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Chronic Disease, In the News, Pain, Research, Science, Stanford News

Scientific discovery could lead to treatments for chronic pancreatitis

Scientific discovery could lead to treatments for chronic pancreatitis

Pancreatitis is one of the most common gastrointestinal hospital admissions-related illness. Patients with the acute form of the disease show up at hospitals doubled over with severe abdominal pain, a swollen belly that’s tender to the touch, nausea, and vomiting.

For some patients the disease flares up then disappears. For others, it develops into an ongoing, chronic form of the disease with no known cure. Not only is it extremely painful, it also causes malnutrition and carries with it a high risk of leading to pancreatic cancer. Treatment options are pretty much limited to prescription pain killers.

This has great implication in a disease that has no active therapy with no known agents that can alter its natural devastating course

It’s known that chronic pancreatitis is marked by the uncontrolled growth of scar tissue in the pancreas known as fibrosis, which slowly destroys the organ’s ability to function. Since the pancreas is in charge of excreting enzymes to digest food, patients begin to suffer malnutrition. It’s also known that excessive alcohol consumption is the leading cause of pancreatitis but just what is happening at a molecular level to cause the fibrosis is less clear.

Now, Stanford researcher and gastroenterologist Aida Habtezion, MD, and colleagues here and at Cedars-Sinai Medical Center have published research that sheds light on what exactly is happening and could lead to treatments for the severe disease. In a story I wrote on the study, Habtezion discusses their discovery of a new molecular pathway that when blocked by an experimental pharmacological drug can slow the progression of pancreatitis in animal models and in human cells.

As Habtezion told me, her lab’s research into just how the immune cells of the pancreas behave when inflamed with pancreatitis unveiled the new pathway:

“For the first time we can show that macrophages interact with pancreatic stellate cells via a particular immune pathway, and by targeting this pathway we show a decrease in chronic pancreatitis/fibrosis progression,” she said. “This has great implication in a disease that has no active therapy with no known agents that can alter its natural devastating course.”

The hope is that researchers will now be able to develop a form of the experimental pharmacological agent used in the study to block the molecular pathway that can be given to humans. Blocking the pathway will block the scar tissue growth, and hopefully either slow the progression of the disease or reverse it altogether.

Cardiovascular Medicine, Medical Apps, Precision health, Research, Stanford News, Technology

MyHeart Counts shows that smartphones are catching on as new research tool

MyHeart Counts shows that smartphones are catching on as new research tool

using iPhone - 560

In the three months since Stanford researcher and cardiologist Michael McConnell, MD, told ABC’s Nightline that the new MyHeart Counts iPhone app would give scientists “a whole new way to do research,” the number of users has continued to steadily climb.

“Traditionally reaching many people to participate in research studies is quite challenging,” McConnell told business correspondent Rebecca Jarvis in March. “The ability to reach people through their phone is one major advance.”

The number of iPhone owners who have downloaded the app and consented to participate in a large-scale study of the human heart has now reached 40,000. In an effort to keep updated on how the app is progressing as a new research method, I reached out to McConnell, the lead investigator of the study, with a few questions. The MyHeart Counts study continues to break ground as a new method for reaching large numbers of research participants in a short amount of time, McConnell told me. Comparing it to traditional research trials, he said:

There have been larger research studies, particularly national efforts to study their populations, but we believe enrolling this many participants in such a short time frame is unprecedented.

The app, which was launched in early March, collects data about users’ physical activity using the smartphone’s built-in motion sensors. Participants also answer surveys concerning their cardiac-risk factors. In return, they get coaching tips and feedback on their chances of developing heart disease.

McConnell says that the next phase of the project, which will use behavior-modification methods to encourage healthy behaviors, is about to be launched. App users will be given more personalized feedback about their individual behaviors and risk, based on the American Heart Association’s Life’s Simple 7 guidance. Future tips will include messages on everything from how to manage blood pressure, eat better, lose weight and control blood sugar. Part of the study is to determine whether these type of “pings” used through apps are actually successful at changing human behavior, McConnell told me:

Healthy behaviors are critical to preventing heart disease and stroke, so the MyHeart Counts app will study which motivational tools are most helpful. This will follow the second activity and fitness assessment… The initial approach will be empowering participants with more personalized feedback about their individual behaviors and risk.

To sign up for the MyHeart Counts study, visit the iTunes store.

Previously: Lights, camera, action — Stanford cardiologist discusses MyHeart counts on ABC’s Nightline, Build it (an easy way to join research studies) and the volunteers will comeMyHeart Counts app debuts with a splash and Stanford launches iPhone app to study heart health
Photo by Japanexperterna (CC BY-SA)

In the News, Medical Education, Research, Science, Stanford News

Medical students explore the wide, wide world of research at annual Stanford symposium

Medical students explore the wide, wide world of research at annual Stanford symposium

Research SymposiumTraining medical students in research skills has long been a focus at Stanford. To get an inside glimpse of how this works, read my story on the Stanford Medical Student Research Symposium, an annual event where students present poster boards of their research for judging by faculty.

The depth and breadth of individual research accomplished by medical students who, at the same time are juggling classroom and clinical education, is impressive. The faculty representative at the event explained the educational process to me:

“Stanford tries really hard to open doors in the area of scientific research and give students a little nudge to go through,” said Laurence Baker, PhD, director of the Scholarly Concentration program, a required program of study for medical students that promotes in-depth learning and scholarship. Each of Stanford’s medical students are required to complete at least one quarter’s worth of research, but most do more, he said.

“We train the kind of doctors who become leaders,” Baker said. “Whether that involves publishing, clinical work, research or patenting — education in scientific research is a key element of training.”

My story also provides a taste of the conversation between one of the students who used the Veterans Administration database to conduct his research of opioid drug use and a judge of the event, who plays the dual role of evaluator and teacher. She provides both constructive criticism and encouragement to the budding physician-scientist:

In a dress shirt and tie, Raymond Deng, a third-year medical student, stood next to a poster describing his research on opioid use among veterans. “I’m interested in addiction medicine,” he said. “Prescription drug abuse is huge.” He was discussing his findings with Sonoo Thadaney, director of the Program in Bedside Medicine… Thadaney, the symposium judge, listened intently to his description, nodding her head in encouragement. “Why did you pick this study?” she said, clipboard in hand. “Personal reasons,” Deng said, adding that someone in his life has a heroin addiction, and that an epidemic in prescription drug abuse has been shown to have contributed to an increase in heroin use. She nodded again. “The great thing with data like this is that the data itself can bring up questions that we didn’t think of,” she said. “If the Googles and the Yahoos of the world can use data like this for research, so can we. Great work. Go crazy with it.”

Previously: Contemporary health issues focus of Stanford med students research presentation, As part of annual tradition, budding physician-scientists display their work and New class of physician-scientists showcase research.
Photo by Norbert von der Groeben

otolaryngology, Research, Science, Stanford News, Stem Cells

Molecular sleuthing uncovers new clue toward deafness cure

Molecular sleuthing uncovers new clue toward deafness cure

In another step along the path toward finding cures for deafness, Stanford scientists report they have discovered a subset of cells in the mammalian utricle, the inner ear structure that controls balance, that can regenerate into hair cells when damaged.

The study was published today in Nature Communications, and senior author Alan Cheng, MD, explained the significance of the findings to me this way:

We rely on our inner ear sensory organs to hear and sense motion. Such functions require specialized hair cells to detect the vibrations of sound or motion. Once lost, hair cells needed for hearing do not regenerate and thus hearing loss is permanent, while those to sense motion can regenerate to a limited degree. Until now, the origin of these regenerated hair cells and the mechanisms that limit this process of regeneration in the utricle have not been clear. Here, we found two distinct populations of such hair cell progenitors in the neonatal mouse utricle, where they can regenerate lost hair cells. Unlike the utricle from older mice, the degree of regeneration and also cell division at this age are a lot more robust.

The study also provides an improved understanding of the molecular pathway that leads to this transformation, knowledge that could maybe one day be used to help researchers figure out how to artificially encourage hair cell renewal in humans.

Previously: Understanding hearing loss at the molecular level, New version of popular antibiotic eliminates side effect of deafness and Stanford chair of otolarnygology discusses future regenerative therapies for hearing loss

Cardiovascular Medicine, Research, Stanford News, Technology

Stanford launches iPhone app to study heart health

Stanford launches iPhone app to study heart health

Dr. Alan Yeung,  MD., Chief (Clinical) Division of Cardiovascular Medicine Interventional Cardiology,and Dr Michael McConnell, MD.,  with a new health app for iPhone on Thursday, February 26, 2015. ( Norbert von der Groeben/ Stanford School of Medicine )

A new, first-of-its-kind iPhone app, designed by Stanford Medicine heart experts as a fun way for users to learn about their own heart health while at the same helping to advance the field of cardiovascular medicine, was launched today.

The app, called MyHeart Counts, takes advantage of the iPhone’s built-in motion sensors to collect data on physical activity and other cardiac risk factors for a research study. It’s now available for free in the App Store. As I describe in our press release:

The free app uses the new ResearchKit framework announced today by Apple to present users with a simple way to participate in the study, complete tasks and answer surveys from their iPhone. The app will deliver a comprehensive assessment of each user’s heart health and provide information on how to improve it. It will also be used to study various methods — designed to be both easy and fun — for using smartphones and other wearable devices to enhance heart-healthy habits.

“MyHeart Counts aims to be the largest study of measured physical activity and cardiovascular health to date,” [said Stanford cardiologist Michael McConnell, MD, lead investigator for the study]. “We want people to join in this research effort to give fundamental new insights into how activity helps your heart, across all ages, genders, cultures and countries.”

Users start by providing some basic health information – age, weight, blood pressure – all kept confidential, and are then asked to record a week of activity. The app in return provides the user with a number representing their “heart age.” For example, if you’re 40 years old, and your heart age is reported as 20 years, that’s good news. If those numbers are reversed, there might be something to worry about.

The ultimate goal of the study, McConnell and his collaborator Alan Yeung, MD, told me, is to provide scientific evidence as to the effectiveness of the myriad methods of behavioral motivation techniques marketed through wearable devices to improve health. The idea is to use hard data to find out what really works:

Recently, there has been an explosion in the marketing of wearable devices to record and report information about behaviors, such as physical activity or sleep patterns, to improve health, but there is limited scientific evidence available to show whether they are effective, McConnell said.

As a physician who regularly sees patients in the clinic, McConnell knows first hand how hard it can be to change a patient’s behavior. Physical activity has been shown to be far more effective in improving health than medication, but getting patients to be more active isn’t easy.

“Preventive medicine hasn’t worked by having doctors make to-do lists for their patient, then seeing them six months later and hoping they did everything on the list,” McConnell told me. “The future needs a much more ongoing engagement with people’s health. We need to understand how to reach out to modify behavior long before we end up having to see someone for a heart attack or stroke.”

Previously: Lack of exercise shown to have largest impact on heart disease risk for women over the age of 30
Photo, of Alan Yeung (left) and Michael McConnell, by Norbert von der Groeben

LGBT, Medical Education, Medical Schools, Research, Stanford News

Stanford study shows many LGBT med students stay in the closet

Stanford study shows many LGBT med students stay in the closet

doctor by rainbow flagFears of discrimination from faculty, peers and patients continue to pressure many in the lesbian, gay, bisexual and transgender community to stay “in the closet” while in medical school, according to a Stanford study published today in Academic Medicine.

Some medical students worry that “coming out” could affect their grades; others are influenced by homophobic or sexist remarks overheard from peers and faculty to keep their sexual or gender identity hidden, according to the results of an online survey sent by the study’s authors to medical students throughout the U.S. and Canada. One respondent recounted an appointment during a surgery rotation with a transgender patient who was “treated like a freak by the residents and attendings behind closed doors, joking at his expense.”

The study, authored by members of the Stanford Lesbian, Gay, Bisexual & Transgender Medical Education Research Group, was accompanied by a commentary that maintains the medical community is less accepting of sexual and gender minorities than the business or law communities. From a press release I wrote on the study:

“There is still this huge percentage of medical students who are afraid of discrimination in medical school and how it could affect the rest of their careers,” said Mitchell Lunn, MD, a co-author of both papers and co-founder of Stanford’s LGBT research group. “We are supposed to be a field that is accepting of people and one that takes care of people regardless of differences, and yet we can’t even do that for people who are part of our own community.”

The study found that a third of sexual minority medical students choose to remain “in the closet” during medical school, 40 percent of medical students who identify as “not heterosexual” are afraid of discrimination in medical school, and two-thirds of gender minority medical students (those identifying as something other than male or female) conceal their gender identity during medical school.

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Cardiovascular Medicine, Chronic Disease, Research, Stanford News, Surgery, Transplants

Growing number of donor hearts rejected for transplantation, Stanford study finds

Growing number of donor hearts rejected for transplantation, Stanford study finds

KhushAs a health writer, I’ve interviewed and written about numerous heart patients whose lives were saved when someone else died and donated their hearts for transplantation.

Those patients expressed both the anguish of hoping and praying for a new heart — when that means someone else has to die — and the overwhelming gratefulness for those donor hearts that saved their lives.

So when I wrote a story about a new Stanford study that shows an increasing number of donor hearts being rejected for transplantation, it struck a chord.

The study, published today online in the American Journal of Transplantation, found that the number of hearts rejected for transplant by surgeons and transplant centers is on the rise despite the growing need for such organs. As cardiologist Kiran Khush, MD, the lead author of the study, said in my story on the work, “We’ve become more conservative over the past 15-20 years in terms of acceptance, which is particularly troubling because of the national shortage of donor hearts and the growing number of critically ill patients awaiting heart transplantation.”

Khush and her colleagues sought to study national trends in donor-heart use by examining data from the federal government’s Organ Procurement and Transplantation Network on all donated hearts from 1995-2010. Of 82,053 potential donor hearts, 34 percent were accepted and 48 percent were declined. The remainder were used for other purposes such as research.

The researchers found a significant decrease in donor heart acceptance, from 44 percent in 1995 to 29 percent in 2006, which rebounded slightly to 32 percent in 2010. They also found, as I wrote in the story:

Among a portion of donor hearts that are referred to as “marginal” — those with undesirable qualities, such as being small or coming from an older donor — their use in transplantation varied significantly across geographical regions depending on choices made by the surgeons and the transplant centers.

The study explored possible reasons for so few organs being accepted. Increasing scrutiny by regulatory agencies of the 140 or so transplant centers across the country may have had the unintended result of making surgeons and centers more risk averse and as a result reject more hearts. Also, an increasing us of mechanical circulatory support devices that help keep patients alive while waiting for donor hears, may cause surgeons to wait longer for “better hearts.”

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Big data, Cardiovascular Medicine, Chronic Disease, Research, Stanford News

Big data used to help identify patients at risk of deadly high-cholesterol disorder

Big data used to help identify patients at risk of deadly high-cholesterol disorder

Familial hypercholesterolemia is not exactly a catchy name. But Stanford cardiologist Josh Knowles, MD, is determined to make it easier to remember. This little known, high-cholesterol disease is a silent killer. If you don’t know you have it, it can strike suddenly – and years before most people ever start worrying about heart attacks.

Knowles and fellow researchers at Stanford have launched a new research project aimed at identifying people at-risk of having FH. Using “big data” research methods and software that “teaches” a computer how to recognize patterns, researchers plan to comb through electronic medical records at Stanford hospitals and, if successful, pinpoint those who might have the disease and not know it.

In a story I wrote on the new project, Knowles described how this innovative technology could potentially be used to transform health care:

Machine learning, in which computer algorithms learn to recognize patterns within data, is widely used by Internet businesses such as Amazon and Netflix to improve customer experience, get information about trends, identify likes and dislikes and target advertisements. These techniques have not been widely applied in medicine, but we believe that they offer the potential to transform health care, particularly with the increased reliance on electronic health records.

Using these methods to help identify patients with FH is a good place to start, Knowles said, since there are currently few systematic approaches to finding people with FH, and many doctors are unfamiliar with the disease. As he told me:

This disorder certainly leads to premature death in thousands of Americans each year … Less than 10 percent of cases are diagnosed, leaving an estimated 600,000 to 1 million people undiagnosed. If found early enough and treated aggressively with statin-based regimens, people can live longer, healthier lives.

The project is part of a larger initiative called FIND FH (Flag, Identify, Network, Deliver), a collaborative effort involving Stanford Medicine, Amgen Inc., and the nonprofit Familial Hypercholesterolemia Foundation to use innovative technologies to identify individuals with the disorder who are undiagnosed, untreated, or undertreated.

Previously: Registration for Big Data in Biomedicine conference now open, Hope for patients with familial hypercholesterolemia and Born with high cholesterol
Photo by Dwight Eschliman

Infectious Disease, otolaryngology, Public Health, Research, Science, Stanford News

New version of popular antibiotic eliminates side effect of deafness

New version of popular antibiotic eliminates side effect of deafness

About five years before he died, my father was prescribed gentamycin, one of the most commonly used class of antibiotics called aminoglycosides, for a heart infection of unknown origins. The antibiotic successfully cured him of the life-threatening infection, but it also left him with a life-changing side effect, one with the strange-sounding name of oscillopsia.

Oscillopsia is a balance disorder that creates the illusion of an unstable visual world in its patients that can be quite disabling. For my father, it messed with his tennis game in the remaining years of his life and forced him to sit on the couch when he would rather have been running around with his grandchildren. But he was lucky. In addition to balance disorders, side effects from these cheap and extremely effective antibiotics that have been used for decades worldwide, include high rates of deafness and kidney damage.

ChengNow, Stanford researchers led by otolaryngologoist Alan Cheng, MD, (pictured at left) and Tony Ricci, PhD, have made a modified version of these drugs that successfully treats infections without the side effects of deafness and kidney damage. In a press release on the study, which was published Friday in the Journal of Clinical Investigation, I wrote about a boy (whose story is also told in this Stanford-produced video) who lost his hearing from these antibiotic treatments during his battle with cancer:

On Christmas Eve, 2002, Bryce Faber was diagnosed with a deadly cancer called neuroblastoma. The 2-year-old’s treatment, which, in addition to surgery, included massive amounts of radiation followed by even more massive amounts of antibiotics, no doubt saved his life. But those same mega-doses of antibiotics, while staving off infections in his immunosuppressed body, caused a permanent side effect: deafness.

“All I remember is coming out of treatment not being able to hear anything,” said Bryce, now a healthy 14-year-old living in Arizona. “I asked my mom, ‘Why have all the people stopped talking?’ He was 90 percent deaf.

These are extremely important life-saving drugs, Ricci, a basic scientist and expert on the biophysics of the inner ear, told me. But they could be so much better if patients didn’t have to risk their toxic side effects. So far, the new versions of the drug that he and colleagues developed have only been tested in mice, but the hope is to conduct clinical trials as soon as is safely possible. “If we can eventually prevent people from going deaf from taking these antibiotics, in my mind, we will have been successful,” Ricci said. “Our goal is to replace the existing aminoglycosides with ones that aren’t toxic.”

The new drugs have not yet been tested as to whether they still cause balance disorders. That’s on the docket for the future. But my article describing this wedding of basic science with clinical treatment is a hopeful reminder of the importance of modern-day scientists to public health.

Previously: Listen to this: Research upends understanding of how humans perceive sound; Stanford developed probe aids study of hearing and Studying the inner ear and advancing research in developmental biology

Cardiovascular Medicine, Chronic Disease, Health Costs, Research, Stanford News

Home health-care treatments for lymphedema patients cut costs and improve care

Home health-care treatments for lymphedema patients cut costs and improve care

Lymphedema, an incurable chronic illness that involves severe swelling of the limbs, is frequently ignored, often misdiagnosed and under treated. Now a study by a Stanford researcher, who has for years worked to change this, illustrates how the use of home health-care treatment can help. The research appears today in PLOS ONE.

In a story I wrote on the study, Stanley Rockson, MD, a leading expert on lymph disorders, explains that one of the major challenges to improving care for lymphedema patients is that home care is poorly reimbursed by third-party payers. Rockson and colleagues set out to examine the cost effects of the use of one of these home-care therapeutics called a compression device to reduce swelling.

This is clearly a compelling argument for increased coverage of compression devices and similar home-care devices to reduce costs

By examining the health-care claims from a national private health insurer from 2007 to 2013, researchers found that patients who used these compression devices reduced annual health-care costs from $62,190 to $50,000. As Rockson explains in a press release, “Total health-care costs for these patients are very high, but can be profoundly reduced with treatment intervention, in this case a compression device. This is clearly a compelling argument for increased coverage of similar home-care devices to reduce costs.”

Rockson, who both researches lymphedema and treats patients with the disorder, has worked over the years to educate both the public and health-care professionals about this “hidden” disease. As a reporter who covers his research, he has also helped educate me – and in my piece I describe both the cause of the disease and available treatments:

Lymphedema is most commonly caused by the removal of or damage to lymph nodes as a part of cancer treatment. It results from a blockage in the lymphatic system, which is part of the immune system. The blockage prevents lymph fluid from draining well, and the fluid buildup leads to swelling, which can be painful and debilitating. These symptoms can be controlled with various treatments, including treatments done at home and outpatient physical therapy. Home treatments for lymphedema include manual lymphatic massage, multilayer bandaging techniques and application of various compressive garments to reduce tissue fluid.

I’ve written several other stories about Rockson’s work on lymphedema over the years. One such piece, published in 2009, helps bring a greater understanding to the disease by describing how it impacted one patient. Hearing firsthand from a patient about what it’s actually like to live with lymphedema day-in and day-out makes the ongoing search for better treatments and possible cures all the more pressing:

Julie Karbo fights a battle every day to keep her lymphedema under control. Every night she hooks her arm up to a portable pump to help drain away fluids. Every day she wears compression sleeves to keep the swelling down. She limits the number of groceries she carries into the house to make sure she doesn’t put undue strain on the affected arm, and keeps a close watch for any possible infection-causing scratches or spider bites.

“A bee sting or a spider bite can lead to a very serious infection,” says Karbo, 49, a high-tech public relations executive and single mother of two in the Bay Area, who—unlike many lymphedema patients—never had cancer. “It’s something that greatly impacts the way you live your life.”

Previously: New blood test could bring lymphedema detection (and treatment) into the 21st century and New Stanford registry to track lymphedema in breast cancer patients

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