GENETIC MUTATIONS

MYSTERY OF WHY HUMANS & ANIMALS DIED

The mystery of why humans die at around 80, while other mammals live far shorter or longer lives, may finally have been solved by scientists.

Humans and animals die after amassing a similar number of genetic mutations, researchers have found, suggesting the speed of DNA errors is critical in determining the lifespan of a species.

There are huge variations in the lifespan of mammals in the animal kingdom, from South Asian rats, which live for just six months, to bowhead whales, which can survive for 200 years.

Previously, experts have suggested that size is the key to longevity, with smaller animals burning up energy more quickly, requiring a faster cell turnover, which causes a speedier decline.

But a new study from the Wellcome Sanger Institute in Cambridge suggests the speed of genetic damage could be the key to survival, with long-living animals successfully slowing down their rate of DNA mutations regardless of their size.

It helps explain how a five-inch long naked mole rat can live for 25 years, about the same as a far larger giraffe, which typically lives for 24.

When scientists checked their mutation rates, they were surprisingly similar. Naked mole rats suffer 93 mutations a year and giraffes 99.

 

 

 

 

 

 

 

 

 

In contrast, mice suffer 796 mutations a year and only live for 3.7 years. The average human lifespan in the study was 83.6 years, but the mutation rate was far lower at around 47.

Genetic changes, known as somatic mutations, occur in all cells and are largely harmless, but some can start a cell on the path to cancer or impair normal functioning.

Dr Alex Cagan, the first author of the study, said: “To find a similar pattern of genetic changes in animals as different from one another as a mouse and a tiger was surprising.

“But the most exciting aspect of the study has to be finding that lifespan is inversely proportional to the somatic mutation rate. This suggests that somatic mutations may play a role in ageing.”

The team analysed genetic errors in the stem cells from the intestines of 16 species of mammal and found that the longer the lifespan of a species, the slower the rate at which mutations occur.

The average number of mutations at the end of lifespan across species was around 3200, suggesting there is a critical mass of errors after which a body is unable to function correctly.

 

 

AGEING IS A COMPLEX PROCESS

Although the figure differed about threefold across species the variation was far less than the variation in body size, which varied up to 40,000 fold.

The researchers believe the study opens the door to understanding the ageing process, and the inevitability and timing of death.

Dr Inigo Martincorena, the senior author of the study, said: “Ageing is a complex process, the result of multiple forms of molecular damage in our cells and tissues.

“Somatic mutations have been speculated to contribute to ageing since the 1950s, but studying them has remained difficult.

“With the recent advances in DNA sequencing technologies, we can finally investigate the roles that somatic mutations play in ageing and in multiple diseases.”

The research was published in the journal Nature.

 

Information on this page is provided for interest only on a "best efforts" basis and does not 
constitute personal advice. Always discuss medical conditions and related matters with your doctor.

 

Reference: https://news.yahoo.com/mystery-why-humans-die-around-173539273.html

 

COVID FACTS & FICTIONS

mRNA Vaccines Alters Human DNA?

 Fact 1: mRNA (messenger Ribonucleic Acid) is a molecule that instructs DNA (deoxyribonucleic acid) to make protein. 

In general, RNA cannot be incorporated into DNA readily. Human DNA is housed in the nucleus of the cell and is separate from the rest of the cell. Movement of molecules in and out of the nucleus is strictly controlled.  

Since mRNA vaccines only tell human cells to produce the Covid-19 virus' spike protein, which the body then mounts an immune response against, the vaccines themselves do not have any part of the virus' genetic code and cannot make the entire virus itself.  

"The mRNA of the spike protein alone is like the body of a car without its engine. It looks like a car but goes nowhere," says Professor Ooi Eng Eong, an expert on emerging infectious diseases at Duke-NUS Medical School. 

Professor Ooi pointed out that there were several limitations in the study that the doctors referenced.

First, the study used a DNA sequencing technique known as high throughput screening, in which multiple genes and even the entire genome can be sequenced simultaneously. This generate a lot of genetic material, and polymerase chain reactions were used to amplify this material. If error are present, they will be amplified. 

Experiments were also done in an artificial environment of a cell line in a test tube and not in patient tissues. Results from this do not always accurately replicate what occurs in animal or human cells.

"The proof of pudding will be to find Sars-COV-2 integrated into the genome of a Covid-19 patient. Despite the many genome level studies that have been done, such an event has not been found. The evidence that Sars-CoV-2 is able ti insert its genome into the human genome is thus inconclusive at this stage," said Professor Ooi.

 

Body Natural Immune System

Fact 2: There is a theoretical possibility that a vaccine may induce the body to produce a low level of antibodies that may be insufficient to kill the virus if the person is infected with Sars-CoV-2, the virus which causes the Covid-19 disease. There is a possibility that the virus may stay in the body and mutate.

But international data so far has shown that the coronavirus mutates slowly and if the vast majority of the global population is vaccinated, the chances of mutations happening will be small.

Vaccines which train the body's immune system to fight off the virus in the event of a real infection, have been shown to be highly effective in reducing the number of Covid-19 infections and mortality rate.  

As for whether the body's natural immunity after being infected could be better at fending off the virus than the community conferred by vaccination, Professor Paul Thambiah, president of the Asia Pacific Society of Clinical Microbiology and Infection, said: "There is a theoretical possibility that natural infection gives better and more long lasting immunity than vaccination, but many people are not willing to take the risk,"

He added that this idea is not new. In the past, there were those who advocates "chicken pox parties" when a child in the neighborhood had chicken pox instead of having children vaccinated against the disease.

"When people realized that some children can get seriously ill from chicken pox and how safe the chicken pox vaccines are, that idea has gone out of the window," said Professor Thambiah.

 

 Side Effects

 Fact 3:  When trying to determine whether an event was caused by a drug, some factors such as how biologically plausible the event is, the time frame after the dose was taken and if the effect was observed again after reintroduction, needs to be considered, Dr Danny Soon of the Consortium for Clinical Research and Innovation Singapore (Cris) said.

Associate Professor Hsu Li Yang, vice-dean of global health at the NUS Saw Swee Hock School of Public Health, said that baseline comparisons for side effects also need to be made to tell if there are higher incidents of these conditions after vaccination.

"For more common conditions like heart attacks and strokes that happen on a daily basis in singapore, it is quite likely that one can have a stroke within a week after vaccination, but which is not actually triggered by the vaccine," Said Professor Hsu.

Three independent bodies of medical experts in Singapore have reiterated that the risk of heart conditions associated with Covid-19 mRNA vaccine is "very small" for the fact that there were a handful of people belonging to the under 30 age group who suffered from myocarditis (inflammation of the heart muscles) and pericarditis (inflammable of the lining outside the heart), and have recommended that people still get the vaccines in the interest of public health.

Singapore's HSA, the Health Sciences Authority said in general, five to seven individuals per 100,000 people a year are hospitalised for mycarditis or pericarditis. "The frequency of heart attacks and strokes in vaccinated people locally is within the background incidence rate, and therefore there is no evidence currently that the vaccines can directly cause these events." HSA said. 

 Long-Term Side Effect

The mRNA vaccine and the protein it triggers production of are both broken down by the human body after a few days. This makes it highly unlikely that there will be side effects that occur years later.

The majority of vaccine side effects such as injection site pain and swelling, fever and fatigue are predictable and happen within days of injection. Severe allergic reactions can also happen but these are rare and for the majority of vaccines usually occur within hours of the injection. 

Some unusual side effects have been observed weeks after Covid-19 vaccinations, like facial muscle weakness and bleeding. The health authorities are continuing to monitor for these nearer term side effects as vaccinations continue, Dr Soon added. 

 

Information on this page is provided for interest only on a "best efforts" basis and does not 
constitute personal advice. Always discuss medical conditions and related matters with your doctor.

 

Source: Singhealth Tomorow's Medicine Research & The Straits Times

 

 

 

COVID-19 VACCINE

 

                           Fig 1 above is obtained from the website @sciencemag.org

 

 ALLERGY

Severe allergy-like reactions in at least eight people who received the COVID-19 vaccine produced by Pfizer and BioNTech over the past 2 weeks may be due to a compound in the packaging of the messenger RNA (mRNA) that forms the vaccine’s main ingredient, scientists say. A similar mRNA vaccine developed by Moderna, which was authorized for emergency use in the United States on Friday, also contains the compound, polyethylene glycol (PEG).

PEG has never been used before in an approved vaccine, but it is found in many drugs that have occasionally triggered anaphylaxis—a potentially life-threatening reaction that can cause rashes, a plummeting blood pressure, shortness of breath, and a fast heartbeat. Some allergists and immunologists believe a small number of people previously exposed to PEG may have high levels of antibodies against PEG, putting them at risk of an anaphylactic reaction to the vaccine. 

"Until we know there is truly a PEG story, we need to be very careful in talking about that as a done deal,” says Alkis Togias, branch chief of allergy, asthma, and airway biology at U.S. National Institute of Allergy and Infectious Diseases (NIAID).

Pfizer, too, says it is “actively seeking follow-up.” A statement recommends that “appropriate medical treatment and supervision should always be readily available” in case a vaccinee develops anaphylaxis.

Anaphylactic reactions can occur with any vaccine, but are usually extremely rare—about one per 1 million doses. As of 19 December, the United States had seen six cases of anaphylaxis among 272,001 people who received the COVID-19 vaccine, according to a recent presentation by Thomas Clark of the U.S. Centers for Disease Control and Prevention (CDC); the United Kingdom has recorded two. Because the Pfizer and Moderna mRNA vaccines use a new platform, the reactions call for careful scrutiny, says Elizabeth Phillips, a drug hypersensitivity researcher at Vanderbilt University Medical Center who attended an NIAID meeting on 16 December. “This is new.” 

“Allergies in general are so common in the population that this could create a resistance against the vaccines in the population,” adds Janos Szebeni, an immunologist at Semmelweis University in Budapest, Hungary, who has long studied hypersensitivity reactions to PEG.

Scientists who believe PEG may be the culprit stress that vaccination should continue. “We need to get vaccinated,” Phillips says. “We need to try and curtail this pandemic.” But more data are urgently needed, she adds: “These next couple of weeks in the U.S. are going to be extremely important for defining what to do next.”

 

CLINICAL TRIAL

Pfizer’s and Moderna’s clinical trials of the vaccines, which involved tens of thousands of people, did not find serious adverse events caused by the vaccine. But both studies excluded people with a history of allergies to components of the COVID-19 vaccines; Pfizer also excluded those who previously had a severe adverse reaction from any vaccine. People with previous allergic reactions to food or drugs were not excluded, but may have been underrepresented.

The two vaccines both contain mRNA wrapped in lipid nanoparticles (LNPs) that help carry it to human cells but also act as an adjuvant, a vaccine ingredient that bolsters the immune response. The LNPs are “PEGylated”—chemically attached to PEG molecules that cover the outside of the particles and increase their stability and life span.

PEGs are also used in everyday products such as toothpaste and shampoo as thickeners, solvents, softeners, and moisture carriers, and they’ve been used as a laxative for decades. An increasing number of biopharmaceuticals include PEGylated compounds as well.

PEGs were long thought to be biologically inert, but a growing body of evidence suggests they are not. As much as 72% of people have at least some antibodies against PEGs, according to a 2016 study led by Samuel Lai, a pharmaco-engineer at the University of North Carolina, Chapel Hill, presumably as a result of exposure to cosmetics and pharmaceuticals. About 7% have a level that may be high enough to predispose them to anaphylactic reactions, he found. Other studies have also found antibodies against PEG, but at lower levels.

Szebeni says the mechanism behind PEG-conjugated anaphylaxis is relatively unknown because it does not involve immunoglobulin E (IgE), the antibody type that causes classical allergic reactions. (That’s why he prefers to call them “anaphylactoid” reactions.) Instead, PEG triggers two other classes of antibodies, immunoglobulin M (IgM) and immunoglobulin G (IgG), involved in a branch of the body’s innate immunity called the complement system, which Szebeni has spent decades studying in a pig model he developed.

In 1999, while working at the Walter Reed Army Institute of Research, Szebeni described a new type of drug-induced reaction he dubbed complement activation-related pseudoallergy (CARPA), a nonspecific immune response to nanoparticle-based medicines, often PEGylated, that are mistakenly recognized by the immune system as viruses.

Szebeni believes CARPA explains the severe anaphylactoid reactions some PEGylated drugs are occasionally known to cause, including cancer blockbuster Doxil. A team assembled by Bruce Sullenger, a surgeon at Duke University, experienced similar issues with an experimental anticoagulant containing PEGylated RNA. The team had to halt a phase III trial in 2014 after about 0.6% of 1600 people who received the drug had severe allergic responses and one participant died. “That stopped the trial,” Sullenger says. The team found that every participant with an anaphylaxis had high levels of anti-PEG IgG. But some with no adverse reaction had high levels as well, Sullenger adds. “So, it is not sufficient to just have these antibodies.”

At the NIAID meeting, several attendees stressed that PEGylated nanoparticles may cause problems through a mechanism other than CARPA. Just last month, Phillips and scientists at FDA and other institutions published a paper showing patients who suffered an anaphylactic reaction to PEGylated drugs did have IgE antibodies to PEG after all, suggesting those may be involved, rather than IgG and IgM.

Other scientists, meanwhile, are not convinced PEG is involved at all. “There is a lot of exaggeration when it comes to the risk of PEGs and CARPA,” says Moein Moghimi, a nanomedicine researcher at Newcastle University who suspects a more conventional mechanism is causing the reactions. “You are technically delivering an adjuvant at the injection site to excite the local immune system. It happens that some people get too much excitement, because they have a relatively high number of local immune cells.”

Others note the amount of PEG in the mRNA vaccines is orders of magnitude lower than in most PEGylated drugs. And whereas those drugs are often given intravenously, the two COVID-19 vaccines are injected into a muscle, which leads to a delayed exposure and a much lower level of PEG in the blood, where most anti-PEG antibodies are.

Nevertheless, the companies were aware of the risk. In a stock market prospectus filed on 6 December 2018, Moderna acknowledged the possibility of “reactions to the PEG from some lipids or PEG otherwise associated with the LNP.” And in a September paper, BioNTech researchers proposed an alternative to PEG for therapeutic mRNA delivery, noting: “The PEGylation of nanoparticles can also have substantial disadvantages concerning activity and safety.’”

Katalin Karikó, a senior vice president at BioNTech who co-invented the mRNA technology underlying both vaccines, says she discussed with Szebeni whether PEG in the vaccine could be an issue. (The two know each other well; both are Hungarian and in the 1980s, Karikó taught Szebeni how to make liposomes in her lab.) They agreed that given the low amount of lipid and the intramuscular administration, the risk was negligible.

Karikó emphasizes that based on what we know so far, the risk is still low. “All vaccines carry some risk. But the benefit of the vaccine outweighs the risk,” she says.

Szebeni agrees, but says he hopes that’s also true in the long run. He notes that both mRNA vaccines require two shots, and he worries anti-PEG antibodies triggered by the first shot could increase the risk of an allergic reaction to the second or to PEGylated drugs.

 

RISK 

To understand the risk, Phillips says, it’s crucial to unravel the mechanisms underlying the immune reactions and find out how often they are likely to occur. The known U.S. cases are currently under study, but key clues may have vanished: Anaphylactic reactions produce biomarkers that only remain in the blood for a few hours. At the NIAID meeting, participants discussed ways to ensure that blood samples from future cases are taken immediately and tested for those markers.

If PEG does turn out to be the culprit, the question is, what can be done? Screening millions of people for anti-PEG antibodies before they are vaccinated is not feasible. Instead, CDC guidelines recommend not giving the Pfizer or Moderna vaccines to anyone with a history of severe allergic reaction to any component of the vaccine. For people who have had a severe reaction to another vaccine or injectable medication, the risks and benefits of vaccination should be carefully weighed, CDC says. And people who might be at high risk of an anaphylactic reaction should stay at the vaccination site for 30 minutes after their shot so they can be treated if necessary.

“At least [anaphylaxis] is something that happens quickly,” Philips says. “So, it’s something that you can be very much alerted to, prepared to recognize early and be prepared to treat early.”

 

Information on this page is provided for interest only on a "best efforts" basis and does not 
constitute personal advice. Always discuss medical conditions and related matters with your doctor.

 

Reference: https://www.sciencemag.org/news/2020/12/suspicions-grow-nanoparticles-pfizer-s-covid-19-vaccine-trigger-rare-allergic-reactions

 

 

 

 

 

COVID-19 VERSUS SARS

 SIMILARITY

• These are the similarities and differences between the latest health emergency and its predecessor, Sars, which affected more than 8,000 people in 37 countries

• The two diseases are genetically similar and both have flu-like symptoms, but the new virus is clinically milder

 

Structure of Coronavirus

The two viruses share similar symptoms. Carriers of the latest coronavirus (covid-19) experience fever, malaise, dry cough, shortness of breath and occasionally respiratory distress, according to a number of medical journals. The virus carriers’ vital signs have been stable in most cases, but leukopenia, a decrease in white blood cells, and lymphopenia, a reduction in the white blood cells known as lymphocytes, were common, studies say.

Similarly, Sars also usually brings with it flu-like signs – including fever, chills, muscle aches, headache and occasionally diarrhoea. Both viruses are known to cause pneumonia.

The genetic sequence of the latest coronavirus is at least 70 per cent similar to Sars, according to medical journals. Both belong to the large coronavirus family which causes illnesses ranging from the common cold to more severe diseases.

Sars-infected cells inspected under a microscope during a news conference in Hong Kong in 2003 were found to be similar to the new coronavirus to the one that caused Sars, but they are not identical. 

 

TRANSMISSION

According to the WHO, both viruses are zoonotic – transmissible from animals to humans. Although the scientific research is ongoing, some studies suggest bats are the most likely hosts for the virus' origins, although it could not have been transmitted directly to humans.

Researchers have compared the new coronavirus’ genetic sequence with those in a library of viral sequences, and found that the most closely related viruses were that coronaviruses originated from the bats. The Chinese Centre for Disease Control (CDC) said it analysed samples of 15 animals from the seafood market thought to be at the centre of the outbreak, but found no match.

 

DIFFERENCES

The new virus (covid-19) is clinically milder than Sars in terms of severity, case fatality rate and transmissibility, according to medical data.So far, the mortality rate for the new virus is about 3.6 per cent – with 360 deaths out of the 10,000 people infected.

Meanwhile, the Sars outbreak infected 8,437 people worldwide with a mortality rate of 10 per cent. According to a WHO report, the deaths of 813 people were attributed to the Sars virus between November 1, 2002 and July 11, 2003.

CONTAGION

Nevertheless, the scale of the outbreak of the new coronavirus has already exceeded Sars, with the number of infected patients already outstripping the previous health emergency.

Another factor complicating prevention is the suggestion that the new coronavirus, unlike Sars, is transmissible even by people who are not showing any symptoms.

Information on this page is provided for interest only on a "best efforts" basis and does not 
constitute personal advice. Always discuss medical conditions and related matters with your doctor.

 

Ref:www.scmp.com/news/china/society/article/3048472

THE QUEST for ALZHEIMER APPLICABLE IN THE FUTURE

Alzheimer’s and other forms of dementia remain devastating conditions to both patients and their families, yet Lovestone says he feels more optimistic today than ever before. 

Scientists have known for years that the brains of Alzheimer’s patients are filled with a protein called beta amyloid that accumulates in between neurons, which are the cells that send and receive signals from your brain.  Yet drugs that target the formation of beta amyloid have so far been unsuccessful at stopping or reversing the disease.

                     Beta amyloid protein plaques in the brain of an Alzheimer's patient


 Recently, though, Janssen has focused on a different approach aimed at tau, a protein that accumulates in thread-like “tangles” inside of neurons. 

“These tangles can spread from one neuron to the next, killing brain cells,” Lovestone explains. “The compound developed by Janssen is designed to potentially prevent the spread of tau.”  

 Janssen also recently began an early clinical trial of an anti-tau vaccine, which could be given to patients even in extremely early stages of the disease, before symptoms have begun.

“The progress that we’ve made in the past few years has been enormous,” he says. “We have a much better understanding about how Alzheimer’s develops, which genes and other risk factors are driving the disease, and how it progresses. While there is still much to do, we are preparing for a future in which Alzheimer’s is a treatable—and even preventable—disease.”

Information on this page is provided for interest only on a "best efforts" basis and does not 
constitute personal advice. Always discuss medical conditions and related matters with your doctor.

Ref: https://www.jnj.com/innovation/

BREAKTHROUGH RESEARCH on ALZHEIMER

ALZHEIMER

For the first time, how the most well-known genetic risk factor for Alzheimer's disease causes signs in human brain cells and also, the scientists who managed to correct the gene and erase its harmful effects.

 

The apolipoprotein (APOE) gene in the development of Alzheimer's and its complex role has been studied extensively. For instance, researchers know that having one copy of the APOE4 gene variant raises the risk of Alzheimer's by two to three times. And, having two copies of this genetic variant puts people at a 12-fold higher risk. Normally, APOE's role is to provide instructions for creating the protein of the same name. In combination with fats, APOE creates lipoproteins, which help to transport and regulate levels of cholesterol throughout our bloodstream.

However, the E4 version of the gene seems to be particularly damaging to the brain, with several studies showing that this genetic variant increases the risk of toxic amyloid beta and tau buildup. But why is that? What makes the E4 variant of this gene so much more harmful than other variants? Researchers at the Gladstone Institutes in San Francisco, CA, wanted to find out. Their findings have just been published in the journal Nature Medicine.

More specifically, the researchers wanted to locate and understand the fine yet crucial difference between the E3 and E4 variants that makes the APOE4 gene so devastating.
Is it a case, the researchers wondered, of the E4 variant making APOE3 lose some of its functions? Or is it the case that more APOE4 has toxic effects?

Lead investigator Dr. Yadong Huang — a professor of neurology and pathology at the University of California, San Francisco — explains the importance of this question.
"It's fundamentally important," he says, "to address this question because it changes how you treat the problem. If the damage is caused due to the loss of a protein's function, you would want to increase protein levels to supplement those functions." "But if the accumulation of a protein leads to a toxic function, you want to lower production of the protein to block its detrimental effect."

To find out, the researchers modeled the disease in human cells, examining the effect of APOE4 on human brain cells for the first time. Dr. Huang explains why changing the disease model was, in itself, a huge step for Alzheimer's research. "Many drugs," he explains, "work beautifully in a mouse model, but so far they've all failed in clinical trials. One concern within the field has been how poorly these mouse models really mimic human disease."

Applying stem cell technology to skin cells from people with Alzheimer's who had two copies of the APOE4 gene, Dr. Huang and his team created neurons. The researchers also created brain cells using skin cells from people who didn't have Alzheimer's and had two copies of the APOE3 gene. The scientists found that in human brain cells, the APOE4 protein has a "pathogenic conformation" — meaning that it has an abnormal form that prevents it from functioning properly, leading to a series of disease-causing problems. Namely, "APOE4-expressing neurons had higher levels of tau phosphorylation," the authors write, which was "unrelated to their increased production of amyloid-[beta] peptides, and [...] they displayed GABAergic neuron degeneration." Importantly, they also found that "APOE4 increased [amyloid-beta] production in human, but not in mouse, neurons." "There's an important species difference in the effect of APOE4 on amyloid beta," explains first study author Chengzhong Wang.

CORRECTING FAULTY GENE

Next, Dr. Huang and team wanted to see whether it was the loss of APOE3 or the accumulation of APOE4 that caused the disease. So, they compared neurons that did not produce either the E3 or the E4 variant of the protein with cells that had APOE4 added to them.

The former continued to behave normally, while adding APOE4 led to Alzheimer's-like pathologies. This confirmed the fact that it is the presence of the APOE4 that causes the disease.

As a final step, Dr. Huang and his team looked for ways in which to fix the faulty gene. To this end, they applied a previously developed APOE4 "structure corrector." The so-called structure corrector has been shown in previous research, led by the same Dr. Huang, to change the structure of APOE4 so that it looks and behaves more like the inoffensive APOE3.

Applying this compound to human APOE4 neurons corrected the defects, thereby eliminating signs of the disease, restoring normal cell function, and helping the cells to live longer.

The researchers conclude:

"Treatment of APOE4-expressing neurons with a small-molecule structure corrector ameliorated the detrimental effects, thus showing that correcting the pathogenic conformation of APOE4 is a viable therapeutic approach for APOE4-related [Alzheimer's disease]."

 

Information on this page is provided for interest only on a "best efforts" basis and does not 
constitute personal advice. Always discuss medical conditions and related matters with your doctor.

Reference:  https://www.medicalnewstoday.com/articles/321455.php

Robotic Vitroretinal Surgery

The *Preceyes system focuses on robotic assistance for vitreoretinal (VR) surgeons. The system is designed to provide assistance so that the surgeon can work with higher accuracy and precision, while at the same time improving on dexterity. The system is expected to improve treatment outcomes for patients and increase procedural safety, while the higher degree of automation inherent to robotics is also expected to improve clinical workflows and bring down costs.

The Preceyes robot is unique because of both its ultra-high-precision and ultra-high-dexterity. This is achieved by scaling down movements in the system, which dramatically increases precision by more than a factor of 10, while also filtering out any surgeon hand tremor. The instruments used in VR surgery are so fine that they often bend and deform when inserted into the eye by hand—the level of control in our system means this does not happen. The integration of the system with the conventional operating room is also very sophisticated, and the system can be used with the majority of operating tables.

Firstly there is patient access to surgery. The level of manual control and precision that these VR surgeons have is incredible, but it takes years and years of training to get to that level. Also, a VR surgeon can quickly reach an age where hand tremor and other inaccuracies can become a problem, often long before the normal retirement age. So being able to use robotics to take over some of the precision and dexterity allows us to train surgeons faster and extend the number of years they can work once trained. This is, of course, an even bigger issue in emerging economies, where there is currently a very significant shortage of VR surgeons. But, given that the incidence of VR diseases is expected to double in the next 15 years, there will also soon be a shortage of VR surgeons in developed economies as well.

The other benefit is the improved accuracy and precision of the surgery overall, which is expected to lead to dramatically improved patient safety and health outcomes. This is a pattern that is true for all robotic surgery. The ultra-high precision required in VR surgery would suggest that the gains for patients from robotic assistance could be even greater.

Finally, the technology opens up opportunities for totally new therapies, particularly gene and cell therapies, vein cannulation, and the possibility of sub-retinal implants. With the Preceyes system you can place a needle in the sub-retinal space with a 10 micrometer precision and keep it there for two or three minutes while you carefully inject a fluid—that is something that is just impossible manually.

*  Preceyes is currently undergoing first-in-human trials, which is a development stage.


Information on this page is provided for interest only on a "best efforts" basis and does not 
constitute personal advice. Always discuss medical conditions and related matters with your doctor.

Reference: http://www.medgadget.com

Prostrate Cancer Screening - A Better Way

Current Method

Current methods of prostate cancer screening, such as prostate-specific antigen (PSA) tests and digital rectal exams (DRE), are somewhat unreliable and can lead to many uncertainties for both patient and urologist. Prostate biopsy, the most reliable method of detection, is a challenge because of the difficulties in visualizing not only the entirety of the prostate, but also the location of the biopsy needle. Trans-rectal ultrasound-guided prostate biopsy (TRUS), the current biopsy standard, commonly suffers from poor image resolution, and the biopsy needle often passes through tumor-free areas of the prostate - potentially missing the tumor entirely.

In addition, it can be difficult to distinguish between lesions that necessitate only a “watchful waiting” period and more aggressive lesions that require therapy. A more confident characterization of the type of lesion could help avoid the risk of side effects such as incontinence, impotence and bowel problems that can result from therapy.

This is the current method of biospy and its drawbacks from random sampling:

To obtain prostate tissue for cancer testing, a series of needles is poke  (between 12 and 24) into different areas of the gland, guided by ultrasound. This method was used since the 1980s. The ultrasound images help to place the needles properly, but the pictures aren’t distinct enough to be able to tell if it is cancerous from normal prostate tissue, so there is no certainty of the target to home in on suspicious areas for biopsy. The truth is the current method is a scattershot “blind” approach in the hope that, if a tumor is present, one of the needles will encounter it. These random biopsies can miss some harmful tumors, while turning up others that are inconsequential and may end up being treated unnecessarily.

 

The new Technology - Image Guided Prostrate Biopsy

An MRI scan is better than ultrasound at revealing details in soft tissue in the case of the prostate gland. Prostate cancer cannot be diagnose from an MRI image, but can certainly it can be used to identify suspicious areas that warrant closer examination with a needle biopsy.  The new fusion guided targeted biopsy technology combined the detailed MRI scans with live real-time ultrasound images of the prostate will enable a better diagnosis and outcome.
 
Targeted MR/ultrasound biopsy is poised to become a new standard in prostate care. This technique fuses pre-biopsy MR images of the prostate with ultrasound-guided biopsy images in real time, for excellent delineaon of the prostate and suspicious lesions, as well as clear visualization of the biopsy needle.

The fusion of the MR and ultrasound images uses electromagnetic tracking, similar to your car’s GPS system. A small, localized electromagnetic field is generated and used in conjunction with a navigation sensor mounted to the trans-rectal ultrasound probe to determine the location and spatial orientation of the biopsy device. A sophisticated algorithm maintains the fusion of MR and ultrasound images even when the patient moves.

The Use of Uronav

 

A revolutionary new test can better pinpoint trouble spots and lead to a quicker prostate cancer diagnosis. Invivo’s UroNav uses a combination of MRI and Ultrasound. Unlike traditional biopsies that take twelve samples, UroNav allows doctors to identify and remove only what looks irregular. “Standard prostate biopsies are random and are systematically obtain random samplings from the prostate. There’s no guarantee that a biopsy will hit the cancer. For men who are moderate to high risk, UroNav can cut down on random biopsies that may find nothing. It can also help to diagnose the cancer faster. The new technology, called UroNav, is like taking the blindfold off. The new UroNav technology that is being used utilizes the UroNav Fusion Biopsy System, and fuses (overlay) pre-biopsy MR images of the prostate with ultrasound-guided biopsy images in real time, for clear delineation of the prostate and suspicious lesions, as well as clear visualization of the biopsy needle.

Prostate cancer specialists at the University of Michigan Comprehensive Cancer Center (link is external) are refining prostate cancer diagnosis to better identify those cancers that are more likely to grow quickly and spread to other parts of the body.
The University of Michigan is the first in the region to offer men a new technology that combines MRI and real-time ultrasound to help guide a biopsy needle, ensuring that tissue from all suspicious areas is captured.

The fusion guided biopsy approach isn’t perfect. A recent study found that the fusion method missed almost as many prostate tumors as did standard biopsy. But as my Cleveland Clinic colleague, urologist J. Stephen Jones, MD, noted, the cancers that the fusion method missed were far more likely to be clinically insignificant ones.

Put another way, fusion guided biopsy is better than the existing approach at finding prostate tumors we need to treat, while overlooking those we don’t need to worry about.

Each year in the United States, about 700,000 men with worrisome PSA levels undergo repeat prostate biopsies. The fusion guided biopsy approach should help reduce that number, by giving better information the first time around. This tool should also be a boon to men who’ve been diagnosed with small, slow-growing prostate tumors and who are on active surveillance – also called watchful waiting – by possibly reducing the number of biopsies they must undergo.

Information on this page is provided for interest only on a "best efforts" basis and does not 
constitute personal advice. Always discuss medical conditions and related matters with your doctor.

Refernce: http://www.uofmhealth.org & https://health.clevelandclinic.org

Alzheimer Disease

Like all types of dementia, Alzheimer's is caused by brain cell death. It is a progressive neurodegenerative disease, which means there is progressive brain cell death that happens over a course of time. The total brain size shrinks with Alzheimer's - the tissue has progressively fewer nerve cells and connections. A neurodegenerative type of dementia, the disease starts mild and gets progressively worse. 

While they cannot be seen or tested in the living brain affected by Alzheimer's disease, postmortem/autopsy will always show tiny inclusions in the nerve tissue, called plaques and tangles:
 

• Plaques are found between the dying cells in the brain - from the build-up of a protein called beta-amyloid (you may hear the term "amyloid plaques").
• The tangles are within the brain neurons - from a disintegration of another protein, called tau. 

The abnormal protein clumps, inclusions, in the brain tissue are always present with the disease, but there could be another underlying process that is actually causing the Alzheimer's - scientists are not yet sure.

This sort of change in brain nerves is also witnessed in other disorders, and researchers want to find out more than just that there are protein abnormalities - they also want to know how these develop so that a cure or prevention might be discovered.  

The most common presentation marking Alzheimer's dementia is where symptoms of memory loss are the most prominent, especially in the area of learning and recalling new information. But the initial presentation can also be one of mainly language problems, in which case the greatest symptom is struggling to find the right words.

If visuospatial deficits are most prominent, meanwhile, these would include inability to recognize objects and faces, to comprehend separate parts of a scene at once (simultanagnosia), and a type of difficulty with reading text (alexia). Finally, the most prominent deficits in "executive dysfunction" would be to do with reasoning, judgment and problem-solving.

Symptoms of Alzheimer's Disease

1. Worsened ability to take in and remember new information, for example:

• "Repetitive questions or conversations
• Misplacing personal belongings
• Forgetting events or appointments
• Getting lost on a familiar route."

2. Impairments to reasoning, complex tasking, exercising judgment:

• "Poor understanding of safety risks
• Inability to manage finances
• Poor decision-making ability
• Inability to plan complex or sequential activities."

3. Impaired visuospatial abilities (but not, for example, due to eye sight problems):

• "Inability to recognize faces or common objects or to find objects in direct view
• Inability to operate simple implements, or orient clothing to the body."

4. Impaired speaking, reading and writing:

• "Difficulty thinking of common words while speaking, hesitations
• Speech, spelling, and writing errors."

5. Changes in personality and behavior, for example:

• Out-of-character mood changes, including agitation; less interest, motivation or initiative; apathy; social withdrawal
• Loss of empathy
• Compulsive, obsessive or socially unacceptable behavior.

 

Stages of Alzheimer's Disease

 The progression of Alzheimer's can be broken down into three basic stages:

• Preclinical (no signs or symptoms yet)
• Mild cognitive impairment
• Dementia.

The Alzheimer's Association has broken this down further, describing seven stages along a continuum of cognitive decline based on symptom severity - from a state of no impairment, through mild and moderate decline, and eventually reaching "very severe decline." 

 It is not usually until stage four that a diagnosis is clear - here it is called mild or early-stage Alzheimer's disease, and "a careful medical interview should be able to detect clear-cut symptoms in several areas." 

Mild Alzheimer;s Disease (early stage)

In the early stages of Alzheimer's, a person may function independently. He or she may still drive, work and be part of social activities. Despite this, the person may feel as if he or she is having memory lapses, such as forgetting familiar words or the location of everyday objects.
Friends, family or neighbors begin to notice difficulties. During a detailed medical interview, doctors may be able to detect problems in memory or concentration. Common difficulties include:

• Problems coming up with the right word or name
• Trouble remembering names when introduced to new people
• Having greater difficulty performing tasks in social or work settings
• Forgetting material that one has just read
• Losing or misplacing a valuable object
• Increasing trouble with planning or organizing

Moderate Alzheimer's Disease (middle stage)

Moderate Alzheimer's is typically the longest stage and can last for many years. As the disease progresses, the person with Alzheimer's will require a greater level of care.
You may notice the person with Alzheimer's confusing words, getting frustrated or angry, or acting in unexpected ways, such as refusing to bathe. Damage to nerve cells in the brain can make it difficult to express thoughts and perform routine tasks.
At this point, symptoms will be noticeable to others and may include:

• Forgetfulness of events or about one's own personal history
• Feeling moody or withdrawn, especially in socially or mentally challenging situations
• Being unable to recall their own address or telephone number or the high school or college from which they graduated
• Confusion about where they are or what day it is
• The need for help choosing proper clothing for the season or the occasion
• Trouble controlling bladder and bowels in some individuals
• Changes in sleep patterns, such as sleeping during the day and becoming restless at night
• An increased risk of wandering and becoming lost
• Personality and behavioral changes, including suspiciousness and delusions or compulsive, repetitive behavior like hand-wringing or tissue shredding

Severe Alzheimer's Disease (late stage)

In the final stage of this disease, individuals lose the ability to respond to their environment, to carry on a conversation and, eventually, to control movement. They may still say words or phrases, but communicating pain becomes difficult. As memory and cognitive skills continue to worsen, personality changes may take place and individuals need extensive help with daily activities.
At this stage, individuals may:

• Require full-time, around-the-clock assistance with daily personal care
• Lose awareness of recent experiences as well as of their surroundings
• Require high levels of assistance with daily activities and personal care
• Experience changes in physical abilities, including the ability to walk, sit and, eventually, swallow
• Have increasing difficulty communicating
• Become vulnerable to infections, especially pneumonia

  

How common is Alzheimer's Disease?

In the US, the most recent census has enabled researchers to give estimates of how many people have Alzheimer's disease. In 2010, some 4.7 million people of 65 years of age and older were living with Alzheimer's disease in the US.

 
The 2013 statistical report from the Alzheimer's Association gives a proportion of the population affected - just over a tenth of people in the over-65 age group have the disease in the US. In the over-85s, the proportion goes up to about a third.
 
  

Information on this page is provided for interest only on a "best efforts" basis and does not 
constitute personal advice. Always discuss medical conditions and related matters with your doctor.

Reference: http://www.medicalnewstoday.com

Advanced Robotic Telemedicine

InTouch Vita is a remote presence device component of a total acute care telemedicine solution and most advanced robotic device incorporating an array of intuitive, easy-to-use features that encourage physician adoption and clinical use. It was designed to increase efficiency with its AutoDrive capabilities that enable a remote medical provider to directly control or to automatically direct Vita to move to an intended location. 

InTouch Vita is cleared by the FDA for active patient monitoring that may be needed for taking immediate clinical action. Developed by InTouch Health and iRobot, the InTouch Vita can improve the independence of the remote clinician in managing patient care.

The VITA raises the bar for overseeing patient care remotely and allows doctors to proactively control a situation as if they were there.

An enhanced navigation capability that enables the VITA to better manage driving and navigation elements so the health care professional can put more focus on patient care tasks. State‐of‐the-art mapping and Obstacle Detection Obstacle Avoidance (ODOA) technologies allow safe, fast and highly flexible navigation in a clinical environment. This capability will allow a remote clinician or bedside nurse to send the VITA to a target destination with a single click, enabling a number of breakthrough clinical applications. A new, simple to use iPad user interface will enable quick and easy navigation to anywhere the VITA needs to go, as well as interaction with the patient, family and care team.

Real-time access to important clinical data, enabling a range of new workflow improvements for physicians, nurses and other patient care team members. For example, the VITA can be integrated with live patient data from the electronic medical record and is equipped with the ability to connect with diagnostic devices such as otoscopes and ultrasound. It comes equipped with the latest electronic stethoscope.

InTouch Health envisions that the expandable VITA platform will provide additional value in orchestrating team-wide care, as a clinical assistant to enhance efficiency and quality, and as a patient advocate to enhance the care experience.

Information on this page is provided for interest only on a "best efforts" basis and does not 
constitute personal advice. Always discuss medical conditions and related matters with your doctor.

Ref: http://www.intouchhealth.com/our-solutions/patient-access/intouch-vita/

Erectile Dysfunction Shock Wave Therapy (EDSWT)

Erectile Dysfunction Shock Wave Therapy (EDSWT) is an innovative approach to vasculogenic ED, delivered by Medispec’s ED1000, a device that uses advanced acoustics technology. This technology has proven to be effective in cardiology, with recent success in reversible ischemic tissues of the heart. EDSWT utilizes low-intensity extracorporeal shock waves, focusing on blood vessels and encouraging neovascularization in the penis shaft and crus. The low-intensity shock waves help relieve vascular deficiency, a common cause of erectile dysfunction.

By courtesy of Medispec

Proven effective in clinical testing, the ED1000 is a unique mobile system that performs the EDSWT protocol in a safe, efficient manner. Vasculogenic and diabetic ED patients, who are responsive to PDE5 inhibitors as well as those who are unresponsive, can receive shock wave therapy from the ED1000 and experience improved erectile functionality.

For the latter, which includes a substantial number of severe ED patients, the only solution to date are vacuum pumps, injections and perhaps implants. EDSWT therapy brings hope to those patients, by allowing more than 70% of them to become responsive to PDE5 inhibitors. As “end-stage” ED patients, they will be able to enjoy normal sexual functionality. With over 50% of men aged 40-70 suffering from ED, and even more from transient ED, Medispec’s breakthrough therapeutic system can bring lasting improvement in erectile function and new sexual spontaneity to millions – painlessly, naturally and safety.

Unlike conventional ED treatment, such as PDE5 inhibitors, EDSWT does not involve the use of any pharmaceuticals. Moreover, the shock wave treatment causes no side-effects or systemic load on other organs and healthy tissues. The non-invasive, painless EDSWT procedure is performed during a series of brief visits to the urology office, and requires no sedation or anesthesia. Discernable improvement in the erectile function of the penis can be visible within two weeks after therapy begins. 

Recent clinical studies revealed that patients reported a high rate of satisfaction for more than two years after treatment – all without reliance on PDE5 inhibitors. In clinical tests, EDSWT has shown significant long-term effectiveness. These results are confirmed by a double-blind placebo controlled study of a large group of patients.

 

Information on this page is provided for interest only on a "best efforts" basis and does not 
constitute personal advice. Always discuss medical conditions and related matters with your doctor.

Ref: http://medispec.com/solutions/erectile-disfunction/

LASER THERAPY

Low Level Laser Therapy (LLLT)

Laser therapy can be used any time a patient needs a drug-less procedure for the control of pain, when conventional therapies have been ineffective, or when the acceleration of healing from injuries is desired.

LLLT is the application of red and near infra-red light over injuries or lesions to improve wound and soft tissue healing, reduce inflammation and give relief for both acute and chronic pain. Red and near infrared light operate between the wavelength of 600nm to 1000nm and is commonly used in LLLT and are typically delivering 10mW - 500mW. The power density typically ranges from 0.005W/cm² -> 5 W/cm².

Low level laser supplies energy to the body in the form of non-thermal photons of light. Light is transmitted through the skin's layers at all wavelengths in the visible range.
However, light waves in the near infrared ranges penetrate the deepest of all light waves in the visible spectrum. When low level laser light waves penetrate deeply into the skin, they optimize the immune responses of our blood. This has both anti-inflammatory and immunostimulate effects. When the correct intensity and treatment times are used, red and near infrared light reduces oxidative stress and increases Adenosine Triphosphate (ATP). This improves cell metabolism and reduce inflammation. LLLT is popularly used for soft tissue injuries, joint conditions, neuropathic pain, non-healing leg and pressure ulcers.

It is a scientific fact that light transmitted to the blood in this way has positive effects throughout the whole body, supplying vital oxygen and energy to every cell. For most people, laser therapy is quite passive. There is no pulsating shocks felt, as in forms of electronic stimulation, or heat used as with ultrasound. The most noticeable sensation is the touch of the probe head of the laser, as it comes in contact with the skin.

Generally, the more chronic or severe the condition, the longer it takes to respond. The majority of conditions treated will take anywhere from 4-5 or 10-15 treatments. Once again, the number of treatments depends upon the severity of the condition and it duration. You should notice a difference after 1-2 treatments but it may take 4-5 sessions before a dramatic or marked change is perceived.

In all the years that low level lasers have been tested in research and clinical applications, no adverse side effects or negative impacts have been reported. Food and Drug Administration (FDA) classifies lasers Laser Therapy Systems as "Non-Significant Risk" devices, requiring a minimum of safety precautions. The only precaution is avoid direct viewing of the laser beam. Care should be exercised not to stare into the laser beam or to point it at the eyes, and the use of safety glasses is recommended.
 

Physiological Effects of LLLT

• Bio-stimulation, including improve metabolism & increased cell metabolism
• Improved blood circulation and vasodilation
• Analgesic effect
• Anti-inflammatory and anti-edematous effects
• Simulation of wound healing

Benefits of LLLT to Users

• Relieves acute and chronic pains
• Increases the speed, quality and tensile strength of tissure repair
• Increases blood supply
• Simulates immune system
• Stimulates nerve function
• Develops collagen and muscle tissue
• Helps generate new and healthy cells and tissue
• Promotes faster wound healing and clot formation
• Reduces inflammation

Applications of LLLT

According to published medical reports, many acute and chronic conditions may be improved or eliminated with laser use: including: 

Arthritis Carpal Tunnel Syndrome Chondromalacia Patellae Fibromyalgia Heel Spurs/Plantar Fascitis Migraine Headaches Neck Pain/Whiplash

Back Pain Nerve Root Pain Pots-Operative Pain Repetitive Stress Injuries TMJ Pain/Dysfunction Tendonitis/Tendinosis Tennis Elbow

Bursitis Neuralgia Trigger Points Sprains/Strains Swelling Wound Healing

Information on this page is provided for interest only on a "best efforts" basis and does not 
constitute personal advice. Always discuss medical conditions and related matters with your doctor.

Source:  http://www.vasportsmedicine.com/cold-laser.asp