Surgical 3-D printing: 300 prints, 16 specialties and counting

3-D printing is rapidly becoming a part of surgical planning. Since July 2013, Boston Children’s Hospital’s 3-D printing service, part of the Simulator Program, has received about 200 requests from 16 departments around the hospital. It’s generated a total of about 300 prints, most of them replicating parts of the body to be operated on.

Most prints take between 4 and 28 hours to produce. The largest to date—an entire malformed rib cage—took 105 hours and 35 minutes to create and weighed 8.9 pounds. The smallest—a tiny tangle of blood vessels in the brain—took 4 hours and 21 minutes and weighed 1.34 ounces. Here is sampling of what’s been coming off the production line.

Read Full Story | Leave a Comment

Rescuing intestinal stem cells from attack in diabetes

diabetic enteropathy and colonic stem cells
Blood levels of the hormone IGFBP3 (enterostaminine), shown here in green, are markedly elevated in people with longstanding type 1 diabetes and launch a lethal attack on intestinal stem cells. Adding a protein that soaks up the excess hormone restores normal stem cell function and could help prevent or treat diabetic enteropathy. (All images by Riseon)

Up to 80 percent of people with long-standing type 1 diabetes develop gastrointestinal symptoms—abdominal pain, bloating, nausea, vomiting, diarrhea, constipation and fecal incontinence—that severely diminish quality of life. Recent evidence suggests that this condition, known as diabetic enteropathy, results from damage to the intestinal lining, but the details beyond that have been unclear.

A study in this week’s Cell Stem Cell, led by Paolo Fiorina, MD, PhD, now provides some answers. It demonstrates how diabetes can lead to destruction of the stem cells that maintain the intestinal lining, and identifies a potential drug that could protect these stem cells and prevent or treat diabetic enteropathy.

Read Full Story | Leave a Comment

Maternal-infant health research will bring placenta into view

placental health
A pre-1858 schematic of the placental circulation from Gray’s Anatomy (Wikimedia Commons).

The afterbirth has generally been an afterthought, but that’s about to change.

This week, 19 research centers were awarded grants from NIH’s Human Placenta Project, which is seeking to learn more about the intricate organ that sustained us in the womb, the interface between us and our mothers.

A robust placenta is key to a healthy pregnancy and baby, but strangely, not much is actually known about it. “It’s a fascinating but very poorly understood structure,” says P. Ellen Grant, MD, who directs the Fetal-Neonatal Neuroimaging and Developmental Science Center at Boston Children’s Hospital and is leading one of the projects.

Read Full Story | Leave a Comment

Beth Stevens: A transformative thinker in neuroscience

When 2015 MacArthur “genius” grant winner Beth Stevens, PhD, began studying the role of glia in the brain in the 1990s, these cells—“glue” from the Greek—weren’t given much thought. Traditionally, glia were thought to merely protect and support neurons, the brain’s real players.

But Stevens, from the Department of Neurology and the F.M. Kirby Neurobiology Center at Boston Children’s Hospital, has made the case that glia are key actors in the brain, not just caretakers. Her work—at the interface between the nervous and immune systems—is helping transform how neurologic disorders like autism, amyotrophic lateral sclerosis (ALS), Alzheimer’s disease and schizophrenia are viewed.

Read Full Story | Leave a Comment

3-D printed models may soon guide one-of-a-kind pediatric heart operations

Photo credit: Bryce Vickmark, MIT News
Photo credit: Bryce Vickmark, MIT News

No two hearts are alike. It sounds like poetry, but this adage takes on a special meaning for pediatric cardiac surgeons.

Children born with congenital heart disease have unique cardiac anatomies. To correct them, surgeons need a nuanced understanding of each structure and chamber of the heart, and for decades have relied on (increasingly sophisticated) imaging technology.

Soon, though, they will be able to touch, turn and view replicas of their patients’ hearts up close. Researchers at Boston Children’s Hospital and MIT have jointly designed a computer program that can convert MRI scans of a patient’s heart into 3-D physical models.

Read Full Story | Leave a Comment

My work, my life, my innovations: Jean Connor, PhD, RN, CPNP

Stepping into Dr. Jean Connor’s office, the first thing you notice is color. So much color. Bella, Connor’s 9-year-old daughter, has decorated the space with handmade inspirational signs and artwork that explode with vibrant energy. “That’s how I innovate,” says Connor. “I like having all that positive energy around me.”

Connor, who has her PhD in nursing, directs nursing research at the Boston Children’s Heart Center. She was the first nurse to complete her post-doc at the Harvard School of Public Health and received a Champions in Healthcare award from the Boston Business Journal in 2012. Connor’s work translates industry research into actionable lessons and innovations that improve care at the bedside. In 2009, she developed a nursing acuity measurement tool called CAMEO (Complexity Assessment and Monitoring to Ensure Optimal Outcomes) that has since been validated to measure nursing workload across all pediatric and neonatal settings in the United States.

“I absolutely love my job,” Connor says. “I never thought I’d leave the bedside, but I feel like I’m impacting what happens at the bedside. We each have our ability to contribute to make the best possible experience for patients and families.”

Scroll over the items around Dr. Connor’s office to learn more about what inspires her.

Read Full Story | Leave a Comment

Stress-induced stem cells debunked: The final word on STAP

In early 2014, controversy erupted when two papers in Nature indicated that exposing ordinary cells to stress—an acid bath or mechanical stress—could quickly and efficiently turn them into pluripotent stem cells, capable of developing into virtually all the tissues in the body.

The technique, called “stimulus-triggered acquisition of pluripotency,” or STAP, was lauded for its simplicity compared to other methods like nuclear transfer into egg cells or cellular reprogramming with a set of transcription factors.

Not so fast.

Six months later, the papers were retracted. And this week in Nature, a team led by George Q. Daley, MD, PhD, director of the Stem Cell Transplantation Program at Boston Children’s Hospital, and Peter Park, PhD, head of the Computational Genomics Group at Harvard Medical School (HMS) details what went wrong. In a companion paper, the Daley Lab provides a roadmap for verifying a cell’s pluripotent status.

Read the full story on the HMS website.

Read Full Story | Leave a Comment

Four emerging advances in childhood cancer

girl-in-jfcThe 20th century saw great strides in curing childhood cancer, thanks primarily to the discovery that broadly toxic chemotherapy agents could kill malignant cells. Once virtually incurable, pediatric cancer now has an overall long-term survival rate topping 80 percent.

In the 21st century, attention is turning to additional, less toxic developments in cancer therapy. Lisa Diller, MD, Chief Medical Officer of Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, cites four coming changes:

  • Precision medicine treatments targeting specific genetic and epigenetic pathways
  • Immunotherapy drugs gaining FDA approval
  • Innovations to reduce treatment toxicity
  • A stronger focus on improving survival of childhood cancer globally.

Read more on the Dana-Farber/Boston Children’s website.

Read Full Story | Leave a Comment

Respiratory illness in children with gastroesophageal reflux: Are acid blockers part of the problem?

Lungs stomach-cropped-Shutterstock-flatcat
(Flatcat via Shutterstock)

Gastroesophageal reflux disease (GERD), in which stomach acids back up into the esophagus, is increasingly diagnosed in children. One study based on insurance-claims data found that GERD diagnoses in infants more than tripled between 2000 and 2005 (from 3.4 to 12.3 percent). In addition to heartburn and chest pain, GERD has been implicated in cough, wheezing and pneumonia.

To reduce such acid-related symptoms, doctors increasingly prescribe acid suppression medications such as proton pump inhibitors (PPIs). They’re among the most-prescribed drug classes in the U.S. But clinicians in the Aerodigestive Program at Boston Children’s Hospital noticed that a large number of their GERD patients had lung cultures positive for bacteria, and that a strong predictor was the amount of non-acid reflux the child had.

“We then had to ask the question, ‘are acid suppression medications, which are being prescribed to treat respiratory symptoms, actually worsening the problem?’” says program director Rachel Rosen, MD, MPH. “What are these medications doing to change the bacteria composition in children?”

Read Full Story | Leave a Comment

Q + A: Scientist on a roller coaster

FriendThe twists and turns of Stephen Friend’s career are both dizzying and thrilling. In the early days, Stephen Friend, MD, PhD, CEO and co-founder of Sage Bionetworks, spent many a late night as a resident in the emergency room at Children’s Hospital of Philadelphia with Gary Fleischer, MD, current pediatrician-in-chief at Boston Children’s Hospital.

Friend later wound up at Boston Children’s as well, where he did his pediatric hematology-oncology fellowship and later, as part of the faculty, helped co-lead the team that identified the first tumor suppressor at Boston Children’s. A few years later, Friend left academia to pursue his passion in a startup and later engineered a landing at Sage Bionetworks, a nonprofit focused on patient engagement and open science in the research process. The Resilience Project, one of Sage’s research initiatives, analyzes DNA from healthy volunteers to discover rare mutations that protect resilient people from serious childhood illnesses.

In November, Friend will be on the Global Pediatric Innovation Summit + Awards stage as a panelist on the Patient Engagement in a Big Data World panel. He sat down with Vector to share his thoughts on working outside one’s comfort zone, suspending disbelief, supporting emerging innovators and more.

Read Full Story | Leave a Comment