2017 Resident Graduation Wrap-Up!

Saturday, June 17 marked a memorable evening for Duke Anesthesiology’s “Resident Class of 2017” as they graduated from this nationally-acclaimed program and gathered with their families to celebrate at Hope Valley Country Club in Durham.

Chairman Joseph Mathew delivered opening remarks about the impact anesthesiologists have on patient care before he, the director (Dr. Annemarie Thompson) and assistant directors (Drs. Brian Colin and Ankeet Udani) of the residency program gave each of the 13 graduates their diplomas. The Outstanding Graduate Award was presented to Dr. Jenna Falcinelli, the co-chief resident of the graduating class. And, Drs. Annie Castro, Theresa Crowgey and Taylor Herbert were all winners of Dr. Richard Moon’s trainee quiz awards.

Several awards were also presented to faculty throughout the evening. Dr. Brian Ginsberg received the Robert Sladen Teacher of the Year Award; Dr. Kerri Wahl received the Mentor Award and Dr. Abigail Melnick received the Residency Program Contribution Award.

Additionally, the department recognized resident leadership positions by presenting them with certificates:

  • Chief Resident Leadership: Drs. Jenna Falcinelli and Chris Wahal
  • Academic Chief Resident Leadership: Drs. Taylor Herbert and Kendall Smith
  • Teaching Scholar Leadership: Drs. Stephanie Jones and Alex Reskallah

Congratulations to all of the graduates and award winners!

Resident Graduates Post-Residency Plans
Jason Bluth Private practice in Hawaii
Jenna Falcinelli Pediatric Anesthesiology Fellowship at Duke University
Taylor Herbert Critical Care Medicine Fellowship at Duke University
Alina Hulsey Adult Cardiothoracic Anesthesiology Fellowship at Duke University
Shawn Jia Critical Care Medicine Fellowship at University of California, San Francisco
Stephanie Jones Pediatric Anesthesiology Fellowship at Duke University
Allison Overmon Adult Cardiothoracic Anesthesiology Fellowship at Duke University
Alexander Reskallah Critical Care Medicine Fellowship at Duke University
Brian Rogers Adult Cardiothoracic Anesthesiology Fellowship at Duke University, then a Critical Care Medicine Fellowship at Johns Hopkins University
Brandon Seifert Private practice in Buffalo, New York
Kendall Smith Critical Care Medicine Fellowship at Duke University
Dennis Thapa Pain Medicine Fellowship at Massachusetts General
Chris Wahal Regional Anesthesiology and Acute Pain Medicine Fellowship at Duke University

Chris Keith2017 Resident Graduation Wrap-Up!
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Dr. Jordt Named Co-Chair of Terrorism & Inhalation Disasters Section

Sven-Eric Jordt, PhDThe American Thoracic Society (ATS) elected Duke Anesthesiology’s Sven-Eric Jordt, PhD, as the co-chair of its Section on Terrorism and Inhalation Disasters (TID) on May 23 at the society’s annual meeting.

TID brings together ATS members with interests in mechanisms and treatment approaches for chemically-induced inhalation injuries and their health effects, epidemiology of inhalation injuries, identification and control of inhalation threats associated with terrorism, industrial accidents, infectious diseases and environmental disasters, preparedness and first responder networks. Dr. Jordt will support the section’s mission by coordinating section proposals, official society publications and outreach efforts.

An ATS report calling for an increase in research efforts to develop new therapeutics for chemical inhalation injury was published in the June 1, 2017 issue of the Annals of the American Thoracic Society, titled “An Official American Thoracic Society Workshop Report: Chemical Inhalational Disasters. Biology of Lung Injury, Development of Novel Therapeutics, and Medical Preparedness.”

Dr. Jordt is an associate professor of anesthesiology, faculty of Duke Anesthesiology’s Center for Translational Pain Medicine, and the director of the Chemical Sensing, Pain and Inflammation Research Laboratory which focuses on the mechanisms that enable humans and animals to sense touch, pain and irritation.

Chris KeithDr. Jordt Named Co-Chair of Terrorism & Inhalation Disasters Section
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Dr. Swaminathan Elected Vice President of ASE

Madhav Swaminathan, MD, FASE, FAHAOn June 4, Duke Anesthesiology’s Madhav Swaminathan, MD, MMCi, became the first anesthesiologist to be appointed as vice president of the American Society of Echocardiography (ASE) in the organization’s 42-year history.

“It is humbling to be accepted by the society into a key leadership role that will eventually lead to the presidency of the largest and most influential voice in echocardiography in the world,” says Dr. Swaminathan. “It represents recognition of years of hard work by many giants in the field who have made it possible for an anesthesiologist to be in this position.”

In his new role as vice president on ASE’s Board of Directors, Dr. Swaminathan says he hopes to continue some of the work that they have been doing in the society – expanding its global presence in echocardiography and reaching out to non-traditional users of cardiovascular ultrasound, such as critical care medicine practitioners, through educational initiatives. He believes these efforts will continue to foster innovation in echocardiography and explore novel ways in which diagnostic cardiovascular ultrasound can add value to population health.

According to Dr. Swaminathan, Duke Anesthesiology has been a leader in the field of perioperative echocardiography since its inception. “My appointment to the leadership of the ASE is unprecedented and reflects years of hard work by leaders in our specialty,” adds Dr. Swaminathan. “Many in our institution, including Drs. Joseph Mathew, Jonathan Mark, and Mark Newman of Duke Anesthesiology, and Joseph Kisslo and Pamela Douglas of Duke Medicine, both past ASE presidents, have been instrumental in this effort.”

Dr. Swaminathan has assumed roles on several ASE committees, most recently as chairman of the Membership Committee and chairman of the Council on Perioperative Echocardiography. He has also served on the Industry Relations Committee, Education Committee, and as co-chairman and chairman of the Perioperative Echocardiography track for ASE’s Scientific Sessions from 2011-2015. Notably, he was the first anesthesiologist selected to deliver the prestigious Feigenbaum Lecture at ASE’s Scientific Sessions in 2015.

Dr. Swaminathan is a professor of anesthesiology, the clinical director of the Cardiothoracic Anesthesiology Division, and co-director of Perioperative Optimization. His research focuses on elucidating mechanisms of, and risk factors for, perioperative acute kidney injury in patients undergoing heart surgery with emphasis on the role of early recovery of kidney function. He is also involved in research exploring the role of transesophageal echocardiography in outcomes after cardiac surgery.

Chris KeithDr. Swaminathan Elected Vice President of ASE
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Cancer-Pain Discovery at Duke Makes Headlines

Ru-Rong Ji, PhDOnce hailed as a breakthrough in cancer treatment, immunotherapies are now raising concerns as doctors note new side effects like severe allergic reactions, acute-onset diabetes and heart damage.

These drugs, which work by unleashing the immune system to fight cancer, are only effective in about a fifth of cases, prompting many patients to wonder if they are worth the risk.

But a new study from Duke University researchers, featured in Duke TODAY and The San Diego Union-Tribune, suggests there may be a quick and easy way to predict which cancer patients are likely to benefit from immunotherapy treatments.

The researchers showed that a molecule called PD-L1, which is blocked by the popular immunotherapy drug, nivolumab, acts not only on immune cells but also on the nerve cells that signal pain. That insight could lead to a simple test that measures subtle differences in pain sensitivity to gauge whether or not the body is responding to treatment.

The findings, published May 22 in the journal, Nature Neuroscience, underscore the surreptitious nature of cancer, which uses a variety of tricks to evade detection by the body’s natural defense mechanisms.

“Cancer cells are smart. We already knew that they produced PD-L1 to suppress the immune system,” said senior study author Ru-Rong Ji, Ph.D., professor of anesthesiology and neurobiology at Duke University School of Medicine. “But there’s another defense system at play as well, and that is pain. We showed that this well-known molecule can mask pain, so that cancers can grow without setting off any alarms before metastasis.”

In its early stages, when cancer cells are just starting to grow and multiply in a given tissue or organ, the disease is not usually painful. But as the cancer becomes more aggressive and spreads throughout the body, these cells secrete thousands of pain-inducing chemicals, which either trigger pain-sensing nerve fibers or, in the case of molecules like nerve growth factor, generate entirely new ones. The pain can become so unbearable that some cancer patients die from opioid overdoses.

Ji has been studying pain for over twenty years. Recently, his group noticed that mouse models of melanoma didn’t show the typical signs of pain that he observed in mice with other kinds of cancer, which would flinch or lick their hind paws whenever they were in discomfort.

Ji also knew that melanoma cells could produce a molecule called PD-L1, which latched onto a receptor called PD-1 on the surface of white blood cells, effectively putting the brakes on the immune response. Ji wondered whether there was a connection. So his team treated mice with nivolumab, a drug that prevents PD-L1 from binding to PD-1. Then they poked the animals’ hind paws with a calibrated filament and measured how much force it took for them to withdraw their hind paws. They found that the mice responded to much lower forces than before treatment, indicating they had become more sensitive to pain. In addition, they also found that nivolumab caused spontaneous pain in mice with melanoma, which made them tend to their affected hindpaws like never before.

Next, the researchers performed the opposite experiment. They injected PD-L1 — the pain-masking factor in this equation — into the hind paws or spinal cord of mouse models of three different kinds of pain — inflammatory, neuropathic and bone cancer pain. In every case, the injections of PD-L1 had an analgesic effect, deadening the mice’s sensitivity to pain.

“The effect was surprisingly fast,” said Ji. “We saw a reduction of pain in under half an hour.”

To figure out the mechanism behind this quick response, Ji’s team examined the sensory neurons of the dorsal root ganglion (DRG), a collection of nerves and neurons near the top of the spinal cord. They isolated these cells from mouse DRGs as well as human DRGs from donors and cultured them in a dish, with or without PD-L1, and then recorded their electrical activity. The researchers found that PD-L1 impaired the ability of sodium channels to fire neurons (action potentials) in response to pain.

Ji believes the finding could potentially lead to new treatments for pain, as well as new ways to predict the efficacy of already existing treatments based on PD-1 and PD-L1. “The response to cancer drugs can take a long time, weeks to months,” he said. “The response to pain happens in minutes to hours.”

Sensory neurons from human dorsal root ganglia, a collection of nerves and neurons near the top of the spinal cord, show red for PD-1, a binding site for immunotherapies against cancer. The blue stain shows cell nuclei. Photo credit: Ru-Rong Ji Lab, Duke Anesthesiology

Sensory neurons from human dorsal root ganglia, a collection of nerves and neurons near the top of the spinal cord, show red for PD-1, a binding site for immunotherapies against cancer. The blue stain shows cell nuclei. Photo credit: Ru-Rong Ji Lab, Duke Anesthesiology

In the future, Ji would like to explore whether the mechanism uncovered in this study also applies to other immunotherapy treatments. He is also interested in working with clinicians to measure changes in patients’ pain sensitivity after treatment, a first step toward developing a diagnostic test.

The study was a collaboration between Duke University and two Chinese universities, Fudan University and Nantong University. Professor Yu-Qiu Zhang from Fudan University, the co-senior author of the paper, is a well-known expert in cancer pain. The lead author, Dr. Gang Chen, was an Assistant Professor at Duke  and is now a Professor at Nantong.

The research was supported by the National Institutes of Health (NS87988, DE17794, and DE22743), the National Science Fund of China (31420103903), and the National Research Foundation of Korea (2013R1A6A3A04065858)

CITATION:  “PD-L1 inhibits acute and chronic pain by suppressing nociceptive neuron activity via PD-1,” Gang Chen, Yong Ho Kim, Hui Li, Hao Luo, Da-Lu Liu, Zhi-Jun Zhang, Mark Lay, Wonseok Chang, Yu-Qiu Zhang, and Ru-Rong Ji. Nature Neuroscience, May 22, 2017. DOI: doi:10.1038/nn.4571

Source: Duke University Office of News and Communications (Durham, N.C. – Tuesday, May 23, 2017)

Chris KeithCancer-Pain Discovery at Duke Makes Headlines
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Duke Anesthesiology Marks Academic Evening’s Silver Anniversary

A special 25th anniversary edition of Academic Evening was held on May 16 at the Millennium Hotel in Durham. All training levels and divisions of Duke Anesthesiology were represented by the 102 poster abstracts, presented by the department’s junior-level investigators and faculty. The annual event supports research and discovery with the overall goal of advancing anesthesia, critical care and pain management.

A key element to the evening was guest judge Dr. Aman Mahajan, the executive chairman of the Department of Anesthesiology & Perioperative Medicine at the UCLA David Geffen School of Medicine, and the Ronald L. Katz Professor of Anesthesiology and Bioengineering. Dr. Mahajan’s expertise is in cardiothoracic anesthesiology, cardiac electrophysiology and echocardiography. As director of the UCLA Perioperative Services at UCLA, he coordinates a multidisciplinary team of physicians involved in the care of patients undergoing surgical and interventional procedures. Dr. Mahajan’s research focuses on autonomic neural modulation of cardiac electrophysiology and assessment of cardiac mechanical function in heart failure.

After 23 years of service to Academic Evening, Dr. David Warner served as program director for the final time. Dr. Jeffrey Gadsden co-directed for the first time and will assume the event’s future leadership. “It was a pleasure and honor to work alongside Dr. Warner. He essentially built this event into what it is today,” says Dr. Gadsden.

“Academic Evening allows us to celebrate our academic successes and often serves to foster new and exciting research ideas and collaborations between departmental subspecialties,” says senior resident, Dr. Kendall Smith, winner of the Bill White Resident Research Award. “To receive this award among the many excellent resident entries this year was both a surprise and a great honor.”

At the night’s conclusion, Drs. Gadsden and Warner thanked all of the participants and everyone who helped make this event possible, especially those who served as abstract judges, moderators, mentors, and support staff. “Just when you think you couldn’t be more proud of the department you work in, you receive more than 100 abstracts of original research. It’s humbling,” says Dr. Gadsden.

Congratulations to each of the award winners and teams, listed below.

2017 Academic Evening Winners

1st Place
Martin Sigurdsson, MD

Runner-Up
Shu Yu, MD

Runner-Up
Chao Xiong, MD

1st Place
Rebecca Scholl, MD

Runner-Up
Hassan Amhaz, MD

Runner-Up
Claudia Villalpando, MD

1st Place
Kendall Smith, MD

Runner-Up
Jon Andrews, MD

Runner-Up
Rebecca Anderson, MD

1st Place
Benjamin Andrew, BS, RD

Runner-Up
Andrea Ansari, BS

1st Place
Michael Young, MD

1st Place
Benjamin Dunne, MD

Runner-Up 
James Kim, MD

1st Place
Suraj Yalamuri, MD
Michael Plakke, MD

Runner-Up
Tera Cushman, MD

Runner-Up
Jennifer Lee, MD

View the 25th Annual Academic Evening Photo Gallery

View the Academic Evening 25th Anniversary Video

Chris KeithDuke Anesthesiology Marks Academic Evening’s Silver Anniversary
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Dr. Habib Appointed to SOAP Board of Directors

Ashraf S. Habib, MBBCh, MSc, MHSc, FRCAThe Society for Obstetric Anesthesia and Perinatology (SOAP) has elected Duke Anesthesiology’s Dr. Ashraf Habib to serve as the director at large on its board of directors. The announcement was made at the society’s 49th annual meeting, titled “Beyond the Obstetric Suite.”

SOAP’s mission is to improve the pregnancy-related outcomes of women and neonates through the support of obstetric anesthesiology research, the provision of education to its members, other providers, and pregnant women, and the promotion of excellence in clinical anesthetic care.

Dr. Habib is the chief of Duke Anesthesiology’s Women’s Anesthesia Division. He has been a SOAP member for the past 17 years in which he has been active in a number of SOAP committees, including the international outreach committee (member 2004-2008, chairman since 2008), the research committee (since 2008), and the resident affairs committee (since 2009). He has also  served on a number of the American Society of Anesthesiologists (ASA) committees related to obstetric anesthesia, including the ASA abstract review subcommittee on obstetric anesthesia and perinatology (member 2009-2013, chair since 2013), and the ASA education track subcommittee (since 2013).

Dr. Habib says the experience he has gained through his work, participating in and leading several international outreach trips teaching obstetric anesthesia overseas (Croatia, Egypt and Romania), has made him appreciate the opportunities that SOAP can have as a leader in improving the care of pregnant women worldwide.

Chris KeithDr. Habib Appointed to SOAP Board of Directors
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