Blasts May Cause Brain Injury without Symptoms…

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According to researchers at Duke Medicine and the U.S. Department of Veterans Affairs, veterans who have exposed to blasts and do not report signs of traumatic brain injury (TBI) may still have damage to the brain's white matter similar to veterans with TBI. The findings, published in the Journal of Head Trauma Rehabilitation, suggest that a lack of apparent TBI symptoms following an explosion may not precisely portray the degree of brain injury. Veterans of recent military conflicts in Iraq and Afghanistan often have a history of exposure to explosive forces from bombs, grenades, and other devices, although relatively little is known about whether this injures the brain. However, evidence is piling up, especially among professional athletes, that subconcussive events have an effect on the brain. "Similar to sports injuries, people near an explosion assume that if they don’t have clear symptoms, losing consciousness, blurred vision, headaches, they haven’t had injury to the brain. Our findings are important because they’re showing that even if you don’t have symptoms, there may still be damage,” said senior author and associate professor of psychiatry and behavioral sciences at Duke University School of Medicine and a psychiatrist at the Durham Veterans Affairs Medical Center, Rajendra A. Morey, M.D. Researchers in the Mid-Atlantic Mental Illness Research, Education and Clinical Center at the W.G. (Bill) Hefner Veterans Affairs Medical Center in Salisbury, N.C., examined 45 U.S. veterans who volunteered to participate in the study. The veterans, who served since September 2001, were separated into three groups: veterans with a history of blast exposure with symptoms of TBI; veterans with a history of blast exposure without symptoms of TBI; and veterans without blast exposure. The study primarily focused on veterans with primary blast exposure, or blast exposure without external injuries, and did not include those with brain injury from direct hits to the head. In order to measure injury to the brain, the researchers used a type of MRI called Diffusion Tensor Imaging (DTI). DTI can spot injury to the brain’s white matter by measuring the flow of fluid in the brain. In healthy white matter, fluid moves in a directional pattern, implying that the white matter fibers are undamaged. Injured fibers allow the fluid to diffuse. White matter is the connective wiring that joins different regions of the brain. Since most cognitive processes involve several parts of the brain operating together, injury to white matter can significantly harm the brain’s communication network and may result in cognitive ailments. Both cohorts of veterans who were near an explosion, regardless of whether they had TBI symptoms, demonstrated a tremendous amount of injury as opposed to the veterans not exposed to an explosion. The injury was not restricted to one area of the brain, and each individual had a different pattern of injury. Using neuropsychological testing to evaluate cognitive performance, the researchers found a link between the amount of white matter injury and changes in reaction time and the ability to switch between mental tasks. However, brain injury was not asscociated to performance on other cognitive tests, including decision-making and organization. “We expected the group that reported few symptoms at the time of primary blast exposure to be similar to the group without exposure. It was a surprise to find relatively similar DTI changes in both groups exposed to primary blast. We are not sure whether this indicates differences among individuals in symptoms-reporting or subconcussive effects of primary blast. It is clear there is more we need to know about the functional consequences of blast exposures,” said research health scientist at the W.G. (Bill) Hefner Veterans Affairs Medical Center and the study’s lead author, Katherine H. Taber, Ph.D. Given the study’s findings, the researchers noted clinicians treating veterans should take into account a person’s exposure to explosive forces, even among those who did not initially show symptoms of TBI. In the future, they may use brain imaging to support clinical tests. “Imaging could potentially augment the existing approaches that clinicians use to evaluate brain injury by looking below the surface for TBI pathology,” Morey said. The researchers said that the results are at this time preliminary, and should be duplicated in a much larger ... Read more

Nonsurgical Gamma-knife Stereotactic Radiosurgery …

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Research conducted by the Beaumont Health System radiation oncologists and neurosurgeons discovered that symptoms of trigeminal neuralgia, or TN, a nerve disorder causing extreme facial pain, was significantly decreased in patients treated with Gamma Knife stereotactic radiosurgery. The results have since been published recently in the journal Clinical Neurology and Neurosurgery. TN is a disorder of the trigeminal nerve, which is in charge for feeling in the face. In most cases, the facial pain is caused by a blood vessel putting pressure on the nerve by pressing on it. It is believed that TN is a result of deterioration of the protective covering of the trigeminal nerve.   "The Gamma Knife is not actually a knife. Gamma Knife stereotactic radiosurgery is a nonsurgical technique that precisely delivers a high dose of radiation to a targeted area. It sends more than 200 beams of gamma radiation, while the low intensity of the individual beams avoids causing damage to the surrounding tissues,” said radiation oncologist, Beaumont Hospital, Royal Oak and associate professor, Oakland University William Beaumont School of Medicine, Inga Grills, M.D.   In addition to serving as principal investigator, Grills and a team of Beaumont researchers analyzed data of 149 patients who were treated with Gamma Knife Stereotactic Radiosurgery, or GK SRS.   After the treatment, patients were assessed in a period of two weeks, then every three to six months. Patients reported if they experienced normal, decreased or no facial pain. Researchers concluded GK SRS provides satisfactory relief for those with TN, particularly those who are not fitted or have failed medical or surgical treatments.   "This study demonstrates patients with severe facial pain caused by trigeminal neuralgia will experience less discomfort after Gamma Knife Stereotactic Radiosurgery. They can resume daily activities such as brushing their teeth, washing their face and even smiling, without the unbearable sensation that is often caused by this condition," explains Grills.   According to the American Association of Neurological Surgeons, roughly 150,000 people are diagnosed with TN on an annual basis. Women over the age of 50 are among those who are most commonly diagnosed. Those at risk are people with high-blood pressure or with multiple sclerosis. ... Read more

Study Shows Stronger Cancer Treatments with Fewer Side …

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A new study led by Alexey Ryazanov, a professor of pharmacology at Rutgers Robert Wood Johnson Medical School and member of the Rutgers Cancer Institute of New Jersey, suggests finding a way to make chemotherapy and radiation more effective as cancer treatments than they currently are, in addition to removing crippling side effects that patients fear. Side effects such as heart damage, nausea, and hair loss happens when cancer therapy kills healthy cells alongside the malignant cells that are being targeted. It is a medical form of collateral damage. However, Ryazanov delineates that if a way could be found to safeguard those healthy cells, then doses of chemo and radiation could actually be increased, "killing all the cancer cells and the patient would be cured. We also could start treating cancers that now can't be cured because the most effective doses are too toxic to normal tissues." The solution to Ryazanov's vision of cancer treatment is addition by subtraction, particularly elimination of eEF2K, an enzyme that impacts the rates at which proteins are created in the human body. Ryazanov first identified eEF2K more than a quarter century ago, and since then, bit by bit, he and other scientists have uncovered many intricate processes for which that enzyme is responsible. Ryazanov's latest findings, published in the journal Developmental Cell, reveal that the existence of eEF2K deliberately weakens healthy cells. His evidence is the enzyme's involvement in a process where defective cells involved in reproduction are degraded and ultimately destroyed, as a means to preserve genetic quality from one generation to the next. “Still, there is eEF2K in every cell in the body, the enzyme's presence tends to leave cells less robust than they otherwise would be.It is that added weakness that leaves healthy cells vulnerable to being poisoned by chemo and radiation,” Ryazanov explained. Ryazanov notes that removing the enzyme would make those healthy cells stronger, to the point where they would survive cancer therapy, and that, in turn, would terminate the side effects. Yet, how would healthy cells survive cancer treatment while malignant cells would not? Ryazanov explains that tumors grow and cancer spreads when malignant cells divide and duplicate. Chemo and radiation are purposefully designed to obstruct cell division, and Ryazanov says removing the enzyme eEF2K actually makes the cancer cells more susceptible to the treatment. By contrast, as long as healthy cells are strong enough to resist being poisoned, the cancer therapies won't hurt them. In 2008, Ryazanov founded Longevica Pharmaceuticals, a company whose mission is to perfect medications designed to eliminate the enzyme and improve the performance of chemo and radiation. Animal testing is has already been commenced, and Ryazanov hopes that his new findings will lead to the day when medications that pass those tests can be tried in people. He even predicts that taking such a drug may be as easy as swallowing a pill. Ryazanov says there is a comforting logic to the research and drug development that have become his life's work, due to the fact that the cancer therapies he wants to enhance and improve already exist and are known to work. “Making chemo and radiation less toxic can make those therapies dramatically more effective in the relatively near future, while other cutting-edge approaches to cancer treatment might need far more time to prove their ultimate worth,” he ... Read more

Humidification of Mouth, Throat, Shortens Mucostis, …

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According to a research study presented at the 2014 Multidisciplinary Head and Neck Cancer Symposium, patients who underwent daily humidification of the mouth and throat area starting from day one of radiation therapy treatment spent nearly 50 percent fewer days in the hospital to manage their side effects. The study was carried out by the Trans Tasman Radiation Oncology Group and assessed 210 head and neck cancer patients in New Zealand and Australia from June 2007 through June 2011. Patients in this Phase III trial were randomized to institutional standard of care (control arm) or humidification (HUM) using the Fisher & Paykel Healthcare MR880 humidifier. The humidified air is administered through the nose through a plastic interface (mask-type apparatus) that can be worn by patients while sleeping or while sitting during the day. Patients began HUM on the first day of radiation therapy and continued until the ulceration their mouth and throat had subsided. On average, HUM patients spent 57 percent as many days in the hospital to manage side effects (control = 4.1 days vs. HUM = 2.3 days). The recurrence of normal eating patterns was also considerably higher at three months following radiotherapy in the group using humidifiers. (Nutritional Mode score at 20 weeks, a clinician-reported assessment of nutritional status, control = 4.8 vs. HUM = 5.23.) Only 43 patients (42 percent of the patients in the HUM arm) met the outlined standard of HUM fulfillment and were able to contribute to the per protocol (PP) analysis; the mean average use of humidification for these patients was 3.6 hours per day (range of 0-14 hours/day). In patients who met the HUM defined benchmark, the area under the curve for CTCAE version 3.0 functional mucositis score (a clinician assessment of mucositis symptom burden for patients) was reduced (control = 8.63 vs. HUM PP = 6.74). The proportion of compliant HUM patients who never required a feeding tube was also increased (control = 0.73 vs. HUM PP = 0.85). There was also a tendency for patients to report a reduction in symptom burden when using humidification but only in those patients compliant in using the humidifier. "Mucositis (inflammation and ulceration of the mouth and throat) is a painful side effect of radiation therapy that can negatively affect patients' quality of life. This study has provided efficacy signals consistent with a role for humidification in reducing symptom burden for patients during radiotherapy for head and neck cancer. Preventing or reducing hospitalizations may also mean it is cost effective. The rationale for using humidification is based on the fact that moisturizing wounds generally helps them heal faster," said Andrew Macann, FRANZCR, lead author of the study and a radiation oncologist at Auckland City Hospital in Auckland, New Zealand. "These results are encouraging, particularly given the signals favoring humidification were seen across clinician-reported outcomes, patient-reported outcomes and independent data such as hospitalizations. Although patients in the study did not use the humidifiers as much as was hoped, we obtained feedback about why some patients did not like using the humidifier. Our next step is to work at increasing the proportion of patients who use the humidifier ... Read more

Intensive Radiotherapy Holds More Benefits for …

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According to a study spanning 10 years, a radiotherapy treatment plan involving higher doses of radiation is regarded as a much better option as opposed to lowering doses for men with localized prostate cancer. Having 37 sessions, or fractions, of radiotherapy at 74 Gray (Gy) as opposed to 32 fractions at 64 Gy, controlled the disease more efficiently and diminished the chance that men would require follow-up hormone-deprivation therapy, which can lead to long-term side-effects. The study’s findings, published in The Lancet Oncology, come from the major RT01 phase III trial. The trial was led by Professor Dearnaley at The Institute of Cancer Research, London, and The Royal Marsden NHS Foundation Trust, and was funded and conducted by the Medical Research Council Clinical Trials Unit at UCL. The study also featured several leading clinical research centers in the UK, New Zealand, and Australia. In addition, the study exhibited the overall efficiency of radiotherapy for men with localized disease. Around three quarters of men treated with either the more or less intensive radiotherapy treatment plans were still alive after 10 years. Established in 1998, the trial divided 843 men with localized prostate cancer into two groups to contrast the two doses of radiotherapy. Some 421 men had the less and 422 the more intensive treatment plans. Both cohorts also had standard hormone-deprivation treatment concurrently with their radiotherapy. The five-year results of the trial have previously demonstrated the benefits of dose-escalated radiotherapy, and served as an influential role in changing NICE guidance to recommend it in prostate cancer. Dose escalation is now the standard for localized prostate cancer in the UK. The new 10-year results further fortify the evidence for selecting higher does radiotherapy, in addition to showing the long-term benefits of the treatment. Following 10 years, 55 per cent of men on the 37-fraction regime, when juxtaposed with 43 per cent of men on the 32-fraction regime, had survived without their cancer progressing into a more perilous form, as measured by the standard prostate-specific antigen (PSA) test. In each half of the study, 71 per cent of men were alive following 10 years, with only 11 per cent dying from prostate cancer. Men who were administered the higher dose were more likely to have side-effects connected with radiotherapy, but few men had severe side-effects. Receiving the higher dose reduced the need for follow-up hormone treatment, which also has its own risk of side-effects. The trial did not reveal that men given dose-escalated radiotherapy live longer, however both cohorts of men lived much longer than expected. Almost three quarters of all the men in the study were still alive after 10 years, and of the 236 men who had died since treatment, only 91 had died of prostate cancer. "Our study has proved that treating men with localized prostate cancer using higher doses of radiotherapy is more effective than a less intensive regime. The dose-escalated regime is safe in the long term, and reduces the chances that a cancer will return and men will require further hormone-deprivation treatment. The side-effects of hormone treatment do need to be balanced against those of the extra radiotherapy doses, but overall our study has shown men are better off after having the escalated regime, as is now the norm in the UK,” said Study leader Professor David Dearnaley, Professor of Uro-Oncology at The Institute of Cancer Research, London, and Honorary Consultant at the Royal Marsden NHS Foundation Trust. "Another key finding to come out of our study is that radiotherapy in general is both a safe and an effective treatment for localized prostate cancer. Almost three quarters of men treated with either the more or less intensive radiotherapy regimes are still alive after 10 years, and of the men who have died, less than half actually died from prostate cancer. Further refinements in radiotherapy techniques since our trial began have made treatment even safer and are very important as men with localized prostate cancer have such favorable long-term survival prospects,” he added. Senior Scientist and Statistician at the MRC Clinical Trials Unit at UCL, Matthew Sydes said: "The RT01 trial has already changed how men with localized prostate cancer are treated. The current NICE guidelines recommend the use of the higher dose of radiotherapy, based on the five-year results of RT01. The trial also helped to develop guidelines on how to limit the radiation that organs near the tumor receive, and helped hospitals across the UK to introduce quality-assured conformal radiotherapy. It is now contributing to biological studies to help better understand the disease and the side-effects of ... Read more

Claron Awarded CE Mark for NilRead Diagnostic …

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Opens European Headquarters March 3, 2014, Toronto — Claron Technology, the leader in universal medical imaging viewers, announces that it has been awarded the CE mark for its NilRead zero-footprint viewer for the diagnostic interpretation of medical images. Coinciding with this, Claron has opened European headquarters in Hasselt, Belgium, under the direction of Tom Tilmans, director of sales. In addition to spearheading direct sales efforts, Tilmans will recruit and manage a team of European partners and distributors. NilRead is a universal, web-based zero-footprint viewer that enables diagnostic interpretation of medical images and related digital information on a variety of computers anytime, anywhere across the enterprise and beyond. It supports viewing of all cleared DICOM imaging modalities and both 2-D and 3-D viewing. Running from a remote server, NilRead requires no software download while delivering the highest quality performance, comparable with a full-featured PACS viewer. NilRead features customizable hanging protocols, prior-current comparisons and extensive measurements. Its advanced visualization features include thin/thick slabs, MIP, volume rendering, PET/CT fusion and more. NilRead delivers the highest levels of security and leaves no information on the viewing hardware when the session is complete. It is the first zero-footprint viewer supporting multi-diagnostic monitor configurations. Claron has recently extended Nil with data adapters for popular vendor neutral archive (VNA) solutions and with bi-directional Web API for integration with workflow solutions. This, combined with strong support for non-DICOM data, including native support for video and multiple image formats – such as jpeg, png, tiff, bmp, PDF and others – makes Nil the ultimate companion to a multi-specialty enterprise archive. “NilRead received FDA and Health Canada clearance for diagnostic use several months ago and has been extremely well-received in North America,” says Claudio Gatti, Co-CEO and Co-Founder of Claron Technology. “With CE acceptance, we are pleased to start offering the technology throughout Europe. The functionality of both viewers will be expanded at ECR with localization in all major European languages to facilitate adoption through the European Community.” “We are extremely pleased to welcome Tom Tilmans to Claron to spearhead the introduction of Nil in Europe,” says Reuven Soraya, sales and marketing vice president for Claron. “Tom brings a wealth of experience and business connections to the company. With Tom’s expertise and the new CE mark, we are looking forward to extending the value of Nil to European customers.” Claron’s Nil family of viewers also includes NilShare for non-diagnostic use, which has been helping to meet the image sharing needs of a wide range of needs of medical facilities since 2010. Claron’s Nil enterprise viewers are in daily use at hundreds of health care facilities.  About Claron Technology, Inc. Claron is dedicated to the application of image processing, image sharing and image distribution in medicine. It has extensive experience in developing systems that help clinicians identify anatomy and tissues of interest, visualize and analyze them, and securely distribute them on a variety of different platforms from desktop to smartphones. Claron helps healthcare providers deliver more value to their patients by making physicians more efficient and ... Read more

Cancer Patients Demand More Written Information …

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Based on a new study, patients who receive radiotherapy for pelvic cancers demand to be better informed regarding the numerous side effects prior to treatment. Around half of the patients who participated in a UK survey reported unfulfilled information needs on a variety of issues, including rehabilitation, ways to access supportive services, and how to cope with the treatment's sexual consequences. Over two thirds of the 58 patients said they were given written information, mostly by a nurse, and this was, for the most part, well received. None of the respondents requested less information. The authors of the study, published in Cancer Nursing Practice, said individualized evaluation of patients' needs was essential before, during, and immediately following treatment, and once again during the course of rehabilitation. They ultimately concluded that healthcare professionals should provide sufficient information about the next stages of care without overwhelming their patients. Furthermore, nurses should establish early on in the treatment plan how each patient wants information to be delivered to them and ... Read more

New Treatment Alternative for First Line of Attack in …

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According to a recent study conducted by Manchester researchers, has proven to reveal promising results for a new treatment option in follicular lymphoma. Follicular lymphoma is a kind of non-Hodgkin's lymphoma, a blood cancer, that typically develops slowly. The majority of patients are diagnosed when the disease is at an advanced stage. Recent advancements in treatment have included the use of antibodies to purposely target the tumorcells and to stimulate the patient's own immune system to attack their tumor(s). The use of such antibodies has significantly enhanced treatment response, however unfortunately most patients are still prone to relapse. Radioimmunotherapy, a procedure in which a radioactive substance is fastened to the antibody, has been proven to be successful in treating patients who have previously relapsed. As a result, today a team made up of researchers from The University of Manchester, part of the Manchester Cancer Research Centre, have investigated the use of radioimmunotherapy treatment in newly diagnosed patients. The study published in the Journal of Clinical Oncology, examined the effects of delivering the treatment in two fractions or doses, such an approach is thought to enhance the penetration of the drug within larger tumors and also helps diminsh the side effects connected to a full dose treatment. "This was the first study to look at giving two fractions of radioimmunotherapy as an initial treatment in follicular lymphoma. We wanted to assess its safety and effectiveness in a group of high-risk patients who conventionally have done less well,” said lead researcher of the study,” Professor Tim Illidge. The researchers soon discovered that that their treatment plan was indeed practical and safe, in addition to involving very few side effects. "We saw a high overall response rate, of 94.4%, and 50 of the 72 (69.4%) patients treated in the study achieved complete response, meaning their symptoms disappeared. These results are encouraging, but we need further studies in larger numbers of patients to fully compare this treatment to the standard treatment of 6-8 cycles of chemotherapy," noted ... Read more

Premier Family Practice Associates Selects RamSoft …

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February 28, 2014 – Toronto, Ontario, Canada - Premier Family Practice Associates is a multi-specialty, family practice provider in Bakersfield, CA. Drs. Luis Cousin, Hemmal Kothary and Albert Peinado, owners of PFPA, are joined by Drs. Michaela Ginn and Mary Milkie-Andrews to offer a wider range of professional medical services to the surrounding community. They have selected PowerServer PACS for its ability to automate every aspect of their in-house radiology workflow and provide them with the tools for fast and efficient reporting. According to Dr. Luis Cousin, owner of Premier Family Practice Associates, they selected PowerServer PACS based on prior experience with the solution. “We’ve seen, first hand, how efficiently PowerServer PACS manages radiology workflow that we knew it would be the ideal solution for PFPA,” says Dr. Cousin. “It provides us with unlimited freedom to manage our radiology workflow now, and because it’s fully customizable, it will grow with our business needs. Ms. Marilyn Solano, director of sales and marketing adds “We’ve designed our PowerServer line around a single platform database for ease of use and easy customization. As a result, Premier Family Practice Associates will benefit from access from anywhere, a fully automated and customized workflow, and rapid report distribution. ” PowerServer PACS is built on RamSoft’s industry-leading single platform technology and includes a built-in workflow engine that automates every step from queuing patient data to the modality, to radiologist interpretation and report distribution. Its web-based architecture provides end users with the convenience of being accessible from anywhere without losing productivity. PowerServer PACS supports all modalities and is designed to create efficient workflow management for imaging facilities of any size with any number of locations. About RamSoft, Inc.: RamSoft, a Canadian IT software and services company with 20 years of experience, is dedicated to developing and delivering cost effective RIS, PACS and Teleradiology solutions for its clients in the U.S. and around the world. The company’s goal is to enable imaging facilities, radiology centers, and ambulatory and acute-care practices to continue offering superior patient care while improving workflow efficiencies. RamSoft, Inc. offers a wide range of affordable and feature-rich solutions such as the PowerServer™ Series of PACS, RIS/PACS, Teleradiology, and patient information management ... Read more

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