Published by
Stanford Medicine

Chronic Disease, Neuroscience, Parenting, Pediatrics, Research

High blood sugar linked to reduced brain growth in children with Type 1 diabetes

High blood sugar linked to reduced brain growth in children with Type 1 diabetes

Some areas of the brain grow more slowly in children with Type 1 diabetes than those without, according to findings published this week in Diabetes. Researchers also found that children with the highest and most variable blood sugar levels had the slowest brain growth.

Glucose, the main form of sugar in our blood, is the brain’s primary fuel, and in Type 1 diabetes, the body loses the ability to produce a key hormone needed to regulate blood sugar levels. Type 1 diabetes treatment for children has often focused on making sure their glucose levels don’t get too low, since very low glucose can quickly put someone into a coma. But it’s emerging that chronically-high sugar is also bad for the brain.

The better the glucose control, the more likely that a child’s brain development will be unimpeded.

The new study, conducted at Stanford and four other universities, tracked brain structure and cognitive function in 144 young children with Type 1 diabetes and a comparison group of 72 children without diabetes over 18 months. MRI scans showed that the brains of both groups of kids were growing, but gray- and white-matter growth was slower in several areas of the brain in the diabetic children.

“These studies provide strong evidence that the developing brain is a vulnerable target for diabetes complications,” the researchers wrote. The affected brain areas have a variety of roles, including visual-spatial processing; auditory, language and object processing; executive function; spatial and working memory; and integration of information from sensory systems.

I asked two of the paper’s Stanford authors for more thoughts about what they found.

“The magnitude of the group differences in brain growth over time was surprising,” said Allan Reiss, MD, the study’s senior author. “I actually thought these differences would be more subtle — they were not.”

Past studies have found cognitive and brain-structure changes associated with diabetes in older patients, but this research stands out because the kids included were so young — at the start of the study, their ages ranged from 4 to just under 10, with an average age of 7 — and because the study had a prospective design, following children forward in time. In addition to examining brain structure, the researchers also tested the kids’ cognitive function with standard tests of IQ, learning and memory, and mood and behavior, among others. They saw no significant differences in cognitive function between the two groups, a finding Reiss said did not surprise him.

Continue Reading »

Aging, Dermatology, Public Health, Videos

Don’t skip the sunscreen in wintertime

Don’t skip the sunscreen in wintertime

When you’re spending time outdoors during the wintertime, it’s easy to justify skipping the sunscreen when the sun isn’t beating down on you mercilessly and you’re bundled up instead of sporting a swimsuit. But UV rays from the sun can penetrate clouds and snow can reflect sun onto your face, hands and any other exposed skin. So it’s important to remember to take sun safety precautions even on cold or overcast days, too.

This  Stanford Health Care video featuring dermatologist Justin Ko, MD, MBA, includes important tips for preventing skin cancer year-round. As I, like many others, prepare for a family trip to Tahoe to take advantage of the recent snow, Ko’s reminder about sun safety habits during the winter comes at a good time. For example, I suspect I’ve been skimping on sunscreen: Ko says you need a shot glass-full to completely cover your body. If you’re using a spray-on sunscreen, you need to spray for a full 60 seconds.

Watch the video to learn more information about how to identify possible cancerous moles and preventing high-risk exposures, like tanning beds.

Previously: Skin cancer linked to UV-caused mutation in new oncogene, say Stanford researchers, Humble anti-fungal pill appears to have a noble side-effect: treating skin cancer, Skin cancer images help people check skin more often and effectively, and The importance of sunscreen in preventing skin cancer

Medical Education, Medical Schools, Stanford News

Stanford Medicine Music Network brings together healers, musicians and music lovers

Stanford Medicine Music Network brings together healers, musicians and music lovers

sarahkenricMore than 100 physicians, students and members of the Stanford community gathered last week at the Li Ka Shing Center for Learning and Knowledge for the inaugural concert of the Stanford Medicine Music Network.

During the event, Lloyd Minor, MD, dean of the medical school, told the audience, “It is so gratifying to be here this evening, and to see that musicians in the medical community have a means to continue to play and perform.” Music was a big part of Minor’s life in medical school and he played the cello in a musical trio that played at various events during that time.

The network was launched last year after Minor and Steve Goodman, MD, PhD, associate dean for research and translational science, discovered they both attended a 1976 cello performance by Yo-Yo Ma, who was then a student at Harvard. The shared memory inspired them to establish a musical home for the medical community. They joined forces with Audrey Shafer, MD, professor of anesthesiology and director of the Medicine and Muse Program, and Ben Robison, a medical student and professional violinist, and created the Stanford Medicine Music Network (SMMN, pronounced “summon”).

Among the goals of the network are to connect musicians for group practices, organize chamber music and string quartet groups and stage performances at Stanford and in the surrounding community in an effort to contribute to healthy communities.

The concert featured classical and contemporary music as well as a special gift presentation by Charles Prober, MD, senior associate dean of medical education, thanking medical student Kenric Tam and his parents, Carol and Kingsang, for their generous donation of a grand piano. The piano, which will reside outside Paul Berg Hall, will be available for events and members of the Stanford Medicine community to play.

As the program ended, Goodman noted in his concluding remarks that the word “summon” describes multiple aspects of what the network represents. “As musicians, we are summoned to perform, and this in turn summons those who care to listen,” he said. “As physicians and medical students, many of us are answering a summons we felt to care for others, and I think keeping music in our lives allows us to do a better job of that.”

Previously: Stanford’s Medicine and the Muse symposium features author of “The Kite Runner”“Deconstructed Pain:” Medicine meets fine artsStanford network launched to connect musicians, music lovers and What physicians can learn from musicians

Biomed Bites, Research, Videos

Using organic chemistry to decipher embryogenesis

Using organic chemistry to decipher embryogenesis

Here’s this week’s Biomed Bites, a weekly feature that highlights some of Stanford’s most innovative research and introduces Scope readers to scientists in a variety of biomedical disciplines. 

For decades, scientists were stumped by a tricky puzzle: How does a fertilized egg cell, nearly uniform, developed into an organism, with specialized cells and a vertical and horizontal axis?

Many experiments demonstrated that several signaling pathways — including one known as the Hedgehog pathway — establish gradients of certain chemicals in a developing organism, allowing cells to differentiate.

Puzzles remain, however. Is it possible to intervene in development gone awry? And, a more recent discovery showed the Hedgehog pathway is active in some cancers. Can that be reversed?

Stanford biochemist James Chen, PhD, uses the magic of organic chemistry to examine developmental pathways. Here’s Chen in the video above:

(We’re) trying to understand the molecular mechanisms that underlie embryogenesis. We view this through the lens of organic chemistry, meaning that we use small molecules that we synthesize to try to understand the processes that control the patterning of different parts of your body…

Using these tools we can figure out what genes are doing at what time to control the formation of complex structures.

The discoveries made by Chen’s team can then be used to develop therapies for a variety of disorders.

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

Previously: Zebrafish: A must-have for biomedical labs, Viva la hedgehog! Signaling protein also shown to be important in prostate growth and Another blow to the Hedgehog pathway? New hope for patients with drug-resistant cancers

Big data, Cancer, Cardiovascular Medicine, Fertility, Men's Health, Research, Stanford News

Male infertility can be warning of hypertension, Stanford study finds

Male infertility can be warning of hypertension, Stanford study finds

sperm graffitiA study of more than 9,000 men with fertility problems links poor semen quality to a higher chance of having hypertension and other health conditions. The findings suggest that more-comprehensive examinations of men undergoing treatment for infertility would be a smart idea.

About a quarter of the adults in the United States (and in the entire world) have hypertension, or high blood pressure. Although it’s the most important preventable risk factor for premature death worldwide, hypertension often goes undiagnosed.

In a study published today in Fertility and Sterility, Stanford urologist Mike Eisenberg, MD, PhD, and his colleagues analyzed the medical records of 9,387 men, mostly between 30 and 50 years old, who had provided semen samples in the course of being evaluated at Stanford to determine the cause of their infertility. The researchers found a substantial link between poor semen quality and specific diseases of the circulatory system, notably hypertension, vascular disease and heart disease.

“To the best of my knowledge, there’s never been a study showing this association before,” Eisenberg told me when I interviewed him for a press release about the findings. “There are a lot of men who have hypertension, so understanding that correlation is of huge interest to us.”

In the past few years, Eisenberg has used similar big data techniques to discover links between male infertility and cancer and heightened overall mortality, as well as between childlessness and death rates in married heterosexual men.

Eisenberg sums it all up and proposes a way forward in the release:

Infertility is a warning: Problems with reproduction may mean problems with overall health … That visit to a fertility clinic represents a big opportunity to improve their treatment for other conditions, which we now suspect could actually help resolve the infertility they came in for in the first place.

Previously: Poor semen quality linked to heightened mortality rate in men, Men with kids are at lower risk of dying from cardiovascular disease than their childless counterparts and Low sperm count can mean increased cancer risk
Photo by Grace Hebert

Applied Biotechnology, Stanford News, Videos

How Stanford researchers are engineering materials that mimic those found in our own bodies

How Stanford researchers are engineering materials that mimic those found in our own bodies

Modern medicine is quite good at replacing the mechanical functions of the body with prosthetics – which have been in development for the past 4000 years – but research into creating synthetic tissues that are biochemically functional is just beginning. Sarah Heilshorn, PhD, an associate professor of materials science and engineering, shares her research on engineering materials that mimic those found in our own bodies in this Stanford+Connects video, “Materials that Heal.”

Approximately 50 percent of the human body can be recreated; what are missing are systems that depend upon cells, such as the nervous or gastro-intestinal system. Scientists can keep cells alive in a Petri dish, but making them into functional tissue requires some kind of material to serve as an interactive cell-scaffolding. Heilshorn describes how her lab is producing protein-based synthetic material that effectively interacts with cells on a chemical and biological level. Watch the video to learn more.

Heilshorn heads the Heilshorn Biomaterials Research Group at Stanford.

Previously: The “new frontier” of synthetic biology, Drew Endy discusses the potential to program life and future of genetic engineering at TEDxStanford and Drew Endy discusses developing rewritable digital data storage in DNA

Aging, Cancer, Genetics, Research

Telomeres tell all about longevity and health

Telomeres tell all about longevity and health

10085714333_d8367dbe2a_oIf I were to go back to school for a PhD, I think I’d study telomeres. Telomeres, the protective caps at the end of each chromosome, shrink with aging and other stressors leaving an organism vulnerable to a various disorders and cancer.

So, telomere fan that I am, I was thrilled to sit in on a recent Psychiatry & Behavior Sciences Grand Rounds talk at Stanford featuring Elizabeth Blackburn, PhD. A professor of biology and physiology at the University of California, San Francisco,  Blackburn won the Nobel Prize in 2009 for her work on telomeres.

During the event, she gave the packed auditorium a whirlwind overview of telomere biology. Blackburn explained to attendees that telomere length is affected by both genes and the environment, and that some folks just start out with longer ones. Telomeres are maintained by an enzyme called telomerase. Slashing the amount of telomerase can cause early, immune dysfunction, cancer and diabetes. Some genetic telomere troubles manifest as disorders such as aplastic anemia or pulmonary fibrosis.

In general, telomere length correlates with what Blackburn called a “health span,” or duration of time someone stays healthy.

Recently she and colleagues measured telomere length in 100,000 people of all ages, a project they needed to develop a special robot to complete. They found that length of telomeres decreases into age 75. Then, it curves up to 95, accounting for the longevity of individuals with long telomeres. And yes, older women tend to have longer telomeres than older men.

Continue Reading »

Emergency Medicine, Medical Education, Patient Care, SMS Unplugged

Role reversal: How I went from med student to ED patient in under two minutes

Role reversal: How I went from med student to ED patient in under two minutes

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.

emergency sign - smallAs part of the second-year clinical skills course, each member of my class is required to complete two 8-hour Emergency Department (ED) shifts. I had my first ED shift last week, and when I walked in, I introduced myself as a second-year medical student who needed to practice IV placements, EKGs, and any other procedures that happened to come my way. Three hours later, when I walked out of the ED, staff knew me not as a medical student, but as a recently discharged patient, grasping paperwork with my official diagnosis: “syncope and collapse.”

It was 30 minutes into my ED shift, while I was watching a pelvic exam (ironic, given my post a couple weeks ago), when I began to feel a little dizzy. I’ve fainted twice before – once in high school after getting my blood drawn, and once when watching a C-section at a clinic in India – so I recognized the signs: feeling a little hot, starting to see black dots, slightly swaying. I tried to fight off the sensation by breathing slowly, but I could tell it wasn’t working. At the earliest possible opportunity, I turned to the attending in the room, saying, “Is it okay if I leave? I’m feeling lightheaded.”

I barely waited to hear her response before I bolted out of the room and found the closest stool to sit on. Bad call. The stool had no back to it, and next thing I knew, I was on the ground. When I opened my eyes, there were at least five  nurses around me, one whom matter-of-factly said, “Honey, you just became a patient.” Another nurse quietly slipped my hospital badge off my jacket, returning two minutes later with a medical bracelet that she fastened around my wrist.

My memory of those early moments is a little shaky, but I do remember saying over and over again, “I’m so sorry, I’m so sorry.” I felt awful that I had come to the ED to learn from the patients, physicians, and staff – without being a burden – but had ended up being another patient for whom they had to provide care. The nurses and attendings immediately normalized the situation, telling me repeatedly that this is a common occurrence in the ED and that many of them had had this happen to them as well. Their assurances made me feel so much better.

The efficiency of the events that followed totally impressed me. The nurse helping me to the bed did the fastest history on me I’ve ever heard, all while hooking me up to a BP cuff and a pulse oximeter. Did I have allergies? (Nope.) Did I  have diabetes? (Nope.) When was the last time I ate? (That morning). Any other medical conditions that I’m being treated for? (Nope.) Any family history of cardiac conditions? (Nope.)

The attending who was with me when I initially felt lightheaded came in at that point and asked, “Has this happened to you before?” and when I told her about the C-section, joked, “ObGyn probably isn’t your favorite thing, huh?” She then laid out the plan for what would happen next: an EKG, a glucose stick, and a blood test, to check for cardiac abnormalities, low blood sugar, and anemia, respectively. Within 30 minutes, all three of these had been done, and I even got a bonus ultrasound thrown in by someone who was practicing recognizing cardiac pathology (not that I had any). Noticing my scrubs and med student badge, this person took the time to show me each ultrasound image, pointing out the various heart chambers, valves, and the location where my IVC entered my right atrium.

By 2 PM, my tests were all back, everything was normal, and I was able to laugh about the entire situation: Somehow, I had come into the ED hoping to practice blood draws and EKGs but came out having them done to me instead. Just another day in the life of a med student.

Hamsika Chandrasekar is a second-year student at Stanford’s medical school. She has an interest in medical education and pediatrics.

Photo by zoomar

 

Nutrition, Obesity, Stanford News, Videos

Easy-to-follow tips to avoid overeating this holiday

Easy-to-follow tips to avoid overeating this holiday

‘Tis the season for overindulging. A recent report showed that we can easily consume 2,000 calories (or more) during a holiday dinner, particularly if the celebration includes appetizers and a few glasses of wine. As Neha Shah, a registered dietitian at Stanford, explains in the above Stanford Health Care video, overeating during this time of year is tied to many factors. She says, “There is so much food available at one given social setting that it’s easy to overeat and not realize it.”

There are simple techniques, however, that can help you resist the temptation to pile your plate high and go back for seconds. Watch the full video to learn easy-to-follow tips for making healthier choices this holiday season as you eat, drink and be merry.

Previously: “Less is more:” Eating wisely, with delight, during the holidays, Eat well, be well and enjoy (a little) candy, Learning tools for mindful eating and Enjoying the turkey while watching your waistline
Photo in featured-entry box by George Redgrave

Health Costs, Health Policy, Patient Care, Research

Spotting stellar primary care practices, Stanford study identifies 10 practices that lead to excellence

Spotting stellar primary care practices, Stanford study identifies 10 practices that lead to excellence

crutches-538883_1280Many of us know first-hand that expensive, substandard health care abounds in America. The problem has been analyzed and bemoaned, measured and critiqued. Solutions, bright spots and success stories are less abundant—in fact they are downright rare. That’s why recent findings from a partnership between Stanford’s Clinical Excellence Research Center and the Peterson Center on Healthcare, a new organization that aims to improve health care in the United States, are so exciting. Bucking current theories, researchers found that independent, primary care medical practices can provide superior care while saving money. And, they identified 10 principles these practices embrace, which distinguish them from their peers.

I had the chance to speak with CERC Director Arnold Milstein, MD, about the Stanford-based project:

What exactly did you do?

We examined the performance of more than 15,000 primary care practices looking for “positive outliers” or practices that provide excellent care at a lower cost. This is the first  systematic comparison of its kind and we weren’t sure we’d be able to discern any differences. But we did. We found a substantial difference in measures of quality and the total annual amount of health care spending between sites. Then, we arranged for  observers (independent physicians) to visit these offices to understand what was different about care delivery at sites associated with less spending and high quality scores.  They discovered 10 distinguishing features of successful health-care practices that were present much more frequently in these positive outlier practices than in other offices. There are some major differences in how they deliver care.

What were some these features? Did any surprise you?

About two-thirds align with current national initiatives such as Choosing Wisely and the Patient Centered Medical Home, but about one-third are new ideas.

The 10 features are not abstract ideas, they are tangible and therefore more easily transferable. For example, the higher-performing sites are ‘always on’ — patients can reach the care team quickly 24/7. I use the word ‘care teams’ because I’m not referring to physicians only. These teams include nurses, nurse practitioners, medical assistants and/or office managers, developed  to the highest of their abilities. These teams often treat conditions in a gray zone between primary care and specialist care. They follow up with their patients when a case is referred to a specialist. They check in with patients to ensure they are able to follow self-care recommendations.  Their work station is shared, so they can learn from each other. These teams adhere to systems to deliver care — choosing individual tests and treatments carefully. Distribution of revenues among physicians is not  solely based on service volume. Finally, these practices invest much less in office rent and costly testing hardware.

 

Continue Reading »

Stanford Medicine Resources: