January 14, 2015

Bench and Bedside is a digest of the previous month’s stories about the clinical and academic activities of our physicians and scientists. We welcome your submissions and feedback.

12/19/2014

Texas Children’s Medical Staff: Required Training for Fluroscopic Procedures

On May 1, 2013 the Texas Department of State Health Services (DSHS) made specific changes to its regulations of Texas Administrative Code §289.227 “Use of Radiation Machines in the Healing Arts.” This rule requires all physicians and midlevel providers to obtain additional radiation training prior to performing fluoroscopic procedures. This is not a Texas Children’s Hospital policy but a modification of state law goes into effect May 1, 2015. Read more

12/18/2014

Mata conjoined twins take first step toward separation with tissue expansion

Conjoined 8-month-old twin girls, Knatalye Hope and Adeline Faith Mata, underwent a five-hour surgery December 16 at Texas Children’s Hospital Main Campus to place custom-made tissue expanders into their chest and abdomen area. The tissue expanders will help stretch the babies’ skin in preparation for their separation surgery, which is expected to take place early next year. Dr. Alberto Hernandez with Interventional Radiology performed the examination. Chief of Plastic Surgery Dr. Larry Hollier and Dr. Ed Buchanan with the Division of Plastic and Reconstructive Surgery conducted the tissue expander placement surgery. Dr. Helana Karlberg led the anesthesia team and Audra Rushing led the surgical nursing team. Read more

12/18/2014

Tessier receives NASPGHAN Fellow Research Award for C. Difficile study

Dr. M. Elizabeth Tessier, a pediatric gastroenterology fellow at Texas Children’s, received the 2014 Fellow Research Award from the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN). Her award-winning study titled, “Bile acid signatures in children confer protection from clostridium difficile infection,” found that changes in the bile acid composition in the stool may predispose patients to Clostridium difficile (C.diff), a bacterial infection that causes intestinal inflammation and diarrhea. Read more

12/17/2014

Neurosurgery represents Texas Children’s at AANS Annual Meeting

The Texas Children’s Hospital Division of Neurosurgery was well represented at the recent American Association of Neurological Surgeons annual meeting in Amelia Island, Fla. The division had eight posters accepted for presentation. Of those eight, three were selected as “Top Posters.” In addition, Neurosurgery had four abstracts accepted for oral presentation. Read more

12/16/2014

Voice of Nursing blog: Physician-nurse partnership (By Dr. Tony Mott)

Trust, respect and a sense of humor. What do these things have in common? In my opinion, they’re the key ingredients for developing a successful nurse-physician partnership. As medical director, my partnership with Assistant Clinical Director Tarra Kerr is vital to the success of 15 West Tower. In fact, from our shared partnership, we have established a shared vision – a vision of what 15WT can be and the path to that end. Read more

12/16/2014

Department of Surgery unveils surgery preparation video

No parent ever wants to hear their child will need to have surgery – whether it’s a routine procedure that only takes minutes or it’s something more serious. That’s why the Department of Surgery goes out of its way to make the surgical experience at Texas Children’s a good one for patients as well as their families. The department’s most recent effort to ensure a positive surgical experience is had by all is a video for parents that talks about what to expect when their child has surgery at Texas Children’s. The video, available in English and Spanish, covers eating and drinking instructions, what to bring to the hospital and what parents will experience while their child is in surgery. “Our goal in the Department of Surgery is to have our patients and their families prepared as well as possible for the surgical experience,” Chief of Plastic Surgery Dr. Larry Hollier said. “Setting appropriate expectations is crucial to patient satisfaction.” Read more or Watch video

12/16/2014

The patient census and what it means for Texas Children’s

On any given day, hundreds of patients come through the hospital doors at Main Campus and West Campus. Whether they walk through our doors on their own, or are transferred from another hospital, these patients require the care of Texas Children’s Hospital specialists. In November, 101 patients had to be turned away from Texas Children’s Hospital. The patients were denied a transfer from another institution because we were above census. “We have to always remember that when people come to us, they are bringing their children who are ill for care,” said Surgeon-in-Chief Dr. Charles D. Fraser, Jr. “We have to put ourselves in their position, and respond.” Read more or Watch video

12/16/20146

Texas Children’s hosts second cardiac artery anomalies conference

Texas Children’s Hospital hosted its second national conference December 4 and 5, addressing a series of fatal conditions known as coronary artery anomalies. Coronary artery anomalies are a group of rare congenital heart defects that have been associated with coronary ischemia, myocardial infarction, and sudden death. It is the second most common cause of sudden death in young healthy athletes. Read more

12/16/20146

Texas Children’s Heart Transplant Program celebrates 30th anniversary

Texas Children’s Hospital recently celebrated the 30th anniversary of its heart transplant program. Since its inception in 1984, Texas Children’s Heart Center has performed more than 300 heart transplants, making the program one of the most active and largest in the nation. “The true results of our team’s exceptional work over the past 30 years can be seen in the hundreds of success stories of our patient families,” said Texas Children’s Heart Failure, Cardiomyopathy and Cardiac Transplantation Medical Director Dr. Jeff Dreyer. “As one of the largest programs in the nation, our experience in treating patients with heart failure is leading the way in positive outcomes.” Read more

12/09/2014

Kayyal to co-lead development of Neuro-NICU program

Dr. Simon Kayyal, an assistant professor of pediatrics and neurology at Baylor College of Medicine, recently joined Texas Children’s neurology team. He will develop and co-lead the Neuro-Neonatal Intensive Care Unit (Neuro-NICU) with Texas Children’s Neonatologist Dr. Jeffrey R. Kaiser, a professor of pediatrics, obstetrics and gynecology at Baylor College of Medicine. Read more

12/08/2014

Hand and Microvascular Surgery Clinic offers multidisciplinary team

Patients treated at the Texas Children’s Hospital Hand and Microvascular Surgery Clinic now benefit from not only two physicians whose focus is on hand and upper extremity care but also from a full-time certified hand therapist. Plastic and reconstructive surgeons Dr. Mitchel Seruya and Dr. Thomas Hunt III formed a multidisciplinary team with certified hand therapist Tara Haas. Seruya, Hunt and Haas work with registered nurses, occupational hand therapists and medical assistants to perform clinical evaluations, formulate diagnoses and provide treatment plans for patients. Read more

12/03/2014

Texas Children’s Pediatrics opens new practice, merges two others

Texas Children’s Pediatrics recently welcomed a new practice to the inner loop and merged two others in the Houston area. The new practice, Texas Children’s Pediatrics Green Park, opened November 18 and is located at 7505 S. Main St., Suite 450. Three new physicians – Dr. Michael Connelly, Dr. Shannon Hayes and Dr. Jackie Wanebo – are seeing patients at the location. Connelly, a Houston native, earned his medical degree from and completed his residency with the University of Texas Medical School in Houston. Connelly specializes in fitness, healthy eating, and infants and newborns. Hayes is from Katy and earned her medical degree from Baylor College of Medicine. Hayes completed her residency at Baylor as well, and trained at Texas Children’s Hospital. Wanebo came to Texas from Charlottesville, Va., earned her medical degree from the University of Virginia and completed her residency with the University of North Carolina Chapel Hill. She specializes in asthma, healthy eating, teenagers and children with special needs. Read more

 

Submissions for Bench and Bedside

Bench and Bedside will be produced monthly to spotlight recent news about Texas Children’s physicians and scientists. The Connect team welcomes submissions related to speaking engagements, staff awards/recognition, research, clinical work and academic activities. Send your questions or submissions to connectnews@texaschildrens.org.

January 13, 2015

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Renowned tissue engineering expert and Harvard Medical School John Homans Professor of Surgery Dr. Joseph Vacanti will be the featured speaker at this year’s Denton A. Cooley Lectureship in Surgical Innovation Tuesday, February 10.

Beginning at 7:30 a.m. in the fourth-floor Conference Center at Texas Children’s Pavilion for Women, Vacanti will discuss “Tissue Engineering and The Care of Children,” a burgeoning area of research that has untapped potential for people who need new organs. His talk will be streamed on West Campus in room 150.10 as well as in the auditorium at Children’s Hospital of San Antonio. Please RSVP to Lesa Porterfiled at Ext: 6-5722 or Importer@texaschildrens.org if you plan to attend.

Vacanti’s academic surgical career has included both clinical innovation and basic research related to organ transplantation and tissue engineering, a mission that stems from his long-held interest in solving the problem of organ shortages.

While at Boston Children’s Hospital, he launched the nation’s first liver transplantation program specifically for the pediatric population and instituted New England’s first successful pediatric extracorporeal membrane osygenation, or ECMO, program.

He then began to conceptualize the design of implantable systems that would generate new tissue and replace lost function. Vacanti’s approach to developing tissue involves a scaffold made of an artificial, biodegradable polymer, seeding it with living cells, and bathing it in growth factors. The cells can come from living tissue or stem cells. The cells multiply, filling up the scaffold, and growing into a three-dimensional tissue. Once implanted in the body, the cells recreate their proper tissue functions, blood vessels grow into the new tissue, the scaffold melts away, and lab-grown tissue becomes indistinguishable from its surroundings.

Vacanti earned his Bachelor of Science, summa cum laude, from Creighton University; his medical degree, with high distinction, from University of Nebraska College of Medicine; and a Master of Science from Harvard Medical School. He trained in general surgery at the Massachusetts General Hospital, in pediatric surgery at Boston Children’s Hospital, and in transplantation at the University of Pittsburgh.

Since 1974, Vacanti has held academic appointments at Harvard Medical School. He currently holds the following positions at Massachusetts General Hospital: co-director of the Center for Regenerative Medicine, director of the Laboratory for Tissue Engineering and Organ Fabrication, and chief of Pediatric Transplantion.

In addition to being a founding co-president of the Tissue Engineering Regenerative Medicine International Society (TERMIS), which has 4,000 active members from 80 countries worldwide, Vacanti has authored more than 320 original reports, 69 book chapters, 54 reviews, and more than 473 abstracts. He also has 81 patents or patents pending in the United States, Canada, Europe, and Japan, and was elected in 2001 to the Institute of Medicine of the National Academy of Sciences.

Among others, Vacanti has received the Thomas Sheen Award presented by the New Jersey Chapter of the American College of Surgeons and the 2013 William E. Ladd Medal, the highest honor awarded by the Surgical Section of the American Academy of Pediatrics. He now will be one of several distinguished visiting professors to speak at the Denton A. Cooley Lectureship in Surgical Innovation.

Created seven years ago, the lectureship honors Dr. Denton A. Cooley, a living legend in cardiovascular and surgical innovation. Last year, Cooley was named the most innovative surgeon alive for his groundbreaking work in cardiovascular surgery. He ranked No. 1 on the list of 20 surgeons for the accolade given by Healthcare Administration Degree Programs, which is a website that provides free information for those seeking a career in the medical industry.

Cooley might be best known for performing the first successful human heart transplant in the United States in 1968 and the first human implant of a total artificial heart in the world in 1969. However, his many other contributions are even more important, including his techniques for repairing diseased heart valves and aortic and ventricular aneurysms. Cooley also promoted and popularized the use of non-blood prime for the heart-lung machine, sparing patients unnecessary exposure to blood and allowing more operations to be performed.

Before he retired from the operating room, he and his team had performed more than 100,000 open-heart operations at the Texas Heart Institute, which he founded in 1962. Cooley has authored or coauthored 13 books and more than 1,300 scientific papers. He also has won several awards, including Texas Children’s Hospital’s Distinguished Surgeon Award.

Cooley currently is chief of cardiovascular surgery at St. Luke’s Episcopal Hospital; surgeon-in-chief emeritus at the Texas Heart Institute; consultant in cardiovascular surgery at Texas Children’s Hospital; and clinical professor of surgery at The University of Texas Medical School at Houston.

January 6, 2015

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Texas Children’s researchers have embarked on a five-year crossover dietary intervention study that could determine why certain children with Irritable Bowel Syndrome (IBS) develop symptoms when eating wheat.

IBS is a common gastrointestinal (GI) disorder that can develop in children at any age. Since IBS patients have extremely sensitive digestive tracts, they may experience frequent abdominal pain, bloating, flatulence and changes in bowel habits that include diarrhea and/or constipation.

A group of sugars called FODMAPs (Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols) are known to exacerbate IBS symptoms. Since these sugars are poorly digested in the small intestine, trillions of bacteria in the colon ferment the sugars, which can produce excessive gas in IBS sufferers. One of these hard-to-digest sugars is fructans.

In collaboration with researchers at Baylor College of Medicine and funding from the National Institutes of Health (NIH), Texas Children’s Gastroenterologist Dr. Bruno Chumpitazi and his team are conducting a double-blind, randomized, placebo-controlled study to examine the effects of fructans – a natural sugar found in wheat – in 80 children with IBS.

“Certain IBS children experience unpleasant GI symptoms when challenged with fructans,” said Chumpitazi, director of Texas Children’s Neurogastroenterology and Motility program. “We hypothesize these symptoms are due to the composition of bacteria in their gut, or gut microbiome, and what these bacteria do with the fructans.”

All 80 children will receive the same low FODMAP diet with varying drinks prepared by the Children’s Nutrition Research Center at Baylor. Based on randomization, one drink will contain fructans while the other will contain maltodextrin, a starch that our bodies can easily absorb without the help of gut bacteria.

“The children will consume the assigned diet over a period of 72 hours,” said Chumpitazi. “They will return to their normal diet for at least seven days before starting the low FODMAP diet with a different drink combination.”

With the help of Texas Children’s Microbiome Center led by Dr. James Versalovic and the Texas Children’s Center for Pediatric Abdominal Pain Research led by Dr. Robert J. Shulman, researchers will track the children’s symptoms daily and collect stool samples before and after the dietary interventions to monitor changes in their gut microbiome’s bacterial composition and bacterial byproducts. The byproducts produced by the bacteria will also be measured through breath testing.

The objective of the NIH-funded study is to identify whether bacteria in the gut and/or other factors are responsible for IBS symptoms in patients when fructans are consumed.

“If we understand why IBS children in the trial respond differently to the fructan challenge, it could help scientists develop targeted therapies to enhance the quality of life for patients with this GI disorder,” said Chumpitazi.

Other Baylor College of Medicine scientists collaborating in this study include Dr. Joe Petrosino and Dr. Aleksander Milosavljevic.

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Amy Smith, a board certified music therapist at Texas Children’s, received the prestigious 2014 Arthur Flagler Fultz Research Grant from the American Music Therapy Association (AMTA).

The grant will support Smith’s study, “The Effects of Live Contingent Singing on Preterm Neonates with Bronchopulmonary Dysplasia,” which will examine the impact of a live music therapy intervention on the physiologic and behavioral responses of preterm infants with a chronic lung condition.

The study is slated to begin in early 2015 and run through mid-2016. The research team includes physicians, nurse practitioners and researchers from Texas Children’s Hospital. The results from the study will provide important information on the potential impact of music therapy on the overall well-being of infants with chronic and long term hospitalization needs.

The AMTA Arthur Flagler Fultz Research Award is the largest and most prestigious grant awarded to one individual each year from a highly competitive field of applications.

“I am honored to receive this research grant award,” said Smith. “This generous funding will help us advance music therapy research and identify innovative music therapy treatments for Texas Children’s patients.”

Since the hospital launched the program in 2013, Smith has provided music therapy to patients in the Neonatal Intensive Care Unit and the Inpatient Rehabilitation Unit.

The Music Therapy program is part of the Creative Arts Therapy program in the Child Life Department which provides developmental, educational and therapeutic interventions for children undergoing medical treatment.

“Music therapy is about providing families with the tools to interact and bond with their babies,” said Smith. “When a parent has a very small and very sick baby, they may be unable to hold or touch their newborn and music therapy can encourage bonding through songs and lullabies.”

Click here to watch a video about Texas Children’s Music Therapy program. For more information about music therapy, click here to visit our website.

December 23, 2014

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Conjoined 8-month-old twin girls, Knatalye Hope and Adeline Faith Mata, underwent a five-hour surgery December 16 at Texas Children’s Hospital Main Campus to place custom-made tissue expanders into their chest and abdomen area. The tissue expanders will help stretch the babies’ skin in preparation for their separation surgery, which is expected to take place early next year.

During their recent surgery, the infants also had an examination to help assess their anatomy and the placement of PICC catheters in preparation for the twins’ separation. Dr. Alberto Hernandez with Interventional Radiology performed the examination. Chief of Plastic Surgery Dr. Larry Hollier and Dr. Ed Buchanan with the Division of Plastic and Reconstructive Surgery conducted the tissue expander placement surgery. Dr. Helana Karlberg led the anesthesia team and Audra Rushing led the surgical nursing team.

“We are pleased the babies did so well during the surgery,” Hollier said. “A multidisciplinary team continues to monitor them in our neonatal intensive care unit as they recover.”

The tissue expander placement surgery requires a recovery time of six to eight weeks, during which additional fluid will be added to the tissue expanders, which are like balloons, to allow the skin to be stretched gradually. The extra skin is needed to provide coverage once the babies are separated.

During the girl’s recovery, the planning process for the separation surgery will continue among a team of multidisciplinary specialists in pediatric surgery, urology, plastic surgery, orthopedic surgery, cardiovascular surgery and pediatric gynecology.

“We have been preparing for the twins’ separation surgery for months and the process is ongoing,” said Dr. Darrell Cass, pediatric surgeon and co-director of Texas Children’s Fetal Center. “In addition to multidisciplinary meetings, our plans have included, among other things, building a 3-D model of their organs, conducting simulations of the surgery and post-operative care they will receive, as well as helping create devices to support their care, such as a swing which will hold the girls upright to alleviate pressure on their healing incisions.”

Anticipated to take approximately 24 hours, the separation surgery will involve two teams of surgeons who will work together to separate the twins, who share a chest wall, lungs, pericardial sac (the lining of the heart), diaphragm, liver and pelvis. The separation team will start the surgery and the reconstruction team will complete the procedure.

Surgeons at Texas Children’s Hospital in 1992 successfully separated Tiesha and Lesha Turner, who were 1 year old and shared a sternum, liver, entwined intestines and fused organs. The separation of Knatalye and Adeline will be the second such procedure performed at the hospital.

Cass said he expects the surgery to go well and for each child to be able to live independently and to have a good life.

Knatalye and Adeline were born April 11 at Texas Children’s Pavilion for Women. Delivered via Caesarean-section at 31 weeks gestation, the twins each weighed 3 pounds, 7 ounces.

The girls’ parents, Elysse and John Mata, and their 5-year-old brother, Azariah, learned during a routine ultrasound on Jan. 13 that Elysse was carrying twins and they were conjoined. Subsequently, the family was referred from a physician in Lubbock, their hometown, to the Texas Children’s Fetal Center where they underwent extensive prenatal imaging, multidisciplinary consultation and development of plans to achieve a safe delivery and postnatal care.

Now 8 months old, the babies weigh about 15 pounds each and are doing well as they continue to be cared for by a team of specialists in the Level IV neonatal intensive care unit at Texas Children’s Hospital.

Elysse Mata said the day before the tissue expander placement surgery she is confident her girls are in good hands at Texas Children’s Hospital.

“I have an extreme amount of faith in the team at Texas Children’s and in God,” she said. “I know He put us here for a reason.”

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Texas Children’s Transition Medicine Team hosted a dinner this fall at Texas Children’s Pavilion for Women in conjunction with the Annual Chronic Illness and Disability Conference. More than 100 people interested in transition medicine attended to learn about Texas Children’s program and the progress being made in this new branch of medicine.

Transition medicine describes the planned process of moving pediatric patients into the adult health care system in a way that optimizes their health and ability to function. Texas Children’s is dedicated to helping these patients smoothly transfer to adult care without a decline or break in treatment needed for optimal health.

David Gonzalez, a Texas Children’s patient and student at Saint Thomas University, kicked off the dinner with his inspirational story and spoke to the importance of a solid transition program. He encouraged the audience to support the hospital’s efforts so that future patients will not have the same difficulties he had during his transition period.

The October 2 dinner also offered an opportunity to award the second Benjamin B. Ligums Scholar to Dr. David Hall, medical director for the Harris Health System’s El Franco Lee Health Center. The scholar program allows a provider in the community to receive training on the adult special needs population as well as project management assistance in setting up a referral process between them and their surrounding pediatric providers. Hall will build upon the successes of Dr. Elizabeth Bosquez, the first Benjamin B. Ligums Scholar.

This night also celebrated and acknowledged two remarkable families who have dedicated themselves to the transition medicine cause with their generous philanthropic support. The Ligums family was acknowledged for their support in creating the Benjamin B. Ligums Scholar Program, and the Robbins family was acknowledged for their commitment to support the Annual Chronic Illness and Disability Conference each year.

The transition medicine team has been working together for more than two years and has made great progress. They have focused on:

Readiness – preparing patients to self manage their disease and succeed in the adult world.
Handoff – ensuring that patients are not lost to follow-up during the move from the pediatric to the adult health care system.
Transfer – guaranteeing an adult provider for our patients to transition to at the appropriate age.

For a more comprehensive look inside the transition medicine plan, visit www.texaschildrens.org/transitionmedicine. For questions or additional information, please contact Caitlyn Barrow at crbarrow@texaschildrens.org or 713-798-3323, or Kris Barton at krbarton@texaschildrens.org or Ext. 4-1265.

December 17, 2014
The Texas Children’s Hospital Division of Neurosurgery was well represented at the recent American Association of Neurological Surgeons annual meeting in Amelia Island, Fla. The division had eight posters accepted for presentation. Of those eight, three were selected as “Top Posters.” In addition, Neurosurgery had four abstracts accepted for oral presentation.
Top Poster Presentations
  • Comparison of Patient Populations and Utilization for Hypothalamic Hamartoma Treatment
    Dr. Sandi Lam, Dr. Daniel Curry, Dr. Thomas Luerssen, Iwen Elaine Pan, PhD
  • Use of a Formal Assessment Instrument of Evaluation of Resident Operative Skills in Pediatric Neurosurgery
    Caroline Hadley, Dr. Sandi Lam, Valentina Briceno Marmol, RN, Dr. Thomas Luerssen, Dr. Andrew Jea
  • Endonasal Endoscopic Resection of Pediatric Craniopharyngiomas
    Dr. Sohum Desai, Dr. William Whitehead
Poster Presentations
  • Endoscopic Third Ventriculostomy and Ventriculoperitoneal Shunting: A Comparative Effectiveness Study with MarketScan Administrative Data
    Dr. Sandi Lam, Dr. Dominic Harris, Dr. Thomas Luerssen, Iwen Elaine Pan, PhD
  • Cerebrospinal Fluid Shunt Placement in Children: A Model of Hospitalization Cost
    Dr. Sandi Lam, Dr. Visish Srinivasan, Dr. Thomas Luerssen, Iwen Elaine Pan, PhD
  • Using Pediatrics National Surgical Quality Improvement Program (NSQIP) Data to Examine 30-Day Outcomes of Craniosynostosis Surgery
    Dr. Jared Fridley, Dr. Sandi Lam, Dr. Thomas Luerssen, Iwen Elaine Pan, PhD
  • Using Pediatrics National Surgical Quality Improvement Program (NSQIP) Data to Examine 30-day Outcomes of Posterior Fossa Tumor Surgery
    Dr. Sandi Lam, Dr. Jared Fridley, Dr. Andrew Jea, Dr. Thomas Luerssen, Iwen Elaine Pan, PhD
  • The Safety and Efficacy of Use of Low Molecular Weight Heparin in Pediatric Neurosurgical Patients
    Dr. David Gonda, Dr. Jared Fridley, Sheila Ryan, JD, MPH, CCRP, Valentina Briceno Marmol, RN, Dr. Sandi Lam, Dr. Thomas Luerssen, Dr. Andrew Jea
Oral Presentations
  • Outcomes of Pediatric Autologous Cranioplasty after Decompressive Craniectomy: A Multicenter Study
    Dr. Sandi Lam, Pediatric Outcomes Workgroup
  • Streamlining Fetal Repair of Myelomeningoceles
    Dr. Jared Fridley, Dr.William Whitehead
  • The Efficacy of Routine Use of Recombinant Human Bone Morphogenetic Protein-2 in Occipitocervical and Atlantoaxial Fusions of the Pediatric Spine
    Dr. Christina Sayama, Caroline Hadley, Valentina Briceno Marmol, RN, Dr. Huy Dinh, Sheila Ryan, JD, MPH, CCRP, Dr. Daniel Fulkerson, Dr. Thomas Luerssen, Dr. Andrew Jea
  • Acute Implantatationo Reduced Graphene Oxide Scaffolds in Spinal Cord Injury in Rats
    Dr. Jared Fridley, Dr. Thomas Luerssen, Dr. Andrew Jea