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News Article | April 25, 2017
Site: www.eurekalert.org

These changes, known as epigenetic modifications, control the activity of our genes without changing the actual DNA sequence. One of the main epigenetic modifications is DNA methylation, which plays a key role in embryonic development and the formation of different cell types, regulating when and where genes are switched on. Although DNA methylation was originally thought to be a very stable modification, which once established in early life was then maintained throughout the life span of an individual, there is now growing evidence that the level of DNA methylation can be affected by a range of environmental factors such as parental health, diet and lifestyle. Researchers from the University of Southampton, as part of the EpiGen Global Consortium, analysed the levels of DNA methylation, in umbilical cord tissue of babies born in the Southampton Women's Survey. They compared DNA methylation levels present at birth with the amount of fat tissue in the child at four and six years of age. They found that lower DNA methylation at the CDKN2A gene, which regulates the production of fat cells, was associated with a greater risk of the child developing obesity in later life. Analysis showed that a 10 percent decrease in methylation at the CDKN2A gene was associated with an increase in fat mass of around 220g, at age 4 years. The results, published in EBio Medicine, were replicated in other groups of children and adults, notably the Singapore GUSTO study, the Australian RAINE study and the UK BIOCLAIMS cohort. Lead author Karen Lillycrop said: "This is exciting new evidence that epigenetic changes detectable at birth are linked to a child's health as they grow up. It was very promising to see our initial findings confirmed in so many other cohorts. Not only does it strengthen the body of evidence that shows a mothers health during pregnancy can affect the future health of her child, but it could also allow us to more accurately predict the future risk of obesity. If we can do this, then preventative strategies can be developed in early life to prevent the development of obesity." Professor Keith Godfrey, from the Medical Research Council Lifecourse Epidemiology Unit and the National Institute for Health Research Southampton Biomedical Research Centre and a member of the study team said: "The new findings provide the first direct evidence linking faltering of a baby's growth in the womb with epigenetic modifications that themselves may increase the risk of childhood obesity. The findings are now helping us to trial new nutritional interventions before and during pregnancy to reduce the baby's risk on obesity in childhood and later life, and strengthen the view that effective prevention of childhood obesity has to begin before the baby is born. The new findings may also lead to innovative approaches to the treatment of established obesity in later life." The EpiGen Global Consortium brings together expertise from the Human Development and Health Academic Unit, MRC Lifecourse Epidemiology Unit and Centre for Biological Sciences, University of Southampton; Singapore Institute for Clinical Sciences; National University of Singapore; Auckland UniServices Limited and the Liggins Institute, University of Auckland. The Consortium's aim is to improve human health through the life course by further understanding developmental and environmental processes. The research includes a focus on epigenetics, the biology of understanding how gene function is regulated by environmental factors, such as maternal nutrition, during the very early stages of development. This research was carried out as part of a collaboration with the Nestlé Research Centre, in Lausanne, Switzerland.


News Article | April 27, 2017
Site: www.eurekalert.org

A clinical trial funded by Arthritis Research UK and the National Institute for Health Research (NIHR) led by professors from the Universities of Liverpool and Bristol has discovered a drug combination that could help thousands of children with arthritis. Over 5,000 children and adolescents with Juvenile Idiopathic Arthritis (JIA) in the UK are likely to develop uveitis, a condition that causes inflammation in the middle layer of the eye. The drug combination discovery will help preventing them from serious complications, including blindness. The trial was first of its kind in the world and the findings are a major step forward for children with JIA. The drug therapy has already been approved for use and the study is published today in The New England Journal of Medicine. The trial's Co-Chief Investigators, Professors Michael Beresford and A. V. Ramanan, and colleagues from across the UK, found that a drug called Adalimumab, in combination with Methotrexate, was an effective therapy in children and adolescents with JIA-associated uveitis. The majority (75 per cent) of those children treated with Adalimumab experienced a significant reduction in eye inflammation. An early analysis of the data was so convincing that the trial was stopped early. In this randomised, placebo controlled trial on review of 90 of the target 149 patients with JIA-associated uveitis, the data and safety monitoring committee noted that the Adalimumab group had evidence of a significantly lower risk of treatment failure than the placebo group. This multi-centre trial involved extremely close collaboration between paediatric rheumatology and ophthalmology colleagues across the country and was sponsored by University Hospitals Bristol NHS Foundation Trust, and co-ordinated by the Clinical Trials Research Centre at the University of Liverpool. The trial outcomes directly led to the changes in commissioning guidelines and resulted NHS England approving the use of Adalimumab in children with uveitis that threatens their sight, and for whom other treatments have proven ineffective. Professor Beresford from University of Liverpool's Institute of Translational Medicine and Alder Hey Children's NHS Foundation Trust said: "This landmark trial has demonstrated the commitment and leadership of colleagues across the UK in working closely with patients and parents in tackling a key priority of finding the very best way of caring for children with arthritis and this serious problem of uveitis. "It has shown the UK to be extremely well placed to deliver challenging trials in children, with the support of the NIHR Clinical Research Network and networks that are in place across the UK." Professor Ramanan from University Hospitals Bristol NHS Foundation Trust and University of Bristol said, "Uveitis in children is an important cause of loss of vision. This study demonstrates the benefit of Adalimumab in children with uveitis. This is the first randomised trial of its kind worldwide and the results will have a major impact in children with uveitis all around the world." There are 15,000 children and adolescents in the UK with the auto-immune disease JIA. One third of those are likely to develop uveitis, leading to more serious visual impairments and may be registered as blind. Stephen Simpson, director of research and programmes at Arthritis Research UK, said: "We are thrilled of the outcome of this trial and the huge promise it heralds for transforming the quality of life for the large numbers of children with JIA-associated uveitis. "This trial is an impressive example of how investing in exceptional science can ultimately help change how treatment is delivered with direct and immediate benefit for patients." The full study, entitled 'Adalimumab plus Methotrexate for Uveitis in Juvenile Idiopathic Arthritis' can be found here http://www.


Patients at risk of developing bowel cancer can significantly benefit from a follow-up colonoscopy, finds research published today in Lancet Oncology. Currently, everyone in the UK over the age of 60 is invited to be screened for bowel cancer, also known as colorectal cancer. It is a major cause of illness and death in developed countries. Small growths in the bowel, called polyps or adenomas, can develop into cancer over a long period of time. However, removing these precancerous growths can drastically reduce the risk of developing bowel cancer. The new research, funded by the National Institute for Health Research (NIHR), shows that most patients who have had treatment to remove growths in their bowel and are classed as being at 'intermediate risk' can benefit substantially from a follow-up or 'surveillance' colonoscopy. However, a proportion of this group of patients are at low risk compared with the general population and are unlikely to benefit significantly from colonoscopy surveillance. The researchers suggest the findings could lead to changes in the way patients are screened and followed-up, and even reduce costs for healthcare services. Professor Wendy Atkin, from the Department of Surgery and Cancer at Imperial College London and chief investigator on the study, said: "The findings could influence national and international guidelines for the screening and surveillance of bowel cancer and could lead to cost savings for the NHS by reducing unnecessary procedures." Those patients who have one-to-two large adenomas (1 cm or larger) or three-to-four small adenomas are classed as being at 'intermediate risk' and are recommended to have a follow-up colonoscopy three years after their adenomas are removed. Most patients offered this surveillance are at intermediate risk In the latest study, researchers from Imperial College London looked at the incidence of bowel cancer and the effectiveness of follow-up colonoscopies in reducing incidence in people found to have intermediate-risk adenomas. The study was commissioned on behalf of the UK National Screening Committee to help inform its current bowel cancer screening programme for the NHS. Professor Atkin, said: "Colonoscopies carry a small risk of complications for patients, and are demanding on NHS resources, with around 20 per cent of colonoscopies in the UK performed for surveillance. It is therefore important to assess whether all people classed as being at intermediate risk need to undergo follow-up colonoscopy." Researchers looked at data for more than 250,000 patients and identified approximately 12,000 people who were diagnosed with intermediate-risk adenomas across 17 UK hospitals. These patients were monitored over an eight year period, and the incidence of bowel cancer was compared in those who had a follow-up colonoscopy with those who had not. They identified a subgroup of patients within the intermediate-risk group, with large adenomas (2 cm or larger), advanced pathology in the adenomas, or polyps in the upper half of the large bowel who were at a higher risk of developing bowel cancer. These 'higher-risk' patients appeared to benefit substantially from at least one follow-up colonoscopy. In addition, intermediate-risk patients who fell into the 'lower-risk' subgroup were found to have a smaller chance of developing bowel cancer than that of the general population. For this group of patients, the researchers suggest that follow-up colonoscopies may not be warranted at all if the initial colonoscopy is of high quality. According to the researchers, the findings will help to shape current and future guidelines on bowel cancer screening both in the UK and internationally. If the changes are adopted, they could lead to cost savings for the NHS and reallocating of resources to focus on those most at risk. "The quality of colonoscopy has improved in recent years and it is important we identify those people who would benefit from a follow-up colonoscopy," said Professor Atkin. "This research showed that there is a subgroup that definitely benefits but there is also a subgroup that possibly don't require a follow-up colonoscopy. "The results of this study provide robust evidence which will be important for informing future surveillance guidelines for how we monitor people in the intermediate-risk group, and will help minimise the costs and risks associated with the unnecessary colonoscopies that are currently performed." Adenoma surveillance and colorectal cancer incidence: a retrospective, multicentre, cohort study by Atkin, W. et al, is published in the journal Lancet Oncology.


News Article | April 25, 2017
Site: www.eurekalert.org

The findings, published today in The Lancet, show women fare worse than men at every stage of treatment, leading to the study's authors to call for urgent improvement in how the condition is managed in women. The researchers, from Imperial College London and the University of Cambridge, found that women are less likely than men to be deemed suitable for keyhole surgery for the condition, which is associated with better outcomes. They are also more likely to be offered no surgical treatment at all. The findings are based on a review of international research into the condition, carried out since 2000. An abdominal aortic aneurysm is caused by a weakening in the wall of the aorta, the body's largest blood vessel, which carries blood from the heart through the abdomen to the rest of the body. Degenerative changes in the aortic wall cause weakening and ballooning of the blood vessel, sometimes to more than three times its normal diameter, with a risk of a potentially life-threatening rupture. Surgical repair for these aneurysms is offered only when the swelling is large enough to make the risk of rupture greater than the risks of the operation, with two types of surgery available. Open surgery involves cutting into the abdomen and replacing all of the ballooning section of the aorta with a tube-like graft. The second procedure, endovascular repair, is a minimally invasive 'keyhole' technique which involves inserting a tube-like graft through the leg artery into the swollen section of the aorta to reinforce the blood vessel's weakened wall. It is associated with better early outcomes than open surgery, but can only be offered when the aneurysm meets certain criteria, due to the shape and size of the grafts. For some patients with large aneurysms, the risk of both of these options are deemed to outweigh the risk of rupture and no treatment is offered unless patient fitness can be improved. The study, funded by the National Institute for Health Research, found that only a third of women were deemed suitable for keyhole surgery, compared with just over half of men. Less than a fifth of men were not offered surgery, compared with a third of women. Mortality rates for women for the 30 days after keyhole surgery were 2.3 per cent compared with 1.4 per cent for men. For open surgery, this rose to 5.4 per cent for women and 2.8 per cent for men. Women tend to develop aneurysms at an older age than men, and their aortas are smaller. Given the current technologies available, both of these factors can affect which type of surgery is deemed suitable, or whether surgery is an option at all. The researchers say that while these factors will form the basis of future research, age and physical fitness are not enough to account for the differences seen in mortality between men and women. Professor Janet Powell, from Imperial's Department of Surgery & Cancer and who led the research, said: "Our findings show that despite overall improvement in mortality rates for this condition, there is a huge disparity between outcomes for men and women, which is not acceptable. "The way abdominal aortic aneurysm is managed in women needs urgent improvement. We need to see if the devices used for keyhole surgery can be made more flexible to enable more women to be offered this option. We also need more grafts designed to fit women, who have smaller aortas, as all the grafts currently available have been designed for men." In the UK, abdominal aortic aneurysm is more prevalent in men, with men over 65 regularly screened for the condition. The condition often has no symptoms and many women are only diagnosed when the aneurysm ruptures, at which point the likelihood of survival can be less than 20 per cent. Professor Powell added: "Abdominal aortic aneurysm is still seen as mainly a male condition, and as a result, the way we manage the condition - from screening to diagnosis and treatment - has been developed with men in mind. Our study shows that this needs to change." 'Morphological suitability for endovascular repair, non-intervention rates, and operative mortality in women and men assessed for intact abdominal aortic aneurysm repair: systematic reviews with meta-analysis' by Ulug, P et al, is published in The Lancet.


BRISTOL, 05-May-2017 — /EuropaWire/ — A new drug combination that could help thousands of children with arthritis and prevent them from serious complications, including blindness, has been discovered by researchers and thanks to a trial funded by Arthritis Research UK and the National Institute for Health Research (NIHR). Over 5,000 children and adolescents with juvenile idiopathic arthritis (JIA) in the UK are likely to develop uveitis, a condition that causes inflammation in the middle layer of the eye. The trial, the first of its kind in the world, and the findings are a major step forward for children with JIA. The drug therapy has already been approved for use and the study is published in The New England Journal of Medicine. The trial’s co-chief investigators, Professors A. V. Ramanan from the University of Bristol’s School of Clinical Sciences and Michael Beresford from the University of Liverpool and Alder Hey Children’s NHS Foundation Trust, and colleagues from across the UK, found that a drug called adalimumab, in combination with methotrexate, was an effective therapy in children and adolescents with JIA-associated uveitis. The majority (75 per cent) of those children treated with adalimumab experienced a significant reduction in eye inflammation. An early analysis of the data was so convincing that the trial was stopped early. In this randomised, placebo-controlled trial on review of 90 of the target 149 patients with JIA-associated uveitis, the data and safety monitoring committee noted that the adalimumab group had evidence of a significantly lower risk of treatment failure than the placebo group. This multi-centre trial involved extremely close collaboration between paediatric rheumatology and ophthalmology colleagues across the country and was sponsored by University Hospitals Bristol NHS Foundation Trust, and co-ordinated by the Clinical Trials Research Centre at the University of Liverpool. The trial outcomes directly led to the changes in commissioning guidelines and resulted in NHS England approving the use of adalimumab in children with uveitis that threatens their sight, and for whom other treatments have proven ineffective. Professor Ramanan from University Hospitals Bristol NHS Foundation Trust and University of Bristol said: “Uveitis in children is an important cause of loss of vision. This study demonstrates the benefit of adalimumab in children with uveitis. This is the first randomised trial of its kind worldwide and the results will have a major impact in children with uveitis all around the world.” Professor Beresford from University of Liverpool and Alder Hey Children’s NHS Foundation Trust said: “This landmark trial has demonstrated the commitment and leadership of colleagues across the UK in working closely with patients and parents in tackling a key priority of finding the very best way of caring for children with arthritis and this serious problem of uveitis. “It has shown the UK to be extremely well placed to deliver challenging trials in children, with the support of the NIHR Clinical Research Network and other research networks that are in place across the UK.” There are 15,000 children and adolescents in the UK with the auto-immune disease JIA. One third of those are likely to develop uveitis, leading to more serious visual impairments and may be registered as blind. Stephen Simpson, director of research and programmes at Arthritis Research UK, said: “We’re thrilled of the outcome of this trial and the huge promise it heralds for transforming the quality of life for the large numbers of children with JIA-associated uveitis. “This trial is an impressive example of how investing in exceptional science can ultimately help change how treatment is delivered with direct and immediate benefit for patients.” Further informatio Paper ‘Adalimumab plus Methotrexate for Uveitis in Juvenile Idiopathic Arthritis’ by Athimalaipet V. Ramanan et al in The New England Journal of Medicine.


News Article | May 19, 2017
Site: www.prweb.com

Inmedix, the leader in heart rate variability (HRV) application as an informative diagnostic tool in autoimmune disease, today announced the establishment of a subsidiary, Inmedix UK, Ltd. In coordination with the National Institute for Health Research (NIHR) Office for Clinical Research Infrastructure (NOCRI) and with input from the National Institute for Health Care Excellence (NICE), Inmedix seeks to evaluate its ANS Neuroscan within a single payer system to more fully evaluate its health economic impact. Daniel Austen will direct Inmedix UK Ltd. logistics in cooperation with rheumatology Professors Ernest Choy, and Peter Taylor. Choy serves as Head of Rheumatology and Translational Research at the Institute of Infection and Immunity and Director of the Cardiff Regional Experimental Arthritis Treatment and Evaluation (CREATE) Centre at Cardiff University School of Medicine. Taylor is Professor of Musculoskeletal Sciences at the University of Oxford and Director of Clinical Sciences at the Botnar Research Centre within the Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences and chairs the NOCRI Translational Research Partnership. “The UK is an ideal place for medical research and development,” said Austen. “We have a cohesive, single payer system and our independent health and social care guidance body, NICE, has the important role through its medtech evaluation program of providing clinical excellence for our patients at the best possible price.” The ANS Neuroscan measures autonomic nervous system (ANS) status, which has been shown to influence many human immune functions at work in RA and in other autoimmune diseases. Through electrocardiogram (ECG) tracing, the ANS Neuroscan uses proprietary heart rate variability (HRV) technology to assess the patient’s ANS profile. Inmedix shared with NICE and NOCRI its published proof-of-concept study (n=33) of observed accuracy – with 90% sensitivity and 95.7% specificity – for the ANS Neuroscan to predict therapeutic biologic response for RA.1,2. At year one, 0% of patients with a baseline poor ANS profile achieved disease control using either etanercept (Enbrel®, Amgen) or adalimumab (Humira®, AbbVie). For patients with a baseline beneficial ANS profile, 65% achieved disease control as defined by an ACR70 response, a standard endpoint for measuring efficacy in RA. “We’re pleased to work with NIHR, NOCRI, and NICE as we address the goal of improving outcomes for patients with RA while reducing unsustainable costs,” said Andrew J. Holman, MD, CEO & Co-founder of Inmedix. “Conducting research in the UK single payer system will allow Inmedix to not only to seek greater rates of autoimmune disease remission, but to also assess the cost impact of reducing the need to so often escalate to biologic therapies.” According to Express Scripts, even though only 2 percent of the U.S. population uses biologic drugs, biologics account for 40 percent of prescription drug spending.3 RA affects nearly two million Americans, including children, at a tangible societal cost of $19.3 billion per year (2005 dollars).4 In the U.S., specialty pharmaceutical costs exceeded $87 billion in 2014, with rheumatologists responsible for 25%, mostly for biologic treatment of RA. The UK market is approximately one sixth the size of the U.S. market. Reducing the need to escalate to biologic care by enhancing non-biologic outcomes through ANS optimization strategies could potentially reduce specialty pharmacy costs for autoimmune diseases by 30-40%. About Inmedix, LLC Seattle-based biotech Inmedix is committed to engaging in world class research to discover innovative solutions for pressing healthcare needs related to the autonomic nervous system (ANS). Inmedix’s ANS Neuroscan is the leading heart rate variability (HRV) application as an informative diagnostic tool in autoimmune disease, beginning with patients with rheumatoid arthritis (RA). The company’s science and technology hopes to raise therapeutic outcomes so that patients will no longer need to cycle through failure of one therapeutic intervention after another. For more information, visit http://www.inmedix.com. References 1.    Holman AJ, Ng E. Heart rate variability predicts anti-tumor necrosis factor therapy response for inflammatory arthritis. Autonomic Neurosci Basic Clinical 2008 Dec 5;143(1-2):58-67. 2.    Holman AJ, Ng E. How substantive is Heart Rate Variability as a Predictor of Anti-TNF Treatment Outcome for Inflammatory Arthritis? Arthritis Rheumatol 2015;67(suppl 10). 3.    Birnbaum H, Pike C, Kaufman R et al. Societal cost of rheumatoid arthritis patients in the US. Curr Med Res Opin 2010 Jan;26(1):77-90. 4.    http://health.usnews.com/health-news/health-wellness/articles/2015/02/06/why-are-biologic-drugs-so-costly


News Article | April 20, 2017
Site: www.eurekalert.org

Stimulating the brain by taking on leadership roles at work or staying on in education help people stay mentally healthy in later life, according to new research. Stimulating the brain by taking on leadership roles at work or staying on in education help people stay mentally healthy in later life, according to new research. The large-scale investigation published in the journal PLOS Medicine and led by the University of Exeter, used data from more than 2,000 mentally fit people over the age of 65, examined the theory that experiences in early or mid life which challenge the brain make people more resilient to changes resulting from age or illness - they have higher "cognitive reserve". The analysis, funded by the Economic and Social Research Council (ESRC) found that people with higher levels of reserve are more likely to stay mentally fit for longer, making the brain more resilient to illnesses such as dementia. The research team included collaborators from the universities of Bangor, Newcastle and Cambridge. Linda Clare, Professor of Clinical Psychology of Ageing and Dementia at the University of Exeter, said: "Losing mental ability is not inevitable in later life. We know that we can all take action to increase our chances of maintaining our own mental health, through healthy living and engaging in stimulating activities. It's important that we understand how and why this occurs, so we can give people meaningful and effective measures to take control of living full and active lives into older age. "People who engage in stimulating activity which stretches the brain, challenging it to use different strategies that exercise a variety of networks, have higher 'Cognitive reserve'. This builds a buffer in the brain, making it more resilient. It means signs of decline only become evident at a higher threshold of illness or decay than when this buffer is absent." The research team analysed data from 2,315 mentally fit participants aged over 65 years who took part in the first wave of interviews for the Cognitive Function and Ageing Study Wales (CFAS-Wales). They analysed whether a healthy lifestyle was associated with better performance on a mental ability test. They found that a healthy diet, more physical activity, more social and mentally stimulating activity and moderate alcohol consumption all seemed to boost cognitive performance. Professor Bob Woods of Bangor University, who leads the CFAS Wales study, said: "We found that people with a healthier lifestyle had better scores on tests of mental ability, and this was partly accounted for by their level of cognitive reserve. "Our results highlight the important of policies and measures that encourage older people to make changes in their diet, exercise more, and engage in more socially oriented and mentally stimulating activities." Professor Fiona Matthews of Newcastle University, who is principal statistician on the CFAS studies, said "Many of the factors found here to be important are not only healthy for our brain, but also help at younger age avoiding heart disease". Professor Clare is supported by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care South West Peninsula (NIHR PenCLAHRC). Testing our the efficacy of brain stimulation is part one aspect of the PROTECT (Platform for Research Online to investigate Genetics and Cognition in Ageing) trial, which involves Professor Clare. It has already recruited 20,000 people over the age of 50. They are taking part in Exeter-led research to establish which lifestyle measures can make a meaningful difference to keep people stay physically and mentally active in older age. The paper, Potentially modifiable lifestyle factors, cognitive reserve, and cognitive function in later life: A cross-sectional study, is published in PLOS Medicine. Authors are Linda Clare, Yu-Tzu Wu, Julia C. Teale, Catherine MacLeod, Fiona Matthews, Carol Brayne, Bob Woods, and the CFAS-Wales study team¶.


News Article | April 17, 2017
Site: co.newswire.com

ARS Therapeutics, Inc. Could Provide Immediate Help For ALS Patients Amyotrophic lateral sclerosis (ALS/Lou Gehrigs Disease) may be a severally under diagnosed disease. According to the National Institute for Health (NIH), there are approximately 5,500 new cases of ALS in the United States, however, some independent researchers are believing that it might be far greater, 5 to 10 times the numbers provided by the NIH. A large percentage of patients go un-diagnosed and misdiagnosed. If there are 25,000 to 50,000 newly diagnosed patients in the US, why are there only a few FDA approved drugs? Rizole (Rilutek) is the only FDA-approve drug currently available to treat ALS and improves overall survival by a few months. There are several late-stage drugs in development for ALS patients, Tirasemtiv (by CytoKinetics) is a promising late-stage drug in development, currently in a phase 3 global clinical trial. Enrollment was completed last year and results are expected this in 2017. There are several biotechnology and pharmaceutical drugs in development, as well as a stem-cell research. Unfortunately, these drugs may be years away from being approved and available for patients. Sadly, the last resource that ALS patients have is time. There are exploratory options with natural supplements, participatory l-Serine. L-serine is a naturally occurring non-essential amino acid that is found in our bodies and may help contribute to healthy motor neuron cells. An FDA approved clinical trial is nearing completion for assessing L-serine in Lou Gehrigs/ALS patients. A major research hospital in Los Angeles is initiating another clinical trial with L-serine and ALS in 2017.  ARS Therapeutics recently released a natural supplement that helps protect motor neurons cells with L-serine.  The supplement is branded "ALS Complete" and is available directly at http://www.alstreatments.com and is also carried by the worlds largest online retailer www.Amazon.com. We hope there is additional research and advancement with this horrible/life devastating disease.


News Article | May 24, 2017
Site: www.eurekalert.org

"We expect our results to have a major influence on the future of autopsy practice in the UK, and across the world" - Professors Guy Rutty and Bruno Morgan A ground-breaking study by University of Leicester pathologists and radiologists could represent a breakthrough in how autopsy practice is conducted in the United Kingdom and around the world. The research was led by Professors Guy Rutty and Bruno Morgan from the University of Leicester. It was funded by the National Institute for Health Research (NIHR) and is published in the Lancet. Professor Rutty explained: "Over the years there have been several attempts to develop alternative approaches to the invasive autopsy to limit the extent to which the cadaver is dissected. Although these techniques have been published, the invasive examination remains the standard adopted approach." A previous study of PMCT published in the Lancet in 2012 showed promise for using medical imaging to investigate the cause of natural death, but with a major weakness: the inability to diagnose coronary artery disease, the most common cause of natural death. Professor Morgan explained: "In clinical CT scanning, a contrast agent is injected into a vein and circulation delivers it around the body. This allows the CT scan to show the state of blood vessels anywhere in the body. However, the lack of circulation in cadavers means these techniques cannot be used." This has been overcome by developing a novel minimally invasive coronary artery angiography technique. A variety of these techniques have been developed around the world over the last few years, but this is the first large-scale fully autopsy-controlled trial to demonstrate their efficacy in adult natural death. Professor Rutty explained: "Here at the University of Leicester we developed a quick and minimally invasive approach to improve diagnostic accuracy. This uniquely uses a combination of standard contrast agent (positive) and air (negative) to show the coronary artery lumens and ventricular cavities." Professor Morgan explained: "By 'minimally invasive' we mean that we use a catheter inserted into an artery to perform the angiography. The insertion techniques are like those we use on patients every day in our clinics, with just the use of local anaesthetic to numb the skin." The Leicester team applied their PMCTA technique to a cohort of 240 deaths investigated by the HM coroner. They show that a cause of death could be given in 92% of cases, based on "the balance of probabilities", the burden of proof required by the HM Coroner. Comparison with independently generated autopsy results showed that PMCTA had a similar accuracy to autopsy, did not miss autopsy-identifiable unnatural or "reportable" causes of death, and would also not significantly change population "cause of death" statistics. Professor Morgan added: "We have shown that PMCT enhanced by targeted coronary angiography can diagnose the cause of death in up to 90% of HM Coronial investigations for suspected natural death. This is the most successful application of PMCT and PMCTA to-date in natural death, and shows that a significant number of deaths could be investigated without the need for an invasive autopsy." PMCTA was found to be superior at identifying trauma and haemorrhage, whereas autopsy was superior at identifying pulmonary thromboembolism. Both tests had different strengths and weaknesses in heart and lung disease. Professor Rutty cautioned: "Both autopsy and PMCTA have different strengths and weaknesses as investigative approaches. When a higher burden of proof is required the 'gold standard' of death investigation should include both PMCT and invasive autopsy." The findings of the study are unique from an international perspective as it focuses on natural death. In the study a small number of unnatural deaths were also examined, showing PMCTA was also useful in these cases. Professor Rutty concludes: "There is already great interest in providing PMCTA as an alternative to autopsy in the UK with several centres, including Leicester, recently initiating services. These data now provide strong evidence to validate these services, especially where they use angiography techniques. We therefore expect these results to have a major influence on the future of autopsy practice in the UK, and across the world." Professors Rutty and Morgan are internationally recognised as pioneers, researchers and practitioners within the field of post mortem computed tomography. They are the authors of the largest body of scientific publications in this field within the United Kingdom, including research studies and educational papers and book chapters. They both state "we dedicate the success of our research to the families of Leicestershire, who have consented for their loved ones to be involved in these studies, despite being in a period of bereavement." They have pioneered other investigative adjuncts to augment PMCT studies, developed a 'patent-pending' PMCT catheter, and they have launched the first educational postgraduate teaching programs for PMCT at the University of Leicester, which started in 2016. The team believes adopting PMCTA as the standard first-line test in natural death would have a positive and profound effect on the public and religious groups within the UK and potentially beyond. The research was authored by Professor Guy Rutty (East Midlands forensic Pathology Unit, CSMM) and Professor Bruno Morgan (University Radiology Unit, CSMM), in collaboration with other University of Leicester, and University Hospitals of Leicester employees past and present. The paper 'Diagnostic accuracy of post-mortem Computed Tomography with targeted Coronary Angiography (PMCTA) when used as the first-line investigation for HM Coroner post-mortem investigations: prospective, blind comparison to a gold standard study' is published in The Lancet. More information about the postgraduate teaching programs in PMCT at the University of Leicester is available below: A video highlighting the new research is available here: https:/ Images are available here: https:/


News Article | May 26, 2017
Site: www.sciencedaily.com

A ground-breaking study by University of Leicester pathologists and radiologists could represent a breakthrough in how autopsy practice is conducted in the United Kingdom and around the world. The research was led by Professors Guy Rutty and Bruno Morgan from the University of Leicester. It was funded by the National Institute for Health Research (NIHR) and is published in the Lancet. Professor Rutty explained: "Over the years there have been several attempts to develop alternative approaches to the invasive autopsy to limit the extent to which the cadaver is dissected. Although these techniques have been published, the invasive examination remains the standard adopted approach." A previous study of PMCT published in the Lancet in 2012 showed promise for using medical imaging to investigate the cause of natural death, but with a major weakness: the inability to diagnose coronary artery disease, the most common cause of natural death. Professor Morgan explained: "In clinical CT scanning, a contrast agent is injected into a vein and circulation delivers it around the body. This allows the CT scan to show the state of blood vessels anywhere in the body. However, the lack of circulation in cadavers means these techniques cannot be used." This has been overcome by developing a novel minimally invasive coronary artery angiography technique. A variety of these techniques have been developed around the world over the last few years, but this is the first large-scale fully autopsy-controlled trial to demonstrate their efficacy in adult natural death. Professor Rutty explained: "Here at the University of Leicester we developed a quick and minimally invasive approach to improve diagnostic accuracy. This uniquely uses a combination of standard contrast agent (positive) and air (negative) to show the coronary artery lumens and ventricular cavities." Professor Morgan explained: "By 'minimally invasive' we mean that we use a catheter inserted into an artery to perform the angiography. The insertion techniques are like those we use on patients every day in our clinics, with just the use of local anaesthetic to numb the skin." The Leicester team applied their PMCTA technique to a cohort of 240 deaths investigated by the HM coroner. They show that a cause of death could be given in 92% of cases, based on "the balance of probabilities," the burden of proof required by the HM Coroner. Comparison with independently generated autopsy results showed that PMCTA had a similar accuracy to autopsy, did not miss autopsy-identifiable unnatural or "reportable" causes of death, and would also not significantly change population "cause of death" statistics. Professor Morgan added: "We have shown that PMCT enhanced by targeted coronary angiography can diagnose the cause of death in up to 90% of HM Coronial investigations for suspected natural death. This is the most successful application of PMCT and PMCTA to-date in natural death, and shows that a significant number of deaths could be investigated without the need for an invasive autopsy." PMCTA was found to be superior at identifying trauma and haemorrhage, whereas autopsy was superior at identifying pulmonary thromboembolism. Both tests had different strengths and weaknesses in heart and lung disease. Professor Rutty cautioned: "Both autopsy and PMCTA have different strengths and weaknesses as investigative approaches. When a higher burden of proof is required the 'gold standard' of death investigation should include both PMCT and invasive autopsy." The findings of the study are unique from an international perspective as it focuses on natural death. In the study a small number of unnatural deaths were also examined, showing PMCTA was also useful in these cases. Professor Rutty concludes: "There is already great interest in providing PMCTA as an alternative to autopsy in the UK with several centres, including Leicester, recently initiating services. These data now provide strong evidence to validate these services, especially where they use angiography techniques. We therefore expect these results to have a major influence on the future of autopsy practice in the UK, and across the world." Professors Rutty and Morgan are internationally recognised as pioneers, researchers and practitioners within the field of post mortem computed tomography. They are the authors of the largest body of scientific publications in this field within the United Kingdom, including research studies and educational papers and book chapters. They both state "we dedicate the success of our research to the families of Leicestershire, who have consented for their loved ones to be involved in these studies, despite being in a period of bereavement." They have pioneered other investigative adjuncts to augment PMCT studies, developed a 'patent-pending' PMCT catheter, and they have launched the first educational postgraduate teaching programs for PMCT at the University of Leicester, which started in 2016. The team believes adopting PMCTA as the standard first-line test in natural death would have a positive and profound effect on the public and religious groups within the UK and potentially beyond. The research was authored by Professor Guy Rutty (East Midlands forensic Pathology Unit, CSMM) and Professor Bruno Morgan (University Radiology Unit, CSMM), in collaboration with other University of Leicester, and University Hospitals of Leicester employees past and present.

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