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Aging, Cancer, Emergency Medicine, Medical Education, Pregnancy, Stanford News

Stanford Medicine magazine reports on time’s intersection with health

Stanford Medicine magazine reports on time's intersection with health

Why is it that giant tortoises typically live for 100 years but humans in the United States are lucky to make it past 80? And why does the life of an African killifish zip past in a matter of months?

I’ve often mused about the variability of life spans and I figure pretty much everyone else has too. But while editing the new issue of Stanford Medicine magazine’s special report on time and health, “Life time: The long and short of it,” I learned that serious scientists believe the limits are not set in stone.

“Ways of prolonging human life span are now within the realm of possibility,” says professor of genetics Anne Brunet, PhD, in “The Time of Your Life,” an article on the science of life spans. My first thought was, wow! Then I wondered if some day humans could live like the “immortal jellyfish,” which reverts back to its polyp state, matures and reverts again, ad infinitum. Now that would be interesting.

Also covered in the issue:

  • “Hacking the Biological Clock”: An article on attempts to co-opt the body’s timekeepers to treat cancer, ease jetlag and reverse learning disabilities.
  • “Time Lines”: A Q&A with bestselling author and physician Abraham Verghese, MD, on the timeless rituals of medicine. (The digital edition includes audio of an interview with Verghese.)
  • “Tick Tock”: A blow-by-blow account of the air-ambulance rescue of an injured toddler.
  • “Before I Go”: An essay about the nature of time from a young neurosurgeon who is now living with an advanced form of lung cancer. (The neurosurgeon, Paul Kalanithi, MD, is featured in the video above, and our digital edition also includes audio of an interview with him.)

The issue also includes a story about the danger-fraught birth of an unusual set of triplets and an excerpt from the new biography of Nobel Prize-winning Stanford biochemist Paul Berg, PhD, describing the sticky situation he found himself in graduate school.

Previously Stanford Medicine magazine traverses the immune system, Stanford Medicine magazine opens up the world of surgery and Mysteries of the heart: Stanford Medicine magazine answers cardiovascular questions.

Cardiovascular Medicine, Immunology, Medicine and Literature, Stanford News, Surgery

Stanford Medicine magazine’s big reads of 2014

Stanford Medicine magazine's big reads of 2014

brain attackThis year’s most-read Stanford Medicine magazine stories were all about the heart, surgery and the immune system – the themes of this year’s three issues. The top 10 (as determined by pageviews on our website):

Previously: Stanford Medicine magazine’s big reads of 2013 and Stanford Medicine magazine’s big reads of 2012
Illustration, from the article “Brain attack” in the Fall 2014 magazine issue, by Jeffrey Decoster

Immunology, Mental Health, Stanford News

Stanford Medicine magazine traverses the immune system

Stanford Medicine magazine traverses the immune system

cover_fall2014_2If you want to understand the human immune system, try studying humans – not mice. That’s what Mark Davis, PhD, urges in a special report on the immune system in the new issue of Stanford Medicine magazine.

For decades, most research on the immune system has used mice. Davis, director of Stanford’s Institute for Immunology, Transplantation and Infection, launched Stanford’s Human Immune Monitoring Center a few years ago to change the immunology research paradigm.

“Inbred mice have not, in most cases, been a reliable guide for developing treatments for human immunological diseases,” Davis says in the special report, titled “Balancing act: The immune system.”

As the editor of the magazine, I wanted to feature a story that showed how human-focused immunology research plays out. So I was glad to learn that the center is in the midst of its largest study so far – one to figure out the cause of chronic fatigue syndrome. A team led by Stanford professor of infectious diseases José Montoya, MD, is looking for meaningful patterns in the components of blood samples gathered from 200 patients with chronic fatigue syndrome and 400 healthy subjects.

“It’s like dumping a hundred different puzzles on the floor and trying to find two pieces that fit,” Davis says in our story. We also have a video about a patient’s seven-year battle with chronic fatigue, from despair to recovery.

Also covered in this issue:

  • “I can eat it”: on a revolutionary treatment for food allergies
  • “Brain attack”: on the struggle to help children with psychiatric illness caused by a malfunctioning immune system – a condition known as PANS or PANDAS
  • “When bones collide”: on a new view on the cause of osteoarthritis: autoinflammation
  • “My rendezvous with insanity”: a Q&A with Susannah Cahalan, author of Brain on Fire: My Month of Madness, her memoir of surviving an autoimmune attack on her brain
  • “The swashbuckler”: on look back to the early days of molecular biology when Mark Davis cracked one of the greatest mysteries of the immune system

The issue also includes an article on efforts at the VA Palo Alto Health Care System to use peer-support services to help veterans with post-traumatic stress disorder, and a story on the growing concern that biomedical research results are often erroneous and efforts being made to solve the problem.

The issue was funded in part by the Institute for Immunology, Transplantation and Infection.

Previously: Stanford Medicine magazine opens up the world of surgery, Mysteries of the heart: Stanford Medicine magazine answers cardiovascular questions and From womb to world: Stanford Medicine Magazine explores new work on having a baby.
Illustration by Jeffrey Decoster

Medicine and Literature, Stanford News, Surgery

Stanford Medicine magazine opens up the world of surgery

Stanford Medicine magazine opens up the world of surgery

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It used to be “big hole, big surgeon” — but no more, according to Stanford’s chair of surgery, Tom Krummel, MD, who’s one of the surgeons featured in Stanford Medicine magazine’s report on surgery and life in the operating room, “Inside job: Surgeons at work.”

During his career of more than 30 years, Krummel has seen a massive shift from open surgeries to minimally invasive procedures — major surgeries conducted with tools that work through small openings.

“We do the same big operation. We just don’t make a big hole,” he said in the article leading off the report.

In the same issue, CNN’s chief medical correspondent, neurosurgeon Sanjay Gupta, MD, talks about why he’s “doubling down” on his support for medical marijuana.

As the editor, I’m biased — but I think it’s worth a read, along with the rest of the issue, which includes:

The issue also includes a report on research on Alzheimer’s disease, and an excerpt from Surgeon General’s Warning, a new book by Associated Press medical reporter Mike Stobbe on the fall from power of the U.S. surgeon general. The digital edition offers audio interviews with Gupta, Stobbe, Stanford surgeon and humanitarian-aid volunteer Sherry Wren, MD, and photographer Max Aguilera-Hellweg, MD.

Previously: The vanishing U.S. surgeon general: A conversation with AP reporter Mike Stobbe, Mysteries of the heart: Stanford Medicine magazine answers cardiovascular questions, From womb to world: Stanford Medicine Magazine explores new work on having a baby and Factoring in the environment: A report from Stanford Medicine magazine
Photo by Max Aguilera-Hellweg

Obesity, Research, Stanford News

Secrets of fat cells discovered

Secrets of fat cells discovered

fat_and_skinnyWhy aren’t we all drowning in fat? Before talking with Mary Teruel, PhD, this question certainly never occurred to me. (On a personal level, though, I admit I’ve wondered about the opposite!) But after our conversation I saw why it’s such a good question — and how great it is that Teruel has come up with an answer.

Normally your body replaces about 10 percent of your fat cells a year, explained Teruel, a Stanford assistant professor of chemical and systems biology. Little by little, the old ones die, and new ones develop from flat, spindly precursor cells.

Teruel knew, based on her previous experiments, that the switch that triggers the conversion of precursor cells into fat cells is an “on-off” sort, not a dimmer which can be dialed up and down.

Here’s what’s going on in a little more detail: The switch controls the amount of PPAR-gamma in a cell. PPAR-gamma is a nuclear receptor protein that is the master regulator of fat-cell development. In precursor cells, the switch is in the “off-state” and there’s no PPAR-gamma in the cell, but when the cell senses a stimulus that can cause fat cell development, the switch flips to the “on-state” and the cell rapidly makes huge amounts of PPAR-gamma which then turns on hundreds of downstream genes that create a full-fledged fat cell over a period of up to 12 days.

So here’s what was puzzling Teruel: Every human has a large number of precursor cells that all sense the same stimulus, but rather than all converting at once to fat cells (causing us to “drown in fat”) for a given strong stimulus, only a few cells develop into fat cells at any given time, allowing a healthy, constant renewal of our fat tissue. What allows this slow, controlled renewal of fat cells, as well as prevents the unhealthy situation in which all fat cells would turn back into precursors when PPAR-gamma drops below the threshold needed to flip the switch on?
If you can manipulate the rate fat cells mature, you could do a lot for obesity.
Experiments she did with postdoctoral researcher Robert Ahrends, PhD, and colleagues, explain, and provide clues about how to control the rate at which fat forms.

The answer, they discovered, has two parts. First of all, they discovered that the master fat-regulator switch has multiple layers of feedback. Teruel, who has a PhD in aeronautical engineering, explains that these multiple layers allow the body to control the rate of fat cell formation much as a pilot would control the pitch of an aircraft. Second, they found that not all precursor cells are alike — they vary in the quantity they carry of PPAR-gamma and other regulatory proteins.

This realization is a big deal. For one thing, it gives researchers new ideas for treating obesity and diabetes — so far, conditions that resist effective treatment without serious side effects.

“If you can manipulate the rate fat cells mature, you could do a lot for obesity,” she pointed out.

“This might be the heart of how you treat disease,” said Teruel. “We can’t just use one drug for treatment. Disease is more complicated than people think. It would be like trying to control an airplane and only being able to turn the rudder. This might work in a car or boat, but an airplane can move in three-dimensions, and a change in any one dimension affects the other two. Only controlling one dimension is a sure way to crash the plane.”

Teruel’s Stanford website has more info about her research as well as a striking depiction of a fat cell’s development.

They published the results of their studies on Friday in the journal Science (subscription required). They were supported by Stanford University New Faculty Startup Funds, the National Institutes of Health (grant P50GM107615), the German Research Foundation, and the American Heart Association.

Previously: Early findings show nutrigenomics could make weight loss more efficient, Study shows banning soda purchases using food stamps would reduce obesity and type-2 diabetes, Fed Up: A documentary looks for answers about childhood obesity
Photo by Jason Eppink

Imaging, Ophthalmology, Research, Stanford News, Technology

Instagram for eyes: Stanford ophthalmologists develop low-cost device to ease image sharing

Instagram for eyes: Stanford ophthalmologists develop low-cost device to ease image sharing

eye-phoneThis probably won’t grab as many headlines as the news of a smartphone that wakes you up with the sizzle and smell of bacon, but it should!

A team of Stanford scientists is using 3D printing to create inexpensive adapters that make it easy to use a smartphone and an ordinary examination lens to capture high-quality images of the front and back of the eye. And – what seems to me as just as important – providing a nearly effortless way to share those images.

“Think Instagram for the eyes,” said one of the developers, assistant professor of ophthalmology Robert Chang, MD.

This is a big deal because most primary-care doctors have no good way to see into patients’ eyes, and no easy way to share the images. The usual eye-imaging instruments are expensive and hard to use, and even ophthalmologists who have the equipment and know-how find capturing and sharing the images slow going.

As one of Chang’s fellow developers, Stanford ophthalmology resident Dave Myung, MD, PhD, told me when I interviewed him for an article in Inside Stanford Medicine:

“A picture is truly worth a thousand words… Imagine a car accident victim arriving in the emergency department with an eye injury resulting in a hyphema – blood inside the front of her eye. Normally the physician would have to describe this finding in her electronic record with words alone. Smartphones today not only have the camera resolution to supplement those words with a high-resolution photo, but also the data-transfer capability to upload that photo securely to the medical record in a matter of seconds.”

The scientists describe the adapters, currently dubbed the EyeGo, in two articles in the new issue (volume 3, issue 1) of Journal of Mobile Technology in Medicine. And you can read my story to learn more about the development process, including how Myung pieced together the first prototype (with plastic bits he ordered from the Internet and a few Legos), how mechanical engineering graduate student Alex Jais created the first printed model on his own 3D printer, and how residents Lisa He, MD, and Brian Toy, MD, are leading studies to test them out.

Those interested in using an EyeGo adapter for research or beta-testing can e-mail the team at eyegotech@gmail.com.

Previously: Image of the Week: Sigmoid volvulus and Treating common forms of blindness using tissue generated with ink-jet printing technology
Photograph by Dave Myung

Cardiovascular Medicine, Research, Stanford News, Technology, Transplants

Mysteries of the heart: Stanford Medicine magazine answers cardiovascular questions

Mysteries of the heart: Stanford Medicine magazine answers cardiovascular questions

spring14_magazine-coverThe heart is a paradoxical organ. It declares its presence with that distinctive thump thump, yet its moment-to-moment condition is really hard to decipher. But as I learned while editing the just-published Stanford Medicine magazine special report “Mysteries of the heart,” new technologies and research are making it easier to assess heart health and diagnose disease. With heart disease the No. 1 cause of death worldwide, that’s good news.

The issue, published during American Heart Month, was supported in part by the Stanford Cardiovascular Institute. Among its contents:

  • A change of heart“: An interview with former vice president Dick Cheney on having “virtually everything done to me that you could do to a heart patient,” culminating with a transplant.
  • Fresh starts for hearts“: A feature on using stem cells to revolutionize cardiac care, and a family for which new treatments can’t come soon enough.
  • The ultramarathoner’s heart“: Visionary computer designer Mike Nuttall’s exploits as an ultramarathoner, despite having severe heart disease (online only).
  • Hiding in plain sight“: The story of a man born with high cholesterol — a surprisingly common but hidden and deadly condition.
  • Switching course“: A piece detailing the untangling of a heart surgery that saves babies, but threatens their lives in adulthood.
  • The heart gadgeteers“: A report on the new wave of heart- and fitness-monitoring devices, and why it’s hard to integrate them into the medical system.
  • Easy does it“: An article on an alternative to open-heart surgery to replace aortic valves.
  • Dear Dr. Shumway”: Catching up with a kid who in 1968 wrote to transplant pioneer Norman Shumway, MD, for advice — on his frog heart transplant.

The issue also includes articles on the use of big data in medicine, which will be the focus of the Big Data in Biomedicine conference May 21-23 at Stanford.

Previously: From womb to world: Stanford Medicine Magazine explores new work on having a babyFactoring in the environment: A report from Stanford Medicine magazine and New issue of Stanford Medicine magazine asks, What do we know about blood?
Illustration by Jason Holley

Medicine and Literature, Stanford News

Stanford Medicine magazine's big reads of 2013

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The 10 most-read Stanford Medicine magazine stories published this year (as determined by pageviews on our website):

Almost without hope – Seeking a path to health on the Rosebud Indian Reservation: Tracie White’s report on life in one of the hardest places in America to stay healthy — the Rosebud reservation in South Dakota.

Labor day – The C-section comes under review: An article by Julie Greicius explaining the rise of C-sections and why a decrease in how often the procedure is performed should be around the corner.

Microbe computers – Built from the stuff of life: A feature by Andrew Myers on the creation of a computer made of biological molecules that can run inside our cells.

Blood, sweat and fears – A common phobia’s odd pathophysiology: John Sanford’s story about conquering blood phobia.

Against the flow – What’s behind the decline in blood transfusions?: Sara Williams explains the drop in transfusions — and why it’s good news for health.

Leo and Frida – The doctor and the artist: A feature by Catherine Reef on the friendship between artist Frida Kahlo and Stanford surgeon Leo Eloesser, MD.

Too deeply attached – The rise of placenta accreta: Erin Digitale describes the epidemic of placenta accreta and how this potentially fatal condition affected one family.

Roll up your sleeve – There’s still no substitute for blood: Jessica Shugart on why blood donation remains crucial.

In his blood – A doctor driven by hemophilia: Krista Conger profiles Holbrook Kohrt, MD, a physician who grew up with hemophilia and is dedicating his life to finding cures for life-threatening disease.

Priming the pumps – Debugging Dhaka’s water: Ruthann Richter tells how a trip to the slums of Dhaka, Bangladesh led to a radical solution for contaminated drinking water.

Previously: Stanford Medicine magazine’s big reads of 2012 and Stanford Medicine magazine’s big reads of 2011
Illustration (the cover of our special report “Blood at work”) by Renphoto

Pregnancy, Stanford News, Technology, Videos, Women's Health

Placenta: the video game

Placenta: the video game

Fetus-Placenta-copy-3

As I discovered while editing the new Stanford Medicine magazine report on childbirth, the placenta is a terribly important organ yet a big question mark for most people. To help demystify it we used a new kind of storytelling – an interactive simulation that allows you to observe and control the development of the placenta. It’s a companion to an article on the epidemic of the potentially fatal condition known as placenta accreta.

The producer, David Sarno, a former Los Angeles Times technology reporter and a 2013 John S. Knight Journalism fellow, built the simulation using the tools of video game design. It’s the first finished product of his start-up, Lighthaus, dedicated to creating interactive digital stories. If you’re curious about the placenta – or this new mixture of technology and storytelling – click on the image above to get to the video. (Note: To run the program you’ll need the Unity web player, which is free and downloads pretty quickly at the link.)

Previously: From womb to world: Stanford Medicine Magazine explores new work on having a baby, Touchable journalism technology helps to teach medicine, Species-specific differences among placentas due to long-ago viral infection, say Stanford researchers and The placenta sacrifices itself to keep baby healthy in case of starvation, research shows
Illustration by Bruce Rudolph/Lighthaus Inc.

NIH, Research, Science, Stanford News

A new era in scientific discourse? PubMed gets comments

A new era in scientific discourse? PubMed gets comments

typing - smallPubMed, the massive index of biomedical research articles, has begun an experiment: Enabling the posting of comments on the articles’ citations. This might not seem like a big deal, but in this case the comments system, PubMed Commons, is creating a buzz.

Some of the tweets following the Oct. 22 announcement: “PubMed Commons will change the way science works, but I predict a big impact on science bloggers as well” (@Neuro_Skeptic), “Science buzz and criticism gets a powerful boost” (@phylogenomics) and “Seriously get ready for a turbo-charged #PubMed (@AlbertErives).”

It was actually two Stanford professors – biostatistician Rob Tibshirani, PhD, and biochemist Pat Brown, PhD – who got the project rolling. I talked with Tibshirani for an article in Inside Stanford Medicine about the project’s beginnings and what he hopes it will accomplish. For starters, he sees it as a way for readers to note errors in the scientific literature in a place other researchers will see. But he also hopes it will generally expand scientific discourse and build community:

“Science can be lonely,” Tibshirani said. “Just having people talk about your work is nice. Sure it’s nice to have good comments. But it’s nice to have comments at all. At least someone cares enough to read your paper.”

For now, during this expanded pilot phase, only individuals who have published articles indexed in PubMed can make comments or see them. Tibshirani says he’s hopeful the leaders of the National Institutes of Health will decide to allow the general public to see the comments too. More on the how and why of the project as well as the quandary over anonymous comments (yea or nay) in the article.

For a fuller picture of the social media reaction, see this Storify created by Hilda Bastian, a blogger at Scientific American and an editor at the National Center for Biotechnology Information, the organization within the NIH that runs PubMed.
Photo by Mike Traboe

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