Cancer successes are usually measured in months, not years. Large clinical trial on promising new treatments are celebrated when they show an average effect of a dozen weeks, and extension of life that can be measured in years is cause for rapture. So a new treatment that cuts down a high-risk cancer’s recurrence rate over a 2-year period by 20 percent is a major leap forward - even if the cancer is not among the most common types.

The cancer, in this case, is neuroblastoma, a tumor originating in nerve tissues outside the brain that predominantly strikes children under the age of 5. Though there are only 650 estimated new cases of neuroblastoma in the United States every year, that’s still enough for it to rank as the second most common solid tumor in children. While successful cures for low and intermediate-risk neuroblastoma cases have been found, roughly half of patients have a “high-risk” form of the disease that has only a 40 percent survival rate. That makes the new research, published today in the New England Journal of Medicine, the biggest advance in more than a decade for patients and families affected by the most deadly forms of the disease.

“Neuroblastoma is a rare pediatric cancer, but this is so, so, so, remarkable,” said Susan Cohn, professor of pediatrics at Comer Children’s Hospital and an author of the study. “To improve survival rates by 20 percent is fantastic.”

The treatment at the heart of the study is a form of immunotherapy, the drug strategy that seeks to recruit a patient’s native immune system to attack the tumor. An antibody against a protein expressed by tumor cells, called ch14.18, is the central prong of the three-drug therapy tested in the trial. Two other drugs, interleukin-2 and GM-CSF, are immune factors designed to help stimulate white blood cells to kill tumor cells. In the trial’s experimental group, this trio of drugs was added to the normal course of therapy for high-risk neuroblastoma, which includes surgery, chemotherapy, radiation, a transplant of the patient’s own stem cells to restore healthy blood cells, and retinoic acid.

Recruiting patients for the trial was a long and arduous process, Cohn said, due to concerns from patients’ families about trial randomization and side effects. Ten years of recruitment later, the study had enough power to be stopped — when analysis of the results showed an overwhelmingly positive effect of treatment, it was considered unethical to proceed. Patients in the control group were given the option of switching to the immunotherapy, and new patients were enrolled in a non-randomized trial to continue assessing long-term effects of the treatment.

Understanding the toxicity of the treatment is especially important, as the initial trial revealed a suite of side effects that accompanied the substantial benefits. Pain, reduced blood pressure, fluid in the lungs, and other adverse effects need to be closely watched by health professionals during the treatment, Cohn said.

“It’s not an easy therapy; there are lots of side effects and patients must be monitored carefully while they are receiving treatment in the hospital,” Cohn said. “If it hadn’t shown a clear advantage, we would no longer do it.”

read more

Dr. William Dale talks with a patient in his geriatrics clinic (photo by Bart Harris)

Creating a new research field doesn’t happen overnight. It requires bringing together like-minded researchers willing to push out into the unknown, funding agencies willing to be convinced that the new field is worth of grant dollars, and some semblance of an overall plan so that those efforts and dollars are put to optimal use. Soldering together a new field out of two existing fields can save some of the groundwork, but also creates its own set of obstacles, as representatives from each pre-existing discipline maneuver for common ground with their colleagues from across the fence.

The very young field of geriatric oncology, the study of cancer and cancer treatments in the elderly, has already jumped some of those hurdles. Most importantly, the field has a very good reason to exist, as cancer is primarily a disease of the elderly, and the U.S. population is growing increasingly older as baby boomers reach retirement age. Clinics focused on the care of elderly patients with cancer have sprung to life, including the SOCARE Clinic at the University of Chicago Medical Center. Yet there remains a void of knowledge about how cancer forms, grows, and can potentially be cured in older patients, due to clinical trials that enroll primarily younger subjects. Filling that void - and creating a field to do so - was the focus of a two-day conference last weekend at the Hilton O’Hare, where 50 members of the newly-formed Cancer & Aging Research Group discussed the fine details of how best to proceed.

Two numbers presented by NYU’s Daniel Gardner and echoed by several others demonstrated the need for geriatric oncology research: 61 percent of new cancer cases occur in people older than 65, but only 25 percent of patients on cancer clinical trials are from that age group. What’s more, the elderly that do make it into trials of new drugs and therapies are a special breed - “Olympic athletes” that meet strict enrollment requirements designed to pick research subjects that are largely free of co-morbid health conditions beyond their cancer. That leaves physicians in the dark about how to treat less healthy elderly cancer patients, with no evidence to guide their treatment decisions.

“For the vulnerable and frail adults, there’s so little data…it’s a really big population that’s coming to the clinic right now, where almost every patient I see I don’t have the right kind of evidence for,” said Supriya Mohile from the University of Rochester, who organized the conference with Arti Hurria from City of Hope Hospital in California and William Dale, section chief of geriatrics and palliative medicine at the University of Chicago.

One central question of the conference was whether to remedy that shortage by designing clinical trials specifically for older patients or by lobbying clinical researchers to include more elderly subjects in trials. Both solutions hinge upon improving recruitment rates for elderly patients, the burden of which often falls on the researchers themselves. In a talk titled “We Have Met the Enemy, and it is Us,” University of Chicago assistant professor Blase Polite showed data from several studies showing that patients older than 65 are typically half as likely to be offered an experimental cancer treatment. When elderly patients are offered the chance to enroll in a clinical trial, they are as likely - if not more so - as those under 65 to say Yes, he found.

The gap in enrolling elderly patients in clinical trial may stem from a larger problem of physician-patient communication, many presenters argued. Decisions about cancer treatment are certainly different for a 45-year-old vs. a 75-year-old, and a patient’s weighing of treatment side effects, quality of life, and the chance of a cure may change with age. But as Northwestern’s Linda Emanuel argued, physicians need to better understand that internal calculus for elderly patients facing the possibility of death.

“[There are] gratifications that are unique to those that are facing the end of life, through age or through cancer or through other terminal conditions,” Emanuel said. “What is that kind of wellbeing? I don’t think we know, we in the research field. We don’t have measures for it and we don’t have methods for it.”

read more

Covering medical research for the University of Chicago, one hears a lot about racial health disparities and the efforts to narrow those gaps. But some statistics still pack a punch, and Otis Webb Brawley’s talk at the University of Chicago last Thursday contained several left hooks. The five-year risk of death after diagnosis with breast cancer is almost twice as high for black women as for white women - but 30 years ago, the risk was nearly equal. An uninsured patient with stage 1 colon cancer is more likely to die from their disease than an insured patient with the more-dangerous stage 2 colon cancer. Obesity in children has risen five-fold since 1970, and obesity is expected to pass cancer as the #1 cause of cancer by the year 2030…if it hasn’t already.

In Brawley’s role as chief medical and scientific officer for the American Cancer Society, it’s his job to use these statistics to make clear arguments to scientists, physicians, politicians, and laypeople about what must be done to reduce cancer disparities. But Brawley’s talk for the Bowman Society Lecture Series (named for retired professor, and former teacher of Brawley at the Pritzker School of Medicine, James Bowman), was distinctly not about just throwing money at the problem. His central philosophy was “equal treatment yields equal outcomes among equal patients” - but sometimes, deciding what that equal treatment should be is the hard part.

Brawley took care to set his talk in the context of spiraling health care costs in the United States, showing the now-familiar graph plotting our highest-in-the-world health care spending against the country’s mediocre life expectancy. Racial disparities could explain part of those poor returns on US health care spending, but Brawley put the focus on “faith-based medicine” - not health care based on religion, but care (and associated spending) based on assumptions about what works rather than hard evidence. As an example, Brawley cited the practice of chest X-ray screening, considered by physicians in the 1960’s to be a necessary routine procedure for the detection of cardiopulmonary disease. But clinical trials found that these screens caused more harm than good, through increased rates of lung cancer and over-diagnosis.

“We did all those things because we thought we were doing the right thing, but we didn’t do rigorous assessment before we started doing them,” Brawley said. “So I ask the question: are we willing to be scientific and accept scientific realities? There are things that we do that add to the incredible cost of health care, but make no difference in outcome.”

That tough talk should apply equally to the problem of reducing health disparities in minority populations, Brawley emphasized. While some pursue the genetic risk factors that may explain disparate rates of disease in minorities, Brawley argued that socioeconomic factors were a much bigger target for intervention. A 1998 study that compared the breast cancer mortality gap in the general population versus women in the U.S. military medical system (who receive free health insurance and easier access to hospital care) found that the gap was still there, but almost two-thirds smaller. The other third could be genetics, Brawley conceded, but the more significant - and, in his view, easier to fix - factors were social and economic.

read more

In 1994, Italy’s Roberto Baggio was widely considered to be the best soccer player in the world. Having led his country to the final of the World Cup, played before over 100,000 people in the Rose Bowl, Baggio was the obvious choice to take his team’s critical fifth penalty shot in the shootout that would determine the championship. All he had to do was kick the ball past the goalkeeper from 12 yards away, something a star such as Baggio could probably do in his sleep. But at the biggest moment on the biggest stage in world sports, he flubbed it, skying his penalty shot over the crossbar and giving Brazil the World Cup.

Sportswriters and fans love to label such failures as abstract incidents of “choking,” and worse, often use them as evidence of an athlete’s lack of character and resolve. But research from the lab of Sian Beilock, associate professor of psychology at the University of Chicago, has found that choking actually results from information overload in the brain, with active thought overwhelming the more reflexive working memory. That research is the centerpiece of her new book, called  Choke: What the Secrets of the Brain Reveal About Getting it Right When You Have To, released just this week.

ScienceLife has written about Beilock’s research in the past, when her laboratory looked at how hockey players’ brains process active language differently from non-athletes. But Beilock hasn’t restricted herself to the NHL; she’s also invited golfers into the lab for putting experiments and tested how the attitudes of female teachers toward math affects the performance of their female students. Taken together, her work is less about the sports fans’ concept of “choking” and more about how external and internal factors keep the brain from performing optimally, knowledge that you don’t have to be a world-class soccer player to use.

Coverage of the book has run this week at Time, US News & World Report, and NPR.

Elsewhere…

An experiment published in Science this week demonstrates a central tenet of Einstein’s theory of relativity, by showing that a clock on the floor runs slightly slower than a clock one meter above it. Wired and Discover both offer blogs explaining why that’s important for everything from clock calibration to air travel. Quote the paper’s first author in Wired: “It’s interesting to think about - are frequent flyers getting younger [because they move so much] or aging faster [because they spend so much time in the air]?”

How has mad scientist research changed over the years? Gawker blog io9 made a graph.

The MacLean Center for Clinical Medical Ethics at the University of Chicago is oldest such program in the United States, has trained scores of physicians in ethical matters, and administers an excellent seminar series that has provided ample material for this here blog. Mark Siegler, the center’s first and so far only director, will receive a lifetime achievement award next month from the American Society for Bioethics and Humanities.

Just twenty years ago, there were no therapies available for the management of multiple sclerosis. Physicians could give patients drugs to try and blunt the damage caused by the disease’s intermittent attacks on the central nervous system, but no therapies had been proven effective at preventing those attacks. That changed in the mid-90’s, when successful studies and clinical trials led to the approval of interferon therapies, immune system modulators that block the autoimmune response responsible for MS attacks.

Interferon therapies have since multiplied, and other MS treatments have come to market. But each of these approaches have side effects, must be delivered by injections, and don’t work in every patient. Today, the FDA approved a sixth MS therapy, called fingolimod - the first protection against MS attacks available as a pill. Experts welcomed the decision, saying it would give neurologists a valuable new weapon in the fight against multiple sclerosis.

“This is the first pill for multiple sclerosis,” said Anthony Reder, MD, professor of neurology at the University of Chicago Medical Center. “We have six drugs right now, and they all involve injections. So the convenience alone of a pill is a major change in how we treat MS. It also expands the drugs available to treat MS, and may get some people who can’t take the other medicines. It will be used to replace drugs that are failing and possibly for new starts in some people.”

Fingolimod, code-named FTY-720 in trials and soon to be released by drug company Novartis as Gilenya, took a strange route to the clinic. The drug is based on a type of fungus, originally discovered in the intestines of wasps by Japanese researchers. Observing that the fungus secreted a chemical with the natural ability to suppress immune responses, scientists refined the chemical into a drug intended for use in people receiving transplanted organs. The eventual clinical trials for that use failed, but a secondary use presented itself: neutralizing the immune system attacks in multiple sclerosis patients.

This time around, the clinical data was much more successful. The results of two large Phase III clinical trials published in the New England Journal of Medicine in February showed exciting effects - a roughly 50 percent decrease in attacks in patients treated with fingolimod relative to patients receiving placebo or interferon therapy. MRI images also showed that fingolimod-treated subjects had fewer brain lesions, signs of progressive, permanent damage caused by MS attacks. Some side effects were observed, such as a transient decrease in heart rate after the first dose and a slight uptick in the number of infections, and experts said those will need to be monitored as the drug reaches a wide population.

“As always with these drugs, the people in study were a restricted group of patients with no cardiac disease, no diabetes, no pulmonary abnormalities,” Reder said. “When we go out into the real world, we have to be more conscious of potential side effects and interactions with other conditions.”

read more

In recent weeks, stem cell research has once again been drawn into a battle over political, ethical, and legal questions. Given all the controversy, it’s easy to forget that there are still many scientific questions surrounding stem cells and their potential for medical use. The ability of such cells to grow into different types of organs and tissue is exciting, but harnessing that ability has remained a challenge for scientists. Much work remains to be done in finding the control panel for pushing stem cells in a particular direction - and some of that work continues despite recent court rulings.

Mesenchymal stem cells are less controversial than their embryonic cousins because they can be harvested from adult bone marrow. But they are also more restricted in their potential, with their future limited to three destinies: bone, fat, or cartilage. Of course, those three fates alone would be very useful in medicine, with applications for orthopedic surgery, arthritis, and wound healing. So scientists are looking for the best ways to manipulate mesenchymal stem cells (MSCs) toward one of those forms.

In the laboratory of Tong-Chuan He, associate professor of surgery at the University of Chicago Medical Center, the desired outcome for mesenchymal stem cells is bone.

“Our goal is try to develop an efficient way to promote cells to making bone,” He said. “Ideally, we can create a treatment where we don’t have to use protein, deliver genes or modify cells. It can be a form of cell-based therapy.”

He and colleagues tested different growth factors from the appropriately-named bone morphogenetic protein (BMP) family on the basis of their ability to drive stem cells to become bone. The majority of research and therapy development focused on two members of the family, BMP2 and BMP7. But a 2007 study by He’s lab found that a neglected underdog, BMP9, was the real heavy hitter in pushing stem cells into a career as a bone cell.

But identifying BMP9 only gave researchers the key to bone differentiation, and it was necessary to find the lock as well. A new paper published by He’s lab last month in the Journal of Biological Chemistry, in collaboration with a team of Chinese researchers, tested out different receptors for BMP9 to determine which were critical for bone differentiation. The team tested a series of type I receptors (ALK1 through ALK7) to see which ones helped BMP9 drive MSCs - harvested from adult and embryonic mice - to become bone.

read more

Studying a disease using an animal model is not as simple as merely replicating it. For instance, a variety of techniques have been used in animals to simulate the neurological disorder multiple sclerosis, where the protective myelin sheath that wraps around neuronal axons is lost, but each method has its advantages and disadvantages. Scientists have used toxins to directly damage myelin, but the effects are unpredictable and hard to control. Triggering an autoimmune response against myelin imitates the true biological mechanism of MS, but the immunological and neurological effects are difficult to separate.

Because Brian Popko, professor of neurology at the University of Chicago Medical Center, is interested in how to remyelinate neurons that lose their myelin sheath, a different model was required. What if you could create a mouse where the myelinating cells, called oligodendrocytes, die off on command, producing a more controlled demyelination independent of immune system effects? Such a model would allow for studies of how the nervous system responds to demyelination, and how it may recover - information that could be valuable for developing and testing new drugs for MS.

In a paper published today by the journal Brain, Popko’s group describes just such a mouse. Years of genetic engineering and selective breeding have produced a new mouse model where researchers can trigger demyelination, and then watch closely as the mice develop the telltale signs of neurological disease: muscle tremors, difficulty walking and staying upright. But incredibly, in a matter of weeks, most of the mice have recovered, exhibiting motor behavior indistinguishable by the naked eye from normal mice. The central nervous system (CNS) mounts a natural comeback - and the next step is to figure out how.

“The one thing that this model shows without question is that the central nervous system has an extremely robust potential to remyelinate,” Popko said. “We’ve pretty much wiped out all CNS myelin, and yet it recovers, the mouse comes back to normal.”

From start to finish, the mouse’s brush with neurological disease is about 2-1/2 months long. Each mouse is bred with a genetic “sleeper agent” - the toxin diptheria, known in humans as a source of upper respiratory illness. Popko’s laboratory devised a way to place a dormant diptheria toxin inside oligodendrocytes, a weapon that only switches on when the mouse is injected as an adult with a common drug. Within three weeks, the oligodendrocytes have been wiped out, and the mouse’s axons are left without their protective myelin. At five weeks, the mouse shows severe neurological symptoms, completely unable to run on a treadmill test called the Rotarod. But five weeks later, the mouse is able to log-roll the Rotarod as well as normal mice, and microscopic pictures find that their axons have a new, albeit thin, coating of myelin.

Videos of the mice before and after recovery can be seen at the Myelin Repair Foundation, a non-profit organization that helps fund Popko’s research.

“If you look at these videos, it explains why the Myelin Repair Foundation exists,” Popko said. “A mouse without myelin is very sick, while the mouse who has gone through myelin repair is doing quite well.”

read more

Many people take pride in never missing a day of work, and fighting through what they perceive as a minor illness to put in a full shift at the office. But what if your office is a hospital ward? Doctors who show up for work sick run the risk of spreading their illness to patients, further complicating their health issues. But with the tight schedules and long hours of the hospital, there’s even more pressure to get out of bed and fight through your sniffles (or worse).

Medical residents, physicians in their first few years out of medical school, have the tightest schedules and longest hours of all, and a study by University of Chicago and Massachusetts General Hospital researchers found that population to be especially guilty of “presenteeism.” In the wake of last year’s H1N1 flu epidemic, concerns about this bad habit have grown, and Vineet Arora, Anupam Jena and colleagues surveyed residents from 12 medical centers. In a study published in the Journal of the American Medical Association, they found that 60 percent of residents surveyed showed up to work sick at least once in the academic year 2008-09.

“Hospitals need to build systems and create a workplace culture that enables all caregivers, not just residents, to feel comfortable calling in sick,” Arora said of the results. “Their colleagues and their patients will thank them.”

See coverage at CNN, Scientific American, and AP.

Elsewhere…

How many species bear your name? If your name is Robert F. Inger, the answer is more than 50, ranging from Calamalaria ingeri to Ingerna charlesdarwini. That’s the kind of list you rack up when you’ve spent seven decades studying amphibians and reptiles in Borneo, Thailand, Malaysia, India, and China. Last week, Inger - a graduate of the University of Chicago and curator emeritus at the Field Museum in Chicago - celebrated his 90th birthday, and his colleagues put together a website to celebrate the occasion.

The official opening of the University of Chicago Center in Beijing was celebrated this week, a space designed to foster collaboration between our faculty and Chinese researchers and experts. As this feature describes, many such partnerships are already underway, including the AIDS education efforts of professor of medicine Renslow Sherer and fossil-hunting projects by paleontologist Paul Sereno. By a stroke of luck, ScienceLife will write about another Sino-UofC research collaboration next week - stay tuned!

Our contribution to President Obama’s Commission for the Study of Bioethical Issues, physician/bioethicist/friar Daniel Sulmasy, was profiled in the Chicago Tribune.

Another genetic sequencing race, this time between…Mars and Hershey’s? The Snickers maker struck the first blow with Wednesday’s online public domain publication of the Cacao Genome Database, while a group funded by Hershey’s hopes to publish their sequence in a journal soon. The competition is both delicious and beneficial, experts said, and may someday yield more efficient cocoa famring as well as chocolate that is both healthier and better-tasting. Yes, please.

Regular readers of the New York Times Magazine are familiar with Diagnosis, Dr. Lisa Sanders’ long-running column of medical mysteries. With false leads, twists, and surprise endings, these hospital narratives are typically as suspenseful as a Raymond Carver story, or perhaps more appropriately, an episode of House. The subject matter of these mysteries are usually what doctors call “fascinomas,” unusual and odd maladies that one rarely, if ever, encounters in the clinic. But in this past Sunday’s installment, which featured the Medical Center’s John Henning Schumann, how a particular fascinoma was diagnosed was just as interesting as the diagnosis itself.

The story, in a nutshell: a 40-year-old friend of Schumann’s was suffering nightly fevers of unknown origin, and doctors were stumped. A multitude of tests found nothing out of sorts, save a non-cancerous mass in the patient’s liver that appeared to be a hemangioma - a cluster of blood vessels. Hemangiomas don’t typically cause fevers, so the patient’s doctors were unsure whether to perform the major surgery required to remove the mass from the patient.

And then: the internet! Amid his doctors’ uncertainty, that patient (an internet expert) and his significant other decided to start a blog about the medical mystery in which he found himself the central character.

“They had a huge social network of very over-educated people, many doctors, many not, but people connected to doctors,” said Schumann, an assistant professor of medicine. “Their attitude was let’s put it out there and see what they think.”

Schumann, a concerned observer from afar, posted a link to his friend’s blog on his own blog, Glass Hospital, and the story was picked up by Kevin Pho, founder of the popular medical blog KevinMD. Pho’s post drove traffic to the patient’s blog, where doctors left comments with diagnosis suggestions and links to published obscure case reports similar to his ordeal.

The commenters’ consensus - that the hemangioma was the likely cause of the symptoms and should be removed - agreed with the eventual, independent assessment of the patient’s doctors. But Schumann said in an interview with ScienceLife that the process was still helpful to his friend, if mostly in a psychological sense.

“I don’t think it necessarily solved the case, but I think it might have expedited it slightly, and it provided a ray of hope,” Schumann said. “For a guy who is web-savvy, it gave him a level of comfort that I don’t think all the medical specialists in the world could provide.”

read more

Endoscopy and colonoscopy are well-known tools of the physician, minimally invasive devices that navigate the channels of the digestive system to spot cancers, ulcers, and other defects once difficult to spot without major surgery. In the shadow of these procedures lies bronchoscopy, which uses similar technology to explore the labyrinth of the lungs. With the flexible tube of the bronchoscope, a pulmonologist can detect potentially cancerous lesions, take samples for pathological testing, help remove dangerous nodules, and apply heat or install valves to help treat asthma and emphysema. We discussed this exciting new world of bronchoscopy with D. Kyle Hogarth, assistant professor of medicine at the University of Chicago Medical Center and an expert on the field. Hogarth discusses the basic warning signs and risk factors for lung disease, talks about the innovative new bronchial thermoplasty treatment for severe asthma, and gives an overview of how bronchoscopes help physicians locate and remove lung cancers.

read more

The human body is not just an organism, it’s an ecosystem. To the billions of microscopic bacteria, viruses and fungi living in the various nooks and crannies of our intestines, mouth, nose, and other areas, we are the world, the environment that drives their evolution. Though scientists and physicians have long known that humans are housing projects for a wide array of species, research on the clinical impact that microscopic population exerts upon its host is just starting to establish momentum. Many researchers are now exploring links between what’s become known as the “microbiome” and everything from infectious disease to diabetes and obesity to psychiatric disorders.

An official seal of approval was stamped on to these efforts by the National Institutes of Health in 2008, with the announcement of the $157 million “Human Microbiome Project.” Tuesday, the project was given another $42 million bolus of funding, $1.1 million of which went to a team of University of Chicago and Argonne National Laboratory scientists. But research into the microbiome is already yielding interesting results on the world inside your gut, and how it is affected by diet from the very start of life.

The debate over giving babies breast milk or formula has swung like a pendulum since the mid-20th-century, with medical societies now endorsing breastfeeding infants whenever possible. Studies have shown that breastfeeding has advantages in protecting infants from infection and disease and provides essential, easily-digestible nutrients. But what is the biological basis for breast milk’s superiority? Scientists have speculated that it has to do with the effect of diet on the microbes of the gut. In a paper published last month at PLoS ONE, Michael Morowitz, assistant professor of surgery and pediatrics at Comer Children’s Hospital, sought to test that hypothesis with the latest genetic technology.

Morowitz was drawn from surgery to microbiology after witnessing the damage caused by a frightening infant disease: neonatal necrotizing enterocolitis (NEC). Seen often in premature babies, NEC causes intestinal inflammation that can require surgical removal and may lead to lifelong complications or death. As the surgeon on such procedures, Morowitz said he became interested in ongoing research on how to reduce the number of NEC cases.

“You say to yourself, ‘How can you prevent it?’ The literature tells you there aren’t many ways other than supporting breast milk usage,” Morowitz said. Others had proposed a link between breast milk, gut bacteria, and protection against NEC, but until recently the technology did not exist to take a full census of the microbial world, he said.

For the PLoS ONE paper, Morowitz and his team decided to study the effects of breast-milk versus formula on the microbe population in the intestines of piglets. By recording a “transcriptome” - a snapshot of gene expression - from the intestinal fluid of the piglets, Morowitz’s team could detect which bacterial species were present and active in the two groups.

read more

A “hunchbacked” dinosaur is found in Spain, and the University of Chicago’s dinosaur expert Paul Sereno was available for comment. As Nature News points out, the interesting thing may not be the large hump on its back, but the tiny bumps on its arms, which suggest the presence of feathers long before they were predicted to have first appeared. But um, no, I’m pretty sure it doesn’t raise questions about whether humans and dinosaurs lived together.

Researchers at Argonne got to test the entries for the Automotive X-Prize, the contest to design an extremely energy-efficient car that gets the equivalent of 100 miles per gallon. See pictures and read a bit of commentary on some of the candidates from Argonne mechanical engineer Mike Duoba at Wired.

If you thought medicinal marijuana was controversial, try to wrap your head around the small study (only 12 patients) that found a benefit of psilocybin - the ingredient in “psychedelic” mushrooms - for reducing anxiety in cancer patients. The finding reflects a renewed interest in studying the possible clinical uses for psychedelics, a topic ScienceLife discussed in the context of the drug ecstasy last year. See also the recent Nature Neuroscience Review article about what is currently know about how psychedelics affect the brain, and how those effects might be harnessed for the treatment of mood disorders.

Comer Children’s Hospital nurse Tiffany Cupp was on Chicago Public Radio last week talking about her experiences offering medical relief in Haiti. If you prefer video to audio, we spoke with her about the experience earlier this year.

It seems as though every media outlet has run at least one “Is technology changing our brains?” story in recent months, most of which have come under heavy fire from science bloggers. But here’s a good summary, found via MindHacks, of what we really know and don’t know about how video games, computers, and so-called “brain games” actually affect the way our brains function. It’s written by a team of cognitive scientists including Daphne Bavelier, who actually studies the effect of playing video games on vision and attention.

Personalized genomics sites like 23andme are old news now, but this article in Nature Medicine profiles several ventures taking it to the next level, with sites organizing volunteer DIY genomics research projects.

There’s a lot of interesting angles to the New Yorker’s profile of Francis Collins, but what might be most interesting to some readers is how it opens the lid slightly on the workings of the National Institutes of Health, a $31 billion a year agency.

Last week, a multi-center study published in JAMA demonstrated the value of genetic testing for breast cancer risk, a simple test that allows women the choice of preventive surgery. The study and the accompanying editorial urged wider screening of women for the variants of the BRCA1 and BRCA2 genes that can create as much as ten times the risk of contracting breast cancer. But while a test for these risk variants has existed since the mid-1990s, only a fraction of women (and men) carrying the high-risk mutations have been identified. Some have blamed Myriad Genetics, the owners of the controversial patent on the BRCA 1 and 2 genes, for this shortfall. But what if a major contributing factor is something far less legally complicated: a physician’s finite time?

The average assessment of a patient’s genetic risk can take anywhere from 70 to 170 minutes, said Kevin Hughes, surgeon at Massachusetts General Hospital, who spoke to the University of Chicago Breast Cancer SPORE program Tuesday afternoon. Interviewing a patient about their symptoms and family history, running various risk assessment calculations and decisions, and producing the necessary paperwork eats up a great deal of time and effort even before the test is run. To find all of the approximately 1 million carriers of BRCA1/2 mutations in the United States, this exhaustive process would take an estimated 11,000 person years, Hughes calculated.

But a possible time-saving answer is to contract out some of those information-collection, decision-making, and paperwork-completing duties to a proven hard worker: the computer. Many of the electronic medical records systems rolling out in hospitals across the United States are ill-equipped to deal with the family histories and other information critical for genetic risk assessment, so Hughes and partners at Mass Gen developed their own free program, called Hughes RiskApps. A sort of electronic questionnaire that patients fill out on a tablet PC by checking boxes with a stylus, the program quickly gathers all the relevant information about the appearance of cancer in a patient’s relatives and their own medical history - but then, the real cool stuff happens.

Rather than dumping all the collected information on an overworked physician or genetic counselor, the program does its own thinking, a process known as Clinical Decision Support. By generating a family pedigree and running the various risk calculations itself, the computer program can make a recommendation in seconds on whether the patient - and other family members with a high risk - should be tested for BRCA mutations. What’s more, it can automatically generate all the paperwork necessary to obtain those tests, and even customized informational handouts to give the patient.

“The idea with this is to let the patient do the work putting the data in, let the computer do the work of doing the analysis, and then present it to the doctor in a way that makes it very easy for them to go on and take care of that patient and what to do next with them,” Hughes said. “It’s trying to take the workload away from the doctor and the center and putting it into the computer.”

read more

Two months ago, ScienceLife wrote about a very special scientific conference, focused less on data and graphs than on the real human effects when a scientific breakthrough is successfully translated to the clinic. Called Celebrating the Miracles, the conference brought together families with diabetic children whose lives had been changed by the discovery that their disease could be treated with a simple pill instead of frequent injections of insulin. The word “miracle” is tossed around a lot, but talking to the parents of these children and the scientists and physicians who study and treat diabetes was a really moving experience about the power of science to change lives.

At the conference, each family had the opportunity to record a video message about their child’s “transition” from insulin to pills. Those stories, alongside interviews with the physicians and scientists from the Kovler Diabetes Center who treated the children and spoke at the conference, were assembled into the following video. Enjoy:

Inside a ballroom of the Chicago Sheraton Wednesday morning, an unusual live event was taking place. As a few dozen people looked on with intent interest, an abstract mix of watery reds, fluffy yellows and pulsating browns filled a giant projection screen. Swooping above and into this mixture were what looked like two metallic alligator heads, joined occasionally by various other silver creatures to help lift, cut and suction the material below. Through the whole process, the operator of these tools offered audio narration from halfway across the country, conversing casually with a panel of experts in the ballroom.

The strange screening was a live surgical broadcast, one of many offered at the 2010 World Congress on Endourology held last week. Dr. Steven Shichman, a urologic surgeon from Connecticut, was performing a robotic partial nephrectomy - removing a tumorous mass from the top of a 70-year-old man’s kidney. Despite the large remote audience, Shichman went about his work with calm professionalism, slowly and methodically clearing tissue until the kidney, tumor, and important blood vessels took shape within what looked like (to the non-surgical observer) an impossible mess. After carefully clamping the major blood vessels to the kidney, Shichman deftly removed the bulbous tumor and sutured the organ surface, completing those time-sensitive tasks in a brisk 11 minutes. Hundreds of miles away from his operating room, he received a round of applause.

Endourologists concern themselves with fixing or removing the kidney, prostate, and bladder, but the live surgery revealed the meeting’s emphasis on a different organ: the eyes. Like any medical conference, there were plenty of data, numbers, and graphs to pore over about the effectiveness of established and experimental surgeries. But the main purpose of the meeting, which attracted over 900 urologists from 50 different countries, was the sharing of surgical techniques and strategies, an information exchange of a sort that would be familiar to craftsmen of any field.

“We will cover 1,300 abstracts, and I am sure that all of us can learn from each other,” said Arieh Shalhav, professor of surgery at the University of Chicago Medical Center and the President of this year’s World Congress.

Sharing knowledge is essential in a field that has advanced quickly over the last two decades, first with the introduction of laparoscopic, minimally-invasive procedures in the 1990’s and lately with the use of surgical robots such as the da Vinci system. The new technology and methods have changed major surgeries requiring large abdominal incisions to intricate procedures that leave behind only a few marks mere millimeters in diameter. The role that urologic surgeons have played in pushing forward the boundaries of minimally-invasive surgery was underlined by Jeffrey Matthews, professor and chair of surgery at the Medical Center, in his welcoming remarks.

“We’re looking to you not only for leadership in urology and urological disease, but also leading all of surgery in your approaches to innovation and minimally invasive techniques and other advances,” Matthews said.

Interestingly, some of the discussion Wednesday at the conference engaged over just how hard to keep pushing the boundaries of minimally-invasive surgeries given the field’s recent successes. A new technique known as LESS - Laparoendoscopic Single Site Surgery - was the floor topic for one such debate, between Matthew Gettman of Mayo Clinic and Stuart Wolf from the University of Michigan.

read more