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Imaging, Ophthalmology, Research, Stanford News, Technology

Instagram for eyes: Stanford ophthalmologists develop low-cost device to ease image sharing

Instagram for eyes: Stanford ophthalmologists develop low-cost device to ease image sharing

eye-phoneThis probably won’t grab as many headlines as the news of a smartphone that wakes you up with the sizzle and smell of bacon, but it should!

A team of Stanford scientists is using 3D printing to create inexpensive adapters that make it easy to use a smartphone and an ordinary examination lens to capture high-quality images of the front and back of the eye. And – what seems to me as just as important – providing a nearly effortless way to share those images.

“Think Instagram for the eyes,” said one of the developers, assistant professor of ophthalmology Robert Chang, MD.

This is a big deal because most primary-care doctors have no good way to see into patients’ eyes, and no easy way to share the images. The usual eye-imaging instruments are expensive and hard to use, and even ophthalmologists who have the equipment and know-how find capturing and sharing the images slow going.

As one of Chang’s fellow developers, Stanford ophthalmology resident Dave Myung, MD, PhD, told me when I interviewed him for an article in Inside Stanford Medicine:

“A picture is truly worth a thousand words… Imagine a car accident victim arriving in the emergency department with an eye injury resulting in a hyphema – blood inside the front of her eye. Normally the physician would have to describe this finding in her electronic record with words alone. Smartphones today not only have the camera resolution to supplement those words with a high-resolution photo, but also the data-transfer capability to upload that photo securely to the medical record in a matter of seconds.”

The scientists describe the adapters, currently dubbed the EyeGo, in two articles in the new issue (volume 3, issue 1) of Journal of Mobile Technology in Medicine. And you can read my story to learn more about the development process, including how Myung pieced together the first prototype (with plastic bits he ordered from the Internet and a few Legos), how mechanical engineering graduate student Alex Jais created the first printed model on his own 3D printer, and how residents Lisa He, MD, and Brian Toy, MD, are leading studies to test them out.

Those interested in using an EyeGo adapter for research or beta-testing can e-mail the team at eyegotech@gmail.com.

Previously: Image of the Week: Sigmoid volvulus and Treating common forms of blindness using tissue generated with ink-jet printing technology
Photograph by Dave Myung

Cardiovascular Medicine, Research, Stanford News, Technology, Transplants

Mysteries of the heart: Stanford Medicine magazine answers cardiovascular questions

Mysteries of the heart: Stanford Medicine magazine answers cardiovascular questions

spring14_magazine-coverThe heart is a paradoxical organ. It declares its presence with that distinctive thump thump, yet its moment-to-moment condition is really hard to decipher. But as I learned while editing the just-published Stanford Medicine magazine special report “Mysteries of the heart,” new technologies and research are making it easier to assess heart health and diagnose disease. With heart disease the No. 1 cause of death worldwide, that’s good news.

The issue, published during American Heart Month, was supported in part by the Stanford Cardiovascular Institute. Among its contents:

  • A change of heart“: An interview with former vice president Dick Cheney on having “virtually everything done to me that you could do to a heart patient,” culminating with a transplant.
  • Fresh starts for hearts“: A feature on using stem cells to revolutionize cardiac care, and a family for which new treatments can’t come soon enough.
  • The ultramarathoner’s heart“: Visionary computer designer Mike Nuttall’s exploits as an ultramarathoner, despite having severe heart disease (online only).
  • Hiding in plain sight“: The story of a man born with high cholesterol — a surprisingly common but hidden and deadly condition.
  • Switching course“: A piece detailing the untangling of a heart surgery that saves babies, but threatens their lives in adulthood.
  • The heart gadgeteers“: A report on the new wave of heart- and fitness-monitoring devices, and why it’s hard to integrate them into the medical system.
  • Easy does it“: An article on an alternative to open-heart surgery to replace aortic valves.
  • Dear Dr. Shumway”: Catching up with a kid who in 1968 wrote to transplant pioneer Norman Shumway, MD, for advice — on his frog heart transplant.

The issue also includes articles on the use of big data in medicine, which will be the focus of the Big Data in Biomedicine conference May 21-23 at Stanford.

Previously: From womb to world: Stanford Medicine Magazine explores new work on having a babyFactoring in the environment: A report from Stanford Medicine magazine and New issue of Stanford Medicine magazine asks, What do we know about blood?
Illustration by Jason Holley

Medicine and Literature, Stanford News

Stanford Medicine magazine’s big reads of 2013

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The 10 most-read Stanford Medicine magazine stories published this year (as determined by pageviews on our website):

Almost without hope – Seeking a path to health on the Rosebud Indian Reservation: Tracie White’s report on life in one of the hardest places in America to stay healthy — the Rosebud reservation in South Dakota.

Labor day – The C-section comes under review: An article by Julie Greicius explaining the rise of C-sections and why a decrease in how often the procedure is performed should be around the corner.

Microbe computers – Built from the stuff of life: A feature by Andrew Myers on the creation of a computer made of biological molecules that can run inside our cells.

Blood, sweat and fears – A common phobia’s odd pathophysiology: John Sanford’s story about conquering blood phobia.

Against the flow – What’s behind the decline in blood transfusions?: Sara Williams explains the drop in transfusions — and why it’s good news for health.

Leo and Frida – The doctor and the artist: A feature by Catherine Reef on the friendship between artist Frida Kahlo and Stanford surgeon Leo Eloesser, MD.

Too deeply attached – The rise of placenta accreta: Erin Digitale describes the epidemic of placenta accreta and how this potentially fatal condition affected one family.

Roll up your sleeve – There’s still no substitute for blood: Jessica Shugart on why blood donation remains crucial.

In his blood – A doctor driven by hemophilia: Krista Conger profiles Holbrook Kohrt, MD, a physician who grew up with hemophilia and is dedicating his life to finding cures for life-threatening disease.

Priming the pumps – Debugging Dhaka’s water: Ruthann Richter tells how a trip to the slums of Dhaka, Bangladesh led to a radical solution for contaminated drinking water.

Previously: Stanford Medicine magazine’s big reads of 2012 and Stanford Medicine magazine’s big reads of 2011
Illustration (the cover of our special report “Blood at work”) by Renphoto

Pregnancy, Stanford News, Technology, Videos, Women's Health

Placenta: the video game

Placenta: the video game

Fetus-Placenta-copy-3

As I discovered while editing the new Stanford Medicine magazine report on childbirth, the placenta is a terribly important organ yet a big question mark for most people. To help demystify it we used a new kind of storytelling - an interactive simulation that allows you to observe and control the development of the placenta. It’s a companion to an article on the epidemic of the potentially fatal condition known as placenta accreta.

The producer, David Sarno, a former Los Angeles Times technology reporter and a 2013 John S. Knight Journalism fellow, built the simulation using the tools of video game design. It’s the first finished product of his start-up, Lighthaus, dedicated to creating interactive digital stories. If you’re curious about the placenta - or this new mixture of technology and storytelling - click on the image above to get to the video. (Note: To run the program you’ll need the Unity web player, which is free and downloads pretty quickly at the link.)

Previously: From womb to world: Stanford Medicine Magazine explores new work on having a baby, Touchable journalism technology helps to teach medicine, Species-specific differences among placentas due to long-ago viral infection, say Stanford researchers and The placenta sacrifices itself to keep baby healthy in case of starvation, research shows
Illustration by Bruce Rudolph/Lighthaus Inc.

NIH, Research, Science, Stanford News

A new era in scientific discourse? PubMed gets comments

A new era in scientific discourse? PubMed gets comments

typing - smallPubMed, the massive index of biomedical research articles, has begun an experiment: Enabling the posting of comments on the articles’ citations. This might not seem like a big deal, but in this case the comments system, PubMed Commons, is creating a buzz.

Some of the tweets following the Oct. 22 announcement: “PubMed Commons will change the way science works, but I predict a big impact on science bloggers as well” (@Neuro_Skeptic), “Science buzz and criticism gets a powerful boost” (@phylogenomics) and “Seriously get ready for a turbo-charged #PubMed (@AlbertErives).”

It was actually two Stanford professors - biostatistician Rob Tibshirani, PhD, and biochemist Pat Brown, PhD – who got the project rolling. I talked with Tibshirani for an article in Inside Stanford Medicine about the project’s beginnings and what he hopes it will accomplish. For starters, he sees it as a way for readers to note errors in the scientific literature in a place other researchers will see. But he also hopes it will generally expand scientific discourse and build community:

“Science can be lonely,” Tibshirani said. “Just having people talk about your work is nice. Sure it’s nice to have good comments. But it’s nice to have comments at all. At least someone cares enough to read your paper.”

For now, during this expanded pilot phase, only individuals who have published articles indexed in PubMed can make comments or see them. Tibshirani says he’s hopeful the leaders of the National Institutes of Health will decide to allow the general public to see the comments too. More on the how and why of the project as well as the quandary over anonymous comments (yea or nay) in the article.

For a fuller picture of the social media reaction, see this Storify created by Hilda Bastian, a blogger at Scientific American and an editor at the National Center for Biotechnology Information, the organization within the NIH that runs PubMed.
Photo by Mike Traboe

Research, Science, Stanford News, Videos

The key to speed? Inside a cell, it’s trigger waves

The key to speed? Inside a cell, it's trigger waves

Think of what you see in this video as a message going viral, only it’s spreading not in cyberspace but in cytoplasm. The video shows a trigger wave, an under-appreciated chemical phenomenon that can help cells get things done fast. Stanford graduate student Jeremy Chang and professor of chemical and systems biology Jim Ferrell, MD, PhD, published a video of this scene as part of their recent paper (subscription required) in Nature. The August 29 paper describes several lines of evidence all pointing to the conclusion that in frog eggs the dramatic dance of mitosis – in other words, the process of the egg dividing and forming two new eggs – is launched by trigger waves.

At the end of this post I’ll explain in more detail what’s happening in the video. But first I’ll answer the question: Why study how frog eggs divide? It’s not as odd as it sounds.

The eggs of these frogs (African clawed frogs or Xenopus laevis) are popular cells to study because, as cells go, they’re huge – about 1 millimeter in diameter – which makes them relatively easy to manipulate and observe. But of particular relevance for this study is a mystery Ferrell and Chang wanted to solve concerning mitosis. Mitosis in a frog egg happens way too fast than would be possible if it were orchestrated merely by proteins randomly diffusing hither and thither – which is how most people assume things work most of the time in cells. If only random diffusion were in play, mitosis in a big cell like this would take several hours, Ferrell said. But in reality it takes just 10 minutes. So something more is going on and that something, as Ferrell and Chang have shown, is the cell’s equivalent of going viral: trigger waves.

“It’s a physical process that takes place in lots of settings,” Ferrell told me. “The spread of a fire in a forest is an example of a trigger wave. The spread of an action potential from the body of a nerve to its axon is an example. Or a joke spreading through YouTube. The main ingredient you need for a trigger wave is positive feedback. It’s an autocatalytic process.”

To learn more about mitosis in the frog egg, Chang and Ferrell looked at the master regulator of mitosis, a protein called cyclin-dependent kinase 1, or CDK1. Activated molecules of CDK1 not only start mitosis, they turn inactive CDK1 molecules into active ones. In other words, there’s positive feedback, and the result is a trigger wave spreading CDK1 activity across the cell.

To scale up the trigger wave to make it easier to see, Chang whipped up an extract from the guts of many frog eggs mixed together. He also figured out how to get the nuclei in the extract to undergo mitosis over and over again – in this video, seven rounds, and sometimes up to 15. (Ferrell said Chang is legendary in Xenopus research circles for engineering such a massive multiplicity of mitoses. Chang said it was sheer luck: Switching from a glass tube to Teflon to hold the extract did the trick.)

The flashing green spots in the video are the nuclei undergoing mitosis: They disappear when the cell pulls itself apart and reappear when the division is complete. You can see trigger waves traveling from both the top and the bottom of the tube. Take a look at the topmost nucleus and you’ll see it blink off, shortly followed by its neighbor and so on down the line. The same happens if you follow the nuclei from the bottom up. The first cycle is a little messy but later rounds are clearer.

Continue Reading »

Research, Stanford News

Clues about kidney disease from an unexpected direction

Clues about kidney disease from an unexpected direction

Karlene Cimprich, PhD, is a Stanford professor who normally studies how cells keep their strands of DNA in proper working order. Her newly published research (subscription required) provides insights into the DNA repair process, but as a very interesting bonus it also turns up a new avenue for drugs to treat kidney disease. The unifying factor for these disparate discoveries is the mysterious antenna-like cellular structure called the primary cilium.

Most people don’t realize that nearly every cell in the human body has an antenna. Well it does, even though the rod-like projection was overlooked for decades after its discovery more than 100 years ago. An article I wrote in Stanford Medicine magazine explains:

The primary cilium is not a recent discovery. Swiss anatomist K.W. Zimmermann described the structure and suggested a sensory role in 1898, but other scientists largely ignored it. In later years it was written off as a quirk of evolution. The outburst of research over the past decade has revealed that the tiny projection is acting as the receiving station for cells’ signaling chains, the communication networks that govern and coordinate cell actions.

In the past two decades scientists have started paying attention to the primary cilium, and they’ve discovered not only its receiving-station role, but its importance for health.

Cimprich’s research started out having nothing to do with the primary cilium. About five years ago, Renee Paulsen, then a graduate student in her lab, launched a search for proteins needed to repair damage to a cell’s DNA. Another graduate student, Claudia Choi, assessed some of those proteins that were especially needed to repair DNA when the cells were stressed.

One of the big hits was a protein called NEK8.

A literature search revealed intriguing info about NEK8: It’s also faulty in certain kidney diseases — which are known to result in part from defective primary cilia.

This led Cimprich and her team to the work reported today in Molecular Cell: details of the molecular mechanism NEK8 uses to prevent DNA damage and clues to how NEK8’s malfunction relates to the primary cilium and kidney disease.

Continue Reading »

Emergency Medicine, Public Safety, Stanford News

“Preparation is everything:” More on how Stanford and Packard got ready for the Asiana crash

"Preparation is everything:" More on how Stanford and Packard got ready for the Asiana crash

blog crash pic 5 ed

“Preparation is everything,” said Stanford’s chief of trauma and critical care surgery, David Spain, MD, when I asked him about the breathtaking response by the Stanford and Lucile Packard Children’s hospital staff who helped care for the influx of Asiana Airlines crash victims July 6.

While reporting a story on the response for today’s Inside Stanford Medicine, it became apparent just how well the staff had prepared.

In the past year, they’ve participated in two large-scale mass-casualty exercises: One, an active-shooter scenario, was a statewide effort; the other, an earthquake scenario, was a joint training with Stanford University, Stanford University School of Medicine, Santa Clara County and Palo Alto.

Maybe most fortuitously, just last month as part of a Stanford Office of Emergency Management training program, every emergency department nurse completed training for triaging disaster casualties, and then on June 14, just three weeks before the crash, emergency management program managers Eric Giardini and Laura Harwood ran a simulation with the whole emergency department of “code triage” — exactly the scenario faced after the plane crash.

When I talked about that simulation with Brandon Bond, the administrative director of the emergency management office, he told me how valuable it proved to be: “They set up the patient triage system in the ambulance bay, deployed the triage disaster supplies as well as simulated patient triage. Every component that the team had exercised last month was utilized during the event July 6.”

Previously: After the plane crash: Inside the command center with Stanford Hospital’s chief of staffBehind-the-scenes look at treating SFO plane-crash survivors“Everyone came together right away:” How Stanford response teams treated SFO plane-crash victims
Photograph, of medical teams receiving patients at the Marc and Laura Andreessen Emergency Department, by Brandon Bond

Emergency Medicine, Global Health, Infectious Disease, Public Health, Stanford News

Factoring in the environment: A report from Stanford Medicine magazine

Factoring in the environment: A report from Stanford Medicine magazine

summer 13 cover blogIt’s right before our eyes: The water we drink, the air we breathe, our neighborhood — in other words, our environment — can make or break our health. This simple truth gnawed at Pulitzer Prize-winning investigative reporter/Stanford medical alum Sheri Fink, MD, PhD, as Hurricane Sandy approached New York City last fall.

As she writes in the new issue of Stanford Medicine magazine, a collaboration with the Stanford Woods Institute for the Environment:

The images of the hurricane spinning toward my city, and the knowledge that thousands of New York’s most fragile residents would be left in its path, in facilities that were not hardened to withstand significant flooding or power outages, made my stomach sink.

Fink’s article on heroics in New York City’s hospitals and nursing homes during Hurricane Sandy is part of the special report, Environmental impact: The health effect,” in this summer’s issue of the magazine, which has just been published.

Also in the issue:

  • “Water solutions:” Actor Matt Damon and engineer Gary White, co-founders of water.org, discuss how they intend to solve the global water crisis.
  • “Priming the pumps:” The tale of a trip to the slums of Dhaka that led to a radical solution for contaminated drinking water.
  • “Street smarts:” A feature on senior citizens using tablet computers developed at Stanford to wake up city officials to safety hazards in their working-class neighborhood.
  • “Close encounters:” A story on scientists who are combining data from satellite images and studies on the ground to grasp the ecology of disease-bearing pests.

This issue’s “Plus” section, featuring stories unrelated to the special report, includes:

  • “Leo and Frida:” The tale of the friendship between artist Frida Kahlo and Stanford surgeon Leo Eloesser, MD.
  • “Winnie’s tale:” The story of how a cancer treatment 30 years in the making came in the nick of time for centenarian Winnie Bazurto.

Previously: New issue of Stanford Medicine magazine asks, What do we know about blood? The money crunch: Stanford Medicine magazine’s new special reportThe data deluge: A report from Stanford Medicine magazine, Tens of thousands of children still affected by Hurricane Katrina, Pulitzer Prize-winner Sheri Fink: the final hours at New Orleans Memorial and Murky waters: A look at Memorial Medical Center after Hurricane Katrina
Illustration by Brian Cronin

Stanford News, Videos

Suspending Three Fold: Time-lapse video of a sculpture’s installation

Suspending Three Fold: Time-lapse video of a sculpture's installation

Over two long weeks in January, sculptor Alyson Shotz and team installed Three Fold, her new sculpture in Stanford Medicine’s Li Ka Shing Center for Knowledge and Learning. She got the job done with a team of art installation specialists from Atthowe Fine Art Services and DCM Fabrication. Together they assembled the sculpture’s three sections, covered the metal slats making up each section with thousands of acrylic pieces (with the help of more than 20,000 screws), peeled the blue protective film off the acrylic, mounted the sections on cables and raised them up.

This video shows those weeks compressed into less than five minutes.

The end result? As I wrote in Inside Stanford Medicine last week:

Sailing above the Yang and Yamazaki Lobby on the second floor of the center, the glimmering, undulating lattice appears lightweight and ephemeral — like a scaffold made of dragonfly wings. In reality, it weighs more than 3,000 pounds. The 56-foot-long sculpture, titled Three Fold, is actually made of curved aluminum slats covered on both sides with dichroic-acrylic-coated plastic. Though the acrylic is clear, it both reflects and refracts, resulting in a spectrum of iridescent colors that change with the angle and quality of the ambient light.

Previously: More than shiny: Stanford’s new sculpture by Alyson Shotz and Sculptor Alyson Shotz explores the relationship between art and science at Stanford

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