The Mount Sinai Medical Center is the first institution in New York State to use in the clinical setting a newly approved imaging technique to detect Alzheimer’s disease (AD) in people who are cognitively impaired. Until now, physicians have been limited in their ability to diagnose AD, guided almost exclusively by a patient’s mental and behavioural symptoms and family history. The innovative technique
A new three-dimensional (3-D) digital mammography technique has the potential to significantly improve the accuracy of breast cancer screening, according to a study.
Two-dimensional (2-D) x-ray mammography, the current primary screening method for early detection of breast cancer in women, is a valuable tool but has some limitations. Surrounding normal tissue can mask lesions, and 2-D views do not provide direct information about the volumetric appearance
Robotic surgery though the mouth is a safe and effective way to remove tumours of the throat and voice box, according to a study by head and neck cancer surgeons at the Ohio State University Comprehensive Cancer Center
Stroboscopic training, performing a physical activity while using eyewear that simulates a strobe-like experience, has been found to increase visual short-term memory retention, and the effects last for 24 hours.
Participants in a Duke University study engaged in physical activities, such as playing catch, while using either specialised eyewear that limits vision to only brief snapshots or while using eyewear with clear lenses that provides uninterrupted vision. Participants from the Duke community, including varsity athletes, completed a computer-based visual memory test before and after the physical activities. The study found that participants who trained with the strobe eyewear gained a boost in visual memory abilities.
Participants completed a memory test that required them to note the identity of eight letters of the alphabet that were briefly displayed on a computer screen. After a variable delay, participants were asked to recall one of the eight letters. On easy-level trials, the recall prompt came immediately after the letters disappeared, but on more difficult trials, the prompt came as late as 2.5 seconds following the display. Because participants did not know which letter they would be asked to recall, they had to retain all of the items in memory.
‘Humans have a memory buffer in their brain that keeps information alive for a certain short-lived period,’ said Greg Appelbaum, assistant professor of psychiatry at Duke and first author of the study. ‘Wearing the strobe eyewear during the physical training seemed to boost the ability to retain information in this buffer.’
The strobe eyewear disrupts vision by only allowing the user to see glimpses of the world. Users must adjust their visual processing in order to perform normally, and this adjustment produces a lingering benefit: once participants removed the strobe eyewear, there was an observed boost in their visual memory retention that was found to still be active 24 hours later.
Earlier work by Appelbaum and the project’s senior researcher, Stephen Mitroff, had shown that stroboscopic training improves visual perception, including the ability to detect subtle motion cues and the processing of briefly presented visual information. Yet the earlier study had not determined how long the benefits might last.
‘Our earlier work on stroboscopic training showed that it can improve perceptual abilities, but we dont know exactly how,’ said Mitroff, associate professor of psychology and neuroscience and member of the Duke Institute for Brain Sciences. ‘This project takes a big step by showing that these improved perceptual abilities are driven, at least in part, by improvements in visual memory.’
‘Improving human cognition is an important goal with so many benefits,’ said Appelbaum, also a member of the Duke Institute for Brain Sciences. ‘Interestingly, our findings demonstrate one way in which visual experience has the capacity to improve cognition.’
Duke University
Scientists have developed a way to produce three-dimensional X-ray images of the breast at a radiation dose that is lower than the 2D radiography methods used in clinics today. The new method enables the production of 3D diagnostic computed tomography (CT) images with a spatial resolution 2-3 times higher than present hospital scanners, but with a radiation dose that is about 25 times lower. This breakthrough has the potential to overcome the main obstacle limiting conventional CT imaging of the breast: the high radio-sensitivity of the breast glandular tissue. Synchrotron X-rays at beamline ID17, the medical station of the ESRF, have been used to test the technique which, once deployed in hospitals, will make CT scans a diagnostic tool to complement dual view mammography.
The multidisciplinary team comprised physicists, radiologists and mathematicians from the European Synchrotron Radiation Facility (ESRF, Grenoble, France), the Ludwig Maximilians University in Munich (LMU, Cluster of Excellence MAP) and the University of California at Los Angeles (UCLA). The first authors are Yunzhe Zhao of UCLA and Emmanuel Brun of the LMU/ESRF.
Early detection contributes to an improved prognosis and results in reduced breast cancer mortality. The breast cancer screening method typically used today is ‘dual-view digital mammography’. The limitation is that it only provides two images of the breast tissue, which can explain why 10 percent to 20 percent of breast tumours are not detectable on mammograms. Mammograms can also sometimes appear abnormal, when no breast cancers are actually present.
Computed tomography (CT), an X-ray technique that allows a precise 3D visualisation of the human body organs, cannot be routinely used for breast cancer diagnosis because the risk of long-term effects in radiosensitive organs like the breast is considered too high.
Recognising these limitations, scientists have tackled the problem using a new approach. They combined three ingredients that together should now make CT scans for early detection of breast cancer become possible. These ingredients are: high energy X-rays, a special detection method called ‘phase contrast imaging’ and the use of a sophisticated novel mathematical algorithm, known as ‘equally sloped tomography’ (EST), to reconstruct the CT images from X-ray data. Tissues are more transparent to high energy X-rays and therefore less dose is deposited (a factor of 6 in radiation dose reduction). Phase contrast imaging, mastered by the ESRF and the LMU-MAP teams, allows the production of images using fewer X-rays to obtain the same image contrast. Finally, the EST method, originally developed by researchers at UCLA, needs 4 times less radiation to obtain the same image quality.
The team X-rayed a human breast at multiple different angles using phase contrast tomography and applied the EST algorithm to 512 images to produce higher resolution 3-D images of the organ than ever before and at a lower dose than a mammogram.
In a blind evaluation, five independent radiologists from the LMU ranked the generated images as having the highest sharpness, contrast, and overall image quality compared to 3-D images of breast tissue created through other standard methods.
‘This new technique can open up the doors to the clinical use of computed tomography in the breast diagnosis, which would be a powerful tool to fight even better and earlier against breast cancer’, says Prof. Maximilian Reiser, Director of the Radiology Department of the LMU, which provided the medical expertise for this research. ‘This result has been obtained thanks to the synergy of the expertise by researchers from very different disciplines. These high-quality X-ray CT images at high energies are the result of a 10-year effort at the ESRF’ says Alberto Bravin, head of the ESRF medical research laboratory who led the team in Grenoble. ‘After dramatically reducing the dose delivered during the examination of the breast, our next objective is to develop this technique in the early visualisation of other human diseases and to work towards its clinical implementation.’ adds Paola Coan, Professor of X-ray imaging at the LMU and member of the Munich-Centre for Advanced Photonics (MAP), who led the group from Munich.
ESRFStroke is the fourth leading cause of death and a common cause of long-term disability in the United States, but doctors have very few proven treatment methods. Now a new device that mechanically removes stroke-causing clots from the brain is being hailed as a game-changer.
In a recent clinical trial, the SOLITAIRE Flow Restoration Device dramatically outperformed the standard mechanical treatment.
SOLITAIRE, which was approved by the U.S. Food and Drug Administration in March, is among an entirely new generation of devices designed to remove blood clots from blocked brain arteries in patients experiencing an ischemic stroke. It has a self-expanding, stent-like design, and once inserted into a blocked artery using a thin catheter tube, it compresses and traps the clot. The clot is then removed by withdrawing the device, reopening the blocked blood vessel.
‘This new device is significantly changing the way we can treat ischemic stroke,’ said the study’s lead author, Dr. Jeffrey L. Saver, director of the UCLA Stroke Center and a professor of neurology at the David Geffen School of Medicine at UCLA. ‘We are going from our first generation of clot-removing procedures, which were only moderately good in reopening target arteries, to now having a highly effective tool.’
Results of the study showed that the device opened blocked vessels without causing symptomatic bleeding in or around the brain in 61 percent of patients. The standard FDA
Monitoring the effectiveness of the HPV vaccine in Canada requires that data from multiple registries and other data sources be combined. Linking registries can be problematic, however, since they are often managed by unrelated organisations. Privacy legislation may also restrict the sharing of data for such linkages. To address these challenges, Dr. Khaled El Emam and his team at the CHEO Research Institute have developed a secure protocol that allows the linking of individual patient records without revealing personal information.
According to Dr. El Emam, previous protocols were not secure or did not protect privacy; this new evidence-based protocol, however, is the strongest on record. It can be generalised for use in monitoring other conditions or diseases, or vaccination programs.
‘There is a need to do long-term evaluations of vaccines, and to monitor vaccination rates and how they vary by individual and family characteristics. Access to data to perform such surveillance is often challenging because of legitimate privacy concerns. Our protocol addresses these concerns directly and facilitates rapid data sharing,’ explained Dr. El Emam.
HPV, or the human papillomavirus, is one of the most prevalent sexually transmitted viral infections in the world, causing symptoms that range from genital warts to increased risk of cervical cancer. An effective preventative quadrivalent vaccine has been available in Canada since 2007 (and a second, bivalent vaccine was approved for use in 2010) and is regularly administered to girls through publicly funded school-based programs. The vaccine can potentially reduce health care costs and HPV-related illnesses and death, but the long-term effectiveness of the vaccine is not yet known. Further research is required to gauge the vaccine’s lasting impact on health and to inform policy decisions concerning the allocation of health resources.
The new protocol uses a number of cryptographic techniques, including a commutative hash function and homomorphic cryptosystem. The secure computation allows registries to match records on identifiers such as SIN, health card number and date of birth without revealing these values to anyone, and then perform analytics on the linked data without that linked data being disclosed. The protocol provides end-to-end privacy protection for surveillance programs and eliminates many concerns about sharing data.
‘We set out to assess the impact of the HPV vaccine by creating a secure protocol to link simulated databases on cancer, cervical screening, health care services and immunisation. Such linkage can only be done in an environment that is responsive to patient privacy concerns,’ explained Dr. El Emam. ‘The protocol we created would allow any public health unit to link databases from multiple sources and compute relevant statistics from linked data without revealing personal information, and hence, still provide strong patient privacy guarantees.’
Children’s Hospital of Eastern Ontario Research Institute
Hip resurfacing – an alternative to hip replacement often recommended to younger patients – is prone to early failure in many instances, and should not be used in women, according to a study led by the University of Bristol.
The observational study, conducted on behalf of the National Joint Registry for England and Wales, examined data from 434,650 hip operations undertaken between April 2003 and September 2011, of which 31,932 (7.3 per cent) were resurfacings. The research looked at how many resurfacing implants failed in the first seven years after surgery and whether the head size of the implant affected failure rates. Patients with resurfacing were also compared with those who had undergone hip replacement with other bearing surfaces.
Hip resurfacing is similar to total hip replacement, except the femoral head (the rounded top section of the thigh bone) is not completely removed. Instead, the superficial bone is removed and replaced with a metal cap. Hip resurfacings always have metal-on-metal bearings, whilst total hip replacements can have a variety of bearing options, such as ceramic, metal, or plastic. Resurfacing is often offered to younger patients as an alternative to hip replacement, but is also commonly used in older patients.
The researchers found that the use of smaller head sizes was linked to higher failure rates and in most cases, resurfacing implants failed more quickly than other bearing surfaces. The only exception to this was for men with a large (≥ 54mm) femoral head, who showed comparable rates of implant success to those who had undergone total hip replacement. This group constituted only 23 per cent (5,085) of the total resurfacing operations in men during the period studied. Women who underwent hip resurfacing experienced particularly poor implant survival, with failure rates up to five times higher than other bearing surfaces.
According to Ashley Blom, Professor of Orthopaedic Surgery in the University
A study showed that some doctors, particularly surgeons, are not explaining the risk of specific outcomes that matter most to patients. Overlooked risks that led to a legal claim or complaint included chronic pain, sexual dysfunction, visual or hearing loss, and the need for re-operation.
Lead author Dr Marie Bismark from the University of Melbourne School of Population Health said the study revealed that doctors may routinely underestimate the importance patients place on understanding certain risks in advance of treatment.
‘Increasingly, doctors are expected to advise and empower patients to make rational choices by sharing information that may affect treatment decisions, including risks of adverse outcomes,’ she said.
‘However, doctors, especially surgeons, are often unsure which clinical risks they should disclose and discuss with patients before treatment and this is reflected in this study.’
The authors found that the most common justifications doctors gave for not telling patients about particular risks before treatment were that they considered such risks too rare to warrant discussion, or that the specific risk was covered by a more general risk that was discussed.
‘It is not necessary, or helpful, for doctors to provide a laundry list of all possible risks. Instead, doctors should focus on discussing those risks which are likely to matter most to the patient before them,’ she said.
From a sample of nearly 10,000 patient complaints and malpractice claims from Australia between 2001 and 2008, researchers identified 481 disputes involving alleged deficiencies in obtaining informed consent.
The authors found that 45 (9%) of the cases studied were disputed duty cases
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