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Early PET Shows Increased Risk of Relapse in Patients with Stage I/II …

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According to a recent study, provisional analysis of the intergroup EORTC-LYSA-FIL 20051 H10 trial published in the Journal of Clinical Oncology points to an increased risk of early relapse when eliminating radiotherapy in early PET scan negative patients with stage I/II Hodgkin's lymphoma. Early outcome, however, was superb in both arms, and the final analysis should determine whether these preliminary findings are in fact sustained over time. "The standard ... Read more

Ultrasound Misses Numerous Heart Defects in Fetuses…

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Based on research conducted at Linköping University in Sweden, one reason why malformations are not detected is obesity in the expectant mother. Moreover, six out of ten grave heart defects in fetuses go unnoticed in the ultrasound scans administered to all pregnant women. On an annual basis 2,000 children are born in Sweden with serious malformations, of which almost half are heart defects. Detecting these during the first stage of pregnancy is a significant challenge for prenatal healthcare. "The lives of children born with serious heart defects are in constant danger; some of them need immediate operations or medical treatment. If these defects are detected during the pregnancy the babies can be born in Lund or Gothenburg where the hospital has facilities for child heart surgery," explains senior physician at the Linköping University Hospital Women's Clinic and also a graduate student in obstetrics and gynaecology at Linköping University, Eric Hildebrand. The root of his study is an examination of over 21,000 ultrasound scans in the south-east healthcare region in Sweden, covering the counties of Jönköping, Kalmar, and Östergötland. In this region all expecting mothers are offered two ultrasound scans, the first in weeks 11-14, and the second in weeks 18-20. In the first scan the midwife dates the pregnancy, searches for the possibility of twins and carries out a general examination of the anatomy of the embryo. In the second scan the organs are screened for malformations. In the examination the results of the two scans are compared. Unsurprisingly, considerably fewer malformations are revelaed in the first scan. It was especially difficult to detect heart defects. During the eleventh to the fourteenth weeks no defects were found at all, yet in the eighteenth to twentieth week, 37% of serious defects were discovered. One reason for missing malformations is that the ultrasound image is affected by the body of the mother. For instance diagnosis is made more difficult by obesity-a BMI over 30-which is the case for 13% of the mothers. "Subcutaneous fat detracts from the quality of the image, making it more difficult for us to see malformations," said Hildebrand. The statistics also reveal that obesity itself raises the risk of conditions like spina bifida, although the increased risk for the individual is small. That makes it doubly important to be able to provide strong embryo diagnostics for the expectant mother. In the case of chromosome abnormalities, a thorough examination of the national medical birth register of children born between 1995 and 2010 showed that one in 700 children was born with Downs syndrome. A certain connection with obesity was also seen. Hildebrand suggests a couple of important measures for a more trustworthy embryo diagnostic that came out of the in the studies: -The methods of detecting heart defects need to be improved. One way is to give midwives additional education and training in interpreting heart images, including with what is known as color Doppler for blood flow in the heart. -The best diagnostic tool for Downs Syndrome is the CUB, or Combined Ultrasound and Biochemical screening test, which works just as well regardless of whether the mother is obese or ... Read more

E.coli Cajoled to Resists Radiation Damage in the Lab…

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According to a recent study, researchers have managed to exploit the ability of an organism to evolve in reaction to punishment from a volatile environment. The researchers have cajoled the model bacterium Escherichia coli to significantly resist ... Read more

Heart Scans Only Useful in Prescribing Statins under …

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According to a new study by researchers at UC San Francisco, as long as low-cost statins, which lower cholesterol, are readily available and patients don't mind taking them, it doesn't make sense to perform a heart scan to measure how much plaque ... Read more

CT Scans Show Not to Interfere with Heart Rhythm …

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Back when US health administrators issued an advisory in 2008 warning that computed tomography (CT) imaging might interfere with pacemakers or implantable cardioverter-defibrillators, the medical community needed more evidence to support the health agency’s recommendations/suggestions. According to a new study, researchers now have reported their findings of the first study to assess the apprehension in “real world,” medical practice. The results showed that such negative interference, if it exists, is not significant enough to warrant drastic changes in medical practice. The study’s findings were published online February 2014, in the Journal of the American College of Cardiology.  “The presence of cardiac devices should not delay or result in cancellation of clinically indicated CT imaging procedures,” stated the study’s senior author, Timm-Michael Dickfeld, MD, PhD, associate professor of medicine at the University of Maryland School of Medicine (Baltimore, MD, USA) and chief of electrophysiology at the Baltimore Veterans Affairs (VA) Medical Center. The original US Food and Drug Administration (FDA) counseling, which prompted this study, recommended having a physician present during CT scans, ready to take emergency measures to manage possible adverse events, and to observe the rhythm device in the patient following CT imaging to provide correct function. An updated FDA advisory, issued in 2013, did not pay special focus to standard device checks but called for a physician to be available when the CT involves continuous scanning over the device for more than a few seconds. “For CT scans for diagnostic purposes, the FDA advisory may warrant further evaluation,” said the study’s lead investigator, cardiovascular medicine fellow Ayman Hussein, MD. In retrospect, the researchers studied the records of patients who received over 500 CT scans between July 2000 and May 2010 performed at the University of Maryland Medical Center and the Baltimore VA Medical Center. They searched for key adverse effects such as abnormally high or low heart rate, death, an immediate intervention, hospital admission, or secondary effects such as changes in the device caused by CT imaging. However, the scans did not produce any of the primary outcomes, while several slight secondary effects were noted in a small group of devices, but there was no clear tie to CT. Similar changes were seen in a group of devices not exposed to CT. “Clinicians and the FDA are collectively committed to patient safety. We also must rely on outcome data that helps us decide on the course of action best for our patients. This study provides what is probably the best information we will have for years to come,” noted Dickfeld. “At the very least, the study may provide valuable input for reevaluation of the FDA’s original advisory,” said study co-author and associate professor of diagnostic radiology and nuclear medicine at the University of Maryland School of Medicine, Jean Jeudy Jr., ... Read more

Less Expensive, but Possibly Riskier New Prostate …

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According to a new study by Yale School of Medicine researchers have found a quicker and less expensive form of radiotherapy designed for treating prostate cancer may come at a price. The standard external beam radiation therapy for prostate cancer is called intensity modulated radiation therapy (IMRT). Stereotactic body radiotherapy (SBRT) is a newer kind of treatment that administers a greater dose of radiation per treatment than IMRT. As a result, patients receiving SBRT can complete an entire course of treatment in one to two weeks, as opposed to seven to nine weeks for IMRT. In relation,there have been few studies comparing the costs of these treatments, and their toxicity. This new study, published in the Journal of Clinical Oncology by researchers at the Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center at Yale Cancer Center, compared IMRT to SBRT in a national sample of 4,005, Medicare patients aged 66 and older receiving prostate cancer treatment. Participants underwent either SBRT or IMRT as a primary treatment for prostate cancer during 2008 to 2011. "All the reports we have about the toxicity of SBRT comes from pioneering institutions. But now that SBRT is being used nationally, it is important to determine the costs and complications on a national level," said first author and assistant professor of therapeutic radiology at Yale Cancer Center, James Yu, M.D. Yu, senior author Cary Gross, M.D., and their colleagues discovered that the average per-patient cost to Medicare for a course of SBRT was about $13,600, as opposed to $21,000 for IMRT. Furthermore, the team found that at 24 months following the start of the treatment, there were increased side effects for SBRT as opposed to IMRT, as a result of urethral irritation, urinary incontinence, and obstruction. However, even when including the cost of treating complications, the overall medical costs due to SBRT were still lower than that of IMRT. "While these data are by no means definitive, our findings emphasize the need to carefully assess the impact of new cancer treatment technologies in actual practice," said Gross, professor of internal medicine at Yale School of Medicine, and director of the Yale COPPER Center at Yale Cancer ... Read more

New Imaging Method Zeroes in on Cancer…

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Cancer is the second most common cause of death in Switzerland. There are various reasons why in the age of cutting-edge medicine it is still difficult to fashion a cure for this disease. A tumor may, for instance, comprise of different tumor cell subpopulations, each of which has its own profile and reacts differently when subjected to therapy, or not. Additionally, the cancer cells and the healthy cells in the body interact and communicate with one another. How a tumor then actually develops and whether metastases form simply relies on which signals a tumor cell receives from its surrounding environment. With the development of a new method the team led by Prof. Bernd Bodenmiller from the Institute of Molecular Life Sciences at the University of Zurich, in collaboration with ETH Zurich and University Hospital Zurich, has succeeded in comprehensively profiling and visualizing tumor cells from patient samples. This promising new method has since been published in Nature Methods. In an effort to determine a tumor's cell profile, its environment relationships and the circuit structure within and in between cells is a highly multifaceted enterprise. This is because the biomarkers, i.e. the particular molecules of the various cell types and their circuits, have to be measured in their spatial relationships. "With our method it is possible to obtain a comprehensive picture using a novel imaging technique that currently can simultaneously record 32, and in the near future more than one hundred biomarkers. Furthermore, thanks to state-of-the-art imaging the information about the cells' neighborhood relationships is kept and their direct impact on the cellular switch and control circuits can be visualized,” explains study coordinator, Bernd Bodenmiller. The new method is predicated on techniques which are already routinely applied and used in hospitals, with two significant innovations. First, the biomarkers are visualized using pure metal isotopes instead of dyes. To accomplish this, biomarkers are set on very thin tissue sections are labelled with antibodies. The antibodies are joined to the pure metal isotopes. Then tiny pieces of tissue are extracted with a laser system developed by Prof. Detlef Günther from the ETH Zurich, and the metal isotopes of the pieces are measured with a mass spectrometer which can determine the mass and quantity of the individual metal isotopes. "This trick gets round the problem of the limited number of colours in the analysis of biological samples," noted Bodenmiller. Secondly, information about the cells, and their control circuits, is no longer qualitative. With the new measurement method it is possible to accurately determine which cells experience what effect and to what extent. In this way the weak points of the control system can be pinpointed and this helps in the development of new therapeutic approaches and methods. According to Bodenmiller, this is the reason on why it is becoming increasingly important to understand these interactions for diagnosis and therapy. The preliminary measurement results of the new biomarker technique for breast cancer have shown the heterogeneity of tumors. As a result of major growth, some tumors suffer from oxygen shortage on the inside, while others mistreat the body's own immune cells to further their growth. Cell-cell interaction and cell location in the center or on the edges of the tumor also have a vital impact. One thing is certain: no tumor is like any other and Bodenmiller believes that treatment should be based on this principle. For their next phase, his research team wishes to use the new measurement method to explore the roles played by control circuits and cell communication in metastasis ... Read more

Unique Imaging System Illuminates Tumors using …

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Researchers at the Cedars-Sinai Maxine Dunitz Neurosurgical Institute and Department of Neurosurgery have developed a unique, compact, relatively cost-effective imaging device to "light up" malignant brain tumors and other cancers. The experimental imaging modality comprises of a special camera designed and developed at Cedars-Sinai and a new, targeted imaging agent predicated on a synthetic version of a small protein, a peptide, located in the venom of the deathstalker scorpion. The imaging agent, Tumor Paint BLZ-100, a product of Blaze Bioscience Inc., homes to brain tumor cells. When enthused by a laser in the near-infrared part of the spectrum, it emanates a glow that is invisible to the eye but can be captured by the camera. Results of animal studies, published as the feature article in the February issue of Neurosurgical Focus, provide the basis for the launch of human clinical trials. The system would be used during surgery to determine if it allows neurosurgeons to remove more tumor and spare more healthy tissue. Malignant brain tumors called gliomas are among the most fatal of tumors, with patients usually surviving only around 15 months following diagnosis. "We know that survival statistics increase if we can remove all of a tumor, but it is impossible to visualize with the naked eye where tumor stops and brain tissue starts, and current imaging systems don't provide a definitive view," said chair and professor of the Department of Neurosurgery, the article's senior author, Keith Black, MD. "Gliomas have tentacles that invade normal tissue and present big challenges for neurosurgeons: Taking out too much normal brain tissue can have catastrophic consequences, but stopping short of total removal gives remaining cancer cells a head start on growing back. That's why we have worked to develop imaging systems that will provide a clear distinction, during surgery, between diseased tissue and normal brain," said Black, who also serves as the director of the Maxine Dunitz Neurosurgical Institute, director of the Johnnie L. Cochran, Jr. Brain Tumor Center and the Ruth and Lawrence Harvey Chair in Neuroscience. In studies in laboratory mice with implanted human brain tumors, the new imaging system clearly defined tumor tissue from normal brain tissue. Additionally, with near-infrared light's ability to penetrate deep into the tissue, the system identified tumors that had moved away from the main tumor and would have otherwise gone undetected. Pramod Butte, MBBS, PhD, research scientist and assistant professor in the Department of Neurosurgery, the article's first author, explained the tumor-imaging process comprises of two parts: deploying a fluorescent "dye" that latches only onto cancer cells, and using a laser and a special camera to render an invisible image visible. To get the dye to the tumor, it is connected to a peptide called chlorotoxin, which, converse to its name, is not toxic. It totally ignores normal tissue, yet seeks out and binds to a range of malignant tumor cells. It first was derived from the venom of the yellow Israeli scorpion, also called the deathstalker. Article co-author Adam Mamelak, MD, professor of neurosurgery and director of functional neurosurgery, has studied the synthetic version of chlorotoxin and its tumor-targeting properties for more than a decade. In this study, chlorotoxin was binded to a molecule, indocyanine green, a near-infrared dye, a version of which already is approved by the Food and Drug Administration. The chlorotoxin-indocyanine green combination, Tumor Paint BLZ-100, gives off a glow when stimulated by near-infrared light. "Injected intravenously, the chlorotoxin seeks out the brain tumor, carrying with it indocyanine green, which has been used in a variety of medical imaging applications. When we shine a near-infrared laser on the tissue, the tumor glows. But the glow emitted by the tumor is invisible to the human eye," said Butte, whose MBBS is India's equivalent of an MD. The camera device, designed in Butte's lab, solves this problem by capturing two images and combining them on a high-definition monitor. "Other experimental systems we have seen, which use different tumor-targeting methods, are larger and bulkier because they consist of two cameras," Butte said. "Our single-camera device takes both near-infrared and white light images simultaneously. This is achieved by alternately strobing the laser and normal white lights at very high speeds. The eye just sees normal light, but the camera is capturing white light once, near-infrared light next, over and over. We then superimpose the two HD images. The image from the laser shows the tumor, and the image produced from white light shows the visible 'landscape' so we can see where the tumor is in context to what we actually can see." The prototype is compact, but the authors said they are working to make the next generations even smaller, lighter and portable so the device will require very little space in operating room, allowing the neurosurgeon to focus on the operating microscope and give little attention on the imaging system. "We hope that eventually the camera can be transported in a small bag, but we are not sacrificing image quality for portability," Butte said. "In fact, most systems that use two cameras lose a lot of light. But because of the special filters we use and the way we arrange them, we lose very little light. And from what we have seen and tested, our device provides about 10 times greater sensitivity and contrast than others." In an editorial accompanying the journal article, David W. Roberts, MD, from the Section of Neurosurgery at the Geisel School of Medicine at Dartmouth College, said the Cedars-Sinai "paper presents a newer direction in which fluorescence-guided surgery may well be headed." He noted that the researchers overcame one of the limitations of near-infrared technology -- that it is outside of the visible portion of the spectrum. "In this regard, Butte and colleagues have contributed to the field with their implementation of an optical system that is sensitive and efficient. They have characterized well its performance in phantom and animal models, demonstrating proof-of-concept and ... Read more

Carotid Artery MRI Helps Predict Possibility of …

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Based on a new study published online in the journal Radiology, noninvasive imaging of carotid artery plaque with MRI can precisely predict future cardiovascular events like strokes and heart attacks in people without a history of cardiovascular disease. For quite some time researchers have known that some arterial plaque is more hazardous due to its vulnerability to rupture. MRI can distinguish features of vulnerable plaque, such as a lipid core with a thin fibrous cap. This capability makes MRI a promisingly valuable tool for identifying patients at risk for later cardiovascular events. To study the predictive value of MRI plaque imaging, researchers conducted carotid artery ultrasound and MRI on 946 asymptomatic patients from the Multi-Ethnic Study of Atherosclerosis (MESA). The carotid arteries are the large vessels found on either side of the neck that carry oxygenated blood to the front part of the brain. They are highly accessible for imaging, and their condition tends to mirror that of the coronary arteries that supply the heart with oxygenated blood. The researchers applied ultrasound to evaluate carotid wall thickness and MRI to define carotid plaque composition and the remodeling index, a measure of changes in vessel size. Imaging results were juxtaposed with cardiovascular events, including heart attacks, stroke and death, for an average of 5 and a half years following examination. "We studied asymptomatic individuals with a low risk of cardiovascular events at baseline and used noninvasive imaging to predict the risk of an event downstream. This is the first population-based prospective study to determine if vulnerable plaque features by MRI add to the risk of a cardiovascular event beyond the traditional risk factors,” said David A. Bluemke, M.D, Ph.D., from the National Institutes of Health Clinical Center in Bethesda, Md Cardiovascular events took place in 59 of the patients. Abnormal thickening of the carotid artery wall and the existence of a lipid core and calcium in the internal carotid artery on MRI were major predictors of subsequent events. A lipid core was present in almost half of the patients who had an event, as opposed to only 17.8 percent of those who did not have an event. "The primary factors that predicted future risk were measures of vessel wall thickness in combination with the presence or absence of a lipid core. The presence of a lipid core was 50 percent more common in people who had subsequent events,” said Bluemke. Use of MRI improved the reclassification of baseline cardiovascular risk in the study group. When both the carotid remodeling index and lipid core were used for risk stratification, around 16 percent more patients with events and 7 percent without events were correctly reclassified compared with the use of traditional risk factors. "The results bolster the use of MRI as a surrogate marker of efficacy in therapeutic studies and point to a role in determining which patients might need more aggressive treatments. As risk factor prediction gets better, we'll be able to screen more intelligently and use more intensive treatments in those individuals who face a higher risk of cardiovascular events,” said Bluemke. Bluemke noted that sequences for plaque composition could be readily integrated to existing carotid MRI angiography protocols for clinical purposes. "Carotid MRI has significant advantages," he said. "The results are more reproducible than those of ultrasound." Availability and cost effectiveness could limit and restrict the use of MRI, Bluemke warned. However, ultrasound and computed tomography (CT) are viable alternatives for screening, he noted, especially with improvements in CT dose ... Read more

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