Study: High-intensitystatinslowermortality tor perspectives. and internetsearches ofpatientanddoc- of equivocal messagesfrom theirdoctors have beenhesitanttotakethembecause cardiovascular disease.Patients, inturn, intensity statinstotheirpatientswith bated thebenefitsofprescribing high- and stroke. which canattacksarteries, lead to heart caused by thebuildupofplaquein acceleration ofcardiovascular disease monly prescribed forpreventing the cholesterol levels in theblood,are com- lished onlineNov.. 9inJAMACardiology ate-intensity statins. The studywaspub- overchance ofsurvival thoseonmoder- high-intensity statinshadanincreased searchers foundthatpatientstaking at the School of Medicine. vascular disease,according toresearchers brain functions. brain functions. helps tointegrateone’s feelings, actionsandseveral other the bodyandprocesses emotionsandempathy. The insula of the insula, a brain regionpart that detects cues from differencesstudy foundstructural between thesexes inone from the School of Medicine. girls differently, according brain-scanning study toanew intensity statintherapy forpatientswith sociation jointlyrecommended high- Cardiology andAmericanHeart As- statins. damage, associatedwithhigher-intensity side effects,suchasdiabetesormuscle studies have shown anincreased riskof cine andthestudy’s seniorauthor. Some MD, professor of cardiovascular medi ing medication,” saidPaul Heidenreich, becausepart most people don’t like tak amountoffearonthepatient’scertain Volume 8, No. 21 No.21 Volume 8, By ErinDigitale andgirlsdifferently of boys PTSD changesthebrains Conflicting recommendations A By Yasemin Saplakoglu Health-care providers have longde- Statins, that lowers a class of drugs Over thedurationofayear, there- Among youth with post-traumatic stress disorder, the Traumatic stress affectsthebrainsofadolescentboys and In 2013,theAmericanCollegeof “Previously, there was definitely a treatments forpeoplewithcardio- the value ofhigh-intensitystatin large nationalstudyhasconfirmed inside Stanford

medicine November 21, 2016 November al - - tan ak including older adults.” for patientswithcardiovascular disease, advantage tensity statinsconferasurvival author. results show “The that high-in- ford andthestudy’s lead cardiology fellow atStan- Fatima Rodriguez, MD,a fined clinicalcohort,” said large,well-de- used avery of thisstudyisthatwe adults over 75. lation not well-studied: but also in apatient popu- with cardiovascular disease, and middle-agedpatients vival, not only in younger fact increase ratesofsur- high-intensity statinsdoin They determinedthat ACC/AHA guidelines. theevidence tosupport reich andhisteamfound those ofmoderateintensity. are more beneficialthan that higher-intensitystatins lack ofconclusive evidence intensity statins,noting the mended only moderate- Care System, whichrecom- Veterans AffairsHealth established in2014by the however, from guidelines AHA guidelinesdiffered, older than 75. The ACC/ cular diseasewhowere no atherosclerotic cardiovas - country receiving carecountry from the Veterans records of 509,766 patients across the Large samplesize See a / s “The greatest strength“The In theirstudy, Heiden- The researchers studiedthemedical hu Ptsd tt er stoc , page7 k. co PublishedbytheOfficeofCommunication&PublicAffairs m vides important evidenceonthatfront. Itvides important alsomeans symptomatic infection,” Richardson said. “It pro- of manifestations,including minimallyspectrum Ebola inthatitcausesa islikemostotherviruses of minimallysymptomaticinfection tobe25percent. of thestudy, theresearchers calculatedthe prevalence spread thanpreviously believed. Based ontheresults ings alsosuggestthattheepidemicwasmore wide- candidate inanthropology attheuniversity. The find- Geographic Medicine atStanford who isnow aPhD mer fellow intheDivision ofInfectious Diseases and signs of illness, said Gene Richardson, MD, a for and thatpeoplemaybeinfectedwithoutshowing Ebola doesnotuniformlycausesevere virus disease, transmission in the village. they hadnosymptomsduringthetimeofactive cating theyhadbeeninfectedatonetime. Yet 12said lage that was an Ebola hot spot. known tohave hadthedisease inaSierra Leone vil- institutions identified14individualspreviously un- researchers from theSchoolofMedicine andother By RuthannRichter in study inSierraconfirmed Leone village Existence ofasymptomaticEbola “The study corroborates“The previous evidence that The research confirmsprevious suspicionsthatthe indi- These individualshadantibodiestothevirus, A year after the Ebola epidemic in West Africa, chance over ofsurvival thoseonmoderate-intensity statins.Statinsare drugsthatlower cholesterol levelsintheblood. A review ofmore thanahalf-millionhealthrecords showed thatpatientstakinghigh-intensitystatinshadanincreased 2014, theresearchers said. They included overall patientdeathratesfrom 2013to morbidities and cholesterol values.” their detailedclinicaldata,includingco- patient population,we alsohadaccessto addition to defining this large, national diovascular disease,” saidRodriguez. “In largepatientpopulationrichincar- very Affairs Health Care isa System. “This The primary purpose was to look atThe primary - the Ebola virus but reported having nosymptoms, astudy found. but virus Ebola the A small numberofvillagersinSierra Leonewere infectedwith kudu in Sierra Leone, a Testing individuals of Partners In Health, is the senior author. Farmer, MD,PhD, aHarvard professor anddirector Richardson is leadauthorofthestudy, andPaul Medicine and Hygiene’s annual meetinginAtlanta. sented Nov. 14 attheAmericanSociety of Tropical Neglected TropicalDiseases. The studyalsowaspre - than we thought.” there wasalotmore human-to-humantransmission gone undetectedduringtheoutbreak. This shows oftransmissionevents mayhavea significantportion The research villageof Su wasdone intherural - The studywaspublishedonlineNov. 15inPLOS statins inmany moderate-intensity orlow-intensity Heidenreich said. oftherestlarge arteries ofthebody,” the brain and thebuildup — the heart, the three mainareas affectedby plaque are basically disease.“These eral artery cerebrovascular diseaseandperiph- disease, artery patients with coronary Patients were taking high-intensity, Cynthi a G o l ds mi th / Center Ro b H yr See o See n Page 4 diagnostics. limits of at power and Medicine looks of The fall issue s s /Shu f o statin, page6 Stanford r Di ebola, page7 tt s e er as stoc e C

o ntr k. co o m l DNA sequencing determines lymphoma origin, prognosis

By Krista Conger spectively enrolled patients with diffuse large B-cell germinal center subtype live for five years or more af- lymphoma. DLBCL is the most common type of non- ter diagnosis, while those with activated B-cell-like tu- Sequencing tiny bits of DNA circulating in the Hodgkin lymphoma and is highly biologically variable. mors have a poorer prognosis with current treatment blood of patients with lymphoma can accurately iden- As a result, patients vary widely in their response to regimes. These subtypes are known to predict differen- tify the cancer subtype and pinpoint mutations that treatment. About one-third of seemingly successfully tial responses to emerging targeted therapies, but they might cause drug resistance, according to researchers at treated patients eventually relapse, or their tumors be- are cumbersome to measure accurately and require the School of Medicine. come resistant to treatment. Additionally, a form of in- biopsies. This knowledge could help personalize cancer dolent B cell lymphoma, which progresses slowly with Finally, the researchers were able to predict from treatment by revealing which patients are likely to be only mild symptoms, can transform without warning the ctDNA sequences those patients whose disease was treated successfully and those who may have a poorer into an aggressive form of the disease. transforming into a much more aggressive form prior to prognosis. ‘Transformation is very difficult to detect’ the emergence of clinical symptoms, and even to iden- Tracking sequence changes over time could also tify and track specific mutations known to inhibit the provide a kind of early warning system to identify the “This transformation is very difficult to detect, and response to the targeted therapy with a drug known as emergence of an aggressive form of the cancer by pro- usually requires an invasive biopsy to diagnose,” said ibrutinib. viding a real-time window into tumor evolution. The Diehn. “Our approach will allow us to monitor patients “In this study we’ve shown five distinct ways — by findings bolster the growing notion that noninvasive, over time with a simple blood test, and may help us quantifying tumor burden, identifying disease subtype, blood-based biopsies of what’s known as circulating tu- identify transformation much earlier.” cataloging mutations, predicting transformation and mor DNA are likely to transform cancer care. The researchers used an enhanced version of a tech- providing early warnings of recurrence — that circulat- “Now we can identify the subtype of the tumor, nique they developed called CAPP-Seq to isolate and ing tumor DNA can yield potentially clinically useful watch how it changes over time and begin to tailor our sequence circulating tumor DNA, or ctDNA, from information,” said Diehn. “Now we’re eager to conduct chemotherapy choices based on the presence or absence blood samples from the patients. Unlike previous stud- prospective studies in recently diagnosed patients to of specific mutations,” said assistant professor of medi- ies, which tracked lymphoma progression by monitor- learn how we can best improve patient care.” ing the sequence of just Alizadeh and Diehn are both investigators at the Mark Tuschman one cancer-associated pro- Ludwig Center for Cancer Stem Cell Research and tein, CAPP-Seq can iden- Medicine at Stanford. tify a much larger range The team’s work is an example of Stanford Medi- of mutations in the tumor cine’s focus on precision health, the goal of which is to genome. anticipate and prevent disease in the healthy and pre- They then compared cisely diagnose and treat disease in the ill. the ctDNA sequences ob- Other Stanford co-authors of the study are research tained from the patients’ associates Henning Stehr, PhD, and Chih Long Liu, stored blood samples with PhD; former research assistant Alexander Craig; post- those of the tumor cells doctoral scholars Mohammad Esfahani, PhD, and from invasive biopsies, Daniel Klass, PhD; former postdoctoral scholar Alexan- and paired the informa- der Lovejoy, PhD; graduate student Jacob Chabon; re- tion with what was known search assistant Li Zhou; clinical trials assistant Cynthia about the course of the pa- Glover; assistant professor of Brendan Visser, tient’s disease and eventual MD; associate professor of surgery George Poultsides, outcome. They found that MD; professor of medicine Ranjana Advani, MD; clini- low levels of ctDNA after cal assistant professor of medicine Lauren Maeda, MD; diagnosis but before treat- clinical assistant professor of medicine Neel Gupta, ment correlated strongly MD; professor of medicine Ronald Levy, MD; assis- with progression-free tant professor of pathology Robert Ohgami, MD, PhD; survival in the patients. and clinical assistant professor of pathology Christian Those with higher levels of Kunder, MD, PhD. Maximilian Diehn and Ash Alizadeh have found a way to monitor cancer DNA in the blood of patients with lymphoma, which could help identify those who are likely to be treated successfully. ctDNA faired more poorly Newman, Klass and Alizadeh are co-inventors on overall. Furthermore, they patent applications related to CAPP-Seq, and Newman, were able to detect the Diehn and Alizadeh are consultants for Roche Molecu- cine Ash Alizadeh, MD, PhD. “We’ve moved beyond presence of ctDNA in the blood of relapsing patients lar Systems. Lovejoy and Klass are currently employed just measuring disease burden based on the amount of on average six months before any clinical symptoms ap- by Roche Molecular Systems. tumor DNA in the blood.” peared and as long as 2.5 years before clinical signs of The research was supported by the Damon Runyon Alizadeh and assistant professor of radiation oncol- relapse. Cancer Research Foundation, the American Society of ogy Maximilian Diehn, MD, PhD, share senior author- Determining cancer’s cell of origin Hematology, the V Foundation for Cancer Research, ship of the study, which was published Nov. 9 in Science the German Research Foundation, the Stanford TRAM Translational Medicine. Postdoctoral scholars Florian Perhaps even more importantly, however, the re- Pilot Grant, the American Society of Clinical Oncology Scherer, MD, and David Kurtz, MD, and instructor searchers found they could use CAPP-Seq to determine and the National Institutes of Health. Aaron Newman, PhD, are the lead authors. the type of B cell from which the cancer originated and Stanford’s departments of Medicine and of Radiation The researchers conducted a study of 92 pro- predict prognosis. About two-thirds of people with the Oncology also supported the work. ISM

More GABA in one brain region linked to better working memory

By Bruce Goldman The discovery helps to clarify at least in your head and remembering that you Health Care System who sees numerous one aspect of the brain’s mysterious ways, need to steer the car onto the freeway patients with this disorder. The amount of a particular chemical and could someday help guide therapies exit in about two minutes — Yoon is the lead author of in a particular part of your brain predicts for those whose working memory could all this time not forgetting the study, which was pub- your ability to simultaneously hang onto stand improvement. who you’re talking to. Like lished Nov. 16 in the Journal several bits of information in your work- And whose couldn’t? a computer’s RAM, working of Neuroscience. The study ing memory, a School of Medicine scien- Working memory is the brain func- memory serves as a buffer teases apart three key com- tist and his UC-Davis collaborators have tion that lets you carry on a phone con- where information, derived ponents of working memory learned. versation while adding three numbers from the senses or retrieved and shows that one compo- from long-term memory, can nent, but not the other two, is Inside Stanford Medicine is be temporarily placed so the tied to the amount of a chem- conscious brain can process ical called GABA in a brain

id e published monthly in July and Stanford December and semi-monthly it. It’s tied to assessments of Jong Yoon area known as the dorsolateral

in s the rest of the year. cognitive capacity such as prefrontal cortex, or DLPFC. medicine IQ, and to real-world outcomes such as Richard Maddock, MD, a professor of is produced by Paul Costello academic performance. psychiatry at UCD, is senior author of Office of Communication & Public Affairs Chief communications officer Load, maintenance, distraction the study. Stanford University Susan Ipaktchian This component, referred to as load, is School of Medicine Director of print & resistance 3172 Porter Drive Web communications a measure of the number of separate bits Palo Alto, CA 94304 John Sanford As most people eventually find out, of information a person’s working mem- Mail code 5471 Editor working memory declines with age. ory can store at the same time. A second (650) 723-6911 Robin Weiss “Deficits in working memory also component, maintenance, denotes how http://med.stanford.edu/news/ Graphic designer characterize various neuropsychiatric long information can be stored in work- conditions and are particularly evident ing memory before it’s lost. A third, dis- Send letters, comments and story ideas to John in schizophrenia,” said Jong Yoon, MD, traction resistance, gauges how well an Sanford at 723-8309 or at [email protected]. an assistant professor of psychiatry and individual’s working memory holds onto Please also contact him to receive an e-mail version of Inside Stanford Medicine. behavioral sciences at Stanford and a psy- information in the face of interfering chiatrist at the Palo Alto Veterans Affairs stimuli. See gaba, page 7 2 November 21, 2016 Inside Stanford Medicine Blocking CD47 could boost immunotherapy for canine cancer By Christopher Vaughan ers took canine lymphoma, one of the vived. When CV1 was used by itself to us about treating disease in humans,” most common cancers in dogs, and put treat the cancer, only 20 percent of the Weiskopf said. Blocking a cell surface protein called it into laboratory mice. Weiskopf then mice survived. But when the anti-CD20 Weissman noted that it is an impor- CD47 may help treat at least one kind injected the mice with CV1, a molecule antibody and CV1 molecule were used tant first step that the molecular tools of cancer in dogs, according to a study he helped develop to bind tightly to the together, 100 percent of the mice sur- used to target human CD47 also work by researchers at the School of Medicine against dog cancers, at least when tested and other institutions. norbert von der groeben in a mouse host. “This should provide The work expands on research by impetus to produce even more effective Irving Weissman, MD, professor of anti-CD47 proteins that are designed for pathology and of developmental biol- optimal targeting of dog — and sepa- ogy, and his colleagues, who found that rately, cat — CD47 molecules and can- blocking CD47 might be useful in treat- cers,” he said. Weissman is also director ing nearly every kind of human cancer. of the Stanford Ludwig Center for Can- The study was published online Nov. cer Stem Cell Research and Medicine. 14 in Cancer Immunology Research. Other Stanford co-authors of the Kipp Weiskopf, MD, PhD, a former study are graduate student Amira Barkal; student at the School of Medicine, is former postdoctoral scholar Susan Pro- lead author of the study. Weissman, di- haska; former student rector of the Stanford Institute for Stem Aaron Ring, MD, PhD; and former Cell Biology and Regenerative Medicine, lab technicians Peter Schnorr and Kelly and Jaime Modiano, VMS, PhD, of the McKenna. University of Minnesota, share senior Researchers from the University of authorship. Minnesota, Elanco Animal Health U.S. ‘Don’t eat me’ Inc. and the Genomics Institute of the Novartis Research Foundation also co- The CD47 protein acts as a “don’t authored the study. eat me” signal to immune cells called The work expands on research by Irving Weissman and his colleagues, who found that blocking CD47 The work was supported by the Na- macrophages, which normally engulf might be useful in treating nearly every kind of human cancer. tional Institutes of Health, the Mor- and devour cancer cells and other dis- ris Animal Foundation, the Joseph and eased and dying cells. It turns out that Laurie Lacob Gynecologic/Ovarian Can- nearly every kind of cancer uses CD47 CD47 receptor and block the “don’t vived with no further evidence of dis- cer Fund, Ludwig Cancer Research, the to evade these macrophages. Covering eat me” signal. In some cases, they also ease. They seemed to be cured. Siebel Stem Cell Institute, the Thomas up the CD47 “don’t eat me” protein al- used a specially devised antibody against Leading cause of illness in dogs and Stacey Siebel Foundation, Stanford lows the immune cells to find and swal- a protein called CD20 to act as an “eat SPARK, the Skippy Frank Fund for Life low cancer cells. An anti-CD47 antibody me” signal to attract immune cells to the Cancer is among the leading causes Sciences and Translational Research, and is currently in a small, phase-1 clinical cancer. of illness in dogs, and clinical trials with an anonymous donors fund. trial in cancer patients at Stanford and They found that when anti-CD20 actual cancer-stricken dogs are the next Stanford’s departments of Pathology elsewhere. antibody alone was used to treat the dog step. “We hope that these studies help and of Developmental Biology also sup- Weiskopf and his fellow research- cancer in mice, none of the mice sur- companion animals and further inform ported the work. ISM

Three faculty members New compliance, study management elected fellows of AAAS resources available for researchers

Two professors at the School of Medicine and one at Cartoonresource / shutterstock.com the School of Earth, Energy & Environmental Sciences Spectrum, the Stanford Center for Clinical and have been elected fellows of the American Association Translational Research and Education, recently estab- for the Advancement of Science. lished two new groups to assist Stanford researchers in They are among 391 new AAAS fellows chosen this managing studies and complying with the labyrinth year by their peers for scientifically or socially distin- of government regulations associated with clinical guished efforts to advance sci- research. ence or its applications. OnCore training Andrew Hoffman, MD, pro- fessor of endocrinology, was se- The first, Spectrum’s OnCore support team, is lected for contributions to the currently scheduling training sessions for groups field of epigenetics, particularly interested in using the OnCore clinical research for discerning underlying mech- management system. The schoolwide adoption of anisms of genomic imprinting OnCore will make it easier for investigators to man- and long-range chromatin inter- age clinical research and monitor participant recruit- actions. Hoffman’s lab examines ment. OnCore also provides tools for multisite study the role of insulinlike growth Andrew Hoffman management. For more info, contact the manager factors in normal physiology of this group, Yona Shulaker, at shulaker@stanford. and in oncogenesis. edu, or visit http://medicine.stanford.edu/news/cur- This office will be developing School of Medicine Lawrence Steinman, MD, rent-news/standard-news/department-wide-roll-out- clinical research policies, standard operating proce- professor of neurology and planned-for-oncore.html. dures and systems for tracking regulatory compliance. neurological sciences, was se- Clinical research guidance It is currently focused on tracking Stanford studies lected for discoveries about the listed on ClinicalTrials.gov and training researchers molecular basis for lymphocyte The second resource, the Clinical Research Quality on upcoming results-posting regulation changes. It is homing to the brain in relapsing Office, is staffed with experts who can help research under the leadership of faculty director Mark Pegram, multiple sclerosis, which led to teams understand clinical research regulations and MD, professor of oncology, and administrative direc- an effective approved therapy adopt best practices. They can also help groups pre- tor Jennifer Brown, RN. For more information, visit for multiple sclerosis. Steinman, pare for audits by industry sponsors or the Food and https://spectrum.stanford.edu/page_listings/detail/ who holds the George A. Zim- Drug Administration. clinical-research-quality--2. SM Lawrence Steinman mermann Professorship, focuses his research on understanding the pathogenesis of autoimmune diseases, particularly multiple sclerosis. $25 million awarded to joint center for the study of regulatory science Steven Gorelick, PhD, pro- fessor of Earth system science, The Food and Drug Administration has awarded natural language processing and machine learning to was selected for contributions the UCSF-Stanford Center of Excellence in Regulatory analyze the contents of enormous databases of adverse to improving the understand- Science and Innovation a five-year, $25 million grant. effects from drugs reported by patients and clinicians. ing of mechanisms of subsurface The collaborative venture is one of five FDA Cen- Altman and Kathy Giacomini, PhD, professor of contaminant transport and for ters of Excellence in Regulatory Science and Innova- bioengineering and therapeutic sciences in the UCSF pioneering leadership in de- tion intended to advance the science of regulation. School of Pharmacy, lead the center. Altman is also veloping optimization models New technologies in biomedical research require new director of Stanford’s biomedical informatics training for hydroeconomic analysis. approaches to evaluating safety and effectiveness. program. Gorelick, who holds the Cyrus The UCSF-Stanford center launched in 2014 with The new $25 million grant supports research, col- F. Tolman Professorship, stud- Steven Gorelick an initial $3.3 million grant from the FDA to develop laboration and education. Researchers will use the ies groundwater management, projects that can help with regulating health care. For grant to address how to regulate the development and water resources vulnerability in developing regions, op- example, one project, headed by Russ Altman, MD, approval of new medical products; provide public lec- timal remediation design, hydrogeophysics and ecohy- PhD, professor of bioengineering, of genetics of medi- tures, panel discussions and workshops on FDA regula- drology. ISM cine and of biomedical data science at Stanford, uses tions; and provide training in regulatory science. ISM Inside Stanford Medicine november 21, 2016 3 Stanford’s inaugural health-focused hackathon brings innovators together

By Ula Chrobak rachel leslie Foot++, a muscle stimulator for people with a gait abnormality known as foot Stanford students, faculty and health drop, and Benjamin, an app that informs professionals, as well as designers and users of lower-cost options for prescrip- entrepreneurs from across the United tion drugs and insurance plans. A total States, teamed up for a weekend of of 12 teams won prizes. health care innovation Nov. 5-6 at the The prizes were awarded based on inaugural health++ hackathon. problem-solving potential and feasibility Participants pitched their projects, to implement. The goal was not to create formed teams and went from idea to pro- a finished product, which is hard to do totype in 36 hours. The goal: create a de- in a mere 36 hours. Instead, the biggest sign, app or business plan that improves impact of bringing together clinicians, health care affordability and access. business experts and engineers for the Health care systems can be slow to weekend was to create a starting point embrace new technologies, said Oliver for future innovation. Aalami, MD, clinical associate profes- “We hope that hackathon can serve sor of surgery, who was a faculty adviser as a launching pad, sparking future col- for the event. Aalami said many doctors laborations and getting people from all already rely on smartphones for sharing departments thinking about health care diagnoses and prescribing advice, mak- innovation,” Wang said. ing that a good platform for innovations. Health++ organizers are already look- Aalami added that while a number Participants in Stanford’s health++ hackathon present their prototypes and business models to judges ing forward to next year. Aalami said of health care technology projects have during the project expo. that Stanford Health Care plans to con- formed at Stanford, the interdisciplinary tribute deidentified medical records next connection to bring them to fruition has year, which could be used by hackers in been lacking. “The left arm doesn’t know amazing things happen.” prototype in 36 hours,” said Pharmassist big data projects. what the right arm is doing,” he said. Winning projects lead team member Zahoor Zafrulla. The event organizers are excited about Interdisciplinary teamwork Zafrulla said he would have needed the potential for the event to initiate an A novel pill-bottle sticker that makes a week to 10 days to complete the proj- interdisciplinary community of collabo- Of the 257 hackathon participants, prescription labels more accessible to ect on his own. As a full-time engineer, rators on health care issues. about half were Stanford undergrads and people with visual impairments, called he said, this was not possible. Zafrulla’s “A ton of problems in health care re- a quarter were Stanford , busi- Pharmassist, won the grand prize at the team included experts in biomedical en- quire interdisciplinary thinking,” Roy ness students and graduate students. The event. When placed on a smartphone, gineering, biology and computer science. said. “We hope health++ can help facili- rest were designers, engineers and entre- the sticker’s unique pattern would enable “They’re coming to the event with tate that paradigm shift.” preneurs from other institutions and pri- the phone to read aloud the prescribing very deep experience and an understand- Other advisers for the event were vate companies. information, track the number of pills ing of what the problem is, and basically Robert Chang, MD, assistant profes- “It’s incredible to see the energy and left and help order a refill. saying, ‘OK, let’s spend two days and see sor of ophthalmology; Ami Bhatt, MD, interest not just from the engineering “By getting together at the hackathon how we can prototype something to ad- PhD, assistant professor of hematology school — traditionally I think hack- with a team of five people, it was so awe- dress this problem,’” said Leung. and of genetics; and Marta Zanchi, PhD, athons appeal the most to engineering some that we could build a working The other grand prize winners were a Biodesign faculty member. ISM students — but the design school and business school have been super-excited Thomas Lau as well,” said Sherman Leung, a Stanford computer science major who helped or- ganize the event. “It’s the first time in my Stanford career that I’ve seen something so interdisciplinary.” The event’s co-founders were under- graduates Jason Wang and Shivaal Roy, who are now co-presidents of the Stan- ford student group Stanford Healthcare Innovations in Future Technologies. The group teamed up with other undergradu- ates, as well as with medical students and advisers, to make health++ happen. “We have such a perfect ecosystem with the hospital, the graduate schools, the undergraduate school,” Aalami said. “It’s just a perfect ecosystem to have Panelists from industry and academia discuss opportunities for innovation in health care affordability at the hackathon, which took place Nov. 5-6.

Fall issue of Stanford Medicine looks at power, limits of diagnostics

By Rosanne Spector He and other researchers in the field of diagnos- layed diagnoses — persist throughout all settings of tics are taking advantage of advances in biomedical care and continue to harm an unacceptable number In the future, your toilet might save your life. research, engineering and computer technology to of patients.” Of course, your toilet would have to be very make diagnostics more informative and less inva- Part of the problem, said Gambhir, is that re- special to accomplish this, but that’s what Sanjiv sive. One Stanford team, search aimed at improving Gambhir, MD, PhD, professor and chair of radiol- for example, is helping to “The future is all about being diagnoses receives much ogy, and his colleagues are working on in his lab at create a real-life version of less funding than research the School of Medicine. the tricorder, a sci-fi de- able to intercept diseases on new treatments. Gambhir envisions a future in which we nearly vice used by the character The fall magazine, pro- continuously monitor our health. So he’s develop- Dr. McCoy on Star Trek to early and, ideally, duced with the support ing diagnostic tools, such as a “smart” toilet to de- diagnose patients. Another prevent them.” of Stanford’s Department tect diabetes and a smart bra to detect breast cancer. team is developing an im- of Radiology, includes As he explains in the new issue of Stanford Medicine aging method for cancer patients that eliminates a Q&A with Travis Tygart, the CEO of the U.S. magazine, the resulting data might tell each of us, radiation exposure and might even help fight the Anti-Doping Agency. The online version of the or our health-care team, if something is amiss right disease. magazine includes an edited recording of the con- away. Falling short of potential versation with Tygart about cleaning up sports. “The future is all about being able to intercept Also in the special report: diseases early and, ideally, prevent them. If we can At present, however, diagnostic methods fall • The story of Gambhir’s quest to save his son actually do something about a disease such as an ag- short of their potential. According to a 2015 Na- after he was diagnosed with a brain tumor — and gressive cancer, then it is worth monitoring for it,” tional Academy of Medicine report, “The delivery his son’s legacy to diagnostics. Gambhir said in the lead article of the magazine’s of health care has proceeded for decades with a • An article about how School of Medicine special report on diagnostics. blind spot: Diagnostic errors — inaccurate or de- Dean Lloyd Minor, MD, discovered the cause of

4 November 21, 2016 Inside Stanford Medicine Magnetic tool makes gallbladder-removal surgery less invasive

levita magnetics By Sara Wykes

Researchers at School of Medicine and three hos- pitals in Chile have demonstrated the safety of a new magnet-driven device that enables surgeons to make fewer incisions while performing laparoscopic gallblad- der surgery. Each year, more than 1 million people in the United States have their gallbladders removed, putting that procedure, called a cholecystectomy, on the nation’s top-10 list of . The gallbladder is closely shel- tered in the curve of the liver, so removing it can be tricky. Even in the most skilled hands, manipulat- ing the laparoscopic instruments used in the surgery poses a risk of causing internal damage that can lead to scarring. The new magnet-driven device makes the surgery less invasive by obviating the need for an incision through which an instrument is inserted to retract the gallbladder. Instead, an external magnet does that job. levita magnetics In a paper published online Oct. 24 in Annals of Sur- gery, the researchers shared the results of a 50-patient clinical trial in which they demonstrated the safety of the device. Homero Rivas, MD, assistant professor of surgery at Stanford and director of innovative surgery at Stanford Health Care, is lead author of the paper. The senior author is Mario Uribe, MD, of the Hospital Salvador in Santiago, Chile. Nationwide, the device, which has received clear- ance from the Food and Drug Administration, is in use at Stanford Medicine and two other medical centers. “Laparoscopy has truly revolutionized surgery over the past 30 years or so, and with very good results, but it still relies on a given number of incisions and instruments,” Rivas said. “Surgeons and patients con- tinuously search for painless, scarless operations. This device takes a step toward that goal by reducing the Top: In an illustration of how the magnet-driven tool works, the external magnet is depicted on the abdomen (left), and the grasper, which is need for fixed, transabdominal instruments.” attracted to the magnet, is attached to the gallbladder (right). Below: A photo of the tool, which has received clearance by the Food and Drug How it works Administration. The device has two parts: an external magnet and a slender rod with a detachable clip that includes a mag- age time for patients to return to work was five days. Stanford’s Department of Surgery also supported net. The rod, with the clip at its far end, looks much The device was the idea of Alberto Rodriguez- the work. ISM like the reaching devices that people can use to grab Navarro, MD, who specialized in minimally invasive objects from high shelves. A surgeon inserts the rod surgery in his native Chile and is now CEO of Levita through the belly button and manipulates its clip to Magnetics, the San Mateo-based company he founded grasp the gallbladder. The clip is then released from to develop the magnetic surgical system. the rod but remains connected to the gallbladder. The Rivas said he has used the device primarily for cho- Please give blood external magnet is placed on the abdomen to control lecystectomies, but he believes it is versatile enough to Blood type needed: the movement of the clip attached to the gallbladder. be applied to bowel resections, appendectomies, hyster- A-, B-, AB-, O- A rod with a camera attached to it sends video to a ectomies, gastrectomies and other abdominal surgeries. monitor in the operating room, giving the surgeon an “I hope that greater availability of the device will al- To request an appointment, call 723-7831 inside view of the area near the gallbladder. Other in- low other innovators to propose other uses that even its or you can make an appointment online. struments are inserted through incisions to detach the pioneers have not thought of,” Rivas said. organ, after which the rod that was earlier unhitched Surgeons at three Santiago hospitals — the Hospital 3373 Hillview Ave., Palo Alto from the clip is reconnected to it and used to remove Salvador, the Hospital Luis Tisne and the Hospital Pa- 445 Burgess Drive, Menlo Park, the organ from the patient. dre Hurtado — also are co-authors of the study. 515 South Dr., Mountain View The study documented an average hospital stay for The research was supported by a grant from the http://bloodcenter.stanford.edu patients of 22 hours, and an average pain score of 0.6 Chilean Economic Development Agency and spon- on a scale of 0 to 10 seven days after surgery. The aver- sored by Levita Magnetics.

certain patients’ extraordinary hearing line. problems — for instance, hearing the • A story about a family seeking an sound of their own eyeballs moving — explanation for a mysterious seizure and went on to find a cure. disorder striking two of their children, • A sampler of diagnostic tools and how using computers to mine ge- emerging from Stanford, including a netic data can secure answers more magneto-sensor that detects cancer quickly. proteins with sensitivity hundreds of The issue also includes an essay by times greater than current methods, physician-journalist Nancy Snyderman, an ultrasound camera-in-a-pill that MD, a consulting professor with Stan- can see through the walls of intestines, ford’s Center for Innovation in Global and a software program for analyzing Health, on the collision of science and tumor tissue samples that determines a politics, and an excerpt from Drug prognosis more accurately than people Dealer, MD, a new book by Stanford can. assistant professor of psychiatry Anna • An article on the stethoscope, ask- Lembke, MD, on how doctors are fuel- ing whether the 200-year-old device is ing the opioid epidemic. still relevant. A video about the stetho- The magazine is available online. scope, featuring Stanford clinicians, Print copies are being sent to subscrib- including professor of medicine and ers. Others can request a copy by call- bestselling author Abraham Verghese, ing 723-6911 or by sending an email to MD, is available in the magazine on- [email protected]. ISM

Inside Stanford Medicine november 21, 2016 5 5 questions Douglas Owens on new statin recommendation an occasional feature in which an expert answers five questions on a science or policy topic The U.S. Preventive Services Task about 7 percent in adults ages 45-64 to 20 percent in those 65 and older. It is Force now recommends adults ages 40 somewhat higher in men than in women. to 75 with no history of heart disease — Douglas Owens, MD, was a member of the task force when the guideline was but who nevertheless have at least one risk factor and an elevated risk of cardio- developed. He is a professor of medicine at the School of Medicine and director vascular disease — take a low- to moderate-dose statin. of the Center for Health Policy and Center for Primary Care and Outcomes The independent panel of experts in prevention and evidence-based medicine Research. The centers are part of Stanford Health Policy. He is also a physician issued the recommendation in the Nov. 13 issue of JAMA. with the Veterans Affairs Palo Alto Health Care System. An estimated 505,000 adults died of coronary heart and cerebrovascular dis- Beth Duff-Brown, the communications manager at Stanford Health Policy, re- ease in 2011. The prevalence of heart disease increases with age, ranging from cently asked Owens some questions about the new statin guidelines.

What prompted this new recommendation by terol is a significant risk factor for cardiovascular statin. So the task force suggests people in this age 1the task force? disease and stroke, and statins help prevent the group consult their physicians about whether a Owens: Cardiovascular disease is the leading formation of the so-called bad cholesterol. Statin statin may be beneficial. cause of death in the United States, accounting drugs also help lower triglycerides, or blood fats, for 1 in 3 deaths among adults due to heart attack and raise the so-called good cholesterol, HDL. Do these new statin guidelines override the and stroke. And statins can provide an important While there are some reported side effects from 4 task force recommendation in 2008 that benefit to people at elevated risk of cardiovascu- the use of statins, such as muscle and joint aches, adults be screened for lipid disorders due to high lar disease. But in order to know whether statins most people tolerate statins fairly well. There is cholesterol? are going to be beneficial, it’s important to know mixed evidence about whether statins may result Owens: Yes, this recommendation replaces the something about the patient’s cardiovascular risk. in a modest increase in the chance of diabetes, but 2008 recommendation on screening for lipid dis- We reviewed the literature comprehensively — the task force assessed the benefits to orders in adults. including 19 randomized clinical trials involving clearly outweigh harms in patients at The accumulating evidence on more than 73,340 patients, as well as additional increased risk of cardiovascular disease. the role of statins in preventing heart observational studies — to understand both the disease has now led the task force to benefits and the harms of statins. We concluded Who should be taking low- to mod- reframe its main clinical question that the benefits outweigh the harms in appropri- 3 erate-dose statins? from “Who should be screened for ate patients at increased risk of cardiovascular dis- Owens: The task force recommends dyslipidemia?” to “Which popu- ease. The primary benefit of statins is a reduction that clinicians offer statins to adults lation should be prescribed statin in your chance of having a heart attack or stroke. who are 40 to 75 years old and have at therapy?” least one existing cardiovascular disease We recommend that physicians What are statins and why do they offer such risk, such as diabetes, hypertension, Douglas Owens go beyond screening for elevated 2 benefit? high cholesterol or smoking. They also lipid levels and assess overall cardio- Owens: A statin is a drug that reduces the pro- must have a calculated risk of 10 per- vascular risk to identify adults ages duction of cholesterol by the liver. High choles- cent or more that they will experience a heart at- 40 to 75 years who will benefit most from statin

roger ashford / shutterstock.com tack or stroke in the next decade. use. The task force recommends clinicians use the American College of Cardiology/American Heart What does the task force hope to accomplish Association risk calculator to estimate cardiovas- 5 with the new recommendation? cular risk because it provides gender- and race- We hope this guideline will help both clini- specific estimates of heart disease and stroke. cians and patients decide what their cardiovascu- For people with a risk of 7.5 to 10 percent of lar risk is and what steps they can take to reduce heart attack or stroke over the next decade, the those risks, which include a healthy lifestyle, a task force recommends individual decision-mak- healthy diet and exercise, and for appropriate pa- ing, as the benefits of statins are less in this age tients at elevated risk for cardiovascular disease, group because these people have a lower baseline potentially a statin. risk of having a cardiovascular event. We also hope to highlight areas that would The task force also looked at initiation of benefit from additional research. Further research statins in people 75 or older and found there on the long-term harms of statin therapy, and on wasn’t enough evidence to determine whether the balance of benefits and harms of statin use in people in this age group who have not previously adults 76 years and older, would be helpful in in- been on a statin would benefit from starting a forming clinicians and patients. ISM

Statin 9 percent higher chance of survival compared to to doctors, a message that pops up on the doctor’s continued from page 1 those on moderate-intensity statins. screen that asks why a cardiovascular patient isn’t “Our results suggest that clinical trial data from on a high-intensity statin.” different but commonly prescribed forms, such heart studies for those younger than 75 The researchers also hope to fol- as rosuvastatin and atorvastatin. The researchers could also be applied to this older popu- low up on longer-term data from also followed one group that wasn’t taking any lation,” Heidenreich said. these patient populations. “Not statins. Patients had different severities of cardio- Finally, they studied the effect of dif- only do we hope to continue study- vascular disease, making some more likely to be ferent doses within the high-intensity ing this population, but we also prescribed higher-intensity statins than others. So statin group. Patients treated with the hope to study patients without the researchers assigned each patient a score for maximum dose of statins were 10 per- prior cardiovascular disease but the propensity to receive high-intensity statins cent more likely to survive than patients who are at high risk for it,” said and adjusted the results of the study accordingly. on submaximal doses. “This suggests to Rodriguez. The results showed a 9 percent increased practitioners that instead of starting a Finally, they hope these results chance of survival for patients taking high-inten- patient on a low dose, just to go ahead Paul Heidenreich will help to settle the debate on sity statins compared to those receiving moderate- and put them on the maximum dose which guidelines doctors should intensity treatments. “We they can tolerate,” Rodriguez use when prescribing statins to patients. Heiden- found basically the same “The greatest strength of said. reich said, “We think this should give clinicians, risk reductions reviewed by A limitation of the study physicians and nurse practitioners more comfort the Veterans Affairs guide- this study is that we used was that the researchers were in following the American College of Cardiology lines, but they didn’t think unable to determine whether and American Heart Association guidelines and the benefit was significant a very large, well-defined patients died of cardiovascu- putting people with prior cardiovascular disease because the sample size was clinical cohort.” lar disease or another cause. on a high-intensity statin.” small,” Heidenreich said. Settling the debate The work is an example of Stanford Medicine’s “We have so many more patients, we can be con- focus on precision health, the goal of which is to fident that it wasn’t due to chance.” The next step, researchers said, is to find out anticipate and prevent disease in the healthy and Examining specific patient groups why some patients who should be on high-inten- precisely diagnose and treat disease in the ill. sity statins are not. They hope doctors will take Other Stanford affiliated co-authors are David The study considered data from patients over their study’s results into consideration when pre- Maron, MD, clinical professor of medicine and 75 — a group little studied in clinical trials. It scribing statins. “There are a lot of guidelines and Joshua Knowles, MD, PhD, assistant professor of found that patients between the ages of 75 and recommendations out there, so I think we also medicine. 85 taking high-intensity statins had a survival-rate have to make the system better,” Rodriguez said. Stanford’s Department of Medicine supported benefit comparable to that of younger patients: a “Maybe hospitals can employ a clinical reminder this study. ISM

6 November 21, 2016 Inside Stanford Medicine develop PTSD than boys who experience PhD, the study’s lead author and an in- To better understand the findings, PTSD trauma, but scientists have been unable structor of psychiatry and behavioral the researchers say what’s needed next continued from page 1 to determine why. sciences. “Our findings sug- are longitudinal studies fol- The research team conducted MRI gest it is possible that boys lowing traumatized young The findings were published online scans of the brains of 59 study partici- and girls could exhibit dif- people of both sexes over Nov. 11 in Depression and Anxiety. The pants ages 9-17. Thirty of them — 14 ferent trauma symptoms time. They also say stud- study is the first to show differences be- girls and 16 boys — had trauma symp- and that they might benefit ies that further explore how tween male and female PTSD patients in toms, and 29 others — the control group from different approaches to PTSD might manifest itself a part of the insula involved in emotion of 15 girls and 14 boys — did not. The treatment.” differently in boys and girls, and empathy. traumatized and nontraumatized partici- The insula normally as well as tests of whether “The insula appears to play a key role pants had similar ages and IQs. Of the changes during childhood sex-specific treatments are in the development of PTSD,” said the traumatized participants, five had ex- and adolescence, with beneficial, are needed. study’s senior author, Victor Carrion, perienced one episode of trauma, while smaller insula volume typi- Victor Carrion The work is an example MD, professor of psychiatry and behav- the remaining 25 had experienced two cally seen as children and of Stanford Medicine’s focus ioral sciences at Stanford. “The differ- or more episodes or had been exposed to teenagers grow older. Thus, the findings on precision health, the goal of which is ence we saw between the brains of boys chronic trauma. imply that traumatic stress could con- to anticipate and prevent disease in the and girls who have experienced psycho- The researchers saw no differences in tribute to accelerated cortical aging of healthy and precisely diagnose and treat logical trauma is important because it brain structure between boys and girls in the insula in girls who develop PTSD, disease in the ill. may help explain differences in trauma the control group. However, among the Klabunde said. Additional co-authors of the paper symptoms between sexes.” traumatized boys and girls, they saw dif- “There are some studies suggesting were Mira Raman, a scientific program- Smaller insula in traumatized girls ferences in a portion of the insula called that high levels of stress could contribute mer at Stanford; and a researcher from the anterior circular sulcus. This brain re- to early puberty in girls,” she said. Iowa State University. Among young people who are ex- gion had larger volume and surface area The researchers also noted that their Carrion is a member of the Stanford posed to traumatic stress, some develop in traumatized boys than in boys in the work may help scientists understand how Neurosciences Institute. PTSD while others do not. People with control group. In addition, the region’s experiencing trauma could play into dif- The research was supported by PTSD may experience flashbacks of volume and surface area were smaller in ferences between the sexes in regulating the National Institutes of Health, the traumatic events; may avoid places, peo- girls with trauma than among girls in the emotions. “By better understanding sex National Alliance for Research on ple and things that remind them of the control group. differences in a region of the brain in- Schizophrenia and Depression, and trauma; and may suffer a variety of other Findings could help clinicians volved in emotion processing, clinicians the American Foundation for Suicide problems, including social withdrawal and scientists may be able to develop sex- Prevention. and difficulty sleeping or concentrating. “It is important that people who work specific trauma and emotion dysregula- Stanford’s Department of Psychiatry Prior research has shown that girls who with traumatized youth consider the tion treatments,” the authors write in the and Behavioral Sciences also supported experienced trauma are more likely to sex differences,” said Megan Klabunde, study. the work. ISM

measure of viral antibodies. The researchers then re- some published cases of survivors transmitting the virus Ebola cruited 187 men, women and children from Sukudu who through sexual contact. continued from page 1 had likely been exposed to Ebola, either because they Richardson said the study indicates that public were living in the same household or had shared a public health efforts to prevent infection and contain the virus country where Richardson and his colleagues cared for toilet with a person confirmed to have had the disease. during the epidemic were not entirely effective. hundreds of patients in Ebola treatment units managed Of these, 14 were found to be carrying antibodies “It reminds us that we need to do a much, much by Partners In Health. to Ebola, indicating they had been infected better job in future epidemics,” Richardson The village, with about 900 residents, had been one at some point, though they had not been said. of three major hot spots in the Kono District, in the included in the original count. Twelve of He and his colleagues are now working in eastern part of the country, during the heat of the Ebola them said they had had no symptoms of other villages in Sierra Leone where public crisis between November 2014 and February 2015. the disease, which typically causes fever, health surveillance was poor during the epi- There were 34 reported cases of Ebola in the village, unexplained bleeding, headache, muscle demic, testing and interviewing individuals including 28 deaths. pain, rash, vomiting, diarrhea, breathing to get a better handle on the true number of More than 28,000 cases of Ebola infection were re- problems and difficulty swallowing. Two people affected during the crisis. ported in Africa during the epidemic, the largest and recalled having had a fever at the time of “We expect to find a lot more undocu- longest in history. More than 11,000 people are esti- the outbreak, the scientists reported. mented survivors, so we can begin to answer mated to have died because of the disease. In combining the initial reports of 34 in- Gene Richardson the question of what was the true burden of In the aftermath, Richardson and his colleagues fections with the 14 newly identified cases, disease,” he said. decided to go back to the village to try to determine the researchers calculated the prevalence of Other Stanford co-authors of the paper whether the Ebola infection could be minimally symp- minimally symptomatic infection in the village to have are Michele Barry, MD, director of the Stanford Center tomatic, as previous studies have suggested. He worked been 25 percent. for Innovation in Global Health, and James Holland with a local physician and two community health work- Richardson said it is unknown if an asymptomatic Jones, PhD, associate professor of Earth systems sci- ers in gathering data for the study, a process that was individual is capable of transmitting the virus. Because ence and a senior fellow at the Woods Institute for the approved by the local village chief. these individuals did not have an active case of the dis- Environment. They used a test known as the ELISA assay, a tech- ease, “They were not passing it along in the usual way, Researchers from Partners in Health, Brigham and nique that can detect the presence of an antibody. They through vomiting or diarrhea,” he said. “It’s unclear if Women’s Hospital, UC-, the Kono Dis- first made sure the test was accurate by comparing re- they can pass it along it sexually.” trict Ebola Response Centre and the Kono District sults from 30 Ebola survivors in Sukudu with those of Working in other Sierra Leone villages Health Management Team in Sierra Leone also co-au- 132 people in other villages where the virus had not thored the study. been reported. The virus has been shown to hide out for months The study was funded by the Stanford Center for Richardson said the test proved to be a reasonable in semen, even after symptoms have subsided, with Innovation in Global Health. ISM

GABA one-third of the variance in individuals’ taxing one or another working-memory — the researchers found. In contrast, no continued from page 2 load capacity.” component more heavily. The smaller significant association emerged linking In the study, 23 healthy participants the deterioration in performance on a GABA levels in the DLPFC to mainte- The DLPFC, a broad swath of neu- ages 19-32 were subjected to batteries of test of a particular working-memory nance or to distraction resistance, or ty- ral tissue on the forebrain surface, has tests of working memory. Yoon reasoned component, the greater the individual’s ing participants’ load capacity to GABA been shown in animal studies and in that different components of work- capacity regarding that component was levels in the visual cortex. Nor did imag- observations of brain-damaged patients ing memory would involve different judged to be. ing reveal any connection between per- to be integral to high-level executive neurotransmitter inputs. So he devised Stop and go signals formance on tests of load capacity and functions in the brain, such as planning, working-memory tests that separated the levels of glutamate in the DLPFC. prioritizing and avoiding distractions. It measurement of load, maintenance and Using an advanced imaging method, Schizophrenic patients, Yoon said, are has likewise been strongly implicated in distraction resistance. the scientists measured GABA levels in known to be deficient in an enzyme es- working memory. The DLPFC orches- Participants repeated several related the DLPFC and, for comparison, in the sential to GABA production. So, drugs trates activity in numerous distant cen- tasks. In the simplest, they were shown visual cortex. GABA, secreted by nerve that boost GABA levels or function in ters throughout the brain, including the a drawing of a face and then, after a cells, is an inhibitory neurotransmitter: the brain might prove helpful in restor- visual cortex, which is located near the two-second delay, shown a second face Its uptake by other nerve cells inhibits ing their impaired working memory. He brain’s surface but in the hindbrain. and asked whether it was the same as their firing. plans to test this hypothesis. Tie to working-memory capacity or different from the first one. Varia- Yoon and his associates also measured The work is an example of Stanford tions of this task — initially presenting levels of an excitatory neurotransmitter, Medicine’s focus on precision health, the “No previous study has ever pin- two faces instead of just one; lengthen- glutamate. By far the two most abun- goal of which is to anticipate and pre- pointed GABA’s link with working ing the intervening delay; or displaying dant neurotransmitters in the brain, vent disease in the healthy and precisely memory in humans,” said Yoon. “Work- a different, irrelevant face between the GABA and glutamate are considered to diagnose and treat disease in the ill. ing memory is a complex process, re- initial and final displays — tested load, be that organ’s stop and go signals. The study was funded by the Na- quiring coordinated activity in centers maintenance and distraction resistance, Individuals with higher levels of tional Institute for Mental Health. throughout the brain. Yet, remarkably, respectively. The investigators compared GABA in their DLPFC performed bet- Stanford’s Department of Psychiatry the amount of this one chemical in a sin- individuals’ error rates on the simple ver- ter on tests of their load capacity — the and Behavioral Sciences also supported gle part of the brain accounts for close to sion of the task with outcomes on tasks ability to juggle more bits of information the work. ISM Inside Stanford Medicine november 21, 2016 7 p eo p le Cyberknife used to treat rare condition in pediatric patient norbert von der groeben By Joe Molica awareness of the condition and support neurosurgery research. In October 2014, Kendall Kemm’s parents received Kendall returned to Stanford in October to con- devastating news: Their then-10-year-old daughter had tinue her treatment. With funds raised through Ken- suffered a hemorrhagic stroke. dall’s Crusade, she presented a check to Chang to help Kendall’s stroke was a result of an arteriovenous fund his research on treatment and support a patient malformation, or AVM, a rare defect that results in a travel fund for AVM patients. tangle of abnormal blood vessels that disrupts the nor- “When I first met Kendall and her family, they were mal flow of blood. AVMs are most often found in the so determined to learn all they could about AVMs,” brain or spinal cord and affect less than 1 percent of the Chang said. “Although some AVMs are inoperable, the population. CyberKnife opens up additional treatment options that Kendall survived, and is being treated at Stanford other technology doesn’t allow.” Health Care through stereotactic radiosurgery, which Kendall’s AVM is now approximately 90 percent uses radiation to shrink and ultimately destroy the gone, with her next AVM in her brain. MRI scheduled for norbert von der groeben Kendall travels from to Stanford for next year. Additional treatment because Stanford Health Care offers a unique treatments will be approach using CyberKnife technology, which deliv- considered as her ers radiation with unprecedented precision. The Cy- progress is moni- berKnife was invented at Stanford, and is used to treat a tored. Kendall has re- variety of conditions. Steven Chang, MD, professor of mained positive and neurosurgery, and Scott Soltys, MD, assistant professor devoted to her mis- of radiation oncology, oversee Kendall’s treatment. sion to help fellow “When Kendall had her stroke, it was devastating,” AVM patients. said Kendall’s mother, journalist Leslie Gudel Kemm. “I’m grateful for “We spent the better part of the first month crying, and what we’ve been then doing research. So few doctors want to treat kids able to do for the with this condition, but when we connected with Dr. other kids that are Chang, he said, ‘We can treat this.’” going through the Kendall’s Crusade same thing as me,” she said. “But I want Grateful for the care she received at Stanford Health us to get to a point Care and Lucile Packard Children’s Hospital Stanford, where the research Kendall brainstormed ways to help others with the same will help to develop a condition. Together with her family, she formed Kend- cure, so no other kids all’s Crusade. The nonprofit aims to provide financial have to go through Top: Accompanied by research associate Lorelei Shoemaker (left), Kendall Kemm visits a neuroscience lab, assistance to families affected by AVM, raise overall this. ISM where she gets a close look at a human brain. Below: Kendall helps Shoemaker with an experiment.

cine and of genetics, was named a 2016 Kavli Frontiers , effective Sept. 1. He is chief of the division of of note of Science Fellow by the National Academy of Sciences. pediatric endocrinology. His research and clinical focus reports on significant honors and awards for faculty, staff and students The program selects outstanding young scientists to at- is on improving care for children with Type 1 diabetes. tend symposia, thereby promoting communication and Robert Malenka, MD, PhD, professor of psychiatry collaboration. In her research, Curtis uses experimental and behavioral sciences and the Nancy Friend Pritzker Christopher Almond, MD, was promoted to asso- and analytical approaches to improve the diagnosis and Professor in Psychiatry and Behavioral Sciences, has ciate professor of pediatrics, effective Aug. 1. treatment of cancer. been awarded the Julius Axelrod Prize by the Society for Ben Barres, MD, PhD, professor of neurobiology, James Dunn, MD, PhD, was appointed professor of Neuroscience. The $25,000 prize recognizes exceptional of developmental biology and of neurology and neu- surgery, as well as surgeon-in-chief at Lucile Packard achievements in neuropharmacology and an exemplary rological sciences, has received the Society for Neuro- Children’s Hospital Stanford and chief of pediatric sur- commitment to mentoring young researchers. Malenka’s science’s Ralph W. Gerard Prize in Neuroscience, the gery at the School of Medicine, effective Oct. 1. He spe- interests include translating research on synaptic trans- society’s highest award. He will share the $25,000 prize cializes in using surgical and bioengineering techniques mission into clinically useful therapies. with fellow recipient Thomas Jessell, PhD, of Colum- to help children with short bowel syndrome, which can Arash Momeni, MD, was appointed assistant profes- bia University. The prize honors outstanding scientists occur in preterm infants and infants with congenital sor of surgery, effective Sept. 1. He is the co-director who have made significant contributions to neurosci- anomalies. of the hand transplant program. He specializes in mi- ence. Barres’ research focuses on the role of glial cells Brice Gaudilliere, MD, PhD, was appointed assis- crosurgical reconstruction of the breast, head and neck, in development and synapse function and in diseases tant professor of anesthesiology, perioperative and pain trunk and extremities. such as Alzheimer’s. medicine, effective Sept. 1. His research combines high- Prithvi Mruthyunjaya, MD, was appointed associate Christopher Contag, PhD, professor of pediatrics dimensional mass cytometry analysis with machine- professor of ophthalmology, effective Sept. 1. He is the and of microbiology and immunology, will receive learning-based biocomputation to study the human director of ocular oncology. He specializes in the treat- the 2017 Britton Chance Biomedical Optics Award immune system’s response to perturbations, such as ment of pediatric and adult ocular cancers and condi- from SPIE, the international society for optics and pregnancy. His clinical interests include surgical trauma, tions affecting the retina. His research interests include photonics. The award recognizes outstanding lifetime ischemic stroke, pregnancy and preterm labor. ocular cancer imaging, genetics and tumor biopsy. contributions to biomedical optics. Contag develops James Jacobs, MD, PhD, was appointed associate Lidia Schapira, MD, was appointed associate profes- and uses optics-based imaging tools to study biology in professor of psychiatry and behavioral sciences, effective sor of medicine, effective Sept. 1. Her research focuses living animal models of human disease, and for early Sept. 1. He is the executive director of Vaden Health on cancer survivorship and on improving communica- detection of cancer in patients. Center and associate vice provost for student affairs. tion between caregivers and patients. Christina Curtis, PhD, assistant professor of medi- David Maahs, MD, PhD, was appointed professor of Alex Sox-Harris, PhD, was appointed associate pro- fessor (research) of surgery, effective Sept. 1. He is the director of clinical research for the De- partment of Surgery, and his research focuses on the evaluation of health-care quality and efficacy. Eric Sun, MD, PhD, was appointed assistant professor of anesthesia, perioperative and pain medicine, effective Sept. 1. His research inter- ests include health economics and policy, with a focus on economics and policy in the periop- erative setting. ISM Ben Barres Christopher Contag Christina Curtis James Dunn James Jacobs

David Maahs Robert Malenka Arash Momeni Prithvi Mruthyunjaya Lidia Schapira Alex Sox-Harris Eric Sun 8 November 21, 2016 Inside Stanford Medicine