We are Number One Again!

For the 15th consecutive year, The Johns Hopkins Hospital has topped U.S. News & World Report's rankings of American hospitals. Of the 176 medical centers in this year's edition of America's Best Hospitals, 16 made their way to the Honor Roll.

All had to demonstrate excellence by achieving a high ranking in no fewer than six specialties. US News & World Report ranks the centers based on an analysis of objective indicators such as death rates, technology, nurse staffing, service mix and discharge planning.

Hopkins ranked in the top 10 in 16 of the 17 specialty categories listed. In addition to landing at the top of the honor roll, the Hospital ranked #1 in Gynecology, Otolaryngology, Kidney Diseases, Rheumatology and Urology; #2 in Geriatrics, Neurology and Neurosurgery, and Ophthalmology; #3 in Cancer, Digestive Disorders, Hormonal Disorders, Heart/Heart Surgery, Pediatrics, Psychiatry, and Respiratory Disorders; #4 in Orthopedics; #14 in Rehabilitation.

Responding to the U.S. News announcement today, Steve Thompson, Senior Vice President of Johns Hopkins Medicine and CEO of Johns Hopkins Medicine International said: "We are very pleased with this year's results. I am proud of this recognition of the excellence of our dedicated faculty physicians, researchers, nurses and clinical staff who every day support Hopkins' tradition of innovation and compassionate care."

For more information about Johns Hopkins, visit www.jhintl.net. For the rankings, visit www.usnews.com


Let There Be Light - From Artificial Retinas

Ophthalmologists fighting retinitis pigmentosa may have found some daylight. While participating in a three-way trial initiated by a Chicago group, Hopkins ophthalmologist Julia Haller began implanting "artificial retinas" into eight patients ranging in age from their 20s to 50s who were in advanced stages of the blinding disease.

The technology, which relies on a 2-millimeter-diameter silicon computer chip that is surgically implanted in the eye, appears to benefit from electrical microcurrents within the tiny chip itself. The chip contains 5,000 microscopic solar cells that convert light energy from images into electrochemical impulses that stimulate the remaining functional retinal cells of RP patients.

How could microscopic solar cells possibly be up to such a task, especially since they wold be attempting to stimulate a compromised second layer of cells below where the healthy cells once lay?

"The chip itself does not give vision," says Haller, "but we think the microcurrents released by the chip may be causing neighboring cells to release chemical messengers that improve the health of the remaining rods and cones in the center of the retina, one quarter of an inch away from the chip itself."

Haller also speculates that when the foreign body is implanted in the eye, a healing response ensues that rejuvenates tissue quality.

Johns Hopkins Scientists Use Gene Therapy to Prevent Heart Arrhythmias From Stem Cell Transplants

Heart specialists at Johns Hopkins believe they have figured a way around the barrier to successful adult stem cell therapy for millions of Americans who have survived a heart attack but remain at risk of dying from chronic heart failure.

Two clinical trials using transplanted adult stem cells successfully led to tissue regrowth in damaged hearts, but 11 of 18 patients later developed potentially fatal heart rhythm disturbances. "It was a potential case of the cure being worse than the disease," says Eduardo Marbán, M.D., Ph.D., professor and chief of cardiology at The Johns Hopkins University School of Medicine

Marbán's team says it has discovered the source of the arrhythmias to be transplantation of myoblasts, which are adult stem cells taken from patients' own healthy skeletal muscle. In petri dish studies, the transplantation process caused an immediate disruption in heart muscle tissue's regular electrical rhythm.

Moreover, the Hopkins group was able to minimize arrhythmias dramatically by using gene therapy to replace a key protein, called connexin 43. Connexin 43 makes up the gap junctions between muscle cells, allowing cells to communicate with each other to regularly contract and expand.

"Our results confirmed that myoblast transplantation was responsible for the arrhythmias and that higher doses of stem cells aggravate the problem. But we were not exactly sure how this was related to the subsequent cell regrowth occurring in the heart, or if it could be treated using gene therapy," explains Marbán.

In the gene therapy experiments, the Hopkins team increased production of connexin 43 by injecting a virus carrying the gene that codes for the gap-junction protein into the cultured cells. A majority of cultures, 13 of 14, which did not receive connexin gene therapy, went on to develop irregular heart-cell signals.

While their precise biological action is not known, adult stem cells are a special type of body cell found in skeletal muscle, heart, bone marrow and other tissues that gives rise to other types of specialized cells, including bone, cartilage, fat, and muscle, such as the heart. Because they can be extracted and reinjected into the same person, use of adult stem cells avoids the potential for rejection by the body's immune system.

The study was funded by the Donald W. Reynolds Foundation, the American College of Cardiology and the National Institutes of Health.


Stem Cells Grown in Lab Mirror Normal Developmental Steps

Johns Hopkins scientists have developed a way to study the earliest steps of human blood development using human embryonic stem cells grown in a lab dish instead of the embryos themselves.

The Johns Hopkins researchers' system involves the study of existing embryonic stem cell lines derived from in vitro fertilization methods, and so doesn't require generation of embryos through cloning, a technique recently reported by South Korean scientists.

In their report on the work in the June issue of the journal Blood, the Johns Hopkins team demonstrated a clear similarity between how human embryonic stem cells specialize into blood cells and how blood cells develop in human embryos.

Knowing the steps by which stem cells develop into blood cells are likely to help medical researchers figure out how to treat cancers of the blood, such as leukemia and lymphoma.

"More and more we're learning that the genes that turn on in the embryo to make blood stem cells are the same genes that go wrong in cancer," says Elias Zambidis, M.D., Ph.D., assistant professor of pediatrics and oncology in the Johns Hopkins School of Medicine.

Historically, scientists have worked on mouse and zebrafish models of embryological blood cell development, but ethical and technical barriers have stood in the way of an in-depth study of blood formation in human embryos.

Without any chemical manipulation or stimulation, the clusters of human stem cells first became colonies of cells that can produce endothelium, or the tissue that makes up the circulatory system. These colonies can then also form the precursors of blood cells, in a structure similar to the yolk sac of human embryos.

Finally, some of the cells in the colonies form blood cells similar to those found in the liver and bone marrow of a developing fetus, making it simple for the researchers to pick out the blood cells for further investigation.

Because embryonic stem cells are capable of becoming virtually every type of cell in the human body, understanding how they do so might provide the chance to harness that process to make a limitless supply of specific cells for therapeutic purposes.

The research was funded by grants from the National Institutes of Health and from the American Society of Clinical Oncology.

New Cosmetic Procedure "Elevates" Facial Skin

A procedure using barbed sutures to lift sagging or wrinkling skin from the brow, midface and neck is currently being performed by surgeons in the Johns Hopkins Division of Plastic and Reconstructive Surgery.

The procedure provides a low-risk alternative to a face-lift for people looking for subtle, quicker results with less pain, according to Craig A. Vander Kolk, M.D., co-director of the Johns Hopkins Cosmetic Center. The process takes approximately one hour under local anesthesia and uses the only barbed suture to have FDA approval.

Each suture, like a porcupine's quill, contains tiny barbs, placed at equal intervals on the thread, which grab tissue. Thus, once a thread is inserted (via a small incision) along the contour lines of the face and tension is applied upward, the barbs pull the skin tissue. Collagen forms around the suture to maintain the elevation of the skin. The results depend on several factors, including the patient's age, facial structure or amount of facial fat. The process also is reversible.

Vander Kolk notes that there are no studies to judge the operation's long-term effectiveness, and some physicians question the ability of the sutures to hold tissues for extended periods of time. Clear polypropylene has been used in other medical products for years and is not absorbed by the body.

For more information about cosmetic procedures, visit the Johns Hopkins Cosmetic Center website.


CME COURSES

August 1-18, 2005
Database Design and Implementation in Clinical Research
Johns Hopkins Bloomberg School of Public Health
Baltimore, MD

August 15-18, 2005
Perioperative Management - In Its 21st Year
The St. Regis Aspen Hotel, Aspen, CO

JOHNS HOPKINS MEDICINE INTERNATIONAL PARTNERSHIPS OVERSEAS

Johns Hopkins Medicine International has signed a Memorandum of Understanding (MOU) with the Apollo Hospitals Group, the largest private healthcare network in Asia. The MOU establishes areas of collaboration that range from Continuing Medical Education and Second Opinions to nurse education and partnerships with clinical departments in some of the 35 hospitals managed by the group.

"We are very pleased to enter into this relationship with Apollo" said Steve Thompson, senior vice president of Johns Hopkins Medicine and CEO of Johns Hopkins Medicine International. "As a leader in healthcare services, Apollo is definitely contributing to the Johns Hopkins mission of sharing knowledge and best practices with the world."


New Members Elected to Johns Hopkins Medicine Board of Trustees

Janie Elizabeth (Liza) Bailey - a third great-niece of Johns Hopkins, Mrs. Bailey is a recently retired managing director of Credit Suisse First Boston.

Robert C. Baker - chairman and chief executive officer of National Realty & Development Corporation. Mr. Baker is a founding member of the advisory council of the Brady Urological Institute at The Johns Hopkins Hospital.

Richard O. Bernt - managing partner of the Baltimore law firm of Gallagher, Evelius & Jones.

Philip (Phil) M. Butterfield - chief executive officer of the Bank of Bermuda.

Richard A. Forsythe - president of Forsythe Technology Inc., a national provider of technology infrastructure solutions to industries.

Edward W. Gillespie - founder and principal of Quinn Gillespie and Associates, a bipartisan public affairs firm.