Archive for March 2016

Ultra-sensitive test for cancers & HIV developed by Stanford chemists

March 26, 2016
Photo by Tom Mallinson

Photo by Tom Mallinson

Stanford chemists have now developed a highly sensitive and specific tool to screen cancer and HIV — 1000 times more sensitive than current clinical tests. More precise screening could allow for much earlier detection and treatment, as well as help avoid false positive results and their resulting unnecessary procedures and stress.

Developed in the lab of chemist Carolyn Bertozzi, PhD, this new ultrasensitive screening technique has already been tested as a biomarker for thyroid cancer in clinical trials. The study results were recently reported in ACS Central Science.

Many standard clinical blood tests are based on immunoassays, which use highly specific antibodies to detect specific molecules known to be associated with the target disease. Bertozzi’s new screening test adds the power of DNA detection to this standard procedure. Rather than marking, or “flagging”, disease-related antibodies using customary chemical compounds, the team flagged the antibodies using DNA.

A recent Stanford news release explains:

The researchers tested their technique, with its signature DNA flag, against four commercially available, FDA-approved tests for a biomarker for thyroid cancer. It outperformed the sensitivity of all of them, by at least 800 times, and as much as 10,000 times. By detecting the biomarkers of disease at lower concentrations, physicians could theoretically catch diseases far earlier in their progression.

Bertozzi is currently testing their ultrasensitive screening method in clinical trials for other diseases, including HIV. If its effectiveness is proven, the researchers expect it to be readily adopted in clinics. Cheng-ting “Jason” Tsai, co-author and graduate student in Bertozzi’s group, said in the news release:

Many of our collaborators are excited that the test can be readily deployed in their lab. In contrast to many new diagnostic techniques, this test is performed on pre-existing machines that most clinical labs are already familiar with.

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.

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Acne Treatments: A Q&A with Stanford dermatologist Justin Ko

March 14, 2016

Most of us suffer through at least minor acne as a teenager, but many battle severe acne into adulthood. It affects up to 50 million people annually and can cause permanent scarring, poor self-image, depression and anxiety.

The American Academy of Dermatology recently published new guidelines for acne treatment in the Journal of the American Academy of Dermatology. The new guidelines recommend using several therapies at once. I spoke about them with Justin Ko, MD, MBA, clinical assistant professor of dermatology.

What is your advise for people that suffer from mild to severe acne?

There are great treatments out there! Find a physician with whom you feel comfortable; someone who is willing to talk through the reasons behind acne and formulates with you a personalized treatment approach based on your type of acne, skin type, other health issues, preferences, etc. A therapeutic partnership between a provider and patient is essential. I think that being able to treat acne successfully and effectively is the mark of a good dermatologist. It is and remains immensely satisfying for me to go through this journey with my patients and see them come out the other side with a newfound comfort in their skin. 

What do you think of the new American Academy of Dermatology guidelines?

The AAD’s acne treatment recommendations represent the current standard of care. Our core treatment arsenal is comprised of topical treatments, oral antibiotics, hormonally-based treatments and isotrenoin (accutane), as well as other less-commonly used treatments that can have their place for the appropriate patent or situation. I agree with the guidelines that it is especially important for a topical regimen to form the foundation of any approach to acne treatment and not to rely on a single modality.

How has acne treatment changed in the past two decades?

We now have an appreciation for the fact that different types of acne require different approaches. I myself am using oral antibiotics less and more hormonally-based treatments and isotrenoin (accutane) when I think a patient will benefit. Here at Stanford, we also see acne-like eruptions in different forms due to underlying medical conditions and treatments, including new targeted-cancer treatments.

How do laser treatments and photodynamic light therapy work?

In the right settings these treatments can be good, as a companion to “traditional” treatments or situations when a patient is unable to use “traditional” treatments. They work in a couple ways. Some light-based treatments take advantage of a property of selected wavelengths of light that reduce the skin’s immune activity. Acne is fundamentally inflammation around hair follicles, so these light-based treatments can help.

Photodynamic therapy and intensive treatment protocols for PDT actually aim to shrink the oil glands, which play a role in acne formation in unlucky people. This intensive treatment can be quite painful, but it can be effective.

As with any of this, it’s essential to find a provider who is trained in the appropriate, safe and effective use of laser therapy.

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.

Video series focuses on bridging cultural gaps in the clinic

March 11, 2016

Imagine you visit a doctor in a far-off land with a different language. Although you have an interpreter, the doctor barely looks at you — instead relaying all information through the interpreter. You feel extra, ignored. If anything, you are building a relationship with the interpreter, not the doctor.

And that’s not good, VJ Periyakoil, MD, clinical associate professor of medicine, points out in the video above.

Our goal is to talk with the patient, through the interpreter, not talk about the patient, to the interpreter.

The video is part of the Stanford Cross Cultural Medicine Microlecture Series, a series of very short talks (about one to five minutes) that aims to bridge the growing communication gap between doctors and their patients as the U.S. population becomes older and more diverse. There are already 11 million Americans that are nonliterate in English and 25 million with only limited English proficiency.

Are doctors prepared?

These talks highlight key issues in cross-cultural encounters, including a range of practice tips for health professionals provided by experienced medical interpreters and from Periyakoil. The videos typically end with a take-home message listing the problem and solution — making it easy to quickly learn the concept. Periyakoil and her colleagues hope that health professionals will use the series as a tool to reflect on their own practice.

Microlecture 4 emphasizes the importance of talking directly to the patient even when working with a medical interpreter. Patients with limited English proficiency have the right to complete healthcare information, as well as the right to the therapeutic bond between every doctor and patient.

There are currently 16 microlectures posted on the website, but many more are on their way. A total of 44 microlectures have been made and two new ones are being released each week. The lectures also build off recommendations developed in a paper on ethnogeriatrics by the American Geriatrics Society. 

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.

Networking to save lives: A Q&A on ovarian cancer

March 4, 2016
Photo by geralt.

Photo by geralt.

Approximately 22,280 women will be diagnosed with ovarian cancer, and an estimated 14,240 will die from the disease in the United States this year. Ovarian cancer is deadly in part because the early warning signs are limited and nonspecific — such as abdominal bloating, pelvic pain, a frequent need to urinate and quickly feeling full when eating — so the symptoms are often blamed on other more common conditions. And pap smears don’t detect it, so only 15 percent of ovarian cancer cases are detected before the disease has spread to other tissues.

In 2009, the Department of Defense Ovarian Cancer Research Program created a unique, interactive virtual academy for early-career ovarian cancer researchers, called the OCRP Ovarian Cancer Academy. I recently spoke with a new member of the academy, Erinn Rankin, PhD, assistant professor of obstetrics and gynecology and radiation oncology, about the program and her research

What is unique about the Ovarian Cancer Academy?

The program is a really special funding mechanism that pairs early-career investigators with a local university mentor and a secondary mentor from another university. It provides early-investigators access to the ovarian cancer community, mentorship from established researchers and networking opportunities. Once a year, all members meet together in person. We also have monthly webinars that cover topics for early career development, such as introducing us to patient advocacy groups. And we discuss our individual research and try to identify areas where we can collaborate.

It’s a great grant that will support my research for five years with a total of about one million dollars. But really the access to all the mentors, investigators and networking is more important to my career than the money. I’m very honored and privileged to be part of it. I have a really supportive mentor, Jonathan Berek, MD, who is chair of obstetrics and gynecology here at Stanford. He’s fostered my career in ovarian cancer research. He’s also provided me with the opportunity to collaborate with other great researchers, like Oliver Dorigo, MD, PhD.

What are the major challenges of ovarian cancer diagnosis and treatment?

 Ovarian cancer is a highly metastatic and deadly disease. Most patients are diagnosed with advanced metastatic disease. The standard of care for these patients is quite striking. They go through a surgical debulking and then they are treated with conventional chemotherapy. Unfortunately, most of them become resistant to the chemotherapy after multiple cycles, so they end up succumbing to their disease.

It’s such a devastating cancer. If we can make an impact for these patients, it would be wonderful. Since we don’t have good mechanisms to detect the disease earlier, a good way to improve overall survival is to develop new therapies that can effectively treat resistant metastatic disease and prevent recurrence. 

What is the specific focus of your ovarian cancer research?

I study how the microenvironment of a tumor influences metastatic progression. In particular, I focus on how hypoxia, or low oxygen supply, drives ovarian cancer metastasis and its resistance to therapy. Virtually every solid tumor has areas of hypoxia. And hypoxia in these tumors is often associated with poor response to therapy, further metastatic progression and poor patient survival. This is the case in ovarian cancer.

We’ve identified a new, really exciting cancer therapy target — a cell receptor enzyme called axl that has a molecular link to hypoxia. Axl is highly expressed in ovarian cancer metastatic lesions in comparison to normal ovary tissue. We identified axl as a key factor regulating ovarian cancer metastasis through genetic means. We then collaborated with Amato Giaccia, PhD, in the radiation oncology department and Jennifer Cochran, PhD, in the bioengineering department to develop a novel therapeutic agent to target axl for metastatic therapy.

Our research now focuses on how our anti-axl therapy works to treat advanced metastatic ovarian cancer. We’re testing it in combination with the standard of care, which is chemotherapy, in two preclinical mouse models of ovarian cancer. We’re really excited. Our anti-axl therapy appears to be a highly potent and safe hypoxia inhibitor. Once we generate more preclinical data, we plan to take this agent into clinical trials. I hope our therapy will make a difference for these patients.

This is a reposting of my Scope medical blog story, courtesy of Stanford School of Medicine.

Not just an image: Radiologists boost communication skills

March 1, 2016
Dr. Marcus Maydew, radiologist from Creighton University, reviews an x-ray (Offutt Air Force Base).

Dr. Marcus Maydew, radiologist from Creighton University, reviews an x-ray (Offutt Air Force Base).

As a Hodgkin’s lymphoma survivor, I’ve had plenty of CT scans, mammograms, chest X-rays and MRIs during my diagnosis, therapy and 20 years of follow-up care. So I’ve interacted with radiologists at many Bay Area clinics, including Stanford where I was treated — that is, if you count getting summary reports in the mail as “interactions.”

This type of interaction may be changing with the growing movement toward patient-centered care, which is a critical component of the new American College of Radiology’s Imaging 3.0 initiative. Some radiologists are now going beyond image interpretation by discussing test results directly with their patients.

“Many interventional radiologists are now creating their own clinics, seeing patients and following them like any other surgeon,” Sandip Biswal, MD, a Stanford associate professor of radiology, told me. “Patient interactions are also quite heavy in mammography, particularly if the radiologist sees something suspicious.”

As radiologists come out of their reading rooms, many need to improve their communication skills, and a new training program at UMass Memorial Medical Center, called “Coming Out of the Dark,” teaches first and fourth-year radiology residents effective communication skills through role-playing. The program is led by Carolynn DeBenedectis, MD, an assistant professor of radiology there.

The participants practice six scenarios, such as delivering bad news from breast imaging tests, with trained actors performing as the patients. They are evaluated by both the patient actors and attending radiologists with prior communication skills training. The sessions are also videotaped and reviewed with the residents. The same participants return two weeks later to role-play six similar scenarios in order to evaluate their improvement.

At the Radiological Society of North America 2015 meeting, DeBenedectis reported on last year’s pilot program results. Participants were graded using a standard communications assessment scale and their scores on average improved about 5 percent between the two sessions — from 74 percent to 79 percent for first-year residents. More importantly, participants found the training useful, as reported in a recent online story.

We could probably all benefit from improved communication skills. However, there is some controversy over whether diagnostic radiologists should discuss imaging results directly with their patients after their scans. Biswal explained to me:

In the patient’s best interest, we really need to take a team approach. The primary care physician or referring specialist has the best understanding of what the patient is going through, so they can better convey the news. For radiologists to sit down with a patient and give them imaging results without knowing their full story can be potentially dangerous. There is an art to conveying this type of information that takes years of practice. I think of it like this: if it was my mother, how would I want her to be treated?

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.


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