An approved international test to check whether people need open-heart surgery could be sending twice as many people under the knife unnecessarily, at a cost of nearly GBP 75m, research by the University of Leicester has suggested.

Since 2012 doctors have been using exercise testing on people with a condition called aortic stenosis (AS) to determine whether they need an operation to save their life.

However, a study, led by Gerry McCann, Professor of Cardiac Imaging and Honorary Consultant Cardiologist from the University of Leicester Department of Cardiovascular Sciences, who conducted the research as part of a NIHR Fellowship, has shown the current approach is ‘highly inaccurate’ and if followed may send thousands of patients to surgery before it is needed.

The exercise test, which involves cycling on a stationary bike, is used to determine whether surgery is needed for people with the condition – but it only has a 60 per cent accuracy rate, the study found.

AS, which is the narrowing of the aortic heart valve, affects predominantly older people and affects up to three per cent of people over 75 years of age. Symptoms, such as chest pain, breathlessness and feeling faint, can take years to develop. However, when they do it means the person is seriously ill and could die from heart failure or sudden death.

If exercise test participants become breathless, they are recommended to have valve replacement therapy. About 10,000 aortic valve replacements are performed every year at a cost of up to GBP 15,000. Hospital recuperation then takes between seven and 10 days.

Professor McCann, who is also a consultant cardiologist from the NIHR Leicester Cardiovascular Biomedical Research Unit (BRU), said: ‘There is no doubt that valve replacement therapy is highly effective for patients with symptoms, however there are risks involved. It’s a major operation and there’s a one per cent chance of people dying or having a stroke during or after. There’s also the chance they could develop an infection.

‘It can often take six months to recover, but if they survive they tend to do very well afterwards. However, if we know a patient has AS and no symptoms and we do nothing there’s also a one per cent chance they will die so there’s a fine line between whether we should intervene or not.

‘Our findings showed that this exercise test, which has been approved by the American Heart Association/American College of Cardiology and the European Society of Cardiology, was highly inaccurate as almost twice the number of people who became breathless during the test did not develop symptoms within a year.’

Professor McCann now wants to conduct further research to find a more accurate way to determine whether doctors should wait for symptoms to develop or to intervene beforehand. Ultimately a clinical study comparing early surgery versus waiting for symptoms to develop is needed.

University of Leicester www2.le.ac.uk/offices/press/press-releases/2017/february/controversial-test-could-be-leading-to-unnecessary-open-heart-operations

According to the National Institutes of Health, more than six million cases of chronic wounds cost $20 billion ( Euro 17.8 billiion) each year in the United States. Diabetic ulcers, pressure sores, surgical site wounds and traumatic injuries to high-risk patients account for most wounds that won’t heal. However, data from a University of Missouri School of Medicine study indicates that a recently developed skin-graft harvesting system aids in chronic wound recovery and reduces care costs by accelerating the healing process.
‘Chronic wounds occur when healing fails to progress normally and persists for more than 30 days,’ said Jeffrey Litt, DO, assistant professor of surgery at the MU School of Medicine and lead author of the study. ‘Current treatments such as moist dressings, frequent irrigations and wound cleaning are not always enough to ensure that healing occurs in high-risk patients. Although a skin graft can be used to close a wound that refuses to heal, the surgical technique usually is painful, time-consuming and leaves significant donor site wounds.’
Split-thickness skin grafting currently is the gold standard for treating traumatic and burn injury-related skin loss. The surgical procedure involves removing the top two layers of skin from a healthy donor site, and transplanting the tissue to an injured area. However, split-thickness grafting must be performed in an operating room and the technique is limited by the availability of donor skin. Additionally, donor sites usually are large, painful and also can become chronic wounds.
In the study, Litt’s team at MU Health Care used a recently developed autograft harvesting system to care for 13 patients with various types of chronic wounds. The new technology, which Litt’s team did not develop, was used to harvest only the top layer of skin for much smaller, consistently sized donor grafts. The minimally invasive approach, performed in an outpatient clinic setting, also resulted in much less donor site damage and little to no pain. Following the patients’ care, clinical outcomes and costs were evaluated.
‘Eight of the 13 high-risk patients treated with the autograft system experienced much faster healing of their chronic wounds,’ said Litt, who also serves as medical director of MU Health Care’s burn and wound programme. ‘Four of these patients fully healed in less than one month. Additionally, the comparatively rapid closure of the open wounds also reduced healthcare costs by an average of $1,153 ( Euro 1,026) per patient and $650 ( Euro 580) to the burn and wound programme.’
Litt’s team noted that the accelerated healing also resulted in no wound recurrence – a complication associated with at-risk patient populations.

University of Missouri School of Medicine http://tinyurl.com/ydyhjkeb

The immunotherapy nivolumab is kinder than chemotherapy for people with advanced head and neck cancer – easing many of the negative effects of the disease on patients’ quality of life.
Both head and neck cancer and the treatment for it can have a huge impact on patients – affecting their speech, breathing, eating and drinking, facial appearance, and general wellbeing.
All of this can cause substantial psychological, as well as physical, distress.
But patients taking part in a major phase III clinical trial – led by researchers at The Institute of Cancer Research, London, and The Royal Marsden NHS Foundation Trust – reported that nivolumab helped them maintain a better quality of life for longer.
By contrast, the same study also found that people treated with standard chemotherapies docetaxel, methotrexate or cetuximab reported a decline in quality of life from the start of treatment.
Last year, the clinical trial of 361 patients found that nivolumab – which sparks the immune system into action against cancers – greatly increased survival for people with recurrent or metastatic head and neck cancer.
But the drug was initially rejected by NICE in April this year and is currently under consultation before a final decision is due.
The new results add to the growing body of evidence that immunotherapy can be a smarter, kinder treatment for people with cancer.
In the latest study, 129 patients on the trial filled in questionnaires about their quality of life – covering physical symptoms, mental health and general wellbeing.
While patients on chemotherapy judged their quality of life to be lower at nine and 15 weeks into the trial, patients on nivolumab gave consistently better ratings throughout.
After nine weeks, patients given nivolumab reported that they were doing better than their counterparts on other treatments for a range of symptoms, including pain, sensory problems, appetite loss, tiredness and breathing problems.
After 15 weeks, the list of beneficial effects was even longer, with patients taking nivolumab being less badly affected by nausea, insomnia and weight loss.

Institute of Cancer Research
www.icr.ac.uk/news-archive/immunotherapy-kinder-than-chemotherapy-for-patients-with-head-and-neck-cancer

Chemists at the University of Alabama at Birmingham have designed triple-threat cancer-fighting polymer capsules that bring the promise of guided drug delivery closer to preclinical testing.

These multilayer capsules show three traits that have been difficult to achieve in a single entity. They have good imaging contrast that allows detection with low-power ultrasound, they can stably and efficiently encapsulate the cancer drug doxorubicin, and both a low- and higher-power dose of ultrasound can trigger the release of that cargo.

These three features create a guided drug delivery system to target solid tumours. Therapeutic efficacy can be further improved through surface modifications to boost targeting capabilities. Diagnostic low-power ultrasound then could visualize the nanocapsules as they concentrated in a tumour, and therapeutic higher-dose ultrasound would release the drug at ground zero, sparing the rest of the body from dose-limiting toxicity.

This precise control of when and where doxorubicin or other cancer drugs are released could offer a non-invasive alternative to cancer surgery or systemic chemotherapy, the UAB researchers report.

‘We envision an entirely different approach to treating solid human tumours of numerous pathologic subtypes, including common metastatic malignancies such as breast, melanoma, colon, prostate and lung, utilizing these capsules as a delivery platform,’ said Eugenia Kharlampieva, Ph.D., an associate professor in the Department of Chemistry, UAB College of Arts and Sciences. ‘These capsules can protect encapsulated therapeutics from degradation or clearance prior to reaching the target and have ultrasound contrast as a means of visualizing the drug release. They can release their encapsulated drug cargo in specific locations via externally applied ultrasound exposure.’

Kharlampieva – who creates her novel ‘smart’ particles while working at the intersection of polymer chemistry, nanotechnology and biomedical science – says there is an urgent, and so far unmet, need for such an easily fabricated, guided drug delivery system.

University of Alabama at Birmingham www.uab.edu/news/innovation/item/8162-uab-creates-triple-threat-cancer-fighting-polymer-capsules-for-guided-drug-delivery

A recent study, affiliated with UNIST has proposed the possibility of in situ human health monitoring simply by wearing a contact lens with built-in wireless smart sensors.

This study has been jointly conducted by Professor Jang-Ung Park of Materials Science and Engineering, Professor Chang Young Lee of Life Science, and Professor Franklin Bien of Electrical and Computer Engineering at UNIST in collaboration with Professor Hong Kyun Kim of Ophthalmology and Professor Kwi-Hyun Bae of Internal Medicine at Kyungpook National University (KNU).

In the study, the research team unveiled a smart contact lens sensor that could help monitor biomarkers for intraocular pressure (IOP), diabetes mellitus, and other health conditions. The research team expects that this research breakthrough could lead to the development of biosensors capable of detecting and treating various human diseases, and used as a component of next-generation smart contact lens-related electronic devices.

Diabetes is the most common cause of high blood sugar levels. Hyperglycaemia is a condition in which an excessive amount of glucose circulates in the blood plasma. If this condition persists for more than two hours, a patient will be diagnosed with diabetes.

Since blood sugar can be measured with tears, many attempts have been made to monitor diabetes with contact lenses. Despite numerous studies in the last several decades, the biggest drawback with conventional smart contact lenses was thought to be poor wearability. The electrodes used in existing smart contact lenses are opaque, and therefore obscure the view when wearing it. Moreover, because they lens-shaped firm plastic material, many people complain of comfort issues with contact lens wear which made wearing them impossible.

Professor Park and his research team solved these issues by developing a sensor based on transparent and flexible materials. Their new smart contact lens sensors use electrodes made of highly stretchable and transparent graphene sheets and metal nanowires.

Using this sensor, patients with diabetes and glaucoma may one day be able to self-monitor blood glucose levels and eye pressure. Through the embedded wireless antenna in the contact lens sensor, patients can also transmit their health information, which allows real-time monitoring of their health conditions, as well. In addition, because the system uses wireless antenna to read sensor information, no separate power source, like battery is required for the smart contact lens sensors.

Intraocular pressure measurement can be achieved using the dielectric layers. The dielectric layer is an electrically non-conductive layer, characterized by polarity that divides both positive and negative charges. The thickness of this layer changes from thinning as the intraocular pressure increases, to thickening as the intraocular pressure decreases. The IOP sensor, embedded in the contact lenses senses this and transmits the information to the wireless antenna.

According to the research team, their newly-developed smart lenses with built-in pressure-sensing and glucose-monitoring sensors could still detect blood glucose and IOP despite the deformation of the contact lenses. The sensor characteristics were also maintained even when exposed to various substances in human tears.

UNIST news.unist.ac.kr/smart-contact-lens-sensor-for-diabetic-and-glaucoma-diagnosis/