A baby’s skull is made of several plates of bone that fuse together over time to form a single structure. Previous research has shown that approximately one in 2,000 babies have plates that fuse too early – a condition called craniosynostosis – causing cranial deformities that can lead to learning impairments and other neurodevelopmental problems. Craniofacial surgeons across the country differ on when surgical intervention is needed for some abnormalities. Now, researchers at the University of Missouri School of Medicine are recommending a new method to help determine when surgery is needed.

‘Children with a condition known as metopic craniosynostosis develop a vertical ridge in their foreheads due to a premature fusing of the cranium’s frontal bones,’ said Arshad Muzaffar, MD, professor in the Division of Plastic Surgery at the MU School of Medicine and senior author of the study. ‘This can create increased pressure on the brain that can lead to neurodevelopmental disorders and learning problems. However, depending on the severity of the skull abnormality, recommendations on when to surgically intervene vary among craniofacial surgeons. At MU, we take a multidisciplinary approach that incorporates a measurement known as cephalic width-intercoronal distance ratio.”

The study included 104 infants diagnosed with metopic craniosynostosis and who received CT scans at MU between 2006 and 2012. The children were divided into two groups: those who were recommended for surgery and those who were recommended for close observation. The babies’ skull development was evaluated using five existing standard cranial measurements.

In addition to these standard measurements, the researchers evaluated the cephalic width-intercoronal distance ratio, which indicates how narrow the front of the skull is compared to the back. When the ratio is above a certain value, the measurement shows a potential need for surgery. The measurement can be performed at no additional cost to the patient.

Muzaffar cautioned, however, that the ratio should not be the only factor when making a decision about surgery. Instead, it should be used as one component of a suite of data gathered from a comprehensive, multidisciplinary evaluation which, when taken together, helps the team make recommendations regarding the need for surgical treatment.

‘While it may not be a suitable measurement for all craniosynostosis patients, in certain cases in which the premature fusion of the frontal bones is not as pronounced, surgeons can benefit by adding the cephalic width-intercoronal distance ratio to their evaluation,’ said Muzaffar, who also serves as the director of craniofacial and pediatric plastic surgery at MU. ‘We feel this is another tool to help treatment centers around the country make surgical decisions in cases that do not present a clear course of action. It is a quick, easy-to-perform objective measurement that provides extra insight to ensure patients receive care at the most appropriate time.’

University of Missouri School of Medicine medicine.missouri.edu/news/20160926-measurement-helps-craniofacial-surgeons.php

New light-based technologies that facilitate a ‘look inside’ the human body using light – and without cutting into the tissue – promise to enable both compact, wearable devices for point-of-care diagnostics as well as powerful new systems that provide even more information and from even deeper under the skin.
Recent work and visionary future directions are detailed in a new open-access article by Antonio Pifferi and colleagues at the Politecnico di Milano and Istituto di Fotonica e Nanotechnologie CNR .
The article is part of a special section on Clinical Near-Infrared Spectroscopy and Imaging under Guest Editors Marco Ferrari (Universita degli Studi dell Aquila), Joseph Culver (Washington University School of Medicine in St. Louis), Yoko Hoshi (Hamamatsu University School of Medicine), and Heidrun Wabnitz (Physikalisch-Technische Bundesanstalt).
The desirability of noninvasively probing human tissues and their functions has sparked new physical concepts, theoretical models, instruments, measurement approaches, and applications, note the authors in ‘New frontiers in time-domain diffuse optics.’
We are at the dawn of the next generation of time-domain systems, with a breakthrough in performance, size, cost, and flexibility that has the potential for great impact on new and widespread applications, the authors assert. This breakthrough is enabled by impressive advancements in single-photon detection boosted by high-energy physics and positron-emission tomography systems.
In diffuse optical imaging, light is injected into the surface of a medium, such as the body. The light signal is re-emitted elsewhere on the surface and analysed as to how it has changed. The analysis yields information about the chemical composition of the tissues, their densities, and other aspects.
The simplest methods compare continuous-wave properties of the original signal and the re-emitted light.
Systems that also analyse frequency or time changes in the light signal provide additional data. Current state-of-the-art methods use technologies that enable time-to-digital conversion of the signal, providing even more detail.
Wearable time-domain devices already have been developed for continuous-wave systems, enabling studies in breast cancer detection, brain mapping, muscle monitoring, and non-invasive assessment of lipids, bone, and collagen. Time-domain techniques have also been used in non-destructive characterization of food, wood, pharmaceuticals, and semiconductor powers.
Over the next 20 years researchers envision that such systems will become smaller, making feasible their integration into wearable devices, and smarter, increasing their overall accuracy in detecting and identifying tissue components.
Future devices could be used in brain monitors or muscle oximeters, even for in vivo detection of the brain function during motor or cognitive tasks.
‘What makes the future technology unique is its potential to probe noninvasively and in greater depth into human functions and chemical composition, yet with simple personal appliances usable at home and compatible with normal life,’ Pifferi said. Currently unreachable organs and functions would be accessible, including the heart.
Quite surprisingly, Pifferi noted, after the thermometer and the blood pressure meter, not many other diagnostic devices for personal healthcare have been brought into the home.
‘The new smart sensors, interacting in the ambient environment and transmitting hidden internal information over the cloud, will populate the Internet of Things to the benefit of clinical, industrial, and consumer-level applications,’ he said.

SPIE http://tinyurl.com/j3v43kn

Researchers at the University of Adelaide are urging doctors and patients to refrain from using a specific steroid treatment to treat infertility in women unless clinically indicated, because of its links to miscarriage, preterm birth and birth defects.

Researchers from the University’s Robinson Research Institute, led by Professor Sarah Robertson, say widespread use of the drug is not warranted, given there is a high degree of suspicion that corticosteroid drugs – such as prednisolone – can interfere with embryo implantation, and may have harmful effects on pregnancy and the child.

Corticosteroids are increasingly used to treat infertility in women with repeated IVF failure and recurrent miscarriage. Many women receive the drug in the belief that reducing immune cells called ‘natural killer’ cells will facilitate a pregnancy. However, this belief is mistaken, as despite their alarming name these cells are actually required for healthy pregnancy.

Professor Robertson says there is a great deal of medical and consumer misunderstanding about the role of the immune system in fertility and healthy pregnancy.

‘Steroid drugs such as prednisolone act as immune suppressants, preventing the body’s immune system from responding to pregnancy. But by suppressing the natural immune response, these drugs may lead to further complications,’ Professor Robertson says.

‘The immune system plays a critical role in reproduction and fertility. Natural killer cells and other immune cells help to build a robust placenta to support healthy fetal growth. But if we suppress or bypass the body’s natural biology, there can be dire consequences that don’t appear until later,’ she says.

‘For example, suppression of the immune system through inappropriate use of these drugs is linked to impaired placental development, which in turn elevates the risk of miscarriage, preterm birth and birth defects.’

Research shows that women taking corticosteroids over the first trimester of pregnancy have a 64percent increase in miscarriage; the risk of preterm birth is more than doubled; and their children have an elevated risk of birth defects, including a 3-4 times greater risk of cleft palate.

‘Our main message to clinicians and to women hoping to achieve pregnancy is that they should be focused on achieving good-quality pregnancy and the life-time health of the child, not just getting pregnant,’ Professor Robertson says.

‘Corticosteroids such as prednisolone may impair healthy pregnancy, which may lead to poorer long-term outcomes for the baby.

‘We believe IVF doctors should not be offering this treatment to most patients, and should discuss concerns with women who request it.

‘The exception would be in specific cases where the patient has a diagnosed autoimmune condition, but those cases are rare,’ she says.

University of Adelaide www.adelaide.edu.au/news/news87602.html

Scientists at The Scripps Research Institute (TSRI) have developed a vaccine that blocks the pain-numbing effects of the opioid drugs oxycodone (oxy) and hydrocodone (hydro) in animal models. The vaccine also appears to decrease the risk of fatal opioid overdose, a growing cause of death in the United States.

‘We saw both blunting of the drug’s effects and, remarkably, prevention of drug lethality,’ said Kim D. Janda, the Ely R. Callaway Jr. Professor of Chemistry and member of the Skaggs Institute for Chemical Biology at TSRI. ‘The protection against overdose death was unforeseen but clearly of enormous potential clinical benefit.’

The new oxy/hydro vaccine takes advantage of the immune system’s ability to recognize, seek out and neutralize invaders.

Opioids were designed to reach receptors in the brain, causing pain reduction and feelings of euphoria. For their vaccine, the researchers combined a signature opioid structure with a molecule to trigger an immune response. When injected, the vaccine teaches the immune system to bind to the drug molecule and remove it from circulation.

The vaccine-derived antibodies were tailored by TSRI scientists to seek out the prescription drug and block the opioid from reaching the brain, potentially depriving a person of the ‘reward’ of consuming the drug, Janda explained.

The scientists believe a vaccine approach could have an advantage over current opioid addiction therapies because it would not alter brain chemistry like many of today’s anti-addiction therapies do.

‘The vaccine approach stops the drug before it even gets to the brain,’ said study co-author Cody J. Wenthur, a research associate in the Janda laboratory. ‘It’s like a pre-emptive strike.’

The researchers found that their vaccine design blocked pain perception of oxy/hydro use in mice. Indeed, those given the vaccine did not display the usual symptoms of a drug high, such as ignoring pain and discomfort.

In further tests, the rodents also appeared less susceptible to fatal overdose. Although it was found that some vaccinated mice did succumb to the opioid drug’s toxic effects, the researchers noted that it took much longer for the drug to impart its toxicity. If this effect holds true in humans, the vaccine could extend the window of time for clinical assistance if overdose occurs.

The scientists also discovered that the vaccine remained effective in mice for the entire 60-day study period, and they believe it has the potential to last even longer.

This oxy/hydro vaccine is not the first ever tested, but it is the first to use a faithful representation of the opioid in its design, which prompts the remarkable efficacy seen with the TSRI vaccine. ‘Our goal was to create a vaccine that mirrored the drug’s natural structure. Clearly this tactic provided a broadly useful opioid deterrent,’ said study first author Atsushi Kimishima, a research associate in the Janda laboratory.

The study did raise some new questions. For example, researchers found that once antibodies bound to the drug, the drug stayed in the body-though neutralized-for a long time. The next steps will be to investigate this phenomenon and further study the optimal vaccine dose and injection schedule. The scientists also stated it may be possible to make the vaccine even more effective.

Scripps Research Institute www.scripps.edu/news/press/2016/20161123janda.html