EXPLORER, the world’s first whole-body PET/CT scanner has produced some amazing human images, opening doors to numerous diagnostic and therapeutic applications in the future. The first human images by the scanner were shown at the Radiological Society of North America annual meeting, Nov. 24- Nov. 30 in Chicago.
Simon Cherry
and Ramsey Badawi
A brainchild of UC Davis scientists Simon Cherry and Ramsey Badawi, the EXPLORER combines positron emission tomography (PET) and X-ray computed tomography (CT) making it possible to image the whole body at the same time. The scanner has been developed in partnership with Shanghai-based United Imaging Healthcare (UIH), which built the system based on its latest technology platform and will eventually manufacture the devices for the broader health care market.
Researchers say that the machine captures radiation far more efficiently than any other scanner, producing images in as little as 1 second and, over time, produce videos that can track the journey of specially tagged drugs through our entire body.
EXPLORER is 40 times faster than current PET scanners and can produce images of whole-body in as little as 20 to 30 seconds. The radiation dose can be further reduced at the expense of a few extra seconds under the scanner or if needed a longer scan at the standard dose will produce optimal image quality.
“The tradeoff between image quality, acquisition time and injected radiation dose will vary for different applications, but in all cases, we can scan better, faster or with less radiation dose, or some combination of these,” Cherry said.
It is for the first time that a scanner can visualize simultaneously that what is happening at the organ as well as tissue level. It will also benefit patients and physician by documenting the spread of cancer, inflammation in body tissues, various infection, immunological and metabolic disorders and much more.
“I don’t think it will be long before we see at a number of EXPLORER systems around the world,” said Cherry and is very optimistic about the future of the EXPLORER.
The UC Davis team is working closely with UIH to get the first system installed in Sacramento, USA, and the first system is expected to begin imaging patients as early as June 2019.
Here’s a scan of a whole body taken using the EXPLORER
CDC encourages healthcare practitioners, partner organizations, and other state programs to create awareness in the community about HPV virus, different pathologies caused by the virus and its mode of transmission. CDC also promotes adolescent’s HPV vaccination programs and provides guidance on achieving high HPV vaccination rates.
Healthcare providers are often faced with the dilemmas about initiating the conversation with parents and adolescents about HPV vaccination. This short informative video offers simple and practical guidance to have a successful conversation with parents about the vaccine.
In an extraordinary scientific feat, researchers were successful in growing human oocytes from the earliest follicular stage in the laboratory in just 20 days instead of 5 months in the body. The eggs fertility potential is unknown yet, and it remains to be seen whether they can produce healthy babies.
The study was carried out in collaboration with the Royal Infirmary Edinburgh, The Center for Human Reproduction in New York and the Royal Hospital for Sick Children in Edinburgh, and published January 2018 in Journal of molecular human reproduction.
This process of oocytes maturation in lab could find potential applications in fertility preservation of cancer patients during the chemotherapy treatments. Immature eggs recovered from patients’ ovarian tissue could be matured in the lab and stored for later fertilization without the fear of reintroducing cancer.
Professor Evelyn Telfer from School of Biological Sciences said, “Being able to fully develop human eggs in the lab could widen the scope of available fertility treatments. We are now working on optimizing the conditions that support egg development in this way and studying how healthy they are. We also hope to find out, subject to regulatory approval, whether they can be fertilized.”
Till now researchers have successfully produced live offspring in mouse from in vitro grown (IVG) oocytes from primordial follicles. They have also grown human oocytes from secondary/multi-laminar stage to obtain fully grown oocytes capable of meiotic maturation.
However, this is the first report of in vitro complete human oocyte growth from immature primordial/unilaminar follicles using two-step culture system.
A series of magnified images show human eggs in development stages. Prof. Evelyn Telfer and Dr. Marie McLaughlin/University of Edinburgh/Handout via REUTERS
The scientist obtained fresh ovarian cortical pieces of approximate size 5 mm × 4 mm from women undergoing elective cesarean section. Fragments were cultured for 8 days according to the institute predetermined protocols.
Follicles ranging in diameter from 100–150 μm were dissected for further isolated culture. After about 8 days cumulus-oocyte complexes (COCs) were retrieved by gentle pressure on the cultured follicles. These COCs were further cultured for 4 more days when complexes containing oocytes >100 μm diameter were selected for in vitro maturation (IVM) in SAGE medium and subsequently fixed for analysis.
Confocal immuno-histochemical analysis of oocytes more than 100 μm diameter showed the presence of a Metaphase II spindle confirming that these IVG oocytes had resumed meiosis but their developmental potential is unknown.
Other scientists are looking at this process with great concern because of the shortened maturation process and lack of genetic analysis of the matured egg.
Telfer agrees that much work needed to be done and said, “We had no great expectations. To see at least one [egg reaching maturity], we thought, ‘Wow, that’s actually quite incredible.’”
The eggs fertility potential is unknown yet because of lack of regulatory approval, and even if they have can be fertilized much research is needed to see whether they can produce healthy babies.
But, the study has given new insights on human egg development that could be very useful in fertility treatment and regenerative therapies.
Her team is working on improving the process and getting an approval from the United Kingdom’s Human Fertilization and Embryology Authority—to try fertilizing the lab-matured eggs to create human embryos.
This is the 3rd report in the series of expert reports Diet, Nutrition, Physical Activity, and Cancer: A Global Perspective, and updates the two previous comprehensive reports, which were published in 1997 and 2007.
The report has distilled evidence of 30 years of research into 10 recommendations that could help prevent cancer by lifestyle modification. The report is based on a review of data from 51 million people, including 3.5 million cancer cases in 17 cancers.
The evidence shows that a modification in your diet, staying physically active, having a healthy body weight and other health-related choices can prevent 12 cancer diagnoses. These include breast, colorectal, pancreatic, endometrial, ovarian, prostate, liver, gallbladder, kidney, bladder, stomach and esophageal cancers.
In 2012, an estimated 14.1 million new cases of cancer occurred worldwide, with nearly 1 in 6 deaths due to cancer.
“The evidence is clear that making changes to diet and exercise and maintaining a healthy weight cuts cancer risks, regardless of age. The message may not be glamorous, but these changes can save your life,” said Kelly Browning, Chief Executive Officer of AICR.
The ten recommendations are:
1) Maintaining a healthy weight is the most important thing you can do to reduce your risk of cancer. Aim to be in the lower end healthy Body Mass Index (BMI) range.
2) Be physically active-incorporate physical activity as a part of your daily life. Walk more and sit less, for maximum health benefits, aim for 150 minutes of moderate, or 75 minutes of vigorous, physical activity a week.
3) Eat a diet rich in vegetables, fruits, whole grains, and beans. AICR recommends a plant-based diet that forms at least two-thirds of your plate.
4) Limit the intake of fast food. There is strong evidence that consuming "fast-foods" and a "Western-type" diet are causes of weight gain, overweight and obesity, which are linked to 12 cancers. Glycemic load also increases the risk for endometrial cancer.
5) Limit red meat and avoiding processed meat - red meat includes beef, pork and lamb and processed meat includes ham, bacon, salami, hot dogs, sausages.
6) Limit consumption of sugar-sweetened beverages- Whenever you feel thirsty drink water or unsweetened beverages.
7) Limit alcohol consumption- alcohol in any form is a potent carcinogen. It's linked to 6 different cancers. The best advice for those concerned about cancer is not to drink.
8) Do not take the supplement for cancer prevention-Aim to obtain nutrition from diet instead of popping the supplements. The panel doesn’t discourage the use of multivitamins or specific supplements for those sub-sections of the population who stand to benefit from them, such as women of childbearing age and the elderly. But, dietary supplements will not avoid cancer.
9) Mothers, please breastfeed your baby- There is a strong evidence that breastfeeding your baby protects against breast cancer later in life.
10) If you are already diagnosed with cancer, you should follow the nutritional advice from an appropriately trained professional. For breast cancer survivors, there is persuasive evidence that nutritional factors and physical activity reliably predict important outcomes from breast cancer.
The report emphasizes the need for knowledge about the link between lifestyle and cancer. In a 2017 AICR Cancer Risk Awareness Survey more than 50% of the population who responded was not aware of the link between obesity and cancer.
The report provides robust evidence for healthcare professionals and government officials to advise the patients about healthy eating and making policies that make healthy eating more affordable.
AICR today launched Cancer Health Check – an easy-to-use tool, which shows how your lifestyle stacks up against known cancer risks and outlines the changes you can make to follow AICR’s evidence-based Cancer Prevention Recommendations.
Results of a
recent umbrella review published online in BMJ have provided strong evidence to
support the association between excess body weight and 11 cancers that include G.I
tract, endometrial and postmenopausal breast malignancies.
“The
association is now clear; it’s time to get serious about prevention, “write Professors
Yikyung Park and Graham A Colditz in an accompanying editorial.
An Umbrella
review is the reviews of existing systematic reviews and only considers the
highest level of evidence to be included, namely systematic reviews and meta-analysis.[1]
Hence, the findings from this umbrella review is the strongest evidence put
forth so far linking obesity and cancer.
The study by
Kyrgiou et al. initially selected 204 individual meta-analyses from 49 papers and
further narrowed it down to 95 meta-analysis based on validity and association
provided by the studies. 76% of the meta-analyses provided varied level of
evidence for association between obesity and cancer.
The
literature search was performed for meta-analysis and reviews that investigated
association between adiposity indices and risk of developing or dying from any
cancer. Adiposity indices included in the study were body mass index, waist
circumference, hip circumference, waist to hip ratio, weight, weight gain, and
weight loss from bariatric surgery. Obesity
was defined as a body mass index (BMI) >30 kg/m2.
The nine obesity
related cancers with strong evidence were endometrial cancer (premenopausal
women), breast cancer (postmenopausal), kidney cancer, multiple myeloma, esophageal
adenocarcinoma, colon and rectal cancer (in men), biliary tract system and pancreatic
cancer. The risk of ovarian and stomach cancer increases as the weight
increases with maximum risk in obese vs. normal weight individuals.
The BMI was
measured as a continuous variable.
With every 5
units increase in BMI, the risk of developing rectal cancer increased by 9% in
men and that of developing biliary tract cancers increased by 56%.
For each 5
kg of weight gain in adulthood the risk of postmenopausal breast cancer
increased by 11% even if the women have never used HRT, similarly for .1
increases in waist to hip ratio the risk of endometrial cancer increased by 21%.
Obesity has become
a major public health problem in last four decades with the incidence being
doubled among women and tripled among men. And preventing adult weight gain can
bring down the risk of these cancers.
The authors
also stressed the importance of primary care physicians in medical practice
because they are the primary point of contact with the patients. They said “Given
the critical role of healthcare providers in obesity screening and prevention,
clinicians, particularly those in primary care, can be a powerful force to
lower the burden of obesity related cancers, as well as the many other chronic
diseases linked to obesity such as diabetes, heart disease, and stroke.”
Although
more prospective studies are needed to confirm the association, personalized
primary preventive strategies could be designed in subjects at ‘ high risk’ for
cancers.
Moaza Al
Matrooshi from Dubai, becomes the first woman to give birth to a healthy
baby boy after transplant of her ovarian tissue that was frozen prepubescent at age 9.
Over 60
children have been born to women who have undergone ovarian tissue transplants worldwide,
but all these patients were adults when the ovarian tissue was preserved.
She is at
present 24 and the frozen ovarian tissue was replanted about a year back. Moaza was born with beta thalassemia and
needed bone marrow transplant to save her life.
She had to
have chemotherapy before she was set to receive bone marrow transplant. Her right
ovary was removed cut into strips, frozen, and stored at a hospital in Leeds. It
was mixed with cryoprotective agent and stored at -196 C in liquid nitrogen.
Moaza received
the chemotherapy and bone marrow transplant, but attained a premature menopause
at 20 years of age due to chemotoxicity.
About a year
back surgeons in Denmark replanted five strips of the ovarian tissue back into
her body - four were stitched on to her failed left ovary and one on to the
side of her uterus.
The ovarian
tissue gained blood supply and started functioning as was evident from rising
hormonal levels and evidence of ovulation. Moaza underwent IVF to maximize the
chances of conception.
Two embryos
were transplanted resulting in the birth of healthy baby boy on Tuesday,
December 15 in London at the Portland Hospital for Women and Children.
Moaza
Al Matrooshi with her husband and baby boy: JOE MILES / AFP/GETTY IMAGES
The
medical community was overjoyed and celebrated the birth of the boy as it paved
the way to restoring fertility to women who receive chemotherapy at an early age.
Survival rates for children with cancers have reached 90%, but they get the
life back and loose the fertility.
Dr. Sara Matthews
who was Moaza’s obstetrician and gynecologist said "This is a huge step
forward. We know that ovarian tissue transplantation works for older women, but
we've never known if we could take tissue from a child, freeze it and make it
work again. This is moving from an experimental technique to a practical
application."
Scientists
in Leeds were pioneer in performing the world's first transplant of frozen
ovarian tissue back in 1999.
Last year a
woman in Belgium also gave birth after transplant of her ovarian tissue removed
when she was 13 years old and have entered puberty. The first woman in the
world to give birth following the transplantation of her own ovarian tissue in
2004 also happened to be from Belgium.
Michael Greger,
MD, FACLM is a
physician, New York Times bestselling author, and internationally recognized professional
speaker on a number of important public health issues. Dr. Greger has lectured
at the Conference on World Affairs, the National Institutes of Health, and the
International Bird Flu Summit, among countless other symposia
and institutions; testified before Congress; has appeared on shows such as The
Colbert Report and The Dr. Oz Show; and was invited as an expert witness in
defense of Oprah Winfrey at the infamous "meat defamation" trial.[1]
His website is NutritionFacts.org, which has got a collection of videos and articles
about healthy plant based diet.
The topic of his presentation was How
not to die: The role of diet in preventing, arresting and reversing our top 15
killers. The presentation was based upon his latest book How not to Die, which became an
instant New York Times Best Seller.
The book is available on Amazon and
other sites in kindle, audio CD, paperback and hardcover.
Photo courtesy: Amazon
The presentation begins with a
personal note about Dr.Greger’s grandmother, who was diagnosed with end stage
heart disease at age 65 and was sent home to await death as Drs. Said that
nothing could be done to improve her condition.
She was confined to wheelchair and was in a really bad shape. She was
rescued by Nathan Pritikin, one of our early lifestyle medicine pioneers.
She was put on a completely different
diet of lots of fruits and vegetables, and the outcome is a history.
Not only she defied death, but lived a
healthy life for another 31 years --- till the age of 96, and enjoyed her 6
grandchildren and great grandchildren.
This incidence inspired Dr. Greger to choose
medicine and later specialize and dedicate his life to life style changes and
prevention and cure of diseases.
He maintains his non-profit website
solely dedicated to nutrition, diet and cure of diseases through healthy plant
based diet- NutritionFacts.org.
The 15 most common cause of diseases
worldwide are Heart disease, Cancer, Hypertension, smoking and COPD, Stroke,
Diabetes, kidney failures, respiratory infection, suicide, blood septicemia,
parkinsonism.
Talking about heart disease Dr. Greger
said “Heart disease is a choice like dental cavities.”Coronary
heart disease; atherosclerosis; hardening of the arteries, begins in childhood. By
age 10, the arteries of nearly all kids raised on the standard American diet
already have fatty streaks—the first stage of the disease.[2]
When
researchers took people with heart disease and put them on the kind of
plant-based diet followed by those populations that didn’t suffer from heart
disease, their hope was to slow the disease process down—maybe even stop it.
But instead, something miraculous happened.
The disease
started to reverse, to get better. As soon as patients stopped eating an
artery-clogging diet, their arteries started opening up. Their bodies
were able to start dissolving some of the plaque away. Even in some cases of
severe triple vessel heart disease, arteries opened up without drugs, without
surgery—suggesting their bodies wanted to heal all along, but were just never
given the chance. This improvement in blood flow to the heart is after just
three weeks of eating healthy.
Similarly,
he has put out reasons and evidence for each of the 15 diseases he described
that can be prevented, or reversed with diet.
The complete lecture can be heard
here.
He has a famous list of daily dozen
that should be consumed daily to add years to your life.
This is the list by Dr.Michael Greger as told to Daily Mail, UK.[3]
1Cruciferous
vegetables, such as broccoli, brussels sprouts, cabbage, cauliflower, kale,
spring greens, radishes, turnip tops, watercress
One serving a day: A serving is half a
cup chopped or quarter of a cup of broccoli or brussels sprouts.
2 Greens
including spring greens, kale, young salad greens, sorrel, spinach, swiss chard
Two servings a day: A serving is
one cup raw or half a cup cooked.
Two servings a
day: A serving is one cup raw leafy vegetables; half a cup raw or cooked
non-leafy vegetables; half a cup vegetable juice; a quarter of a cup dried
mushrooms
Three servings a
day: That's a quarter of a cup of hummus or bean dip; half a cup of cooked
beans, split peas, lentils or tofu; or a full cup of fresh peas or sprouted
lentils.
5 Berries: Any
small edible fruit, including grapes, raisins, blackberries, cherries,
raspberries and strawberries
One serving a
day: A serving is half a cup of fresh or frozen, or quarter of a cup of dried.
The SurePath kit for collecting and transporting the cervical specimens.
Clinical pearls:
HPV testing can now be performed on samples collected for liquid based
pap test in the BD SurePath preservation fluid using the SurePath
vial.
Before the approval, healthcare providers have to collect two different
samples in two different collecting fluids according to the specification of
the testing labs.
It is not approved as a first line primary screening test.
The U.S. FDA
today approved the Roche COBAS test as the first test for Human Papilloma
Virus(HPV) from cervical samples collected for Pap Test in BD SurePath
Preservative fluid.[1]
COBAS HPV test
is a qualitative in vitro test for the detection of Human
Papillomavirus in patient specimens. The test utilizes amplification of target
DNA by the Polymerase Chain Reaction (PCR) and nucleic acid hybridization for
the detection of 14 high-risk (HR) HPV types in a single analysis.
BD SurePath
is a liquid based pap test and the test pack includes collection kit, along
with storage and transportation components with a vial of preservative liquid.
Some other
properties of BD SurePath liquid-based
Pap test are ease of transportation, have less than 24%Ethanolwhich
results in immediate and complete cell fixation, preserving the morphology. It
also has the ability to preserve the sample for 4 weeks at room temperature, 6
weeks refrigerated.[2]
The kit comes with specific instructions on how to collect samples to
minimize the risks of false negative results.
Till date FDA has not approved any HPV test that can be used with the
preservation liquids. Healthcare providers have to collect two different samples,
in two different collecting fluids before the announcement was made.
Now, a single sample collected can be used for carrying out both the
tests. The test has been approved in women 21 years and more, and helps to determine
additional follow-up and diagnostic procedures afterASC-US (Atypical Squamous Cells of
Undetermined Significance) Pap cytology results. It has also been approved for
use is patients 30 years and older as a primary screening test for HPV along
with pap cytology. It detects 14 high-risk HPV types, including HPV 16 and 18, which
are responsible for causing 70% of cervical cancer worldwide.
According to the National Cancer Institute, there will be an estimated
12,990 new cases and 4,120 deaths from cervical cancer in the United States
during 2016.[3]
"Many labs have a preference in how samples are collected for
processing, and this additional approval gives them another clinically
validated option for the Cobas HPV test," Uwe Oberlaender, head of Roche
Molecular Diagnostics, said in a statement.
A recent paper
published in the BMJranks Medical error as the third leading cause of death
after heart disease and cancer.
CDC compiles
the annual list of the most common cause of deaths in USA, based on death
certificates filled out by physicians, funeral directors, medical examiners,
and coroners.
The health
care provider fills the certificates using an International Classification of
Disease (ICD) code to the cause of death, and unfortunately no ICD-10 code
exists at present for human and system factors.
According to
an article published in Journal of patient safety, premature deaths associated
with preventable harm to patients was estimated at more than 400,000 per year
costing the nation a colossal $1 trillion each year.
There's also
the 10,000 serious complications cases resulting from medical errors that occur
each day, beside the 1000 death each day.
"Medicine
today invests heavily in information technology, yet the promised improvement
in patient safety and productivity frankly have not been realized," said
Peter Pronovost, MD, senior vice president for Patient Safety and Quality and
director of the Armstrong Institute for Patient Safety and Quality at Johns
Hopkins.
According to
authors although human error is inevitable, but steps can certainly be taken to
reduce its frequency and severity. They suggest making error made and lesson
learnt more visible instead of conducting closed door mortality meetings, so
that healthcare staff is more aware of such complications.But all
these requires a robust data which is difficult in the absence of standardized collection and reporting at the national
level.
The death
certificate can be changed to include an extra column requiring to address
whether a preventable complication have contributed to the cause of death.
Increasing
trained healthcare staff to rescue patients and limiting human error by always
following set protocols in handling an emergency situation.
Beside USA, medical
errors are also leading cause of deaths in Canada and UK. About 117 other
countries in the world also code the cause of death using ICD codes, using it
as an indicator of health status. ICD-10 also has limited codes to capture the
cause of mortality.
The authors
suggest that when a medical error occurs, the physiological cause of death
along with the error leading to it should be captured.
At the same
time the statistics relating to medical error death should be shared nationally
and internationally as other research is shared, creating a common platform to
heightened awareness.
