A study offers the most in-depth assessment yet of the safety and effectiveness of a high-tech alternative to brain surgery to treat the uncontrollable shaking caused by the most common movement disorder.
The paper outlines the results of an international clinical trial, led by Jeff Elias, MD, of the UVA Health System, that evaluated the scalpel-free approach called focused ultrasound for the treatment of essential tremor (ET), a condition that afflicts an estimated 10 million Americans. Not only did the researchers determine that the procedure was safe and effective, they found that it offered a lasting benefit, reducing shaking for trial participants throughout the 12-month study period.
‘This study represents a major advance for neurosurgery, treatment of brain disease and specifically the treatment of ET,’ Elias said. ‘For the first time in a randomized controlled trial, we have shown that ultrasound can be precisely delivered through the intact human skull to treat a difficult neurological disease.’
The multi-site clinical trial included 76 participants with moderate to severe essential tremor, a condition that oft en robs people of their ability to write, feed themselves and carry out their normal daily activities. The trial participants all had tried existing medications, without success. The mean age was 71, and most had suffered with their tremor for many years.
Seventy-five percent of participants received the experimental treatment using focused ultrasound guided by magnetic resonance imaging. The remaining 25 percent underwent a sham procedure, to act as the control group. (They were later given the opportunity to undergo the real procedure.)
Participants who received the treatment showed dramatic improvement, with the beneficial effects continuing throughout the study period. The researchers employed a 32-point scale to assess tremor severity, and they found that mean tremor scores improved by 47 percent at three months and 40 percent at 12 months. Participants reported major improvements in their quality of life. People who couldn’t feed themselves soup or cereal could again do so.
Participants who received the sham procedure, on the other hand, showed no significant improvements.
‘The degree of tremor control was very good overall in the study, but the most important aspects were the significant gains in disabilities and quality of life – that’s what patients really care about,’ Elias said.
The most commonly reported side effects were gait disturbances and numbness in the hand or face; in most instances, these side effects were temporary but some were permanent.
Based on the clinical trial led by Elias, the federal Food and Drug Administration has approved the focused ultrasound device for the treatment of essential tremor.

University of Virginia Health System http://tinyurl.com/z4pv5ss

Physicians at the University of Alabama at Birmingham and colleagues have discovered that administering the antibiotic azithromycin alongside the standard recommended antibiotic regimen, cefazolin, reduces infection rates by 50 percent for women who have a non-elective caesarean delivery.

A study shows adding the dose of 500 milligrams of azithromycin during a C-section also significantly decreases the use of health care resources, including readmissions, emergency room visits and clinic visits.

‘Infection during pregnancy and during the post-pregnancy period is a major health problem for both mom and baby, and a common underlying cause of death,’ said Alan T. N. Tita, M.D., Ph.D.; professor in the UAB Division of Maternal-Fetal Medicine and the Center for Women’s Reproductive Health, and principal investigator of the study. ‘Women who have a C-section are at significantly increased risk for infection compared to those who deliver vaginally. A major national goal is to reduce the risk of infection after surgery, and this finding is the culmination of investigative work over decades.’

‘When our group first developed the idea that a second antibiotic could help reduce infections for these women, we found reassurance in the fact that some patients who have preterm premature rupture of the membranes receive two antibiotics to help reduce infection and prolong pregnancy,’ Tita said.

A clinical trial was conducted across 14 hospitals in the United States with 2,013 women who were more than 24 weeks’ gestation and undergoing a C-section during labour or after membrane rupture. A randomized group of patients received either the standard antibiotic regimen to prevent infection or a modified regimen with the additional azithromycin. Pfizer Inc. donated the azithromycin and had no other role in the study.

‘These results are extremely important, given that the maternal death rate has increased in the U.S. and there is an urgent need for therapies to decrease serious complications that can lead to maternal deaths,’ said Uma Reddy, M.D., NICHD project officer for the study.

University of Alabama www.uab.edu/medicine/news/latest/item/1259-administering-additional-antibiotic-prior-to-c-section-reduces-infection-rates-by-50-percent

New echocardiographic ultrasound methods can non-invasively evaluate deformation of the heart muscle in order to identify abnormal function in children who were operated for coarctation (narrowing) of the aorta. Surgical intervention in infants is a worldwide and often vital procedure, but new research from Umea University reveals that echocardiography post-surgery can and should be used to detect early and asymptomatic heart dysfunction.

‘Our research suggest that patients who have been operated for aortic coarctation should receive lifelong follow-up,’ says Haki Jashari, doctoral student at the Department of Public Health and Clinical Medicine.
‘It is well established that delayed intervention is associated with undesirable consequences on heart function. But our findings show that even in the absence of symptoms, disturbed heart function was still evident two years after being operated within the first month of life, irrespective of infrequent post-operative hypertension.’

According to Haki Jashari, the best method to assess the impact of aortic coarctation on heart function post-surgery is the non-invasive ultrasound method, equipped with recent echocardiographic modalities. This widely used method is radiation free, inexpensive and patient-friendly.

Coarctation of the aorta is a congenital heart disease, where the main artery coming out of the heart is narrowed just after it branches for the upper body. The narrowing results in high blood pressure in the upper body and low pressure in the lower body. Severe cases presented in the neonatal period can lead to heart failure, while mild narrowing may go unnoticed and is often first diagnosed in childhood or even later. Usually by then, the heart has already responded to the increased pressure with wall thickening. However, the recent data suggest that aortic coarctation represents a much more complicated stiffness of the vasculature rather than just a simple narrowing of the aorta.
Haki Jashari comes from Pristina, Kosovo, where he works as resident doctor in Pediatrics. He is a doctoral student in the Department of Public Health and Clinical Medicine, Umea University.

Umea University www.medfak.umu.se/english/about-the-faculty/news/newsdetailpage/ultrasound-detects-heart-dysfunction-after-successful-repair-of-aortic-narrowing.cid277460

Researchers at the University of Texas at Dallas have developed a wearable diagnostic biosensor that can detect three interconnected, diabetes-related compounds — cortisol, glucose and interleukin-6 — in perspired sweat for up to a week without loss of signal integrity. The team envisions that their wearable devices will contain a small transceiver to send data to an application installed on a cellphone.
"Type 2 diabetes affects so many people. If you have to manage and regulate this chronic problem, these markers are the levers that will help you do that," said Dr. Shalini Prasad, professor of bioengineering in the Erik Jonsson School of Engineering and Computer Science. "We believe we’ve created the first diagnostic wearable that can monitor these compounds for up to a week, which goes beyond the type of single use monitors that are on the market today."
Prasad and lead author Dr. Rujute Munje, a recent bioengineering PhD graduate, describe their wearable diagnostic biosensor that can detect three interconnected compounds — cortisol, glucose and interleukin-6 — in perspired sweat for up to a week without loss of signal integrity.
"If a person has chronic stress, their cortisol levels increase, and their resulting insulin resistance will gradually drive their glucose levels out of the normal range," said Prasad, Cecil H. and Ida Green Professor in Systems Biology Science. "At that point, one could become pre-diabetic, which can progress to type 2 diabetes, and so on. If that happens, your body is under a state of inflammation, and this inflammatory marker, interleukin-6, will indicate that your organs are starting to be affected."
Last October, Prasad and her research team confirmed they could measure glucose and cortisol in sweat. Several significant advances since then have allowed them to create a more practical, versatile tool.
"We wanted to make a product more useful than something disposable after a single use," Prasad said. "It also has to require only your ambient sweat, not a huge amount. And it’s not enough to detect just one thing. Measuring multiple molecules in a combinatorial manner and tracking them over time allows us to tell a story about your health."
One factor that facilitated their device’s progress was the use of room temperature ionic liquid (RTIL), a gel that serves to stabilize the microenvironment at the skin-cell surface so that a week’s worth of hourly readings can be taken without the performance degrading over time.
"This greatly influences the cost model for the device — you’re buying four monitors per month instead of 30; you’re looking at a year’s supply of only about 50," Prasad said. "The RTIL also allows the detector to interface well with different skin types — the texture and quality of paediatric skin versus geriatric skin have created difficulties in prior models. The RTIL’s ionic characteristics make it somewhat like applying moisturizer to skin."
Prasad’s team also determined that their biomarker measurements are reliable with a tiny amount of sweat — just 1 to 3 microliters, much less than the 25 to 50 previously believed necessary.

ScienceDaily
www.sciencedaily.com/releases/2017/06/170623131515.htm