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Cancer, Stanford News, Stem Cells, Videos

A look at stem cells and “chemobrain”

A look at stem cells and "chemobrain"

As many as 75 percent of cancer patients experience memory and attention problems during or after their treatment, and up to 3.9 million are afflicted by long-term cognitive dysfunction. This foggy mental state, often referred to as “chemobrain,” can also affect cancer survivors’ fine motor skills, information processing speed, concentration and ability to calculate.

In this recently posted California Institute for Regenerative Medicine video, Stanford physician-scientist Michelle Monje, MD, PhD, explains the role that damage to stem cells in the brain plays in the condition, outlines some of the interventions that can mitigate patients’ symptoms, and highlights efforts to develop effective regenerative therapies.

Previously: Stanford brain tumor research featured on “Bay Area Proud”, Emmy nod for film about Stanford brain tumor research – and the little boy who made it possible and Stanford study shows effects of chemotherapy and breast cancer on brain function

Ask Stanford Med, Cardiovascular Medicine, Events, Genetics

A conversation about using genetics to advance cardiovascular medicine

A conversation about using genetics to advance cardiovascular medicine

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In recognition of American Heart Month, Stanford Health Care is hosting a heart fair on Saturday. The free community event includes a number of talks ranging in topic from the latest developments in treating atrial fibrillation to specific issues related to women’s heart health.

During the session on heart-disease prevention, Joshua Knowles, MD, PhD, will deliver a talk titled “How We Can (and Will) Use Genetics to Improve Cardiac Health.” Knowles’ research focuses on familial hypercholesterolemia, a genetic disease that causes a deadly buildup of cholesterol in the arteries. He and colleagues recently launched a project that uses a big-data approach to search electronic medical records and identify patients who may have the potentially fatal heart condition.

To kick off the conversation about preventing heart disease, I contacted Knowles to learn more about how the genomics revolution is changing the cardiovascular medicine landscape and what you can do to determine if you have a genetic heart disorder. Below he explains why heart disease is a “complex interplay between genetics and environment” and what the future may hold with respect to personalized treatments and pharmacogenetics.

Let’s start by talking about your work on familial hypercholesterolemia (FH). How has the understanding of the genetic basis of FH evolved over the last few years, and what key questions remain unanswered?

For FH, there has been a revolution in our understanding. FH causes very elevated cholesterol levels and risk of early onset heart disease. We used to think that it affected 1 in 500 individuals, but recent studies have pointed out that this is probably an underestimate and it may affect as many as 1 in 200 people. This means that there may be as many as 1 million people in the United States who are affected. We have also identified new genes that cause FH, and the identification of some of these genes has directly translated into the development of a new class of drugs (so called PCSK9 inhibitors) to treat this condition.

What steps can patients take to determine if they are at risk of, or may have, a genetic cardiovascular disorder like FH?

The easiest way is to know about your family history of medical conditions- to know what illnesses affected parents, grandparents, uncles, aunts and other relatives. Of course, genes aren’t the only things that are passed in families. Good and bad habits, such as exercise patterns, smoking and diet, are also passed down through the generations. But a family history of heart disease or certain forms of cancer is certainly a risk factor.

Past research suggests that patients with a genetic predisposition to heart disease can significantly reduce their chances of having a heart attack or stroke by making changes to their lifestyle, such as eating a diet rich in fruits and vegetables. Can lifestyle changes overcome genetics?

Heart disease is a result of the complex interplay between genetics and environment – lifestyle, for instance. For some people with specific genetic conditions, such as familial hypercholesterolemia or hypertrophic cardiomyopathy, the effect of genetics tends to dominate the effect of environment because the genetic effect is so large.

For the vast majority of people without these “Mendelian” forms of heart disease, which follow the laws of inheritance were derived by nineteenth-century Austrian monk Gregor Mendel, it’s difficult to determine at an individual level how much of the risk is due to genes and how much is due to environment (this is for things like high blood pressure, high cholesterol, coronary disease). One clue is certainly family history. However, for most of these diseases the genes are not “deterministic” – that is, people are not destined to have these diseases. Some are more at risk than others, but there are certainly ways to mitigate genetic risk through lifestyle choices. Choosing not to smoke and exercising regularly are two examples of ways you can help to greatly minimize genetic risk.

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Ask Stanford Med, Events, Nutrition, Obesity, Stanford News

Sticky situation: How sugar affects our health

Sticky situation: How sugar affects our health

132244825_dbf0e21d9f_zHere’s a shocking statistic: On average, Americans consume three pounds of sugar each week, or 3,550 pounds in an entire lifetime. This leads some to blame the sweet stuff for the increase of chronic disease in modern society. But simply reducing our sugar intake is easier said than done, in part because identifying foods with added sugars can be tricky.

This Thursday, Alison Ryan, a clinical dietician with Stanford Health Care, will deliver an in-depth talk on sugar and our health as part of a Stanford Health Library lecture series. Those unable to attend can watch the presentation online here.

In the following Q&A, Ryan discusses the controversies surrounding sugar and the role of sugar in our diet, and she offers tips for making sure your consumption doesn’t exceed daily guidelines.

Why does our body need sugar?

Sugar, in the form of dextrose or glucose, is the main fuel or energy source for the cells of the human body. Without glucose, our body has to get creative and rely on other metabolic pathways, like ketosis, to keep our brain and other organs running. There is an optimal range for our blood sugar levels, and our bodies are making constant efforts to keep blood sugar within this range.

Our body can make glucose from any carbohydrate that is consumed, so consuming monosaccharide (glucose and the like) is not biologically required. This is one of the reasons it’s difficult to determine the right amount of sugar that is required for the human body. Do we think of the optimal amount as the amount needed to function at peak level? Or an amount not to go over in order to avoid detrimental effects on our health?

Sugar intake has been on the rise in human diets. Why do you think that is?

At one time, sugar used to be a seldom available food item. It is now ubiquitous and more of a hallmark for highly processed, low nutritional value foods. Now, consider the food industry and the politics of sugar. Soda companies, makers of desserts, cakes, sugary snack foods, the sugar and corn syrup refiners all lobby to keep their products “part of a balanced diet.” The food industry is deeply involved (or at least vocal about) the food and nutrition guidelines in the U.S. Then there’s the reality that sugar tastes good! Most people enjoy the taste of sweet foods and are drawn to consuming them.

What are some of the health risks of consuming too much sugar?

Sugar has been implicated as playing a role in some obvious ways, like obesity, diabetes, and tooth decay; but also in less direct appearing ways such as heart disease, chronic inflammatory conditions, cancer, etc. Often, when we’re consuming foods high in sugar, we’re not consuming foods that are rich in nutrients. These calorie-dense foods displace the nutrient-dense foods. The net effect is higher intake of calories, with concurrent lower intake of vitamins, minerals, phytonutrients, protein, etc.

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Patient Care, Stanford News, Technology

Medical student-turned-entrepreneur harnesses Google Glass to improve doctor-patient relationship

Medical student-turned-entrepreneur harnesses Google Glass to improve doctor-patient relationship

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When third-year Stanford medical student Pelu Tran began clinical rotations and started caring for patients in the summer of 2012, he experienced firsthand how paperwork, documentation and billing coding can leave “little time for the patient-physician relationship.” He shared his frustrations with Biodesign classmate and Stanford MBA graduate Ian Shakil and, after the pair tested out an early version of Google Glass, the solution became clear: develop a platform based on the wearable technology that automates the record-keeping process for doctors.

Tran, who was recently named to Forbes’ “30-Under-30: Healthcare,” and Shakil founded Augmedix and have raised a total of $23 million in venture capital funding. A story published today in Inside Stanford Medicine explains how the company has dramatically cut the number of hours doctors spend on record keeping:

Contracting with Google Glass, Augmedix provides the much-publicized internet-connected headgear, which looks and feels like a pair of eye glasses, to doctors on a monthly subscription basis. Physicians wear the headgear during appointments with patients and use verbal cues to instantly access a patient’s electronic medical records and transcribe the doctor-patient conversation. A thumbnail-sized screen appears in the corner of the right eye of the device, which also has a camera and a microphone. The visit gets live streamed directly to Augmedix, which then uses a combination of software and human support to type notes into the patient’s electronic medical records. When the doctor’s visit is complete, so is the record-keeping.

According to Tran, physicians who use the service have been able to reduce the number of hours spent record keeping from an average of 17 a week down to just two — or even fewer. “It literally changes the lives of the doctors we work with,” he said. “They’re getting back 15-hours a week to spend with family, with friends, with patients, to provide care. That is the whole point.”

The service is currently available for use in 35 clinics across 11 states and growing. Although Google recently announced that it will stop selling Glass to consumers, the company will continue to contract with companies such as Augmedix that have a specialized use for the technology.

Previously: Using Google Glass to help individuals with autism better understand social cues, Using Google Glass to improve quality of life for Parkinson’s patients and Abraham Verghese uses Google Glass to demonstrate how to begin a patient exam
Photo courtesy of Augmedix

Big data, NIH, Research, Videos

Fly through the inside of a mouse lung

Fly through the inside of a mouse lung

Take a 50-second ride through the inside of an adult mouse lung in this video created by Rex Moats, PhD, scientific director at Children’s Hospital Los Angeles. A post published today on the NIH Director’s Blog describes the animation and points out that the video is a prime example of how scientists are using big data to make biomedical research more accessible to the public:

We begin at the top in the main pipeline, called the bronchus, just below the trachea and wind through a system of increasingly narrow tubes. As you zoom through the airways, take note of the cilia (seen as goldish streaks); these tiny, hair-like structures move dust, germs, and mucus from smaller air passages to larger ones. Our quick trip concludes with a look into the alveoli — the air sacs where oxygen is delivered to red blood cells and carbon dioxide is removed and exhaled.

… [Moats] created this virtual bronchoscopy from micro-computed tomography scans, which use X-rays to create a 3D image. The work demonstrates the power of converting Big Data (in this case, several billion data points) into an animation that makes the complex anatomy of a mammalian lung accessible to everyone.

Speaking of the power of big data, the Big Data in Biomedicine conference returns to Stanford May 20-22. For more information about the program or to register visit the conference website.

Previously: Big data = big finds: Clinical trial for deadly lung cancer launched by Stanford study and Peering deeply – and quite literally – into the intact brain: A video fly-through

Aging, In the News, Neuroscience, Research

The distinctly different brains of “SuperAgers”

The distinctly different brains of “SuperAgers”

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Scientists are gaining insights into the cognitive abilities of “SuperAgers” and why their memories are more resilient against the ravages of time than are other older people’s. ABC News reports today on new research:

The SuperAgers were picked to be studied because all were over age 80 and had the memory capability of a person 20 to 30 years their junior according to the study recently published in the Journal of Neurology.

To understand how SuperAgers managed to keep their mental ability intact, researchers performed a battery of tests on them, including MRI scans on 12 SuperAgers and post-mortem studies on five other SuperAgers to understand the make-up of their brains.

“The brains of the SuperAgers are either wired differently or have structural differences when compared to normal individuals of the same age,” Changiz Geula, a study senior author and a research professor at the Cognitive Neurology and Alzheimer’s Disease Center, said in a prepared statement. “It may be one factor, such as expression of a specific gene, or a combination of factors that offers protection.”

The article goes on to explain that participants’ unusual brain signature had three common components in comparison to normal people of similar ages: notably fewer tangles (a primary marker of Alzheimer’s disease), a thicker region of the cortex and a significant supply of a neuron called von Economo, which is linked to higher social intelligence.

Previously: What brain scans reveal about “super agers”, The secret to living longer? It’s all in the ‘tude and Healthy aging the focus of Stanford study
Photo by Fiona Shields

Genetics, Neuroscience, Stanford News

“The uncertainty was killing me”: A student’s tale of genetic testing for Huntington’s disease

"The uncertainty was killing me": A student's tale of genetic testing for Huntington’s disease

happyImagine you had a 50 percent chance of being diagnosed with a disease that progressively breaks down the nerve cells of your brain, and that as early as your 30s or 40s you could begin exhibiting a range of symptoms of including involuntary movements, emotional problems and cognitive impairment. Such was the fate of Stanford student Kristen Powers.

Powers was three years old when her mother began experiencing symptoms of an incurable neurodegenerative disorder called Huntington’s disease, which claimed her mother’s life in 2011 at the age of 45. By the time she was 11, Powers became fully aware that she and her brother, Nate, had a 50/50 chance of someday developing the disease. Not long after, she learned that a genetic test could tell her if she carried the gene mutation that causes Huntington’s. The only problem was, she had to be 18 in order to take the test.

“The uncertainty was killing me,” said Powers, who was recently named one of the “15 incredibly impressive students at Stanford” by Business Insider. “I was constantly thinking about this ‘What if?’ scenario and it was very consuming in terms of my thoughts and conversations with my best friend. It was getting very tiresome.”

But rather than letting frustration and anxiety dominate her life, Powers channeled her energy into producing a documentary film, titled Twitch, about her experience growing up with her mother’s illness and the potential of carrying the Huntington’s gene.

“My film helped prepare me a lot because it gave me a sense of control in a process that was, very much, out of my control,” she said. “I could distract myself constructively and positively. My film was also a very important process for preparing for the results.”

Distraction came in the form of learning the documentary film business before she was barely old enough to drive a car. Powers had to pitch the idea of potential investors, raise money, hire a film crew, learn about film rights and copyright laws, work with attorneys to draft contracts, and make sure the production didn’t go broke.

To fund the film, she launched a crowdfunding campaign on Indiegogo. “I had decided that if the fundraising campaign was a failure I would take it as sign that I shouldn’t make the film,” she said.

But in the end she raised $18,025, 80 percent more than the goal amount. “I was so surprised. I had never raised more than $300. Within the first night we hit $1,000 and we hit our goal amount on the one-year anniversary of my mom’s passing,” said Powers.

On May 18, 2012, the long-awaited day finally arrived. Accompanied by her family and best friend, Powers took the test that, in her mind, would dictate major life decisions such as if she would have children. When the test results came back two weeks later, she learned the good news: She tested negative.

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Health and Fitness, Nutrition, Public Health

Why establishing a health baseline is a “critical starting point for achieving future health goals”

Why establishing a health baseline is a "critical starting point for achieving future health goals"

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Raise your hand if you want to be more successful at achieving health goals, such as losing weight or lowering your cholesterol levels, and maintaining a healthy lifestyle. Perhaps it’s time to consider creating a health baseline. “A health-care baseline is essentially where you are “at” on the broad, complex spectrum of physical, mental and emotional health,” explains Mary James, MD, an internal medicine physician at Stanford. “This can be a critical starting point for achieving future health goals.”

On Thursday, James will deliver an in-depth talk on the benefits of partnering with your primary care provider to establish a health baseline as part of the Stanford Health Library lecture series. Those unable to attend can watch the presentation online here.

In anticipation of the event, I contacted James to learn more about why its important to have a basis for comparison, beyond the ever-fluctuating number on your bathroom scale or if you’re able to fit into your skinny jeans, to use in measuring progress in meeting your health goals. Below she discusses how assessing the state of your health now can pay off in a longer, more active life in the future.

What is a health baseline?

Your baseline has two basic components: existing illness and potential future illness. Your current baseline has been shaped by your medical, social and family history and is constantly being influenced by common factors in everyday life. Although some components of your healthcare baseline are more modifiable than others, it is important to have an accurate understanding of your current health status.

Why is it important to determine your personal health baseline?

You may be thinking, “I’m healthy – I take no medications and never go to the doctor. Why should I start now?” There are two fundamental components to good health. They are: appropriate treatment for current illness and appropriate preventative care to reduce health decline in the future. While most people actively seek care for the former, we often forget about the latter. Although the data is mixed on whether “routine check ups” are beneficial, there is strong evidence behind many of the preventative maneuvers that are typically discussed and ordered at these visits. Taking appropriate preventative health-care steps can help you avoid the need for prescription medications, hospitalizations and procedures and can help ensure a longer, healthier life.

How can establishing a health baseline help you be more successful in reaching personal wellness goals?

Many wellness goals start with changes in diet and exercise. Your primary care provider can help determine how to start making these changes in a safe, effective manner. Are there exercises you should avoid due to chronic back pain? Is it okay to start running if you have high blood pressure? Is it safe for you to start a vegan diet? What is a safe amount of weight to lose?

Wellness also includes mental and emotional health. Your primary provider can help determine what treatment is most appropriate for common conditions such as depression and anxiety. Maybe you’ve been feeling “down” lately – is this true depression that warrants medical treatment, or is it safe try a new yoga or meditation class first? These are just a few of the many things that can be assessed and addressed as part of your health baseline. Together, you and your primary care provider can prioritize health problems and determine effective interventions.

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Complementary Medicine, In the News, Mental Health, Pediatrics, Research, Stanford News

Stanford researchers to study effectiveness of yoga-based wellness program at local schools

Stanford researchers to study effectiveness of yoga-based wellness program at local schools

kids_yogaManaging stress and making healthy choices is a daily struggle for many of us. But what if way back in elementary school we had learned resiliency skills and mind-body practices to cope with anxiety, reduce incidents of bulling and violence, and boost our cognitive ability? Would this training have helped us keep our flight-or-fight response in check and live healthier lives?

A four-year study conducted by researchers at Stanford aims to answer these questions. The project will evaluate a yoga-based health and wellness program involving 3,400 students at the Ravenswood City School District. The program, which has been funded for three years by the Sonima Foundation, includes exercise-based on yoga, basic fitness regimes, relaxation techniques, mindfulness practices and nutrition. As the San Jose Mercury News reports:

The plan is to employ a multi-method approach that involves biology, physiology and psychology — a complete bio-psychosocial assessment — to measure [students’] emotions and behavior, academic and cognitive strengths and weaknesses, brain activity and structure, stress-related hormone levels, and sleep patterns.

“We’re really looking forward to a year from now — when I tell you this is effective — for you not to only take it on my word, but for you to also have data,” said Dr. Victor Carrion, a professor of psychiatry and behavioral sciences at [Stanford].

Carrion is also the director of the Stanford Early Life Stress and Pediatric Anxiety Program at Lucile Packard Children’s Hospital.

In 2012, he launched a mindfulness program in the Ravenswood City School District to treat post-traumatic stress disorder in teens that was featured on a PBS NewsHour segment. Jones and his wife happened to catch the broadcast, and because Carrion has done pro bono work with students and parents in the community for years, the partnership between the district, Stanford and the Sonima Foundation was forged.

The four-year study is also in partnership with the Center for Education Policy and Law at the University of San Diego.

“This is something that for years has been a gap in our educational system,” Carrion said. “There’s nothing… that teaches children to socialize and to be in touch with their emotions and to take care of their inner health.”

Previously: Stanford researchers use yoga to help underserved youth manage stress and gain focus, Yoga classes may boost high-school students’ mental well-being and Study shows meditation may lower teens’ risk of developing heart disease
Photo by Nicole Mark

Events, Pain, Stanford News

Advances in diagnosing and treating a painful and common jaw disorder

Advances in diagnosing and treating a painful and common jaw disorder

3439490784_46b2cfd9e3_zOn New Years Eve, Australian rapper Iggy Azalea shared with her Twitter followers that she was diagnosed with a temporomandibular joint dysfunction (often referred to as TMD or TMJ). The singer is among the estimated 10 million Americans who suffer from the condition, which is more common in women than men and people ages 20 to 40.

Symptoms of the disorder include a stiffness of jaw muscles, limited movement, clicking or locking of the jaw and radiating facial pain. It was previously believed that problems with how the teeth fit together or the structure of the jaw caused the condition. But in talking to Michele Jehenson, DDS, a clinical assistant professor at the Pain Management Center at Stanford, I was told, “There is still a lot we do not know about what causes [temporomandibular joint dysfunction] but one thing we do know is that they are not caused by upper and lower teeth misalignment or improper jaw position. We now believe that TMD susceptibility is, at least, partly genetic.”

Since the causes of the TMD are not clear, diagnosing the condition can be challenging. Currently, there is no standardize test for providers to use to diagnose patients, so physicians continue to rely on the clinical evaluation, including palpation, range of motion and auscultation. But imaging technologies are starting to play a more important role. Jehenson noted, “We now have more accurate imaging such as cone beam CT scans or MRIs. Some dentists use joint vibration analysis or EMG, but these electronic sensors have been shown to be unreliable and lead to over diagnosis.”

Over the past two decades, there as been a significant amount of research on the outcomes of TMD treatments. As Jehenson told me:

Evidence is very clear that aggressive and non-reversible treatments for TMD (braces, jaw surgery, crowns, full time wear of appliance, jaw repositioning) are rarely indicated. The best treatments should be conservative. Depending on the case, treatments are usually a mix of medication (oral or topical), nighttime appliance wear, injections, physical therapies, behavior modification and counseling, sleep and stress management.

To learn more about the diagnosis and treatment of TMD, join Jehenson for a Stanford Health Library talk on Thursday at 7 PM Pacific Time. During the event, she’ll l further discuss evidence based versus non-evidence based treatments. Those unable to attend in person can watch the talk online.

Photo by Eric Allix Rogers

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