Simultaneous injections of the radiopharmaceuticals fluorine-18 fluorodeoxyglucose (18F-FDG) and 18F-sodium fluoride (18F-NaF) followed by quantitative scanning significantly improves image quality and detection of bone metastases at a lower dose, according to research presented at the 2017 Annual Meeting of the Society of Nuclear Medicine and Molecular Imaging (SNMMI).
“For certain patients with breast and prostate cancer who require evaluation of metastatic disease, a single PET/MR exam can provide more accurate information with less radiation dose in one procedure that is more convenient for patients and potentially less costly for the healthcare system,” said Andrei Iagaru, MD, associate professor of radiology and division chief, Nuclear Medicine and Molecular Imaging, Stanford University School of Medicine in Stanford, Calif.  
Dual-agent PET/MR is further supported by time of flight, a quantitative feature of modern PET image reconstruction that approximates the position where photons are created as radioactive agents decay, which translates into finer image quality.
For this study, researchers prospectively enrolled 55 cancer patients—39 men with prostate cancer and 17 women with breast cancer, ages 34 to 85, in line for conventional bone scan to determine the spread of their disease. All participants were administered simultaneous injections of the imaging agent 18F NaF for the evaluation of bone turnover and FDG for increased metabolic activity and/or inflammation.
After injection, scientists performed PET/ MRI scans with time of flight capability and compared the results with conventional technetium 99m-methyl diphosphonate (99mTc MDP) bone scintigraphy. Results of the study showed improved detection of prostate and breast cancer that had metastasized to bone. Dual-agent PET/MR pointed to bone metastases in 22 patients who were also found positive for metastases with conventional bone scan. In addition, PET/MR detected more bone metastases in 14 patients when compared to the conventional bone scan, which caught only one lesion that was not detected by PET/MR.
Researchers concluded that PET/MR found a greater extent of metastases and, as an added benefit, significantly reduced the required radiation dose from the injected agents—80 percent less from 18F-NaF and 67 percent less from 18F-FDG.

Society of Nuclear Medicine and Molecular Imaging www.snmmi.org/NewsPublications/NewsDetail.aspx?ItemNumber=24410

In the last decade, mounting evidence has linked seizure-like activity in the brain to some of the cognitive decline seen in patients with Alzheimer’s disease. Patients with Alzheimer’s disease have an increased risk of epilepsy and nearly half may experience subclinical epileptic activity – disrupted electrical activity in the brain that doesn’t result in a seizure but which can be measured by electroencephalogram (EEG) or other brain scan technology.
In a recent feasibility study, clinician-scientists at Beth Israel Deaconess Medical Center (BIDMC) tested an anti-epileptic drug for its potential impact on the brain activity of patients with mild Alzheimer’s disease. The team, led by Daniel Z. Press, MD, of the Berenson-Allen Center for Non-invasive Brain Stimulation at BIDMC, documented changes in patients’ EEGs that suggest the drug could have a beneficial effect.
“In the field of Alzheimer’s disease research, there has been a major search for drugs to slow its progression,” said Press, an Instructor of Neurology in the Cognitive Neurology Unit at BIDMC and an Associate Professor of Neurology at Harvard Medical School. “If this abnormal electrical activity is leading to more damage, then suppressing it could potentially slow the progression of the disease.”
In this double-blind within-subject study, a small group of patients with mild Alzheimer’s disease visited BIDMC three times. At each visit, patients were given a baseline (EEG) to measure the electrical activity in the brain. Next, patients were given injections containing either inactive placebo or the anti-seizure drug levetiracetam, at either a low dose (2.5 mg/kg) or a higher dose (7.5 mg/kg). Neither patients nor medical professionals knew which injections patients were receiving, but each patient eventually got one of each type, in a random order.
After receiving the injection, patients underwent another EEG, then magnetic resonance imaging (MRI) – which measures blood flow in the brain, another way to quantify brain activity and determine where in the brain it is taking place. Finally, patients took a standardized cognitive test, designed to measure memory, executive functioning, naming, visuospatial ability and semantic function – capabilities all affected by Alzheimer’s disease.
In the seven patients able to complete the study protocol successfully, Press and colleagues analysed changes in their EEGs. (Blood flow analysis from the MRI data is still underway.) Overall, higher doses of the anti-seizure drug appeared to normalize abnormalities seen in the patients’ EEG profiles. That is, researchers saw overall increases in brain wave frequencies that had been abnormally low in Alzheimer’s disease patients prior to receiving the higher dose of levetiracetam, and, likewise, saw decreases in those that had been abnormally high.
“It’s worth noting, we did not demonstrate any improvement in cognitive function after a single dose of medication in this study,” said Press. “It’s too early to use the drug widely, but we’re preparing for a larger, longer study.”

Beth Israel Deaconess Medical Center
www.bidmc.org/News/PRLandingPage/2017/June/Press-Anti-Epilepsy-Alzheimers.aspx

Patients with hypertrophic cardiomyopathy are urged to take it easy. But new research shows they might benefit from moderate aerobic exercise.
Exercise for cardiovascular disease patients.
As one of the most common causes of sudden cardiac death in young people, hypertrophic cardiomyopathy can push patients into sedentary lifestyles.

Current guidelines recommend people with HCM, the most common genetic cardiovascular disease, limit intense exercise because of concerns over triggering ventricular arrhythmias. But new Michigan Medicine research finds there may be reason to re-evaluate the guidelines.

‘We are challenging the idea that exercise is dangerous for these patients,’ says senior author Sharlene Day, M.D., a Michigan Medicine cardiologist and associate professor. ‘And we show that it can actually be beneficial.’

University of Michigan researchers collaborated with colleagues at Stanford University and the VA Palo Alto Health Care System for the study, released in JAMA and presented as a late-breaking clinical trial at the American College of Cardiology’s annual Scientific Session.

The preliminary study announced a small but statistically significant increase in exercise capacity in HCM patients who underwent moderate-intensity exercise training.

The general population is encouraged to stay active to maintain good health and reduce the risk of cardiovascular events. Yet because of the risk of sudden cardiac death, people with HCM are told not to participate in competitive sports.

But there isn’t a global consensus on whether it’s safe for those with HCM to participate in recreational activities, such as jogging. Surveys have revealed most patients with HCM reduce their activity levels after diagnosis, becoming less active than the general population.

First author Sara Saberi, M.D., says providers need data to guide their recommendations so they don’t become coloured by emotion.

‘We have those images entrenched in our brains of young, healthy athletes collapsing suddenly in the middle of a competition, and these devastating events trigger a visceral response,’ says Saberi, a Michigan Medicine cardiologist and assistant professor. ‘But by limiting exercise, we’re creating another set of health problems that stem from obesity, like coronary heart disease, diabetes, obstructive sleep apnoea, depression and anxiety.’

Saberi’s team studied 136 patients with HCM between ages 18 and 80. For 16 weeks, members of one group were told to continue with their usual level of physical activity while the other group members were given individualized exercise plans the researchers created.

The exercises were moderate, including walking, using an elliptical machine, jogging or biking, and excluding intervals or weight training. The participants began week one working out at least three times each week for 20 minutes. By the end of the program, they were working out four to seven times per week for up to an hour.

The exercise group participants experienced a small but statistically significant increase in peak VO2 max, a measure of exercise capability, after the 16 weeks. Reduced peak VO2 is common in HCM patients, and it correlates with mortality in HCM.

‘The findings show patients that follow an exercise prescription can actually train and improve their functional capacity,’ Saberi says.

In this preliminary study, neither group experienced any major adverse effects, such as death, appropriate shocks from an implantable cardioverter-defibrillator or sustained ventricular tachycardia.

Of note, there was also a statistically significant improvement in self-reported physical functioning in the exercise group compared with the usual-activity group.

‘The findings show patients that follow an exercise prescription can actually train and improve their functional capacity.’

Michigan Medicine labblog.uofmhealth.org/lab-report/moderate-exercise-may-be-beneficial-for-hcm-patients

The biocompatible near-infrared 3D tracking system used to guide the suturing in the first smart tissue autonomous robot (STAR) surgery has the potential to improve manual and robot-assisted surgery and interventions through unobstructed 3D visibility and enhanced accuracy, according to a study. The study successfully demonstrates feasibility in live subjects (in-vivo) and demonstrates 3D tracking of tissue and surgical tools with millimeter accuracy in ex-vivo tests. More accurate and consistent suturing helps reduce leakage, which can improve surgical outcomes.

Authored by the development team from Sheikh Zayed Institute for Pediatric Surgical Innovation at Children’s National Health System and funded by the National Institutes of Health, the study explains the design of the 3D tracking system with near-infrared fluorescent (NIRF) markers and, using robotic experiments, compares its tracking accuracies against standard optical tracking methods. At speeds of 1 mm/second, the team observed tracking accuracies of 1.61 mm that degraded only to 1.71 mm when the markers were covered in blood and tissue.

‘A fundamental challenge in soft-tissue surgery is that target tissue moves and deforms, becomes occluded by blood or other tissue, which makes it difficult to differentiate from surrounding tissue,’ says Axel Krieger, Ph.D., senior author on the study and program lead for Smart Tools at the Sheikh Zayed Institute. ‘By enabling accurate tracking of tools and tissue in the surgical environment, this innovative work has the potential to improve many applications for manual and robot-assisted surgery.’

The system is made up of small biocompatible NIRF markers with a novel fused plenoptic and near-infrared (NIR) camera tracking system, enabling 3D tracking that can overcome blood and tissue occlusion in an uncontrolled, rapidly changing surgical environment. Krieger explains that the NIR imaging has the potential to overcome occlusion problems because NIR light penetrates deeper than visual light.

‘This work describes the ‘super human eyes’ and a bit of ‘intelligence’ of our STAR robotic system, making tasks such as soft tissue surgery on live subjects possible,’ explains Peter C. Kim, M.D., vice president and associate surgeon in chief of the Sheikh Zayed Institute.

EurekAlert www.eurekalert.org/pub_releases/2017-02/cnhs-b3t021717.php

Pulsed cavitation ultrasound (PCU) can be used to remotely soften human degenerative calcified biosprosthetic valves and may significantly improve the valve opening function, according to a study.
Olivier Villemain, MD, et al., examined the effects of PCU on human bioprosthetic heart valves that were removed from patients because they were heavily calcified and were non-functional. PCU, also called histotripsy, uses short-pulses of focused high pressure ultrasound to soften biological tissue. The ultrasound is delivered by a transducer that can be placed outside of the body and directed in a focused manner to the area of interest.
The removed valves were surgically implanted in sheep or were studied in an experimental bath apparatus in order to examine the longer-term effects of PCU. The researchers found that the PCU was able to soften the stiff calcified valves and improve the function of the valves. The amount of stenosis of the calcified aortic valves decreased by about two-fold on average in both the animal model and the experimental apparatus. The researchers believe that this new non-invasive approach has the potential to improve the outcome of patients with severe calcified bioprosthesis stenosis by avoiding risky surgical or transcatheter reintervention.
This study was designed as a proof of concept study and did not evaluate the potential risk of PCU causing pieces of the calcified aortic valve breaking off and causing an embolic stroke.
"The results of this experimental study must be regarded as provisional because neither the safety nor efficacy of this technique have been evaluated in humans," commented Douglas L. Mann, MD, FACC, editor-in-chief of JACC: Basic to Translational Science. "However, the concept of using high energy ultrasound to restore the function of calcified artificial tissue valves, analogous to the manner in which nephrologists use ultrasound to break up kidney stones, is both provocative and exciting. The ultrasound devices to perform this type of therapy exist today, so the ability to translate these concepts to patients can move very quickly."

American College of Cardiology www.acc.org/latest-in-cardiology/articles/2017/06/16/10/40/can-pulsed-cultivation-ultrasound-improve-valve-function?w_nav=LC