Chronic, unresolved inflammation can be quite harmful, right down to the cellular level. At the macro level, it has links to cancer, diabetes, heart disease and other degenerative conditions.
This is why the body keeps a tight rein on the inflammatory response and maintains a host of factors that resolve inflammation once the need for it (for instance, to clear an infection or heal an injury) has passed.
We know pretty well which factors work between cells to turn on and turn off inflammation. That knowledge has led to the development of drugs like ibuprofen, acetaminophen and naproxen, all of which temper pro-inflammatory factors.
However, when you look at the signals and signaling pathways within cells, things get more complex, especially when it comes to factors that turn off inflammation. We haven’t completely grasped the full complement of proteins that transmit these internal anti-inflammatory signals. If we did, we could potentially add new drugs to our pharmacopeia to regulate or resolve inflammation or maintain cells in a non-inflamed state, and perhaps help prevent rejection of transplanted organs and tissues.
David Briscoe, MD, and his team at Boston Children’s Hospital’s Transplant Research Program, has taken the field one step closer to grasping those internal pathways by studying a cellular protein called DEPTOR. Full story »
With the latest technologies and techniques, MRI (bottom) is in many cases just as good as, if not better than, CT (top) when taking images of a child's chest. (Courtesy Edward Y. Lee, MD, MPH)
Magnetic resonance imaging, or MRI, can produce stunningly detailed images of the body’s tissues and structures. Historically, however, the chest—and in particular, the lungs and airway—has proven challenging for radiologists to clearly visualize through MR images.
Why is that? Unlike most other solid organs, the lung and trachea aren’t really solid. The air spaces within them do not absorb the magnetic fields or produce the radio signals needed to generate high-quality diagnostic images. Also, they are in constant motion—we have to breathe, after all.
For these reasons, radiologists have long relied on x-rays and computed tomography (CT) scans to take pictures of the lungs. Both can produce very good, highly detailed diagnostic images, but both also come with risks related to their reliance on ionizing radiation.
The lung MRI’s time may now have come. In a review paper in Radiologic Clinics of North America (RCNA), an international team of radiologists led by Simon Warfield, PhD, and Edward Y. Lee, MD, MPH, of Boston Children’s Department of Radiology outlines several recent advances that have made MRI a more viable—radiation-free—alternative for diagnostic imaging of children’s lungs and airway. Full story »
The discovery of penicillin in 1928 marked the beginning of the antibiotic era and dramatic improvements in health and medicine. With mass production of the new ‘wonder drug’ in the 1940s, threats from previously lethal diseases like bacterial infections and pneumonia waned. However, less than 100 years later, the Centers for Disease Control and Prevention (CDC) is sounding alarms about the increasing threat of antibiotic resistance.
The United States is edging closer to the cliff of a post-antibiotic era in which medications lose their effectiveness, the CDC cautioned in a September report, detailing the burden and threat posed by antibiotic-resistant bacteria.
Every year, more than 2 million people in the U.S. contract antibiotic-resistant infections, and at least 23,000 people die as a result. Estimates vary, but data suggest that the direct health care costs of antibiotic resistance may top $20 billion annually.
The path from remedy to resistance is rapid. “Every time antibiotics are used in any setting, bacteria evolve by developing resistance. This process can happen with alarming speed,” says Steve Solomon, MD, director of CDC’s Office of Antimicrobial Resistance. Full story »
Boston Children’s Hospital convened the National Pediatric Innovation Summit + Awards 2013 with an ambitious goal: to bring together thought leaders to address the toughest challenges in pediatric health care. During the two-day summit, a series of panels and town hall discussions sparked dynamic dialogue.
While the summit was designed as a forum for ongoing discussion and relationship building, five key takeaways have emerged. Full story »
First-generation clinical decision support has been plagued by poor uptake among physicians, largely due to its overwhelming nature and perceived lack of applicability to clinical practice. But predictive analytics, built into these platforms, could produce the next significant wave in innovation in pediatric care, according to Joseph Frassica, MD, chief medical informatics officer and chief technology officer of Philips Healthcare.
Frassica spoke about predictive analytics last week at a panel on innovation acceleration at the Boston Children’s Hospital National Pediatric Innovation Summit + Awards 2013. Vector caught up with him afterward. Full story »
A moment of levity as the panelists discuss challenges in pediatric care and care delivery.
To summarize the state of pediatric health care today, Steven Altschuler, MD, president and CEO of Children’s Hospital of Philadelphia (CHOP), quoted the 1963 movie The Leopard
: “Everything must change, so that everything can stay the same.”
He spoke at a panel discussion with two other children’s hospitals’ CEOs—Boston Children’s Hospital’s outgoing CEO James Mandell, MD, and Herman Gray, CEO of Children’s Hospital of Michigan (CHM)—during Boston Children’s Pediatric Health Innovation Summit + Awards on September 27 in Boston. Erik Halvorsen, PhD, director of Boston Children’s Technology and Innovation Development Office, moderated the session on the top challenges in pediatric health care and care delivery.
“For us to continue to support our missions in the traditional manner and for us to continue to advance pediatric health care, we need to change everything, including the reimbursement and research-funding models, as well as the education of our new caregivers,” Altschuler said. In his estimation, medical education has “unprepared new doctors and nurses to practice appropriate medicine in a safe, effective manner. The education is completely out of touch with reality.” Full story »
Wrapping up the National Pediatric Innovation Summit + Awards on Sept. 27, emcee Bruce Zetter, PhD, who runs a lab in Boston Children’s Vascular Biology program, remarked, “I thought I was going to learn about technology. What I learned about was communication.”
Surgeon, writer and public health researcher Atul Gawande, MD, MPH, laid bare this often overlooked element of medicine in his closing keynote. He eloquently made the point that communication—and more specifically systems—is where innovation is most needed and where it can have the most impact.
“We have emerged from the century of the molecule to the century of the system,” Gawande said.
Right now, these systems are broken, seemingly everywhere. Gawande recounted the sad tale of Duane Smith, a patient who survived a severe car crash that ruptured his spleen, only to lose his fingers, toes, nose and job from an ordinary strep infection. Full story »
Vertex Pharmaceuticals CEO Jeffrey Leiden, MD, PhD, at Boston Children’s Hospital’s National Pediatric Innovation Summit + Awards 2013. (Courtesy Vertex Pharmaceuticals)
“I can’t imagine a better time to have an innovation summit in pediatric medicine. We’ve reached a tipping point in pediatrics medicine with scientific innovations converging to completely change the way we think about and treat pediatric disease,” Jeffrey Leiden, MD, PhD, president and CEO of Vertex, shared during the opening keynote at Boston Children’s Hospital’s National Pediatric Innovation Summit + Awards 2013. Full story »
Algae similar to these could be the source of a powerful local anesthetic. (Micropix/Wikimedia Commons)
Two years ago, we told the story of the quest of Charles Berde, MD, PhD
, of Boston Children’s Division of Pain Medicine, to turn an algal toxin called neosaxitoxin into a long-lasting local anesthetic
At that time, Berde—together with Alberto Rodríguez-Navarro, MD, from Padre Hurtado Hospital in Santiago, Chile, and a Chilean company called Proteus SA—already knew that neosaxitoxin, a site 1 sodium channel blocker which in nature is produced by algal blooms, could help patients who had undergone laproscopic surgery recover more quickly and experience less pain compared with the current state -of-the-art local anesthetic called bupivacaine.
The group has now taken a big leap forward. In May, they launched a Phase 1 clinical trial at Boston Children’s in healthy male patients, aimed at showing that neosaxitoxin produced by Proteus from bioreactor-grown algae is safe using clinically relevant doses. Full story »
A kidney stone seen on CT (James Heilman/Wikimedia Commons)
Two national trends have preoccupied Caleb Nelson, MD, MPH
, and his colleagues in the Boston Children’s Hospital’s Urology Department over the past few years. One is the rise in overall exposure to medical radiation. The second is specifically the increased use of computed tomography (CT)
scans—rather than clinician-preferred ultrasound
—in children with kidney stones
“We see a lot of kids with stones, and there is a clinical need to better manage their condition,” Nelson explains. “Medical radiation is a risk factor for problems down the road, and we know that the amount of radiation people are receiving has gone through the roof in recent years.”
How big is the problem? Nelson cites data collected on radiation exposure on the U.S. population from 1987 to 2006 by the National Council on Radiation Protection and Measurements (NCRP). At the beginning of the study, about 18 percent of all radiation exposure was medical. By 2006, that number had grown to 48 percent (see chart below). Full story »