This post originally appeared in longer form on Harvard Medical School’s news site. Try not to scratch when you read it.
Illustration: David Roberson
There’s itch, and then there’s itch.
New research has revealed distinct sets of itch-generating neurons that explain why current itch therapies often fail. It also suggests new ways to selectively silence itch.
“We think this [research] has therapeutic implications,” says Clifford Woolf, PhD, director of the F.M. Kirby Neurobiology Center at Boston Children’s Hospital and professor of neurology at Harvard Medical School (HMS).
While itch is more aggravating than life-threatening, Woolf and HMS graduate student David Roberson hope their work might one day ease the torment itch can cause, particularly in children.
“If you go into the pediatric immunology wards, you see little kids with their hands in mittens or sometimes tied down because they scratch themselves to a point where they damage themselves,” says Woolf. Full story »
When someone is terminally ill, what is the right treatment course? Should treatment be stopped altogether? What is in the patient’s best interest? What role should medical professionals, including clinical ethicists, play in the decision-making process?
Such decisions can tear families apart, and the choices can confound politicians, policy makers and the public. In 2012, Massachusetts voters rejected a ballot question that would have allowed physician-assisted suicide for terminally ill patients. The initiative lost by 1 percent of the vote. Federal legislation would have provided Medicare reimbursement to physicians for counseling patients about living wills and end-of-life care, but the provision was dropped amid claims that it would create “death panels” that would judge whether a patient is “worthy” of care.
Publicly, most palliative care and end-of-life debates focus on the elderly, but the issues are especially complex and wrenching for children and teens facing severe, painful or life-threatening conditions. Children are at the beginning, not the end, of life, and the adults involved in medical decision-making may have conflicting interests and wishes. Full story »
A slippery coating inspired by the surface of a pitcher plant could help keep IV lines free of bacteria and blood clots. (kleo_marlo/Flickr)
Pick up a piece of IV tubing (should you happen to have one nearby) and run your hand down the length of it. The surface feels pretty smooth, yes?
From the perspective of bacteria and platelets, that same surface is pockmarked with nooks and crannies where they can stick, aggregate and start to form blood clots (in the case of platelets) or hard-to-combat biofilms (in the case of bacteria).
That’s a problem for hospital care. Contaminated central lines (IV lines threaded into deep veins for long periods of time) cause upwards of 41,000 costly and potentially fatal central line-associated bloodstream infections (CLABSIs) in pediatric and adult patients in U.S. hospitals every year. And blood clots can preclude patients, including premature babies, from receiving new lung-protecting treatments because they can’t tolerate anticoagulants.
Both problems may have a single solution. Clinicians in Boston Children’s Department of Newborn Medicine and engineers at Harvard’s Wyss Institute for Biologically Inspired Engineering have collaborated to develop a coating, inspired by pitcher plants, that makes the surfaces of clinical-grade plastics so slippery that platelets and bacteria can’t get a toehold. Full story »
Facing the Giants (ForeverMan724)
Does clinical medicine have the courage to lead health care reform? A former pediatric resident at Boston Children’s Hospital recently asked this question before a standing-room-only audience during the hospital’s annual Blackfan Lecture. I’m talking about Donald Berwick, MD, MPP, FRCP
—co-founder and president emeritus of the Institute for Healthcare Improvement (IHI)
and Administrator of the U.S. Centers for Medicare & Medicaid Services (CMS) from July 2010 to December 2011.
Berwick, who may run for Massachusetts Governor in 2014, didn’t just ask physicians and hospitals to embrace health care reform, as they’ve come to embrace quality improvement programs and checklists. He urged them to lead. To rescue health care.
In 1998, the Choluteca Bridge was one of the few in Honduras to withstand Hurricane Mitch. Unfortunately, the river beneath it had moved, leaving a bridge spanning dry land. “This,” Berwick declared, “is American health care.”
So why can’t we move the bridge to the river? Following Gloria Steinem’s advice to name a problem before trying to tackle it, Berwick outlined 11 uncomfortable challenges—11 “monsters under the bed” that need to be faced. Full story »
Could diabetes be treated without insulin shots? (Tess Watson/Flickr)
For decades, patients have managed their type 1 diabetes by injecting themselves with insulin to regulate the glucose in their blood. While this form of medical management addresses the immediate danger of low insulin levels, long-term complications associated with diabetes, like heart and kidney diseases, still threaten more than 215,000 children currently living with the disease in the United States.
“Insulin injections can manage hyperglycemia by reducing the patient’s glucose levels, but it is not the cure,” says Paolo Fiorina, MD, PhD, of the Nephrology Division at Boston Children’s Hospital.
Fiorina is currently involved in new research targeting a molecular pathway that triggers diabetes in the first place—potentially providing a permanent cure. It could potentially change the face of diabetes treatment in children. Full story »
Interior of a bladder (Gray's Anatomy of the Human Body)
Ask a group of 15-year-olds what’s on their minds, and you’ll likely hear something along the lines of video games, parties and maybe homework. Ask Adrian Haber, a sophomore at Boston Latin School, and you’ll hear something surprising: nanoparticles and bladder spasms.
Under the mentorship of urologist Hiep Nguyen, MD, at Boston Children’s Hospital, Haber has pioneered a new drug delivery system for bladder spasm medication. Nguyen believes Haber’s work has laid the groundwork for what may become a safer, more effective alternative to existing drug therapies.
The student and doctor began their partnership in November 2012; Haber, already a veteran of the Boston Regional Science Fair, was looking for a new project—one that would combine his interests in physics and biology. His mother Constance Houck, MD, an anesthesiologist at Boston Children’s, knew just the person to ask. And Nguyen had a problem that was long overdue for a solution. Full story »
Whole-exome sequencing reveals a gene mutation that comes into play only if inherited from the father.
For a small subset of boys and girls who undergo early puberty, there’s now a specific explanation. New genetic research, involving whole-exome sequencing, has identified four novel heterozygous mutations in a gene known as MKRN3
. Interestingly, while precocious puberty is more common in girls, all 15 affected children in the study inherited the mutations from their fathers.
Precocious puberty—the development of secondary sexual characteristics before 8 years in girls and 9 years in boys—has been associated with short stature, long-term health risks and an increase in conduct and behavioral disorders during adolescence. Physiologically, there are two types: central and peripheral. Central, the more common form, occurs when the pituitary gland, which controls puberty development, is activated too early.
“While a great deal of genetic studies have focused on the overall genetic contribution to pubertal timing, far less research has been conducted to find specific genetic causes of central precocious puberty,” says Andrew Dauber, MD, MMSc, of the Division of Endocrinology at Boston Children’s Hospital, who co-authored the study, published online this week by The New England Journal of Medicine. Full story »
Sea cucumbers drive off attackers by expelling their innards. Neutrophils do the same, forming NETs to fight bacteria. But that same capability might also help fuel dangerous blood clots. (Anders Poulsen/Wikimedia Commons)
Sea cucumbers have an unusual way of defending themselves
. When threatened, they ensnare their foes with sticky threads. Some even expel their own internal organs to repel attackers.
Immune system cells called neutrophils sometimes do much the same: When confronted with bacteria, they unravel and shoot out their chromatin—the tightly wound mix of DNA and proteins that keeps genes packaged in cells. The resulting molecular mesh, known as a neutrophil extracellular trap, or NET, traps and kills bacteria, providing an additional line of defense against bloodstream infections.
But neutrophils and NETs can go awry. Since 2010, Denisa Wagner, PhD, of the Program in Cellular and Molecular Medicine at Boston Children’s Hospital, has been studying NETs’ role in deep vein thromboses (DVTs)—blood clots that form in veins deep in the body where blood clots shouldn’t, usually in the legs. Full story »
Teens with type 1 diabetes can download their blood glucose data and attend "virtual clinics" from home.
Most adolescents fight for the freedom to manage their own lives, especially when it comes to friends, curfews and hobbies. That excitement conspicuously slips away when they’re faced with managing something less glamorous—like diabetes.
Since diabetes is a chronic illness with potentially serious risks, it requires continuous management. But adolescents aren’t exactly lining up around the block for extra medical visits.
“Some adolescents forget to do things like take insulin or check their blood glucose level, and they could benefit from more frequent check-ins with their diabetes team,” says Erinn Rhodes, MD, MPH, director of the Type 2 Diabetes Program and Inpatient Diabetes Program at Boston Children’s Hospital. “But that’s not easy, especially if time is limited or if transportation is a challenge.”
So Rhodes has designed a study for adolescents 13 to 17 years old, to see if “televisits”—video conferences between teens and their diabetes care providers—can improve their diabetes while encouraging better self-management. Full story »