Clinical Research Training Program Fellow
Warren Grant Magnuson Clinical Center
2nd year Pediatrics Resident at Duke University
M.D.- Duke University School of Medicine
MPH - in maternal and child health, University of North Carolina at Chapel Hill
Hometown: New Haven, CT



My name is Karin Minter, I'm from New Haven, CT. Since high school I have earned the following degrees:

BA – Cornell University, Major in Psychology (graduated 1994)
Postbaccalaureate Premedical Program Certificate – Columbia University (finished 1996)
MPH – University of North Carolina at Chapel Hill, concentrated in maternal and child health (graduated 2000)
MD – Duke University School of Medicine (graduated May 2002)

I learned about CRTP from the program brochure, available at Duke. I was debating what to do during my third year of medical school (at Duke, we have one year of mandatory research). I ended up doing that research year at UNC to get my MPH, but I still wanted to do the CRTP program after I finished my graduate work. The directors of the CRTP program were flexible enough to allow me to defer for one year.

My research was devoted to Sickle Cell Anemia and Inhaled Nitric Oxide. I was involved in several research projects studying the potential therapeutic role of inhaled nitric oxide (NO) for complications of sickle cell anemia during my CRTP year. My tutor was Dr. Griffin Rodgers, NIDDK, and my mentor was Dr. Mark Gladwin in Critical Care Medicine. I am an associate investigator on these NIH protocols, targeted delivery of nitric oxide by hemoglobin to improve regional blood flow in sickle cell disease, pulmonary hypertension in adult patients with sickle cell anemia, and a new protocol presented to the IRB on May 1, 2001, inhaled nitric oxide therapy for patients with sickle cell anemia and secondary pulmonary hypertension.

Blood Flow Study
Using strain gauge plethysmography to measure forearm blood flow, we investigated the hypothesis that patients with sickle cell anemia experience baseline endothelial dysfunction. I helped to edit this protocol and present it to the Institutional Review Board of the NHLBI when I first arrived. I also took on a separate portion of the protocol, which set out to study the role of the white blood cell in sickle cell anemia. I drew blood from our patients at baseline and after two hours of inhaled nitric oxide, so that I might isolate the total RNA from the peripheral blood mononuclear cells in order to perform microarray analyses.

Pulmonary Hypertension Screening Study
This longitudinal, prospective study was designed to determine the prevalence, morbidity, and mortality of secondary pulmonary hypertension and sickle cell anemia. To date, retrospective studies based on chart reviews of tertiary care center populations, estimate a 20-30 percent prevalence of secondary pulmonary hypertension in sickle cell disease. This new study uses echocardiographic findings to diagnose pulmonary hypertension (tricuspid jet velocity is related to pulmonary artery pressure).

Pulmonary Hypertension Treatment Study
Sickle cell anemia is an autosomal recessive disorder and the most common genetic disease affecting African-Americans. Approximately 0.15 percent of African-Americans are homozygous for sickle cell disease, and 8 percent have sickle cell trait. Acute pain crisis, acute chest syndrome (ACS), and secondary pulmonary hypertension are common complications of sickle cell anemia. Inhaled nitric oxide (NO) has been proposed as a possible therapy both for primary and for secondary pulmonary hypertension. Furthermore, a number of recent studies have suggested that NO may have a favorable impact on sickle red cells at the molecular level and could improve the abnormal microvascular perfusion that is characteristic of sickle cell anemia.

I was involved in the conceptualization of this clinical trial, designed (1) to determine the pathophysiological processes that are associated with and potentially contribute to secondary pulmonary hypertension in adult patients with sickle cell anemia, (2) to determine the relative acute vasodilatory effects of oxygen, intravenous prostacyclin, and inhaled nitric oxide on pulmonary artery pressures and other hemodynamic parameters inpatients with secondary pulmonary hypertension and sickle cell anemia, and (3) to determine the effects of two months of inhaled nitric oxide on pulmonary artery pressures, other hemodynamic parameters, exercise tolerance, and symptoms in this patient population.

Other Activities
I also wrote an article entitled, ''Pulmonary Complications of Sickle Cell Anemia: An Urgent Need for Improved Recognition, Treatment, and Research.'' This is a Pulmonary Perspective (a hybrid opinion piece and review article), which we submitted to the American Journal of Respiratory and Clinical Care Medicine. The article calls for pulmonary subspecialists to play an active role in the management, treatment, and research on sickle cell anemia. More than ever, patients with sickle cell disease are living into adulthood. Pulmonary disease in the form of acute chest syndrome, pulmonary hypertension, asthma, and thromboembolism increasingly contribute to the morbidity and mortality of these patients.

Before I came to the NIH, I received my MPH from the University of North Carolina at Chapel Hill. There I learned all about generating research questions, designing sound studies, critically reading and evaluating the literature. I decided that I wanted to do clinical research on sickle cell anemia because it is a horrible disease that has a significant impact on the African American community.

My days at the NIH varied enormously. Some days I spent all of my time in clinic seeing patients with sickle cell anemia, and other days I worked in the lab trying to isolate RNA from peripheral blood mononuclear cells. On study days, I helped with all of the patient preparation (assisting with line placement, gathering vital signs, drawing blood, etc.) and I also had to take care of my microarray project which involved drawing blood at particular times and taking it to the lab to begin processing it.

I came to the NIH hoping to get some hands-on experience doing some of the things that I read about in my master's program. Not only did I do that, I also developed a profound interest in clinical research on sickle cell anemia. I hope that my future in pediatrics will include a significant amount of such research. I am in the process of applying to residency programs in pediatrics. If I decide to do a fellowship after residency, I will seriously consider returning to the NIH.

My mentor, Dr. Mark Gladwin, has been incredibly helpful. Although I am no longer living and working on campus, he continues to be an amazing resource for me! We remain in contact, and I do not hesitate to call when I have questions or concerns about my career. Sometimes it is nice to have someone in medicine who is easily approachable and sincerely interested in giving sound advice.

I recommend to future students to carefully choose a mentor with whyom you share a common vision! It is difficult to maximize a relationship that was not meant to be in the first place. After that, it's all about open communication. If a mentee is not getting what they want out of the experience, it is up to them to voice their concerns.

The most impressive aspect about the NIH was the truly awesome number of experts all stuffed into one building. If you are willing to work hard and are interested in collaborating, the NIH is the place to work. You can get virtually anything done.

On weekends I would take the metro downtown to go to the museums or to visit friends. In DC and Bethesda I enjoyed going to all of the fabulous restaurants. I also enjoyed walking around and looking at the cherry blossoms in Spring.

I started my pediatrics residency in July 2002.

Clinical Research Training Program Fellow
National Institutes of Neurological Disorders and Stroke (NINDS
2nd year Neurological Surgery Resident, University of Virginia Medical Center
Medical School-University of Maryland School of Medicine
B.A.-Anthropology, University of Pennsylvania, The College of Arts and Sciences
Hometown: Baltimore, Maryland



My name is Charles Sansur. In 2001-2002, I was a fourth-year medical student at the University of Maryland. I was born and raised in Baltimore, and graduated from the Gilman School in 1993. I graduated from the University of Pennsylvania in 1996, with a major in Anthropology and minor in Biology. I enrolled at the University of Maryland School of Medicine in 1997.

I first was informed about the research training programs at the NIH through the Office of Student Research at my medical school. During my junior year of medical school, representatives of the Clinical Research Training Program (CRTP) visited my school to present their unique program, and I immediately became interested. I decided to apply to CRTP and was accepted in March of 2001.

I came to the NIH with an interest in Neurosurgery, and a desire to indulge myself in patient-oriented clinical research. After interviewing with several potential mentors in different braches of the NINDS, I chose to work in the Surgical Neurology Branch under the direction of Dr. John Heiss and Dr. Edward Oldfield. I was involved with the investigation of the pathophysiology of syringomyelia, a disease in which a cyst or cavity develops in the spinal cord. Specifically, I studied pressure in the subarachnoid space during different physiological maneuvers, before, during, and after surgery. I also studied cerebrospinal fluid (CSF) dynamics in patients with syringomyelia using CT myelography.

A typical work day when seeing preoperative or postoperative patients would involve my mentor and I preparing our equipment for pressure analysis. We would then bring our patient to the fluoroscopy area where he or she would have a lumbar puncture. During this same session, the pressure testing was performed with the spinal needle in place. The rest of the day would be dedicated to seeing the patient's sequential CT scans of the spine for our CT myelogram study. On the day of the patient's surgery, I would scrub to assist with the operation. For days not directly associated with patient care, I analyzed pressure recordings, CT myelograms, and MRI images of patients with Chiari I malformations. I also worked on abstracts and journals articles, and met with my mentors to discuss the progress with my research. Ample time was available for me to attend various NIH-sponsored lectures and symposiums held on campus.

There is no question that my experience at NIH solidified my interest in clinical research. I plan to continue to study and see patients with syringomyelia throughout my career as a future academic neurosurgeon. It is quite possible that I will return to the NIH in the future to continue my research during residency, or after residency training to work as an attending.

One of the most significant components of my NIH experience was the relationship that I had with my mentor. My mentor was an invaluable resource from whom I learned a great deal. Not only was he always available to answer questions, but he also served as an outstanding role model. The relationship that you develop with a mentor at the NIH is a life-long commitment that promotes your career, and serves as a stimulus to achieve as much as possible in your field of interest.

Aside from the research experience at the NIH, one cannot ignore the benefits of living in Bethesda. Downtown Bethesda is a thriving, energetic area. Furthermore, its proximity to Washington DC gives you the chance to explore our nation's capital. For students in CRTP, subsidized housing is available in downtown Bethesda. I am matched at the University of Virginia's Neurosurgery program. I will start Neurosurgery residency in July of 2002.

Clinical Research Training Program Fellow
Department of Transfusion Medicine, Warren G. Magnuson Clinical Center
MD, Dartmouth Medical School
2nd year Surgery Resident at Dartmouth-Hitchcock Medical Center (July, 2003)
AB in Biochemistry and Molecular Biology, Dartmouth College.
Lennoxville, Quebec, Canada



Although my first love is surgery, I have always been fascinated by the nexus between clinical research and public health. The NIH Clinical Research Training Program (CRTP) afforded me a unique opportunity to advance my training in both areas while building a wealth of experience not readily obtainable during medical school. Moreover, it allowed me to broaden my understanding of HIV—invaluable knowledge for any future surgeon.

Working under the direction of Dr. Harvey Alter, I designed and developed a database enabling longitudinal analysis of parameters including HIV viral load, CD4 lymphocyte count, and treatment protocols pursued in a 17-year observational study of 159 HIV positive subjects. I then employed that database and the National Death Index to determine patients' current vital status, conduct survival analyses, and examine factors predictive of disease progression. I also organized testing of stored samples for viral loads and receptor genotypes.

In October 2002, I presented an oral abstract of my results at the 2002 Meeting of the American Association of Blood Banks (AABB). We continue to test for other receptor genotypes thought to play a role in HIV infection.

With all of the necessary data and analytical software installed on my laptop computer, I was usually able to design my own daily and weekly work schedule. During a typical week I would attend departmental Grand Rounds, see study subjects in clinic, attend HIV clinic with an Infectious Disease Fellow, and attend lectures by world-renown scientists at the Great Clinical Teachers series, Wednesday afternoon lectures, and Clinical Center Grand Rounds.

This flexible schedule allowed me to meet surgeons and researchers at the National Cancer Institute (NCI)—an opportunity that eventually led to a one-month clinical elective in the NCI Surgery Branch. The elective was a fantastic experience, allowing me to participate in groundbreaking experimental treatments for cancer patients, including peritoneal perfusions and isolated liver perfusions. My time at the NCI solidified my desire to focus on surgical oncology following my training in general surgery.

My experience at the NIH has convinced me that my research interests lie in the clinical and public health arenas, rather than in basic science. Given the general lack of clinical research training at most medical schools, the CRTP was an invaluable addition to my medical education. Thanks in part to my experience at the NIH, I developed an interest in outcomes research and plan to pursue a Masters of Public Health during the course of my surgery residency.

I am, without question, very interested in pursuing future clinical and research opportunities at the NIH. It is a uniquely challenging and dynamic environment, and the quality of life in Bethesda is excellent. Any cultural or music event you could imagine can be found in the Washington area, and the ocean is under an hour away.