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Imaging technique can help surgeons spot stray cancer cells

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Combining an imaging technology with a new drug that “lights up” lung cancer cells may help surgeons spot hidden bits of cancer, a new study suggests.

The small, preliminary study found that the new combo — dubbed intraoperative molecular imaging, or IMI — helped improve outcomes in surgeries of 1 out of 4 patients.

The drug used in IMI is called OTL38. The drug isn’t yet approved by the U.S. Food and Drug Administration. OTL38 is made up of a dye that can be seen by near infrared light and a targeting molecule. The molecule targets receptors on cancer cells, making them visible with near infrared light.

That’s important because lung cancer can come back after surgery if any areas of cancer are missed. Past studies have shown that cancer comes back after surgery for as many as 30 percent to 55 percent of people with a type of cancer called non-small cell lung cancer, the researchers said.
The findings were to be presented Monday at the Society of Thoracic Surgeons’ annual meeting, in New Orleans.

“Near-infrared imaging with OTL38 may be a powerful tool to help surgeons significantly improve the quality of lung cancer surgery,” study author Dr. Inderpal Sarkaria said in a meeting news release. Sarkaria is a thoracic surgeon from the University of Pittsburgh Medical Center.

The study included 92 people from six different hospitals being treated for non-small cell lung cancers. They were all scheduled for surgeries to remove the areas of suspected cancer.

All 92 patients were given OTL38 intravenously. Lung cancer surgeries are done in three parts, according to the researchers. These include inspection, resection and specimen check.

After removing areas identified by imaging before surgery, the surgeons looked for cancers that might have been missed — inspection. They do this during surgery with a visual inspection and manual touch of the area.

Surgeons were able to find two patients who had additional suspicious lesions during the inspection phase. The molecular imaging technology found 10 additional cancers in seven patients.

During the resection, or tumor removal phase, the researchers found the new technology located lesions that weren’t found in 11 patients. And, during the specimen check phase, the molecular imaging found microscopic areas of tumor left at the edges in eight patients.

Overall, the molecular imaging technique and drug may have improved surgical outcomes for 26 percent of the lung cancer patients.

Dr. Brendon Stiles, a thoracic surgeon at New York-Presbyterian Hospital in New York City, wasn’t involved in the study, but reviewed the findings.

He said the potential for the new technology is “exciting” for certain types of early lung cancer lesions that aren’t easy to see or feel.

“There really shouldn’t be any side effects; it’s fast and user-friendly,” Stiles said.

But he added that the technology may be somewhat limited because near infrared light doesn’t see deeply into the body.

“Pre-op imaging has gotten so amazingly good, we’re finding earlier and earlier cancers. It’s hard to think they’d find nodules that weren’t on the CT scan,” Stiles said.

Lead study author Dr. Sunil Singhal, from the Hospital of the University of Pennsylvania, said the research team will begin a multi-site randomized clinical trial of the drug and imaging combination this spring.

Findings presented at meetings are typically viewed as preliminary until they’ve been published in a peer-reviewed journal.

More information

Learn more about lung cancer and types of imaging tests from the Radiological Society of North America.

Copyright 2020 HealthDay. All rights reserved.



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Study finds differences in heart failure trends between former East, West Germany

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July 1 (UPI) — Differences in heart health between people in the eastern and western parts of Germany show a long-term effect of the Berlin Wall on the country, according to new findings presented Wednesday on HFA Discoveries.

Germany was divided in the aftermath of World War II, and different healthcare structures developed in East and West Germany. The country became unified again in 1990, but new research shows effects of the decades-long separation persist, researchers say.

From 2000 to 2017, the absolute number of hospital admissions due to heart failure throughout Germany increased continuously by nearly 94 percent — to approximately 465,000 from just under 240,000 — researchers said.

However, the increase was much higher, at 119 percent, in the region that once encompassed East Germany, compared to just over 88 percent in the region once known as West Germany, they said.

Study co-author Marcus Dörr, a professor at the University Medicine Greifswald in Germany, said differences between the two regions in prevalence of heart failure risk factors may explain the findings.

“In fact, previous research has shown that, for example, hypertension, diabetes and obesity are much more common in East than in West Germany,” Dörr said in a press release.

In addition, lingering differences in patient care, as well as in the management of healthcare systems between the two regions, still might exist, Dörr said.

In general, heart failure is the most common reason for hospital admissions in the United States, Germany and much of the world, he said.

For their research, Dörr and his colleagues analyzed data from the Federal Health Monitoring project, an annual census of routine health data in Germany, for 2000 through 2017.

Heart failure was the leading cause of disease-related hospitalization in Germany in 2017, they found.

However, heart failure hospitalization rates nearly doubled in the former East Germany — to 2.9 percent from 1.5 percent — from 2000 to 2017, while it increased to 2.2 percent from 1.4 percent in the former West Germany over the same period, the researchers said.

While the overall length of hospital stays decreased continuously over the same period, the total number of heart failure-related hospital days increased by 51 percent in East Germany, compared to 35 percent in West Germany.

In 2017, heart failure was by far the leading cause of in-hospital death across Germany, accounting for 8.2 percent of deaths, they found.

However, in the region that once was East Germany, heart disease caused 65 deaths per 100,000 inhabitants in 2017, compared to 43 deaths per 100,000 inhabitants in the former West Germany, they said.

The differences may have to do with the average age of people in East Germany — four years older than it is in the West — but the differences in heart failure-related parameters were similar after standardization, the researchers said.

Before reunification in 1990, East and West Germany had distinct healthcare systems, Dörr said. The system in East Germany was essentially run by the state, with less than 1 percent of physicians working in private practice, and there were often shortages of technical equipment, he said.

“Since 1990, both regions have the same federal healthcare system with more physicians in private practice and similar clinical care pathways” Dörr said. “More research is needed to explain the huge differences observed between East and West Germany.”



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Discrimination increases hypertension risk by 49 percent in black Americans, study finds

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July 1 (UPI) — Facing racial discrimination increases risk for high blood pressure among black Americans, according to a study published Wednesday by the journal Hypertension.

Black people who reported “medium levels” of lifetime discrimination had a 49 percent increased risk for high blood pressure, or hypertension, compared to those who indicated low levels of lifetime discrimination, the researchers found.

The study was based on nearly 2,000 black Americans who participated in The Jackson Heart Study, which focused on cardiovascular disease among residents in the tri-county region of Jackson, Mississippi.

“African Americans continue to be disproportionately affected by hypertension, making it imperative to identify the drivers of hypertension in this population,” co-author Allana T. Forde, said in a statement.

“Greater lifetime discrimination was associated with an increased risk for hypertension among African Americans in this study, which reflects the impact of cumulative exposure to stressors over one’s lifetime and the physiological reactions to stress that contribute to deleterious health outcomes,” said Forde, a postdoctoral research fellow at the Urban Health Collaborative at Drexel University.

Forde and colleagues reviewed data on 1,845 black Americans, aged 21 to 85, who were enrolled in The Jackson Heart Study. None of the participants had a history of hypertension at the start of the research, the authors said.

Participants self-reported their discrimination experiences through in-home interviews, questionnaires and in-clinic examinations, researchers said.

For the purposes of the study, having hypertension was defined as taking blood pressure-lowering medication, having a systolic blood pressure of 140 mm Hg or above or having diastolic blood pressure higher than 90 mm Hg at follow-up visits, according to the authors.

During the follow-up period, more than half of the participants — 954, or 52 percent — developed hypertension.

The study results, Forde said, “suggest how social determinants such as racism and discrimination affect health in measurable ways.”

Strategies to reduce health inequities and improve health are needed to address these broader social determinants, she added.

Although the study included experiences of discrimination among a large sample of black Americans, discrimination was measured at a single point in time, which limited the researchers’ ability to capture changes in discrimination experiences over the entire follow-up period, according to the researchers.

In all, nearly 80 million American adults are living with high blood pressure, including more than 40 percent of black Americans, according to the American Heart Association.

“Previous studies have shown that discrimination affects African Americans’ health,” Forde said.

“Traditional risk factors, such as diet and physical activity, have been strongly correlated with hypertension, yet important psychosocial factors like discrimination, which also have the potential to negatively impact health, are rarely considered,” she said.



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Official COVID-19 count may underestimate deaths by 28 percent

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July 1 (UPI) — Official counts of COVID-19 cases in the United States may underestimate deaths by as much as 28 percent, according to an analysis published Wednesday by JAMA Internal Medicine.

From March 1 through May 30, an estimated 122,300 Americans died after being infected with the new coronavirus, SARS-CoV-2, the researchers said. That’s higher than the Center for Disease Control and Prevention’s tally of 95,235.

The difference is based on the researchers’ assessment of “excess deaths” across the country — the actual number of reported deaths compared to figures from the same period for the previous five years.”

There have been questions about whether the reported statistics overcount COVID-19 deaths, but our analyses suggest the opposite,” study co-author Daniel Weinberger, an associate professor of epidemiology at Yale University School of Medicine, told UPI.

“The number of reported COVID-19 deaths likely represents an undercount of the true burden caused by the virus.”

Analyses of “excess deaths” have been used to estimate deaths caused by infectious diseases in the past, including pneumonia, the flu and HIV, according to Weinberger and his colleagues.

As of Wednesday morning, nearly 2.7 million people in the United States have been diagnosed with COVID-19, and more than 127,000 have died, according to figures from Johns Hopkins University.

CDC officials acknowledged last week that the total number of people actually infected with COVID-19 may be 10 times higher than official estimates because many who are infected don’t experience symptoms and don’t know they have it.

For the study, researchers reviewed mortality data from the CDC’s National Center for Health Statistics.They compared the “expected” number of deaths for the period — based on an average of totals for 2015-19 — and compared it to the total for 2020. The period covers the peak of the COVID-19 outbreak so far in parts of the United States.

The excess deaths for the three-month period in 2020 could be attributed to COVID-19, but may also be influenced by “people avoiding care for emergency medical conditions, like heart attacks,” as well as declines in certain categories of deaths, like car accidents, Weinberger said.

“Excess deaths can provide useful information in addition to the traditional statistics that are based on laboratory testing, [but] the data need to be interpreted with caution,” Weinberger said. “Looking at changes in deaths due to any cause provides a more complete picture of the epidemic.”



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