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Cancer, Neuroscience, Pediatrics, Research, Stanford News, Videos

Brain tumor growth driven by neuronal activity, Stanford-led study finds

Brain tumor growth driven by neuronal activity, Stanford-led study finds

Nerve activity in the cerebral cortex can drive the growth of deadly brain tumors called high-grade gliomas, new research has found. The finding, from a study of mice with human brain tumors, provides a surprising example of an organ’s function driving the growth of tumors within it, according to Michelle Monje, MD, PhD, the Stanford neuroscientist who led the work. The work appears online today in Cell.

High-grade gliomas include tumors that affect children, teens and adults. They are the most lethal of all brain tumors, and their survival rates have scarcely improved in 30 years. Monje’s team and others around the world are trying to learn how the tumors arise and grow, with the hope that this understanding will enable development of new drugs that specifically attack the tumors’ vulnerabilities.

From our press release about the research:

Monje’s team identified a specific protein, called neuroligin-3, which is largely responsible for the increase in tumor growth associated with neuronal activity in the cerebral cortex. Neuroligin-3 had similar effects across the different types of high-grade gliomas, in spite of the fact that the four cancers have different molecular and genetic characteristics.

“To see a microenvironmental factor that affects all of these very distinct classes of high-grade gliomas was a big surprise,” Monje said.

The identity of the factor was also unexpected. In healthy tissue, neuroligin-3 helps to direct the formation and activity of synapses, playing an important role in the brain’s ability to remodel itself. The new study showed that a secreted form of neuroligin-3 promotes tumor growth.

“This group of tumors hijacks a basic mechanism of neuroplasticity,” Monje said.

Blocking the tumor-stimulating effects of neuroligin-3 might be an effective treatment for high-grade gliomas, Monje added.

In the video above, Monje describes some of the earlier work that led her team to ask whether nerve activity could drive tumor growth. In the healthy brain, it’s important for neuronal activity to be able to modify how the brain grows and develops, she explains – this is how experience changes our brains. But: “The growth-inducing effects of neuronal activity are very robust and it made me wonder if a similar physiology was being hijacked by glioma cells,” she says in the video.

Previously: Emmy nod for film about Stanford brain tumor research — and the little boy who made it possible, Big advance against a vicious pediatric brain tumor and New Stanford trial targets rare brain tumor

Patient Care, Pediatrics, Stanford News

A high-school student reflects on bringing joy to pediatric intensive care unit

A high-school student reflects on bringing joy to pediatric intensive care unit

heart-balloonThe pediatric intensive care unit can feel like an alternate reality, one in which the challenges of treating severe illness push being a kid into the background. That’s why it was lovely to read an essay (subscription required) in this week’s issue of the Journal of the American Medical Association that reflects on a moment of childhood fun within the confines of the PICU at Lucile Packard Children’s Hospital Stanford.

The essay, written by high-school freshman Julie Cornfield, describes how her father, pediatric pulmonologist David Cornfield, MD, enlisted her help in bringing joy to one of his young patients. Here is Julie’s description of how she met that patient, whom she later describes as “vivacious, strong, unbelievably kind, and outgoing, despite, or maybe because of, [her] sickness:”

Soon we found ourselves in the Pediatric Intensive Care Unit, where critically ill children are treated for all sorts of sicknesses, and where my dad spends most of his time. As I trailed behind my father down a long hall, we passed quizzical-looking nurses and young doctors. Everywhere I looked, there was a child with a life-threatening issue, and the air was thick with anxiety. After having me sanitize my hands,my Dad led me into a door at the very end of the hall.

That was when I caught my first glance of Adrianna, a frail 8-year-old girl with severe arthritis that had led to lung issues. My father introduced me to Addie and her mother, and then we unveiled our fluffy guest. Adrianna’s eyes grew to the size of saucers and she squeaked with joy. Her face lit up and it looked like, for a second, she forgot her pain.

The rest of the essay, including the moving story of a balloon the young patient gave to Julie’s dad, is well worth a read.

Photo by Pedro Moura Pinheiro

Cancer, Events, Pediatrics, Stanford News, Videos

Pediatric nephrologist Mary Leonard discusses bone health in children with chronic diseases at Childx

Pediatric nephrologist Mary Leonard discusses bone health in children with chronic diseases at Childx

The inaugural Childx conference was held here last month video interviews featuring keynote speakers, panelists and moderators are now on the Stanford YouTube channel. To continue the discussion of driving innovation in maternal and child health, we’ll be featuring a selection of the videos this month on Scope.

Stanford pediatric nephrologist Mary Leonard, MD, initially began her career as a physician-scientist by investigating the bone complications of pediatric kidney disease. One of her earlier findings was that a number of the risk factors for poor bone development were also associated with many other childhood diseases, such as inflammatory bowel disease and cancer.

In the above video, Leonard explains how advances in treating pediatric kidney failure, cancer and other diseases is creating a growing population of survivors who are entering adulthood facing other health risks, including poor bone health, insulin resistance and cardiovascular disease. Watch the full interview to understand the magnitude of the problem and learn about efforts to develop prevention methods.

Previously: Childx speaker Matthew Gillman discusses obesity prevention, Pediatric health expert Alan Guttmacher outlines key issues facing children’s health today, “It’s not just science fiction anymore”: Childx speakers talk stem cell and gene therapy and Global health and precision medicine: Highlights from day two of Stanford’s Childx conference

Parenting, Pediatrics

Overwhelmed as a mom of multiples

Overwhelmed as a mom of multiples

twin babies

My babies were three days old when my husband offered to get take-out from one of our favorite restaurants. I said, “Yes,” as I might have said it before the girls were born. But as soon as he left I realized this was my first time alone with my twins. In the small, silent room, I whispered to them, “Okay girls. It’s just you and me. Be good for mommy.”

Everything was quiet for a while, until one started crying. I picked her up and rocked slowly side to side. Just when she calmed, the other started crying. That got the first one crying again, this time louder and more distressed. I had one baby crying in my arms and the other crying in a bassinet and I didn’t know what to do.

The day-to-day challenge of multiples is simply this: There may be multiple of them, but there’s often only one of you

Was it five minutes? Ten? It seemed like eternity. I tried putting them on the bed next to each other, and leaning over to hug them both at once. They hated it. Unable to choose one over the other, I found myself choosing neither. I felt absolutely overwhelmed.

Finally, an early Beatles song came to mind, and I sang it softly to them. “Tell me why-y-y-y you cry…” When I saw how my singing quieted them, suddenly the tears started pouring out of my eyes, but I didn’t dare stop singing: “Is there anything that I can do? ‘Cause I really can’t stand it, I’m so in love with you.”

“Hello!” My husband returned with the take-out. My face was red hot, my eyes half blind from crying, my nose uselessly stuffed, my throat caught. I was a mess. And I was singing – badly. But my babies weren’t crying anymore.

That’s when I knew – I mean really felt – that I was their mom. I could hardly believe there was a moment even a minute long when I felt so alone and helpless. Their dad took one baby, I took the other; we fed them, we changed them, we tucked them back to sleep. And after it all, the food was still warm.

The day-to-day challenge of multiples is simply this: There may be multiple of them, but there’s often only one of you. Sometimes your babies need more of you than you have to give. You love them equally and you don’t like having to choose one to take care of first while another waits and cries for you. You will envy the single moms of single babies who complain that they must hold their baby all the time. You wish you could hold your babies all the time – the best you can do for them is one at a time.

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Events, Obesity, Pediatrics, Stanford News, Videos

Childx speaker Matthew Gillman discusses obesity prevention

Childx speaker Matthew Gillman discusses obesity prevention

The inaugural Childx conference was held here last month, and video interviews featuring keynote speakers, panelists and moderators are now on the Stanford YouTube channel. To continue the discussion of driving innovation in maternal and child health, we’ll be featuring a selection of the videos this month on Scope.

The prevalence of childhood obesity in the United States has not changed significantly since 2004 and remains at about 17 percent. However, the rate of obesity among preschool children, ages 2 to 5, has dropped from nearly 14 percent to 8.4 percent, according to data from the Centers for Disease Control and Prevention. Matthew Gillman, MD, a professor in the Department of Nutrition at Harvard Medical School, is among the group of researchers working to understand why rates of obesity among younger children have decreased.

In the above video interview from the Childx conference, Gillman discusses two possible reasons why fewer children under the age of five are obese and how this statistic points to potential prenatal underpinnings that influence a child’s risk of obesity. He goes on to explain how researchers previously believed that our health habits in adulthood gave rise to chronic disease, but that studies have shown the risk for these conditions may be determined early in life, even before birth. Watch his full interview to learn more about how fetal development influences our overall health.

Previously: “It’s not just science fiction anymore”: Childx speakers talk stem cell and gene therapy, Global health and precision medicine: Highlights from day two of Stanford’s Childx conference, Innovating for kids’ health: More from first day of Stanford’s Childx and “What we’re really talking about is changing the arc of children’s lives:” Stanford’s Childx kicks off

In the News, Pediatrics, Sleep, Stanford News, Videos

Stanford doc gives teens a crash course on the dangers of sleep deprivation

Stanford doc gives teens a crash course on the dangers of sleep deprivation

Numerous studies, including a big one published in Pediatrics earlier this year, have shown that adolescents are getting less sleep than ever before. But most teens are unlikley unaware of the dangers of sleep deprivation – and that’s something that a group of Stanford clinicians is trying to change. Rafael Pelayo, MD, with the Stanford Center for Sleep Sciences and Medicine, and colleagues recently gave a “crash course” on sleep, and the importance of getting enough, to students at nearby Menlo-Atherton High School. ABC7 captured the story in the video above.

Previously: Talking about teens’ “great sleep recession”, With school bells ringing, parents should ensure their children are doing enough sleeping, Study shows poor sleep habits as a teenager can “stack the deck against you for obesity later in life”, What are the consequences of sleep deprivation? and Want teens to eat healthy? Make sure they get a good night’s sleep

Events, Parenting, Pediatrics, Stanford News, Videos

Pediatric health expert Alan Guttmacher outlines key issues facing children’s health today

Pediatric health expert Alan Guttmacher outlines key issues facing children's health today

The inaugural Childx conference was held here last month, and video interviews featuring keynote speakers, panelists and moderators are now on the Stanford YouTube channel. To continue the discussion of driving innovation in maternal and child health, we’ll be featuring a selection of the videos this month on Scope.

During his keynote speech at Stanford’s recent Childx conference, Alan Guttmacher, MD, director of the Eunice Kennedy Shriver National Institute of Child Health and Development, told attendees, “We need to be a society that values children.”

In the above video, Guttmacher emphasizes this point as he outlines key issues facing children’s health today. He explains that it’s the dawn of a new era in medical research with the potential to improve the lives of children throughout their life span. To make a lasting difference in children’s lives, he says, research needs to go beyond the medical approach and integrate social and environmental factors. He highlights the example of preterm birth, saying that while we’ve made strides in reducing the infant mortality rate of babies born too early, more needs to be done to understand the causes of preterm birth and prevent it.

Watch the full interview to learn more about why investing in pediatrics research can help the generations of tomorrow build a healthier future.

Previously: “It’s not just science fiction anymore”: Childx speakers talk stem cell and gene therapy, Global health and precision medicine: Highlights from day two of Stanford’s Childx conference, Innovating for kids’ health: More from first day of Stanford’s Childx, “What we’re really talking about is changing the arc of children’s lives:” Stanford’s Childx kicks off and Countdown to Childx: Q&A with pediatric health expert Alan Guttmacher

Events, Global Health, History, Pediatrics, Surgery, Transplants

From Costa Rica to Stanford: Pediatric liver transplant surgeon shares his story

From Costa Rica to Stanford: Pediatric liver transplant surgeon shares his story

Esquivel - croppedThese days, Carlos Esquivel, MD, PhD, is best known as one of the top pediatric liver transplant surgeons. But just a few decades ago, he worked as a generalist physician in an ill-equipped Costa Rican village located across from a river teeming with man-sized crocodiles.

Esquivel told a gripping tale of his journey from his native Costa Rica to Stanford during a recent Café Scientifque presentation. He described how he spent only a year in remote San Vito before traveling to the United States and joining the lab of innovative surgeon F.W. Blaisdell, MD, who took Esquivel under his wing and treated him like a son. On to Sweden, where Esquivel earned his post-doctorate degree, before mastering his transplantation skills with Thomas Starzl, MD, PhD, who is known as the “father of trasnplantation” and conducted the first human liver transplant in 1963.

Back then, transplant surgeons wore knee-high fishing waders to perform transplantations — they were that messy, Esquivel said. And few dared to do liver transplants in children. Fast-forward to today: Transplant surgeries are shorter, much less bloody, and much more survivable thanks to the improvements in technology and immunosuppressant drugs. Last year, the team at Lucile Packard Children’s Hospital Stanford tallied a 100 percent one-year survival rate, Esquivel told the audience.

Now, the primary problem is the shortage of organs. More than 120,000 people in the United States are waiting for a new organ. Kidneys are most in-demand, but thousands of people are also waiting for new livers. And like kidneys, livers can be taken from living donors, Esquivel said. Sometimes, an adult liver can even be split in two, saving the lives of another adult and a child.

Livers can regenerate, making it an ideal organ to donate. However, the donation surgery can cause complications and donation is a choice that potential donors — and their doctors — should consider carefully, Esquivel said.

Esquivel said surgeries are physically taxing, but also take a great deal of mental preparation. Before surgeries, he said he runs through all the scenarios, trying to prepare for every possibility.

To raise awareness about organ donation, Esquivel, an avid cyclist, completed an across-the-county bicycle race with a former transplant patient. And he has high hopes for the future. Once, transplanted livers only lasted 12 to 15 years, but today, some livers last as long as 30 years, Esquivel said.

Previously: How mentorship shaped a Stanford surgeon’s 30 years of liver transplants, Raising awareness about rare diseases and Record number of organ transplants saves five lives in a day
Photo courtesy of Lucile Packard Foundation for Children’s Health/ Toni Gauthier

Events, Medical Education, Medical Schools, Pediatrics, SMS Unplugged

A Match made at Stanford: From medical student to resident

A Match made at Stanford: From medical student to resident

SMS (“Stanford Medical School”) Unplugged is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category.

IMG_1127On March 20, in synchrony with thousands of senior medical students across the country, I received an envelope that determined where I would be spending the next three years of my life for residency training.

My academic advisor, Oscar Salvatierra, MD, had come out of retirement to share this day with his students. He had supported us over the years, from studying for our first-year exams to choosing a specialty and applying to residency. He supported my husband and me in the additional challenges of tackling medical school as a married couple, guided us through my husband’s decision to pursue a combined MD/PhD degree, and even weighed in on our decision to have a child during medical school. Now, on Match Day, I was so grateful that he was the one to call my name and hand me my letter.

“Open. Open. Open,” my daughter demanded, grasping for the bright red envelope with the same steady persistence that she normally uses to ask for raisins. My husband took her from my arms so that my shaking fingers were free to open the envelope and unfold the letter. It was real, right there in black and white: I’ll be staying at Stanford for a pediatrics residency.

I grinned, then I cried, then I started soaking in the hugs and congratulations of my family, friends, and mentors who all knew how desperately I had hoped for this outcome. But the fun part about Match Day is that there is more than just your own news to celebrate. Within minutes, I was fighting through the crowds to track down my friends and classmates to find out where they had matched. I was incredibly impressed, but not at all surprised, to hear about the excellent programs they will be attending across the country.

As I stepped back into my apartment later that morning, clutching my residency Match letter, it felt a lot like bringing a newborn baby home from the hospital: it was odd and unsettling to walk back through familiar doors into my familiar home when our family’s life was all at once so deeply changed. In residency (like becoming a parent), I am going to have to work harder than I’ve ever worked before, and be challenged in ways I haven’t even imagined. But at the same time, I have no doubt that it will be worth it, and that this was exactly what I want for my life.

I hope that my classmates are feeling the same excitement to start the next phase of the journey. Congratulations to the Stanford Medicine Class of 2015 on an incredible Match!

Jennifer DeCoste-Lopez is a final-year Stanford medical student who will soon start a residency in pediatrics at Stanford. She was born and raised in Kentucky and went to college at Harvard. She currently splits her time between clinical rotations, developing a new curriculum in end-of-life care, and caring for her young daughter.

Photo courtesy of Jennifer DeCoste-Lopez

Global Health, Immunology, Infectious Disease, Pediatrics, Stanford News

Researchers tackle unusual challenge in polio eradication

Researchers tackle unusual challenge in polio eradication

poliovaccinationPolio is a tricky foe. One of the biggest hurdles in the World Health Organization’s polio eradication campaign is that the virus causes no symptoms in 90 percent of people who contract it. But these silently infected individuals can still spread the virus to others by coughing, sneezing or shedding it in their feces. And those they infect may become permanently paralyzed by or die.

Polio’s evasiveness has also led to a big speed bump on the road to eliminate the disease. As I report in the current issue of Inside Stanford Medicine, scientists are trying to figure out how to stop a form of poliovirus that is derived from one type of  polio vaccine. Oral vaccines, which consist of live poliovirus that has been inactivated, can occasionally mutate in someone’s intestines to regain infectiousness. And, in rare instances, these viruses escape to the environment in feces, spreading to other people via sewage-contaminated water.

These “circulating vaccine-derived viruses” are threatening to overtake naturally occurring, “wild” poliovirus as the main source of paralysis in the communities where polio persists. The CDC’s most recent report on polio infections in Nigeria says that during the first nine months of 2014, the vaccine-derived viruses caused 22 cases of paralyzing poliomyletis, whereas wild virus caused six cases, for instance.

To tackle the problem, researchers are investigating how the injected polio vaccine, which is made with killed virus, might be substituted for the oral vaccine. The injected vaccine has some potential disadvantages for use in developing countries, so it’s not necessarily an easy substitution. In my story, Stanford’s Yvonne Maldonado, MD, who is studying the problem with a grant from the Bill & Melinda Gates Foundation, explains:

“We don’t really understand how well the killed vaccine is going to work in kids in developing countries, where there is lots of exposure to sewage, and malnutrition leaves children with weakened immune systems,” Maldonado said.

Her Gates Foundation grant examines semi-rural communities in Mexico where children now receive routine doses of the killed vaccine, followed by twice-a-year doses of the live vaccine.

“It’s an opportunity for us to study a natural experiment,” Maldonado said. Her team wants to know if the primary immune response to the killed vaccine will reduce shedding and transmission of later doses of live vaccine. They hope that starting with one or more doses of the injected vaccine will give kids the best of both worlds: from the shot, protection against circulating vaccine-derived viruses; from the oral vaccine, intestinal immunity.

Previously: TED talk discusses the movement to eradicate polio and New dollar-a-dose vaccine cuts life-threatening rotavirus complications by half
Photo of children in South Sudan receiving oral polio vaccine by United Nations Photo

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