Welcome to pilot episode 2 of our Medical Center research news podcast. We’re keeping the water wings on for now as we continue to refine the format and discover all the technical struggles inherent in podcasting, but please do listen and give us feedback on how we’re doing - and if you have good ideas for a name.

In this episode, we talk to J. Martin Leland about the Stay in the Game event and preventing injuries for baseball, golf, and tennis season. Dianna Douglas reports on the oldest patient to ever receive Whipple surgery at the University of Chicago Medical Center, talking with Kevin Roggin and William Dale about the procedure. And Rob Mitchum reports from a news conference held last weekend by Sen. Dick Durbin about the impact of potential cuts to the National Institutes of Health budget currently being debated in Congress. Thanks for listening!

University of Chicago Research Podcast Episode #0.2 by robmitchum

[If you missed episode 0.1, you can listen here.]

As the call for pitchers and catchers to report goes out in Arizona and Florida, amateur athletes are also getting the itch for warm weather and outdoor activity.  Whether you’re dusting off your baseball glove, your tennis racket, or your golf clubs, it’s not too early to start thinking about avoiding a sports injury that could keep you out of commission for most of this season. On Wednesday, March 2nd, at the Tinley Park Convention Center, the University of Chicago Medical Center will present a free seminar, Stay in the Game, featuring a panel of sports medicine specialists (and a buffet and iPad raffle, to boot).

Among the panelists will be J. Martin Leland, MD, assistant professor of surgery, and ScienceLife’s go-to expert on sports medicine topics. Leland has worked with professional baseball teams, college athletics programs, and youth athletes of all ages to diagnose and treat sports injuries such as torn labrums and ligament sprains, using physical therapy, non-surgical interventions, or surgical procedures whenever appropriate. But Leland also has an interest in preventing those injuries from happening in the first place, and will present tips on avoiding elbow and shoulder damage from various sports at the Tinley Park program.

“Prevention is very different. You’re thinking of very different things in terms of preventing injuries compared to if you’re trying to rehab one,” Leland said. “If you’re trying to rehab a specific injury, you’re going to have a very specific course. Prevention tends to be a broader strategy.”

As such, Leland identified four areas where injury prevention can be strengthened for athletes of all ages: conditioning, equipment, hydration, and mechanics. Though he’ll expand upon those topics at Wednesday’s event - and will, of course, answer attendee’s questions - here’s a sneak preview of his tips for avoiding the disabled list this year.

Conditioning

“I’ve worked with numerous professional baseball players, some of whom are incredibly flexible, to the point where grown men who are centerfielders in Major League Baseball can do a split at the drop of a hat,” Leland said.

That’s testimony to the importance of stretching and flexibility in avoiding sports injuries - a ritual you can personally observe if you ever show up early enough to watch the warm-ups before a baseball game. But amateur athletes should also be sure to stretch their muscles before any type of strenuous activity, even for a sport like golf that seems distinctly low-impact. People can loosen muscles with an activity as simple as jumping jacks, Leland said, but should make sure that all stretches are “slow, gradual, and progressive,” holding the stretch for at least 30 seconds, and avoiding stretches that could actually do more harm than good.

“You’ll see some people when they’re trying to stretch their hamstrings, they’ll bounce up and down,” Leland said. “That actually increases your risk of injury, and you can strain or tear a muscle doing those stretching exercises alone.”

Equipment

One of the most important precautions against injuries on the playing field is simply making sure the playing field is as safe as possible. Many youth baseball leagues have started to transition to new magnetic breakaway bases, Leland said, replacing the more common rigid, locked-in-place versions that can cause ankle and leg injuries during slides.

“When you slide into them really hard, the breakaway bases will move out of the way and it’s not like you’re basically sliding into a brick wall,” Leland said.

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Last week, we brought you exclusive video from the rehearsal space of Turnover Time, the band of Medical Center employees formed to raise money for David Song’s relief efforts with Medical Aid for Children in Latin America. The band’s big debut took place at the Lend an Ear fundraiser Saturday night at the University of Chicago International House, and by all accounts, it was a roaring success. The event raised nearly $25,000 for the annual trips led by Song to the Dominican Republic to reconstruct ears and repair cleft palates, with an additional $17,000 donated via the MACLA website (where you can still make a donation). In exchange for their philanthropy, the standing-room-only crowd at the fundraiser was treated to two sets of music from Turnover Time, excerpts of which appear below. Enjoy the tunes!

Turnover Time is Shahab Akhter (drums), John Alverdy (keys), James Anderson (vocals), Kevin Johnson (vocals), Jeff Matthews (guitar), Joan Matthews (bass), Jono Matthews (guitar), Sarah Pae (vocals), Nikki Phillips (vocals).

Eodromaeus, or "Dawn Runner" (Copyright Todd Marshall)

While ScienceLife was away at the Science Online 2011 meeting two weeks ago, our friends in the University of Chicago News Office tried to sneak a dinosaur story past us. Eodromaeus, the “dawn runner,” is the latest edition to the dinosaur discovery menagerie of Paul Sereno, professor of organismal biology and anatomy, discovered in the fossil dig site of Argentina known as the “Valley of the Moon.” While only four feet tall and roughly 10-15 pounds, Eodromaeus was (as Chicago Tribune great Bill Mullen puts it) a “nasty looking little critter,” a carnivorous predecessor to the T. Rex in a time (230 million years ago) when dinosaurs were not yet the dominant lifeform on the scene. [You can watch a cool time-lapse movie of the reconstruction of Eodromaeus here, as well as an interview with Sereno about the discovery and its significance for the rise of dinosaurs.]

As the excellent fossil blogger Brian Switek describes at the Smithsonian’s Dinosaur Tracking site, the discovery of Eodromaeus rearranges scientific theories about the early days of dinosaurs. A previous discovery of Sereno’s team in the same area, Eoraptor or “dawn plunderer,” was once thought to be an ancestor of the larger meat-eating dinosaurs that came later. But comparing the teeth of Eoraptor and its neighbor Eodromaeus suggests that the former was actually an omnivore ancestor of the more benevolent sauropods, with Eodromaeus near at the top of the T. Rex family tree.

“We’re looking at the dawn of the dinosaur era where the fork in the road is still very narrow in the divergence of plant eaters from meat eaters,” Sereno told the Tribune. “That is why Eoraptor and Eodromaeus look so much alike.”

But as in Hollywood, your 15 minutes of fame are very short in the world of dinosaurs. In the mere two weeks since Eodromaeus was unveiled, another thunder lizard has stolen the spotlight: the hilarious-looking Linhenykus, the “one-fingered” dinosaur. Seriously, imagine trying not to laugh as one of these ran towards you (bear in mind that they were also small enough to “s[t]and comfortably in the palm of your hand.”). As Switek points out at Dinosaur Tracking, a current theory goes that Linhenykus, and other dinosaurs with one pronounced digit, may have used their comedically short arms to dig for ants and termites.

Nabokov’s Hobby

The research of lepidopterist Vladimir Nabokov never quite got the credit it deserved while he was alive and working as curator of butterflies at Harvard’s Museum of Comparative Zoology. Perhaps it was his outlandish ideas, about butterflies migrating from Asia through Siberia and Alaska and down to South America. Or perhaps it was because he was better known as the experimental novelist responsible for Lolita, Pale Fire, and other books. Catching and studying butterflies was a lifelong hobby for the Russian-born Nabokov, but despite publishing at least one manuscript (pdf, found via Carl Zimmer’s twitter) on the evolution of a group of species known as Polyommatus blues, he was largely ignored by the scientific community as an amateur.

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When you think of a medical instrument, you usually think of a scalpel or forceps. But nine employees of the Medical Center are also proficient in instruments of a musical nature, and are putting those side talents to use for a good cause this weekend.

For the last 11 years, plastic surgeon David Song has led a team of University of Chicago Medical Center employees to the Dominican Republic for two weeks of charity care. Working with Medical Aid for Children in Latin America (MACLA), the team of surgeons, anesthesiologists, nurses, and residents focuses on ear reconstruction, cleft palate surgery, and burn treatment for disfigured residents of Hispaniola (including Haitians and Dominicans) who might otherwise face a life of discrimination and pain.

“A lot of children in the Dominican Republic are born without ears, and they’re ostracized from the community,” said Song, professor and vice chairman of surgery. “Shamanism and voodoo are still practiced in some of these villages near the Haitian border, and a lot of these villagers feel that these children with congenital deformities are really possessed by a demon. They see us as exorcists, when simply it’s reconstructive surgery, and we’re able to reintegrate them back into the village and have them be accepted by their families as normal human beings. That’s really touching for us.”

This Saturday’s “Lend an Ear” fundraiser (pdf), to be held at the International House on the University of Chicago campus, will feature a different type of philanthropy: the debut of the Medical Center band Turnover Time. Named for the medical jargon of the time between procedures in the operating room, the nine members of Turnover Time include surgeons, anesthesiologists, techs, medical students, and residents with serious musical chops. In the video below, you can watch them rehearsing some of the songs from their Saturday setlist, including Coldplay’s “Clocks,” the gospel tune “Oh Happy Day,” and Bonnie Raitt’s “Angel from Montgomery.”

“I knew they were talented, but they blew me away,” Song said of viewing of a Turnover Time rehearsal earlier this month. “It’s an expressive way for them to directly affect our philanthropy and our efforts across the globe and the Western Hemisphere. They’ll have a great time, raise money for a great cause, and it brings the entire Medical Center community together.”

ScienceLife ran 219 posts in 2010, and choosing the best of them is as hard as picking a favorite gene.  So here’s a month-by-month scan of a busy year at the University of Chicago Medical Center, full of exciting discoveries in the laboratory and the clinic. The impact of some of this research is already being felt by patients receiving improved, evidence-based medical care. For other studies, the clinical benefit may be years in the future, and may take unpredictable forms. As a closing message for 2010, we’ll re-quote the recently departed Eugene Goldwasser, whose laboratory research isolating and purifying the hormone erythropoietin has helped millions of people worldwide.

“It is a particularly impressive example of how basic research can pay a dividend that could not be anticipated at the start,” Goldwasser wrote about his life’s work, “and it is a pity that the lesson still has not been learned by those who control public funding of science.”

January: Tong Chuan-He looked at how cancer may result from cells who don’t want to grow up. Scientists studied how sleep affects the language learning skills of starlings (with painstakingly acquired video of the experiment!). Richard Jones combined two laboratory staples - Western blots and DNA micro-arrays - to develop a new method for studying protein networks. While physicians such as Tammy Utset treat patients with lupus, UChicago scientists are looking for the genetic origins of the autoimmune disorder.

February: Many Medical Center employees returned from volunteering with relief efforts in Haiti, and we filmed video interviews with Rex Haydon, Tiffany Cupp, Richard Cook, and Dima Awad on their experiences. Most of the human genome is “junk” between protein-encoding regions, but Marcelo Nobrega developed a way to find important regulatory elements in that genetic sea. Like birds, human learning can be affected by sleep, and Leila Kheirandish-Gozal reported on the impact of obstructive sleep apnea upon learning in children. Can a single protein in the brain create behaviors associated with drug addiction in rats?

March: Everyone knows air travel is stressful, but did you know that eastbound flights cause stronger cortisol changes than westbound trips? The laboratory of Milan Mrksich found a way to direct stem cells to form fat or bone by shaping them into stars or flowers, a brilliant example of bioengineering. Computational neuroscientists discovered how touch is like vision in the brain, knowledge that could be used to someday re-engineer Luke Skywalker’s robot hand. Dartmouth president and Partners in Health co-founder Jim Yong Kim visited to talk about a new, needed area of research: health care delivery.

April: Researchers at the Field Museum and the University of Chicago teamed up for the Emerging Pathogens Project, an effort to find new viruses in animals before they jump to humans. Cardiologist Martin Burke tested out a new type of internal defibrillator device that can go under the skin, instead of into the heart (the clinical trial, reported in May, was a success). In a lecture to the MacLean Center of Clinical Medical Ethics, transplant surgeon J. Michael Millis described his efforts to bring American organ transplant practices to China.

May: A trial testing the erectile dysfunction drug Viagra for a rare, untreatable lung disease failed, but pulmonologist Imre Noth found a silver lining. Lauren Sallan and Michael Coates uncovered evidence of a previously unappreciated mass extinction event 360 million years ago that changed the path of life on Earth. Researchers from the University of Chicago and around the world presented science at the frontier of biotechnology at the annual BIO conference.

June: In a study that is literally the size of an entire country, epidemiologist Habibul Ahsan measured the toll of a tragic, accidental exposure of millions to arsenic in Bangladesh. Putting a gene from fireflies into the pancreas of mice isn’t mad science, it’s an imaging tool that will help study cures for diabetes. Epigenetics, the modifications that turn genes on and off, took off in 2010, and cardiologists Stephen Archer and Jalees Rehman linked one epigenetic factor to pulmonary artery hypertension.

July: Scientists don’t often get to see the fruits of their research in the flesh, but the Celebrating the Miracles gathering of diabetic children weaned off injected insulin thanks to genetic research was a moving exception (video of the event can also be viewed). Another hot topic in science and medicine this year was the use of computational analysis to sift through rapidly accumulating data, topics explored by Gary An and Andrey Rzhetsky. Or you can build a computer model of a brain network to study the dynamics of epilepsy, like neurologist Wim van Drongelen.

August: Air pollution is a problem indoors as well as outdoors in developing countries where dung and firewood are used to cook food - a problem being tackled in a project led by Sola Olopade. A study of the hormonal changes induced by a stressful test revealed a surprising protective effect of marriage and long relationships. Microbiologist Olaf Schneewind’s laboratory developed two new strategies against MRSA, the most-wanted cause of hospital-acquired infections.

September: To study multiple sclerosis, neurologist Brian Popko’ s laboratory developed a new mouse model that can replicate the disease, then spontaneously recover. Meanwhile, a new drug to treat MS, originally isolated from fungus found in wasps, was approved by the FDA and is being studied for broader uses at the Medical Center. The micro-organisms that live in humans were analyzed as part of a “microbiome” study looking at the protective effects of breast-feeding against a intestinal disease.

October: Common wisdom on quitting smoking says to stay away from cigarette-associated cues, but research from psychiatrist Harriet de Wit’s laboratory revealed that abstinence could make craving even worse. A study of how getting a good night’s rest affects dieting results suggested that “sleeping off the pounds” isn’t merely a fantasy. Graduate student Daniel Matute solved a 100-year-old riddle about how quickly new species become reproductively incompatible with each other.

November: In perhaps our favorite study of the year, geneticist George Perry found a way to acquire the genomic information of endangered species from…poop. The evolutionary biologist Leigh Van Valen passed away, but his Lewis Caroll-inspired Red Queen Hypothesis lives on. Sometimes statistics don’t tell the whole truth, as in the curious case of the aspirin paradox - why the cardio-protective drug may actually predict worse outcomes after heart attack.

December: Evolution textbooks may need a rewrite after geneticist Manyuan Long’s laboratory discovered that new genes can be just as essential as old genes. A study by neurobiologist Nicholas Hatsopoulos proved that the only thing better than a thought-controlled device is a thought-controlled device equipped with a robot arm. Ripped from the headlines: microbiologist Jack Miller weighed in on the hype over arsenic-based bacteria, and ethicist/physician/friar Daniel Sulmasy discussed the Presidential Bioethics Commission’s report on synthetic biology.

All told, it was a great year of science and medicine. Let’s do it again in 2011! Regular posting will resume Jan. 3rd. Happy Holidays.

Artist's rendering of the new Eckhardt Center (Courtesy of HOK/JCDA/AJSNY)

Today, the University of Chicago announced plans to construct the William Eckhardt Research Center, an innovative new building along Ellis Avenue that will be home to many researchers in the physical sciences.

But just as newsworthy as the new building is one of its prominent tenants: the Institute for Molecular Engineering, the largest new department launched at the University since the Harris School of Public Policy in 1988. The Institute, called the IME for short, will serve as a bridge between the Physical Sciences Division and the Biological Sciences Division for shared goals in research and education.

But what exactly is molecular engineering? The specific mission of the IME will be set next year when a director is named, but the general direction of this exciting new discipline was summarized last year by a faculty committee appointed to evaluate the IME’s creation. ScienceLife talked to a few of those committee members to learn about what molecular engineering is, what kinds of problems it might solve, and what kind of students it will create.

Biology and medicine is increasingly focused on how small scale interactions are important for both normal function and disease. Simultaneously, engineers grounded in physics and chemistry are looking toward biological systems for ideas and solutions. Increasingly, physical and biological sciences are speaking the same language, said Raphael Lee, Paul and Ailene Russell Professor of Surgery, Medicine, and Organismal Biology & Anatomy.

“On the molecular scale, behavior is described by laws of physics and chemistry,” Lee said “The rules of biology and physics are identical at the molecule scale. That’s where the fields boundaries blur and overlap.”

At this common ground, molecular engineering provides a skill set for the next generation of scientists to address the world’s biggest problems. The knowledge gathered through basic science in biology, chemistry, and physics laboratories can be combined and applied to major issues, such as providing clean water to undeveloped countries, or developing more efficient energy sources.

“This is making the science much more applied: we know how it works, so let’s try to make it better. How do we apply that knowledge to these problems that we see,” said Erin Adams, Assistant Professor of Biochemistry and Molecular Biophysics.

Molecular engineering innovation may also lead to the development of new technologies for medical care. Scaffolds for stem cell treatment might be designed through engineering, chemistry, and biology collaboration. Animals that have evolved natural self-healing abilities could inform the design of materials that repair themselves, which could in turn be used for the design of industrial products and medical devices.

“I think it’s entirely possible that new kinds of tools could be generated in molecular engineering that would have therapeutic implications,” said Julian Solway, Professor of Medicine and Pediatrics. “The problems that we’re addressing are the same problems, and the solutions that we want to find are well-suited to be approached by both camps.”

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Imagine There’s No Hunger

This post is going up around lunchtime, and you might be just now picturing what you’re going to eat. There are those healthy whole-wheat pasta leftovers in the fridge, but just down the street is a deli where you can purchase a giant Italian sub with hot peppers and cheese and a bag of chips on the side. Just the thought of that delicious sandwich is making your mouth salivate and your stomach grumble in anticipation. Wait, were we talking about you, or me?

The ability of people to make themselves hungry just by imagining food has always baffled psychologists, who would predict just the opposite response. Using imagination for habituation, the gradual diminishing of a stimuli’s power to provoke a response with repetition, is a classic tool of psychological treatment. For example, people with phobias are often instructed to repeatedly imagine the cause of their fear (spiders, heights, airplanes) until their emotional response subsides. By that theory, repeatedly imagining a delicious pizza should eventually make you less hungry for a slice, rather than increase craving.

But maybe people are just imagining the wrong thing, thought researchers from the business school at Carnegie-Mellon in this week’s Science. Instead of imagining the food before it is eaten, perhaps people could imagine actually eating that food to habituate themselves against its wily charms. Using a particularly seductive denizen of the office vending machine, M&M’s, the authors instructed their subjects to imagine eating 30 pieces of the candy in succession, like picturing the process of inserting 30 quarters into a vending machine. This tedious fantasy actually worked when the subjects were subsequently given a nice big bowl of M&Ms - subjects who imagined eating 30 pieces of candy ate less than subjects who only imagined a 3-piece snack, or no snack at all. The trick was found to be stimulus-specific, in that a session of imaginary M&M eating had no effect on subsequent eating of another snack; in this case, cheese cubes.

Aside from it’s dietary implications, the study is a pretty amazing demonstration of the power of imagination - “The difference between actual experience and mental representations of experience may be smaller than previously assumed,” the authors write. But it’s unlikely that anyone will incorporate this imagination trick into a get-thin quick diet plan, as you can’t sell a customer the ability to imagine eating unhealthy food, and therefore can’t hire Kirstie Alley to endorse it. But it is something we can all try for free, at home or at our office desk. So while I write the rest of this post, I’ll devote part of my mind to imagining the laborious consumption of that delicious Italian sub sandwich, rather than the sandwich in all it’s pre-eaten glory.

[H/T to the Wall Street Journal Health Blog for the article.]

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Ultrasound imaging is best known for pictures of developing fetuses; 3D is typically associated with monster movies. But when you put the two together and aim the technology at the heart, they create a valuable tool that is changing the way heart disease is treated. Three-dimensional echocardiography is a cutting edge imaging technique used to obtain a detailed look at a patient’s heart in motion, figure out what may be wrong, and determine the best way to fix it.

The high-definition images collected by “3D Echo” can detect holes in the heart, problems with the valves that let blood pass between chambers, and irregularities in muscle contraction and blood flow. Information gathered during an echocardiogram can help surgeons create detailed plans for procedures to correct heart problems and can give them immediate feedback in the operating room after the surgery to make sure it was successful. For the increasing number of procedures that can be performed with cardiac catheterization instead of open heart surgery, a 3D echocardiogram provides live information to help guide cardiologists in their repairs.

“This is progressing very quickly and in many diseases, it really, really changes the way that people think about cardiology,” said Roberto Lang, professor of medicine and the director of the Noninvasive Cardiac Imaging Lab at the University of Chicago Medical Center. “We can look at the heart and tell the surgeon what he or she is going to encounter at the time of surgery.”

At this month’s American Heart Association meeting in Chicago, Lang presented research and participated in panels on the latest uses of 3D echocardiography. Since its submarine-sonar-inspired origin in 1953, the sonogram has been applied to cardiac function in many ways, through 2D images (similar to today’s fetal ultrasounds), through 3D reconstructions built from 2D data, to today’s instantaneous 3D view. Though real-time 3D imaging was only made possible 8 years ago, it is rapidly sweeping into the hospitals around the world, and new uses are still being discovered as the technology improves further.

During the AHA meeting, Lang presented what he calls “fusion imaging,” a combination of 3D Echo and computed tomography (CT) scanning to help determine the best place to implant a pacemaker for restoring normal heart contraction. Another presentation focuses on how 3D Echo can collect information about problems with the mitral valve - the portal between the left atrium and left ventricle of the heart. The precise location of leaks and other abnormalities can be mapped from the same angle the surgeon will see during surgery, Lang said, minimizing surprises on the operating table.

The best way to grasp the value of 3D echocardiograms is to see one, and last year, a production company came to the Medical Center and filmed Lang at work and talking about his field. Watch the results below.

“When we do these studies, we use all the different modalities and integrate them into a simple study,” Lang says in the video. “You want to be a detective and find out exactly what is happening to the patient, so you use all the technologies available and integrate them in order to come up with a good question or a good answer.”

[Thanks to Philips and Tomorrow Media for the video footage.]

Fangs You Very Much, Evolution

Where did the snake get its fangs? It sounds like the lead-in to a Rudyard Kipling Just So stories, but it’s a legitimate evolutionary biology question about one of nature’s deadliest weapons, one that goes back 20 million years ago to the oldest snakes in the fossil record. But even those ancient snakes had fangs similar to the poisonous snakes of today, with a hollow tube running through the tooth to inject venom into some poor prey like a hypodermic needle. How snakes (and other venomous reptiles) evolved such an elegantly dangerous mechanism was a mystery, until a new study published this week by University of Chicago’s Jonathan Mitchell and colleagues.

To study the evolution of snake fangs, Mitchell and his team were forced to go to a non-snake reptile - the mysterious Uatchitodon, a roughly 200 million year old reptile known only by its teeth. But in this case, the teeth were what the scientists cared about, and they compared the dental fossils from Uatchitodons found in Virginia, North Carolina, and Arizona. Interestingly, the teeth of older specimens appeared to show a kind of proto-fang, with a “canal” running down the outside of the tooth for the delivery of venom. This style of venom delivery is more similar to the modern-day Gila monster, the authors wrote, which “chews” its venom into its victims (shudder).

Later Uatchitodon teeth display a new form more similar to modern snakes, with the once-external groove now hidden inside the tooth. “This fossil really suggests that you can’t get hollow fangs any other way,” says co-author Wolfgang Wüstertold Nature News. Indeed, modern snakes even demonstrate a fast-forward highlight reel of this evolution, with grooved “replacement fangs” that give way to the mature, tubular model. It’s also a demonstration of the kind of transitional, evolutionary process that intelligent design supporters absolutely hate, demonstrating that the highly successful fang mechanism didn’t just appear out of nowhere, but through a series of intermediate steps that were also functional in their own right.

Another Bridge to China

The effort to help Wuhan University revise their medical school curriculum, described here yesterday, is not the only current collaboration between the University of Chicago Medical Center and Chinese hospitals. Last month, a delegation from Comer Children’s Hospital and the Department of Pediatrics visited Shanghai, where they signed an agreement establishing an educational, clinical, and research collaboration with Shanghai Children’s Medical Center (SCMC).

The relationship between the two pediatric hospitals sprouted from a training program started by Donald Liu, professor of surgery at Comer, who has taught minimally invasive techniques to surgical fellows from the Shanghai hospital for the last 10 years. For a disease called gastroschisis, where an infant is born with their bowels on the outside of their body, Liu’s instruction helped SCMC improve survival rates from 30 percent to 95 percent in 10 years. The success of that informal program and a successful visit from SCMC leadership to Chicago last year inspired the expanded collaboration, which will begin next year.

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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.

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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.

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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.

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The early discovery of the high-risk breast cancer genes BRCA 1 and 2 has made the disease a testing ground for how genetic testing can be translated into actual health benefits. The relationship between gene mutations and disease risk is not always crystal clear, but BRCA1/2 is a notable exception: women with a mutation are as much as ten times more likely to develop breast cancer. That heavy knowledge has created many ethical debates about the value of testing a patient for the risk mutations, weighing the benefits of knowing and rigorously screening versus the stress of not knowing whether any preventive measures can truly offset the genetic cancer risk.

The latter half of that equation takes a hit today with an article in the Journal of the American Medical Association that clarifies the benefits of risk-reducing surgery in patients with BRCA1 or 2 mutations. A multi-institutional study, including researchers Wendy Rubinstein and Funmi Olopade of the University of Chicago Medical Center, looked at the outcomes of thousands of women who tested positive for BRCA1/2 mutations, about half of whom chose to undergo at least one type of risk-reducing surgery. Some patients opted for masectomy, some chose risk-reducing salpingo-oophorectomy (RRSO) - the removal of the ovaries and Fallopian tubes - while others chose no surgery at all.

When researchers compared the rates of breast and ovarian cancer among the three groups, they found dramatic evidence in favor of preventive surgery. In women who underwent risk-reducing masectomy, zero percent contracted breast cancer in the following three years. Not a single case in a high-risk population, where among BRCA1/2 mutation-positive women who did not undergo masectomy breast cancer was found in 7 percent of subjects over the same three-year period.

But a masectomy is a major procedure, and despite improvements in surgical technique and cosmetic reconstruction, it carries its own substantial risk and lifestyle changes. By comparison, removing the ovaries and Fallopian tubes in an RRSO surgery is a lower risk procedure that can even be performed in outpatient settings, according to an accompanying JAMA editorial. After a mutation-carrying woman is done having children, physicians strongly recommend salpingo-oophorectomy followed by hormone replacement therapy.

The benefits of that strategy were also shown in the new paper, as RRSO decreased the risk of both ovarian and breast cancer. Again, the magic number of zero pops up in regards to cases of ovarian cancer in BRCA-2 women who underwent RRSO, while barely 1 percent of women with the BRCA-1 mutation contracted ovarian cancer after the procedure (relative to 3 percent of women without RRSO). What’s more, RRSO decreased the risk of breast cancer by two-thirds (in BRCA-2 subjects) or one-third (in BRCA-1). Those effects manifested themselves in lower mortality, which RRSO reduced by more than half in those with no prior breast cancer and 70 percent in those who had a previous cancer diagnosis.

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A medical residency is no walk in the park. For a resident, there are no weekends, and working 9 to 5 is a half-day. Working overnight is routine - every 3 or 4 nights on some rotations - and entails more than just the “graveyard shift,” as a typical on-call shift can run from 7 in the morning to 1 in the afternoon…the next day.

In 2003, pushback from patient groups and politicians led the Accreditation Council for Graduate Medical Education (ACGME), the body that oversees U.S. residency programs, to institute limits on duty hours. Residents were restricted to working 80-hour weeks, limited to 24 hours of continuous care (with a 6-hour extension allowed for some activities), and were supposed to receive an average of one day off for every seven days.

Hospitals initially struggled to adapt to the new restrictions, redrawing schedules and hiring support staff to cover for the missing resident hours. But just when things were settling down, another round of restrictions is growing imminent, this time fueled by studies showing that being awake for longer than 16 hours is equivalent to having a blood alcohol level of 0.05 percent. Last year, the Institute of Medicine recommended that residents be restricted to 16-hour shifts, or be required to take a mandatory 5-hour nap if they work more than 16 hours. The panel also recommended additional supervision, particularly of interns, the first-year residents just out of medical school.

An ACGME task force subsequently softened the restrictions, limiting the 16-hour rule to interns. A public comment period for those guidelines just ended, but most medical centers are already assuming that they will be put in place next summer unchanged and are planning accordingly. I spoke to two University of Chicago Medical Center faculty members who supervise residency programs - Terrance Peabody, chair of orthopedic surgery, and Vineet Arora, associate professor of medicine - about how hospitals are preparing for the changes.

How do you feel about the new ACGME recommendations?

“The real issue is that, in surgery culture, taking care of someone for 24 hours is a big part of the learning experience,” Peabody said. “It’s important that residents undergo following somebody through that period of time. The concept of making a surgeon a shift worker goes against the real culture of surgeons, who feel obligated to provide some continuity of care, and whose tasks aren’t easily delegated the way they are in internal medicine.”

“I think it’s a very tall order for medicine especially given the value of following patients through the night,” Arora said. “I can also understand it’s a reasonable compromise between what ACGME had to balance, which was the fact that there was a public pressure to reduce hours amid the data about fatigue, as well as still preserving the opportunity for residents to work overnight and follow patients.”

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