Posts Tagged ‘women’

Imaging system guides brain tumor removal to improve patient outcomes

The imaging system is known as desorption electrospray ionization mass spectrometry (DESI MS). The technique was developed by R. Graham Cooks, Ph.D., at Purdue University, and the brain study was done with collaborators at Harvard Medical School and Dana Farber Cancer Institute, and is described in the June 30 issue of the Proceedings of the National Academies of Science. DESI MS promises to be a significant improvement over the current method of distinguishing brain tumor tissue from healthy tissue, which relies on an extremely lengthy and difficult procedure for surgeons and patients.

The current protocol uses frozen section pathology, which involves removing suspected tumor tissue and having it analyzed by pathologists. They use a freezing and staining method that takes about 20 minutes and is too slow to be repeated multiple times during surgery. This method, developed more than 150 years ago, is both inefficient and lacks precision. It can result in incomplete tumor removal and regrowth, as well as inadvertent damage to healthy tissue, which can cause significant deficits in functioning for patients.

The new technique solves some of the problems of the current method. Researchers use the ability of mass spectrometry to identify metabolites that are present in brain tumors, but not in healthy tissue. As surgery progresses, tissue samples are removed and sprayed with a charged liquid that splashes onto the surface of the tissue, lifting off droplets; the droplets are then sucked into a mass spectrometer, where the mass and charge of the metabolites are measured. Brain gliomas produce large amounts of a tumor metabolite, 2-hydroxyglutarate (2-HG), which is captured in the droplets. This very rapid, objective method allows for clear delineation of tumor versus non-tumor tissue, so surgeons can remove all, and only, tumor tissue.

The DESI MS system was first tested on glioma specimens from 35 patients. Twenty one of the 35 samples contained high levels of 2-HG, a product of the mutant form of a gene known as IDH, which is associated with tumor formation. The results clearly demonstrated that DESI MS can detect 2-HG in tumor tissue with very high sensitivity and specificity.

The researchers went on to test the system in an operating room. The group installed a complete DESI MS system in the Advanced Multimodality Image Guided Operating (AMIGO) suite at Brigham and Women’s Hospital that is a part of the National Center for Image-Guided Therapy. The AMIGO surgical suite is an operating room with built-in imaging devices such as MRI, so the surgeon can use it to map the tumor pre-operatively. Tissue sections from tumors from two patients were examined using DESI MS. In both cases, the post-operative analysis confirmed that intraoperative DESI MS had accurately detected the presence of 2-HG in each tumor.

The researchers chose detection of 2-HG to test the DESI MS system because about 80% of gliomas and glioblastomas are associated with mutations in the IDH gene, which results in high levels of 2-HG. The approach described here could be applicable to the resection of all 2-HG-producing tumors.

Gliomas are tumors of brain glial cells and account for the majority of malignant brain tumors in adults. Gliomas make up approximately 30% of all brain and central nervous system tumors and 80% of all malignant brain tumors. These experiments provide proof-of-concept of the accuracy and practicality of the DESI MS system, and suggest that the system can be used with this common 2-HG-producing tumor, as well as other tumors in which a metabolic marker of malignancy is produced.

The DESI MS system was shown to be extremely accurate and was easily adapted for use in the clinical setting. It does not have the limitations of MRI, which cannot provide information about the type of tumor, and requires that surgery be halted for an hour or longer for scanning and interpretation of results. Moreover, each operating room that contains an MRI machine costs more than $10 million. In contrast, DESI MS platforms could be set up in any operating room at a very small fraction of the cost. The DESI MS system promises to be a powerful new tool for both research and clinical applications with the potential to transform surgical care of patients with brain tumors and other solid tumors.

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Medicine looking deeper into vital differences between women, men

That’s hardly an earth-shattering observation, but the fact is that, aside from the most obvious physical differences between the sexes, medicine has traditionally treated women as if they were merely smaller men.

“When we look closely, we tend to find differences” between men and women, said Sarah L. Berga, M.D., professor and chair of obstetrics and gynecology and vice president for women’s health services at Wake Forest Baptist Medical Center. “But for most of the past, we never looked.”

That started to change in the late 1980s, when physicians and researchers recognized that women’s health encompassed more than those conditions unique to females; that women’s experiences with gender-common conditions and the treatments for them often differed significantly from those of men.

“If women didn’t respond to a drug the same way as men, the thought was that it was because their body size was different,” Berga said. “Then the idea arose that maybe it was also because their bodies were different.”

When investigators began to explore how women’s and men’s bodies differed, some of the answers were startling.

“One of the biggest things we’ve learned is that cellular biology is sex-specific,” said Berga, whose interest in sex differences dates to her undergraduate days at the University of Virginia in the 1970s. “Every single cell has a chromosomal sex, and the ‘cellular machinery’ is independent of hormones.

“But we’ve also learned that most sex differences are the result of the interaction between this chromosomal distinction and hormones.”

As a result, it is now commonly accepted that there is a biological basis for sex differences in a number of common conditions, among them heart disease, stroke, arthritis, dementia, colon cancer and depression. And there’s active research into why other conditions — including obesity, bronchitis, asthma, multiple sclerosis and thyroid disease — occur more frequently in women than men.

“We’re beginning to truly understand how men and women differ in very fundamental ways and how these differences affect disease risk, symptoms, diagnostic sensitivity and specificity and responses to therapy,” said Berga, who joined the Wake Forest Baptist faculty in November 2011. “We now need to adjust our approaches and develop sex-specific interventions and therapies so both men and women benefit.”

The best way to do that, Berga said, is through research that directly compares men and women.

“If you do a study in men and then do another study in women you will not have learned anything about sex differences,” she said. “You may have learned about X in men and Y in women but you probably won’t have gotten the full story. Direct comparison is the only way to get that. It’s important that we discipline ourselves to do it this way.”

In addition to gender, age and ethnicity are also being studied as factors more frequently than in the past.

“Age is a definitely big modifier,” Berga said, “and we’re beginning to understand different genetic elements in different populations that can affect responses to drugs or make a disease more common in one group than another.”

Wake Forest Baptist researchers are among those active in this field, with recently published studies indicating that:

● High blood pressure is potentially more dangerous for women than men.

● Women who survive a stroke have a worse quality of life than their male counterparts.

● Calcium supplements regularly prescribed to prevent osteoporosis in women undergoing treatment for breast cancer may not be effective and could even be harmful.

● Therapies that reduce hot flashes in women are ineffective in men who experience hot flashes as a side effect of hormone therapy for prostate cancer.

● Women and African-Americans are at higher risk of heart attack from atrial fibrillation than men and whites.

Have findings such as these had a widespread impact on diagnosis and treatment? “Not as much as you might think,” Berga said, adding that the vast majority of diagnoses, therapies and drug dosages for common conditions are still based on symptoms, responses and outcomes in adult white males.

“That doesn’t mean they’re all bad or wrong,” she said. “You might suspect that something should be done differently according to gender, but you can’t say there is unless you prove it.”

And that’s not necessarily a simple, direct path.

“There are two things going on at once,” Berga said. “One is the urge to simplify, to make things efficient, to arrive at something that’s one-size-fits all. The other is that if something doesn’t work in a one-size-fits all model, then you have to find the reason and determine what should be changed, and you run into questions about how much it will cost to do this, how long it will take and so on.”

But Berga is generally in favor of going down that road.

“Now that we have the tools to find out certain things, we should use them,” she said. “The more we know about individual people, the better we can help them.”

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New way to more accurately detect cervical cancer in women

The American Cancer Society predicts that this year in the United States, more than 12,100 women will be diagnosed with cervical cancer, and roughly 4,220 women will die of the disease. Newer Pap tests and HPV screening more accurately identify pre-cancerous cellular changes that potentially develop into cervical cancer. When treated early, the chances of effectively treating and curing cervical cancer increase dramatically. Compared to a conventional Pap tests, the newer FDA approved process has increased detection of a significant pre-cancerous condition by more than 64%. By making the cervical cells easier to see, the new liquid-based Pap test produces better results for screening and detecting cervical cancer and its precursors.

HPV is present in more than 99% of women who develop cervical cancer. Newer DNA-based technology has also proven to be up to 40% more accurate than traditional Pap tests.

“After decades of women going to their doctor for annual Pap tests, the FDA, in a historic decision in April 2014, approved HPV testing as a replacement for the Pap test. Because of this new option for patients, more tests are now being developed to further expand the options for women and we are excited to be a part of this new, more accurate, more sensitive, and more comfortable method to prevent cancer in women. It’s a groundbreaking development that provides women in our community with access to the best cervical health screening available today,” says Dr. Mark Martens.

In this study, patients will have cancer causing HPV strains tested from the liquid-based Pap specimen to determine if either one or both tests will improve cancer detection. In order to be eligible to participate women must be at least 21 years of age or older and have not had a Pap test in the past four months or a hysterectomy. Other requirements must also be met in order to qualify for this clinical research study. Women who participate will receive study related medical care at no charge, and will be compensated for study related procedures.

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