Having a stroke damages immune cells as well as affecting the brain, research has found. The findings help explain why patients have a greater risk of catching life-threatening infections, such as pneumonia, after having a stroke.

Therapies that boost survival of the affected immune cells or compensate for their damage could help improve the recovery of stroke patients, the researchers say.

The study found that patients have reduced levels of protective antibodies in their blood after having a stroke, which might explain why they are more susceptible to infections. Tests with mice revealed those which experienced a stroke had fewer numbers of specialised immune cells called marginal zone B cells, which produce antibodies. Affected mice were more susceptible to bacterial lung infections, the researchers found. Loss of the B cells was caused by a chemical called noradrenaline produced by nerves activated during stroke.

Researchers, led by the University of Edinburgh’s Roslin Institute, found they could protect the mice from infections using a therapy to block the effects of noradrenaline.

We now plan to build on our findings by developing and testing new treatments that can block or bypass these immune deficits with B cells a particular target.

Noradrenaline is part of the body’s fight or flight response. It helps to prepare the body for action and has a range of effects, such as raising heart rate, boosting blood supply and triggering the release of energy from stores.

Blocking noradrenaline would probably be too dangerous in stroke patients, the researchers caution.

They say development of other therapies that block or bypass the damage to the immune system could offer new approaches to help cut the risk of infection after stroke.

University of Edinburgh www.ed.ac.uk/news/2017/immune-discovery-points-to-stroke-therapy

A new study shows that a hybrid molecular imaging system unites three imaging modalities to map the composition of dangerous arterial plaques before they rupture and induce a major cardiac event.
Certain types of plaques associated with atherosclerosis are prone to instability and tend to break apart, which can lead to embolism and sudden death, if left untreated. Lesions called thin-cap fibro atheroma (TCFA) are especially prone to rupture. Stanford University researchers have developed a scanner that unites optical, radioluminescence, and photoacoustic imaging to evaluate for TCFA.
“This is the first clinical imaging system able to detect vulnerable plaque in their earliest stages,” said Raiyan T. Zaman, PhD, instructor of cardiovascular medicine at Stanford University School of Medicine in Stanford, Calif. “Our novel imaging system can detect these vulnerable plaques despite their small size, complex biochemistry and morphology. This could lead to a paradigm shift in the way coronary artery disease is diagnosed and assessed.”
Early diagnosis and treatment could save lives by preventing the progression, and subsequent rupture, of these plaques. That is precisely why researchers designed the Circumferential-Intravascular-Radioluminescence-Photoacoustic-Imaging (CIRPI) system, which allows not just high-acuity optical imaging via beta-sensitive probe, but also radioluminescent marking inside the artery to determine the extent of inflammation. Photoacoustic imaging also provides information about the often-complex biological makeup of the plaques (how much is calcified or comprised of cholesterol or triglycerides).
“This is an important and potentially life-saving tool that could one day be used by interventional cardiologists to identify the appropriate treatment plan for patients at risk of future TCFA rupture,” explained Zaman.
For this study, researchers focused on atherosclerotic samples of both human and mouse carotid arteries and performed CIRPI following injection of fluorine-18 fluorodeoxyglucose (18F-FDG). Photoacoustic lasers were used at different wavelengths to delineate plaque composition. The result was a never-before-seen 360-degree perspective of arterial plaque burden, confirmed effective by follow-up radiography, ultrasound and histology.

Society of Nuclear Medicine and Molecular Imaging www.snmmi.org/NewsPublications/NewsDetail.aspx?ItemNumber=24263

Heart tissue can be imaged in real-time during keyhole procedures using a new optical ultrasound needle developed by researchers at UCL and Queen Mary University of London (QMUL).
The revolutionary technology has been successfully used for minimally invasive heart surgery in pigs, giving an unprecedented, high-resolution view of soft tissues up to 2.5 cm in front of the instrument, inside the body.
Doctors currently rely on external ultrasound probes combined with pre-operative imaging scans to visualise soft tissue and organs during keyhole procedures as the miniature surgical instruments used do not support internal ultrasound imaging.
For the study the team of surgeons, engineers, physicists and material chemists designed and built the optical ultrasound technology to fit into existing single-use medical devices, such as a needle.
“The optical ultrasound needle is perfect for procedures where there is a small tissue target that is hard to see during keyhole surgery using current methods and missing it could have disastrous consequences,” said Dr Malcolm Finlay, study co-lead and consultant cardiologist at QMUL and Barts Heart Centre.
“We now have real-time imaging that allows us to differentiate between tissues at a remarkable depth, helping to guide the highest risk moments of these procedures. This will reduce the chances of complications occurring during routine but skilled procedures such as ablation procedures in the heart. The technology has been designed to be completely compatible with MRI and other current methods, so it could also be used during brain or foetal surgery, or with guiding epidural needles.”
The team developed the all-optical ultrasound imaging technology for use in a clinical setting over four years. They made sure it was sensitive enough to image centimetre-scale depths of tissues when moving; it fitted into the existing clinical workflow and worked inside the body.
“This is the first demonstration of all-optical ultrasound imaging in a clinically realistic environment. Using inexpensive optical fibres, we have been able to achieve high resolution imaging using needle tips under 1 mm. We now hope to replicate this success across a number of other clinical applications where minimally invasive surgical techniques are being used,” explained study co-lead, Dr Adrien Desjardins (Wellcome EPSRC Centre for Interventional and Surgical Sciences at UCL).
The technology uses a miniature optical fibre encased within a customised clinical needle to deliver a brief pulse of light which generates ultrasonic pulses. Reflections of these ultrasonic pulses from tissue are detected by a sensor on a second optical fibre, giving real-time ultrasound imaging to guide surgery.
One of the key innovations was the development of a black flexible material that included a mesh of carbon nanotubes enclosed within clinical grade silicone precisely applied to an optical fibre. The carbon nanotubes absorb pulsed laser light, and this absorption leads to an ultrasound wave via the photoacoustic effect.
A second innovation was the development of highly sensitive optical fibre sensors based on polymer optical microresonators for detecting the ultrasound waves. This work was undertaken in a related UCL study led by Dr James Guggenheim.
University College London
www.ucl.ac.uk/news/news-articles/1217/011217-ultrasound-imaging-needle-surgery

New technology being developed by researchers at the University of Waterloo and the Sunnybrook Research Institute is using artificial intelligence (AI) to help detect melanoma skin cancer earlier.
The technology employs machine-learning software to analyse images of skin lesions and provide doctors with objective data on tell-tale biomarkers of melanoma, which is deadly if detected too late, but highly treatable if caught early.
The AI system—trained using tens of thousands of skin images and their corresponding eumelanin and hemoglobin levels—could initially reduce the number of unnecessary biopsies, a significant healthcare cost. It gives doctors objective information on lesion characteristics to help them rule out melanoma before taking more invasive action.
The technology could be available to doctors as early as next year. “This could be a very powerful tool for skin cancer clinical decision support,” said Alexander Wong, a professor of systems design engineering at Waterloo. “The more interpretable information there is, the better the decisions are.”
Currently, dermatologists largely rely on subjective visual examinations of skin lesions such as moles to decide if patients should undergo biopsies to diagnose the disease.
The new system deciphers levels of biomarker substances in lesions, adding consistent, quantitative information to assessments currently based on appearance alone. In particular, changes in the concentration and distribution of eumelanin, a chemical that gives skin its colour, and hemoglobin, a protein in red blood cells, are strong indicators of melanoma.
“There can be a huge lag time before doctors even figure out what is going on with the patient,” said Wong who is also the Canada Research Chair in Medical Imaging Systems. “Our goal is to shorten that process.”
University of Waterloo http://tinyurl.com/ybbq9kek

In the largest, most rigorous study of its kind, acupuncture was found to significantly reduce the debilitating joint pain experienced by tens of thousands of women each year while being treated for early stage breast cancer, according to SWOG research results.
Investigators from SWOG, the global cancer clinical trials network funded by the National Cancer Institute (NCI), conducted a randomized, blinded, multicentre trial, known as S1200, to test whether acupuncture is effective in alleviating pain caused by aromatase inhibitors, a common treatment for hormone sensitive breast cancers.
Treating this pain effectively, without the use of opioids or other drugs, is a top cancer research priority. Tens of thousands of women each year are treated with aromatase inhibitors (AIs), pills that stop the production of estrogen and essentially starve hormone receptor-positive breast cancer cells. Some women are advised to take these pills daily for up to 10 years. But as a side effect of this therapy, many women – as many as 50 percent – experience joint pain and stiffness. This affects knees, hips, hands, and wrists, and makes it difficult for women to walk, sit, climb stairs, and perform simple tasks like typing or driving.
“Some of my patients have difficulty getting out of a chair,” said Dr. Dawn Hershman, the lead researcher of the study and a SWOG vice chair. “As a result, with no good treatment options for their pain and stiffness, many women stop their cancer treatment. This is probably the most commonly cited reason breast cancer patients stop taking AI medication. So we need a solution – one that doesn’t include opioids or drugs that can be addictive or have serious side effects. We want women to continue their cancer treatment and have a good quality of life.”
SWOG researchers for years have chased a way to relieve AI pain – known as AI-Associated Musculoskeletal Syndrome (AIMSS). Many women don’t want to take pills to relieve symptoms caused by other pills, according to Hershman, leader of the Breast Cancer Program at the Herbert Irving Comprehensive Cancer Centre at NewYork-Presbyterian/Columbia University Irving Medical Centre and professor of medicine and epidemiology at Columbia. In a single-centre study at Columbia, acupuncture showed promise. Hershman wanted to put it to the test in a larger, more rigorous study. Hershman and her team enrolled a total of 226 patients from 11 cancer centres nationwide and randomly assigned them to one of three arms. One group received true acupuncture. Another received sham acupuncture, a method of superficially inserting needles in different, non-therapeutic locations on the body. Finally, another group received no treatment at all.
Patients got twice-weekly treatments for six weeks, then a weekly maintenance treatment for another six weeks. Patients reported on their pain before, during, and after treatment using a variety of methods. The primary endpoint – or key indicator for the trial – was the patient’s level of worst pain using the Brief Pain Inventory (BPI-WP), a patient-reported measure, at the end of the first six weeks of treatment.
Results showed that, on average, patients experienced less pain on the acupuncture arm compared with the sham and treatment-free arms. Patients experienced relief for 24 weeks.
“This work strongly shows that true acupuncture results in better outcomes for women,” said Dr. Katherine Crew, a SWOG executive officer, director of the Clinical Breast Cancer Prevention Program at NewYork-Presbyterian/Columbia University Irving Medical Center and an associate professor of medicine and epidemiology at Columbia and a co-investigator on the study team. “I expect this work to influence medical practice, as well as insurers’ willingness to reimburse for acupuncture during AI treatment.”
SWOGhttps://tinyurl.com/ya58napm