An analysis of reports on more than 4,000 patients suggests that nearly one in three people discharged from hospital intensive care units, or ICUs, has clinically important and persistent symptoms of depression, according to researchers at Johns Hopkins Medicine. Symptoms can last for a year or more for some patients and are more likely to occur in people who have a history of psychological distress before an ICU stay, the investigators say. The prevalence of depressive symptoms in this population is three to four times that of the general population, says study coauthor O. Joseph Bienvenu, associate professor of psychiatry and behavioural sciences at the Johns Hopkins University School of Medicine. “Not only can people with depression have slower physical recovery, but they also experience financial strain because they often cannot return to work and their caregivers must stay home with them,” Bienvenu says. Psychological symptoms occurring before an ICU stay and psychological distress experienced during the ICU stay or hospitalization were the risk factors most associated with depressive symptoms after hospital discharge, the review found. “It’s very clear that ICU survivors have physical, cognitive, and psychological problems that greatly impair their reintegration into society, return to work, and being able to take on previous roles in life,” says senior study author Dale Needham, professor of medicine at JHU’s School of Medicine. “If patients are talking about the ICU being stressful, or they’re having unusual memories or feeling down in the dumps, we should take that seriously,” Needham adds. “Healthcare providers, family members, and caregivers should pay attention to those symptoms and make sure they’re not glossed over.” More than 5 million patients in the United States are admitted to ICUs each year, Needham says.
John Hopkins Medicine http://tinyurl.com/jnkqmj6
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One downside to medical sensors that test human sweat: You have to sweat. Sweating from exertion or a stifling room temperature can be impractical for some patients and unsafe for others. And unless they are on the second leg of the Tour de France, it’s unlikely patients will want to sweat all day for the benefit of a sensor reading. But researchers at the University of Cincinnati have come up with a novel way to stimulate sweat glands on a small, isolated patch of skin so subjects can stay cool and comfortable and go about their daily routine without spending hours on a treadmill. UC professor Jason Heikenfeld and UC graduate Zachary Sonner came up with a device the size of a Band-Aid that uses a chemical stimulant to produce sweat, even when the patient is relaxed and cool. The sensors also can predict how much patients sweat, an important factor in understanding the hormones or chemicals the biosensors measure. "Doctors would love to know if chemical concentrations are increasing or decreasing over time," Heikenfeld said. "What was your baseline before you got sick? Then by measuring the change in concentrations, we know even more about how sick you are or how quickly you are getting better." Blood analysis is considered the gold standard for biometric analysis. But biometric testing with blood is invasive and often requires the use of a lab. It is far more difficult for doctors to perform continuous monitoring of blood over hours or days. Sweat provides a non-invasive alternative, with chemical markers that are more useful in monitoring health than saliva or tears, Heikenfeld said. “People for a long time ignored sweat because, although it can be a higher-quality fluid for biomarkers, you can’t rely on having access to it,” Heikenfeld said. “Our goal was to achieve methods to stimulate sweat whenever needed — or for days.” Scientists say sweat provides much of the same useful information about patients as blood. The problem has always been getting the same consistent sample as is possible with a standard blood draw, he said. For the study, the researchers applied sensors and a gel containing carbachol, a chemical used in eyedrops, to their subject’s forearm for 2.5 minutes. They used three methods to obtain sensor data: the gel and sensors alone and in combination with memory foam padding (to provide better contact between the sensor and the skin) and iontophoresis, an electrical current at 0.2 milliamps that drives a tiny amount of carbachol into the upper layer of the skin and locally stimulates sweat glands but causes no physical sensation or discomfort. Then they recorded data obtained from the subject’s sweat for 30 minutes using sensors that measured concentrations of sweat electrolytes. Carbachol was effective at inducing sweating under the sensor for as long as five hours. Heikenfeld said a subsequent study successful generated sensor results for several days using this process to stimulate sweat. They used a pH-sensitive dye to observe the results. The orange dye turned blue when it reacted with sweat. This demonstrated that the sweat glands were stimulated evenly across the sensor area. “This work represents a significant leap forward in sweat-sensing technology,” the study concluded.
University of Cincinnati magazine.uc.edu/editors_picks/recent_features/Sweat.html
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Patients with early stage lung cancer live longer when they receive a lobectomy — the most common type of operation for the disease — rather than a less extensive operation or radiation treatment, according to a study. "Our data suggest that the more aggressively we treat early lung cancer, the better the outcome," said lead author Alex Bryant, BS, of the School of Medicine at the University of California, San Diego. "This study is one of the best-powered and detailed analyses to date and suggests that lobectomy is still the preferred treatment of this disease for most patients." Using the Veterans Affairs Informatics and Computing Infrastructure (VINCI), Bryant, James D. Murphy, MD, and colleagues identified patients who were diagnosed with early stage non-small cell lung cancer (NSCLC) between 2006 and 2015, and who were treated with either surgery or radiation. In all, 4,069 patients were included: 73% (2,986) underwent lobectomy, 16% (634) received a sublobar resection, and 11% (449) received stereotactic body radiation therapy (SBRT). Lobectomy is the removal of an entire lobe of the lung; sublobar resection is a less extensive operation that includes wedge and segmental resections; SBRT delivers very high doses of radiation over a short period of time (typically 1-2 weeks), precisely targeting the tumour. The researchers described VINCI as an "extremely rich source of health information" from which they were able to gather detailed data related to a large, nationwide group of veterans. The database includes patient-specific data related to preoperative pulmonary function, smoking history, and tumour staging. Factors such as these are often not available and have not been consistently addressed in previous studies, which sets this study apart, according to Dr. Bryant. In their analyses, the researchers found that the 5-year incidence of cancer death was lowest in the lobectomy group at 23%, with the sublobar group at 32%, and SBRT patients at 45%. SBRT also was associated with a 45% increased risk of cancer death compared with lobectomy. Surgery, though, was not without risks. The study showed that both surgical groups had higher immediate mortality compared to radiation due to operative risks. The 30-day mortality was 1.9% for lobectomy, 1.7% for sublobar resection, and 0.5% for SBRT. But as time went on and with longer follow-up, the surgery groups demonstrated superiority to SBRT, with long-term survival favouring surgery, especially lobectomy, over radiation. The 5-year overall survival rate for lobectomy patients was 70%, followed by the sublobar resection group at 56%, and SBRT at 44%. "Our data suggest that the higher operative risks of surgery are more than offset by improved survival in the months and years after treatment, particularly for lobectomy," said Dr. Bryant. The study also showed that the use of SBRT increased throughout the study period, accounting for 2% of all treatments in 2006 and 19% in 2015. Dr. Bryant explained that for patients who are too sick to tolerate a major operation like lobectomy, SBRT makes sense and has become an increasingly common option. Less extensive surgeries, such as sublobar resections, also remain a possibility, but there are ongoing concerns about a higher risk of tumor recurrences, he said. As a result, lobectomy remains the standard treatment for early lung cancer in patients who can tolerate a major surgical procedure. "The public should be aware that lung cancer — even when caught at a very early stage — is a serious diagnosis and deserves aggressive treatment," said Dr. Bryant. EurekAlert www.eurekalert.org/pub_releases/2017-11/e-si113017.php
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A multidisciplinary group that includes the University of Illinois at Urbana-Champaign and the University of Washington at Tacoma has developed a novel platform to diagnose infectious disease at the point-of-care, using a smartphone as the detection instrument in conjunction with a test kit in the format of a credit card. The group is led by Illinois Electrical and Computer Engineering Professor Brian T. Cunningham; Illinois Bioengineering Professor Rashid Bashir; and, University of Washington at Tacoma Professor David L. Hirschberg, who is affiliated with Sciences and Mathematics, division of the School of Interdisciplinary Arts and Sciences. Findings have demonstrated detection of four horse respiratory diseases, and in Biomedical Microdevices, where the system was used to detect and quantify the presence of Zika, Dengue, and Chikungunya virus in a droplet of whole blood. Project collaborators include Dr. David Nash, a private practice equine expert and veterinarian in Kentucky, and Dr. Ian Brooks, a computer scientist at the National Center for Supercomputing Applications. The low-cost, portable, smartphone-integrated system provides a promising solution to address the challenges of infectious disease diagnostics, especially in resource-limited settings or in situations where a result is needed immediately. The diagnostic tool’s integration with mobile communications technology allows personalized patient care and facilitates information management for both healthcare providers and epidemiological surveillance efforts. Importantly, the system achieves detection limits comparable to those obtained by laboratory-based methods and instruments, in about 30 minutes. A useful capability for human point-of-care (POC) diagnosis or for a mobile veterinary laboratory, is to simultaneously test for the presence of more than one pathogen with a single test protocol, which lowers cost, saves time and effort, and allows for a panel of pathogens, which may cause similar symptoms, to be identified. Infectious diseases remain the world’s top contributors to human death and disability, and with recent outbreaks of Zika virus infections, there is a keen need for simple, sensitive, and easily translatable point-of-care tests. Zika virus appeared in the international spotlight in late 2015 as evidence emerged of a possible link between an epidemic affecting Brazil and increased rates of microcephaly in newborns. Zika has become a widespread global problem—the World Health Organization (WHO) documented last year that since June 2016, 60 nations and territories report ongoing mosquito-borne transmission. Additionally, since Zika virus infection shares symptoms with other diseases such as Dengue and Chikungunya, quick, accurate diagnosis is required to differentiate these infections and to determine the need for aggressive treatment or quarantine. The technology is intended to enable clinicians to rapidly diagnose disease in their office or in the field, resulting in earlier, more informed patient management decisions, while markedly improving the control of disease outbreaks. An important prerequisite for the widespread adoption of point-of-care tests at the patient’s side is the availability of detection instruments that are inexpensive, portable, and able to share data wirelessly over the Internet. The system uses a commercial smartphone to acquire and interpret real-time images of an enzymatic amplification reaction that takes place in a silicon microfluidic chip that generates green fluorescence and displays a visual read-out of the test. The system is composed of an unmodified smartphone and a portable 3D–printed cradle that supports the optical and electrical components, and interfaces with the rear-facing camera of the smartphone. The software application operating on the smartphone gathers information about the tests conducted on the microfluidic card, patient-specific information, and the results from the assays, that are then communicated to a cloud storage database. Dr. Nash observes that, “This project is a game changer. This is the future of medicine—empowered front-line healthcare professionals. We can’t stop viruses and bacteria, but we can diagnose more quickly. We were able to demonstrate the clear benefit to humankind, as well as to animals, during the proposal phase of the project, and our results have proved our premise.
University of Illinois mntl.illinois.edu/news/article/23759
The optimal follow-up protocol for patients with completely resected non-small cell lung cancer (NSCLC) remains elusive after results of the IFCT-0302 trial, presented at the ESMO 2017 Congress in Madrid, did not show a difference in overall survival (OS) between patients who received computed tomography (CT) scans as part of their follow-up, and those who did not. Indeed, the findings suggest regular CT scans, which many guidelines recommend, may not be necessary. “Because there is no difference between arms, both follow-up protocols are acceptable,” said study investigator Prof. Virginie Westeel, from Centre Hospitalier Régional Universitaire, Hôpital Jean Minjoz in Besançon, France. “A conservative point of view would be to do a yearly CT-scan, which might be of interest over the long-term, however, doing regular scans every six months may be of no value in the first two post-operative years,” she said. The suggestion is a departure from standard clinical practice, since the majority of medical societies and clinical practice guidelines recommend follow-up visits in which chest CT is considered appropriate every three to six months in the first two years after surgery. The multicentre study included 1775 patients with completely resected stage I–II-IIIA NSCLC who completed follow-up visits every 6 months for the first two years, and yearly until five years. Patients were randomised to a control follow-up, that included clinical examination and chest X-ray (CXR), or an experimental follow-up that included the control protocol with the addition of thoraco-abdominal CT-scan plus bronchoscopy (optional for adenocarcinomas). After a median follow-up of eight years and 10 months, overall survival (OS) was not significantly different between the groups (hazard ratio [HR] 0.95, 95% CI: 0.82-1.09; p=0.37) at a median of 99.7 months in the control arm and 123.6 months in the experimental arm. Three-year disease-free survival rates were also similar, at 63.3% and 60.2% respectively, as were eight-year OS rates at 51.7% and 54.6%, respectively. Commenting on the study, ESMO spokesperson Dr. Floriana Morgillo, from the University of Campania Luigi Vanvitelli, Naples, Italy, said that although the study does not demonstrate a significant benefit with CT-based follow-up, the trend towards better survival in the CT arm suggests longer follow-up may eventually reveal a benefit of this approach. However, in the meantime, she says CT-based surveillance is still an appropriate option because of its potential for impacting second primary cancers. “A significant proportion of patients with early stage NSCLC develop second cancers between the second and fourth year after surgery, and early detection of these with CT-based surveillance beyond two years could allow curative treatment,” Morgillo said, adding that patients must also be informed of the radiation exposure with CT.
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Peripheral neuropathy is a very common side-effect of chemotherapy and may eventually lead to early discontinuation of treatment.
Collaboration between research and industry led to the identification and successful testing of a new molecule capable of preventing this neurological complication.
This molecule could potentially become the first existing treatment to prevent this frequent adverse effect and improve the quality of life of cancer patients.
IDIBELL Researchers of the Neuro-Oncology Unit of Bellvitge University Hospital – Catalan Institute of Oncology, led by Dr. Jordi Bruna, have successfully tested a new molecule capable of preventing the development of peripheral neuropathy induced by chemotherapy in cancer patients, especially in colon cancer cases, the third most common neoplasm in the world. The molecule, which has a completely novel mechanism of action, would be the first treatment against this neurological complication, for which no effective treatment has yet been approved. One of the main adverse effects of certain chemotherapeutics used in the treatment of cancers is peripheral neuropathy, which can cause tingling, numbness, pain or alterations in the functionality of patients, among others. This complication, so far, has been regarded as a “price to pay” despite having a demonstrated negative impact on the quality of life of the patient, increasing their care expenses and often preventing the complete and effective administration of the cytostatic treatment, with the potential decrease of survival chances that entails. Researchers at the HUB-ICO-IDIBELL Unit identified a new molecule – developed by the Catalan laboratory Esteve – as a candidate to prevent the onset of this adverse effect. "Through a public-private partnership, we have been able to design a Phase 2b clinical trial (randomized with placebo), which has allowed us to get a great deal of scientific information – effect on pain, pathophysiology – and draw conclusions as to the potential of the drug in the prevention of neuropathies during cytostatic treatment”, explains Dr. Bruna, who led the trial. The results of the study prove a decrease in the appearance of disorders associated with nerve dysfunction in those cancer patients who took the new drug. "When the trial was designed, safety data from the previous trials limited the duration of treatment with the new molecule and this meant that we had to work at low doses in relation to the duration of the chemotherapy treatment, but we have nevertheless obtained positive results and now we have enough information to be able to extend the duration of the treatment. Therefore, we hope to obtain even more satisfactory results" the IDIBELL researcher comments. "Given the usual pace of clinical trials and drug agencies following fast-track approval processes in severe or orphan pathologies, this new drug could potentially reach the market soon, since it would be the first available treatment to avoid this type of neuropathy. In addition, it has other medical uses as a non-opioid analgesic”, adds Bruna. In any case, improving pain control and reducing the occurrence of severe neuropathy is undoubtedly the most prominent benefit of the development of this novel drug.. IDIBELL www.idibell.cat/modul/news/en/1024/researchers-prove-the-effectiveness-of-a-new-drug-to-prevent-the-onset-and-the-pain-of-chemotherapy-induced-neuropathy
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The 2018 edition of the event is expected to welcome more than 4,200 exhibiting companies and 103,000 attendees from 150+ countries.
Accompanying the exhibition will be 19business, leadership and Continuing Medical Education (CME) conferences providing the very latest updates and insights into cutting edge procedures, techniques and skills.
2018 will also see the introduction of the Personal Healthcare Technology Zone. Exhibitors will display the latest in “Smart” Healthcare Technology that connects patients to physicians and hospitals/clinics.
Other event features include Hands-On-Training modules, a dedicated 3D Medical Printing zone, and a showcase of the Dealer and Distributors.
Arab Health 2018 will take place from 29 January to 01 February 2018 at the Dubai International Convention and Exhibition Centre.
Visitor registration during the show days will be charged at AED100, so make sure to register here today for FREE access to the exhibition.
Click here for more information on Arab Health 2018.
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During operations, it can be difficult for surgeons to avoid severing crucial nerves because they look so much like other tissue. A new non-invasive approach that uses polarized light to make nerves stand out from other tissue could help surgeons avoid accidentally injuring nerves or assist them in identifying nerves in need of repair. Although nerve injuries are a known complication for many types of surgery, surgeries involving the hand and wrist come with a higher risk because of the dense networks of nerves in this area. There are a few techniques available to help doctors identify nerves, but they have various limitations such as not providing real-time information, requiring physical contact with the nerve or requiring the addition of a fluorescent dye. Cousins, Kenneth and Patrick Chin, developed the idea independently from any institute to use an optical technique known as collimated polarized light imaging (CPLi) to identify nerves during surgery. Kenneth later joined a research group led by Thomas van Gulik, a surgeon at the Academic Medical Center, and brought along a working prototype which has been further developed into a practical system that can be deployed in the operating room. In The Optical Society (OSA) journal Biomedical Optics Express, the researchers report that a surgeon using CPLi technology was able to correctly identify nerves in a human hand 100 percent of the time, compared to an accuracy rate of 77 percent for the surgeon who identified nerves using only a visual inspection. CPLi uses a polarized beam of light to illuminate the tissue. When this light passes through a nerve, the tissue’s unique internal structure reflects the light in a way that is dependent on how the nerve fibre is oriented compared to the orientation of the polarization of the light. By rotating the light’s polarization, the reflection appears to switch on and off, making the nerve tissue stand out from other tissue. For this application, it was important to use light that was collimated, meaning all the light waves were parallel to each other, to maximize the amount of light reflected by the tissue. “We adapted the optics used for CPLi so that they could be incorporated in a surgical microscope, which can be placed above the surgical area,” said Kenneth Chin. “The resulting system can be used in a wide range of surgical fields where superficial nerves need to be identified.” After testing their technique on animal tissue, the researchers used it to examine 13 tissue sites from the hand of a human cadaver. A surgeon looked for nerve tissue at these sites by eye under typical surgical illumination while a different surgeon used CPLi for an independent assessment. Histological evaluation was then used to verify the presence of nerve tissue at each site. The surgeon using visual inspection correctly identified nerve tissue in 10 of the 13 cases while the surgeon using CPLi correctly identified nerve tissue in all cases. With patient consent, the researchers also used CPLi to successfully identify nerve tissue during a procedure to relieve pain in the wrist. They plan to do additional tests of the technique during live surgery to better understand how the optical reflection of nerves might vary among patients and under various surgical conditions.
The Optical Society www.osa.org/en-us/about_osa/newsroom/news_releases/2017/new_tool_aims_to_make_surgery_safer_by_helping_doc/
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Engineers at the University of California San Diego have developed a smartphone case and app that could make it easier for patients to record and track their blood glucose readings, whether they’re at home or on the go. Currently, checking blood sugar levels can be a hassle for people with diabetes, especially when they have to pack their glucose monitoring kits around with them every time they leave the house. “Integrating blood glucose sensing into a smartphone would eliminate the need for patients to carry a separate device,” said Patrick Mercier, a professor of electrical and computer engineering at UC San Diego. “An added benefit is the ability to autonomously store, process and send blood glucose readings from the phone to a care provider or cloud service.” The device, called GPhone, is a new proof-of-concept portable glucose-sensing system developed by Mercier, nanoengineering professor Joseph Wang, and their colleagues at the UC San Diego Jacobs School of Engineering. Wang and Mercier are the director and co-director, respectively, of the Center for Wearable Sensors at UC San Diego. GPhone has two main parts. One is a slim, 3D printed case that fits over a smartphone and has a permanent, reusable sensor on one corner. The second part consists of small, one-time use, enzyme-packed pellets that magnetically attach to the sensor. The pellets are housed inside a 3D-printed stylus attached to the side of the smartphone case. To run a test, the user would first take the stylus and dispense a pellet onto the sensor—this step activates the sensor. The user would then drop a blood sample on top. The sensor measures the blood glucose concentration, then wirelessly transmits the data via Bluetooth to a custom-designed Android app that displays the numbers on the smartphone screen. The test takes about 20 seconds. Afterwards, the used pellet is discarded, deactivating the sensor until the next test. The stylus holds enough pellets for 30 tests before it needs to be refilled. A printed circuit board enables the whole system to run off a smartphone battery. The pellets contain an enzyme called glucose oxidase that reacts with glucose. This reaction generates an electrical signal that can be measured by the sensor’s electrodes. The greater the signal, the higher the glucose concentration. The team tested the system on different solutions of known glucose concentrations. The results were accurate throughout multiple tests. A key innovation in this design is the reusable sensor. In previous glucose sensors developed by the team, the enzymes were permanently built-in on top of the electrodes. The problem was that the enzymes wore out after several uses. The sensor would no longer work and had to be completely replaced. Keeping the enzymes in separate pellets resolved this issue. “This system is versatile and can be easily modified to detect other substances for use in healthcare, environmental and defense applications,” Wang said. The system stores a considerable amount of data so that users can track their readings over long time periods. However, there is a trade-off in price. While the reusable glucose sensor and 3D printed parts are inexpensive, refill pellets may be slightly more costly than test strips in today’s glucose monitoring kits.
Jacobs School of Engineeringhttps://tinyurl.com/y8jy998h
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Researchers at Sanford Burnham Prebys Medical Discovery Institute (SBP) have developed a proof-of-concept nanosystem that dramatically improves the visualization of tumours. The platform achieves a five-fold increase over existing tumour-specific optical imaging methods. The novel approach generates bright tumour signals by delivering “quantum dots” to cancer cells without any toxic effects. Xiangyou Liu, Ph.D., and Gary Braun, Ph.D., developed the method in the laboratories of Kazuki Sugahara, M.D., Ph.D., adjunct assistant professor at SBP and adjunct associate research scientist at Columbia University, and Erkki Ruoslahti, M.D., Ph.D., distinguished professor at SBP. “Tumour imaging is an integral part of cancer detection, treatment and tracking the progress of patients after treatment,” says Sugahara. “Although significant progress has been made in the last two decades, better and more sensitive detection, such as the method we are developing, will contribute to more personalized and potentially more effective interventions to improve the clinical outcomes of cancer patients.” The new method utilizes quantum dots, QDs—tiny particles that emit intense fluorescent signals when exposed to light—and an “etchant” that eliminates background signals. The QDs are delivered intravenously, and some of them leave the bloodstream and cross membranes, entering cancer cells. Fluorescent signals emitted from excess QDs that remain in the bloodstream are then made invisible by injecting the etchant. “The novelty of our nanosystem is how the etchant works,” explains Braun. The etchant and the QDs undergo a “cation exchange” that occurs when zinc in the QDs is swapped for silver in the etchant. Silver-containing QDs lose their fluorescent capabilities, and because the etchant can’t cross membranes to reach tumour cells, the QDs that have reached the tumour remain fluorescent. Thus, the entire process eliminates background fluorescence while preserving tumour-specific signals. The method was developed using mice harbouring human breast, prostate and gastric tumours. QDs were actively delivered to tumours using iRGD, a tumour penetrating peptide that activates a transport pathway that drives the peptide along with bystander molecules—in this case fluorescent QDs—into cancer cells. iRGD methodology was originally developed in Ruoslahti’s lab. To our knowledge, this is the first in vivo example of a background-destroying etchant being used to enhance the specificity of imaging,” says Sugahara. “We are encouraged that we were able to achieve a tumour-specific contrast index (CI) between five- and ten-fold greater than the general cut-off for optical imaging, which is 2.5.” “Moving forward we will focus on developing our novel nanosystem to work with routine imaging tests like PET scans and MRIs. In our studies with mice, we use optical imaging, which isn’t always practical for humans,” Sugahara explains.
Sanford Burnham Prebys Medical Discovery Institute (SBP) http://tinyurl.com/yczo8jyt
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