Inside the Lancet Commission on Global Surgery: A conversation with John G. Meara

meara-global-surgery
John G. Meara, MD, plastic surgeon-in-chief at Boston Children’s Hospital, co-chaired the Lancet Commission on Global Surgery, which released its findings today.

Although global health has come a long way over the past 25 years, access to surgical care remains very uneven across the world. Five billion people lack access to basic surgical care; this translates into unnecessary death and disability. More than one-third of all global deaths are from conditions requiring surgical care—more than the number of deaths from HIV/AIDs, tuberculosis and malaria combined. In addition, one-quarter of the world’s disability has been attributed to surgically treatable conditions.

In January 2014, an international team of 25 surgeons and public health experts launched The Lancet Commission on Global Surgery to address the widespread need for surgical care around the world. After 14 months of global consultation and four international meetings, the commission published a 32,000- word report today in The Lancet that provides a strategy for governments, policy makers, non-profits, funding agencies, academic institutions, professional associations, health care providers and local communities to engage in concrete action in low- and middle-income countries.

On May 6, the commission hosts its North American launch in Boston to present its key findings and priority action items. John G. Meara, MD, DMD, MBA, Plastic Surgeon-in Chief at Boston Children’s Hospital and the Kletjian Professor of Global Surgery at Harvard Medical School, is one of three chairs of the commission. We sat down with Meara to learn more about the commission’s work, which he describes as one of the “most impactful things he has done in his career to date.”

Read Full Story | Leave a Comment

What we’ve been reading: Week of April 20, 2015

(Stougard/Wikimedia Commons)
(Stougard/Wikimedia Commons)

Chinese team reports gene-editing human embryos (MIT Technology Review)
Using the CRISPR technique, the researchers attempted to correct the gene for thalassemia in fertilized eggs. The experiment showed that the technique is far from ready from clinical use, and added new fuel to the already-fiery debate over editing genes in human embryos.

How Apple is building an ecosystem for your body (Fast Company)
The company’s HealthKit and ResearchKit together may form the core of a new “digital ecosystem” for health data and digital medicine, just as iTunes did for music and movies. But a lot of unanswered questions remain that could affect Apple’s chances for success in the health arena.

Read Full Story | Leave a Comment

Protecting the brain in newborn bloodstream infections

NICU%20baby-Shutterstock-cropped

Preterm infants in neonatal intensive care units, particularly those with catheters and intravenous lines, are at high risk for bacteremia—bloodstream infections that can cause lasting brain injury. A new study may change how people think about these infections, suggesting that inflammation is as important to address as the infection itself.

Using a novel mouse model of bloodstream infections in newborns, infectious disease physician-researcher Ofer Levy, MD, PhD, demonstrates that bacteremia can damage the brain even when the bacteria don’t actually get into the central nervous system. Findings were published online last week in the Journal of Infectious Diseases.

“There has been a lot of indirect epidemiologic evidence for a link between bacteremia, inflammation and cerebral injury, but it showed only a correlation, not causation,” says Levy. “Here we demonstrate directly in an animal model that inflammation alone can cause brain injury in newborns with bacteremia, even without entry of the bacteria to the central nervous system.”

Read Full Story | Leave a Comment

Early neglect and deprivation change the body’s stress response systems

Photo: Angela Catlin/Wikimedia Commons
Photo: Angela Catlin/Wikimedia Commons

Severe social and emotional deprivation in early life is written into our biochemical stress responses. That’s the latest learning from the long-running Bucharest Early Intervention Project (BEIP), which began in 2000 and has been tracking severely neglected Romanian children in orphanages. Some of these children were randomly picked to be placed with carefully screened foster care families, and they’ve been compared with those left behind ever since.

While studies in rodents have linked early-life adversity with hyper-reactivity of the sympathetic nervous system and the hypothalamicpituitaryadrenal (HPA) axis, the relationship has been harder to pin down in humans. BEIP’s study, involving almost 140 children around the age of 12, had children perform potentially stressful tasks, including delivering a speech before teachers, receiving social feedback from other children and playing a computer game that malfunctioned partway through.

Unlike the rodents, the institutionalized children had blunted responses in the sympathetic nervous system, which is associated with the “fight or flight” response, and in the HPA axis, which regulates production of the stress hormone cortisol. The researchers note that this dulled physiologic response has been linked to health problems, including chronic fatigue, pain syndrome and auto-immune conditions, as well as aggression and behavioral problems.

Read Full Story | Leave a Comment

Pediatric innovators showcase highlights inventions

Innovators Showcase Boston Children's HospitalSome great inventions were on view this week at the second annual Boston Children’s Hospital Innovators Showcase. Hosted by the hospital’s Innovation Acceleration Program and Technology & Innovation Development Office, the event featured everything from virtual reality goggles with gesture control to biomedical technologies. Below are a few new projects that caught Vector’s eye (expect to hear more about them in the coming months), a kid-friendly interview about the SimLab and list of inventions kids themselves would like to see. (Photos by Katherine Cohen except as noted)

Read Full Story | Leave a Comment

What we’ve been reading: Week of April 13, 2015

reading april 2

Can a smart vest help people who are deaf “hear” speech? (The Atlantic)
Inventor and neuroscientist David Eagleman has created a vest that transmits spoken words into vibrations in a vest that can be felt and translated- or effectively “heard”- by the wearer.

Electrified: Adventures in transcranial direct current stimulation (The New Yorker)
Neuroscientists at the University of New Mexico have developed a brain stimulation therapy they believe may have a whole host of benefits, from chronic pain relief to improved memory function. Our own Alexander Rotenberg, MD, PhD, weighed in on this technique’s potential applications in pediatrics in a Vector post last summer.

The problem with satisfied patients (The Atlantic)
When patient satisfaction surveys are directly tied to federal funding, hospital administrators put extra effort into making patients happy. But does happier always mean healthier?

Read Full Story | Leave a Comment

BabySee: Mobile app lets you see through an infant’s eyes

David Hunter, MD, PhD, chief of Ophthalmology at Boston Children’s Hospital, gets a lot of questions from parents, but the number one question is: “What can my baby see?”

That depends. How old is the baby?

Five days after birth, she might see something like the image at left; at 3 months, the image at right:

BabySee 5 days and 3 mos

At 6 months and 9 months, there’s increasing color and resolution:

Read Full Story | Leave a Comment

Advances in SCID (“bubble boy” disease): A Q&A with a child hematologist/oncologist

David Williams, Luigi Notarangelo and Sun-Yung PaiSung-Yun Pai, MD, a pediatric hematologist/oncologist at Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, was lead author on two recent articles on severe combined immune deficiency (SCID) in The New England Journal of Medicine. The first reviewed outcomes after bone marrow transplantation; the second reported the first results of a new international gene therapy trial for X-linked SCID. Here, she discusses what’s known to date about these therapies.

Q: What is SCID?

A: SCID is a group of disorders that compromise the blood’s T cells, a key component of the immune system that helps the body fight common viral infections, other opportunistic infections and fungal infections. T-cells are also important for the development of antibody responses to bacteria and other microorganisms. A baby born with SCID appears healthy at birth, but once the maternal antibodies that the baby is born with start to wane, the infant is at risk for life-threatening infections. Unless diagnosed and treated—with a stem cell transplant from a healthy donor or a more experimental therapy like gene therapy—babies with SCID typically die before their first birthday.

Read Full Story | Leave a Comment

On the clock: Circadian genes may regulate brain plasticity

brain circadian rhythmsIt’s long been known that a master clock in the hypothalamus, deep in the center of our brain, governs our bodily functions on a 24-hour cycle. It keeps time through the oscillatory activity of timekeeper molecules, much of which is controlled by a gene fittingly named Clock.

It’s also been known that the timekeeper molecules and their regulators live outside this master clock, but what exactly they do there remains mysterious. A new study reveals one surprising function: they appear to regulate the timing of brain plasticity—the ability of the brain to learn from and change in response to experiences.

“We found that a cell-intrinsic Clock may control the normal trajectory of brain development,” says Takao Hensch, PhD, a professor in the Departments of Molecular and Cellular Biology and Neurology at Harvard University and a member of the F.M. Kirby Neurobiology Center at Boston Children’s Hospital.

Read Full Story | Leave a Comment

What we’ve been reading: Week of April 6, 2015

What we've been readingExome sequencing comes to the clinic (JAMA)
An approachable and thorough summary of the growing trend, describing the ways in which sequencing can help provide a diagnosis, the diagnostic yield (as high as 40 percent or more, depending on the population), how often the results have changed treatment decisions and the question of who pays.

Who Owns CRISPR? (The Scientist)
Excellent coverage of the escalating patent scramble for genome editing.

Doctors Make House Calls On Tablets Carried By Houston Firefighters (NPR)
Interesting use of telemedicine in Houston, where many people call 911 in non-emergency situations. EMTs carry tablets, and can have callers chat with a physician on a video app, avoiding the need to take them to the ED.

Read Full Story | Leave a Comment