Severe acute liver failure (ALF), a rare but life-threatening illness, is associated with high death rates if patients don’t receive timely treatment or a liver transplant. Unlike the heart or the kidneys, there is no established mechanical device to replace the liver’s function. Now, University of Maryland School of Medicine (UM SOM) researchers report that a device that removes toxins from the blood can also effectively provide a bridge to liver transplantation or buy time for a traumatically injured liver to heal, suggesting broader uses for the device than previously thought.
The researchers, present the largest series of cases in the United States in which the Molecular Adsorbent Recirculating System has been used as temporary liver replacement for ALF.
MARS can be likened to a dialysis machine for the liver. It essentially “washes” a patient’s blood with a solution containing albumin – normally produced by healthy livers – to remove toxins such as bile acids, ammonia, bilirubin, copper, iron and phenols from the blood.
“We’ve found in the use of MARS that we’re able to get trauma patients with massive liver injury to recovery and, in patients who are deemed good transplant candidates, get them to transplant with excellent survivals,” says lead researcher, Steven I. Hanish, MD, associate professor of surgery at UM SOM and a liver transplant surgeon at the University of Maryland Medical Center (UMMC).
The US Food and Drug Administration (FDA) has approved the device to clear the liver after overdoses and poisonings, and reduce the effects of brain swelling related to liver failure. However, it is not yet FDA-approved as a bridge to transplant.

University of Maryland School of Medicine http://tinyurl.com/ya32cuxm

A new paper finds that testing for cervical cancer using HPV testing in addition to the Pap smear is unlikely to detect cancer cases that wouldn’t be found using HPV testing alone.
The main goal of cervical screening programms is to detect and treat pre-cancer before cancer develops. Cytology-based screening, known as the Pap test or Pap smear, is used to detect abnormal cells. The Pap test can also find noncancerous conditions, such as infections and inflammation.
Cervical cancer screening guidelines have changed dramatically over the last 15 years, following introduction of testing for the dozen high-risk human papillomavirus (HPV) types that cause virtually all cervical cancer and its precursors. Despite more research into HPV, and the introduction of preventive HPV vaccines, screening will remain important and comprise many millions of tests annually for decades to come. But improved screening methods have also introduced some confusion, even controversy.
HPV testing is more sensitive than the Pap test for detecting pre-cancer. The HPV test captures the known cancer causing viruses, but there are gynaecologists who believe that there may be unknown cancer causing viruses and so continue to do the Pap smear (plus HPV testing).
However, reports of rare HPV-negative, Pap-test-positive cancers are motivating continued use of both tests (cotesting) despite increased testing costs. An HPV test, in which doctors test a cervicovaginal specimen for the presence of the nucleic acids of carcinogenic types of HPV, is more sensitive than the Pap test (a microscopic examination of exfoliated cells) for detection of pre-cancers. Thus, if a single screening method were chosen to complement HPV vaccination, primary HPV testing likely would gradually supplant the Pap test.
In the US, an interim guidance issued by a committee of experts from several clinical societies recommended primary HPV testing every three years, the same as the Pap test. Alternatively, current guidelines recommend cotesting but, in recognition of the additional reassurance provided by this approach compared with the Pap test alone, the screening interval is extended to every five years. Draft guidelines from the US Preventive Services Task Force recently recommended either primary HPV testing every five years or the Pap test every three years for women 30 to 64, and did not recommend cotesting.
The accumulated evidence supports inclusion of HPV testing in screening; thus, the main choice moving forward is between cotesting and primary HPV testing alone.
Researchers were searching for realistic performance data to quantify the additional benefit of the Pap test component of cotesting, as the costs of intensive screening of all women using two screening tests are substantial.
In January 2003, just prior to US FDA approval of HPV and Pap test cotesting in mid-2003 and interim guidelines in 2004, Kaiser Permanente Northern California, a large integrated healthcare organization, introduced three-year cotesting in women aged 30 years and older. Kaiser Permanente has now screened over a million women by cotesting. This remains the most extensive experience of HPV testing incorporated into routine screening in the world.
Researchers here quantified the detection of cervical precancer and cancer by cotesting compared with HPV testing alone at Kaiser Permanente, where 1,208,710 women have undergone triennial cervical cotesting since 2003. Screening histories preceding cervical cancers (n=623) and precancers (n=5,369) were examined to assess the relative contribution of the Pap test and HPV test components in identifying cases.
The analysis found that HPV testing identified more women subsequently diagnosed with cancer and precancer than the Pap test. HPV testing was statistically significantly more likely to be positive for cancer at any time point, except within 12 months. HPV-negative/ Pap test-positive results preceded only small fractions of cases of precancer (3.5%) and cancer (5.9%); these cancers were more likely to be regional or distant stage than other cases.
The researchers conclude that the added sensitivity of cotesting versus HPV alone for detection of treatable cancer affected extremely few women.
Bioengineer.orghttps://tinyurl.com/y7x5hfp2

University of Adelaide researchers have shown that it is possible for stroke patients to improve motor function using special training involving connecting brain signals with a computer.
In a “proof-of-principle” study, the researchers described how this brain-computer interface (BCI) produced a 36% improvement in motor function of a stroke-damaged hand.
The BCI measures brain electrical signal on the surface of the scalp. Every time a subject imagines performing a specific motor function, for example grasping an object, the BCI takes those electrical signals and transmits them to a computer. Then an advanced mathematical algorithm interprets the brain signals and accordingly supplies a sensory feedback via a robotic manipulator.
“In the majority of strokes, the area of the brain that sends motor commands to the muscles becomes partly damaged and thereby degrades motor functions of the affected parts,” says Dr Sam Darvishi, who completed the work during his PhD in the University of Adelaide’s School of Electrical and Electronic Engineering, under the supervision of Associate Professor Mathias Baumert and Professor Derek Abbott.
“During the early phases of motor learning (such as when we are toddlers) our brain and body learn how to work in harmony when the brain commands the target muscles and then receives feedback via seeing and feeling each body movement. After a stroke the brain needs to re-train the lost skills.
“BCIs have been proposed as an alternate therapy for stroke patients. They have shown some level of promise but, to date, haven’t been particularly effective.
“Our theory is that to achieve clinical results with BCIs we need to have the right feedback to the brain at the right time; we need to provide the same feedback that we receive during natural motor learning, when we are seeing and feeling the body’s movement. We also found there should be a short delay between the brain activation and the activation of target muscles.”
The researchers designed a specific BCI to meet these requirements. In a single case study of one patient they achieved 36% improvement in hand motor function in just 10 training sessions of 30 minutes each.
“This was only a single patient so we can’t generalise the outcome to a whole stroke population,” says Dr Darvishi.
“However it certainly shows enough promise for a larger study of stroke patients to see if this could be a feasible therapy for stroke rehabilitation.  This would be a major step towards helping stroke patients recover from debilitating damage.”

University of Adelaide
www.adelaide.edu.au/news/news94602.html

Live phone calls significantly outperform text messages and letters as a way to remind patients to complete and return at-home screening tests for colon cancer, according to new research in the Journal of General Internal Medicine.
The study included more than 2,700 patients who receive care in safety-net clinics and who were overdue for colon cancer screening. Colon cancer screening is recommended for everyone ages 50-75.
The patients were sent test kits by mail, and 10 percent mailed back their completed tests within three weeks. Those who did not return the kits within that period were assigned to one of seven reminder interventions. These included a phone call from a clinic outreach worker (live call), two automated calls, two text messages, a single reminder letter, or a combination of these strategies.
The live phone call intervention was most effective, resulting in 32 percent of patients in this group completing and returning their test kit within six months. The text message intervention was the least effective — only 17 percent of patients in this group completed and mailed back their test.
"We knew that these patients are not as text savvy as younger patients, but we didn’t expect text messaging to do so poorly, compared to the other strategies," said Gloria Coronado, PhD, lead author and cancer disparities researcher with the Kaiser Permanente Center for Health Research. "Text messaging is a relatively inexpensive way to send patient reminders, but for this group it was also relatively ineffective."
Patients received the various reminders in their preferred language. Phone calls were the most effective strategy for all patients, but English speakers were more likely to respond to the single live phone call, while Spanish speakers were more likely to respond to the combination of a live call and two automated calls.
People assigned to receive the live call and the automated calls had more contacts with the health care system. It appears that Spanish speakers appreciated this additional contact, while English speakers may have been more likely to disregard the additional automated calls, said Coronado.
"The phone calls may help to build trust or confianza, which is an important value and motivator for care-seeking among Hispanics," added Ricardo Jimenez, MD, co-author and medical director of Sea Mar Community Health Centers in Seattle, where the study took place.
"Our study shows that one reminder intervention doesn’t necessarily work for all patients. We need to design interventions tailored to the patient’s language and cultural preference," explained Coronado.
The authors believe it is the first study to rigorously test the effectiveness of reminder strategies in a safety net system among patients with different language preferences.

Eurekalert
www.eurekalert.org/pub_releases/2017-10/kp-pcw100217.php

The treatment of left main coronary artery disease by percutaneous coronary intervention is associated with a smaller risk of severe cardiovascular events than coronary artery bypass grafting in the weeks following surgery. A meta-analysis of several trials and nearly 5,000 patients revealed no differences in mortality between the two treatments. The finding is significant when it comes to selecting the form of treatment: percutaneous coronary intervention is less burdensome on the patient, as it does not require long-term hospitalization and enables rapid return to work.
The prognosis of left main coronary artery disease is worse than in any other form of coronary artery disease. The treatment options include percutaneous coronary intervention and coronary artery bypass grafting. In European and American treatment guidelines, coronary artery bypass grafting is generally regarded as the first-line treatment for severe left main coronary artery disease. However, some studies have suggested that percutaneous coronary intervention with drug-releasing stent implantation would also be a recommendable course of treatment in the severe form of the disease, but the evidence has been inconsistent.
A new study by investigators from the University of Eastern Finland and Oulu University Hospital compared percutaneous coronary intervention with drug-releasing stent implantation and coronary artery bypass grafting in the treatment of left main coronary artery disease.  The authors pooled evidence from six comparable, randomized, controlled trials involving 4,700 people.
The researchers analysed all available randomized studies among patients who had undergone percutaneous coronary intervention or coronary artery bypass grafting, comparing their risk of all-cause mortality, major adverse cardiac and cerebrovascular events, and other cardiovascular events at time points of 30 days, one year and three years after surgery. There were no differences between the treatments as regards the risk of death, or cardiac or cerebrovascular events. Percutaneous coronary intervention patients needed repetitive interventions more often over the years.
According to the researchers, the findings suggest that percutaneous coronary intervention with drug-releasing stent implantation should be more frequently considered as a treatment option for patients suffering from left main coronary artery disease. There are no differences in mortality between patients of percutaneous coronary intervention and patients undergoing coronary artery bypass grafting, and as percutaneous coronary intervention is less burdensome on the patient both from the viewpoint of quality of life and functional capacity, it is an option worth considering.
University of East Finlandhttps://tinyurl.com/y75tll7d