May 16, 2017

Dr. Sundeep Keswani, surgical director of Basic Research and pediatric surgeon at Texas Children’s Hospital and associate professor of surgery in the Division of Pediatric Surgery at Baylor College of Medicine, was recently awarded a $300,000 grant over a period of three years for his project “Targeting the Extracellular Matrix: an Innovative Strategy to Improve Pulmonary Hypertension in Congenital Diaphragmatic Hernia.”

The award was from the March of Dimes Foundation, which supports research consistent with its mission to improve the health of babies by preventing birth defects, premature birth and infant mortality. Less than 10 percent of applications submitted annually to the foundation are awarded.

The focus of Keswani’s awarded research is to understand the molecular mechanisms of neonatal pulmonary hypertension and develop new innovative therapies for these patients.

“The data and ideas in this application were developed here at Texas Children’s and are a direct result of the support we have received from the Department of Surgery and the hard work of our team,” Keswani said. “This work illustrates the need for surgeons to engage in basic science research to take observations from the bedside to the bench with the overall goal of improving patient outcomes.”

Keswani is a member of the pediatric surgery and fetal surgery teams at Texas Children’s and the principal investigator for the Texas Children’s Laboratory for Regenerative Tissue Repair. His NIH-funded laboratory was launched about two years ago and spans all 10 surgical divisions at Texas Children’s. Researchers in the lab study the molecular mechanisms of regenerative fetal tissue repair and are actively developing novel therapeutics to achieve postnatal regenerative wound healing.

“Conducting research is essential to provide new techniques and treatments for children’s surgery,” said Texas Children’s Surgeon-in-Chief Dr. Charles D. Fraser Jr. “Dr. Keswani’s recent award from the March of Dimes is an example of how the Department of Surgery is continuing to grow in this area, bringing in new funding and contributing significant research findings. We are committed to basic and translational research by supporting surgeon-scientists at Texas Children’s Hospital.”

Other recent awards garnered by researchers in the Regenerative Tissue Repair Lab include:

Balaji receives Wound Healing Foundation Research Grant

Dr. Swathi Balaji received the 2017 Wound Healing Foundation-FLASH Clinical Wound Healing Grant Award for her proposal titled “Pathogenesis of Cutaneous Fibrosis and Scarring.”

It is unknown why some individuals heal with robust fibrosis and scarring while others heal from similar injuries with less scarring. Balaji and her colleagues want to understand how immunoregulatory factors, particularly lymphocytes, make decisive contributions to dermal fibrosis. They propose that there are fundamental biologic differences in how fibroblasts and lymphocytes crosstalk to influence scar formation in different people. At the completion of this study, their team hopes to better understand how inflammation shapes scar formation and start working towards the development of innovative tools to promote immune regulatory responses in wounds to prevent dermal scarring as well as help other disease processes characterized by excessive fibroplasia.

The Wound Healing Foundation (WHF), through the support of the Wound Reach Foundation presented this award to Balaji at the 2017 Wound Healing Society Annual Meeting in San Diego.

Basic science research conducted by Balaji received national awards

Balaji was this year’s recipient of the ACell Young Investigator Faculty Award presented to a junior faculty member for a research abstract at the Regenerative Medicine Workshop at Hilton Head. Balaji presented a keynote lecture on her work titled “Effect of Stretch on Extracellular Matrix and Morphology of Fibroblasts in Regenerative Wound Healing.”

Tissue repair after an injury can have a spectrum of fibrosis outcomes, and fibroblasts are the major cell type that regulates the extracellular matrix and fibrosis. Even within a single tissue, fibroblasts exhibit considerable functional diversity in response to different environmental factors such as biomechanical tension and inflammation.

Balaji and her colleagues want to explain the signaling mechanisms among fibroblasts that communicate and regulate their fibrogenic phenotype. Their group is studying the role of exosomes, which are microvesicles on the order of 30-150 nm and contain functional biomolecules such as proteins, lipids, RNA, miRNA, as biomarkers and/or targeted therapeutics to regulate the functional diversity of tissue fibroblasts and their cellular cross talk.

Dr. Monica Fahrenholtz, the postdoctoral fellow on this research project, received the Wound Healing Society trainee travel award at the conference. She gave a quick presentation at this year’s annual meeting.

Hearing the words, “you’re pregnant” can be an exciting, life-changing moment. But for many couples struggling with infertility, the journey to parenthood is frustrating, stressful, and can at times feel hopeless.

For almost two years, Brooke Schmitt and her husband, Daniel, struggled to start a family, but infertility issues got in the way of achieving their dream of parenthood.

“My OB/GYN ran several tests, and it turned out that my numbers were really low,” Brooke said. “Since my ovaries were not releasing eggs, my doctor recommended that I consult with a fertility specialist.”

After consultations with other providers, Schmitt chose the Family Fertility Center at Texas Children’s Pavilion for Women, a regional and national leader in providing advanced fertility services to families who have had difficulty conceiving.

Since opening in July 2014, the center’s reputation was strengthened even more in 2016 when its success rates for in-vitro fertilization (IVF) reached a milestone – 47 percent of embryo transfer patients at the Center achieved clinical pregnancy.

Dr. William Gibbons, chief of Reproductive Medicine at the Pavilion for Women and founding director of the Family Fertility Center, credits the Center’s success to numerous factors – state-of-the-art technology, research and support of Texas Children’s Hospital.

“Texas Children’s allowed me to have resources that many IVF programs don’t have,” Gibbons said. “They enabled us to build the absolute best lab that we could have, and we have almost as much research lab space as clinical lab space.”

The Family Fertility Center is the first in Houston and among the early adopters in the U.S. to offer the EmbryoScope, an embryo monitoring system that provides continuous moving time-lapse images of embryos as they grow. This technology allows fertility specialists to identify the healthiest embryo to transfer to the patient to improve IVF success.

Realizing the uncertainties that often accompany fertility treatments, the Schmitts relied on the Center’s expertise and state-of-the-art capabilities to help facilitate their dream of becoming parents. After consulting with their reproductive endocrinologist Dr. Paul Zarutskie, Brooke and her husband elected to pursue IVF.

“I was really lucky – my numbers were great,” Brooke said. “They retrieved about 41 eggs, and 39 of them fertilized successfully.”

At the end of day five, 12 of Brooke’s embryos were still living. All of them underwent genetic testing, and five of them were healthy. She and her husband, Daniel, implanted an embryo. The other four healthy embryos were cryogenically preserved for future implantation.

Brooke was implanted with an embryo on February 5, 2016. After undergoing blood work to confirm the couple was pregnant, the test came back positive.

Their daughter, Sophia, was born October 19, 2016.

“It’s a surreal feeling to know that you’re a parent and you’ve made this baby,” Brooke said. “We know we couldn’t have made her without the help of Dr. Zarutskie and the fertility team. Between the talent and the state-of-the-art technology there, it was a perfect combination that produced a perfect outcome.”

To read more about the Schmitts’ story in Texas Children’s Annual Report, click here. To learn more about Texas Children’s Family Fertility Center, click here.

May 9, 2017

Texas Children’s recently received an impressive report card from The Joint Commission with surveyors commending the hospital for demonstrating several best practices.

“Our survey results are a great indication that we are meeting the expectation of quality care for our patients,” said Texas Children’s President and CEO Mark A. Wallace. “This should only propel us to continue our focus on providing safe, quality care every single day for every one of our patients.”

Every three years, Texas Children’s undergoes an accreditation process to ensure our delivery of high-quality patient care. On May 1, the Joint Commission survey team arrived at Texas Children’s for a 5-day unannounced survey. The surveyors consisted of an administrator, a pediatrician and ambulatory specialist, four pediatric and OB/GYN nurses, and a life safety engineer.

What Joint Commission noted

The survey is intended to assess the organization’s compliance in patient care areas that contribute to positive outcomes and to measure and improve performance. The Joint Commission team was very impressed with our improved outcomes in asthma, diabetes, radiology efficiency and flow, patient flow and surgical complications.

The team also identified several best practices observed during the survey including:

  • Time out processes across the system
  • NICU infection control practices
  • Error prevention technology in the anesthesia and pharmacy areas
  • Critical lab documentation
  • Simulation of new buildings and processes for latent safety threats

“The Joint Commission survey team visited several Texas Children’s facilities to evaluate patient care processes through on-site observations, staff interviews and tracer methodology,” said Texas Children’s Quality and Safety Director Elaine Whaley. “This year, Joint Commission implemented a new survey methodology called Survey Analysis for Evaluating Risk (SAFER), a matrix that uses a color-coded grid to evaluate the likelihood of harm to our patients, staff and visitors based on the number of occurrences.”

The surveyors were impressed with the knowledge and confidence exhibited by staff and faculty who participated in the tracer interviews. They complimented them on their ability to navigate Epic and explain the continuum of care, and they were impressed by our staff’s ability to talk about quality projects and outcomes.

How we prepared for the survey

Preparing for regulatory surveys is an ongoing process underscored by Texas Children’s daily focus on patient safety and high quality programs. Texas Children’s uses a consultant on an ongoing basis to review our processes and evaluate our survey readiness. The information provided by the consultant helps the organization fine tune.

“The results we get from area tracers during the preparation process provide information we need to develop and implement an organization-wide readiness education program,” said Danyalle Evans, Texas Children’s assistant director, System Accreditation and Readiness. “We regularly evaluate our internal processes against regulatory guidelines to identify opportunities for improvement. Regulatory surveys are valuable evaluation tools, but we have a deliberate focus on the quality and safety of our patients’ care every day.”

The Joint Commission accredits and certifies more than 20,500 health care organizations and programs in the United States. Approximately 77 percent of the nation’s hospitals are accredited by The Joint Commission.

Each year, Texas Children’s produces an annual report spotlighting the breadth, depth and growth of our organization. The report typically is in the form of a book that is mailed out to tens of thousands of our health care peers, government and community leaders, donors and other internal and external constituents.

This year we have a new way to share our experiences that will reach you and anyone with whom you wish to share it – the Texas Children’s Hospital online Annual Report. The report went live this week and is a dynamic representation of our growth and success in 2016.

Throughout the site, you will find articles, pictures, videos and graphics that highlight our patients, staff and growth. You also can hear directly from our President and CEO Mark Wallace in a video address about our year and what’s to come.

Each section of the site – news, notes and numbers – gives you an opportunity to experience how and why Texas Children’s health care system continues to get bigger and even better.

“At Texas Children’s, we are so passionate about our work and our mission that it is easy to get swept up in the incredible pace at which we move, build and expand,” Wallace said. “We get a lot done in the span of one short year, and 2016 was no different.”

Read all about it at texaschildrensannualreport.org. Share the link to the online report with friends and colleagues, and encourage them to do the same.

Dr. Jordan Orange has been selected to receive a 2017 Michael E. DeBakey, M.D., Excellence in Research Award, a prestigious honor given annually to Baylor College of Medicine faculty who have made the most significant published scientific contribution to clinical or basic biomedical research during the past three years.

Orange’s peers – Drs. Emily Mace, Lisa Forbes and Tiphanie Vogel – nominated him for the award in honor of his work as a distinguished pediatrician-scientist who has made seminal contributions to the fields of clinical immunology, basic immunology and cell biology.

Specifically, they highlighted three papers that represent the breadth, caliber and recent impact of Orange’s work as chief of the Section of Immunology, Allergy and Rheumatology and director of the Center for Human Immunobiology. These papers were published in Nature Genetics, the Journal of Clinical Investigation and the Journal of Cell Biology and are described in greater detail below.

“Dr. Orange orchestrates a vibrant and successful clinical and basic research program applying cutting-edge cell biology to questions of important clinical relevance,” Mace said. “In addition to being a pioneer in the field of NK cell deficiency and an international authority in the study and treatment of primary immunodeficiency, he is also a world’s expert in the field of highly quantitative imaging, including super-resolution and total internal reflection microscopy.”

Mace added that Orange’s scientific accomplishments are paralleled only by his success as a leader and mentor.

“His scientific vision and innovation are combined with tireless dedication to both teaching and learning,” she said. “We all are honored to count him as a colleague.”

Orange will be presented with the DeBakey, M.D., Excellence in Research Award on May 15. To learn more about the award, click here. To learn more about the scientific research that garnered Orange the DeBakey award, see below.

Nature Genetics – Through collaboration with the Baylor Hopkins Center for Mendelian Genomics, Orange has become a leader in the discovery of novel monogenic causes of primary immunodeficiency. The discovery of COPA syndrome (Watkin et al., Nature Genetics 2015) was the result of a multi-institute collaboration led by Orange. This rare, autosomal dominant autoimmune syndrome leads to arthritis and interstitial lung disease and was identified through whole exome sequencing of affected patients and their unaffected family members. This genetic discovery was validated in Orange’s laboratory by identifying the mechanism of disease through modeling of the impacted pathway. This work was also recognized with the Lee C. Howley Sr. prize for the most outstanding paper of the year by the Arthritis Foundation in 2015.

Journal of Clinical Investigation – NK cells are innate lymphocytes that eliminate infected or diseased cells. The field of primary NK cell deficiency (NKD) is one in which Orange has been a pioneer; he penned one of the first descriptions of NKD in 2003. While rare, NKD is severe and frequently fatal. To date, four monogenic causes of isolated NKD have been published, two of these from Orange’s group. Most recently, Orange led an international team that discovered biallelic mutations in the transcription factor IRF8 are a novel cause of NKD. This paper, published in the Journal of Clinical Investigation in 2017 (Mace et al.), ended a decade-long quest to solve the original published case of NKD. Again, modeling of patient mutations in the Orange laboratory using cutting-edge cell biology revealed the mechanism of impaired NK cell development in a cohort of patients from unrelated families.

Cell Biology – As NK cells lie at the heart of Orange’s research, it is not surprising that understanding NK cell function has been a cornerstone of his basic science program. He has led the field of NK cell biology by using highly quantitative microscopy and image analysis to deeply probe their function. In the January 2017 issue of the Journal of Cell Biology, Hsu et al. describe the purpose of NK cell lytic granule convergence, a mechanism by which NK cells direct their potent cytolytic machinery to prevent damage to bystander cells. This finding, which has important clinical implications for the field of immunotherapy, featured the application of novel technology to mimic an NK cell microenvironment. This work was showcased on the cover of the journal and merited an editorial from the well-known cell biologist Dr. Ira Mellman, as well as a feature on the journal’s weekly podcast.

May 4, 2017

On April 28, the popular Grammy-nominated singer-songwriter Jewel toured Texas Children’s newest full-service community hospital – Texas Children’s Hospital The Woodlands.

The hospital’s chief medical officer Dr. Charles Hankins showed Jewel around the new, state-of-the-art facility and shared early successes of the inpatient hospital, which opened its doors less than a month ago on April 11.

The first stop on the tour was the audiology suite in the Outpatient Building on The Woodlands campus, where the group was treated to a look at the audiology booth which was generously given by Jewel.

Jewel then went room to room on the acute care floor of the inpatient facility talking with patients and families about their experiences, and played board games in the hospital’s playroom. The visit to the hospital brought a refreshing smile to many of the children’s faces.

Later that evening, nearly 600 guests gathered in a lavish tent on the grounds of Texas Children’s Hospital The Woodlands for the hospital’s Grand Opening Gala.

Featuring a big board and live auction, the event co-chaired by Tracey & Sean O’Neal and Johnna & Ryan Edone raised $900,000 for the hospital and was capped off with a performance by Jewel.

The artist shared the inspiration behind her music and her gratitude for the work being done at Texas Children’s.

View a photo gallery below from the tour and from Jewel’s performance at the grand opening gala.

May 3, 2017

On May 1, 2017, surveyors from The Joint Commission arrived at Texas Children’s Hospital to conduct an unannounced 5-day survey to ensure that we are meeting the expectations of delivering the safest, high quality care to our patients and their families.

Every three years, Texas Children’s undergoes an accreditation process by the Joint Commission survey team to access the organization’s compliance in patient care areas that contribute to positive outcomes, and to measure and improve performance.

This week, surveyors will visit Texas Children’s Medical Center Campus, Pavilion for Women, West Campus, The Woodlands, ambulatory clinics, dialysis, and health centers to evaluate our patient care processes through a variety of measurement tools including on-site observations, staff interviews, and tracer methodology. Just this year, the Joint Commission implemented a new survey methodology called Survey Analysis for Evaluating Risk (SAFER), a matrix that uses a color-coded grid to evaluate the likelihood of harm to patients, staff and visitors based on the number of occurrences.

“Our first day of the survey went very well, with surveyors citing positive feedback in several of our patient care and safety protocols,” said Texas Children’s Quality and Safety Director Elaine Whaley. “Since these accreditation surveys are unannounced, preparing for the Joint Commission survey has been a crucial, on-going and continuous process for our employees and staff.”

Next week, Connect will have an article with an overview of this week’s survey.

The Joint Commission accredits and certifies more than 20,500 health care organizations and programs in the United States. Approximately 77 percent of the nation’s hospitals are accredited by The Joint Commission.