A team of researchers have discovered a new way for early detection of a potentially deadly fungal infection in patients with suppressed immune systems such as those being treated for leukemia or who have had an organ transplant.
A multidisciplinary research group led by Allan Brasier of The University of Texas Medical Branch at Galveston.
Patients receiving leukemia chemotherapy treatments, bone marrow stem cell transplants or lung transplants are some of those at risk for serious infection by the disease-causing Aspergillus fungus, a common mould in the environment that easily becomes airborne. When inhaled, the mould colonizes the respiratory tract. In patients with immune suppression from their chemotherapy treatment, the mould invades into the bloodstream where it spreads and infects several organs including the liver, lungs and brain. People with normal immune systems are able to destroy the inhaled mould without becoming infected.
Despite close monitoring for infection and aggressive anti-fungal therapy in vulnerable people, the fatality rates are as high as 50 to 90 percent depending on a patient’s underlying disease and site of infection. While early diagnosis can improve the patient’s outcome, timely detection of the infection is difficult.
Currently, the infection is diagnosed with X-rays and tests that measure levels of fungal molecules that produce an immune reaction in a patient’s blood. These tests are not very accurate and often can lead to a wrong diagnosis.
The study describes how the team studied patients undergoing chemotherapy for leukemia, bone marrow transplants and lung transplants from several of the collaborating institutions and identified, confirmed and evaluated a new method of detecting the infectious mould in patients with leukemia. Similar people with no health conditions participated in the study as a comparison group.
The test results for the mould were different for each group of patients, so future commercial diagnostic tests using this technology should be tailored for different medical conditions commonly linked with this infection.
Brasier, director of UTMB’s Institute for Translational Sciences, said the breakthrough was ‘an example of successful collaboration that brought together experts in several different scientific fields to approach a difficult problem.’ The team’s discovery could translate to refined diagnostics, earlier treatment and improved survival for patients affected by this infection. More studies will be needed to confirm and validate this panel as a diagnostic test in independent patients.

The University of Texas Medical Branch at Galveston http://tinyurl.com/hezj57l

Researchers at UBC and the Paul Scherrer Institut (PSI) in Switzerland have created a microneedle drug monitoring system that could one day replace costly, invasive blood draws and improve patient comfort.

The new system consists of a small, thin patch that is pressed against a patient’s arm during medical treatment and measures drugs in their bloodstream painlessly without drawing any blood. The tiny needle-like projection, less than half a milimetre long, resembles a hollow cone and doesn’t pierce the skin like a standard hypodermic needle.

‘Many groups are researching microneedle technology for painless vaccines and drug delivery,’ said researcher Sahan Ranamukhaarachchi, a PhD student and Vanier scholar in UBC’s faculties of applied science and pharmaceutical sciences, who developed this technology during a research exchange at PSI. ‘Using them to painlessly monitor drugs is a newer idea.’

Microneedles are designed to puncture the outer layer of skin, which acts as a protective shield, but not the next layers of epidermis and the dermis, which house nerves, blood vessels and active immune cells.

The microneedle created by Ranamukhaarachchi and his colleagues was developed to monitor the antibiotic vancomycin, which is used to treat serious infections and is administered through an intravenous line. Patients taking the antibiotic undergo three to four blood draws per day and need to be closely monitored because vancomycin can cause life-threatening toxic side effects.

The researchers discovered that they could use the fluid found just below the outer layer of skin, instead of blood, to monitor levels of vancomycin in the bloodstream. The microneedle collects just a tiny bit of this fluid, less than a millionth of a millilitre, and a reaction occurs on the inside of the microneedle that researchers can detect using an optical sensor. This technique allows researchers to quickly and easily determine the concentration of vancomycin.

‘This is probably one of the smallest probe volumes ever recorded for a medically relevant analysis,’ said Urs Hafeli, associate professor in UBC’s faculty of pharmaceutical sciences.

‘The combination of knowhow from UBC and PSI, bringing together microneedles, microfluidics, optics and biotechnology, allowed us to create such a device capable of both collecting the fluid and performing the analysis in one device,’ said Victor Cadarso, a research scientist and Ambizione Fellow at PSI.

University of British Columbia news.ubc.ca/2016/07/25/scientists-develop-painless-and-inexpensive-microneedle-system-to-monitor-drugs/

Among patients experiencing some symptoms of depression, the use of a web-based guided self-help intervention reduced the incidence of major depressive disorder over 12 months compared with enhanced usual care, according to a study.
Major depressive disorder (MDD) is a common condition associated with substantial illness and economic costs. It is projected that MDD will be the leading cause of premature mortality and disability in high-income countries by 2030. Evidence-based treatments for MDD are not very successful in improving functional and health outcomes. Attention has increasingly been focused on the prevention of MDD.
Claudia Buntrock, M.Sc., of Leuphana University Lueneburg, Germany, and colleagues randomly assigned 406 adults with sub-threshold depression (some symptoms of depression, but no current MDD per certain criteria) to either a web-based guided self-help intervention (cognitive-behavioural and problem-solving therapy supported by an online trainer; n = 202) or a web-based psycho-education programme (n = 204). All participants had unrestricted access to usual care (visits to the primary care clinician).
Among the patients (average age, 45 years; 74 percent women), 335 (82 percent) completed the telephone follow-up at 12 months. The researchers found that 55 participants (27 percent) in the intervention group experienced MDD compared with 84 participants (41 percent) in the control group. The number needed to treat to avoid 1 new case of MDD was 6.
‘Results of the study suggest that the intervention could effectively reduce the risk of MDD onset or at least delay onset,’ the authors write. ‘Further research is needed to understand whether the effects are generalizable to both first onset of depression and depression recurrence as well as efficacy without the use of an online trainer.’

ScienceDaily http://tinyurl.com/ju4rn9j

Patients who have had a stroke in the back of the brain are at greater risk of having another within two years if blood flow to the region is diminished, according to results of a multi-centre study led by researchers at the University of Illinois at Chicago. These stroke patients are the most likely to benefit from risky intervention to unblock arteries, and they can be identified using a new MRI-based technology developed at UIC.
The vertebrobasilar region in the back of the brain is responsible for locomotion and balance. Vertebrobasilar strokes can be devastating, causing partial or total paralysis. They account for 30 percent to 40 percent of all strokes, or about 200,000 cases per year in the U.S.
Stroke patients found to have narrowing of the blood vessels in the back of the brain caused by atherosclerosis can have angioplasty, a procedure to open blocked arteries, but the procedure carries its own risks. And because blockages don’t always correlate to locally reduced blood flow – thought to be the real culprit in raising stroke risk – researchers wanted to better understand the relationship between arterial blockages, blood flow, and recurrent strokes.
‘Having a blockage present in a blood vessel doesn’t always correlate to low blood flow,’ says Dr. Sepideh Amin-Hanjani, professor of neurological surgery at the UIC College of Medicine and principal investigator on the study. ‘There can be a blockage and flow can be normal, if other nearby blood vessels are able to compensate.’
She and her colleagues wanted to try to identify which stroke patients are at highest risk for further strokes and so might benefit from angioplasty despite the risks of the procedure.
They followed 72 adult patients who had a stroke or temporary symptoms of a stroke, known as a transient ischemic attack, in the back of the brain and who also had at least 50 percent blockage of the arteries in that part of the brain. The patients were followed for an average of 22 months at five academic medical centres as they continued receiving standard care for their condition from their neurologists.
Participants were evaluated for reduced blood flow in the back of the brain using NOVA, or Noninvasive Optimal Vessel Analysis, a software program that can quantify the volume, velocity, and direction of blood flowing through any major vessel in the brain using standard MRI equipment. The NOVA software was developed at UIC by Dr. Fady Charbel, professor and head of neurological surgery, who is a co-author of the new study.
One-fourth of the study participants were found to have diminished blood flow in the back of the brain, which turned out to be a significant predictor of subsequent stroke. These patients had 12- and 24-month stroke-free survival rates of 78 percent and 70 percent, respectively, compared to 96 percent and 87 percent for patients with normal blood flow.
‘At one year, the risk for patients with low blood flow was about five times as high as risk for patients without low flow in the back of the brain,’ Hanjani said. For these patients, the benefits of angioplasty probably outweigh the risks.
‘About three-quarters of patients didn’t have low blood flow in the vertebrobasilar region – other arteries are doing the job of ensuring that proper blood flow is reaching that area – and these patients would not benefit from treatments aimed at opening the vessels, such as angioplasty – in fact, the procedure would put these patients at unnecessary risk,’ Hanjani said.

University of Illinois at Chicago http://tinyurl.com/jxl37yo

Conducted at the BioMag laboratory at the Helsinki University Hospital, a new patient study could open a new opportunity to rehabilitate patients with spinal cord damage. Dr Anastasia Shulga, a medical doctor specialising in neurology, led a study in which two patients with spinal cord injuries received a form of treatment that combined transcranial magnetic stimulation with simultaneous peripheral nerve stimulation given repeatedly for nearly six months. This was the first time that attempts were made to rehabilitate patients paralysed as a result of a spinal cord injury through long-term stimulation treatment of this type.

Both patients who participated in the study had spinal cord injuries caused by trauma. One patient was paraplegic, paralysed from the knees down, and the other was tetraplegic, with some voluntary movement of the hands but no capacity to grasp. Both patients had been injured more than two years ago and had received conventional rehabilitation treatments throughout their recovery, and continued to do so during the stimulation treatment.

After approximately six months of the stimulation treatment, the paraplegic patient could bend both ankles, and the tetraplegic could grasp an object.

‘We observed strengthened neural connections and partial restoration of movement to muscles which the patients were previously entirely unable to use,’ explains Anastasia Shulga.

The movement restored during the treatment was still present a month after the stimulation treatment had ended. One of the patients is participating in a further study in which stimulation is given more extensively and for an even longer period.

Dr. Jyrki Makela, head of the BioMag laboratory, points out that rehabilitation of patients with chronic spinal cord injuries is highly challenging, and new treatment methods are sorely needed:

‘This is a case study with two patients only, but we think the results are promising. Further study is needed to confirm whether long-term paired associative stimulation can be used in rehabilitation after spinal cord injury by itself and, possibly, in combination with other therapeutic strategies.’

Helsinki University www.helsinki.fi/en/news/repeated-stimulation-treatment-can-restore-movement-to-paralysed-muscles