A brain-computer interface that can decipher the thoughts of people who are unable to communicate could revolutionize the lives of those living with complete locked-in syndrome. Counter to expectations, the participants in the study reported being ‘happy’ despite their condition.
In the trial, people with complete locked-in syndrome, who were incapable of even moving their eyes to communicate, were able to respond ‘yes’ or ‘no’ via thought to spoken questions. A non-invasive brain-computer interface (BCI) detected their responses by measuring changes in blood oxygen levels in the brain.
The results overturn previous theories that people with complete locked-in syndrome lack the goal_directed thinking necessary to use a brain computer interface and are therefore incapable of communication.
Extensive investigations were carried out in four people with ALS (amyotrophic lateral sclerosis) – a progressive motor neuron disease that leads to complete destruction of the part of the nervous system responsible for movement.
The researchers asked personal questions with known answers and open questions that needed ‘yes’ or ‘no’ answers including: ‘Your husband’s name is Joachim?’ and ‘Are you happy?’. They found the questions elicited correct responses seven times out of ten.
Professor Niels Birbaumer, a neuroscientist at the Wyss Center for Bio and Neuroengineering in Geneva, senior author of the paper said: ‘The striking results overturn my own theory that people with complete locked-in syndrome are not capable of communication. We found that all four people we tested were able to answer the personal questions we asked them, using their thoughts alone. If we can replicate this study in more patients I believe we could restore useful communication in completely locked-in states for people with motor neuron diseases.’
The question ‘Are you happy?’ resulted in a consistent ‘Yes’ response from the four people, repeated over weeks of questioning.
Professor Birbaumer said: ‘We were initially surprised at the positive responses when we questioned the four completely locked-in participants about their quality of life. All four had accepted artificial ventilation in order to sustain their life when breathing became impossible so, in a sense, they had already chosen to live. What we observed was as long as they received satisfactory care at home, they found their quality of life acceptable. It is for this reason, if we could make this technique widely clinically available, it would have a huge impact on the day-to-day life of people with complete locked-in syndrome’.

Wyss Center http://tinyurl.com/j7plj5n

Although treatable, empyema is a potentially deadly accumulation of pus around the lungs, occurring most commonly as a complication of pneumonia. To better manage this disease in the face of rising demand for treatment, the American Association for Thoracic Surgery (AATS) Guidelines Committee called for the formation of the Empyema Management Guidelines Working Group. Comprised of experts from a variety of disciplines including thoracic surgery, pulmonary and critical care medicine, infectious diseases, and interventional radiology, the group was tasked with analysing the latest literature about empyema and issuing new evidence-based clinical guidelines. The resulting Consensus Statement is published in the www.jtcvsonline.org/.

In the United States, around 1 million patients each year are hospitalised with pneumonia. Of this group, around 20percent to 40percent develop a parapneumonic effusion and 5percent-10percent of these will progress to empyema. Patients who experience empyema face discouraging odds: approximately 15percent of them will die and 30percent will require surgical draining to clear the infection. While occurrences of empyema dropped dramatically during first half of the 20th century thanks to improved antibiotic regimens, that trend changed in the 1990s. Now, doctors are seeing more cases, making empyema an even more relevant subject for clinical study.

‘The management of empyema has historically varied significantly from hospital to hospital and across the many different medical specialists who may care for patients with this disease,’ remarked lead author K. Robert Shen, MD, Department of Surgery, Mayo Clinic College of Medicine, Rochester, MN. ‘These new guidelines formulated by the AATS are important because they represent an attempt to develop recommendations that are based upon the best available current scientific evidence.

The guidelines encompass empyema presentation, diagnosis, and treatment presenting a comprehensive strategy for doctors treating empyema patients. There are several top-level takeaways from their findings:

Patients with pneumonia that fail to respond to established antibiotic therapy or unexplained sepsis should always be evaluated for a possible pleural effusion. If either a parapneumonic effusion or empyema is found, patients should undergo immediate treatment.
According to the group’s findings, surgery remains the most effective method for management of most patients with empyema despite advances in radiologic imaging, antibiotics, and other medications that have made it possible to treat without undergoing a surgical procedure.
Management of paediatric empyema differs significantly from treatment in adults. Investigators acknowledge there is currently disagreement about the best treatment protocols for children with empyema. After a comprehensive analysis of current literature, the group issued a recommendation that pediatric patients should initially be treated with a tube thoracostomy with or without the subsequent instillation of fibrinolytic agents.

As empyema cases become increasingly common, investigators hope these guidelines can help make diagnosis and treatment protocols more uniform across the country to help offer patients the best care possible. ‘Despite the widespread use of antibiotics and availability of pneumococcal vaccines, empyema remains the most common complication of pneumonia and an important cause of morbidity and mortality worldwide,’ concluded Dr. Shen. ‘It is hoped that these guidelines will provide clinicians who care for pneumonia patients with practical guidelines on the best way to treat their patients who develop empyema.’

EurekAlert www.eurekalert.org/pub_releases/2017-04/aaft-ain042017.php

Like many surgeons, Dr. Jason Spector is often faced with the challenge of securely closing the abdominal wall without injuring the intestines. If the process goes awry, there can be serious consequences for patients, including bowel perforations or a hernia at the incision site. Often, repairing these complications requires additional surgeries.
“I’ve done a lot of incisional hernia repairs on people who’ve had two, three, or more hernia repairs,” said Dr. Spector, a professor of surgery (plastic surgery) and of plastic surgery in otolaryngology at Weill Cornell Medicine, an adjunct professor in the Meinig School of Bioengineering and a plastic surgeon at NewYork-Presbyterian/Weill Cornell Medical Center.
Unsatisfied with the existing tools to help prevent these poor outcomes, Dr. Spector turned to his long-time collaborator Dr. David Putnam, an associate professor of biomedical engineering at Cornell University, who works at the Ithaca campus. Dr. Spector asked for material that would be strong enough to protect the intestines from a needle puncture and bendable enough to insert through a laparotomy incision that would quickly dissolve in the body.
As it turned out, Dr. Putnam’s then graduate student Nicole Ricapito had created and was testing a material that met those specifications. In a study the collaborators and their colleagues demonstrated that the compound was strong enough to protect mouse intestines during suturing of the abdomen and quickly dissolved in the body.
The compound is made up of polyethylene glycol, a chemical compound used in laxatives and many personal care products, and dihydroxyacetone (DHA), a natural by-product of the breakdown of glucose in the body. The U.S. Food and Drug Administration has approved the use of DHA in nutritional supplements and spray tanners. The polyethylene glycol lends flexibility to the device and DHA adds strength, Dr. Putnam said. Both break down when exposed to water in the body.
In the study, the material was used in lieu of plastic or metal devices called retractors that surgeons typically use to protect the intestines. Traditional retractors must be removed before the incision is completely closed, leaving the surgeon to carefully make the final stiches without protection for the intestines. But Drs. Spector and Putnam’s device is left behind in the abdominal cavity, allowing the final sutures to be made with protection still in place. The study found that the device dissolved within three hours of the surgery, leaving no scarring or signs of toxicity.
The next step for the collaborators will be to try to replicate the results with further preclinical testing. If further study of the device shows it to be safe and effective, Drs. Spector and Putnam hope to pursue commercial development. Cornell University has filed a patent for the device.

Weill Cornell Medicine
news.weill.cornell.edu/news/2017/07/dissolvable-device-could-make-closing-surgical-incisions-a-cinch

A new study led by researchers at UC San Francisco and Kaiser Permanente has identified genetic predictors of normal prostate-specific antigen (PSA) levels in healthy men, which could be used to improve the accuracy of PSA-based prostate cancer screening tests.
Until recently, PSA tests for prostate cancer were considered an exemplar of successful early cancer detection leading to improved treatment outcomes. But over the past five years, a series of studies has suggested that the tests are not sensitive enough: frequent false positives lead to too many unnecessary medical procedures, and false negatives give men a false sense of security. In 2012, the test was given a ‘D’ rating by the U.S. Preventive Task Force, and the test is no longer covered by some insurers.
‘In the few years that PSA testing has become less popular, the use of the test has declined and the number of prostate cancer diagnoses has dropped,’ said John Witte, PhD, a UCSF professor of epidemiology and biostatistics and of urology, and co-senior author of the new study. ‘Disturbingly, some of the cases that are detected are now being diagnosed at a later stage, making successful treatment less likely. It’s a big conundrum for the field.’
One of the problems with current PSA tests is that they are a one-size-fits-all measurement of a protein that men naturally produce at different levels. The new genome-wide association study – led by Witte and co-senior author Stephen K. Van Den Eeden, PhD, a research scientist at Kaiser Permanente Division of Research and professor of urology at UCSF – suggests that the PSA test could regain its place in cancer prevention by factoring in genetic variations that affect the amount of PSA different men naturally produce.
Key to the study was Kaiser Permanente’s rich and comprehensive long-term dataset. The study included 28,503 men from the Kaiser Permanente cohort and 17,428 men from additional replication cohorts, in the aggregate representing nearly half a million PSA tests going back to the 1990s.
‘The unique setting of Kaiser Permanente allowed us to link every man in the study to our electronic clinical data and determine not just that they had a test, but also the level and frequency of testing over many years,’ said Van Den Eeden.
Using this large and rich study population, Witte’s group was able to identify 40 genetic regions, or loci, that together predict nearly 10 percent of normal variation in PSA levels in men who do not have cancer.
The authors also determined that the rest of the genomic sites studied in the paper explained an additional 32 percent of normal PSA variation, though the study was not sensitive enough to identify the specific genetic loci responsible for this additional variation. The results suggest that even more genetic predictors of PSA levels are likely to be uncovered by future studies, the authors said.
Understanding a given patient’s genetic predisposition to high PSA could allow physicians to better evaluate test results to predict the patient’s actual risk of prostate cancer, according to Witte, either by normalizing the results of PSA screens based on each individual’s natural PSA levels or by adjusting the threshold used to determine if a test result should trigger further testing, such as a prostate biopsy.

UC San Francisco (UCSF) http://tinyurl.com/yct5sks5

People with multiple sclerosis can show signs of something wrong five years before the onset of disease, much earlier than previously thought, according to a new analysis of health records from people with the condition.

The new research is a first step to identifying red flags to help doctors screen for the disease and start interventions earlier. This could point researchers in a new direction for finding the root cause of the disease.

‘Proving that people with multiple sclerosis have already changed their behaviour in the five years before even the earliest medical recognition of the condition is very important because it means we have to look beyond those five years to understand how it is caused,’ said Helen Tremlett, senior author of the study and a professor in the department of medicine at the Djavad Mowafaghian Centre for Brain Health.

Multiple sclerosis is thought to be an autoimmune disease where the body attacks the protective coating, known as myelin, around brain cells. Once a person is diagnosed with multiple sclerosis, a physician will try to pinpoint the onset of the disease, sometimes known as the patient’s first demyelinating event, and can include problems with vision or motor control.

The researchers examined health records of 14,000 people with multiple sclerosis from B.C., Saskatchewan, Manitoba and Nova Scotia over a 20-year period and compared them to the health records of 72,000 people without the disease. They were looking for something called a prodrome, an early set of symptoms that can indicate the onset of a disease.

Prodromes have been identified for other neurological conditions like Alzheimer’s and Parkinson’s diseases. The recognition of these prodromes has provided clues about how the diseases might begin and has stimulated new research into causes or triggers.

This study of patients from across Canada revealed that there is a phase where people begin to show symptoms before multiple sclerosis is medically recognized. During this phase patients tend to visit their physicians, be admitted to a hospital and fill prescriptions more than the general population.

‘There’s something going on here that makes this population of people unique,’ said Jose Wijnands, first author of the manuscript, a postdoctoral fellow and a Michael Smith Foundation for Health Research trainee.

‘When other degenerative brain diseases have a prodrome, it suggests that something may be happening,’ said Tremlett. ‘We hope to uncover what this might be in multiple sclerosis.’

Going forward, the team of researchers will try to understand why these patients had been using the health-care system differently, and whether there are trends in illnesses reported and prescriptions filled that point to a specific set of symptoms that doctors could use to help identify multiple sclerosis earlier.

University of British Columbia news.ubc.ca/2017/04/21/medical-history-reveals-multiple-sclerosis-begins-to-impact-patients-sooner/