Photo of Mobile Stroke Treatment Unit
Photo Credit: NewYork-Presbyterian

New York's No. 1 hospital delivers advanced stroke treatment to New York City patients

NEW YORK (October 11, 2016) — NewYork-Presbyterian, in collaboration with Weill Cornell Medicine, Columbia University Medical Center and the FDNY, is launching the Mobile Stroke Treatment Unit (MSTU), the first of its kind on the East Coast. The MSTU is an emergency vehicle specially equipped to provide immediate, specialized care to patients who may be having a stroke.

Every year, more than 795,000 people in the United States suffer from a blockage in an artery of the brain, making stroke one of the most widespread and debilitating conditions and a leading cause of serious long-term disability in the United States. Such blockages can deprive the brain of blood flow and oxygen, which, over the course of minutes, can lead to death or disability.

"The Mobile Stroke Treatment Unit delivers the most advanced technologies, expert staff and life-saving treatment to more stroke victims in need," said Dr. Steven J. Corwin, president and CEO of NewYork-Presbyterian. "We are very proud to be the only hospital on the East Coast to provide these services. This is a remarkable achievement as we move forward in revolutionizing stroke care."

Staffed by a highly specialized team of two paramedics from the Regional Emergency Medical Services Council of New York City, a computed tomography (CT) technologist and a neurologist, the MSTU is designed to significantly reduce the time from the onset of symptoms to the delivery of care, a crucial factor in improving stroke outcomes. The unit also contains equipment and medications specific to diagnosing and treating strokes, including a medication called tPA, which dissolves the clot and improves blood flow to the part of the brain being deprived of blood in the event of an ischemic stroke. It is complete with a portable CT scanner that can image the patient's brain on the spot to detect if the patient is having a stroke. The CT scan is then wirelessly transmitted to NewYork-Presbyterian, where it is promptly evaluated by a neuroradiologist.

Dr. Matthew Fink, neurologist-in-chief and chief of the Division of Stroke and Critical Care Neurology at NewYork-Presbyterian/Weill Cornell Medical Center and the Louis and Gertrude Feil Professor and chairman of the Department of Neurology at Weill Cornell Medicine; Dr. Richard Mayeux, neurologist-in-chief at NewYork-Presbyterian/Columbia University Medical Center and the Gertrude H. Sergievsky Professor of Neurology, Psychiatry and Epidemiology and chair of the Department of Neurology at Columbia University College of Physicians and Surgeons; and Dr. Randolph Marshall, chief of the Division of Stroke and Cerebrovascular Disease and attending neurologist on the Stroke Service at NewYork-Presbyterian/Columbia University Medical Center and the Elizabeth K. Harris Professor of Neurology at Columbia University College of Physicians and Surgeons, will collectively lead a team of stroke care specialists assigned to the unit.

"The most effective method in saving a stroke victim's life is to diagnose and treat immediately after a stroke occurs," Dr. Fink said. "The MSTU rapidly brings a neurologist and advanced technologies of an emergency room directly to the patient, offering state-of-the-art care that is only moments away. This is just the beginning — there will be a number of innovative clinical treatments that we will be developing in the future for the treatment of stroke in the field."

The New York City 911 System via the FDNY will deploy the unit into communities surrounding NewYork-Presbyterian/Weill Cornell Medical Center at East 68th Street and NewYork-Presbyterian/Columbia University Irving Medical Center at West 168th Street when a patient is experiencing stroke symptoms.

"The FDNY is proud to partner with NewYork-Presbyterian to bring the Mobile Stroke Treatment Unit into the 911 system, making this advanced, life-saving care readily available to patients suffering a stroke," said Fire Commissioner Daniel A. Nigro. "This new unit will work closely with FDNY Paramedics, EMTs and Firefighters on some of the most serious medical calls the Department responds to, increasing the level of pre-hospital care our patients receive, preventing further long-term effects due to patients who have suffered a stroke, and potentially saving many more lives."

The MSTU team will follow up with each patient after admission and gather information about their outcomes after 90 days; the percentage of patients treated on the MSTU who made a full recovery compared to those delivered by standard Emergency Medical Services transport; and overall cost of care. Researchers will share information with similar units throughout the United States for a larger analysis on best treatment practices for emergency stroke care.

The MSTU began serving patients on October 3, 2016. To learn more, visit www.nyp.org/mobile-stroke-treatment-unit.

NewYork-Presbyterian

NewYork-Presbyterian is one of the nation's most comprehensive healthcare delivery networks, focused on providing innovative and compassionate care to patients in the New York metropolitan area and throughout the globe. In collaboration with two renowned medical school partners, Weill Cornell Medicine and Columbia University College of Physicians & Surgeons, NewYork-Presbyterian is consistently recognized as a leader in medical education, groundbreaking research and clinical innovation.

NewYork-Presbyterian has four major divisions: NewYork-Presbyterian Hospital is ranked #1 in the New York metropolitan area by U.S. News and World Report and repeatedly named to the magazine's Honor Roll of best hospitals in the nation; NewYork-Presbyterian Regional Hospital Network is comprised of leading hospitals in and around New York and delivers high-quality care to patients throughout the region; NewYork-Presbyterian Physician Services connects medical experts with patients in their communities; and NewYork-Presbyterian Community and Population Health features the hospital's ambulatory care network sites and operations, community care initiatives and healthcare quality programs, including NewYork Quality Care, established by NewYork-Presbyterian, Weill Cornell and Columbia.

NewYork-Presbyterian is one of the largest healthcare providers in the U.S. Each year, nearly 29,000 NewYork-Presbyterian professionals deliver exceptional care to more than 2 million patients.

For more information, visit www.nyp.org and find us on Facebook, Twitter and YouTube.

Columbia University Medical Center

Columbia University Medical Center provides international leadership in basic, preclinical, and clinical research; medical and health sciences education; and patient care. The medical center trains future leaders and includes the dedicated work of many physicians, scientists, public health professionals, dentists, and nurses at the College of Physicians and Surgeons, the Mailman School of Public Health, the College of Dental Medicine, the School of Nursing, the biomedical departments of the Graduate School of Arts and Sciences, and allied research centers and institutions. Columbia University Medical Center is home to the largest medical research enterprise in New York City and State and one of the largest faculty medical practices in the Northeast. The campus that Columbia University Medical Center shares with its hospital partner, NewYork-Presbyterian, is now called the Columbia University Irving Medical Center. For more information, visit cumc.columbia.edu or columbiadoctors.org.

Weill Cornell Medicine

Weill Cornell Medicine is committed to excellence in patient care, scientific discovery and the education of future physicians in New York City and around the world. The doctors and scientists of Weill Cornell Medicine&mdash:faculty from Weill Cornell Medical College, Weill Cornell Graduate School of Medical Sciences, and Weill Cornell Physician Organization — are engaged in world-class clinical care and cutting-edge research that connect patients to the latest treatment innovations and prevention strategies. Located in the heart of the Upper East Side's scientific corridor, Weill Cornell Medicine's powerful network of collaborators extends to its parent university Cornell University; to Qatar, where Weill Cornell Medicine-Qatar offers a Cornell University medical degree; and to programs in Tanzania, Haiti, Brazil, Austria and Turkey. Weill Cornell Medicine faculty provide comprehensive patient care at NewYork-Presbyterian/Weill Cornell Medical Center, NewYork-Presbyterian/Lower Manhattan Hospital and NewYork-Presbyterian/Queens. Weill Cornell Medicine is also affiliated with Houston Methodist. For more information, visit weill.cornell.edu.

New level of certification recognizes NewYork-Presbyterian Hospital, Columbia University Medical Center and Weill Cornell Medicine as among the best in the nation for the treatment of complex stroke cases

NEW YORK (June 23, 2016) — NewYork-Presbyterian Hospital has been certified by the Joint Commission as a Comprehensive Stroke Center (CSC), the highest level of stroke certification a hospital can receive. They join the elite group of certified Comprehensive Stroke Centers throughout the United States. This marks the first time a hospital has applied for certification with two different sites — NewYork-Presbyterian/Columbia University Medical Center and NewYork-Presbyterian/Weill Cornell Medical Center.

"Achieving advanced certification as a Comprehensive Stroke Center is incredibly important for us. We are extremely pleased to have been awarded this distinction," said Dr. Steven J. Corwin, president and CEO of NewYork-Presbyterian. "This award recognizes the extraordinary advances, research and standard of care that NewYork-Presbyterian, Weill Cornell Medicine and Columbia University Medical Center provide every day for New Yorkers."

The Joint Commission's gold seal is awarded to institutions that provide the most advanced stroke care to patients with exceptional, around-the-clock treatment. According to the Joint Commission, a CSC must meet all the general eligibility requirements for Disease-Specific Care and Primary Stroke Center certification. In addition, CSCs are required to:

• Have dedicated neuro-intensive care unit (ICU) beds for complex stroke patients and provide neuro-critical care 24 hours a day, seven days a week
• Have advanced imaging capabilities
• Maintain 24/7 availability of neurosurgeons, neurologists, neurointerventionalists and neuroradiologists
• Meet minimum volume requirements for: treating patients with a diagnosis of subarachnoid hemorrhage, performing endovascular coiling or surgical clipping procedures for aneurysms, and administering IV tPA
• Coordinate post-hospital care for patients
• Use a peer review process to evaluate and monitor the care provided to patients with ischemic or hemorrhagic stroke
• Participate in stroke research

"At NewYork-Presbyterian, we treat nearly 2,000 stroke patients each year — one of the highest volumes in the world and the highest in Manhattan," said Dr. Corwin. "Our specially trained neurologists, neurosurgeons, neuro-critical care specialists and nurses at NewYork-Presbyterian, Columbia and Weill Cornell all deliver and maintain the most remarkable stroke care, with the best rates of survival and recovery."

The Joint Commission places industry-recognized standards on the clinical practice guidelines and requirements needed for accreditation. These requirements were developed in collaboration with the American Heart Association/American Stroke Association (AHA/ASA). To receive advanced certification, NewYork-Presbyterian underwent a rigorous screening process in April 2016 and received official certification on June 10.

"Stroke is the fifth-leading cause of death in this country," said Dr. Corwin. "It is our responsibility as a leading Comprehensive Stroke Center to treat strokes accurately and effectively in order to save lives and combat the full range of neurological disorders."

For more information on the Joint Commission and American Heart Association's Advanced Certification for Comprehensive Stroke Center, visit www.jointcommission.org.

NewYork-Presbyterian

NewYork-Presbyterian is one of the nation's most comprehensive healthcare delivery networks, focused on providing innovative and compassionate care to patients in the New York metropolitan area and throughout the globe. In collaboration with two renowned medical school partners, Weill Cornell Medicine and Columbia University College of Physicians & Surgeons, NewYork-Presbyterian is consistently recognized as a leader in medical education, groundbreaking research and clinical innovation.

NewYork-Presbyterian has four major divisions: NewYork-Presbyterian Hospital is ranked #1 in the New York metropolitan area by U.S. News and World Report and repeatedly named to the magazine's Honor Roll of best hospitals in the nation; NewYork-Presbyterian Regional Hospital Network is comprised of leading hospitals in and around New York and delivers high-quality care to patients throughout the region; NewYork-Presbyterian Physician Services connects medical experts with patients in their communities; and NewYork-Presbyterian Community and Population Health features the hospital's ambulatory care network sites and operations, community care initiatives and healthcare quality programs, including NewYork Quality Care, established by NewYork-Presbyterian, Columbia and Weill Cornell.

NewYork-Presbyterian is one of the largest healthcare providers in the U.S. Each year, nearly 29,000 NewYork-Presbyterian professionals deliver exceptional care to more than 2 million patients.

For more information, visit www.nyp.org and find us on Facebook, Twitter and YouTube.

Columbia University Medical Center

Columbia University Medical Center provides international leadership in basic, preclinical, and clinical research; medical and health sciences education; and patient care. The medical center trains future leaders and includes the dedicated work of many physicians, scientists, public health professionals, dentists, and nurses at the College of Physicians and Surgeons, the Mailman School of Public Health, the College of Dental Medicine, the School of Nursing, the biomedical departments of the Graduate School of Arts and Sciences, and allied research centers and institutions. Columbia University Medical Center is home to the largest medical research enterprise in New York City and State and one of the largest faculty medical practices in the Northeast. For more information, visit cumc.columbia.edu or columbiadoctors.org.

Weill Cornell Medicine

Weill Cornell Medicine is committed to excellence in patient care, scientific discovery and the education of future physicians in New York City and around the world. The doctors and scientists of Weill Cornell Medicine—faculty from Weill Cornell Medical College, Weill Cornell Graduate School of Medical Sciences, and Weill Cornell Physician Organization—are engaged in world-class clinical care and cutting-edge research that connect patients to the latest treatment innovations and prevention strategies. Located in the heart of the Upper East Side's scientific corridor, Weill Cornell Medicine's powerful network of collaborators extends to its parent university Cornell University; to Qatar, where Weill Cornell Medicine-Qatar offers a Cornell University medical degree; and to programs in Tanzania, Haiti, Brazil, Austria and Turkey. Weill Cornell Medicine faculty provide comprehensive patient care at NewYork-Presbyterian/Weill Cornell Medical Center, NewYork-Presbyterian/Lower Manhattan Hospital and NewYork-Presbyterian/Queens. Weill Cornell Medicine is also affiliated with Houston Methodist. For more information, visit weill.cornell.edu.

Certain types of bacteria in the gut can leverage the immune system to decrease the severity of stroke, according to new research from Weill Cornell Medicine. This finding can help mitigate stroke — which is the second leading cause of death worldwide.

In the study, published March 28 in Nature Medicine, mice received a combination of antibiotics. Two weeks later, the researcher team — which included collaborators at Memorial Sloan Kettering Cancer Center — induced the most common type of stroke, called ischemic stroke, in which an obstructed blood vessel prevents blood from reaching the brain. Mice treated with antibiotics experienced a stroke that was about 60 percent smaller than rodents that did not receive the medication. The microbial environment in the gut directed the immune cells there to protect the brain, the investigators said, shielding it from the stroke's full force.

"Our experiment shows a new relationship between the brain and the intestine," said Dr. Josef Anrather, the Finbar and Marianne Kenny Research Scholar in Neurology and an associate professor of neuroscience in the Feil Family Brain and Mind Research Institute at Weill Cornell Medicine. "The intestinal microbiota shape stroke outcome, which will impact how the medical community views stroke and defines stroke risk."

The findings suggest that modifying the microbiotic makeup of the gut can become an innovative method to prevent stroke. This could be especially useful to high-risk patients, like those undergoing cardiac surgery or those who have multiple obstructed blood vessels in the brain.

Further investigation is needed to understand exactly which bacterial components elicited their protective message. However, the researchers do know that the bacteria did not interact with the brain chemically, but rather influenced neural survival by modifying the behavior of immune cells. Immune cells from the gut made their way to the outer coverings of the brain, called the meninges, where they organized and directed a response to the stroke.

"One of the most surprising findings was that the immune system made strokes smaller by orchestrating the response from outside the brain, like a conductor who doesn't play an instrument himself but instructs the others, which ultimately creates music," said Dr. Costantino Iadecola, director of the Feil Family Brain and Mind Research Institute and the Anne Parrish Titzell Professor of Neurology at Weill Cornell Medicine.

The newfound connection between the gut and the brain holds promising implications for preventing stroke in the future, which the investigators say might be achieved by changing dietary habits in patients or "at risk" individuals.

"Dietary intervention is much easier to accomplish than drug use, and it could reach a broad base," Dr. Anrather said. "This is a little far off from the current study — it's music of the future. But diet has the biggest effect of composition of microbiota, and once beneficial and deleterious species are identified, we can address them with dietary intervention."

Clinicians have long observed that using a "dirty drug" that hits a number of targets instead of just one is the most efficacious approach to treat conditions that cause abnormal heart rhythms. Now, Weill Cornell Medicine researchers have discovered how this kind of drug becomes "dirty."

In the study, published Nov. 16 in The Journal of General Physiology, the investigators identified a possible mechanism involved in the beneficial, as well as toxic, effects of the most popular of the multi-target, antiarrhythmic drugs, amiodarone. These findings may not only impact what drugs doctors prescribe to the approximately 2.7 million American patients with atrial fibrillation — a condition characterized by a quivering, irregular heartbeat that's a major risk factor for stroke — but also lead to more research on this type of drug to guide the development of better options with fewer side effects.

"If you were in the business of bringing new drugs to market, a drug like amiodarone, which takes this promiscuous approach, looks pretty scary," said senior author Dr. Olaf S. Andersen, a Professor of Physiology and Biophysics at Weill Cornell Medicine and director of the Tri-Institutional M.D.-Ph.D. Program. "But when you have a system that is as complicated as the one that regulates rhythm in the heart, it may actually be advantageous to have a number of different targets."

"Until now, there has really been no understanding of how amiodarone can alter so many targets, and why this is important," said first author Dr. Radda Rusinova, an instructor in physiology and biophysics at Weill Cornell Medicine. "Now we have a solid hypothesis that can be followed up on in future studies, and a starting point to figure out how to change this drug to make it better at doing its job."

The investigators, including a collaborator from the University of Arkansas, studied four antiarrhythmic drugs — amiodarone, dronedarone, propranolol and pindolol. Amiodarone was developed in 1967 and is still considered the most effective of the lot, but little was known about how it simultaneously regulates a number of membrane proteins, including potassium channels, other ion channels, and hormone receptors. If one could determine how and why amiodarone works, other scientists down the line could alter it, with the goal of achieving the same outcomes with fewer serious side effects, like hyperthyroidism and negative impacts on the liver, lungs and eyes.

To conduct the work, they used simple synthetic lipid environments, as well as mixtures of lipids to create an environment that's more cell-like — and therefore human-like. They found that at doses that typically would be used therapeutically, amiodarone affects the lipid bilayer — an outside envelope of the cell where membrane proteins reside, which in turn can affect the proteins themselves.

Like amiodarone, dronedarone — which was developed to have fewer side effects — also altered lipid bilayer properties; it was in fact more potent than amiodarone, which might cause dronedarone to become toxic at lower concentrations than amiodarone. This may explain why dronedarone is considered less effective as an antiarrhythmic. Despite seemingly good effects in cellular electrophysiological studies, it becomes difficult to administer safely because it is toxic at lower concentrations, which limits the dosage such that it may take too long to reach effective levels.

"Some drugs just have the right effects on a number of different targets. Amiodarone is one of those drugs," Dr. Andersen said. "That's our key takeaway: Dirty drugs may be good for you."

New York (October 2, 2015) — Renowned heart surgeon Dr. Leonard Girardi has been named chair of the Department of Cardiothoracic Surgery at Weill Cornell Medical College and cardiothoracic surgeon-in-chief at NewYork-Presbyterian/Weill Cornell Medical Center.

In his new role, Dr. Girardi will maintain and enhance the department's distinguished clinical care and biomedical research programs, championing minimally invasive techniques for cardiovascular surgery by recruiting surgeons who will augment the exceptional team already at the medical college. Dr. Girardi, who is also the O. Wayne Isom Professor of Cardiothoracic Surgery, is a Weill Cornell alumnus who has achieved a near 30-year career at the medical college and NewYork-Presbyterian/Weill Cornell. He is recognized for performing complex heart surgeries at the highest level of care.

"Dr. Girardi is an esteemed surgeon, researcher and leader, and we are thrilled that he will serve as chair of cardiothoracic surgery at Weill Cornell," said Dr. Laurie H. Glimcher, the Stephen and Suzanne Weiss Dean of Weill Cornell Medical College. "I have no doubt that he will continue to drive excellence at our already outstanding cardiothoracic program, advancing innovative research and pioneering new procedures to provide the very best in patient care."

"The Department of Cardiothoracic Surgery has an accomplished history of pioneering highly specialized, complex and innovative procedures," said Dr. Steven J. Corwin, CEO of NewYork-Presbyterian Hospital. "As an outstanding member of the Department for many years, Dr. Girardi is ideally suited to further this legacy of high-quality, patient-centered care."

"We have a proud legacy of providing high-quality, exemplary patient care," Dr. Girardi said. "To confidently take on the most difficult cardiothoracic cases, you need the support of the entire institution, and this is where Weill Cornell and NewYork-Presbyterian really shine. I'm honored to lead this department and continue to make innovations in this field."

The Department of Cardiothoracic Surgery, a recognized leader in adult and pediatric heart, lung and esophageal surgery, is dedicated to providing patients with compassionate, quality-driven, comprehensive care in three boroughs of New York City. Its surgeons have expertise in complex procedures, including aortic aneurysm repair and bypass, and they are developing new surgical techniques that lessen recovery time and pain for patients, many of whom are older, sicker and have other illnesses. The department is pioneering minimally invasive robotic techniques for valve surgery and, for the sickest, offers a procedure that enables surgeons to replace patients' unhealthy valves without requiring heart-lung bypass machines to manage the heart's pumping action.

Thoracic surgeons at the department are also using robotic surgeries to remove lung tumors; patients treated this way typically see improved breathing function earlier than they would from open surgery and require less pain medication. Surgeons treating patients with esophageal cancer also utilize minimally invasive techniques. This highly specialized approach has elevated the department to the level of quaternary care — a step above the more common tertiary care — which means that it offers the most advanced treatment options.

In addition, physician-scientists are driving critical discoveries in heart and lung diseases and translating them into new surgical techniques and clinical trials. They are developing and testing minimally invasive surgical approaches to correct an abnormal heart rhythm called atrial fibrillation; leading clinical trials that use immunotherapy to reduce the risk of recurrence in patients with lung and esophageal cancer; and conducting comprehensive genomic studies of cancer tumors to better understand how and why the disease spreads to the lungs. Researchers are also investigating ways to prevent stroke in patients who require aortic repair.

The Department of Cardiothoracic Surgery is also dedicated to training the next generation of surgeons. All of the department's surgeons are full-time members of Weill Cornell's teaching faculty.

Dr. Girardi is a fellow of the American Heart Association and the American College of Surgeons. He has won numerous awards, including an early-career NIH Research Fellowship and a 2004 Stephen Gold Award for Humanitarianism in Medicine. He has published more than 100 research articles in journals; presented at national and international meetings; and serves on the editorial boards of the Journal of Thoracic and Cardiothoracic Surgery, Aorta, and the Journal of Cardiac Surgery. He was section editor for certification materials for surgeons specializing in adult cardiac surgery, and has written numerous book chapters.

Dr. Girardi received his bachelor's degree in biochemistry with honors from Harvard University and his medical degree from Weill Cornell Medical College in 1989 as a member of its honor society, Alpha Omega Alpha. He completed residencies in general surgery and cardiothoracic surgery at NewYork-Presbyterian/Weill Cornell, as well as a one-year fellowship in cardiothoracic surgery under Dr. Michael DeBakey at Baylor College of Medicine. He returned to Weill Cornell and NewYork-Presbyterian in 1997 as a faculty member and attending surgeon.

NewYork-Presbyterian/Weill Cornell Medical Center

NewYork-Presbyterian/Weill Cornell Medical Center, located in New York City, is one of the leading academic medical centers in the world, comprising the teaching hospital NewYork-Presbyterian and Weill Cornell Medical College, the medical school of Cornell University. NewYork-Presbyterian/Weill Cornell provides state-of-the-art inpatient, ambulatory and preventive care in all areas of medicine, and is committed to excellence in patient care, education, research and community service. Weill Cornell physician-scientists have been responsible for many medical advances — including the development of the Pap test for cervical cancer; the synthesis of penicillin; the first successful embryo-biopsy pregnancy and birth in the U.S.; the first clinical trial for gene therapy for Parkinson's disease; the first indication of bone marrow's critical role in tumor growth; and, most recently, the world's first successful use of deep brain stimulation to treat a minimally conscious brain-injured patient. NewYork-Presbyterian Hospital also comprises NewYork-Presbyterian/Columbia University Medical Center, NewYork-Presbyterian/Morgan Stanley Children's Hospital, NewYork-Presbyterian/Westchester Division, NewYork-Presbyterian/The Allen Hospital, and NewYork-Presbyterian/Lower Manhattan Hospital. The hospital is also closely affiliated with NewYork-Presbyterian/Hudson Valley Hospital, NewYork-Presbyterian/Lawrence Hospital and NewYork-Presbyterian/Queens. NewYork-Presbyterian is the #1 hospital in the New York metropolitan area, according to U.S. News & World Report, and consistently named to the magazine's Honor Roll of best hospitals in the nation. Weill Cornell Medical College is the first U.S. medical college to offer a medical degree overseas and maintains a strong global presence in Austria, Brazil, Haiti, Tanzania, Turkey and Qatar. For more information, visit www.nyp.org and weill.cornell.edu.

Weill Cornell Medical College

Weill Cornell Medical College, Cornell University's medical school located in New York City, is committed to excellence in research, teaching, patient care and the advancement of the art and science of medicine, locally, nationally and globally. Physicians and scientists of Weill Cornell Medical College are engaged in cutting-edge research from bench to bedside aimed at unlocking mysteries of the human body in health and sickness and toward developing new treatments and prevention strategies. In its commitment to global health and education, Weill Cornell has a strong presence in places such as Qatar, Tanzania, Haiti, Brazil, Austria and Turkey. Through the historic Weill Cornell Medical College in Qatar, Cornell University is the first in the U.S. to offer a M.D. degree overseas. Weill Cornell is the birthplace of many medical advances — including the development of the Pap test for cervical cancer, the synthesis of penicillin, the first successful embryo-biopsy pregnancy and birth in the U.S., the first clinical trial of gene therapy for Parkinson's disease, and most recently, the world's first successful use of deep brain stimulation to treat a minimally conscious brain-injured patient. Weill Cornell Medical College is affiliated with NewYork-Presbyterian Hospital, where its faculty provides comprehensive patient care at NewYork-Presbyterian Hospital/Weill Cornell Medical Center. The Medical College is also affiliated with Houston Methodist. For more information, visit weill.cornell.edu.

Dr. Costantino Iadecola Wins Excellence Award in Hypertension Research

Dr. Costantino Iadecola, director of the Feil Family Brain and Mind Research Institute and the Anne Parrish Titzell Professor of Neurology, has won the 2015 Excellence Award for Hypertension Research from the American Heart Association's Council on Hypertension.

Dr. Costantino Iadecola

The accolade, sponsored by Novartis, is the council's most prestigious award and carries a $10,000 honorarium. It recognizes researchers' contributions to the field of hypertension that have led to improved treatment and a greater understanding of high blood pressure.

A neurobiologist and neurologist, Dr. Iadecola was honored for his research into the connection between hypertension and stroke and Alzheimer's disease. He discovered that blood vessels in the brain are uniquely and highly susceptible to the effects of hypertension. The resulting damage to the vessels may lead not only to stroke and vascular dementia, but also to an increased risk of developing Alzheimer's disease. Dr. Iadecola received the award at a reception on Sept. 18 during the American Heart Association's 2015 Hypertension Scientific Sessions in Washington, D.C. Dr. Iadecola also gave a lecture during the four-day conference.

"I am honored and humbled to have been selected for this award, which I am delighted to accept on behalf of my associates in the Feil Family Brain and Mind Research Institute who made the research possible," Dr. Iadecola said.

"This recognition has been typically bestowed on scientists working on the heart and blood vessels," he added. "Giving this award for research on the link between high blood pressure and Alzheimer's disease highlights the fact that the hypertension community worldwide acknowledges that the brain is a critical target of hypertension. This realization strengthens my resolve to continue this work, with the ultimate goal of developing new therapies to shield the brain from the devastating impact of hypertension."

Additional Awards and Honors

Dr. Wallace Carter, an associate professor of emergency medicine in clinical medicine and an adjunct associate professor of clinical medicine, received the Council of Emergency Medicine Residency Directors CORD Impact Award at its annual academic assembly on April 15 in Phoenix. The council is a scientific and educational organization focused on improving the quality of emergency medical care, enhancing the quality of emergency medicine instruction and encouraging communication between the faculty of various emergency medicine training programs. The Impact Award is given annually to faculty members who have made significant contributions toward those goals.

Dr. Marisa Censani, an assistant professor of pediatrics, was appointed to the Pediatric Endocrine Society's Obesity Committee for a three-year term, effective May 1. The society's mission is to advance the care of children and adolescents with endocrine disorders. The committee focuses on the problem of childhood and adolescent obesity caused, at least in part, by endocrine disorders.

Dr. Nikolaos Skubas, a professor of clinical anesthesiology and of anesthesiology in clinical cardiothoracic surgery, was elected into the Society of Cardiovascular Anesthesiologists Nominating Committee in May for a two-year term. The society is an international organization of anesthesiologists that promotes excellence in clinical care, education and research in the subspecialty.

Patients who develop an infection of the heart valves, known as bacterial endocarditis, have an elevated risk of stroke beginning four months before and up to five months after diagnosis — a period significantly longer than previously reported, researchers from Weill Cornell Medical College and NewYork-Presbyterian Hospital found in a new study, published July 10 in the journal Neurology.

Veins in the head, artwork. Credit: Getty Images

Some 40,000 people are diagnosed each year with endocarditis, a condition that primarily affects the elderly and those who have damaged or artificial heart valves or other heart conditions. Stroke is a complication of the condition, which can occur when clumps of bacteria and cell fragments that have formed at the site of infection in the heart break loose and travel through the bloodstream to the brain.

Earlier research found that patients face an increased risk for stroke within a few weeks after an endocarditis diagnosis. However, in their study, the Weill Cornell and NewYork-Presbyterian investigators found that the risk for stroke actually extends to nine months, with the greatest risk occurring within a month after diagnosis, during which time a patient is 90 times more likely to have a stroke. This study — and the correlation between endocarditis and stroke — is important because the findings impact how patients are treated.

"Strokes are treated differently if they're from an infective source," said the study's co-first author, Dr. Alexander Merkler, a neurocritical care fellow at NewYork-Presbyterian/Weill Cornell Medical Center. "Patients who have a stroke due to endocarditis are not candidates for an effective clot-busting drug, called tPA, but they are still eligible for other potentially life-saving measures, like clot retrieval.

"A patient who has a stroke that may be caused by endocarditis really needs a multidisciplinary team of clinicians, including a neurologist, a cardiologist, a cardiothoracic surgeon and an infectious disease specialist," he added.

To better quantify the link between the two conditions, the investigators, under the mentorship of Drs. Hooman Kamel and Babak Navi, who are both assistant professors of neurology and of neuroscience in the Department of Neurology and the Feil Family Brain and Mind Research Institute at Weill Cornell and neurologists at NewYork-Presbyterian/Weill Cornell, turned to a de-identified administrative claims database from California. They selected anyone who was diagnosed with infective endocarditis in a four-year term between July 1, 2007 and June 30, 2011. Based on diagnosis codes, they found nearly 18,000 patients who fit this criteria.

Next, they looked through that patient pool for anyone who also had a stroke within a one-year period (six months before and six months after they were diagnosed with endocarditis) and found 2,275 people who fit the bill. To determine the relationship between endocarditis and stroke, they compared the risk of stroke in one-month periods from six months before to six months after the diagnosis of endocarditis to the corresponding period two years earlier, called the baseline risk of stroke. Using this method, each patient served as his or her own control.

The data told a story: Patients who were diagnosed with endocarditis were at a very elevated risk for having a stroke. The risk of stroke was highest in the month following endocarditis diagnosis, when patients were 90 times more likely to have a stroke than if they did not have endocarditis. The risk of stroke was increased four months before a diagnosis of endocarditis and lasted for five months after the diagnosis of endocarditis.

With further research and further insight into the relationship between endocarditis and stroke, there may be a way to prevent strokes from occurring in this population, Dr. Merkler said. But in the meantime, he advises that patients should be vigilant for symptoms of stroke and should immediately call 911 if they occur.

High-density lipoprotein (HDL) is often referred to as "good" cholesterol because it transports fat molecules out of blood vessels, protecting against stroke and heart disease. Now, researchers at Weill Cornell Medical College have discovered that HDL in blood also carries a protein that powerfully regulates immune function. Together they play an important role in preventing inflammation in the body.

In the study, published June 8 in Nature, the investigators found that a lipid molecule called sphingosine 1-phosphate (S1P) that is bound to HDL suppresses the formation of T and B immune cells in the bone marrow. In doing so, HDL and S1P block these cells from launching an abnormal immune response that leads to damaging inflammation, a hallmark of many disorders including autoimmune diseases, cardiovascular disease and neuroinflammatory disease, such as multiple sclerosis.

"Our study shows that S1P that is bound to HDL helps prevent inflammation in many tissues," said senior investigator Dr. Timothy Hla, director of the Center for Vascular Biology and a professor of pathology and laboratory medicine at Weill Cornell. "When there is less S1P that is bound to HDL in blood, there are more B and T cells that can be activated to produce unwanted inflammation."

Dr. Hla has been studying S1P for more than two decades. He discovered that it is a key regulator of vascular function, and that about 65 percent of S1P in blood is bound to apolipoprotein M (ApoM), a member of the lipoprotein family, within the HDL particle. But until this study, the researchers did not know what specific function HDL-bound S1P served.

The team, including first author Dr. Victoria Blaho, an instructor in pathology and laboratory medicine, and researchers from the National Institutes of Health and Stanford University, studied mice that lacked HDL-bound S1P.

Dr. Timothy Hla. Photo credit: Carlos Rene Perez

Mice lacking HDL-bound S1P developed worse inflammation in a model of multiple sclerosis. The reason for this, the investigators found, is that HDL-bound S1P suppresses the formation of T and B immune cells in the bone marrow. While both immune cells help fight infection, an overabundance of these cells can also trigger unwanted inflammation.

The findings help explain why blood HDL levels are such an important measure of cardiovascular health, Dr. Hla said.

"Blood HDL levels are associated with heart and brain health — the higher the HDL in blood, the less risk one has for cardiovascular diseases, stroke, and dementia," Dr. Hla said. "The corollary is that the lower the HDL, the higher the risk of these diseases." Blood levels of ApoM and S1P have not been studied in these diseases.

The findings further suggest that molecules that mimic HDL-bound S1P could be useful in reducing damaging inflammation that has gone awry, Dr. Hla said. Such molecules are not known and will need to be developed in the future.

However, a related S1P1 receptor inhibitor called Gilenya, has already been approved for use in multiple sclerosis, a condition in which the immune system attacks nerve fibers due to unwanted inflammation, Dr. Hla said.

"The unique function of HDL-S1P could be further exploited for innovative therapeutic opportunities," he said.

For this research, Dr. Blaho received funding from the National Institutes of Health (F32 CA14211), the New York Stem Cell Foundation (C026878) and the Leon Levy Foundation (supported through the Feil Family Brain and Mind Research Institute). Dr. Hla received funding from the NIH (HL67330 and HL89934), as well as through Fondation Leducq.

Dr. Olga Boudker, an associate professor of physiology and biophysics at Weill Cornell Medical College, has been named a Howard Hughes Medical Institute Investigator, a prestigious honor that comes with unrestricted, flexible and long-term research support. Dr. Boudker's research in the Department of Physiology and Biophysics focuses on how glutamate pumps, which play an important role in brain function, work on the molecular level. This research will help researchers develop new therapies to treat patients with brain disease and injury.

The Howard Hughes Medical Institute (HHMI) is a science philanthropy that commits more than $600 million annually to support top biomedical researchers from across the country that it believes can make significant contributions to science. This year, Dr. Boudker was one of just 26 scientists to be awarded the HHMI Investigator designation out of a pool of about 900 applicants.

"This award means so much to me, and I'm incredibly humbled to receive it," Dr. Boudker said. "It is recognition of my work, and comes with an enormous amount of freedom, but also with increased pressure and a lot more responsibility."

Dr. Boudker's work in structural biology began with a drive to understand how brain cells communicate with each other in everyday processes like memory, cognition and thought. An important component of that communication between brain cells is a molecule called glutamate, a neurotransmitter that must be passed from one cell to another when they "talk." Glutamate is one of the most common chemicals found throughout the human body and in all human cells, but if it is allowed to flow unchecked between brain cells, it disrupts their communications and can lead to serious problems including seizures and neuropathic pain. In cases where there's been a brain injury or disease, like stroke, the leftover glutamate that spills throughout the region is what continues to kill off brain cells and spread trauma.

In order for glutamate to be swiftly removed from the space between cells before toxicity occurs, glutamate pumps have to do that heavy and continuous lifting. Dr. Boudker, a third-generation scientist, has dedicated the last 14 years of her work — including a decade at Weill Cornell — to understanding these molecular pumps.

"To put this in scale, a human is 10 million folds smaller than the Earth. In contrast, glutamate pumps are 100 million times smaller than a human," said Dr. Boudker. "They're like tiny — and immensely important — creatures on a huge planet."

And these tiny pumps are unfortunately not as yet amenable to being studied at the atomic level, Dr. Boudker said. So instead, she and her team studied an analogous pump from a bacterium that normally lives in hydrothermic vents deep within the Sea of Japan at 100 degrees Celsius, but is architecturally and functionally very similar to the pumps in the human brain.

What they found, Dr. Boudker said, is remarkable and represents a major scientific breakthrough. She likens the glutamate pump to an ancient hoist powered by a watermill at the bottom of a hill. In the molecular world, ions, such as sodium, flow from the outside to the inside of the cell like water flowing downhill and power uptake of glutamate into the cell, which is like the ore that's being pulled from the mine. This process of glutamate transport can best be explained, again, by a new comparison, this time to an elevator system. This elevator sits on the surface of the cell and has two stops, one on the outside and the other on the inside. On the outside, the doors open, and glutamate and sodium pour into the cabin. Once the cabins moves across the cell surface, the molecules are let back out into the cell interior. Dr. Boudker and her team obtained atomic resolution snapshots of these movements using X-ray crystallography.

When Dr. Boudker presented these findings at a research conference in 2009 and showed a video that displayed this mechanism of membrane transport, the audience took a collective, audible breath, a sure sign of their surprise and wonder, she recalled.

"Seeing how that process works is really stunning," Dr. Boudker said. "Previously, no one ever realized that proteins could work this way. Our finding went against the existing paradigm and altered the way we view such molecular machines."

In partnership with Dr. Scott Blanchard, an associate professor of physiology and biophysics at Weill Cornell, the team was able to visualize these cabin movements in real time using fluorescent techniques. This discovery — understanding how the glutamate pump works and watching one molecule at a time move from the outside to the inside of the cell surface — has been the most memorable work she's done to date.

Dr. Boudker and her team are now exploring how these pumps can be tweaked to make them work faster. If pharmacological agents could be discovered that improve how glutamate pumps work, they might help patients after they've had a stroke or traumatic brain injury to minimize secondary damage.

But the crux of her work is still centered on the basic science, she said, and not the clinical ramifications. The way she sees it, biomedical science is akin to an apple tree: While the fruit represents patient-centered treatments, deep underground the root system — a support structure that allows the tree to flourish and fruit to grow — is the fundamental science where she focuses her energy.

With this new designation in hand, Dr. Boudker said, "I'm ready to get back into the lab."

Researchers at Weill Cornell Medical College have developed a new mathematical method that can predict the type and severity of impairment that a patient with brain damage will have given the location of their lesion. With further development, this tool could not only allow clinicians to make more precise prognoses, but could also help them provide individual patients with personalized treatment plans, investigators say.

Dr. Amy Kuceyeski, an assistant professor of mathematics in the Department of Radiology and at the Feil Family Brain and Mind Research Institute at Weill Cornell, pioneered this computational Network Modification (NeMo) Tool, which calculates how much damage a patient has sustained to their brain's white matter, the tissue that connects different brain regions. When using this tool to evaluate patients with either multiple sclerosis (MS) or stroke, Dr. Kuceyeski and her team, who imported data into the NeMo tool that was derived solely from earlier MRI images of the brain, found that white matter damage can be used to predict physical and cognitive impairments a patient will experience. This research, which was published in two separate journals in November 2014 and February of this year, shows that using the NeMo tool could provide clinicians with an easy way to deliver more accurate prognoses and rehabilitation plans for their patients.

"The brain is mysterious, so anything that can be done to quantify the relationship between the behavior at the organism level and the anatomy is pretty interesting," said Dr. Kuceyeski, a former Leon Levy Neuroscience Fellow and lead author on both studies. "If we can improve the accuracy of a prognosis or help clinicians make more targeted treatment decisions, that would be amazing. That's where the research is going."

The ability to trace impairments to their root location provides a wealth of knowledge about the way our brains function – knowledge that is crucial in delivering targeted treatments in a clinical setting. Current research is looking at how doctors might be able to examine a patient's initial brain scan and use the NeMo tool to deliver a more accurate prognosis for the next six to 12 months. With an accurate long-term prognosis, tailored rehabilitative plans can be developed for each patient.

To use the NeMo tool, researchers first analyzed each patient's MRI images. They superimposed the damaged brain area onto an atlas derived from healthy subjects, and the computer output a score that indicates what percentage of the connective tissue – or white matter – was lost for a given functional area, known as gray matter. The researchers then tested the subjects' cognitive and physical abilities to glean which impairment corresponded to which brain location. This ultimately allowed researchers to make connections between the location of a patient's initial lesions and their impairments.

Dr. Kuceyeski and her colleagues used the tool in two different studies. The first, published November 2014 in the American Journal of Neuroradiology, investigated processing speed in patients with MS who were receiving care at the Judith Jaffe Multiple Sclerosis Clinical Care and Research Center at Weill Cornell and NewYork-Presbyterian Hospital.

Processing speed, which controls attention and short-term memory, is important to carrying out many everyday tasks. To test this ability, the scientists administered the Symbol Digits Modality Task (SDMT), which asks patients to decode symbols into their number equivalents by using a legend. Using data collected by Dr. Susan Gauthier, an associate professor of clinical neurology and of clinical neuroscience at Weill Cornell, the researchers measured patients' ability to complete this task, and also looked at the amount and the location of their brain damage. Using the NeMo tool, they found that processing speed was affected by damage to connective white matter towards the back of the brain that joins visual integration areas. This result shows that these tracts play an important role in processing speed, and that damage to these pathways will likely inhibit the same function in future patients.

Dr. Amy Kuceyeski. Photo credit: Weill Cornell Art & Photography

The second study, published in Human Brain Mapping in February, focused on patients with ischemic stroke who were being treated by physicians in the Division of Rehabilitation Medicine at Weill Cornell. Using data collected by Dr. Michael O'Dell, a professor of clinical rehabilitation medicine, and Dr. Joan Toglia, a senior lecturer in rehabilitation medicine, the investigators reviewed patients' ability to complete 18 cognitive and physical tasks using tests that assessed everything from their motor ability to their attention to their ability to live independently. Along with these findings, researchers also analyzed damage to the connective tracts between different brain regions in an effort to form correlations between brain damage and the individual's impairment. Because many of these functions – like activities of daily living – employ multiple brain regions, it's not as easy to predict how a brain lesion will impact a patient. Nevertheless, the researchers explored these more elusive functions and mapped them to their corresponding brain locations.

The investigators found that the NeMo tool predicted impairments, on average, two to three times more accurately than predictions based on patient information — age, gender, etc. — and lesion size alone. Additionally, findings about processing speed mirrored the MS study, with damage to the connective tracts of visual areas once again corresponding to processing speed impairments. Obtaining the same outcome in a different population demonstrated that the NeMo tool was reliable and effective, and gives further confidence in the structure-function mapping of processing speed.

"The location in the brain of a patient's disease or impairment really matters," Dr. Kuceyeski said. "There was no quantitative map to go between where the brain lesion is and what impairment the person is going to have. The whole idea behind this work was trying to quantify those relationships with the ultimate goal of improving clinical care."