Boston Children
NYU Langone Medical Center became the first academic medical centre to implant a newly FDA-approved heart valve for transcatheter aortic valve replacement (TAVR) in patients with severe aortic stenosis. Mathew R. Williams, MD performed the TAVR procedure and the patient was discharged to her home only two days later. Five additional patients have successfully undergone the procedure since then.
Adenomas are rare liver tumours, a certain percentage of which can become malignant. Using a new MR (magnetic resonance) technique at MedUni Vienna, it is now possible to classify adenomas without subjecting patients to invasive tissue sampling procedures.
Hitherto patients have had to undergo biopsy to take tissue samples for histological examination in order to determine whether a hepatocellular adenoma is benign or potentially malignant. Using a new imaging technique at the University Department of Radiology and Nuclear Medicine at MedUni Vienna (Christian Herold), this type of tumour can now be clearly classified by means of a liver-specific MR contrast agent.
Adenomas of the liver are relatively rare. They can develop in different ways. Hence there are three subtypes (benign, inflammatory, pre-malignant) and a fourth unclassifiable subgroup with different clinical courses and potential progression. It is now possible to determine which group a particular adenoma belongs to using a new MR imaging technique.
The liver-specific contrast agent, gadoxetic acid, targets the bile transporters OATP (organic anion-transporting polypeptide) and MRP (Multidrug Resistance-Related Protein) in adenoma cells and normal liver cells. These will either absorb the agent or re-excrete it. The tumours can then be classified on the basis of the relative proportion of these surface transporters as compared to normal liver cells, as shown in the MR image.
Clear challenges arise when people with an implanted device approach or reach the end of their life. What many people want in that situation is care and treatment to maintain their comfort and quality of life for whatever time they have left . Receiving treatment (for example electric shocks from an implanted defibrillator) as they are dying may provide no benefit but may cause them pain and may cause distress both to them and to those who care about them.
So as to provide the best care for people in the last days, weeks or months of their life it is important to consider deactivation of some of these devices. This requires informed and sensitive discussion with patients and those close to them. Healthcare professionals caring for such people may be faced with practical questions about the exact nature and purpose of each device, how the device can be deactivated and what arrangements are in place in their locality to provide the equipment and the expert support and advice needed. It is important also that healthcare professionals know what actions should be taken when someone has died with an implanted device in place.
Quite distinct from those circumstances, an implanted device may lead to uncertainty when someone with one in place suffers cardiac arrest, and cardiopulmonary resuscitation (CPR) is attempted. Those involved may not have detailed information about the implanted device and may be unsure whether they should modify their approach to CPR.
Dr David Pitcher, President of the Resuscitation Council (UK) says,
Congenital heart experts from Spectrum Health Helen DeVos Children
Although non adherence to medication is common in patients with newly diagnosed hypertension, those with greater compliance may have a lower risk of early heart failure, according to a new study from Italy.
Specifically, in 6.6 years of follow-up, compared with patients who filled their prescriptions less than a quarter of the time those who filled their prescriptions more than three-quarters of the time had a 34% lower risk of being hospitalized for heart failure.
The inverse relationship between drug adherence and hospitalization for heart failure was similar in 71- to 80-years-olds vs 40- to 70-year-olds. ACE inhibitors, angiotensinreceptor blockers (ARBs), and diuretics protected patients against heart failure, but calcium-channel blockers did not.
This research shows that
Patients with scoliosis who undergo surgery may be less likely to develop an infection or other complications after the procedure when a novel wound closure technique pioneered at NYU Langone Medical is utilized, according to new research.
In this new technique, surgeons use a multi-layered flap closure that enables doctors to close several layers of muscle and fascia while maintaining blood supply from the donor site to the recipient site. The researchers believe this new method reduces complication rates by eliminating
Dehydration from diarrhoea, either from viral infection or cholera, accounts for 10 percent of all child deaths worldwide. Though it
A recent study led by DCRI Fellow Jacob Doll found that approximately two-thirds of the patients who were referred to rehabilitation did not attend an initial session.
Cardiac rehabilitation programmes include a mixture of exercise regimens, health education, and cardiovascular risk reduction and medication adherence support. These programmes, which typically comprise 2 to 3 weekly sessions for a total of 36 sessions, are associated with improvements in lifestyle, functional capacity, and quality of life for older adults. Despite this, rates of referral and adherence have traditionally been low, particularly in older adults.
In this study, Doll and his colleagues used data from the National Cardiovascular Data Registry Acute Coronary Treatment Intervention Outcomes Network Registry and Medicare claims to identify 58,269 patients 65 years or older who had a heart attack between 2007 and 2010. Of these patients, 36,376 (62.4 percent) were referred to cardiac rehabilitation. Only 11,862 patients (32.6 percent) attended at least one rehab session during the year following hospital discharge. Of those who had not been referred, 1,795 (8.2 percent) attended at least one session.
Only about 5 percent of the patients completed all 36 sessions, even though the sessions are usually covered by insurance.
These findings, the study
Scientists have developed a technique that could lead to therapies for pain relief in people with intractable pain, potentially including cancer-related pain.
A team of scientists at Kyoto University’s Institute for Integrated Cell-Material Sciences (iCeMS) has developed a novel technique using tiny gold rods to target pain receptors.
Gold nanorods are tiny rods that are 1-100 nanometers wide and long. In comparison, a human hair is 100,000 nanometers wide. The team coated gold nanorods with a special type of protein that transports fat within the body known as a lipoprotein. This allowed the nanorods to bind efficiently to nerve cell membranes bearing a pain receptor called TRPV1 (transient receptor potential vanilloid type 1). Near-infrared light was then applied to the nanorod-coated pain receptors. The nanorods heated up, activating the pain receptors to allow an influx of calcium ions through the membrane. Prolonged activation of TRPV1 is known to subsequently lead to their desensitization, bringing pain relief. Importantly, heating the gold nanorods enabled safe activation of the TRPV1 pain receptors alone, without affecting the membrane in which they lie.
Previous studies had shown that magnetic nanoparticles (tiny particles in the nano-range made out of magnetic materials) are also able to activate TRPV1 receptors by applying a magnetic field. The target cells in this method, however, require genetic modification for it to work. Using lipoprotein-coated gold nanorods does not require genetic modification of the target cells. Also, the nanorods were found to have at least 1,000 times greater efficiency than magnetic nanoparticles in heat generation and in activating TRPV1 receptors.
‘The gold nanorods can be retained in the body for a prolonged period,’ says Tatsuya Murakami, the principal investigator of this study. ‘Local injection of our gold nanorods might enable repetitive and on-demand treatment for people experiencing intractable pain because prior genetic engineering of the target cells is unnecessary.’ Kyoto University iCeMS
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