Whizbang

Feminism, Travel, and Shoes

Oct 13 2010

Next week I get to spend a few days with some of the most amazing women in the US, having a conversation about advancing to equality over the next decade. Vision2020 aims to finish the work of the suffragists and achieve gender equity by the centennial of the 19th amendment in 2020. You can read their blog via the link in my right column.

Of course, I now have to pack for this gathering. All events will be business casual, and I have two days of air travel. Kitten heels are in order.

I inspected my black low-heels last night, and they have a major chunk out of one patent heel. I saw these at Target last week, and they may provide a reasonable replacement:

Veralis $24.99

Black suede, walkable heel, feminine detail. Yes, these might make the cut.

I see a trip to Target on my way home today.

One response so far

What I’m Reading: Where Good Ideas Come From

Oct 12 2010

Last week a couple of reviews brought Steven Johnson’s new book to my attention, so I downloaded it. Where Good Ideas Come From: The Natural History of Innovation deserves a post, and I’m only about a third of the way through it. The book brings together a lot of ideas about innovation and supports or debunks them. Sudden inspiration? Not so much- most paradigm shifts build slowly in the mind. Only in retrospective telling of the tale do “a-ha” moments occur. When appropriate synapses suddenly get together and form the thought, the thinker is often doing something else entirely. Walking, working other jobs, and dreaming may all allow our brains to mix chaotic ideas and “suddenly” form the “next big thing.”

When does most laboratory innovation occur? From hidden camera studies, lab meetings are the most fruitful time. The interplay of perspectives between people provides the right level of disorganization to make the thoughts flow. Being a solo scientist at the bench provides far few insights. Cities provide more innovation than small towns, and open areas in buildings encourage more idea flow than isolated offices or cubicles.

I had previously heard of the concept of “The Adjacent Possible” before, but it was not called this term. What does this mean? Innovation depends on the next step. Once tools have been developed, that next step becomes inevitable, even though it may seem like a paradigm-shifting innovation at the time. Something that is one small step farther away remains out of reach; even though we can think it, the tools and connections are not adjacent yet.

Reading this book provides an entertaining counterpoint to the thoughts of St. Kern, Martyr of Baltimore. He bemoans the lack of passion to pursue evening and weekend work in cancer research. Johnson’s book would suggest that the “down time” Kern dismisses may be more important to the creative process than more time at the bench. Indeed, many of the 36 people he found in his last survey of an almost empty building may have been generating data, but not the “discovery.” The innovation, the creation tends to come about during interactions with others. Someone may finish the experiment on Saturday, but the meaning, the eureka moment, is more likely to occur at the next lab meeting.

This book is a great read, and I may find more to say as I peruse more of it. If you haven’t picked it up yet, you should.

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Journal Club: Isolated Renal Pelvis Dilatation

Oct 09 2010

Background

Normal Urinary Tract (Click to embiggen)

Normal urinary tract anatomy is shown in the figure. As nephrons come together in the kidney, the tubules join into a central collecting system, the pelvis. This space is continuous with the ureter, the tube that leads from the kidney to the bladder. One of the most common abnormalities on prenatal ultrasound is dilatation of these urine collecting structures. The area where the pelvis becomes the ureter (the ureteropelvic junction or UPJ) is a common site of narrowing and obstruction in children.

The natural history and treatment of urinary tract dilatation remains unclear, even as our ability to detect subtle abnormalities increases. Prospective urinary tract screening in Messina, Italy, may help answer these questions.

Outcome and management of isolated severe renal pelvis dilatation detected at postnatal screening

Mami et al. Pediatr Nephrol 25:2093, 2010

Study Design

The authors performed a prospective screening study of healthy 2-month-old infants from January 1, 2001, through December 31, 2005. Over the 5 years, 11,801 infants were screened with ultrasound (US) for hip dysplasia and renal abnormalities. 46 infants had severe renal pelvis dilatation (RPD; pelvis diameter 15-20 mm) without other abnormalities of the urinary tract and became the study group. In addition, 240 healthy infants with normal US were enrolled as a control group.

All infants in both groups had prospective follow-up US every 3-4 months for 1 year. No prophylactic antibiotics were given to prevent urinary tract infections (UTIs). If a UTI was diagnosed and/or RPD persisted after 1 year of age, voiding cystourethrogram and nuclear scans were performed to assess vesicoureteroreflux and functional obstruction, respectively.

Results

RPD on one or both sides occurred in 0.4% of screened infants with approximately twice as many males as females affected. When only one side showed RPD, the left kidney was twice as likely as the right to be affected. Over 12 months of follow-up, one-third of infants demonstrated resolution of RPD. Of the children with persistent abnormalities, 2/3 had UPJ obstruction (see figure) and the others had vesicoureteral reflux.

Renal Pelvic Dilatation (RPD) from UPJ Obstruction

Only 5 of 46 infants (14%) developed UTIs during the study, with 3 of the 5 having reflux. In contrast, the normal control group showed 2.5% of participants having UTIs in the same time period.

So What?

Our current practice following abnormal prenatal US of the urinary tract is to obtain an US 7-14 days after birth. If the tract still appears dilated, we see the baby at 1-2 months of age with voiding cystourethrogram and nuclear scan.

Obviously, we are doing a lot more imaging on a lot more infants.

This study suggests that it is safe to wait for “invasive” imaging studies until RPD has persisted for a year or the child suffers a UTI. Since at least a third of these infants will resolve their RPD, they would not have to undergo catheterization with radiation exposure for the cystogram or nuclear scan.

The authors also discuss the relevant literature; the incidence of RPD and UTI was similar to previously published work. They also touch briefly on some of the controversies surrounding UTI prophylaxis. Current practice favors such treatment in infants with reflux, and many babies with RPD would receive such treatment until imaging studies were completed. The present study suggests a less aggressive approach is safe.

The study is a well-done prospective single-center endeavor. Based on these results, plus others discussed in the paper, we can safely reduce the studies and antibiotics we use in children with RPD.

One response so far

Background: Denver the Wondercat

Oct 08 2010

Denver

So some background may help the Child’s Play folks address my question.

We had a cat, Denver the Wondercat. One of my first posts on my old blog featured our 17-year-old feline with chronic kidney disease.

He did not like the “kidney diet.” He did not like the pills. He especially disliked the pill holders. Fish flavored? Guess not.

Then we started giving him fluid infusions. Three nights a week my husband would hold him while I inserted a 14 gauge needle into the loose skin on his back and let 250 mL (~8 oz) of saline with potassium run in.

Median survival at the time of his diagnosis: 6 months. Denver made it almost 2 years. They were high-maintenance years, but well worth the effort.

I started telling patients about my cat with kidney disease. The diet, the pills, and the shots were far more interesting when I explained how they helped my cat than when I explained how they helped my patients.

Then I flipped through the Disney DVDs we own, and I realized that talking animals dominated the genre. The Disney people are not stupid; they know how to get to kids!

Anyway, I have been working on a book about Denver (I’m still looking for an agent) that I hope will help children with kidney disease and their siblings better understand their treatments. Children and grandchildren of adults with kidney disease may also enjoy such a book, and kidney disease is the most common cause of death in pet cats in the US.

But I still wonder why children identify so strongly with my cat or other animals, animated or living. I’m waiting, Child’s Play.

2 responses so far

A Question for Child’s Play

Oct 07 2010

So I am a Pediatric Nephrologist. I work with children with kidney problems. I make them take medications, some of which are shots.

This behavior has not resulted in popularity.

Click image to see original and more at disney.go.com

Explaining that the treatment will help them grow and feel better doesn’t work that well. Not until the lesson is delivered by…an animal.

Walt Disney figured this out in the 20th century. So I ask my fellow Scientopians over at Child’s Play:

Why can Mickey take my message home better than I can, at least in the school-aged group?

4 responses so far

More Thoughts on St. Kern

Oct 05 2010

Burning scientific passion

By now most of you know about Scott Kern, the martyr of Baltimore, and the kerfluffle he caused last week. My colleagues here at Scientopia (I do have to single out the wonderful Drugmonkey post) and elsewhere have taken on his message, and I have enjoyed the shenanigans on twitter (#K3RN3D). Of course, I consider it hypocritical that he admits to attending football games during his training in Ann Arbor in this bio; I mean, where was his passion then?

Passion is a key component of the scientific process, but creativity is just as important. Looking at the world or a problem in a new way leads to the really important discoveries.

Last week I wrote a short essay for an unrelated activity; they asked, “What gives you your creative jolt?”

Living well provides the most important stimulation. Walking outdoors, listening to music, and reading novels may all provide that spark of curiosity that leads me in a new direction. Cooking can also clear my brain and allow important synapses to find each other. I also find my online interactions provide a new peer group that stimulates me. We tweet and blog together, providing comments and fodder for the next post.

I never know from where my next important idea will spring; it is important to stay active and experience life to its fullest.

Some of my best biomedical ideas came to me while I was working out or reading a novel or watching a movie. We all need periods to recharge and allow our brains to associate new things. One could make the case that cancer might be cured faster if we made its scientists take a break outside on gorgeous fall days. Or even go to football games. Then I heard this morning’s story on the Nobel Prize in Physics and the discovery of graphene. These scientists have a tradition of “crazy experiments” on Friday afternoons, one of which involved cellophane tape across a block of graphite. That goofy activity led to the creation of this wonder-material with a multitude of potential uses.

They may not have cured cancer, but they have discovered something incredible! At least in part because they had goof-around time!

Who?

Of course, I also wonder what the editors had in mind when they published this inflammatory piece. Could this be a call for visibility? I mean, Cancer Biology & Therapy is not one of my top 10 journals, but then I have chosen a different path in medicine. It’s a young publication with an Impact Factor (flawed as this measurement can be) of 2.71. Cancer Research is 7.54, while the glamour mags score in the 30′s. Could this be an attempt on the part of the editors to drive traffic and name recognition for their publication?

Or am I just getting cynical?

My husband worked for a mentor as “passionate” as Kern once, a man who said he really didn’t remember much about his children between their births and graduation from college. A man who held his weekly lab meeting at 5pm on Fridays. A man who drove my husband out of science and into the clinic. I wonder how many capable, creative people have left the world of research because of this demand for “passion?” And how many patients they might have cured.

Image of fire courtesy of PhotoXpress.

2 responses so far

Dragon Phylogeny

Oct 01 2010

Some people believe that science ignores effective alternative treatments to keep funding research. They really think we would deprive patients of cures to further our livelihoods.

They are wrong.

Some diseases are dragons. With the right sword, they are dead, killed, over. For example, the dragon Polio can be slain by a vaccine. Researchers who had studied the virus’ predilection for certain cells in the central nervous system and other characteristics turned to other diseases. Of course, now that we have lived without the horrors of polio for a generation, some people are rejecting the tools that killed the dragon.

Infectious diseases are often dragons. A vaccine, an antibiotic can conquer them. If you miss, though, you may still end up dead. If you conquer them, then you find a new dragon.

Other diseases are more difficult to conquer. We swing our sword and a limb comes off; instead of dying, though, the limb grows back. Or, like some starfish, each piece grows into a new dragon. Or we kill the dragon but injure ourselves in the process.

We keep challenging these complex disorders, these wicked dragons. We try new weapons, sharpen the ones we have, and find new targets. The work is slow and difficult. Herbs and other “alternative” remedies do get studied in our labs. Some work; many do not. If they work they are no longer “alternative” medicine; they are medicine.

Please remember that we want dragons to be extinct. Even if it means early retirement!

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Food Fights of a Certain Age

Sep 29 2010

The October issue of More, a magazine targeting women over 40, arrived in my mailbox last week. I have slowly leafed through it, and today hit an interesting article in the body & mind section. Eating for Less Than One explores a “new epidemic” of eating disorders among women over the age of 35. Older women are more likely to have disordered eating than the classical eating disorders, but the impact on their lives may be as severe as anorexia nervosa. Unfortunately, this article does not appear to be available on their web site at this time.

They only present numbers about the “surge of these illnesses among women several decades older” than the Justin Bieber set from a couple of sources, One group of 10 US eating-disorder clinics reports close to 20 percent of its patients are now over 30. The program at the University of North Carolina at Chapel Hill reports that about half of their current patients are 35 or older. They present the stories of 4 women with various problems:

The “Healthy” Eater: She spends a lot of time research health claims, eliminating “bad” foods from her diet and adding others that may provide additional “magic fairly dust” to improve her health. She may eat only organic or raw foods, making it difficult to go out. “Brit” admits that her food issues contributed to her divorce and have led to ongoing social isolation.
The Finicky Eater: My family would nominate me for this category, but I rarely cannot satisfy (or even overeat) anywhere I go. This woman eats only french fries, bagels, macaroni and cheese, pasta with butter or marinara sayce, vegetarian pizza, corn, broccoli, apples, and bananas. She describes aversions to the texture of other foods in her mouth. Recently when someone offered her a lunch, she said she was fasting for a medical procedure rather than admit that she would only eat nine foods, none of which were available.
The Doughnut Junkie: Binge eating and obesity in response to a family that told her incessantly she was fat growing up. She got thinner during therapy for a breast tumor. As the weight started returning her mom said, “Don’t you wish you could stay on that chemo forever? You sure did look good.” She knows that soon her self-disgust will bottom out and she will stop binging, as she has before.
The Dieting Champion: This woman describes pushing food around on her plate so it looks like she’s eating. In reality, no food enters her body. She keeps eliminating foods from her diet, and eventually enjoys the “buzz” that accompanies fasting. She also exercises compulsively. Therapy is helping, but she cannot eat a hot lunch because a cooked meal mid-day triggers such self-loathing. She can now take 1 day off a week from the gym.

So why are we seeing these issues now? According to Kathryn Zerbe, MD, director of the Oregon Psychoanalytic Institute in Portland:

Michelle Pfeiffer at 51

In our mothers’ generation, there was acceptance that your body wasn’t going to look the same at 50 as it did at 25. Today there’s not. For some women, an obsession with a rigid diet is a way of trying to skirt the issue of aging and mortality.

Let’s face it: many actresses and celebrities have better bodies in their 50s than I ever had.

With a careful history, many of these women with “late-onset” eating disorders reveal eating problems earlier in their lives. Some of the psychological issues involve the need for control, much as they do with classic anorexia nervosa.

While obesity and its complications are epidemic, other maladaptive relationships with food are also on the rise.

3 responses so far

Women’s Health: The Wonder of Turmeric

Sep 27 2010

From page 28 of the July-August 2010 issue of Women’s Health:

As one of the more “aged” members of this collective, I felt compelled to address the benefits of turmeric, also known as Indian saffron because of its deep golden color. According to The World’s Healthiest Foods:

At the make-up table?

Turmeric has a peppery, warm and bitter flavor and a mild fragrance slightly reminiscent of orange and ginger, and while it is best known as one of the ingredients used to make curry, it also gives ballpark mustard its bright yellow color.

Turmeric comes from the root of the Curcuma longa plant and has a tough brown skin and a deep orange flesh. Turmeric has long been used as a powerful anti-inflammatory in both the Chinese and Indian systems of medicine. Turmeric was traditionally called “Indian saffron” because of its deep yellow-orange color and has been used throughout history as a condiment, healing remedy and textile dye.

Fellow Scientopian Krystal D’Costa of Anthropology in Practice has blogged about the use of turmeric in Gaye Holud, a Bengali wedding ritual, where its yellow color sanctifies the couple the evening before their vows. The post confirms what I remember most from dropping curry in my lap: it stains!

To further demonstrate this property of the spice, I performed an experiment (once a scientist, always a scientist). First I put 1/4 teaspoon of lotion (my vehicle) in each of two stainless steel containers. I then mixed 1/8 teaspoon of turmeric into one of the containers.

Line added to emphasize demarcation

I applied roughly equal amounts of each onto the back of my left hand. Even after rubbing both in, a yellow cast can be seen on the turmeric side, even on my olive skin. My fair-skinned daughter would look positively jaundiced!

When googling turmeric and skin care, one site provided a realistic, sober assessment of the spice’s active ingredient, curcumin:

If you asked a dermatologist or skin care scientist what features they would want in a beneficial skin care ingredient, the answer may include the ability to neutralize free radicals, reduce inflammation, modulate abnormal cell growth, reduce UV damage, and inhibit accumulation of age-related pigments. Interestingly enough, curcumin’s resume matches all of the above quite well. Also, considering that skin is a lipid rich tissue (just as the brain is), curcumin may turn out to be not just neuroprotector but skin protector as well.

That said, the research into the effects of curcumin on skin aging is scant or absent (depending on where you draw the quality line). There is some evidence that topical curcuminoids reduce the incidence of skin tumors in mice as well as partly prevent UV damage. However, realistic human clinical studies are required to assess practical skin benefits of curcumin, if any.

Being a sciencey-type person, I then went to the primary literature via PubMed. My search used the terms “topical” and “curcumin” and located 58 citations, including 10 review articles. One that caught my attention studied its use in photoaging in mice; a portion of the abstract includes the following:

Curcumin (diferuloylmethane) is a phytochemical with diverse antioxidant and antiinflammatory properties. However, it shows a poor topical bioavailability.

The authors went on to test the effects of encapsulated vesicles of curcumin and demonstrated that it restored redox balance to damaged skin. Free curcumin in lotion did nothing, presumably because it cannot penetrate skin!

So leave your turmeric in the kitchen (unless you’re Bengali or otherwise engaged in a paint-the-body-yellow ritual of some sort); it is not going to stop wrinkles mixed in your moisturizer! Studies are underway using non-pigmented metabolites and effective delivery vehicles, so someday curcumin may be in our make-up case and sunblock. In the meantime, eating curry and yellow mustard may provide some anti-aging benefits, as well as delicious foods!

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Background Normal Urinary Tract (Click to embiggen)

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Background

Normal Urinary Tract (Click to embiggen)