<![CDATA[UCSF Department of Surgery News ]]>https://surgery.ucsf.edu/news--events.aspxUCSF NewsenMon, 29 Oct 2018 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=80284 <![CDATA[UCSF Surgical and Critical Care NP Fellowship Achieves Accreditation with Distinction from ANCC ]]> The UCSF Surgical and Critical Care Nurse Practitioner Fellowship Program, a joint program of the Department of Surgery, Department of Anesthesia, and UCSF Health, was recently awarded the Accreditation with Distinction, the highest recognition awarded by the American Nurses Credentialing Center's Accreditation Program:

UCSF Surgical and Critical Care Fellowship Program is accredited with distinction as a Practice Transition Program by the American Nurses Credentialing Center's Commission on Accreditation.

The Surgical and Critical Care Nurse Practitioner Fellowship Program is led by nurse practitioners Kerry Decker, RN, MS, ANP-BC and Thomas Farley, RN, NP, ACNP-BCAssistant Clinical Professor of Nursing, and overseen by a distinguished roster of faculty. The UCSF program is the first Critical Care program for advanced practice registered nurses (APRNs) in the state of California, and the first Surgical APRN program nationwide to achieve this distinction.

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UCSF Health News Release

UCSF Health is proud to announce that UCSF Surgical and Critical Care Nurse Practitioner Fellowship Program has achieved accreditation with distinction from the American Nurses Credentialing Center (ANCC).  

ANCC Practice Transition Accreditation validates hospital based residency or fellowship programs that transition nurses or advanced practice registered nurses (APRNs) into new practice settings that meet rigorous, evidence-based standards for quality and excellence. Nurse Practitioners in the UCSF Surgical and Critical Care Nurse Practitioner Fellowship gain experience that allow the fellow to acquire specific post graduate skills in managing surgical and critically ill patients in the tertiary acute hospital setting. It prepares licensed and certified AG‐ACNPs to provide care for adults in critical care and surgery settings through focused clinical rotations emphasizing advanced assessment, planning, negotiation, and collaboration skills necessary to delivery safe, high quality care. 

"The nurse practitioner preceptors, physicians, and health administrative executives are extremely proud of this achievement and what the ANCC accreditation conveys to the Critical Care and Surgical NP Fellowship at UCSF Health. Transition programs are extremely valuable to engage new providers in the complexities of current health care delivery and uniqueness of the specialty care required", said Mitchel Erickson NP, Director of Advanced Practice, UCSF Health. 

"ANCC accreditation gives fellows assurance that UCSF Health offers an elevated transition program with a clear course of instruction and enables our transitioning advanced practice nurses gain the skills and confidence needed to perform effectively within a new practice setting", states Kerry Decker, NP, Co-director of the Fellowship Program at UCSF Health.

ANCC's internationally renowned credentialing programs certify nurses in specialty practice areas; recognize healthcare organizations for promoting safe, positive work environments; and accredit providers and approvers of continuing nursing education.  

UCSF Surgical and Critical Care Nurse Practitioner Fellowship Program is the first Critical Care APRN program in California and the first Surgical APRN program in the country to achieve this designation.

UCSF Surgical and Critical Care Care Fellowship Leadership

- by Richard Barg https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=80284
Fri, 26 Oct 2018 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=80200 <![CDATA[Michael Conte, MD Awarded 4-year $1.7M NIH U01 Grant to Fund National Center in Diabetic Foot Consortium]]> Conte Michael CopyMichael S. Conte, MD, chief of the Division of Vascular and Endovascular Surgery at UCSF, and one of nation's leading vascular surgeons, was awarded a 4-year, $1.7M U01 grant by the National Institute of Diabetes, Digestive, and Kidney Diseases (NIDDK), a unit of the NIH, to fund one of 6 national centers in the Diabetic Foot Consortium. 

Conte and podiatrist Alexander Reyzelman, DPM, a co-investigator on the grant, are co-Directors of the UCSF Center for Limb Preservation.

The NIDDK research is being carried out via a network of Clinical Research Units (CRUs). The UCSF Diabetic Foot CRU is comprised of teams at UCSF Medical Center at Parnassus and Zuckerberg San Francisco General Hospital (ZSFG), and builds on the work of the UCSF Center for Limb Preservation, UCSF Diabetes Center, UCSF Center for Vulnerable Populations, UCSF Clinical and Translational Science Institute (CTSI), the Center for Type 2 Diabetes Translational Research (CDTR) of the NIDDK.  

Diabetic foot ulcers (DFU) are a debilitating complication for up to a quarter of the nearly 30 million individuals in the U.S. who have diabetes and the cause of most non-traumatic lower leg amputations. New diagnostic and therapeutic modalities are sorely needed for this major public health problem, but advances thus far have been hampered by challenges in clinical trial design and execution. The UCSF DFU will conduct innovative studies in a socio-economic ethnically diverse patient population and will generate high quality data for the national consortium.  

Dr. Conte views the research as having great potential to improve the care of patients with diabetes at risk of foot and leg amputation:

This new NIH program represents a tremendous opportunity to advance the science and care of vulnerable patients with DFU, a major unmet need. This award reflects the high quality clinical care and scientific expertise of our team at UCSF, ZSFG, and the Center for Limb Preservation. We are excited to amplify our ongoing work through the NIDDK Consortium.

Co-Investigators on the study include podiatrists Monara Dini, DPM and Alexander Reyzelman, Dean Schillinger, MD, chief of the UCSF Division of General Internal Medicine at ZSFG and founding Director of the UCSF Center for Vulnerable Populations, and vascular surgeon Shant Vartanian, MD.

Project Information at NIH RePORTER 

NIDDK Workshop on Biomarkers for the Diabetic Foot Consortium

Related Story at UCSF News

Saving Limbs and Toes From the Grip of Diabetes With Clinic's New Approach

- by Lauren Washburn and Richard Barg https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=80200
Fri, 19 Oct 2018 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=80238 <![CDATA[Qizhi Tang, Ph.D. Featured Speaker at First Annual UCSF Immuno"XX": Women in Immunology Symposium]]> Immunologist Qizhi Tang, Ph.D., professor and director of the Department of Surgery's Transplantation Research Lab and Tang Lab, is one of the featured speakers at the first annual UCSF Immuno"XX": Women in Immunology Symposium on October 22, 2018 and will lead the session on Tolerance and Immunity.  

Immuno"XX" is focused on two goals: 1) providing a platform to highlight female scientists from UCSF, and 2) building a community of female immunologists to facilitate collaborations and provide career building opportunities. Synapse, the UCSF student newspaper, recently published an article about the the genesis of the conference.

Where is the XX in immunology? Less than 30% of faculty in the UCSF Immunology department are women. That's 13% less female representation than the UCSF-wide faculty demographic, where men still hold the majority.

This event was inspired by three students in the immunology graduate program, Camilia Azimi, Casey Burnett, and Tara Mcintyre, who said they were frustrated as first years by the lack of diversity at the faculty mentorship level. They decided to bring awareness by promoting the scientific accomplishments of women within the UCSF community. 

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The ImmunoX Initiative

The conference is hosted by hosted by the UCSF Bakar ImmunoX Initiative, of which Dr. Tang is a co-founder and co-developer. UCSF News called the initiative  a "radical collaboration across UCSF" in a recent article:

UC San Francisco is launching the Bakar ImmunoX Initiative, an innovative research program that will promote collaborative, cutting-edge research and data sharing to catalyze discoveries about the central role of the immune system in human health and harness its power to treat a wide range of diseases.

Boosted by a significant new gift from the Gerson Bakar Foundation, ImmunoX aims to break down the barriers that traditionally separate immunology research by disease area, and instead organize the UCSF immunology community around a set of collaborative "CoProjects" that will tackle fundamental questions in the field.

These CoProjects will be conducted within the UCSF CoLabs (previously referred to as Central Research Laboratories), an integrated research platform currently in development. The CoLabs are a pillar of the University's reimagining of its original campus at Parnassus Heights as a next-generation hub for research, education and patient care. The CoLabs will provide scientists across the University with access to a shared ecosystem of state-of-the-art research facilities for processing clinical tissue samples; performing single-cell genomic, proteomic, and imaging experiments; and analyzing and curating the resulting data.

The UCSF Department of Surgery is a high volume leader in solid organ transplants nationwide, making it well-positioned to unravelling the mechanisms of organ transplant rejection and tolerance.

A  driving force behind the initiative is the search for immune patterns across human disease.

The initiative was inspired by a growing recognition that immune cells throughout the body use common tools and programs to respond to many different situations. These include deciding whether to fight off a viral infection or merely contain it when a full response could damage sensitive tissues, or recognizing which bacteria pose a threat and which are helpful and beneficial to the organism's health.

"We are coming to understand the immune system as the adjudicator of all tissue, the peacemaker as well as the destroyer," said Matthew "Max" Krummel, PhD, a UCSF professor of pathology and one of the leaders in developing ImmunoX...

To pursue such immune-based therapies for a range of human diseases, Krummel developed the ImmunoX Initiative with colleagues Mark Anderson, MD, PhD, of the UCSF Diabetes CenterMark Ansel, PhD, and Jason Cyster, PhD, of the Department of Microbiology and Immunology; Jeroen Roose, PhD, of the Department of Anatomy; and Qizhi Tang, PhD, of the Department of Surgery.

- by Richard Barg https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=80238
Wed, 17 Oct 2018 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=80237 <![CDATA[Sanziana A. Roman, M.D. Interviewed by UCSF School of Medicine for Global Diversity Awareness Month]]> Roman, SSanziana A. Roman, M.D., FACS, professor of surgery and Dean's Diversity Leader for Leadership Equity and Inclusion at UCSF, was interviewed by the School of Medicine (SOM) in conjunction with "Global Diversity Awareness Month", October 2018. Differences Matter is a multi-year, multi-faceted School of Medicine initiative designed to make UCSF the most diverse, equitable and inclusive academic medical system in the country. Here is the full interview by Lesley Snyder, originally published on the SOM website:

Tell me a bit about your background.

I am very thankful for where I am and what I am able to do every day. I grew up in a communist country (Romania) during the height of communism. There were many years when we didn't have our basic needs met. I came to the States in high school and feel like I am living the American dream, because I am here at UCSF, being able to do what I love, and understanding what it means to come from nothing. I love being in San Francisco and at UCSF. I identify as LGBT, so living here and doing this work in such a creative, thoughtful place, is a dream.

October is Diversity Month! Tell me about your work as a Dean's Diversity Leader in the School of Medicine's Differences Matter program.

My work as a Dean's Diversity Leader focuses on the Leadership Equity and Inclusion pillar. We lack clear guidelines about how these important leadership positions are assigned. Some departments are more transparent than others. Dean King has taken important steps in putting rules in place about search committees, as it pertains to women and URM composition, but making sure that there is equity in leadership positions at UCSF – including Division Chiefs, Vice Chairs, Residency Directors, and Chairs – and that there are opportunities for all to advance, is integral to our goal of becoming the most diverse, equitable, and inclusive academic medical center in the country.

I work with Dr. Renee Navarro and Dr. Catherine Lucey on this pillar. The first task has been to come up with guidelines that are based in best practices currently in existence, that we can put forth to the Chairs for adoption across the School of Medicine. Hopefully other schools of at UCSF will eventually adopt these guidelines. We have created a committee with senior faculty that have history, knowledge, and academic weight within the school, to inquire within the clinical departments and come up with a point by point list of what is being done and what should change.

We are also looking at faculty development. How are our URM faculty and women being developed at UCSF? How are endowed chairs awarded? Do we have demographic data on our leadership? Each department has to put together a Diversity Report – how do we analyze those results and how can we assure there is advancement? The more we understand who we are, what we're made of, and what challenges we have, the better informed we will be to carve our way forward.

What is your personal commitment to advancing diversity, equity, and inclusion at UCSF?

My team is very mindful of the diversity of our colleagues. In hiring for the surgery department, our Chair thinks about this issue and has championed a search committee for every recruitment, irrespective of the seniority of the role. She seeks the best candidates across all demographics and geography, and seeks out opportunities for URM via postings to national minority societies and makes sure the roles are available broadly, so we have a diverse applicant pool to choose from.

We have been very thoughtful about hiring to represent our patient population. We recently hired a Spanish-American clinician, since we have many Spanish-speaking patients. In our patient interactions, we are very thoughtful about health equity – how are we treating patients of different backgrounds, not just clinically, but based on their personal beliefs. We have designed specific procedures for people that take these values into account, including scar-free surgery.

What are some resources students, faculty, and staff can take advantage of to learn more about DEI efforts at UCSF and/or become allies?

We have terrific opportunities to learn, train and explore diversity and inclusion at UCSF. In regards to learners, we need to be mindful about how we incorporate diversity into training, because we don't want people to be fatigued; rather, these concepts should become fully integrated into our culture. It is really about making sure we operate in an environment where everyone feels they belong, and we empower people to be there for each other. When people see things that are unjust, they need to feel as if they can say something. Allyship is really important. Making people – especially those in positions of power – aware of their privilege, is where it starts. People who have a lot of privilege don't tend to think actively about it. This is not surprising, since we all have our own experiential story. However, making them aware that not everyone is so lucky, allows you to be more aware and thoughtful. Doing the right thing should be built into our definition of professionalism and humanism, and at the core of medical practice.

What is a fun fact your colleagues may not know about you?

Before I went to medical school, I was a professional opera singer. I recently got back into performing with some of my surgical colleagues. Who knew that coming to UCSF would bring back the music in my life!

Thank you, Sanziana. Keep on singing!

Interviewed by Lesley Snyder


- by Richard Barg https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=80237
Tue, 16 Oct 2018 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=80231 <![CDATA[Gregory P. Victorino, M.D. Appointed Chief of UCSF-East Bay Surgery Program]]> RNF9283 Victorino Gregory TwitterGregory P. Victorino, M.D., currently the Interim Chief of the UCSF East-Bay Surgery Program, has been appointed to the position of Chief. Victorino, a highly regarded trauma surgeon and professor of surgery, is also Director of Trauma Services at Highland Hospital. His leadership  was crucial to the designation of Highland Hospital as a Level 1 Trauma Center serving the East Bay.

Victorino has deep roots in the community with a strong record of clinical outreach. In 2016, he was named Outstanding Physician of the Year by the Alameda Health System. He is also a dedicated teacher and mentor to UCSF-East Bay general surgery residents, and a respected thought leader. His body of professional work includes more than 80 peer-reviewed publications.

Victorino completed his undergraduate degree at UC Berkeley in 1986 and earned his MD at the University of Pittsburgh. He returned to the Bay Area in 1991, completing a general surgery residency at UC Davis-East Bay in 1998, followed by a trauma-critical care fellowship at UC Davis. Soon thereafter, he joined the UCSF Department of Surgery as a faculty member.

Victorino succeeds Alden H. Harken, M.D., professor emeritus of surgery, who retired in 2017 after 14 years of leading the program, and whose energy and innovation have created a lasting legacy.

- by Richard Barg https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=80231
Mon, 3 Sep 2018 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=79997 <![CDATA[Department of Surgery Welcomes New Clinical Fellows for the 2018-19 Academic Year]]> The Department of Surgery warmly welcomes our new clinical fellows for the 2018-19 academic year, a diverse group of accomplished surgeons bringing a rich array of experiences from leading institutions. The UCSF Department of Surgery is one of the leading surgical departments in the world with a rich history of scientific, educational, and clinical advancements. It is also one of the largest clinical services at UCSF. In this rarefied learning environment, these clinical fellows will have the opportunity to work as integral members of multidisciplinary clinical teams and learn state-of-the-art surgical techniques in their chosen speciality.


Zachary Dietch MD MBA Zachary C. Dietch, M.D., MBA
Clinical Fellow (PGY-6)
Abdominal Transplant Surgery
Seiji Yamaguchi MD Seiji Yamaguchi, M.D. 
Clinical Fellow (PGY-6)
Abdominal Transplant Surgery


Daphne Ly Photo Daphne P. Ly, M.D. 

Clinical Fellow (PGY-6)
Breast Surgical Oncology

Jami D Rothman MD Scm Jami D. Rothman, MD, ScM 

Clinical Fellow (PGY-6)
Breast Surgical Oncology


Monica Jain Photo

Clinical Fellow (PGY-6)
Endocrine Surgery

Treitl Daniela 303Hr

Clinical Fellow (PGY-6)
Endocrine Surgery



  Clinical Fellow (PGY-4)
  Limb Preservation



Srinivasa Dhivya

  Clinical Fellow (PGY-6)



Ryanpicedit Ryan Macht M.D., M.S. 

Clinical Fellow (PGY-6)
Minimally Invasive & Bariatric Surgery



Clinical Fellow (PGY-6)
Surgical Critical Care

Clinical Fellow (PGY-6)
Surgical Critical Care


  Clinical Fellow (PGY-6)
  Thoracic Surgery



  Bian Wu, M.D. 
  Clinical Fellow (PGY-6)
  Vascular Surgery
- by Richard Barg https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=79997
Fri, 31 Aug 2018 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=79980 <![CDATA[FDA Awards UCSF and Stanford 5-year $6.7M P50 Pediatric Device Consortia (PDC) Grant]]>

Michael Harrison, MD, Professor Emeritus of Surgery, Pediatrics, Obstetrics, Gynecology and Reproductive Sciences at the University of California, San Francisco (UCSF), Shuvo Roy, PhD, Professor of Bioengineering & Therapeutic Sciences at UCSF, and James Wall, MD, Assistant Professor of Surgery at Stanford University have been awarded a five-year $6.7 million Pediatric Device Consortia (PDC) P50 grant from the U.S. Food and Drug Administration (FDA). The UCSF-Stanford PDC is one of five centers selected to participate in the national program aimed at accelerating the development and availability of medical devices designed specifically for kids, whose access to state-of-the-art medical technology lags 5-10 years behind adults.

Advancing Pediatric Device Development 

Located in the heart of Silicon Valley, the UCSF-Stanford PDC will leverage the strengths of UCSF's program in surgical device innovation, Stanford's renowned Biodesign program, Northern California's top two children's hospitals, and a rich network of device industry and entrepreneurial partners to support pediatric device innovators through the total product development lifecycle. Features of the joint initiative include concept-stage market and value analysis assessments; comprehensive in-house engineering and product development services; regulatory, patenting, and business planning services; and commercialization strategy advising. 

James Wall MdThe grant will also provide $250,000 in seed funding through an annual Accelerator competition and support for a demonstration project that utilizes "real world evidence," or patient data routinely collected from a variety of sources (e.g., EHR, claims activity, product registries, etc.), to augment the evidence base available for regulatory decision-making.

Meeting the Challenge

Navigating the device development pathway is challenging, particularly for pediatric device innovators, as the small market sizes often ward off interest from investors and larger corporations. That's where the PDC steps in – offering assistance through each stage of development to individual entrepreneurs, academic physicians and researchers, trainees, and startups, primarily through its weekly Innovators Forum and Pediatric Device Accelerator. The UCSF PDC held its first Accelerator competition in November 2017, awarding eight seed grants ranging from $20,000 to $50,000 to pediatric device innovators across the country. The funds and personalized advising have allowed the projects to make significant strides, namely three that have progressed to the clinical testing stage: 

  • UC Berkeley spinout InkSpace Imaging, recipient of a $50,000 Accelerator Award, is developing flexible MRI coils for pediatric patients and will begin their first clinical study later this year. The PDC's internal staff assisted the device developers in navigating the IRB process, finding clinical collaborators at UCSF, and matching them with a commercialization mentor from the PDC's deep network of advisors. 
  • Tabla, a handheld acoustic pneumonia detection device invented by UCSF MD/PhD candidate Adam Rao, is being used to collect data from patients with cardiogenic pulmonary edema to determine whether it can detect daily lung fluid changes associated with heart failure exacerbation. They also plan to collect data on pneumonia patients in an upcoming study. In addition to funding, the PDC helped recruit a machine learning engineer and clinical research coordinator to the team.
  • Utilizing its proprietary 3D printing technology, UNYQ is creating custom-fit braces for children with the chest wall defect pectus carinatum. The PDC linked UNYQ and UCSF pediatric surgeon Benjamin Padilla, MD, who will serve as a clinical collaborator. The team is currently enrolling patients in a pilot trial at UCSF. 

A Strong Legacy of Device Innovation 

Pediatric Device Consortia Grant Program

In 2009, the UCSF PDC became part of the first cohort of academic medical centers to receive FDA funding to launch programs dedicated to stimulating and supporting pediatric device development. The 2018 grant award makes UCSF the longest running continually funded consortium of this type. Under the leadership of Drs. Harrison and Roy, the UCSF PDC has advanced 10 internally developed devices to first-in-human trials and guided three to market availability. Collectively, the technologies incubated have attracted over $30 million in external funding. The UCSF PDC has also been a catalyst for establishing a thriving ecosystem in medical device innovation at UCSF, paving the way for programs such as UCSF Surgical InnovationsUC Berkeley-UCSF Master of Translational Medicine, and the Rosenman Institute at QB3.  

Since its founding in 2000, Stanford Biodesign has established an internationally recognized model for device development, having launched 45 successful startup companies whose technologies have now reached over a million patients. Dr. Wall, who serves as Assistant Director of the Byers Center for Biodesign Innovation Fellowship, will be the PI for Stanford and will mentor one fellow per year to apply the Biodesign process to pediatric-specific technologies.

- by Stacy Kim https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=79980
Sun, 26 Aug 2018 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=79760 <![CDATA[Tammy T. Chang, MD, PhD Awarded NASA and National Science Foundation Grants to Study Microgravity in Biological Systems]]> Surgeon-scientist Tammy T. Chang, MD, PhD, principal investigator in the The Chang Laboratory for Liver Tissue Engineering, has been awarded grants by two prestigious federal funders of research, the NASA Space Biology Program, and the National Science Foundation (NSF) in collaboration with the Center for the Advancement of Science in Space (CASIS). 

Dr. Chang is a gastrointestinal surgeon who takes care of patients primarily in an acute care setting.  She holds an appointment as an assistant professor in the Division of General Surgery. Dr. Chang's research is focused on microgravity as it impacts biological systems  in a simulated environment on Earth in the NASA research and aboard the International Space Station in the NSF grant. 

In the NASA grant, Dr. Chang, one of six awardees new to the Space Biology Program, will use liver organoids generate in simulated microgravity on Earth to investigate the molecular basis of three-dimensional cellular organization and vasculogenesis enabled by the microgravity environment.

In The NSF/CASIS funded project, she and her research team will use the organoids as building blocks to create larger self-organized structures by leveraging the sustained microgravity onboard the International Space Station, pro-angiogenic biomaterials, and physiologic microfluidic flow.  The goal is to benefit human health on Earth by developing novel human stem cell-derived functional liver tissues that can be implanted as an alternative or adjunct to liver transplantation.

Dr. Chang believes her work could one day alter the treatment of end-stage liver disease and reduce the need for liver transplants with concomitant improvements to the social fabric:

As a surgeon-scientist, my long-term goal is to develop novel tissue-based therapies for the treatment of end-stage liver disease and to translate discoveries in the laboratory into surgical procedures that benefit patients in the operating room. The NASA Space Biology and NSF/CASIS projects are aimed at investigating whether microgravity may be key tool for developing thick vascularized tissues that may be implanted as functional tissue replacement therapy.  If successful, the results of this research will represent a breakthrough in our ability to generate thick vascularized tissues for therapeutic implantation and may spur development of an entirely new space-based biomedical industry. Moreover, having large functional tissue engineered constructs with "off-the-shelf" availability could alleviate the morbidity and mortality associated with organ failure as well as the social injustices linked transplant tourism and organ trafficking.
- by Richard Barg https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=79760
Sat, 25 Aug 2018 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=79624 <![CDATA[Laura J. Esserman, MD, MBA Selected as 2018 OncLive Giant of Cancer Care in Cancer Diagnostics]]> Laura J Esserman MD MBA Is The Onclive 2018 Giant Of Cancer Care In Cancer Diagnostics

Laura J. Esserman, MD, MBA was selected as the 2018 OncLive® "Giant of Cancer Care" in Cancer Diagnostics. Dr. Esserman is professor of Surgery and Radiology at UCSF and director of the UCSF Carol Franc Buck Breast Care Center. She was chosen by an elite committee of her peers based on her long history of outstanding work in the field as noted in the announcement:

  • Dr. Esserman led efforts to address harms of screening including overdiagnosis, and proposed tools including the development of molecular diagnostics to help reclassify tumors as indolent lesions of epithelial origin or ultralow risk.
  • She leads the I-SPY Trials, a groundbreaking national public-private collaboration designed to reduce the time and cost for drug development, to find the right drug for the right patient earlier in the disease course when cure is possible.
  • She led the creation of the University of California-wide, and now national, Athena Breast Health Network, which integrates clinical care and research, and follows 150,000 women from screening through treatment and outcomes. This spawned the WISDOM study to determine weather personalized screening has higher healthcare value than the standard of annual screening.
  • Dr. Esserman was included as one of TIME magazine's 100 Most Influential People of 2016 and was the recipient of the 2016 Stanford Business School Ernest C. Arbuckle Award and the 2016 Personalized Medicine World Conference Luminary Award.

The official announcement headlined, "OncLive Salutes 21 Visionaries With Giants of Cancer Care Award" reflected the significance of the honor:  

Twenty-one changemakers have been selected to receive a 2018 OncLive Giants of Cancer Care® award. The august group represents the largest class of inductees since the awards program was established in 2013. Recipients must be catalysts for change, demonstrating great accomplishment, imagination, inspiration, courage, and—perhaps most important—a true sense of urgency. The 2018 winners were recognized on Thursday, May 31, during an exclusive celebration at the Adler Planetarium in Chicago, Illinois.

This year, a record number of individuals were nominated to receive the Giants award. These exceptional physicians and researchers have challenged the reigning paradigms in oncology with their innovative and groundbreaking contributions to patient care, clinical practice, and translational research. This year also marks the program's largest international contingent, with almost 2 dozen nominees from outside the United States.

A 7-member advisory board chaired by Patrick I. Borgen, MD, reviewed the career achievements of the nominees, narrowing the field to 171 trailblazers, who were then voted on by an elite selection committee of distinguished oncologists and hematologists.


- by Richard Barg https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=79624
Thu, 23 Aug 2018 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=79882 <![CDATA[Hoping to Save Limbs and Toes, California Moves to Curtail Diabetes]]> Dr Alexander Reyzelman Right Confers With Michael Rubenstein A Diabetes Patient Photo By David Gorn Calmatters
Dr. Alexander Reyzelman treats diabetes patient Michael Rubenstein. Photo by David Gorn/CALmatters

The word "amputation" threw a chill down Michael Rubenstein's spine.

The 67-year-old diabetic from San Mateo still winces at the thought. "They told me I'd need to cut it off right about here," he said, sawing his hand across his left shin.

Series Logo The Hidden Cure WellnessTwo months after that diagnosis, he's on an exam table at the Center for Limb Preservation at UC San Francisco, his leg still whole, the threat of gangrene and amputation gone and his mood a lot less bleak and fearful. "Yeah, it turns out I didn't need that," he said.

Many others are not so lucky. More than 12,000 Californians lost limbs or toes to diabetes in 2016, state data show. More than 2.5 million people in the state have been diagnosed with adult diabetes, or Type 2, and risk a similar fate if it goes unchecked. That's especially true for low-income patients, who may lack regular preventive medical services. They're 10 times as likely as their wealthier counterparts to lose a toe, foot or leg, according to one study.

That disparity is part of the impetus for a new diabetes prevention program for patients in Medi-Cal, the state's version of the federal Medicaid health program for low-income residents. The rate of diabetes in California grew from 8.7% of the population in 2010 to 10.2% in 2016, while amputations increased by almost a third.

"Most of those amputations are unnecessary," said Alexander Reyzelman, co-director of the UCSF clinic that saved Rubenstein's left leg with procedures to increase blood flow.

The state has set aside $5 million annually for five years to help Medi-Cal patients at risk for diabetes, a chronic condition that can lead to blindness, heart disease and stroke, among other ills. The money will fund a program, beginning in January, intended to improve their diets, lower their blood sugar and make them aware of such potentially dire consequences as amputation. 

Preventing or curtailing the progress of the disease could save taxpayers an estimated $45 million a year in treatment costs, according to the Davis-based nonprofit Public Health Advocates, which urged lawmakers to create the program.

Participants will have a year's access to trained peer coaches, who'll teach them to eat less sugar and fewer other carbohydrates and increase fiber with more fruit and vegetables. The coaches will also help foster other lifestyle changes, such as giving up smoking and exercising more. The regimen is based on a federal program that the Center for Disease Prevention and Control says can cut the risk of diabetes by more than half.

The effort is part of an overall state approach that goes beyond medication, aimed at producing a healthier population that requires less expensive public care. About a third of Californians receive their care through Medi-Cal.

About 25,000 people a year are expected to join the program.

"This gives us the opportunity to intervene before they become really sick," said Flojaune Cofer, director of state policy and research at Public Health Advocates.

"Once they have the disease, that's when it gets expensive," with added medications and significantly more tests, she said. "We think this model can be duplicated in many ways. It could be useful for asthma, it could be useful for hypertension."

People with diabetes can develop poor blood flow to their extremities and suffer nerve damage and lack of feeling, most often in their legs and feet. In some cases, the result is gangrene. In some of those instances, amputation may be the only way to save a life.

The increase in diabetes and the threat of amputation are "a silent, sinister crisis," said David Armstrong, a podiatric surgeon teaching at the University of Southern California's Keck School of Medicine. "The problem is getting bigger and bigger, and you can't fight it by just chopping off a leg."

Amputation can cause as many health problems as it solves, according to Reyzelman: "When you lose a leg to amputation, 50 to 70% of patients will die within five years. You don't want to lose a leg."

Experts say a multidisciplinary approach can bring patients back from the brink of amputation. Vascular surgeons, podiatrists and reconstructive microsurgeons have joined forces to treat diabetes at medical centers across the state, including those at UCSF, UCLA, UC San Diego, UC Davis and USC.

The hope is that more patients can walk away like Rubenstein: intact.

"If I needed to get an amputation, I was willing to do that," Rubenstein said. "But I certainly didn't want that. Who would want that? Absolutely no one, that's who."

Reprinted coutesy of CALmatters.org, an independent public interest journalism venture covering California state politics and government. This is the third article in a series on state efforts to foster healthy living as a way to reduce chronic illness.

Hoping to save limbs and toes, California moves to curtail diabetes (Original Story at CALmatters)

Related Story at UCSF News

Saving Limbs and Toes From the Grip of Diabetes With Clinic's New Approach

- by David Gorn, CALmatters https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=79882
Thu, 23 Aug 2018 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=79806 <![CDATA[UCSF General Surgery Residency Program Ranked No. 1 in Western U.S. in Annual Doximity Survey]]> The UCSF General Surgery Residency was ranked No. 1 in research output and by reputation among sister programs in California and across the western U.S. in the Doximity 2018-19 annual survey. Nationally, the program placed in the 99th percentile for research output

The residency program is led by Department Chair Julie Ann Sosa, M.D., M.A., FACS, Program Director Linda M. Reilly, M.D., Associate Directors Ryutaro Hirose, M.D., Kenzo Hirose, M.D., and Lygia Stewart, M.D., and Administrative Director Rachelle Bresnahan.

Graduating Chiefs And Leadership News Story

Top Ranked General Surgery Residencies (2018-19)

Western U.S.

Doximity Navigator

Research Output

  1. University of California (San Francisco)
  2. UCLA David Geffen School of Medicine/UCLA Medical Center
  3. University of Washington
  4. Stanford Health Care-Sponsored Stanford University
  5. Oregon Health & Science University
  6. University of California Davis Health
  7. University of Southern California/LAC+USC Medical Center
  8. University of Colorado
  9. University of California (Irvine)
  10. University of California (San Diego) Medical Center


  1. University of California (San Francisco)
  2. University of Washington
  3. Stanford Health Care-Sponsored Stanford University
  4. UCLA David Geffen School of Medicine/UCLA Medical Center
  5. Oregon Health & Science University
  6. University of Southern California/LAC+USC Medical Center
  7. University of California Davis Health
  8. University of Colorado
  9. University of California (San Diego) Medical Center
  10. Mayo Clinic College of Medicine and Science (Arizona)

Large Public Hospitals Across U.S.

Research Output

  1. University of California (San Francisco)
  2. UCLA David Geffen School of Medicine/UCLA Medical Center
  3. University of Michigan Health System
  4. UPMC Medical Education (Pittsburgh)
  5. New York University School of Medicine
  6. University of Washington
  7. Stanford Health Care-Sponsored Stanford University
  8. Emory University School of Medicine
  9. Oregon Health & Science University
  10. University of Illinois College of Medicine at Chicago


  1. University of Michigan Health System
  2. University of California (San Francisco)
  3. University of Texas Southwestern Medical School
  4. University of Washington
  5. Stanford Health Care-Sponsored Stanford University
  6. Emory University School of Medicine
  7. UPMC Medical Education (Pittsburgh)
  8. New York University School of Medicine
  9. UCLA David Geffen School of Medicine/UCLA Medical Center
  10. Oregon Health & Science University

National Rankings

Research Output

  1. Johns Hopkins University
  2. Massachusetts General Hospital
  3. University of California (San Francisco)
  4. Duke University Hospital
  5. UCLA David Geffen School of Medicine/UCLA Medical Center
  6. Washington University/B-JH/SLCH Consortium
  7. University of Michigan Health System
  8. Brigham and Women's Hospital
  9. McGaw Medical Center of Northwestern University
  10. UPMC Medical Education (Pittsburgh)


  1. Massachusetts General Hospital
  2. Johns Hopkins University
  3. University of Michigan Health System
  4. Washington University/B-JH/SLCH Consortium
  5. University of California (San Francisco)
  6. Vanderbilt University Medical Center
  7. Brigham and Women's Hospital
  8. Duke University Hospital
  9. University of Pennsylvania Health System
  10. University of Washington

Note: Doximity received more than 315,000 peer nominations, ratings and hand-written reviews to determine its top residency programs for the 2018-19 "Doximity Residency Navigator". The data shown above was current as of July 24, 2018.  Data for research output may change between surveys and may affect ranking after publication of initial results.

Related Links

Doximity Releases 2018-2019 Residency Navigator

Doximity Residency Navigator - Residency Programs (Clinician Login Required for Full Search)

Doximity Residency Navigator - Residency Research Methodology

- by Richard Barg https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=79806
Wed, 22 Aug 2018 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=80032 <![CDATA[The New Transportation Revolution: UCSF Research Team to Track Injuries Involving Electronic Scooters]]> "When technology enters transportation, people forget that it also becomes public health. It becomes something where human lives are at stake." --- Dr. Catherine Juillard, UCSF trauma surgeon at Zuckerberg San Francisco General Hospital (ZSFG)

Rsz Juillard CatherineThe New York Times, NBC Nightly News and UCSF News Center report on the controvery surrounding the influx of new vehicles such as motor-assisted scooters and mopeds into urban areas, and their impact on safety, notably here in San Francisco. Many in this class are shared or "just-in-time" vehicles that users rent on the spot, some maybe for the first time. 

Catherine Juillard, M.D., MPH., a trauma surgeon and assistant professor in the UCSF Department of Surgery at ZSFG, and Christopher Colwell, MD, a UCSF professor and chief of emergency medicine at ZSFG, will be studying the impact of their on public safety at a very granular level, distinguishing, for example, among injuries that involve electric bikes, mo-peds and scooters, hoverboards, Segways, and unicycles. The goal of this research is to eventually provide Chris Colwell headshotlawmakers and analysts with the data that will inform sound regulation and public policy. 

Juillard told the New York Times:

"I can say that several years ago that I didn't see these types of injuries happening, and now I do," said Dr. Juillard, who is also a professor researching injury prevention at the University of California, San Francisco. "But we have to do the hard work of looking at the data to determine if there's truly a trend."

Colwell, who sees a wide range of injuries that many not necessarily require surgery, added:

"I'm quite confident that we were seeing five to 10 injuries from this a week, and I'm probably underestimating that," Dr. Colwell said. "We saw one or zero a month before the increase in electric scooters."

The UCSF researchers have teamed with Megan Wier, an epidemiologist with the San Francisco Department of Public Health and the Vision Zero SF Injury Prevention Research (VZIPR) Collaborative to study this emergent issue and its impact. The NY Times described the somewhat frenetic process to develop standardized data-collection.

With the clock ticking, Ms. Wier and her colleagues combed through months of police and hospital records to help inform the classifications. But she believes the most useful injury patterns will emerge only after a data schema is established and the scooters return to San Francisco.

NBC Nightly News also covered the story in its national broadcast, underscoring the importance of this issue across the U.S. and internationally. NBC interviewed both Juillard and Colwell for the story as did UCSF News.

Related Links

Health Officials Prepare to Track Electric Scooter Injuries      New York Times
Scooter Safety: UCSF Doctors to Track New Injuries UCSF News
- by Richard Barg https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=80032
Wed, 1 Aug 2018 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=80215 <![CDATA[Unveiling of Wraparound Mural in Ward 3M]]> The Wraparound Project recently unveiled a new mural in Ward 3M of the Zuckerberg San Francisco General. This mural was designed by Wraparound clients who participated in an Art workshop facilitated by Marco Razo and generously funded by Bank of America. The Art Workshop fast became a safe, welcoming space for clients to express themselves while learning a new skill. Participants in this workshop have gone on to showcase their work in galleries across the city. As an added benefit, participants also partook in workshop development - learning the vital resume writing and interview skills necessary for employment. 

- by Adaobi Nwabuo https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=80215
Thu, 19 Jul 2018 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=78972 <![CDATA[Endocrine Surgeon Insoo Suh, MD Pioneers New Hybrid Surgical Option for "Hidden Scar" Thyroidectomy]]> Insoo At Conference

Insoo Suh, M.D., FACS, assistant professor of endocrine surgery and noted surgical innovator, presented his experiences using "scarless" transoral endoscopic thyroid and parathyroid surgery to a national audience at the 2018 meeting of the American Association of Endocrine Surgeons (AAES). Minimally invasive and remote access thyroid surgery has been evolving with the transoral endoscopic thyroidectomy vestibular approach (TOETVA) emerging as a true "scarless" thyroidectomy. Dr. Suh helped pioneer this technique and is among the first surgeons in the U.S. to utililze it. 

Dr. Suh also discussed his experiences with a new hybrid procedure using a TransOral and Submental Technique (TOaST) technique, a refinement that pairs the transoral approach with a small easily hidden incision just under the chin, offering patients an additional surgical option with a number of potential benefits including:

  • Decrease in postoperative complications and patient discomfort
  • The ability to accommodate larger thyroid specimens
  • Maintaining virtually all of the cosmetic benefits of traditional scarless surgery


Related Publication

The first case report on the use of the TOaST technique was recently published at:

Chen Y, Chomsky-Higgins K, Nwaogu I, Seib CD, Gosnell JE, Shen WT, Duh QY, Suh I, Hidden in Plain Sight: Transoral and Submental Thyroidectomy as a Compelling Alternative to "Scarless" Thyroidectomy, Journal of laparoendoscopic & advanced surgical techniques. Part A, May-07-2018; [Epub ahead of print]. PubMed

- by Richard Barg https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=78972
Tue, 17 Jul 2018 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=79582 <![CDATA[Bay Area Girl Undergoes First-Ever Pediatric Heart Transplant At UCSF]]> Peter Kouretas MD PhdCBS SF Bay Area (KPIX) reports on the first-ever pediatric heart transplant at UCSF. The surgical team was led by Peter Kouretas, M.D., Ph.D., associate professor of surgery and surgical director of Pediatric Heart Transplantation at UCSF. 

The first-ever pediatric heart transplant at UCSF Benioff Children's Hospital may have just saved a young Bay Area girl's life.

It's been tough for 11-year-old Andrea to keep up with other students during gym class in Walnut Creek.

"I would feel short of breath, I would need to take a break more often than other people would," she says. 

Andrea has a rare form of cardiomyopathy, which is a genetic disease that makes it difficult for the heart to pump blood. But thanks to a new team of doctors at UCSF, she has a new outlook and a new heart. 

"For Andrea's family to trust us to be our very first heart transplant program here, we needed to be able to do this and say we can do this," says Dr. Jeffrey Gossett Director of the Pediatric Heart Transplant Program.

On Monday, the hospital celebrated with Andrea's family. They are moving to a transitional home nearby so doctors can monitor her for two weeks.

"It's just the beginning of the road also, it was very, very stressful," says her father, Calin. "But we're very happy that the outcome has been this beautiful princess you see here who is feeling good."

Because Andrea also has a heart rhythm problem that complicates her condition, doctors said she had a 30 percent chance of dying within one year. Now she has a 95 percent chance of survival.

"Activity level, functionally – they'll get back to normal and lead a good functioning life," said Dr. Pete Kouretas, Surgical Director of the program.

Read full story at CBS SF Bay Area (KPIX)


- by Richard Barg https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=79582
Sat, 14 Jul 2018 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=79706 <![CDATA[Trauma Surgeon Lucy Kornblith, M.D. Recipient of (EAST) Trauma Research Scholarship]]> Trauma Surgeon Lucy Kornblith, M.D. has been awarded the Eastern Association for the Surgery of Trauma (EAST) Trauma Research Scholarship to study post-injury platelet biology. Dr. Kornblith is a graduate of the UCSF General Surgery Residency Program and subsequently completed fellowships in Surgical Critical Care and Trauma Surgery, and Trauma and Emergency Care at UCSF. She will be joining the UCSF General Surgery Faculty August 1, 2018 and will be based at Zuckerberg San Francisco General.

Dr. Kornblith described how this award is advancing her career aspirations as an academic surgeon in the field of trauma:

My ultimate career goal is to become an independently funded trauma surgeon-scientist. The EAST Research Scholarship gives me the opportunity to perform critical preliminary investigations toward identifying the mechanistic role of platelets and platelet-endothelial interactions in trauma-induced coagulopathy. In an atmosphere of scarce funding opportunities, this scholarship will allow me to build a scientific foundation upon which I can study post-injury platelet biology to ultimately reduce the morbidity and mortality associated with post-injury hemorrhage through novel platelet-based therapies.

Dr. Lucy Zumwinkle Kornblith: Recipient of the 2018 EAST Trauma Research Scholarship (Official Announcement)

- by Richard Barg https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=79706
Tue, 10 Jul 2018 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=79515 <![CDATA[Nancy Ascher, MD, PhD Invited to Serve on WHO Task Force on Donation and Transplantation of Human Organs and Tissues]]> Nancy Ascher, M.D., Ph.D., the world-renowned organ transplant surgeon and a former Chair of the UCSF Department of Surgery, has also been invited to serve on the WHO Task Force on Donation and Transplantation of Human Organs and Tissues, an international multidisciplinary task force of 31 experts spanning the fields of medicine, surgery, ethics, law, patients' rights, public administration and health systems. The task force is charged with establishing the fundamentals of ethical transplantation, providing guidance to health ministries and governments pertaining to legislation, registries, organ procurement, patient management, and standards of care. 



As outgoing President of the The Transplantation Society (TTS), Dr. Ascher also delivered the Presidential Address to the 27th International Congress of The Transplantation Society in Madrid, Spain on July 4th entitled, Ensuring the Future of Transplantation - How Will We Protect Our Women?

Dr. Ascher, the Congress Chair, gave a second lecture, Holy Grail of Work-Life Balance": Mindfulness, emotional intelligence and well-being in a session focused on developing a successful career in transplantation. UCSF was well represented at the Congress with more than 60 invited talks and abstracts.

- by Richard Barg https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=79515
Mon, 2 Jul 2018 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=78580 <![CDATA[Department of Surgery Welcomes Endocrine Surgeon and Diversity Leader Sanziana A. Roman, MD to Faculty]]> The Department of Surgery welcomes endocrine surgeon Sanziana A. Roman, M.D., FACS to the faculty as a professor of Surgery in the Section of Endocrine Surgery, Division of General Surgery. Dr. Roman also has been appointed Director of Learning and Teaching in the Procedural Specialties and Dean's Diversity Leader for Leadership Equity and Inclusion in the School of Medicine at UCSF. 

Dr. Roman's clinical interest is in endocrine and minimally invasive surgery, with a focus in thyroid and adrenal diseases, including pediatric and adult endocrine tumors. She is one of only a few high-volume adrenal surgeons in the country performing posterior retroperitoneoscopic adrenalectomy (PRA), a procedure she helped to pioneer.

Dr. Roman is the author of more than 180 peer-reviewed publications in outcomes analysis, cost-effectiveness/decision analysis, meta-analysis, and survey-based methodologies, as well as clinical, translational and stem cell research.


- by Richard Barg https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=78580
Fri, 29 Jun 2018 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=79576 <![CDATA[Trauma Surgeon Andre Campbell, M.D. Vents Frustration over Toll of Pervasive Daily Gun Violence in Nation's ERs ]]>

UCSF trauma surgeon Andre Campbell, M.D., who was on the trauma team that treated victims injured in the shooting at the YouTube headquarters in California, vented his frustration over decades of gun violence in a press conference about the shooting.  As reported by CNN, Campbell challenged the news media to look beyond the sensational events and address the pervasive omnipresent gun violence that is a daily occurrence in the U.S. Campbell was widely praised in social media for stance as well as his decades of service as a trauma surgeon and mentorship to many generations of medical students and surgical residents at UCSF. 

"To think that after we've seen Las Vegas, Parkland, the Pulse nightclub shooting, that we would see an end to this, but we have not," Campbell, an attending trauma surgeon at Zuckerberg San Francisco General Hospital and Trauma Center, told reporters.

"Gun violence happens every day throughout the United States. It happens here in San Francisco. It happens in the Bay Area. It happens all over the country," Campbell said. "But I don't see you guys out here because I'd like to make sure that people know that we got a serious problem that we need to address." 
"I don't have all the answers ... at least we're having a discussion about it nationally," he said. "This is a real problem."
"This is a terrible day in the United States," said Campbell, a professor of surgery at the University of California, San Francisco, School of Medicine."I didn't see all these cameras out here ... last week when I was here," he said. 

"That's the problem, when something like this happens, which is terribly unfortunate, then you guys come out," Campbell said. "The reality is we have to deal with this all the time. We have to deal with the families."

"We kind of quietly do our job and we don't say a whole lot," he said. "But today just seemed like it was a day where people wanted to hear what was going on."

 "We as trauma providers, we are just saddened by the fact that this is a persistent problem. "It happens with such regularity. It's unbelievable," he said of gun violence. 

"We need to work together to find a solution," Campbell said.








Listen to KQED Interview with Dr. Andre Campbell

Wed, 27 Jun 2018 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=79470 <![CDATA[Residency Program Director Linda M. Reilly, MD Honored with 2018 UCSF Excellence and Innovation Award in Graduate Medical Education]]> Linda M. Reilly, M.D., Program Director of the UCSF General Surgery Residency Program, was named a 2018 Recipient of the UCSF Excellence and Innovation Award in Graduate Medical Education (GME). The award was presented at the UCSF GME Celebration and QI Symposium on June 18th at the UCSF Kalmanovitz Library at Parnassus Heights. Dr. Reilly is a vascular surgeon and professor in the Division of Vascular & Endovascular Surgery.

Award recipients have demonstrated a commitment to advancing graduate medical education at UCSF through educational and clinical quality improvement, service excellence, and innovation. Awardees demonstrate excellence in the following areas: 

  • Educational leadership in his/her department, at UCSF, and/or nationally
  • Participation in innovative GME-related projects
  • Extraordinary efforts to address resident/fellow needs and well-being
  • Other contributions to improving graduate medical education at UCSF and/or nationally

Reilly GME Awards 259 Copy

- by Richard Barg https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=79470
Wed, 20 Jun 2018 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=78670 <![CDATA[Storied Medical Educator Patricia O'Sullivan, EdD Honored with Lifetime Achievement in Mentoring Award]]> Patricia S. O'Sullivan, EdD, professor of Surgery and Medicine at UCSF, received the 2018 Lifetime Achievement in Mentoring Award from the Faculty Mentoring Program at an award celebration on June 13th at the Lange Room in the UCSF Parnassus Library. 

Dr. O'Sullivan is director of the Office of Research and Development in Medical Education (RaDME) and holds the Endowed Chair for Surgical Education at UCSF. Her teaching and mentoring excellence have enriched the careers of faculty and trainees spanning a multitude of programs in the Department of Surgery including Resident ResearchMedical Student Surgical EducationSurgical Skills CenterCenter for Surgery in Older Adults, and Center for Mindfulness in Surgery.

Dr. O'Sullivan's scholarship has been described as one that "focuses on faculty development and assessment. Believing in a continuum between development and scholarship, she oversees opportunities at UCSF for individuals to gain skills and develop their scholarship."

UCSF 20180613 Sullivan 068 700W




Read full announcement

Patricia O'Sullivan Receives 2018 UCSF Lifetime Mentoring Award (UCSF News) 

Interview with Patricia S. O'Sullivan
Learn more about her philosphy and teaching innovations

- by Richard Barg https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=78670
Mon, 18 Jun 2018 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=79465 <![CDATA[Surgical Innovations and TheraNova Forge Partnership to Speed MedTech Devices to Market]]> UCSF Surgical Innovations and San Francisco-based medical device developer TheraNova have formed a partnership that will allow for co-development of medical device technologies between them. UCSF innovators will now have a streamlined mechanism to collaborate with TheraNova engineers, which will help speed commercialization of products. The agreement formalizes a longstanding collaborative relationship between Surgical Innovations and TheraNova, providing access to the respective expertise and capabilities of each group, notably:

  • The partnership agreement establishes mechanisms for collaboration and access to expertise at both sites, enabling supported technologies to benefit from UCSF's intellectual and clinical environment and TheraNova's comprehensive product development capabilities.
  • TheraNova projects and spin-outs will benefit from UCSF expertise and collaborators for clinical trials and academic grants.
  • UCSF technologies will be supported by TheraNova's certified manufacturing facilities, product development expertise and fundraising experience. The agreement also outlines provisions for the development of joint inventions.

As a major source of medtech innovation in San Francisco, UCSF has an unparalleled environment for device invention at the doorstep of Silicon Valley. We have world-class clinical KOLs, state-of-the-art research facilities, leading translational bioengineers and passionate trainees working at the frontier of patient care," says Hanmin Lee, MD, surgeon-in-chief of UCSF Benioff Children's Hospital San Francisco and Surgical Innovations' clinical lead.

In addition to TheraNova, Surgical Innovations has industry partnerships with Zeus Industrial Products and ANSYS. The program plans to continue expanding its portfolio of industry partners to put more resources and expertise into the hands of its physician-inventors and accelerate the path to patient care.

"UCSF has a long history of collaborating with external partners to translate our research into actual products," says UCSF professor of bioengineering Shuvo Roy, PhD. "TheraNova has resources in every step of the device development process, and we look forward to utilizing their expertise and working together to accelerate groundbreaking innovation to patients."

Read the TheraNova press release (PR Newswire)

- by Stacy Kim https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=79465
Sat, 16 Jun 2018 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=79559 <![CDATA[Highlights of 2018 UCSF Naffziger Surgical Society Meeting in San Francisco]]> The UCSF Howard C. Naffziger Surgical Society, the alumni society of graduates of the UCSF General Surgery Residency Program and associate members, held its 2018 meeting May 10-11 in San Francisco. Proceedings kicked with a Women in Surgery event at the home of Shelley Marks, the past President of the Society.

The Naffziger Day Symposium generated substantive discussion of the history and future of surgical training and practice, while celebrating the common lineage of graduates of the UCSF Department of Surgery. Symposium speakers included UCSF Department of Surgery Chair Julie Ann Sosa, MD, MA, FACS, Lygia Stewart, MD of UCSF, Edward Chen, MD of Emory University, John Renz, MD, PhD of Univ. of Chicago, Robert E. Glasgow, MD of Univ. of Utah, Sunil Bhoyrul, MD of Scripps Memorial Hospital La Jolla, Jerry Goldstone, MD, FACS, FRCSE (hon) of Case Western Reserve; and the featured guest lecturer, Gerard M. Doherty, MD a Professor at Harvard Medical School and Surgeon-in-Chief at Brigham Health and Dana-Farber Cancer Institute. Following the symposium, there was a celebration dinner honoring the outgoing class of graduating Chief Residents.  



Lawrence Way Effect

View the Slides from Dr. Sunil Bhoyrul's Talk

Women in Surgery Event

IMG 5623 Shelley Marks Home 1

IMG 5633 Women In Surgery 2

Naffziger Day

Naffziger Day 2018 Group Picture For Story

Endocrine Surgeons Naffizger Day

- by Richard Barg https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=79559
Fri, 15 Jun 2018 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=79563 <![CDATA[Bill Browder Gives Riveting Account of Russia Experiences at 21st Maurice Galante Lecture]]> The 21st Maurice Galante Lecture was given by Bill Browder, founder and CEO of Hermitage Capital Management, on June 13th at UCSF Mission Bay in Byers Auditorium in Genentech Hall. Browder was the largest foreign investor in Russia until 2005, when he was denied entry to the country for exposing corruption in Russian state-owned companies. 

In 2009, Browder's Russian lawyer, Sergei Magnitsky, was killed in a Moscow prison after uncovering and exposing high-level corruption committed by Russian government officials. In February 2015, Browder published the New York Times bestseller Red Notice: How I Became Putin's No.1 Enemy,  recounting his battles with the Russian government and work to seek justice for Magnitsky and others like him. The lecture was followed by a book signing and reception. 



- by Richard Barg https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=79563
Fri, 15 Jun 2018 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=78063 <![CDATA[Trauma Surgeon Peggy Knudson, MD Leads First Large-scale Investigation of Pulmonary Clots after Injury]]> The CLOTT (Coalition of Leaders in Thromboembolism) study group, led by trauma surgeon M. Margaret "Peggy" Knudson, M.D., FACS, has begun enrolling patients in a landmark clinical trial looking at the treatment and prevention of post-traumatic pulmonary embolism. The study, which includes  investigators at 17 Level 1 trauma centers, is funded by a $4.25M grant from the Defense Medical Research and Development Program (DMRDP). 

CLOTT Image2Dr. Knudson, the study's principal investigator, is a professor of surgery and member of the UCSF Department of Surgery at Zuckerberg San Francisco General Hospital (ZSFG). She also serves as Medical Director for the Military Health System (MHS) Strategic-ACS Partnership. Dr. Knudson describes the study as the first large scale investigation of pulmonary clots after injury, one that has the ability to change how PE patients are cared for and how to prevent the potentially lethal complication.

The National Trauma Institute highlighted some of the key goals of the study:

The group will compare the safety of observation vs. treatment of asymptomatic peripheral pulmonary clots discovered on computed tomography angiography (CTA). Additionally, they aim to define the role of post-injury fibrinolysis shutdown in the development of post-traumatic pulmonary embolism (PE). 

Investigators have begun to enroll injured civilian adult patients in the age range of 18-40 years who are at risk for PE. The study will characterize the risk factors for those with symptomatic, central PE versus those with asymptomatic, peripheral thrombi. Five of the trauma centers in the study will analyze blood samples with thromboelastography (TEG) in order to better characterize the failure of clot lysis (fibrinolytic shutdown) in injured patients.

"This will be the first large scale investigation of pulmonary clots after injury and has the ability to change how we care for and prevent this potentially lethal complication."  Principal Investigator Peggy Knudson, MD

View full clinical trial abstract (The Pathogenesis of Post-Traumatic Pulmonary Embolism: A Prospective Multi-center Investigation by the CLOTT Study Group)

- by Richard Barg https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=78063
Thu, 14 Jun 2018 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=78691 <![CDATA[Nature Article by Willenbring Lab Demonstrates How Liver Cells Switch Identities to Grow New Tissue]]> In the medieval ages, alchemists dedicated their lifetimes searching for the formula that would transform ordinary metals into gold. In our bodies, several cases of "cellular alchemy" have been reported. Known as transdifferentiation, this process consists of one specialized cell type transmuting into a different one. 

Until now, this phenomenon had only been observed in the context of replenishing cells lost from pre-existing structures. Now, UCSF researchers, led by Holger Willenbring, MD, PhD, professor of surgery and associate director of the Liver Center at UCSF, and a member of the Eli and Edythe Broad Center of Regeneration Medicine and Stem Cell Research, show, for the first time, that transdifferentiation can also occur to generate a structure that failed to be built in development. 

The researchers made these findings in a mouse model of Alagille syndrome (ALGS), a rare, inherited genetic disorder where the bile ducts, responsible for delivering bile made in the liver to the intestine, are either not formed or of insufficient diameter. The resulting accumulation of bile in the liver can cause irreparable damage, with 50 percent of patients requiring a liver transplant. 

In breakthrough research published May 2, 2018 in the journal Nature, Willenbring and colleagues generated mice lacking Notch signaling required to form biliary ducts during development, and observed that in these mice hepatocytes transdifferentiated into mature cholangiocytes and formed bile ducts that reverse liver damage. These findings change the paradigm in the field, where thus far hepatocytes had only been found to convert into biliary duct cells incompletely and transiently in the context of injury in an adult animal.  

In addition to making more of themselves, liver cells can switch their identity to produce a liver cell type that is lost or, in the case of severe ALGS, never formed," said Willenbring who was a senior author of the study and leads the Willenbring Lab at UCSF. 

Although the experiments were carried out in mice, they hold great promise for the development of novel therapies for ALGS and other liver disorders.  

Our study shows that the form and function of hepatocytes -- the cell type that provides most of the liver's functions -- are remarkably flexible. This flexibility provides an opportunity for therapy for a large group of liver diseases," says Willenbring. More specifically, he continued, "using transcription factors to make bile ducts from hepatocytes has potential as a safe and effective therapy. With our finding that an entire biliary system can be 'retrofitted' in the mouse liver, I am encouraged that this eventually will work in patients.


Co-lead authors were Johanna R. Schaub, PhD, and Simone Kurial, of UCSF, as well as Kari A. Huppert, of Cincinnati Children's Hospital Medical Center. The study was co-led by Willenbring and Stacey Huppert, PhD at Cincinnati Children's Hospital Medical Center.

Read Related Article at UCSF News

Willenbring Lab

- by Leonardo M.R. Ferreira, Ph.D. https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=78691
Tue, 12 Jun 2018 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=79445 <![CDATA[Pediatric Surgeon Benjamin Padilla, MD Honored with Exceptional Physician Award]]> Benjamin Padilla M.D., a UCSF pediatric and fetal surgeon, and assistant professor in the Division of Pediatric Surgery, has been honored with the Exceptional Physician Award by UCSF Health. He was one of only eight recipients out of more than 100 nominations from a pool of several thousand UCSF physicians.

The awards were announced by Josh Adler, MD, Executive Vice President, Physician Services, UCSF Health in an email to the entire UCSF community:

These eight physicians were nominated and selected based on their demonstration of our core values of PRIDE -- Professionalism, Respect, Integrity, Diversity and Excellence.  Their hard work, dedication and contribution is a testament to the exemplary relationships they have with faculty, staff and patients, and their steadfast commitment to providing outstanding care for our patients.   Please join me in congratulating them on their exceptional service.

Hanmin Lee, M.D., Professor and Surgeon in Chief of UCSF Benioff Children's Hospital San Francisco and Chief of the Division of Pediatric Surgery, was effusive in his praise of Dr. Padilla:

Ben is a very deserving recipient leading our hyperinsulinism, endocrine, chest wall, oncology and pediatric ECLS programs. Just as importantly, Ben is incredibly devoted to his patients and his families spending countless hours counseling and comforting them. His patients constantly rave about what a compassionate doctor he is. He was nominated for this award by his colleagues which speaks to how highly he is regarded by his peers. I couldn't be prouder to call him my partner!

- by Richard Barg https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=79445
Wed, 6 Jun 2018 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=79341 <![CDATA[Turning Surgeons Into Innovators Without Taking Them Out of the OR]]> Academic hospitals have all the makings for rich medical device development. They have physicians to identify surgical needs, researchers to test theories, bioengineers to design and create devices and patients to participate in clinical trials.

However, the disconnect between engineering and surgical departments makes innovation a challenge. So does surgeons' all-consuming job Number One—treating patients.

Providing the Infrastructure for Surgeons to Innovate

Surgical Innovations, part of the University of California, San Francisco's Department of Surgery and Bioengineering & Therapeutic Sciences, aims to open communication between clinical academic surgeons and bioengineering colleagues. It also gives surgeons a platform to develop life-enhancing and lifesaving medical devices.

Shuvo RoyLaunched in 2015, Surgical Innovations draws on the expertise of one of the country's top medical schools for research and primary care. UCSF providers conduct more than 1,300 clinical trials per year. Its research department boasts more than 1,800 active inventions.

"Clinical trainees and grad students work closely together," said Surgical Innovations engineering lead Shuvo Roy, PhD. "We also have post-doc engineers who move technology from bench to clinical studies."

Turning Surgeons Into Innovators - MD + DI

Michael R. Harrison - 144xSurgical Innovations evolved out of UCSF's 
Pediatric Device Consortium (PDC), which creates and develops devices to improve children's health. Michael Harrison, MD, who founded and leads PDC, pioneered fetal surgery procedures at UCSF in the early 1980s. 

"There were no devices or tools back then," Harrison said. "We were inventing, designing, developing, and using devices without regulatory control. And we were very successful."

Harrison also recognized an ongoing need for pediatric-specific devices. FDA agreed. In 2007, Congress passed the Pediatric Medical Device Safety and Improvement Act to stimulate pediatric device development. UCSF became one of the few institutions to develop pediatric devices. 

Surgical Innovations expands on PDC's infrastructure by enabling more surgeons to succeed in medical device innovation. For example, Roy leads the development of a bioartificial pancreas to help people with unstable Type I diabetes. 

Also called Brittle diabetes, unstable diabetes is a severe form of the disease that causes unpredictable, severe blood glucose level swings. Although insulin pumps and continuous glucose monitoring systems(CGM, aka Artificial Pancreas) help, Roy said often CGMs pose a 10-minute to 15-minute delay between levels measured in tissue and blood glucose levels. The bioartificial pancreas works in real-time.

The bioartificial pancreas uses silicon nanopore membranes developed by UCSF's Biodesign Laboratory. Insulin-producing cells are put into a pouch of silicon nanopore membranes, which protects cells from the body's immune system. Surgeons insert the bioartificial pancreas between a small artery and a vein, which allows for an immediate insulin response. 

Roy said the bioartificial pancreas doesn't require sensors. "The cells are the sensor," he said. There's also no need for lifelong immunosuppression medication, which is necessary for a pancreas transplant.

"The silicon nanopore membranes allow us to achieve a high level of immune protection and allow small molecules to pass through," he said. "And it's biocompatible. The device can be used inside the body for months, or possibly years, at a time."

Roy's team of vascular surgeons, immunologists, and other specialists have tested the concept in pigs. Clinical trials are the next step.

Smart Pressure Ulcer Detection

Chumfong, IsabelleHanmin Lee - 144Isabelle Chumfong, MD (pictured left), spent her research years working with Surgical Innovations clinical lead Hanmin Lee, MD (pictured right), biomedical engineers Sachin Rangarajan, Michael Hemati, and medical device engineer Sharvari Deshpande, to develop SmartDerm, a wearable sensor that measures pressure levels on the skin to help prevent pressure ulcers. Pressure ulcers affect 2.5 million patients a year at roughly $9.1 billion to $11.6 billion annually.

The current standard of care to determine pressure ulcer risk is the Braden Scale, developed in 1987. The Braden Scale examines six criteria, of which, Lee said don't always give an accurate picture. SmartDerm uses Big Data to more clearly determine risk, while the sensors measure pressure.

"We use large data sets to determine who's at highest risk through a proprietary machine learning algorithm," Lee said. "Our scoring system is more accurate and cost-effective than the Braden Scale. The low-profile sensor gives us real-time data on pressure ulcers—where they are on the body and for what period of time."

Rangarajan and Hemati, both UCSF Masters of Translational Medicine graduates, created a startup for SmartDerm. Deshpande joined later to focus on analyzing large data and creating the risk algorithm.

Lee said preliminary data shows the devices don't harm patients. The next step is a clinical trial to determine if SmartDerm trumps the Braden Scale.

Magnets for Sleep Apnea

Harrison leads the development of Magnap, a device used to treat moderate obstructive sleep apnea (OSA). OSA affects about 18 million adults, causing health problems and an eroded quality of life. The most common treatment is a continuous positive airway pressure device (CPAP), which is effective, but not popular with patients. It's uncomfortable, noisy, and may slip off in the middle of the night (or the patient pulls it off in frustration).

Magnap uses magnets instead of a mask to provide a more comfortable solution. Surgeons insert a small magnet on the hyoid bone in the neck, secured by sutures. During sleep, the patient wears a fitted collar that contains a second magnet. The collar magnet attracts the internal magnet, keeping the airway open. "It uses very little force, only a couple pounds of pressure," Harrison said.

Surgical Innovations is in the midst of a 10-person clinical trial for Magnap. Harrison said the first patient reported the device "saved my life." Three additional patients are currently undergoing treatment.

Depending on the outcome of the current trial, Harrison said he plans to seek FDA clearance.

Harrison said Surgical Innovations will continue to serve as a resource to its clinicians, graduate students and to the medtech community at large. "When someone from industry says 'we have a problem,' we'll see if we can figure out a solution."

- by Heather R. Johnson https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=79341
Tue, 22 May 2018 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=78866 <![CDATA[Surgical Innovations Hosts Symposium Uniting Partners Around Children's Health]]> On May 17, the Second Annual UCSF Engineering for Children's Health Symposium was held at Mission Bay Conference Center. Over one hundred clinicians, engineers, scientists, administrators, industry professionals, and government partners gathered to discuss groundbreaking research and developing technologies in pediatric medicine.

UCSF 20180517 Childrens Health Symposium 075

The event commenced with opening remarks by Hanmin Lee, MD, Surgeon-in-Chief of the UCSF Benioff Children's Hospitals and Professor and Chief of the UCSF Division of Pediatric Surgery, along with Bertram Lubin, MD, Associate Dean of Children's Health at UCSF, which highlighted the large unmet need for pediatric medical devices, due to the lack of economic incentives for new technology development for small markets. Research talks by faculty from UCSF and UC Berkeley along with industry partners covered three main themes: fetal therapy and diagnostic technologies, device solutions for kids, and AR/VR and emerging technologies.

UCSF 20180517 Childrens Health Symposium 011

Pediatric surgeon Tippi MacKenzie, MD, kicked off the research presentations with her work on maternal-fetal precision medicine, specifically the effect of fetal T cell tolerance of maternal antigens on preterm labor. Dr. MacKenzie, who is currently leading the world's first clinical trial of in utero stem cell transplantation, also discussed advancements in the field of fetal therapy, which began with the first open fetal surgery performed by Dr. Michael Harrison at UCSF and evolved towards innovative molecular therapies being studied in her lab. Aaron Kornblith, MD, Assistant Clinical

Professor of Emergency Medicine and Pediatrics at UCSF, and Adam Rao, MD/PhD candidate in the Medical Scientist Training Program at UCSF, presented Rao's Tabla device – a digital tool for detecting pediatric asthma, one of the most common chronic pediatric diseases in the United States. The handheld device detects acoustic sound waves which are then analyzed by a machine-learning algorithm to assess disease severity.

Additional highlights included talks by Tejal Desai, PhD, Professor and Chair of Bioengineering and Therapeutic Sciences at UCSF, on nanoscale materials for therapeutic drug delivery, and Homayoon Kazerooni, PhD, Professor of Mechanical Engineering at UC Berkeley, on exoskeletons for pediatric mobility disorders. The presenters' wide range of disciplines, from clinical to engineering specialties, exemplified the pressing need for collaboration in the field of pediatric medicine.

UCSF 20180517 Childrens Health Symposium 025

Throughout the day, attendees interacted with demos of novel pediatric devices under development, including a tracheostomy alarm (Asphyxi-Alert), enteral feeding system (Gravitas Medical), breastfeeding appliance for infants with cleft palate, and ionic-dilution technology for vascular catheter navigation (Piccolo Medical). Adam Rao's Tabla, Dr. Kazerooni's SuitX, virtual reality software KindVR, and the UCSF Pediatric Device Consortium returned for the second year with updates on their devices and ongoing clinical trials. The program also included a human-centered design workshop facilitated by Amanda Sammann, MD, Assistant Professor of Surgery and Executive Director of The Better Lab. The hands-on session allowed participants to reimagine the pediatric patient experience through group brainstorming activities.

In the afternoon, Dr. Lee moderated a panel discussion on incentivizing pediatric device development between leading industry, government, and academic experts. Panelists shared their challenges and lessons learned as pediatric device developers and discussed the need for cross-sector collaboraiton and incentive strategies to get more pediatric devices to the market faster. The symposium concluded with a keynote presentation by Vasum Peiris, MD, MPH, Chief Medical Officer for Pediatrics and Special Populations at FDA's Center for Devices and Radiological Health, who shared the FDA's priorities and initiatives for improving pediatric public health and resources available to device innovators. 

UCSF 20180517 Childrens Health Symposium 055The annual event, hosted by UCSF Surgical Innovations, UCSF Benioff Children's Hospitals, UCSF Pediatric Device Consortium, and UCSF-Stanford Center of excellence in Regulatory Science and Innovation, serves as a foundation for forging partnerships between clinical, academic, and industry stakeholders, learning about innovative research and technologies, and building momentum towards implementing cutting-edge solutions into pediatric clinical care

Event program

- by Stacy Kim https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=78866
Mon, 21 May 2018 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=78593 <![CDATA[Resident Research Winners Announced for Presentations at 31st Annual J. Engelbert Dunphy Resident Research Symposium]]> The 31st Annual J. Engelbert Dunphy Resident Research Symposium was held Wednesday, April 25, 2018 at UCSF Medical Center at Mission Bay. The program showcased the laboratory research of residents, fellows and medical students in the Department of Surgery, and honors the life and accomplishments of J. Engelbert Dunphy, M.D., a legendary surgeon and a former chair of the UCSF Department of Surgery.

This year's J. Englebert Dunphy Visiting Professor, Carla M. Pugh, MD, PhD, FACS, Professor of Surgery and Director of the Technology Enabled Clinical Improvement (T.E.C.I.) Center at Stanford University, delivered a highly engaging and fascinating keynote presentation entitled, "Hacking Healthcare with Sensors: Unfolding the Metrics of Physician Expertise".

Symposium Winners

Visit the Resident Research Symposium Page

31st Annual Resident Research Symposium Program 

- by Richard Barg https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=78593
Wed, 16 May 2018 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=78739 <![CDATA[Department of Surgery Announces 21st Maurice Galante Lecture Featuring Bill Browder]]> Bill Browder News StoryThe 21st Maurice Galante Lecture will feature Bill Browder, founder and CEO of Hermitage Capital Management. Browder was the largest foreign investor in Russia until 2005, when he was denied entry to the country for exposing corruption in Russian state-owned companies.

In 2009, Browder's Russian lawyer, Sergei Magnitsky, was killed in a Moscow prison after uncovering and exposing high-level corruption committed by Russian government officials. In February 2015, Browder published the New York Times bestseller Red Notice: How I Became Putin's No.1 Enemy, which recounts his experience in Russia and his ongoing fight for justice for Sergei Magnitsky.

Established in celebration of intellectual exchange outside of medicine, the Maurice Galante Lecture Series was created in 1995 in honor of the late Maurice Galante, MD, a UCSF professor emeritus of surgery. Regarded as "one of the last generation of real 'general' surgeons," Galante brought superb technical expertise to a wide variety of surgical procedures.

The lecture, followed by a book signing and reception, will be held on Wednesday, June 13th at 4:00pm at the UCSF Mission Bay campus, Byers Auditorium in Genentech Hall, 600 16th Street.

Please RSVP by June 3rd at www.ucsfgalante.rsvpify.com

- by Teresa Toy and Sarah Krumholz https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=78739
Wed, 16 May 2018 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=78747 <![CDATA[Iris Liu Awarded Summer Intern Scholarship in Cardiothoracic Surgery by American Association of Thoracic Surgery]]> Iris Liu, BA, a first-year medical student at UCSF and former HHMI scholar at Dartmouth,has been awarded a prestigious Summer Intern Scholarship in Cardiothoracic Surgery by the American Association of Thoracic Surgery for 2018. The program was established to introduce the field of cardiothoracic surgery to first and second year medical students with the goal of broadening their educational experience by working in an AATS member's, cardiothoracic surgery department. The Scholarship is partially funded by Scanlan International Inc. and the AATS Foundation.

Liu's research is focused on studying mechanisms of resistance and recurrence in non-small cell lung cancer, with an emphasis on harnessing large-scale "omics" data to elucidate patterns of molecular alterations in the tumor and tumor microenvironment. She will pursue this research in the Kratz Lab and Bivona Lab at UCSF and will attend the AATS annual meeting in 2019.

- by Richard Barg https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=78747
Tue, 15 May 2018 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=78697 <![CDATA[ April Painting Event Spanning Four Campuses Highlights Department of Surgery Commitment to Staff Engagement]]> Dos Staff Engagment Painting MTZ

ZSFG Els Pic 1The Department of Surgery Staff Engagement Committee hosted a painting event across four campuses on Friday, April 27th. The event allowed staff at Parnassus, Mission Bay, Mt. Zion, and ZSFG to let their creativity flow in a calming, relaxed atmosphere.

Attendees were provided a blank canvas, brushes and a variety of paint colors and encouraged to let their artistic abilities loose while calming music played in the background. Flowers, dinosaurs, scenes of nature, and abstract art were all produced by the staff. Comments from staff included:

"It Was A Lot of Fun"
"It Was Nice to See Faces" of Co-Workers."

The Staff Engagement Committee was established with the goal of uniting the staff of the Department of Surgery from all of the various UCSF campuses. While we are spread out around San Francisco, our mission and goals are all the same. The engagement events are conceptualized with the purpose of allowing staff to interact with other staff members in the Department of Surgery. Often, staff only know others through email communication or as voices over the telephone. Face-to-face interactions are severely limited. We encourage personal connections as that will only strengthen us as a cohesive group.

The next event, Department of Surgery Ice Cream Social, will take place on Friday, May 25th at 2:00pm - 3:30pm at the following campuses:

  • Parnassus: N-225
  • Mission Bay: MH-5200-D
  • ZSFG: Surgical Research Lab, Bldg. 1, Rm 210
Parnassus Campus Painting     Parnassus Campus Painting TWO

Mission Bay Painting

- by Matt Kuhn and Aiten Hassouna https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=78697
Mon, 14 May 2018 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=78690 <![CDATA[Pediatric Surgeon Amar Nijagal Receives Jay Grosfeld MD Scholar Award from APSAF]]> Amar Nijagal, M.D., assistant professor of Surgery in the Division of Pediatric Surgery, received the Jay Grosfeld MD Scholar Award from the American Pediatric Surgical Association Foundation (APSAF) at the 2018 APSA annual meeting. Dr. Nijagal was one of two junior faculty honored with the highly competitive award for his grant proposal, "Investigating the fetal mechanisms of liver and bile duct repair: a link to the prenatal origins of biliary atresia".

The Department of Surgery is also pleased to announce the launch of the Nijagal Lab website. The lab will study how immune cells regulate the development and repair of fetal organs with a research focus on the development of the liver and bile ducts. The fetal liver is ripe with interactions between developing hepatocytes/cholangiocytes and the hematopoietic system. Other members of the lab include postdoctoral fellow Anas Alkhani, M.D. and researcher Katya Polovina, B.S.

- by Richard Barg https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=78690
Thu, 3 May 2018 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=78559 <![CDATA[UCSF Naffziger Society Symposium to be Held May 11th with Harvard Professor Gerard M. Doherty as Featured Guest Lecturer]]> The UCSF Howard C. Naffziger Surgical Society, the alumni society for graduates of the the UCSF General Surgery Residency Program and associate members, will hold its 2nd annual "Naffziger Society Day" symposium on Friday May 11th in San Francisco. 

Naffziger Society Day brings together multiple generations of UCSF surgeons including former chief residents, surgeons in academic medicine, those with community practices, and retired surgeons. The symposium generates substantive discussion of the history and future of surgical training and practice, while celebrating the common lineage of graduates of the UCSF Department of Surgery.

The distinguished list of symposium speakers includes UCSF faculty Julie Ann Sosa, MD, MA, FACS, the new Department of Surgery Chair, and Lygia Stewart, MDEdward Chen, MD of Emory University; Jerry Goldstone, MD, FACS, FRCSE (hon) of Case Western Reserve; and the featured guest lecturer, Gerard M. Doherty, MD of Harvard Medical School who is also Surgeon-in-Chief at Brigham Health and Dana-Farber Cancer Institute.

Sosajulie 2017 ET 144x192 Lygia Stewart - 144x Edward Chen Goldstone Jerry Gerard M Doherty MD story image

There will be a celebration dinner following the symposium honoring the outgoing class of graduating Chief Residents. Naffziger Day will be preceded by a Women in Surgery event on the evening of May 10th.

Full Details on this Year's Events

- by Richard Barg https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=78559
Fri, 27 Apr 2018 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=78581 <![CDATA[Survivor On the Margins: Historic UCSF Transplant Patient and His Pioneering Surgeon]]> Survivor on the Margins

Richard Schielke, long-term transplant survivor

I first noticed Richard on a Wednesday before my 8am lecture, sitting in a corner of the nursing building's food court. Or rather, it was the first time I really noticed him, because I realized I had seen him sitting there before, looking ahead contentedly with his hands folded on the table in front of him. Richard, it turns out, is a historic patient at UCSF; one of the first people worldwide to receive a kidney transplant. Born with renal failure in the early 1960s, Richard received his transplant at UCSF in 1971 at age ten, at a time when such procedures were rare and UCSF served as a pioneer in the field.

Richard's transplant was performed by the renowned surgeon Samuel Lee Kountz, MD, a world leader in transplant surgery. After performing the first successful non-twin kidney transplant while training at Stanford University, Dr. Kountz came to UCSF in 1967 and ultimately built UCSF's program into one of the largest and most respected kidney transplant programs worldwide. One quarter of all kidney transplants in the U.S. were performed at UCSF under his supervision, and before his death in 1981, he had personally led over 500 of these operations.

Reading through UCSF's old press releases, I immediately appreciated the number of technological innovations Dr. Kountz pioneered and his impressive list of scientific accolades. Even more impressive is that he accomplished all this before and during the Civil Rights Movement, at a time when few doctors of color were seen in the field of surgery. In fact, he had been the first African American student admitted to the University of Arkansas for Medical Sciences.

But what struck me most were his quotes that emphasized the 'human aspects' of transplant medicine and the personal transitions a transplant catalyzes. In anticipation of the 1972 International Congress of the Transplantation Society, for which he served as President, Dr. Kountz announced, "What we want to do is document the non-scientific aspects of transplants from the patient's viewpoint. Kidney transplants have been so successful that now they can be documented and patients can tell what it has meant to them, their families, and their lives."

Samuel Kountz performing a Kidney TransplantI thought of Dr. Kountz's words as I spoke with Richard, whose transplant is undoubtedly a medical success. Before his transplant, he explains, "I was crying, peeing the bed, guessing I'm dying. And I could hear them talking, the nephrologist telling my parents, 'The urine's backed up into his kidneys, his kidneys are destroyed, he's gonna die. I'm surprised he's not dead yet.' All of a sudden, my mother's having seven weeks of testing." His mother, Richard soon learned, was being tested to determine whether she could serve as his kidney donor. She could.

Immediately after the transplant, Richard remembers a striking change. "The kidney started working right when they put it in. I woke up with all this energy that I'd never had before. Because all you do when you have renal failure is sleep. You're tired and run down. When I awoke after the transplant, I could hear people in the operating room saying, 'What an amazing transplant'. I woke up and I felt so… not powerful exactly. But felt so alive. Now I'm suddenly a kid at 11, 12 years old. I'm riding my bicycle, I'm going out in the sun, I'm being with my buddies. I'm feeling really alive."

That was one of many transitions Richard experienced when he returned home after the surgery. He explains, "When you leave the hospital world here—cartoons, food, doctors, nurses paying attention to you—you go back to 'the root of awakening,' I call it. Trying to be a ten year-old kid, but you feel like you're going on 30. You grow up really fast."

His parents were only beginning to grapple with post-transplant life. "There's a lot of heartache with parents that have sick kids. I'm getting better. But my mom was the donor, so she was still in pain and recovering." Already poor before Richard's healthcare needs and struggling to pay for follow-up visits after the surgery, his parents began fighting over money. When his father started beating his mother, Richard found himself in the middle, trying to explain to doctors why his mother was black and blue, and ultimately taking beatings himself to protect her. "I held it, I took care of it, somehow some way." By his mid-teens, Richard's parents had divorced, and Richard began living at a children's home in Gilroy.

To manage his pain, he explains, "I found this magical thing called drinking. I drank myself out of a will, lost everything, lost almost everybody that I really wanted to love. I don't know how I kept the organ. Some would say you really don't deserve to be here today. True."

After working briefly for NASA as a machinist at Moffett Field in Mountain View, Richard suffered his first epileptic seizure and stopped working. He moved to Indiana for several years, but returned to San Francisco in 1994 when he learned that a brain surgery might cure him of epilepsy.

He began working at the Fillmore Auditorium and the Warfield Theater. Even with the job, though, it became increasingly challenging to afford housing in the City. "The longest I lived in one place was about six years before being priced out in 2005 when rents more than doubled," says Richard. First moving from the Inner Sunset to the Henry Hotel at 6th and Mission, Richard later found other temporary housing in the Tenderloin and China Town. Now, he uses Social Security checks to stay at Motel 6, and sleeps there until his money for the month runs out. "I'm still on the streets," he says. "And I am trying to understand what's happened, because it feels like another failure in my life. I've always been the one that's persistent and believes I'm gonna make it and I'm gonna get through it. But it's been a long time, way too long. I know it's not my fault but it's becoming painful."

"My personal prayer—in soul and body and heart—is that if you have the time, you gotta make sure that the people who work at the hospital know that you're really grateful to be alive."

Talking to Richard, our conversation cycles through the same themes. In one moment he expresses immense gratitude for the hospital, the doctors, and the staff at UCSF. "My personal prayer—in soul and body and heart—is that if you have the time, you gotta make sure that the people who work at the hospital know that you're really grateful to be alive. You realize wow, the guy that I saw walking around in the blue uniform makes the bed go up and down. Wow, that guy makes my room clean so I don't get an infection or lose my organ. Wow that's the anesthesiologist. That's the nurse, who is running intensive care units where a patient's hooked up to so many machines. The people that are polishing the floors and getting the operating rooms ready for you or me when we're having major surgeries. People that don't get to be recognized but they make a really big impact. I'm really grateful for them."

In the next moment, he talks of lost opportunities, of botched possibility. He repeatedly mentions how he doesn't feel like the model transplant patient, and asks me rhetorically, "How is it that the junkyard dog's still living?"

But I feel stuck on the counterpoints: Richard hasn't used drugs or alcohol since quitting 34 years ago. He traveled to San Francisco alone when he needed surgery for his epilepsy, and recovered with little help from family or friends. I sense that he is still searching for a sense of purpose, and sometimes ponders the meaning behind the transplant. "I know I could make a difference. I know I can make a difference because I've been the poor, uneducated patient. I've been epileptic guy. I've been the drunk. I've been the drug addict. I've been the homeless guy."

Dr. Samuel KountzI see someone, too, who craves to be seen for his role as a patient in UCSF's transplant history, yet equally longs to be seen and heard as someone beyond his health conditions. "I'm not just a patient," he emphasizes. "I have feelings. I like to eat food, I love to walk, I like to take pictures. I love music, I love beautiful, classic cars. I love dressing up nice."

Just as Richard circles around these themes, I circle around the question of how to measure the success of his historic transplant. Dr. Kountz understood the importance of tracking patients' post-operative experiences to see the effects of organ transplantation beyond pure physiology. He may have been ahead of his time for placing such emphasis on the social, financial, and personal effects that transplant surgery could have on a patient. And I can't help but hold two feelings at once: that UCSF has served Richard well, and that the institution, the City of San Francisco, and I as a future physician owe him more.

Background for This Story

Berry Ketura 2018This article is reprinted courtesy of the UCSF School of Medicine (SOM) and the author Kacey Berry, a 1st year medical student. Kacey became intrigued by the presence of Richard Schielke on the Parnassus campus and soon learned he was a kidney transplant patient, an historic one, having received his donor organ nearly 47 years ago in 1971. His doctor turned out to be a renowned African-American transplant surgeon, Samuel Lee Kountz, MD, a pioneer in the field.

Kelsi Evans 667Dr. Kountz' life as a surgeon was previously highlighted and chronicled by Kelsi Evans in a February 2017 post on the "Brought to Light blog". Kelsi, a project archivist at the UCSF Library, penned the story in honor of Black History Month. The blog is part of the Archives & Special Collections, an invaluable resource for aspiring medical student-cum-authors like Kacey Berry. The stories of Richard Schielke and his trailblazing surgeon, Dr. Kountz, leave an indelible imprint, enriching the history of both the Department of Surgery and the Division of Transplant Surgery. Kacey has given readers a window into the past, insight into Richard's endurance despite significant obstacles, and perspective into the work of Dr. Kountz, viewed against the backdrop of the era in which he practiced, making his achievements all the more remarkable.

Related Links

- by Kacey Berry, UCSF Medical Student https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=78581
Thu, 12 Apr 2018 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=78181 <![CDATA[U.S. News Ranks UCSF No. 4 Nationally for Surgery Education Curriculum Taught in Medical School]]> USN Med Surgery 2019UCSF was recently ranked No. 4 nationally for the surgery curriculum taught in medical school, placing it in the top 2.5% of the 177 medical and osteopathic schools surveyed in the U.S. News & World Report survey of best graduate and professional schools.  

The curriculum, developed by highly acclaimed Department of Surgery faculty, encompasses didactic in-class learning fused with early longitudinal immersion in clinical teams, and an inquiry-focused learning environment that encourages medical students to ask questions that push the frontiers of science and understanding of human health and disease.

To serve as a resource for medical students, the Department created a dedicated medical student portal, launched during a recent Grand Rounds presentation, The New Bridges Curriculum and the Future of Surgical Education

Andre Campbell - 144xMatthew Lin - 144pxThe core of program, led by program director Andre Campbell, M.D. and associate director Matthew Y.C. Lin, M.D., is the Department of Surgery Clerkship which provides UCSF medical students with a solid, enduring surgical foundation, offering diverse training opportunities including lecture series, faculty-led case presentations, observed physical exams, informal bedside rounds, and both hands-on patient care and procedures. Students rotate through numerous locations throughout the Bay Area. The Bridges Curriculum, among the most innovative in the U.S., is tightly integrated into the surgery component of medical school training.

The program is unique in the one-on-one attention faculty devote to students, each of whom is paired with a surgery mentor/preceptor during their clerkship, emblematic of the faculty's dedication to excellence in medical education. The Department of Surgery has also been a pioneer in surgical teaching innovations, including the publication of didactic videos online, the integration of a cadaver curriculum during the third year of medical school, and affording numerous research opportunities to medical students that often result in published work early in their careers.

- by Richard Barg https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=78181
Thu, 12 Apr 2018 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=78523 <![CDATA[Resident Research Symposium Headlined by Stanford Professor Carla M. Pugh Set for April 25th at UCSF Mission Bay]]> CarlapughThe 31st Annual J. Engelbert Dunphy Resident Research Symposium will be held Wednesday, April 25, 2018 at UCSF Medical Center at Mission Bay beginning at 9:00 a.m. The Department of Surgery is honored to have Stanford professor Carla M. Pugh, MD, PhD, FACS as this year's visiting Dunphy Professor.

The J. Engelbert Dunphy Resident Research Symposium showcases the laboratory research of residents, fellows and medical students in the Department of Surgery, and honors the life and accomplishments of J. Engelbert Dunphy, M.D., a legendary surgeon and a former chair of the UCSF Department of Surgery.

Carla Pugh is Professor of Surgery at Stanford University School of Medicine. She is also the Director of the Technology Enabled Clinical Improvement (T.E.C.I.) Center. Her clinical area of expertise is Acute Care Surgery. Dr. Pugh, recently was inducted into The American Institute for Medical and Biological Engineering, is renowned for her work in the field.

Wednesday, April 25, 2018

9:00 am - Resident Presentations
2:15 pm - Keynote Presentation
3:15 pm - Awards Presentation


UCSF Medical Center at Mission Bay
Betty Irene Moore Women's Hospital and Bakar Cancer Hospital
1855 4th St.
William and Susan Oberndorf Auditorium (1st floor - Room A1602B)
San Francisco, CA 94158

Visit the Resident Research Symposium Page for Complete Details

31st Annual Resident Research Symposium Program 

- by Richard Barg https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=78523
Wed, 11 Apr 2018 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=78341 <![CDATA[HHMI Research Fellow Simon N. Chu Awarded Dean's Prize in Research and Scholarship by UCSF School of Medicine]]> Simon N. Chu, M.S., has been awarded the 2018 Dean's Prize in Research and Scholarship by the UCSF School of Medicine for his molecular medicine research. Chu, a senior medical student in the UC Berkeley-UCSF Joint Medical Program, and Howard Hughes Medical Institute (HHMI) Research Fellow, will present his research on the immune response following transplantation in the HIV infected recipient at the upcoming 2018 Inquiry Symposium on Wed. May 2nd at the Milberry Gym on the Parnassus campus between 10:00 am and 11:30 am. 

The symposium showcases award-winning research from the four UCSF graduate programs. This is the second time Chu has won this prestigious award, the first for HIV-related research in the laboratory of Dr. Joseph "Mike" McCune. He has also been invited to present on this topic at the upcoming Annual J. Engelbert Dunphy Resident Research Symposium sponsored by the Department of Surgery on Wed. April 25, 2018.

Chu is also a member of the PRIME Program in Medicine for the Urban Underserved, designed to nurture, support and equip participating medical students to become leaders in underserved care. Chu recently received an Equity Plus merit scholarship award from this program for his high level of scholarly activities.

Chu is currently a research fellow in the Transplantation Research Laboratory and is co-mentored by Qizhi Tang, Ph.D. and Peter G. Stock, M.D., Ph.D. Chu's research focus is the immunological basis underlying enhanced transplant rejection in HIV-positive solid organ transplant recipients.

The field of HIV-Positive organ transplantation largely owes its existence to Peter Stock, who designed and led the first clinical trials enrolling HIV-Positive organ transplant recipients. He then successfully lobbied to have legal barriers removed on both the federal and state levels that would have prevented further research. Chu's work is aimed at overcoming a key issue in HIV-organ transplantation, a higher rate of graft rejection seen in HIV+ recipients.

Simon Chu For Slideshow


- by Richard Barg https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=78341
Wed, 28 Mar 2018 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=78325 <![CDATA[Gun Violence and Health Equity - Another Perspective on the "March for Our Lives" Demonstrations]]> Delvecchio Finley, MPP, CEO of the Alameda Health System, visionary leader and agent of change in public health care, and Gregory P. Victorino, M.D., professor of surgery and director of Trauma Services at Highland Hospital, have written an insightful Op-Ed exposing one of the vastly under-appreciated consequences of easy access to guns, namely the lack of heath equity or "the ability to attain one's full health potential". This condition is manifest in low-income and impoverished communities disproportionately affected by gun violence. Fortunately, Alameda Health System has established a Traumatic Violence Intervention Program, similar to the San Francisco Wraparound Project at Zuckerberg SFG to stem the tide of recurring violence.

Note:  This Op-Ed was originally published in The Mercury News on March 23, 2018. Please visit their site to view comments and social media links. 

Op-Ed on Gun Violence and Health Equity

Limiting access to guns is paramount to giving low-income students the same chance at health as those in wealthier neighborhoods.

Across our country, young people and their families are staging coordinated "March for Our Lives" demonstrations following the murder of 17 at a Florida High School to demand policymakers do more to protect them and their schools by restricting access to guns, particularly assault-style weapons.

To many, the ease of access to guns is an issue of rights to own guns and public safety.

It is also an issue of health equity.

Ebt L Picweek 0312 1Limiting access to guns and reducing the constant threat of gun violence is needed not just to protect schools, but is paramount to giving people and families living in low-income communities in Oakland and Alameda County the same chance at health and wellness as realized in less impoverished neighborhoods.

Health equity is achieved when every person can "attain his or her full health potential" and no one is "disadvantaged from achieving this potential because of social position or other socially determined circumstances," such as homelessness, poverty, education and exposure to violence that lead to differences in length of life; quality of life; rates of disease, disability, and death; severity of disease; and access to treatment.

This is not always achieved among certain ethnic groups and communities.

While the death of 17 individuals draws intense reaction and scrutiny, according to the Centers for Disease Control and Prevention, more than 16 African American males, many living in disadvantaged communities, are killed by guns in the United States — every day.

It's time to recognize that easy access to guns jeopardizes safety and health everywhere.

The U.S. Department of Housing and Urban Development (HUD) states that exposure to violent crimes damages the health and development of victims, family members, and entire communities— and that low-income people and racial and ethnic minorities are disproportionately affected.

In Alameda County, the same areas that have the most assault-related emergency department visits also have the highest rates of stroke, diabetes and heart disease. A study published in the American Journal of Public Health shows a strong relationship exists between perceived neighborhood safety and obesity rates because residents fearful of violence do not engage in healthy activities like walking or riding bikes.

The impact of this health inequity extends to the entire health care industry. A 2017 Health Affairs study estimated "that the annual financial burden associated with the emergency department and inpatient care for firearm-related injuries to be $2.8 billion in hospital charges. Considering the costs of rehabilitation, repeat admissions, and lost work, the CDC estimates that each year, approximately $46 billion are lost due to firearm-related injuries" — nearly the same amount spent on chronic obstructive pulmonary disease, the third leading cause of death in the United States."

Surgeons in our Level 1 trauma department witness the pain and suffering of the indiscriminate use of firearms every day. They join their peers at the American Association for the Surgery of Trauma in calling for research, reporting and advocacy to find common ground to create a safer America. Our Traumatic Violence Intervention Program intervenes with victims of gunshot violence to prevent acts of retribution by taking advantage of critical "teachable moments" to point victims away from violence by connecting them to GED programs, relocation services and counseling for family members.

Unfortunately, these programs, like many efforts to combat chronic diseases and other health inequities, have limited impact without upstream interactions, such as stemming the flood of easily accessible guns into low-income communities.

Let's hope that the collective voices from suburbs and low-income communities; from schools and churches calling for meaningful legislation resound so loudly that we finally eliminate this malignant cancer of senseless violence.

- by Delvecchio Finley, MPP and Gregory P. Victorino, MD, FACS https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=78325
Tue, 27 Mar 2018 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=78088 <![CDATA[Department of Surgery Ranks 3rd Nationally in NIH Funding for Surgery Category - Three Surgeon-Scientists Rank in Top 20]]> The UCSF Department of Surgery now ranks No. 3 nationally in NIH research funding among all academic surgery programs, a stunning rise from 6th the last time the survey was done. Three Department of Surgery faculty also ranked in the top 20 of all NIH-funded principal investigators nationally in the category of surgery.

The highly respected Blue Ridge Institute for Medical Research utilized data from the Research Portfolio Online Reporting Tool (RePORT) to survey U.S. medical schools for their NIH funding levels between October 1, 2016 to September 30, 2017. UCSF was the top public recipient of NIH funding nationwide. UCSF School of Medicine was also the top recipient of NIH funding among medical schools.

Blue Ridge also looked at NIH funding levels among 76 departments of surgery nationally. UCSF is now ranked third, at $16,261,894, rising from sixth in the last survey, while finishing in the top 4% overall.

Among 534 NIH-funded principal investigators in the category of surgery, three Department of Surgery faculty, breast surgeon Laura J. Esserman, M.D., M.B.A., and transplant surgeons Peter G. Stock, M.D., Ph.D., and Sandy Feng, M.D., Ph.D., ranked in the top 20, 4th, 8th, and 20th respectively, and as a group in the top 4%.

All three have consistently ranked in the uppermost tier of NIH-funded investigators in the surgery category in recent years. Stock has finished among the top 20 investigators for the past 3 years; Feng for the past 5 years, ranking in the top 10 for four of those years; and Esserman has ranked No. 4 in each of the past three years.

The Department also has other NIH-funded collaborators in programs such as in the Surgical Innovations Program that bring in additional NIH funding.

Laura J. Esserman - 144x Laura J. Esserman, M.D., MBA

Professor of Surgery and Radiology
Division of General Surgery
Alfred A. de Lorimier Endowed Chair in General Surgery
Director, UCSF Carol Franc Buck Breast Care Center
Chief, Section of Breast Care Surgery

Peter G. Stock - 144

Professor of Surgery
Surgical Director, Kidney and Pancreas Transplant Program
Surgical Director, Pediatric Renal Transplant Program
Co-Director, Pancreatic Islet Cell Transplant Program
Chair, Department of Surgery Research Committee
Program, Director, T32 Training Program in Transplant Surgery

Sandy Feng -144

Professor of Surgery
Division of Transplant Surgery
Director, Abdominal Transplant Fellowship Program


- by Richard Barg https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=78088
Tue, 27 Mar 2018 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=78310 <![CDATA[Michael Zobel Awarded Prestigious Resident Research Scholarship by American College of Surgeons (ACS)]]> Michael Zobel, M.D, a third-year (PGY-3) general surgery resident at UCSF, has been awarded a prestigious two-year resident research scholarship by the American College of Surgeons for 2018-2020. The scholarships are supported by the generosity of Fellows, Chapters, and friends of the College, to encourage residents to pursue careers in academic surgery.

Dr. Zobel's research is focused on targeting novel genes to suppress metastasis in neuroblastoma, as well as the role of the tumor micro-environment and the immune system in this process. 

Beginning in summer 2018, Dr. Zobel will be a surgery research fellow at Children's Hospital Los Angeles working with pediatric Eugene S. Kim, MD, FACS, FAAP to identify novel treatments for the aggressive childhood cancer, neuroblastoma.

Dr. Zobel has been invited to attend the Clinical Congress of the American College of Surgeons in 2021 where he will report on his research to the Scientific Forum, and receive a certificate at the annual meeting of the Scholarships Committee.

Zobel has published three peer-reviewed papers and has invited for numerous presentations and posters at various symposiums and meetings. At UCSF, he counts among his mentors: Lan Vu, M.D.Matthew Y.C. Lin, M.D.Benjamin Padilla, M.D.Hanmin Lee, M.D.Amar Nijagal, M.D., and Lygia Stewart, M.D..

- by Richard Barg https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=78310
Mon, 26 Mar 2018 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=78306 <![CDATA[Thoracic Oncology Program Launches Kratz Lab Focused on Therapeutic Interventions for Early-Stage Lung Cancers]]> Johannes -Kratz -200x 200The Thoracic Oncology Program proudly announces the launch of the Kratz Lab, which will focus on understanding the genetic and immunological mechanisms that drive early-stage, surgically resectable thoracic malignancies, most notably non-small cell lung cancer. The translationally-focused Kratz Lab will use the knowledge gained from investigating these mechanisms to identify novel therapeutic targets and treatments for this group of patients. 

Johannes R. Kratz, M.D., assistant professor in the Division of Adult Cardiothoracic Surgery and Van Auken Endowed Chair in Thoracic Oncology, is the lab's principal investigator. He is also director of advanced minimally invasive thoracic surgery. 

Among the roster of collaborators is David M. Jablons, M.D., renowned lung cancer surgeon, and director of the Thoracic Oncology Program and Thoracic Oncology Lab. Together with Michael Mann, M.D., the trio developed a prognostic assay for early-stage lung cancer, now in widespread clinical use, that identifies patients across a risk continuum. That work has been continued by Gavitt Woodard, M.D., a general surgery research resident in the Thoracic Oncology Lab, who played a key role in devising a prospective study that provided further evidence of the utility of the assay. The thoracic oncology tissue bank, started by Dr. Jablons in the mid-1990s when lung cancer was a distant outpost for research, now one of the largest and most comprehensive in U.S., undergirds the research. 

The prognostic assay informs treatment decisions after surgery. Patients likely to see their cancer recur (high risk) receive targeted interventions while those at low risk avoid more toxic therapies. Much like Oncotype DX, the revolutionary genomic test for cancer staging, the assay developed by Jablons, Kratz and Mann was a breakthrough in lung cancer, supplanting conventional methods of staging based on tumor histology, size, and nodal status with a far more precise moleculary-driven prognostic testing modality.  

The Kratz Lab is, in effect, standing of the shoulders of the prior research. Using state-of-the-art precision medicine technology, the lab will develop novel targeted therapies for these early-stage lung cancer patients, a group at high risk for recurrence despite having had what appeared to be curative surgery.  Adding such therapies to the treatment armanentarium could one day boost overall 5-year survival from 45-50% to 75-90%, a number in line with other solid tumor cancers such as those of the colon and breast.

- by Richard Barg https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=78306
Sat, 24 Mar 2018 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=78188 <![CDATA[Leonardo M. R. Ferreira Discusses Designer Cell Therapies for Complex Diseases at Future of DNA Synthetic Biology Symposium]]> Molecular immunologist and human genome engineer Leonardo M.R. Ferreira, Ph.D., a postdoctoral scholar in the laboratories of Dr. Qizhi Tang (Department of Surgery) and Dr. Jeffrey Bluestone (Diabetes Center) at UCSF, recently gave a captivating talk about his research at the Future of DNA, Blockchain, and Synthetic Biology Symposium on March 7th at Galvanize SF.  The symposium brought together scientists, entrepreneurs, and angel investors to discuss the latest advances in research and opportunities for founders.

Dr. Ferreira discussed using genome editing to control the immune response in transplantation and immune disorders. His talk, "Designer Cell Therapies for Complex Diseases", focused on two cell and gene therapy strategies under development. The first consisted of genetically deleting a receptor required for HIV infection in blood stem cells and infusing the modified cells back into the patient as a lasting treatment for AIDS; clinical trials are ongoing in China. The second consisted of immune gene engineering in stem cells to create inexhaustible sources of universally compatible tissues and organs for transplantation.

- by Richard Barg https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=78188
Fri, 16 Mar 2018 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=78121 <![CDATA[Department of Surgery Welcomes New Class of General Surgery Residents on Match Day 2018]]> The Department of Surgery warmly welcomes our seven new categorical residents comprising the Class of 2025. We congratulate them in matching with our program. This is a diverse group of highly accomplished individuals that bring a wide array of life experiences and academic excellence to UCSF. We look forward to these newly minted residents' arrival and to providing them an enriching and rewarding experience over the next seven years as they train to become future leaders in academic surgery.  

PGY-1 Categorical General Surgery Residents (2018-19)

Match Dayjpg

- by Rachelle Bresnahan and Alexi Callen https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=78121
Tue, 13 Mar 2018 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=78093 <![CDATA[Jason Pomerantz Awarded 5-year $1.7M NIH Grant to Investigate Muscle Stem Cells for Therapeutic Potential]]> Jason H. Pomerantz, M.D., associate professor of surgery and surgical director of the UCSF Craniofacial Center, has been awarded a 5-year $1.7M R01 grant from National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) to study muscle stem cells, a subpopulation of muscle progenitors that are focal points of vulnerability in muscle dysfunction from disease, trauma or aging.

Project Narrative

Jason In Lab"Muscle dysfunction from disease, trauma or aging, a major health care burden not adequately alleviated by available therapies, could be greatly reduced by treatments that directly address regeneration pathophysiology by capitalizing on muscle stem cells. Muscle stem cells are a subpopulation of incompletely understood muscle progenitors called satellite cells that are focal points of vulnerability in muscle aging and disease states, and in turn, promising therapeutic targets. The proposed research will result in a deeper understanding of the populations of human satellite cells that exist naturally in a broad age range of adults, a necessary foundation for developing muscle stem cell therapeutic applications."

View full abstract at NIH RePORTER

About the Pomerantz Lab

The Pomerantz Lab studies basic and translational aspects of tissue regeneration. With foundations in muscle and cancer biology, the lab investigates regenerative mechanisms including stem cell development and de-differentiation. Using model organisms such as zebrafish and mice, and extending discoveries to human cells and tissues, the lab hopes to gain fundamental insight that can be translated into clinical advances, notably solving the structural and reconstructive problems of the limbs, face, and head, whether congenital or acquired.

- by Richard Barg https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=78093
Fri, 9 Mar 2018 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=78064 <![CDATA[Meditation Room Named for Jeff Pearl, Mount Zion's "Heart"]]> Jeff Pearl was Mount Zion. He lived and breathed the hospital, its patients and families, and staff; and he was as much a part of Mount Zion as the hospital was a part of him.

Known for his warmth as well as his medical skill, Pearl, who died in August 2017, was professor emeritus of surgery at UCSF and held a number of key positions at Mount Zion for 35 years.  His friends, family, and closest colleagues gathered recently in the heart of the UCSF Mount Zion campus to announce the renaming and dedication of the Jeffrey M. Pearl, MD, Meditation Room, where they celebrated his profound contributions to UCSF's clinical, research, and training missions.

3 Jeff PearlPearl was passionate about the hospital, said Bruce Wintroub, MD, vice dean of the School of Medicine and chair of dermatology. His spirit and vision for community service was unmatched, said Dixie Horning, executive director of the UCSF National Center of Excellence in Women's Health. It was an inspiration to have as a friend someone who was so caring about everything around him, said Ernie Ring, MD, professor emeritus of radiology, who preceded Pearl as Mount Zion's chief medical officer and associate dean. All were Pearl's close friends.

"With Jeff's name on the meditation room, we know he will not be forgotten," said Cindy Perlis, who, as director of the Ernest H. Rosenbaum, MD, Art for Recovery program, worked with Pearl to create the room during a refurbishment of the building lobby from 1998 to 2002. Chancellor Sam Hawgood attended the event, as did Pearl's wife Anne, his daughter and son-in-law Laura and David Shapiro, and their two children, Danny and Lindsey.

Nominated for a number of architecture awards, the room bears Pearl's mark as well as his name. He had strong opinions about what to include (a glass privacy wall, stained-glass waterfall and other art, a water fountain, cherrywood benches and panels) and what not to include (no carpet that would need replacing or stuffed sofa where people might be tempted to take naps). Two venerable wooden doors that originally hung in the Mount Zion nursing school grace the room's entrance. Although a destination dedicated to quiet, it has seen many funerals, celebrations of life, and weddings.

Mount Zion Health Fund Spearheaded the Naming

Also on hand at the event was Dana Corvin, board president of Mount Zion Health Fund (MZHF), a foundation of the Jewish Community Federation and Endowment Fund that collaborates closely with UCSF to support Mount Zion-based programs. Generous funding from the Julius R. Krevans Fund of MZHF made the Pearl renaming possible and will fund several Art for Recovery programs at Mount Zion.

In its 28-year giving history, MZHF has granted nearly $40 million, an average of $2 million annually, to UCSF Mount Zion for a wide range of patient care, education, and research projects. With the goal of supporting programs designed to advance the physical, emotional, and spiritual health of vulnerable populations, MZHF reflects the Jewish values, traditions, and 130-year history of Mount Zion Hospital.

Among its major gifts are the Mount Zion Health Fund Distinguished Professorship in Endocrinology, currently held by David Gardner, MD; and the Harris Fishbon Distinguished Professorship in Clinical Translational Research in Aging, held by Christine Ritchie, MD. The fund also recently awarded a multi-year grant to support the creation of the Center for Education in Primary Palliative Care at the Mount Zion campus, under the direction of Michael Rabow, MD.

1 Pearl Meditation Room

Pearl's Legacy at UCSF Mount Zion

Pearl grew up in San Francisco, attended UC Berkeley as an undergraduate, and earned his MD at Mount Sinai School of Medicine. He started his medical practice in 1978, joining his father, Milton, at Mount Zion well before the hospital merged with UCSF in 1990. He joined the UCSF faculty in 1991 and remained a strong advocate for Mount Zion, ultimately serving as associate dean and associate medical director of the UCSF Mount Zion Medical Center. He also served for a time as vice chair of the UCSF Department of Surgery. 

In honor of his family history at Mount Zion, Pearl later established the Milton and Helen Pearl Award for Outstanding Service, an award recognizing a Mount Zion staff member for exceptional service that benefits patients, patients' families, physicians, and co-workers.

2 Sam Anne Danny

Throughout his UCSF career, Pearl was widely recognized as an outstanding surgeon, a committed teacher to medical students and residents, and a valued colleague. Diagnosed in 2014 with progressive supranuclear palsy, Pearl retired in 2014. He found another welcoming community with the Marin Dance Theatre Parkinson's Dance Project, a movement class for individuals with Parkinson's and related diseases.

"Jeff showed strength and humor and reminded us all that life goes on," Cindy Perlis said, in describing Pearl's approach to life and death. The room now named for him will carry his spirit, and the spirit of his Mount Zion friends, so we may never forget the heart of Jeffrey Pearl.

- by Patricia Meagher https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=78064
Wed, 28 Feb 2018 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=77932 <![CDATA[Renowned Breast Surgeon Laura J. Esserman Discusses Her Life and Research at Department of Surgery Staff Engagement Event]]> Renowned breast surgeon Laura J. Esserman, MD, MBA gave a captivating talk about her richly textured life and innovative research at a Staff Engagement Event hosted by the Department of Surgery on February 9th at UCSF Mount Zion.

The research portion of her talk focused on two landmark clinical trials she serves as principal investigator on. The first, the WISDOM Study (Women Informed to Screen Depending on Measures of Risk (WISDOM), is a pragmatic, adaptive, randomized clinical trial comparing a comprehensive risk-based, or personalized approach to traditional annual breast cancer screening and with a goal of recruiting 100,000 women from throughout California for the study.

The second, the I-Spy trials offer an unprecedented and streamlined approach to clinical trial design . Stage II and III breast cancer patients receive drugs targeted to the specific molecular profile of their tumors in a neoadjuvant setting (prior to surgery). The response of any individual patient to a drug is factored into subsequent interventions in the study, creating a "continuous learning engine", a trial design that "takes 10 years off the clock" in providing researchers with statistically significant results.   

Watch Replay of Staff Engagement Event Featuring Dr. Laura Esserman (UCSF MyAccess Login Required)

The WISDOM Study: breaking the deadlock in the breast cancer screening debate (NPJ Breast) (PDF)

Massive study launched to test personalized approach to breast cancer screening (University of California News) 

About the I-Spy Trials

Esserman At Talk

- by Richard Barg https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=77932
Wed, 28 Feb 2018 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=77991 <![CDATA[Quan-Yang Duh, MD Recounts Iconic Immigrant Journey in Address to Pacific Coast Surgical Association]]> K P1Xc K4l _400x 400Quan-Yang Duh M.D., professor and chief of the section of endocrine surgery at University of California, San Francisco (UCSF) and outgoing President of the Pacific Coast Surgical Association, told a rapt audience of attendees at the organization's annual meeting of his journey as an immigrant, his rescue by a Greek family in 1971, and his work as endocrine surgeon, encapsulated in an inspirational story spanning multiple cultures. Dr. Duh was warmly introduced by fellow UCSF endocrine surgeon and medical historian Wen T. Shen, MD, MA.

Below are thoughts and reactions of Dr. Duh's friends, colleagues and family, interspersed with images and slides from the event. The link to the talk itself is not available.  

Sherry Wren@PCSAsurg President @EndoSurgSF gives presidential address, his amazing immigrant story coming to the US at age 15 to becoming one of the worlds greatest surgeons pic.twitter.com/mmwrpWhZpy

— Sherry Wren (@sherrywrenFebruary 17, 2018

Michel Yeh@PCSAsurg President Dr. Quan-Yang Duh @EndoSurgSF on an immigrant's journey, growing up Greek, and embracing both old and new in thyroid surgery. Beautiful oration.@NAChristakis@DAChristakispic.twitter.com/HGZlr3lADq

— Michael Yeh (@michaelyehmd) February 17, 2018

Andre S Twitter Picturev1 BiggerOutstanding Presidential Address by @EndoSurgSF describing his life journey as an immigrant and his outstanding academic career @PCSAsurg #PCSA2018. He is an amazing scholar, surgeon and person! pic.twitter.com/pXpdYiDiyK

— Dr. Andre Campbell (@TraumaDocSF) February 17, 2018

Rescued By Greek Family

Michel Yeh

Thanks @wshen16 (Wen T. Shen, MD, MA) for your eloquent introduction of @PCSAsurg president Dr. Quan-Yang Duh @EndoSurgSF, who manifests the very best of values from multiple cultures. May his example shape our definition of #surgicalleadership. @herbchen@AsianAcadSurg@gpyangmdpic.twitter.com/EoUn8s0W7b

— Michael Yeh (@michaelyehmd) February 18, 2018

Quan -and -Wen -on -Podium

Wen Shens Tribute

Wen Shen Introduction

NachristakisMy brother, @EndoSurgSF gave amazing presidential address on the theme of learning from the old & embracing the new. He spoke as well of the immigrant success stories in our extended family & the USA. And of the importance, paradoxical for a surgeon, of questioning authority. 6/ pic.twitter.com/obAHBwy5g8

— Nicholas A. Christakis (@NAChristakis) February 17, 2018

Question Authority

O5z3vzkz BiggerInspiring address by Pac Coast Surgical president Quan-Yang Duh @EndoSurgSF. ICYMI, a perfect blend of #DACA justification and thyroid surgery history! pic.twitter.com/xbqoBBAZzi

— Gerard Doherty (@gmdohertyFebruary 17, 2018

Julie SosaFantastic endocrine surgeon, friend and now partner.
Congratulations @EndoSurgSF! @UCSFSurgery  UCSFEndosurg
 @UCSF @wshen16  @SanzianaR @DaceySeib @TheAAEz  

— Julie A Sosa (@Jasosamd) February 17, 2018

Katrina ChristakisMy brother: the humble, measured, supportive Dr. Quan-Yang Duh aka @EndoSurgSF. So proud. https://t.co/MvOqn7GXGm

— Katrina Christakis (@katrina_PC) February 19, 2018

Quan And

- by Richard Barg https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=77991
Tue, 27 Feb 2018 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=74446 <![CDATA[The WISDOM Study: Breaking the Deadlock In the Breast Cancer Screening Debate]]> An article commentary recently published in NPJ Breast Cancer, a Nature Research journal, discusses the WISDOM Study (Women Informed to Screen Depending on Measures of Risk (WISDOM), a groundbreaking clinical trial recruiting 100,000 women from throughout California that will compare annual breast cancer screening with personalized risk-based breast cancer screening. The study is led by Laura J. Esserman, MD, MBA (pictured)professor of surgery and director of the Carol Franc Buck Breast Care Center at the UCSF Helen Diller Family Comprehensive Cancer Center. She and the other Wisdom Study and Athena (Athena Breast Health Network) investigators co-authored the article.


There are few medical issues that have generated as much controversy as screening for breast cancer. In science, controversy often stimulates innovation; however, the intensely divisive debate over mammographic screening has had the opposite effect and has stifled progress. The same two questions—whether it is better to screen annually or bi-annually, and whether women are best served by beginning screening at 40 or some later age—have been debated for 20 years, based on data generated three to four decades ago. The controversy has continued largely because our current approach to screening assumes all women have the same risk for the same type of breast cancer. In fact, we now know that cancers vary tremendously in terms of timing of onset, rate of growth, and probability of metastasis.

In an era of personalized medicine, we have the opportunity to investigate tailored screening based on a woman's specific risk for a specific tumor type, generating new data that can inform best practices rather than to continue the rancorous debate. It is time to move from debate to wisdom by asking new questions and generating new knowledge. The WISDOM Study (Women Informed to Screen Depending On Measures of risk) is a pragmatic, adaptive, randomized clinical trial comparing a comprehensive risk-based, or personalized approach to traditional annual breast cancer screening.

The multicenter trial will enroll 100,000 women, powered for a primary endpoint of non-inferiority with respect to the number of late stage cancers detected. The trial will determine whether screening based on personalized risk is as safe, less morbid, preferred by women, will facilitate prevention for those most likely to benefit, and adapt as we learn who is at risk for what kind of cancer. Funded by the Patient Centered Outcomes Research Institute, WISDOM is the product of a multi-year stakeholder engagement process that has brought together consumers, advocates, primary care physicians, specialists, policy makers, technology companies and payers to help break the deadlock in this debate and advance towards a new, dynamic approach to breast cancer screening.

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- by Richard Barg https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=74446
Tue, 27 Feb 2018 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=78045 <![CDATA[Dr. Jon Kabat-Zinn, Legendary Mindfulness Instructor, Lauds Department of Surgery Efforts Studying MBSR in Surgical Interns and Faculty]]> Jon Kabat-Zinn, Ph.D, the universally acclaimed mediation instructor and Professor emeritus at the University of Massachusetts Medical School, recently gave the "Second Annual Ellen Hughes Lectureship" in Herbst Hall at UCSF Mount Zion, "The Key to Clinician Wellbeing through Mindfulness: Embodied Practice, Embodied Presence".

Kabat-Zinn is world-renowned for developing the Mindfulness-Based Stress Reduction (MBSR) course, a fixture of integrated medicine, and the founding director of Stress Reduction Clinic at UMass. 

During the Q&A following his talk, Kabat-Zinn lauded the research studies of Carter Lebares, M.D.director of the UCSF Center for Mindfulness in Surgery, where surgical interns and later faculty have received MBSR training to prevent physician burnout, a phenomenon defined as the stress, anxiety, and depression that lead to emotional exhaustion, depersonalization and self-doubts about work effectiveness.  Last fall, her research group published results showing that 7 in 10 trainee surgeons experienced symptoms of burnout.

When Lebares related these studies to Kabat-Zinn during the Q&A, as well as an anecdote about a UCSF transplant surgeon who used his mindfulness training to great effectiveness in navigating an especially grueling two days of back to back surgeries, Kabat-Zinn was nearly ecstatic, saying it was "music to my ears" that MBSR training was being taught to surgeons at UCSF so they could take better care of their patients as well as themselves.        

Lebares paid tribute to Kabat-Zinn's pioneering work in the field, saying that without his indefatigable commitment to validating the effectiveness of MBSR thorough hundreds of clinical studies and public outreach, none of her work would have been possible. When asked about Lebares' long-term challenge of making MBSR part of the standard physician curriculum, Kabat-Zinn related several stories showing how he overcame obstacles in his quest to make mindfulness training ubiquitous, unveiling a blueprint on how MBSR could be extended to medicine and, in particular, surgery.

- by Richard Barg https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=78045
Mon, 26 Feb 2018 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=78035 <![CDATA[Sonja Schrepfer and Tobias Deuse Awarded 4-year $2.4M NIH Grant to Study Space-Related Physiological Changes and Altered Immune Function]]> UCSF 20170710 Space 178A

Sonja Schrepfer, M.D., Ph.D.
 and Tobias Deuse, M.D. have been awarded a 4-year $2.4M NIH grant by the National Center for Advancing Translational Sciences (NCATS) to investigate space-related physiological changes, analogous to those observed during aging, including defects in bone healing, loss of cardiovascular and neurological capacity, and altered immune function. Dr. Schrepfer is associate professor and director of the UCSF Transplant and Stem Cell Immunobiology (TSI) Lab. Dr. Deuse is associate professor and director of minimally-invasive cardiac surgery at UCSF. He is also a principal investigator in the TSI lab. This work complements other innovative research by the TSI lab funded by the National Aeronautics and Space Administration (NASA).

Project Summary

Microgravity as Model For Immunological Senescence and Its Impact an Tissue Stem Cells and Regeneration

"Many space-related physiological changes resemble those observed during aging, including defects in bone healing, loss of cardiovascular and neurological capacity, and altered immune function. We hypothesize that microgravity-related aging of the immune system is associated with an increase of terminally differentiated CD8+ effector memory T (TEMRA) cells which impair stem-cell based tissue regenerative health. This project proposal aims to investigate the relationship between an individual's immune aging and healing outcomes, and to investigate the biology of aging from two directions—not only during its development in microgravity conditions but also during recovery."

View full description at NIH Project Reporter

About the Transplant and Stem Cell Immunobiology (TSI) Lab

The Transplant and Stem Cell Immunobiology (TSI) Laboratory uses multiple research directions to answer complex questions about stem cell therapy, heart and lung transplantation, and cardiovascular disease. The laboratory focuses on the immunogenicity of allogeneic stem cells, tissues, and organs, and is interested in designing methods to prevent immunological recognition and rejection of such materials. The TSI Lab  investigates mechanisms implicated in the development cardiovascular disease with the dual aims of prevention and cure, encompassing basic science (e.g. identifying novel molecules involved in pluripotent stem cell immunogenicity) to translational medicine (e.g. developing drugs that may be useful in reducing myointimal hyperplasia).

- by Richard Barg https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=78035
Sun, 25 Feb 2018 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=78029 <![CDATA[Teaching To Technology: Will Robots in the OR Shift the Surgical Instruction Model?]]> Courtney Green Teaching EDIT

UCSF general surgery research fellow Courtney A. Green, M.D. was recently interviewed by Daniel Seeger of Surgical Products Magazine about changes in the surgical instruction model heralded by the advent of robotic surgery in the operating room. 

It's well understood that robotic-assisted surgical systems are transforming the work that happens in the operating room. But does the increasing prominence of the devices in the healthcare field also require a transformation in how surgical instruction takes place?

Courtney GreenCourtney Green, MD, a research fellow in the general surgery program at the University of California, San Francisco, has been trying to answer that very question. She presented the results of her research at the Society of Laparoendoscopic Surgeons Minimally Invasive Surgery Week conference in the fall.

"With robotics, I started getting interested in it because of the unique teaching component of it," Green says. "Because it's so separate, because the surgeon's at a console separate from the patient — and separate from the resident sometimes — there has to be a lot more active teaching or active engagement, which surgeons aren't necessarily ever taught how to do. The whole surgical educational model has always been an apprenticeship model: you see one, do one, teach one."

One key to properly initiating a resident into working with a surgical robot is being mindful about how the process is distinctly different than other surgeries. Primarily, the dynamic in the OR is significantly altered by basic proximity factors.

"The process of performing a surgery may not be all that different with robotics; but the process of observing an expert and learning to recreate that performance — well, that has changed dramatically," Green says. "One must observe the surgeon's movements on the console and simultaneously process the consequential actions in the operative field located some distance away." 

Although there are some who view developing facility with robotic systems as basically similar to the learning curve experienced with previous advances such as laparoscopy, Green's research suggests otherwise.

"Unlike in laparoscopy, where you're still assisting a surgeon and still playing a role in the surgical field, robotics creates so much autonomy for an individual surgeon," Green notes. "That's great where resources are limited, but it results in a challenge in a training environment because the resident is no longer depended on to be that surgical assistant."

Dr. Green developed the robotics curriculum for the UCSF Department of Surgery. Her latest research, "Investigation into the Perceptual Expertise of a Robotic Surgeon: How do we learn to feel what we see?" is funded by a CSERT grant.

- by Richard Barg https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=78029
Sun, 25 Feb 2018 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=78015 <![CDATA[Wired Magazine Visits Shuvo Roy and The Kidney Project]]> Roy and Oruganti

Kidney failure is a debilitating and ultimately deadly illness, and a health policy crisis. With 468,000 people on dialysis in the U.S., costing the government $31 billion dollars a year, very little money is spent on researching alternatives to current treatments.

Wired magazine's Megan Molteni visited Shuvo Roy, PhD, to check in on the progress of the implantable artificial kidney, which has been in the works for more than 20 years. Roy is a faculty member in the Department of Bioengineering and Therapeutic Sciences, a joint department of the UCSF Schools of Pharmacy and Medicine.

The implantable artificial kidney employs silicon filters, and will encapsulate living cells that would help recreate most of the essential functions of the kidneys.

model of artificial kidney

"Silicon is the most perfected man-made material on Earth," Roy told Wired. Buoyed by an outpouring of public interest and donations, the project is nearing early-stage human trials.

Roy is the director of The Kidney Project, which is co-directed by William Fissell, MD, at Vanderbilt University Medical Center. In addition to this project, Dr. Roy plays a a leadership role in numerous other interdisciplinary programs at UCSF including Surgical InnovationsPediatric Device Consortium and the Biodevice Innovation Pathway


Silicon isn't just for computers. It can make a pretty good kidney, too (Wired.com)



- by Grant Burningham https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=78015
Sat, 24 Feb 2018 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=77877 <![CDATA[Johannes Kratz Named Van Auken Endowed Chair in Thoracic Oncology]]> Johannes -Kratz -200x 200Johannes R. Kratz, M.D. has been named the new Van Auken Endowed Chair in Thoracic Oncology. Kratz is an assistant professor in the Division of Adult Cardiothoracic Surgery, a member of the Thoracic Oncology Program, and director of Advanced Minimally Invasive Thoracic Surgery. 

The Van Auken Endowed Chair supports research, teaching and service in the field of thoracic oncology. Kratz has excelled in all three areas.

As a research fellow at UCSF, he was instrumental in the development of a prognostic assay for early-stage lung cancer, working on a team led by David M. Jablons, M.D. and Michael Mann, M.D. The assay is now in widespread clinical use and has helped oncologists make informed determinations on whether to offer their patients adjuvant therapy for lung cancer.

Kratz has also played a pivotal role in helping the Department of Surgery forge a path into thoracic robotic surgery, and has worked closely with residents such as Courtney Green, MD to ensure general surgery residents recieve the requisite training in the technology. Kratz was also the recipient of the Exceptional Physician Award from UCSF Health in 2017.


- by Richard Barg https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=77877
Fri, 16 Feb 2018 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=77923 <![CDATA[Department of Surgery Launches New Medical Student Portal for Surgical Clerkships]]> The Department of Surgery has launched a new medical student portal designed as a resource and comprehensive dashboard for medical students during their surgical clerkships. The program is led by Director Andre Campbell, M.D. and Associate Director Matthew Y.C. Lin, M.D. The site course coordinators are Heidi Crist and Wenia Lee

The Department of Surgery Clerkship provides UCSF medical students with a solid, enduring surgical foundation, offering diverse training opportunities including lecture series, faculty-led case presentations, observed physical exams, informal Bedside Rounds, and both hands-on patient care and procedures. Students rotate through numerous locations including Moffitt-Long Hospital, Zuckerberg San Francisco General Hospital, San Francisco Veterans Administration Hospital, Alameda County Medical Center, Mount Zion Hospital, Mission Bay Hospital, California Pacific Medical Center and Kaiser San Leandro.  

The new Medical Student Portal website was officially unveiled during a recent Grand Rounds presentation, "The New Bridges Curriculum and the Future of Surgical Education", by Drs. Campbell, Lin and Jessica Gosnell, M.D

The UCSF School of Medicine described the principles underlying the Bridges curriculum in a post on its website:

The new UCSF School of Medicine Bridges curriculum is considered the most innovative training currently offered at a medical school in the country. Immersed in clinical teams from the start, Bridges students will be trained to continuously improve care. Their understanding of the foundational sciences will be in sync with what they are learning in active clinical settings. They will be challenged to ask questions that advance not just their understanding of human health and disease but the very frontiers of science.

Basic scientists have complained for years that medical school focuses almost exclusively on concepts in the biomedical sciences that are "tried and true," noted Catherine Lucey, MD, vice dean for education. Students may be exposed to scientific discovery if they work in a research laboratory, but medical school in general does not cover ongoing research.

"We set out with this new curriculum to ensure that every medical student develops an understanding not only of the solid building blocks of biomedical science as they are known today, but also the cutting-edge science occurring today that will lead to advances in the way they care for patients tomorrow," said Lucey.

The implementation of the Bridges curriculum in the Department of Surgery, discussed during Grand Rounds, focuses on providing "early longitudinal immersion in clinical teams with a focus on continuously improving care delivery, and an inquiry-focused curriculum that emphasizes asking questions that push the frontiers of science and understanding of human health and disease". 

Visit the Medical Student Portal

Watch Grand Rounds Lecture (Drs. Drs. Campbell, Lin and Gosnell

School of Medicine Launches New Curriculum to Train the Doctors of the Future 

Grand Grounds Medical Student Portal Copy

- by Richard Barg https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=77923
Tue, 13 Feb 2018 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=77926 <![CDATA[How Hospitals are Working to Prepare At-Risk Older Patients for Surgery]]> Emily Finlayson - 144xEmily Finlayson, MD, MS, director of the Center for Surgery in Older Adults at UCSF,  was interviewed by Becker's Hospital Review on how hospitals work to prepare at-risk older patients for surgery, screening for frailty and meeting patient's health goals. 

Older patients undergo major surgery on a regular basis. However, a number of these patients are at risk for experiencing complications, functional decline and loss of independence after surgery.

With this in mind, Emily Finlayson, MD,  professor of surgery and health policy at University of California - San Francisco Medical Center, set out to determine how to improve outcomes for at-risk older patients.  

She began by looking at whether patients are undergoing interventions that will help them reach their overall health goals. In other words, should some patients receive other types of less invasive treatment besides surgery? Part of that decision involves assessing the patient's fitness for surgery, but another part involves understanding what the patient hopes to get out of the procedure, says Dr. Finlayson. Some patients may aim to live a longer life regardless the cost, while others may seek to maintain a high level of function and independence for as long as they can.

"So, sort of meeting patients where they are," she says. "I thought we needed to beef [that] up. I think surgeons currently aren't trained to have those granular conversations as well as some other specialists. Also, considering the time constraints and the clinic culture, the throughput doesn't really lend itself to that conversation."

Additionally, she says, hospitals are good at screening for major medical risk factors such as heart disease before surgery, but they don't routinely look for frailty components such as functional disability and poor social support.

Ultimately, after thinking about those issues, Dr. Finlayson helped start, and now directs, the UCSF Center for Surgery in Older Adults. The center includes UCSF's Surgery Wellness program, which is designed to help older patients get physically, mentally and logistically prepared for an operation.   

- by Richard Barg https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=77926
Thu, 8 Feb 2018 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=23912 <![CDATA[Division of Vascular and Endovascular Surgery to Host UCSF Vascular Symposium April 19-21 in San Francisco]]> The Division of Vascular and Endovascular Surgery in the Department of Surgery at University of California, San Francisco will host the 2018 UCSF Vascular Symposium on April 19-21 at the Parc 55 San Francisco. The symposium includes a distinguished faculty drawn from UCSF and and other leading institutions. 

The landscape of vascular disease management continues to evolve with advancing technologies, data from clinical trials, and registries, all within the shifting paradigms of affordable care. How do we continue to offer the best modalities for our patients, practice evidence-based and cost-effective care, and begin to understand population-based disease management? 

This year's Vascular Symposium will address the intersection of technology and evidence, probe the algorithms of experts regarding treatment selection, and review the current existing practice guidelines in each disease area. We will again highlight a Mini-Symposium on advanced limb salvage, bringing a multi-disciplinary panel of experts with an interactive program of cases and didactics.

Conference Chair

Michael Conte - 144pxMichael S. Conte, M.D. 
Professor and Chief,
Division of Vascular & Endovascular Surgery
Edwin J. Wylie, M.D. Chair in Vascular Surgery

Conference co-Chairs

Charles M. Eichler - 144pxCharles M. Eichler, M.D.
Clinical Professor of Surgery
Division of Vascular and Endovascular Surgery

Alexander Reyzelman - 144px

Alexander M. Reyzelman, D.P.M. 
Senior Physician Diplomate
Division of Vascular and Endovascular Surgery

Full Program and Registration Details

- by Richard Barg https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=23912
Wed, 7 Feb 2018 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=77884 <![CDATA[Department of Surgery Launches Surgical Skills Center Website]]> The Department of Surgery has launched a new website for its Surgical Skills Center. The program is led by director Edward Kim, M.D., associate director Hueylan Chern, M.D., both associate professors in the Division of General Surgery.

The goal of the Center is to maximize learning in the operating rooms by allowing trainees to master basic technical skills and practice operative techniques and principles outside of the operating room. This is accomplished by providing a structured and robust curriculum including inanimate and tissue models that simulate challenges that occur to novices in the real operations. A recent addition to the cirriculum is robotic surgery training. The lab also supports education research fellowship in teaching, curricular development and research as a pathway to an academic career in surgical education.

The center has its own YouTube Channel and holds frequent competitions.

The other teaching faculty are Patricia O'Sullivan, Ed.D., a professor in the Department of Medicine and Joseph Rapp, M.D., Professor Emeritus of Surgery from the Division of Vascular and Endovascular Surgery. Wendy Fong is the technician and operations manager.

Surgical Skills Center website

2017 Midyear Group Names

2017 Annual Mid-Year Evaluation Competition
Top Row: Matthew Schwenke (rad-p), Joseph Rapp (Vasc/Surgical Skills Faculty), Michael Orloff (gs-p), (Plas Faculty), Keith Hansen (gs-p), Johnathan Li (ophtho), Mohammad Elsayed (gs-p), Steven Pletcher, Alexander Gupta (gs/plas-p), Mary McGrath, Ohns Faculty), Adrian House (ohns), Fourth Row: John Lindsey II, (urol), Benjamin Kipper (rad-p), Alexa Glencer(gs), Laura Wong (plas), Madeleine Strohl (ohns), Nancy Wang (ohns) ,Third Row: Ed Kim (Surgical Skills Center Director), Joseph Yang (omf), Alexander Kim (gs), Joseph Lin (gs), Lesley Everett (ophtho), Lauren Eyler (gs), Neel Pasricha (ophtho), Mary Xu (ohns), Huey!ah Chern (Surgical Skills Center Education Director), Second Row: Heiko Yang (urol), Phillip Harrison (omf), Zachary Matth ay (gs), Marlsa Pulcrano (gs), Frances Wu (ophtho), Kneeling: Bethlehem Mekonnen (ophtho), Wendy Fong (Surgical Skills Center Manager), Hillary Braun (gs), Linn Maung (omf), Not in photo: John Roberts (Department Chair), Nancy Ascher (Transplant Faculty), Linda Reilly (Program Director), Courtney Green (Surgical Skills Center, Education Research Fellow, Cameron Wilson (emeg-p)

- by Richard Barg https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=77884
Wed, 31 Jan 2018 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=77528 <![CDATA[Julie Ann Sosa, MD, MA, FACS Named Chair of UCSF Department of Surgery]]> Sosajulie 2017 ETJulie Ann Sosa, MD, MA, FACS will be the new chair of the UCSF Department of Surgery, effective April 1, 2018. She will also hold the Leon Goldman, MD, Distinguished Professorship in Surgery. Dr. John P. Roberts, who has led the department as interim chair since October 2016, will continue in his leadership role until Dr. Sosa's arrival. 

Dr. Sosa is currently a professor of Surgery and of Medicine (Oncology) and chief of Endocrine Surgery at the Duke University School of Medicine. She also serves as director of the Surgical Center for Outcomes Research (SCORES), leads the Endocrine Neoplasia Diseases Group, and co-leads the Solid Tumor Therapeutics Program at the Duke Cancer Institute and the Duke Clinical Research Institute.  

Dr. Sosa was born in Montreal and raised in upstate New York. She received her AB at Princeton, her MA at Oxford, and her MD at Johns Hopkins, where she also completed the Halsted residency program and a fellowship. Her clinical interest is in endocrine surgery, with a focus in thyroid cancer. She is widely published in outcomes analysis, as well as cost-effectiveness analysis, meta-analysis, and survey-based research. She has served as PI for a number of therapeutic and correlative clinical trials, largely centered around the development of novel small molecule therapies for advanced thyroid cancer and understanding environmental risk factors for the development of the disease. She has mentored more than 70 students, residents, and fellows, and has made surgical education a focus of her science, co-directing the multi-year, prospective National Study of Expectations and Attitudes of Residents in Surgery (NEARS) in conjunction with the American Board of Surgery. 

Her large research group is multi-disciplinary, and she has collaborators in epidemiology, health services research, biostatistics, endocrinology, oncology, pathology, radiology, pharmacology and cancer biology, environmental science, and stem cell research. She has published more than 280 peer-reviewed manuscripts, 50 book chapters, and has authored/edited 4 books.  Dr Sosa has been the recipient of grants from the NIH/NCI, Paget Foundation, the Association for Academic Surgery, the Donaghue Foundation, the American Geriatrics Association/Hartford Foundation, and the Connecticut Stem Cell Research Fund.  

Dr. Sosa is the newly elected editor in chief of the World Journal of Surgery, having served previously as deputy editor of JAMA-Surgery and associate editor of the Journal of Surgical Research. She is on the editorial boards of the Annals of Surgery, Surgery, Annals of Surgical Oncology, Endocrine, Hormones and Cancer, Journal of Thyroid Research, and the International Journal of Endocrine Oncology. She is Treasurer of the American Thyroid Association (ATA) and serves on the Board of Directors/Executive Council of the ATA, Society of Surgical Oncology, International Thyroid Oncology Group, and Association for Academic Surgery Foundation. She has served on ATA guidelines committees for hyperthyroidism, thyroid nodules and differentiated thyroid cancer, and on the NCCN guidelines committee for neuroendocrine tumors. 

- by UCSF Department of Surgery https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=77528
Tue, 30 Jan 2018 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=77841 <![CDATA[One Year Ago Today, Surgeons Hit the Reset Button on My Life]]> Brad Dell Top Image

Brad Dell relives the exhilirating and captivating events leading up to his lung transplant surgery at UCSF on its one-year anniversary. His riveting account appears at Cystic Fibrosis News Today

Jan. 14, 2017 was the worst day of anxiety I'd had in the five months of waiting for my lung transplant. A frantic, nearly palpable tension was in the air. After five confident months believing the "light at the end of the tunnel" was rebirth, rather than death, I suddenly broke. I simply didn't think I had the strength to make it to transplant. I refused to communicate with my parents most of the day (I was fully deaf, so communication took conscious effort), and I walked the streets of cloudy Santa Cruz in a cold sweat, shaking as much as the oxygen tank on uneven wheels that followed me. I texted my girlfriend that night and found she also had a bad-vibe day. We sobbed together.

I prayed intensely that night for quick relief, despite knowing the doctors estimated I'd be on the waiting list for lungs at least five to nine months. It had only been five weeks, and my spirit was already decimated. I didn't only pray for a miracle transplant — I knew 20 people die each day waiting for organs in the United States — I prayed, "If it's in the plan for me to die, let it be swift and let me be at peace with it." What followed was the best sleep I'd had in five months.

What followed that, however, was a rude interruption at 1:30 a.m. I awoke to my lights being turned on, tore off my BiPAP mask, and whined at my parents: "What the frick, man? I was finally sleeping good!" What can I say? Dying makes you irritable. I assumed they turned on the lights to change my IV antibiotic dose. Instead, they were sitting on the edge of my bed, laptop between them. I already knew what was happening. I slapped on my glasses to turn bright, blurry whiteness into a gorgeous, glorious Word document:

UCSF Just Called Email

My trembling heart was shoved into my throat. Eyes wide and glistening, I Facetimed my girlfriend. It was 11:30 p.m. where she was, in Hawaii, but she answered immediately. She knew what was going on before I could articulate the words — the words I'd once molded into poetry and fantasized delivering: "Th-they called. They have th-the lungs for me."  I gazed at her on that shaking phone screen and realized this certainly was the most poetic moment of my life despite my botched delivery.

My parents and I scrambled to pack our things. It's advised that you always have a "go bag" when waiting for transplant, but we thought we had a solid four months before we could expect it. In the car, I experienced the peace I'd prayed for just hours before: a warm water submersion. It was the calmest I ever felt in my life, despite knowing I could be cut open soon (the lungs weren't guaranteed to be viable).

It wasn't hectic in the hospital once we arrived. We sat in a ward and awaited word. I didn't bring my BiPAP with me, so I couldn't sleep the rest of the night. Instead, I thought of my stranger donor, of his family — suffering in those moments......

Continue reading the story at Cystic Fibrosis News Today

- by Brad Dell - His personal account at CF News Today https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=77841
Mon, 29 Jan 2018 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=77810 <![CDATA[Jasleen Kukreja Named Interim Chief of the Division of Adult Cardiothoracic Surgery]]> Kukreja Jasleen 200Jasleen Kukreja, M.D., MPH, program and surgical director the UCSF Lung Transplant Program, has been named interim chief of the UCSF Division of Adult Cardiothoracic Surgery. Dr. Kukreja, the holder of the Doris F. and Donald G. Fisher Distinguished Professor in Pulmonary Therapies and Science, is also director of the adult respiratory mechanical circulatory support (ECMO) program. The UCSF Lung Transplant Program is perennially one the top in the country measured by expected patient survival rates and graft survival rates compiled by the Scientific Registry of Transplant Recipients (SRTR). 

Dr. Kukreja earned her M.D. at UCLA School of Medicine. She did her general surgery residency training at Brigham and Women's Hospital and cardiothoracic surgery residency training at UCSF. She also holds an MPH from Harvard School of Public Health.

Dr. Kukreja succeeds Scot H. Merrick, M.D. who ably led the Division for the past 17 years.  

- by Richard Barg https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=77810
Mon, 29 Jan 2018 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=77801 <![CDATA[A Push To Get Older Adults In Better Shape For Surgery]]> Navigating Aging focuses on medical issues and advice associated with aging and end-of-life care, helping America's 45 million seniors and their families navigate the health care system.

Surgery can be hard on older adults, resulting in serious complications and death far more often than in younger patients. But many seniors aren't adequately prepared for the risks they might face.

Emily Finlayson - 144xInnovative hospitals such as Duke University Medical Center, the University of California-San Francisco Medical Center and Michigan Medicine are working to change that. In the weeks leading up to surgery, they prescribe exercise to seniors, make sure they're eating healthy foods and try to minimize anxiety and stress, among other initiatives.

Research suggests these interventions can enhance seniors' readiness for surgery and potentially lead to improved outcomes. "Changing how we approach older patients is really an imperative," said Dr. Emily Finlayson, director of the Center for Surgery in Older Adults at UCSF.

In that vein, next year the American College of Surgeons (ACS) plans to launch a national effort to improve surgical care for seniors, after defining a broad array of standards that hospitals should meet. The goal is to promote and recognize "centers of excellence in geriatric surgery" across the U.S., said Dr. Ronnie Rosenthal, chair of ACS' geriatric surgery task force.

New evidence from Duke's POSH (Perioperative Optimization of Senior Health) program demonstrates the value of prepping at-risk seniors for surgery, a strategy endorsed by the newly published standards.

In January, researchers reported that older adults who went through the POSH program before major abdominal operations spent less time in the hospital (four days versus six days for a control group), were less likely to return to the hospital in the next 30 days (7.8 percent vs. 18.3 percent), and were more likely to return home without the need for home health care (62.3 percent vs. 51.1 percent). They also had slightly fewer complications.

POSH is an interdisciplinary model of care, bringing together surgeons, geriatricians, anesthesiologists and social workers while actively engaging older patients and their families. Seniors referred by surgeons attend one- to two-hour appointments at Duke's Geriatric Evaluation and Treatment Clinic, where they receive a comprehensive geriatric assessment focused on their functioning (what they can do, with what degree of difficulty), mobility, cognition, medications, nutrition, existing medical conditions and support at home from family or other caregivers, among other factors.

Making sure that older patients understand what surgery might mean for them — the potential benefits as well as harms — is a primary objective. "We ask 'What do you really want to do in the future?' and then spend a good amount of time explaining if surgery will actually help a patient meet that goal," said Dr. Sandhya Lagoo-Deenadayalan, an associate professor of surgery at Duke, who helped launch POSH in 2011.

"When patients leave our clinic, they have a very detailed to-do list," said Dr. Shelley McDonald, an assistant professor of geriatrics who helps run POSH. Although the plan is tailored to each patient, she often recommends: Start walking 20 minutes a day, five days a week; do core-strengthening exercises three times a week; practice deep breathing three to four times a day; stop taking medications that can interact poorly with anesthesia, such as antihistamines and benzodiazepines; eat 30 grams of protein three times a day; drink lots of fluids starting three days before surgery (your urine should be light yellow to clear); and make sure you have someone to sit with you in the hospital and be with you when you return home.

Ralph "Benny" Suggs, 70, went through the POSH program last summer, before surgery to repair a large hernia. "I hadn't had any major surgery, ever," said this retired Navy rear admiral, who's now associate vice chancellor for alumni relations at North Carolina State University. "They went to great lengths to brief me on every little thing — not only the medical procedure itself, but what I could expect physically and emotionally afterwards. That really gives you a sense of confidence that things are going to go well."

At Michigan Medicine, an academic health center operated by the University of Michigan, a similarly intentioned but pared-down program focuses on four objectives before surgery: walking more, getting lungs ready through breathing exercises, eating well and relaxing (spending time with friends and family, getting enough sleep, minimizing stress). Participants get daily text reminders and can log their progress through a patient portal in the hospital's electronic health record.

Empowering older patients to take action before surgery instead of sitting around and worrying is the program's "magic sauce," said Dr. Michael Englesbe, a professor of surgery at Michigan Medicine who is involved with the program.

Difficulties with billing Medicare for preoperative consultations and restructuring how physicians practice are the biggest challenges to implementing this kind of model widely. Still, "a lot of vendors are developing education and activity-tracking programs around surgery, and I expect these kinds of programs will become part of the standard of care in the not-too-distant future," Englesbe suggested.

At UCSF's Surgery Wellness program for older adults, patients are seen by a geriatrician, nutritionist, physical therapist, occupational therapist and a health coach. Consultations last about 90 minutes and result in concrete suggestions for seniors and their families as well as referrals, if needed, to specialists who can undertake more extensive evaluations.

Hoping to expand the reach of UCSF's approach, Finlayson and colleagues are developing a website and digital app, Prehab Pal, that will walk older adults and their caregivers through surgery prep. Created with input from seniors, it will have large-text fonts and easy-to-use design features. "We're putting the final touches on the first product and will pilot in March," Finlayson said.

For patients, knowing how to ask the right questions before surgery and appointing a surrogate to act on your behalf during and immediately after surgery is critically important, noted Rosenthal of ACS, who is also a professor of surgery and geriatrics at Yale University School of Medicine.

The Patient Preferences Project at University of Wisconsin School of Medicine and Public Health has developed and is testing a list of useful questions for older patients. Even if your local hospital doesn't have a program like those at Duke, Michigan Medicine or UCSF, you can ask your surgeon to address these questions:

Should I have surgery? What are my options? What is likely to happen if I do have surgery? If I don't have surgery? In your opinion, will surgery make me feel better? In your opinion, will surgery help me live longer? If so, how much longer? What should I expect if everything goes well? What will my daily life look like after surgery? (Right after, three months later, one year later?) Will I have any tubes or drains put in during or after surgery and will I need them at home? In your opinion, how will this surgery affect my other health problems (such as diabetes or high blood pressure)? After I leave the hospital, what type of care do you think I will need? What happens if things go wrong after surgery? Can you describe serious complications and explain what those might mean for me? If I'm too sick to speak for myself, how can I make sure you know my wishes? If I decide to appoint someone to make medical decisions for me, what do I need to do to make those arrangements official?

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

To contact Judith Graham with a question or comment, click here.

This story was reproduced here with permission of Kaiser Health News

- by  Navigating Aging   https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=77801
Sun, 28 Jan 2018 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=77831 <![CDATA[Carolyn Seib Awarded Grant to Study Postoperative Cognitive Dysfunction in Elderly Thyroid Cancer Patients]]> Seib Carolyn Photo News StoryCarolyn D. Seib, M.D., MAS, a clinical investigator and member of the UCSF endocrine surgery faculty, has been awarded a RAP (Resource Allocation Program) seed grant by the Helen Diller Family Comprehensive Cancer Center to study postoperative cognitive dysfunction in elderly patients undergoing surgery for thyroid cancer.

Dr. Seib's project is part of her ongoing research focused on individualizing the surgical care of older adults. With increasing evidence supporting the surveillance of small, low-risk papillary thyroid cancers, the decision of whether to manage thyroid cancer operatively requires a comprehensive assessment of the risks of thyroid surgery in older adults. With this award, she will use the Tablet-Based Cognitive Assessment Tool (TabCAT) developed at the UCSF Center for Memory and Aging to administer cognitive testing in patients with thyroid cancer undergoing thyroidectomy to assess the incidence of postoperative cognitive dysfunction. This will enable Dr. Seib to determine how this risk should affect surgical decision making in older adults and facilitate accurate informed consent discussions.

- by Richard Barg https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=77831
Sun, 28 Jan 2018 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=76848 <![CDATA[Automatic Acoustic Gunshot Sensor Technology May Benefit Shooting Victims]]> A study led by UCSF-East Bay general surgery resident Magdalene Brooke, MD, and UCSF trauma surgeon Gregory P. Victorino, M.D.found that the use of automatic acoustic gunshot sensor technology may benefit shooting victims. The study was presented at the most recent Clinical Congress of the American College of Surgeons. The surgeons reported that sensors contribute to quicker hospital arrival times and equal survival rates despite more severe injuries. 

A number of U.S. cities have installed acoustic gunshot sensor technology to accurately locate shooting scenes and potential gunshot victims, but the effectiveness of this technology for saving lives had not been studied until surgeons at the University of California, San Francisco-East Bay in Oakland, Calif., found that this sensor technology may benefit shooting victims by helping them get to the emergency room sooner than they may have otherwise.

"Our key finding was that the use of these acoustic gunshot sensors showed promise as a system that may benefit gunshot victims," said lead study author Magdalene A. Brooke, MD, a general surgery resident at University of California San Francisco-East Bay. The study was presented at the American College of Surgeons Clinical Congress 2017. Gregory P. Victorino, MD, FACS, a professor of clinical surgery and trauma surgeon at UCSF-East Bay, was the senior author of the study.

Gunshot sensor technology involves sensors, essentially microphones, mounted on buildings and utility poles. These sensors detect the sound waves of a gunshot, and software calculates input from several sensors to triangulate its location with a margin of error of about 80 feet. The system can distinguish between single and multiple gunshots, and can differentiate gunshots from fireworks and other sounds that may activate it. The idea is to detect gunshots that go unreported and provide responders with more accurate information on the point of origin than they can glean from citizens' calls. About 90 U.S. cities have this technology, and Oakland's system has been in place since 2006. Fewer than 20 percent of shots fired are reported to police, the study authors stated.

View Abstract 

View News Release at American College of Surgeons

- by Richard Barg https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=76848
Fri, 26 Jan 2018 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=77804 <![CDATA[Tobias Deuse Named The Julien I. E. Hoffman, M.D. Chair in Cardiac Surgery]]> Deuse Tobias 200X250Tobias Deuse, M.D., associate professor of surgery and director of minimally-invasive cardiac surgery at UCSF, has been named The Julien I. E. Hoffman, M.D. Chair in Cardiac Surgery. Dr. Deuse, a cardiac and heart transplant surgeon, is internationally renowned for his pioneering work in the development of minimally-invasive techniques for mitral and aortic valve repair, demonstrating high success rates in mitral valve repair utilizing robotic-assisted (fully) endoscopic surgery or "keyhole surgery".

Dr. Deuse is also a principal investigator in the Transplant and Stem Cell Immunobiology (TSI) Laboratory at UCSF. 

The endowed chair was created to support basic science research, to increase the understanding of fundamental principles of cardiac surgery and/or that may have the potential for clinical applications in cardiac surgery. 

Julien I.E. Hoffman, M.D., in whose name the chair is endowed, is a South African-American pediatric cardiologist, professor emeritus of pediatrics, and a senior member of UCSF's Cardiovascular Research Institute. 

- by Richard Barg https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=77804
Fri, 26 Jan 2018 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=77811 <![CDATA[Catherine Juillard Named Director of Center for Global Surgical Studies Director and SF Wraparound Project]]> Juillard Catherine 200Catherine Juillard, M.D., MPH., is the new director of the UCSF Center for Global Surgical Studies and San Francisco Wraparound Project, two Department of Surgery programs based at Zuckerberg San Francisco General. Dr. Juillard is a general and trauma surgeon and an assistant professor in the department. She did her undergraduate work at Stanford, received her MD from David Geffen School of Medicine at UCLA, and earned an MPH from Johns Hopkins University Bloomberg School of Public Health. She did her general surgery residency training at UCLA and Trauma/Critical Care fellowship training at UCSF.

The Center for Global Surgical Studies is a leader in academic global surgery. The program uses the established academic pillars of research and education to create meaningful change in access to surgical care, seeking to reduce the surgical disease burden in low- and middle-income countries (LMICs). 

The San Francisco Wraparound Project works to reduce injury and criminal recidivism among the most vulnerable citizens of San Francisco, serving as a vital point of entry, providing mentorship and risk-reduction resources. A core precept is that violent traumatic events provide a teachable moment, a "golden window" in which the involved individuals can be taught how to avoid high-risk behaviors, interventions that stop the cycle of injury and re-injury.

Dr. Juillard succeeds Rochelle Dicker, M.D., the founding director of both programs who had a major and lasting impact on global surgery and violence prevention during her long and accomplished career at UCSF. Dr. Dicker was recently appointed vice-chair and chief of Surgical Critical Care at UCLA, and associate chief of Trauma and Emergency General Surgery.


- by Richard Barg https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=77811
Wed, 17 Jan 2018 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=77754 <![CDATA[Meet Dr. Tobias Deuse, Internationally Renowned Cardiac and Heart Transplant Surgeon]]> Deuse Toby 144Dr. Tobias Deuse was recruited to UCSF from the University of Hamburg-Eppendorf, one of the leading mitral valve centers in Germany. He is excited by UCSF's team approach to complex heart disease, and recently led the establishment at UCSF of a combined clinic where patients see both an interventional cardiologist and cardiac surgeon on the same day; the specialists then consult with each other and tailor a treatment plan for each patient's unique situation.

If patients meet with a doctor who tells them one thing, and then the next doctor tells them something completely different, they go home confused and frustrated – it's terrible! said Dr. Deuse. "But when they see different specialists working together to develop an individualized plan for them, they feel much better. The hospitals that adapt this team approach will likely be most successful.

Keeping His Day Job – And Night Job

Dr. Deuse studied physics as an undergraduate at the University of Stuttgart in Germany, then earned his medical degree from Ludwig Maximilian University in Munich, where he also completed his cardiac surgery internship before completing his cardiovascular surgery residency at the University Heart Center in Hamburg-Eppendorf, Germany. 

Schrepfer 300DpiHe was drawn very early to cardiothoracic surgery, in part because of a fascination with cardiac anatomy and the challenge of performing meticulous surgery that required tiny sutures. Even as a medical student, he started doing heart transplants on rats. It was there, 19 years ago, that he met Dr. Sonja Schrepfer, another medical student who became his lifelong research partner and eventually his wife. "It was very romantic, meeting in the basement in the animal OR!" said Dr. Deuse with a laugh. 

Dr. Deuse later completed a cardiothoracic surgery transplant fellowship at Stanford University, a pioneering center in the areas of heart and heart-lung transplantation. Among his mentors were Dr. Bruce Reitz, Dr. Philip Oyer and Dr. Craig Miller. Dr. Deuse was then recruited back to Germany, where he served as director of the heart and lung transplantation program at the University of Hamburg-Eppendorf and also practiced as a general cardiac surgeon.

Throughout his career, Dr. Deuse likes to joke that he has had two jobs. His day job is performing elective cardiac surgery. His night and weekend job is performing heart, lung and heart-lung transplants, during the off hours when operating rooms are available for these unscheduled, life-changing procedures.

Dr. Deuse has always juggled a third job, too – in partnership with Dr. Schrepfer, now a renowned stem cell scientist and immunobiologist, he has conducted vascular biology research with the goal of finding better ways to prevent cardiovascular disease.

Minimally Invasive Cardiac Surgery

In recent years, many new avenues have emerged for treating cardiac valve disease. Conditions such as mitral valve prolapse can be treated through open-heart surgery, minimally invasive surgery, or sometimes without any surgery at all – instead inserting collapsible valves or clips through a small incision in the groin and placing them in the heart with catheters.

Nowadays, when we have so many options, it's absolutely crucial that patients are seen by both a cardiologist and a heart surgeon who work together to determine the best treatment option for each patient," said Dr. Tobias Deuse, an internationally renowned cardiac surgeon-scientist and is  director of the Minimally Invasive Cardiac Surgery Program. "There are some procedures that cardiologists do, some that surgeons do, and some procedures that we do together because they involve both of our areas of expertise. With modern heart interventions, the line between cardiology and surgery has become less obvious.

Cardiology And Heart Surgery BHThe UCSF Center for Minimally Invasive Cardiac Surgery offers the full range of minimally invasive approaches for cardiac surgery to appropriately selected patients using small incisions and procedures including the mini-thoracotomy or hemi-sternotomy, specific to the type of surgeryThe benefits are significant including less post-operative pain at the incision site, a shorter hospital stay, a faster return to normal activities, and an improved cosmetic result.

Whereas traditional open surgery usually involves a long incision through the center of the chest, which cuts through the breastbone and requires several weeks to heal, he has significant experience in using smaller incisions. Through these "keyhole" incisions, he inserts long-handled surgical instruments and three-dimensional endoscopes, which allow him to view the surgical site on a video screen as he performs the procedure. These incisions can be made in between the ribs, so no bones need to be cut.

If we can avoid opening up the sternum, patients maintain a fully functioning and stable chest," said Dr. Deuse. "That allows patients – especially those who are frail and elderly – to rehabilitate and mobilize more quickly.

For example, patients recovering from open cardiac procedures should avoid lifting suitcases and other heavier items or using their arms to help them walk for eight weeks, due to the risk of reopening their surgical incision and thereby increasing the chances of wound infection. By contrast, patients who have minimally invasive surgery are allowed to move freely and use their arms as soon as they feel up to it.

Benefits for Obese Patients

Contrary to conventional wisdom, minimally invasive surgery is feasible even in overweight patients.

It's absolutely true that it's much harder to do in obese patients, said Dr. Deuse, noting that surgical instruments need to be inserted through a deeper incision to get to such patients' hearts, and there is less room to maneuver because the internal organs push the patient's diaphragm higher into the chest cavity. 

But very obese patients benefit very much from this approach, because they're at even higher risk of wound infections and have more difficulty standing up and moving after the procedure due to their weight. Because it can benefit such patients, it's worth the effort.

Dr. Deuse has given workshops for minimally invasive mitral valve repair, where he trained other heart surgeons on the procedure. Usually in two-day events, the participants learned about the theory behind valve repair and could then watch live cases in the OR.

Complex Mitral Valve Repair

In Hamburg, Dr. Deuse's "day job" included performing hundreds of heart surgeries, with a focus on reconstructive valve surgery. Perhaps three-quarters of these procedures are complex mitral valve repairs – fixing problems of the valve between the left atrium and left ventricle. "Mitral valve repair is really interesting, because it's demanding, and no two valves are exactly the same," said Dr. Deuse. "For each one, you have to come up with a strategy, which may be very different from the last case you did."

The mitral valve is a parachute-like structure, with two leaflets that open and close a bit like a pair of French doors, and which are connected to the inside of the heart by a number of chords. When the leaflets fail to close together tightly, blood in the left ventricle can flow backwards to the left atrium, compromising blood flow to the rest of the body. Dr. Deuse comes up with a tailored solution for each valve he repairs. For example, if part of a leaflet is calcified and doesn't bend properly, Dr. Deuse can modify the other leaflet so together they form a tight seal. If the chords which pull the leaflets open and close are ruptured, he can insert artificial Gore-Tex chords to replace them.

There is a lot you can do to fix valves, which is why most of them can be repaired," said Dr. Deuse. Repair of a patient's own valve is preferable to replacement, since bioprosthetic valves – such as those from pigs or cows – degenerate over time, and patients younger than 65 may eventually need a second valve replacement. Mechanical valves, which are made from metal and carbon, can last longer, but require patients to take a blood thinner to prevent clotting around the valve. "A nicely repaired valve can last a lifetime," said Dr. Deuse, noting that for cases where repair is not possible, he and his team can also replace the valve.

Innovations in Heart Transplantation and Assist Devices

High Performing Indicator HeartfailureBefore joining the UCSF faculty this year, Dr. Deuse directed the heart and lung transplantation program at the University Heart Center Hamburg, and developed expertise with new technologies and devices. For example, because donor hearts are unable to tolerate prolonged periods of time without blood supply, they are usually stored on ice during transit and should be implanted within four hours after retrieval from the donor.

To improve preservation of the heart and enable transportation of donor organs over longer distances, a new technology called ex vivo heart perfusion (nicknamed "heart in a box") has been developed. This portable box connects the donor heart with a temporary blood supply, allowing the heart to keep beating and receiving oxygen as it travels to its destination.

This technology was recently tested in several countries, and Dr. Deuse's program was among the largest enrollers for the German national trial. "The technology is reliable and not only improves organ preservation, but also allows a functional assessment of the heart while it is connected to the device," said Dr. Deuse. "However, the high costs and laborious operation of the device so far preclude a widespread use of this technology." The device is commercially available in Europe, but is still under clinical investigation in the US. 

Because of the scarcity of donor hearts, only a fraction of patients with end-stage heart failure will receive a heart transplant. One alternative or "bridge to transplant" procedure is the implantation of a ventricular assist device (VAD), a miniaturized pump that can help patients whose own hearts are unable to keep up with the body's need for oxygenated blood. "Just a few years ago, we had these big pneumatic devices which were large, heavy and noisy," said Dr. Deuse. "But modern VADs are becoming a better and better option for heart failure patients."

The latest generation of VADs are smaller than ever before, feature continuous flow pumps rather than the bulkier pulsatile pumps, and can be a good option when patients might otherwise die waiting for a donor heart. Because of his experience with keyhole cardiac surgery, Dr. Deuse established minimally invasive techniques for VAD implantation as well. At UCSF, he joins Dr. Georg Wieselthaler, an internationally renowned expert in the development and implantation of VADs as well as in heart transplantation.

Preventing Heart Attacks

Dr. Deuse is also passionate about the research he conducts with Dr. Sonja Schrepfer, which currently focuses on new strategies to prevent restenosis of coronary arteries. This occurs when the blood vessels feeding the heart re-narrow after an intervention such as an angioplasty, which uses inflatable balloons and stents to push plaque against the artery walls to restore blood flow.

UCSF 20170710 Space 178A

Scientists now believe this process is not so much like a gradually clogging sewer pipe, but happens because of inflammation in the artery wall. Specifically, the smooth muscle cells –which are the main cell population of the arterial wall – proliferate and become resistant to obeying signals to commit suicide when required for the body to maintain overall health. 

We looked at the growth characteristics of these hard-to-control proliferative cells, and found so many similarities to cancer growth," said Dr. Deuse. In particular, they identified a "switch" that seems to trigger the transformation of normal cells into out-of-control cells that are implicated in restenosis. Drs. Deuse and Schrepfer have begun a clinical trial in Germany with angioplasty patients to test a new class of restenosis inhibitors; these borrow a page from the cancer medication playbook in their method of taming uncontrolled growth.

So far, we couldn't find any major side effects or disadvantages of this treatment," said Dr. Deuse. "If we can apply even more localized approaches – such as using these inhibitors as a stent coating – I think this will make any side effects even more unlikely.

Dr. Deuse counts himself lucky to collaborate with a full-time lab scientist. "Since we met in medical school 19 years ago, Dr. Schrepfer and I have done all our research together," he said. "It makes it a little easier for me to come to the lab whenever I have time, because she fills in the gaps when I am not around."

Dr. Deuse is also an enthusiastic educator, and has been inspired by his own mentors, such as Dr. Reitz at Stanford.

You learn the technique when you work with him, but you get so much of the spirit that's behind this, and it's contagious," said Dr. Deuse. "When I teach, I try to make the residents or fellows dig deep and understand the basic principles of the disease, and the strategy behind what we are doing. It's more than just sewing parts together. It's asking, 'Why are we doing it this way, and not another way?' It's almost like learning a language – rather than learning words by rote, helping them understand where the words come from, and what are their roots.

"The research institutions here are phenomenal," Dr. Deuse said. "The combination of excellence in clinical care, cutting-edge basic science, and the many bright people clustered here at UCSF is just incredible. It doesn't get any better than this."

This profile is adapted from a similar article published by UCSF Cardiology

- by UCSF Cardiology https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=77754
Wed, 10 Jan 2018 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=76526 <![CDATA[Marlene Grenon and Greg Zahner Discuss Link Between Depression and PAD In Vascular News]]> Marlene Grenon, M.D., C.M., and Greg Zahner, MSc discuss the link between depression and the increased risk of peripheral artery disease (PAD) in a story at Vascular News. Marlene Grenon is an associate professor in the Division of Vascular and Endovascular Surgery and Greg J. Zahner is a fourth year medical student at UCSF School of Medicine. The article is entitled, "Depression and Peripheral Artery Disease: The Intersectionality of Mental and Physical Wellbeing". Excerpts appear below followed by a link to the full article, which also contains footnote sources.

Psychotherapy and pharmacotherapy are the mainstays of depression treatment, but not enough research has been conducted to determine whether these treatments mitigate vascular risk. Due to the safety of depression treatment and its efficacy in treating depression symptoms, the American Heart Association (AHA) currently recommends selective serotonin reuptake inhibitors (SSRIs), cognitive therapy, and exercise for depressed patients with coronary artery disease.

No current guidelines exist for depression in PAD. While more research is needed before official guidelines are issued, the current evidence is certainly enough to warrant action. We believe there are tangible steps each vascular surgeon can and should take in their daily practice to mitigate the negative impact of co-morbid depression on PAD and improve the overall wellbeing of their patients.

You cannot treat a problem you cannot see 

Whether or not asking about your patient's emotional wellbeing or personal life is part of your clinical style, the importance of screening for depression is paramount and certainly relevant for improving clinical outcomes. The AHA recommends screening patients with heart disease for depression using the PHQ-2, which consists of two simple questions. Over the past two weeks, how often have you been bothered by any of the following problems? Little interest or pleasure in doing things. Feeling down, depressed or hopeless. If they answer affirmatively to either question, then have them complete a PHQ-9 for more comprehensive screening. The PHQ-9 is 88% sensitive and 88% specific for major depression, and a score of 10 is used as the cut-off for moderate depression.

Once you have identified possible depression, do not let it go unaddressed 

Just like a non-healing ulcer, depression can linger and cause problems for your patients now and down the road. Follow-up with them to make sure treatment is being pursued.

Know your limits and refer when necessary

Concerned about a potentially depressed patient not seeking treatment? Act and refer them to appropriate psychological, psychiatric, behavioural health, or wellness programmes. If you practise in an integrated health system, follow-up with their other providers and communicate your concerns with the patient's primary care provider.

Motivated to do more? Think innovatively! 

As evidence on the importance of vascular rehabilitation for PAD patients mounts, we must consider all aspects of a patient's wellness. In the last year, we have partnered with the new University of California San Francisco (UCSF) Bridge's Curriculum to launch a vascular rehab programme at the San Francisco VA Medical Center. Under supervision, medical students serve as health coaches during this 12-week programme aimed at secondary prevention. The programme is based on five pillars: exercise, diet/nutrition, smoking cessation, medication adherence, and stress management/mindfulness. In summary, data are accumulating supporting a close relationship between depression and PAD. Furthermore, depression should potentially be considered a risk factor for PAD, and the impact it has on patients' outcomes should be recognised. It is time to engage in this conversation with our patients and amongst ourselves in order to develop optimal treatment strategies and hopefully improve outcomes.

Read full article at Vascular News

- by Richard Barg and Matt Kuhn https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=76526
Fri, 29 Dec 2017 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=73674 <![CDATA[UCSF Earns Highest Performance Rating for Procedures Performed by Cardiac, Colorectal, Thoracic, Vascular and Lung Transplant Surgeons]]> UCSF Medical Center earned "high performance" ratings – the highest ratings possible – in eight common conditions and procedures in the U.S. News & World Report Best Hospitals Survey for 2017-2018, seven within the UCSF Department of Surgery:

U.S. News evaluated more than 4,500 hospitals to determine how well they performed using data on patient survival, nurse staffing, volume and more. Within the Department of Surgery, the programs that perform these procedures include Cardiac Surgery, Thoracic Surgery, Colorectal Surgery, Vascular Surgery, and Lung Transplantation. 

Jasleen Kukreja - 144x Madhulika Varma - 144x David M. Jablons - 144 Michael Conte - 144px
- by Richard Barg https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=73674
Thu, 28 Dec 2017 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=77506 <![CDATA[Patient Frailty Associated with Increased Morbidity for Common Ambulatory Surgeries in Older Adults ]]> A new research study shows that patient frailty should be assessed in preoperative planning for surgery in older adults, even for common ambulatory general surgery operations. The study, led by principal investigator and lead author, Carolyn D. Seib, M.D., MAS, a general and endocrine surgeon at UCSF, was reported on in the journal JAMA Surgery and highlighted by the NY Times in a subsequent article.

Importantly, the study found that frailty is more closely associated with the risk of complications than  chronological age. It has implications for both treatment planning and informed consent for older adults undergoing otherwise routine ambulatory surgery, but who are deemed frail. Dr. Seib underscored the significance of the study's findings.

Our JAMA Surgery study expands on the work of Dr. Emily Finlayson, director of the UCSF Center for Surgery in Older Adults and co-author, that evaluated survival and functional status after colon cancer surgery, finding that nursing home residents experienced substantial and sustained functional decline after surgery. While it is fairly intuitive that patient frailty can adversely impact outcomes for major operations like colon resections, our study shows that frailty contributes to morbidity even for common ambulatory operations that patients and providers often treat as routine. Thus, we should take frailty into account for any operation, big or small, and make screening for frailty a routine component of preoperative clinic visits. Surgeons will then be able to more accurately relay surgical risk to patients and their families during informed consent discussions, and ensure that the proposed surgical intervention is consistent with the treatment plan. It is essential that we provide specialized care tailored to the needs of the older adult to improve surgical outcomes and limit morbidity.

Frailty, Dr. Seib notes, involves decreased physiological reserve that determines how patients will respond to physical stress. In fleshing out this concept, she told the NY Times:

Surgery brings plenty of that, said Dr. Carolyn Seib, a general and endocrine surgeon at the University of California, San Francisco. The effects of anesthesia and inflammation, the risk of blood clots or infection, muscle weakness caused by days in bed — all can take a toll.

"The more frail a patient is, the higher the risk of complications," Dr. Seib said.

Researchers have shown that after major operations — including cardiac and colon cancer surgery and kidney transplants — frail older patients are more prone than others to longer hospital stays, being readmitted within a month of a procedure and winding up in nursing homes after they're discharged.

They're also more likely to die.

But a study that Dr. Seib and her colleagues published in JAMA Surgery this month shows that frail seniors face higher complications even after ambulatory surgery, outpatient procedures often considered routine.

Hernia repairs, thyroid or parathyroid surgery, operations for breast cancer — "patients and providers often don't think twice about these," Dr. Seib said.

Yet when the researchers looked at 141,000 patients over age 40 in a national surgical database, they found that serious complications were two to four times higher in patients with moderate to high frailty, although complication rates overall were low (1.7 percent, with .7 percent experiencing serious complications).

"We have to take frailty into account for any operation, big or small," Dr. Seib said. Although surgeons increasingly screen for frailty, "I wouldn't say it's routine yet," she added.

So she and other researchers recommend that before an operation, patients and families ask: Is my mother showing signs of frailty? Should we do an assessment that indicates how frail she might be?

The JAMA Surgery paper was co-authored by Emily Finlayson, MD, MS, Jessica E. Gosnell, MD, Insoo Suh, MDWen T. Shen, MD, MA, and Quan-Yang Duh, MD, all faculty in the UCSF Department of Surgery, Holly Rochefort, MD, a previous endocrine surgery fellow, and Kathryn Chomsky-Higgins, MD, MS, a current UCSF-East Bay surgical resident.

- by Richard Barg https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=77506
Wed, 27 Dec 2017 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=77390 <![CDATA[Courtney Green Awarded CESERT Robotic Grant from Association for Surgical Education (ASE) Foundation]]> Courtney A. Green, M.D., research fellow in the General Surgery Residency program, has been awarded a CSERT (Center for Excellence in Surgical Education, Research and Training) grant from the Association for Surgical Education (ASE) Foundation. Her research project is entitled, "Investigation into the Perceptual Expertise of a Robotic Surgeon: How do we learn to feel what we see?"

Surgical education grants are among the most difficult to obtain. Moreover, this grant has historically been awarded to faculty affiliated with academic institutions, underscoring Dr. Green's achievement here as a resident. Patricia O'Sullivan, Ed.D., Director of Research and Development in Medical Education in the Center for Faculty Educators, and professor of surgery and medicine, has been Dr. Green's mentor in this project. 

Training residents to use robotic technology in a unique and complex robotic learning environment has become an existential teaching challenge. 

Between 2015 and 2018, Dr. Green has focused on robotic education. She designed and implemented a 7-year longitudinal curriculum for surgical residents, which includes six hospitals, seven robots and numerous surgical faculty. The curriculum incorporates online modules, docking proficiency, simulation evaluation, annual tissue labs and opportunity for FDA approved Qualification Equivalent Certification at time of graduation.

Standing on the shoulders of that experience, Dr. Green, as principal investigator on the CSERT Robotic Grant, now seeks to elucidate perceptual expertise by investigating expert surgeons' gestures and language used to describe video of surgical procedures to better understand the components of professional vision required to master surgical technique.

Read full abstract at Resident Reseach website

Robotics in the Department of Surgery (Inside Surgery)

Robotic Surgery Inside Surgery jpg

- by Richard Barg https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=77390
Tue, 26 Dec 2017 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=77352 <![CDATA[UCSF Medical Center Reaccredited as "Comprehensive Center" for Bariatric Surgery by American College of Surgeons, MBSAQIP and ASMBS]]> MBSAQIP---Seal -copyUCSF Medical Center has been reaccredited as a "Comprehensive Center" for bariatric surgery by the American College of Surgeons (ACS) Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) and American Society for Metabolic and Bariatric Surgery (ASMBS). The UCSF Bariatric Surgery Center offers a full range of surgical weight-loss options, including laparoscopic and open Roux-Y gastric bypass, laparoscopic sleeve gastrectomy, and laparoscopic and open revisional bariatric surgery.

The formal letter from the MBSAQIP to Stanley J. Rogers, M.D., Associate Professor and Director of the Bariatric Surgery Center, read in part:

On behalf of the American College of Surgeons (ACS) Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP), in partnership with the American Society for Metabolic and Bariatric Surgery  (ASMBS), we would like to congratulate you and your team at University of California San Francisco Medical Center on achieving a Comprehensive Center accreditation. A MBSAQIP accreditation for University of California San Francisco Medical Center formally acknowledges your commitment to providing and supporting quality improvement and patient safety efforts for metabolic and bariatric surgery patients. As an accredited program you have demonstrated that your center meets the needs of your patients by providing multidisciplinary, high-quality, patient-centered care.

UCSF Bariatric Surgery Program Team

Bariatric Surgeons

Stanley J. Rogers, M.D. - Program Director & Associate Professor of Surgery
Jonathan Carter, M.D. - Associate Professor of Surgery
Andrew M. Posselt, M.D., Ph.D. - Professor of Surgery
Matthew Y.C. Lin, M.D. - Assistant Professor of Surgery

Medical Director

John P. Cello, M.D. - Gastroenterologist, Professor of Medicine & Surgery

Program Coordinator

Ryan Patrick Wilson, PA-C, MSPAS, MPH, Senior Physician Assistant

PRP Coordinator

Elliazar Enriquez, Sr. LVN

Program Outpatient Senior Dietitian

Mary Ellen DiPaola, R.D., C.D.E.

Program Psychiatrist

John R. Chamberlain, M.D., Professor of Psychiatry

Clinical Fellow

Sandhya Kumar, M.D., MIS/Bariatric Surgery Fellow

MBSAQIP works to advance safe, high-quality care for bariatric surgical patients through the accreditation of bariatric surgical centers. A bariatric surgical center achieves accreditation following a rigorous review process during which it proves it can maintain certain physical resources, human resources, and standards of practice. All accredited centers report their outcomes to the MBSAQIP database.

- by Richard Barg https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=77352
Tue, 26 Dec 2017 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=73858 <![CDATA[American College of Surgeons Verifies Highland Hospital as Adult Level 1 Trauma Center]]> The American College of Surgeons (ACS) has verified Highland Hospital, the flagship facility in the Alameda Health System, as an adult Level 1 Trauma Center, affirming the earlier designation by the state of California through a local Emergency Medical Services Agency (LEMSA).

Practically speaking, the imprimatur of the ACS is the last critical and essential step for a hospital to be   recognized as a Level 1 Trauma Center, the highest designation made by local government for a trauma center. During the verification process, ACS sent a team to Highland Hospital to review its full spectrum of care, from pre-admission to discharge and rehabilitation. National verification was based, in part, on Highland Hospital's board-certified trauma surgeons being immediately available for any critical care need. Highland Hospital now becomes the first adult Level 1 Trauma Center in the East Bay.

UCSF Department of Surgery faculty based at Highland and the surgical residents who train there comprise the UCSF-East Bay Surgery Program, and the surgical component of the trauma service at Highland. The program is led by Gregory P. Victorino, M.D.Professor and Interim Chief of the UCSF program. Victorino is also Interim Chair of the Department of Surgery at Alameda Health System, and Director of Trauma Services. Victorino's leadership was crucial to Highland's elevation from a Level 2 to a Level 1 Trauma Center. Those efforts were tacitly acknowledged when Alameda Health System named him "Physician of the Year" in 2016.

Highland Hosptial

Dr. Ghassan Jamaleddine, chief medical officer for Alameda Health System which runs Highland, was effusive in his praise of the trauma surgeons at Highland and the quality of its residency programs, among the most competitive in the nation:

Highland Hospital is the first destination Alameda County emergency medical service workers consider for critical trauma patients, he said.

"Highland trauma surgeons are highly skilled and respected," Jamaleddine added.

The surgeons are also on the staff of UC San Francisco, and Highland's medical residency programs is one of the most desired in the nation, he said. The hospital gets about 3,000 applications each year for 30 positions, 10 of them in trauma, he said.

The UCSF-East Bay General Surgery Residency Program is led by Program Director Barnard J. A. Palmer, M.D., M.Ed., an alumnus of the program and a recipient of numerous resident teaching awards.

Alameda Health System announced the verification of Highland Hospital as an adult Level 1Trauma Center on its website earlier this year.

Alameda Health System today announced the American College of Surgeons' (ACS) verified Highland Hospital as an adult Level 1 Trauma Center, the highest designation given by the national organization. This recognition for excellence makes Highland Hospital the only adult Level 1 trauma facility in the East Bay.

Alameda Health System Highland Hospital provides essential health care services to all residents of Alameda County and treats more than 2,400 trauma patients each year, most them victims of traffic accidents and seniors suffering falls. "Level 1" is the highest possible designation for a trauma center, indicating the center's 24/7 ability to treat all trauma incidents with the highest skill level. The Highland Trauma team earned the designation following one of the most rigorous verification processes in the country.

"Verification as an adult Level 1 Trauma Center validates the quality of trauma care we provide, and acknowledges all departments at Highland Hospital—not just the trauma surgeons and surgical subspecialists, but all departments that collaborate to save patient lives before, during and after their admittance to the Emergency Department," said Gregory Victorino, M.D., Chief, Division of Trauma at Highland Hospital. "This national recognition emphasizes that we are truly a comprehensive medical center, and solidifies our commitment to being a regional and national leader."

Highland has been a designated adult Level II Trauma Center since 1980.

"Highland Hospital has always been a valued partner in providing vital emergency medical services in Alameda County, said Travis Kusman, director of Alameda County Emergency Medical Services Agency.  "The Level I Trauma Center designation validates Highland's commitment to the consistent delivery of high quality care to critically injured patients."

The designation also affirms Highland's commitment beyond care at the bedside to its engagement in teaching and training of future providers and establishment of programs to prevent traumatic injuries.

An ACS team of experts in the field of trauma conducted an on-site review and an analysis of the full spectrum of care, from the pre-hospital phase through rehabilitation. National verification was based on Highland Hospital's ability to treat all aspects of incoming trauma cases with certified trauma surgeons immediately available for any critical care need. The accreditation will undergo renewal every three years.

As a Level 1 Trauma Center, Highland is capable of providing total care for every aspect of injury – from prevention through rehabilitation. The criteria for this level of certification included providing leadership in prevention and public education to our surrounding communities, operating a credentialed teaching and research program to help direct new innovations in trauma care, and providing substance abuse screening and patient intervention.

Related Story

Highland Hospital named east bay's only level 1 adult trama center (East Bay Times)

- by Richard Barg https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=73858
Sat, 23 Dec 2017 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=74172 <![CDATA[Department of Surgery Welcomes New Clinical Fellows for 2017-18 Academic Year]]> The Department of Surgery proudly welcomes our new clinical fellows for the 2017-18 academic year. Clinical fellows receive state-of-the-art subspecialty training, an enriching mentorship experience, and the opportunity to work as integral members of a multidisciplinary clinical team led by world-class attending surgeons. This training supports the Department's threefold mission to develop the next generation of leaders in surgery, provide outstanding quality clinical care, and to make significant advances in scientific knowledge and clinical practice through basic and clinical research.

New Clinical Fellows for 2017-18

Clinical Fellow (PGY-6)
Surgical Critical Care and Trauma Surgery
Clinical Fellow (PGY-6)
Endocrine Surgery
Abdominal Transplant Fellow (PGY-6)
Division of Transplant Surgery 
Clinical Fellow (PGY-4)
Limb Preservation 
Clinical Fellow (PGY-6)
Advanced GI MIS/Bariatric Surgery
Clinical Fellow (PGY-6)
Endocrine Surgery
Kimberly Stone Forweb  
Clinical Fellow (PGY-6)
Breast Surgery 
Clinical Fellow (PGY-6)
Surgical Critical Care and Trauma 
Clinical Fellow (PGY-6)
Breast Surgery
Clinical Fellow (PGY-6)
Thoracic Surgery
Clinical Fellow
Microsurgery (PGY-6) 
Clinical Fellow (PGY-6)
Vascular Surgery 

Clinical Fellowships in the Department of Surgery

- by Richard Barg https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=74172
Wed, 20 Dec 2017 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=77388 <![CDATA[Quan-Yang Duh Receives 2017 Paul Starr Award from American Thyroid Association]]> Quan-Yang Duh M.D., professor and chief of endocrine surgery at UCSF, and a nationally and internationally recognized leader in the field, is the recipient of the 2017 Paul Starr Award from the  American Thyroid Association (ATA). The Paul Starr Award Lecture recognizes an outstanding contributor to clinical thyroidology. Dr. Duh delivered the 2017 lecture for this award entitled, "Technical and Technological Advances that Changed Thyroid Surgery" on October 20th at the ATA annual meeting in Victoria, British Columbia.

Here is the full text of the award announcement.

October 16, 2017—The American Thyroid Association (ATA) announces with pleasure that the 2017 Paul Starr Award recipient is Quan-Yang Duh, MD, FACS, Professor of Surgery and Chief of Endocrine Surgery at the University of San Francisco (UCSF). Dr. Duh is also Attending Surgeon at the Veterans Affairs Medical Center in San Francisco.
The Paul Starr Award is presented to an outstanding contributor to clinical thyroidology. At the ATA annual meeting in Victoria, British Columbia, Dr. Duh will deliver the Starr Lecture at 1:00 pm on October 20, 2017. His lecture is titled "Technical and Technological Advances that Changed Thyroid Surgery." 

Dr. Duh joined the ATA in 1990 and has served on the editorial boards of Thyroid and VideoEndocrinology; as well as several committees, ATA Research, Surgical Affairs and Annual Meeting Program Committee.

Dr. Duh is recognized nationally and internationally as a leader in endocrine surgery. He graduated Phi Beta Kappa and Summa Cum Laude from Yale University, then attended UCSF Medical School, where he graduated Alpha Omega Alpha (Honor Medical Society). He then did a surgical residency and a fellowship in endocrine surgery at UCSF and subsequently joined their surgical faculty.
As a teacher, a researcher, and a surgeon, Dr. Duh has served as a mentor to more than 100 surgery and research fellows, has assured the future of endocrinology and endocrine surgery. In addition, Dr. Duh has written more than 300 peer-reviewed articles and has been a committee member for many practice guidelines involving thyroid cancer, parathyroid surgery, pheochromocytoma, and adrenal surgery.

As stated in his letters of nomination for the Paul Starr Award, Dr. Duh's superb skills and expertise, his wealth of knowledge, and his approachable manner and kindness lead all who work with him and learn from him—including his patients—to trust and admire him. He is indeed an outstanding contributor to clinical thyroidology.

- by Richard Barg https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=77388
Tue, 19 Dec 2017 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=77432 <![CDATA["Top Ten" Paper by Sandhya Kumar Headlines Strong Showing by UCSF Bariatric Surgery During Obesity Week]]> Sandhya Kumar, M.D., MIS/Bariatric Surgery clinical fellow at UCSF, presented her "Top 10" paper, Is laparoscopic sleeve gastrectomy safer than laparoscopic gastric bypass? A comparison of complications and mortality using the MBSAQIP data registryat the 34th Annual Meeting of the American Society for Metabolic and Bariatric Surgery (ASMBS) during "Obesity Week". Kumar was the lead-off presenter in the ASMBS abstracts 2017 paper sessions on October 31st.

Dr. Kumar's paper headlined a strong overall showing by UCSF Bariatric Surgery during "Obesity Week", evidencing the program's strong commitment to research, and paralleling its clinical excellence as an accredited Comprehensive Bariatric Surgery Center. Later, Dr. Kumar gave a second podium talk, and Stephanie Wood, MB BCh, MHs, the 2016-17 MIS/Bariatric Surgery fellow at UCSF, presented two papers.

Stanley J. Rogers, M.D., Bariatric Surgery Program Director, Jonathan Carter, M.D., MIS/Bariatric Surgery Fellowship Director, and gastrointestinal/bariatric surgeon Matthew Y.C. Lin, M.D. were co-authors on each of the papers. UCSF general surgery resident Barbara Hamilton, M.D. was also a co-author on one paper.


Selected Papers Presented During Obesity Week 

  • Is laparoscopic sleeve gastrectomy safer than laparoscopic gastric bypass? A comparison of complications and mortality using the MBSAQIP data registry, Sandhya Kumar, Barbara Hamilton, Soren Jonzzon, Stephanie G. Wood, Stanley Rogers, Jonathan Carter, Matthew Lin, University of California San Francisco - "Top 10 Paper" -  View PowerPoint Slides
  • A risk nomogram for complications after laparoscopic bariatric surgery derived from the MBSAQIP registry, Sandhya Kumar, Barbara Hamilton, Stephanie G. Wood, Stanley Rogers, Matthew Lin, Jonathan Carter, University of California San Francisco
  • Is it safe to perform concomitant cholecystectomy with laparoscopic gastric bypass? Stephanie G. Wood, Sandhya Kumar, Stanley Rogers, Matthew Lin, Jonathan Carter
  • Is it safe to perform concomitant cholecystectomy with laparoscopic sleeve gastrectomy? Stephanie G. Wood, Sandhya Kumar, Stanley Rogers, Matthew Lin, Jonathan Carter

"Top 10 Paper" Summary

Is laparoscopic sleeve gastrectomy safer than laparoscopic gastric bypass? A comparison of complications and mortality using the MBSAQIP data registry.
Laparoscopic sleeve gastrectomy is rapidly gaining popularity and is now the most commonly performed operation for weight-loss (bariatric) surgery, but its risk profile is still being understood. The goal of the study was to compare the two main bariatric surgery operations, laparoscopic sleeve gastrectomy, and laparoscopic roux-en-y gastric bypass (which has long been the gold-standard) in terms of operative complications within 30 days. We used machine learning and traditional regression techniques to build a statistical model for complications after surgery using the newly released Metabolic and Bariatric Surgery Quality Improvement Data Registry (MBSAQIP), which captures over 168,000 cases across the United States and Canada. We found that even when adjusted for patient comorbidities, laparoscopic sleeve gastrectomy had about half the risk-adjusted odds of leak, major complications, and death. In fact, the type of operation performed was the strongest predictor of post-operative complications. This supports the idea that laparoscopic sleeve gastrectomy is a significantly safer operation in terms of perioperative complications. These results will inform preoperative pre-operative discussion and help chose the right operation for a given patient.

View abstracts and data summaries of selected presentations (UCSF Researcher(s) as Main Presenter or co-author) 

- by Richard Barg https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=77432
Thu, 14 Dec 2017 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=74347 <![CDATA[Trauma Surgeon Peggy Knudson Tells Vox News How Doctors Save Lives After a Mass Shooting]]> In the wake of October's mass shooting at a Harvest country music festival in Las Vegas, Vox News reached out to UCSF trauma surgeon M. Margaret "Peggy" Knudson, M.D., FACS for her thoughts on how doctors manage an influx of mass shooting victims, and the critical techniques for ensuring their patients' survival.

Knudson, a professor in the UCSF Department of Surgery at Zuckerberg San Francisco General (ZSFG), is a nationally recognized expert on mass trauma events and war injuries. Currently Medical Director for the Military Health System (MHS) Strategic-ACS Partnership, Knudson served as a Senior Visiting Surgeon in the Iraq war theater and treated victims of the Asiana Airlines crash at San Francisco International airport in 2014.

In a recent seminal talk, "When Peace Breaks Out", Knudson argued for training civilian and military surgeons alike to handle mass trauma cases, whether arising from domestic terror events, natural or man-made disasters, and casualties of future wars. One of her central tenets is that advanced trauma care techniques learned on the battlefield in recent American wars can be used to save lives after mass shootings. In her interview with Vox, Knudson underscored three key practices that can literally make the difference between life and death in the crucible of a mass casualty event.

1)  Stop the bleeding

The most common reason people die at the scene of a mass shooting event is bleeding. (The second most common cause of death at these events is massive brain injury.)

Before the Iraq and Afghanistan wars, the use of tourniquets in medicine had fallen out of favor. "Tourniquets to control extremity bleeding were not used, and best practice was that they shouldn't be used," said Rasmussen. But new evidence changed the practice: Military health professionals saw early on that patients on whom tourniquets were used were more likely to survive their injuries.

This change in practice is why the Department of Homeland Security launched the Stop the Bleed campaign in 2015, encouraging bystanders in violent attacks to compress the wounds of victims if health professionals haven't yet arrived at the scene. And people who were at the Las Vegas country music festival when the shooting happened reported seeing bystanders using belts as tourniquets. "In the past 15 years of war," Margaret Knudson, a professor of surgery at the University of California San Francisco, added, "those techniques have saved many lives on the battlefield."

2)  Small stopgap surgeries

Some gunshot victims need immediate surgery.

But doing all the necessary surgeries immediately in a mass casualty event is usually impossible. So doctors now do smaller and quicker surgeries first, with one key goal: saving lives. This type of care was perfected in Iraq and Afghanistan, and it's called damage control surgery.

For example, for a patient with a more minor blood vessel injury on the leg, doctors may put a small piece of plastic in place (called a "shunt") to keep the blood flowing. That can allow them to move on to do other, more critical surgeries on the same patient or help other patients in a more critical state. Later, the doctors can go back and do a more definitive surgery to repair the broken blood vessel. "We do these abbreviated surgeries whenever we can," and they help save lives, said Knudson.

3)  Help clotting by giving blood plasma and platelets first

Patients wounded by gunshot typically have lost a lot of blood. If they need surgery, they'll also probably need blood transfusions.

Blood transfusions often involve supplementing patients with specific blood components (also known as products) — like blood plasma, including red blood cells, which carry oxygen, or platelets, which are essential for making blood clot.

In the past, doctors would first respond by giving patients saline solutions (mixtures of sodium chloride in water) in addition to or followed by blood products. But in the recent wars, military doctors started to notice that patients actually fared better when they got the blood products immediately.

"When someone loses 20 to 30 percent of their blood volume from a gunshot wound," said Rasmussen, "we don't give them ... saline solutions. We try to give plasma, platelets, and packed red blood cells right away."

Studies conducted during the wars also helped doctors refine the ratios and amounts of blood products to give to the injured. "We learned from military experience that it's really important to give clotting factors almost first, and in a better ratio," Knudson said. That decreased mortality in military wounds, and it's dramatically changing the way we care for patients in the civilian world. "Not only does it save some of the blood by using products judiciously but it also allows you to [better] direct what you give," said Knudson.

Read full article at Vox News

- by Richard Barg https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=74347
Thu, 30 Nov 2017 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=76303 <![CDATA[Pediatric Device Consortium Holds Inaugural Pediatric Device Accelerator Pitch Competition]]> IMG_0549-2

On Tuesday, November 14, the UCSF Pediatric Device Consortium (PDC) held its inaugural Pediatric Device Accelerator Pitch Competition at UCSF's Mission Bay campus. The competition awarded a total of $252,500, funded by FDA's Office of Orphan Products Development and the UCSF Department of Surgery, to teams developing novel medical devices for children.

Eight finalists, selected from a pool of 55 applicants from across the world, had just under 10 minutes to pitch their product ideas to a judges' panel of five industry professionals: Mike Billig (CEO of Experien Group), Dan Burnett (President and CEO of TheraNova), Denise Forkey (Consultant at Denise Forkey Medical Device Development Solutions), Chris Jones (Consultant at Orb Product Development), and Russ Lindemann (Co-Founder of JustRight Surgical). The presentations, which included the pediatric clinical need, proposed technology, potential market, commercialization approach, and current development status, were followed by Q&A from the judges.

After the pitches, the judges presented prizes in increments of $50,000, $30,000 and $20,000. Top honors were awarded to InkSpace Imaging, Inc. and Auctus Surgical, Inc. InkSpace Imaging is a UC Berkeley spinout developing printed flexible MRI coils to overcome the barriers of long exam times, the need for anesthesia, and bulkiness of current MRI machines, which currently limit the use of MRI in children. Auctus Surgical, a San Francisco startup that reunites the team from CoAlign Innovations, acquired by Stryker in 2014, aims to improve outcomes for children with scoliosis with their flexible spinal tethering system that uses magnetically actuated spools for additional tensioning.


Awards at the $30,000 level went to Shape Change Technologies, LLC, of Thousand Oaks, CA; Certus Critical Care, Inc., a UC Davis spinout; and UCSF's Tabla project, led by medical student Adam Rao. Thorn Tech, LLC, of Castro Valley, Boston Children's Hospital, and UNYQ of San Francisco each won $20,000 to develop their projects over the next year. Tabla, a handheld device used to detect pneumonia, also received the People's Choice Award, a $2,500 prize sponsored by the UCSF Department of Surgery based on audience votes. In addition to funding, the finalists will receive advising from the UCSF PDC, including clinical and technical feedback, regulatory assistance, and commercialization coaching, in order to help drive their device ideas towards market availability for patient benefit.

The Pediatric Device Accelerator supplements the ongoing work of the UCSF PDC, which is led by UCSF Professors Michael Harrison, MD, and Shuvo Roy, PhD. The consortium is one of seven FDA-funded programs across the U.S. working to stimulate pediatric medical device innovation and development. Since 2009, the UCSF PDC has assisted over 85 projects through its twice-weekly innovators' forum, network of experts, and training opportunities. For UCSF projects alone, the PDC's support has resulted in 11 clinical trials of novel device technologies conducted at UCSF, $29.5 million in follow-on funding for projects, and the launch of nine startups.

For more information, please visit www.pediatricdeviceconsortium.org or contact Stacy Kim at stacy.kim@ucsf.edu.

- by Stacy Kim https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=76303
Tue, 31 Oct 2017 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=74598 <![CDATA[Burned Out Trainee Surgeons at High Risk for Alcohol Abuse, Depression, Suicidal Thoughts]]> UCSF News reports on the results of study led by Carter Lebares, M.D., assistant professor and director the UCSF Center for Mindfulness in Surgery, to assess burnout in general surgery residents. An online survey was distributed in September, 2016, to all ACGME-accredited general surgery programs. Stress, anxiety, depression, resilience, mindfulness, and alcohol use were assessed and analyzed for prevalence. The results, published online in the Journal of the American College of Surgeons on Oct. 26, 2017, were stunning, finding that "7 of 10 trainee surgeons in the survey experienced burnout as a result of emotional exhaustion, "depersonalization" and doubts about their work effectiveness, impacting their performance and potentially patients health.

"Surgical trainees live in a culture where high stress is normative, but excessive stress must be addressed," said Lebares, noting that 53 percent of residents scored positive for high perceived stress. "While surgical trainees have willingly chosen a high-stress career, the existence of overwhelming stress is evidenced by the strong association between stress and distress symptoms like depression, suicidal thoughts and high anxiety."

According to Lebares, there is point after stress can overwhelm the resources of a person to handle it  effectively.

"Although stress is initially stimulating, there is a tipping point when demand outstrips resources and stress becomes overwhelming," Lebares said. "In the absence of adequate coping skills, overwhelming stress that lasts for years has been associated with mood disorders and physiologic deterioration that can lead to disruption of neuro-endocrine regulation and exacerbation of atherosclerosis."

"Although stress is initially stimulating, there is a tipping point when demand outstrips resources and stress becomes overwhelming," Lebares said. "In the absence of adequate coping skills, overwhelming stress that lasts for years has been associated with mood disorders and physiologic deterioration that can lead to disruption of neuro-endocrine regulation and exacerbation of atherosclerosis."

The study also found that mindfulness might present silver lining to stressed residents according the UCSF News.

However, the study revealed two silver linings. Emotional exhaustion, high stress and anxiety, which peaked in the third year of residency, appeared to decline markedly during the later lab years. Secondly, while most of the residents scored high on stress resilience, researchers noted that it was their "dispositional mindfulness" that seemed to serve as a psychological buffer against the rigors of training. Mindfulness was associated with an 85 percent lower probability of scoring high in stress.

"Mindfulness isn't about thinking nicer thoughts; it's about recognizing stressors, learning to pause and to assess those stressors in a less reactive and emotional way," said Lebares, who is also director of the UCSF Center for Mindfulness in Surgery.

- by Richard Barg https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=74598
Sat, 21 Oct 2017 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=74338 <![CDATA[Kevin Hiler and Lawrence Sue, Volunteer Clinical Faculty, Receive Distinguished Teaching Awards]]>

Kevin L. Hiler, M.D., associate clinical professor in the UCSF Department of Surgery and Lawrence Sue, M.D., assistant clinical professor in the Department of Surgery at the University of California San Francisco, Fresno, are recipients of 2017 Distinguished Teaching Awards from the UCSF Center for Faculty Educators (CFE), part of the Haile T. Debas Academy of Medical EducatorsThe awards were presented at a ceremony hosted by the UCSF School of Medicine on October 18th in Cole Hall Auditorium at UCSF Parnassus. 

Hiler received a Special Recognition Award, presented to members of the Volunteer Clinical Faculty (VCF) "who have made contributions through excellence in teaching, and significant contributions in the field of medicine." 

Sue received a Henry J. Kaiser Award for Excellence in Teaching.

Since 1969, the School of Medicine has recognized exceptional faculty instructors through these annual awards. They bestow significant academic distinction, as well as a modest monetary award for the winners. The Henry J. Kaiser Awards for Excellence in Teaching are significant as only medical students and residents can nominate any faculty who teaches medical students or residents.

About the Center for Faculty Educators

The Center for Faculty Educators is the home to the Academy of Medical Educators, internationally recognized education scholars, and volunteer clinical faculty. It provides community, mentorship, recognition, career growth, and skills development in teaching and educational scholarship to the faculty and staff committed to innovation and excellence in health professions education.

About Volunteer Clinical Faculty

Volunteer Clinical Faculty (VCF) are board-certified health care professionals who teach in various clinical settings, and play a significant role in advancing UCSF's mission to transform health care. Being a VCF is a valuable way for physicians to engage on a part-time, non-salaried, voluntary basis in the areas of teaching, system-change research and clinical expertise.

The Academy's Excellence in Teaching Awards are peer-nominated, and honor outstanding front-line teachers of medical students, residents, and fellows who often go unrecognized. These teachers create and encourage an intellectually stimulating environment that promotes critical thinking and learning.

2016 17 CB And SRTA Recipients FINAL

- by Richard Barg https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=74338
Sat, 21 Oct 2017 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=74341 <![CDATA[Medical Students Ammar Joudeh and Carolyn Rennels Develop Project to Reduce Surgical Site Infections]]> The October 2017 Update of the UCSF Bridges Curriculum highlights a project of UCSF medical students Ammar Joudeh and Carolyn Rennels to reduce surgical site infections by distributing chlorhexidine wipes to patients before elective surgery at Zuckerberg San Francisco General Hospital. The project is part of a Bridges Curriculum Clinical Microsystems Clerkship (CMC). Jennifer Kerns, MD, MS, MPH, assistant professor in obstetrics and gynecology at ZSFG, serves as coach. 

Surgical site infections (SSI) are a major cause of morbidity and mortality associated with surgical procedures. They occur in 2%-5% of patients undergoing inpatient surgery in the US.1 Patients with SSI have a 2-11 times higher risk of death compared with operative patients without an SSI.2 SSIs are associated with 7-11 additional postoperative hospital days and may be responsible for 3.5-10 billion dollars in additional healthcare expenditures annually.  

The use of chlorhexidine (CHG) wipes, distributed in pre-op anesthesia clinic to patients scheduled for elective, incisional procedures from the neck down at ZSFG, appeared to reduce SSI rates for planned C-sections: 

Surgical site infections (SSI) are a major cause of morbidity and mortality associated with surgical procedures. They occur in 2%-5% of patients undergoing inpatient surgery in the US. Patients with SSI have a 2-11 times higher risk of death compared with operative patients without an SSI. SSIs are associated with 7-11 additional postoperative hospital days and may be responsible for 3.5-10 billion dollars in additional healthcare expenditures annually. At ZSFGH, SSI rates for many procedures are above the California statewide average, with an SIR of 0.96. After CHG was made available for planned C-sections at ZSFG, SSI rates decreased. (footnotes omitted, but appear in full poster - see link below)

- by Richard Barg https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=74341
Thu, 5 Oct 2017 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=74177 <![CDATA[Surgical Innovations Accelerator Projects Harness Unique Talents of MTM Student Teams]]> Grasp Sm2

At the heart of the UC Berkeley-UCSF Master of Translational Medicine (MTM) program is a hands-on capstone project, where student teams work on developing medical technologies from idea to bedside. Three Surgical Innovations Accelerator projects from the Spring 2017 cycle have been selected to participate in the program this year: Percutaneous AV Fistula, Tracheostomy Alarm, and Augmented Surgical Vision, adding to a lengthy list of Surgical Innovations (SI) projects that have hosted MTM student teams. Since MTM's launch in 2010, eight SI projects comprised of MTM students have been selected, some spanning multiple years.

The year-long MTM program blends the engineering, clinical, and entrepreneurial aspects of translating medical innovation into clinical reality. Students' backgrounds range from bioengineering and life sciences to business and clinical experiences. SI project concepts are proposed to the MTM students, and teams are assembled to align student skills and interests with sponsor needs. Throughout the school year, team members spend approximately 10-30 hours per week on their capstones, integrating their projects into their course assignments. The focus of each project is dependent on the current development phase, potentially including technical development, prototyping, intellectual property evaluation, market scoping, or business case development.

The clinical and technical mentorship from SI paired with MTM students' enthusiasm and focus on the business aspects of device development create an ideal synergy.

Surgical Innovations projects are built around clinician-discovered needs, which provide real-world context for MTM teams to understand translational medicine," said Shuvo Roy, PhD, who serves as faculty lead for both initiatives, attesting to the benefits of the program's partnership. "The collaborative nature of the projects and teams is key.

Executive Director Moose O'Donnell, PhD, agrees.

The MTM students bring a range of skills not typically found in a clinical team, including engineering design experience and interest in regulatory and business affairs. The students have the time and motivation to dig into the contextual questions to ask 'what will it take to move this idea to the clinic.' Most of the MTM students come to the program to learn how to advance exactly the sort of health care innovations the SI projects are developing.

ST 2017_iconThe three Accelerator projects chosen for MTM pitched their ideas to industry professionals at the Surgical Innovations Shark Tank in April 2017. The PIs look forward to the opportunity to lead their respective MTM student teams:

Percutaneous AV Fistula

Principal Investigator - Shant Vartanian, MD,  UCSF Department of Surgery

Hemodialysis via an arteriovenous fistula has lower mortality rates than those dialyzed with a tunneled catheter and arteriovenous graft. They also have better durability, lower rates of revision, and lower rates of infection and hospitalization. This team will develop a minimally invasive, percutaneous method of creating an arteriovenous fistula in the clinic for hemodialysis patients. The MTM team members are a recent biology graduate with bench technique and animal research experience, an accomplished engineer with a background in aerospace and human factors engineering, and a biomedical engineer with experience at a major device manufacturer.

Tracheostomy Alarm

Principal Investigator - David Conrad, MD, UCSF Department of Otolaryngology 

Ensuring a tracheostomy tube stays in the neck and does not fall out (accidental decannulation) is critical in the postoperative and long term care of patients with tracheostomies. This project is a wireless alarm system that senses accidental decannulation and alerts a personal electronic device or nursing station. The student team's backgrounds include extensive research in biochemistry and genomics, clinical trial management, medical device sales, and biology.

Augmented Surgical Vision

Principal Investigators - Alan BC Dang, MD & Alexis BC Dang, MD, UCSF Department of Orthopaedic Surgery

Lighting plays a critical role in tissue visualization, surgical safety, and surgical speed. This team aims to determine the optimal spectral lighting characteristics for highlighting various tissue types and building a surgical LED array that provides optimal lighting for specific surgical procedures. The MTM team consists of a recent biology graduate with hobby interests in robotics and prototyping, a physicist who has interned with major medical device companies, and a surgical resident from Taiwan.

- by Stacy Kim https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=74177
Tue, 3 Oct 2017 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=74168 <![CDATA[Minnie Sarwal Co-Leader of 5-year $8M NIH Grant to Study Role of CMV Infection in Kidney Transplant Rejection]]> UCLA, UCSF and City of Hope have received a five-year, $8 million grant from the National Institute of Allergy and Infectious Diseases to study how a common virus called cytomegalovirus may provoke the immune system to reject transplanted kidneys. Minnie M. Sarwal M.D., Ph.D., FRCP, DCH, professor and director of Precision Transplant Medicine in the UCSF Department of Surgery, is co-leader and principal investigator on the grant, which will investigate how a common virus called cytomegalovirus (CMV) may provoke the immune system to reject transplanted kidneys. Sarwal is an internationally recognized leader in renal and transplant immunology, medicine, genomics, and proteomics. The Sarwal Lab is focused on investigating the mechanisms of injury in organ failure, notably acute and chronic kidney disease, and injury in kidney transplantation.

The 14-member interdisciplinary team is co-led by principal investigator Dr. Elaine Reed, Professor of Pathology and Director of the UCLA Immunogenetics Center. It includes outstanding scientists whose specialties extend from transplant immunology and infectious disease to genomics and computational immunology, a group that includes Tara Sigdel, Ph.D. of the Sarwal Lab, transplant nephrologist Flavio Vincenti, M.D.Lewis L. Lanier, Ph.D, Professor and Chair of the Department of Microbiology and Immunology, UCSF and Marina Sirota, Ph.D, Assistant Professor at the Institute for Computational Health Sciences at UCSF.   In 2016, there were 33,611 transplants performed in the U.S., nearly 60% for kidneys.  An estimated 15 percent of kidney transplant patients develop CMV infections following surgery, which are one of the leading causes of organ failure and death. Sarwal believes the grant will be critical in helping to gain a better understanding of CMV infection in transplant patients, thus enabling early detection strategies and effective treatments to be developed.

Cytomegalovirus or CMV is a virus that infects nearly 70% of adults worldwide with little impact. However, in transplant patients taking powerful immunosuppressive medications, the CMV virus can wreak havoc, making the patients very ill. The virus can often be difficult to detect and treat quickly. With the support of the grant, we hope to better understand how to detect, prevent and treat CMV infection in organ transplant recipients and other immunocompromised patients to significantly improve their quality of life and the function of their transplanted organs.

The consortium will study two types of immune responses in kidney transplant patients with CMV. The first, innate immune response, is a general inflammatory reaction, i.e., inflammation, the first line of defense against infections, which clears disease-causing agents from the immune system. Innate responses trigger a secondary response, the adaptive immune response, a delayed reaction to a specific stimulus. Adaptive immunity is important because antibodies to the virus provide long-lasting protection against it. The project will endeavor to create a molecular map of the cross-talk between the patient's innate and adaptive immune responses.

Another research goal is the development of effective vaccines against CMV. By profiling the immune systems of transplant recipients who successfully ward off CMV infection and comparing them with patients who suffer persistent infection, the group hopes to identify high-risk patients who will need closer monitoring and specific interventions against CMV.

Overview and Selected Projects

Mapping Immune Responses to CMV in Renal Transplant Recipients (NIH RePORTER)


Cytomegalovirus (CMV), a member of the Herpes virus family, has evolved alongside humans for thousands of years with a complex balance of latency, immune evasion, and transmission. While up to 70% of humans worldwide have evidence of CMV infection and seroprevalence approaches 100% in certain areas, healthy people show little to no clinical symptoms of primary infection. CMV disease is rarely observed in immune competent hosts because of innate immune responses and constant surveillance by natural killer (NK) and T cells that cooperatively control CMV. However, CMV is one of the most problematic pathogens in the immunocompromised host, after solid organ and stem cell transplantation causing increased risk of graft dysfunction, mortality and graft loss.

We propose to study the innate and adaptive immune responses to CMV in immunocompromised solid organ transplant recipients using a high-throughput systems biology approach, carefully curated clinical phenotypes and novel statistical and computational approaches to: a) profile innate and adaptive immune responses during primary CMV infection and define the effects of CMV infection on the development of alloimmune responsiveness and transplant rejection; b) determine the role of NK cells in CMV reactivation and chronic transplant rejection and c) define the effects of CMV infection on the development of chronic allograft injury. The long-term goal of the proposed research is to develop a detailed molecular map of the cross-talk between the innate and adaptive immune response in primary and latent CMV infection in the transplant recipient. Detailed insights into the interaction of the virus with the immune system stand to generate concepts for more adequate vaccine strategies, risk assessment for CMV infection to better understand the immune system and to define the interplay of CMV infection and organ transplant injury.

Public Health Relevance Statement

Mapping Immune Reponses to CMV in Renal Transplant Recipients NARRATIVE Cytomegalovirus (CMV) is a ubiquitous, genetically stable herpes virus that infects approximately 70% of the human population and establishes lifelong persistence. Primary infections as well as latency normally occur asymptomatically in immunocompetent hosts. However, in immunocompromised persons, such as transplant recipients, coexistence of CMV with the host leads to viral reactivation and disease associated with high morbidity and mortality. Furthermore, chronic CMV infection accelerates senescence of the immune system with a resultant high level of chronic subclinical inflammation which drives transplant morbidity and loss. We will use high-throughput systems biology technologies and novel statistical and computational approaches to characterize the innate and adaptive immune response to CMV in the setting of solid organ transplantation. Understanding the components of the immune response to CMV will provide valuable insights into chronic rejection and identify new approaches to guide patient management and therapy.

PROJECT 3: Mapping the Evolution of Chronic Transplant Injury in the Context of CMV Infection 

Project Leader - Minnie M. Sarwal M.D., Ph.D., FRCP, DCH

SUMMARY/ABSTRACT CMV infection drives inflammation in the context of organ transplantation, and is associated with chronic rejection in the allograft, which drives accelerated allograft loss and transplant failure. The cascade of molecular mechanisms that trigger graft inflammation in the context of CMV infection are poorly understood. Whole genome, proteome, and immunome profiling of CMV infection and disease in the context of organ transplantation can generate a comprehensive global database to understand CMV infection and reactivation in an immunocompromised host and help design novel strategies to prevent viral reactivation and dampen anti- donor immunity.

In Project 3, we propose to study the evolution of immune responses that drive acute rejection, chronic rejection, and CMV virus infection in kidney transplant recipients by serial assessments of graft transcriptional perturbations (Aim 1), clonal expansion of peripheral T cell and B cell receptors (TCRs and BCRs) through next gene expression sequencing (NGS), and variations in humoral responses to reactivation of antigenic epitopes by high-throughput antibody profiling (Aim 2). In addition, we propose to generate biomarkers for non-invasive monitoring of chronic graft injury by measuring changes in donor derived cell free DNA (dd-cfDNA) by massively multiplexed PCR (mmPCR) and highly refined gene-sets (kSORT and uCRM) mined from previous high-throughput microarray studies (Aim 3). We propose to use a cohort of kidney transplant patients from two of the largest multi-organ transplant programs in the US (UCSF and UCLA).

Cmvplus100x Mid

- by Richard Barg https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=74168
Mon, 2 Oct 2017 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=74154 <![CDATA[UCSF Hosts First Advanced Laparoscopic Course in N. California for Senior Residents and Fellows ]]> The first advanced laparoscopic course in Northern California, dedicated to the training of Minimally Invasive Surgery fellows and surgical senior residents, was held at the UCSF Anatomy Learning Center on Saturday, August 12, 2017. The course, jointly developed by UCSF and Stanford, and co-chaired by Matthew Lin, M.D. and John Morton, MD respectively, provided a one-day comprehensive experience for senior trainees that included a formal didactic curriculum as well as a hands-on cadaver lab. There were over twenty participant trainees drawn from the following institutions:

  • San Joaquin General Hospital
  • Stanford University
  • UC Davis
  • UCSF
  • UCSF-East Bay Surgery Program
  • UCSF-Fresno Department of Surgery

They were taught by nationally renknowned surgeons from UC Davis, UCSF, and Stanford who volunteered their time:  

Figure 1 Homera Rivas MD From Stanford Discusses The Latest Treatment For Achalasia

Topics in the curriculum included: 

  • Laparoscopic Ergonomics
  • Energy Devices/Staplers
  • Heller's Myotomy/POEM
  • Nissen Fundoplication
  • Sleeve Gastrectomy
  • Rou-en-Y Gastric Bypass 

Figure 1 Stan Rogers MD From UCSF Presenting The Nuances Of Fundoplication

There was an overwhelming positive response by the trainees. Gregory J. Haro, MD a UCSF general surgery senior resident, commented:                                                                   

The Northern California Advanced Laparoscopic Course was a highly educational, collaborative, hands-on experience. We were able to review and apply laparoscopic techniques under the tutelage of the best surgeons in Northern California. I am a more thoughtful surgeon as a result of this class and I hope that it will continue for future trainees. 

- by Richard Barg https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=74154
Mon, 2 Oct 2017 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=74162 <![CDATA[UCSF Department of Surgery Faculty Honored with Excellence in Teaching Awards]]> The Haile T. Debas Academy of Medical Educators presented seven Department of Surgery faculty with the Excellence in Teaching Award for 2017 at a ceremony on September 11th at the UCSF School of Nursing, held in conjunction with the Academy's induction of new members. The Academy's Excellence in Teaching Awards are peer-nominated, and honor outstanding front-line teachers of medical students, residents, and fellows who often go unrecognized. These teachers create and encourage an intellectually stimulating environment that promotes critical thinking and learning.

gaspar - warren.jpg       Warren J. Gasper, M.D.

Division of Vascular and Endovascular Surgery
Acting Chief, Section of Vascular Surgery,
San Francisco VA Medical Center
Director, Vascular Integrated Physiology and
Experimental Therapeutics (ViperX)

Ryutaro Hirose - 144   Ryutaro Hirose, M.D.

Professor of Clinical Surgery
Division of Transplant Surgery
Associate Program Director,
UCSF General Surgery Residency Program

Kimberly Kirkwood - 144x  

Kimberly Kirkwood, M.D.
Professor of Surgery
Division of General Surgery

Mary H. McGrath - 144   Mary H. McGrath, M.D., M.P.H.

Professor of Surgery
Division of Plastic and Reconstructive Surgery

Wen Shen - 144x   Wen T. Shen, M.D., M.A.

Associate Professor of Clinical Surgery
Division of General Surgery

Lan Vu MD 144   Lan Vu, M.D.

Assistant Professor of Surgery
Division of Pediatric Surgery

Yee   Laurence F. Yee, M.D.

General & Colorectal Surgeon
Associate Clinical Professor of Surgery, UCSF
Director, Laparoscopic Gastrointestinal Surgery
California Pacific Medical Center

- by Richard Barg https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=74162
Fri, 29 Sep 2017 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=74141 <![CDATA[NIH Awards Shuvo Roy Three-Year $2.4M Grant to Develop Bioartificial Pancreas for Type 1 Diabetes]]> UCSF 20160630 Shuvoroy 0376

The National Institute of Biomedical Imaging and Bioengineering (NIBIB), one of the National Institutes of Health, has awarded bioengineering professor Shuvo Roy, PhD, a three-year, $2.4 million grant to develop a bioartificial pancreas for treatment of Type 1 Diabetes. The project is a collaboration between the Department of SurgeryDepartment of Bioengineering & Therapeutic Sciences, and Diabetes Center at UCSF.

Co-investigators include:

Type 1 Diabetes affects nearly three million people in the United States and 24 million worldwide. Current treatment methods for the autoimmune disease—insulin therapy or pancreas transplant—are severely limited and can lead to serious complications. Dr. Roy's research project focuses on using silicon nanopore membranes (SNMs) as an immunoisolation barrier to protect stem-cell derived insulin producing cells from pro-inflammatory attack, while ensuring physiologic oxygenation and glucose-insulin kinetics. The team's long-term goal is to develop a full-scale implantable bioartificial pancreas.

In addition to this project, Dr. Roy leads several interdisciplinary initiatives at UCSF: Surgical Innovations, Pediatric Device Consortium, Biodevice Innovation Pathway, and The Kidney Project

- by Stacy Kim https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=74141
Thu, 28 Sep 2017 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=74089 <![CDATA[First-In-Human Pilot Trial for Magnetic Compression Anastomosis Device Reports Encouraging Results]]> Results from the first-in-human clinical trial of a magnetic compression anastomosis device known as "Magnamosis" were recently reported on in the Journal of the American College of Surgeons. 

The study, led by Principal Investigator Michael Harrison, MD, is a prospective, single-center, first-in-human pilot clinical trial to evaluate the feasibility and safety of creating an intestinal anastomosis using the Magnamosis device. Magnetic compression anastomosis (magnamosis) uses a pair of self-centering magnetic "Harrison Rings" to create an intestinal anastomosis without sutures or staples. Each magnet is placed within the lumen of a desired segment of the intestine and brought together, or "mated." The magnetic force on the compressed tissue causes necrosis and an anastomosis forms. The magnets then pass through the bowel.

Claire Graves, MD, a general surgery resident who recently completed a research fellowship in surgical innovation with Dr. Harrison, is the paper's lead author. The paper provides historical perspective on the development of magnetic compression anastomosis against the backdrop of the traditional surgical armanentarium, sutures or staples, to create an anastomosis.

Intestinal anastomosis is fundamental to surgery. Whether repairing traumatic injury, correcting congenital anomalies, or resecting tumors, surgeons have performed this procedure for centuries. Currently, most anastomoses are either handsewn or made with staplers, but a device that could automatically and consistently produce an optimal anastomosis could reduce morbidity and save considerable operative time and resources. The concept of compression anastomosis was first credited to French physician Felix-Nicholas Denans in the early 19th century. Magnetic compression anastomosis (magnamosis) is a modern iteration of this classic idea, which uses the force of magnetic attraction to form an intestinal anastomosis without sutures or staples. 

Urological surgeons at UCSF, led by Principal Investigator Marshall Stoller, MD, performed the procedures. The urologists used bowel segments to create uretero-ileal urinary diversions, with encouraging results, according to the authors:

In this first case series of the Magnamosis device in humans, we found that despite the complicated medical conditions and comorbidities of the 5 study participants, the device safely and successfully performed in every case. No patient experienced anastomotic leak, bleeding, or stricture formation. 

The authors also sketched out plans to study expanded uses for the device in subsequent patientsnotably in the setting of laparoscopic surgery:

The Magnamosis device's method of slow tissue remodeling without leaving foreign bodies creates a well-formed anastomosis, which can decrease the incidence of anastomotic leaks. In addition, the simplicity of merely "sticking" the 2 segments of intestine together can save substantial operative time. However, open operation is not the best way to showcase the merits of magnamosis. In our subsequent patients, we plan to focus on laparoscopic delivery of the Magnamosis device, which currently can be deployed using laparoscopic, endoscopic, radiographic, or hybrid techniques. In addition, the device can be sized and adapted to a variety of intraluminal anastomoses, including intestinal, urologic, and biliary applications, with wide-reaching implications for the future of surgery.

Magnamosis 2

Future Plans

Dr. Harrison and his research team are developing additional uses for the Magnamosis device, such as in esophageal atresia and in a novel surgical treatment for diabetes. His startup, Magnamosis, Inc., was recently awarded a NIH SBIR grant to study the effect of Magnetic Duodenal-Ileal Bypass ("DIPASS") on Type 2 diabetes mellitus (T2DM) in rhesus monkeys. 

The study team also included Ryan Hsi, MD, Catherine Co, MD, Dillon Kwiat, BS, and Jill Imamura-Ching, RN. Other contributors to the project were Dr. Shuvo Roy, Dr. Hanmin Lee, Elizabeth Gress, Stacy Kim, Dr. Luzia Toselli, Dr. Marcelo Martinez-Ferro, Dr. Stanley J. Rogers, Dr. Miles Conrad, Dr. Carter Lebares, Richard Fechter and Pamela Derish.

1 S20 S1072751517317015 Gr3

1 S20 S1072751517317015 Gr1

Related Links

Magnamosis First-in-human Study of Feasibility and Safety (Magnamosis) (Clinicaltrials.gov)

Magnetic Compression Anastomosis (Magnamosis): First-In-Human Trial  (Journal of the American College of Surgeons)

Magnamosis, a New Magnetic Way to Connect Intestines, Proving Itself in Clinical Trial (Medgadget.com) 

A-3_Magnamosis III delivery of a magnetic compression anastomosis device using minimally invasive endoscopic techniques

- by Stacy Kim and Richard Barg https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=74089
Tue, 29 Aug 2017 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=73877 <![CDATA[Benjamin Padilla and Michael Harrison Awarded NIH R03 for Cryoanalgesia Study]]> The Eunice Kennedy Shriver National Institute of Children Health & Human Development (NICHD) at the National Institutes of Health (NIH) has awarded pediatric surgeons Benjamin Padilla, MD, and Michael Harrison, MD, a two-year grant to study the use of cryoanalgesia as a novel method of pain control in the Nuss Procedure. The research team includes Sunghoon Kim, MD, and Jill Imamura-Ching, RN. Claire Graves, MD, played a key role in setting up the project and developing the grant application while she was a resident in the Innovation Pathway from 2015 to 2017.

The Nuss Procedure is a minimally invasive repair for individuals with pectus excavatum, or sunken chest disorder. During the surgery, which is most commonly done during adolescence, a steel bar is placed under the sternum and ribs and then flipped, causing the chest to pop out into a normal position.  Although effective, patients experience severe post-operative pain, which current pain management methods (thoracic epidural and patient-controlled analgesia) cannot adequately control and which can lead to dependence on opioids and long-term pain issues.

This study is a prospective, randomized trial comparing cryoanalgesia to thoracic epidural analgesia in post-operative pain control on adolescent and young adult patients who have undergone the Nuss Procedure. Cryoanalgesia is a novel technology that locally freezes the peripheral nerves, causing nerve axons to degenerate. The result is temporary prevention of pain transmission, with complete axonal regeneration occurring in approximately 4-6 weeks. If effective, this pain control strategy could shorten hospital stays and decrease pain and opiate usage among Nuss procedure patients.

This will not be the first time Drs. Harrison and Padilla have collaborated on a study to advance the state of the art in pectus excavatum treatment. For years, they have worked together on the Magnetic Mini-Mover Project, a novel device that uses magnetic force to gradually reform the chest wall over a two-year period. The procedure was devised as an alternative to the painful Nuss Procedure and has been evaluated in two clinical trials under an Investigative Device Exemption (IDE) from the FDA. Currently, the team is working to optimize the device design in preparation for a third human trial.

- by Stacy Kim https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=73877
Fri, 18 Aug 2017 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=73224 <![CDATA[Center for Mindfulness in Surgery Announces New Funding and Plans for Faculty Study in Fall]]> The UCSF Center for Mindfulness in Surgery was recently awarded grants by the Physicians Foundation and UCSF Medical Center "Excellence Fund" to support a study of mindfulness training of faculty in the Departments of Surgery and Anesthesia. The program, led by Carter Lebares, M.D., Principal Investigator on the study, is also funded by the Department of Surgery, which has supported a similar study by Dr. Lebares in surgical interns. 

Physician burnout, which comprises emotional exhaustion, depersonalization and diminished satisfaction with one's work, has been documented in medical students, trainees and every medical specialty examined, and has been growing across specialties. Burnout, diminished performance and the development of mental and physical illness are related. Among physicians, performance deficits from surgical errors to poor professionalism have been shown to result, at least in part, from the effects of stress on cognition. 

Mindfulness-based interventions have shown exceptional promise in improving burnout and distress symptoms, protecting cognition, and enhancing meaningfulness and satisfaction in work among physicians and other high-stress/high-performance groups. Dr. Lebares, working with collaborators in psychiatry, neuropsychiatry, neuroradiology, integrated medicine at UCSF as well as the laboratory of Elizabeth H. Blackburn, a Nobel laureate for her work in telomeres, has developed a streamlined, mindfulness-based intervention for physicians based on the model pioneered by Jon Kabat-Zinn, Ph.D at the University of Massachusetts School of Medicine, Mindfulness-Based Stress Reduction, or simply MBSR. 

Dr. Lebares tested her hypothesis that mindfulness training would reduce burnout and enhance stress resilience in surgeons in by enrolling surgical interns in a randomized clinical trial (RCT) beginning in June 2016. The "Mindful Surgeon" study, Mindful Mental Training for Surgeons to Enhance Resilience and Performance Under Stress, just enrolled a 2nd cohort of surgical interns for the current (2017-18) academic year.

IMG 3894 Standing MeditationA cross-sectional national survey of general surgery residents, undertaken by the UCSF Center for Mindfulness in Surgery in the fall of 2016, found that high dispositional mindfulness reduces the risk of emotional exhaustion, depersonalization, alcohol misuse and abuse, moderate to severe depression and suicidal ideation, by 75% or more. This suggests that while mindfulness may seem out of place among surgeons and the operating room culture, it is in fact already in use in this setting. Promising preliminary data from the first wave of training in surgical interns of the Mindful Surgeon RCT, suggests that mindfulness training could be a powerful component of stress resilience training among surgeons and anesthesiologists. 

The upcoming faculty study will look at the feasibility and acceptability of tailored mindfulness training adapted to the culture of the OR for surgeons and anesthesiologists. The study is designed to test outcomes of well-being, cognition and performance at multiple hospital sites in the UCSF School of Medicine community.

Hobart W. Harris, M.D., M.P.H., Professor and Chief of the Division of General Surgery, was enthusiastic about the concept of using mindfulness training to promote stress resilience in surgeons:

The dynamic interplay between stress, performance and health (both physical and mental) is a fascinating area of research, one with extraordinary practical relevance to the training and management of surgeons. Dr. Lebares' research represents an exciting and comprehensive investigation into how mindfulness training may not only mitigate the potentially harmful physical and psychological effects of stress on surgeons, but also enhance performance.  I am certain that her research will change the way we train and work as surgeons in the not too distant future. 

Comments from residents enrolled in the RCT provided powerful anecdotal support for the training's benefit: 

"I'm on Neurosurg at the General.  I find I'm more purposeful and present with the pts' and families.  I wrote the orders to withdraw care on a 32 yo today and I'm just feeling it.  I'm in it, and it's ok."

"I thought I'd be learning a relaxation technique, but this is work. I didn't believe in it at first, I thought it was sort of ridiculous, but it has changed me. Practicing is work, but it feels like a gift…it's changed how I think, how I see things, how things affect me. Before I go in the OR to update the chief - especially if I have something that will upset him - I do the breathing, I focus, and I am clearer, explain better, am not nervous."


- by Richard Barg https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=73224
Thu, 17 Aug 2017 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=73280 <![CDATA[Inside Surgery Spring/Summer 2017]]> Inside Surgery 2

The Spring/Summer 2017 issue of Inside Surgery is now available online. Inside Surgery is a Department of Surgery brochure showcasing the clinical and research advances of our faculty. The edition highlights minimally invasive bariatric surgery to treat metabolic disease, and robotic surgery deployed across a variety of surgical specialties within the Department. The newsletter begins with a tribute to the outgoing Chair, Nancy L. Ascher, M.D., Ph.D. via a letter from the Interim Chair:

UCSF Medical Center has long been at the forefront of innovation in every facet of surgery. Our outgoing chair of the Department of Surgery, Nancy L. Ascher, MD, PhD, led our team to new heights. She supported outstanding work across the full spectrum of surgical research and practice – from the Surgical Innovations initiative, which helps surgeons, engineers and trainees develop new surgical devices, to the Center for Maternal-Fetal Precision Medicine, which seeks to better diagnose and treat birth defects, to the Center for Surgery in Older Adults, which helps older patients better prepare for and recover from surgery. These are just a few of the creative, visionary developments Dr. Ascher championed during her 17 years as chair. 

She remains active as a UCSF abdominal transplant surgeon, while bringing her leadership gifts to a new level as president of the Transplantation Society, an international nonprofit organization that provides global leadership in transplantation. It is my privilege to serve as interim chair of the UCSF Department of Surgery.

In this issue of Inside Surgery, I am pleased to share a few of the latest highlights in our state-of-the-art care for patients. Our general surgeons have pioneered many of the latest techniques for minimally invasive bariatric surgery, which can now be used to help patients with metabolic disease. Drawing on the world-class expertise across UCSF, we often partner with gastroenterologists to provide even less invasive approaches, which sometimes can be performed endoscopically – eliminating the need for any skin incisions. Our team is highly skilled in treating rare and complex disease, and helps ensure that all patients achieve the best possible outcomes. We are also excited to employ the latest developments in robotic surgery, which can facilitate procedures conducted in challenging anatomical spaces, and in some cases can offer an even less invasive approach, resulting in fewer complications, shorter hospital stays and less postoperative pain. My colleagues and I appreciate the privilege of working with you to provide exceptional patient care.

John P. Roberts - 144John P. Roberts, M.D.
Professor and Interim Chair
Department of Surgery Endowed Chair in Abdominal Transplantation

Read and download the full issue of Inside Surgery

- by Richard Barg https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=73280
Wed, 16 Aug 2017 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=73248 <![CDATA[Donor-Intervention Research Slowed Amidst Issues of Informed Consent and Conflicts Among Disparate IRBs]]> UCSF 20170309 P Stock Surg 027

The Atlantic reports on the difficulties in the current climate of conducting donor-intervention research due to issues of informed consent, disagreements over what constitutes human subject research, and conflicting views of Institutional Review Boards (IRB) spread across multiple centers with patients putatively impacted by the research protocol. Moreover, doctors must test the experimental interventions designed to improve outcomes within the crucible of a short time window, given that a donated organ is suitable for transplantation for only a limited mumber of hours. 

Doctors have a short window of time to experiment on brain-dead donors to improve procedures—and that's if they can get permission.

As a matter of biology, brain death is catastrophic for the body.

Yes, the heart can still beat and a ventilator can provide oxygen, but there is no brain to coordinate the tasks of staying alive. Hormones that tell organs what to do are out of whack. Inflammatory molecules flood the body. Cells die. "You can see the kidneys don't work as well, the lungs don't work was well, and the heart can look stunned," says Darren Malinoski, a trauma surgeon at Oregon Health and Science University. 

There's nothing to do for the dead patient at this point. But his or her organs can be saved, and because most transplanted organs in the United States come from brain-dead donors, these minutes are crucial. For this reason, researchers have wanted to study the use of drugs or procedures in brain-dead donors, halting organ damage that happens in the minutes after death.

But this kind of research is almost impossible to do in the United States. The ethics of so-called donor-intervention research are incredibly fraught. How do you get informed consent and from whom? The dead donor? The live recipient—or possibly dozens of live recipients getting tissues or organs from a single donor, fanned out across the country at different hospitals each with their own ethics review boards? All this would unfold against intense time pressure. Every minute of delay is a minute in which the organ is deteriorating.

Claus Niemann - 144Claus Niemann, M.D.Professor of Anesthesia and Surgery at UCSF, was principal investigator on a clinical study showing that mild hypothermia in deceased organ donors resulted in an overall nearly 40 percent increase in the successful function of donated kidneys after surgery. However, follow-on studies were delayed amid controversies over informed consent and the conflicting guidelines of geographically dispersed Institutional Review Boards (IRB).

In 2015, Malinoski and his co-investigator Claus Niemann, a transplant doctor at University of California San Francisco, published results from a rare donor-intervention trial. The reaction to their study became an object lesson in why doctors avoid this kind of research.

The research team wanted to see if cooling the body temperature of brain-dead donors by about 4.5 degrees Fahrenheit—aka hypothermia—could improve the function of transplanted kidneys. Since kidneys are put on ice after they're taken out of the body, perhaps cooling the kidneys while still in the body could help preserve them. Every institution involved in human subjects research has an institutional review board, and UCSF's board decided doctors did not have to ask for informed consent. In the case of the donors, the board reasoned they were dead and thus not human research subjects. In the case of the organ recipients, it reasoned the hypothermia protocol posed only minimal risk to them.

Sandy Feng -144Sandy Feng, M.D., Ph.D., Professor of Surgery in the Division of Transplant Surgery at UCSF, has played a leading role in developing a road-map for clinical investigators to navigate the ethical, regulatory, and logistical barriers to donor intervention research, creating a pathway so the research can proceed. (Links to her relevant publications and PowerPoint Presentation follow this summary). 

In 2016, Glazier, Feng, and others published the results of a survey of transplant surgeons, institutional review board (IRB) members, and organ procurement organization professionals. They found a wide range of views on the many unresolved questions, such as whether the donor or recipient's hospital IRB should review the trial, who is a human research subject, and what kind of consent is necessary.

In one hypothetical scenario they asked about, a researcher wants to test a drug already used in dead organ donors to find the optimal dose to improve heart transplants. In their survey, 82 percent IRB members thought the trial was human subjects research. In contrast, 58 percent of transplant surgeons and 19 percent of organ procurement organization professionals agreed. IRBs are supposed to oversee human subjects research, so the community does not agree on a question as basic as whether an IRB should even oversee this research.

Practically, this confusion means the research rarely happens. "It gets shut down because everybody understands there is no pathway to doing this research," says Sandy Feng, a transplant surgeon at UCSF who has written extensively about this issue. Funding agencies don't want to fund it. Pharmaceutical companies don't want to pursue it. Doctors shy away, not wanting to risk their reputations.

Responding to public criticism by the consumer advocacy organization Public Citizen, Darren Malinoski, a trauma surgeon at OHSU and one of the principal investigators on the follow-on study, urged that clear guidelines be formulated so research such as his can go forward absent the current controversy.   

To doctors like Malinoski, clear guidelines for donor-intervention research—guidelines that can cut through the mess of diverging opinions—can't come soon enough. He and Niemann had planned a follow-up trial. Cooling the donor's body did appear to improve kidney transplant success, and now they wanted to compare it to an alternative technique that uses a machine to pump liquid through the kidney outside the body. But after the Public Citizen letter came out, potential collaborators were suddenly shaky. "When there's controversy, people don't want to touch it with a 10-foot pole," says Malinoski. "It really set our study back over a year, year and a half." After a lot of meetings and consultations, UCSF eventually gave them the go-ahead. The National Academy of Medicine can provide an authoritative answer for the whole country. "We're looking forward to clarity," he says, "Whatever is decided, we're happy to follow it."

Read full article in the Atlantic

- by Richard Barg https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=73248
Tue, 15 Aug 2017 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=73213 <![CDATA[Jeffrey Pearl, Outstanding Surgeon, Dedicated Teacher and Valued Colleague Passes Away]]> The UCSF Community and the Department of Surgery are saddened to announce the passing of our friend and colleague, Dr. Jeffrey Pearl, Professor Emeritus of Surgery.

Jeffrey Pearl was raised in San Francisco, attended UC Berkeley for his undergraduate studies, and earned his M.D. at Mount Sinai School of Medicine. He completed his general surgery residency training at UC San Diego with Dr. Marshall Orloff, followed by appointments as a major in the U.S. Army and instructor in surgery at Johns Hopkins University.

In 1978, Dr. Pearl began his surgical practice at Mount Zion Hospital where his father, Dr. Milton Pearl, became Chief of Surgery and Chief of Staff. Dr. Pearl joined the UCSF faculty in 1981, playing a critical role in the integration of UCSF and Mount Zion Hospital.

Jeff became Associate Dean and Associate Medical Director of the UCSF Medical Center at Mount Zion where he founded and directed the Northern California Hernia Center. He held the Fishbon Endowed Chair in Ambulatory Surgery and served, for a time, as Vice-Chair of the Department of Surgery where he oversaw departmental finances. Dr. Pearl was also a member of the Galante Lecture Committee.

While at UCSF, Jeff was an unstinting advocate for UCSF Mount Zion, ensuring patient care remained at the highest levels. Dr. Pearl was instrumental in creating the Drs. Milton J. Pearl and Leonard D. Rosenman Surgical Skills Center, which was dedicated on January 6, 2005. This was yet another tangible example of his unwavering dedication to medical education and support of the Department of Surgery. He also created the Central Venous Access Service in collaboration with the Department of Radiology.

Throughout his career at UCSF, Jeffrey Pearl was widely recognized as an outstanding surgeon, committed teacher to medical students and residents, and valued colleague.

Dr. Pearl is survived by wife Anne, daughter Laura Shapiro, son in law David Shapiro, grandchildren Danny and Lindsey Shapiro, brother Louis Pearl (Jetty Swart), and sister Linda Pearl Pruzan.

In lieu of flowers, the family requests that donations be made in Jeff's name to:

Parkinson's Dance Project
c/o Marin Dance Theatre
1 St. Vincent Drive
San Rafael, CA 94903

Read Obituary at SFGate.com

- by Nancy Ascher https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=73213
Mon, 14 Aug 2017 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=73194 <![CDATA[Traveling to Mars Will Wreak Havoc on Our Bodies — Can We Prevent It?]]>

Spacewalk Ucsf Astronaut

UCSF News reports on research into the effects of space travel, known and unknown, to the physiology and bodies of astronauts traveling about the international space station (ISS). The research has profound implications for longer trips to distant planets, notably NASA's goal of flying a manned spacecraft to Mars. Research into the novel and myriad effects of space travel on humans will be critical to the success of this endeavor.

Three faculty in the UCSF Department of Surgery and an esteemed collaborator in the Department of Biochemistry and Biophysics, were among the researchers profiled in this story. Marlene Grenon, M.D., C.M., a vascular surgeon and Director of the Grenon Lab, is conducting pioneering research on how the cardiovascular system fares under the rigors of space travel. Sonja Schrepfer, M.D., Ph.D., Associate Professor and Director of the Transplant and Stem Cell Immunobiology (TSI) Lab and Tobias Deuse, M.D., Associate Professor, Director of Minimally Invasive Cardiac Surgery and a principal investigator in the TSI Lab, are carrying out research, funded by the National Aeronautics and Space Administration (NASA), looking at changes to the function of vascular cells after space flight as well as how the immune system and cell repair are affected. 

Millie Hughes-Fulford, Ph.D., a Professor in the Department of Biochemistry and Biophysics and Director of the Laboratory of Cell Growth at the San Francisco VA Medical Center (SFVAMC), herself a former astronaut with a rarefied career in space research, has several ongoing projects related to space travel including T-Cell Activation and Aging on the ISS - SpaceX3 and SpaceX5 and Bones in Space (Osteo Project). Dr. Hughes-Fulford collaborates with both the Grenon Lab and TSI Lab.

As humans prepare to venture deeper into outer space, including potential trips to Mars, researchers are hard at work trying to understand and mitigate the effects of low gravity and radiation on space travelers' bodies.

Heart of the matter: The cardiovascular system                          

Heart Of The MatterThe radiation and low gravity of space also has an impact on the body's vascular system, causing circulatory problems for astronauts when they return to Earth and an increased risk of heart attack later in life.

Marlene Grenon, associate professor of vascular surgery, has had a longtime interest in the effects of space flight on the vascular system. "Astronauts are in good shape, and exercise protocols are part of their lives," said Grenon. "So we want to know what's going on here. Is it radiation? Gravity? Other physiological factors?"

Grenon, who has a diploma in Space Sciences from the International Space University and has developed UCSF's first course on the effect of spaceflight on the body, has studied the effects of simulated microgravity on the function of vascular endothelial cells which line the inside of blood vessels.

Grenon cultured these cells and placed them in an environment that simulated very low gravity. She found that the lack of gravity causes a decrease in the expression of certain genes in the cells that affect adhesion of plaque to the vessel wall. While the implications of these changes aren't yet clear, it's evident that a lack of gravity affects cell function.

In addition, previous work by Grenon showed that microgravity creates changes in the cells that conduct electricity in the heart, which may put astronauts at risk of cardiac arrhythmias.

Marlene Grenon

Grenon's colleagues Dr. Sonja Schrepfer and Dr. Tobias Deuse, also professors of surgery, are helping put pieces of that puzzle together by determining what changes to the function of vascular cells are evident after space flight.

Schrepfer in 2016 studied the vascular systems of mice that had spent time on the ISS, as well as vascular cells cultured in a microgravity environment on Earth. Her team is still analyzing their data, but so far it appears that the walls of the carotid arteries became thinner in mice in space, possibly because the lower gravity demanded less blood pressure for circulation.

The team also found that the cultured cells showed changes in gene expression and control that resemble changes seen in patients with cardiovascular disease on Earth.

While these changes might not be detrimental in the microgravity of the Space Station, on Earth they result in poor blood circulation.

"When astronauts return to Earth's gravity, muscle weakness is only part of the reason they can't stand up," Schrepfer said. "They also don't get enough blood to their brain, because their vessel function is impaired."

There is hope: Schrepfer and her team have identified a small molecule that prevents vascular walls from thinning in mice. She and her team are planning to do safety trials of that molecule on humans in the near future.

Sonja Schrepfer Tobias DeuseSonja Schrepfer and Tobias Deuse are studying what changes to the function of vascular cells are evident after space flight.
Credit: Noah Berger

Immune system and cell repair

Immune System And Cell RepairSchrepfer has also received an award to study effects of microgravity on the immune system as a model of aging, both in space and after returning to Earth. She has a kindred spirit in Millie Hughes-Fulford, adjunct professor of medicine and the first female scientist to work in space. Hughes-Fulford tended experiments aboard the Columbia space shuttle in 1991, and has been investigating the changes in gene expression in T-cells in space since about 2003.

"Over half of the Apollo astronauts had some sort of immune problem," she said. "So, we knew back then that the immune system wasn't working well in space."

Her current work involves not only looking at gene expression but also at the role of microRNA (miRNA) — tiny molecules that can switch genes on or off. Her research revealed five of these miRNAs, each of which controlled genes that activate T-cells, weren't working properly.

"Before this, we could say that the genes weren't being turned on, but we didn't know why," said Hughes-Fulford. "Now we know the regulators of the genes."

These changes are the same ones seen in aging, leaving the elderly with less robust immune systems. In space, though, the changes begin to occur after 30 minutes, while in a human they may take 30 years. The research by Schrepfer and Hughes-Fulford could help people who travel in space, but also is an opportunity to study changes that can be challenging to follow throughout decades on Earth.

Millie Hughes Fulford

Read full article in UCSF News

- by Richard Barg https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=73194
Wed, 9 Aug 2017 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=73015 <![CDATA[Medical Student Gabrielle LaBove Selected as Inaugural Recipient of Haile T. Debas Diversity Fellowship Award]]> Gabrielle LaBove, a 4th year medical student from Howard University School of Medicine in Washington, DC, has been selected as the inaugural recipient of the Haile T. Debas Diversity Fellowship. As part of her fellowship, she will be taking an elective course and doing a rotation in Plastic Surgery in September 2017. 

The UCSF Department of Surgery established the Haile T. Debas Diversity Fellowship to foster its goal of increasing the number of underrepresented minority academic surgeons. The namesake of the award, Dr. Haile T. Debas, is Professor Emeritus of Surgery, a former Department of Surgery Chair, and Director Emeritus of the UC Global Health Institute (UCGHI). Dr. Debas is world-renowned for his contributions to academic medicine and for a storied career spanning decades as a physician, researcher, professor, and academic leader.

The Haile T. Debas Diversity Fellowship is offered to fourth year medical students as a sub-internship, providing the opportunity to experience first-hand the Department's multi-faceted environment of clinical excellence, inquiry and investigation. The Fellowship provides a stipend of $2,500.00 to defray the cost of tuition, transportation, housing, and incidental expenses.

Visit the Haile T. Debas Diversity Fellowship Page 


- by Heidi Crist and Richard Barg https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=73015
Wed, 9 Aug 2017 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=72880 <![CDATA[Department of Surgery Launches Website for NIH T32 Research Training Grant in GI Surgery]]> UCSF 20160630 Shuvoroy 0459

The UCSF Department of Surgery has launched a new website for its NIH T32 Research Training Program in Gastrointestinal Surgery. The program, led by Hobart W. Harris, M.D., M.P.H., Professor and Chief of the Division of General Surgery, was originally established in 1987 by Dr. Haile T. Debas, Professor Emeritus of Surgery, a past Chair of the Department of Surgery, and currently Director Emeritus of the UC Global Health Institute (UCGHI)

The T32 Research Training Grant in Gastrointestinal Surgery has supported the training of general surgeons treating diseases of the gastrointestinal tract for three decades, providing them with rigorous research training and the tools necessary to genuinely bridge the gap between laboratory and observations and applied diagnostics and therapeutics, enabling them to mature into independent investigators, and assume the mantle of leadership in academic surgery. The program is distinguished by an outstanding faculty drawn from multiple departments within the School of Medicine, conducting a wide range of innovating research impacting the GI tract. The program also leverages the considerable resources of the Department's Scientific Publications Office led by Pamela Derish, M.A

The new website serves as a robust platform for the forty-nine prospective, current and past trainees to interact with one another and provide feedback to faculty, creating a virtuous cycle for continuous performance improvement, a key objective of the NIH for sustainability and productivity of its T32 grants.

The web portal advertises the program to prospective research residents in their PGY-2 and 3 years, showcases the work of its trainees, and reflects its commitment to diversity by increasing the ranks of underrepresented minority academic surgeons. The portal also provides a wealth of information about the curriculum and the experiences of its past trainees. The highly competitive program will fill two slots for the period encompassing the 2018-20 academic research years.

Dr. Harris sees the website as an organic, ever-growing and indispensable resource for its community of resident trainees, faculty and former trainees.

The website will be a wonderful and efficient mechanism for maintaining a long-term longitudinal relationship with our trainees. This new web portal enables program participants to submit updates, news stories, and anonymous or personal feedback to program leadership, a growing "family tree" through which trainees and faculty can stay connected through shared activities, past, present and future.

For more information, please visit the NIH T32 Research Training in Gastrointestinal Surgery website.

- by Richard Barg https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=72880
Thu, 27 Jul 2017 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=72666 <![CDATA[Johannes Kratz and Yeranuí Ledesma Recipients of UCSF Health Exceptional Physician Awards]]> Johannes R. Kratz, M.D. and Yeranuí Ledesma, M.D. are among this year's recipients of the 2017 UCSF Health Exceptional Physician Award. Dr. Kratz, now a member of the Thoracic Oncology Program and Assistant Professor in the Division of Adult Cardiothoracic Surgery, and Dr. Ledesma, a Senior Resident in General Surgery, were among 8 winners out of 61 nominees, notably the only clinical fellow and resident, respectively, at UCSF to receive the award, and the only recipients not on the faculty.  The official announcement reads:

We are delighted to announce the 2017 UCSF Health Exceptional Physician Award Winners.   

These eight physicians display the characteristics of our core values of PRIDE -- Professionalism, Respect, Integrity, Diversity and Excellence.  Their hard work, dedication and contribution is a testament to the exemplary relationships they have with faculty, staff and patients, and their steadfast commitment to providing outstanding care for our patients.   Please join me in congratulating them on their exceptional service. 

  • Juan Gonzalez (Department of Obstetrics, Gynecology and Reproductive Services)
  • Steven Hetts (Department of Radiology)
  • David Hwang (Department of Ophthalmology)
  • Johannes Kratz (Department of Surgery Fellow)
  • Yeranui Ledesma (Department of Surgery Resident)
  • Ngoc Ly (Department of Pediatrics)
  • Sabine Mueller (Department of Neurology)
  • Tina Shih (Department of Neurology) 

We received 61 nominations this year. Thank you to the staff, physicians, students, and patients who contributed to the nomination process.

Josh Adler, MD
Executive Vice President, Physician Services
UCSF Health

- by Richard Barg https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=72666
Fri, 21 Jul 2017 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=72444 <![CDATA[International Symposium on Incisional Hernia Prevention October 19-20, 2017]]> International Symposium On Incisional Hernia Prevention

Hobart W. Harris, M.D., M.P.H., Chief of the Division of General Surgery and Director of the UCSF Center for Hernia Repair and Abdominal Wall Reconstruction, will Chair the International Symposium on Incisional Hernia Prevention, sponsored by the UCSF Department of Surgeryto be held October 19-20, 2017 in San Francisco, CA. UCSF is the leading tertiary referral center in the region for hernia surgery, performing nearly 700 procedures annually, 350 of those for ventral (incisional) hernias that are frequently the most challenging. 

Dr. Harris, a pioneer in the management of complex ventral hernias, stated: 

Interest in the prevention of incisional hernias is growing at a rapid pace worldwide, garnering the attention of surgeons, payers, health science investigators, and the medical technology industry.  Several recent clinical studies have further fueled the expanding focus on hernia prevention, effectively challenging the way we think about this common condition.

The Symposium will bring together preeminent experts in hernia prevention from across the globe, including the investigators responsible for many of the most important clinical trials in this area.  Furthermore, this meeting will enable robust and informative interactions between participants, including surgeons and other health care providers, members of industry, and representatives of research, regulatory and health insurance agencies.

Program Chair

Hobart W. Harris - 144xHobart W. Harris, M.D., M.P.H.
Professor and Chief, Division of General Surgery
Vice-Chair, Department of Surgery
J. Engelbert Dunphy Endowed Chair in Surgery
Director, UCSF Center for Hernia Repair and Abdominal Wall Reconstruction

Program Co-Chair

William HopeWilliam H. Hope, M.D.
General and Robotic Surgery
New Hanover Regional Medical Center
Wilmington, NC

View Course Program

Visit the Symposium Website 

For More Information

Please contact Courtney G. Flookes
(415) 476-5257

- by Richard Barg https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=72444
Thu, 20 Jul 2017 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=72609 <![CDATA[ZSFG Celebrates One-Year Anniversary of Wraparound Mural]]> Zuckerberg San Francisco General Hospital recently celebrated the one-year anniversary of the debut of the Wraparound mural, a profound expression of art and healing that proudly hangs on a wall near the Wraparound Project offices at ZSFG. The mural is the creation of Marco Razo, a noted artist, who first learned of the Wraparound Project after he lost a family member to violence in 2016. The core mission of the Wraparound Project is the prevention of violence thorough culturally sensitive community interventions and support of its victims through proactive outreach, empathy and emotional sustenance.

Razo's mural was inspired by the artistic genre of "magical realism", a realistic view of the world suffused with magical elements, and was intended to serve as tribute to the life that was tragically lost. The painting symbolizes the tree of life with mother earth at her roots.  Sitting atop the globe on either side are two figures representing the Wraparound Project and the Center for Global Surgical Studies respectively, depicted as caring for the earth. The flying figure at the top of the mural represents a symbol of hope for Wraparound clients.

Razo teamed with the Wraparound staff other clients to assemble the mural, first painting pieces of plywood covered in joint compound, then joining them together to complete the finished mural. Ordinary objects such as a wheel and bottles were stamped into the joint compound to add texture. 

Razo continues to volunteer his talents, serving as a mentor and art instructor for Wraparound clients, teaching them them to create their own art pieces, some of which has been sold at fund-raising auctions. Marco's participation as both artist and mentor to the Wraparound Project clients symbolically closes the healing circle of art therapy and medical care. 

To schedule a visit to see the mural, please contact the Wraparound Project at:

(415) 206-3382

Mural Painted By Wrap Around Client

- by Adaobi Nwabuo and Richard Barg https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=72609
Wed, 19 Jul 2017 00:00:00 PSThttps://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=72727 <![CDATA[James Gardner and Nicole Conkling Awarded 2017 ASTS Research Grants]]> James M. Gardner, M.D., Ph.D. and Nicole Conkling, M.D. have been awarded prestigious research grants by the American Society of Transplant Surgeons (ASTS) for its 2017 funding cycle. 

Dr. Gardner, who just completed his Chief Residency in General Surgery at UCSF and is a rising fellow in the Division of Transplant Surgery, was the only transplant fellow in the country to receive the prestigious ASTS-Astellas Fellowship. The award will fund Dr. Gardner's research, which he pursued throughout his residency with the support of Department of Surgery funding, during his clinical fellowship years. 

Dr. Gardner's work, conducted in mentored collaboration with the Mark Anderson Lab at the UCSF Diabetes Center, is focused on the mechanisms regulating self-tolerance in the adaptive immune system, and translating these findings into relevant therapeutics for inducing and maintaining donor-specific tolerance. Dr. Gardner and Dr. Anderson originally discovered a novel population of cells distributed throughout the body's secondary lymphoid organs, which are capable of inducing robust self-tolerance and preventing autoimmunity (Gardner et al. Science 2008, Immunity 2013). Their work on this population is also supported by an NIH/NIHAI R01 - (Developing eTACs as a Novel Method of Tolerance in Type 1 Diabetes) and an American Diabetes Association Young Investigator Award.

Dr. Conkling, a Resident Research Fellow in Plastic Surgery, was awarded the ASTS Resident Scientist Scholarship to fund her project to study chimeric antigen receptor T-regulatory cell therapy for rejection in a mouse model of composite tissue transplantation in the Transplantation Immunology Lab ("Tang Lab") led by Qizhi Tang, Ph.D. A composite tissue allograft (CTA) such as a hand or face is made up skin, muscle, tendon, nerves, bone and blood vessels that may be transplanted to a victim of trauma, burn, or other disfiguring tissue loss to restore both form and function.

Immunosuppressive medication is currently the only option for preventing rejection of CTAs. However, because the surgery is life-enhancing as opposed to life-saving (such as the transplantation of a kidney or liver for end-stage renal or liver disease respectively), committing a patient to a lifetime of immunosuppressive therapy becomes harder to ethically justify. The holy grail in this area is to discover alternate less toxic ways to induce immunological tolerance to CTAs by lowering or even eliminating immunosuppressive medication requirements.

Dr. Conkling's project, funded by the ASTS, is emblematic of this research, with a long-term goal of developing targeted cell-based anti-rejection therapies in the setting of composite transplants. She is also funded by a Ruth L. Kirschstein National Research Service Award (NRSA) Individual Postdoctoral Fellowship (F32 NIH/NIAID), which speaks to the exceptional mentorship and innovation in the Tang lab.

Read full announcement

2017 ASTS–Astellas Fellowship in Transplantation

James M. Gardner, M.D., Ph.D.
Abdominal Transplant Fellow (PGY-6)
Division of Transplant Surgery

Donor-Specific Tolerance Induction by Extrathymic Aire-Expressing Cells

Synopsis: The purpose of our research is to understand the fundamental mechanisms regulating self-tolerance in the adaptive immune system, and to translate these findings into relevant therapeutics for inducing and maintaining donor-specific tolerance. In mentored collaboration with the Mark Anderson lab at the UCSF Diabetes Center, our lab studies a gene called the Autoimmune Regulator, or Aire, which was found to be a key regulator of central tolerance, and is required by educator cells in the thymus to expose the developing T-cell pool to a diverse array of one's own antigenic diversity. In 2008 we discovered of a novel population of Aire-expressing cells outside the thymus—distributed throughout the body's secondary lymphoid organs—which we named extrathymic Aire-expressing cells (eTACs), and which we demonstrated could be modified to induce robust self-tolerance and prevent autoimmunity (Gardner et al. Science 2008, Immunity 2013).

Our current research has three aims. First, to better understand the basic biology and immunology of eTACs. To this end, we have defined and are currently publishing work describing the family of antigen-presenting cells to which eTACs belong, and the mechanisms by which they induce tolerance. This basic biology and immunology is essential to any further therapeutic efforts. Second, to define the developmental biology of this cell population, and specifically how eTACs can be differentiated in vitro for diagnostic and therapeutic purposes. This work will greatly facilitate the ability to both study these cells and to develop translational cellular therapies. Third, to pioneer a therapeutic role for eTACs in inducing and maintaining donor-specific tolerance in a murine allogeneic transplant model. Together this research program aims to define a novel branch of adaptive immunity, and to apply these findings directly to transplant tolerance.

2017 ASTS Resident Scientist Scholarship

Chimeric Antigen Reception T-regulatory Cells for Targeted Rejection Therapy in Murine Hindlimb Composite Tissue Transplant

Nicole Conkling, M.D.
Resident Research Fellow
Plastic & Reconstructive Surgery
UCSF Transplantation Immunology Lab ("Tang Lab")

Synopsis: Vascularized composite tissue allotransplantation (VCTA) still faces many challenges regarding the unique immunologic demands of composite grafts and their propensity toward rejection. Acute rejection is extremely common in clinical VCTA, and chronic rejection remains poorly described. Interest has emerged in cellular therapies as an alternative to immunosuppressive drugs to treat rejection. T-regulatory cells (T-regs), which induce a more tolerogenic state, are known to be instrumental in long-term graft survival, attenuating the long-term sequelae of chronic rejection. Engineered chimeric antigen receptor (CAR) T-regs activated by donor antigens may allow for efficient, targeted therapy for VCTA rejection.

This study employs a murine hindlimb transplant model with two specific aims. First, transplanted mice will be observed clinically and serially biopsied to study the kinetics and cellular aspects of VCTA rejection, examining the architecture of the tissues and populations of graft cellular infiltrates. Second, recipients with rejection will be treated with CAR T-regs as salvage therapy. We hypothesize that CAR T-reg infusion will halt or reverse the rejection process. This project seeks to elucidate what is known about rejection in VCTA, as well as apply a targeted cellular intervention for salvage of rejected grafts. CAR T-cells have shown clinical promise in other fields, and they could feasibly be translated to the treatment of rejection in human VCTA. CAR T-regs represent a powerful tool for treating composite allografts threatened by rejection, as well as progress toward achieving the goal of tolerance without the life-long use of immunosuppressive drugs.

- by Richard Barg https://surgery.ucsf.edu/news--events/ucsf-news.aspx?id=72727