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Applied Biotechnology, In the News, Patient Care, Technology

Building bodies, one organ at a time

Building bodies, one organ at a time

bioprinting muscle. jpg

If you’ve been to a geek or tech event like the annual Maker Faire that happens every spring here in the Bay Area, you’ve probably seen demonstrations of 3D printers that can spit out toys or jewelry.

What’s really interesting is how researchers and doctors are harnessing that technology to help their patients by making prosthetics for amputated arms, or replacements parts for damaged bones. A recent article in the San Jose Mercury News highlights this new frontier and features Stanford cardiologist Paul Wang, MD, who describes one of the biggest advantages of 3D printing:

“You can make things for tens of dollars rather than thousands of dollars,” said Stanford University professor Dr. Paul Wang, a cardiovascular and bioengineering expert who is among those studying the printers’ potential for prosthetics, replacement bones and other applications. “It’s totally opened up what’s possible.”

Printing prosthetics or bone substitutes using inorganic materials is just the beginning of how scientists hope to use 3D printing; many are trying to use the technology to print living tissue and organs. Doing so is a challenging endeavor – for starters, even relatively simple organs need networks of blood vessels that can constantly feed its cells – but several research teams are betting they can solve the puzzle:

University of Pennsylvania researchers say they’ve designed a way to print those [blood vessel] networks and a Russian company, 3D Bioprinting Solutions, has vowed this year to 3D-print a transplantable thyroid gland, which is laced with blood vessels.

Still other researchers are 3D-printing insulin-producing pancreatic tissues to help manage diabetes, viruses that can attack cancer cells and organ models that surgeons can practice on or that can be used to help design medical devices.

Stanford’s Wang, for example, has made a 3D-printed model of the heart along with a prototype of a tiny gadget he envisions one day could crawl though real hearts to gather information on the organ’s health or kill cells that damage it.

The field has the potential to be a financial windfall for companies that can bring a viable medical product to market, but one of the biggest hurdles is the regulatory process, which can stretch out over a decade or more for new devices. Still, as detailed in the article, proponents are “encouraged by the impact 3D printing already is having on health care” and remain optimistic about the future.

Previously: Countdown to Medicine X: 3D printing takes shapeCreating organ models using 3D printing3D printer in China makes tiny ear and 3D printer uses living cells to produce a human kidney
Photo of researcher printing muscle tissue by U.S. Army Materiel Command

Applied Biotechnology, Bioengineering, Biomed Bites, Cancer, Imaging, Technology, Videos

Beam me up! Detecting disease with non-invasive technology

Beam me up! Detecting disease with non-invasive technology

Here’s this week’s Biomed Bites, a feature appearing each Thursday that introduces readers to Stanford’s most innovative biomedical researchers.

Star Trek fans rejoice! Stanford radiologist Sam Gambhir, MD, PhD, hopes that someday he’ll be able to scan patients using a handheld device — similar to the one used by Bones in the popular sci-fi series — to check their health.

“Our long-term goals are to be able to figure out what’s going on in each and every one of you cells anywhere in your body by essentially scanning you,” Gambhir said in the video above. “We’ve been working on this area for well over three decades.”

This is useful because it will help doctors diagnose diseases such as cancer months or even years before the symptoms become apparent, Gambhir said.

And these advances aren’t light-years away. “Many of the things we’re doing have already started to move into the hospital setting and are being tested in patients. Many others will come in the years to follow,” he said.

Gambhir is chair of the Department of Radiology. He also directs the Molecular Imaging Program and the Canary Center for Cancer Early Detection.

Learn more about Stanford Medicine’s Biomedical Innovation Initiative and about other faculty leaders who are driving biomedical innovation here.

Previously: Stanford partnering with Google [x] and Duke to better understand the human body, Nano-hitchhikers ride stem cells into heart, let researchers watch in real time and weeks later and Developing a new molecular imaging system and technique for early disease detection

Behavioral Science, Health and Fitness, Medical Apps, Public Health, Technology

What needs to happen for wearable devices to improve people’s health?

What needs to happen for wearable devices to improve people's health?

15353072639_f3a79557df_z“Wearable devices” are pieces of technology that are worn in clothes or accessories, and they often have biometric functionality – they can measure and record heart rates, steps taken, temperature, or sleep habits. Numerous tech companies have begun manufacturing and marketing such devices, which are part of a larger movement often referred to as the “quantified self” – where data about one’s life is meticulously gathered and recorded. Only 1% to 2% of Americans have used a wearable device, but annual sales are projected to increase to more than $50 billion by 2018.

Health and fitness apps are also proliferating, from software that maps where you run or provides a digital workout community, to programs that count calories or suggest how to improve your sleep. But what’s the real impact for people’s health?

Earlier this month, a report from the Journal of the American Medical Association called into question the idea that wearable devices will effect population-scale changes in health. There is a big gap, the authors claim, between recording health information and changing health behavior, and little evidence suggests that this gap is being bridged. Wearable devices might be seen as facilitating change, but not driving it. Mitesh Patel, MD, MBA, from University of Pennsylvania, and colleagues wrote:

Ultimately, it is the engagement strategies—the combinations of individual encouragement, social competition and collaboration, and effective feedback loops—that connect with human behavior.

The difficulty of population health is that changes have to be sustained to have meaningful effects, and that is quite difficult. The authors identify four steps that must be taken to bridge this gap towards sustained change.

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Cancer, Medical Apps, Stanford News, Technology

Using a smartphone and the Folding@home app to advance disease research

Using a smartphone and the Folding@home app to advance disease research

protein

Smartphones now have the power that personal computers had a few years ago, and more and more people have them. So researchers are developing ways to harness that computing power to solve pressing biomedical problems.

As described in a Stanford News piece, Stanford’s Vijay Pande, PhD, in partnership with Sony, recently developed a smartphone app that “folds” proteins while the phone’s owner sleeps. “There are a ton of people with really powerful phones, and if we can use them efficiently, it sets the stage for something really great,” said Pande, a Stanford chemistry professor.

This particular mobile app, called Folding@home, investigates the biology of diseases, including cancer, Alzheimer’s, and Parkinson’s disease. It’s an extension of the Folding@home distributed computing project started in 2007, and it’s now available on GooglePlay.

Disease biology is dependent on proteins, which are complex linear chains of molecules that become “folded up”, like snarled balls of yarn. The chain needs to be absolutely correct; any mutation that shifts a few molecules out of place will cause the protein to not work optimally, not work at all, or, worse, work in a way that does damage to the organism.

Understanding protein configurations is key to developing cures for disease. While real proteins take milliseconds to curl up, simulating this process with computers takes thousands of hours. But if 10,000 people download and use the Folding@home app, and it runs 8 hours a day while the phone is not otherwise in use, the team’s first research question could be solved in three months.

The app’s first focus is a kinase protein found in breast cancer. It seems that different people’s tumors respond differently to the several drugs available; currently, doctors use a guess-and-check method to choose a drug, but information derived from the proteins could enable doctors to choose correctly on the first try. In something as time-sensitive as cancer, this could save lives.

Next up for the app is a project related to Alzheimer’s disease. Eventually, if enough people enroll, the researchers could launch several projects simultaneously, allowing people to choose to take part in one that is personally meaningful.

Image of a protein Argonne National Laboratory

Cancer, Public Health, Research, Stanford News, Technology

Stanford researchers explore new ways of identifying colon cancer

Stanford researchers explore new ways of identifying colon cancer

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

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

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

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

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

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

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

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

Health and Fitness, Patient Care, SMS Unplugged, Technology

“Nudges” in health: Lessons from a fitness tracker on how to motivate patients

“Nudges” in health: Lessons from a fitness tracker on how to motivate patients

SMS (“Stanford Medical School”) Unplugged was recently launched as 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.

fitness trackerIt was 11:47 PM. That meant that I had 13 minutes to reach my pre-set goal of  “activity” that the fitness tracker on my wrist had been registering throughout the day. If I met the goal I would get a “trophy” on the accompanying app. I probably looked pretty funny bouncing around my living room doing a squat here and a sit-up there, punching a pretend opponent, and running in place. But I made it minutes before midnight. If I hadn’t – well, then I would have just blamed the piece of technology on my arm for not working.

The tracker was a gift from my cousin Steve. Steve is impressively fit; he runs marathons, tackles obstacle courses, and races road bikes. A few years back at Christmas dinner, Steve challenged me to a pull-up contest – I was super hyped and ready for it until, well, I lost. Every holiday season since then, I’ve spent the weeks prior to heading home logging extra push-ups, pull-ups, and bicep curls just in case a re-match comes up. Without knowing it, Steve inspired me to get active. Now, with blinking lights and status reminders, the fitness tracker he gave me does so more frequently, more annoyingly, but in a way, more enjoyably and effectively.

The fitness band on my wrist doesn’t tell me to go to the gym or go for a run. The periodic updates on how far I am from my pre-set goal, however, “nudge” me to get up during a commercial and do a set of push-ups, to get out for a walk, or to take the stairs. I’ve even turned to running in place or a set of body squats whenever I find myself yawning to make sure I get enough points.

In the past, I’ve been good about working out, even doing stretches of two-a-day gym trips. But this doesn’t last very long as I use the busy “medical school” schedule as an excuse. After getting the fitness tracker, it’s been a string of random, spontaneous, and unstructured “work outs” throughout the day. While I may not have achieved Mr. America status, I’ve felt good about meeting my daily goal and racking up “trophies.” It’s even become a bit of a game to see how high I can actually make my numbers go. I’m competing against myself. This may sound weird, but at least I know my opponent and understand what I’m up against, right?

Wearing the fitness band reminded me of the concept of nudges. Nudges, as discussed by Richard Thaler, PhD, and Cass Sunstein, JD, describe how a person can be steered toward making a particular decision without hard instruction. An individual encounters small pushes towards doing something that is desired of them, unaware that they’re being led in that direction. Commercial companies have mastered this in form of advertising, making us feel as if we “need” their product. This fitness band has me thinking that I’m playing a game; the soreness in my legs and looser fitting clothes would indicate that I’m working out.

My experience with the fitness tracker has reminded me of the importance in framing conversations with patients. We often resort to telling patients, “You should work out and eat healthy – if you don’t you’ll get this or that disease.” It’s easy to frame things in the negative and use scare tactics. But rather than give constant reminders of what they aren’t doing, conversations with patients should contain nudges of encouragement. Nudges such as aligning goals with patient priorities, setting check-in time-points, and incorporating social networks for accountability. If we could do for chronic-disease management what the fitness band tries to do for working out, our patients might have an easier time.

Moises Gallegos is a fourth-year medical student. He’ll be going into emergency medicine, and he’s interested in public-health topics such as health education, health promotion and global health.

Photo by Vernon Chan

Biomed Bites, In the News, Research, Stem Cells, Technology, Videos

“It gives me the chills just thinking about it”: Stanford researcher on the potential of stem cells

"It gives me the chills just thinking about it": Stanford researcher on the potential of stem cells

Welcome to the last Biomed Bites of 2014. We’ll be continuing this series next year — check each Thursday to meet more of Stanford’s most innovative biomedical researchers. 

If you watch this video and aren’t moved by the passion and conviction of Stanford biologist Margaret Fuller, PhD, then email me. Seriously, I’ll try to talk some sense into you. Because Fuller’s enthusiasm for biomedicine is downright contagious. This is a professor who you want to teach biology.

Fuller, a professor of developmental biology and of genetics, works with adult stem cells, and she’s palpably gleeful about their potential to improve the health of millions.

“I was really struck and inspired by a recent article in the New York Times,” Fuller says in the video above. She’s talking about “Human Muscle Regenerated with Animal Help,” a 2012 piece that told the story of Sgt. Ron Strang, a Marine who lost part of his quadriceps in Afghanistan. Yet here is Strang, walking, thanks to the donation of a extracellular matrix from a pig. This paper-like sheet secreted signals instructing his stem cells to come to the rescue and build new muscle. “It was amazing,” Strang told the Times reporter. “Right off the bat I could do a full stride, I could bend my knee, kick it out a little bit…”

“This is really amazing,” Fuller agrees. “It gives me the chills just thinking about it. This is the kind of knowledge and advances of the basic work that I do… The hope is that understanding those underlying mechanisms will allow people to design small molecules and other strategies that can be used to induce our own adult stem cells to be called into action for repair.”

Learn more about Stanford Medicine’s Biomedical Innovation Initiative and about other faculty leaders who are driving biomedical innovation here.

Previously: Center for Reproductive and Stem Cell Biology receives NIH boost, Why the competition isn’t adult vs. embryonic stem cells and Induced pluripotent stem cell mysteries explored by Stanford researchers

Mental Health, Research, Technology

Reducing your stress level could be as simple as checking email less frequently

Reducing your stress level could be as simple as checking email less frequently

4329363938_26522735d1_zAs the end of 2014 approaches, many of us are thinking about what changes we’re going to make come Jan. 1 to be healthier and happier. Those looking for ways to reduce their stress level in 2015 may want to consider adopting a New Year’s resolution to limit how often they check their email throughout the day.

A study (subscription required) recently published in Computers in Human Behavior suggests that there are psychological benefits to easing up on the number of times you click your inbox. For the experiment, researchers at the University of British Columbia instructed half the participants to read emails no more than three times a day for a week, while a second group was allowed to check their inbox as often as they wished. The groups’ instructions were then reversed the following week. New York Magazine reports:

Overall, “limiting the number of times people checked their email per day lessened tension during a particularly important activity and lowered overall day-to-day stress,” the researchers write, and was associated with various other positive measures of psychological well-being. Those who checked their email a lot also didn’t perceive themselves as any more productive than those who were on an email diet.

…This study, combined with a lot of prior research into things like the distractions imposed by task-switching, paint a pretty clear picture: Ceaselessly checking your email probably isn’t making you more productive, and it probably is making you more stressed.

Previously: What email does to your brain
Photo by Ian Lamont

Parenting, Pediatrics, Pregnancy, Technology, Women's Health

Stanford alumni aim to redesign the breast pump

Stanford alumni aim to redesign the breast pump

2014-11-21 15.02.36

Three Stanford graduates have an idea that could dramatically impact the daily life of active breastfeeding women: They plan to design and build a breast pump that is discreet, intuitive, and supportive of mothers. This may sound obvious, but nothing like it currently exists. In August of this year, Cara Delzer, MBA; Gabrielle Guthrie, MFA; and Santhi Analytis, PhD, founded Moxxly, “a consumer products company designing for women.” They’re in the final stretch of their 16-week incubation with Highway 1, which helps hardware startups move from a concept to a prototype ready for production.

“We’ve talked to women, hundreds of women, who have told us things like ‘pumping makes me feel like a cow,'” shares Delzer, Moxxly’s CEO, who I interviewed in late November. So she and her colleagues are aiming to re-imagine the pumping experience.

Delzer experienced the current, poorly-imagined pumps firsthand after the recent birth of her child: “I just remember watching my husband take piece after piece out of the pump box for the first time thinking, how in the world am I going to put this together? All those pieces, and clean them? I was already overwhelmed as a new mom, but completely overwhelmed by the pump.” Once she went back to work, she found that she was spending 25 percent of her day dealing with the logistics of pumping – mentally integrating it into her schedule, worrying about having all the parts. The experience is similar for many of today’s busy, mobile moms.

Meanwhile, Guthrie was at Stanford developing her passion for designing for women, Delzer recounts. “A lot of things that have been designed for women and girls in the past have followed this ‘shrink it and pink it’ trope where you literally make it smaller and bright pink and think, ‘Oh, now the girls will buy it.’ Well, Gabrielle doesn’t buy it.” For her masters’ thesis, Guthrie interviewed working moms, and the breast pump kept coming up as something that needed to be redesigned. She spent much of her last year at Stanford working on just that. At a hackathon, she and Analytis worked together to put the new designs into practice, and Analytis, whose PhD is in mechanical engineering, was hooked on solving this problem as well.

The three women “got together, looked one another in the eyes and said, ‘Do we believe this is a problem? Do we believe we can solve it? Do we believe the time is now?’ And it was yes, yes, yes,” said Delzer. They took on the challenge despite the fact that the breast pump is an FDA-regulated medical device and they will face a lengthy review process. They invented the name “Moxxly” with the intent of conveying spunkiness and strength, and incorporated XX to signify women.

Continue Reading »

Imaging, Patient Care, Stanford News, Technology

Every foot has a story: Why communication is key in radiology

Every foot has a story: Why communication is key in radiology

11739904364_92e702bc65_zBack in the day, radiology departments were simpler. After obtaining an x-ray, the technologist would hand off the images to the radiologist. In the process, the radiologist might ask about the technologist’s family, how Aunt Lucy was faring or how that day’s commute had been. Maybe a senior technologist would walk by, glance at the pinned up images and offer the junior technologist some advice on how to improve the positioning of the patient. The primary care doctor and the junior radiologist might chat about the patient over their lunchtime tennis game.

Not to say it wasn’t busy — it was. But in a smaller, simpler environment, informal relationships were easier to maintain. Despite their informality, these relationships, and the communication that went with them, served as a powerful means to improve patient care, according to Stanford radiologist David Larson, MD.

Fast forward to today. At a busy, top-tier hospital, radiologists might not know their colleagues, much less the technologists or referring physicians. All images remain on computers — no need to pin anything up for public viewing, or to receive unsolicited comments, or advice.

The many technological improvements, as well as the scale and speed of modern radiology, have inadvertently thwarted communication, Larson and colleagues write in a paper recently published in the American Journal of Roentgenology. Here’s Larson:

In radiology, we’re in the business of information. Everything we do from the time that somebody even thinks of a question, to the time they ask for an imaging study, to when we then interpret the images, is really all about information.

So we need to be really good at moving that information efficiently and effectively, which means we need to be good at communicating… But in many ways, we’re thinking as if we still operate in a small, simple environment, even though we’re operating in a large, complex environment.

For example, Larson said, in addition to having the images, it’s also important for radiologists to know about a patient’s history. He said information that someone runs 20 miles a week, for example, makes a big difference when interpreting an image of a foot. “I have been in the situation where I looked at the study and was about to call it normal. Then I looked at the history, looked back at the study, and found the very subtle stress fracture,” Larson said. “A good history makes that possible.”

Larson pointed out that Stanford is continuously improving its own communication processes. For example, the hospital recently hired a reading room assistant, what Larson referred to as an “air traffic controller,” to direct queries and facilitate communication among physicians.

Previously: Despite genetic advances, detection still key in breast cancer, Using 3-D technology to screen for breast cancer and Better communication between caregivers reduces medical errors, study finds
Photo by Jill Carlson

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