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

In the operating room of the future, robots will be an integral part of the surgical team, working alongside human surgeons to make surgeries safer, faster and more precise. Engineers in Michael Yip’s lab at UC San Diego are developing advanced robotic systems to help make that vision a reality.

From intelligent algorithms that can enable robots to lend a helping hand during surgery, to ‘smart’ endoscopes that can autonomously maneuver through sensitive nooks and crannies inside the body, the robotics technologies in Yip’s lab are all inspired by a common goal: to augment the capabilities of surgeons.

The goal is not to replace human surgeons, but to better assist and enable them to do much more, said Yip, a professor of electrical engineering. Human surgeons, he explained, are still needed to make decisions that can’t be left to a robot, such as what treatment is best for the patient, or how a surgical procedure should be performed.

Meanwhile, robots will be used to perform tasks that humans cannot. For example, flexible and dexterous robots armed with high-power computing and sub-millimeter precision will be able to perform minimally invasive surgery, control complex instruments and navigate through spaces in the body that a human surgeon can’t access. These robots could perform other advanced tasks, such as creating real-time 3D maps inside the body as they self-navigate, relying on a patient’s medical data and imaging information.

This vision illustrates the idea of ‘Shared Autonomy,’ the theme of the most recent UC San Diego Contextual Robotics Institute Forum held on campus during October. In an age of increasing automation, researchers in the institute, such as Yip, are focused on developing robotic systems that can interact well in a human world and benefit society.

The da Vinci Surgical System is a robotic surgical system designed to perform minimally invasive surgery. The system, developed by the company Intuitive Surgical, is remotely controlled by a surgeon from a console. The system is equipped with four robotic arms, but a surgeon is able to control only two of them at a time. Yip’s ARCLab currently has a full da Vinci Surgical System dedicated for research in shared autonomy.

Yip’s team aims to put the other two arms to work. To do this, they are creating software and hardware that will enable these arms to function autonomously. A goal is to have these robotic arms assist the primary surgeon with routine surgical tasks (suction, irrigation or pulling tissue back) that are tedious and are currently performed by additional human surgeons.

‘This would reduce the number of surgeons in the operating room, which would reduce the overall cost of the surgery,’ said Nikhil Das, an electrical engineering Ph.D. student in Yip’s lab. It would also free up surgeons who normally do these tasks to see other patients, he added.

Das develops motion planning algorithms that will enable the auxiliary arms to move without hitting obstacles, such as the surgeon-controlled manipulator arms. He is working on this project with undergraduate student Naman Gupta, who is visiting from Birla Institute of Technology and Science in Pilani, India. Gupta implements these algorithms in a simulated da Vinci system’s robotic arm and is in the process of validating his approach before moving it onto the ARCLab’s da Vinci system.

Other students in the ARCLab are incorporating haptics into the system so that surgeons operating the robotic arms can recover the textures and sensations of feeling the tissues, a critical sensation missing in current systems.

‘We’re trying to close the gap between the surgeon and the robot,’ Das said.

To reach truly small scales, the ARCLab is developing its own robotic catheters. These catheters are meter-long, millimeter-diameter flexible robots that can access the deepest parts of the body from atraumatic locations such as the leg. With 8 wires that are individually controlled by 8 different motors, Yip’s lab can shape and steer the robot catheters in more complex configurations and navigate far more effectively than surgeons could do manually.

One goal is to automate the catheter and incorporate haptic controls so that the operator can receive feedback from the motors. ‘That’s what makes our catheter different from the steerable catheters in industry,’ said Aaron Gunn, a mechanical engineering undergraduate working on this project.

University of California San Diego ucsdnews.ucsd.edu/feature/engineers_developing_advanced_robotic_systems_that_will_become_surgeons

Researchers from UT Southwestern’s Peter O’Donnell Jr. Brain Institute and Harold C. Simmons Comprehensive Cancer Center collaborated with investigators in the Advanced Imaging Research Center to identify 2HG (2-hydroxyglutarate), a metabolite that is produced in gliomas that carry IDH (isocitrate dehydrogenase) gene mutations.

Using MR spectroscopy, the team announced in 2012 that they could detect 2HG in the tumour with high sensitivity and specificity. This next-step study showed that 2HG can be useful in tracking the disease, researchers said.

‘This is the first non-invasive biomarker for brain cancer and represents a major advance for the field. Our current imaging is not nearly as precise and takes a longer time to see results,’ said senior author Dr. Maher, who holds the Theodore H. Strauss Professorship in Neuro-Oncology. ‘Within a week of starting treatment, we know whether we hit the target’. This new method will be a much more rapid way of assessing the therapy – allowing the physician to know to stop treatments that aren’t working or continue treatments that are.’

Most biomarkers are in the blood, so identifying biomarkers that can be tracked without drawing blood or obtaining a tissue biopsy is particularly valuable, said Dr. A. Dean Sherry, Director of the Advanced Imaging Research Center and Professor of Radiology at UT Southwestern, and Professor of Chemistry at UT Dallas, where he holds the Cecil H. and Ida Green Distinguished Chair in Systems Biology.

The technique also may serve as a model to develop other imaging biomarkers for the brain, and already is being used to learn more about the biology of glioma, the most common type of brain cancer.

‘In terms of research, the biomarker is a window’ into IDH-mutant glioma biology and we are using it to learn more about how the tumour grows, responds to therapy, and ultimately becomes resistant to treatment,’ said lead author Dr. Changho Choi, Professor of Radiology and with the Advanced Imaging Research Center, where the study was performed using a dedicated research MR scanner.

2HG tracking also could prove useful in diagnosing some brain tumours in which typical surgical procedures to obtain tissue samples can’t be done. That may be because the tumour isn’t accessible, such as near the brainstem, or when trying to get a sample could cause neurological damage. These patients are excluded from clinical trials because of the lack of available tumour tissue for diagnostic analyses.

‘We established in this study that 2HG levels in these tumours can be used to make a presumptive’ molecular diagnosis of an IDH mutation, based solely on imaging,’ said Dr. Choi.

UT Southwestern Medical Center www.utsouthwestern.edu/newsroom/news-releases/year-2016/oct/biomarker-tracks-tumour.html