Among women with dense breast tissue, for whom traditional mammograms are less effective at detecting cancer, who request additional screening after a negative mammogram, abbreviated breast MRI (AB-MR) may be a valuable cancer detection tool. In a study of 195 asymptomatic women with dense breast tissue who had a negative mammogram within the previous 11 months, AB-MR detected five additional cancers after a negative screening mammography, according to preliminary findings from a Penn Medicine team presented this week at the Radiological Society of North America meeting in Chicago.
To put this in perspective, the cancer detection rate of mammography is roughly 4 cancers in 1,000 women who have a mammogram. Digital tomosynthesis (DBT), or 3D mammography, does slightly better, detecting approximately 25 percent more cancers, or roughly 5 cancers in 1,000 women screened. Based on the preliminary results at Penn Medicine, the cancer detection rate of AB-MR screening is 25 cancers per 1,000 patients. One in eight women in the United States will develop breast cancer at some point during their life.
“Having dense breast tissue makes it more difficult to detect a cancer on a mammogram,” said the study’s lead author, Susan Weinstein, MD, an associate professor of Radiology and the director of breast MRI at Penn Medicine. “Based on the literature and our results, women with dense breast tissue who desire supplemental screening, these results suggest that AB-MR may be a better option than other supplemental screening tests such as whole breast ultrasound.
The most common exam offered for asymptomatic patients seeking supplemental screening is a whole breast screening ultrasound examination. However, screening ultrasound examinations have higher rates of false positives, meaning more cases of positive screenings where no cancer is present.
Based on the results from Penn’s study, the AB-MR may be a better option. American Cancer Society guidelines currently recommend a full breast MRI, not an AB-MR, in women who, based on family history of breast or ovarian cancer and/or previous treatment for Hodgkin disease, have a 20 to 25 percent or greater lifetime risk of breast cancer.

Penn Medicinehttps://tinyurl.com/yd4hph83

The marketing of direct-to-consumer “neurotechnologies” can be enticing: apps that diagnose a mental state, and brain devices that improve cognition or “read” one’s emotional state. However, many of these increasingly popular products aren’t fully supported by science and have little to no regulatory oversight, which poses potential health risks to the public. In a new piece published in the journal Science this week, two bioethicists from Penn Medicine and the University of British Columbia suggest the creation of a working group that would further study, monitor, and provide guidance for this growing industry – which is expected to top $3 billion (€2.63 billion) by 2020.
“There’s a real thirst for knowledge about the efficacy of these products from the public, which remains unclear because of this lack of oversight and gap in knowledge,” said lead author Anna Wexler, PhD, an instructor in the department of Medical Ethics and Health Policy at the Perelman School of Medicine at the University of Pennsylvania. “We believe a diverse, dedicated group would help back up or refute claims made by companies, determine what’s safe, better understand their use among consumers, and address possible ethical concerns.”
The group, made up of researchers, ethicists, funders, and industry experts, among others, the authors wrote, would serve as a clearinghouse for regulatory agencies, such as the U.S. Food and Drug Administration (FDA) and the Federal Trade Commission (FTC), third-party organizations that monitor advertising claims, industry, social and medical scientists, funding agencies, and the public at large.
While some of these techniques are used in clinical and research laboratory settings – for example, electroencephalography (EEG) devices are used to diagnose and treat epilepsy — many consumer-grade versions of neurotechnology devices are only loosely based in science. It is unclear whether the laboratory data collected to test them is applicable to consumer-grade products, leading many in the scientific world to question the efficacy, and advocate for increased regulation of these readily available techniques and products.
For example, some consumer neurostimulation devices may pose dangers, such as skin burns. There are also potential psychological harms from many consumer EEG devices that purport to “read” one’s emotional state.
“If a consumer EEG device erroneously shows that an individual is in a stressed state, this may cause him or her to become stressed or to enact this stressed state, resulting in unwarranted psychological harm,” the authors wrote. Also, a smartphone wellness app that diagnoses symptoms of depression does so without medical support structures, such as a psychologist or mental health counsellor.

Penn Medicinehttps://tinyurl.com/ydfk5fdg

Researchers at Loma Linda University Health found that kidney transplantation can be safely performed using organs testing positive for the hepatitis C virus (HCV) antibody but negative for active viral infection. Their findings, published July 24, 2018 in the American Journal of Transplantation, could expand the number of kidneys available for those in need.
“One way of increasing the kidney donor pool is to utilize more organs from HCV positive donors,” said the study’s lead author, Michael E. de Vera, MD, director of Loma Linda University (LLU) Transplant Institute. “Currently, HCV positive donors are defined by donors that have previously had HCV even if they were cured. Now there has been a call to redefine the definition of an HCV positive donor in hopes that more organs can be used from these donors.”
Co-author of the study, Michael Volk, MD, director of transplant hepatology at LLU Tansplant Institute, participated in a 2017 American Society of Transplantation consensus conference, which encouraged the use of organs testing positive for HCV — those with only a positive antibody, as well as those testing positive for the virus. This recommendation stems in part from the availability of newer and better medications to cure people of the virus. “These organs testing positive for HCV are frequently discarded and often come from younger donors,” Volk said. “This approach has the potential to save lives by increasing the numbers of transplants.”
Although there is a record number of deceased organ donors, de Vera said the gap between the number of kidney transplants performed and the number of patients on the waiting list remains substantial. There are now nearly 95,000 kidney patients on the waiting list, but less than 20,000 kidney transplants occurred in 2017, according to the United Network for Organ Sharing. The problem is even wider in California, where nearly 2,300 people received a kidney in 2017, while nearly 19,000 remained on the waitlist.
HCV is tested in organ donors by checking for the presence of HCV antibodies (Ab) and HCV RNA, de Vera said. The presence of HCV antibodies shows that the virus at some point affected the host, but does not reveal if the host was cured. The presence of HCV RNA, on the other hand, indicates active infection. Many organ donors are HCV Ab positive but HCV RNA negative, and doctors have been reluctant to transplant kidneys from these donors for fear of transmitting HCV to the recipient. As a result, many of these kidneys have not been used in the past.
“Our hope is that this study will convince transplant doctors that the use of these donor kidneys is safe and does not lead to HCV transmission,” said de Vera. “And hopefully, more patients will receive these life-saving organs.”
The study was titled, “Transplantation of hepatitis C virus (HCV) antibody positive, nucleic acid test negative donor kidneys to HCV negative patients frequently results in seroconversion but not HCV viremia.” The study looked at 32 patients who were transplanted with HCV Ab+/NAT- kidneys at Loma Linda University Medical Center from January 2017 to February 2018. All patients consented to the surgeries. Recipient ages ranged from early 40s to late 60s, and donor ages ranged from late 20s to mid 50s. All 32 patients are doing well without evidence of hepatitis C virus infection.
https://lluh.org/?rsource=lluhealth.org/

The two synergistic trade exhibitions for the medical, healthcare and MedTech sectors, Medical Fair Asia and Medical Manufacturing Asia 2018 closed to resounding success on 31st August. With its largest edition to date, more than 14,000 trade visitors from 72 countries visited the fairgrounds of Medical Fair Asia this year — a 16 per cent increase from 2016. Medical Manufacturing Asia 2018 registered some 6,000 visitors from 56 countries – making it a 12 per cent increase from the previous edition.
The three-day synergistic exhibitions hosted more than 1,220 exhibitors from 62 countries who reached out to a diverse, international profile of visitors. While 40 percent of the visitors came from outside Singapore, the majority were from Asia with neighbouring ASEAN countries particularly well represented. As Dr Chew Wei Lun, a certified functional medicine practitioner and first-time visitor observed, “I was impressed by the breadth of products on show and the wide internationality of exhibitors. In fact, I even learned more about the rehabilitative products which I was on the lookout for.”
Confirming its position as the region’s leading business platform for the healthcare and medical sector, Medical Fair Asia 2018 hosted a total of 23 national pavilions and country groups — its strongest line-up yet. The Russian Pavilion was among the nine new country pavilions which made their debut at the show.

The positive market outlook for the medical and MedTech sectors was well-reflected by the number of high-quality visitors seeking cutting-edge solutions among the more than 10,000 products showcased at the exhibition, representing the entire end-to-end value chain from medical manufacturing processes and machinery, to finished products and components.
New technology and digital health solutions were the big draws at the exhibitions, with the new Start-up Park gaining much interest as a dedicated showcase for young companies to pitch to top decision makers and seek potential investors.
On the Medical Manufacturing Asia front, companies with new approaches to innovation also took centre stage, underlined by the opening speech by Dr Koh Poh Koon, Senior Minister of State for Trade and Industry. He emphasized the growing trend of medical technology companies moving up the value chain and the need for new approaches and greater collaboration.
Strengthening their positions as the sourcing and procurement platforms of choice, both exhibitions welcomed visiting delegations and VIP buyers from Malaysia, Indonesia, Thailand, and Vietnam.

Complementing Medical Fair Asia and Medical Manufacturing Asia 2018 were a series of industry-focused conferences, seminars and workshops covering a wide-range of topics such as sports medicine, wearable technologies, robotic surgery, community care and MedTech that attracted 700 international attendees.
The next editions of the co-located exhibitions will take place from 9 to 11 September 2020 at the Marina Bay Sands, Singapore.

Surgical teams now have four new tools to help them improve outcomes for their patients in the form of screening checklists from the American College of Surgeons (ACS) Strong for Surgery program (S4S). The four common risk areas targeted address the following issues:
Delirium – The recognition and treatment of delirium is critically important because postoperative delirium is associated with poor outcomes including functional decline, longer hospitalization, institutionalization, greater costs, and higher mortality. Studies have shown that age, alcohol abuse, poor cognitive and physical functioning, and abnormal laboratory values have been associated with delirium. High-risk patients identified for exhibiting some of the risk criteria can be candidates for interventions designed to prevent or reduce the impact of postoperative delirium.
Prehabilitation – Cognitive, gait, balance, and nutritional and functional impairments place patients at higher risk of perioperative and postoperative complications. Prehabilitation is an opportunity to help patients return quickly to the highest level of functioning possible after operation, thereby reducing surgery‐related morbidity and/or mortality, decreasing the length of stay in hospital and rehabilitation, and reducing readmissions.
Pain Management – Unrelieved pain can result in longer hospital stays, increased rate of readmission, increased outpatient visits, and decreased ability to function fully. To ensure safe, effective pain management after the surgical procedure, it is recommended that patients receive counselling prior to their operations about pain management options. Presurgery counselling with patients that involves expectation setting, potential adverse effects, and the use of non-prescribed medication for pain relief can help patients set realistic goals for recovery.
Patient Directives – An important aspect of patient safety is patient education. Patient education before surgery helps minimize presurgery anxiety related to the operation itself. During this time, discussion referencing the financial burden, post-procedure pain, surgical risks and the necessity of the procedure are also important. The patient should feel supported in the preoperative period and should be encouraged to express his or her feelings about the surgical experience.Checklists, which are the cornerstone of S4S, are integrated into the preoperative phase of clinical practice for elective operations by surgeons and surgical staff. By screening patients for potential risk factors that can lead to surgical complications, these checklists open the door for appropriate interventions to ensure better outcomes for patients. Global research has shown that use of a checklist improves patient optimization for an operation and helps ensure that important aspects of care are followed for each case.“Strong for Surgery brings a well-researched presurgery checklist to surgeons’ offices to help with patient education, communication, and standardization of best practices to improve clinical outcomes.  A patient’s risk of negative outcomes from an operation can be improved by using best practices to prepare them for an operation, and we’re starting to see study results where these checklists have helped to do just that,” said Dr. Varghese.
American College of Surgeonhttps://tinyurl.com/y7s6gpzt