A new study from the Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, shows lesions, which can best be seen on MRI scans, could help identify individuals who are more likely to suffer from more rapidly progressing osteoarthritis.
The SEKOIA study, a major international osteoarthritis disease-modifying trial, carried out MRI scanning on the knees of 176 men and women over 50 years old. They were then followed up for an average of three years with repeated knee X-rays. Individuals with abnormalities on their MRI scans at the first appointment were compared to those without to examine the effect on disease progression.
Individuals with bone marrow lesions (BMLs) on their MRI scan were found to have osteoarthritis that progressed more rapidly than those that did not. On average, the space within the joint is lost at a rate of 0.15mm per year however the Southampton study shows that, overall, individuals with BMLs had a loss rate that was 0.10mm per year faster than those without BMLs. This may lead to earlier need for joint replacement or other intervention.
BMLs show up on MRI as regions of bone beneath the cartilage with ill-defined high signal and represent areas of bone marrow edema, fibrosis, and necrosis. The Southampton researchers believe that therapies to target these abnormalities may slow the progression of this disabling joint disease, but further work is required to examine this.

University of Southampton http://tinyurl.com/zgoujax

A study that used fake patients to assess the performance of direct-to-consumer teledermatology websites suggests that incorrect diagnoses were made, treatment recommendations sometimes contradicted guidelines, and prescriptions frequently lacked disclosure about possible adverse effects and pregnancy risks, according to an article.
In the US, direct-to-consumer teledermatology (DTC) is rapidly expanding and large DTC services are contracting with major health plans to provide telecare. However, relatively little is known about the quality of these services.
Jack S. Resneck, Jr., M.D., of the University of California, San Francisco, and co-authors used study personnel posing as patients to submit six dermatologic cases with photographs, including neoplastic, inflammatory and infectious conditions, to regional and national DTC telemedicine websites and smartphone apps offering services to California residents. The photographs were mostly obtained from publicly available online image search engines. Study patients claimed to be uninsured and paid fees using Visa gift debit cards; no study personnel provided any false government-issued identification cards or numbers.
The authors received responses from 16 DTC websites for 62 clinical encounters over about a month from February to March 2016.
The authors report:
None of the websites asked for identification or raised concern about pseudonym use or falsified photographs.
During 68 percent of encounters, patients were assigned a clinician without any choice; 26 percent disclosed information about clinician licensure; and some used internationally based physicians without California licenses; 23 percent collected the name of an existing primary care physician and 10 percent offered to send records.
A diagnosis or a likely diagnosis was given in 77 percent of cases; prescriptions were ordered in 65 percent of these cases; and relevant adverse effects or pregnancy risks were disclosed in a minority of those.
The websites made several correct diagnoses in cases where photographs alone were adequate but when additional history was needed they often failed to ask simple, relevant questions.
Major diagnoses were missed including secondary syphilis, eczema herpeticum, gram-negative folliculitis and polycystic ovarian syndrome.
Treatments prescribed were sometimes at odds with guidelines.
A significant limitation to this study is that the authors were unable to assess whether clinicians seeing these patients in traditional in-person encounters would have performed any better.
The authors offer a series of recommended practices for DTC telemedicine websites, including obtaining proof of patient identity, collecting relevant medical history, seeking laboratory tests when an in-person physician would have relied on that information, having relationships with local physicians in all the areas where they treat patients, and creating quality assurance programmes.

JAMAhttp://tinyurl.com/hctx7t5

The hormone oestrogen helps protect memory and promote a healthy brain, but this effect wanes as women age, and even estrogen replacement therapy stops working in humans after age 65. Now researchers at University of Florida Health have used gene therapy in a rat model to show that the expression of a particular receptor can reinstate lost memory function.
The scientists included Thomas C. Foster, Ph.D., a professor of neuroscience and the Evelyn F. McKnight chair for research on cognitive aging, and Linda A. Bean, Ph.D.
‘There is a window of time, starting around menopause, when initiation of hormone replacement therapy with estrogen protects the brain against injury and Alzheimer’s disease. However, this window seems to end around age 65,’ Foster said. ‘We wanted to find out what is regulating this window.’
The researchers used gene therapy to overexpress two different estrogen receptors found in the hippocampus, a part of the brain essential to memory regulation. They found that an abundance of one of these receptors, called alpha, reinstated memory in aging rats when paired with estrogen.
Estrogen helps to do this by increasing the brain’s ‘plasticity,’ which is the ability to form and maintain connections between brain cells as things are learned. As plasticity declines, so do the number of connections in the brain, and certain types of memories begin to fade. Without the protective effect of estrogen, women may lose brain plasticity and start forgetting things more often. The loss of estrogen’s protective effects may explain why women are more likely than men to develop dysfunctional memory problems such as Alzheimer’s disease.
The researchers looked at the effects on memory in six groups, which received gene therapy for expression of the alpha receptor, the beta receptor or a control gene. The three different gene therapy groups then received estrogen or a placebo for the next several weeks, until memory testing and examination of brain plasticity. The project involved 72 animals. Only the group with gene therapy for the alpha receptor plus estrogen showed any beneficial effects on memory and increased brain plasticity markers.
‘In the short term, this finding helps us understand how estrogen rescues memory and keeps the brain young and plastic,’ Foster said. ‘In the long term, this finding may eventually allow us to bypass estrogen and target the receptor or brain plasticity mechanisms directly.’

University of Florida Health http://tinyurl.com/qbkrmz9

A new study shows that using a transparent air-tight helmet instead of a face mask helps critically ill patients breathe better and can prevent them from needing a ventilator. Patients with helmet ventilation also spent less time in the intensive care unit and had better survival.
The study followed 83 patients suffering from acute respiratory distress syndrome (ARDS), a severe, often lethal, injury to the lungs. ARDS causes fluid to accumulate in the lungs’ microscopic air sacs. It can lead to partial collapse of the lungs, dangerously low blood-oxygen levels and death.
The subjects in this study all required mechanical breathing assistance. They were randomly assigned to receive some form of non-invasive ventilation, using either a standard mask, strapped onto the face and covering the nose, mouth and chin; or the helmet, which surrounds the patient’s entire head and is sealed with a soft air-tight collar that wraps around the patient’s neck.
A primary goal of non-invasive ventilation is to prevent intubation, placement of a tube through the mouth or nose into the trachea to pump air into the lungs. Complications of endotracheal intubation are common. They include pneumonia, the need for strong sedatives, and delirium.
‘In this group of critically ill patients, the helmet made a substantial difference,’ said pulmonologist John P. Kress, MD, professor of medicine at the University of Chicago and senior author of the study. ‘The University’s data and safety monitoring board recommended that we stop the trial early because the helmet consistently demonstrated multiple advantages, particularly the reduced need to intubate patients and longer-term reduction in mortality.’
‘After reviewing our data,’ he added, ‘the board felt that it would be difficult to justify enrolling more patients in the face-mask arm of the trial, which exposed them to greater risks.’
The helmet ‘confers several advantages over the face mask,’ the authors wrote. It is less likely to leak. This enables the care team to increase air pressure into the helmet, which helps keep the airway and lungs open and improves oxygen levels. It is also more comfortable, easier to tolerate because it doesn’t touch the face, and patients can see through it well enough to watch television, talk or read.
Patients who required the face mask for oxygenation for at least 8 hours were eligible to enroll in the study. Forty-four of the 83 patients who qualified to participate were then randomly assigned to the helmet group. The other 39 were assigned to the face-mask group.
All patients were severely ill with a 50 percent risk of requiring intubation or dying in the intensive care unit. About half of the patients had weakened immune systems from cancer or transplantation.
Patients in the helmet group, however, were three times less likely to require intubation, the study’s primary endpoint. Only 18.2 percent of those wearing a helmet required an endotracheal tube, versus 61.5 percent of those wearing a face mask. The helmet group had, on average, more ventilator-free days (28 vs 12.5).
Helmet patients were also more likely to survive. When compared at 90 days, 34 percent (15 patients) in the helmet group had died, compared to 56 percent (22 patients) in the face mask group.
Adverse trial-related events were minor. They included 3 skin ulcers for each group.
‘The helmet interface has unique advantages and disadvantages,’ wrote Jeremy Beitler, MD, MPH, of the University of California, San Diego, in an accompanying editorial. ‘Careful selection of patients is important.’ This approach, he wrote, ‘warrants testing in a multi-centre trial.’
‘These findings build on a shifting paradigm where less is more in the care of critically ill patients,’ said Bhakti Patel, MD, clinical instructor of medicine at the University and first author of the study. ‘We have chosen less sedation for more mental animation; less bed rest for more physical activity; and now we’re choosing less intubations for more non-invasive ventilation.’

University of Chicago http://tinyurl.com/hqt2bnv

Samsung Medison, an affiliate of Samsung Electronics, announced that its latest imaging technology Crystal Vue’ has been featured on the front cover of Ultrasound in Obstetrics & Gynecology (UOG), a renowned academic journal in the women’s healthcare industry and the official journal published by the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG).
The March edition of the UOG featured a clinical case study by Dr. Christoph Lees, professor at the Department of Surgery & Cancer within the Faculty of Medicine at Imperial College in London. Using Samsung’s premium diagnostic ultrasound system WS80A, Professor Lees introduced two cases of prenatal imaging through Crystal Vue, of which the rib & vertebral images were selected as the Picture of the Month by UOG.
‘Our experience with Crystal Vue over the past few months, specifically imaging of the bone and soft tissue interface, leads us to believe that it may offer new opportunities for prenatal imaging, particularly for the skeletal system, but also in facial and brain imaging,’ Professor Lees stated in his study. ‘We were able to obtain highly detailed images that give particular information on the contour of the ribs and allow inference on mineralization.’
Crystal Vue is an advanced 3D volume rendering technology that enables users to assess detailed information of internal and external structures of the fetus or uterus and helps easily differentiate between the soft tissue and bone. With the additional morphological information, users may deepen their understanding of the patients and fetus.
Crystal Vue was first introduced at the 25th World Congress on Ultrasound in Obstetrics and Gynecology, held in Canada in October 2015, as the latest imaging function of the WS80A. The WS80A with Crystal Vue is currently available globally.
‘We are thrilled that Samsung’s latest technology was recognized in a leading academic journal as a new diagnostic imaging that can provide more clinical values in women’s health,’ said Dongsoo Jun, President of Health & Medical Equipment Business at Samsung Electronics and CEO of Samsung Medison. ‘With Samsung’s leading display and software technology, we will continue to develop new features that can increase diagnosis confidence and contribute to women and fetal health.’

www.samsung.com