In a proof-of-principle case report, researchers announce that targeted fluorescence successfully identified pulmonary metastases in a patient with osteosarcoma, making it easier for surgeons to locate the tumours for resection.
The case study  by Jarrod Predina, Andrew Newton, Charuhas Deshpande, and Sunil Singhal of The Perelman School of Medicine at the University of Pennsylvania, and Philip Low of Purdue University, is notable for its impact on osteosarcoma resection, according to editor-in-chief, Brian Pogue.  
Osteosarcomas express a number of unique molecular markers, including the folate receptor alpha (FRα). This study utilized a near-infrared contrast agent known as OTL38, which binds to pulmonary metastases expressing FRα, and emits in the NIR range.  
In this study, the fluorescence emitted from the contrast agent allowed surgeons to locate both a known lung nodule and a small occult metastases-less than a half a centimetre-that was not visible in preoperative imaging, suggesting that this approach may enable the detection of small or hard-to-locate nodules during minimally invasive resection.  
The drug was safely delivered and no toxicity was observed, the authors reported. Both nodules were successfully resected using real-time fluorescence feedback.  
The authors report that this technique may enhance the surgeon’s ability to perform a variety of oncologic procedures including tumour localization, margin assessment, and intraoperative staging.   "The authors were able to examine the spatial heterogeneity of the folate-dye uptake and show that even though there is a complex uptake pattern, the shapes were representative of the underlying pathology distribution, and therefore provide a reasonable molecular tag for resection margins," said Brian Pogue.  
Initial reports indicate that more than 90% of primary lung cancers accumulate OTL38 and generate tumour fluorescence during minimally invasive pulmonary resection, suggesting that this technique may have application beyond pulmonary osteosarcoma. Future research will explore if this approach could be applicable to other pulmonary malignancies that express the FRα.  
SPIEspie.org/about-spie/press-room/press-releases/molecular-imaging-technique-successfully-identifies-lung-nodules-for-resection-in-patient-with-osteosarcoma

Although digital breast tomosynthesis (DBT), or 3-D mammography, costs more than a digital mammography (DM) screening, it actually may help rein in cancer screening costs, according to preliminary findings (PD7-05) presented by researchers from the Perelman School of Medicine. The group analysed 46,483 screening episodes – a single screening mammogram and all subsequent breast diagnosis related costs for the following year – in two hospitals within the University of Pennsylvania Health System in 2012 and 2013.
“Early detection is critical to saving lives and lowering costs,” said senior author Emily F. Conant, MD, chief of Breast Imaging at Penn Medicine. “Fortunately, breast imaging is more precise than ever thanks to DBT. Despite its higher initial cost, DBT is increasingly being embraced by radiologists nationwide. If you look at expenses associated with breast diagnosis in the following year after initial screening, DBT is more cost effective in terms of health system or population level screening.”
Previous studies modelling outcomes have demonstrated that DBT can be cost effective. In this study, the authors analysed actual costs and patient outcomes within a single health system where both DM and DBT screening occurred. They excluded any episodes in which the patient had a prior breast cancer diagnosis or reached 90 years of age before the end of the follow-up period. DM represented 53 percent of the episodes and DBT represented 47 percent. Fifty three percent of women studied received DM and 47 percent received DBT.
They tested DBT and DM according to four outcomes – true positive (TP), true negative (TN), false positive (FP), and false negative (FN) rates – by comparing the Breast Imaging Reporting and Data System (BI-RADS) score (assigned at screening with data about subsequent cancer diagnosis).
DBT was a more effective screening method. Compared to DM episodes, DBT episodes had lower FP (8.6% vs. 10.8%) and higher TN (90.9% vs. 88.7%, p<0.001) rates. (There were no statistically significant differences between DBT and DM episodes with respect to TP and FN rates.)
Although it screened more effectively, DBT did cost more than DM. Overall, average episode costs were higher for DBT compared to DM ($378.02 vs. $286.62). This difference was driven by higher average screening costs ($215.94 vs. $155.76), which approximated the additional charge for DBT, as well as follow-up costs ($23.67 vs. $12.11). There was no significant difference in costs between DBT and DM episodes within the diagnosis or cancer treatment windows.
DM and DBT episodes had roughly the same average episode costs per woman screened for FP ($67.75 vs. $65.71), FN ($4.63 vs. $5.60) and TP ($85.80 vs. $65.15) outcomes despite the higher cost per individual DBT study. The higher costs for TN ($219.84 vs. $150.16) outcomes approximated the higher CMS (Centers for Medicam and Medicinal Services) charge for DBT.
Penn Medicinehttps://tinyurl.com/y7nemu7g

Accurately detecting a rare but devastating cause of blindness in premature babies can be done as effectively with telemedicine as with traditional, in-person eye exams, a study suggests. This is believed to be the first study to directly compare the two approaches.
The finding could enable more blindness-preventing treatment for infants born in rural and other areas where there are few ophthalmologists trained to detect the condition, called retinopathy of prematurity, or ROP. Musician Stevie Wonder went blind due to this condition.
“A lack of access to trained ophthalmologists with experience diagnosing ROP sadly prevents many premature infants from receiving much-needed screening, both in developed and developing countries,” said the study’s lead researcher, Michael F. Chiang, M.D., a professor of ophthalmology and medical informatics & clinical epidemiology in the OHSU School of Medicine and a paediatric ophthalmologist at OHSU’s Elks Children’s Eye Clinic.
Retinopathy of prematurity is caused by abnormal blood vessel growth near the retina, the light-sensitive portion in the back of an eye.
Some U.S. medical associations recommend an in-person exam, which involves a special magnifying device that shines light into a baby’s dilated eye, to diagnose the condition. But trained professionals aren’t always easy to find in rural areas and developing countries.
The research team compared the accuracy of in-person exams with digital eye images that were remotely evaluated by professionals. They partnered with seven medical institutions to examine the eyes of 281 infants who were at risk for the condition. Each eye was evaluated both in-person and remotely with a wide-angle telemedicine image.
The researchers found there was no difference in the overall accuracy between the two evaluation methods. In-person examiners were found to be slightly better at accurately diagnosing the condition’s later-stage development, but the research team concluded telemedicine could be used to diagnose clinically significant cases of retinopathy of prematurity.
OHSU School of Medicinenews.ohsu.edu/2018/04/06/telemedicine-provides-accurate-diagnosis-of-rare-cause-of-blindness-in-preemies

Microscopic yeast have been wreaking havoc in hospitals around the world—creeping into catheters, ventilator tubes, and IV lines—and causing deadly invasive infection. One culprit species, Candida auris, is resistant to many antifungals, meaning once a person is infected, there are limited treatment options. But in a recent Antimicrobial Agents and Chemotherapy study, researchers confirmed a new drug compound kills drug-resistant C. auris, both in the laboratory and in a mouse model that mimics human infection.
APX001, the prodrug of the active moiety APX001A, is currently in clinical development by Amplyx Pharmaceuticals. It works through a novel mechanism of action. Unlike other antifungal agents that poke holes in yeast cell membranes or inhibit sterol synthesis, the new drug targets an enzyme called Gwt1, which is required for anchoring critical proteins to the fungal cell wall. This means C. auris can’t grow properly and has a harder time forming drug-resistant fungal biofilms that are a stubborn source of hospital outbreaks. Gwt1 is highly conserved across fungal species, suggesting the new drug could treat a broad range of fungal infections.
“The drug is first in a new class of antifungals, which could help stave off drug resistance. Even the most troublesome strains are unlikely to have developed workarounds for its mechanism of action,” said study lead Mahmoud A. Ghannoum, PhD, professor of dermatology at Case Western Reserve University School of Medicine and director of the Center for Medical Mycology at Case Western Reserve University and University Hospitals Cleveland Medical Center.
In the new study, Ghannoum’s team tested the drug against 16 different C. auris strains, collected from infected patients in Germany, Japan, South Korea, and India. When they exposed the isolates to the new drug, they found it more potent than nine other currently available antifungals. According to the authors, the concentration of study drug needed to kill C. auris growing in laboratory dishes was “eight-fold lower than the next most active drug, anidulafungin, and more than 30-fold lower than all other compounds tested.”
The researchers also developed a new mouse model of invasive C. auris infection for the study. Said Ghannoum, “To help the discovery of effective drugs it will be necessary to have an animal model that mimics this infection. Our work helps this process in two ways: first we developed the needed animal model that mimics the infection caused by this devastating yeast, and second, we used the developed model to show the drug is effective in treating this infection.”
Ghannoum studied immunocompromised mice infected with C. auris via their tail vein—similar to very sick humans in hospitals who experience bloodstream infections. Infected mice treated with APX001 and anidulafungin had significant reductions in kidney and lung fungal burden two days post-treatment, compared to control animals. APX001 also significantly decreased fungal burden in the brain, consistent with brain penetration, whereas reduction with anidulafungin did not reach significance. The results suggest the new drug could help treat even the most invasive infections.
According to Ghannoum, the most exciting element of the study is that it brings a promising antifungal one step closer to patients. It helps lay the foundation for phase 2 clinical trials that study that study the safety and efficacy of new drugs in patients with fungal infections. There is an urgent need for such studies, as C. auris infection has become a serious threat to healthcare facilities worldwide—and resistance to commercially available antifungal drugs is rising.
Case Western Reserve University Medical Schoolcasemed.case.edu/cwrumed360/news-releases/release.cfm?news_id=906&news_category=8

Fysicon announced on March 7 that it has been acquired by Canon Medical Systems Corporation.

Linda Elberse, CEO of Fysicon: "Being part of a major player as Canon Medical Systems Corporation gives us the opportunity to cover all parts of the world with our innovative systems. Now Canon Medical has completed the image by adding Fysicon’s new developed hemodynamic monitoring system “QMAPP”, the sophisticated device management system “DataLinQ” and the cloud based image distribution software “EVOCS" and last but not least Fysicon’s knowledge of connectivity and workflow management. Canon Medical is a strong brand name and a leading supplier, that will help us take the next steps into strengthening and growing our footprint in the global market. Furthermore we will keep developing new technologies and exploring new areas in the medical field together with our new parent company. We are very proud to have joined forces!”

Toshio Takiguchi, President of Canon Medical Systems, said: “We are really pleased that we can provide new clinical value to patients and medical professionals by combining Fysicon’s advanced technologies with our systems.“ 

About Fysicon
Fysicon was founded in 1996 and employs approximately 40 employees. The company is headquartered in the Netherlands (Oss) and has a subsidiary in the UK. Hospitals around the world are using Fysicon’s hardware and software to streamline cardiac workflows and manage their data exchange.
Fysicon designs, develops and produces innovative medical technologies in the areas of structural heart disease and medical imaging for hospitals, research institutes and industry. Both hardware as well as software are developed and produced in-house, to guarantee the highest level of quality.  Fysicon challenges healthcare by developing innovative, intuitive and high quality medical solutions for healthcare professionals empowering them to treat patients faster, better and more cost effective.www.fysicon.com 

About Canon Medical Sytems Corporation
Canon Medical offers a full range of diagnostic medical imaging solutions including Ultrasound, CT, X-Ray, and MR, across the globe. On January 4, 2018, Toshiba Medical changed its company name to Canon Medical Systems Corporation. In line with our continued Made for Life philosophy, patients are at the heart of everything we do. Our mission is to provide medical professionals with solutions that support their efforts in contributing to the health and wellbeing of patients worldwide so that together our industry-leading solutions deliver an enriched quality of life.https://global.medical.canon