Epilepsy affects more than 65 million people worldwide. One-third of these patients have seizures that are not controlled by medications. In addition, one-third have brain lesions, the hallmark of the disease, which cannot be located by conventional imaging methods. Researchers at the Perelman School of Medicine at the University of Pennsylvania have piloted a new method using advanced non-invasive neuroimaging to recognize the neurotransmitter glutamate, thought to be the culprit in the most common form of medication-resistant epilepsy.
Glutamate is an amino acid which transmits signals from neuron to neuron, telling them when to fire. Glutamate normally docks with the neuron, gives it the signal to fire and is swiftly cleared. In patients with epilepsy, stroke and possibly ALS, the glutamate is not cleared, leaving the neuron overwhelmed with messages and in a toxic state of prolonged excitation.
In localization-related epilepsy, the most common form of medication-resistant epilepsy, seizures are generated in a focused section of the brain; in 65 percent of patients, this occurs in the temporal lobe. Removal of the seizure-generating region of the temporal lobe, guided by preoperative MRI, can offer a cure. However, a third of these patients have no identified abnormality on conventional imaging studies and, therefore, more limited surgical options.
‘Identification of the brain region generating seizures in location-related epilepsy is associated with significantly increased chance of seizure freedom after surgery,’ said the new study’s lead author, Kathryn Davis, MD, MSTR, an assistant professor of Neurology at Penn. ‘The aim of the study was to investigate whether a novel imaging method, developed at Penn, could use glutamate to localize and identify the epileptic lesions and map epileptic networks in these most challenging patients.’
‘We theorized that if we could develop a technique which allows us to track the path of and make non-invasive measurements of glutamate in the brain, we would be able to better identify the brain lesions and epileptic foci that current methods miss,’ said senior author Ravinder Reddy, PhD, a professor of Radiology and director of Penn’s Center for Magnetic Resonance and Optical Imaging.
Reddy’s lab developed the glutamate chemical exchange saturation transfer (GluCEST) imaging method, a very high resolution magnetic resonance imaging contrast method not available before now, to measure how much glutamate was in different regions of the brain including the hippocampi, two structures within the left and right temporal lobes responsible for short- and long-term memory and spatial navigation and the most frequent seizure onset region in adult epilepsy patients.
The study tested four patients with medication-resistant epilepsy and 11 controls. In all four patients, concentrations of glutamate were found to be higher in one of the hippocampi, and confirmatory methods (electroencephalography and magnetic resonance spectra) verified independently that the hippocampus with the elevated glutamate was located in the same hemisphere as the epileptic focus/lesion. Consistent lateralization to one side was not seen in the control group.

Penn Medicinehttp://tinyurl.com/jrbr5se

Two simple interventions — sterile tubing change in combination with hub scrub compliance — can significantly reduce the rates of central line-associated bloodstream infection (CLABSI) in children’s hospital neonatal intensive care units (NICUs), according to a multi-centre improvement collaborative.
“The practices we identified that are associated with lower central line infections should be considered by clinicians in efforts to decrease central line infection rates,” said Dr. Anthony J. Piazza, from Emory School of Medicine, Atlanta, Georgia. “These central line care practices can be incorporated into daily patient care. Lowering central line infections can decrease health care costs and may be associated with fewer deaths, shorter hospital stays, and improved developmental outcomes.”
Dr. Piazza and colleagues from 17 centres participating in the Standardizing Line Care Under Guideline (SLUG Bug) collaborative used orchestrated testing to identify infection practices that contribute to reductions in infection rates.
The collaborative CLABSI rate decreased from a baseline rate of 1.333 to 1.076 per 1000 line-days, a 19.28% reduction, according to the study.
Among the 14 centres that had decreased CLABSI rates during the study period, sterile tubing changes decreased rates by an average of 0.51 and the addition of hub scrub compliance monitoring decreased rates by an average of 1.25 per 1000 line-days.
“We are excited to have identified specific infection prevention practices that helped achieve very low rates of infection,” Dr. Piazza said. “We are hopeful these findings can spread to other areas of the hospital that are still working on lowering infection rates.”

Medscapehttp://tinyurl.com/hpbnysc

Combining optical coherence tomography (OCT) with another advanced imaging technology may more accurately identify coronary artery plaques that are most likely to rupture and cause a heart attack. In a report, investigators from the Wellman Center for Photomedicine at Massachusetts General Hospital (MGH) describe the first use in patients of a catheter-based device utilizing both OCT and near-infrared autofluorescence (NIRAF) imaging.

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

Head and neck cancer patients may no longer have to undergo invasive post-treatment surgery to remove remaining cancer cells, as research shows that innovative scanning-led surveillance can help identify the need for, and guidance of, neck dissection.

The study from the Universities of Birmingham and Warwick and University Hospitals Coventry and Warwickshire used advanced imaging to identify cancer cells still present after treatment of head and neck cancer with primary chemoradiotherapy.

Previous guidelines meant that all head and neck cancer patients have to undergo neck dissection surgery, a three-hour operation with considerable morbidity and up to a one week hospital stay, because there was no reliable way to identify which patients still had remaining cancer cells.

The use of positron emission tomography