In a landmark study, UNC School of Medicine researchers have shown that blood glucose testing does not offer a significant advantage in blood sugar control or quality of life for type 2 diabetes patients who are not treated with insulin. The paper details findings from a randomized trial called “The MONITOR Trial.” This study is the first large pragmatic study examining glucose monitoring in the United States.
Type 2 diabetes is an epidemic afflicting one in 11 people in the United States. For those treated with insulin, checking blood sugar with a finger stick at home is an accepted practice for monitoring the effects of insulin therapy. However, the majority of type 2 diabetes patients are not treated with insulin. These patients, too, are often recommended glucose monitoring, despite an ongoing debate about its effectiveness in controlling diabetes or improving how patients feel.
“Our study results have the potential to transform current clinical practice for patients and their providers by placing a spotlight on the perennial question, ‘to test or not to test?’” said Katrina Donahue, MD, MPH, senior author of the study and Professor and Director of Research at UNC Family Medicine.
During the study, 450 patients were assigned to one of three groups: no blood sugar monitoring, once daily glucose monitoring, or enhanced once-daily glucose monitoring with an internet-delivered tailored message of encouragement or instruction.
The trial lasted one year. By the end:

• There were no significant differences in blood glucose control across the three groups.
• There were no significant differences found in health-related quality of life.
• There were no notable differences in hypoglycemia (low blood sugar), hospitalizations, emergency room visits. Between programs, there was also no difference in the number of individuals who had to start using insulin treatment to better control blood sugar levels.

“Of course, patients and providers have to consider each unique situation as they determine whether home blood glucose monitoring is appropriate,” Donahue said. “But the study’s null results suggest that self-monitoring of blood glucose in non-insulin treated type 2 diabetes has limited utility. For the majority, the costs may outweigh the benefits.”

UNC Healthcare
news.unchealthcare.org/news/2017/june/is-the-finger-stick-blood-test-necessary-for-type-2-diabetes-treatment

Researchers at the University of Rochester Medical Center have developed a new imaging technique that could revolutionize how eye health and disease are assessed. The group is first to be able to make out individual cells at the back of the eye that are implicated in vision loss in diseases like glaucoma. They hope their new technique could prevent vision loss via earlier diagnosis and treatment for these diseases.
In a study Ethan A. Rossi, Ph.D., assistant professor of Ophthalmology at the University of Pittsburgh School of Medicine, describes a new method to non-invasively image the human retina. The group, led by David Williams, Ph.D., Dean for Research in Arts, Sciences, and Engineering and the William G. Allyn Chair for Medical Optics at the University of Rochester, was able to distinguish individual retinal ganglion cells (RGCs), which bear most of the responsibility of relaying visual information to the brain.
There has been a longstanding interest in imaging RGCs because their death causes vision loss in glaucoma, the second leading cause of acquired blindness worldwide. Despite great efforts, no one has successfully captured images of individual human RGCs, in part because they are nearly perfectly transparent.
This new approach might eventually allow us to detect the loss of single ganglion cells. The sooner we can catch the loss, the better our chances of halting disease and preventing vision loss.
Instead of imaging RGCs directly, glaucoma is currently diagnosed by assessing the thickness of the nerve fibres projecting from the RGCs to the brain. However, by the time a change is typically detected in the retinal nerve fibre thickness, a patient may have lost tens of thousands of RGCs or more.
“In principle, this new approach might eventually allow us to detect the loss of single ganglion cells,” said Williams. “The sooner we can catch the loss, the better our chances of halting disease and preventing vision loss.”
Rossi and his colleagues were able to see RGCs by modifying an existing technology – confocal adaptive optics scanning light ophthalmoscopy (AOSLO).  They collected multiple images, varying the size and location of the detector they used to gather light scattered out of the retina for each image, and then combined those images. The technique, called multi-offset detection, was performed at the University of Rochester Medical Center in animals as well as volunteers with normal vision and patients with age-related macular degeneration.

The University of Rochester Medical Centerhttp://tinyurl.com/yc78dk4v

MagnaSafe Registry, a new multicenter study led by scientists at The Scripps Research Institute (TSRI), has demonstrated that appropriately screened and monitored patients with standard or non-MRI-conditional pacemakers and defibrillators can undergo MRI at a field strength of 1.5 tesla without harm. These devices are not presently approved by the U.S. Food and Drug Administration (FDA) for MRI scanning.

The researchers observed no patient deaths, device or lead failures, losses of pacing function or ventricular arrhythmias in 1,500 patients who underwent MRI using a specific protocol for device interrogation, device programming, patient monitoring and follow-up designed to reduce the risk of patient harm from MRI effects.

New Study Defines a Protocol for MRI Scanning and Defines the Risk of MRI

The use of MRI poses potential safety concerns for patients with an implanted cardiac device.

These concerns are a result of the potential for magnetic field-induced cardiac lead heating, which could result in cardiac injury and damage to an implanted device. As a result, it has long been recommended that patients with a pacemaker or defibrillator not undergo MRI scanning, even when MRIs are considered the most appropriate diagnostic imaging method for their care.

Despite the development of devices designed to reduce the potential risks associated with MRI, a large number of patients have devices that have not been shown to meet these criteria and are considered ‘non-MRI-conditional.’ At least half these patients are predicted to have the need for MRI after a device has been implanted.

Researchers established the MagnaSafe Registry to determine the frequency of cardiac device-related events among patients with non-MRI-conditional devices, as well as to define a simplified protocol for screening, monitoring and device programming before MRI.

‘Given the great clinical demand for MRI for patients with a standard pacemaker or defibrillator, we wanted to determine the risk,’ said study leader Dr. Robert Russo, an adjunct professor at TSRI and director of The La Jolla Cardiovascular Research Institute.

In the MagnaSafe Registry, researchers at 19 U.S. institutions tested 1,000 cases with a non-MRI-conditional pacemaker (one not approved for use in an MRI) and 500 cases of patients with a non-MRI-conditional implantable cardioverter defibrillator (ICD), a device that can shock the heart in response to a potentially fatal cardiac rhythm. They scanned regions other than the chest, such as the brain, spine or extremities-where MRI is traditionally the best option for imaging.

The researchers tested the devices at an MRI field strength of 1.5 tesla, a standard strength for MRI scanners and reprogrammed some devices according to a prespecified protocol for the MRI examination.

The Scripps Institute www.scripps.edu/news/press/2017/20170222russo.html

Health specialists at the University of York have found than acupuncture treatment can boost the effectiveness of standard medical care, lessening the severity of chronic pain and depression.
The trials involved approximately 18,000 patients diagnosed with chronic pain of the neck, lower back, head, and knee.
In a report, the researchers showed that there is significant evidence to demonstrate that acupuncture provides more than a placebo effect.
Professor of Acupuncture Research, Hugh MacPherson, working with a team of scientists from the UK and US, brought together the results of 29 high quality clinical trials focused on patients treated with acupuncture and standard medical care.
In the majority of these trials, patients with chronic pain treated with acupuncture and standard medical care were tested against those who were provided with standard medical care alone, such as anti-inflammatory drugs and physiotherapy. The trials involved approximately 18,000 patients diagnosed with chronic pain of the neck, lower back, head, and knee.
The report shows that the addition of acupuncture compared to standard medical care alone significantly reduced the number of headaches and migraine attacks and reduced the severity of neck and lower back pain. It also showed that acupuncture reduced the pain and disability of osteoarthritis, which led to patients being less reliant on anti-inflammatory tablets to control pain.

Hull University http://tinyurl.com/y8j5grso

For patients with colorectal cancer that has metastasised to the liver, having a primary tumour on the left side, as opposed to the right side of the colon, is known to be a significant advantage in terms of treatment response.
But now a new study, presented here at the ESMO 19th World Congress on Gastrointestinal Cancer, suggests this imbalance may be at least partially redressed.
Reversing the usual pattern, patients whose liver metastases had spread from right-sided primary tumours (RSP) had a 36% better survival rate after treatment with a combination of first-line chemotherapy and selective internal radiation therapy (SIRT) using Y-90 resin microspheres, compared to chemotherapy alone, according to the study.
This same treatment combination was no better than chemotherapy only in patients with left-sided primary tumours (LSP).
“These findings are good news for patients with right-sided primary tumours, who have a much worse prognosis and fewer treatment options than patients with left-sided tumours,” said study investigator Guy van Hazel, MD, from the University of Western Australia in Perth, Australia.
“We are excited because hitherto no treatment apart from the addition of bevacizumab to chemotherapy has improved the dismal outcome of liver metastases coming from right-sided primary tumours.”
The analysis included 739 patients from two completed studies called SIRFLOX (SF) and FOXFIRE-Global (FFG).
All patients had liver-only or liver-dominant metastatic colorectal cancer (mCRC), and had been randomised to receive either standard chemotherapy alone, or combined with SIRT. The chemotherapy regimen was mFOLFOX6, and most patients received bevacizumab as well.
Information on the patients’ primary tumour location was recorded at the start, with 24% having right-sided and 73% left-sided disease (the remaining 3% had primary tumours on both sides of the colon, or the primary tumour site was unknown).
Overall, outcomes were not different between the chemotherapy alone and chemotherapy plus SIRT groups, with median overall survival (OS) and progression-free survival (PFS) around 24 months and 11 months, respectively.
However, when the investigators examined patients with RSP and LSP separately they saw a clear difference.
Patients with liver metastases from RSP had significantly better OS when SIRT was added to their chemotherapy compared to those who had chemotherapy alone (22.0 vs. 17.1 months, respectively; p=0.007; Hazard Ratio [HR]: 0.64 [95% CI: 0.46-0.89]), but this was not the case for patients with LSP (24.6 vs. 25.6 months; p=0.279; HR: 1.12 [0.92-1.36]).
“That means that RSP patients treated with chemotherapy plus SIRT have a 36% reduced risk of dying at any time point,” said van Hazel.
There was also a 27% improvement in PFS, although this was not statistically significant.
“This is the first time that location of primary tumour has been linked to radiation therapy,” said van Hazel, and although it’s possible that it may only apply to patients receiving first-line therapy, he said it opens a new treatment option for these patients.

ESMO
www.esmo.org/Press-Office/Press-Releases/Right-sided-Colorectal-Tumours-An-Internal-Radiation-Advantage?hit=ehp