Recent graduates: Never fear if you haven’t picked a career yet; it’s never too late to figure out what you want to do when you grow up. I’m on my third career, and Rahim Nazerali, MD, now an assistant professor of surgery at Stanford, is on his second.

He explains in this recent Stanford Health Care video:

I had a career in international health and I felt like I wasn’t interacting with enough people, I was doing a lot of behind the desk work and I never really interacted with the people I was affecting. I entered medicine for that reason.

And when he entered medical school at Brown University, Nazerali thought he would pursue emergency medicine or orthopedics. But he was wrong again. In the video, he describes a surgery — which he watched on his first day on a plastic surgery rotation — that convinced him that this field was the one for him. Plastic surgeons converted a gaping post-tumor chest hole into a natural looking chest: “You could hardly even tell that anyone was there,” Nazerali said. “At that point, I thought, ‘I want to do that.'”

Now, he’s on the front lines of patient care, where he hopes to stay.

“Many patients come back in after they have their confidence back, after they have their life back, after they have their time with their family back,” Nazerali said. “That’s what makes it really rewarding.”

Previously: Why become a doctor? A personal story from a Stanford oncologist, Students draw inspiration from Jimmy Kimmel Live! to up the cool factor of research careers and Stanford’s senior associate dean of medical education talks admission, career paths

These days it seems that just about anything can be recreated on a microchip. But still, I did a double-take when I read about the new way that scientists are using technology to study pregnancy: They’ve created a “placenta-on-a-chip.”

A functioning placenta is critical for a healthy pregnancy because it regulates the flow of nutrients, oxygen and waste products between the mother and fetus. It also controls the fetus’ exposure to bacteria, viruses and other harmful substances. Researchers would like to learn more about how the placenta acts as a “crossing guard” and how it can regulate the body’s traffic so well. Yet, studying the placenta is hard to do because it’s highly variable, and tinkering with the placenta is risky for the fetus.

To overcome these challenges, an interdisciplinary team led by a University of Pennsylvania researcher created a two-chambered microchip that mimics the structure and function of the human placenta. The study was published online in the Journal of Maternal-Fetal and Neonatal Medicine and is reported on in this National Institutes of Health press release:

The device consists of a semi-permeable membrane between two tiny chambers, one filled with maternal cells derived from a delivered placenta and the other filled with fetal cells derived from an umbilical cord.

After designing the structure of the model, the researchers tested its function by evaluating the transfer of glucose (a substance made by the body when converting carbohydrates to energy) from the maternal compartment to the fetal compartment. The successful transfer of glucose in the device mirrored what occurs in the body.

As Roberto Romero, MD, chief of the perinatology research branch at the NIH’s National Institute of Child Health and Human Development, explains in the press release, this new technology could help researchers explore how the placenta works, and what happens when it fails, in ways that couldn’t be safely done before. This, the researchers say, could lead to more successful pregnancies.

Previously: NIH puts focus on the placenta, the “fascinating” and “least understood” organ, Placenta: the video game, The placenta sacrifices itself to keep baby healthy in case of starvation, research shows, The placenta sacrifices itself to keep baby healthy in case of starvation, research shows and Program focuses on the treatment of placental disorders
Photo by Jack Fussell

So let’s say you want to make a piece of electronics that works just like the brain. Where would you start?

That’s the question neuroscientist Bill Newsome, PhD, director of the Stanford Neurosciences Institute, posed in a recent talk to a Worldview Stanford class on decision-making.

I thought the idea was so intriguing I wrote a series of stories about what it would take to reverse engineer the brain, and how close we are to succeeding at each. We’re still a ways from computers that mimic our own agile noggins, but a number of people are making progress in everything from figuring out where the brain’s wiring goes to creating computers that can learn.

These are the steps Newsome outlined to take us from our own grey goo to electronics with human-like capacities:

1. Map the connections: Neuroscientists Karl Deisseroth, MD, PhD, and Brian Wandell, PhD, are mapping where the brain’s 100 billion neurons go.
2. Monitor the signals: Biologist Mark Schnitzer, PhD, and bioengineer Michael Lin, MD, PhD, have created ways of watching signals in real time as they fire throughout the brain
3. Manipulate the system: Neuroscientists Karl Deisseroth, MD, PhD, and Amit Etkin, MD, PhD, are working on techniques to manipulate the way the brain works and watch what happens.
4. Develop a theory: Not only do we not know how the brain works, we don’t even really have a theory. Applied physicist Surya Ganguli, PhD, is working to change that.
5. Digitize the circuits: If you want to turn the brain into electronics you need some wiring that mimics the brain. Bioengineer Kwabena Boahen has made just such a chip.
6. Teach electronics to interact: Engineer Fei-Fei Li, PhD, has taught a computer to recognize images with almost human-like precision. This kind of ability will be needed by electronics of the future like self-driving cars or smarter robots.

Previously: Neuroscientists dream big, come up with ideas for prosthetics, mental health, stroke and more
Image, based on two Shutterstock images, by Eric Cheng

Please join me in a round of applause for Stanford Medicine magazine for recently winning six awards in a national competition, including top prize in the category of “best articles of the year.”

The publication earned a platinum, three golds, a silver and a bronze in the 2015 Circle of Excellence Awards Program, a contest held by the Council for the Advancement and Support of Education, or CASE. The magazine is produced by the School of Medicine’s Office of Communication & Public Affairs and edited by Rosanne Spector.

As my colleague Susan Ipaktchian writes in a news story detailing the magazine’s awards, the judges were “particularly blown away by the depth of the reporting and the degree of access the reporters had to their sources.” More from the piece:

Writer Tracie White earned the sole platinum award in the best-articles category for “Almost without hope,” a look at the heartbreakingly scarce medical resources on an Indian reservation in South Dakota. The judges wrote that they “admired the author’s handling of a subject ripe with standard conventions and hackneyed writing. The author never fell into this trap, capturing the story and delivering it creatively. With a strong fact/narrative balance, the author got this one right. Job well done.”

…

The magazine earned a gold award for periodical design for its spring 2014 issue, whose theme was mysteries of the heart. The judges said the theme “was carried through the entire magazine in an exceptional way, and we especially loved the variety of interpretations of the theme seen in the illustrations, each of which was compelling, a wonder to look at and a strong partner to the editorial in terms of conveying the subject.” The magazine’s art direction is provided by David Armario Design.

The illustration for “Fresh starts for hearts,” a story in the spring 2014 issue, earned a silver award. The artist who created the image is Jason Holley. “The illustration for this article was beautiful in an artistic way, yet told a story that complemented the article completely,” the judges wrote.

Look for the release of the latest issue of Stanford Medicine in coming days.

Previously: Stem cell medicine for hearts? Yes, please, says one amazing family, Kudos for Stanford Medicine magazine, Broken promises: The state of health care on Native American reservations and Stanford Medicine magazine writers score two awards
Illustration, from the article “Fresh starts for hearts” in the spring 2014 magazine issue, by Jason Holley

Researchers in the U.K. have found a way to make growing synthetic tissue more sustainable. At present, the size of engineered tissues is limited because the cells die from lack of oxygen when the pieces get too big. By adding an oxygen-carrying protein to the stem cells prior to combining them with tissue scaffolding, the researchers overcame this problem.

The study, led by Adam Perriman, PhD, research fellow at the University of Bristol’s Synthetic Biology Research Centre, and Anthony Hollander, PhD, professor of integrative biology at the University of Liverpool, was published yesterday in Nature Communications. The tissue they were fabricating was cartilage, but the process could potentially be applied to other tissues, as well.

Perriman describes the findings in a press release:

We were surprised and delighted to discover that we could deliver the necessary quantity [of oxygen] to the cells to supplement their oxygen requirements. It’s like supplying each cell with its own scuba tank, which it can use to breathe from when there is not enough oxygen in the local environment.

Hollander also comments on the significance of the research:

We have already shown that stem cells can help create parts of the body that can be successfully transplanted into patients, but we have now found a way of making their success even better. Growing large organs remains a huge challenge but with this technology we have overcome one of the major hurdles.

Creating larger pieces of cartilage gives us a possible way of repairing some of the worst damage to human joint tissue, such as the debilitating changes seen in hip or knee osteoarthritis or the severe injuries caused by major trauma, for example in road traffic accidents or war injuries.

Previously: Building bodies, one organ at a time, How Stanford researchers are engineering materials that mimic those found in our own bodies and A brief look at “caring” for engineered tissue
Photo by Warwick Bromley

One day in 1996, on the banks of the Columbia River near Kennewick, Washington, two men found a human skull about ten feet from shore. Eventually, the nearly complete skeleton of an adult man was unearthed and found to be nearly 9,000 years old.

Since that find, controversy has swirled as to whether the man was an ancestor of Native American tribes living in the area, or was more closely related to other population groups around the Pacific Rim. A study published in 2014, based in part on anatomical measurements, concluded that the skeleton, known as the Kennewick Man, was more likely related to indigenous Japanese or Polynesian peoples.

Now Stanford geneticists Morten Rasmussen, PhD, and Carlos Bustamante, PhD, working with Eske Willerslev, PhD, and others at the University of Copenhagen’s Centre for GeoGenetics have studied tiny snippets of ancient DNA isolated from a hand bone. They’ve compared these DNA sequences with those of modern humans and concluded that the Kennewick Man (known to many Native Americans as the Ancient One) is more closely related to Native American groups than to any other population in the world.

The findings are published today online in Nature, and they’re likely to reignite an ongoing controversy as to the skeleton’s origins and to whom the remains belong.

As Rasmussen said in our press release:

Due to the massive controversy surrounding the origins of this sample, the ability to address this will be of interest to both scientists and tribal members. […]

Although the exterior preservation of the skeleton was pristine, the DNA in the sample was highly degraded and dominated by DNA from soil bacteria and other environmental sources. With the little material we had available, we applied the newest methods to squeeze every piece of information out of the bone.

Increasingly, such methods of isolating and sequencing ancient DNA are being used to solve millennia-old mysteries, including those surrounding Otzi the Iceman and a young child known as the Anzick boy buried more than 12,000 years ago in Montana.

Bustamante explained in the release:

Advances in DNA sequencing technology have given us important new tools for studying the great human diasporas and the history of indigenous populations. Now we are seeing its adoption in new areas, including forensics and archeology. The case of Kennewick Man is particularly interesting given the debates surrounding the origins of Native American populations. Morten’s work aligns beautifully with the oral history of native peoples and lends strong support for their claims. I believe that ancient DNA analysis could become standard practice in these types of cases since it can provide objective means of assessing both genetic ancestry and relatedness to living individuals and present-day populations.

Previously: Caribbean skeletons hold slave trade secrets,  Melting pot or mosaic? International collaboration studies genomic diversity in Mexico and  On the hunt for ancient DNA, Stanford researchers improve the odds
Photo, of bust showing how Kennewick Man may have looked, by Brittany Tatchell/Smithsonian (bust by StudioEIS; forensic facial reconstruction by sculptor Amanda Danning)

Welcome to Biomed Bites, a weekly feature that introduces readers to some of Stanford’s most innovative researchers. 

Tweak a piano string and you’ve created a different note. Tweak a gene and no one knows exactly what might happen. Perhaps the resultant protein is completely defective. Perhaps the same change does nothing in me but turns your world upside down. Who knows?

One Stanford researcher is working to demystify some of that variability, an endeavor that could lead to big changes in the development of therapies for diseases such as cancer. Daniel Jarosz, PhD, assistant professor of chemical and systems biology and of developmental biology, describes his work in the video above:

We all know there are many mutations associated with disease, for example, that give rise to that disease in some patients, yet there are other patients that have the same mutations and don’t have any effects. We’d really like to understand that…

The clinical benefits of this work are potentially very large.

For example, Jarosz said he and his team study why some tumor genes are able to evolve rapidly to evade chemotherapy. With a greater understanding of what conditions cause rapid evolution — and drug resistance — they can more easily evaluate new therapies.

Learn more about Stanford Medicine’s Biomedical Innovation Initiative and about other faculty leaders who are driving biomedical innovation here.

Previously: From finches to cancer: A Stanford researcher explores the role of evolution in disease, Computing our evolution and Whole genome sequencing: The known knowns and the unknown unknowns

In Malawi, children as young as five years old work in tobacco fields. Here, in the Silicon Valley, five-year-olds compete to attend top preschools. Stanford communications major Minkee Sohn highlighted that dramatic contrast with a parody video, “Fresh Recruits,” for a new Stanford anthropology class. Taught by Matthew Kohrman, PhD, the class, “Smoke and Mirrors in Global Health,” aimed to raise awareness about the global tobacco industry and was the subject of a recent Stanford News article.

Simply acknowledging that “smoking is bad for you” is no longer enough to halt tobacco’s spread. As noted in the piece, the tobacco industry remains a powerful global force and produces three times as many cigarettes as it did during the smoking heyday in America in the 1960s; it’s also the source of millions of preventable deaths. Kohrman encouraged his students to develop original communication strategies and to take on hard-hitting issues, such as the use of underage labor.

For their final projects, Kohrman’s class presented a slew of web-based videos, exposés and written critiques exploring little known facets of the global tobacco industry, including:

• Chinese academia’s involvement in the tobacco industry
• Philip Morris’ use of child labor in Africa
• South Korea’s flawed approaches to tobacco control

Overall, Kohrman, an associate professor of anthropology, deemed his experimental class a “great success.” The course uncovered many little-known aspects of global tobacco, and taught students to “understand the sociocultural means by which something highly dangerous to health such as the cigarette is made both politically contentious and inert.”

Alex Giacomini is an English literature major at UC Berkeley and a writing and social media intern in the medical school’s Office of Communication and Public Affairs.  

Previously: A call to stop tobacco marketing, Cigarettes and chronographs: How tobacco industry marketing targeted racing enthusiasts and How e-cigarettes are sparking a new wave of tobacco marketing 
Photo by Jo Naylor

This post is part of the Biodesign’s Jugaad series following a group of Stanford Biodesign fellows from India. (Jugaad is a Hindi word that means an inexpensive, innovative solution.) The fellows will spend months immersed in the interdisciplinary environment of Stanford Bio-X, learning the Biodesign process of researching clinical needs and prototyping a medical device. The Biodesign program is now in its 14th year, and past fellows have successfully launched 36 companies focused on developing devices for unmet medical needs.

When the Indian biodesign fellows observed a pacemaker implantation earlier this year, the surgeon spent four hours trying to firmly insert wires from the pacemaker into the heart muscle. Even after a painstaking surgery, the wires fall out in about five percent of cases. That’s an expensive and risky problem.

The team’s solution, which was officially revealed at the biodesign symposium last week, is a device made of popsicle sticks and a spring that attaches to the long wire that screws into the heart. The spring records the amount of force a surgeon uses when screwing in the wire. If it records a higher force, that likely means the screw went firmly into the heart muscle. A lower force means it might not have inserted well and the surgeon should try again.

The team presented their prototype to an audience of faculty, the program’s alumni and local business leaders. Harsh Sheth, MD, said their inexpensive solution to a widespread problem met with good reviews. “We were strongly encouraged to continue developing this,” he said. The team needs to finish their fellowship, but they say they might return to the idea when they are done.

Sheth and his fellow teammates Shashi Ranjan, PhD, and Debayan Saha, all had prior experience in either surgery or engineering but had never been through a deliberative process that would result in a device that combines medical needs, engineering expertise and business sense.

They’ll take their newfound skills back to India, where they’ll start the process over in the second phase of their fellowship. Their departure marks the end of Indian biodesign fellows spending immersive time at Stanford. Ranjan told me that he’s glad he applied to the program when he did rather than waiting a year, when he would have done the entire program in India.

“Being at Stanford was an amazing experience,” he said. “We had access to Silicon Valley, business, technology. We don’t have anything like that [at home].” In the future, fellows might visit the U.S. or other partner countries for shorter stays, and Stanford fellows will have opportunities to learn about biodesign in India.

Previously: Success breeds success: Early innovators in India created a sense of possibility, A jugaad for keeping pacemakers in plac, The next challenge for biodesign: constraining health-care costs and Stanford-India Biodesign co-founder: Our hope is to “inspire others and create a ripple effect” in India
Photo by Amy Adams

There are many things chief residents want new residents to know right out the gate, but much of that goes unsaid. So the blog Academic Life in Emergency Medicine recently put together a list titled “Dear Residents: 10 Things Your New Chiefs Want You to Know.” Each one was written by a different chief resident, as part of the blog’s Chief Resident Incubator project.

It’s a thoughtful collection of reflections that offers an interesting mix of poignant comments and practical advice. The full list is worth a read, but a few stand out:

 “WHEN YOU FEEL LIKE CRYING, CRY TO ME.”

…Know that every one of your attendings and senior residents continue to go through these same trials. When you find yourself on the ropes and feeling utterly alone, call us. We might not be able to make that Surgical ICU rotation any less painful, but we’ll at least buy you a beer and share some stories from our own days working the surgery salt mine.

(Rory Stuart, Chief Resident, Wright State University, Dayton, OH)

…

WE ARE A TEAM

…Our learning should not only take place during scheduled conference time; we can all learn from each other. Share your successes and failures. Teach us all what you know, and what you wish you would have known. When we get out on our own, we all represent this residency program. Together we can make each other and this program better.

(Valerie Cohen, Chief Resident, Christiana Care Health System, Newark, DE)

NEITHER RESIDENCY NOR LIFE ARE FAIR. USE IT AS AN OPPORTUNITY TO SHINE

…Your week long string of night shifts was not borne of malice or vendetta. We try to make decisions that are in the best interest of the program and we ALWAYS consider your requests.

Your faculty, chiefs, and colleagues are paying attention to how you react to these perceived slights. When you take that extra shift in stride, we’ll notice. When you take on a task that nobody else stepped up for, we’ll notice. When you swap into a weekend night shift so a co-resident can celebrate an anniversary or birthday, we’ll notice.

(Jimmy Lindsey, Chief Resident, University of Chicago, Chicago, IL)

Previously: Soon-to-be medicine resident reflects on what makes a good teacher, Keeping an even keel: Stanford surgery residents learn to balance work and life and A call to action to improve balance and reduce stress in the lives of resident physicians
Via Wing of Zock
Photo by U.S. Navy