New Clues for Detecting Colorectal Cancers Earlier

Patients saw their family doctor significantly more often in the year before their diagnosis than did people without cancer

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How scientists built the world’s first lab-grown limbs

Harald Ott spent weeks in a lab tending to a tiny rat’s forelimb. He got a special incubator for it, monitored it daily, cared for its every need.

The reason a rat leg was worth all that work? There was no rat attached to it.

Ott, a researcher and thoracic surgeon at Massachusetts General Hospital, is the proud parent of the world’s first lab-grown biolimb — a living, functioning, artificial leg that responds to stimuli and even circulates blood,  the hospital announced Tuesday. Though it’s still a long way off from made-to-order transplants for humans, Ott and other regeneration experts say that the tiny pink rat leg is a step toward the future of artificial limbs.

“This is science fiction coming to life,” Daniel Weiss, a lung regeneration specialist at the University of Vermont College of Medicine, told the New Scientist.

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ObamaCare’s Electronic-Records Debacle

The rule raises health-care costs even as it means doctors see fewer patients while providing worse care.

The debate over ObamaCare has obscured another important example of government meddling in medicine. Starting this year, physicians like myself who treat Medicare patients must adopt electronic health records, known as EHRs, which are digital versions of a patient’s paper charts. If doctors do not comply, our reimbursement rates will be cut by 1%, rising to a maximum of 5% by the end of the decade.

I am an unwilling participant in this program. In my experience, EHRs harm patients more than they help.

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Apparently our poor bedside manner is a national crisis, judging by how my fellow physicians feel about the EHR program. A 2014 survey by the industry group Medical Economics discovered that 67% of doctors are “dissatisfied with [EHR] functionality.” Three of four physicians said electronic health records “do not save them time,” according to Deloitte. Doctors reported spending—or more accurately, wasting—an average of 48 minutes each day dealing with this system.

That plays into the issue of higher costs. The Deloitte survey also found that three of four physicians think electronic health records “increase costs.” There are three reasons. 

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Not surprisingly, a recent study in Perspectives in Health Information Management found that electronic health records encourage errors that can “endanger patient safety or decrease the quality of care.” America saw a real-life example during the recent Ebola crisis, when “patient zero” in Dallas, Thomas Eric Duncan, received a delayed diagnosis due in part to problems with EHRs.

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Training Dogs to Sniff Out Cancer

Since 2004, research has begun to accumulate suggesting that dogs may be able to smell the subtle chemical differences between healthy and cancerous tissue, including bladder cancer, melanomaand cancers of the lung, breast and prostate. But scientists debate whether the research will result in useful medical applications.

Dogs have already been trained to respond to diabetic emergencies, or alert passers-by if an owner is about to have a seizure. And on the cancer front, nonprofit organizations like the In Situ Foundation, based in California, and the Medical Detection Dogs charity in Britain are among a growing number of independent groups sponsoring research into the area.

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The next step will be to build a mechanical, hand-held sensor that can detect that cancer chemical in the clinic. That’s where Charlie Johnson a professor at Penn who specializes in experimental nanophysics, the study of molecular interactions between microscopic materials, comes in.

He is developing what he calls Cyborg sensors, which include biological and mechanical components – a combination of carbon nanotubes and single-stranded DNA that preferentially bond with one specific chemical compound. These precise sensors, in theory, could be programmed to bind to, and detect, the isolated compounds that Dr. Otto’s dogs are singling out.

“We are effectively building an electronic nose,” said Dr. Johnson, who added that a prototype for his ovarian cancer sensor will probably be ready

in the next five years.

Some experts remain skeptical.

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Primary Care is Not General Motors

http://acountrydoctorwrites.wordpress.com/2014/07/20/primary-care-is-not-general-motors/

'Barefoot' Running Heads Into the Sunset

"Barefoot" running may be going the way of the caveman.

The much-hyped running style that had weekend warriors ditching sneakers to jog with little or nothing on their feet, as humans had for millennia before the advent of footwear, is falling out of favor.

Health claims that had helped drive the trend are coming under attack. Vibram, which makes the FiveFingers shoes that look like gloves for the feet, has offered to settle a class-action suit that contends the company profited from unsubstantiated claims the shoes strengthen muscles and prevent injury

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An About-Face on a Risky Transplant

When the world’s first face transplant was performed in France in 2005, it pushed medical boundaries and made headlines. Yet the procedure’s future was very much in doubt.

The surgeons, operating on a 38-year-old Frenchwoman whose face had been mauled by her pet Labrador, had to surmount the opposition of prestigious medical societies, which declared the procedure unethical and immoral. Critics, including surgeons who had lost out in competing to do the first face transplant, said the pioneering team did not follow ethical and legal guidelines.

But the first comprehensive review of every face transplant reported since then — 28 in seven countries, counting the French case but not two done in Turkey since the review was completed — has removed many of those early doubts.

The report, published online by The Lancet on Sunday, says the procedure is generally safe and feasible, and should be offered to more patients.

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Hearing quality restored with bionic ear technology used for gene therapy

Researchers at UNSW Australia have for the first time used electrical pulses delivered from a cochlear implant to deliver gene therapy, thereby successfully regrowing auditory nerves. The research also heralds a possible new way of treating a range of neurological disorders, including Parkinson's disease, and psychiatric conditions such as depression through this novel way of delivering gene therapy..

Professor Housley and his team at UNSW developed a way of using electrical pulses delivered from the cochlear implant to deliver the DNA to the cells close to the array of implanted electrodes. These cells then produce neurotrophins.

"No-one had tried to use the cochlear implant itself for gene therapy," says Professor Housley. "With our technique, the cochlear implant can be very effective for this."

While the neurotrophin production dropped away after a couple of months, Professor Housley says ultimately the changes in the hearing nerve may be maintained by the ongoing neural activity generated by the cochlear implant.

"We think it's possible that in the future this gene delivery would only add a few minutes to the implant procedure," says the paper's first author, Jeremy Pinyon, whose PhD is based on this work. "The surgeon who installs the device would inject the DNA solution into the cochlea and then fire electrical impulses to trigger the DNA transfer once the implant is inserted."

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Answering an Emergency Call: Yes, There Is a Doctor on Board

WHEN I travel, I try to remember a quotation often attributed to William Butler Yeats that there are no strangers, only friends you have not yet met.

I’m a retinal surgeon at University Hospitals Case Medical Center in Cleveland. When I travel in that capacity, I’m either speaking at a meeting or going someplace to help train other surgeons. I enjoy every place I go. I’m not needy when I travel. I don’t get jet-lagged. I try to just take things in stride.

But no doctor wants to hear, “Is there a doctor on board?”

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TEAMWORK IS BEST WHEN MAKING SURGERY DECISIONS FOR ELDERLY

Deciding if a sick, elderly patient should have surgery should be a team effort, with input from the patient, family members, the surgeon, primary care physician, nurses, and non-clinicians, such as social workers or advocates.
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How Much Does Your Doctor Really Make?

The U.S. government released payment data for 880,000 physicians this week—to widespread misinterpretation. What the numbers can actually tell us.

These approaches to looking at the new payment records suffer three major flaws.
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Breakthrough in Quest to Grow Body Parts

Lab-Made Vaginas Transplanted Into Patients Whose Own Were Absent Due to Rare Disease

Scientists have successfully transplanted laboratory-made vaginas into four teenage girls whose own were absent because of a rare disease, marking a milestone in the quest to grow structurally complex body parts.

The experiment was published Thursday in the journal Lancet along with another study, in which a separate group of researchers transplanted lab-made nostrils into patients whose noses were damaged by cancer.

The vaginas were created from the patients' own cells and implanted between 2005 and 2008. Today, the women report normal sexual function.

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Dr. Atala began the effort to make a lab-grown vagina in the late 1990s to address disorders that cause some girls to be born without normal vaginas. Cancer and trauma can also lead to vaginal damage or loss. Currently, doctors reconstruct the vagina using a patient's own skin or part of the intestine, but both cause other physical problems.

The effort immediately hit a roadblock: "We couldn't even get the vaginal mucosal cells to grow outside the body," Dr. Atala recalled. After solving that problem, the team needed to find something to serve as a scaffold—or skeleton—on which the cells would sit. They rejected various options, including the material used to make surgical sutures, before settling on one they liked: tissue from a pig's intestine.

The pig tissue was first bathed in detergent, which removed the original cells and left behind a scaffold-like structure made from collagen. This was coated on one side with epithelial cells, which line the body's cavities, and which had been obtained via a biopsy of the patient's external genitals. The other side was coated with smooth muscle cells, also from the patient. When the scaffold was placed in an incubator and nourished with chemicals and oxygen, the cells began to grow.

The scaffold was hand-sewn into a vagina-like shape and tailored to fit the patient. Surgeons created a cavity in the patient's pelvis and sutured the cell-populated scaffold to reproductive structures, including the uterus.

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3D Printing Low-Cost Prosthetics Parts in Uganda

Researchers at the University of Toronto, in collaboration with Autodesk Research (Toronto, Ontario) and CBM Canada (Stouffville, Ontario) are employing 3D-printing techniques to produce cheap, fast, and easily customizable prosthetic sockets for use in the developing world. I was invited to check out the lab on behalf of Medgadget to get a better idea of what’s the latest in custom printed prosthetic devices.
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Ryan Schmidt: We first create a 3D scan of the limb using an Xbox Kinect. We can bring that digital limb into Autodesk Meshmixer, smooth out the rough scan mesh, and use it directly to design the socket. We create a molded “bucket” around the limb’s contours, and can use Meshmixer to quickly push and pull parts of the design to modify its shape. In the end, the model is sent to a 3D printer, which prints the socket in a few hours using PLA (poly lactic acid), a thermoplastic that is easily modifiable with heat. This method can make a typical socket for under $10;;

Medgadget: What benefits does this 3D printing method have over the traditional method?

Matt Ratto: The traditional method involves wrapping an amputated limb with a plastic mold to first create a negative cast. Once that dries, plaster is poured into the negative cast to make a positive cast, which serves as a representation of the actual limb. Finally, a socket is molded around the positive cast, and can be used upon curing.

Ryan Schmidt: The traditional method is very time-consuming, especially if iteration needs to be done. It’s a destructive process, so any modifications destroy the original molds, and that information is lost. The method we use with 3D printing allows for a quick scan to digitize the limb, simplifying the process. It allows for quick and non-destructive modifications.

3D scanning has become increasingly widespread, and the capabilities of 3D printers have been steadily improving. The missing piece now, and the novelty of Meshmixer, is the ability to deal with the data and models and link the scanning and fabrication.

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Why I Prescribe the Love Drug

An important and great post by Dr. Wible
Check out her blog!

People die without love.
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Google develops contact lens glucose monitor

MOUNTAIN VIEW, Calif. (AP) — Google unveiled Thursday a contact lens that monitors glucose levels in tears, a potential reprieve for millions of diabetics who have to jab their fingers to draw their own blood as many as 10 times a day.

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The 10 most popular KevinMD posts of 2013

KevinMD.com shares the stories of the many who intersect with our health care system, but are rarely heard from.  Over 2500 articles were published this year from these voices, including practicing physicians, patients, policy experts, nurses, social workers, medical students, and hospital chaplains, among others.

I sincerely appreciate your continued readership and conversation.

Here are the most popular posts of 2013.

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VAPOR ‘NANOBUBBLES’ DETECT MALARIA THROUGH SKIN

A noninvasive technology can accurately detect even low levels of malaria infection through the skin in seconds with a laser scanner that requires no dyes, diagnostic chemicals, or needles.

As reported in a preclinical study published this week in the Proceedings of the National Academy of Sciences, the technology detected a single malaria-infected cell among a million normal cells with zero false-positive readings.

The technology uses a low-powered laser that creates tiny vapor “nanobubbles” inside malaria-infected cells. The bursting bubbles have a unique acoustic signature that allows for an extremely sensitive diagnosis
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TREATMENT SHOWS PROMISE FOR HUSHING TINNITUS

For tens of millions of Americans, there’s no such thing as the sound of silence. Instead, even in a quiet room, they hear a constant ringing, buzzing, hissing, humming, or other noise in their ears that isn’t real.

Tinnitus, or ringing in the ears, may be the result of sensory nerves in the face and neck trying to compensate for a reduction of input from the ear’s cochlea, new research shows.

The findings by University of Michigan Medical School researchers offer a new target for treating the condition. The team has a patent pending and device in development based on the approach.

Susan Shore, the senior author of the paper, explains that her team has confirmed that a process called stimulus-timing dependent multisensory plasticity is altered in animals with tinnitus—and that this plasticity is “exquisitely sensitive” to the timing of signals coming in to a key area of the brain. The findings are published online in the Journal of Neuroscience.

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5 Health Tech Trends to Watch in 2014

2013 was a big year for consumer health technology. According to mobile tech consultancy Research2Guidance, there are now close to 100,000 mobile health apps in 62 app stores, with the top 10 apps generating over 4 million free downloads every day.

This year also saw increased adoption of wearable tech, such as the Nike+ FuelBand and Fitbit — a market that is expected to grow to 100 million units by the end of 2014.

So if 2013 was the year of wearables and health apps, what’s on tap for next year? Here are five exciting health tech trends to keep an eye on for the new year.

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What Does the Spleen Do?