Mission: Possible - Children's Hospital Boston

Newborn Medicine A simpler way to check catheter placement
Otolaryngology Neural stem cells may help regrow the cochlea
Hematology/Oncology A faster recovery from marrow transplants
First steps toward a
living cochlear implant
Most cases of deafness are caused by the
dysfunction or death of cells in the cochlea,
the snail-shell-shaped structure in
the inner ear. Douglas Cotanche, PhD, a researcher
in Otolaryngology, now reports that his lab has grown
all the assorted cell types in the cochlea from just one
source: neural stem cells. The study was published
online June 20 by the journal Hearing Research.
Neural stem cells were first isolated from mice
in 1998 by Evan Snyder, MD, PhD, formerly of
Children’s Department of Neurology. Cotanche’s
team implanted the cells deep inside the sound-damaged
cochleas of guinea pigs and mice. Six weeks
later, the cells had migrated throughout the cochlea
and formed satellite cells, spiral ganglion cells and
Schwann cells, which make up the cochlea’s nervous
tissue, as well as the hair cells and supporting cells of
the organ of Corti (the actual hearing organ). “Getting
these cells to integrate into the damaged ear and
make the variety of cochlear cell types is a big step,”
says Cotanche.
The researchers couldn’t show complete rebuilding
of the cochlea, but they believe that with more time
and more stem cells, most of the cochlea could be repopulated.
Cotanche’s next goal is to implant human
neural stem cells in animals and test whether the new
cochlear cells connect with the auditory nerve and
the brain, and whether they respond to sound stimulation—in
other words, whether they restore hearing.
Resident invents a glowing catheter
The placement of central
catheters, which deliver
lifesaving nutrition and
medicine to the most premature
infants, is a “blind” procedure.
The catheter is typically inserted
in the forearm or ankle and advanced
until it reaches a location
near the heart. Only an X-ray can
reveal whether the catheter has
gone astray, veering too close to
the heart, into the neck or even
winding back down the arm.
Adjustments are often required,
leading to delays, more X-rays
and exposure of the infant to
more radiation.
“I thought to myself, there
must be a better way to do this,”
says Farhad Imam, MD, PhD,
a clinical fellow in Newborn
Medicine at Children’s Hospital
Boston, who witnessed several
“misroutings” as a resident in
the Neonatal Intensive Care Unit
(NICU). Imam’s solution was
intuitive: He threaded a central
Farhad Imam, MD, PhD
catheter with an illuminated
fiber-optic wire to make it glow, allowing its progress through the body to be tracked
with the naked eye. After night shifts during his residency and the first year of his NICU
fellowship, Imam spent afternoons testing his design on rabbits. The catheter’s red gleam
was visible through tissue—and even fur.
Initially funded by a Lovejoy Research Award for residents, Imam is now supported
by a Massachusetts Technology Transfer Center grant and he’s con-
tracted with two engineering firms to help build a prototype
Boosting blood stem cells Zebrafish show the way
light-guided catheter over the next year. “The catheter
By systematically screening more than ,500 chemicals in zebrafish, Leonard Zon,
will be most readily usable in newborns,” he
MD, Trista North, PhD, and Wolfram Goessling, MD, PhD, of Children’s Stem
says, “but it should also work in children and
Cell Program, have identified an available drug that ramps up production of blood
possibly in adults.”
stem cells, helping patients recover immune function more quickly after chemotherapy
or bone marrow transplants. The drug, a derivative of prostaglandin E ,
may be tested as early as next year in patients undergoing cord blood transplant for
leukemia. The paper appeared in the June 1 issue of Nature.
Jacqueline Armstrong and Monique
Yoakim-Turk of Children’s Intellectual Property
Office helped Imam file a patent, recognizing
that a light-guided catheter could save money
and time by replacing the current technique. “Residents
have cool ideas,” says Yoakim-Turk. “They’re new and tend to
question what others don’t anymore.”
Go to Children’s News’ Online Extras at
www.childrenshospital.org/chnews to read more research briefs.
Have research news you would like to share?
Email nancy.fliesler@childrens.harvard.edu or call ext. 5-2426.
Cheonil Kim, MD, attended medical
school in Seoul, Korea, where he was
born, but he knew that once he finished
his degree, he wanted to practice medicine
in the United States. But before he could
leave Korea, he had to serve in the medical
branch of its army. “It was just like that show
M*A*S*H,” he remembers, laughing.
After the army, Kim made the move overseas
and in 1980 began his fellowship at Children’s
Hospital Boston. From the start, he found
it to be a great fit. “I liked it and they liked
me,” he says. “The families make you feel so
good about working here.” One of the biggest
differences he noticed between American
and Korean hospitals was how patient-doctor
relationships worked. “People are more skeptical
of health professionals in Korea,” he says.
“Families here are positive because they trust
in you—and the institution. That motivates me
to give 100 percent.”
Kim trained in General Surgery for two
years before he decided to make a switch to
Gratitudes
Children’s News | August 2007 www.childrenshospital.org
The secret to his success
DESTINATION:
Children’s
The following letter was sent to Jennifer Finn,
general manager at Fitcorp.
The Nussenbaum family
South Korea
il Kim, MD
Anesthesiologist
Anesthesia. “It takes a certain type of person to
be a surgeon and that wasn’t me,” he says. But
that hasn’t kept Kim out of the operating room
(OR). As an OR director focusing on anesthesia
during otolaryngologic (ears, nose and
throat) surgeries, he ensures that the surgeries
run smoothly, while acting as a liaison between
surgeons, nurses, departments and families.
Despite his success, Kim still considers his
language barrier to be a big challenge. “I give
professional talks, but it’s on a basic level of
communication,” he says. “It helps that I’m
in the medical field, especially at Children’s,
since people really try to understand me in
context, despite my mispronunciations.” He
brushes up on his elocution from time to time
with English lessons and gets a fair amount
of practice talking to his three American-born
sons. Kim considers himself a family man and
attributes this to his heritage. “My cultural
identity is pretty strong,” he says. “I’m very
family-oriented and half of the food I eat is
from my culture—I like the spice.” Although
all of his sons are American, he says, “They
have stronger cultural connections to Korea
than I thought they would—their heritage is
always on their minds, and that’s reflected in
the food they eat.”
Being bilingual has been useful to Kim when
treating Korean-speaking patients over the
years, and many departments have sought his
Dear Jennifer,
translation help. “Even if the family speaks
basic English, they may need clear communication
to feel comfortable. I’m proud to help,”
he says.
Kim knows that the decision he made
decades ago to immigrate to the United States
was the right one. “In Korea, the medical
profession is about fame and prestige,” he says.
“Those weren’t my goals and that’s not my
style,” he says. “Here, it’s about respecting the
individual and quality of care. People appreciate
my work and my presence. I consider that
success.”
Five months ago my teenage son was hospitalized at Children’s
Hospital Boston. What began as a simple case of mono turned into
a serious illness that ultimately necessitated him having a bone
marrow transplant. My wife and I spent four months at Children’s
with our son, and we continue to return with him on an outpatient
basis during the long recovery period.
During my son’s hospitalization, I managed to set aside time every
day to come to Fitcorp so that I could work out, shower, shave and
try to clear my head. As difficult as this ordeal has been for me
and my family, I cannot even begin to imagine what it would have
been like had I not been able to retreat to Fitcorp. It is hard to put
into words just how important it was to have your club available
to me, even for this short time each day.
I just wanted to thank you so much for making this resource
available to me and other families of Children’s patients. It is a
wonderful service that you provide to parents who must endure
the nightmare of having a sick child.
Cheonil Kim, MD
Adam Nussenbaum