Archive for month: August, 2020

To operate on the brain, doctors need to see fine details on a small scale. A tiny camera that could produce 3-D images from inside the brain would help surgeons see more intricacies of the tissue they are handling and lead to faster, safer procedures.
An endoscope with such a camera is being developed at NASA

Ji and colleagues used a microscopy technique called stimulated Raman scattering, or SRS, to image cancer cells in human brain tissue. SRS produces different signals for proteins and lipids, which can then be assigned a colour (blue and green, respectively), allowing the authors to differentiate brain cortex from tumour from white matter. Biopsies from adult and paediatric patients with glioblastoma revealed not only distinctive features with SRS microscopy but also the presence of infiltrating cells in tissues that appeared otherwise normal with traditional staining. Such infiltrating cells are important to catch early because leaving them behind after surgery nearly always leads to cancer recurrence. To make this SRS microscopy approach amenable to routine use in neuropathology, the authors also created an objective classifier that integrated different image characteristics, such as the protein/ lipid ratio, axonal density, and degree of cellularity, into one output, on a scale of 0 to 1, that would alert the pathologist to tumour infiltration. The classifier was built using more than 1400 images from patients with glioblastoma and epilepsy, and could distinguish between tumour-infiltrated and non-tumour regions with >99% accuracy, regardless of tumour grade or histologic subtype. This label-free imaging technology could therefore be used to complement existing neurosurgical workflows, allowing for rapid and objective characterization of brain tissues and, in turn, clinical decision-making.

Science Translation Medicine http://tinyurl.com/oxq8ojx

Although there is no evidence that human prion disease, AD or cerebral amyloid angiopahy (CAA) is contagious (spread from person to person by direct contact), the study of eight patients suggests that amyloid beta (the peptides that form the main components of the amyloid plaques found in the brains of patients with AD) may potentially be transmissible via certain medical procedures.
Human transmission of prion disease has occurred as a result of various medical procedures (iatrogenic transmission), with incubation periods that can exceed five decades.
One such iatrogenic route of transmission was via the treatment in the UK of 1,848 persons of short stature with human growth hormone (HGH) extracted from cadaver-sourced pituitary glands, some of which were inadvertently prion-contaminated. The treatments began in 1958 and ceased in 1985 following reports of CJD among recipients. By the year 2000, 38 of the patients had developed CJD. As of 2012, 450 cases of iatrogenic CJD have been identified in countries worldwide after treatment with cadaverderived HGH and, to a lesser extent, other medical procedures, including transplant and neurosurgery.
John Collinge, Sebastian Brandner and colleagues at UCL conducted autopsy studies, including extensive brain tissue sampling, of eight UK patients aged 36

A new breast cancer survivorship care guideline created by the American Cancer Society and the American Society of Clinical Oncology provides guidance to primary care and other clinicians in caring for the estimated 3.1 million female adult survivors of breast cancer in the United States. The guideline is the third in a continuing series of guidelines to provide guidance on identifying and managing potential physical and psychosocial long-term and late effects of cancer and its treatment, as well as other key elements of adult post-treatment survivorship care. Previous guidelines address the needs of survivors of prostate and colorectal cancers.
The guideline recommends that breast cancer patients should undergo regular surveillance for breast cancer recurrence, including evaluation with a detailed cancer-related history and physical examination, and should be screened for new primary breast cancer consistent with guidelines. At the same time, data do not support performing routine laboratory tests or imaging tests, except mammography when indicated, in asymptomatic patients to evaluate for breast cancer recurrence.
The guideline also recommends that primary care clinicians counsel patients about the importance of maintaining a healthy lifestyle, monitor for post-treatment symptoms that can adversely affect quality of life, and counsel patients to adhere to endocrine therapy. In addition to recommendations about screening tests and lifestyle factors, the guideline includes information on a broad range of other issues, from cognitive impairment and body image to fatigue and care coordination.

Postponing the start of adjuvant chemotherapy for more than 90 days following surgery may significantly increase risk of death for breast cancer patients, particularly those with triple-negative breast cancer (TNBC), according to a new study from The University of Texas MD Anderson Cancer Center. Further, the researchers found that factors such as socio-economic status, insurance coverage and ethnicity were associated with delayed treatment.
Adjuvant chemotherapy, which is given after primary surgery, has been demonstrated to benefit patients by decreasing the risk of recurrence and death, explained Mariana Chavez Mac Gregor, M.D., assistant professor, Health Services Research and Breast Medical Oncology. However, delaying the start of adjuvant chemotherapy may allow small remnants of the tumour to grow or become drug-resistant.
Currently, there are no guidelines recommending the optimal time to initiation of adjuvant chemotherapy. The Centers for Medicare & Medicaid Services (CMS) considers the administration of adjuvant chemotherapy within 120 days of diagnosis for certain patients as a quality metric. Eleven cancer hospitals, including MD Anderson, are now reporting on this metric.
Past studies have suggested that delaying the initiation of therapy could result in adverse patient outcomes, but the optimal timing for starting adjuvant therapy has not been defined. To clarify this time frame relative to modern treatments and identify factors contributing to delayed treatment, the researchers analysed data from the California Cancer Registry.
This population-based study examined data from 24,823 patients with Stage I to III invasive breast cancer diagnosed between January 1, 2005 and December 31, 2010 and treated with adjuvant chemotherapy. This is the largest study investigating the effects of delayed chemotherapy initiation with contemporary treatment regimens.