A team of Mayo Clinic researchers has, for the first time, successfully mapped patterns of prostate cancer recurrence, following surgery. Using C-11 choline PET imaging and multi-parametric MRI, researchers found an anatomically diverse pattern of recurrence, which may help optimize treatment of patients whose prostate cancer returns after surgery.
‘This study has important implications for men who have a rising prostate-specific antigen (PSA) test, also known as biochemical recurrence, after radical prostatectomy for prostate cancer,’ says Jeffrey Karnes, M.D., a urological surgeon at Mayo Clinic. ‘In men with biochemical recurrence, determining where the disease has recurred is quite challenging, especially when the PSA level is low.’
According to Dr. Karnes, in the U.S., approximately 30 percent of patients who have had an initial prostate cancer surgically excised will suffer a recurrence and seek treatment. ‘Current imaging tests like conventional bone and CT scans are not sensitive enough to identify sites of recurrence, especially when the PSA value is lower than 10,’ he says.
Dr. Karnes says the combination of C-11 choline PET scanning and multiparametric MRI, helps physicians accurately identify sites of recurrence at an average PSA of 2. More importantly, he says, ‘This type of staging allows us to identify sites of recurrent disease that can be potentially treated either surgically or with radiation.’
Dr. Karnes and his team also were able to describe patterns of prostate cancer recurrence. They found that nearly two-thirds of men in the study had recurrence limited to the pelvis, which potentially can be targeted for radiation therapy.

Mayo Clinic http://tinyurl.com/h9ot93x

Early bicycle exercise during their stay in a hospital intensive care unit (ICU) may help some patients recover more quickly.
Researchers at McMaster University and St. Joseph’s Healthcare Hamilton have demonstrated that physiotherapists can safely start in-bed cycling sessions with critically ill, mechanically ventilated patients early on in their ICU stay.
‘People may think that ICU patients are too sick for physical activity, but we know that if patients start in-bed cycling two weeks into their ICU stay, they will walk farther at hospital discharge,’ says the study’s lead author Michelle Kho, an assistant professor with the School of Rehabilitation Science at McMaster University and physiotherapist at St. Joseph’s Healthcare Hamilton.
‘Our TryCYCLE study builds on this previous work and finds it is safe and feasible to systematically start in-bed cycling within the first four days of mechanical ventilation and continue throughout a patient’s ICU stay.’
Patients who survive their ICU stay are at high risk for muscle weakness and disability, and muscle atrophy and weakness starts within days of a patient’s admission to the ICU. Cycling targets the legs, especially the hip flexors, which are most vulnerable to these effects during bed rest.
By strengthening their muscles and overall health, patients may go home sooner, stronger and happier. This not only benefits the patient, but could alleviate the high cost of critical care for the healthcare system. TryCYCLE is the first of a series of studies that will determine the effects of early in-bed cycling with critically ill patients.
Over a year, Kho and her team conducted a study of 33 patients in the ICU at St. Joseph’s Healthcare Hamilton. The special in-bed cycling equipment was provided by the St. Joseph’s Healthcare Foundation.
Patients were 18 years of age or older, receiving mechanical ventilation, and walking independently prior to admission to the ICU. The treatment in the ICU was 30 minutes of supine cycling using a motorized stationary bicycle affixed to the bed, six days a week.
The researchers found that early cycling within the first four days of mechanical ventilation among patients with stable blood flow is safe and feasible. Patients started cycling within the first three days of ICU admission and cycled about 9 km on average during their ICU stay.

McMaster University http://tinyurl.com/h7bqgbv

Researchers from the UCL GOS Institute of Child Health have discovered a new gene change that identifies a type of the movement disorder, muscle dystonia. This new discovery will allow doctors to more easily identify patients who can benefit from treatment so effective that it can restore the ability to walk.
The team from UCL Great Ormond Street Institute of Child Health, along with colleagues at the University of Cambridge and the NIHR Rare Disease Bioresource, identified a change in a gene, called KMT2B, in 28 patients who had dystonia.

Dystonia is one of the most common movement disorders and is thought to affect 70,000 people in the UK. It can cause a wide range of disabling symptoms, including painful muscle spasms and abnormal postures, and can affect walking and speech. In most of the 28 cases, the patients – many of whom were young children who were thought to have a diagnosis of cerebral palsy – were unable to walk.

For some patients, treatment with Deep Brain Stimulation, in which electrical impulses are delivered to a specific area in the brain, either restored or significantly improved independent walking and improved hand and arm movement. In one patient, improvements have been sustained over six years.

Given the findings, the team now suggest that testing for these changes in the gene should form part of standard testing for patients with dystonia. This will allow the most effective treatment to be offered to patients early on.

Dr Manju Kurian, paediatric neurologist at Great Ormond Street Hospital and lead researcher on the paper, says ‘Through DNA sequencing, we have identified a new genetic movement disorder that can be treated with Deep Brain Stimulation. This can dramatically improve the lives of children with the condition and enable them to have a wider range of movement with long-lasting effects,’

‘Remarkably nearly all patients who had Deep Brain Stimulation showed considerable improvements. One patient was able to walk independently within two weeks; in five patients, the improvement has lasted for more than three years. It is an astounding result.’

Former GOSH patient, Dominika, aged 21, was diagnosed with dystonia when she was 13 and had deep brain stimulation treatment two years ago:

When I was young I was able to speak and write normally but I started to have problems with walking when I was about 10. By the time I was 11 or 12, my walking had got worse and I started to notice my writing and speech was deteriorating.
Throughout high school, I had lots of different tests to try and find out what was wrong with me and I first came to GOSH just after my 13th birthday. They gave me lots more tests and told me that I had a type of dystonia which means my muscles aren’t working properly and I can’t move my body as well as I should.

By the time I got to the last year in high school, I was finding walking very difficult and so I started using a wheelchair because it was easier and less painful.

I was given a drug treatment for my dystonia but it didn’t seem to be making things much better so when I was 19, I was offered deep brain stimulation surgery.

Since the operation, life has been good and the surgery has really changed things for me. It has allowed me to walk around mostly unaided. I have seen a big difference with my hands – I can now write and draw, something I wasn’t able to do before. Now, I just do physiotherapy exercises at home to keep my movement as strong as possible. This has meant that I have been able to go to university and I am currently in my final year studying Computer Game Art. I get to practise my drawing using traditional and digital media, and hopefully one day I can get a job doing the two things I love best, drawing and playing video games.

Great Ormond Street Hospital for Children www.gosh.nhs.uk/news/latest-press-releases/2016-press-releases/remarkable-recovery-patients-diagnosed-newly-defined-movement-disorder-0

A unique new imaging method, called ‘polarized nuclear imaging’ – combining powerful aspects of both magnetic resonance imaging and gamma-ray imaging and developed by physicists in the University of Virginia’s departments of Physics and Radiology – has potential for new types of high-resolution medical diagnostics as well as industrial and physics research applications.
‘This method makes possible a truly new, absolutely different class of medical diagnostics,’ said Wilson Miller, who, along with his colleague Gordon Cates, directed the research. ‘We’re combining the advantages of using highly detectable nuclear tracers with the spectral sensitivity and diagnostic power of MRI techniques.’
‘We have demonstrated the feasibility of the new technique by producing a proof-of-principle image in a manner never before accomplished,’ Cates said. ‘In our technique, rather than imaging protons in water, as in MRI, we image a radioactive isotope of xenon that has been polarized using laser techniques.’
Cates and his colleagues believe that the technique, once refined, could provide a new, relatively inexpensive way to visualize the gas space of the lungs by having patients inhale a gas containing the isotopes and using PNI to produce an image. The method likewise might work to image targeted areas of the body by injecting isotopes into the bloodstream. Because the technique would use such small quantities of tracer material, when it comes to medical use, the radioactivity would pose little to no danger to people.
MRI, is effective because it uses a variety of contrast mechanisms to sort out specific characteristics in an image. And highly sensitive gamma-ray detectors can resolve minuscule amounts of radioactive tracer material, key to homing in on points of particular interest.
The new UVA technique uses magnetic resonance to obtain the spatial information, and then collects image information by detecting gamma rays produced by the tracer material – an isotope of xenon Xe-131m, which is a by-product of Iodine 131 (used for treatment of thyroid problems).
‘Unlike MRI, which detects faint radio waves, we detect gamma rays that are emitted from the xenon isotope,’ Cates said. ‘Since it is possible to detect a gamma ray from even a single atom, we gain an enormous increase in imaging sensitivity, and dramatically reduce the amount of material needed for performing magnetic-resonance techniques.’
As an example, had Cates and Miller filled their imaging subject – in this case a small glass cell shaped like the Chinese symbol for the word ‘middle’ – with water rather than the radioactive isotope, they would have needed about 10 billion times more water molecules than the number of isotope atoms they used to achieve the same image quality.
This means that with minute quantities of material, they can achieve detailed imagery using magnetic-resonance techniques that would otherwise be
impossible using a radioactive tracer.
The authors note that considerable work still needs to be done to demonstrate the utility of the new technique in living subjects, but the unique approach ‘represents an exciting new technology.’
To develop it for practical use, the researchers say they would need to increase the size of the detectors or the amounts of tracer material, and they are seeking alternative radioactive isotopes that would retain their polarization once inside a living subject.

University of Virginia http://tinyurl.com/zpobeo7

Intensive Care Units (ICUs), which provide the most expensive and invasive forms of care in a hospital setting, are being used too often for patients who don’t need that level of care, according to a new study by LA BioMed and UCLA researchers .
The researchers studied 808 ICU admissions from July 1, 2015 to June 15, 2016 at Harbor-UCLA Medical Center and found that more than half the patients could have been cared for in less expensive and invasive settings.
Of the patients in the study, 23.4percent were in need of close monitoring but not ICU-level care. Another 20.9percent of the patients were critically ill but unlikely to recover because they had underlying illnesses or severity of acute illness. For another 8percent, death was imminent or the same outcomes were expected in non-ICU care.
‘Our study found over 50percent of patients admitted to the ICU were categorized into groups suggesting that they were potentially either too well or too sick to benefit from ICU care or could have received equivalent care in non-ICU settings,’ said Dong W. Chang, MD, an LA BioMed researcher and the corresponding author for the study. ‘This research indicates that ICU care is inefficient because it is devoting substantial resources to patients who are less likely to benefit from this level of care. These findings are a concern for patients, providers and the healthcare system because ICU care is frequently invasive and comes at a substantial cost.’
The researchers added up the number of days each of the patients in the study spent in ICU and found nearly 65percent of the total number of days those patients spent in ICU were allocated to care that was considered discretionary monitoring, had a low likelihood of benefit despite critical illness or would have been manageable in non-ICU settings.
‘While this is a study of just one hospital and results may differ at other medical centres, we suspect that these characteristics of ICU utilization are commonplace and prevalent in many institutions,’ said Dr. Chang.
The researchers also noted that in other hospitals, the ICU may be the most appropriate level of care because the hospitals don’t have appropriate levels of care for those patients outside the ICU.
‘However, there is likely to be a subset of patients in which ICU care leads to unwanted, invasive care without significant clinical benefit,’ said Dr. Chang. ‘Refining our ability to identify these patients and developing approaches to improve ICU utilization for those patients are important steps to assure the best care for patients and the most efficient use of the healthcare system’s limited resources.’

LA BioMed http://tinyurl.com/ztppu5j