New technology being developed by researchers at the University of Waterloo and the Sunnybrook Research Institute is using artificial intelligence (AI) to help detect melanoma skin cancer earlier.
The technology employs machine-learning software to analyse images of skin lesions and provide doctors with objective data on tell-tale biomarkers of melanoma, which is deadly if detected too late, but highly treatable if caught early.
The AI system—trained using tens of thousands of skin images and their corresponding eumelanin and hemoglobin levels—could initially reduce the number of unnecessary biopsies, a significant healthcare cost. It gives doctors objective information on lesion characteristics to help them rule out melanoma before taking more invasive action.
The technology could be available to doctors as early as next year. “This could be a very powerful tool for skin cancer clinical decision support,” said Alexander Wong, a professor of systems design engineering at Waterloo. “The more interpretable information there is, the better the decisions are.”
Currently, dermatologists largely rely on subjective visual examinations of skin lesions such as moles to decide if patients should undergo biopsies to diagnose the disease.
The new system deciphers levels of biomarker substances in lesions, adding consistent, quantitative information to assessments currently based on appearance alone. In particular, changes in the concentration and distribution of eumelanin, a chemical that gives skin its colour, and hemoglobin, a protein in red blood cells, are strong indicators of melanoma.
“There can be a huge lag time before doctors even figure out what is going on with the patient,” said Wong who is also the Canada Research Chair in Medical Imaging Systems. “Our goal is to shorten that process.”
University of Waterloo http://tinyurl.com/ybbq9kek

In the largest, most rigorous study of its kind, acupuncture was found to significantly reduce the debilitating joint pain experienced by tens of thousands of women each year while being treated for early stage breast cancer, according to SWOG research results.
Investigators from SWOG, the global cancer clinical trials network funded by the National Cancer Institute (NCI), conducted a randomized, blinded, multicentre trial, known as S1200, to test whether acupuncture is effective in alleviating pain caused by aromatase inhibitors, a common treatment for hormone sensitive breast cancers.
Treating this pain effectively, without the use of opioids or other drugs, is a top cancer research priority. Tens of thousands of women each year are treated with aromatase inhibitors (AIs), pills that stop the production of estrogen and essentially starve hormone receptor-positive breast cancer cells. Some women are advised to take these pills daily for up to 10 years. But as a side effect of this therapy, many women – as many as 50 percent – experience joint pain and stiffness. This affects knees, hips, hands, and wrists, and makes it difficult for women to walk, sit, climb stairs, and perform simple tasks like typing or driving.
“Some of my patients have difficulty getting out of a chair,” said Dr. Dawn Hershman, the lead researcher of the study and a SWOG vice chair. “As a result, with no good treatment options for their pain and stiffness, many women stop their cancer treatment. This is probably the most commonly cited reason breast cancer patients stop taking AI medication. So we need a solution – one that doesn’t include opioids or drugs that can be addictive or have serious side effects. We want women to continue their cancer treatment and have a good quality of life.”
SWOG researchers for years have chased a way to relieve AI pain – known as AI-Associated Musculoskeletal Syndrome (AIMSS). Many women don’t want to take pills to relieve symptoms caused by other pills, according to Hershman, leader of the Breast Cancer Program at the Herbert Irving Comprehensive Cancer Centre at NewYork-Presbyterian/Columbia University Irving Medical Centre and professor of medicine and epidemiology at Columbia. In a single-centre study at Columbia, acupuncture showed promise. Hershman wanted to put it to the test in a larger, more rigorous study. Hershman and her team enrolled a total of 226 patients from 11 cancer centres nationwide and randomly assigned them to one of three arms. One group received true acupuncture. Another received sham acupuncture, a method of superficially inserting needles in different, non-therapeutic locations on the body. Finally, another group received no treatment at all.
Patients got twice-weekly treatments for six weeks, then a weekly maintenance treatment for another six weeks. Patients reported on their pain before, during, and after treatment using a variety of methods. The primary endpoint – or key indicator for the trial – was the patient’s level of worst pain using the Brief Pain Inventory (BPI-WP), a patient-reported measure, at the end of the first six weeks of treatment.
Results showed that, on average, patients experienced less pain on the acupuncture arm compared with the sham and treatment-free arms. Patients experienced relief for 24 weeks.
“This work strongly shows that true acupuncture results in better outcomes for women,” said Dr. Katherine Crew, a SWOG executive officer, director of the Clinical Breast Cancer Prevention Program at NewYork-Presbyterian/Columbia University Irving Medical Center and an associate professor of medicine and epidemiology at Columbia and a co-investigator on the study team. “I expect this work to influence medical practice, as well as insurers’ willingness to reimburse for acupuncture during AI treatment.”
SWOGhttps://tinyurl.com/ya58napm

Despite evidence showing that the routine use of sonography in hospital emergency departments can safely improve care for adults when evaluating for possible abdominal trauma injuries, researchers at UC Davis Medical Center could not identify any significant improvements in care for pediatric trauma patients. The findings, which resulted from a randomized clinical study involving 925 children with blunt torso trauma who were evaluated in the emergency department at the medical centre, showed no difference in important clinical outcomes. The outcomes assessed were developed for the study mainly based on previous research in injured adults.
The UC Davis team investigated the Focused Assessment with Sonography for Trauma (FAST) to determine whether the use of the FAST examination could safely lead to a decrease in the use of computed tomography (CT) scans for children, and other outcomes. FAST is a bedside ultrasound examination using a portable ultrasound machine. It has not been routinely used in the initial emergency department evaluations of injured children. CT scans represent the “gold standard” in diagnostic imaging for clinicians, including the identification of intra-abdominal injuries, but they also pose a greater radiation risk for children than they do for adults.
“A lot of our work has looked at the appropriate use of CT scans in injured patients,” said James Holmes, professor of emergency medicine and the study’s lead author. “At least in the adult trauma population, there’s evidence that you can use ultrasound to safely decrease CT use. One of the big questions has been whether that holds true for children, too.”
Holmes and his colleagues identified a study cohort of hemodynamically-stable children who presented in the emergency department at UC Davis Medical Center with blunt torso injuries resulting from mechanisms such as motor vehicle collisions and falls greater than 20 feet (6m). Four hundred and sixty patients were randomized to the FAST group and 465 to the no-FAST group, who received the same standard trauma evaluations but without ultrasound.
As in previous studies, the researchers wanted to determine whether the FAST protocol could significantly decrease the length-of-stay for patients in the emergency department, reduce hospital billing charges and still identify injuries when compared to patients who did not receive a FAST examination.
“We were surprised that the routine use of FAST did not show any significant differences,” said Nathan Kuppermann, professor and chair of emergency medicine at UC Davis and the study’s senior author and co-principal investigator. “The use of FAST compared with our standard trauma care did not decrease CT scan use, improve resource use, emergency department length-of-stay, safety or hospital charges.”

UC Davis Health http://tinyurl.com/yceftcp4

Nisha Pradhan was seven when she began to suspect she was missing out on something. Her sister seemed to have an uncanny knack for predicting what their mother was making for dinner. Pradhan, meanwhile, never had a clue.
“I would just stare at her,” Pradhan says. “She’s younger than me—how does she know more than I do?”
Now 21, Pradhan knows she has a limited ability to detect odour—including the smell of dinner cooking. Her situation is not unique: The sense of smell is often taken for granted, until it malfunctions.
As a patient in a clinical trial being conducted at Rockefeller University, Pradhan is helping scientists develop new smell tests, which promise to help improve diagnosis because they can be used reliably for anyone, anywhere. Because smell disorders can be linked to a variety of health conditions—interfering with appetite, as well as social interaction and sometimes leading to isolation, anxiety, and depression.
“People have their vision and hearing tested throughout their lives, but smell testing is exceedingly rare,” says neuroscientist Leslie Vosshall.
The new tests, developed by Vosshall along with Julien Hsieh, a Rockefeller clinical scholar, and their colleagues could even aid the early detection of neurological disorders that have been linked to problems with olfaction.
People suffer from smell loss for various reasons—a head trauma or sinus infection, for example, or even a common cold—and the cause can be as hard to pinpoint as the condition itself. In Pradhan’s case, she believes she lost much of her sense of smell as a young child, although she’s not sure how. She brought the issue up with her paediatrician, but never received any testing or guidance.
Both the medical community and the people affected by smell loss can be prone to overlook it. “Olfies,” says Pradhan, referring to people with a normal sense of smell, “think not having a sense of smell just affects our ability to detect gas leaks, smoke, and bad body odour. But it deprives us of so much more, including emotions and memories that are so intimate and integral to the human experience.”
A handful of tests already exist for diagnosing people like her. One problem with these tests is that they rely on a patient’s ability to detect and identify single types of odour molecules, such as rose-scented phenylethyl alcohol. However, the ability to detect odours and to recognize them can vary greatly between people. So, someone with an otherwise normal sense of smell may not be able to detect the rose molecule. Meanwhile, another person who can smell roses but is from an area where these flowers are scarce may struggle to put a name to the scent. In either case, there is the potential for misdiagnosis, particularly when testing across different populations and countries.
Hsieh and colleagues set out to eliminate these potential biases with the help of “white smells,” made by mixing many odours together to produce something unfamiliar. Just as a combination of wavelengths of light produces white light, and many frequencies of sound make up white noise, the team generated white smells from assortments of 30 different odour molecules. Their two new tests ask patients to distinguish white smells with overlapping ingredients and to detect white smells at increasingly lower concentrations.
If a person is unable to detect a single component of the test scent, this has little effect on the outcome, and test takers don’t need to identify the odour at all. “We’re really excited about these new tests,” says Vosshall, who is Robin Chemers Neustein Professor and a Howard Hughes Medical Institute investigator. “They focus on the problem of smell itself, because they don’t force people to match smells to words.”
Clinical trials conducted at The Rockefeller University Hospital and Taichung Veterans General Hospital in Taiwan showed that the new tests detected smell loss more reliably than conventional options. The results open up the possibility of a new means to detect smell loss worldwide. It could be used for detection of Alzheimer’s and Parkinson’s diseases, says Hsieh, now a resident at the Geneva University Hospitals in Switzerland.
“The goal is to use changes in the sense of smell, along with other biomarkers, to identify underlying causes of these neurological disorders very early, and so potentially improve treatment,” he says.

Rockefeller University www.rockefeller.edu/news/20624-new-smell-test-aid-early-detection-alzheimers-parkinsons/

Braunschweig Municipal Hospital and Siemens Healthineers are breaking new ground through an innovative medical technology partnership. Together, they have entered into a long-term Asset Management Services (AMS) contract. Braunschweig Municipal Hospital is one of the largest hospitals in northern Germany, with 1,499 beds and 38 clinics and institutes. Siemens Healthineers will assume responsibility for supplying and maintaining all initial and replacement equipment in the areas of radiology, radiotherapy and nuclear medicine. The partnership also includes strategic and operational consulting services to drive continuous improvement initiatives over time. On October 23, in Braunschweig, the parties signed a ten-year contract with a five-year extension option.
“The primary goal of this technology partnership is to assure high-quality and cost-effective medical care for our patients through first-class diagnostic radiological, surgical and radiotherapy services”, explains Ulrich Markurth, mayor of Braunschweig and chairman of the hospital’s supervisory board.
“We are very pleased to be able to contribute as a technology partner in the coming years to further improve the quality of patient care at the Braunschweig Municipal Hospital and its performance capability,” says Dr. Stefan Schaller, head of Siemens Healthineers in Germany. “In addition to the provision of innovative medical technology systems, we support the Braunschweig Municipal Hospital in planning new buildings and optimizing workflows in radiology, cardiology and the emergency department as well as in all steps towards the digitization of healthcare. This holistic package provides the hospital with security of planning, budget certainty and future reliability over the entire duration of the project.”
Matthias Platsch, President of Siemens Healthineers Services adds: “We are delighted to have been chosen as a technology partner for the Braunschweig Municipal Hospital and we are both proud and humbled by the vote of confidence that this important healthcare provider has placed in our new services portfolio. In this, Siemens Healthineers’ first asset management services partnership in Germany, we will combine the strength of our innovative product portfolio with the forward-looking business approach of our enterprise services to help deliver best-value clinical outcomes for patients. Together with the Braunschweig Municipal Hospital, we will transform healthcare delivery by leveraging our combined expertise in established and new care models. With a fresh look at the design and operation of the facility we will significantly improve the patient experience, and the new technologies we will deploy will enable more efficient and more precise clinical diagnosis. We are very excited to play such a role in the future of healthcare in Braunschweig.”
Hospital CEO Dr. Andreas Goepfert explains that the award of the contract for this technology partnership, including the vendor-neutral procurement and management of around 50 new systems (ranging from magnetic resonance and computed tomography, to angiography, X-ray, nuclear medicine and radiotherapy machines) is the result of a Europe-wide call for tenders via an initial selection process and a competitive dialogue. The fundamental premise is that this innovative, end-to-end partnership model – for procurement and management, in particular – will generate savings for the hospital compared to a series of individual, reactive calls for tender.
As a consequence, Siemens Healthineers will be responsible for procurement, installation, maintenance, servicing, an innovation guarantee (through updates and upgrades), and an availability guarantee for all devices. The long-term technology roadmap takes into consideration the hospital’s strategic orientation, especially its current plan to concentrate the hospital at two locations. A Syngo.via Enterprise solution will also give the hospital access to all Siemens Healthineers’ software applications, enabling it to stay at the forefront of digital innovation.
 “The technology partnership in the area of radiology will bring together the heterogeneous imaging device landscape and IT in our radiology department at Braunschweig Municipal Hospital,” forecasts its medical director, Dr. Thomas Bartkiewicz. “That ensures we always stay at the forefront of innovation in diagnostic imaging and imaging-based treatment, while ensuring radiation exposure for patients and employees is kept to a minimum.” Complex interfaces will be removed and the clinical staff will find their day-to-day work routines become noticeably simpler. Nursing director Ulrich Heller adds: “Different operating processes from various device manufacturers will be reduced to a single standardized system.” This will speed up workflows and improve quality of care at the same time. In addition, maintenance plans and contracts that were not previously coordinated will be combined as part of an optimized programme in the future. The result will be a sustainable reduction in maintenance costs.
The ‘Braunschweig Model’ for a technology partnership enables the hospital to respond flexibly to changing requirements and future device needs due to a separate ‘innovation budget’. This includes possible changes in both the scope and the timing of procurement throughout the entire term of the partnership. The fixed quarterly payment fee also provides the hospital with budgetary certainty for the contract duration.
“The technology partnership guarantees predictability of costs whilst providing security of investments in the fields of radiology, radiotherapy and nuclear medicine,” says hospital CEO Goepfert. The long-term technology partnership will enable the hospital to benefit from future technological advances in radiology, including innovative algorithms to improve image reading and computer-assisted diagnostic modules. This will ensure high-quality and cost-effective patient care for the long term.
The AMS also encompasses a number of flagship projects in which the two partners will work closely together in the future. For example, Siemens Healthineers will contribute the know-how in the area of molecular diagnostics built up by its company NEO New Oncology GmbH. Thanks to genome analyses of tumour tissue performed by NEO New Oncology, Braunschweig Municipal Hospital will be able to create customized, targeted treatment recommendations that will facilitate highly promising precision medical treatment for cancer patients. www.siemens.com/healthineers