconds.

"That's what we expect from physicians and that is the job," he said. "But I won't miss being on 'instant on' mode constantly."

He has largely relied on methodology, hard data and the scientific process to light his way, but he'll soon be heading for a territory where those tools are less in demand. One place he'll be spending more time will be the kitchen — Romanoff is accomplished chef.

He's been written about in Bon Appetit magazine and studied at the Culinary Institute of America in New York and with a host of European and American master chefs. He plans to take more classes and teach as well. (His favorite style of food? Comfort food.)

Even after he steps down from his current post, Romanoff will continue to work at Cedars-Sinai devoting his time to special projects. He estimates those will wrap up in six months.

What then?

"I don't know what I'm going to do after that," he smiled. "The best advice I heard about all this is: 'You shouldn't try to figure it out, while you're still doing what you're doing.'"

Letter from Chief of Staff: Updating Online Profiles

Dear Colleague:

In an effort to enhance efficient communication and ensure that patients are admitted to correct providers, I request that you please take a moment to update your online profile with your current information and preferences.

Important new fields have been added to help us determine to whom you would like your patients admitted and your preferred after-hours contact information. The availability of this information to the Emergency Department physicians should eliminate the need for unnecessary phone calls and will help to provide patients with efficient and seamless care.

You can access your profile by logging on to CS-Link™  and clicking on web activities (you do not need to be in a patients chart), click on user profile and you will directed to the Provider Privileges Inquiry page. Your logon and password are the same ones you use for CS-Link.

Please review and update both your general and emergency contact information.

Thank you so much,

Peggy Miles, MD
Chief of Staff

Two Minutes With …

This question-and-answer feature will help you get to know some of the physicians in the Cedars-Sinai Department of Surgery.

Chung RexRex Chung, MD

Where did you grow up?

I was born in San Diego and grew up in the coastal area of Del Mar, back when it was still just a little beach town. Some of my fondest memories were walking to the beach hand in hand with my late grandmother and gathering shells and rocks to bring back home.

Why did you decide to specialize in trauma surgery?

Ever since dedicating my life to medicine, I have enjoyed and valued just about every subject I have come across within the field. It was a tough choice to for me to even decide upon general surgery over internal medicine for residency, but I soon found that the diversity and opportunities within were a perfect fit for me. Being a trauma and critical care surgeon continues to allow me access to a broad range of procedures to learn, skills to hone, patients to meet and intellectual endeavors to pursue. It was a satisfying feeling when I realized that I could handle the many types of emergencies that the job presented me.

What is the most rewarding aspect of your job?

There are numerous rewards that I encounter regularly on the job, including the immediate gratification of seeing a very sick patient readily recover under the care of my team. Over the years however, the most rewarding aspect has been seeing the residents progress from their first day in general surgery residency and steadily develop utilizing much blood, sweat and tears into fully capable surgeons ready to change the world in their own ways. It is a humbling thing to be a part of that.

How do you unwind at the end of the day?

Taking an early evening walk to the beach with my boys, Ryder and Cameron. It never fails to clear my mind and bring a smile to my face.

Is there something or someplace you have never seen that you would like to see in the near future?

My family grew up skiing and snowboarding and we used to take a family trip every year to Mammoth. I have never been to Whistler, British Columbia, but have heard much about it and have longed to go. In the near future, managing to organize a trip with my whole family to relax and experience it together would be a dream.

Father of Three Thanks Circle of Friends

James Liotta thanks Cedars-Sinai staff for caring for his three children during the Circle of Friends event in May.

James Liotta can name three good reasons why he's grateful to Cedars-Sinai – Gemma, Hannah and James. They're his children.

"It's because of you that my three children are alive today," Liotta said to more than 500 Cedars-Sinai employees at the Circle of Friends recognition event Monday, May 23, in Harvey Morse Auditorium.

Liotta's oldest daughter Gemma, 5, was born at Cedars-Sinai. But at 18 months, she contracted a potentially deadly staph infection and returned to Cedars-Sinai. A delicate surgery helped restore the child to health.


Paula Anastasia, RN, and Alfredo Trento, MD, were honored at the Circle of Friends event.

In 2014, Liotta and his wife welcomed daughter Hannah and son James into their family. However, the twins were born prematurely and with serious medical complications. The babies spent their first three months clinging to life in the Cedars-Sinai Neonatal Intensive Care Unit, part of the Maxine Dunitz Children's Health Center.

The twins recovered, explained Liotta, because "every nurse, every doctor, every respiratory therapist and every other staff member on that unit was all hands on deck working tirelessly."

Founded in 2009, Circle of Friends was created as part of the Community Relations and Development Division's strategy to provide grateful patients and their families an opportunity to say thank you by making a philanthropic gift in honor of a Cedars-Sinai physician, nurse, volunteer or staff member. Every month, the most recent Circle of Friends honorees – each of whom receives a lapel pin and letter of acknowledgment – are highlighted in The Bridge.

In seven years, the Circle of Friends program has honored more than 2,800 people.

"Some of these individuals have been recognized multiple times," Cedars-Sinai President and CEO Thomas M. Priselac told the audience at the recognition event. "So the number of honors awarded actually is more than 14,350, which is extraordinary."

In light of the high numbers, the Circle of Friends program is introducing a new multitiered system. Those who receive 25 or more honors will be given a lapel pin accented with a green circle. Meanwhile, a gray-accented lapel pin will signify 50 or more honors; an aqua circle, 75 or more honors; and a red circle for 100 or more honors.

"I'm privileged to be part of an organization that has such an incredible staff, and I wanted to take a moment to personally thank all of you for the profound impact you have on people's lives," Priselac said.

Shlomo Melmed, MD, executive vice president of Academic Affairs and dean of the medical faculty, also applauded Cedars-Sinai's staff.

"Just today, I talked to a patient on 7 Southeast," he said. "He explained that as a patient here, he felt like a human being. ‘I feel dignified and safe' – that's what he told me. And so we thank all of you for embracing our community."

Among the many of Circle of Friends honorees, two were singled out at the May event.

Linda Burnes Bolton, DrPH, RN, FAAN, health system chief nurse executive, vice president for nursing, chief nursing officer and director of nursing research at Cedars-Sinai, presented a plaque to Paula Anastasia, RN, MN, AOCN, clinical nurse specialist, Women's Cancer Program.

"I want you to join me in recognizing someone who symbolizes a commitment to providing phenomenal care," Burnes Bolton said. "An oncology nurse for more than 30 years, Paula is truly passionate about her work and speaks nationally on the subjects of ovarian cancer, chemotherapy-symptom management and survivorship issues. Her dedication is reflected by the fact that she's been honored by patients and their loved ones 40 times – the most received by any nurse."

Chief of Staff Peggy B. Miles, MD, handed a plaque to Alfredo Trento, MD, professor, Surgery, director, Cardio-Thoracic Surgery.

"A great physician treats the patient, not just the disease," Miles said. "Dr. Trento leads by example, providing exceptional care and changing the lives of families. He is the top Circle of Friends recipient, having received 247 honors to date. He's performed more than 7,500 cardiac surgeries, but his thoughtfulness and kindness are cited by patients just as often as his tremendous skills."

FDA Cautions Against Zecuity Patches, High Doses of Loperamide, and Aspirin Overuse

Pharmacy Focus

The U.S. Food and Drug Administration is warning about heart problems associated with taking higher than recommended doses of the common over-the-counter and prescription diarrhea medicine loperamide. Also, the FDA has temporarily suspended sales of Zecuity patches for migraine headaches over concerns of burning and scarring. And the agency warned about the risks of serious bleeding that can result from taking too much aspirin, which is contained in over-the-counter products for stomach upset.

FDA: Burning and Scarring Linked to Zecuity Patch

The U.S. Food and Drug Administration has temporarily is suspended sales, marketing and distribution of the Zecuity (sumatriptan iontophoretic transdermal system) patch for migraine headaches after reports of its use caused serious burns and permanent scarring. Health care professionals should stop prescribing Zecuity, and patients should not use any remaining patches.

The FDA website has more information.

FDA: Loperamide Overuse Can Cause Heart Problems

The FDA is warning against taking higher than recommended doses of the common over-the-counter and prescription diarrhea medicine loperamide. Misuse or abuse of the product can cause serious heart problems that can lead to death, according to the FDA. The majority of reported serious heart problems occurred in individuals who were intentionally taking high doses in an attempt to self-treat opioid withdrawal symptoms or achieve a feeling of euphoria.

The FDA website has more information.

FDA: Serious Bleeding Can Result from Overuse of Aspirin

The FDA is warning consumers about the risk of serious bleeding when using over-the-counter aspirin-containing antacid products to treat heartburn, sour stomach, acid indigestion or upset stomach. Taking too much aspirin carries the risk of serious bleeding. The agency is urging the public to seek other products for the conditions that do not contain aspirin.

The FDA has more information.

Case Against Social Media Triumphs in Debate

Ryan Spurrier, MD

The gloves came off in a war of wit and words over the proper role of social media in medicine at the 13th annual Dr. Leon Morgenstern Great Debates in Clinical Medicine Resident Competition on Friday, June 3.

To underscore the fierceness of the bout to come, the theme from Rocky played as the debaters — Cedars-Sinai resident physicians Ryan Spurrier, MD, and Justin Steggerda, MD — marched into a standing-room-only crowd in Harvey Morse Auditorium.

When the hourlong debate was over, Spurrier triumphed with his argument that social media poses a threat to professionalism in medicine. A veteran of the event, Spurrier collected his second Morgenstern Trophy and a cash prize.

In honor of the event's 13th birthday, Rabbi Jason Weiner bar mitzvahed the debate.

During the debate, Spurrier asserted that the misuse of social media could ruin credibility and erode the physician-patient relationship.

"We must hold ourselves as physicians to a higher standard than other professionals and we must certainly rise above the frivolity and the interactions that are commonplace in social media," Spurrier said. "As physicians we raised our hands and took an oath; the last line of our Hippocratic oath reads, 'May I always act so to protect the finest traditions of my calling.'"

Spurrier added that privacy and integrity could easily be jeopardized as well if social media is not used carefully and critically.

"Even the occasional lapse in judgment in the age of social media lasts forever. It can serve to undermine the tenets of professional behavior and has the potential to generate public mistrust of the medical profession as a whole," he said. "Society demands that physicians fill an elite role as unflinching professionals with an unwavering commitment to the care of their patients. It is society's very confidence in the professionalism of each and every one of us here today that comforts the sick in their time of uncertainty and fear."

Steggerda countered that when used properly, social media offers physicians a new opportunity to connect with patients, build relationships and provide accurate patient education.

"Patients want to be your friend," Steggerda said. "They want to have a voice in their own care and they want to feel as though they can engage in discussion with you, and being a little more human from that standpoint may actually help develop that patient-physician relationship."

Steggerda agreed with Spurrier that professionalism was critically important when engaging in social media. With what he prescribed as a "healthy dose of caution," physicians could learn best practices for using social media effectively without damaging their reputation or practice. In his opinion, social media is another form of evolving technology that helps physicians improve how they relate to and treat their patients.

"Amongst physicians, patients and medical education, social media offers the opportunity to extend healthcare to reach a broader population, to keep up with new discoveries, treatments and research, and to overall improve the state of clinical medicine," said Steggerda. "Do not be left behind."

Leo Gordon, MD, coordinator and moderator of the Great Debates, recognized both participants for their contributions to an event that promotes the advancement of the medical profession.

"It's very easy to get down about the state of medicine," said Gordon. "But then we meet people like Dr. Spurrier and Dr. Steggerda, and you are convinced that we will pass this wonderful profession on to committed, enthusiastic and reputable people like those you heard from this morning."

Goals of the Anesthesia Pre-Procedure Evaluation Center

The Pre-Procedure Testing Program underwent a redesign to better meet the needs of pre-procedure patients, their surgical teams and referring physicians. In June 2013, its name was changed to the Anesthesia Pre-Procedure Evaluation Center and it opened a one-stop shop in the state-of-the-art Advanced Health Sciences Pavilion, Plaza Level.

Its goals:

  • Ensure patient safety by evaluating patients far in advance to identify risk factors and optimize patients' medical conditions
  • Improve efficiency by ensuring each patient's chart is complete 72 hours prior to surgery
  • Enhance value by eliminating avoidable delays and cancellations on the day of surgery

The center offers the following pre-procedure services:

  • RN assessment with expertise in surgery and anesthesia
  • Anesthesia pre-procedure evaluation (phone consult acceptable in certain cases)
  • Medical evaluation for patients without an existing provider by an Inpatient Specialty Program physician
  • Testing for Pre-procedure patients: labs, electrocardiogram, chest X-ray

Operational Hours/Contact Information:

The center is currently open Monday through Friday from 8:30 a.m. to 7 p.m. Beginning Monday, Aug. 22, those hours will change to 9 a.m. to 5:30 p.m. The center is closed holidays and weekends.

Patients and referring providers are encouraged to contact the center for an appointment. Same-day appointments are accepted for patients outside our geographical area and for patients without a primary care provider. Staff can be reached by:

Telephone: 424-315-2525
Fax: 424-315-7258
Email: apec@cshs.org
CN IV: Charito Bernal, RN, MPH, CPAN
Manager: Kyung Jun, RN, MSN, CNOR


Frequently asked questions:

  • Is there a charge for anesthesia consult? No
  • Is there a charge for medical evaluation? Yes
  • What should patients bring to the center for the appointment?
  • Photo ID and insurance card
  • Copies of pre-op tests results (if performed by non-Cedars Sinai physicians)
  • Updated medical history, allergies and medication list (if not updated online)
  • What can the patient expect if having an appointment?
  • The patient will get a confirmation call regarding the date and time of appointment, arrival time, parking instructions, how to activate My CS-Link account and complete a questionnaire prior to the visit. All patients will be registered before seen at the center.

Metabolic Plasticity in Breast Cancer

By V. Krishnan Ramanujan, PhD

Ramanujan Krishnan

V. Krishnan Ramanujan, PhD

Neoplastic transformation is a stochastic step in the life of a breast epithelial cell. Not all the transformed cells survive to become malignant cancers. The holy grail of breast cancer research is to understand how a transformed cell survives within a normal mammary epithelium amid the prevailing regulatory checkpoints and protective mechanisms in a normal tissue environment.

Regardless of their origin, all transformed cells display a variety of adaptive strategies (such as aerobic glycolysis and hypoxia) to increase their survival and proliferative potential. Intriguingly, both these adaptive mechanisms have aberrant mitochondrial metabolism as a common denominator. While aerobic glycolysis is an attempt to increase cancer cell biomass via compromised mitochondrial metabolism in the presence of oxygen, hypoxia is another extreme of mitochondrial shutdown owing to limited oxygen supply within a growing tumor.

While trying to identify the putative mitochondrial defects in human breast cancer cells, our laboratory (Metabolic Photonics Laboratory) uncovered a significant diversity in mitochondrial number, enzymatic activity and response to mitochondrial perturbations between these cells.

Metabolic

Three-dimensional reconstruction of a live mouse tumor spheroid showing the spatial heterogeneity in mitochondrial metabolism. Labeled with mitochondrial metabolic marker (red) and a plasma membrane marker (green).

Our long-term goal is to identify and understand the metabolic routes by which we could target the metabolic vulnerabilities in cancer cells, thereby making them revert to a nontumorigenic, normal-like phenotype (metabolic plasticity). Toward achieving this goal, we have been making significant inroads by focusing on mitochondrial Complex I, which is the largest enzyme in the electron transport chain and is the least studied enzyme in the context of cancer metabolism.

In an in vitro model system, we recently demonstrated that mitochondrial Complex I deficiency directly led to aerobic glycolysis phenotype that is known to favor tumorigenic growth in a number of breast cancers. In a follow-up in vivo study using human breast cancer xenograft model, we discovered that pharmacological enhancement of mitochondrial Complex I function in aggressive human triple-negative breast cancer cells led to a significant reduction (~70 percent) in tumor growth with a concomitant reduction in aerobic glycolysis phenotype.

These studies gave us a vital clue that mitochondrial Complex I normalization could be a powerful strategy to control breast cancers. By a multidisciplinary approach involving high-resolution metabolic imaging, novel transgenic mouse models and human biospecimens, we are currently focusing on elucidating how we could extend the scope of metabolic plasticity idea to various breast cancer subtypes and to primary and metastatic tumor control.

Principal investigator : V. Krishnan Ramanujan, PhD

Lab : Metabolic Photonics Laboratory, Cedars-Sinai departments of Surgery and Biomedical Sciences

Intramural funding comes from the Department of Surgery, extramural funding from the National Cancer Institute, Susan G. Komen organization and American Cancer Society.

Gewertz Lectures About Innovation and Leadership

Bruce Gewertz, MD

Bruce L. Gewertz, MD

Bruce L. Gewertz, MD, surgeon-in-chief and chair of the Department of Surgery, delivered four lectures across the country in May.

They were:

  • Sustaining Fulfillment in Work and Life. Jonathon Towne Lecture, Medical College of Wisconsin, Milwaukee, May 10.
  • Management of Carotid Artery Disease. Grand Rounds, Medical College of Wisconsin, Milwaukee, May 11.
  • The Best Medicine: Leadership Lessons for Work and Life. Maja and Frank Moody State-of-the-Art Lecture, Society for Surgery of the Alimentary Tract, San Diego, May 23.
  • Fostering Innovation in Healthcare: Can We Balance Academic Values, Venture Capital and Conflicts of Interests? Annual Visiting Professor, Harvard-Longwood T32 Training Program in Vascular Biology, Boston, May 31.

Gewertz also holds the Harriet and Steven Nichols Distinguished Chair in Surgery. He is vice president of Interventional Services and vice dean of Academic Affairs.

Reminder About Block Utilization, Operating Room Access

To help improve block utilization and operating room access, here is a reminder about the process related to block utilization credit when applicable.

If you release a block 15 days or more in advance, the released time will be credited back to your block utilization.

To release any unneeded block time, please email the attached form to centralschedulers@cshs.org.

For more information, please contact Brian Gutierrez at brian.gutierrez@cshs.org or 310-423-1627.

Block Release Request Form - June 14, 2016 (PDF)  

The Campaign for Cedars-Sinai Begins Public Phase

Cedars-Sinai is conducting its most ambitious fundraising effort in the history of the institution – the Campaign for Cedars-Sinai – with a goal of raising $600 million by 2018. This July marks the beginning of the public phase of the campaign, when the organization will begin sharing its goals and mission with the community at large.

Each member of the Cedars-Sinai staff can have a direct impact on the campaign's success. Cedars-Sinai's collective commitment to providing world-class care to patients is critical in raising philanthropic support. Grateful patients compose the majority of Cedars-Sinai's donors – about 75 percent. These investments help fund innovative research and technology that lead to groundbreaking advances in patient care.

The Campaign for Cedars-Sinai supports interdisciplinary collaboration and innovation in the following key areas:

  • Disease prevention and control
  • Precision medicine and targeted therapies
  • Aging and longevity
  • Innovations in healthcare and technology
  • Education and training

Additional information about these key areas can be found on the Cedars-Sinai intranet.

Since its launch on July 1, 2010, the Campaign for Cedars-Sinai has raised more than $480 million, largely through major gifts of several thousand dollars or more. The public phase of the campaign, which runs through June 2018, will focus on attracting donors at all levels of support.

In the coming months, staff members will hear more about the Campaign for Cedars-Sinai — and the impact of its supporters — through communications in Cedars-Sinai publications and in public advertising initiatives.

Staff will have the opportunity to learn more about the campaign and become involved at a launch event on Friday, July 8, from 7 a.m.-5 p.m. in Harvey Morse Auditorium. The event will feature giveaways and presentations from senior medical and institutional leadership talking about the innovations and research funded by the campaign.

CS-Link Tip: Creating and Editing Lists

Physicians often need to find a patient in the hospital, and CS-Link can make this task easier and more efficient. The idea is to create a patient list with the help of the toolbar. Here's a look.

Learn to be more efficient by attending a Physician Efficiency Training session. The classes are held in the Cafeteria Conference Room C. July classes are:

  • Tuesday, July 12, 7:30-9 a.m.
  • Thursday, July 14, noon-1:30 p.m.
  • Wednesday, July 20, 5-6:30 p.m.

If you have questions, email groupeisphysicians@cshs.org.

Circle of Friends Honorees for May

The Circle of Friends program honored 201 people in May.

Circle of Friends allows grateful patients to make a donation in honor of the physicians, nurses, caregivers and others who have made a difference during their time at Cedars-Sinai. When a gift is made, the person being honored receives a custom lapel pin and a letter of acknowledgement.

Click here for more information about the program and for a list of past honorees.

  • Kenneth Adashek, MD
  • David E. Aftergood, MD
  • Karen M. Alexander
  • Farin Amersi, MD
  • Ellen Anifantis, LCSW
  • Alagappan Annamalai, MD
  • Teresita W. Arcalas, RN
  • M. William Audeh, MD
  • Babak Azarbal, MD
  • Hyun W. Bae, MD
  • C. Noel Bairey Merz, MD
  • Babak R. Bamshad, MD
  • Tina G. Ban, RN
  • Marife N. Banda
  • Maria Elena T. Bautista, RN
  • Arash Bereliani, MD
  • Stephanie C. Berkey, RN
  • Satinder J. Bhatia, MD
  • Brooke Bianco, RN
  • Keith L. Black, MD
  • Darina Brezhnev, PharmD
  • Earl W. Brien, MD
  • Barry J. Brock, MD
  • Eileen G. Brown, OCN, RN
  • Christiane Michele J. Burnison, MD
  • Marshia G. Caceres, MSW, LCSW, ACM
  • Zenaida S. Cacpal
  • Allison H. Canavan, MD
  • Brendan J. Carroll, MD
  • Kirk Y. Chang, MD
  • Cheryl G. Charles, MD
  • Timothy Charlton, MD
  • George Chaux, MD
  • Wen Cheng, MD
  • Mark Y. Choi, MD
  • Myles J. Cohen, MD
  • Stephen R. Corday, MD
  • Kenneth A. Corre, MD
  • Alice C. Cruz, MD
  • Lawrence S. Czer, MD
  • Ram C. Dandillaya, MD
  • Catherine M. Dang, MD
  • Robert M. Davidson, MD
  • Robert W. Decker, MD
  • Stephen C. Deutsch, MD
  • Noam Z. Drazin, MD
  • Elitzafan Ebrahim Doost, RN
  • Joshua D. Ellenhorn, MD
  • Aileen M. Espiritu, BSN, RN
  • Joselito S. Espiritu, BSN, RN
  • Richard Essner, MD
  • Maicolorein Faustino, RN
  • Joel D. Feinstein, MD
  • Alfredo C. Feliciano
  • Morton H. Field, MD
  • Eiman Firoozmand, MD
  • Brian L. Flyer, MD
  • Charles A. Forscher, MD
  • Joyce N. Fox, MD
  • Andrew L. Freedman, MD
  • Stuart Friedman, MD
  • Jason A. Fuentes
  • Clark B. Fuller, MD
  • Rodney A. Gabriel, MD
  • Sara Ghandehari, MD
  • Neil J. Goldberg, MD
  • Sherry L. Goldman, RN, NP
  • Gloria A. Gomez
  • Maria M. Gozip, RN
  • Jeffrey R. Gramer, MD
  • Abe Green, MD
  • Sean Greschel, RN
  • Marshall L. Grode, MD
  • Behrooz Hakimian, MD
  • David S. Hallegua, MD
  • Michele A. Hamilton, MD
  • John G. Harold, MD
  • Michael D. Harris, MD
  • Andrew E. Hendifar, MD
  • Susan K. Henry, RN
  • David M. Hoffman, MD
  • Martin L. Hopp, MD
  • Robin R. Hudson, RN, CPAN
  • Marney Jakubowicz, LVN
  • Laith H. Jamil, MD
  • Bojana Jankovic, MD
  • Wilbur L. Jones
  • Jay L. Jordan, MD
  • Stanley C. Jordan, MD
  • Jessica Jung, RN
  • Stephanie M. Kagimoto
  • Kamran Kalpari, MD
  • Edidiong C. N. Kaminska, MD
  • Saibal Kar, MD
  • Sheila Kar, MD
  • Beth Y. Karlan, MD
  • Scott R. Karlan, MD
  • Ronald P. Karlsberg, MD
  • David Kawashiri, MD
  • Yael Kessler
  • Raj Khandwalla, MD
  • Sarah J. Kilpatrick, MD, PhD
  • Cindy K. Kim, RN
  • Hyung L. Kim, MD
  • Rodelia Kingsby
  • Michelle M. Kittleson, MD, PhD
  • Robert Klapper, MD
  • Keith L. Klein, MD
  • Jon A. Kobashigawa, MD
  • Michael A. Kropf, MD
  • Noel B. Lara, RN
  • Magda Leavitt, MSN, RN
  • Madeline S. Lerman, BSN, RN
  • Ronald S. Leuchter, MD
  • Michael I. Lewis, MD
  • Richard A. Lewis, MD
  • Michael C. Lill, MD
  • Simon K. Lo, MD
  • Dorothy L. Lowery
  • Cheryle C. Maano-Requejo
  • Rajendra Makkar, MD
  • William J. Mandel, MD
  • Daniel R. Margulies, MD
  • Edmund J. Martinez
  • Hasmik Martirosyan
  • David N. Matsumura, MD
  • Bryan M. May, RN
  • Philomena McAndrew, MD
  • Robert J. McKenna Jr., MD
  • Krista N. Meadows, MSN, RN
  • Nicolas Melo, MD
  • Tamar Meszaros, MD
  • Stewart Middler, MD, PhD
  • Jaime D. Moriguchi, MD
  • Kyle K. Mosqueda
  • Lori Ann Mountain, RN
  • Ronald B. Natale, MD
  • Alan C. Newman, DDS
  • David G. Ng, MD
  • Leslie Nieva
  • Nicholas N. Nissen, MD
  • Arthur J. Ochoa, JD
  • Ronald L. Paquette, MD
  • Jignesh K. Patel, MD, PhD
  • Rema D. Pendon, RN
  • Surasak Phuphanich, MD
  • Imelda M. Pichon Queja, RN
  • Mark Pimentel, MD
  • Julie I. Pinero, RN
  • Margareta D. Pisarska, MD
  • Terry E. Podell, MD
  • Edwin M. Posadas, MD
  • Angel P. Puquiz, BSN, RN
  • Susan M. Rabizadeh, MD
  • Adela R. Reales-Pardo, RN
  • Richard M. Ress, MD
  • Miranda Ripper, RN
  • Susan L. Roberts, BSN, RN, RN-C
  • Robert M. Rose, MD
  • Barry E. Rosenbloom, MD
  • John Sabino, RN
  • Michelle Sanchez, RN
  • Howard M. Sandler, MD, MS
  • Gregory P. Sarna, MD
  • Jay N. Schapira, MD
  • Konrad H. Schlick, MD
  • Prediman K. Shah, MD
  • Bahman Shamloo, MD
  • Michael M. Shehata, MD
  • Nicholas Shipman, RN
  • Allan W. Silberman, MD, PhD
  • Gena T. Smith, RN
  • Daniel J. Stone, MD
  • Leslie Stricke, MD
  • Eric R. Sue, MD
  • Steve C. Sun, MD
  • Charles D. Swerdlow, MD
  • Steven Sykes, MD
  • Steven W. Tabak, MD
  • Victor F. Tapson, MD
  • Sam S. Torbati, MD
  • Duc T. Tran, MD
  • Tram T. Tran, MD
  • Alfredo Trento, MD
  • Leo Treyzon, MD, MS
  • Rosalind C. Tu, RN
  • Franca Uchemefuna, RN
  • Lynette Ursini, RN
  • Richard J. Van Allan, MD
  • Michael B. Van Scoy-Mosher, MD
  • Jocelyn Velicaria, RN
  • Robert A. Vescio, MD
  • Carl Violano, MD
  • Olga Voroshilovsky, MD
  • Christine S. Walsh, MD
  • Edward M. Wolin, MD
  • Curtis D. Woodworth, RN
  • Clement C. Yang, MD
  • Arthur M. Zapata, RN
  • Christopher Zarembinski, MD
  • Hong Zhou, NP
  • Lum Zuna