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Libby New Co-Director of Pathology Ph.D. Program at UR

9/29/2016

Dr. Richard Libby is the new co-director of the Pathology Ph.D. program. Libby is co-director with Dr. Lianping Xing and will replace former co-chair, Dr. Robert Mooney, who will transition to part-time on Jan. 1, 2017.

Rick-Libby

When did you join the university?

I joined the University in 2006.  Prior to joining the university, I did postdoctoral fellowships at The Jackson Laboratory (Bar Harbor, Maine) and The MRC Institute for Hearing Research (Nottingham, United Kingdom). 

What are your research interests?

My laboratory focuses on understanding cell death pathways in neurodegenerative disease. We are particularly interested in understanding neurodegenerative pathways in diseases of the retina, such as glaucoma and other optic neuropathies.

What are you looking forward to most in this new position?

Over the last 19 years Bob Mooney built a very strong program. Importantly, Bob focused the program on understanding the pathophysiology of human disease, aligning the program perfectly with the University’s and NIH’s interest in understanding human disease. 

Several years ago, Dr. Lianping Xing joined Bob as co-director of the program. Lian’s efforts have significantly strengthened the program, particularly in modernizing the course work and preparing our new students for the challenges of graduate study. 

I am looking forward to working with Lian and Donna Shannon (the program coordinator) to continue to enhance the program, focusing on training our students for the challenges of studying complex human diseases. Also, I am looking forward to working with our students to help them on their way toward establishing fulfilling careers.

 

 

Hospital Shows Appreciation to Pathology Staff

9/19/2016

Hundreds of employees from the URMC Department of Pathology and Laboratory Medicine attended a staff appreciation event presented by Strong Memorial Hospital leadership on Tuesday, Sept. 20.  

"This is just a small way for us at the hospital to say thank you for everything that you do each and every day," said Kathy Parrinello, COO and Executive Vice President of Strong Memorial Hospital.  

food_trucksShe noted the "overwhelming" statistics, citing the millions of lab tests (very conservatively estimated to be 6.2 million) that are processed in UR Medicine Labs each year.  

Pathology and Lab Medicine has more than 900 employees stationed at URMC and  approximately 30 additional lab locations across the Greater Rochester Region.  

"You are part of the important work we do at the Medical Center," said Parrinello. addressing the crowd. "As you all know, it is laboratory testing and pathology that help our clinicians diagnose patients and develop appropriate treatment plans. For all of the kudos that Strong and the Medical Center gets for treating patients, you are the behind-the-scenes folks that do the work." 

Nearly 530 staff dined on fare from local food trucks including Bento Box, Marty's Meats, Le Petit Poutine, and Lugia's Ice Cream.  

Posters"I think we have a really good department and do a really good job on all fronts and this is a small way to say thank you," said Pathology Chair, Dr. Bruce Smoller, who thanked Parrinello and the hospital for the event. "I want to thank them for helping us to show the level of appreciation that we really feel for everybody who works in the department."  

A poster display inside the Saunders Research Building atrium also showed testimonials from healthcare providers within URMC. Click here to read what they had to say. 

To view more event photos click here

 

Alumni Spotlight: Forensic Pathologist, Dr. Lorraine Lopez-Morell

9/6/2016

Former Pathology resident, Dr. Lorraine Lopez-Morell, is achieving her dream of being a forensic pathologist right in Rochester.  

Dr. Lopez is the Associate Medical Examiner in the Office of the Monroe County Medical Examiner. 

She was raised in Puerto Rico and came to the U.S. at the age of 18 to go to Michigan State University for undergrad. While she was very young, her father passed away while waiting for a heart transplant.

This tragedy inspired her to pursue a career that would allow her to help other people. The field of pathology drew her interest.  

Lopez"I love taking things apart and figuring out how everything works in the body like a machine, and that's what pathology essentially is," she said. "You have to know every single aspect of the human body."  

After earning her MD from Columbia University in NY City, Dr. Lopez came to UR for residency from 2010-14. During that time, she was impressed by the work ethic that played a big part in shaping the culture there.  

"Most of the attendings taught me what it means to be a real professional; how to do the hard work and appreciate what you've done at the end of the day, and go home satisfied with that,” she said. “I think that was really important to everyone as an overarching theme – to leave no stone unturned and be really at peace with what you've worked on that day."  

As a medical examiner, she is doing just that. From testifying in court to dealing with police, attorneys, jury members and those who are laypeople in terms of medicine, she is able to take something as complex as an autopsy and make it easy to understand.

The Office of the Medical Examiner follows statues on what cases require autopsies or what examination is required for a given case. While the chief medical examiner (whom, in Monroe County, is fellow alumna, Dr. Nadia Granger) has discretionary power over what kinds of cases require autopsy, there are several types of cases in which it’s always required: If a person is killed or suspected to have been killed at the hands of someone else, killed by their own hand, or dies accidentally. Dr. Lopez says these requirements are not likely to change anytime soon.  

Every autopsy is very hands-on. And while some see digital imaging as a feasible alternative (in some cases), the necessary equipment is costly and the image resolution not up to par with an actual autopsy.

Part of her role includes explaining the cause of death to family members of the deceased.  

"Here, if families have a lot of questions, we're happy to speak with them about interpreting what's in our reports," she said. "I find it rewarding, to listen to someone come to the realization that they understand what really happened to their loved one."  

In addition to her daily workload, Dr. Lopez is interested in doing research. This month, she will present research on a heart condition called left-dominant arrhythmogenic cardiomyopathy to the National Association of Medical Examiners.  

She hopes to explore public health issues in the future, such as the rising number of opioid-related deaths in the county. 

After finishing residency, Dr. Lopez completed two forensic pathology fellowships; first at Wake Forest Baptist Medical Center, and at East Carolina University. A self-proclaimed Northeasterner, she now enjoys living in Rochester.  

Her work requires the sort of strength and composure that doesn't waver in the midst of tragedy and the need to find answers. For her, though, it’s nothing to be afraid of.  

"I'm not affected as much by thinking of death because it's an inevitable part of life," she said. "We can come to accept it, and talking about it is the first step." 

 

Alumni Spotlight: Dr. Jiaoti Huang, Pathology Chair at Duke University

8/26/2016

Some pathologists find themselves torn between research and clinical practice, but Dr. Jiaoti Huang, MD, PhD isn't one of them. 

“If things work well, you don’t have to spend a lot of effort balancing the work,” he said. “For me, the more clinical work I do the more problems and issues that I discover for my research.”

HuangHuang joined the URMC Pathology faculty as an assistant professor in 2000 and was promoted to full professor in 2007. He left in 2008 to work at UCLA until making the move to Duke University, where he was named Pathology Department chair in January 2016. 

Since then, he has continued to thrive, receiving, the Synergistic Idea Award from the Department of Defense Prostate Cancer Research Program in February. 

His successful career has led Dr. Huang to become an authority on prostate cancer research. His most recent breakthrough began when he observed that advanced-stage patients diagnosed with adenocarcinoma were inexplicably seeing their cancer transform to small cell carcinoma – an incurable and rapidly progressing form.

Supported by two active grants including a Stand Up to Cancer Dream Team Award, he worked with a team that performed 250 biopsies of metastatic prostate cancer that has been heavily treated with conventional and newer drugs.

From there, he discovered novel histologic features of metastatic prostate cancer and the molecular mechanism responsible for the transformation from a relatively indolent to a very aggressive form. Knowing more about the molecular basis of this phenomenon can now help physicians develop better treatment plans for their patients. 

The results of the project were used to apply for a new R01 grant from the National Cancer Institute which started July 1. None of this would have been possible without working in a clinical setting, Huang says. 

“This project was born from my clinical practice," he said. "If that is the basis of your research, your clinical activity does not really interfere." 

He has received teaching awards at both URMC and UCLA and has seven grants that are currently active, including three from the National Cancer Institute. Huang attributes much of his success to the support and encouragement he received early on from former colleagues in Rochester (notably, Drs. Daniel Ryan and Brendan Boyce). 

“The Pathology Department at the University of Rochester creates a conducive environment for junior faculty to go on with their academic careers,” he said. 

Now Dr. Huang is looking to bring that same culture to his a much larger institution, understanding the need to support young, incoming faculty rather than “throwing them into the swimming pool” and expecting them to survive. 

Outside of work, he enjoys exercise, cuisine, and travel. He's gone to several Duke basketball games and has even met the legendary Coach K. He describes the experience of seeing the team's championship trophies, photos and memorabilia as “mesmerizing.”

He and his wife, Hong, have two children – Kevin, who is a freshman studying mathematics at Duke, and Katherine, a Harvard graduate who works in finance in New York City. 

The Lifesaving Work of the Blood Bank and Transfusion Medicine Unit

7/13/2016

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Have you ever wondered what happens to blood donations when they are taken to a hospital?     

According to the American Red Cross, 6.8 million Americans give blood each year. The Blood Bank and Transfusion Medicine Unit at Strong Memorial Hospital receives and stores these blood products to be ready for patients around the clock. 

We spoke with Debra Masel, Blood Bank chief supervisor, and Aimee Kievitt, lab supervisor, to learn more.

Where do blood products stored in the Blood Bank come from?

The vast majority of our blood comes directly from the American Red Cross located on John Street in Henrietta.

There is also a small donor room located off the main lobby at SMH where patients scheduled for surgery, and who qualify to donate their own blood, can have a unit of blood collected. This blood is then stored in the Blood Bank specifically for them if a transfusion is needed during their surgery.

What are the main functions of the Blood Bank?

We do testing to make sure that the blood received from the American Red Cross is compatible with patients who need it. If a patient has any type of transfusion issue, we need to identify and resolve the problem to ensure that the blood is truly compatible and that we’re not causing more harm by transfusing them.

Our attending physicians, nurses, residents and fellow provide clinical consultation on effective and safe use of blood transfusions, and evaluate transfusion reactions.

How much blood does the Blood Bank receive each day?

We transfuse about 100 units a day. During the blood collection process, approximately 500 milliliters of whole blood is collected which is then separated into red cell, plasma and platelet products. A unit of red cells has a volume of approximately 400 milliliters, which includes a preservative solution to increase the shelf life of the product.

What’s the difference between a blood sample and a blood product?

A blood sample is drawn directly from the patient and is used to complete pretransfusion testing to ensure compatibility with the intended blood product. Blood products are collected from volunteer donors.

A donation is separated into its component parts – plasma (55%), red blood cells (45%), and white blood cells and platelets (less than 1%) – which are each stored and used separately to help multiple patients.

What happens when there’s a trauma patient in the Emergency Department who needs blood products?

The Blood Bank has a trauma pager so when a Level 1 trauma patient is being transported to the hospital, the technologists are notified. They then prepare the trauma cooler with four units of O Negative (O-) uncrossmatched red blood cells, commonly known as the “universal donor.” When a staff member from the ED comes to pick up the blood, he or she will bring a patient blood sample for testing to be performed.

It is important to switch the patient to blood products identically matched to their own blood type as soon as possible, since our research at SMH shows that ABO identical transfusions are safer than use of “universal donor” red cells or plasma.

BloodbanktestWhat kind of testing does Blood Bank perform?

The Blood Bank processes about 120 patient samples a day, many of which are outpatient samples for pre-operative and prenatal testing. About 90 percent of our transfusions are given to inpatients and the remaining 10 percent are transfusions received by outpatients.

What happens if a patient with very rare blood type needs a transfusion?

Sometimes there are other complications besides a patient’s blood type. If a patient has multiple antibodies, for example, finding compatible donors in the available blood inventory may not be possible.

In that case, we contact the Rare Donor Registry via the American Red Cross and a national search is initiated to identify a compatible donor. If we request something that’s available in the registry, they send it to us. We have gotten products from Florida, California, and other states.

What if the Red Cross can’t find what you’re looking for?

If we have a need for a rare unit and the American Red Cross has nothing in inventory, they can search their database to find a donor who matches the patient’s needs. They contact the donor and let them know that they are a rare match for a patient in need and request that they come to a center to donate.

How does a critical shortage in blood donations affect the work of the Blood Bank and Transfusion Medicine Unit?

In the event of a critical shortage (and it would have to be very dramatic) hospital administration and our attending physician and resident on call are notified. Our physicians and technologists will triage requests so that only clinically urgent transfusions are performed during the shortage.

The hospital chief medical officer may ask surgeons to reschedule elective surgeries so that the available blood supply can be conserved for urgent needs.

Thankfully, the community response to blood shortages has been good in bolstering the blood supply so that the drastic measure of rescheduling surgeries hasn’t happened in many years.

What’s a more common type of shortage you encounter?

When there’s a shortage of O- blood and the Red Cross can’t provide our normal inventory levels, we may need to evaluate every requested transfusion for clinical necessity and urgency.

It’s very important to obtain a patient sample as quickly as possible so that trauma patients receive products identical to their blood type instead of group O- blood. In those cases, it requires a higher level of communication and coordination between Blood Bank and the ED or Operating Room so we can appropriately supply their needs.

The same is true for platelet shortages. Our physicians, nurse and technologists evaluate each request for necessity and urgency. We discuss orders with providers to hold off on transfusion or reevaluate whether a transfusion is absolutely necessary when the necessity or urgency are not clear from the order.

Bloodbank3When do you have the greatest need for blood donations?

Summers (around the Fourth of July) and December tend to be the two times when supplies are running lowest. Schools, which hold many blood drives, are closed, and people are on vacation so they are not available to donate blood.

What have been the biggest changes in blood banking within the last decade?

There has been a national push for restrictive transfusion practices, and this is a good thing. Blood transfusion can be lifesaving in certain situations but it’s not the cure-all. A transfusion is like a liquid transplant. If a patient doesn’t have a specific need to be transfused, they shouldn’t be.

Research performed here has led to substantial changes in transfusion practices to render them safer for the recipient, such as use of ABO identical transfusions, leukoreduced transfusions for all patients and washed transfusions for select patient groups. This has led to many fewer complications of blood transfusion and increased survival in some instances.

How has your role in patient care changed over time? 

In the last decade, our staff has started to interact more directly with nurses and ordering providers to discuss patient cases; their underlying diagnosis, signs, symptoms, and whether transfusion is the most appropriate course of action. There have been more of those types of collaborative and educational discussions. 

In photos: 

Top: The Blood Bank at URMC stores all blood products in a cooler where staff can pull units needed for patients. 

Middle: Lisa Hughes, a medical technologist, performs a test to determine the blood type of a patient who has received a bone marrow transplant.

Bottom: Medical technologist, Kim Bastian, releases a blood product to a patient for a transfusion. In this case, the patient has had transfusion reactions, so the product has been "washed" with saline to help prevent further reactions from occurring.

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