New X-ray imaging developed by scientists
Scientists have developed an X-ray imaging system that enables researchers to see
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Undescended testis: The recommended surgery is being performed too late
Undescended testis is commonly found in new-born boys and usually normalizes spontaneously by the age of six months. In one in a hundred boys, however, at least one testis remains undescended
Phone counselling reduces pain, disability after back surgery
Research by Johns Hopkins scientists suggests that having a short series of phone conversations with trained counsellors can substantially boost recovery and reduce pain in patients after spinal surgery.
The phone calls, designed to enrich standard pre- and post-operative care by reinforcing the value of sticking with physical therapy and back-strengthening exercise regimens, are a relatively inexpensive and simple intervention that can maximize surgical outcomes for the hundreds of thousands of patients who undergo spinal surgeries every year, the investigators say.
New nanodevice defeats drug resistance
Chemotherapy often shrinks tumours at first, but as cancer cells become resistant to drug treatment, tumours can grow back. A new nanodevice developed by MIT researchers can help overcome that by first blocking the gene that confers drug resistance, then launching a new chemotherapy attack against the disarmed tumours.
The device, which consists of gold nanoparticles embedded in a hydrogel that can be injected or implanted at a tumour site, could also be used more broadly to disrupt any gene involved in cancer.
Using portable ultrasound to identify possible heart attacks and strokes before symptoms arise
A study of portable ultrasound performed in the United States, Canada, and India has revealed the potential of this technology for identifying plaques in peripheral arteries that can lead to heart attacks and stroke before symptoms occur, in both developed and developing country environments, allowing preventive treatment in those affected.
The study was conducted by Dr. Ram Bedi, affiliate assistant professor, department of bioengineering, University of Washington (Seattle, WA, USA), and Prof. Jagat Narula, editor-in-chief of Global Heart and Icahn School of Medicine at Mount Sinai (New York, NY, USA), and colleagues.
Many research studies have shown that it is possible to evaluate subclinical atherosclerotic cardiovascular disease (ASCVD) using ultrasound imaging. Because more portable and lower cost ultrasound devices are now available, combined with increased automation and enhancements, it may be possible in the near future to typically examine people with ultrasound to establish any ASCVD present before symptoms arise, so that future disease can be prevented, for example using medication. In this study, ASCVD was determined using ultrasound of both the carotid arteries and the ileofemoral arteries. The findings were summarized in an easy to understand index called the Fuster-Narula (FUN) Score.
Data were gathered from four cohorts, two Indian and two North American. In India, a medical camp setting was used, and screening with automated ultrasound imaging was conducted over eight days in 941 comparatively young (mean age 44 years, 34% female) asymptomatic volunteers recruited from the semi-urban town of Sirsa (Haryana) and urban city of Jaipur (Rajasthan) in northern India. The cohort from Sirsa was specifically recruited because all participants had already undergone aggressive lifestyle changes (smoking cessation, no alcohol, vegetarian diet, physically active lifestyles, daily meditation), radiology resident physicians who had no earlier training in vascular ultrasound were trained right on the spot to perform the ultrasound examinations.
To compare the imaging findings with traditional risk factors, two cohorts (481 persons) were recruited from primary care clinics in North America (one in Richmond, TX, USA, the other in Toronto, Canada). As well as the same ultrasound examinations given in the Indian cohort, comprehensive ASCVD risk factor information collected from these participants, all of whom were self-referred asymptomatic individuals (mean age 60 years, 39% female). Data collected included cholesterol levels, blood pressure, glucose level, weight, height, smoking and family history. These people were attending clinics for routine health examinations in most cases. Effectiveness of established ASCVD prevention guidelines was then compared to findings from direct imaging; ultrasound was performed by trained experts at each center.
In India, ultrasound revealed plaques in at least one artery in almost a quarter (24%) of those examined; 107 (11%) had plaques in only the carotids, 70 (7%) in both the carotids and iliofemoral arteries, and 47 (5%) had plaques in only the iliofemoral arteries. If just the carotids had been examined, 177 (19%) of the asymptomatic individuals would have been identified with plaques; by adding the iliofemoral examination, 47 additional individuals (5% of the total) were identified with plaque. Older age and male sex were associated with the presence of plaque both in urban and semi-urban populations (the much higher levels of smoking in men could account for their higher risk).
Data from the American and Canadian clinics showed that 203 subjects (42%) had carotid plaque; 166 of these (82% of those with plaque) would not have qualified for lipid-lowering therapy such as statins under the most widely used guidelines known as ATP III (Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults [Adult Treatment Panel]) guidelines. Using the recently published, more rigid ATP IV guidelines, 67 people (one-third of those with plaque and 14% of the total US/Canadian cohort) individuals with carotid plaque would also have failed to qualify for treatment.
Furthermore, the study revealed 34 individuals in the United States and Canada who qualified for treatment under ATP III but did not have any plaques, and this number increased to 81 under ATP IV (if receiving treatment such as statins, these people could be said to be overtreated, since no plaques were seen).
The investigators reported,
Nearly one in five women who undergo hysterectomy may not need the procedure
It is estimated that one in three women in the United States will have had a hysterectomy by the age of 60. Although the numbers of hysterectomies are decreasing, a new study of more than three thousand women in Michigan who underwent hysterectomy for benign indications reveals that alternatives to hysterectomy are being underused and that treatment guidelines are often not followed. Post-surgical pathology showed that nearly one in five (18%) of hysterectomies that were done for benign indications were unnecessary, and that nearly two in five (37.8%) of women under 40 had unsupportive pathology.
Over 400,000 hysterectomies are performed in the US each year. About 68% of surgeries for benign conditions are done because of abnormal uterine bleeding, uterine fibroids, and endometriosis. The American Congress of Obstetricians and Gynecologists recommends alternatives to hysterectomy, including hormonal and other forms of medical management, operative hysteroscopy, endometrial ablation, and use of the levonorgestrel intrauterine device as primary management of these conditions in many cases.
‘Over the past decade, there has been a substantial decline in the number of hysterectomies performed annually in the United States,’ observes senior investigator Daniel M. Morgan, MD, Associate Professor of Obstetrics and Gynecology at the University of Michigan. ‘An earlier study found a 36.4% decrease in number of hysterectomies performed in the U.S. in 2010 compared to 2002. However, despite the decrease in numbers of hysterectomies in the U.S., appropriateness of hysterectomy is still an area of concern and it continues to be a target for quality improvement.’
Investigators set out to assess how often alternatives to hysterectomy are being recommended to women with benign gynaecologic disease before performing hysterectomy and how often the pathologic findings from the hysterectomy supported an indication for surgery. They examined the medical records of 3,397 women who underwent hysterectomies for benign conditions in Michigan with these goals in mind. Data were collected over a ten-month period in 2013 from 52 hospitals participating in the Michigan Surgery Quality Collaborative (MSQC). Indications for surgery included uterine fibroids, abnormal uterine bleeding, endometriosis, or pelvic pain.
Nearly 40% of women did not have documentation of alternative treatment before their hysterectomy. Fewer than 30% received medical therapy, while 24% underwent other minor surgical procedures before the hysterectomy. Alternative treatment was more likely to be considered among women under 40 years old and among women with larger uteri. About 68% of women under 40 received alternative treatment compared with 62% of those aged 40-50 and 56% of those aged 50 or above.
Nearly one in five women (18.3%) had postsurgical pathologic findings that did not support having undergone a hysterectomy. The rate of unsupportive pathology was highest among women under 40 years. Nearly two in five women under 40 (37.8%) had pathologic findings that did not support undergoing a hysterectomy versus those aged 40-50 (12%) and over 50 years (7.5%). The frequency of unsupportive pathology was highest among women with a pre-operative diagnosis of endometriosis or chronic pain.
‘This study provides evidence that alternatives to hysterectomy are underutilized in women undergoing hysterectomy for abnormal uterine bleeding, uterine fibroids, endometriosis, or pelvic pain,’ says Dr. Morgan.
‘Although quality in gynaecologic surgery has focused on care after a procedure, these findings suggest that appropriateness of surgery could serve as an important quality metric in gynaecology,’ comments noted expert Jason D. Wright, MD, Chief of the Division of Gynecologic Oncology and Sol Goldman Associate Professor of Obstetrics and Gynecology at Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, New York.
Dr. Wright adds: ‘Reducing the number of procedures performed in women who may not necessarily require the procedure in the first place has the potential to have an even more meaningful impact in reducing adverse outcomes and cost than optimization of postoperative care. As reimbursement policies shift, appropriateness of surgery will likely become an even greater imperative from patients and payers.’ EurekAlert
New device reduces scarring in damaged blood vessels
When blood vessels are damaged through surgery, it can trigger an endless cycle of scarring and repair.
Vibratory stimulation applied to the sole of the foot shows promise for fall
Findings show that imperceptible vibratory stimulation applied to the soles of the feet improved balance by reducing postural sway and gait variability in elderly study participants. The vibratory stimulation is delivered by a urethane foam insole with embedded piezoelectric actuators, which generates the mechanical stimulation. The study was conducted by researchers from the Institute for Aging Research (IFAR) at Hebrew SeniorLife, Beth Israel Deaconess Medical Center, the Wyss Institute for Biologically Inspired Engineering at Harvard University, and Harvard Medical School, all of Boston, Massachusetts; and Merck Sharpe and Dohme (MSD) Consumer Care, Inc., of Memphis, Tennessee.
These findings are significant because poor balance and an irregular gait are directly related to fall risk. Falls are the leading cause of death from injury among seniors. Risk increases with age and even the fear of falling can reduce quality of life.
1 in 3 seniors falls each year, and 25% of those who fall suffer moderate to severe injuries, such as hip fractures.
Only 25% of hip fracture patients make a full recovery; 40% require nursing home care; and nearly 25% die within 12 months.
By 2020, the annual direct and indirect cost of fall injuries is expected to reach nearly $55 billion.
‘Although loss of sensation in the feet is a common problem among elderly people that can impair balance and gait and result in falls, there are currently no interventions available that can reverse sensory impairments and prevent these dangerous consequences,’ said study lead author Lewis Lipsitz, M.D., Director of the Institute for Aging Research. ‘We were very excited to discover that small amounts of vibratory noise applied to the soles of the feet may be able to do just that.’
This study follows earlier research that looked at how the physical principle of stochastic resonance could be applied to mitigate deficits in the human somatosensory systems that develop due to disease, injury, or age. The somatosensory system informs us about objects in our external environment through touch. Receptors are distributed all over the body and different types of receptors respond to many different kinds of stimuli. Stochastic resonance (SR) is a phenomenon whereby the detectability of weak signals in certain types of systems can be improved through the careful addition of low
Temple Study Suggests a Novel Approach for Treating Non-Cardiac Chest Pain
Chest pain doesn’t necessarily come from the heart. An estimated 200,000 Americans each year experience non-cardiac chest pain, which in addition to pain can involve painful swallowing, discomfort and anxiety. Non-cardiac chest pain can be frightening for patients and result in visits to the emergency room because the painful symptoms, while often originating in the esophagus, can mimic a heart attack. Current treatment
Children’s sleep app
The first smartphone app of its kind to help children with sleep problems and their families was launched by Professor Tanya Byron at Evelina London Children