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Chronic Disease, Genetics, Pediatrics, Stanford News

Stem cells implicated in Duchenne muscular dystrophy

Stem cells implicated in Duchenne muscular dystrophy

640px-Duchenne-muscular-dystrophyStanford researchers published a paper today in Science Translational Medicine describing how stem cells are involved in the development of Duchenne muscular dystrophy, a disease that results in progressive, often severe muscle weakness. It affects about one in every 3,600 boys born in the U.S.

The research team determined that the stem cells surrounding muscle tissue gradually became less able to create new muscle cells and instead begin to express genes that lead to connective tissue formation. Excess connective tissue accumulation, which is called fibrosis, occurs in many diseases. Thomas Rando, MD, PhD, a Stanford neurologist and one of the authors of the paper said in a release about the new study:

These cells are losing their ability to produce muscle, and are beginning to look more like fibroblasts, which secrete connective tissue. It’s possible that if we could prevent this transition in the muscle stem cells, we could slow or ameliorate the fibrosis seen in muscular dystrophy in humans.

The researchers also found that a drug already approved to treat high blood pressure in humans called losartin can slow these changes in stem cells in laboratory mice, although much more work is needed to find out if it could be helpful in children with Duchenne.

The researchers are focusing on how to get the drug to target only muscle cells, but they’re also interested in how they can apply their findings to other diseases. Rando, who directs the Glenn Center for the Biology of Aging at Stanford, also commented:

Fibrosis seems to occur in a vicious cycle. As the muscle stem cells become less able to regenerate new muscle, the tissue is less able to repair itself after damage. This leads to fibrosis, which then further impairs muscle formation. Understanding the biological basis of fibrosis could have a profound effect on many other diseases.

Previously: Working on a gene therapy for muscular dystrophy, New mouse model of muscular dystrophy provides clues to cardiac  failure, and Mouse model of muscular dystrophy points finger at stem cells
Photo of muscle cells affected by Duchenne disease by Edwin P. Ewing

Pediatrics, Research, Stanford News

Silicon Valley entrepreneur Sean Parker establishes allergy center at Stanford

Silicon Valley entrepreneur Sean Parker establishes allergy center at Stanford

DrKariNadeau-Dec2014Here at Scope, we’ve often written about the life-threatening nature of allergic reactions and the work that Stanford scientists are doing to understand dangerous allergies. For instance, Stanford immunologist Kari Nadeau, MD, PhD, (pictured at right) leads research to combat children’s food allergies with oral immunotherapy, a treatment in which patients consume tiny but gradually increasing doses of their allergy triggers under a doctor’s supervision.

Today, the efforts of Nadeau and other Stanford allergy researchers are receiving a big boost. Silicon Valley entrepreneur and philanthropist Sean Parker has announced that he’s donating $24 million to establish an allergy research center at Stanford, which Nadeau will lead. Parker has a personal interest in the topic because of his own experience with severe food allergies. Scientists at the Sean N. Parker Center for Allergy Research at Stanford University will study the underlying mechanisms of all types of allergies in children and adults and will aim to develop lasting allergy cures.

From the press release about the center’s launch:

“We are excited about the center because there is enormous clinical need for better understanding of and treatment for allergies,” said Lloyd Minor, MD, dean of Stanford University School of Medicine. “For instance, the recent profound increase in the incidence of serious food allergy is fascinating and deeply concerning at the same time. Sean Parker’s generous gift will enable Stanford Medicine experts, under Dr. Nadeau’s leadership, to collaborate and innovate across academic disciplines for the benefit of millions of people with allergies.”

“I am thrilled and honored to direct the Sean N. Parker Center for Allergy Research at Stanford University,” said Dr. Nadeau, associate professor of pediatrics at the medical school and an immunologist at Lucile Packard Children’s Hospital Stanford and Stanford Health Care. “Sean is well-versed in immunology, and has been a fantastic partner to work with. He’s an entrepreneur and visionary, and we look forward to using this gift and center as the springboard to improve the lives of those adults with allergies through immunotherapy that goes beyond oral therapy.”

Previously: Taking a bite out of food allergies: Stanford doctors exploring new ways to help sufferers, Ask Stanford Med: Pediatric immunologist answers your questions about food allergy research and Researchers show how DNA-based test could keep peanut allergy at bay

Medical Education, SMS Unplugged

When the white coat comes off: Is “medical student” a full-time profession?

When the white coat comes off: Is “medical student” a full-time profession?

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.

P1000878In our transition to medical school as first-year medical students, one significant part of our learning has been adopting the dress of the medical profession. Twice a week, in our first year Practice of Medicine course, we wear professional attire and don our white coats, the famous symbol of the medical profession. As we learn how to interview and interact with patients, the white coats encourage us to fully embrace our new professional roles as physicians in training.

At first, the strong symbolism of the white coat made me highly aware of the different roles and personas that we occupy as medical students. If the white coat symbolized my role as a professional, wearing a T-shirt and shorts to my developmental biology class symbolized something decidedly more student-like. In many ways, being able to take off the white coat and hang it up for the day was a convenient way to demarcate our different selves: our professional persona on the one hand, and our “normal” (and more familiar) role as students on the other.

Over time, however, I began to feel a shift in terms of what that my “normal” self was. As I spent more and more time practicing clinical skills that involved helping people to feel comfortable, respected, and cared for, it felt only natural to adopt these qualities in my daily life. After all, after devoting a great deal of effort doing the little things to help make the lives of our patients better, did it really make sense to stop putting in the same effort when interacting with the rest of the world, just because the white coat and badge came off? Is our role as physicians only to help the patients who are sitting in front of us, or should we be thinking about our impact on the well-being of everybody we interact with, from our faculty and staff to the person answering the customer service complaint line?

In some ways, this idea of adopting the professional persona full-time is a scary one. Work-life balance is one of the most discussed concerns among medical students, and many (if not all) of us have fears of our work dominating our lives and keeping us from important things in our lives such as family and friends. Because of this, I have a feeling that the separation that the symbolic white coat offers will become more and more important for us as our careers progress and we become more immersed in our work lives.

That being said, I also acknowledge that, as medical students, the professional persona can help us to consider our daily impact on the world around us, which just might influence the health and happiness of a few extra people each day. For now, then, I’m willing to admit that perhaps there is a little more value to taking our professional mindset home with us than I first realized.

Nathaniel Fleming is a first-year medical student and a native Oregonian. His interests include health policy and clinical research. 

Photo courtesy of Nathaniel Fleming

Nutrition, Parenting, Public Health

“Less is more”: More holiday eating tips from a Stanford nutrition lecturer

"Less is more": More holiday eating tips from a Stanford nutrition lecturer

cake-buffet-58682_1280My grandmother is fortunate enough to live within an easy drive of the Shady Maple Smorgasbord, a Pennsylvania Dutch-style dining extravaganza in Lancaster County. It’s the size of a large auditorium, packed with tables and two gigantic buffet lines. It’s the biggest restaurant, serving the most food, to the most people, that I’ve ever seen.

For dinner, each day the buffet includes: “46 salad bar items, 3 soups, 8 homemade breads & rolls, 4 cheeses, 8 meats, 14 vegetables, 10 cold desserts, 3 hot desserts, 8 pies, 6 cakes, sundae bar & many beverages.” Plus the daily specials. On Tuesday, for example, there’s also: “salmon, Cajun catfish, cod, oyster stew, beef brisket, New York strip steak and baked potatoes.”  A surfeit of tastiness, abundance beyond words — mmmm, mmmm, let’s go!

Not so fast, Stanford-based dietician, Maya Adam, MD, would say. “Size matters. We can enjoy absolutely any food, as long as its consumed in moderation,” she writes in a Healthier, Happy Lives Blog post, published today by Stanford Children’s Health.

That means no King Size KitKat and no seconds at the smorgasbord dessert line, either. Try using smaller dishes, Adam suggests. Cut servings in half, eat half, save some for later or share with a friend. And pay attention to the food. No texting, TV watching or mindlessly shoveling food into your mouth. Savor each bite, Adam writes:

The truth is, when we eat real, fresh food in modest amounts (even if it’s cooked with a pat of butter and a sprinkle of salt) it doesn’t take much to leave us feeling completely satisfied.

Don’t flip out if you just can’t resist that smorgasbord. But practice moderation — that’s the real way to think big about food.

Previously: Diabetes and nutrition: Healthy holiday eating tips, red meat and disease risk, and going vegetarian, Where is the love? A discussion of nutrition, health and repairing our relationship with food and “Less is more”: Eating wisely, with delight, during the holidays 
Photo by Hans

Cardiovascular Medicine, Events, Research, Stanford News

At Stanford Cardiovascular Institute’s annual retreat, a glimpse into the future of cardiovascular medicine

At Stanford Cardiovascular Institute’s annual retreat, a glimpse into the future of cardiovascular medicine

doctor listening to heartWhat will the future of cardiovascular medicine look like?

A group of scientists, engineers, educators, surgeons, physicians and students explored this question at the Stanford Cardiovascular Institute’s annual retreat earlier this month. More than 100 attendees crowded into Stanford’s Li Ka Shing Center for Learning and Knowledge to learn about the research and advances that will transform cardiovascular care.

“For this year’s retreat we’ve  asked selected members to dig deep into the past and project the future of their specialties,” institute director Joseph Wu, MD, PhD, told the audience.

Talks presented during the day – on topics including sports medicine, stem cells, women’s health and biodesign – reflected the breadth of the institute’s scholarship and the diversity of its members.

Stem cell scientist Hiromitsu Nakuchi, MD, PhD, spoke about recent advances in stem cell biology and regenerative medicine. Only a few years ago, stem cell-based regenerative medicine was widely perceived as the province of science fiction. No more, Nakuchi said. His lab has been working on a new technique to transform human skin cells into induced pluripotent stem cells, or iPS cells, which can then be used to develop organs. The ultimate goal of this research: To create genetically matched human organs in large animals.

Researchers like geneticist Michael Snyder, PhD, envision a day when an “omics” profile will be sequenced before birth, and Snyder took to the stage to discuss the potential of personalized medicine. “I’m a believer in the future,” he said. “Genomics will move medicine from diagnose-and-treat to predict-and-prevent.” After sequencing his own genome and thousands of other biomarkers to create an integrated personal omics profile, Snyder learned that he was at risk for Type 2 diabetes. This knowledge allowed him to transform his diet and ramp up his physical activity, and it provided him a first hand glimpse of the diagnostic power of genomics. Genomic sequencing has the potential to change the way physicians care for patients, Snyder told the audience, resulting in more effective, patient-tailored therapies and a greater focus on disease prevention.

Continue Reading »

Chronic Disease, Stanford News, Videos

A primer on preventing or delaying type 2 diabetes

A primer on preventing or delaying type 2 diabetes

Diabetes affects an estimated 29 million Americans, and one in four people don’t know they have the disease, according to the latest data from the Centers for Disease Control and Prevention.

Stanford Health Library recently held a three-part lecture series about preventing or delaying the onset of type 2 diabetes. A the first event, Stanford primary care doctor Bryant Lin, MD, shared with the audience that diabetes is “a topic near and dear to his heart” and that he deals with the disease “in both his personal life and clinical life.” Lin’s family medical history puts him at high risk for the disease: His mother, her six siblings and his maternal grandparents were all diagnosed with diabetes. On the clinical side, he treats diabetic patients at Stanford Health Care.

In the above video, Lin provides an overview of the epidemiology, pathophysiology, risk-assessment and diagnosis of diabetes.

This video is the first lecture in a three-part series addressing important questions related to diabetes and lifestyle choices.

Previously: Diabetes and nutrition: Healthy holiday eating tips, red meat and disease risk, and going vegetarian, Diabetes and nutrition: Why healthy eating is a key component of prevention and management and Examining the role of exercise in managing and preventing diabetes

In the News, Patient Care, Pediatrics, Stanford News

Fifty-plus years of Sunshine: Long-time Stanford neonatologist discusses his career

Fifty-plus years of Sunshine: Long-time Stanford neonatologist discusses his career

sunshineWith a name like Dr. Sunshine, parents should know their premature babies are in good hands. On yesterday’s Forum, neonatologist Philip Sunshine, MD, discussed the fifty-plus years he’s been caring for preemies. At 84, he’s still at it, working 30 hours in a step-down nursery at Lucile Packard Children’s Hospital Stanford. (He jokingly told host Michael Krasny, “I do all the stuff the young people don’t want to do.”)

During the hour, Sunshine, a 2015 “Legends of Neonatology” honoree, talked about the changing field of neonatology, including his views on the ever-growing popularity of home births (“Home deliveries are for pizzas only,” he quipped, referencing a pin his former classmate always wore). He also read e-mails and took calls from listeners – many of whom thanked him for saving their children’s lives (30,000 and counting).

Previously: Eightysomething “neonatology superhero” still at itA pioneer of modern-day neonatology and Neonatologist celebrates 50 years of preemie care
Photo courtesy of Lucile Packard Children’s Hospital Stanford

Mental Health, Stanford News, Videos

Workaholics vs work engagement: The difference is play

Workaholics vs work engagement: The difference is play

In a culture that places high value on “hard work,” we often lionize the wrong kind of work. A new study from the Journal of Management explores the difference between “workaholics” and “work engagement” – the former has serious negative consequences for health and social relationships, just like any addiction, while the latter actually has overwhelmingly positive effects. And when people are healthier and happier, they’re also more productive at work. Malissa Clark, PhD, one of the study’s authors, was quoted in UGA Today:

We see that there are two very different constructs. One is feeling driven to work because of an internal compulsion, where there’s guilt if you’re not working—that’s workaholism. The other feeling is wanting to work because you feel joy in work and that’s why you go to work everyday, because you enjoy it. And I say that is work engagement.

Stanford alum Brendan Boyle, MS, knows how to enjoy work, and teaches his audience in this Stanford+Connects video. The secret is play.

Boyle, who teaches at the d.school (School of Design), is an expert on the interaction between play and design thinking. He asserts that the opposite of play is not work, but boredom. Play is not frivolity, but a certain set of behaviors that can be incorporated into a multitude of tasks, whether at work or at home. Play can be, in a sense, a way of interacting with the world.

Watch the video to learn more – it ends with laughter.

Nutrition, Parenting, Pediatrics, Public Health

Tips on how parents with a history of eating disorders can enjoy the holidays

Tips on how parents with a history of eating disorders can enjoy the holidays

5294777976_8eb6ae86d9_zThe holiday season is often a joyful time when friends and family hit pause on their busy schedules to enjoy each other’s company. There’s also lots and lots of food involved, which can be challenging for parents with a history of eating disorders.

Recent research has found that parental eating disorders (either a past or current condition) are associated with numerous problems in child feeding, including difficulties in transitioning to solid foods and deciding which types of foods to offer and in what quantities. Studies observing the interactions of mothers with eating disorders and their young children noted greater conflict and more controlling behavior over eating, appetite, and food choices. Mothers with eating disorders often tell researchers and clinicians that their children’s troubling eating patterns are associated with their own eating habits, and shape and weight concerns  too often intervene in the decisions parents make in feeding their children.

Holiday celebrations can make these feeding relationships even more complex. Traditions of eating together with family or friends may create additional stress for parents. Additionally, family gatherings can reawaken memories of negative experiences parents may have had as children at the dinner table, adding another layer of worry and hyper-vigilance.

So what should parents with a history of eating disorders, or those concerned about their children overeating, do during the holidays? Here are some tips for having a more pleasurable and relaxing time:

  • Plan ahead: Talk to your partner about your concerns and come up with a strategy for how to cope with stressful situations around eating. Talk about what you’ll do if there is food on the table that you typically don’t eat, or if your child asks for second and third servings of foods. A rule of thumb should be to allow the child to experience a variety of food to a certain extent, as long as it doesn’t contradict any significant beliefs or preferences (such as non-kosher food).
  • Talk with your child before things get out of hand: Walk your child through the social gathering beforehand and discuss potential conflicts that may arise. The discussion should be appropriate to the child’s age. With children ages 2-3, parents could talk about the meal, mention that it will be probably very tasty, and set some limits. For instance, one could say that after dinner the child can have one or two desserts, but not more. With older children, parents should encourage autonomous eating based on the child’s regulation of hunger and satiety. This is an opportunity to discuss with children the differences between families, as well as your normal routine and special events. You should also discuss general boundaries and choices of your household.
  • Add fun activities that don’t involve food: Many celebrations and traditions revolve around food. To participate with your family in more neutral activities that are less nerve-wracking, parents should think of supplementary pastimes that all family members will enjoy. Shifting the focus away from the meal for part of the time can help parents “lower the volume” of their eating disorder when they spend time with their children.
  • Unwind: Despite being worried that loved ones will gain excessive weight during the holidays, parents should remind themselves that in a healthy-eating style, people don’t become overweight following a few specific meals. In addition, you should focus on the positive aspects of the social gathering for them and for their children – meeting family members or friends you may have not seen in a while, catching up with things you do not have time for during the year, and strengthening your relationships with your children. Before anxiety-provoking situations, parents should use any method of relaxation and stress-reduction that works for them and fits the context – have a long relaxing shower, drink a hot tea, listen to music, or stay away from the dinner table until the meal begins.

The holiday season can be a better experience for you and your family once you work through and resolve any concerns involving children’s eating.

Shiri Sadeh-Sharvit, PhD, is a psychologist and a visiting instructor at Stanford. She’s now recruiting mothers with a history of eating disorders to a parenting program study at Stanford. For more information contact shiris@stanford.edu.

Photo by Micah Elizabeth Scott

Research, Sleep

Holiday nightcap? Drinking before bed may be counterproductive

Holiday nightcap? Drinking before bed may be counterproductive

nightcap2

If you’ve ever taken a drink of alcohol before bed to help you fall asleep, you’re not alone – approximately 20 percent of Americans do so regularly. But new research from the University of Missouri shows that while a nightcap can make you sleepy in the short term, regular alcohol consumption before bed interferes with the body’s sleep regulator and can actually cause insomnia.

A study published last month in Alcohol helps us understand alcohol’s effects in a new way. It was previously thought that alcohol shifts the circadian rhythm, the body’s “internal clock,” resulting in simply being sleepy sooner; in fact, it disrupts the mechanism by which the brain “feels” tired. Alcohol increases the production of adenosine, a naturally occurring chemical that accumulates outside cells when you’ve been awake for a long time; it signals the need for sleep by blocking “wakefulness” receptors in the basal forebrain. Adenosine levels decrease during sleep, maintaining the brain’s sleep/wake homeostasis.

Alcohol-induced adenosine wears off too quickly, which makes for less restful sleep in the short term, and can compromise the brain’s ability to maintain homeostasis in the long term (i.e., insomnia).

I asked Stanford sleep expert Brandon Peters, MD, to weigh in and he told me:

I concur that alcohol should not be used as a sleep aid. Though alcohol may induce sleepiness, as it quickly wears off it fragments sleep, leading to awakenings. Alcohol also can relax the muscles of the upper airway and contribute to obstructive sleep apnea and snoring. It is recommended that alcohol not be consumed for the several hours preceding bedtime.

What to do instead? Peters suggests:

Rather than relying on an alcohol-containing nightcap, insomnia can be improved with changes as part of a structured cognitive-behavioral therapy for insomnia (CBTI) program. Sleeping pills are also not a preferred option; you don’t need medication to feel hungry, so why would you need medication to feel sleepy? Sleep is a natural process that can be enhanced with simple interventions. If difficulty falling or staying asleep persists beyond 3 months, assistance should be sought from a board-certified sleep specialist.

Photo by Stephen Janofsky

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