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Medicine and Society, Stanford News

Actor Anna Deavere Smith on getting into and under the skin of a character

Actor Anna Deavere Smith on getting into and under the skin of a character

ADS - smallThe “skin” issue of Stanford Medicine magazine is out and online. In it, I have a Q&A with actor and playwright Anna Deavere Smith. TV audiences came to know Anna through her work as Nancy McNally, the White House national security advisor on the famed series “The West Wing.” And now, after seven seasons, she’s ending another acclaimed role, hospital administrator Gloria Akalitus on Showtime’s “Nurse Jackie.” Bur her seminal work has been in the theater, in two groundbreaking plays early in her career: “Twilight Los Angeles” and “Fires in the Mirror.” Her last theatrical piece, “Let Me Down Easy,” was a paean to the human body in its strength and fragility.

There are few actors who get into and under the skin of their characters more acutely than Anna. We thought it would be interesting (and different) for this issue of the magazine, which focuses on skin diseases, to talk with Anna and get another sort of take on skin. “In the early part of my career [my skin color] was a big stumbling block,” she told me. “There were stereotypes. As a woman, if you didn’t fit into the idea of a tragic mulatto or mammy it was really hard to situate yourself.”

Read on in the Q&A.

Previously: This summer’s Stanford Medicine magazine shows some skin and Let me down easy: A conversation with Anna Deavere Smith
Illustration by Tina Berning

Research, Sports, Stanford News

New research offers comprehensive picture of the lingering effects of sports injuries

New research offers comprehensive picture of the lingering effects of sports injuries

15403-injuries_newsIn an effort to better understand the lasting impact of sports injuries, Stanford physicians collaborated with the university’s athletic department to enroll nearly 1,700 student athletes in an electronic pre-participation evaluation (ePPE) program and track their health over a three-year period.

During the course of the study, which was published in the current issue of The American Journal of Sports Medicine, the researchers documented 3,126 injuries (1,473 for women and 1,653 for men) that caused athletes to miss an average of 31 days of competition each. Musculoskeletal injuries were the most common, but athletes also suffered from concussions, eating disorders and infectious illnesses. As reported in a Stanford news story today, the research provides new insights into the lasting impact of injuries in greater detail than ever:

Among the findings, 11 percent of the students still suffered symptoms from a previous injury at the time of their next ePPE. Head injuries accounted for 9 percent of all injuries. Although only 3 percent of women reported a diagnosed eating disorder, 15 percent of all women reported a history of stress fractures, which can be associated with low body fat, from either disordered eating or overtraining.

[Gordon Matheson, MD, PhD, who led the study,] said that although the data are eye-opening, interpreting the material and deciding what is particularly meaningful may be an even bigger effort.

“We know that student-athletes have a lot of injuries from sport participation. But unless we have pooled, aggregate data like this, it’s difficult to measure trends and spot areas of concern applied to prevention,” said Matheson.

Researchers hope to partner with other universities to expand their data set and learn more about why some players are symptomatic at the time of follow-up evaluations and, ultimately, help make sports safer.

Previously: Female high-school athletes suffer more overuse injuries than their male counterparts, Director of Stanford Runner’s Injury Clinic discusses advances in treating six common running injuries, Lingering effects of injuries sideline many former college athletes later in life and Sports medicine specialists, educators endorse checklist to reduce injuries among youth athletes
Photo by Andrey Popov/Shutterstock

Autoimmune Disease, Immunology, Public Health, Research, Sleep, Stanford News

Cause of 2009 swine-flu-vaccine association with narcolepsy revealed?

Cause of 2009 swine-flu-vaccine association with narcolepsy revealed?

syringesBack in 2001, in the wacko cinematic tour de farce “Rat Race,” British actor Rowan Atkinson – a.k.a. the iconic “Mr. Bean” – put a humorous face on narcolepsy, a rare, chronic, incurable and lifelong sleep disorder that can strike at any time, even in the heat of a foot race.

In 2009, narcolepsy suddenly became, for a time, not quite so rare.

The swine flu pandemic sweeping the world that year was no joke. In the United States alone, the H1N1 strain of influenza virus responsible for that pandemic resulted in 274,304 hospitalizations and 12,469 deaths, as mentioned in our news release on a just-published study in Science Translational Medicine.

There probably would have been far more hospitalizations and deaths had not several vaccines tailored to that particular influenza strain been rushed to the market. Two vaccines in particular — Focetria, manufactured by Novartis, and Pandemrix, made by GlaxoSmithKline — are credited with saving a lot of lives in Europe. But there was a dark side. As our news release notes:

Populations that had been immunized with GlaxoSmithKline’s Pandemrix vaccine showed an increase in narcolepsy, but those immunized with Novartis’ Focetria did not.

That’s not news; it’s been known for some time. But the findings in the new study, whose senior author is Stanford neuroimmunologist Larry Steinman, MD, may explain why.

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Aging, Cancer, Dermatology, Genetics, Research, Stanford News

Genetic secrets of youthful skin

Genetic secrets of youthful skin

new hatEvery year, upwards of $140 billion a year gets spent on cosmetics. In the United States alone, says an authoritative report, a recent year saw upwards of 5.6 million Botox procedures, 1.1 million chemical peels, almost a half-million laser skin procedures, 196,286 eyelid surgeries and a whole bunch of face lifts.

If you’ve got the courage to compare your present-tense face with the one you were wearing 20 or even 10 years ago, you’ll see why. As I wrote in a just-published Stanford Medicine article, “Wither youth?”:

The terrain of aging skin grows all too familiar with the passing years: bags under the eyes, crow’s feet, jowls, tiny tangles of blood vessels, ever more pronounced pores and pits and pigmentation irregularities. Then there are wrinkles — long, deep “frown lines” radiating upward from the inside edges of the eyebrows and “laugh lines” that trace a furrow from our nostrils to the edges of our lips in our 40s, and finer lines that start crisscrossing our faces in our 50s. Sagging skin gets more prominent in our later years as we lose bone and fat.

“And,” I added wistfully, “it’s all right there on the very outside of us, where everyone else can see it.”

Stanford dermatologist Anne Chang, MD, who sees a whole lot of skin, got to wondering: Why does skin grow old? Armed with a sophisticated understanding of genetics, she went beyond lamenting lost youth and resolved to address the question scientifically, asking: “Can you turn back time? Can aging effects be reversed? Can you rejuvenate skin, make it young again?”

The answers she’s come up with so far – from hereditary factors to a possible underlying genetic basis for how some treatments now in common commercial cosmetic use (such as broadband light therapy) could potentially slow or even reverse the aging of skin – are described in my magazine article.

Previously: This summer’s Stanford Medicine magazine shows some skinResearchers identify genetic basis for rosacea, New study: Genes may affect skin youthfulness and Aging research comes of age
Photo by thepeachpeddler

Behavioral Science, Health and Fitness, Mental Health, Public Health, Research, Stanford News

Exposure to nature helps quash depression – so enjoy the great outdoors!

Exposure to nature helps quash depression - so enjoy the great outdoors!


hiking_news-1

Walking is good for your health. But walking somewhere natural is even better, according to a new Stanford-led study.

Study participants who walked in a natural area for 90 minutes showed less activity in a brain region associated with depression than those who walked through a city or other urban area, a Stanford News story states. From the piece:

“These results suggest that accessible natural areas may be vital for mental health in our rapidly urbanizing world,” said co-author Gretchen Daily, the Bing Professor in Environmental Science and a senior fellow at the Stanford Woods Institute for the Environment. “Our findings can help inform the growing movement worldwide to make cities more livable, and to make nature more accessible to all who live in them.”

Even further, the research supports — but does not prove — a link between urbanization and growing rates of mental illness, said co-author James Gross, PhD, a professor of psychology.

The researchers had one group of participants walk in a grassland with oak trees and shrubs. The other group walked along a traffic-clogged four-lane road. They then measured heart and respiration rates, performed brain scans and had the participants answer a series of questions. The results showed that:

Neural activity in the subgenual prefrontal cortex, a brain region active during rumination – repetitive thought focused on negative emotions – decreased among participants who walked in nature versus those who walked in an urban environment.

Evidence that supports the knowledge you’ve had since grade school: The outdoors really can make you feel better.

Previously: To get your creative juices flowing, start movingA look at the effects of city living on mental health and Out-of-office autoreply: Reaping the benefits of nature
Photo by Linda A. Cicero/Stanford News Service

Genetics, In the News, Research, Science, Stanford News, Stem Cells, Technology

CRISPR marches forward: Stanford scientists optimize use in human blood cells

CRISPR marches forward: Stanford scientists optimize use in human blood cells

The CRISPR news just keeps coming. As we’ve described here before, CRISPR is a breakthrough way of editing the genome of many organisms, including humans — a kind of biological cut-and-paste function that is already transforming scientific and clinical research. However, there are still some significant scientific hurdles that exist when attempting to use the technique in cells directly isolated from human patients (these are called primary cells) rather than human cell lines grown for long periods of time in the laboratory setting.

Now pediatric stem cell biologist Matthew Porteus, MD, PhD, and postdoctoral scholars Ayal Hendel, PhD, and Rasmus Bak, PhD, have collaborated with researchers at Santa Clara-based Agilent Research Laboratories to show that chemically modifying the guide RNAs tasked with directing the site of genome snipping significantly enhances the efficiency of editing in human primary blood cells — an advance that brings therapies for human patients closer. The research was published yesterday in Nature Biotechnology.

As Porteus, who hopes to one day use the technique to help children with genetic blood diseases like sickle cell anemia, explained to me in an email:

We have now achieved the highest rates of editing in primary human blood cells. These frequencies are now high enough to compete with the other genome editing platforms for therapeutic editing in these cell types.

Porteus and Hendel previously developed a way to identify how frequently the CRISPR system does (or does not) modify the DNA where scientists tell it. Hendel characterizes the new research as something that will allow industrial-scale manufacturing of pharmaceutical-grade CRISPR reagents. As he told me:

Our research shows that scientists can now modify the CRISPR technology to improve its activity and specificity, as well as to open new doors for its use it for imaging, biochemistry, epigenetic, and gene activation or repression studies.

Rasmus agrees, saying, “Our findings will not only benefit researchers working with primary cells, but it will also accelerate the translation of CRISPR gene editing into new therapies for patients.”

Onward!

(Those of you wanting a thorough primer on CRISPR —how it works and what could be done with it — should check out Carl Zimmer’s comprehensive article in Quanta magazine. If you prefer to learn by listening (perhaps, as I sometimes do, while on the treadmill), I found this podcast from Radiolab light, but interesting.)

Previously: Policing the editor: Stanford scientists devise way to monitor CRISPR effectiveness and “It’s not just science fiction anymore”: Childx speakers talk stem cell and gene therapy

 

Events, Health and Fitness, Sports, Stanford News, Videos

Stanford Football team physician shares tips for staying healthy while working out

Stanford Football team physician shares tips for staying healthy while working out

Last month, more than 750 people gathered on the Stanford Medicine campus for the annual Health Matters event. There, Jason Dragoo, MD, team physician for Stanford Football and the U.S. Olympic Committee, delivered a talk about preventing injuries and improving fitness performance. As he explains in the above video, he and colleagues dramatically changed the conditioning program for football players over the last five years: gone is the traditional weight room packed with machines and racks and in its place is a training facility stocked with kettle bells, Pilates equipment, medicine balls, wooden sticks and core boards. As a result, the injury rate dropped more than 70 percent and the team’s success has skyrocketed. 

Watch Dragoo’s full presentation and learn how you can apply the workout tactics employed by Stanford Football to avoid injury and improve your own exercise regimen. And check out the Stanford Medicine YouTube channel for more Health Matters videos, including:

Previously: Stanford Medicine’s Health Matters event, in pictures and Stanford’s Health Matters happening on Saturday

Bioengineering, Cancer, Imaging, Microbiology, Research, Science, Stanford News

Stanford team develops technique to magnetically levitate single cells

Stanford team develops technique to magnetically levitate single cells

Remember the levitating frog? That feat — the levitation of a live frog using a powerful magnet — was awarded the 2000 Ig Nobel Prize. Fascinating to watch, the demonstration also cemented a longstanding belief that levitating anything smaller than 20 microns was flat-out impossible. Much less something alive.

Not so, a team of Stanford-based researchers showed in a paper published today in the Proceedings of the National Academy of Sciences (PNAS). Using a 2-inch-long device made of two magnets affixed with plastic, the team showed it’s possible to levitate individual cells.

The video above demonstrates the technique in a population of breast cancer cells. Originally, the cells hover, suspended between the two magnets. But when exposed to an acid, they start to die and fall as their density increases.

“It has very broad implications in multiple diseases including cancer, especially for point-of-care applications where it can bring the central lab diagnostics to the comfort of patients’ homes or physicians’ office,” Utkan Demirci, PhD, a co-senior author and associate professor of radiology, told me.

The technique makes it possible to distinguish healthy cells from cancerous cells, monitor the real-time response of bacteria or yeast to drugs and distinguish other differences between cells that were thought to be homogenous, said Naside Gozde Durmus, PhD, a postdoctoral research fellow and first author of the paper.

Critically, the technique does not require treating the cells with antibodies or other markers, Durmus said. That ensures the cells are not altered by any treatments and makes the technique easy to use in a variety of settings, including potentially in physicians’ offices or in resource-poor settings.

The device works by balancing the gravitational mass of a cell against its inherent magnetic signature, which is negligible when compared with the cell’s density, Durmus said.

Interestingly, however, the cells — or bacteria treated with an antibiotic — do not die at the same rate, providing hints at their individual adaptations to environmental stressors, said co-senior author Lars Steinmetz, PhD, a professor of genetics.

To enhance the precision of the technique, the researchers can tweak the concentration of the solution that holds the cells, Durmus said. A highly concentrated solution allows for the differentiation of cells of similar densities, while a less concentrated solution can be used to examine a population of heterogeneous cells.

The team plans to investigate the applications of the device next, including its use in resource-poor settings where the cells can be observed using only a lens attached to an iPhone, Durmus said.

Previously: Harnessing magnetic levitation to analyze what we eat, Researchers develop device to sort blood cells with magnetic nanoparticles and Stanford-developed smart phone blood-testing device wins international award
Video courtesy of Naside Gozde Durmus

Cancer, Patient Care, Research, Stanford News

From petri dish to patient: Studying, treating – and trying to cure – less common cancers

From petri dish to patient: Studying, treating - and trying to cure - less common cancers

surviving melonomaIn 2015, more than 1.5 million Americans were diagnosed with cancer. Around forty percent of those new diagnoses were in three types of cancer — breast, lung, and prostate —  so it’s no surprise that those are the ones you hear about most often. But hundreds of thousands of new cancer patients each year are diagnosed with less common cancers, some affecting only a handful of patients a year. These are the diseases you don’t often hear about.

Before a few months ago, I have to admit that I didn’t know anything about cutaneous T cell lymphoma (CTCL). Each year, just a few thousand adults in the U.S. are diagnosed with the cancer, which often starts as an itchy, scaly rash — not the first thing that comes to mind when you think of classic cancer symptoms. Most people first learn about CTCL when they, or someone close to them, is diagnosed. I, on the other hand, started investigating it because I was writing about Stanford’s Cutaneous Lymphoma Group, which is spearheading research and new treatments of the disease.

At the same time, I was researching metastatic melanoma, the most advanced form of the skin cancer. While melanoma of any variety is relatively common (almost 75,000 new cases a year in the U.S.), only four percent of new diagnoses are the most severe, metastatic type. To understand both CTCL and metastatic melanoma, I spoke to patients being treated at Stanford clinics, doctors who specialize in the diseases, and researchers who study the cancers at the most basic molecular and genetic levels.

Science writers and scientists alike often justify research on rare diseases by explaining how we can learn about more common conditions through studying less common ones. But hearing about melanoma and CTCL — and how findings in the lab quickly trickle up to change clinical practice and save patients’ lives — it became ever clearer to me that research on these rarer cancers has an immeasurable impact all on its own. The clinicians I talked to were all avid proponents of integrating the latest research into their practices as soon as they could, and constantly tweaking their protocols to find the best ways to help patients. And each patient was able to get a new lease on life thanks to clinical trials and scientist-doctors willing to try new things.

To learn more about CTCL and metastatic melanoma, check out my features in the latest issue of Stanford Medicine magazine: “The rarest of rashes,” and “Surviving melanoma.”

Sarah C.P. Williams is an award-winning science writer covering biology, chemistry, translational research, medicine, ecology, technology and anything else that catches her eye.

Previously: This summer’s Stanford Medicine magazine shows some skinGene-sequencing rare tumors – and what it means for cancer research and treatmentA rare cancer survivor’s journey to thriving and advocatingHumble anti-fungal pill appears to have a noble side-effect: treating skin cancer and Raising awareness about rare diseases
Illustration by Matthew Bandsuch

Bioengineering, Cardiovascular Medicine, Global Health, Stanford News, Technology

Stanford-India Biodesign co-founder: “You can become a millionaire, but also make a difference”

Stanford-India Biodesign co-founder: "You can become a millionaire, but also make a difference"

This post is part of the Biodesign’s Jugaad series following a group of Stanford Biodesign fellows from India. (Jugaad is a Hindi word that means an inexpensive, innovative solution.) The fellows will spend months immersed in the interdisciplinary environment of Stanford Bio-X, learning the Biodesign process of researching clinical needs and prototyping a medical device. The Biodesign program is now in its 14th year, and past fellows have successfully launched 36 companies focused on developing devices for unmet medical needs.

4499846308_9f084d26f0_zThe three Indian biodesign fellows who were at Stanford for the past six months have returned to New Delhi, where they’ll finish up their fellowship. They’re the last class of fellows from the Stanford-India Biodesign program, and in India they’ll be joining two teams already in progress as part of the new School of International Biodesign (SIB).

Balram Bhargava, MD, executive director of Stanford-India Biodesign (India), was at Stanford for the fellow’s final presentation of their prototype. He helped establish the relationship between Stanford and India and is now revamping the new self-sufficient program.

How did Stanford-India Biodesign originate?

I was at a retirement party in September 2006 for Ulrich Sigwart, MD, who developed the first stent. He called in some friends from all over the world, including Paul Yock, MD (director of the Stanford Biodesign Program). Paul and I shared a taxi ride to Ulrich’s vacation home and got talking. That’s when the program started. By January 2008 the first batch of fellows was here.

The basic intent was to start this innovative program in India and ultimately make it self-sufficient. We selected students from India and sent them to Stanford, then they finished out their fellowship in India.

How has the program changed over the years?

Our early fellows returned from Stanford with high-end ideas such as robots. I had to pull them all down back to the ground. My role was to give this program a soul, and I think I have been successful at that. After a few years Stanford also accepted that frugal design was the right thing for the world and I’m happy about that.

Many of our students had the intention of setting up a company and becoming millionaires. We’ve given them the idea that you can become a millionaire, but at the same time you can make a difference. That’s the delicate balance we want to teach. The students have been very bright and many of them have really delivered on this dream.

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