Ultrasonography findings seem to correlate well with the disease activity of idiopathic inflammatory myopathies (IIMs), and may be a useful tool for patient evaluation, according to a study.
Joana Sousa Neves, M.D., from the Hospital Conde de Bertiandos in Ponte de Lima, Portugal, and colleagues evaluated 15 IIM patients (from 2005 to 2015). Patients had a mean age of 52.2 ± 22.09 years and mean disease duration of 4.6 ± 3.20 years. Assessments included a physical examination, muscle strength tests, laboratory analysis, and a selective muscle ultrasonography assessment.
The researchers found that nine of the 15 patients were in clinical remission, and ultrasonography revealed a preserved muscle pattern. In one patient with longstanding polymyositis with proximal weakness, symmetrical proximal muscle atrophy was found. In the remaining five patients, inflammation and focal or generalized muscle edema were present with muscular weakness, suggesting active disease. One of these patients in acute flare presented with atrophy changes plus edema. An additional patient had early untreated myositis with moderate power Doppler signal.
“As far as muscle ultrasonography assessment is concerned, a single specific pattern was not observed in our study. A mixture of muscle edema and atrophy was detected depending on disease activity and duration,” the authors write. “Ultrasonography findings seem to correlate well with disease activity, suggested by clinical data, and may be a useful tool to complement patient evaluation.”

Physician’s Weekly http://tinyurl.com/yaoy7u9u

Both short and long surgical incisions for caesarean births are associated with increased pain after delivery, suggests a study. Based on the findings, the authors recommend an optimal range for caesarean incision length to be between 12 and 17 centimetres (about 4.5 – 6.5 inches), and advise that neither shorter nor longer incisions be performed when possible.
“To our knowledge, this ‘Goldilocks effect’ of surgical incision length on pain outcomes has not been previously reported, and merits further investigation to unravel the effects of short-term tissue stretch and increased tissue trauma on acute and chronic post-caesarean pain,” said lead researcher Ruth Landau, M.D., associate director of obstetric anaesthesia and director of the Center for Precision Medicine in Anesthesiology at Columbia University Medical Center in New York. “We were surprised to find tremendous variability in surgical incision length. While the median length was 15 centimetres, the range was from 9 to 23 centimetres, which may in part be due to the surgeons’ practice and patients’ body characteristics.”
The study included 690 women undergoing elective caesarean delivery, of which 37 percent had a repeat caesarean, who were evaluated pre-operatively and followed for up to 12 months. Both the shorter and longer extremes of surgical incision length were associated with increased pain. Women with shorter incisions (less than 12 cm or about 4.5 inches) were more likely to report higher pain scores immediately after delivery, which, according to the authors, likely indicates intense tissue stretching during delivery. Women with longer incisions (more than 17 cm or about 6.5 inches) were also more likely to report higher pain scores, including wound hyperalgesia, or an increased sensitivity to pain around the surgical incision. 
Consistent with the researchers’ previous work, chronic pain after caesarean delivery was extremely rare, with less than 3 percent of women reporting chronic pain one year after their caesarean delivery. Among those who underwent a repeat caesarean, chronic pain was reported by 12 of them, compared to seven of the women who had a caesarean for the first time (4.7 percent vs 1.6 percent). Overall at one year, surgical-related pain symptoms, mostly described as “tender pain,” were reported by 4.7 percent of women, and neuropathic symptoms such as itching, tingling or numbing were reported by 19 percent.
 
American Society of Anesthesiologists (ASA)
www.asahq.org/about-asa/newsroom/news-releases/2017/10/length-of-incision-may-affect-pain-after-cesarean-delivery

Paediatric patients with head and neck cancer can be treated with proton beam therapy (PBT) instead of traditional photon radiation, and it will result in similar outcomes with less impact on quality of life. Researchers from the Perelman School of Medicine at the University of Pennsylvania as well as Children’s Hospital of Philadelphia analysed cases of paediatric head and neck cancer treated with PBT between 2010 and 2016 and found similar rates of tumour control and lower rates of toxicity than what is historically expected from photon radiation.
Cancers of the head and neck account for about 12 percent of all paediatric cancers, and they are generally different tumour types than those that affect adults. For solid tumours like neuroblastoma, thyroid cancer, and soft tissue sarcomas, treatment usually involves a combination of therapies including chemotherapy, radiation, and surgery. Post-operative radiation can be critical, since surgeons may not be able to completely remove all cancer given the complexity of the head and neck region.
The area’s sensitivity also means the effects of treatment can lower patient quality of life due to symptoms including loss of appetite, difficulty swallowing, or mucositis – in which ulcers form in the digestive tract, usually in reaction to chemotherapy or radiation.
“These concerns are especially important to address in paediatric patients, since they’re still developing and may need to deal with any adverse effects for the rest of their lives. This study shows that protons may be an important tool in improving quality of life both during treatment and for years after for these young patients,” said the study’s senior author Christine Hill-Kayser, MD, chief of the Paediatric Radiation Oncology Service at Penn and an attending physician at CHOP. CHOP cancer patients who need radiation therapy are treated at Penn, including proton therapy through the Roberts Proton Therapy Center.
Jennifer Vogel, MD, a resident in Radiation Oncology at Penn, is the study’s lead author.
Researchers looked at 69 Paediatric head and neck cancer patients treated with PBT at Penn and CHOP between 2010 and 2016. Thirty-five (50 percent) of those patients had rhabdomyosarcoma, a cancer of the cells that make up skeletal muscles. Ten (7 percent) were treated for Ewing sarcoma, a cancer most commonly found in the bone or soft tissue. The other 24 were treated for a variety of other cancers affecting the head and neck regions.
One year after treatment, 93 percent of patients were still alive, and 92 percent did not experience recurrence at their primary disease site.
Toxicities, or side effects, are measured on a scale from 1 to 5 with 5 being the most severe. In this study, no patients were above grade 3, and the most severe toxicities at that level were mucositis (4 percent), loss of appetite (22 percent), and difficulty swallowing (7 percent).
“Different disease sites required different dosage levels, and we specifically found the severity of muscositis was associated with higher doses of radiation,” Vogel said.
Those numbers are still well below what is typically associated with photon radiation. In rhabdomyosarcoma, for example, 46 percent of patients historically report grade 3 or 4 mucositis.
 “These data show proton therapy is not only effective, it is also more tolerable for patients,” Hill-Kayser said. “This study shows this treatment is safe and offers practice guidelines for delivering head and neck proton therapy in the Paediatric population.”
Penn Medicine
www.pennmedicine.org/news/news-releases/2017/october/proton-therapy-lowers-treatment-side-effects-in-Paediatric-head-and-neck-cancer-patients

Researchers at the University of Illinois at Urbana-Champaign have developed technology that enables a smartphone to perform lab-grade medical diagnostic tests that typically require large, expensive instruments. Costing only $550, the spectral transmission-reflectance-intensity (TRI)-Analyzer from Bioengineering and Electrical & Computer Engineering Professor Brian Cunningham’s lab attaches to a smartphone and analyses patient blood, urine, or saliva samples as reliably as clinic-based instruments that cost thousands of dollars.
“Our TRI Analyzer is like the Swiss Army knife of biosensing,” said Cunningham, the Donald Biggar Willett Professor of Engineering and director of the Micro + Nanotechnology Lab at Illinois. “It’s capable of performing the three most common types of tests in medical diagnostics, so in practice, thousands of already-developed tests could be adapted to it.”
In a recently published paper, Cunningham’s team used the TRI Analyzer to perform two commercially available assays—a test to detect a biomarker associated with pre-term birth in pregnant women and the PKU test for newborns to indirectly detect an enzyme essential for normal growth and development. Their tests results were comparable to those acquired with clinic-grade spectrometer instrumentation.
“The TRI Analyzer is more of a portable laboratory than a specialized device,” said Kenny Long, an MD/PhD student and lead author of the research study.
Among the many diagnostic tests that can be adapted to their point-of-care smartphone format, Long said, is an enzyme-linked immunosorbent assay (ELISA), which detects and measures a wide variety of proteins and antibodies in blood and is commonly used for a wide range of health diagnostics tests. The system is capable of detecting the output of any test that uses a liquid that changes colour, or a liquid that generates light output (such as from fluorescent dyes).
The TRI Analyzer operates by converting the smartphone camera into a high-performance spectrometer. Specifically, the analyser illuminates a sample fluid with the phone’s internal white LED flash or with an inexpensive external green laser diode. The light from the sample is collected in an optical fibre and guided through a diffraction grating into the phone’s rear-facing internal camera. These optical components are all arranged within a 3D-printed plastic cradle.
The TRI Analyzer can simultaneously measure multiple samples by using a microfluidic cartridge that slides through an opening in the back of the cradle. This ability to analyse multiple samples quickly and reliably makes the Analyzer suitable for patients who lack convenient access to a clinic or hospital with diagnostic test facilities or for patients with urgent health situations requiring rapid results. 

University of Illinois at Urbana-Champaign
bioengineering.illinois.edu/news/article/23435
 

A new generation of brain scanner, that can be worn like a helmet allowing patients to move naturally whilst being scanned, has been developed by researchers at the Sir Peter Mansfield Imaging Centre, University of Nottingham and the Wellcome Centre for Human Neuroimaging, UCL. It is part of a five-year Wellcome funded project which has the potential to revolutionise the world of human brain imaging.
The researchers demonstrate that they can measure brain activity while people make natural movements, including nodding, stretching, drinking tea and even playing ping pong. Not only can this new, light-weight, magnetoencephalography (MEG) system be worn, but it is also more sensitive than currently available systems.
The researchers hope this new scanner will improve research and treatment for patients who can’t use traditional fixed MEG scanners, such as young children with epilepsy or patients with neurodegenerative disorders like Parkinson’s disease.
Dr Matt Brookes leads the MEG work in the School of Physics and Astronomy at the University of Nottingham, where the prototype was built, he said: “This new technology raises exciting new opportunities for a new generation of functional brain imaging. Being able to scan individuals whilst they move around offers new possibilities, for example to measure brain function during real world tasks, or genuine social interactions. This has significant potential for impact on our understanding of not only healthy brain function but also on a range of neurological, neurodegenerative and mental health conditions.”
Brain cells operate and communicate by producing electrical currents. These currents generate tiny magnetic fields that are detected outside the head. Researchers use MEG to map brain function by measuring these magnetic fields. This allows for a millisecond-by-millisecond picture of which parts of the brain are engaged when we undertake different tasks, such as speaking or moving.
Current MEG scanners are large and weigh around half a ton. This is because the sensors used to measure the brain’s magnetic field need to be kept very cold (-269°C), which requires bulky cooling technology. With current scanners, the patient must remain very still whilst being scanned, as even a 5-mm movement can make the images unusable. This means it is often difficult to scan people who find it hard to remain still such as young children, or patients with movement disorders. It also poses problems when one might need a patient to remain still for a long time in order to capture a rarely occurring event in the brain, such as an epileptic seizure.
These problems have been solved in the new scanner by scaling down the technology and taking advantage of new ‘quantum’ sensors that can be mounted in a 3D-printed prototype helmet. As the new sensors are very light in weight and can work at room temperature, they can be placed directly onto the scalp surface. Positioning the sensors much closer to the brain increases the amount of signal that they can pick up.
The light-weight nature of the new scanner also means that, for the first time, subjects can move their heads during the scanning. However, the quantum sensors will only operate in this way when the Earth’s magnetic field has been reduced by a factor of around 50,000. To solve this problem, the research team developed special electromagnetic coils, which helped to reduce the Earth’s field around the scanner. These coils were designed specifically to sit either side of the subject, and close to the walls of the room, to ensure that the scanner environment is not claustrophobic.
The scanner is based around helmets that can be made to fit anyone who needs to be scanned. Following success of their prototype system, the researchers are now working towards new styles of helmet, which will have the appearance of a bicycle helmet, that will be suitable for babies and children as well as adults. The researchers predict this new type of scanner will provide a four-fold increase in sensitivity in adults, potentially increasing to 15 or 20-fold with infants.
University of Nottinghamwww.nottingham.ac.uk/news/pressreleases/2018/march/new-brain-scanner-allows-patients-to-move-freely-for-the-first-time.aspx