By Elizabeth Baier
Anyone who has spent much time in Minnesota's "Med City" can't help but notice that wheelchairs are everywhere.
From city parking ramps and downtown sidewalks to park trails and the local mall, the chairs have an inescapable presence.
More than likely that has do to with the fact that Rochester is home to Mayo Clinic, visited by thousands of patients every day. Many of them use wheelchairs to get around. So it's not surprising that they exist in big numbers.
The big curiosity is how they end up all over the city with their users nowhere in sight — a fact that some local residents can be oblivious to.
Denny and Carol Scanlan say empty wheelchairs are just part of the Rochester landscape.
"I never even thought of it until just now," Denny Scanlan says over a drink at American Legion Post 92, where he is a member. "Well, I see them kind of everywhere we go, I guess — where you least expect them."
"Yes," says his wife, with a laugh. "At the mall. In a restaurant. " She adds, "We're so used to it that I don't even notice it."
But some people do notice the big blue chairs.
At the Blue Water Salon on the skyway level of the Doubletree Hotel, owner Shelly Joseph often sees them just outside her door, in a public stairwell largely used by hotel staff.
"I don't know why they're in here, but randomly they're in this stairwell," she says. "It's a fire exit, basically."
At the Starbucks across the hall, manager Dawn Lee-Britt sees wheelchairs outside the employee entrance at the back of the coffee shop at least a couple of times a week.
"Sometimes we can't get out," she says. "I'm getting used to it because we see them so often." She adds: "It's like they don't need it anymore or it's time to go.
Mayo Clinic has 1,180 wheelchairs in its Rochester fleet, largely for patient transport. It loses up to 150 chairs each year, says general services manager Ralph Marquez, who oversees patient equipment.
At $550 each, that could be as much as $82,500 a year.
"Yes, it's a financial burden to us from that standpoint, but it's also a service we provide," Marquez says. "And if the patient, you know, truly comes first, sometimes that's the expense of the business."
Because the clinic does not want to keep patients from leaving the campus, the clinic's courier service rounds up wheelchairs weekly, mostly from hotels and other places that alert them.
But the chairs can travel much farther than that.
"We've gotten calls from Orlando Airport. Goodwill up in Duluth had one of our chairs and luckily we were able to retrieve that one. We've had them in Denver, out east in a few airports," Marquez says. "They get back to us dirty and needing to be cleaned. People may take them home for a while. They wind up everywhere."
That includes the Rochester Public Library, where communications manager John Hunziker considers wheelchairs normal.
"I'm sure if you aren't used to Rochester, seeing somebody going down the skyway, you know, pushing an IV on a rolling stand looks kind of weird," he says. "But it's just part of living in Rochester."
And on some days, part of Hunziker's job is to let the Mayo Clinic know there's a blue chair to pick up in the lobby.
By Robert Preidt
Cesarean delivery was the most common inpatient surgery in the United States in 2011 and was used in nearly one-third of all deliveries, research shows.
The new study found that 1.3 million babies were delivered by cesarean section in 2011. The findings also revealed wide variations in C-section rates at hospitals across the United States, but the reasons for such differences are unclear.
"We found that the variability in hospital cesarean rates was not driven by differences in maternal diagnoses or pregnancy complexity. This means there was significantly higher variation in hospital rates than would be expected based on women's health conditions," lead author Katy Kozhimannil, an assistant professor in the School of Public Health at the University of Minnesota, said in a university news release.
The researchers analyzed data from more than 1,300 hospitals in 46 states. They found that the overall rate of C-section was about 33 percent. Between hospitals, however, that rate ranged between 19 and 48 percent, according to the study.
For women who'd never previously had a C-section, the overall C-section rate was 22 percent. Depending on the hospital, that rate ranged between 11 percent and 36 percent, the researchers said.
C-section rates ranged from 8 percent to 32 percent among lower-risk women and from 56 percent to 92 percent among higher-risk women, according to the study published Oct. 21 in the journal PLoS Medicine.
The findings highlight the roles that hospitals' policies, practices and culture may have in influencing C-section rates, the study authors concluded.
"Women deserve evidence-based, consistent, high-quality maternity care, regardless of the hospital where they give birth, and these results indicate that we have a long way to go toward reaching this goal in the U.S.," Kozhimannil said in the news release.
BY ISSIE LAPOWSKY
When you’re deaf, finding a job isn’t easy.
The trickiest part, explains Ryan Hait Campbell, is the interview. “You’re not required to tell an employer you’re deaf until the interview, but sometimes, they’re a little shocked,” says Campbell, who has been deaf since birth. “They don’t know how to handle it.”
Because of things like this, he says, unemployment rates are staggeringly high among the deaf. Hard numbers are tough to come by, but some figures estimate that around half of people with hearing disabilities are unemployed.
But Campbell wants to change this. He’s the co-founder and CEO of MotionSavvy, an Alameda, California-based startup that’s developing a case for tablet computers that can serve as a virtual interpreter for the deaf. Known as UNI, the case uses gesture recognition technology developed by Leap Motion to translate sign language into audible speech. It then merges this with voice recognition technology to convert spoken word to text. Because there are a variety of signs for any given word, users can upload new signs using a feature called Sign Builder. The system learns how individual users sign, while also distributing each new sign to every UNI device.
‘THIS COULD REALLY GIVE DEAF PEOPLE THE POWER TO LIVE THE LIFESTYLE THEY WANT TO LIVE. WE THINK THAT IS VERY POWERFUL.’
On Tuesday, MotionSavvy launched an IndieGoGo campaign for UNI to raise money and recruit beta testers to help build its dictionary of signs. For $499, a discounted rate, 200 selected backers will get a tablet and UNI case to try at home. “This could really give deaf people the power to live the lifestyle they want to live,” Campbell says, “and we think that is very powerful.”
Such technology would have seemed a distant dream not long ago. But the past decade has brought a wave of investment and interest in both gesture recognition technology and voice recognition technology, driven by companies like Apple and Microsoft, as well as smaller players like Nuance and Leap Motion. That hasn’t gone unnoticed by those who want to improve the lives of the deaf community. MotionSavvy is one of several players trying to capitalize on the convergence of these trends.
Just last week, Transcense, launched an IndieGoGo campaign for an app that provides real-time voice recognition so deaf people can follow a conversation. But unlike UNI, it doesn’t give deaf people who haven’t mastered speech a clear way to talk back. For MotionSavvy, that is the final—and most important—puzzle piece.
“It’s kind of like solving a quadratic equation at this point. It’s figuring out the right variables and stacking things together in such a way that they’ll all perform efficiently,” says Stephen Jacobs, associate director of Rochester Institute of Technology’s Center for Media Arts, Games Interaction, and Creativity.
Jacobs introduced Campbell to MotionSavvy CTO Alexandr Opalka when both were studying at RIT. Opalka, who also is deaf, had been working on similar technology as a student in RIT’s National Technical Institute for the Deaf. They teamed up with four other deaf students, and in 2012, launched MotionSavvy.
The technology is in its earliest stages. UNI recognizes only 300 signs, and its voice recognition component remains unreliable, though Opalka says UNI will come equipped with new and improved voice recognition for beta testers. And yet, during a demo of UNI at WIRED’s New York City office, it wasn’t hard to see just how transformative a technology like this could be. Campbell used it to sign a few common phrases to Opalka, such as “What’s your name?” and “Where are you from?” Yes, it was wonky, but still it struck me as sort of magical.
‘I BROUGHT THIS TO A TABLE OF OLDER DEAF PEOPLE, AND THEY ALL FREAKED OUT.’
Campbell says that reaction’s not entirely unique. “I brought this to a table of older deaf people, and they all freaked out,” he says.
But it’s not just the deaf and hard of hearing who are excited about UNI. Campbell says the FCC has gotten in touch. For many low-income deaf people, translators, video relay services, and other communication tools are prohibitively expensive. So the National Deaf-Blind Equipment Distribution Program picks up the tab. When the commercial version of UNI launches in 2015, it’ll cost $799, plus a $20 monthly subscription for Sign Builder. It’s not cheap, but it’s better than the alternative.
Campbell acknowledges the product is a “moonshot,” and admits it may never replace human interpreters. In fact, he and Opalka hope that it does the opposite. If UNI can achieve its intended purpose—facilitating one-on-one communication— then it could become easier for deaf people to get decent jobs. And who typically pays for interpreters? Employers. “If you can’t communicate during an interview, you’re not getting the job,” Opalka says. “With UNI, we predict more people who are deaf will be able to get jobs and stay working, and that’s how we’ll get more people to hire interpreters. There will be more people in the workforce.”
A Department of Veterans Affairs initiative targeting staph infections in hospitalized patients has produced positive results, according to data released by the VA.
Among VA patients in ICUs between 2007 and 2012, healthcare-associated MRSA infection rates dropped 72% — from 1.64 to 0.46 per 1,000 patient days. Infection rates dropped 66% — from 0.47 to 0.16 per 1,000 patient days — for patients treated in non-ICU hospital units.
“These results are striking,” Carolyn Clancy, MD, VA’s interim under secretary for health, said in a news release. “Healthcare-associated infections are a major challenge throughout the healthcare industry, but we have found in VA that consistently applying some simple preventive strategies can make a very big difference, and that difference is being recognized.”
VA’s prevention practices consist of patient screening programs for MRSA, contact precautions for hospitalized patients found to have MRSA, and hand hygiene reminders with hand sanitizer stations placed in common areas, patient wards and specialty clinics throughout medical centers, according to the release. Practices are reinforced via computerized reminders, training, measurement and continual feedback.
MRSA infections are a serious global healthcare issue and are difficult to treat because the bacterium is resistant to many antibiotics. In a Centers for Disease Control and Prevention 2012 MRSA surveillance report from its Active Bacterial Core surveillance, the CDC cites 75,309 cases of invasive MRSA infections and 9,670 deaths due to invasive MRSA in 2012, according to the release.
“The VA healthcare system is able to implement and assess these prevention strategies,” Martin Evans, MD, director of VA’s MRSA control program, said in the release. “What we’ve learned translates into better healthcare for the veterans we serve.”
By Eun Kyung Kim
James Wathen had stopped eating. Frail and barely able to speak, the 73-year-old whispered to a health care worker that he missed his dog, a one-eyed Chihuahua he hadn't seen since paramedics whisked him away to a Kentucky hospital weeks earlier.
So a team of nurses hustled to learn the fate of Wathen's beloved pet, Bubba, hoping a reunion might provide some peace and comfort to their heartbroken and deteriorating patient — even if arranging one meant bending ahospital rule against pets.
A series of phone calls eventually led the nurses to the Knox-Whitley Animal Shelter, where Bubba was taken and placed with a foster family, said Mary-Ann Smyth, president of the non-profit facility.
Coincidentally, Bubba had also recently fallen ill.
"The dog quit eating a week ago, which is very strange," Smyth told TODAY.com. "The dog didn’t know where James was and James didn't know where the dog was and believe it or not, they both stopped eating at about the same time."
Plans were made to bring the little pooch, who lacked his bottom row of teeth along with his right eye, to the hospital over the weekend.
“He was so sad at first. We had him wrapped in a baby blanket and he was shivering,” Smyth said. “The minute we got about 20 steps from this guy’s room — I kid you not — his little head went up. His eyes got real bright and he was like a different dog.”
She says a similar transformation took place in Wathen during his roughly 30-minute hospital reunion Saturday with Bubba.
"They didn’t think James was going to make it," she recalled being told during her initial visit to the hospital. “I was 10 feet from his bed and you could barely understand him because he was so hard to hear. The nurse had to lean up right against his face to hear what he was saying."
But he slowly perked up as his dog snuggled with him on his bed. By the time Bubba returned for a second visit Tuesday, visible changes were noticeable in both man and his best friend.
"He’s done a complete turnaround. He's speaking, he's sitting up, he’s eating. He doesn't look like the same guy," said Smyth, who didn't attend the second visit but saw Wathen in footage recorded by the shelter's director. "And the dog is eating and doing better now, too."
Baptist Health Corbin, the hospital treating Wathen, did not return repeated messages left by TODAY.com seeking comment.
But nurse Kimberly Probus told WKYT-TV a team of nurses went looking for Bubba after "one of our social workers realized it was mourning the loss of the dog that was making our patient even worse and emotionally unhealthy."
Smyth said she's not surprised at the healing power pets provide their owners.
"I hope this story will show to people the tremendous difference that animals can make in people’s lives," she said. She also hopes it will encourage people to think about rescuing pets from shelters like hers, which is rebuilding its facility after its previous home burned down in a fire last November.
“One of the biggest problems we face is the way some people think of animals. People just don’t see animals as creatures and beings, they see them as property,” she said. “I hope people understand they’re not 'its,' they’re 'beings.'”
By JESSICA FIRGER
When Donna Tookes learned she had breast cancer last winter, the 59-year-old thought she had no choice but to accept one of the most dreaded side-effects of chemotherapy: losing her mane of silver hair, a feature that strangers young and old frequently stopped to admire.
"I had resigned myself," Tookes told CBS News. "I had purchased an array of scarves, about 10. And I actually practiced tying them."
Tookes was diagnosed with breast cancer in January after her annual mammogram, when her doctors detected some mild calcifications in her right breast. These clusters of white flecks visible on her scan indicated there might be something seriously wrong. After a few subsequent tests, Tookes learned she had HER2 breast cancer, an especially aggressive form that can be difficult to treat. Though her doctors caught the cancer early, they wanted to be certain it would never return, which meant a unilateral mastectomy followed by 12 rounds of punishing chemotherapy.
"You have a consultation before you start chemotherapy," said Tookes, who lives with her husband and children in Stamford, Connecticut, and has worked for more than three decades as a flight attendant. "I was told I would lose my hair. And then the nurse assured me, she told me 'you're beautiful,' and that I was one of the only ones who could carry the bald look because I have that bone structure."
But her family could see that losing her hair would take a serious toll on her psyche. Tookes had heard about some treatment in Europe that helps prevent chemo-related hair loss, though she didn't know many details. Secretly, her husband began to conduct research. He wrote to friends in Sweden, who were able to obtain information about a new and innovative therapy called a scalp cooling cap. He soon found out that Mount Sinai Beth Israel in New York City was involved in a clinical trial on the device, known as the DigniCap System, which is worn by a patient during chemotherapy transfusions.
The snug cap is secured onto a patient's head each time she undergoes chemotherapy. It chills the scalp down to 5 degrees Celsius so that the blood vessels surrounding the hair roots contract, meaning that less of the toxins from chemo enter the hair follicle. This minimizes -- and in some cases completely stops -- a patient's hair from falling out.
At first, Tookes was slightly skeptical, but her family finally convinced her to move her cancer treatment from her hospital in Connecticut to Mount Sinai Beth Israel in New York City.
Dr. Paula Klein, assistant professor of medicine, hematology and medical oncology at the Icahn School of Medicine at Mount Sinai and principal investigator for the clinical trial, told CBS News the device has been effective at limiting hair loss in nearly all of her patients enrolled.
"Unfortunately, in breast cancer the two most active agents are associated with significant hair loss," said Klein. "For many women with early stage breast cancer, they are getting chemotherapy for prevention of recurrence."
Klein said overall, women who use the cap lose just 25 percent of their hair. There are some patients who lose more and a lucky handful who lost no hair at all.
The clinical trial is now in its final phase. The company behind the cap, Dignitana, will be submitting results to the U.S. Food and Drug Administration by the end of November, and hope to win FDA approval for the cap in 2015.
For women struggling through a difficult medical ordeal, the benefit is significant. Research published in 2008 in the journal Psycho-Oncology looked at 38 existing studies on breast cancer treatment and quality of life issues, and found hair loss consistently ranked the most troubling side effect of treatment for women. "Significant alopecia [hair loss] is problematic," said Klein. "Every time you look in the mirror, you remember you're getting cancer treatment."
Many breast cancer survivors report that even when their hair finally grows back after chemotherapy it is often different in color or texture than the hair they had before, due to the period of time it takes the hair follicles to recover from the damage caused by the drugs.
Moreover, the feelings associated with hair loss impact nearly every aspect of a breast cancer patient's life -- from her self-image and sexuality to whether or not she is comfortable at work or even walking into the supermarket to buy a quart of milk.
When she first prepared for treatment, Tookes worried how people would react to her appearance if she lost all of her hair. But it didn't happen. Seven weeks into chemo, she finally felt confident enough to return the unused wardrobe of scarves. She still had a full head of hair. Because the cooling therapy was used only on her scalp, Tookes did still lose her eyebrows and "everything south of there."
Tookes is now cancer-free and says the therapy helped her stay optimistic about her prognosis. "My mother used to say, you just comb your hair and get yourself together and you'll get through hard times," she said.
By MIKE STOBBE
For more than two months, health officials have been struggling to understand the size of a national wave of severe respiratory illnesses caused by an unusual virus. This week, they expect the wave to start looking a whole lot bigger.
But that's because a new test will be speeding through a backlog of cases. Starting Tuesday, the Centers for Disease Control and Prevention is using a new test to help the agency process four or five times more specimens per day that it has been.
The test is a yes/no check for enterovirus 68, which since August has been fingered as the cause of hundreds of asthma-like respiratory illnesses in children — some so severe the patients needed a breathing machine. The virus is being investigated as a cause of at least 6 deaths.
It will largely replace a test which can distinguish a number of viruses, but has a much longer turnaround.
The result? Instead of national case counts growing by around 30 a day, they're expected to jump to 90 or more.
But for at least a week or two, the anticipated flood of new numbers will reflect what was seen in the backlog of about 1,000 specimens from September. The numbers will not show what's been happening more recently, noted Mark Pallansch, director of the CDC's division of viral diseases.
Enterovirus 68 is one of a pack of viruses that spread around the country every year around the start of school, generally causing cold-like illnesses. Those viruses tend to wane after September, and some experts think that's what's been happening.
One of the places hardest hit by the enterovirus 68 wave was Children's Mercy Hospital in Kansas City, Missouri. The specialized pediatric hospital was flooded with cases of wheezing, very sick children in August, hitting a peak of nearly 300 in the last week of the month.
But that kind of patient traffic has steadily declined since mid-September, said Dr. Jason Newland, a pediatric infectious diseases physician there.
"Now it's settled down" to near-normal levels, Newland said. Given the seasonality of the virus, "it makes sense it would kind of be going away," he added.
The germ was first identified in the U.S. in 1962, and small numbers of cases have been regularly reported since 1987. Because it's not routinely tested for, it may have spread widely in previous years without being identified in people who just seemed to have a cold, health officials have said.
But some viruses seem to surge in multi-year cycles, and it's possible that enterovirus surged this year for the first time in quite a while. If that's true, it may have had an unusually harsh impact because there were a large number of children who had never been infected with it before and never acquired immunity, Newland said.
Whatever the reason, the virus gained national attention in August when hospitals in Kansas City and Chicago saw severe breathing illnesses in kids in numbers they never see at that time of year.
Health officials began finding enterovirus 68. The CDC, in Atlanta, has been receiving specimens from severely ill children all over the country and doing about 80 percent of the testing for the virus. The test has been used for disease surveillance, but not treatment. Doctors give over-the-counter medicines for milder cases, and provide oxygen or other supportive care for more severe ones.
The CDC has been diagnosing enterovirus 68 in roughly half of the specimens sent in, Pallansch said. Others have been diagnosed with an assortment of other respiratory germs.
As of Friday, lab tests by the CDC have confirmed illness caused by the germ in 691 people in 46 states and the District of Columbia. The CDC is expected to post new numbers Tuesday and Wednesday.
Aside from the CDC, labs in California, Indiana, Minnesota and New York also have been doing enterovirus testing and contributing to the national count. It hasn't been determined if or when the states will begin using the new test, which was developed by a CDC team led by Allan Nix.
Meanwhile, the virus also is being eyed as possible factor in muscle weakness and paralysis in at least 27 children and adults in a dozen states. That includes at least 10 in the Denver area, and a cluster of three seen at Children's Mercy, Newland said.
By Debra Wood
One out of every six newly licensed nurses (more than 17 percent) leave their first nursing job within the first year and one out of every three (33.5 percent) leave within two years. But not all nurse turnover is bad, according to a new study from the RN Work Project, funded by the Robert Wood Johnson Foundation.
“It seemed high,” said Carol S. Brewer, PhD, RN, FAAN, professor at the University at Buffalo School of Nursing and co-director of the RN Work Project, the only longitudinal study of registered nurses conducted in the United States. “Most of them take a new job in a hospital. We’ve emphasized who left their first job, but it doesn’t mean they have left hospital work necessarily.”
While many nursing leaders have voiced concern that high turnover among new nurses may result in a loss of those nurses to the profession, that’s not what the RN Work Project team has found. Most of those leaving move on to another job in health care.
“Not only are they staying in health care, they are staying in health care as nurses,” said Christine T. Kovner, PhD, RN, FAAN, professor at the New York University College of Nursing and co-director of the RN Work Project. “Very few leave. A tiny percent become a case manager or work for an insurance company, verifying people had the right treatment.”
Such outside jobs tend to offer better hours, with no nights or weekends. The nurses are still using their knowledge and skills but they are not providing hands-on care.
The RN Work Project looks at nurse turnover from the first job, and the majority of first jobs are in the hospital setting, Brewer explained. However, in the sample, nurses working in other settings had higher turnover rates than those working in acute care.
Kovner hypothesized that since new nurses are having a harder time finding first jobs in hospitals, they may begin their careers in a nursing home and leave when a hospital position opens up. On the other hand, those who succeed in landing a hospital job may feel the need to stay at least a year, because that’s what many nursing professors recommend. Hospitals also tend to offer better benefits, such as tuition reimbursement and child care, and hold an attraction for new nurses.
“Our students, if they could get a job in an ICU, they’d be happy, and the other place they want to work is the emergency room,” Kovner said. “They want to save lives, every day.”
The RN Work Project data excludes nurses who have left their first position at a hospital for another in the same facility, which is disruptive to the unit but may be a positive for the organization overall, since the nurse knows the culture and policies. The nurse may change to come off the night shift or to obtain a position in a specialty unit, such as pediatrics.
“That’s an example of the type of turnover an organization likes,” Kovner said. “You have an experienced nurse going to the ICU [or another unit].”
While nurse turnover represents a high cost for health care employers, as much as $6.4 million for a large acute care hospital, some departures of RNs is good for the workplace. Brewer, Kovner and colleagues describe the difference between dysfunctional and functional turnover in the paper, published in the journal Policy, Politics & Nursing Practice.
“Dysfunctional is when the good people leave,” Brewer said.
The RN Work Project has not differentiated between voluntary and involuntary departures, the latter of which may be due to poor performance or downsizing. And some nurse turnover is beneficial.
“If you never had turnover, the organization would become stagnant,” Kovner added. “It’s useful to have some people leave, particularly the people you want to leave. It offers the opportunity to have new blood come in.”
New nursing graduates might bring with them the latest knowledge, and more seasoned nurses may bring ideas proven successful at other organizations.
Once again, Brewer and Kovner report managers or direct supervisors play a big role in nurses leaving their jobs. Organizations hoping to reduce turnover could consider more management training for people in those roles.
“Leadership seems a big issue,” Brewer said. “The supervisor support piece has been consistent.”
Both nurse researchers cited the challenge of measuring nurse turnover accurately. Organizations and researchers often describe it differently, Brewer said. And hospitals often do not want to release information about their turnover rates, since nurses would most likely apply to those with lower rates, Kovner added. When assessing nurse turnover data, she advises looking at the response rate and the methodology used.
“There are huge inconsistencies in reports about turnover,” Kovner said. “It’s extremely important managers and policy makers understand where the data came from.”
By Catharine Paddock PhD
At present, diagnosis of lung cancer relies on an invasive biopsy that is only effective after tumors are bigger than 3 cm or even metastatic. Earlier detection would vastly improve patients' chances of survival. Now a team of researchers is developing a "lab-on-a-chip" that promises to detect lung cancer - and possibly other deadly cancers - much earlier, using only a small drop of a patient's blood.
In the Royal Society of Chemistry journal, Yong Zeng, assistant professor of chemistry at the University of Kansas, and colleagues report a breakthrough study describing their invention.
For some time, scientists have been excited by the idea of testing for disease biomarkers in "exosomes" - tiny vesicles or bags of molecules that cells, including cancer cells - release now and again. When they first spotted them, researchers thought exosomes were just for getting rid of cell waste, but now they know they also do other important things such as carry messages to other cells near and far.
The challenge, however, is developing a technology that is small enough to target and analyze the contents of exosomes - mostly nucleic acids and proteins - to find unique biomarkers of disease. This is because exosomes are tiny - around 30 to 150 nanometers (nm) in diameter - much smaller, for example, than red blood cells.
Current methods for separating out and testing exosomes require several steps of ultracentrifugation - a lengthy and inefficient lab procedure, as Prof. Zeng explains:
"There aren't many technologies out there that are suitable for efficient isolation and sensitive molecular profiling of exosomes. First, current exosome isolation protocols are time-consuming and difficult to standardize. Second, conventional downstream analyses on collected exosomes are slow and require large samples, which is a key setback in clinical development of exosomal biomarkers."
Now, using microfluid technology, he and his colleagues have developed a lab-on-a-chip that can analyze the contents of targeted exosomes and spot the early signs of deadly cancer. They have already successfully tested it on lung cancer.
Lab-on-a-chip device uses smaller samples, is faster, cheaper and more sensitive
The new device, which uses much smaller samples, promises to produce results faster, more cheaply, with better sensitivity compared to conventional benchtop instruments, as Prof. Zeng continues to explain:
"A lab-on-a-chip shrinks the pipettes, test tubes and analysis instruments of a modern chemistry lab onto a microchip-sized wafer."
The technology behind the device - known as microfluidics - came out of new semiconductor electronics and has been under intensive development since the 1990s, he adds:
"Essentially, it allows precise manipulation of minuscule fluid volumes down to one trillionth of a liter or less to carry out multiple laboratory functions, such as sample purification, running of chemical and biological reactions, and analytical measurement."
Unlike breast and colon cancer, there is no widely accepted screening tool for lung cancer, which in most cases is first diagnosed based on symptoms that normally indicate lung function is already impaired.
To diagnose lung cancer, doctors have to perform a biopsy - remove a piece of tissue from the lung and send it to a lab for molecular analysis. It is rarely possible to do this in the early stages as tumors are too small to be spotted on scans.
"In contrast, our blood-based test is minimally invasive, inexpensive, and more sensitive, thus suitable for large population screening to detect early-stage tumors," says Prof. Zeng, adding that the technique offers a general platform for detecting exosomes from cancer cells. The team has already used the device to test for ovarian cancer, and in theory, says Prof. Zeng, it should also be applicable to other cancer types.
"Our long-term goal is to translate this technology into clinical investigation of the pathological implication of exosomes in tumor development. Such knowledge would help develop better predictive biomarkers and more efficient targeted therapy to improve the clinical outcome," he adds.
The team has received further funding from the National Cancer Institute at the National Institutes of Health to further develop the lab-on-a-chip.
In March 2013, Medical News Today learned how another team of scientists is developing a lab-on-a-chip that is implanted under the skin to track levels of substances in the blood and transmit the results wirelessly to a smartphone or other receiving device.
By Marie Ellis
Imagine swallowing a pill with tiny needles instead of getting an injection. Then again, imagine swallowing a pill with tiny needles. It may sound painful, but according to the researchers who developed the novel capsule - which could replace painful injections - there are no harmful side effects.
The researchers, from the Massachusetts Institute of Technology (MIT) and Massachusetts General Hospital (MGH), have published the results of their study - which tested the microneedle pill in the gastrointestinal (GI) tracts of pigs - in the Journal of Pharmaceutical Sciences.
Though most of us would probably prefer swallowing a pill over having an injection, many drugs cannot be given in pill form because they are broken down in the stomach before being absorbed.
Biopharmaceuticals made from large proteins, such as antibodies - known as "biologics" - are used to treat cancer, arthritis and Crohn's disease, and also include vaccines, recombinant DNA and RNA.
"The large size of these biologic drugs makes them nonabsorbable," explains lead author MIT graduate student Carl Schoellhammer. "And before they even would be absorbed, they're degraded in your GI tract by acids and enzymes that just eat up the molecules and make them inactive."
In an effort to design a capsule that is capable of delivering a wide range of drugs - while preventing degradation and effectively injecting the medicine into the GI tract - Schoellhammer and colleagues constructed the capsule from acrylic, including a reservoir for the drug that is coated with hollow, 5 mm long needles made of stainless steel.
The capsule measures 2 cm long and 1 cm in diameter.
Needle capsule worked safely and effectively in pigs
The team notes that previous studies involving humans who have accidentally swallowed sharp objects have suggested swallowing a capsule coated with short needles could be safe. They explain that there are no pain receptors in the GI tract and that, as a result, patients would not feel any pain.
But to assess whether their capsule could safely and effectively deliver the drugs, the researchers tested the pill in pigs, using insulin in the drug reservoir.
The capsules took more than a week to move through the whole digestive tract, and there were no traces of tissue damage, the researchers say. Additionally, the microneedles effectively injected insulin into the lining of the pigs' stomachs, small intestines and colons, which resulted in their blood glucose levels dropping.
Co-lead author Giovanni Traverso, a research fellow at MIT's Koch Institute for Integrative Cancer Research and gastroenterologist at MGH, notes that the pigs' reduction in blood glucose was faster and larger than the drop observed from insulin injection.
"The kinetics are much better and much faster-onset than those seen with traditional under-the-skin administration," he says. "For molecules that are particularly difficult to absorb, this would be a way of actually administering them at much higher efficiency."
'Oral delivery of drugs is a major challenge'
Though they used insulin for their tests in pigs, the researchers say they envision their capsule being used to deliver biologics to humans.
"This could be a way that the patient can circumvent the need to have an infusion or subcutaneous administration of a drug," says Traverso.
Prof. Samir Mitragotri, a professor at the University of California-Santa Barbara - who was not involved in the research - says:
"This is a very interesting approach. Oral delivery of drugs is a major challenge, especially for protein drugs. There is tremendous motivation on various fronts for finding other ways to deliver drugs without using the standard needle and syringe."
In terms of future modifications, the team plans to alter the capsule so that contractions of the digestive tract slowly squeeze the drug out of the capsule as it travels through the body, and they also want to make the needles out of degradable polymers and sugar that break off, becoming embedded in the gut lining and slowly disintegrating.