October 21, 2014

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Texas Children’s is all about improving patient outcomes. Every day, we’re creating a healthier future for children through excellence in patient care, education and research.

A perfect example of this is Texas Children’s Neuroscience Center, where neurologists and neurosurgeons partner with researchers from the Jan and Dan Neurological Research Institute (NRI) to improve the lives of children with brain disorders.

A video spotlight of the Neuroscience Center features powerful testimonials from patients and experts in the field. Dr. Gary Clark, chief of Neurology; Dr. Thomas Luerssen, chief of Neurosurgery; Dr. Huda Zoghbi, director of the NRI; and Dr. Anne Anderson, medical director of the Epilepsy Monitoring Unit; share their team’s contributions to the Neuroscience Center, which have led to incredible advances in the way we diagnose and treat neurological disease and improve patient outcomes.

Children receive comprehensive, multidisciplinary care from a diverse team of specialists at the Neuroscience Center. On average, more than 30,000 clinic visits and 900 surgeries are performed at our facility each year.

Patients like 17-year old Ellie – whose battled seizures since she was a year old – came to the Neuroscience Center after exhausting all avenues. Today, her future is bright.

102214neuroscienceinside640“When I was younger, I was not able to go out and do things on my own, like walk a dog or go to school,” said Ellie. “The seizures used to be daily, sometimes four or five times a day. Texas Children’s has given me my life back.”

Ellie’s story is one of many success stories emerging from the Neuroscience Center, where our team of experts use a multidisciplinary approach to improve patient outcomes.

“We coordinate multiple specialties to treat children with neurological disorders in a profoundly different way,” said Dr. Clark.

Neurologists collaborate with neurosurgeons to deliver complete care in more than 12 pediatric specialty clinics, including our recently expanded Epilepsy Monitoring Unit, which closely monitors and treats patients with epileptic seizures.

The Neuroscience Center brings together a diverse group of pediatric specialists representing different areas of expertise:

  • Neurology
  • Neurosurgery
  • Neurophysiology
  • Neurological Critical Care
  • Genetics

“From diagnosis to treatment – whether it involves surgery, inpatient rehabilitation or access to a clinical trial – patients receive the full complement of services in one location,” said Dr. Luerssen.

However, the Neuroscience Center would not be this successful without the support of the NRI at Texas Children’s. Under the leadership of Dr. Zoghbi, scientists work tirelessly each day to uncover the genetic mutations responsible for a number of rare neurological disorders.

“Without research, it’s almost impossible to understand these devastating disorders,” said Zoghbi. “The NRI is the home of many physicians and physician-scientists who study brain disorders, in the hope of developing new therapies to improve the quality of life for our patients.”

Click here to learn more about the NRI. Click here to visit the Neuroscience Center website.

October 14, 2014

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Dr. Silke Paust, an assistant professor of human immunobiology at Baylor College of Medicine, recently won the prestigious “Women and Diversity Paper of the Year” award from the Society for Leukocyte Biology.

Her award-winning study titled, “Critical role for the chemokine receptor CXCR6 in NK cell-mediated antigen-specific memory of haptens and viruses” explores the long-lived immunological memory of natural killer cells in the liver and their potential to help scientists develop targeted vaccines to treat infection and disease.

“Natural killer cells have an immunological memory that allows for rapid and enhanced responses when the body is re-invaded by the same pathogen,” said Paust, the lead author of the study. “In order for the immune system to remember an antigen-specific vaccine, it’s important to have some aspect of the immune system that persists for a long period of time.”

Natural killer cells, a subset of white blood cells that target cancer cells and a wide variety of infectious microbes, binds to their target and deliver a lethal burst of toxins that puncture holes in the membrane of infected cells, killing them instantly.

In their study, Paust and her colleagues injected laboratory mice with influenza and HIV vaccines to test whether natural killer cells in the liver remembered previous antigen-specific vaccinations. They found that specific subsets of natural killer cells found in the mouse liver developed long-lived and highly specific memory to a variety of antigens, which is critical to mediating a sufficient and protective immune response of protection.

When our bodies are exposed to a virus or other foreign invader, the immune system activates many immune cells to fight off infection. After the threat has passed, most of the cells die, however, memory natural killer cells remain in the body, similarly to memory T and B cells. When encountered by the same antigen again, memory immune cells respond rapidly resulting in a more powerful immune response.

Through Paust’s research, an additional cell type that can now be targeted for vaccination has been identified. “Natural killer cells are attractive targets for therapeutic intervention for the prevention and treatment of human disease, such as cancers and viral infection,” said Paust.

Paust will present her research at the 2014 Society for Leukocyte Biology and the International Endotoxin and Innate Immunity Society Joint Conference which will be held October 23 – 25 in Salt Lake City, Utah.

October 7, 2014

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“I’m ecstatic to introduce to you our Voice of Nursing blog,” said Lori Armstrong, chief nursing officer.

As the largest segment of the Texas Children’s workforce, the nurses are the heart and soul of this organization. You are at the bedside of the children and women who trust their care to us. You truly make a difference in the outcomes of our patients.

Through the reinvention of nursing, we have taken many steps toward helping our nursing staff be the strongest it can be. At 2,500 strong, I truly believe we are the best we’ve ever been. You now have access to better education, you have more colleagues to help with the incredible patient volumes, and your nurse leaders are now closer to the unit to help meet your needs. Our nurses are more qualified than ever to care for the increasingly complex cases we see each day.

Together, we do tremendous work here, and this blog is a place for Nursing to shine. It’s a tool to: communicate about new, successful approaches to patient care; share advice about things that have made a difference in your career; or tell us about a patient who has changed the way you care for others. The Voice of Nursing is a place for you to share your stories. These stories may give you ideas for implementing successful practices in your own units, or they may just help you get through a rough day at work. This is your space to inspire other nurses and share our successes with colleagues across the organization.

I hope you find this blog informative and inspirational, but more than anything, I hope it starts an open conversation between all of us. You will hear from me, and I hope to hear from you.

So let’s get started!

Jump to areas of interest. On the right-hand side, you will find the strategic areas the blog will address. You can use these tabs to go back to stories that may interest you and read what your colleagues have shared in the past.

Connect and comment. Below each post you’ll find room to comment. I encourage you to leave your thoughts after each blog that inspires you. I encourage open feedback that’s also courteous and respectful.

Make sure to write to me as well.

Subscribe. There is a button on the column to the right of the page which gives you the option to subscribe. When you subscribe, you’ll receive the new blog posts in your email inbox once a week. I highly encourage it!

I’m so excited about the Voice of Nursing. This is our space for your voice – let’s start the conversation.

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Research done by Texas Children’s ophthalmologists could put doctors one step closer to understanding why some children go blind.

Dr. Mohamed Hussein, assistant professor of ophthalmology with Baylor College of Medicine, recently collaborated with three of his colleagues at Texas Children’s and three of his colleagues at other institutions to evaluate the association of autonomic drug use to the development and severity of retinopathy of prematurity – one of the leading cause of blindness in developing countries.

The group’s findings were published in the current issue of the Journal of the American Association for Pediatric Ophthalmology and Strabismus, and reveal a significant association between the use of autonomic drugs, the development of ROP and the need for ROP treatment.

“What this means,” said Hussein, the lead author of the journal article, “is that we may be closer to having a better understanding of the theory of how ROP happens.”

To date, researchers have not been able to determine the exact cause for the disease that blinded soul musician Stevie Wonder, actor Tom Sullivan and jazz singer Diane Schuur. Most research has focused on an infant’s oxygen levels since ROP primarily affects premature babies who received intensive neonatal care, including oxygen therapy.

“No one had looked at ROP and autonomic drug use,” Hussein said. “Now we have, and now more research can be done to find a cause.”

Until then, Hussein said he is not ready to advocate recommendations regarding the use or the dose of the autonomic nervous system drugs used in neonatal intensive care units.

“These medications are used a lot in the NICU, so I’m not saying don’t use them,” he said. “More studies need to be done.”

Ultimately, Hussein said he hopes his research will lead to the cause of ROP as well as a way to prevent and better treat the disease, which affects between 5 percent and 8 percent of NICU babies in developed countries and up to 30 percent of NICU babies in developing countries.

“ROP is a big problem for pediatric ophthalmologists,” Hussein said, adding that the disease is becoming more prevalent with the increased survival rate of premature babies. “There is a real need for more information.”

September 30, 2014

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The Jan and Dan Duncan Neurological Research Institute (NRI) at Texas Children’s and Baylor College of Medicine welcomed two new faculty members, Dr. Akash Patel and Dr. Mingshan Xue.

“I am thrilled to have Dr. Patel and Dr. Xue launch their independent research careers at the NRI,” said Dr. Huda Zoghbi, founding director of the NRI. “Dr. Xue has a stellar track record and is one of the most innovative scientists that I know. Dr. Patel is one of those rare neurosurgeons who chooses to do basic research while maintaining an active neurological practice.”

Akash Patel and Mingshan Xue launch their research careers at the NRI.

Dr. Akash Patel
Patel, an assistant professor in the department of Neurosurgery at Baylor and the NRI, is a neurosurgeon who specializes in the treatment of malignant and benign tumors of the brain and skull base. His clinical interests include neuroendoscopy and minimally invasive neurosurgery, awake craniotomy and brain mapping for tumors in eloquent regions of the brain, and surgery for deep brain tumors: intraventricular, pineal, insular and brainstem.

Patel is a member of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons. He earned an undergraduate degree in biochemistry from Rice University. While earning his medical degree at Baylor, Patel explored his interest in genetics and basic research by working in the laboratory of Zoghbi. He continued to work under Zoghbi’s mentorship as he completed his residency in neurosurgery at Baylor and MD Anderson, and developed a passion for research.

Patel’s research focuses on determining the molecular underpinnings of inherited and sporadic forms of various brain tumors, including gliomas, meningiomas, and acoustic neuromas. He is particularly interested in studying tumors that are part of inherited tumor syndromes as a means to gain insight into more common, sporadic forms of these tumors. His ultimate goal is to help translate these findings into targeted therapies to treat common and aggressive cases.

Dr. Mingshan Xue
Xue is an assistant professor in the department of Neuroscience at Baylor. He is also a member of the Cain Foundation Laboratories and the NRI.

Xue earned his undergraduate degree in biology from Fudan University in Shanghai, China. He obtained his Ph.D. in neuroscience from Baylor and completed his postdoctoral training at the University of California in San Diego.

Xue’s research explores the communication mechanisms of cortical circuits in the brain that control motor, sensory and cognitive functions, and how dysfunction and abnormal neural circuit development can contribute to the pathogenesis of neurological disorders such as autism and childhood epilepsy. Xue’s primary goal is to translate these findings into new therapeutic interventions to treat developmental disorders.

Xue is eager to begin his contribution to the NRI, saying, “The NRI offers an exciting opportunity to collaborate with world-class researchers from diverse backgrounds to improve the quality of life for patients with devastating neurological disorders.”

The NRI at Texas Children’s and Baylor is a basic research institute committed to understanding the pathogenesis of neurological diseases with the ultimate goal of developing treatments to improve the quality of life for patients.

September 9, 2014

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Physicians at the Fetal Center completed their first fetoscopic procedure to repair spina bifida in-utero – an innovative approach that was developed by Dr. Michael Belfort, obstetrician and gynecologist-in-chief at Texas Children’s Pavilion for Women and Dr. William Whitehead, pediatric neurosurgeon at Texas Children’s.

“Our hope is that these types of innovations will lead us to a new era of fetal medicine and surgery,” Belfort said.

Myelomeningocele, or open neural tube defect (NTD), is a form of spina bifida and occurs in 3.4 out of every 10,000 live births in the U.S. and is the most common permanently disabling birth defect for which there is no known cure. Myelomeningocele is a developmental defect in which the spine is improperly formed and the spinal cord is open to, and fused with, the skin. It is usually associated with hydrocephalus, or the buildup of cerebrospinal fluid in the brain, which requires surgical treatment to drain the fluid via an implanted device called a shunt. Originally, closure of the defect occurred after the birth of the baby, which was associated with an 80-90 percent chance that a shunt would be required for life.

But after a breakthrough NICHD-funded study entitled the Management of Myelomeningocele Study (MOMS) demonstrated a significant decrease in the risk of hydrocephalus for select patients undergoing fetal closure of the spine, as well as possible improvement in lower extremity function, compared to patients who underwent standard closure after birth, the Fetal Center adopted this as a treatment option and began performing open fetal surgery to treat spina bifida. To date, we still have one of only a handful of centers in the country that is able to perform this complex in-utero repair. Texas Children’s Fetal Center has completed 23 of these surgeries since 2011, with excellent results.

This technique, the standard of care in the US, involves a uterine incision and can cause maternal complications. With this in mind, the team at the Fetal Center wanted to focus on reducing the risks to the mother and countering the risks of preterm delivery. Working in conjunction with Dr. Jose Luis Peiro and Dr. Elena Carreras of Vall D’Hebron Hospital in Barcelona, Spain, they developed a fetoscopic approach to the repair.

The surgery was over three years in the making and features an in-utero, single layer, sutured repair through only two, four millimeter incisions in the uterus (rather than the 5-6cm opening that is required for an open procedure). In order to practice and perfect performing the closure using a minimally invasive fetoscopic approach, the team built a simulator using a child’s kickball that replicated the mother’s uterus. Inside the kickball, a doll acted as the fetus including a spina bifida defect on the doll’s back. Drs. Belfort and Whitehead practiced closing the defect using a team approach in which they both carry out specific parts of the surgery in a coordinated fashion. The two surgeons performed more than 30 simulated procedures including two full simulations, gowned and gloved, under actual OR conditions with a full support team.

“We have a magnificent team of specialists from a number of departments working together in the best interests of our fetal and neonatal patients. I am incredibly proud to be a member of this outstanding team and to be able to play a role in this mission,” Belfort said.

With a multi-disciplinary structured program in place, clinical planning and training and full Institutional Review Board approval for this experimental procedure, the team performed the first in-utero spin bifida closure on their first patient on July 30, 2014. The procedure went as planned and so far mom and baby are doing well. Doctors are optimistic and are waiting to access the outcome of the repair once the baby has been delivered.

“It is important to note that this mother has not been exposed to a significant uterine incision and we are much less concerned about her risk of a ruptured uterus during this pregnancy than we are after an open repair,” Belfort said. “We look forward to an uneventful delivery and a healthy baby.”

In addition to an expert operating room team and nursing staff, a multidisciplinary team of specialists led this first surgery at Texas Children’s Fetal Center, including Dr. Michael Belfort, Dr. William Whitehead, Dr. Alireza Shamshirsaz, Dr. Oluyinka O. Olutoye, Dr. Olutoyin Olutoye, Dr. David Mann, and Dr. Rodrigo Ruano.

“With the ever-advancing technology and imaging capabilities and dedicated surgeons, I am excited to see what the future holds when it comes to repairing anomalies fetoscopically,” Belfort said. “I am so impressed by what can be achieved with our exceptional team.”

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Christian Spear puts on her headphones and closes her eyes as she stands next to a purple microphone. The former American Idol contestant is not on the stage performing in front of thousands, and she’s not competing in a television program anymore, but she is performing with all of the same passion. She is singing from the heart inside the Purple Songs Can Fly studio at Texas Children’s Cancer Center. It’s a song she wrote and composed along with Anita Kruse, founder and executive director of Purple Songs Can Fly. The program gives patients in the cancer center the chance to compose their own songs and Spear has signed on to be a songwriter for the year, helping children with their tunes.

“Coming back to Texas Children’s has been nothing short of a full-circle experience for me,” said Spear. “It is always so humbling to be amongst children and families who are enduring the very things I endured years ago.”

Spear is a 15 year cancer survivor. She received her treatment right here at this very hospital, and now she is proud to be here hoping to inspire each child she meets. Today, her personal experience and the kids’ battles have inspired the lyrics to her latest song, No One Fights Alone. The song is about uniting in the fight against cancer and it’s dedicated to children at Texas Children’s Cancer Center and beyond. It is in honor of Childhood Cancer Awareness Month. When she opens her mouth and the song lyrics spill out, the emotions are palpable.

“Cancer can’t steal away your joy or ever dim your light,” Spear sings with raw emotion. “Cancer can’t break your spirit or take away your will to fight.”

Take action! Share the video on social media and use the hashtag #NoOneFightsAlone to share your personal stories.

She said having survived cancer inspires so many areas of her life, especially her songwriting.

“I was able to grow with a completely new outlook on life,” said Spear. “I try to find joy in everything around me and it’s inspired my songs to always have a message of hope.”

“Because Christian is a childhood cancer survivor herself, she embodies the spirit of hope, courage, resilience, creativity, connection and love that we all seek,” said Kruse.

Spear’s time at the hospital is spent with the children, and it’s clear she relates to them on a different level. Being a survivor gives her a special connection with those who are still fighting the disease. Her former physician, Dr. ZoAnn Dryer, is among her many fans.

“Stories like Christian’s are what help all of us get up in the morning with a smile on our faces and literally a song, usually hers, in our hearts,” said Dryer. “Christian is a blessing to all, and I am so very proud to introduce her to my patients undergoing therapy so they can truly begin to believe there is light at the end of the ‘cancer tunnel.’”

Spear recently sang her song at a ribbon-tying ceremony which brought together patients and staff to tie more than 600 gold ribbons, each signifying one patient diagnosed with cancer at the cancer center over the last year. Nationally, more than 15,000 children will be diagnosed in one year. The cancer center also provides supportive care to children with cancer in five African counties: Botswana, Uganda, Malawi, Tanzania and Swaziland.

“Our patients serve as our inspiration to provide the best quality medical and psychosocial care, conduct state-of-the art research and train our future leaders in the field,” said Dr. David Poplack, chief of Texas Children’s Cancer Center.

The ribbons will be on display all month at the children’s playground on the first floor of Abercrombie Building. It’s a small reminder of the universal message that no one fights alone.

View photos from the event

“‘No One Fights Alone’ means whether I’m battling a disease, or just having a bad day, I will never be without the love and support of my friends and family,” said Spear. “That’s what I hope to leave each listener with, love and support to bring them joy.”