Scientists have moved a step closer to being able to preserve fertility in young boys who undergo chemotherapy and radiation treatments for cancer. The new research addresses the safety of an option scientists are developing for boys who aren
The mental health conditions of most people who commit suicide remain undiagnosed, even though many visit a primary care provider or medical specialist in the year before they die, according to a national study led by Henry Ford Health System with the Mental Health Research Network.
Among those in the study, 83 percent received health care treatment in the year prior to dying, and they used medical and primary care services more frequently than any other health service. However, a mental health diagnosis was made in less than half (45 percent) of these cases.
To help prevent suicides, health care providers should therefore become more attuned to their patients
Injured patients who have alcohol in their blood have a reduced risk for developing cardiac and renal complications, according to a study from the University of Illinois at Chicago School of Public Health. Among patients who did develop complications, those with alcohol in their blood were less likely to die.
‘After an injury, if you are intoxicated there seems to be a substantial protective effect,’ says UIC injury epidemiologist Lee Friedman, author of the study. ‘But we don
An ancient form of meditation and exercise could help women who suffer from urinary incontinence, according to a new study from UC San Francisco.
In a study UCSF researchers discovered that a yoga training program, designed to improve pelvic health, can help women gain more control over their urination and avoid accidental urine leakage.
‘Yoga is often directed at mindful awareness, increasing relaxation, and relieving anxiety and stress,’ said first author Alison Huang, MD, assistant professor in the UCSF School of Medicine. ‘For these reasons, yoga has been directed at a variety of other conditions
A study by researchers at Hospital for Special Surgery (HSS) finds that electromyography (EMG) testing to determine the quality of donor nerves can improve the outcome of nerve transfer surgery to restore function in patients with a brachial plexus injury. EMG is a sophisticated test used to objectively measure muscle and nerve function.
‘Our study found that pre-operative EMG evaluation should be considered a critical component of the donor nerve selection process when planning brachial plexus nerve transfer reconstruction,’ said Scott W. Wolfe, MD, senior investigator and Director of the Center for Brachial Plexus and Traumatic Nerve Injury at Hospital for Special Surgery in New York City.
The brachial plexus is a network of nerves that extends from the spinal cord in the neck, under the collarbone and down the arm. These nerves control the hand, wrist, elbow and shoulder. Injury to the brachial plexus can be devastating, and the most common cause is a serious accident or sports injury. Nerve reconstruction is considered when the nerves are so severely damaged they cannot recover on their own. These complex operations can take up to 12 hours.
One way surgeons can reconstruct nerves is by performing a nerve transfer to restore function. They carefully dissect out portions, or fascicles, of nearby functioning nerves (called ‘donor nerves’) and transfer these fascicles to the injured nerves to restore electrical connectivity and enable nerve regeneration to the paralysed muscle. ‘A nerve transfer takes a working nerve from one muscle and transfers part of that nerve to the injured, non-working nerve or another muscle, so the two muscles can share the nerve and regain function,’ Dr. Wolfe explained.
Electromyography is often used in the pre-operative assessment of brachial plexus injuries to estimate the degree of damage. However, the ability to predict surgical outcomes using pre-operative EMG to test donor nerves had not been previously evaluated. Researchers hypothesised that the health of the donor nerve and corresponding muscle, as assessed by EMG, could predict the outcome of nerve transfer surgery.
A retrospective review was conducted to investigate outcomes of nerve transfers for elbow flexion (ability to bend one’s elbow) and shoulder abduction (ability to lift arm away from the body). Muscle strength was graded both pre-operatively and at least one-year after surgery. Pre-operative EMG results for donor nerves were classified on a scale that rated their level of function and then compared with the patient’s muscle strength and range of motion after surgery.
Forty nerve transfers were identified. Twenty-seven were performed for elbow flexion and 13 for shoulder abduction. Overall, the 29 transfers using a normal donor nerve showed significantly greater post-operative improvement in muscle strength and function than the 11 transfers with the less robust donor nerve, as classified by EMG.
In the shoulder patients, the use of normal donor nerves resulted in greater strength and active motion compared to less robust donor nerves. In the elbow cohort, double nerve transfers with two normal donor nerves demonstrated improved strength compared to double nerve transfers when one of the donor nerves was affected by the injury.
Joseph Feinberg, MD, physiatrist-in-chief and co-medical director of the Brachial Plexus Center at HSS, has developed a system to classify potential donor nerves according to four levels of functioning: normal, moderately limited function, very limited function and no function.
‘Interestingly, we found that some of the donor nerves that were damaged and had some functional limitations were still healthy enough to do their job after the nerve transfer operation,’ Dr. Feinberg said. ‘On the flip side, if electromyography shows that a potential donor nerve is not at all functional, the surgeon may want to consider a different nerve donor, or potentially another solution such as nerve grafting or muscle transfer.’
‘Our findings demonstrate that a semi-quantitative EMG classification describing the quality of donor nerves can predict outcome as measured by post-operative muscle strength and range of motion,’ said Dr. Wolfe. ‘Despite the small numbers studied, we observed significantly greater gains in strength and range of motion in the normal donor nerve group as compared to the less robust donor nerves. EMG evaluation has value as a confirmatory component of the donor nerve selection process when planning brachial plexus surgery.’
EurekAlert
New research from McMaster University suggests that a commonly performed test during certain types of heart surgery is not helpful and possibly harmful.
The testing procedure, known as defibrillator testing (DT), is commonly used on people who require implantable cardioverter-defibrillators (ICDs) to prevent sudden cardiac death. It involves putting the patient into cardiac arrest to determine if the defibrillator can first recognise, then successfully shock the patient back into a normal heart rhythm. It requires the use of general anaesthesia and is associated with uncommon but potentially life-threatening complications.
‘As with many things in medicine, technology evolves and our knowledge grows and we have presented good evidence that the DT, which has been in use for nearly 30 years, is no longer necessary,’ says lead author Jeff Healey, associate professor of medicine, in the Michael G. DeGroote School of Medicine at McMaster University.
‘Without the testing we can save a significant amount of time, money and more importantly, avoid potentially serious complications in patients who are receiving an ICD,’ he says.
Similar to a pacemaker, an ICD is a small battery-powered electrical impulse generator meant as a permanent safeguard against sudden arrhythmias. Each year, about 300,000 worldwide receive an ICD. Of these, approximately 70 per cent undergo the routine defibrillation testing that often leads to potential complications including possible harm from ICD shocks, says Healey.
‘Over the last 10 years, there has been an important shift in practice around the world towards ICD implantation without the test. However, until now, there has been no scientific evidence to support this change in practice. Our study now provides clear and robust evidence to guide practice.’
To test the procedure, Healey initiated a randomized trial, called the ‘Shockless IMPLant Evaluation (SIMPLE)’ study. It is the largest randomised clinical trial of ICD recipients to date, involving a cohort of 2,500 patients worldwide.
The trial compared standard DT in a patient to those who do not have the testing performed and revealed that those who received ICDs without DT did as well as those who underwent the standard testing.
McMaster University
The new interferon-free, all-oral, three direct-acting-antiviral (3D) treatment regimen in development by AbbVie has achieved very high rates of virological response in patients chronically infected with hepatitis C virus (HCV) genotype 1 (GT1); according to the results of three studies presented at the International Liver CongressTM 2014.
The 3D regimen consists of the HCV NS3/4A protease inhibitor ABT-450 dosed with ritonavir, the NS5A inhibitor ABT-267, and the NS5B RNA polymerase inhibitor ABT-333.
‘Using this investigational 3D regimen, with or without ribavirin, these studies have demonstrated consistently high cure rates across a number of patient types, including the more difficult-to-treat subtype GT1a, and HCV patients with compensated cirrhosis,’ said EASL’s Scientific Committee Member Dr. Alessio Aghemo, Gastroenterology and Hepatology Unit, Ospedale Maggiore Policlinico, University of Milan. ‘The impressive SVR12 results seen are consistent with the results from AbbVie’s phase II studies,’ he added.
In the SAPPHIRE-I study, treatment na
Max Ortiz Catalan has developed a new method for the treatment of phantom limb pain (PLP) after an amputation. The method is based on a unique combination of several technologies, and has been initially tested on a patient who has suffered from severe phantom limb pain for 48 years. A case study shows a drastic reduction of pain.
People who lose an arm or a leg often experience phantom sensations, as if the missing limb were still there. Seventy per cent of amputees experience pain in the amputated limb despite that it no longer exists. Phantom limb pain can be a serious chronic and deteriorating condition that reduces the quality of the person
The ZNA hospital network of Antwerp, Belgium, is extending its existing Agfa HealthCare ICIS imaging platform beyond radiology.. With the deployment, all other image-producing departments of the hospital group will be integrated, whether they produce DICOM or non-DICOM images. In addition, patient images from other facilities can be quickly and easily imported as well. The ICIS VIEW zero footprint image viewer will be implemented for internal and external image distribution, for all types of medical images.
With nine sites in the Antwerp area, ZNA is not only among Belgium
Obese people who have stomach surgery to help them lose weight will halve their risk of heart attack according to new research from a team of doctors at the University of East Anglia, University of Manchester and University of Aberdeen.
The procedures, known as bariatric surgery, involve techniques such as gastric banding, which are available on the National Health Service (NHS), UK for selected patients.
New research published today in the International Journal of Cardiology reviewed data from 14 studies involving more than 29,000 patients who underwent bariatric surgery. It reveals that death rates were reduced by 40 per cent, and that heart attacks in particular were reduced by half
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