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Children's National News - Fall 2012




Kurt Newman, MD, President and Chief Executive Officer
Timothy Kane, MD, Appointed New Chief of General and Thoracic Surgery

Children’s National Medical Center has named Timothy Kane, MD, as Chief of the Division of General and Thoracic Surgery. Dr. Kane has been at Children’s National since August of 2010. He is an internationally known pediatric surgeon with expertise in minimally invasive techniques. 

Dr. Kane is a Principal Investigator in the Minimally Invasive Therapy Program in the Bioengineering Initiative of the Sheikh Zayed Institute for Pediatric Surgical Innovation. He serves as the America’s Representative on the executive committee of the International Pediatric Endosurgical Group, the premier worldwide organization for advancing minimally invasive surgery in children. 

“I’m honored to lead a team of surgeons who are among the best in the world,” said Dr. Kane, who began his new role in July. “With our forward-thinking research in the Sheikh Zayed Institute and our outstanding clinicians, Children’s National is well positioned to lead the field of pediatric surgery, with the ultimate goal of improving the lives of kids.” 

Dr. Kane has worked to improve minimally invasive surgical techniques and speed their incorporation into standard clinical care for pediatrics. He is a leader in neonatal minimally invasive surgery and is often able to repair complex diagnoses – including tracheosophageal fistula, duodenal atresia, congenital diaphragmatic hernia, and intestinal malrotation – using minimally invasive surgical techniques.  

“Tim Kane’s leadership as a clinician, educator, and researcher are true assets to our patients and the larger community,” said Anthony Sandler, MD, Senior Vice President of the Joseph E. Robert, Jr., Center for Surgical Care at Children’s National. “I am confident Dr. Kane will continue to advance the field of pediatric surgery, which will impact children worldwide.”

In addition to his role as a surgeon, Dr. Kane directs the Fellowship Program in Pediatric Surgery at Children’s National. He has trained many fellows who have gone on to be leaders in minimally invasive surgery in pediatrics. 

Dr. Kane received his medical degree from the State University of New York Upstate Medical University in Syracuse and completed post graduate work at the University of Cincinnati and the University of Alabama at Birmingham.

Dr. Kane replaces Dr. Sandler, who was recently named Senior Vice President of the Joseph E. Robert, Jr., Center for Surgical Care. The position of Senior Vice President was previously held by Kurt Newman, MD, who is now President and CEO at Children’s National. 
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New Study Finds External Stimulation Impacts White Matter Development in the Postnatal Brain 

A team at Children’s National Medical Center has found that external stimulation has an impact on the postnatal development of a specific region of the brain. Published in Nature Neuroscience, the study used sensory deprivation to look at the growth and collection of NG2-expressing oligodendrocyte progenitor cells (NG2 cells) in the sensory cortex of the brain. This type of research is part of the Center for Neuroscience Research focus on understanding the development and treatment of white matter diseases.

NG2 cells can develop into oligodendrocytes progenitor cells that generate myelin, the protective material around the axons of neurons, but this is based on functional and developmental interactions with outside stimuli. With this kind of plasticity, or ability to change and mold a cell in different ways, the researchers were able to determine that sensory stimuli can control the number and positioning of developing NG2 cells.

“Understanding how external stimulation and experience impact the development of NG2 cells means that we can try to modulate these factors to help regulate and promote the expansion of these cells. This could ultimately have an impact on white matter diseases,” stated Vittorio Gallo, PhD, study coordinator and Director of the Center for Neuroscience Research at the Children’s Research Institute. “We will now investigate in detail how sensory experience can regulate NG2 cell development, particularly how experience activates specific genes and molecular pathways in these cells.”

Collectively called NG2 progenitors, these cells also serve as the primary source of cells to regenerate oligodendrocytes and myelin in the postnatal brain. Without myelin, the brain does not function properly. Myelination can be impaired for a number of reasons, resulting in mental retardation and developmental disabilities. Myelination, white matter growth and repair, and the study of complex mechanisms of pre- and postnatal brain development are a key focus of the Center for Neuroscience Research at Children’s National, which also houses the White Matter Diseases Program, one of the largest clinical programs in the country for treating children with disorders that cause the brain’s white matter to degenerate. 
    
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Early Study Shows Sleeve Gastrectomy is Safe Alternative to Gastric Bypass for Adolescents with Morbid Obesity

A new study published in the journal Surgery suggests that laparoscopic sleeve gastrectomy, a surgical alternative to the well-known gastric bypass procedure for weight-loss surgery, offers fewer complications and maintains the weight loss and other related benefits of bariatric surgery when used in adolescent patients. 

The study, led by Children’s National Medical Center surgeon Evan P. Nadler, MD, was the first of its kind in the United States to look at the success of this approach with a particular focus on how well it could work for extremely obese teenagers. The team reviewed the outcomes for 23 patients who underwent sleeve gastrectomy at Children’s National and found on average that patients had lost approximately 40 percent of their excess weight (more than 65 pounds) within one year of the procedure.

“By the time a teenager comes to the Weight-Loss Surgery Program, we know that most conventional methods of weight loss, including diet and exercise, have not significantly helped to improve their health,” said Dr. Nadler, who is also the co-director of the Children’s National Obesity Institute  as well as a principal investigator in the Sheikh Zayed Institute for Pediatric Surgical Innovation. “We want to use our surgical experience to identify the safest and most effective surgeries to help these teens find a way to a healthier life, as soon as possible.”

In addition to weight loss, those who underwent laparoscopic sleeve gastrectomy saw important reductions in obesity-related complications such as type 2 diabetes and sleep apnea. Prior to surgery, the adolescent patient group had a combination of 64 different complications related to their weight. After one year, the number of weight-related complications had dropped to 22 for the entire study group. 

Many studies have shown that the risk of complications from gastric bypass are relatively high, so the weight-loss surgery community continues to seek alternative methods from gastric-banding devices, which are currently not FDA-approved for use in children, to other minimally invasive procedures like sleeve gastrectomy. 

To be eligible for consideration as part of the Children’s National Weight-Loss Surgery Program, patients must meet very specific medical requirements that include an extremely high body mass index (BMI), the completion of a six-month medically supervised exercise and diet program, and a psychological evaluation. 

To refer a patient

Patients are seen at three locations: Children’s National Medical Center-Sheikh Zayed Campus for Advanced Children’s Medicine, the Spring Valley Regional Outpatient Center, and Children’s National Specialists of Virginia, LLC, an affiliated private practice. The easiest way to schedule at any of these locations is to email Evan P. Nadler, MD at enadler@childrensnational.org. For patients who wish to be seen at Children’s National Specialists of Virginia, LLC, please email Faisal Qureshi at fqureshi@cnsv.org.

Additionally, you may click here to fill out the Weight Loss Surgery Referral form.
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Study: Most SIDS-Related Online Content Is Inaccurate

According to a new study from Children’s National Medical Center, the majority of information found online on safe infant sleep recommendations is inaccurate. The study, “Safe Infant Sleep Recommendations on the Internet: Let’s Google It,” published in the Journal of Pediatrics, searched 13 SIDS-related key phrases and analyzed the top 100 websites using Google.

Led by pediatrician and SIDS researcher Rachel Y. Moon, MD, the team judged accuracy of information against the American Academy of Pediatrics (AAP) recommendations, which were updated in 2011.

Of the 1,300 websites reviewed, 43.5 percent provided accurate information, 28.1 percent inaccurate information and 28.4 percent of information was not relevant. The search terms that provided the highest percentage of accurate information were “infant cigarette smoking,” “infant sleep position,” and “infant sleep surface.” The search terms “pacifier infant,” “infant home monitors,” and “infant co-sleeping” provided the lowest percentage of accurate information.

Dr. Moon cites two factors that make these finding particularly troubling: 70

percent of adults use the Internet for health-related information and decisions, and parents are more likely to discount information when there are contradictory sources.

“There is so much for sleep-deprived parents to think about with an infant at home, which makes it all the more important to provide accurate information,” advises Dr. Moon.

Dr. Moon recommends parents visit sites with trusted information. The study found that government sites and the AAP were the most accurate. Blogs and product websites were less accurate. Parents should ask their pediatrician for good resources.
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Children's National Health Monthly Web-based CME Presentations!

Children’s National Health Network offers monthly web-based CME presentations for community pediatricians in DC, Maryland, and Virginia. All sessions are recorded and will be archived at ChildrensNational.org/CNHN for future viewing if you are unable to participate live. To receive CME credit, you must submit a seminar evaluation and credit claim form for each session. Once completed, please fax the forms to 202-476-2399. Contact Donnita Pickett at 202-476-2777 with questions. Click here to see upcoming and past presentations. 

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Publications:

Early results after laparoscopic sleeve gastrectomy in adolescents with morbid obesity.
Nadler EP, Barefoot LC, Qureshi FG.
Surgery. 2012 Aug;152(2):212-7.
PMID: 22828142[PubMed - in process]

Factors influencing infant sleep position: decisions do not differ by SES in African-American families.
Robida D, Moon RY.
Arch Dis Child. 2012 Aug 17. [Epub ahead of print]
PMID: 22904266 [PubMed - as supplied by publisher]

Clinical Outcomes of Neonatal Onset Proximal versus Distal Urea Cycle Disorders Do Not Differ.
Ah Mew N, Krivitzky L, McCarter R, Batshaw M, Tuchman M; Urea Cycle Disorders
Consortium of the Rare Diseases Clinical Research Network.
J Pediatr. 2012 Aug 14. [Epub ahead of print]
PMID: 22901741 [PubMed - as supplied by publisher]

The Medical Home: Relationships With Family Functioning for Children With and Without Special Health Care Needs.
Arauz Boudreau AD, Van Cleave JM, Gnanasekaran SK, Kurowski DS, Kuhlthau KA.
Acad Pediatr. 2012 Aug 9. [Epub ahead of print]
PMID: 22884797 [PubMed - as supplied by publisher]

African-American Parents' Trust in their Child's Primary Care Provider.
Horn IB, Mitchell SJ, Wang J, Joseph JG, Wissow LS.
Acad Pediatr. 2012 Aug 1. [Epub ahead of print]
PMID: 22858071 [PubMed - as supplied by publisher]

PROMIS pediatric measures in pediatric oncology: Valid and clinically feasible indicators of patient-reported outcomes.
Hinds PS, Nuss SL, Ruccione KS, Withycombe JS, Jacobs S, Deluca H, Faulkner C, Liu Y, Cheng YI, Gross HE, Wang J, Dewalt DA.
Pediatr Blood Cancer. 2012 Jul 24. doi: 10.1002/pbc.24233. [Epub ahead of print]
PMID: 22829446 [PubMed - as supplied by publisher]

Demographics, Trends, and Outcomes in Pediatric Acute Myocarditis in the United States, 2006 to 2011.
Ghelani SJ, Spaeder MC, Pastor W, Spurney CF, Klugman D.
Circ Cardiovasc Qual Outcomes. 2012 Jul 24. [Epub ahead of print]
PMID: 22828827 [PubMed - as supplied by publisher]

Neurotransmitter abnormalities and response to supplementation in SPG11.
Vanderver A, Tonduti D, Auerbach S, Schmidt JL, Parikh S, Gowans GC, Jackson KE,
Brock PL, Patterson M, Nehrebecky M, Godfrey R, Zein WM, Gahl W, Toro C.
Mol Genet Metab. 2012 Jun 1. [Epub ahead of print]
PMID: 22749184 [PubMed - as supplied by publisher

Save the Date:
Join Children’s National on Sunday, October 21, 2012, from 6:30-8:30 pm for the American Academy of Pediatrics National Conference Alumni Reception in New Orleans, LA Visit: www.childrensnational.org/alumni for more information.

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