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Infectious Disease, Parenting, Pediatrics, Pregnancy, Public Health

Cocooning newborns against pertussis

Cocooning newborns against pertussis

Grandparent hand with babyAt my last prenatal visit, I got a booster shot for whooping cough (sometimes called pertussis). The Centers for Disease Control and Prevention recommends women get a booster in the third trimester of every pregnancy. Whooping cough has been on the rise for years, and there’s an outbreak happening in California, where we live.

Newborns are especially vulnerable to severe complications from the disease, so doctors suggest that anyone who’s going to be in close contact with newborns and isn’t up-to-date also get a booster: fathers, siblings and even visiting grandparents. The strategy is called “cocooning.”

But what do you do when a grandparent doesn’t want to get a shot? A lot of people don’t like getting vaccinations, either because they want to avoid the discomfort of a shot in the arm or they don’t believe vaccines are effective. (They are.) It’s a question that comes up more often than I expected in online communities. Many pregnant women insist that grandparents who won’t get pertussis shots won’t be allowed to see the new grandchild. Others argue that you can’t force a medical decision like that on someone else. Throw in the added complication that if you’re a first-time parent, it might be the first time you’ve had to confront your parents about how you plan to raise your child. What a mess.

I’m lucky that most of my daughters’ grandparents are already vaccinated for pertussis: My parents and my mother-in-law came to stay and help us with the baby a few years ago and all got vaccinated at the time. But with all the things occupying us as new parents, we didn’t even think to ask my father-in-law, who lives nearby but didn’t have any extended stays in our home. As it turns out, he’s not a fan of vaccinations, and he insists that he got the flu from his last flu shot. (He didn’t.) Obviously, he hadn’t gotten the pertussis booster.

For this baby, we’re planning on bringing up the shot with him, but we’re not expecting him to actually get one. So what will we do? I surprised myself by deciding that I won’t insist he get one in order to see the baby, as long as he doesn’t have any cold symptoms when he visits. (Pertussis usually starts as a mild cold that gets progressively worse; by the time most people are diagnosed, they’ve been sniffling and shedding pertussis bacteria for weeks since they first showed symptoms.) But, who knows? Maybe Grandpa Lesko will surprise us and get the shot for the baby’s sake – or just to avoid the sniffle quarantine policy.

We’ll see.

Previously: Failure to vaccinate linked to pertussis deathsCDC: More U.S. adults need to get recommended vaccinations, and Whooping cough vaccine’s power fades faster than expected
Photo by Ashley Grant

CDC, Chronic Disease, Health Policy, In the News, Infectious Disease, Public Health

To screen or not to screen for hepatitis C

Hep CIn the past few years, newer, more effective treatments have been introduced for hepatitis C – a disease that can lead to chronic liver problems and in the worst cases, liver cancer. In 2012, the Centers for Disease Control and Prevention recommended screening for the disease in anyone born between 1945-1965, since about three-quarters of cases occur in this age group, the Baby Boomers. Last year, the World Health Organization also called for more screening for the disease.

But in a recent analysis piece in The BMJ (formerly the British Medical Journal), several scientists, including Stanford epidemiologist John Ioannidis, MD, DSc, lay out the case that universal screening in this age group may not be warranted. A story in the San Francisco Chronicle today quotes Ioannidis:

“The question is whether these aggressive screening policies are justified and whether they would result in more benefit than harm,” said Dr. John Ioannidis...“We know very little about the potential harms of these drugs, especially in the long-term. And we don’t know how they will translate into long-term benefits.”

Ioannidis and his colleagues suggest that instead of rolling out widespread screening programs, researchers, as soon as possible, start a randomized trial to test the usefulness of screening and who may benefit from it.

On top of the medical uncertainties of the new treatments, they’re expensive, costing about $84,000 for the 12-week treatment. But they’ve been shown to cure patients of their hepatitis C infections at the end of that 12 week stint. Not all people who contract the disease will develop chronic infections, but a majority – two-thirds -will. Twenty percent of those cases will go on to develop severe liver disease.

Advocates of universal screening say that the new screening strategy could identify many people who don’t know they’re sick – symptoms from hepatitis C chronic infections can take years to manifest. But Ioannidis and his colleagues note that many people will get unnecessary treatment and that the long-term uncertainties of the treatment should be taken into consideration.

Previously: Despite steep price tag, use of hepatitis C drug among prisoners could save money overallA primer on hepatitis CFor patients with advanced hepatitis C, benefits of new drugs outweigh costsDrugs offer new hope for hepatitis C and Program examines hepatitis C, the “silent epidemic”
Photo of hepatitis C virus by AJ Cann

Emergency Medicine, Pediatrics, Pregnancy, Stanford News

Helping families navigate the NICU

Helping families navigate the NICU

Packard preemieEarly this morning, the baby girl that’s been growing inside me for 33 weeks decided to have a dance party in my belly. Not great timing, but it’s always a nice reminder to know she’s getting stronger every day and will soon be more than a pre-dawn percussionist in our lives. One of my biggest fears – as it is for many expecting parents – has been what might happen if I went into early labor or if something unexpected turns up when she’s born and she has to stay in the Neonatal Intensive Care Unit.

Those days, waiting for a baby to be well enough to come home from the NICU can be exhausting and confusing. And there’s often a lot to learn about the health issues many preemies suffer. So a new program at Stanford’s Lucile Packard Children’s Hospital, which admits 1,500 babies each year, aims to make that time a little less overwhelming.

The NICU Family Support Program was started last year and represents a new partnership between the hospital and the March of Dimes. The program is available at several hospitals nationwide and helps 90,000 families every year. Families gain access to print and online versions of educational materials to help them understand their babies’ health issues and treatments. A recent feature story describes the program’s holistic approach:

“We work very hard to take care of the whole family and not just the baby,” [hospital president Christopher] Dawes said in announcing the new partnership with the March of Dimes. “This program increases parents’ confidence and gives NICU staff the tools they need to support families and babies.”

. . .

“When you have a premature baby, you have to learn a whole new language. You are so inundated with terms, it’s easy to get mixed up,” said [mother of twin preemies Heather] Keller. “The March of Dimes website and written materials are a great reference that families can use throughout their journey. It’s accurate and written in a language that’s easy for families to understand, but is not complicated or condescending.”

In addition to the materials, the program offers iPads to NICU families, providing them with easy access to the March of Dimes materials and website without having to leave their babies’ bedsides.

The NICU Family Support Program is designed to help families become more involved in the care their young children receive. It’s an approach that can alleviate some of the burden parents of NICU patients feel at what is otherwise a harrowing time in their lives.

Previously: The year in the life of a preemie – and his parents, NICU trauma intervention shown to benefit mothers of preemies, Using the iPad to connect ill newborns, parents, Special care to protect newborns’ fragile brains and The emotional struggles of parents of preemies
Photo, of a Packard Children’s patient and his mom, by Doug Peck

Cancer, Public Health, Research, Stanford News, Technology

Stanford researchers explore new ways of identifying colon cancer

Stanford researchers explore new ways of identifying colon cancer

B0006254 Human colon cancer cellsAfter my aunt died from colorectal cancer several years ago, my father was primed when his doctor suggested he get screened for colon cancer himself, and it’s a good thing he did. The doctor who performed the colonoscopy (a visual exam of the rectum and colon) found a large precancerous polyp.

If my father had skipped out on being screened, he would likely have been dead in five years. He was lucky that the polyp was easily visible during the exam, but not all lesions that turn out to be cancerous are. Some pre-cancerous areas are flat or depressed and much harder to see on colonoscopies or sigmoidoscopies.

Now, a team of Stanford researchers led by Matthew Bogyo, PhD, a professor of pathology and microbiology and immunology, are working on ways to make these less obviously cancerous regions on the colon more visible during screenings. They’re doing so by developing compounds that begin to fluoresce – or glow – when they attach themselves to enzymes called cysteine cathepsins. Present in nearly all cells of our bodies, cysteine cathepsins are abundant in and around cancerous tumor sites. “They’re regulators of inflammation,” Bogyo said when we spoke recently. “When a tumor starts to form, you get inflammation, and the tumor benefits from this inflammatory response. We take advantage of that inflammation, using these enzymes as markers.”

The researchers studied how well the compounds, called quenched fluorescent probes, identified lesions in two strains of mice – one, a specially bred strain of mice that produce a higher number of intestinal polyps and the other a wild-type mouse in which colon cancer is induced by a orally administered drug – as well as in human tissue samples. Their study was published today in the scientific journal Chemistry and Biology. A statistical analysis of the results showed that the probe was highly effective at identifying true cases of intestinal lesions and had a low rate of false positives. “Optical contrast agents allow us to see where lesions are and pick out problem areas,” Bogyo told me. “When they are ‘found’ by these enzymes, they turn bright.” Although it’s hard to compare a test like this to current methods of colorectal cancer screening, which do not involve the use of contrast agents, Bogyo is encouraged by the study’s results.

Bogyo noted that he was surprised that the probe worked just as well identifying lesions in mice intestines when it was applied topically to the inside surface of the intestines as when it was injected into the bloodstream. This opens up the possibility that – if approved for use in humans – it could simplify how the probe is used. A colonoscopist could simply spray the contrast agent out of the end of the endoscope to get a confirmation of potentially dangerous lesions.

Getting these kinds of probes into human use is still years away. Currently, no other targeted optical contrast agents are approved for human use, and the process of gaining approval from the Federal Drug Administration, much like developing a new drug, can be an expensive and arduous one. The probes would need to be tested for safety in animals and eventually humans before they could be approved for widespread use.

But the field is a promising one, and Bogyo is not the only researcher pursuing contrast agents as cancer-screening tools. He is optimistic and is currently exploring companies that may want to invest in developing cysteine cathepsin contrast agents for human use. Incorporating contrast agents into current practices “would move the field forward and make colonoscopy more accurate and rapid,” he said.

Previously: Researchers explore colonoscopy’s effect on the incidence of colorectal cancer, No day on the beach: A colon cancer survivor’s story, The cost-effectiveness of screening colon-cancer patients for Lynch disorder and Bacterial balance in gut tied to colon cancer risk
Photo of colon cancer cells by Wellcome Images

Neuroscience, Research, Sports, Stanford News

Forces at work in concussions more complicated than previously thought, new Stanford study reveals

Forces at work in concussions more complicated than previously thought, new Stanford study reveals

640px-Hischool_football_sunsetThe college bowls of New Year’s Day are behind us, and many football fans are already looking forward to next month’s Super Bowl. But they’re also talking more about the traumatic head injuries that plague football players, which scientists and clinicians still don’t understand fully.

One Stanford team is measuring the physical forces that an athlete’s head undergoes in a much more detailed way than in past studies, using a specially-outfitted mouthguard that we wrote about last year. Just before Christmas, Stanford bioengineer David Camarillo, PhD, and his team published a paper in the Annals of Biomedical Engineering that provides a much more complete picture of head injuries among athletes.

Helmets used in football and other sports are only evaluated on how well they protect in three directions of movement: front/back, up/down, and left/right. But, as a press release from the university notes, researchers suspect that rotational accelerations (roll, pitch, yaw) play an important role in serious injuries.

The team customized a commercially available mouthguard to measure movement in all six directions, and they recorded 500 impacts on Stanford football players, local boxers and mixed martial arts athletes. Two of the impacts resulted in concussions. The researchers analyzed the impacts and found that using six degree-of-freedom data proved to be more predictive of injuries than the current three degree-of-freedom standard. They also found that one particular part of the brain is more likely involved in concussion injuries. The release details these findings:

The current work… has helped identify a brain structure that bears closer scrutiny for its potential role in concussion symptoms. While the two concussion impacts inflicted very different magnitude and directional forces on the head, computer models indicated that they both put strain on a particular part of the brain, the corpus callosum. Previous concussion studies have identified the corpus callosum as a potential injury site.

“One of the things the corpus callosum does is manage depth perception and visual judgment by communicating and integrating information from each eye across the left and right hemisphere of the brain,” said lead author Fidel Hernandez, a mechanical engineering graduate student in Camarillo’s lab. “If your eyes can’t communicate, your ability to perceive objects in three dimensions may be impaired and you may feel out of balance, which is a classic concussion symptom.”

At the beginning of this year, a new law went into effect in California limiting the time high school football players’ full-contact practice time to just two 90 minute sessions per week; the new law also bans out-of-season full-contact practice. Texas has had a similar law on the books since 2013. The laws indicate the growing concern over head injuries, and more accurate information from studies like Camarillo’s can help coaches and parents decide when a player needs to step off the field.

Beyond influencing possible changes to industry standards, another possible implications for Camarillo’s research is that it will allow coaches to remotely monitor impact forces that players undergo. Many players under-report impact injuries, something that complicates understanding the phenomena. Accurate measurements can help clarify the picture.

Previously: Mouthguard technology by Stanford bioengineers could improve concussion measurementStanford undergrad studies cellular effects of concussionsKids and concussions: What to keep in mindDeveloping a computer model to better diagnose brain damage, concussions and Study suggests football-related concussions caused by series of hits, not a single blow.
Photo by  Jacoplane

Mental Health, Nutrition

Eating healthy, managing stress, and staying well during the holidays: A round-up of experts’ tips

dog in Santa hat - smallOver the last five years, since Scope launched in 2009, we’ve published many holiday-themed posts. This year, we’re collecting the best of them in one place, and they include tips about eating well, exercising and managing stress during the holidays, as well as healthy ways to kick off your new year.

Eating healthy during the holidays

Managing holiday stress

Starting the new year off right

Other holiday themes

Photo by starsandspirals

Aging, Chronic Disease, Dermatology, Stanford News

Patching up diabetic ulcers

Patching up diabetic ulcers

Like the more than 29 million people in the U.S, my mother has diabetes. Her eldest sister and my maternal grandmother both died of complications of the disease, and her one surviving sister is coping with complications that will probably claim her life in a few years. I’ve got gestational diabetes (a temporary version of the disease that occurs during pregnancy), and due to that and my family history I’m likely to develop type-2 diabetes down the line, also. So I’m always very interested in hearing about research advances related to the disease.

One such advance: As reported today in the the Proceedings of the National Academy of Sciences, Stanford researchers have developed a new skin patch that delivers a drug to aid the healing of diabetic ulcers. Diabetic ulcers (or open wounds) are one of the most common complications of the disease, with an estimated 15 percent of diabetics developing them. They often occur on the feet and are the leading cause of diabetes-related amputations. The high level of blood sugar in diabetics’ blood impairs the body’s ability to grow new blood vessels, which slows down healing of the ulcers.

Deferoxamine, or DFO, is an FDA-approved drug that can help correct this problem, but it would be toxic if taken for as long as diabetics need it to heal their ulcers. So Stanford researchers developed a local application via a skin patch. In a press release, study authors Dominik Duscher, MD, a plastic and reconstructive surgery postdoctoral fellow, and surgeon Geoffrey Gurtner, MD, talked about the findings of their work in animal models:

Not only did the wounds in the mice heal more quickly, Duscher said, but the quality of the new skin was even better than the original. The researchers also used the DFO matrix on a mouse with diabetes to see if it would prevent ulcer formation — and it did. “We were very excited by the results,” Duscher said, “and we hope to start clinical trials soon to test this in humans.”

“This same technology is also effective in preventing pressure ulcers, which are a major source of morbidity and mortality in patients with neurologic injury or the elderly,” said Gurtner, who is also the Johnson & Johnson Distinguished Professor in Surgery II. “The actor Christopher Reeve actually died from a pressure ulcer and not his spinal cord injury, which really emphasizes the extremely limited therapeutic options for these patients.”

Luckily my mother hasn’t had to deal with diabetic ulcers, though when she gets small cuts or chaps on her skin, they do take forever to heal, so she’s super-vigilant about avoiding them. The possibility of preventing more serious ulcers with this patch is a development I’ll be following closely.

Previously: A primer on preventing or delaying type 2 diabetes and New medicine? A look at advances in wound healing

Chronic Disease, Health and Fitness, Nutrition

How to make it through holiday dinners without putting on the pounds

How to make it through holiday dinners without putting on the pounds

640px-Christmas_sugar_cookies,_January_2010A lot of people are worrying about overeating over the holidays, especially if they’re on a diet. We’ve offered advice in the past on how to avoid gaining weight over the holidays, and the  blog Obesity Panacea yesterday listed a few tips for eating healthy. My favorite:

Serve healthy snacks in large bowls and the unhealthy ones in small bowls

This little trick should result in a greater consumption of healthy snacks and a limited consumption of unhealthy ones, not only helping you, but those you have over to your place during the holidays.

A wonderfully simple study found that when snacks are offered in a large bowl, people take 53% more food (146 extra calories) and eat 56% (142 calories) more than when offered the same amount of food but in a smaller bowl (roughly half the size of large bowl).

It’s an easy change to make, but not one I never would have thought about. Other tips include drinking a glass or two of water 30 minutes before a meal and making sure you eat breakfast. Both tips ensure you won’t overeat when you get to the Christmas dinner table.

Previously: “Less is more”: More holiday eating tips from a Stanford nutrition lecturerEasy-to-follow tips to avoid overeating this holiday, “Less is more”: Eating wisely, with delight, during the holidays and Enjoying the turkey while watching your waistline
Photo by sweetfixNYC

Chronic Disease, Genetics, Pediatrics, Stanford News

Stem cells implicated in Duchenne muscular dystrophy

Stem cells implicated in Duchenne muscular dystrophy

640px-Duchenne-muscular-dystrophyStanford researchers published a paper today in Science Translational Medicine describing how stem cells are involved in the development of Duchenne muscular dystrophy, a disease that results in progressive, often severe muscle weakness. It affects about one in every 3,600 boys born in the U.S.

The research team determined that the stem cells surrounding muscle tissue gradually became less able to create new muscle cells and instead begin to express genes that lead to connective tissue formation. Excess connective tissue accumulation, which is called fibrosis, occurs in many diseases. Thomas Rando, MD, PhD, a Stanford neurologist and one of the authors of the paper said in a release about the new study:

These cells are losing their ability to produce muscle, and are beginning to look more like fibroblasts, which secrete connective tissue. It’s possible that if we could prevent this transition in the muscle stem cells, we could slow or ameliorate the fibrosis seen in muscular dystrophy in humans.

The researchers also found that a drug already approved to treat high blood pressure in humans called losartin can slow these changes in stem cells in laboratory mice, although much more work is needed to find out if it could be helpful in children with Duchenne.

The researchers are focusing on how to get the drug to target only muscle cells, but they’re also interested in how they can apply their findings to other diseases. Rando, who directs the Glenn Center for the Biology of Aging at Stanford, also commented:

Fibrosis seems to occur in a vicious cycle. As the muscle stem cells become less able to regenerate new muscle, the tissue is less able to repair itself after damage. This leads to fibrosis, which then further impairs muscle formation. Understanding the biological basis of fibrosis could have a profound effect on many other diseases.

Previously: Working on a gene therapy for muscular dystrophy, New mouse model of muscular dystrophy provides clues to cardiac  failure, and Mouse model of muscular dystrophy points finger at stem cells
Photo of muscle cells affected by Duchenne disease by Edwin P. Ewing

Genetics, NIH, Research, Videos

DNA origami: How our genomes fold

DNA origami: How our genomes fold

Here’s an interesting factoid about our genomes: If you stretched out the DNA in a single cell, which is only a few millionths of an inch wide, it would span more than six feet. And another: DNA folding is a dynamic process that changes over time. Scientists have been trying to understand how DNA folds itself up so efficiently, and a recent post on the NIH Director’s Blog highlights new research illustrating how the human genome folds inside the cell’s nucleus, as well as how DNA folding affects gene regulation. The research team created this delightful video that demonstrates the principles involved using origami art.

Researchers have been working to determine how cells regulate gene expression for nearly as long as we’ve known about DNA. How, for example, do nerve cells know to turn off only nerve cell genes and turn off bone cell genes? DNA folding loops are part of the answer. This research team, which published their findings in a paper in Cell yesterday, found that the number of loops is much lower than expected. There are only 10,000 loops instead of the predicted millions, and they form on/off switches in DNA. As explained in the blog post:

[The] paper in Cell adds fascinating details to that map, and it confirms that DNA loops appear to play a crucial role in gene regulation. The researchers found that many stretches of DNA with the potential to fold into loops have genes located at one end and, at the other end, novel genetic switches. When a loop forms, placing a hidden switch in contact with a once-distant gene, the gene is turned on or off. In fact, the mapping work uncovered thousands of these “secret” switches within the genome—information that may provide valuable new clues for understanding cancer and many other complex, common diseases.

Previously: DNA architecture fascinates Stanford researcher – and dictates biological outcomes

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