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 »
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 »
(Teak Sato/Wikimedia Commons)
Research on rare disorders, or in new fields, often follows a particular trajectory. It tends to start out fragmented, carried out by one or two isolated researchers at a few institutions.
But as researchers find each other, identify more patients and start to collaborate systematically, patterns of disease biology emerge, researchers start speaking the same language and new treatments materialize.
The field of complex vascular anomalies—a set of conditions characterized by blood vessels that have not developed normally—is in this kind of early days. In large part this is because they are relatively rare. In addition, few centers worldwide have the multidisciplinary experience to provide comprehensive care to these rare patients.
But a new coalition forming around vascular anomaly research and care could help unravel the biology of vascular anomalies and fashion better treatments for these children by bringing to bear the resources and knowledge of specialists from across the continent. Full story »
A research registry helped Inga Hofmann, MD, PhD, search the genomes of several patients with a rare blood disorder and reveal new mutations behind it. (Michael David Pedersen/Flickr)
To really understand rare conditions, you need a lot of data from a lot of patients. But no one hospital or center usually sees more than a few patients with any given rare disease, precisely because they’re rare.
This is where case registries become important. These research collaborations, which usually span several institutions, typically focus on a single rare disease or a few related conditions, serving as a data warehouse for collecting information from as many patients and as many places as possible.
One such registry based out of Dana-Farber/Boston Children’s Cancer and Blood Disorders Center—the Pediatric Myelodysplastic Syndromes (MDS) and Bone Marrow Failure (BMF) Registry—has recently started to bear fruit, finding that a unique set of mutations in a single gene may play a larger-than-realized role in a group of rare blood diseases. Full story »
Just like Goldilocks wouldn’t eat porridge that was too hot or too cold, blood vessels won't grow properly in tissues that are too stiff or too loose. (Project Gutenberg/Wikimedia Commons)
In the tale Goldilocks and the Three Bears
, Goldilocks tries all of the bears’ porridge, chairs and beds, finding that only the little bear’s things were just right. Everything else was a little off for her…too hot or too cold, too hard or too soft and so on.
Similarly, for everything to work as it should in the body, things need to be just right. Blood pressure shouldn’t be too high or too low; organs can’t be too big or too small, etc.
Donald Ingber, MD, PhD, and his lab in Boston Children’s Vascular Biology Program take this “just right” approach when thinking about how organs and tissues are structured. Recently, he and a member of his research staff, Akiko Mammoto, MD, PhD, discovered that by changing the stiffness of the surrounding tissues—not too loose and not too tight— they could keep blood vessels from leaking. Their finding could have real consequences for people with sepsis or other diseases featuring leaky vessels. Full story »
There are a couple of ways by which aspirin might affect cancer. (cpradi/Flickr)
Aspirin does a remarkable number of things in the body, enough that it’s said it would never win approval today from the Food and Drug Administration as an over-the-counter drug.
But among those functions are some that may explain something that doctors have recognized for some time: patients with cancer who have been taking aspirin tend to have better outcomes. Full story »
(Jerome Gerrior Racing/Flickr)
In the hours and days following the Boston Marathon bombings, the first concern for the victims was literally life and limb—stabilizing the survivors and treating wounds suffered in the blasts.
But as the survivors begin the road to recovery—a road that promises to be long and complicated—subtler effects of the blast may become apparent, including traumatic brain injuries (TBIs).
“The difference between traumatic brain injuries and the other injuries we’ve seen is that the extent of other injuries can be readily seen,” says Mark Proctor, MD, a neurosurgeon and director of Boston Children’s Brain Injury Center. “You can have a traumatic brain injury without any external signs.”
TBIs have been a major concern among soldiers serving in war zones like Iraq or Afghanistan who have experienced the concussive force of bomb or improvised explosive device (IED) explosions—not unlike the explosions on Marathon Monday. Full story »
Ed. note: This morning at 8:15 EDT, Isaac Kohane, MD, PhD, will tell the audience at TEDMED 2013 about his goal of using every clinical visit to advance medical science.
Clinical research is all about numbers. A new informatics network called SHRINE could help make it easier to get find out if the numbers of patients are there to answer complex questions. (victoriapeckham/Flickr)
To preview his talk, we’ve updated a past Vector story about SHRINE, a system Kohane helped develop to allow scientists to use clinical data from multiple hospitals for research.
Clinical research really comes down to a numbers game. And those numbers can be the bane of the clinical researcher. If there aren’t enough patients in a study, its results could be statistically meaningless. But getting enough patients for a study, particularly for rare diseases, can be a daunting challenge.
The Shared Research Information Network (or SHRINE) could help solve this vexing problem. Developed through Harvard Catalyst by a team led by Isaac “Zak” Kohane, MD, PhD, director of Boston Children’s Hospital’s Informatics Program, SHRINE links the clinical databases of participating Harvard-affiliated hospitals—currently Boston Children’s Hospital, Beth Israel Deaconess Medical Center, Brigham and Women’s Hospital, Dana-Farber Cancer Institute and Massachusetts General Hospital—letting researchers at those hospitals see how many patients from those hospitals meet selected criteria.
Why is this important? Full story »
Babies with newborn jaundice need phototherapy. In the developed world that's easy; in the developing world, not so much. (Bruce R. Wahl/Beth Israel Deaconess Medical Center)
Family lore has it that when I was born, I had to spend a couple of extra days in the hospital for jaundice
, the distinctive yellow tint to the skin that shows that a baby’s liver isn’t fully up and running yet. For me—and most of the newborns that develop jaundice every year in the developed world—the treatment was simple: spending some time lying under bright blue lights (aka phototherapy
Note that I said “developed world.” The story in the developing world is quite different. Sometimes the nearest hospital with phototherapy equipment is hours’ or days’ travel away. Even though it’s simple, phototherapy is power intensive; no power, no treatment.
And untreated jaundice can have devastating consequences. The yellow pigment, called bilirubin, can accumulate in the brain and cause permanent brain damage or death.
The best solution for regions with few resources would have to be small and portable, run on batteries or other off-grid power sources, cost little, but still be safe and deliver the right wavelength and intensity of light. This is where Donna Brezinski, MD, wants to make a difference. And the Bili-Hut is her answer. Full story »