miércoles, 26 de abril de 2017

Newly prescribed hypnotic medicines double the odds of hip fracture

Newly prescribed hypnotic medicines double the odds of hip fracture

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Newly prescribed hypnotic medicines double the odds of hip fracture

Older people newly prescribed sleeping pills like benzodiazepines and 'Z-drugs' have over double the odds of a hip fracture in the first two weeks compared with non-users, according to a new study by researchers at Cardiff University and King's College London.
Dr Ben Carter, Cardiff University's School of Medicine and the Institute of Psychiatry, Psychology and Neuroscience, King's College London, explains: "While 'Z-drugs are fast becoming the doctor's hypnotic prescription of choice, there is no evidence that they are a safer alternative to benzodiazepines in relation to hip fracture risk.
"Our study shows that both appear to significantly increase the risk of hip fracture when newly prescribed by doctors."
The study of people aged over 65 found that new users of these hypnotic medicines experienced nearly two and a half times the fracture rate, when compared with older people not taking hypnotics. An estimated 53% increase in fracture risk was identified in medium-term users (15 to 30 days), as well as a 20% increased risk of hip fracture in long-term users (greater than 30 days).
Dr Carter added: "Careful consideration of the immediate increased risk of hip fracture should inform the clinical decision-making process. Clinically effective measures like strength training to improve frailty, removal of hazards at home, visual correction and a medication review are also needed to mitigate the risk of hip fractures, particularly in the first few days of use."
The research supports previous studies linking use of hypnotics by older people with an increased risk of accidents, dependence, cognitive decline and hip fracture. The drugs are also thought to cause drowsiness, delayed reaction times and impaired balance.

AATS releases new Consensus Statement for better management of empyema

AATS releases new Consensus Statement for better management of empyema

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AATS releases new Consensus Statement for better management of empyema

To better manage empyema in the face of rising demand for treatment, the American Association for Thoracic Surgery (AATS) Guidelines Committee called for the formation of the Empyema Management Guidelines Working Group. The group was tasked with analyzing the latest literature about empyema and issuing new evidence-based clinical guidelines. The resulting Consensus Statement is published in The Journal of Thoracic and Cardiovascular Surgery.
Recommendations address clinical presentation, imaging, surgical treatment, and management of empyema in adults and children
Although treatable, empyema is a potentially deadly accumulation of pus around the lungs, occurring most commonly as a complication of pneumonia. To better manage this disease in the face of rising demand for treatment, the American Association for Thoracic Surgery (AATS) Guidelines Committee called for the formation of the Empyema Management Guidelines Working Group. Comprised of experts from a variety of disciplines including thoracic surgery, pulmonary and critical care medicine, infectious diseases, and interventional radiology, the group was tasked with analyzing the latest literature about empyema and issuing new evidence-based clinical guidelines. The resulting Consensus Statement is published in The Journal of Thoracic and Cardiovascular Surgery.
In the United States, around 1 million patients each year are hospitalized with pneumonia. Of this group, around 20% to 40% develop a parapneumonic effusion and 5%-10% of these will progress to empyema. Patients who experience empyema face discouraging odds: approximately 15% of them will die and 30% will require surgical draining to clear the infection. While occurrences of empyema dropped dramatically during first half of the 20th century thanks to improved antibiotic regimens, that trend changed in the 1990s. Now, doctors are seeing more cases, making empyema an even more relevant subject for clinical study.
"The management of empyema has historically varied significantly from hospital to hospital and across the many different medical specialists who may care for patients with this disease," remarked lead author K. Robert Shen, MD, Department of Surgery, Mayo Clinic College of Medicine, Rochester, MN. "These new guidelines formulated by the AATS are important because they represent an attempt to develop recommendations that are based upon the best available current scientific evidence.
The guidelines encompass empyema presentation, diagnosis, and treatment presenting a comprehensive strategy for doctors treating empyema patients. There are several top-level takeaways from their findings:
·         Patients with pneumonia that fail to respond to established antibiotic therapy or unexplained sepsis should always be evaluated for a possible pleural effusion. If either a parapneumonic effusion or empyema is found, patients should undergo immediate treatment.
·         According to the group's findings, surgery remains the most effective method for management of most patients with empyema despite advances in radiologic imaging, antibiotics, and other medications that have made it possible to treat without undergoing a surgical procedure.
·         Management of pediatric empyema differs significantly from treatment in adults. Investigators acknowledge there is currently disagreement about the best treatment protocols for children with empyema. After a comprehensive analysis of current literature, the group issued a recommendation that pediatric patients should initially be treated with a tube thoracostomy with or without the subsequent instillation of fibrinolytic agents.
As empyema cases become increasingly common, investigators hope these guidelines can help make diagnosis and treatment protocols more uniform across the country to help offer patients the best care possible. "Despite the widespread use of antibiotics and availability of pneumococcal vaccines, empyema remains the most common complication of pneumonia and an important cause of morbidity and mortality worldwide," concluded Dr. Shen. "It is hoped that these guidelines will provide clinicians who care for pneumonia patients with practical guidelines on the best way to treat their patients who develop empyema."

Cartilage-mimicking material may allow surgeons to 3D print replacement knee parts

Cartilage-mimicking material may allow surgeons to 3D print replacement knee parts

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Cartilage-mimicking material may allow surgeons to 3D print replacement knee parts

A cartilage-mimicking material created by researchers at Duke University may one day allow surgeons to 3-D print replacement knee parts that are custom-shaped to each patient's anatomy.
Human knees come with a pair of built-in shock absorbers called the menisci. These ear-shaped hunks of cartilage, nestled between the thigh and shin bones, cushion every step we take. But a lifetime of wear-and-tear -- or a single wrong step during a game of soccer or tennis -- can permanently damage these key supports, leading to pain and an increased risk of developing arthritis.
The hydrogel-based material the researchers developed is the first to match human cartilage in strength and elasticity while also remaining 3-D-printable and stable inside the body. To demonstrate how it might work, the researchers used a $300 3-D printer to create custom menisci for a plastic model of a knee.
"We've made it very easy now for anyone to print something that is pretty close in its mechanical properties to cartilage, in a relatively simple and inexpensive process," said Benjamin Wiley, an associate professor of chemistry at Duke and author on the paper, which appears online in ACS Biomaterials Science and Engineering.
After we reach adulthood, the meniscus has limited ability to heal on its own. Surgeons can attempt to repair a torn or damaged meniscus, but often it must be partially or completely removed. Available implants either do not match the strength and elasticity of the original cartilage, or are not biocompatible, meaning they do not support the growth of cells to encourage healing around the site.
Recently, materials called hydrogels have been gaining traction as a replacement for lost cartilage. Hydrogels are biocompatible and share a very similar molecular structure to cartilage: if you zoom in on either, you'll find a web of long string-like molecules with water molecules wedged into the gaps.
But researchers have struggled to create recipes for synthetic hydrogels that are equal in strength to human cartilage or that are 3-D-printable.
"The current gels that are available are really not as strong as human tissues, and generally, when they come out of a printer nozzle they don't stay put -- they will run all over the place, because they are mostly water," Wiley said.
Feichen Yang, a graduate student in Wiley's lab and author on the paper, experimented with mixing together two different types of hydrogels -- one stiffer and stronger, and the other softer and stretchier -- to create what is called a double-network hydrogel.
"The two networks are woven into each other," Yang said. "And that makes the whole material extremely strong."
By changing the relative amounts of the two hydrogels, Yang could adjust the strength and elasticity of the mixture to arrive at a formula that best matches that of human cartilage.
He also mixed in a special ingredient, a nanoparticle clay, to make the mock-cartilage 3-D-printable. With the addition of the clay, the hydrogel flows like water when placed under shear stress, such as when being squeezed through a small needle. But as soon as the stress is gone, the hydrogel immediately hardens into its printed shape.
3-D printing of other custom-shaped implants, including hip replacements, cranial plates, and even spinal vertebrae, is already practiced in orthopedic surgery. These custom implants are based on virtual 3-D models of a patient's anatomy, which can be obtained from computer tomography (CT) or magnetic resonance imaging (MRI) scans.
Meniscus implants could also benefit from 3-D printing's ability to create customized and complex shapes, the researchers say. "Shape is a huge deal for the meniscus," Wiley said. "This thing is under a lot of pressure, and if it doesn't fit you perfectly it could potentially slide out, or be debilitating or painful."
"A meniscus is not a homogenous material," Yang added. "The middle is stiffer, And the outside is a bit softer. Multi-material 3-D printers let you print different materials in different layers, but with a traditional mold you can only use one material."
In a simple demonstration, Yang took a CT scan of a plastic model of a knee and used the information from the scan to 3-D print new menisci using his double network hydrogel. The whole process, from scan to finished meniscus, took only about a day, he says.
"This is really a young field, just starting out," Wiley said. "I hope that demonstrating the ease with which this can be done will help get a lot of other people interested in making more realistic printable hydrogels with mechanical properties that are even closer to human tissue."

Study finds link between circadian variations in body temperature and arousal in brain-injured patients

Study finds link between circadian variations in body temperature and arousal in brain-injured patients

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Study finds link between circadian variations in body temperature and arousal in brain-injured patients

For people with severe brain injuries, researchers have found that the rhythm of daily fluctuations in body temperature is related to their level of consciousness, according to a preliminary study published in the April 19, 2017, online issue of Neurology, the medical journal of the American Academy of Neurology.
"Our study suggests that the closer the body temperature patterns of a severely brain injured person are to those of a healthy person's circadian rhythm, the better they scored on tests of recovery from coma, especially when looking at arousal, which is necessary for consciousness," said study author Christine Blume, PhD, of the University of Salzburg in Austria.
Circadian rhythms, which are rhythmic variations in body functions brought about by the body's internal clock, are the daily cycles that tell us when to sleep, wake or eat. This biological clock also regulates many of the body's other functions including temperature. It is set by environmental cues, like periods of daylight and dark.
In healthy people, daily variations in body temperature closely follow the sleep-wake cycle, the 24-hour daily sleep pattern controlled by the body's internal clock. Other studies have found that disruptions to the sleep-wake cycle may affect various aspects of health like the immune system and short-term memory. During a normal sleep-wake cycle, the body's core temperature fluctuates and can drop one to two degrees during the early morning hours.
For this study, researchers monitored 18 people with severe brain injuries, those with unresponsive wakefulness syndrome and those in a minimally conscious state. Unresponsive wakefulness syndrome, also known as a vegetative state, is when someone has awakened from a coma, is opening his or her eyes and having periods of sleep, but remains unresponsive. A minimally conscious state is when someone shows signs of awareness.
For one week, researchers continually monitored the body temperatures of participants with external skin sensors. With that temperature data, they were able to determine the length of the circadian rhythm for each person. Length of temperature cycles of participants ranged from 23.5 to 26.3 hours.
Researchers also evaluated the level of consciousness for each person with the Coma Recovery Scale-Revised, measuring things like response to sound and ability to open eyes with or without stimulation. They found that those who scored better on that scale had body temperature patterns that more closely aligned with a healthy 24-hour rhythm.
"This is the first time an association has been found between circadian variations in body temperature and arousal in brain-injured patients. Importantly, arousal is essential for consciousness," said Blume. "Circadian variations are something doctors should keep in mind when diagnosing patients. The time of the day when patients are tested could be crucial. Also, doctors may want to consider creating environments for patients that mimic the light patterns of night and day to help achieve a normal sleep-wake cycle. The hope is that this may help bring a person with a severe brain injury closer to consciousness."
The researchers tested bright light stimulation on eight participants for one week and found positive effects in two patients. Blume said that larger studies are needed to test the hypothesis that bright light is indeed beneficial for patients.
One limitation of the study was that magnetic resonance imaging (MRI) data was not available to evaluate the extent of brain damage, especially in the hypothalamus, the portion of the brain where the body clock is located.
Blume suggests that future studies look at the relationship between body temperature rhythms and other body rhythms like hormone patterns and rest-activity cycles.

Placebo can help reduce intensity of emotional pain from romantic rejection, study finds

Placebo can help reduce intensity of emotional pain from romantic rejection, study finds

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Placebo can help reduce intensity of emotional pain from romantic rejection, study finds

Feeling heartbroken from a recent breakup? Just believing you're doing something to help yourself get over your ex can influence brain regions associated with emotional regulation and lessen the perception of pain.
That's the takeaway from a new University of Colorado Boulder study that measured the neurological and behavioral impacts the placebo effect had on a group of recently broken-hearted volunteers.
"Breaking up with a partner is one of the most emotionally negative experiences a person can have, and it can be an important trigger for developing psychological problems," said first author and postdoctoral research associate Leonie Koban, noting that such social pain is associated with a 20-fold higher risk of developing depression in the coming year. "In our study, we found a placebo can have quite strong effects on reducing the intensity of social pain."
For decades, research has shown that placebos - sham treatments with no active ingredients - can measurably ease pain, Parkinson's disease and other physical ailments.
The new study, published in March in the Journal of Neuroscience, is the first to measure placebos' impact on emotional pain from romantic rejection.
Researchers recruited 40 volunteers who had experienced an "unwanted romantic breakup" in the past six months. They were asked to bring a photo of their ex and a photo of a same-gendered good friend to a brain-imaging lab.
Inside a functional magnetic resonance imaging (fMRI) machine, the participants were shown images of their former partner and asked to recall the breakup. Then they were shown images of their friend. They were also subjected to physical pain (a hot stimulus on their left forearm).
As these stimuli were alternately repeated, the subjects rated how they felt on a scale of 1 (very bad) to 5 (very good). Meanwhile, the fMRI machine tracked their brain activity.
While not identical, the regions that lit up during physical and emotional pain were similar.
This finding alone sends an important message to the heartbroken, said senior author Tor Wager, a professor of psychology and neuroscience at CU Boulder: "Know that your pain is real - neuro-chemically real."
The subjects were then taken out of the machine and given a nasal spray. Half were told it was a "powerful analgesic effective in reducing emotional pain." Half were told it was a simple saline solution.
Back inside the machine, the subjects were again shown images of their ex and subjected to pain. The placebo group not only felt less physical pain and felt better emotionally, but their brain responded differently when shown the ex.
Activity in the brain's dorsolateral prefrontal cortex - an area involved with modulating emotions - increased sharply. Across the brain, areas associated with rejection quieted. Notably, after the placebo, when participants felt the best they also showed increased activity in an area of the midbrain called the periaqueductal gray (PAG). The PAG plays a key role in modulating levels of painkilling brain chemicals, or opioids, and feel-good neurotransmitters like dopamine.
While the study did not look specifically at whether the placebo prompted the release of such chemicals, the authors suspect this could be what's happening.
"The current view is that you have positive expectations and they influence activity in your prefrontal cortex, which in turn influences systems in your midbrain to generate neurochemical opioid or dopamine responses," said Wager.
Previous studies have shown that the placebo effect alone not only eases depression but may actually make antidepressants work better.
"Just the fact that you are doing something for yourself and engaging in something that gives you hope may have an impact," said Wager. "In some cases, the actual chemical in the drug may matter less than we once thought."
The authors said the latest study not only helps them better understand how emotional pain plays out in the brain, but can also hint at ways people can use the power of expectation to their advantage.
Said Koban: "What is becoming more and more clear is that expectations and predictions have a very strong influence on basic experiences, on how we feel and what we perceive."
Bottom line, if you've been dumped recently: "Doing anything that you believe will help you feel better will probably help you feel better," she said.

Restricting amino acids in diet slows tumor growth, prolongs survival in mice

Restricting amino acids in diet slows tumor growth, prolongs survival in mice

News-Medical

Restricting amino acids in diet slows tumor growth, prolongs survival in mice

Cutting out certain amino acids – the building blocks of proteins – from the diet of mice slows tumour growth and prolongs survival, according to new research published in Nature today (Wednesday).
Researchers at the Cancer Research UK Beatson Institute and the University of Glasgow found that removing two non-essential amino acids – serine and glycine – from the diet of mice slowed the development of lymphoma and intestinal cancer.
The researchers also found that the special diet made some cancer cells more susceptible to chemicals in cells called reactive oxygen species.
Chemotherapy and radiotherapy boost levels of these chemicals in the cells, so this research suggests a specially formulated diet could make conventional cancer treatments more effective.
The next stage would be to set up clinical trials with cancer patients to assess the feasibility and safety of such a treatment.
Dr Oliver Maddocks, a Cancer Research UK scientist at the University of Glasgow, said:
Our findings suggest that restricting specific amino acids through a controlled diet plan could be an additional part of treatment for some cancer patients in future, helping to make other treatments more effective.
Professor Karen Vousden, Cancer Research UK’s chief scientist and study co-author, said:
This kind of restricted diet would be a short term measure and must be carefully controlled and monitored by doctors for safety. Our diet is complex and protein - the main source of all amino acids - is vital for our health and well-being. This means that patients cannot safely cut out these specific amino acids simply by following some form of home-made diet.
Amino acids are the building blocks that cells need to make proteins. While healthy cells are able to make sufficient serine and glycine, cancer cells are much more dependent on getting these vital amino acids from the diet.
However, the study also found that the diet was less effective in tumours with an activated Kras gene, such as most pancreatic cancer, because the faulty gene boosted the ability of the cancer cells to make their own serine and glycine. This could help to select which tumours could be best targeted by diet therapy.
Dr Emma Smith, science communication manager at Cancer Research UK, said:
This is a really interesting look at how cutting off the supply of nutrients essential to cancer cell growth and division could help restrain tumours.
The next steps are clinical trials in people to see if giving a specialised diet that lacks these amino acids is safe and helps slow tumour growth as seen in mice. We’d also need to work out which patients are most likely to benefit, depending on the characteristics of their cancer.

Doctors perform first-ever robotic, minimally-invasive surgical removal of stage IV tumor thrombus

Doctors perform first-ever robotic, minimally-invasive surgical removal of stage IV tumor thrombus

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Doctors perform first-ever robotic, minimally-invasive surgical removal of stage IV tumor thrombus

A surgical team at Keck Medicine of the University of Southern California (USC) has pushed the boundaries of clinical care by performing the first-ever robotic, minimally-invasive surgical removal of a stage IV tumor thrombus, which is when a kidney cancer tumor extends into the heart. The nearly 10-hour procedure required painstaking precision from three renowned surgeons, a critical-care anesthesiologist and a radiologist. In doing so, they reduced the patient's risk of sudden death from the tumor breaking off into the heart and lungs.
Typically, the surgery for a stage IV tumor thrombus is both traumatic and risky. It requires major open surgery, wherein the patient's chest and abdomen are opened completely, while the anesthesiologist monitors the patient and the tumor thrombus closely. The goal is to remove the tumor and thrombus from the inferior vena cava and the heart, while ensuring it does not break. Several quarts of blood are needed for transfusion and patients have a one in 20 chance of expiring during the procedure.
The use of robotic surgery techniques significantly reduced trauma to the patient and minimized blood loss by more than five-fold. By using small incisions, the patient's hospital stay was only six days, as opposed to two to three weeks, which is typical after open surgery. Overall recovery time was also reduced significantly. Such multi-disciplinary collaboration lays the groundwork for using advanced technology to build higher standards of patient care, even in the most complex cases.
"This exciting feat promises to redefine the boundaries of what is surgically possible through skill, collaboration and technology," said Inderbir S. Gill, MD, distinguished professor of urology, founding executive director of the USC Institute of Urology and the associate dean of clinical innovation at the Keck School of Medicine of USC. Gill led the multidisciplinary team that performed the surgery. "Our hope is that we can now propel the field at large to turn such futuristic robotic surgery into our present standard-of-care."
Physicians at Keck Medicine are accustomed to providing highly specialized care. As a tertiary and quarternary care medical center, Keck Medicine accepts a high volume of complex cases. However, because it is an academic medical center with some of the top physician-researchers in the country, Keck Medicine has the collective brainpower, skill-set and resources to tackle such advanced cases.
Prior to the surgery, Vinay Duddalwar, MD, associate professor of clinical radiology, created three-dimensional animated maps of the patient's chest and abdomen so that surgeons could pre-plan their entire surgical strategy with extreme, millimeter precision. The procedure began with Namir Katkhouda, MD, PhD, professor of surgery, who performed a surgical maneuver to control blood flow to the patient's liver. Next, Gill used the latest-generation Xi da Vinci surgical robot to completely dissect the tumor-bearing kidney through small keyhole incisions in the patient's abdomen to control various blood vessels, which allowed him access around and into the inferior vena cava where the cancer had spread. Then, Mark Cunningham, MD, associate professor of surgery, put the patient on a heart-lung bypass machine to create a bloodless environment for tumor removal. He opened the patient's heart using a minimally invasive incision through the ribcage. Cunningham and Gill then worked quickly, efficiently and simultaneously from the chest and abdomen to remove the tumor thrombus from the heart and inferior vena cava, respectively, with Cunningham working from the chest downward and Gill working from the abdomen upward. All the while Duraiyah Thangathurai, MD, professor of clinical anesthesiology and chief of critical care medicine, monitored the patient's organ function, keeping a close eye on the patient's heart using an esophageal echo probe. If a portion of the tumor were to break off into the heart or lungs, the patient would die instantly.
"We are proud of our ability to coordinate such complex efforts between the cardiac and urologic surgical teams with skill and dexterity," said Cunningham. "This was the driver of our success and exactly the standard we strive for across the institution."
According to the American Cancer Society, there are approximately 64,000 new cases of kidney cancer diagnosed each year. Only a small fraction of those patients (about 10 percent) have cancer that spreads through the blood vessels without metastasizing to other organs. In a small portion of these patients, the kidney cancer advances all the way up the vena cava into the heart, often rather rapidly. While this is a relatively rare occurrence, this condition could result in sudden death at any time from fragments of the tumor breaking off into the heart and lungs, and surgery is absolutely necessary.
Keck Medicine of USC has long been a pioneer of advanced surgical techniques. In 2003, surgeons at the CardioVascular Thoracic Institute at Keck Medicine of USC developed minimally-invasive techniques for cardiothoracic surgery involving modifications to the incisions and instruments. In 2015, Gill became the first surgeon to use robotic high intensity focused ultrasound surgical ablation to ablate a kidney tumor. In late 2015, Keck Hospital of USC became the first academic medical center in the country to treat prostate cancer with high-intensity focused ultrasound. Currently, the USC Institute of Urology has one of the world's highest volumes of advanced robotic surgeries annually and is a premiere worldwide robotic training center.

IRCM researchers discover how immunotherapy works in some cancer patients

IRCM researchers discover how immunotherapy works in some cancer patients

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IRCM researchers discover how immunotherapy works in some cancer patients

What if our immune system could cure cancer? This logic seems almost too simple to be true, but it forms the basis of an emerging cancer treatment—immunotherapy. André Veillette, a researcher at the Institut de recherches cliniques de Montréal (IRCM) / Montreal Clinical Research Institute and a professor of Université de Montréal's Faculty of Medicine, has a new article today in Nature about this rapidly developing field. Dr. Veillette and his team have discovered why immunotherapy would work in some patients and not at all in others: the SLAMF7 molecule plays a predominant role.
Immunotherapy: An emerging field in cancer treatment
Our immune system has an army of cells comprised of macrophages, T lymphocytes and natural killer cells, which destroy microbes and other invaders. But cancer cells manage to fool these brave soldiers using a variety of stratagems. Immunotherapy works to defeat these stratagems and provides a number of significant benefits. Unlike more invasive therapies such as chemotherapy and radiotherapy, it targets cancer cells and can spare healthy ones.
However, immunotherapy is not always successful. A considerable number of patients do not respond well to this type of treatment. In addition, immunotherapy causes some patients to suffer major side effects due to a hyperactivated immune system. In these cases, it may have been better to try traditional treatments like radiotherapy or chemotherapy from the outset.
Dr. Veillette's research group wanted to understand why immunotherapy is effective in certain cases. The researchers were particularly interested in a potential treatment involving CD47, a protein already recognized as an evasion mechanism. "CD47 acts like a chameleon," explains Dr. Jun Chen, first author of the study and a postdoctoral fellow in Dr. Veillette's laboratory. "It is found on the surface of cancer cells and makes them appear to be healthy: it tells the immune system not to destroy them, which leaves the door open for tumour growth and metastasis," adds Dr. Veillette, who is also Director of the IRCM Molecular Oncology research unit, Full Research Professor in the Department of Medicine at the Université de Montréal and Adjunct Professor at McGill University.
CD47 has been found at high levels in a variety of cancers, including blood cancers. Needless to say, molecules that prevent CD47 from binding to immune cells — CD47 inhibitors — are being extensively studied as potential new anti-cancer treatments. But the IRCM team has identified another very important component of this mechanism: another molecule, SLAMF7, must be present on cancer cells for immune cells to be able to destroy them. So for people whose cancers do not have SLAMF7, the administration of CD47 inhibitors could be counterproductive.
Shift to precision medicine
The discovery of Dr. Veillette's group could be the key to predicting which patients will respond to CD47 inhibitors. Determining whether SLAMF7 is present in the patient's cancer could help establish, from the outset, whether CD47 inhibitors are a good choice of treatment. By preselecting patients in this way, incompatible patients could be rapidly redirected to an alternative treatment with a greater chance of success. This is what is known as precision medicine.
The IRCM laboratory hopes that this discovery will also contribute to the success of upcoming CD47 inhibitor clinical trials. "There are currently more potential new treatments than there are patients available to test them in clinical trials," says Dr. Veillette. "To take advantage of the full potential of emerging treatments like immunotherapy, we should not use them as universal treatments, since very useful ones could be overlooked, thereby hindering our progress in the fight against cancer."

Noninvasive imaging test may spare benign kidney tumor patients from unnecessary surgery

Noninvasive imaging test may spare benign kidney tumor patients from unnecessary surgery

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Noninvasive imaging test may spare benign kidney tumor patients from unnecessary surgery

The latest in a series of studies led by researchers at Johns Hopkins Medicine shows that addition of a widely available, noninvasive imaging test called 99mTc-sestamibi SPECT/CT to CT or MRI increases the accuracy of kidney tumor classification. The research team reports that the potential improvement in diagnostic accuracy will spare thousands of patients each year in the United States alone from having to undergo unnecessary surgery.
In a recent report on ongoing work to improve kidney tumor classification, published in the April issue of the journal Clinical Nuclear Medicine, the team reports that the sestamibi SPECT/CT test-;short for 99mTc-sestamibi single-photon emission computed tomography/computed tomography(CT) -; adds additional diagnostic information in conjunction with conventional CTs and MRI and improves physicians' ability to differentiate between benign and malignant kidney tumors.
"Sestamibi SPECT/CT lets radiologists and urologists 'see' the most common benign kidney tumor, something CT and MRI have not succeeded in doing alone," says Mohamad E. Allaf, M.D., MEA Endowed Professor of Urology at the Johns Hopkins University School of Medicine. "This noninvasive scan may prevent patients with a potentially benign kidney tumor from having to undergo a surgery to remove the tumor or potentially the entire kidney, along with its associated risks and high costs. At Johns Hopkins, use of this test has already spared a number of our patients from unnecessary surgery and unnecessary removal of a kidney that would require them to be on dialysis. These results are hugely encouraging, but we need to do more studies."
For this study, 48 patients who were diagnosed with a kidney tumor on conventional CT or MRI were imaged with sestamibi SPECT/CT at Johns Hopkins prior to surgery. Radiologists, who were not allowed to talk to each other or know the results of the surgeries, graded the conventional and sestamibi SPECT/CT images benign or malignant using a 5-point scale (1 = definitely benign, 5 = definitely cancerous).
Following surgery, similarly 'blinded' pathologists analyzed the tumors without knowing the radiologists' imaging results. Pathology results of surgically removed tumors showed that 8 of the 48 were benign. The remaining 40 were classified as a variety of other tumor types, including malignant renal cell carcinomas.
Reviewing sestamibi SPECT/CT scan results in conjunction with CT or MRI changed the initial rating levels from cancerous (score 3, 4, 5) toward benign (score 1 and 2) in 9 cases, and changed reviewers' score from likely cancerous (score 4) to definitely cancerous (score 5) in 5 cases, or about 10 percent of all cases. The addition of sestamibi SPECT/CT increased the reviewers' diagnostic certainty in 14 of the 48 patients, or in nearly 30 percent of all cases.
Overall, the investigators said, adding sestamibi SPECT/CT helped identify 7 of 9 benign tumors, and conventional imaging with added sestamibi SPECT/CT outperformed conventional imaging alone, as measured by a statistical analysis that measures tradeoffs between sensitivity and specificity. On this measure, a value of 0.50 indicates that a diagnostic test is no better than chance. Conventional imaging combined with sestamibi SPECT/CT had a value of 0.85, while conventional imaging alone had a value of 0.60.
Even for patients whose tumors were not reclassified, the addition of sestamibi SPECT/CT increased physicians' ability to more confidently classify malignant tumors, which reduces the risk of misdiagnosis and unnecessary surgery for all patients, the researchers say.
Radiologists and urologists have been frustrated for decades by the inability of conventional imaging tests, such as CT and MRI, to distinguish benign from malignant kidney tumors. At Johns Hopkins, multispecialty teams work together to determine the best care for patients and as partners on research innovations and quality improvement initiatives. "This collaborative venue enabled two then-residents [Drs. Michael Gorin and Steven Rowe] from different departments and specialties to design a clinical trial based on a few reports in the literature suggesting a potential role for sestamibi SPECT/CT in this diagnostic conundrum, and their hypothesis proved correct," says Mehrbod Som Javadi, MD, assistant professor of radiology at Johns Hopkins University School of Medicine and the senior author on the paper. Pamela T. Johnson, MD, associate professor of radiology at the Johns Hopkins University School of Medicine notes, "these types of advances are critical to our precision medicine initiative, Hopkins inHealth, designed for individualized patient management, and to our mission of high-value health care, where the highest quality care is safely delivered at the lowest personal and financial cost to the patient."
"As radiologists, we have struggled to find noninvasive ways to better classify patients and spare unnecessary surgery, but this has not been easy," says Steven P. Rowe, M.D., Ph.D., one of the two former residents who developed this approach, and now assistant professor of radiology and radiological science at the Johns Hopkins University School of Medicine. "Sestamibi SPECT/CT offers an inexpensive and widely available means of better characterizing kidney tumors, and the identical test is now being performed as part of a large trial in Sweden, for which the first results have just recently been published and appear to confirm our conclusions."
Although further study is needed to validate the accuracy of sestamibi SPECT/CT, this test appears to be a less expensive, faster, noninvasive alternative to surgery, says Michael A. Gorin, M.D., the other resident involved in developing this approach and now chief resident with The James Buchanan Brady Urological Institute of the Johns Hopkins University School of Medicine. "In the absence of diagnostic certainty, surgeons tend to remove kidney tumors in an abundance of caution, leading to an estimated 5,600 surgically removed benign kidney tumors each year in the United States."