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Stony Brook University School of Medicine

Students will now be enrolled in the Renaissance School of Medicine at Stony Brook University. Photo from Stony Brook University

The day before Thanksgiving, Stony Brook University showed its gratefulness for the employees of an East Setauket hedge fund firm.

On Nov. 21, Dr. Samuel L. Stanley Jr., SBU’s president, announced that Stony Brook University School of Medicine has been renamed the Renaissance School of Medicine at Stony Brook University. The programmatic name change honors employees of East Setauket-based hedge fund Renaissance Technologies who have donated to SBU through the decades, according to the university. Jim Simons, former SBU math department chair and co-founder of Renaissance Technologies, and his wife, Marilyn, kicked off the donations more than 35 years ago. Since then, more than $500 million has been donated by 111 Renaissance families, according to a press release from SBU.

“By sharing their talents, their time and their philanthropic giving over the years, 111 current and former employees of Renaissance, almost all of whom did not graduate from Stony Brook University, have committed to Stony Brook’s success and have given generously of their time and treasure to advance the mission of New York’s premier public institution of higher education,” Stanley said in a statement. “It is fitting that we name the academic program that has a tremendous impact on so many in recognition of this generosity and vision as the Renaissance School of Medicine.”

Marilyn Simons commended the Renaissance employees for their generosity in a statement.

“Stony Brook University is an important institution in the Long Island community and it’s certainly had a significant impact on Jim’s and my life,” she said. “Support from Renaissance, particularly for the university’s work in the sciences, medical research and the delivery of health care services, has enhanced the university’s medical services to the Long Island community.”

The name change has faced some opposition in the past few months from residents of the surrounding communities, including members of the North Country Peace Group, a local activist group. Members Myrna Gordon and Bill McNulty attended a Stony Brook Council meeting in December 2017. The council, which serves as an advisory board to the campus and SBU’s president and senior officers, gave Gordon, McNulty and another community member the opportunity to discuss their reasons for opposing the name change, according to Gordon. She said eight months ago, the activist group also submitted a petition with 800 signatures protesting the name change to SUNY trustees and Carl McCall, chairman of the board of trustees.

Gordon said in a phone interview the protesters object to some of the ways Renaissance makes its money, including investing in private prison systems. They also took exception to the financial contributions to the campaign of President Donald Trump (R) and alt-right groups by former co-CEO Robert Mercer, who has since stepped down.

Despite the opposition to the new program name, Gordon said she and other NCPG members are proponents of the university and many of them attend educational, cultural and sporting events at the campus on a regular basis.

Annie Laurie W. Shroyer and Thomas Bilfinger

By Daniel Dunaief

Convenience can come at a cost, even in medicine. When it comes to a heart procedure called cardiac artery bypass surgery, that cost could make a difference in the outcome for the patient.

Annie Laurie W. Shroyer, vice chair for research and professor in the Department of Surgery at Stony Brook University School of Medicine, and Thomas Bilfinger, a professor of surgery in the Division of Cardiothoracic Surgery at SBU, found that the mortality and major morbidity rates were lower for patients of surgeons performing procedures at a single center compared to those performing procedures at more than one center. 

Among physicians who operated at two or more hospitals, these surgeons performed better at their home hospital than at a secondary center.

They’ve published their findings in the Annals of Thoracic Surgery. The Society of Thoracic Surgeons identified the article as the Continuing Medical Education article for the month. The article will provide a much more in-depth learning experience to a subgroup of the journal’s subscribers who seek Continuing Medical Education credits. This, Shroyer explained, will make it more likely that cardiac surgeons will read it thoroughly and discuss it.

“We believe that, based on the results, particularly complex coronary artery bypass grafting (CABG) procedures may have a better outcome at bigger institutions,” Bilfinger explained in an email. Mortality for these procedures overall in the United States is low and the analysis is about differences of a few tenths of a percent, which becomes statistically significant due to the low number.

The central issue, Bilfinger said, is whether “the mother ship does better or worse than the satellite. Decision making about centralizing versus a de-centralized approach seems to be less driven by outcomes and rather by business decisions in many circumstances. The study adds some subjective data to this discussion.”

Using a measure called observed-to-expected mortality ratios based on the health of the patient and risks of the procedure, the ratio for multicenter surgeons was higher for the satellite facilities compared to their home facilities. The ratios were 1.17 for surgeons operating at satellite facilities versus 1.01 for multicenter surgeons performing the procedure at their home hospital.

The volume of surgeries is a complicated issue, Bilfinger cautioned. “There are very well-performing smaller volume places throughout the country,” he explained in an email. “It involves dedication to the procedures from admission to discharge.”

Assuming the surgeon is just as effective in different hospitals, which is “open to discussion,” any observed difference could be attributable to the system, Bilfinger explained. Measuring the effectiveness of the participants in the process, including nurses, anesthesiologists and orderlies, is a question for ongoing research, he continued.

Joseph Carey, a cardiovascular and thoracic surgeon in Torrance, California, conducted a study based on information from California about a decade ago. In an email, Carey suggested that “you pay a price in quality working in unfamiliar conditions and I believe hospital managers do not want their surgeons traveling about.” He added that this paper “is an important reminder” of this.

Carey added that hospital systems and the makeup of the “heart team” may also be important to the outcome of a surgery.

Future research, which Shroyer plans to conduct, will evaluate other factors, such as patient risk, processes and structures of care, that impact cardiac surgical outcomes.

Other researchers could extend this study, which compares the quality of care for surgeons who work at single sites and multisites, to other areas of medical care, enabling hospital networks, insurance companies and patients to make informed risk-based decisions prior to approving difficult procedures.

The challenge, however, with similar studies for other conditions, is in finding national information. “This is the best documented group of procedures there is in the country,” Bilfinger said. For a procedure like back surgery, it might be difficult to come up with a comparable study, although Bilfinger said he “suspects strongly that this is a very similar relationship.”

Shroyer and Bilfinger will extend their work to another cardiothoracic operation. They have submitted a proposal to the Society of Thoracic Surgeons to start a parallel project to look at the difference in risk-adjusted outcomes for mitral valve procedures that compare single-center versus multicenter surgeons. The diversity of procedures may need to be considered in comparing single and multicenter surgeons.

Bilfinger said he recognizes that some doctors and hospital networks may find these conclusions disconcerting. It may give them pause in the internal discussion about value added by new satellites in any system, he explained. “This is worth a public debate. This is one of these aspects of modern health care that the consumer is not aware of.” The average consumer may not put too much emphasis on this, although the sophisticated consumer on Long Island may change or make decisions based on this type of information, he said.

Shroyer and Bilfinger, who have worked on the same floor at the Health Sciences Center since Shroyer arrived from Colorado in 2007, decided to collaborate on this project after a discussion during lunch. The duo were eating at SBU’s Simons Center Café when they were discussing the differences in outcomes for single and multicenter surgical procedures. They submitted a request to access the National Adult Cardiac Surgery Database in 2014 to the Society of Thoracic Surgeons.

For patients who are going to have a cardiac surgical procedure, Shroyer recommends that people choose their surgeon and surgery center “wisely.” She recommends researching the surgeons and their corresponding center’s bypass specific outcomes. She highlights two publicly available resources, which are Adult Cardiac Surgery Database Public Reporting|STS Public Reporting Online and Doctor Ratings — Consumer Reports.

Shroyer cautions that these ratings are somewhat outdated, so she suggests patients ask their surgeons directly about their more recent outcomes. She would also recommend contacting patients.

After conducting this study, Shroyer believes it would likely help patients if they searched for doctors who only perform bypass procedures at a single hospital. She also believes it is important for patients to consider surgeon-specific and center-specific risk-adjusted outcomes.

Ultimately, she said, the decision about a surgeon and a site for surgery is an important one that patients should make based on the likelihood of the best outcome.

“Patients should research their cardiac surgeon-hospital decision even more carefully than if they were buying a new home or a new car,” she explained in an email. “Their future health lies in their cardiac surgeon’s hands.”

Laurie Shroyer, center, with Gerald McDonald, left, who was chief of surgery survive at the VA Central Office and is now retired, and Fred Grover, right, a professor of cardiothoracic surgery in the Department of Surgery at the University of Colorado. Photo from Laurie Shroyer

By Daniel Dunaief

To use the pump or not to use the pump? That is the question heart surgeons face when they’re preparing to perform a surgery that occurs about 145,000 times a year in the United States.

Laurie Shroyer. Photo from SBU

Called coronary artery bypass graft, surgeons perform this procedure to improve blood flow to a heart that is often obstructed by plaque. Patients with severe coronary heart disease benefit from a technique in which an artery or vein from another part of the body is inserted into the heart, bypassing the blockage.

Doctors can perform the surgery with a heart-lung machine, which is called on pump, or without it, which is called off pump.

Recently, a team of researchers led by Laurie Shroyer, who is a professor of surgery and the vice chair for research at the Stony Brook University School of Medicine, published a study in the New England Journal of Medicine that compared the survival and health of 2,203 veterans five years after surgery, with or without the pump.

Contradicting some earlier research that showed no difference in the health and outcomes after the surgery, the study revealed that using the pump increased the survival rate and reduced the rate of other health problems.

Along with the other research articles in this area, this study “should help in deciding the relative value and risks of each technique,” Frederick Grover, a professor of cardiothoracic surgery in the Department of Surgery at the University of Colorado, explained in an email.

The study Shroyer led, which is known as the Rooby trial, showed that on-pump patients had a five-year mortality of 11.9 percent, compared with 15.2 percent for the off-pump patients, Shroyer explained.

The five-year rate of medical complications, including death, nonfatal heart attacks and revascularization procedures was also lower for the on-pump group than the off-pump group, at 27.1 percent compared to 31 percent, respectively.

Consistent with these findings, the overall use of off-pump procedures has declined, from a peak of 23 percent in 2002 to 17 percent in 2012, down to 13.1 percent in 2016, according to data from the Society of Thoracic Surgeons Adult Cardiac Surgery Database Committee.

At one point, surgeons had considered an off-pump approach to be safer, but when other trials didn’t show a benefit and when the current Rooby trial demonstrated on pump had better outcomes, it “likely influenced many surgeons to use the off pump less often for specific reasons, considering it is a somewhat more difficult technique except in the most experienced hands,” Grover wrote.

The explanation for the difference five years after surgery are “not clear,” Shroyer explained in an email. The article suggests that the off-pump patients had less complete revascularization, which is known to decrease long-term survival.

Grover explained that the outcomes may have been better for the on-pump procedures in the Rooby trial for several reasons, including that the surgeons in the different trials had different levels of experience.

Leaders of the study suggested that patients and their surgeons needed to consider how to use the information to inform their medical decisions. Participants in the study were men who were veterans of the armed services.

“The data can likely be extrapolated to the general population since it is not an extremely high-risk population, but it is all male so would primarily extrapolate to males,” Grover suggested. Additionally, patients with specific conditions might still have better outcomes without the use of a pump.

“Our manuscript identifies an example for ‘patients with an extensively calcified aorta, in whom the off-pump technique may result in less manipulation of the aorta, potentially decreasing the risk of aortic emboli or stroke,’” Shroyer wrote in an email. Grover also suggested people with severe liver failure also might want to avoid the pump to prevent additional harm to the liver.

Shroyer and her team have already submitted a proposal to the VA Central Office Cooperative Studies Program. “Pending approval and funding, 10-year follow-ups will be coordinated appropriately,” Shroyer said.

Grover described Shroyer as a “spectacular investigator with a very high level of knowledge of clinical research” and, he added, a “perfectionist.” When he met Shroyer, Grover said he was “blown away by her intelligence, experience, background and energy.” He interviewed her many years ago to direct a major VA Cooperative Study. After the interview and before the next meeting, he called another interviewer and asked if he, too, agreed to hire her on the spot.

Grover recalled a trip back from Washington to Denver 15 years ago after they had been in a 10-hour meeting with no scheduled breaks. She took out her laptop on the airplane and asked him to write up results for a new grant.

“I was beat and finally said if she didn’t let up, I was going to jump out of the airplane just to get away from her,” he recalled. She shut her computer, ordered drinks and they enjoyed a peaceful flight back.

A resident of Setauket, Shroyer lives with her husband Ken, who is the chair of the Department of Pathology at Stony Brook School of Medicine. The professor said she loves the Staller Center, which she considers one of the greatest kept local secrets. She appreciates the opportunity to hear classical music performances by the Emerson String Quartet and by cellist Colin Carr.

When she entered biomedical research in 1992, it was unusual for women to rise to the level of full professor at an academic medical center. She strives to be an outstanding mentor to her trainees, including women and under-represented minorities, so that they can achieve their potential, too. As for her work, Shroyer’s hope is that the Rooby research “will provide useful information to guide future changes in clinical care practices” and, in the longer term “to improve the quality and outcomes for cardiac surgical care.”

At the ribbon cutting of the Kavita and Lalit Bahl Center for Metabolomics and Imaging last December, from left, Lina Obeid; Yusuf Hannun; Kavita and Lalit Bahl; Samuel Stanley, President of Stony Brook University; and Kenneth Kaushansky, dean of Stony Brook University’s School of Medicine. Photo from SBU

By Daniel Dunaief

Many ways to kill cancer involve tapping into a cell’s own termination system. With several cancers, however, the treatment only works until it becomes resistant to the therapy, bringing back a life-threatening disease.

Collaborating with researchers at several other institutions, Dr. Lina Obeid, the director of research at Stony Brook University School of Medicine, has uncovered a way that cancer hides a cell-destroying lipid called ceramide from treatments. The ceramide “gets co-opted by fatty acids for a different species of fats, namely acylceramide, and gets stored side by side with the usual triglycerides,” Obeid explained in an email about her recent finding, which was published in the journal Cell Metabolism. “It makes the ceramide inaccessible and hence the novelty.” The ceramide gets stored as a lipid drop in the cell.

“We describe a completely new metabolic pathway and role in cell biology,” Obeid said. Other researchers suggested that this finding could be important in the battle against cancer. “That acylceramides are formed and deposited in lipid droplets is an amazing finding,” George Carman, the director of the Rutgers Center for Lipid Research, explained in an email. “By modifying the ceramide molecule with an acyl group for its deposit in a lipid droplet takes ceramide out of action and, thus, ineffective as an agent to cause death of cancer cells.”

Carman said Obeid, whom he has known for several years, visited his campus in New Jersey to share her results. “All of us at Rutgers were so excited to hear her story because we knew how important this discovery is to the field of lipid droplet biology as well as to cancer biology,” he said. Obeid conducted some of the work at the Kavita and Lalit Bahl Center for Metabolomics and Imaging at Stony Brook University. The center officially opened on Dec. 1 of last year on the 15th floor of the Health Sciences Center and will move to the Medical and Research Translation Building when it is completed next year. “This study is exactly the kind of major questions we are addressing in the center that [the Bahls] have generously made possible,” she explained.

Obeid discovered three proteins that are involved in this metabolic pathway: a ceramide synthesizing protein called CerS, a fatty acyl-CoA synthetase protein called ACSL and an enzyme that puts them together, called DGAT2, which is also used in fatty triglyceride synthesis. Her research team, which includes scientists from Columbia University, Northrop Veterans Affairs Medical Center and Mansoura University in Egypt is looking into implications for the role of this novel pathway as a target for cancer and obesity.

Indeed, obesity enables more frequent conversion of ceramide into acylceramide. “Fats in cells and in diets increase and predispose to obesity,” Obeid suggested. “This new pathway we found occurs when fatty acids are fed to cells or as high-fat diets are fed to mice.” In theory, this could explain why obesity may predispose people to cancer or make cancer resistance more prevalent for some people. According to Obeid, a high-fat diet can cause this collection of proteins to form in the liver of mice, and she would like to explore the same pathways in humans. Before she can begin any such studies, however, she would need numerous approvals from institutional review boards, among others.

Obeid and her collaborators hypothesize that a lower-fat diet could reduce the likelihood that this lipid would be able to evade cancer therapies.

These kinds of studies “provide the justification for looking at the effect of diet on acylceramide production,” Daniel Raben, a professor of biological chemistry at Johns Hopkins University School of Medicine, explained in an email. Further research could include “isocaloric studies with [high-fat diets] and [low-fat diets] in animals that are age and gender matched.”

Obeid was a part of the first group to describe the lipid’s role in cancer cell death in 1993. “We have been studying its metabolism and looking at how it’s made and broken down,” she said. “We found recently that it associates with these proteins to metabolize it.”

While the lipid provides a way to tackle cancer’s resistance to chemotherapy, it also has other functions in cells, including as a membrane permeability barrier and in skin. A therapy that reduced acylceramide could affect these other areas but “as with hair loss [with chemotherapy treatment], this will likely be easily managed and reversible,” Raben explained.

Obeid and Yusuf Hannun, the director of the Cancer Center at Stony Brook, are searching for other scientists to work at the Kavita and Lalit Bahl Center for Metabolomics and Imaging. “We are actively recruiting for star scientists” at the center, Obeid said. Other researchers suggested that the history of the work Obeid and Hannun have done will attract other researchers.

Hannun and Obeid are “considered the absolute leaders in the area of sphingolipid biochemistry and their clinical implications,” Raben said. “Simply put, they are at the top of this academic pile. Not only are they terrific scientists, they also have an outstanding and well-recognized reputation for training and nurturing young investigators.” Carman asked, “Who wouldn’t want to be associated with a group that continues to make seminal contributions to cancer biology and make an impact on the lives of so many?”

As for the next steps in this particular effort, Carman foresaw some ways to extend this work into the clinical arena. “I can imagine the discovery of a drug that might be used to combat cancer growth,” Carman said. “I can imagine the discovery of a drug that might control the acylation of ceramide to make ceramide more available as a cancer cell inhibitor. Clearly, [Obeid’s] group, along with the outstanding colleagues and facilities at Stony Brook, are positioned to make such discoveries.”

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A professor and student at Stony Brook University School of Medicine look at a medical scan. File photo

Two major power players in the field of medical help and research have come together to form a new partnership.

Stony Brook University School of Medicine and Mount Sinai Health System, of New York City, have joined together to create more academic research opportunities to streamline and expand clinical care initiatives.

While they are not the first school of medicine to connect with a health system on Long Island — Hofstra University’s School of Medicine works with Northwell Health — this certainly means new breakthroughs are on the horizon in Suffolk County.

Dr. Kenneth Kaushansky, senior vice president for Health Sciences at Stony Brook University said that each institution will be bringing its biggest strengths to the table, thus making each other stronger.

Mount Sinai’s Icahn School of Medicine has strong biomedical, clinical research and health policy expertise, while Stony Brook University boasts programs with advanced mathematics, high-performance computing, and physical and chemical science departments.

Combining math and science programs together will help students become well rounded, and open up the possibility for new programs.

A press release said Stony Brook students will also be able to gain experience in areas of medicine that the university doesn’t currently offer, like observing and learning from heart transplants and other pilot programs. And students from either institution are now welcome to take classes at the other.

But this liaison is going beyond students.

Kaushansky said this partnership will improve patient care at both Stony Brook University Hospital and Mount Sinai Hospital by allowing patients to easily seek services from either hospital.

This is a great endeavor that should be encouraged and supported by the community. Not only does this teaming help students get a more in-depth education and give professors more opportunities for expanded lessons, it will in turn help the residents of the North Shore by improving the care that the local hospital can offer through the new discoveries and breakthroughs the new partnership will make.