Scientists at Cold Spring Harbor Laboratory (CSHL) today report a discovery that they hope will lead to the development of a powerful new way of treating an aggressive form of breast cancer.
The breast cancer subtype in question is commonly called ‘HER2-positive’; it

Conventional digital mammography is the most widely-used screening modality for breast cancer, but may yield suspicious findings that turn out not to be cancer, known as false-positives. Such findings are associated with a higher recall rate, or the rate at which women are called back for additional imaging or biopsy that may be deemed unnecessary.
Tomosynthesis, however, allows for 3-D reconstruction of the breast tissue, giving radiologists a clearer view of the overlapping slices of breast tissue.  And though a relatively new technology, it has shown promise at reducing recall rates in all groups of patients, including younger women and those with dense breast tissue.  This study, presented by Emily F. Conant, MD, chief of Breast Imaging the department of Radiology at the Perelman School of Medicine at the University of Pennsylvania, is one of the largest prospective trials in tomosynthesis to date.
For the study, the research team compared imaging results from 15,633 women who underwent tomosynthesis at HUP beginning in 2011 to those of 10,753 patients imaged with digital mammography the prior year. Six radiologists trained in tomosynthesis interpretation reviewed the images.
Researchers found that, compared to conventional mammography, the average recall rate using tomosynthesis decreased from 10.40 percent to 8.78 percent, and the cancer detection rate increased from 4.28 to 5.24 per 1,000 patients, a 22 percent increase.

Johns Hopkins researchers have devised a computerised process that could make minimally invasive surgery more accurate and streamlined using equipment already common in the operating room.

In a report the researchers say initial testing of the algorithm shows that their image-based guidance system is potentially superior to conventional tracking systems that have been the mainstay of surgical navigation over the last decade.

‘Imaging in the operating room opens new possibilities for patient safety and high-precision surgical guidance,’ says Jeffrey Siewerdsen, Ph.D., a professor of biomedical engineering in the Johns Hopkins University School of Medicine. ‘In this work, we devised an imaging method that could overcome traditional barriers in precision and workflow. Rather than adding complicated tracking systems and special markers to the already busy surgical scene, we realised a method in which the imaging system is the tracker and the patient is the marker.’

Siewerdsen explains that current state-of-the-art surgical navigation involves an often cumbersome process in which someone

Concerted effort is needed to reverse the ongoing rise in pertussis cases and deaths, especially among children and young people, according to the article by Emily Peake. ‘This effort begins with nurses and nurse practitioners and other primary care providers who educate patients and the public,’ they write. ‘The battle of pertussis is winnable through education, awareness, and vaccination.’
Caused by infection with Bordetella pertussis bacteria, pertussis has been increasing in recent years. In the United States, average annual pertussis cases increased from less than 3,000 cases per year during the 1980s to 48,000 in 2012, including 20 deaths. Worldwide, there are an estimated 50 million cases of pertussis and 300,000 deaths. Pertussis is a major cause of death in infants worldwide.
Why is pertussis on the rise? ‘Ambivalence toward precautionary childhood vaccinations’ is a key reason, along with the lack of well-child visits and appropriate boosters. The arrival of non-vaccinated immigrants may also be linked to new clusters of pertussis outbreaks, according to Peake and McGuire. They write, ‘Nurses should educate patients and the public that follow-up booster vaccinations at all ages are critical to maintain immunity to pertussis and other vaccine-preventable diseases.’
Issues including vaccine availability and cost, literacy and language barriers, and lack of information all contribute to the lack of recommended vaccinations. Fear of vaccination and religious objections also play a role. Most states allow exemptions from vaccination based on religious reasons, and there’s evidence that even non-religious parents are using these exemptions to avoid vaccinating their children.
Nurses should reassure parents that that recommended vaccines are safe. Current diphtheria-tetanus-pertussis vaccines do not contain the mercury-containing preservative thimerosal. Adverse events occur in only a small fraction of vaccinated children, and most of these are mild local reactions.
‘Practitioners must build a trusting relationship with patients and reinforce the need for vaccinations through face-to-face contact, engaging parents to discuss concerns, and provide evidence-based research to guide recommendations and reassure patients of the safety of vaccines,’ Peake and McGuire write. Waiting rooms provide a good opportunity to present videos and other educational materials.
The World Health Organization is working to increase the percentage of infants who receive at least three doses of pertussis vaccine to 90 percent or higher, especially in developing countries. The authors discuss some international efforts to fight pertussis and other vaccine-preventable diseases, such as the United Nations Foundation’s
Closer to home, partnerships should be formed with service organisations, food banks, churches, hospitals and schools. ‘These groups can help identify those most likely not to be vaccinated and help them find free or low cost immunisations,’ the authors write. ‘Faith community nurses are in an ideal role to create and lead these partnerships.’
Nurses can also advocate for policies aimed at making universal vaccinations available for adolescents and adults. Peake and McGuire conclude, ‘By using our resources and uniting, a global battle will be waged and won against pertussis and the children of tomorrow can breathe easier for a lifetime.’ EurekAlert