The findings, published in npj Digital Medicine, suggest this technology could help surgeons refine their techniques and improve patient outcomes.

The AI system, called Frame-to-Outcome (F2O), analyzes video recorded during the nerve-sparing portion of robot-assisted prostate surgery, when surgeons work to preserve the nerves responsible for sexual function. Rather than relying on experts to manually evaluate each procedure, the system automatically identifies patterns in a surgeon’s movements—called “surgical gestures”—and uses them to predict patient recovery.

Prior studies of these surgical gestures demonstrated a strong relationship between the gestures performed by the surgeon—such as the sequence of instruments used or the speed of stretching nerves to move them aside—and the patient’s outcome. By analyzing the gestures used during surgery, the AI system made determinations about whether the patient will be more or less likely to have a good outcome. Until now, this type of analysis required labor-intensive review by trained human observers.

“Our goal isn’t simply to predict who will recover,” said Andrew Hung, MD, corresponding author of the study and professor of Urology at Cedars-Sinai. “We want to identify the surgical techniques with the best outcomes so surgeons can learn, refine and improve care for our future patients.”

Investigators found that F2O matched expert human reviewers in predicting patient outcomes while dramatically reducing the time required to analyze surgical performance. The technology could eventually provide surgeons with objective feedback on the techniques most closely associated with successful patient recovery.

To develop the system, researchers trained the AI system using videos annotated by human analysts from 294 surgeries from 23 surgeons across four international centers. Then they tested it on an additional 29 surgeries and found its predictions closely matched those of expert human reviewers.

“By identifying and interpreting the gestures that result in positive patient outcomes, we can offer surgeons insights that can help improve surgical performance and patient care,” Hung said.

The study was a collaboration between the Department of Urology, the Department of Computational Biomedicine and the Center for Artificial Intelligence Research and Education (CAIRE) at Cedars-Sinai.

“This work highlights what we can achieve when surgeons and computational biomedicine experts work together toward a shared clinical goal," said Jason Moore, PhD, chair of the Cedars-Sinai Department of Computational Biomedicine and director of CAIRE. "Bringing together these disciplines allowed the team to build something that is technically rigorous and genuinely meaningful for surgeons—and their patients."

Additional Cedars-Sinai authors include Xi Li, Nicholas Matsumoto, Jay Moran, Miguel E. Hernandez, Cherine Yang, Jeanine Kim, Jasmine Lin, Peter Wager, Ujjwal Pasupulety and Atharva Deo.

Other authors include Alvin C. Goh, Christian Wagner and Geoffrey A. Sonn.

Funding: Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health under Award Number R01CA273031. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Cedars-Sinai Health Sciences University is advancing groundbreaking research and educating future leaders in medicine, biomedical sciences and allied health sciences. Learn more about the university.

Cedars-Sinai Study Links Hypertension to Socioeconomic Level

People living in under-resourced neighborhoods are more likely to develop high blood pressure—also known as hypertension—than those in wealthier areas, according to new research from Cedars-Sinai Health Sciences University. The study was published in the American Journal of Hypertension.

“The increased risk for people in the least healthy neighborhoods was similar to being a full decade older than their counterparts in the healthiest neighborhoods,” said Joseph Ebinger, MD, MS, associate professor of Cardiology and director of the Coronary Intensive Care Unit in the Smidt Heart Institute at Cedars-Sinai and senior author of the study. “Although such disparities in hypertension prevalence are known to occur, our study is notable because it demonstrates the persistence of these differences over time.”

Investigators tracked the blood pressure of more than 94,000 Cedars-Sinai patients between 2018 and 2023. They found that, over time, patients in neighborhoods in the lowest 25% of rankings on a scale that assesses education, job opportunities and other social conditions were 7% more likely to develop high blood pressure than patients in the top 75% of neighborhoods.

“Many people do not know they have hypertension and are not being treated for it,” Ebinger said. "Our findings suggest clinicians may consider targeting interventions in the context of socioeconomic data to help prevent at-risk patients from developing the condition, which increases their risk for heart disease, kidney disease and stroke."

Additional Cedars-Sinai authors include Jonathan N. Le, MD; Tzu Yu Huang, MPH; Patrick G. Botting, MSHS; Ellie Albertson, MPH, PhD; Natalie A. Bello, MD, MPH; Christina Harris, MD; Alan Kwan, MD; and Susan Cheng, MD, MPH. 

Other authors include Brian Claggett, PhD.

Funding: This study was supported by grant funding from the NIH/NHLBI (K23HL 153888-03) and by the Smidt Discovery Fund of the Smidt Heart Institute.

Study Links Angina Severity to Composition of Heart Plaque 

About half of women who experience angina, chest pain presumed to be from obstructed blood flow to the heart, don’t have significant coronary artery blockage. And yet, these women have elevated risk for heart attacks and strokes. New research from Cedars-Sinai Health Sciences University, published in Communications Medicine, helps explain why.

Investigators found that buildup in the coronary arteries of women with severe angina was more likely to consist of soft plaque. Soft plaque, also known as noncalcified plaque, is more prone to rupture and trigger dangerous blood clots than its more stable counterpart, known as calcified or hard plaque. 

The findings were based on artificial intelligence analysis of more than 100 CT coronary angiograms (noninvasive heart scans) performed on women with angina and coronary artery disease.

“Our findings expand our understanding of why angina occurs in women without significant artery blockages,” said Damini Dey, PhD, professor of Biomedical Sciences at Cedars-Sinai and corresponding author of the study. “The findings also suggest the need to consider treating these women with medications to prevent the buildup of plaques and reduce the risk of heart attacks and other cardiac events.”

Other Cedars-Sinai authors include Rafal Wolny, Guadalupe Flores Tomasino, Kajetan Grodecki, Joel Lenell, Caroline Park, Rebekah Park, Jacek Kwiecinski, Daniel S. Berman, Piotr J. Slomka, Janet Wei, Martha Gulati and C. Noel Bairey Merz.

Other authors include Osama Dasa, Vinicius Calsavara, Matthew J. Budoff, Eileen Handberg, Carl J. Pepine, Leslee J. Shaw and Balaji Tamarappoo.

Acknowledgements: This study was primarily supported by grants from the NHLBI R01HL151266 and 1R01HL148787. It was also supported by CDMRP-DoD W81XWH-17-2-0030 and McJunkin Family Foundation through funds distributed by the University of Florida, Department of Medicine, Clinical Research Consortium CDRN-1501-26692, the Edythe L. Broad and the Constance Austin Women’s Heart Research Fellowships, Cedars-Sinai Medical Center, Los Angeles, CA, the Barbra Streisand Women’s Cardiovascular Research and Education Program, Cedars-Sinai Medical Center, Los Angeles, the Linda Joy Pollin Women’s Heart Health Program, the Erika Glazer Women’s Heart Health Project, Cedars-Sinai Medical Center, Los Angeles, CA; and the VA Women’s Health Practice-Based Research Network VA HSR&D SDR 10-012. R.W. is supported by a Polish National Science Centre (grant number 2021/43/D/NZ5/02434) and Medical Research Agency (grant number KPOD.07.07-IW.07-0150/24).

Competing interests: Drs. Berman, Slomka, and Dey have received software royalties from Cedars-Sinai Medical Center and report equity in APQ Health.

How the Brain Influences Aging Throughout the Body

Cedars-Sinai Health Sciences University investigators are helping clarify the brain’s role in how the body ages. Their study, published in Nature Communications, identified a group of brain cells that become overactive with age and may impair the body’s ability to maintain consistent temperature, stay properly hydrated and efficiently convert food into energy. 

“These age-related problems make the body more vulnerable to illness and often rob people of their independence,” said Celine Riera, PhD, associate professor of Biomedical Sciences and Neurology, research scientist in the Board of Governors Regenerative Medicine Institute at Cedars-Sinai, and senior author of the study. “We found that a group of brain cells that produce a hormone called vasopressin become overactive with age, contributing to these problems.”

These brain cells are in the hypothalamus, at the base of the brain. In healthy amounts, the vasopressin they produce helps blood vessels constrict. It also helps the kidneys control the amount of water and salt in the body, which helps control blood pressure and urine output. 

When investigators artificially activated these brain cells in young laboratory mice, the cells produced more vasopressin and the mice developed changes similar to those seen in aging mice. Conversely, when investigators reduced the activity of these brain cells in aging mice, the mice were better able to maintain body temperature, hydration and metabolism, Riera said.

The findings provide scientists with new context for understanding how the brain contributes to systemic aging. Future studies may explore whether therapies targeting these brain cells can reduce age-related health problems and improve quality of life in aging people, Riera said.

Additional Cedars-Sinai authors include Nancy Morones, Predrag Jovanovic, Anna Sanetra, Kaitlyn Jang, Nareg Keshishian, Zhihan Clay Cui, Edward Novinbakht, Joshua J. Breunig, Anders Berg, Tamar Pirtskhalava, Selim Chaib, S Ananth Karumanchi, Tamar Tchkonia, Katlin Silm, and James L. Kirkland.

Funding: This work was supported by the Larry L Hillblom Foundation startup grant (C.E.R.), the Cedars-Sinai Pilot Award from the Center on Aging and Diabetes (C.E.R.), the CIRM Scholar fund EDUC-12751 (N.M.), the National Institute of Aging grant RF1AG091203 (C.E.R.) and R37AG013925 (J.L.K., T.T.).

Possible Biomarker Linked to Aggressive Thyroid Cancer

Cedars-Sinai Health Sciences University investigators have found a possible way to identify which patients are at greatest risk of thyroid cancer recurrence and might benefit from more aggressive treatment. Their findings were published in Science Advances.

“The incidence of thyroid cancer has tripled over the past three decades and it is now the most common cancer in adolescents and young adults,” said Anthony T. Nguyen, MD, PhD, assistant professor of Radiation Oncology and Biomedical Sciences and first author of the study. “The biomarker we identified, if further validated, could help us identify patients likely to have more aggressive disease so that we can intensify their treatment.” 

In five patients with locally advanced thyroid cancer, investigators used single-cell RNA sequencing to analyze gene expression patterns in individual cells of the tumor microenvironment, comparing primary thyroid tumors and matched lymph nodes to which cancer had spread. Their findings were confirmed in a separate group of 21 patients with thyroid cancer.

Among multiple differences between primary tumor and lymph node, investigators found that an increase in IL7 receptor protein expression on the surface of immune cells in the lymph nodes was linked to improved patient outcomes.

“Our study is one of the first to use single-cell RNA sequencing to identify a lymph node-specific biomarker for aggressive thyroid cancer,” said Allen Ho, MD, professor of Surgery and co-corresponding author of the study. “Low levels of IL7 receptor in the lymph node can potentially be used to identify patients with more aggressive disease who are candidates for treatment intensification.”

The other corresponding author is Stephen Shiao, MD, PhD, professor of Radiation Oncology and Biomedical Sciences and co-leader of the Cancer Therapeutics Program.

“This study is an example of the promise of single-cell RNA sequencing to assess the status of tumors for more targeted treatment,” said Robert Figlin, MD, interim director of Cedars-Sinai Cancer. 

Additional Cedars-Sinai authors include Jolene Viramontes, Isaiah Vazquez, Catriona McWilliam, Vaishnavi Devarakonda, Regina Henson, Wendy L. Sacks, Jon Mallen-St Clair, Yufei Chen, Evan Walgama, Kevin S. Scher, Justin Moyers, Julie K. Jang, Zachary S. Zumsteg, and Wonwoo Shon.

Howard M. Sandler is also an author of the study.

Funding: This work was supported by: National Institutes of Health grant K08CA191139 (SLS), Conquer Cancer Young Investigator Award (ATN), American Society for Radiation Oncology Junior Faculty Award (SLS), Cedars-Sinai Precision Health Grant (ASH).

New Expert Consensus Aims to Improve Diagnostics in Emergency Care

Cedars-Sinai Health Sciences University investigators convened a panel of medical experts to develop new definitions to improve diagnostic quality and safety in emergency departments. The definitions—diagnostic excellence and missed diagnostic opportunity—address a longstanding gap in the field, as they recognize the role uncertainty plays in emergency care. Their findings are published in Annals of Emergency Medicine. 

“Our new definitions can be used to guide investigations about the diagnostic process in emergency departments to identify opportunities for improvement,” said study first author Carl Berdahl, MD, MS, associate professor of Medicine and Emergency Medicine at Cedars-Sinai. “Future work should explore the integration of these definitions into diagnostic research and quality and safety programs, and evaluate the impact on patients’ health outcomes.”

A 2022 report from the Agency for Healthcare Research and Quality suggested about 1 in 18 patients visiting emergency departments each year receive a misdiagnosis that causes preventable harm or worsens their outcome. This report sparked controversy about what the emergency department’s role should be in assigning diagnoses.

The panel of 10 experts from emergency medicine and related specialties reviewed scientific evidence to arrive at the new definitions. It defined “diagnostic excellence” as using evidence-based practices to arrive at an accurate and timely explanation of a patient’s condition based on the information available at the time; communicating that diagnosis to patients and families; and providing equitable, patient-centered care. It defined a “missed diagnostic opportunity” as a measurable departure from evidence-based practice that may contribute to a delayed or inaccurate diagnosis, or a failure in communicating diagnostic information to patients and families.

Additional Cedars-Sinai authors include Sam S. Torbati, MD; Maxim P. Ptacek, BS; Nabeel Qureshi, PhD; and Teryl K. Nuckols, MD, MSHS.

Additional authors include Gordon D. Schiff, MD; Arjun K. Venkatesh, MD, MBA; Edward G. Seferian, MD, MS; and Johan Carrascoza-Bolanos, BS.

Members of the Multidisciplinary ED Diagnostic Excellence Panel include Adebisi Alli, DO, MS; Marie L. Crandall, MD, MPH; Anuj K. Dalal, MD; Kelly T. Gleason, PhD, BSN; Sachin Gupta, PhD, MBA; Aaryn K. Hammond, MD; Victoria Nash, MS; Michelle D. Lall, MD, MHS, Robert Sherwin, MD; Scott D. Steenburg, MD, MS.

Funding: This work was supported by the Emergency Medicine Foundation’s Diagnostic Excellence in Emergency Medicine Grant. Dr. Berdahl was also supported by K08HS029534 and the National Academy of Medicine Scholars in Diagnostic Excellence Program.

Preclinical Study: Novel CAR T-Cell Therapy Controls Bladder Cancer

Investigators at Cedars-Sinai Health Sciences University have discovered that delivering a specialized CAR T-cell therapy directly into the bladder could control bladder cancer and reduce the need for bladder-removal surgery. The preclinical study, published in the Journal of Experimental Medicine, identifies a strategy that, after further testing in humans, could improve management of organ-confined tumors.

“Current bladder cancer therapies are limited by drug shortages, severe side effects and high recurrence rates, often forcing patients to undergo life-changing bladder-removal surgery,” said Parwiz Abrahimi, MD, PhD, urologic oncologist in the Department of Urology at Cedars-Sinai and first author of the study. “This new strategy has the potential to dramatically reduce the necessity for bladder removal, preserving the patient’s quality of life while maintaining control of their cancer.”

In laboratory mice, investigators found this localized approach safely confined the treatment to the bladder and prevented the engineered cells from escaping into the bloodstream. The findings support the practice of delivering cellular therapies directly via a catheter to treat organ-confined bladder cancers.

Additional authors include Jonathan F. Khan, Alyssa Duren-Lubanski, Winson Cai, Yacine Marouf, Nan Chen, Daniel Hirschhorn, Renata Mammone, Ileana C. Miranda, Jacob E. Tallman, Alejandra Vela-Moreno, Mohamad Hamieh, Bishoy M. Faltas, Thomas M. Carroll, Micaela L. Everitt, Hari K.K. Subramanian, Hikmat A. Al-Ahmadie, Olivier Elemento, Benjamin D. Hopkins, Douglas S. Scherr, Renier J. Brentjens, Jedd D. Wolchok and Taha Merghoub.

Cedars-Sinai Scientists Identify New Driver of Inflammation 

Investigators at Cedars-Sinai Health Sciences University have identified a previously unrecognized driver of harmful inflammation. The findings, published in Nature Communications, center around TRIM21, a protein also linked to autoimmune disease.

“Our findings suggest TRIM21 may be one reason some autoimmune and autoinflammatory diseases share similar features,” said Jessica Carriere, PhD, an assistant professor of Pathology and Laboratory Medicine at Cedars-Sinai and co-corresponding author of the study. “By targeting TRIM21, we may eventually be able to develop new treatments for a range of inflammatory diseases.”

Researchers discovered that TRIM21 helps build the inflammasome, an alarm-like structure inside immune cells that triggers inflammation. While this alarm helps protect the body from infection, it also can become overactive and trigger excessive inflammation that damages healthy tissue and contributes to disease. 

The study, which looked at laboratory mice and human patient samples, showed that TRIM21 not only helps activate this inflammatory response but also enables inflammatory signals to spread from dying immune cells to nearby cells, potentially creating a chain reaction that drives inflammation throughout the body.

Additional Cedars-Sinai authors include Sana Ismaeel, Elisabeth Jäger, Vinicius Dantas Martins, Kaiden A. Sims, Huyen Nguyen, Justin Ruiz, Hemisha Khatri, Savita Devi, Andrea Dorfleutner and Christian Stehlik. 

Additional authors include Chawon Yun, Sonal Khare, Lan H. Chu, Lucia de Almeida, Janset Onyuru, Jae Jin Chae, Daniel L. Kastner, Lori Broderick and Hal M. Hoffman.

Funding: This work was supported by the National Institutes of Health (AI099009 to C.S., AI134030, AI140702, DK143393, CA301129 and AI165797 to C.S. and A.D.), the American Heart Association (834502 and 26CDA1588880 to J.C., 25POST1374216 to S.I., 26POST1558214 to V.D.M., 15PRE25700116 to L.H.C. and 18CDA34110296 to L.d.A.), and the American Cancer Society (PF-23-1149877-01-IBCD to E.J.).

Cedars-Sinai Health Sciences University is advancing groundbreaking research and educating future leaders in medicine, biomedical sciences and allied health sciences. Learn more about the university.

An accomplished neurotologist and skull base surgeon, Miller joined Cedars-Sinai in 2021 and serves as director of Neurotology for the Cedars-Sinai Acoustic Neuroma and Lateral Skull Base Surgery Center. Her expertise includes otology, neurotology, cochlear implantation, vestibular schwannoma and acoustic neuroma care, lateral skull base surgery, Ménière’s disease, and hearing restoration.

“My vision is to continue to develop each of our subspecialties to the highest standard of rigorous academics and education paired with clinical excellence,” said Miller, also the inaugural LuEllen Margaret Edwards Chair in Otology and Neurotology. "Every patient who comes to us deserves care from a team that is both deeply trained and fully committed to outstanding outcomes, and every trainee deserves an environment where they can grow into an exceptional clinician."

As an initial priority, Miller has hired Cedars-Sinai’s first otolaryngology PhD researcher to help lead the development of a hearing regeneration lab.

"We are delighted for Dr. Miller to step into the role of division director," said Cristina R. Ferrone, MD, chair of the Department of Surgery at Cedars-Sinai. "Her expertise as a surgeon, dedication to education and clear vision make her an ideal leader for this team. We look forward to the many ways she will strengthen patient care and mentor the physicians of tomorrow."

Miller earned her bachelor’s degree from Harvard University and her medical degree from Harvard Medical School. She completed her surgical internship and residency in head and neck surgery at UCLA, followed by fellowship training in neurotology and skull base surgery at the University of California, San Diego (UCSD). Prior to joining Cedars-Sinai, Miller served as director of the Center for Balance and Falls at the University of California, San Francisco (UCSF), where she led clinical and research initiatives. She also spent seven years as an associate at the House Ear Clinic.

Miller succeeds Gene Liu, MD, in the role of division director.

“Over the course of his years at Cedars-Sinai, Dr. Liu made outstanding contributions to the Department of Surgery, and we are grateful for his leadership,” Ferrone said. “Through his recruitment of 19 surgeons across the network and the establishment of the ENT residency, he provided a strong foundation of excellence in the academic and clinical footprint of the division for Dr. Miller to build on.”

Read more from the Cedars-Sinai Newsroom—TODAY: Treating Hearing Loss Can Protect Your Brain From Cognitive Decline

Katie Buchholz always knew that she wanted to be a dancer.

“I had been taking classes since I was 4,” Buchholz said. “By eighth grade, I told my parents that this is what I wanted to do with my life.”

After graduating from college with a degree in dance, Buchholz set off from her Texas hometown to pursue her dream in Los Angeles. She spent several years working at a professional dance studio, teaching dance classes for children. She also danced on an international tour with a well-known children’s entertainer. Buchholz was well on her way to the career of her dreams.

But on the night of July 3, 2024, one single moment changed everything.

A Life-Altering Incident

While driving home from an outing with friends, Buchholz sustained life-threatening injuries in a devastating, head-on car crash.  She was rushed by an emergency services team to Cedars-Sinai.

“Katie came to us as a polytrauma, meaning she had multiple serious injuries, and required immediate intervention,” said Yassar Hashim, MD, associate medical director of Trauma at Cedars-Sinai, who was the trauma surgeon on duty the night Buchholz arrived at the medical center. “She had to be intubated right away to secure her airway, and she received a massive blood transfusion to replace what she had lost due to her injuries from the accident.”  

Buchholz had major trauma to both legs, including a broken femur in her right leg and vascular and nerve injury in her left. She broke multiple ribs and her left wrist and had a traumatic brain injury from the impact of the crash.

As a Level I trauma center, Cedars-Sinai is equipped to handle complex injuries like Buchholz’s.

“It’s all about teamwork,” Hashim said. “Each individual, from the trauma surgeons to the Emergency Department physicians, our residents, nurses and more, has a specific role. We follow our protocols and are trained to support these critically injured patients in an environment where every second counts.”

Coordinated Care

As the attending trauma surgeon, Hashim had the role not only to save Buchholz’s life, but to also help coordinate the multidisciplinary care she would need to manage her various injuries.

“There were a lot of teams involved,” Hashim said. “Katie required care from my colleagues in orthopedics, vascular, plastic and reconstructive surgery, Surgical ICU, and more.”

One of the many doctors she would encounter was Mitchel Seruya, MD, director of the Peripheral Nerve and Microsurgery Fellowship and professor of Surgery in the Jim and Eleanor Randall Department of Surgery. Seruya was called upon to repair the severe nerve injury in her left leg.

“The nerve that was severed is an important one because it feeds sensation in the bottom of the foot,” Seruya said. “Especially because she’s a dancer, she needs the feedback of that sensation to be able to feel where her foot is in space. If we couldn’t repair it, the hope of getting back to a career in dance would have been out.”

By harvesting a graft from the nerve that feeds her outer calf and sewing under a microscope with a suture thread that is finer than a doll hair, Seruya was able to reconstruct the injured nerve. The fix is not immediate, though, as electricity goes through the graft at the rate of about an inch per month. As time goes on, sensation will return as it continues to improve.

Little by Little

After being discharged from Cedars-Sinai, Buchholz went home to Texas for several months to stay with her parents.

“I still needed so much help at the beginning,” Buchholz said.

She worked diligently with physical, occupational and speech therapists to improve her strength and coordination. Through her determination and positive attitude, she saw progress. By July 2025, just one year after her accident, she was able to move back to Los Angeles to restart her life and career, even if it looks a little different than what she initially imagined.

“I know this is a long journey, but I live by the mantra of ‘little by little,’” Buchholz said. “Whether it’s being able to blow my own nose, relearning how to walk, or being able to lift heavier weights, I celebrate every incremental step as a win.”

Even while she waits for the nerve regrowth to get full sensation back to her foot, she continues her therapies and has returned to teaching at a local children’s dance studio. She believes her passion influences her healing.

“I was a dancer; I am a dancer,” Buchholz said. “I have progressed so much physically and mentally because I am determined to get back eventually.”

Her physicians praise this positive outlook.

“It is priceless to have patients with this kind of glass-half-full attitude,” Seruya said. “Their mindset helps heal them.”   

Inspiring Others

Buchholz is sharing her story at Cedars-Sinai’s upcoming Trauma Survivors Reunion on Monday, June 8. For the first time, Cedars-Sinai is bringing together trauma survivors, physicians, nurses, social workers, emergency services professionals and other medical staff to celebrate the strength of their patients who overcame life-altering injuries.

At the reunion, she will be able to reconnect with Hashim, the trauma surgeon who helped save her life.

“Because of my brain injury, I have no memories from immediately before or after my accident,” Buchholz said. “I may not recognize the people who were there that night, but I’m excited to meet them and say, ‘Thank you.’”

Hashim is looking forward to the event as well.

“We receive critically injured patients and see them in their most vulnerable state, often with no one else but us to advocate for them,” Hashim said. “I am excited to see Katie again and see how far she has come. These kinds of things are what make my job so rewarding. She went from struggling for her life to speaking at our event. It’s remarkable.”

Read more from Cedars-Sinai Stories and Insights: Stop the Bleed Courses at Cedars-Sinai

“The annual AUA meeting is a pivotal event for urologists worldwide, providing a platform to discuss innovation and inspire future advancements,” said Hyung L. Kim, MD, professor of Urology and chair of the Department of Urology at Cedars-Sinai. “It is a great opportunity for our Cedars-Sinai team to collaborate with peers, sharing insights to advance research and elevate patient care across the field.” 

Cedars-Sinai Experts Available for Interviews

Michael Ahdoot, MD, assistant professor of Urology and director of the Minimally Invasive Urology Institute, will present research on the detection of bladder cancer using an advanced new urine test that measures multiple proteins and antibodies.

Timothy Daskivich, MD, associate professor of Urology and director of Urologic Oncology Research, can address the latest advances in prostate cancer treatment and patient care, including shared decision-making and life expectancy estimates in prostate cancer consultations.

Stephen Freedland, MD, professor of Urology and director of the Center for Integrated Research in Cancer and Lifestyle at Cedars-Sinai Cancer, is available to discuss the EMBARK Phase III international clinical trial, which tested a combination treatment option for men with recurrent prostate cancer. 

Andrew Hung, MD, professor of Urology and vice chair of Academic Development in the Department of Urology, can discuss artificial intelligence in surgical education and innovations in robotic surgery.

Aurash Naser-Tavakolian, MD, associate program director for the Urology Residency Training Program, can discuss treatment of male urinary incontinence and genitourinary reconstruction using minimally invasive surgical procedures.

Awards

Patrick Tamukong, MD, PhD, a urology resident in the Department of Urology at Cedars-Sinai, will receive the Humanism in Medicine Award for Residents and Fellows, presented by the Arnold P. Gold Foundation and the Urology Care Foundation. The award honors urology residents and fellows who exemplify humanism in their patient care and actively engage in humanitarian initiatives beyond their clinical responsibilities.

Scheduling Interviews

To schedule an interview with a Cedars-Sinai expert, contact Jillian Scholten at 949-244-2561 or jillian.scholten@cshs.org.

Some Breast Cancer Survivors Need Closer Heart Disease Monitoring

The racial makeup and socioeconomic status of early-stage breast cancer patients could offer clues about their risk for heart disease, the leading cause of death among breast cancer survivors. Results of a study led by a Cedars-Sinai breast oncologist and published in npj Breast Cancer identified several groups of patients who could benefit from closer monitoring after a breast cancer diagnosis.

“Our study found that—regardless of other medical conditions or the type of cancer treatment received—Black breast cancer survivors and patients living in areas with the lowest per capita income had a higher risk of heart failure over time compared with white patients or those living in areas with the highest per capita income,” said Karissa Britten, MD, breast medical oncologist, member of Cedars-Sinai Cancer and corresponding author of the study.

Looking at data from more than 200,000 breast cancer patients in a National Cancer Institute database, investigators also found that patients of Black, Hispanic, and American Indian/Alaskan Native descent had more advanced and more aggressive tumors, compared with white or Asian American/Pacific Islander patients. Patients from lower-income areas or with lower levels of education also were more likely to have these higher-risk tumors.

“Our Cardio-Oncology Research Program was established to study cardiovascular disease in patients with cancer,” said Robert Figlin, MD, interim director of Cedars-Sinai Cancer. “Our goal is to better understand the risks involved and to develop novel therapies to address them.”

Britten said that no evidence-based guidelines currently exist for heart monitoring of high-risk patients after a diagnosis of early-stage breast cancer, but the study findings point to an opportunity for targeted monitoring and early intervention that could save lives.

Additional authors include Marla Lipsyc-Sharf, Eric H. Yang, Susan McCloskey, Mina S. Sedrak, Mediget Teshome, Julia LaBarbera, Aditya Bardia, and Nicholas McAndrew.

Funding: The collection of cancer incidence data used in this study was supported by the California Department of Public Health pursuant to California Health and Safety Code Section 103885; Centers for Disease Control and Prevention’s (CDC) National Program of Cancer Registries, under cooperative agreement 1NU58DP007156; the National Cancer Institute’s Surveillance, Epidemiology and End Results Program under contract HHSN261201800032I awarded to the University of California, San Francisco, contract HHSN261201800015I awarded to the University of Southern California, and contract HHSN261201800009I awarded to the Public Health Institute.

Use of Hepatitis C-Positive Donors Reduces Pancreas Transplant Wait Times

Researchers at Cedars-Sinai Health Sciences University have discovered that utilizing organs from donors who are hepatitis C virus-positive (HCV+) can greatly shorten wait times for those awaiting pancreas transplants. According to their study published in the American Journal of Transplantation, patients receiving HCV+ organs experienced an average reduction of 117 days in wait time, all while maintaining comparable safety and organ function to those receiving organs from HCV-negative donors.

The study also found that transplant centers can safely handle infections passed from donors to recipients by using direct-acting antiviral therapies that cure hepatitis C, a viral infection that can cause severe liver damage. This method decreases organ wastage and increases the availability of organs for patients, who often face complications while waiting for transplantation.

“By maximizing the potential of available organs, we can transplant more patients and, ultimately, extend more lives,” said Todd Brennan, MD, professor of Surgery at Cedars-Sinai Comprehensive Transplant Center and corresponding author of the study. "Our goal is for this research to help guide national guidelines on donor utilization and expand access to transplantation.”

Additional Cedars-Sinai authors include Tiffany Lim, Yujie Cui, Kambiz Kosari, Georgios Voidonikolas, Tsuyoshi Todo, Justin A. Steggerda, Steven A. Wisel, and Irene K. Kim

Other authors include Gabriel E. Nissen and Olyvia S. Wang.

Novel In-Hospital Screening Method Detects Cognitive Issues

Over 40% of older people admitted to U.S. hospitals have dementia, yet only half of them have been diagnosed with memory and cognitive difficulty. Cedars-Sinai Health Sciences University investigators have developed a comprehensive screening method that identifies previously undiagnosed cognitive impairment and dementia in hospitalized patients. Their findings were published in the Journal of the American Geriatrics Society.

Cognitive impairment, which is more common in older adults, involves challenges with a person’s ability to think, learn, remember and make decisions. In people with dementia, these problems are severe enough to interfere with daily life. Both conditions frequently go undetected, which can adversely affect patient care in hospital settings.

“Early recognition of cognitive issues is critical to improving hospital care, optimizing outcomes, and proactive discharge planning for cognitively impaired patients, who are at increased risk for falling, behavioral issues and hospital readmission,” said Zaldy S. Tan, MD, MPH, medical director of the Jona Goldrich Center for Alzheimer’s and Memory Disorders at Cedars-Sinai and corresponding author of the study. “And yet, cognitive screening of patients remains rare in U.S. hospitals because they lack effective strategies for implementing it.”

The new screening method includes brief cognitive assessments administered by nursing staff to patients over the age 65 who are admitted to the hospital, coupled with an algorithmic tool in the electronic health record that flags patients with cognitive impairment and dementia. When this system was implemented across more than 11,000 hospital admissions, it resulted in the cognitive screening of more than 80% of eligible older adults. It detected previously unrecognized cognitive impairment in 9% of those patients and undiagnosed dementia in 4.3%. Black and older (over 85 years) patients were more likely to be identified to have undiagnosed dementia compared with younger and white patients.

“Our screening approach demonstrated the potential to equitably capture cognitive impairment at the point of hospital admission, allowing for interventions to optimize the care for all vulnerable patients,” Tan said.

Additional Cedars-Sinai authors include Nabeel Qureshi, Nancy L. Sicotte, Drew Hirsch, Cameron Escovedo, Erica Spivack, Mary C. Nasmyth, Mitzi Gonzales, Sarah A. Kremen, Teryl K. Nuckols, Janae McFadden and Pamela R. Roberts.

Other authors include John Mafi.

Funding: The study was supported through internal institutional funding. Data collection was supported by NIH National Center for Advancing Translational Science (NCATS) UCLA CTSI Grant Number UL1TR001881.

Proteins Found in Cancer Extracellular Vesicles Could Guide Drug Development

Cancer cells release tiny biological packages called extracellular vesicles (EVs) that help tumors grow and spread. A team led by Cedars-Sinai Health Sciences University investigators has now connected certain proteins carried in these EVs with poor patient outcomes in multiple cancer types.

Their findings were published in the Journal of Extracellular Vesicles.

“By identifying these proteins, we aim to uncover new targets for drugs that could be used to treat many types of cancer,” said Sungyong You, PhD, professor of Urology and Computational Biomedicine and corresponding author of the study.

Investigators analyzed data from more than 2,200 patients with 12 different cancer types. They linked 26 specific proteins present in EVs from these patients to poor survival. The standout across multiple tumor types was a protein called PTK7. The analysis also showed that blocking PTK7 effectively stops cancer cell growth, highlighting it as a promising target for therapies.

“These findings provide a powerful new blueprint for using EV data to guide cancer drug testing and applications,” said Robert Figlin, MD, interim director of Cedars-Sinai Cancer. “The proteins identified can guide the development of novel therapies and the repurposing of existing drugs for new cancer treatments.”

Additional Cedars-Sinai authors include Jina Kim and Hyoyoung Kim.

Other authors include Su Yeon Yeon, Kyerim Choi, Hojung Kim and Daehee Hwang.

Funding: This research was funded by National Institutes of Health R01CA277530 (H.R.T., Y.Z., V.G.A., J.D.Y., S.Y.), R01CA255727 (Y.Z., H.R.T., S.Y.), R01CA253651 (H.R.T., V.G.A., S.Y.), R01CA253651-04S1 (Y.Z., H.R.T., S.Y.), R01CA246304 (H.R.T., V.G.A., S.Y.), P01CA278732 (S.Y.), and The Samuel Oschin Comprehensive Cancer Institute (SOCCI) at Cedars-Sinai Medical Center through 2024 Program Project Grant (PPG) Team Science Award (S.Y.).

Cedars-Sinai Health Sciences University is advancing groundbreaking research and educating future leaders in medicine, biomedical sciences and allied health sciences. Learn more about the university.

Sin embargo, en cuestión de semanas, su mundo se vino abajo.

“Empecé a tener hinchazón en los tobillos, a perder mucho peso y, en general, a no sentirme bien”, dijo Ponce. “Me hice un análisis de sangre y supe rápidamente que algo andaba mal”.

Se trataba de una recaída importante de vasculitis ANCA, la enfermedad autoinmune con la que había sido diagnosticada en su adolescencia y que había estado en remisión durante varios años. Los médicos le informaron que tenía más del 60% de daño en los riñones y que no había forma de revertirlo. Tendría que comenzar diálisis y, eventualmente, necesitaría un trasplante de riñón.

“Es muy inusual que personas en sus 20 años entren en falla renal. Por lo general, está relacionada con la diabetes y la presión arterial alta en pacientes de 50 años o más”, explicó Tsuyoshi Todo, MD, cirujano de trasplante renal en Cedars-Sinai. “En el caso de Angélica, era una atleta universitaria y estaba en excelente estado de salud. Fue muy desafortunado que sus riñones dejaran de funcionar debido a su enfermedad autoinmune”.

Ponce no quería estar en diálisis el día de su boda, así que puso en pausa los planes y comenzó a buscar un donante.

No tuvo que buscar muy lejos. Su hermana menor, Miranda Ponce, se ofreció de inmediato para hacerse pruebas y ver si podía ser compatible.

Cuando llegaron los resultados, eran una coincidencia perfecta: seis de seis.

“Ese número indica la cantidad de coincidencias que el cuerpo de Miranda comparte con el de Angélica”, explicó Justin Steggerda, MD, cirujano de trasplante renal en Cedars-Sinai y quien realizó la cirugía de Miranda. “Esto significa que el cuerpo de Angélica tiene menos probabilidades de rechazar el trasplante o desarrollar una respuesta inmunitaria que pueda causar problemas en el futuro”.

Miranda no dudó al enterarse de que era la donante ideal.

“Me hizo muy feliz saber que éramos tan compatibles, para que ella pudiera tener la mayor cantidad de años posibles con el mejor riñón”, dijo. “Y sabía que sería reconfortante para ambas pasar por todo este proceso juntas”.

Las hermanas Ponce se sometieron a la cirugía de trasplante en noviembre de 2025 en Cedars-Sinai y pasaron las siguientes semanas recuperándose juntas en la casa de sus padres en Bellflower, California.

“Cada vez que un trasplante de donante vivo ocurre entre hermanos o familiares, es algo muy especial”, dijo Steggerda. “En este caso, permitió que Angélica dejara la diálisis, y eso hace que la historia sea aún más significativa”.

Todo agregó que la determinación y actitud positiva de Angélica fueron clave en su recuperación.

“[Angélica] estaba decidida a no caminar hacia el altar con un catéter de diálisis”, dijo. “Y el hecho de que su hermana diera ese paso para ayudarla en uno de los momentos más importantes de su vida es muy conmovedor”.

Abril marca el Mes Nacional de Dona Vida, que promueve la concientización sobre la donación de órganos y honra a quienes han dado el regalo de la vida. Para conmemorar esta fecha, las hermanas participaron en la ceremonia anual de izamiento de la bandera Dona Vida en Cedars-Sinai.

“Este mes significa muchísimo para mí, en lo personal. Esta es ahora nuestra historia, y como paciente de trasplante siento que tengo una voz para crear conciencia”, dijo Angélica. “Al donar un riñón, le devuelves la vida a alguien. Siento que mi hermana me devolvió la vida”.

Con los desafíos de salud de Angélica ya en el pasado, las hermanas miran hacia un futuro lleno de esperanza, incluida la boda de Angélica en 2027. Miranda será su dama de honor.

“Será la primera vez que participe en una boda, así que estoy muy emocionada”, dijo Miranda. “Mi mayor meta después del trasplante era que ella pudiera tener su boda y, algún día, formar una familia. Mi sueño más grande es ser tía. Así que sí, estoy muy emocionada”.

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Cedar-Sinai's Comprehensive Transplant Center and Smidt Heart Institute professionals, alongside partners from OneLegacy, the nation’s largest organ procurement organization, are marking National Donate Life Month by holding a commemorative procession and flag raising ceremony at Cedars-Sinai Medical Center on Wednesday, April 1.

At 9:10 a.m., patients and their families, physicians, nurses, therapists and more will walk together from the Comprehensive Transplant Center to the flag raising ceremony. Hip-hop star and Cedars-Sinai heart transplant patient Christopher “Kid” Reid will lead the procession.

After a short program of speakers featuring Cedars-Sinai transplant patients and surgeons, the group will raise a Donate Life flag, which will be flown at the medical center throughout the month.

WHO

• Christopher “Kid” Reid, half of the iconic rap duo Kid ’n Play and Cedars-Sinai heart transplant patient. Reid will be available for media interviews about his health journey.
• Angelica Ponce and her sister, Miranda Ponce, Cedars-Sinai kidney transplant patients. When Angelica was in renal failure due to an autoimmune disease, Miranda stepped up to be her donor.
• Chloee Tarazon, Cedars-Sinai liver transplant patient.
• Laura DiChiacchio, MD, PhD, cardiothoracic surgeon in the Smidt Heart Institute and Reid’s transplant surgeon.
• Tsuyoshi Todo, MD, program director of the Abdominal Transplant Fellowship in the Comprehensive Transplant Center and Angelica Ponce’s kidney transplant surgeon.
• Alonzo Urita, regional manager of hospital partnerships, OneLegacy.

WHY

April is National Donate Life Month. The procession and flag raising promotes awareness about organ, eye and tissue donation and honors those who gave the gift of life.

WHEN

Wednesday, April 1

9:10 a.m. Procession begins from Cedars-Sinai Comprehensive Transplant Center

9:30 a.m. Brief speaker presentation at Cedars-Sinai Medical Center

10 a.m.    Flag raising by Cedars-Sinai transplant patients

WHERE

Procession:
Cedars-Sinai Comprehensive Transplant Center
8900 Beverly Blvd.
Los Angeles, CA 90048
Approximate walk distance is 0.5 miles

Ceremony:
Cedars-Sinai Medical Center
Plaza Level between North & South Towers
8700 Beverly Blvd.
Los Angeles, CA 90048 

CONTACT

Jillian Scholten, 949-244-2561, jillian.scholten@cshs.org

Miranda regresaba a casa desde la escuela en una minibicicleta motorizada cuando fue atropellado por un vehículo y luego arrastrado por un camión de carga, lo que le provocó lesiones catastróficas. Inicialmente fue trasladado a un centro de trauma de Nivel II cercano para estabilizarlo, pero sus lesiones eran tan extensas y potencialmente mortales que los médicos decidieron que la mejor oportunidad de salvarle la vida era transferirlo a Cedars-Sinai.

“Como centro de trauma de Nivel I, Cedars-Sinai está preparado para atender casos altamente complejos como el de Albert”, dijo Galinos Barmparas, MD, director médico de Trauma en el Departamento de Cirugía Jim y Eleanor Randall de Cedars-Sinai. “Incluso con los amplios recursos y la experiencia de nuestro equipo, sigue siendo un milagro que Albert esté vivo, dadas las lesiones que sufrió”.

Las graves lesiones por aplastamiento en la pierna izquierda de Miranda requirieron una amputación hasta la cadera. También sufrió una fractura de pelvis, daño en la uretra y enfrentó infecciones severas en las heridas tras ser arrastrado por la carretera. Miranda necesitó más de 20 cirugías y la atención de especialistas de múltiples áreas, incluyendo trauma, ortopedia, cirugía plástica y reconstructiva, urología, pediatría, terapia física y más.

“Nunca pensé que estaría en una situación así en toda mi vida, pero aquí estamos”, dijo Miranda. “Después de un largo camino, he conocido nuevas personas aquí que me han tratado bien. Y la verdad me alegra que hayan querido trabajar conmigo… eso hizo que Cedars-Sinai se sintiera como mi hogar”.

Barmparas señaló que más de 100 trabajadores de la salud contribuyeron a que Miranda llegara a este punto.

“Los pacientes pueden sobrevivir al impacto inicial y a las primeras cirugías”, dijo Barmparas. “Pero si no cuentan con los especialistas y los recursos necesarios, es posible que no logren salir adelante”.

Las bicicletas eléctricas y de gasolina que pueden alcanzar más de 25 millas por hora, como la que conducía Miranda en el momento del accidente, representan una preocupación de seguridad para Barmparas, quien supervisa la cirugía de trauma en Cedars-Sinai.

“Estos vehículos son peligrosos. Puedo decir que veo lesiones por bicicletas motorizadas, bicicletas eléctricas y scooters eléctricos en el área de trauma con regularidad”, dijo. “Los pacientes llegan constantemente con lesiones cerebrales traumáticas, fracturas faciales y otros traumas que cambian la vida”.

El accidente ocurrió a finales de septiembre, por lo que Miranda pasó las fiestas de invierno, así como su cumpleaños número 17, en el hospital. Sin embargo, en ese tiempo ha logrado avances notables en su recuperación y ha recuperado parte de su movilidad con la ayuda de una silla de ruedas y un andador.

“Se siente un poco surrealista ver el progreso que ha tenido”, dijo Romina Kim, MD, médica hospitalista pediátrica en Cedars-Sinai Guerin Children’s. “Pasó de no poder levantarse de la cama a ahora caminar con un andador. Es completamente distinto al joven que vimos hace seis meses. Es realmente un milagro”.

Ahora, después de más de cinco meses en el hospital, Miranda finalmente ha sido dado de alta de Cedars-Sinai para continuar su recuperación en un centro de rehabilitación.

“Lo siguiente es la rehabilitación”, dijo Miranda. “No sé cuánto tiempo estaré ahí, pero espero que sea poco para poder regresar a casa”.

El equipo de Cedars-Sinai celebró recientemente su salida con una caminata de despedida, ondeando pompones y animándolo mientras avanzaba por los pasillos de Cedars-Sinai Guerin Children’s. Sus médicos se sienten alentados por su resiliencia y por lo lejos que ha llegado, no solo en su recuperación física, sino también emocional tras este evento traumático.

“Tiene muchos sueños y aspiraciones”, dijo Kim. “Y con la actitud que tiene, realmente puede llegar a ser lo que quiera. Creo que logrará grandes cosas”.

Por su parte, Miranda espera fortalecerse para retomar su rutina normal y pasar tiempo con sus amigos. Aun así, asegura que extrañará a su equipo de atención en Cedars-Sinai.

“Todos han sido muy solidarios y eso es lo que me mantiene positivo”, dijo Miranda. “Si ellos quieren lo mejor para mí, yo también quiero lo mejor para mí”.

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Within weeks, though, Angelica’s world came crashing down.

“I started getting swelling in my ankles, losing a bunch of weight and just generally not feeling very good,” Ponce said. “I went in for a blood test and knew quickly something was wrong.”

It was a major flare-up of ANCA vasculitis, the autoimmune disease she had been diagnosed with in her teens but had been in remission for several years. Doctors now told her she had more than 60% damage to her kidneys and there was nothing they could do to reverse it. She would need to begin dialysis and, eventually, would require a kidney transplant.  

“It is very unusual for people in their 20s to go into renal failure. Typically, kidney failure is related to diabetes and high blood pressure in patients in their 50s and older,” said Tsuyoshi Todo, MD, a kidney transplant surgeon at Cedars-Sinai. “In Angelica’s case, she was a college athlete and as healthy as they could come. It was very unfortunate she had her kidneys shut down due to her autoimmune disorder.”

Ponce didn’t want to be on dialysis for her wedding, so she put planning on hold and began searching for a kidney donor.

She didn’t have to look very far. Angelica’s younger sister, Miranda Ponce, immediately volunteered to get tested to see if one of her kidneys might be a good match.

When the test results came back, the sisters were a perfect six out of six match.

“That six out of six number indicates the number of matches that Miranda’s body shares in common with Angelica’s body,” said Justin Steggerda, MD, kidney transplant surgeon at Cedars-Sinai who served as the surgeon for Miranda Ponce. “This means Angelica’s body is less likely to react adversely to the transplant and less likely to form some sort of immune response that may later on lead to problems.”

Miranda Ponce said she didn’t hesitate when she found out she was the perfect living donor for her sister.

“I was happy that I had such a good match so that she could have the longest, healthiest years with the best kidney for her,” Miranda Ponce said. “And I knew it would be comforting for us, to go through this whole process together.”

The Ponce sisters went through their kidney transplant surgery at Cedars-Sinai in November 2025. They spent the next few weeks recovering together at their parents’ home in Bellflower, California.

“Anytime a living donor transplant is between siblings or family members, it’s always a really special occasion,” Steggerda said. “In this case, it facilitated Angelica being off dialysis, and I think that’s a really special story.”

Todo said that Angelica’s determination and positive outlook fueled her recovery.

“[Angelica] was determined to not walk down the aisle while she had a dialysis catheter hanging out of her chest,” Todo said. “And the fact that her sister stepped up to help her with a kidney donation for the biggest day of her life is very touching.”

April marks the recognition of Donate Life Month, which promotes awareness about organ donation and honors those who gave the gift of life. To acknowledge this occasion, the Ponce sisters will participate in the annual Donate Life flag raising ceremony at Cedars-Sinai on Wednesday, April 1.

“This month means so much to me, personally. This has become our story now, and being a transplant patient, I feel like I have a voice to raise awareness,” Angelica Ponce said. “By donating a kidney, you give someone their life back, and I feel like my sister gave me my life back because of this.”

With Angelica’s health challenges in the rearview mirror, the Ponce sisters are looking forward to brighter days to come, including Angelica’s wedding in 2027. Miranda will be her sister’s maid of honor.

“This will be my first time being in a wedding so I'm extremely excited,” Miranda Ponce said. “My biggest goal after the transplant was for her to get that wedding and to hopefully one day be a mother and give me nieces and nephews. That’s my biggest dream, honestly, just to be an aunt. So yeah, I'm really excited.”

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Desde hace casi dos años, el Programa de Trasplante Renal de Cedars-Sinai lleva a cabo nefrectomías de donantes vivos —la intervención quirúrgica consistente en extirpar un riñón del donante— de forma totalmente robótica; sin embargo, hasta ahora, la intervención en el receptor no se había realizado con asistencia robótica.

“Hay mucho más en juego cuando se trata de implantar un riñón”, afirmó el doctor Justin Steggerda, quien llevó a cabo el primer trasplante de riñón totalmente robótico del Centro Integral de Trasplantes. “El riesgo de hemorragia aumenta porque no solo se cortan y grapan los vasos sanguíneos, sino que, de hecho, se abren y se suturan para colocar el riñón trasplantado en una posición adecuada que permita su irrigación y mantenga un buen flujo sanguíneo”.

Cedars-Sinai es una de las únicas instituciones de Estados Unidos que ha realizado un trasplante renal totalmente robotizado, lo que la sitúa a la vanguardia de la innovación en trasplantes.

Steggerda habló recientemente con el Newsroom de Cedars-Sinai acerca del trasplante renal robotizado y de quiénes pueden beneficiarse de esta cirugía mínimamente invasiva.

¿En qué beneficia a los pacientes la cirugía de trasplante asistida por robot?

La principal ventaja del método robótico es que la incisión es más pequeña, lo que se traduce en menos dolor y un menor riesgo de infección. Esto permite una recuperación más rápida, una reincorporación más pronta al trabajo y una menor dependencia de los analgésicos. Todas estas son ventajas importantes para lograr resultados centrados en el paciente.

Existe la idea errónea de que son los robots los que realizan la cirugía, y eso no es cierto. Los robots no actúan de forma autónoma. Nosotros los controlamos en cada paso del proceso, por lo que, de hecho, quizá sea más adecuado referirse a ello como cirugía asistida por robot. Pero la ventaja de utilizar el robot es que los instrumentos pueden ser mucho más precisos, lo que permite que la intervención sea mínimamente invasiva.

¿En qué se diferencia la incisión de la cirugía robótica de la de una intervención tradicional?

Un riñón tiene aproximadamente el tamaño de un puño humano, por lo que cualquier incisión debe ser al menos lo suficientemente ancha como para introducir el órgano. En una intervención robótica, esa incisión tiene aproximadamente la longitud de mi palma. En una intervención abierta estándar, la incisión es más ancha —más cercana a la longitud de toda mi mano— para que no solo se pueda introducir el riñón, sino también ver a su alrededor e introducir los instrumentos para completar la operación.

¿Cuáles son los riesgos asociados al trasplante renal robótico?

El mayor reto de una intervención de trasplante robótica es acceder al abdomen de forma segura y operar alrededor de otros órganos que puedan interponerse. Esto difiere de una intervención abierta tradicional. … En un trasplante robótico, debemos tener en cuenta los demás órganos que puedan encontrarse en nuestro campo operatorio, lo que hace que la intervención sea mucho más especializada.

¿Quiénes se beneficiarán más de los procedimientos de trasplante robótico?

Los pacientes con un índice de masa corporal superior a 35 o 40 tienen un mayor riesgo de sufrir infecciones de la herida, lo que se ha asociado con peores resultados del trasplante de riñón a largo plazo. Al reducir algunos de esos riesgos, esperamos obtener mejores resultados en esa población de pacientes.

¿Cuál es el futuro del programa de trasplantes robóticos?

El programa de trasplantes renales robóticos de Cedars-Sinai es un programa que queremos seguir desarrollando. Nos permitirá ampliar el número y los tipos de pacientes a los que realizamos trasplantes, con mejores resultados. En realidad, es el futuro de los trasplantes en general.

Sin embargo, es importante señalar que trabajamos con una población vulnerable que padece enfermedad renal en fase terminal, y es posible que la cirugía robótica no sea la técnica adecuada para todos los pacientes. Siempre evaluaremos cada caso de forma individual para asegurarnos de personalizar la mejor atención posible para cada paciente. A corto plazo, en un horizonte de tres a cinco años, esperamos realizar hasta el 40 % de estos procedimientos de trasplante de forma robótica, a medida que seguimos impulsando la innovación y nos mantenemos a la vanguardia de la cirugía de trasplante renal.

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Miranda was riding home from school on a motorized minibike when he was hit by a vehicle and then dragged by a semitruck, resulting in catastrophic injuries. Initially rushed to a nearby Level II trauma center to be stabilized, Miranda had injuries so extensive and life-threatening that physicians there decided the best chance to save his life was to transfer him to Cedars-Sinai.  

“As a Level I trauma center, Cedars-Sinai is prepared to deal with highly complex cases like Albert’s,” said Galinos Barmparas, MD, medical director of Trauma in the Jim and Eleanor Randall Department of Surgery at Cedars-Sinai. “Even with our team’s extensive resources and expertise, it’s still a miracle Albert is alive, with the injuries he sustained.”

Major crush injuries to Miranda’s left leg required an amputation up to his hip. He also had a broken pelvis, a damaged urethra, and he battled severe infections from wounds he suffered after he was dragged on the road. Miranda required more than 20 surgeries and the expertise of physicians across multiple specialties, including trauma, orthopedics, plastic and reconstructive surgery, urology, pediatrics, physical therapy, and more.

“I never thought I'd be in a situation like this in my entire life, but here we are,” Miranda said. “But after, like, a long way coming, I've met new people here who've treated me well. And I'm actually glad that they wanted to work with me. ... So it made [Cedars-Sinai] feel like home.”

Barmparas said more than 100 healthcare workers helped Miranda get to this point.

“Patients may survive the initial hit and the initial surgeries,” Barmparas said. “But if they don't have the specialists and the resources, they may not be able to make it.”

Electric and gas-powered bikes that can travel upward of 25 miles per hour, like the one Miranda was riding at the time of his accident, are a safety concern for Barmparas, who oversees trauma surgery at Cedars-Sinai.

“These vehicles are dangerous. I can tell you that I see motorized bike, e-bike and electric scooter injuries in the trauma bay on a regular basis,” he said. “Patients come in all the time with traumatic brain injuries, facial fractures and other life-altering trauma.”

The accident occurred in late September, so Miranda spent the winter holidays, as well as his 17^th birthday, in the hospital. But in that time, he has made tremendous strides in his recovery and has regained some mobility with the assistance of a wheelchair and walker.

“It feels a little surreal, I think, the progress that we have seen from him,” said Romina Kim, MD, a pediatric hospitalist with Cedars-Sinai Guerin Children’s. “From not even being able to get out of bed to now walking with the walker. He’s a completely different kid from the one that we saw six months ago. It’s quite a miracle.”

Now, after more than five months in the hospital, Miranda is finally being discharged from Cedars-Sinai to continue his recovery at a rehabilitation center.

“Next is actually the rehab,” Miranda said. “I don't know how long I'll be there, but I hope it's a short amount of time so I can just get home already.”

The Cedars-Sinai team recently celebrated Miranda’s discharge with a celebration walk and send-off tunnel, waving pompoms and cheering him on as he made his way down the hallway of Cedars-Sinai Guerin Children’s. His physicians are encouraged by his resilience and how far he’s come not only with his physical, but also mental recovery from this traumatic event.

“He has a lot of dreams and aspirations,” Kim said. “And with the kind of attitude that he has, he can really become whatever he wants. I think he's going to do great things.”

As for Miranda, he is looking forward to getting stronger so he can get back to his normal routine and spend time with his friends. Still, he says he’ll miss his Cedars-Sinai care team.  

“Everyone has been so supportive and that's what keeps me positive,” Miranda said. “You know, if they want something good for me, I want something good for me as well.”

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La Dra. Irene Kim, directora del Centro Integral de Trasplantes de Cedars-Sinai, atribuye parte del aumento en los trasplantes de hígado al uso de perfusión mecánica, una tecnología que mantiene los órganos donados en mejores condiciones hasta el momento del trasplante.

Este sistema hace circular una solución rica en oxígeno y nutrientes, basada en sangre, a través del órgano donado. La tecnología ayuda a reducir la disfunción del injerto, permite conservar los órganos por más tiempo y mejora la evaluación que realizan los médicos antes del trasplante. Según Kim, esto ha contribuido a aumentar la disponibilidad de órganos para trasplante.

La disposición del equipo para tratar casos altamente complejos también contribuyó al aumento en los trasplantes de pulmón. Cedars-Sinai es reconocido por aceptar pacientes de alto riesgo que anteriormente habían sido rechazados por otros centros médicos.

“Estamos comprometidos a mantenernos a la vanguardia de la tecnología de trasplantes para garantizar los mejores resultados para nuestros pacientes, con tasas de supervivencia que continúan igualando o superando el promedio nacional”, dijo Kim. “Cuantos más órganos podamos trasplantar, más pacientes tendrán una segunda oportunidad de vida. Es un privilegio ayudar a estos pacientes y también honrar a los donantes que dieron el máximo regalo de vida”.

Según datos de la Red de Obtención y Trasplante de Órganos (OPTN), en 2025 se realizaron 49,065 trasplantes en Estados Unidos, la cifra más alta registrada hasta ahora. La organización ha establecido una meta nacional de 60,000 trasplantes de donantes fallecidos al año para finales de 2026.

Nuevos Récords en Trasplantes de Hígado, Pulmón y Donantes Vivos de Riñón

El Departamento de Cirugía Cardíaca del Instituto del Corazón Smidt es el centro con mayor volumen de trasplantes de corazón en California. En 2025, los equipos clínicos y quirúrgicos realizaron 114 trasplantes de corazón en adultos.

El equipo está liderado por la Dra. Joanna Chikwe, presidenta del Departamento de Cirugía Cardíaca; el Dr. Fardad Esmailian, director quirúrgico del Programa de Trasplante de Corazón; y el Dr. Jon Kobashigawa, director del Programa de Trasplante de Corazón en el Departamento de Cardiología. Durante los últimos 13 años, el programa ha realizado un promedio de más de 100 trasplantes de corazón al año, un récord actual en Estados Unidos.

El equipo de trasplante pulmonar, dirigido por el director quirúrgico Dr. Dominick Megna y el director médico Dr. Reinaldo Rampolla, realizó 93 trasplantes de pulmón en 2025, la mayor cifra en la historia de Cedars-Sinai. El récord anterior era de 88, establecido en 2024.

El Programa de Trasplante Pulmonar del Instituto del Corazón Smidt continúa siendo el programa con mayor volumen en California y, en 2025, se ubicó entre los 10 centros con mayor volumen en Estados Unidos.

El Programa de Trasplante de Hígado también alcanzó un nuevo récord. El equipo, liderado por Kim como directora quirúrgica y por el Dr. Alexander Kuo, profesor de Medicina y director médico del programa, realizó 145 trasplantes de hígado en 2025, superando el récord anterior de 136 establecido en 2024.

El equipo del Programa de Trasplante de Riñón completó 324 trasplantes en 2025, incluido un trasplante combinado de páncreas y riñón. El programa está liderado por el Dr. Stanley Jordan, director médico del Laboratorio de Antígenos Leucocitarios Humanos e Inmunología de Trasplantes del Centro Integral de Trasplantes, y el Dr. Tsuyoshi Todo, director quirúrgico.

En 2025, el equipo también realizó 80 trasplantes de riñón de donante vivo, estableciendo un nuevo récord en Cedars-Sinai y superando en más del 15% el récord anterior de 69 trasplantes en 2013.

Este programa, dirigido por los doctores Steven Wisel y Reiad Najjar, se ha transformado en un programa quirúrgico completamente robótico.

“Estos logros reflejan el arduo trabajo del equipo del Centro Integral de Trasplantes de Cedars-Sinai”, dijo Kim, titular de la cátedra Esther and Mark Schulman en Cirugía y Medicina de Trasplantes. “Pero ninguno de estos procedimientos que salvan vidas sería posible sin el altruismo de los donantes de órganos y sus familias. Estamos profundamente agradecidos con quienes dan el regalo de la vida a través de la donación de órganos”.

Lea más en Historias y Perspectivas de Cedars-Sinai: Después de un Trasplante de Pulmón, el Regreso a Correr

“We use our voice to express ourselves, whether it’s enthusiasm at our team scoring a buzzer-beater, or extreme disappointment when they miss the shot,” said Anca Barbu, MD, laryngeal surgeon and associate professor in the Jim and Eleanor Randall Department of Surgery, Division of Otolaryngology-Head and Neck Surgery at Cedars-Sinai. “And those expressions are fine, but the volume at which we’re doing so can put the vocal cords at risk of trauma.”

Barbu, who specializes in professional voice and voice disorders, recently spoke with the Cedars-Sinai Newsroom about tips for enjoying the upcoming NCAA Tournament, and other major sporting events, while maintaining vocal health.

What are the risks of screaming too much during sporting events? What short- and long-term damage can you do?

Vocal cord trauma, also known as phonotrauma, can occur when we overuse our voice, potentially causing damage to the cords. In the short term, this can present as a change or loss of voice. Typically, this type of injury should resolve itself in 24 to 48 hours.

In the long term, vocal cord damage can become chronic laryngitis if the voice doesn’t get a chance to rest and heal.

If you lose your voice all of a sudden, such as in the middle of talking or yelling, we worry about more of an acute event such as a vocal fold hemorrhage. If that happens, seek medical care.

What tips do you recommend for preventing vocal strain while cheering on your favorite team?

In already loud environments, such as a packed arena or even an in-home watch party with friends, people tend to get louder to project over the ambient noise, creating a greater risk of vocal cord strain. I always tell patients that during these times, you can still be animated by cheering with your hands and facial expressions or clapping and using other external noisemakers rather than projecting your voice. Signs and banners are a great option, too. Just think outside of the voice box, if you will.

Are there certain foods and drinks you should avoid to protect your voice?

When you think about the types of foods consumed at these kinds of sporting events or watch parties, they tend to be very reflux-inducing foods. Foods that are greasy, fatty or spicy, alongside alcohol and carbonated beverages, will tend to create more acid in your stomach, leading to heartburn and silent reflux, also known as laryngopharyngeal reflux [LPR]. This creates an environment in your throat where tissues may be swollen, which makes them more prone to trauma and can present as a sore throat the next day. If you’re planning to enjoy these foods that may trigger silent reflux, do so in moderation or consider taking an antacid to help avoid the issue.

Additionally, it is important to avoid other carcinogenic products like tobacco or vaping, as those can irritate your vocal cords and throat as well.

If you do overdo it, how can you recover?

If you lose your voice instantaneously or experience hoarseness following overuse, the best thing to do is to simply be quiet. Vocal rest, avoiding all talking, is recommended for at least 24 and up to 72 hours, depending on the severity of the laryngitis. Do not try to push through with your voice or even whisper, because that is when greater injuries may occur.

At what point should you consult a doctor for vocal issues?

If vocal rest has not resolved the issue in 72 hours, you should contact your primary care doctor.

However, if it's been three or more weeks of laryngitis from yelling and your voice has not returned to baseline, it’s important at that point to see an ENT [ear, nose and throat specialist] for an exam of your vocal cords. If you are someone, such as a singer or actor, who relies on their voice professionally, it would be recommended to specifically see a laryngologist—an ENT with specialized training for voice-related issues, including vocal cord swelling and trauma.

Read more from Cedars-Sinai Stories and Insights: The Science of Hangovers

For nearly two years, the Cedars-Sinai Kidney Transplant Program has been performing living-donor nephrectomies—the surgical procedure of removing a kidney from the donor—fully robotically, but, until now, the recipient procedure had not been robot-assisted.

“The stakes are quite a bit higher when it comes to putting a kidney in,” said Justin Steggerda, MD, who performed the Comprehensive Transplant Center’s first fully robotic kidney transplant. “The risk of bleeding increases because you’re not just cutting and stapling vessels but actually opening them up and sewing them together to get the transplanted kidney positioned well to where it can be reperfused and maintain good blood flow.” 

Cedars-Sinai is one of only a handful of institutions in the United States to have performed a fully robotic kidney transplant, placing it on the leading edge of transplant innovation.

Steggerda recently spoke with the Cedars-Sinai Newsroom about robotic kidney transplantation and who can benefit from the minimally invasive surgery.

How is robotic transplant surgery helpful to patients?

The primary advantage of a robotic approach is a smaller incision, which means less pain and lower risk of infection. This leads to a faster recovery, faster return to work and reduced reliance on pain medication. These are all big advantages for patient-centered outcomes.

There is a misconception that robots are doing the surgery itself, and that is not true. Robots do not act autonomously. We are controlling them every step of the way, so, in fact, it may be more appropriate to refer to it as robot-assisted surgery. But the advantage of using the robot is that the instruments can be much more dexterous, allowing the procedure to be more minimally invasive.

How does the incision for robotic surgery compare to a traditional procedure?

A kidney is about the size of a human fist, so any incision needs to be at least wide enough to get the organ in. For a robotic procedure, that incision is approximately the length of my palm. In a standard, open procedure, the incision is wider—closer to the length of my entire hand—so you can not only get the kidney in, but you can also see around it and get your instruments in to complete the operation.

What are the risks associated with robotic kidney transplant?

The biggest challenge of a robotic transplant procedure is getting into the abdomen safely and operating around other organs that may be in the way. This is different from a traditional, open procedure. … In a robotic transplant, we must be cognizant of the other organs that may be in our operative field, making the procedure more highly specialized.

Who will benefit most from robotic transplant procedures?

Patients with a body mass index over 35 or 40, are at an increased risk for wound infections, which have been associated with worse kidney transplant outcomes in the long term. By reducing some of those risks, we expect to see better outcomes in that population of patients.

What is next for the robotic transplant program?

Robotic kidney transplant at Cedars-Sinai is a program that we want to continue to grow. It will allow us to expand the number and types of patients that we transplant, with better outcomes. It’s really the future of transplantation in general.

It’s important to note, however, that we are working with a fragile population with end-stage kidney disease, and robotic surgery may not be the right technique for every patient. We will always evaluate every case individually to make sure we personalize the best possible care for each patient. In the short, three-to-five-year view, we hope to be performing up to 40% of these transplant procedures robotically as we continue to drive innovation further and stay on the leading edge of kidney transplantation surgery.

Read more from Cedars-Sinai Stories and Insights: What Is Robotic Surgery? How It Works and When It’s Used

Irene Kim, MD, director of the Cedars-Sinai Comprehensive Transplant Center, partially credits the increase in liver transplants to the use of machine perfusion, a technology that circulates oxygen-rich, nutrient-rich, blood-based solution through donor organs until transplantation. Machine perfusion reduces graft dysfunction, allowing organs to be viable longer and improving physicians’ assessments of the organs ahead of transplantation—all of which has served to increase donor organ availability, Kim said.

A willingness to take on the most complex cases also helped drive the increase in lung transplants, according to Kim, as Cedars-Sinai is known for accepting high-risk cases that had been previously turned away by other institutions.

“We are committed to staying on the leading edge of transplant technology to ensure the best results for our patients, with survival outcomes that continue to meet or exceed the national average,” Kim said. “The more organs we can transplant, the more patients can receive a second chance at life. It’s a privilege to not only help these patients, but also to honor the donors who gave the ultimate gift of life.”

According to published data from the Organ Procurement and Transplantation Network (OPTN), 49,065 transplants occurred in the U.S. in 2025—more than in any other year. With records continuing to be set year over year, the OPTN has set an ambitious nationwide goal of 60,000 deceased donor transplants annually by the end of 2026.

New Records in Liver and Lung Transplants, Living Kidney Donors

The Department of Cardiac Surgery in the Smidt Heart Institute is the largest heart transplant center by volume in California, with clinical and surgical teams performing 114 adult heart transplants in 2025. The team, led by Joanna Chikwe, MD, chair of the Department of Cardiac Surgery, Fardad Esmailian, MD, surgical director of the Heart Transplant Program, and Jon Kobashigawa, MD, director of the Heart Transplant Program in the Department of Cardiology, has maintained an average of more than 100 heart transplants each year for the last 13 years, a current record in the U.S.

Surgical Director Dominick Megna, MD, and Medical Director Reinaldo Rampolla, MD, led the lung transplant team to perform 93 lung transplants in 2025—the most ever at Cedars-Sinai—surpassing its previous record of 88 in 2024. The Lung Transplant Program in the Smidt Heart Institute at Cedars-Sinai continues to be the largest by volume in California and, in 2025, earned a place as a top 10 center by volume in the U.S.

The Liver Transplant Program also reached new milestones. The team, led by Kim, as surgical director, and Alexander Kuo, MD, professor of Medicine and medical director of the Liver Transplant Program, performed 145 liver transplants in 2025, exceeding the 2024 record of 136 transplants.

The Kidney Transplant Program team, led by Stanley Jordan, MD, medical director of the Comprehensive Transplant Center’s Human Leukocyte Antigen and Transplant Immunology Laboratory, and Tsuyoshi Todo, MD, surgical director, completed 324 transplants in 2025, including one pancreas-kidney transplant.

Notably, the team performed 80 living donor kidney transplants in 2025, setting a record for the number of living donor kidney transplants performed at Cedars-Sinai, with a more than 15% increase over the previously held record volume of 69 in 2013. This program, led by Steven Wisel, MD, and Reiad Najjar, MD, has transformed into a completely robotic surgical program.

“These achievements are a testament to the hardworking team at the Cedars-Sinai Comprehensive Transplant Center,” said Kim, the Esther and Mark Schulman Chair in Surgery and Transplantation Medicine. “But none of these lifesaving procedures would be possible without the altruism of organ donors and their families. We are tremendously grateful to those who give the gift of life through organ donation.”

Read more from Cedars-Sinai Stories and Insights: After Lung Transplant, a Return to Running

Preclinical Study Targets ‘Zombie’ Cells

Senolytics—a class of drugs that reduce chronic inflammation and tissue damage in aging cells—are shown to eliminate 30% to 70% of “zombie” cells in the body. These zombie cells, known as senescent cells, stop dividing and don’t die, ultimately contributing to a host of diseases of aging, including cancer.

A preclinical study from Cedars-Sinai, published in Aging Cell, had three key findings:

• Senolytic drugs purge the most harmful cells, leaving less-harmful senescent cells behind.
• These remaining “senolytic-resistant” senescent cells can be activated into tissue-damaging senescent cells by infections and other factors in the environment of senescent cells.
• A new class of drugs, “senosensitizers,” can enable senolytics to eliminate these lurking senolytic-resistant “ticking time bomb” cells.

Investigators found that in laboratory mice treated with senolytic drugs, the remaining senescent cells were less inflammatory and damaging than the cells removed by the treatment. Researchers also found that these remaining senescent cells, when activated into tissue-damaging cells by an inflammatory environment, become more vulnerable to senolytics than those in a stable environment.

Based on their findings that infections can make senescent cells become susceptible to senolytics, study authors theorize that targeting senescent cells with newly developed senosensitizers—and then senolytics—might allow more senescent cells to be removed than when using senolytics alone. This could remove senolytic-resistant senescent cells and reduce the impact of infections in previously apparently healthy older people.

“This drug combination, which is still in the preclinical phase, has the potential to target senescent cancer cells that persist after radiation and chemotherapy and may later reemerge as more aggressive disease,” said James Kirkland, MD, PhD, director of the Center for Advanced Gerotherapeutics and senior author of the study.

Additional Cedars-Sinai authors include Masayoshi Suda, Tamar Tchkonia, Selim Chaib, Larissa Langhi Prata, Tamar Pirtskhalava and Nino Giorgadze.

Additional authors include Utkarsh Tripathi, Vagisha Kulshreshtha, Bryan T. Piatkowski, Allyson K. Palmer, Christina Inman, Nathan Gasek, Ming Xu, Kurt O. Johnson, Yi Zhu, Renuka Kandhaya-Pillai, Stefan G. Tullius, Saranya P. Wyles, Rambabu Majji, Hari Krishna Yalamanchili and David B. Allison.

Funding: This work was supported by NIH grants R37AG013925 (J.L.K., T.T.), R33AG061456 (J.L.K., T.T.), R01AG066679 (M.X.), R01AG076642 (M.X.), R01AG064165 (S.G.T.), R01AG087387 (Y.Z.), the Connor Fund (J.L.K., T.T.), Robert J. and Theresa W. Ryan (J.L.K., T.T.), HF-GRO-­23-­ 1199148-­ 3 (J.L.K.), HF-­ GRO-­ 23-­ 1199262-­ 27 (Y.Z., M.S.), the JSPS Grants-­ in-­ Aid for Scientific Research Fund for the Promotion of Joint International Research (Fostering Joint International Research) 23KK0295 (M.S.), the Yamada Science Foundation (M.S.), and USDA/ARS grant CRIS 3092-­ 51000-­ 065-­ 003S (H.K.Y.) and the Noaber Foundation (J.L.K.). U.T. was supported by an American Heart Association predoctoral fellowship (917775).

Cedars-Sinai Study Links GLP-1RA Drugs to Risk of Chronic Cough

Patients who take the widely used Type 2 diabetes and obesity medications known as glucagon-like peptide-1 receptor agonists (GLP-1RAs) appear to be at increased risk of developing chronic cough, according to a new multicenter study led by Cedars-Sinai and published in JAMA Otolaryngology – Head & Neck Surgery.

GLP-1RA medications, marketed under many brand names, work by stimulating insulin release from the pancreas, lowering blood sugar and slowing digestion. As a result, these drugs may help people with Type 2 diabetes manage their blood sugar and help people with obesity lose weight.

Investigators reviewed 10 years of electronic medical records with data on more than 2 million Type 2 diabetes patients at 70 healthcare organizations. They compared records of individuals prescribed a GLP-1RA drug with those who were prescribed a non-GLP-1RA drug to treat diabetes, and found that GLP-1RA use was associated with a significantly increased risk of new chronic cough.

“Further research is needed to confirm the existence, strength and mechanisms of the association between GLP-1RA drugs and chronic cough,” said Anca Barbu, MD, associate professor in the Jim and Eleanor Randall Department of Surgery and the study’s corresponding author. “However, our findings highlight the importance of physicians and care providers asking patients with new-onset chronic cough about possible GLP-1RA use, and for healthcare providers prescribing these medications to discuss chronic cough as a possible side effect.”

The other Cedars-Sinai author is Neelaysh Vukkadala, MD.

Additional authors include Tyler J. Gallagher, MD, MPH; Diego E. Razura, MD; Albert Li, BA; and Ian Kim, PhD. 

Bodily Fluid Changes Linked to Poor Heart Surgery Outcomes

Patients who lose or gain a significant amount of fluid after certain elective heart surgeries are more likely to be readmitted to the ICU, stay longer in the hospital or die than patients whose fluid levels remain stable, according to a new study from Cedars-Sinai. The findings, published in Anesthesia & Analgesia, could help improve patient care.

Investigators reviewed data on 2,557 patients who underwent nonemergency coronary artery bypass grafts, valve surgeries or a combination of the two. They calculated each patient’s total fluid intake (including oral and intravenous fluids and blood products) and output (including urine, stool and surgical drains), based on measurements taken in the operating room and in the ICU after surgery.

“It remains unclear whether changes in cumulative fluid balances above 1.5 liters on the day of ICU discharge actually cause adverse outcomes or are just associated with them,” said senior author Joseph Ebinger, MD, MS, associate professor of Cardiology and director of the Coronary Intensive Care Unit and Clinical Analytics in the Smidt Heart Institute at Cedars-Sinai. “Further study is called for. In the meantime, our findings suggest that greater attention to such variations may help improve outcomes for cardiac surgery patients.”

Other Cedars-Sinai authors are Abirami Kumaresan, George Gill, Jesse Navarrette, Tao Shen, Milad Sharifpour, Dominic Emerson, Joanna Chikwe and Susan Cheng.

Funding: This study was supported in part by a grant from the International Anesthesia Research Society and NIH grant: K23-HL153888. The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Different Immune Cell Types Correlate with Breast Cancer Survival

The quantities of specific types of immune cells that appear in and around a breast cancer tumor are correlated with the prognosis for the patient, according to a new study led by Cedars-Sinai. The findings have implications for use of immunotherapy in this disease, the second leading cause of cancer deaths among women in the U.S.

The study was published in the peer-reviewed journal iScience.

Investigators analyzed images from 12,285 female breast cancers, including estrogen-positive breast cancer, the most common type, in which cancer cells have a protein that binds to the hormone estrogen; estrogen-negative breast cancer, in which the cells lack this protein, was also studied.

Using artificial intelligence (AI), investigators calculated the percentages of different types of immune cells within the tumors, in nearby connective tissue (known as stroma) and in total for both areas. They examined the relationship between these percentages and the likelihood that the patient would die from breast cancer over a certain period of time after diagnosis. Two types of immune cells, CD8+ and CD20+, were found to be associated with a better prognosis in estrogen-positive breast cancer patients, whereas another cell type, CD163+, was associated with a poorer prognosis. CD8+ and FOXP3+ immune cells were associated with a better prognosis in estrogen-negative breast cancer.

“Our findings suggest that the immune system is an important predictor of outcome in hormone-positive breast cancer,” said Paul Pharoah, MD, PhD, professor of cancer epidemiology in the Department of Computational Biomedicine at Cedars-Sinai and the study’s senior and corresponding author. “They support including this subset of patients in clinical trials of immune modulators, which could lead to improved treatments for women with this common cancer.”

Other authors include: Aaron J. Bernstein PhD, Renske Keeman MSc, Amber Hurson PhD, Fiona M. Blows PhD, Manjeet K. Bolla MSc, Jodi L. Miller PhD, Roger L. Milne PhD, Hugo Horlings MD, PhD, Alexandra J. van den Broek PhD, Clara Bodelon PhD, James M. Hodge JD, MPH, Alpa V. Patel PhD, Lauren R. Teras PhD, Federico Canzian PhD, Rudolf Kaaks PhD, Hermann Brenner MD, Ben Schöttker PhD, Sabine Behrens PhD, Jenny Chang-Claude PhD, Tabea Maurer DiplPsych, Nadia Obi PhD, Fergus J. Couch PhD1, H. Raza Ali PhD, Carlos Caldas MD, Irene Andrulis PhD, Gord Glendon MSc, Anna Marie Mulligan MD, Wilma Mesker PhD, Agnes Jager MD, PhD, Annette Heemskerk-Gerritsen PhD, Peter Devilee PhD, Scott M. Lawrence PhD, Jolanta Lissowska PhD, Karun Mutreja PhD, Thomas Ahearn PhD, Stephen Chanock MD, Maire A. Duggan MD, Diana Eccles PhD, J. Louise Jones MB ChB, PhD, Will Tapper PhD, Antoinette Hollestelle PhD, Maartje Hooning PhD, John Martens PhD, Carolien H.M. van Deurzen MD, PhD, Angela Cox PhD3, Simon S. Cross MB BS, Mikael Hartman MD, PhD, Jingmei Li PhD, Thomas C. Putti MD, Ute Hamann PhD, Muhammad Rashid MB BS, PhD, Ania Jakubowska PhD, Nicki Camp PhD, Melissa H. Cessna MD, Amy Berrington de Gonzalez DPhil, Katarzyna Bialkowska PhD, Jacek Gronwald PhD, Jan Lubiński MD, PhD, Siddhartha Yadav MD, Pietro Lio PhD, Doug F. Easton PhD, Mustapha Abubakar MD, PhD, Montse Garcia-Closas MD, DrPH,  and Marjanka K. Schmidt, PhD.

Acknowledgements: The authors thank the Histology and Genomics Cores at the Cancer Research UK Cambridge Institute for technical support, and all patients, researchers, clinicians, and administrative personnel who contributed to the studies taking part in BCAST.  The CPSII study investigators acknowledge the contribution to this study from central cancer registries supported through the Centers for Disease Control and Prevention's National Program of Cancer Registries and cancer registries supported by the National Cancer Institute's Surveillance Epidemiology and End Results Program.

BCAC was supported by Cancer Research UK grant: PPRPGMNov20\100002 and by core funding from the NIHR Cambridge Biomedical Research Centre (NIHR203312). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.  The BCAST project was supported by the Horizon 2020 Research and Innovation Programs of the European Union B (grant number: 633784) and the NIHR Cambridge Biomedical Research Centre. AJB was supported by the NIH Oxford-Cambridge Scholars and Gates Cambridge Scholars programs. (The funding of the contributing studies is listed in a supplementary table in the article.)

Cedars-Sinai Health Sciences University is advancing groundbreaking research and educating future leaders in medicine, biomedical sciences and allied health sciences. Learn more about the university.

The nasal spray vaccine offers a practical alternative for young patients who fear needles.

“That’s probably the biggest benefit of utilizing intranasal,” Corpus told Medscape. “It’s not a poke. And there are also probably adults who would much prefer not to have a needle that can cause some pain.”

The U.S. Centers for Disease Control and Prevention (CDC) only recommends the nasal vaccine for healthy individuals between the ages of 2 and 49. The federal agency warns against using the spray for individuals who are pregnant, those caring for the immunocompromised or those with chronic conditions like lung disease and diabetes.

Although the CDC advises caution when giving the nasal vaccine to young patients with asthma, due to a slightly increased risk of hospitalization, Corpus has seen good results with this group in his practice.

“For kids ages 2 years and up, the asthma safety profile is actually pretty great,” he told Medscape. “It’s well-tolerated, even in kids with a wheeze.”

For children and adults alike, Corpus agrees that the nasal vaccine helps get more people vaccinated each year to protect against a severe illness.

“The hope overall is that when people are deterred for any reason about receiving the syringe, whether it be an adult or a child, you can administer this as a less-burdensome option,” he said. “Getting over that barrier is a huge win.”

Read the complete article from Medscape.

Pain in this area can be dull or sharp and may radiate down the legs. It accounts for 15%-30% of low back pain experienced by patients, according to treatment guidelines from physician specialty groups.

“For the 50-and-up population, I think that most SI joint pain is probably just normal wear and tear,” Bach told AARP.

Joints can wear out with age, allowing bones to rub against each other, causing osteoarthritis—the most common type of arthritis.

Other causes of SI joint pain include traumatic injury from a fall, repetitive activity, lack of movement, hypermobility (when the joint moves too much), hypomobility (when the joint can’t move enough), and reactive arthritis (inflammation caused by infection).

A less common cause of SI joint pain is a chronic, inflammatory type of arthritis called ankylosing spondylitis, which affects the axial skeleton.

“That’s all the midline structures, including your spine, your SI joints, and it can affect your hips, too,” Bach told AARP.   

For patients with mild or moderate pain, ice and over-the-counter anti-inflammatory drugs (NSAIDs) like ibuprofen may be useful. But if the pain becomes unmanageable, Bach recommends seeking medical advice either from a primary care physician or a physical therapist.

“If your pain isn’t going away after a week, and it’s keeping you from doing things, then go see a doctor,” Bach advised.

Read the complete article from AARP.

While many AI tools have been cleared by the U.S. Food and Drug Administration for use in healthcare, patients might not be aware the technology is being employed during a provider visit nor given a clear opportunity to opt out of their use.

“Patients don’t see a pop-up message that says, ‘Today’s care was brought to you by this algorithm,’” Bright said. “The algorithmic influence is just there in the background.”

Bright told Essence that trust is essential for these tools to be useful to Black patients and trust must be earned through equity and transparency. Historically, the Black community has been underrepresented in healthcare data, leading to undertreatment and even misdiagnosis.

“We have to ask who is represented in the data set, and who isn’t,” Bright said. “Anything that uses historical data can amplify existing disparities.”

Bright explained she is intentional about focusing on equity at the Cedars-Sinai Center for AI Research and Education. “We test AI for language, gender, insurance and things like that. We want to make sure that patients and groups of patients aren’t underrepresented in our records.”

While AI can be a useful tool in healthcare, Bright wants all patients—especially Black patients—to feel empowered to ask questions about AI technology and how it is being woven into their care.

“Don’t be afraid of the technology but do be informed. Do ask questions. Do use your voice. We want our tools used with our patients, not on them,” Bright told Essence. “That’s the difference between ethical AI and everything else. You have the right to understand and the right to say no.”

Read the complete article from Essence.

“Early on, I worked with a lot of patients with underlying illnesses such as asthma and chronic obstructive pulmonary disease [COPD] who experienced significant worsening of their symptoms due to wildfire smoke,” said pulmonologist Samuel Cohen, MD.

“Thankfully, most of those patients have improved now that the major trigger has subsided, and they’re back to a more baseline maintenance.”

Stephanie Koven, MD, a Cedars-Sinai primary care physician in Santa Monica, also treated many patients affected by the Palisades fire.

“Not only were we seeing flare-ups of asthma and emphysema for those in affected areas, but a significant increase in anxiety and depression,” Koven said. “I had patients in their 70s and 80s who were retired, and the home they were planning to live in for the rest of their lives was just gone.”

In addition to those retirees, Koven has cared for several members of the L.A. Fire Department who were on the front lines battling the blazes across Southern California.

“With firefighters, we’re most concerned about ongoing exposures over years,” Koven said. “Because of this, we’re more proactive with testing for things like heavy metals and PFAs, often called ‘forever chemicals.’ Firefighters also typically will receive earlier cancer screenings.”

While the general air quality has improved, Cohen said it’s possible that construction in the affected areas could rustle up particulate matter that may have previously settled in the soil.

“It’s especially important for workers in these areas to be sure they have appropriate respirators for protection,” Cohen said.

Koven agreed, adding that while residents who have moved back amid these construction zones may not need to wear masks in their own homes, they can still take other precautions.

“Using a HEPA filter in the home to help pull particulate matter from the air can be helpful,” Koven said. “If you’ve been to a burn site and are returning home, a general recommendation is to take off your shoes so you’re not tracking anything inside. You also could consider changing your outer layer of clothes when entering your home.”

Cohen also noted that some new smart thermostats can track air quality inside your home and will even set reminders for when to change your filters.

And if patients want to increase their overall respiratory health to combat any potential negative impact of returning to an affected area, Cohen says frequent cardiovascular exercise is key.

Both experts say it’s difficult to know yet what, if any, lingering health issues the public may experience because of the initial wildfire smoke exposure or rebuilding in and returning to burn areas.

“If you’re someone who will be moving back to these areas, it’s just important to make sure you’re in tune with how you’re feeling,” Cohen said. “If you begin to experience new-onset symptoms such as shortness of breath or a lingering cough, it’s time to speak to a medical professional.”

Read more on the Cedars-Sinai Blog: How Does Wildfire Smoke Affect Your Health?

The findings, published in JAMA Surgery, provide a framework to better manage ongoing follow-up care of patients whose cancer has not spread to their lymph nodes and who have had their tumors surgically removed.

“We now have a way to identify patients whose higher risk of recurrence may have been previously overlooked,” said Cristina R. Ferrone, MD, chair of the Jim and Eleanor Randall Department of Surgery at Cedars-Sinai and corresponding author of the study. “This gives us the opportunity to change the way we care for this patient population in a meaningful way.”

Pancreatic neuroendocrine tumors are a less common and typically less aggressive form of pancreatic cancer. Patients whose cancer has not spread to the lymph nodes or outside the pancreas have a 91% five-year relative survival rate following surgical treatment, according to the American Cancer Society. However, the Cedars-Sinai study identified a distinct subset of those patients who remain at high risk for their cancer to return.

The multi-institutional study analyzed data from 770 patients across five high-volume institutions and found approximately 10% of patients without lymph node involvement would eventually experience a recurrence of their cancer, most commonly in the liver. This data allowed investigators to develop a 13-point risk score by identifying four key factors that predict a higher risk of recurrence: male sex, a tumor size of 3 centimeters or larger, World Health Organization grade of 2 or higher, and whether cancer cells had entered the blood or lymph vessels, called lymphovascular invasion.

By using the newly created risk score to stratify patients into low-, moderate- and high-risk groups, investigators say they can better predict which patients should receive more frequent and intensive monitoring.

“The current guidelines leave clinicians with a ‘one-size-fits-all’ approach, but it’s clear from our research that not all patients require the same intensity of surveillance,” Ferrone said. “The results address a critical gap in current practice and will hopefully influence future guideline development for well-managed, individualized and cost-effective care.”

Shlomo Melmed, MB, ChB, Cedars-Sinai’s dean of the Medical Faculty and executive vice president of Medicine and Health Sciences, who was not involved in the study, said the new risk score could help physicians and patients around the world.

“The exciting research outcomes of Dr. Ferrone and team will have a significant impact on enhancing the care and management of all patients with neuroendocrine tumors,” Melmed said.  

Additional Cedars-Sinai authors include Shahrzad Arya, MD; Liti Zhang, MD; Alexandra Gangi, MD; Andrew E. Hendifar, MD, MPH; Giulia Cattaneo, PhD; Luigi Liguori, MD; Arsen Osipov, MD; Nicholas N. Nissen, MD; and Kambiz Kosari, MD

Other authors include Marco Ventin, MD; Carlos Fernandez del-Castillo, MD; Motaz Qadan, MD, PhD; Francesco Sabbatino, MD, PhD; Keith D. Lillemoe, MD; Alice C. Wei, MD, MSc; Jin He, MD, PhD; and Amer H. Zureikat, MD

Cedars-Sinai Health Sciences University is advancing groundbreaking research and educating future leaders in medicine, biomedical sciences and allied health sciences. Learn more about the university.

As a highlight of the symposium, Armando E. Giuliano, MD, division director of Breast Surgical Oncology in the Jim and Eleanor Randall Department of Surgery at Cedars-Sinai, will receive the William L. McGuire Memorial Lecture Award in recognition of his significant contributions to the field of breast cancer research.

“It is a great honor to receive the 2025 McGuire Award,” Giuliano said. “We’ve made tremendous progress in the surgical treatment of this disease, and I am especially grateful to the brave patients who participated in the trials that helped us develop new standards of care and improve the lives of patients with early metastatic breast cancer.”

Giuliano was instrumental in refining sentinel lymph node biopsy for breast cancer in the early 1990s, sparing many women from more invasive breast cancer surgery. This technique identifies and removes only the first lymph node where cancer is most likely to spread to determine whether removing additional nodes is medically necessary.

Through two large multicenter trials, ACOSOG Z0010 and ACOSOG Z0011, Giuliano and team validated the technique that led to establishing the less-invasive sentinel lymph node biopsy as the standard of care, as opposed to axillary lymph node dissection, which removed most or all nodes and is associated with increased surgical complications. The findings from these trials transformed surgical management of breast cancer.

“The pioneering contributions Dr. Giuliano has made to breast oncology have not only changed the field, but they have directly and positively impacted the lives of millions of women worldwide,” said Cristina Ferrone, MD, chair of the Department of Surgery at Cedars-Sinai. “It is a privilege to work alongside Dr. Giuliano, and I wholeheartedly congratulate him on this well-deserved honor.”

Giuliano, the Linda and Jim Lippman Chair in Surgical Oncology, associate director of the Samuel Oschin Comprehensive Cancer Institute and co-director of the Saul and Joyce Brandman Breast Center—A Project of Women’s Guild, will present his award lecture on Wednesday, Dec. 10, at 9 a.m. CT.

Additional Cedars-Sinai experts attending the meeting:

Yuan Yuan, MD, PhD, director of Breast Oncology and medical director of Breast Cancer Research, will present data on how patient-derived organoids—tiny groups of cells—can guide therapy in patients with metastatic breast cancer. She also will present research on AI-driven H&E slides predicting triple-negative breast cancer patients’ response to therapy, as well as data from an ongoing clinical trial of a novel PD1-VEGF bispecific antibody for early-stage triple-negative breast cancer.

Stephen Shiao, MD, PhD, professor of Radiation Oncology and radiation oncology director of the Breast Oncology Disease Research Group, will participate in a plenary talk regarding a randomized trial of no-, low- or high-dose preoperative radiation with pembrolizumab and chemotherapy in node-positive, HER2-negative breast cancer. He can also discuss the potential of GLP-1 receptor agonists in combination with radiotherapy to improve overall survival in triple-negative breast cancer. Luxi Chen, MD, who will present a poster detailing this research at the conference, is a recipient of a San Antonio Breast Cancer Symposium Young Investigator Award.

Scheduling interviews:

To schedule an interview with a Cedars-Sinai expert, please contact:

Jillian Scholten | 949-244-2561 | jillian.scholten@cshs.org

Read more in Cedars-Sinai Discoveries: Abreast of Trends in Cancer

What do all those changes have in common? The ability for trauma surgeons to be more deliberate when every second counts, said Margulies, director of Acute Care Surgery in the Jim and Eleanor Randall Department of Surgery at Cedars-Sinai.  

“One of the biggest advancements we’ve made is actually knowing when we can avoid an operation,” said Margulies, who joined Cedars-Sinai in the early 1990s and was medical director of Trauma for more than 25 years.

It was 1984 when Cedars-Sinai was first designated a Level I Adult Trauma Center and, after its most recent evaluation and recertification by the ACS COT, it continues to be one of the longest-running Level I centers in Los Angeles County.  

“Maintaining Level I status for our hospital ensures that patients in our community have access to a center capable of managing any injury, no matter the severity, with the full spectrum of subspecialty support,” said Galinos Barmparas, MD, medical director of Trauma at Cedars-Sinai. “Patients can expect coordinated, expert and compassionate care delivered by a team that lives and breathes trauma readiness.”

Advancements in Care

Early in Margulies’ career, trauma patients often required more invasive, exploratory surgery to determine a diagnosis, Margulies said. But as imaging technologies improved, the care team could make better-informed decisions.

“The increased quality and speed of CT scans have made a big difference,” Margulies said. “And bedside ultrasound also became more common in the ’90s with the focused abdominal sonography in trauma—or FAST—exam, which allows us to make more rapid assessments of critically ill patients and provide more minimally invasive care when appropriate.”

Aside from better treatment techniques and technologies, Margulies said the types of trauma injuries he sees have also shifted.

“Before seatbelt laws were strictly enforced and airbags were required in cars, we saw a lot of head injuries and extreme traumas from ejection following motor vehicle collisions,” Margulies said. “Now that some of those safety measures are in place, we actually see more pedestrians hit by cars, potentially due to distracted driving.”

Margulies also noted that, because the patient population is getting older, many traumas the team treats now are a result of falls.

The trauma team at Cedars-Sinai has grown over the past 40 years as well. In 1999, ACS rules for Level I trauma centers began requiring an attending surgeon to always be on-site, 24 hours a day, seven days a week, 365 days a year.

“There were five of us who were attendings at that time, so I practically lived at the hospital,” Margulies said.

Since then, the team has more than doubled to 11 attending surgeons on faculty, with the expectation to grow. Additionally, all Cedars-Sinai trauma surgeons have completed a fellowship in surgical critical care.

What the Future Holds

Cedars-Sinai will continue to be evaluated by the ACS COT every three years to be redesignated as a Level I center.

“This reverification is both a validation and a reminder of the tremendous daily effort by our trauma team. It represents not just excellence in meeting national standards but a sustained commitment to continuous improvement and compassion in trauma care,” Barmparas said. “Every verification cycle is an opportunity to reflect on how far we’ve come and how we can keep pushing the standard forward for our patients and community.”

Read more from the Cedars-Sinai Blog: Stop the Bleed Courses at Cedars-Sinai

Preclinical Study: Protecting Against Diabetic Corneal Disease

The medical journal Diabetologia recently published a Cedars-Sinai study that helps explain why half of diabetes patients experience deterioration of the cornea, the transparent dome-shaped outer layer of the eye that provides protection and focuses incoming light. The findings point to a potential target for therapies to protect vision in these patients.

Investigators performed experiments comparing diabetic versus nondiabetic human corneal cells to explain the molecular changes that diabetes patients experience. Diabetic corneal disease can lead to delayed wound healing and loss of vision.

“Our findings highlight the major role of a molecule called microRNA-10b in the oxidative stress characteristic of diabetic corneal disease and the damage it causes to cells,” said Mehrnoosh Ghiam, PhD, associate professor of Biomedical Sciences, research scientist in the Board of Governors Regenerative Medicine Institute and senior author of the study. “Inhibiting this molecule restored the cornea’s defenses against oxidative stress and cell damage and allowed the outermost layer of cells to be maintained and renewed.”

Additional Cedars-Sinai authors include Daxian Zha, Joshua Gamez, Shaghaiegh M. Ebrahimi, Yizhou Wang, Nagendra Verma, Adam J Poe, Seok White, Ruchi Shah, Andrei A. Kramerov, Chintda Santiskulvong, Aleksandr B. Stotland, Zhiping P. Wang, Jennifer E. Van Eyk, and Alexander V. Ljubimov.

Other authors include Onkar B. Sawant.

Funding: This work was supported by grants from the National Institutes of Health R01 EY025377 (MS); R01EY029829 (MS); R01EY031377 (AVL), R01EY013431 (AVL); the California Institute for Regenerative Medicine (CIRM EDUC4-12751); and funding from the Board of Governors Regenerative Medicine Institute (MS).

Cedars-Sinai Study Highlights AI Limits in Heart Care

There are limits in applying AI to images of the heart, a new study from the Smidt Heart Institute at Cedars-Sinai reveals. The findings were published in the Journal of the American Society of Echocardiography.

Investigators trained multiple artificial intelligence models to read images from echocardiograms, a type of ultrasound test that evaluates the structure and function of the heart. Their goal was to determine whether AI could use these images to calculate measurements like inflammation and scarring that are normally obtained through another, more costly test called cardiac magnetic resonance imaging (CMRI). By examining findings from1,453 patients who had undergone both tests, they found the AI models could not accomplish this task.

“As compared to echocardiograms, cardiac MRI machines are expensive and not available for many patients, especially those in rural areas, so we had hoped that AI could reduce the need for it,” said Alan Kwan, MD, assistant professor in the Department of Cardiology in the Smidt Heart Institute at Cedars-Sinai and co-senior author of the study. “Our results showed the limited powers of AI in this area.”

Other Cedars-Sinai investigators include: Yuki Sahashi, MD, MSc; Milos Vukadinovic, BS; Grant Duffy, BS; Debiao Li, PhD; Susan Cheng, MD, MMSc, MPH; Daniel S. Berman, MD; and David Ouyang, MD (co-senior author).

Acknowledgments: This work was supported in part by grants from the American Heart Association (23CDA1053659), the NIH (KL2TR001882), (75N92020D00021), the NHLBI (R00HL157421), (75N92020D00021, the NBIB through the Medical Imaging and Data Resource Center (MIDRC), Japanese Society of Echocardiography (Foreign research grant), and Japanese Society for the Promotion of Science, Grants-in-Aid for Scientific Research (JSPS-KAKENHI). No funders had a role in the design/conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Competing interests: ACK reports support from the American Heart Association (AHA; 23CDA1053659) and National Institutes of Health (NIH; KL2TR001882), and consulting fees from InVision Medical Technology. DO reports support from the National Institute of Health (NIH; NHLBI R00HL157421) and Alexion, and consulting or honoraria for lectures from EchoIQ, Ultromics, Pfizer, InVision, the Korean Society of Echo, and the Japanese Society of Echo. YS reports honoraria for consulting from m3.com inc.

Racial Differences and Prostate Cancer Treatment Decisions

Black men choose aggressive prostate cancer treatment—regardless of anticipated life expectancy—more often than Hispanic or Caucasian men, according to new research by Cedars-Sinai investigators published in the journal Prostate Cancer and Prostatic Diseases.

In the study, more than 2,000 men selected to mimic the sociodemographics of the U.S. prostate cancer population were asked to choose between conservative management and aggressive treatment in various prostate cancer diagnosis scenarios. These scenarios required participants to make treatment choices in the setting of different risks of cancer death and side effects, all while considering their anticipated life expectancy. Life expectancy is important because prostate cancer is typically slow-growing, and treatment only benefits men with relatively long life expectancies. Among Hispanic and Caucasian men, lower life expectancy was associated with lower likelihood of choosing aggressive treatment. Black men consistently elected to pursue aggressive treatment regardless of life expectancy. This pattern may put Black men at higher risk for overtreatment.

Timothy J. Daskivich, MD, director of Academic Urologic Oncology for the Department of Urology at Cedars-Sinai and corresponding author of the study, said more research is needed to determine why Black men routinely chose aggressive treatment.

“We have to be aware of cultural differences that may make different groups of patients pursue treatment for different reasons,” Daskivich said. “It’s important to have a holistic view and to understand patients’ motivations for making the decisions they do so that we can provide the best possible care.”

Additional Cedars-Sinai authors include John M. Masterson, Rebecca Gale, Brennan Spiegel and Stephen J. Freedland.

Other authors include Renning Zheng, Michael Luu, Adam Murphy, Yaw A. Nyame and Chad Ritch.

Funding: NIH/NCI K08 CA230155; Open access funding provided by SCELC, Statewide California Electronic Library Consortium.

Cedars-Sinai Health Sciences University is advancing groundbreaking research and educating future leaders in medicine, biomedical sciences and allied health sciences. Learn more about the university.

“Natural wear and tear affect the spine, including the intervertebral discs and spinal joints,” Bach said. “Additionally, we lose muscle mass as we age, including the muscles that support the spine. This combination of changes makes the spine more vulnerable to strain and injury.”

Bach told Parade that while back pain is very common and often increases at 50, regularly doing glute bridges to build strength can help prevent the pain from becoming severe.

“Glute bridges are a bodyweight exercise that can be used to strengthen the gluteal muscles, which play an important role in stabilizing and supporting the spine,” Bach said. “Stronger glutes can help reduce stress on the lower back and improve posture.”

While Bach and other experts agree that glute bridges help reduce the risk of back pain as people age, he wants patients to be sure to listen to their bodies.

“A general rule is: if it hurts, don’t do it,” Bach told Parade. 

If glute bridges cause pain or discomfort, Bach recommends avoiding prolonged periods of bed rest and focusing on other low-impact activities like walking. He also advises using ice—rather than heat—for treating acute back pain.

“Try applying an ice pack for 20 minutes on, 20 minutes off, repeating as tolerated,” Bach said. “If the pain lingers or worsens, consult with your doctor.”

Read the complete article from Parade.

“People are naturally curious about what they can do to improve their health with aging. It can be a little confusing for people,” Espinoza told CBS LA co-anchors Sheba Turk and Jamie Yuccas. “That’s the reason we wanted to launch this clinic … to provide some evidence-based recommendations to the patients, individualized to what they can do to improve their health with aging.”

Although genetics plays a role in how people age, Espinoza considers lifestyle factors—including physical activity, sleep, diet and mental health—more important because they can be modified and nurtured.

“As we age, there is an increased risk for depression, anxiety and mental health issues,” Espinoza told Turk and Yuccas. “So, it’s important to keep your eye on those things and seek help if needed.” She added that the new Cedars-Sinai Healthspan Clinic provides mental health screening for patients and will offer referrals when needed.

Espinoza told Turk and Yuccas that the Healthspan Clinic accepts patients 18 and up but it is especially useful for people who have reached middle age.

“What we really want to do is help people before they have the impacts of a lot of chronic diseases, if we can,” Espinoza said. “But I do want to say, it’s never too late to make positive changes to improve your health.”

Watch the complete video from CBS LA.

The study, which was published in the New England Journal of Medicine and presented at the European Society for Medical Oncology Congress in October, reported that the combination of enzalutamide and leuprolide—currently approved for use in metastatic disease—was effective for improving overall survival in patients whose prostate cancer had returned after primary surgery or radiation therapy.

Prostate cancer is the second-leading cause of cancer death among men, behind lung cancer, and more than 300,000 cases are expected to be diagnosed in the United States this year alone, according to the American Cancer Society.

“Many patients when they’re diagnosed with prostate cancer will choose to undergo surgery or radiation with the hope that that cures the cancer. Unfortunately, in about a third of those patients the cancer will come back,” Freedland told Healthline.

An effective treatment option offers new hope for these patients, who can experience a recurrence of their cancer.

Freedland told WebMD that these results mean a 70-year-old man whose prostate cancer returns could live up to another 15 years, thanks to the combination treatment.

"For many of these patients, I think we are turning [prostate cancer] into a chronic disease, which is really exciting,” Freedland said. He expressed optimism about advances in prostate cancer care and treatment.

“We’re really revolutionizing the management of prostate cancer convincingly over and over,” Freedland told Healthline.

Read the complete stories from WebMD and Healthline.

“This is a major breakthrough for patient safety in California,” said Rita Shane, PharmD, Cedars-Sinai vice president and chief pharmacy officer. Shane helped craft the new law’s language regarding medication reviews when high-risk patients are discharged from a hospital.  

Shane said it is essential to review the discharge medication list to make sure that the medications patients take home are correct since the medications they were on prior to hospitalization may need to be changed or discontinued if new treatments have been added.

The new law closes a gap in patient safety and will lead to pharmacist-led medication reviews for high-risk hospital patients when they are discharged. Studies of the medication review practice at discharge—already implemented at Cedars-Sinai for years—demonstrate dramatically lower errors, by as much as 60%.

A Personal Experience With Medication Error

The issue of patient safety has always been a priority for Shane, but it became personal in 1998 when her father was admitted to a hospital for cancer that had metastasized to his brain.

As his condition worsened, Shane’s father was transferred from one hospital to another. In this transition of care, the new hospital did not review his medication list, leading to the abrupt discontinuation of a medication, which triggered an extreme side effect.

“I saw firsthand the negative impact medication reconciliation errors could have on patient care,” Shane said. “From then on, I made it my mission to prevent this from happening to other families.”

Advocacy in Action

In 2018, 20 years after her father’s passing, Shane helped draft and pass a state bill that requires pharmacy staff to review medication profiles for high-risk patients upon admission at acute-care hospitals with more than 100 beds.

The new legislation focusing on medication reviews when patients are discharged serves as a bookend to her original advocacy work.

When combined, the two laws are expected to better protect patients and minimize the risk of medication errors, which present a growing risk due to what Shane calls the “poly problem.” The term refers to the increasing number of patients who have multiple chronic diseases and who often need treatment by multiple physicians and are prescribed multiple drug therapies. 

“These errors are not intentional,” Shane said. “But there are so many moving parts, the errors can, unfortunately, be introduced, which threatens patient safety and can lead to what should be avoidable hospital readmissions.”

Shane said she is already receiving inquiries about the legislation from hospital pharmacists at healthcare centers outside California who want similar measures adopted in their home states. She hopes to someday see these policies enacted nationwide.

Read more from Cedars-Sinai Magazine: How to Manage Multiple Prescriptions

Widely known as a pioneer in robot-assisted colorectal surgery, Pigazzi performed the world’s first robot-assisted tumor removal for rectal cancer more than 20 years ago. He has continued to advance the colorectal surgery field with his expertise in robot-assisted, laparoscopic and open surgical techniques to treat complex colorectal conditions such as recurrent and metastatic colorectal cancer.

Pigazzi brings to Cedars-Sinai a rich history of surgical leadership. Most recently, Pigazzi was division director of Colorectal Surgery at New York-Presbyterian/Weill Cornell Medical Center. He also was executive director for Surgical Services, vice chair of Clinical Network, and professor in the Department of Surgery at City of Hope Orange County.

In his new role at Cedars-Sinai, Pigazzi will concentrate on developing the academic colorectal practice, opening novel clinical trials and advancing translational research.

“Cedars-Sinai’s new Faculty Division of Colorectal Surgery will continue to build best-in-class, patient-centered care by staying on the forefront of the latest surgical techniques, clinical trials and clinical practices,” said Cristina Ferrone, MD, chair of the Department of Surgery at Cedars-Sinai. “Under Dr. Pigazzi’s esteemed leadership, we will also enrich our training programs as we develop the colorectal surgical leaders of tomorrow.”

In addition to his clinical practice, Pigazzi is involved in many significant research initiatives, including a translational research effort investigating the role dietary sugars play in the development of colorectal cancer. His extensive publication record includes more than 150 peer-reviewed articles and 16 book chapters. 

“Dr. Pigazzi’s innovative clinical work and research discovery for colorectal cancer aligns perfectly with our commitment to providing leading-edge expertise and care for our Cedars-Sinai Cancer patients,” said Robert Figlin, MD, interim director of Cedars-Sinai Cancer.  

Pigazzi earned both his medical and doctoral degrees at Boston University School of Medicine. He then completed his general surgery residency at New York-Presbyterian/Weill Cornell Medical College, followed by advanced fellowship training in minimally invasive surgery at Hackensack University Medical Center and in colorectal surgery at the University of California, Irvine.

“I’m grateful for the opportunity to bring my passion to this leadership role in the Department of Surgery at Cedars-Sinai,” Pigazzi said. “I look forward to growing the division to be the best in the region in terms of clinical, research and academic excellence.”

Read more on the Cedars-Sinai Blog: Taking the Fear Out of Colon Cancer Screening

As temperatures continue to soar in Southern California, the sweltering weather is associated with numerous health risks, including heat exhaustion and heatstroke. But while temperatures rise, so does the risk of another common and extremely painful issue: kidney stones.  

“Dehydration when you’re in drier, hotter climates is a big risk for the formation of stones. The more you sweat or lose fluids, the more concentrated your urine becomes,” said Cedars-Sinai urologist Arash Akhavein, MD. “When urine is too concentrated, it won’t dilute minerals effectively, and those are the conditions under which stones may form.”

What Are Kidney Stones?

Kidney stones are hard substances that form inside the kidneys, usually composed of minerals and salts, such as calcium, oxalate or uric acid. When these stones pass through the ureter, thereby obstructing the flow of urine, they are known to cause excruciating pain.

Who Is at Risk?

“What makes people form stones can be multifactorial,” said Akhavein, adding that diet and genetics also play significant roles.

Those with family history of kidney stones and patients with certain digestive disorders, such as inflammatory bowel disease or chronic diarrhea, are at a higher risk. Approximately 10% of people will develop a kidney stone in their lifetime, according to the National Kidney Foundation, with men at a slightly increased risk than women.

Treatment Options for Stones

While some stones may pass on their own, others may require intervention to remove. This is true especially when they are large and causing blockage, uncontrollable pain or vomiting. Many patients receive shock wave lithotripsy, a noninvasive procedure that focuses high-energy sound waves to break up stones in the urinary tract into smaller, passable fragments.

The most common surgical procedure Akhavein performs is ureteroscopy. This involves guiding a scope through the urethra, during which he can use a laser to break and remove the stone fragments, while placing a temporary ureteral stent to allow passage of urine until swelling resolves.

In more extreme cases, patients may require percutaneous nephrolithotomy, a surgical procedure that punctures through the back into the affected kidney to directly remove stones that are too large to break up or remove through the ureter.

Tips for Kidney Stone Prevention

If you are prone to kidney stones, Akhavein suggests:

1. Hydrate, hydrate, hydrate
   According to Akhavein, healthy adults should produce about 2 ½ liters of urine or more in a 24-hour period to prevent stone formation or reformation. He recommends drinking about 3 liters of water daily, spaced throughout the day for these patients.
    
2. Make lemonade
   The citric acid found in lemon and lime juice can help protect against stones forming or getting larger, so adding lime or lemon to your water or enjoying a glass of fresh-squeezed, sugar-free lemonade is a delicious prevention tactic.
    
3. Mindful eating
   Limiting foods that are high in oxalate, such as spinach, kale and nuts; avoiding excess animal proteins; consuming normal amounts of calcium; and reducing salt intake may help reduce stone production. 
   
   “You don’t need to avoid these things altogether,” Akhavein said. “Everything is fine in moderation.”

Read more on the Cedars-Sinai Blog: What You Need to Know About Kidney Stones

Cedars-Sinai, part of a national multicenter consortium, will be responsible for developing protocols for the procurement and preservation of donor tissue as well as the eye transplant surgeries themselves. The Cedars-Sinai effort is being led by Curtis L. Cetrulo Jr., MD, vice chair of Research in the Jim and Eleanor Randall Department of Surgery and director of the Division of Plastic Surgery at Cedars-Sinai.

“Vision loss affects over 7 million Americans and this award represents an opportunity to really move the needle in our treatment of blindness. With this funding, I’m confident we can make progress toward eye transplantation,” Cetrulo said. “As the only clinically active vascularized composite allotransplantation program approved for face and eye transplantation on the West Coast, we are in a unique position to design the protocols that will allow for successful optic nerve connection and regeneration. We will also be addressing preservation of the donor eye tissue in transit to safeguard the optic nerve and retina, which are very sensitive to periods of decreased blood flow.”

Cedars-Sinai joins several partners, including the University of Colorado Anschutz Medical Campus, the effort’s primary award recipient. The other partners are Johns Hopkins University, University of Wisconsin, Indiana University, University of Southern California, the National Eye Institute and the Foundation for Fighting Blindness. The ARPA-H funding for the project totals up to $46 million, with up to $6 million dedicated to Cedars-Sinai’s clinical surgical efforts.

ARPA-H is a federal agency established to advance high-potential, high-impact biomedical and health research that cannot be readily accomplished through traditional research or commercial activity. 

In its clinical transplantation practice, Cedars-Sinai will employ the robotic Symani Surgical System, which was recently acquired by the hospital. Currently, Cedars-Sinai is the only institution on the West Coast utilizing this new and highly specialized robotic microsurgery technology, which scales down the surgeon’s movements significantly for extreme precision.

“This is just another example of how the Department of Surgery at Cedars-Sinai strives to be at the forefront of the most innovative and life-changing procedures,” said Cristina Ferrone, MD, chair of the Department of Surgery at Cedars-Sinai and the Linda and Jim Lippman Chair in Surgical Oncology. “The work our team is doing on this project has the potential to transform clinical practice and impact the lives of millions of people around the globe.”

Cedars-Sinai is a leader in treating eye disease with novel approaches. Previously, Clive Svendsen, PhD, professor of Biomedical Sciences and Medicine and executive director of the Cedars-Sinai Board of Governors Regenerative Medicine Institute, received a $10.5 million grant from the California Institute for Regenerative Medicine (CIRM) to launch a clinical trial testing treatments for retinitis pigmentosa, an inherited eye disease with no known cure.

Read more from the Cedars-Sinai Blog: Pioneering Advances in Surgery

“I’ve always said, we’re like one coat of paint,” Thomas said. “Even our parents often couldn’t tell who was who when talking to us on the phone.”

Now, the sisters share more than just their DNA—they share a kidney. They also share an uncommon transplant experience, said Irene Kim, MD, the Esther and Mark Schulman Chair in Surgery and Transplantation Medicine and director of the Cedars-Sinai Comprehensive Transplant Center.

“It’s a rare event to transplant a patient with a genetically identical organ because it requires having an identical twin,” Kim said. “This is only the second time in my career that this has happened.”

The twins’ transplant story began in October 2021, when Thomas was diagnosed with multiple myeloma, a rare blood cancer that affects plasma cells. The disease caused her to go into kidney failure and damaged the C1 vertebra in her spine, putting her in a neck brace for more than six months. The next few years included a litany of medical procedures for Thomas, including chemotherapy, neck surgery and even a bone marrow transplant. Her twin was by her side every step of the way.

While Thomas’ cancer is now in remission, her kidney function never returned to normal. A transplant was the next step to keep her from requiring IV fluids or dialysis for the rest of her life. Rodman didn’t hesitate to volunteer to donate one of her own kidneys.

“We never even had to have a conversation about it,” Rodman said. “I knew I couldn’t go on with my life with my sister not being able to have a better quality of life. It was just the right thing to do.”

There were concerns, however, that the immunosuppressant medications typically required for transplant patients to keep their body from rejecting a transplanted organ could cause a recurrence of Thomas’ multiple myeloma. But through testing, Thomas and Rodman learned they were a match across all markers and were more than 99% identical, meaning Thomas could avoid the antirejection drugs that could have caused her cancer to return.  

“Transplantation requires immunosuppression to trick our immune systems into believing that the organ we’re transplanting is not foreign so that our body’s natural immune defense doesn’t attack or reject it, and that immunosuppression can have a lot of side effects of its own,” Kim said. “That we can avoid immunosuppression altogether for Linda by transplanting a kidney that is genetically identical to hers is really exciting and remarkable.”

Kim explained this is an uncommon occurrence in the transplant world not only because demographically, there are just fewer identical twins, but also because doctors must consider the reason a transplant is required. If a transplant is necessary due to a genetic predisposition for kidney disease, giving up a kidney could put the donor at risk down the line. In Thomas’ case, her multiple myeloma was nongenetic.

“Living donor transplants are always an emotional event filled with stress and gratitude, but the bond Linda and Karen share as identical twin sisters is palpable,” Kim said. “It was just such an honor from a transplant surgeon’s perspective to be part of that.”

The pair underwent successful kidney donation and transplant procedures at Cedars-Sinai Medical Center in mid-October. The transplanted kidney began working immediately and Thomas was able to have her dialysis port removed shortly after surgery because it was no longer needed.

Thomas and Rodman spent the remainder of the month and most of November recovering together in Los Angeles so they could be close to the hospital for their many follow-up appointments. As they regained their strength following surgery, they often would spend afternoons visiting local beaches to walk together on the sand.

“The beach is our happy place,” Rodman said.

“I’m just so grateful to have been able to go through this with my sister. If it had been the other way around, it would have absolutely been the same,” Thomas said. “I would do anything for my sister.”

As they look to the future, they’re excited for more big milestones with their families. Rodman recently learned she’ll be a first-time grandmother next spring. They also look forward to more camping trips to the beach and the opportunity to travel.

“We’re only 56 years old,” Rodman said. “We have places to go. We have things to do. We have more life to live.”

Read more from Cedars-Sinai Discoveries Magazine—OR Talk: Triple Organ Transplant

In recognition of Lung Cancer Awareness Month, the Cedars-Sinai Newsroom sat down with Soukiasian to learn more about the recent surgical advances that are benefiting patients, including techniques he has pioneered.

What are some of the latest trends you have seen in lung cancer diagnosis?

While lung cancer remains the second-most common cancer in both men and women, as well as the leading cause of cancer death in the United States, we have been seeing an increased incidence of younger, nonsmoking women being diagnosed. This is a national trend, and we have also seen it in action here at Cedars-Sinai. In fact, the number of lung resections we have done for nonsmoking females during 2024 is higher than all of 2022 and 2023 combined, and the majority of those patients are women who are younger than 70 years old.

It’s a troubling trend to consider because current lung cancer screening guidelines outlined by the American Cancer Society are only geared toward individuals between the ages of 50 and 80 who are active smokers or have a smoking history of at least 20 pack years.

You pioneered an ‘all-in-a-day’ procedure that includes biopsy and resection for lung cancer masses. Can you tell us about this technique?

The Single Anesthetic Bronchoscopic Biopsy and Resection technique was developed in 2022 to allow for real-time, minimally invasive diagnosis via robotic bronchoscopy, followed by immediate resection when indicated. This means many patients will have to undergo just one procedure, instead of two.

We start with the patient under general anesthesia. Using the Ion bronchoscope—a scoping device directed through the patient’s mouth, into their airway and lungs—alongside a specialized CAT scan that recreates a 3D map of the patient’s airway, we can navigate directly to the mass of cancer cells, almost like we’re following Google Maps walking directions. Once we reach the mass, we biopsy it and send the tissue sample to the lab, where it can be quickly analyzed. This whole process typically takes less than an hour.

If the sample comes back as benign, the patient can be woken up and sent home with follow-up instructions. In this case, they have completely avoided unnecessary, invasive surgery. Alternatively, if the sample is determined to be malignant, the patient remains under anesthesia and, at that time, we perform a robotic-assisted resection.

This process allows a patient with early-stage, malignant disease to ultimately obtain a diagnosis as well as a therapeutic intervention within the same day and with the same anesthetic. This not only cuts down on wait times, but can also help to alleviate the mental anguish that goes along with a delay between biopsy/diagnosis and resection. The shorter the period of time a patient has cancer in their body, the better off they are both physically and psychologically.

This technique is becoming more common, and I have had the opportunity to train physicians all over the world in the practice.

What’s next for minimally invasive lung cancer surgery?

Standard robots used in minimally invasive lung procedures are multi-port, meaning they require four small incisions in the patient’s chest, through which all surgical instruments and a camera are inserted. However, Cedars-Sinai was recently part of a Food and Drug Administration (FDA) trial for single-port thoracic surgery, a technique that involves only a single incision.

The single-port robot that was studied in the trial is now FDA approved and, as the only institution in the Western United States using the device, we are the current leader in this field, performing the majority of robotic, single-site lung resections in the country.

Patients undergoing single-port thoracic surgery often experience reduced postoperative pain, shorter hospital stays and faster recovery times. The technique is gaining popularity due to its effectiveness and the improved outcomes it offers, making it a promising option for various thoracic conditions.

What else should readers know about lung cancer?

Early detection is key in this disease. When we can treat lung cancer surgically, before it has spread, we can greatly increase a patient’s survival rate. Some cases where we are able to fully resect the tumor to remove the cancer will go on to require additional chemotherapy or immunotherapy treatments.

This is why it is important to incorporate multidisciplinary care early in the diagnosis and treatment of the disease. The addition of immunotherapy and targeted therapy in the perioperative setting has led to improved survival for patients. Our multidisciplinary team of surgeons, medical oncologists, radiation oncologists, pulmonologists, radiologists and pathologists meet to discuss the appropriate therapy for each patient for a personalized approach.

That being said, data from the American Lung Association (ALA) says that only 1% of eligible California residents are screened for lung cancer. This is significantly lower than the national average of 6%. I am on the leadership board of the local Los Angeles chapter of the ALA, and one of our missions is to increase awareness for and access to lung cancer screening programs in the state.

Cedars-Sinai’s Lung Cancer Screening Program is an excellent local resource. I would encourage all eligible patients between the ages of 50 and 80 who are current smokers or who have quit smoking in the last 15 years to call our experts today for a screening consultation.

Read more from the Cedars-Sinai Blog: Lung Cancer Screening Demystified

Safaa, weighing just 1.1 pounds, was in the Neonatal Intensive Care Unit (NICU) at Cedars-Sinai Guerin Children’s.

“Shortly after Safaa was born, pandemic lockdowns were implemented and only one visitor was allowed in the hospital at a time, so we had to take turns visiting her in the NICU,” Cardello said. “We were not only scared of getting germs at the hospital, but we were scared of bringing germs into the hospital and harming Safaa.”

Safaa experienced a number of health challenges in those early days, including bronchopulmonary dysplasia, or premature lung disease, because her lungs were not fully developed. Additionally, her physicians discovered Safaa had an extremely narrow upper airway, making it difficult for her to breathe without medical intervention.

“I would honestly say Safaa had the smallest windpipe I’ve ever seen,” said Irina Dralyuk, MD, a pediatric pulmonologist at Cedars-Sinai Guerin Children’s and one of Safaa’s consistent care providers.

To bypass her narrow airway, Safaa’s doctors performed a tracheostomy, a procedure to create an opening in the neck that extends to the trachea, allowing easier breathing and enabling oxygen to reach the lungs.

Safaa graduated from the Cedars-Sinai Guerin Children’s NICU four months later, in July 2020, but her airway issues were not solved, so she went home with the tracheostomy tube in her neck.

Fixing Safaa’s Airway

“When I first met Safaa, her airway opening was only a couple of millimeters wide,” said Gene Liu, MD, director of Academic Otolaryngology for Cedars-Sinai Medical Center and a pediatric ear, nose and throat specialist for Cedars-Sinai Guerin Children’s. “And even though she was growing, her windpipe needed help to expand.”

Hoping to avoid a major surgical procedure on her neck that would come with additional risks, Safaa’s family and their care team opted for a less invasive approach using a balloon dilation to gradually widen her airway over time.

“Every few months, we would look at Safaa’s airway with a fiberoptic camera, and the balloon dilation procedure would gently push open the airway little by little until it became a very nice, normal-looking airway,” Liu said.

In March 2024, shortly after Safaa’s 4^th birthday, her tracheostomy tube was removed.

Becoming Like Family

Through four years of appointments and procedures, the Cardello family and Safaa’s Cedars-Sinai care team became quite close.

“Safaa got to know us really well and I think that helped when she would come in for her balloon dilation,” Dralyuk said. “I would always meet her and her family in pre-op and either Dr. Liu or I would carry her back to the procedure area. She’s a tough cookie. She and her parents have done an amazing job.”

Dralyuk said she especially loves to hear Safaa say her name. “Early on, we didn’t know what Safaa’s voice might sound like due to her narrow airway and whether there may be any residual damage to her vocal cords. Now when I see her, and I hear, ‘Hi Dr. Dralyuk,’ it is really special.”

Ahmadi Cardello said she and her family are thankful for the care and attention they received.

“The advice Drs. Liu, Dralyuk and all of Safaa’s other doctors gave us always felt like it was something they would recommend for their own child,” Ahmadi Cardello said. “We didn’t feel alone.”

What’s Next for Safaa

Now that her tracheostomy tube has been removed, Safaa and her parents are waiting patiently for the stoma, or the hole where the tube was previously located, to close. That typically happens on its own in a few months.

Prior to the removal, many things that would be normal for a toddler were risky for Safaa as they could cause infection of the stoma.

“I can’t wait to teach her how to swim,” Cardello said, “It’ll be fun to finally take her to the park and let her play in the sand. We haven’t been able to do that until now.”

Ahmadi Cardello is relieved. “Now that Safaa’s tracheostomy has been removed, I feel like we can all breathe a little easier,” she said.

Read more from the Cedars-Sinai Blog: Common Breathing Problems in Kids and How to Treat Them

The phone rang 30 minutes later.  

“When I picked up the phone, I thought it would be family or friends calling to wish us a happy new year,” Schulz said. “Instead, it was someone from the Smidt Heart Institute at Cedars-Sinai saying they had a heart match for me and asking how soon I could get there.”

Those early moments of 2024 catapulted a chaotic yet beautiful series of events that led to Schulz’s new heart—which was implanted on Jan. 1.

Schulz first sought help at Cedars-Sinai in October 2019. The congestive heart failure he had been diagnosed with several years earlier had become advanced and his heart was giving out.

“At that point, I was so sick that the first hospital I went to said they couldn’t treat me, and they were telling my wife to contact family to say goodbye,” Schulz said. “Thankfully, my wife wouldn’t accept that as an answer and told them to call other hospitals. Several others also rejected me, but eventually, Cedars-Sinai said yes.”

“When Mr. Schulz arrived at Cedars-Sinai, he was critically ill,” said Dominic Emerson, MD, associate surgical director of Heart Transplant and Mechanical Circulatory Support in the Smidt Heart Institute. “We needed to stabilize him quickly to save his life.”

The first course of treatment for Schulz was extracorporeal membrane oxygenation, or ECMO—an often lifesaving treatment where blood is pumped outside of a patient’s body to a portable heart-lung machine, giving the patient’s own organs a rest.

After a period on ECMO, Schulz was stable enough for Emerson and team to surgically place a left ventricular assist device, also known as an LVAD. An LVAD is a mechanical device implanted inside the chest that helps the heart pump oxygen-rich blood to the rest of the body. For Schulz, it would serve as a bridge to transplant, said Lawrence Czer, MD, medical director of the Heart Transplant Program in the Smidt Heart Institute.

“LVAD placement is a major open-heart surgery, and some patients experience a prolonged recovery, but Mr. Schulz was a model patient following the procedure,” Czer said. “He followed all our recovery instructions including walking, watching his nutrition, keeping detailed records, and coming to clinic weekly at first. As a result, he recovered quite well with no complications.”

Several months later, in August 2020, Schulz was placed on the heart transplant list—and the wait began.

“This was early in the COVID-19 pandemic, and it was a really difficult time for my family and especially for my three children,” Schulz said.

While he did well with his LVAD, Schulz said he still felt limited. “My youngest son, who was 6 at the time, wanted me to play with him, and I just wasn’t physically able to do as much as we both wanted.”

But the New Year’s Day phone call changed everything. He arrived at Cedars-Sinai with his family a few hours later, ready to receive the medical center’s first transplanted heart of 2024. Emerson was the transplant surgeon on call when Schulz came into the hospital for his procedure.

“Because we can’t predict when a donor match will be available and when transplants will happen, as surgeons, we don’t always get the opportunity to perform transplants on patients we’ve previously worked with,” Emerson said. “But it’s fantastic when we do. It’s very rewarding to be part of the patient’s entire care arc.”

Schulz said even some of the same nurses who helped him through his recovery in 2019 cared for him following his transplant.

“I am so grateful to the team at Cedars-Sinai for the care I received during both of my experiences,” Schulz said. “The compassion they showed not only to myself, but to my wife and my family, was excellent.”

Now a few months post-transplant, Schulz says he is feeling great. When asked if he made any New Year’s resolutions for himself when he received his new heart, he said he is looking forward to more family trips with his wife and their three kids. Schulz is also excited to feel strong enough to play soccer with his youngest son, Sebastian—something he hasn’t been able to do for many years.

April is Donate Life Month, which promotes awareness about organ, eye and tissue donation and honors those who gave the gift of life. As he experiences this new lease on life, Schulz also shares his gratitude to his donor and the donor’s family.

“I understand this is an incredible gift I’ve been given, and it wouldn’t have been possible without my donor and their family,” Schulz said. “It’s not something I will take for granted. I’m grateful every day.”

Read more from Cedars-Sinai Discoveries Magazine: Heartfelt Support

Investigators found glucagon-like peptide-1 receptor agonists (GLP-1RAs)—medications like Ozempic and Wegovy that are used to treat diabetes and obesity—are associated with an increased risk of aspiration pneumonia following endoscopy. The large, population-based study is published in the leading peer-reviewed journal Gastroenterology. 

Aspiration pneumonia is caused by inhaling foreign materials—including food in the stomach, or secretions from the mouth and nose—into the lungs. Endoscopy is a medical procedure in which a physician puts a tube-like scope down a patient’s throat and into the body to look inside.

One way the new obesity medications work is by slowing digestion, so people feel full longer, causing them to eat less. This also means that food sits in the stomach longer. As a result, the stomach may not empty completely during the usual duration of fasting that is recommended ahead of a surgical procedure to decrease risk of aspiration, explained the study’s corresponding author, Ali Rezaie, MD, medical director of the GI Motility Program and director of bioinformatics at the MAST Program at Cedars-Sinai.

“Aspiration during or after endoscopy can be devastating,” Rezaie said. “If significant, it can lead to respiratory failure, ICU admission and even death. Even mild cases may require close monitoring, respiratory support and medications including antibiotics. It is important we take all possible precautions to prevent aspiration from occurring.” 

The study analyzed data from nearly 1 million de-identified U.S. patients who underwent upper or lower endoscopy procedures between January 2018 and December 2020. Patients who were prescribed GLP-1RA medications had a 33% higher chance of experiencing aspiration pneumonia than those who did not take these medications before the procedure. This comparison also considered other variables that could influence the outcome to ensure a fair comparison between the two groups.

“When we apply this risk to the more than 20 million endoscopies that are performed in the U.S. each year, there may actually be a large number of cases where aspiration could be avoided if the patient safely stops their GLP-1RA medication in advance,” Rezaie said.

“The results of this study could change clinical practice,” said Yee Hui Yeo, MD, first author of the study and a clinical fellow in the Karsh Division of Gastroenterology and Hepatology at Cedars-Sinai. “Patients taking these medications who are scheduled to undergo a procedure should communicate with their healthcare team well in advance to avoid unnecessary and unwanted complications.”

Additional Cedars-Sinai authors involved in the study are Srinivas Gaddam, MD, MPH; Ruchi Mathur, MD; Rabindra Watson, MD; and Jamil Samaan, MD. Additional authors include Wee Han Ng; Pin-Chia Huang, BS; and Kevin Sheng-Kai Ma, DDS.

Read more from the Cedars-Sinai Blog: Weight-Loss Drugs – What to Know Now