We asked BWHers to weigh in on what they’re looking forward to seeing and experiencing at 60 Fenwood Road.

A screen shot of the Aspirin Guide app

Low-dose aspirin is recommended by experts as a preventive measure for patients who have previously had a heart attack or stroke, but the risk of taking it to prevent or delay a first heart attack or stroke is less clear. BWH physician-researchers have developed a free mobile app that takes guesswork out of the equation.

The benefit for reducing the risk of cardiovascular disease (CVD) must be balanced with the increased risk of gastrointestinal or other bleeding. The iPhone and iPad app, “Aspirin Guide,” calculates both the CVD risk score and the bleeding risk score for the individual patient, and helps clinicians decide which patients are appropriate candidates for the use of low-dose aspirin (75 to 81 mg daily).

The app’s content and algorithms were developed by Samia Mora, MD, a cardiologist in the BWH divisions of Preventive Medicine and Cardiovascular, and JoAnn Manson, MD, DrPH, chief of the Division of Preventive Medicine, with technical assistance from software developer Jeffrey Ames. A web-based and Android version of the app will be released in a few weeks.

“We developed the Aspirin Guide app because we realized that weighing the risks and benefits of aspirin for individuals who have not had a heart attack or stroke is a complex process,” Mora said. “The new mobile app enables individualized benefit to risk assessment in a matter of seconds while the patient is with the physician.”

The app calculates a patient’s 10-year CVD risk score and a bleeding risk score, based on the individual risk factors. It uses evidence from the literature, together with the above scores, to guide the clinician on whether the patient is a good candidate for aspirin.

“Aspirin Guide is a user-friendly clinical decision support tool that will facilitate informed and personalized decision-making about the use of aspirin in primary prevention of CVD,” Manson said.

The new building at 60 Fenwood Road opens this fall.

When the Brigham’s new building at 60 Fenwood Road opens this fall, it will be a hub for state-of-the-art labs, outpatient clinical space and advanced imaging facilities.

Researchers and clinicians moving into the building will help accelerate and translate laboratory discoveries into novel treatments for patients.

In addition to its three floors of clinical space, the building will also serve as an anchor for several key research areas, including the Neurosciences, Orthopaedics and Musculoskeletal, and Rheumatology, Immunology and Allergy. It will also be a place for innovation in regenerative medicine, imaging technology and clinical trials.

Departments, divisions and labs will move into the building gradually, starting with administrative spaces in September, clinics in October and research spaces through early 2017.

Here’s a brief look at what you’ll find in the new building:

Neurosciences. The Neurosciences Center will allow investigators from the nervous system disciplines to come together in a single space for the first time. Patients who are seen in the Neurosciences Clinical Center, on the building’s first floor, will be able to enroll in clinical trials. Neurology, Neurosurgery and Psychiatry investigators will pursue basic and translational research on the eighth, ninth and 10th floors of the building, which will include the Harvey Cushing Neuro-Oncology Laboratory (HCNL).

Orthopaedics and Musculoskeletal. The new building will be home to the Orthopaedics and Arthritis Center, which will be jointly led by the Department of Orthopaedics and the Division of Rheumatology, Immunology and Allergy. Through the center, molecular biologists, biomechanical engineers, rheumatologists and others will work in close proximity, sharing their perspectives and solutions with one another. Two centers in the new space, PIVOT and OrACORe, will focus on patient outcomes and the value of specific orthopedic procedures. The Stepping Strong Trauma Center, which aims to accelerate promising multidisciplinary trauma research and clinical care, will reside on the building’s fifth floor. Labs on floor five will focus on bone biology, stem cell biology, orthopedic material sciences and more.

Rheumatology, Immunology and Allergy. Clinical researchers from the Division of Rheumatology, Immunology and Allergy will conduct research on floors five and six of the building. They will also be able to conduct clinical trials in the new space. The division’s Aspirin-Exacerbated Respiratory Disease (AERD) Center will conduct research studies to test hypotheses about the underlying cause of this complex disease and try out new treatments.

Innovation. A new Brigham Innovation Hub space on the third floor will serve as a resource for first-time and experienced innovators. Meanwhile, the building’s lower level will be dedicated to advanced imaging technologies—including a CT scanner and five cutting-edge MRI machines—for research and clinical use. In addition, labs pursuing advances in regenerative medicine and nanotechnology, treatments for immunologic diseases and more will be found on the third and seventh floors of the building.

Joaquim Havens

Seven surgical procedures account for about 80 percent of all admissions, deaths, complications and inpatient costs attributable to operative emergency general surgery (EGS) in the U.S., according to a recent study led by Brigham researchers.

The seven procedures are ranked in terms of their overall “burden,” which is defined by how frequently they occur, result in death and cause complications, as well as their costs. Lead investigator Joaquim Havens, MD, of the Center for Surgery and Public Health, and his team found that partial colectomies—removal of part of the colon—carried the biggest overall burden. Small-bowel resections, cholecystectomies (removal of gallbladder), operative management of peptic ulcer disease, removal of peritoneal (abdominal) adhesions, appendectomies and laparotomies (opening the abdomen) also topped the list.

“Given the high prevalence nationally and high proportion of burden with these seven procedures, this study could lead to better clinical decision-making, patient outcomes and cost savings,” said Havens.

Emergency general surgery encompasses the care of the most acutely ill, highest-risk and most costly general surgery patients. More than 3 million people are admitted to hospitals in the U.S. each year for EGS diagnoses. This population of surgery patients is at particularly high risk for postoperative death when compared to patients undergoing the same procedures under non-emergency circumstances.

Preventive measures, such as undergoing a routine colonoscopy or mentioning the onset of heartburn to a primary care provider, can lessen the likelihood of having to undergo these procedures in an emergency setting, Havens says.

“By reducing the number of people who need these surgeries and making it safer for those patients who do need them, we can make an important difference in people’s health,” Havens said.

Over the four-year study period, Havens and his team analyzed more than 420,000 adult patients who had been admitted with EGS diagnoses and undergone operative procedures within two days of admission. They, to their knowledge, are the first researchers to use a nationally representative sample to identify EGS procedures.

Runners from BWH’s fundraising team for the B.A.A. 10K

Among the 9,000-plus runners racing through Back Bay in the Boston Athletic Association 10K—presented by Brigham and Women’s Hospital—were 200 members of the BWH fundraising team. They stayed in high spirits as they tackled the 6.2-mile course while representing and supporting the hospital on June 26.

The BWH team is projected to raise $110,000 to support life-giving breakthroughs for patients and families in Boston and around the globe.

Their reasons for running varied, but participants all shared one sentiment—a desire to give back to the hospital that provides extraordinary care to patients and families.

Megan Jordan, of Roslindale, ran in honor of her niece, Surina, who was born prematurely and spent more than three months in the Newborn Intensive Care Unit (NICU) at BWH.

“I wanted to do something to support the NICU,” she explained. “If you ever need to deliver a preterm infant, you want to be near the Brigham because the NICU is amazing. The nurses made scrapbooks. My sister would come in and they’d have new clothes for her. The care they provided made something very difficult more manageable. Surina is just the perfect little one.”

Sally Wang, MD, a hospitalist at BWH, ran in memory of Michael J. Davidson, MD, and to support the fellowship that bears his name.

“Dr. Davidson was a phenomenal physician, and I hope we can continue to honor his legacy to support new trainees in the field of cardiothoracic surgery,” Wang said.

Elizabeth Matzkin, MD, surgical director of Women’s Sports Medicine at BWH, formed the Bone to Run team to raise money for research in her field.

“I’ve been wanting to organize a race for our group for a long time, so when the Brigham paired up with the B.A.A., it was a great opportunity to put together a team,” she said. “We hope it will only grow in the years to come.”

Anders Ohman, a senior technical research assistant at BWH, chose to run to support the Gillian Reny Stepping Strong Fund, which was founded by a Boston Marathon bombing survivor to fuel trauma research and care.

“It’s inspiring to see a family turn tragedy into a personal way of giving back, and I love representing the Brigham. I’m really proud to work here,” Ohman said.

New imaging technologies will begin moving into the BBF on July 7.

When the Brigham Building for the Future opens this fall, clinicians and researchers will have access to state-of-the-art technologies that will enable them to push the boundaries of discovery in ways never before possible.

“The BBF will be a one-stop shop, with multidisciplinary experts within arm’s reach and top-of-the-line imaging technologies, interventional procedures and clinical evaluation,” said Stacy Smith, MD, chief of the Division of Musculoskeletal Imaging and Intervention in the Department of Radiology.

In addition to an extensive array of X-Ray, fluoroscopy and ultrasound technologies, a new impressive fleet of noninvasive medical imaging devices will streamline and improve patient care and support Brigham’s research mission to translate promising medical and scientific advances to the clinic. The equipment will be moved into the BBF over several days this month, starting July 7.

New imaging technologies will be housed in the Radiology Department on the Musculoskeletal floor and within Radiology on the lower level of the building. The imaging facility on the lower level will contain a CT scanner and five MRI machines, including a 7 Tesla (7.0T), one of the most powerful commercially available MRI machines in the world, due to arrive in summer 2017. BWH’s 7.0T will be the first installed in a clinical setting in North America. The model is still pending approval by the Food and Drug Administration for clinical use, so the 7.0T in the BBF will be used for research until that time.

Two of the other MRIs will be Siemens’ newest model, the Magnetom Prisma—the first at BWH and the most advanced clinical MRI scanner available. The Prisma has the capability to perform advanced imaging that was previously only available on research scanners.

A ‘Game-Changer’

When it arrives next year, the 7.0T will allow clinicians and researchers to see images that until now were not visible by MRI. It could be “a game-changer” in the diagnosis and treatment of neurodegenerative diseases such as multiple sclerosis (MS) and traumatic brain injury—two major areas of focus for the Ann Romney Center for Neurologic Diseases—said Srinivasan Mukundan, MD, PhD, of the Department of Radiology.

Even researchers who are not moving to the BBF stand to gain from the imaging facility’s offerings. One of those researchers is Alexander Lin, PhD, director of the Department of Radiology’s Center for Clinical Spectroscopy. He and his team are working to create noninvasive, diagnostic methods to better understand how to identify and treat brain cancer. He says that most spectroscopy is done using a standard MRI scanner, but the 7.0T will provide them with much more detailed images of metabolic pathways in the brain.

“We’ll be going from a 3.0T MRI to a 7.0T, which is more than double the strength,” said Lin. “The higher field strength means a better signal and higher-resolution images that will allow us to obtain more information than we can today.”

The imaging facility at the BBF will house equipment specifically selected to best serve the needs of the patients who will be seen in the new building, including those with MS and implanted devices, said Andrew Menard, JD, director of Business Development for the Department of Radiology. Many of the current Radiology spaces throughout the BWH campus that cater to the needs of patients receiving other kinds of treatments will remain where they are.

“Rather than consolidating Radiology spaces, we’ve adapted to the needs of patients,” said Menard. “We’ve selected the right technology for patients who will be seen in this building, and we’ve tried to make access as convenient as possible so that patients can receive imaging without ever having to leave the building where they are being treated.”

Learn more at BWHClinicalandResearchNews.org.

Human beta cells derived from stem cells

BWH and four other Harvard-affiliated institutions have joined forces to establish the Boston Autologous Islet Replacement program—a new center that will perform cell transplantation to accelerate a cure for diabetes.

Recent advancements in stem cell biology have provided an unprecedented opportunity to treat diabetes. Researchers have developed a process to generate a virtually unlimited number of beta cells—insulin-producing cells found in the pancreas—from adult stem cells in the lab. The stem cells would be created from the patient’s own blood cells, which could effectively be “reprogrammed” to perform this new role.

In people with diabetes, beta cells are either depleted or can’t produce enough insulin to maintain a healthy blood sugar level. These new stem-derived beta cells could be used in a clinical setting to replace or replenish a person’s beta cells as a treatment for diabetes.

The newly announced transplantation center, launched by Harvard Stem Cell Institute, BWH and the Joslin Diabetes Center (JDC), in collaboration with Semma Therapeutics and Dana-Farber Cancer Institute, will work toward translating these stem-cell discoveries into treatments that could ultimately cure diabetic patients.

Generating clinical-grade stem cells suitable for use in patients will take time; the program does not expect to conduct its first transplant until 2019 at the earliest. The initial clinical trial will enroll a very small, select group of patients—individuals who have had their pancreas surgically removed because they had incurable pancreatitis or similar conditions and who have not shown signs of islet autoimmunity (the body attacking its own insulin-producing cells).

BWH and JDC will work together in screening and identifying suitable patients. BWH will perform the transplantation procedure, and both BWH and JDC will provide follow-up care.

The Brigham’s involvement in the project has grown out of its international reputation as a leader in transplantation research and surgery. 

“This project builds on our pioneering work in transplantation and exemplifies the Brigham’s commitment to fostering discovery and innovation in order to translate research advancements into new therapies and treatments for our patients,” said BWHC President Betsy Nabel, MD. “We’re excited to partner with these esteemed institutions to push the boundaries in improving the care and treatment of patients with diabetes.”

Betsy Nabel addresses BWH employees.

Earlier this week, BWHC President Betsy Nabel, MD, provided a comprehensive update on several key issues to a full crowd of employees in Bornstein Amphitheater and those tuning in by webcast. Town Meeting topics consisted of an update on nursing contract negotiations (see related story), institutional strategy, and building upgrades and planning projects.

“As we think about BWH, our values today are the same as they were 100 years ago,” said Nabel in outlining the institutional strategy. “The foundation of everything we do is exceptional patient care, research, education and caring for our community.”

Nabel walked attendees through the hospital’s seven strategic priorities and three areas of focus: discovery and innovation, leading-edge care redesign and business development. (Learn more about BWH’s strategic commitments and areas of focus in a special issue of BWH Bulletin on June 24.)

Steve Dempsey, director of Planning and Construction, detailed several of BWH’s ongoing and upcoming capital projects, providing updates on the BBF, NICU and Emergency Department expansions, The Garden Café progress, Thorn Building and 221 Longwood Ave. upgrades, and main entrance renovations at 75 Francis St.

During the question-and-answer session, employees asked about access to standing desks, reduced seating in the Shapiro Center’s Miller Atrium and alternate routes for patient stretchers so that, in the interest of patient safety and privacy, they do not pass through the hospital’s temporary dining areas. Luis Soto, director of Central Transport and Environmental Services, shared that he has put a plan in place for alternate patient transport routes that avoid dining and other busy areas.

If you missed Town Meeting, view the webcast here.

From left: Paula Johnson, Elizabeth Loder, Kristin Schreiber and Gary Strichartz

As a young doctor completing her residency at BWH in the late 1980s, Paula A. Johnson, MD, MPH, was unaware there was an essential element missing from the study of medicine: Women were underrepresented in clinical trials and research. This was a fact that had historically gone unrecognized, Johnson told a packed room at the 11th annual Women’s Health Luncheon on May 6.

“When I began my training at the Brigham 30 years ago, women’s health in our country was in a very different place,” said Johnson, executive director of BWH’s Mary Horrigan Connors Center for Women’s Health and Gender Biology and chief of the Division of Women’s Health. “The lessons I learned then about heart disease, neurologic disorders, autoimmune disease and so many others were based predominantly on studies conducted almost exclusively on men.”

The luncheon was Johnson’s last as the head of the Connors Center. She leaves BWH this summer to become president of Wellesley College.

Thanks to the work of Johnson, the Connors Center and its supporters, local and national awareness of the gender disparity in research has grown. Subsequently, researchers and clinicians have learned more about how disease and the efficacy of treatments differ between sexes.

“We’ve made women’s health into a topic of national significance,” Johnson said. “We’ve influenced legislation requiring that women be included in biomedical research, and we’ve fueled critical research leading to advancements in gender-based care and public health policy. We’ve committed ourselves to making sure that the health of our mothers, daughters, sisters, friends and ourselves is not left to chance.”

Progress Continues

The fight is not over, however. Heart attacks are the leading cause of death for women, but only 30 percent of cardiovascular study participants today are women. Statistics like these prompted the launch of “Us Plus One,” an awareness campaign to recruit new members to the Women’s Health Board of Advocates, a volunteer organization that supports the Connors Center. A brief video, available at usplusone.org, explains why this movement is so critical to ensuring women’s health is not left to chance.

“We need to be confident that health care decisions for diagnoses, medications, medical devices and treatments have been designed for us,” said Karen Zahorsky, chairwoman of the Board of Advocates, who announced at the luncheon that Johnson would be the first to join the board.

Pain is one of many areas where differences in diagnosis and treatment should be different for men and women, according to experts. This topic, “Power Over Pain,” was the focus of the luncheon’s panel discussion with three BWH experts: Elizabeth Loder, MD, MPH, chief of the Divison of Headache and Pain; Kristin Schreiber, MD, PhD, an anesthesiologist and clinical pain researcher; and Gary Strichartz, PhD, MDiv, FRSM, director of the Pain Research Center.

One example of this disparity is seen in fibromyalgia, a disorder causing widespread pain that is more common in women, said Schreiber. The lack of an easily identifiable source, such as an inflamed joint, and its predominance in women have led some in the medical community to take it less seriously, she added.

“The fact that fibromyalgia has been diagnosed predominantly in women has made it a second-class pain diagnosis,” Schreiber said. “For a long time, some physicians didn’t even believe in it. However, we’ve been seeing real biomedical differences in people who have fibromyalgia—these people actually do feel more pain.”

Some research has shown that if a healthy person and someone with fibromyalgia are given the same amount of pain stimulus, Schreiber added, there is more activation in the pain areas of the brain—especially those that have to do with the emotional reaction to pain—in the person with fibromyalgia. “And that activation lasts longer than in healthy people,” she said.

Championing Women’s Health

As Johnson summarized the Connor Center’s contributions to the field of women’s health since the last luncheon in 2015, she highlighted a report from the U.S. Government Accountability Office assessing women’s inclusion in National Institutes of Health-funded clinical trials. The report, which was catalyzed by the center’s work, recognized that much more needs to be done to ensure women are sufficiently represented in research of diseases that affect both men and women. Johnson called it the most significant shift in policy in 20 years.

“None of this progress would be possible without the dedication of the people sitting in this room,” she said. “I am extraordinarily proud, and I know that with the incredible foundation and community we have built, you will be a champion of this work for decades to come.”

From left: Marcia Niland, Wendy Fuld and Anne McCue at an ice-cream social celebrating a successful Joint Commission survey

Last month, representatives from The Joint Commission witnessed firsthand BWH’s leadership in promoting excellence in the quality and safety of patient care during their survey of BWH’s clinical Pathology labs.

“It was very gratifying to hear the inspectors compliment us on having outstanding clinical labs with many best practices,” said Jeffrey Golden, MD, chair of the Department of Pathology. “I am extremely proud of our incredibly strong team and the care we provide to our BWH patients every day.”

During the four-day unannounced visit, which takes place every two years, surveyors from TJC evaluated compliance with laboratory standards in the labs, patient care areas, select on-site ambulatory practices and select off-site locations across BWH, including Anatomic Pathology, ambulatory labs, Blood Bank, Chemistry and various patient nursing units. In addition, the surveyors also focused on TJC National Patient Safety Goals, infection control and emergency preparedness in these locations.

Surveyors used the tracer methodology, a means of evaluation in which they select a patient and use that individual’s record as a roadmap to assess an organization’s compliance with certain standards and its systems of care and services.

“The excellent marks received during this survey epitomize the Department of Pathology’s relentless pursuit of service excellence,” said Milenko Tanasijevic, MD, MBA, director of Pathology’s Clinical Laboratories Division, noting that for the last two decades, Pathology has received high marks from TJC. “We strive continually to provide high-quality, timely laboratory testing to our patients and clinicians.”

Even more impressive, Tanasijevic said, was Pathology staff’s ability to accomplish a host of service advancements while facing the unprecedented challenge of having only 18 months to implement a new laboratory information system and interface it with Partners eCare, BWH’s Epic-based electronic health record system, which launched last year.

There are a few findings that will need to be addressed, mostly related to Epic. For example, there were locations where the names and addresses of the test-performing labs, a requirement on all reports, were not present. Golden said BWH is committed to correcting the findings in an effort to remain at the very highest standard.

“There are always opportunities to do better, and our staff is firmly committed to ongoing quality improvement,” Tanasijevic said.

This survey is particularly notable because it affects almost every department in the hospital, as clinical labs are dispersed across BWH, said Pamela Wakefield, compliance officer for the Clinical Laboratories.

“This was a massive team effort, and we didn’t miss a beat in terms of our preparedness. The credit goes to the frontline staff who made this survey a success. They make us very proud,” Wakefield said.

Celine Vetter

Heart disease is the leading cause of death in the U.S., contributing to one in every four deaths. In a new BWH study published in the Journal of the American Medical Association, researchers found that women who have performed rotating night shift work for more than 10 years had a 15 to 18 percent increased risk of developing coronary heart disease (CHD)—the most common type of heart disease—compared to women who did not work rotating night shifts.

“There are a number of known risk factors for CHD, such as smoking, poor diet, lack of physical activity and elevated body mass index (BMI),” said lead author Celine Vetter, PhD, associate epidemiologist in the Channing Division of Network Medicine and a chronobiologist at BWH. “These are all critical factors when thinking how to prevent CHD; however, even after controlling for these risk factors, we still saw an increased risk of CHD associated with rotating night shift work. Even though the absolute risk is small, and the contribution of shift work to CHD is modest, it is important to note that this is a modifiable risk factor and changing shift schedules may have an impact on the prevention of CHD.”

Researchers examined the association between rotating night shift work and CHD over a period of 24 years. About 189,000 women in the Nurses’ Health Study I and II who reported their lifetime exposure to rotating night shift work (defined as three or more night shifts per month, in addition to day and evening shifts) were included in the analysis. These women also reported on their heart health, indicating whether they had CHD-related chest pain, a heart attack or cardiovascular procedures such as angioplasty, coronary artery bypass graft surgery or stents. In the case of a death or self-reported heart attack, information was confirmed by death certificates and medical records to ensure that the event was related to CHD. Questionnaires also collected data on known risk factors of CHD every two to four years throughout the study period. Over the 24-year period, more than 10,000 newly developed cases of CHD occurred.

Researchers also found that recent night shift work might be most relevant for CHD risk. Additionally, for women who stopped working shifts, a longer time since quitting was associated with a decreasing CHD risk, a new finding that researchers note warrants replication.

“We believe that the results from our study underline the need for future research to further explore the relationship between shift schedules, individual characteristics and coronary health to potentially reduce CHD risk,” Vetter said.

Researchers note that the individual’s biological rhythm—which is often disrupted in rotating night shift workers—along with sleep patterns and quality might modify the association of CHD with shift work. Together with more detailed information on work schedules, future studies might help identify which aspects of work schedules are most critical and who is at highest risk.

Paul Nguyen

A new BWH study has found a significant association between depression and patients being treated for localized prostate cancer (PCa)—cancer that has not spread beyond the prostate—with androgen deprivation therapy (ADT). Through drugs or surgery, ADT reduces a patient’s level of androgen hormones to prevent prostate cancer cells from growing. These findings were published online in the Journal of Clinical Oncology earlier this month.

“We know that patients on hormone therapy often experience decreased sexual function, weight gain and have less energy—many factors that could lead to depression,” said senior author Paul Nguyen, MD, of Radiation Oncology. “After taking a deeper look, we have discovered a significant association between men being treated with ADT for PCa and depression.”

Nguyen calls this discovery “a completely under-recognized phenomenon.” Around 50,000 men are treated with ADT each year.

“It’s important not only for patients to know the potential side effects of the drugs they’re taking, but also for physicians to be aware of this risk so they can recognize signs of depression and refer these patients for appropriate care,” said Nguyen, who is the director of Prostate Brachytherapy at BWH. “Patients and physicians must weigh the risks and benefits of ADT, and the additional risk of depression may make some men hesitant to use this treatment, especially in clinical scenarios where the benefits are less clear.”

Researchers reviewed the data of 78,552 men over the age of 65 with stage I to III PCa; the data came from the SEER Medicare-linked database from 1992 to 2006. Researchers investigated the association between ADT and a diagnosis of depression or confirmation of inpatient or outpatient psychiatric treatment. Additionally, they looked at the association between the duration of ADT and depression.

When compared to patients who did not receive ADT, patients who received ADT had higher incidences of depression and inpatient and outpatient psychiatric treatment. Patients who received ADT had a 23-percent increased risk of depression, a 29-percent increased risk of inpatient psychiatric treatment and a non-significant 7-percent increased risk of outpatient psychiatric treatment when compared with patients not being treated with ADT. The risk of depression increased with the duration of ADT, from 12 percent with fewer than six months, to 26 percent from seven to 11 months of treatment, to 37 percent with patients being treated for 12 months or longer. A similar duration effect was seen for inpatient and outpatient psychiatric treatment.

Researchers encourage future studies to focus on interventions that could successfully reduce this risk and examine whether particular subpopulations are at a higher risk, such as patients with a history of depression.

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BWH wishes the Stepping Strong, Life.Giving.Breakthroughs. and Running to Remember Dr. Michael J. Davidson Marathon teams and all runners a healthy and strong race on Marathon Monday. Congratulations on all of your hard work, fundraising efforts and training. Your BWH family will be cheering for you on April 18!

David Baker

Nearly 15 years ago, David Baker’s uncle Lennie Baker—saxophonist for the doo-wop rock group Sha Na Na—lost kidney function due to diabetes and was put on dialysis. When David learned that his uncle needed a kidney transplant and that he was a match, he decided to donate his own kidney, giving his uncle more than a decade more of life.

Though he originally joined BWH’s Life.Giving.Breakthroughs. Marathon Team to honor his uncle, David is now running the Boston Marathon on April 18 in memory of Lennie, who passed away earlier this year.

“I run to honor my uncle and to show appreciation for the gift of life that BWH gave to him,” said David, of Hanson, Mass. “The doctors and all of the staff at BWH are miracle workers. As I run, I will be thinking of their hard work and all of the amazing memories I have of my uncle. I look forward to continuing to push my personal limits while assisting BWH in pushing the limits of medicine.”

Kelly Laws

Many runners decide to join one of the BWH Marathon teams to honor a loved one. Kelly Laws, RN, another member of BWH’s Life.Giving.Breakthroughs. Marathon Team, is running for those close to her heart: her mother-in-law, who passed away last Marathon Monday, and her patients in BWH’s Medical Intensive Care Unit (MICU). The Boston Marathon will be Laws’s seventh marathon and third time running Boston.

Laws says that many of her patients suffer from interstitial lung disease—a large group of disorders that involve progressive scarring of the lung tissue that supports the air sacs.

“Without a lung transplant, these patients must be on oxygen in the hospital or at home,” said Laws, who lives in Somerville. “These patients can’t breathe on their own, so I thought that I could run for them since they cannot run for themselves.”

In addition to thinking of her patients as she runs, Laws says she looks forward to taking in the experience and enjoying the race with her fellow Marathon team members.

To learn more about the BWH Marathon Program, visit BWHMarathonProgram.org.

On April 6, in observance of National Donate Life Month, BWH held a flag-raising ceremony to honor the lives of people who have been impacted by organ and tissue donation and those who have received the life-changing gift of a transplant. BWH patient and double arm transplant recipient Will Lautzenheiser performed the honor of raising the Donate Life flag at 15 Francis St. during the ceremony. Lautzenheiser received a double arm transplant at BWH in 2014.

Stay tuned for a story about Donate Life Month in an upcoming issue of BWH Bulletin.

Stacey Missmer

Women with endometriosis, especially those 40 years old or younger, may have a higher risk of heart disease, according to new BWH research published in Circulation: Cardiovascular Quality and Outcomes, an American Heart Association journal.

The study examines the link between coronary heart disease—which occurs when plaque builds up inside the coronary arteries and causes damage in the heart’s major blood vessels—and endometriosis, a disorder in which tissue that normally lines the uterus grows outside of the uterus. Researchers reviewed the records of 116,430 women enrolled in the Nurses’ Health Study II. Endometriosis was diagnosed using surgical examinations in 11,903 women.

During 20 years of follow-up with participants, researchers found that compared to women without endometriosis, women with the condition were:

• 1.35 times more likely to need surgery or stenting to open blocked arteries,
• 1.52 times more likely to have a heart attack and
• 1.91 times more likely to develop angina, or chest pain

Moreover, women age 40 or younger with endometriosis were three times more likely to develop heart attack, chest pain or need treatment for blocked arteries, compared to women without endometriosis in the same age group.

“Women with endometriosis should be aware that they may be at higher risk for heart disease compared to women without endometriosis, and this increased risk may be highest when they are young,” said Fan Mu, ScD, the study’s lead author, who was a research assistant at BWH when the study was conducted.

Researchers noted that surgical treatment of endometriosis—removal of the uterus or ovaries—may partly account for the increased risk of heart disease. Surgically induced menopause prior to natural menopause may increase the risk of heart disease, and this elevated risk may be more evident at younger ages.

An estimated 6 to 10 percent of women of reproductive age have endometriosis, but exact numbers are unknown since it cannot be diagnosed without surgery. Many girls and women do not realize that distressing menstrual cramps and pelvic pain can be due to endometriosis.

“It is important for women with endometriosis to adopt heart-healthy lifestyle habits, be screened by their doctors for heart disease and be familiar with symptoms because heart disease remains the primary cause of death in women,” said senior study author Stacey Missmer, ScD, director of Epidemiologic Research in Reproductive Medicine at BWH and scientific director of the Boston Center for Endometriosis.

BWH’s Janet Rich-Edwards, ScD, MPH, director of Developmental Epidemiology at the Connors Center for Women’s Health and Gender Biology, epidemiologist Eric Rimm, ScD, and biostatistician Donna Spiegelman, ScD, were also co-authors of this study.

The Partners strategy is driven by its four-part mission: a fundamental commitment to patient care, research, teaching and service to the community locally and globally. While Partners has an international reputation in all of these areas, as the largest academic research enterprise in the U.S., it is a clear leader in research. In 2015, Partners’ research expenditures totaled more than $1.5 billion.

Research is essential to the health of our communities, our country and world. The treatments, tests, drugs and medical devices used today have come about as the result of successful past research—everything from basic science to clinical trials and patient-centered research, health services and epidemiological research.

But translating research breakthroughs into patient care is a complex process. At Partners, this is the mission of the Partners Innovation team, which has extensive experience in every aspect of the commercial application of research, including business development, deal making, company creation, licensing, IP management and investing.

Much of the work of Partners Innovation occurs behind the scenes. But one event, the annual World Medical Innovation Forum, attracts an international audience of 1,100 of science’s most prominent leaders—CEOs, investors, entrepreneurs and officers of venture-backed companies, business-minded clinicians and investigators, government principals and dealmakers.

This year’s forum, which will be held April 25–27 in Boston, will highlight state-of-the-art emerging approaches to diagnose, treat and manage cancer. A highlight of the forum will be a showcase of the most promising cancer technology innovations from around the world—12 technologies with the potential to revolutionize cancer treatment and patient care over the next decade. The selections, called “The Disruptive Dozen,” will be announced on the final day of the forum. Opening the forum will be rapid-fire presentations by emerging cancer research stars called “First Look: Next Wave of Cancer Breakthroughs.”

“We are pleased to team up with colleagues across all Partners institutions to discuss recent advances in the field of oncology,” said Monica Bertagnolli, MD, chief of BWH’s Division of Surgical Oncology and co-chair of the 2016 World Medical Innovation Forum. “The focus is on Partners research that promises to change the lives of cancer patients in the near future. The range of topics is broad and includes discussion of exciting original approaches, as well as breakthroughs in work that has been pursued for decades. Additional input from leaders in biotechnology will provide valuable insights into the real-world challenges of bringing new anti-cancer therapies to the clinic.”

Learn more about this year’s forum.

Margarita Ramos

A research fellow in the Department of Surgery, Margarita Ramos, MD, MPH, will run her first marathon on April 18 as a member of the BWH Stepping Strong Marathon Team, supporting innovative trauma research and clinical care.

“I can’t wait to join thousands of runners at the Boston Marathon who believe in making a difference,” Ramos said. “It will be a day to celebrate the resilience of the human spirit.”

Ramos says she is excited to run in honor of Gillian Reny, a family friend and Boston Marathon bombing survivor, who was treated at BWH. Ramos, a spectator at the 2013 Boston Marathon, quickly learned from a friend of the Renys that Gillian had been critically injured and transported to BWH. Ramos hurried to the hospital to see how she could help.

“As a trusted friend, I wanted to do everything I could to help Gillian’s family understand the steps the surgical trauma team was taking to care for her,” said Ramos. “I reviewed X-ray images with them and answered their questions. It takes a multidisciplinary medical team to care for our trauma patients, and I was glad to participate.”

Because of this experience, Ramos was inspired to continue research in the field of limb reconstruction. During her general surgery training at BWH, Ramos participated in more than a thousand surgeries. She founded the Cost and Effectiveness in Surgery research group with E.J. Caterson, MD, PhD, of Plastic and Reconstructive Surgery, where she has mentored dozens of premedical, medical and dental students and published numerous articles on providing cost-effective care and improving the quality of life for people with disabilities.

Ramos is currently working on several research projects, including preserving tissue after trauma and treating and preventing traumatic wound infections with a novel biogel dressing.

Having run two half-marathons before, Ramos says she has always wanted to participate in the Boston Marathon. She’s been training hard and has enjoyed getting to know her teammates. 

“Boston is a special city to me,” Ramos said. “This marathon opportunity is dear to my heart. The support I have received from family, friends, the hospital, colleagues and complete strangers has been amazing.”

To learn more about the BWH Marathon Program, visit BWHMarathonProgram.org.

A rendering of the Brigham Building for the Future, which will open this fall

The Brigham Building for the Future (BBF), opening this fall, will be home to research labs and ambulatory clinics dedicated to the neurosciences, orthopaedics, immunology, rheumatology and musculoskeletal health. Clinical and research teams from across BWH’s campus will come together in the 12-story building to collaborate and accelerate the translation of laboratory discoveries into novel treatments for patients.

BWH Bulletin asked for your questions about the new state-of-the-art building and talked with Lani Kuzia, project manager for Real Estate, to find the answers. Here they are below:

What is the address of BBF?
BBF is located at 60 Fenwood Road.

When will various teams be moving in?
With the first patients scheduled to be seen on Oct. 3, the first move is set for Sept. 30. There will be staggered move-ins through March 2017, but all clinical teams will be moved in before the end of October 2016.

What are the plans for patient parking?
Patients able to do so may self-park in the BBF’s underground garage, which contains 150 spaces for patients. They may also leave their car with BWH’s valet service on the second level of the BBF underground garage or at 75 Francis St. for valet parking.

Will people be able to access BBF directly from the Mission Park Garage without having to go outside?
No, there will not be indoor access from the Mission Park Garage to the BBF; however, BBF is just a few steps away from the garage.

Will there be any inpatient beds in the new building?
No. The building will consist of eight floors of research laboratory space and three floors for outpatient clinical visits.

Will there be any food options in the new building?
There will be a cafe in the BBF operated by BWH and Sodexo, a hospitality company.

Are there any public spaces that employees will be able to reserve?
There will be public conference space that employees will be able to reserve as meeting space through the Audio/Visual Resource Scheduler (at BWHPikeNotes.org).

Are there any “green” features in the new building?
The building will incorporate a number of innovative, environmentally friendly features, including a roof garden to reduce storm water runoff and a co-generation power plant that will enable BWH to make enough electricity to power about 80 percent of the BBF’s and Shapiro Center’s electrical needs. The power plant, which was built in Germany, is a natural gas-fired engine that will supply the building with electricity and steam. The BBF has been designed to achieve the environmentally friendly Leadership in Energy and Environmental Design (LEED) Gold certification.

What other innovative features will be part of BBF?
Six highly-sophisticated MRI and CT machines will comprise the BBF’s state-of-the-art underground imaging facility. One of the MRI machines, the 7-Tesla, is the most powerful MRI machine in the world and one of only a few of its kind available to clinicians and researchers. The MRI provides extremely detailed images of metabolic pathways in the brain.

Were any patients or family members of patients involved in the design of the building?
Martie Carnie, BWH’s senior patient advisor, was involved in the planning and design of the building from the beginning, sharing insights from the patient and family perspective with BWH Real Estate and Facilities staff and building architects.
“We talked about what kinds of resources and information would be helpful to patients at the front desk in patient waiting areas and how the front desk should be set up for an easy approach for patients,” said Carnie. “We also discussed clear signage for patients, traffic flow, the use of media in waiting areas and colors for building finishes. It’s important for people to know that the patient and family voice was incorporated.”

Will there be employee tours of the new building?
Employee tours will be available in September for day, evening, night and weekend staff. Dates and more details about tours and celebrations will be forthcoming.

Do you have a question about the BBF? Share it with bwhbulletin@partners.org. Stay tuned for additional stories about the BBF in the coming months in the print and online Bulletin, and view BWH Clinical & Research News’s BBF series.

Giorgio Giatsidis

Researcher Giorgio Giatsidis, MD, of the Department of Surgery, is running this year’s Boston Marathon as a member of the BWH Stepping Strong Marathon Team. His motivation: honoring patients affected by traumatic wounds.

“My patients are my life,” said Giatsidis. “I wanted to run the Boston Marathon to pay tribute to anyone who has ever suffered from a traumatic wound and to raise awareness of innovative research and clinical programs at BWH that are helping to advance trauma healing.”

Giatsidis, a native of Milan, Italy, is a plastic surgeon who specializes in reconstructive and aesthetic surgery. He’s also a researcher, who is currently focused on trauma-related issues and, in particular, methods to reconstruct damaged soft tissues and improve the chance of tissue survival.

After hearing Boston Marathon bombing survivor Gillian Reny’s story of hope and perseverance, Giatsidis was inspired to raise funds to advance trauma research and clinical care. Giatsidis says he has enjoyed the challenge of training for his first marathon and getting to know his teammates. Come race day, he’s excited to run along the historic route and witness the energetic crowds cheering runners on.

“Throughout my career, I’ve had the opportunity to assist a large number of patients affected by trauma,” said Giatsidis. “It has meant so much to me to be able to support them and help them get back to their lives. When I’m running on Marathon Monday, I’ll be thinking about Gillian and all of the other patients who have experienced trauma. These stories are what drive me to be a better physician, researcher and person.”

To learn more about the BWH Marathon Program, visit BWHMarathonProgram.org.

From left: Histology supervisor Donna Skinner and Teresa Bowman, with the team’s staining technology

On March 10, BWH labs recognized National Histotechnology Day and the role histotechnologists play in patient care and research.

Using tissue samples from patients, plants or preclinical models, histotechnologists process, slice and stain samples for pathologists. In a clinical setting, these stains can help to diagnose cancers and other disorders in patients, while other tissue samples help with research.

“We are proud that our work contributes directly to patient care,” said Teresa Bowman, manager of the Specialized Histopathology Lab, which is directed by Jon Aster, MD, PhD.

The National Society of Histotechnology started celebrating the work of histotechnologists four years ago, as there was no existing day or event drawing attention to their work. For Pathology labs, where dedicated technicians sometimes work seven days per week and through holidays, the day of national recognition serves as a positive way to highlight the role they play in patient care.

Each day, the Specialized Histopathology Lab can process and stain anywhere from 20 to 150 tissue samples, depending on demand, and the team typically processes more than 4,000 cases each year. While most of the samples are research-related, the lab also tests preclinical samples for drug efficacy and assesses different types of treatment.

There are five primary steps to histotechnolgy. First, technicians must examine and trim tissue samples to fit on the slides and then place them in chemical solutions to prevent decomposition. Next, the water is removed from the tissue and substituted with wax to provide support, after which the sample is embedded into a larger block of wax. The block of wax and tissue are then placed on an instrument called a microtome, where small sections are cut to form a thin ribbon. These sections of ribbon are placed on slides for observation. Finally, the slides are stained with different dyes to identify cell structures, antibodies or other structures that will help a pathologist or researcher make a diagnosis.

“A lot of people will tell you it’s an art form and that not everyone can do it,” says Bowman. “The tissue can be dry and tissues with disease can be more difficult to section, so you have to have some patience and take the time and finesse to get a good section.”

Although the role histotechnologists play may fly under the radar of most patients, Bowman is proud of the work the lab completes day in and day out.

“The clinical diagnosis and the satisfaction of getting a tough stain to work are the most rewarding parts of the job,” Bowman said. “Although some people don’t know we are here, we are an important part of the diagnostic process.”

Mehra Golshan

The use of contralateral prophylactic mastectomy (CPM)—the surgical removal of a breast unaffected by cancer as part of the course of treatment for breast cancer—more than tripled from 2002 to 2012. However, according to a new BWH study, there has been no evidence of a survival benefit for patients who receive CPM compared to patients who receive breast-conserving surgery, which removes part of the breast tissue but not the entire breast.

Researchers note that while CPM may have a survival benefit for patients who are at high risk of developing breast cancer, such as those with a genetic mutation, the majority of women undergoing CPM are at low risk for developing breast cancer in the unaffected breast. Data show that women who are diagnosed with cancer in one breast are increasingly unlikely to be diagnosed with cancer in the other breast.

“Our analysis highlights the sustained, sharp rise in popularity of CPM and the mounting evidence that this more extensive surgery offers no significant survival benefit to women with a first diagnosis of breast cancer,” said senior author Mehra Golshan, MD, distinguished chair in Surgical Oncology at BWH. “Patients and caregivers should weigh the expected benefits with the potential risks of CPM, including prolonged recovery time, increased risk of complications, cost, the possible need for repeat surgery and effects on self-image.”

Researchers analyzed data from a group of nearly 500,000 women with a stage-one to stage-three breast cancer diagnosis in one breast and followed them from 1998 to 2012. Patients undergoing breast-conserving surgery, unilateral mastectomy—the removal of one breast—and CPM were compared. Nearly 60 percent underwent breast-conserving surgery, 33.4 percent underwent unilateral mastectomy and 7 percent underwent CPM. Overall, the proportion of women undergoing CPM increased from 3.9 percent in 2002 to 12.7 percent in 2012. When compared with breast-conserving therapy, no significant improvement in survival was found for women undergoing CPM.

Importantly, CPM may be indicated for women with BRCA1/2 mutations, a strong family history of breast or ovarian cancer or a personal history of mantle field radiation during childhood. A significant number of younger women are actively choosing CPM over conservative surgery, but only about a third of women who opt for CPM have one or more of these risk factors. Surveys of women suggest that a desire to minimize breast asymmetry and improve overall appearance through increasingly available and expanding reconstructive techniques may influence a decision to undergo CPM. Specifically, research shows that rates of reconstruction in CPM patients increased from 35.3 percent to 55.4 percent during the study period.

“Women with unilateral breast cancer undergoing CPM continue to report a desire to extend life as one of the most important factors leading to their surgical decision,” said Golshan, who is also the medical director of International Oncology Programs at Dana-Farber/Brigham and Women’s Cancer Center. “Understanding why women choose to undergo CPM may create an opportunity for health care providers to counsel women about surgical options, address anxieties, discuss individual preferences and ensure peace of mind related to a patient’s surgical choice.”