Stem Cell Therapy in type 1 Diabetes

A 64-year-old man in the U.S. is likely the first patient who was cured from type 1 diabetes.  According to NYT, his body now controls its insulin and blood sugar levels following an infusion of insulin-producing cells grown from embryonic stem cells.

The only cure that has ever worked in patients with type 1 diabetes is either a pancreas transplant or a transplant of the the insulin producing islet cells, from a donor's pancreas.  Because of a shortage of organs such an approach is not an answer for the vast majority of patients with the disease.  The cells infused in this patient were procured from unused fertilised eggs from a fertility clinic.  It took over 20 years and a team of 15 people to successfully convert stem cells into islet cells at a cost of about $50 million.

If this successful treatment can be replicated it will be a major advance in the history of transplantation and will provide hope to 1.5 million Americans who live with the disease. 

Pig Kidney Successfully Transplanted in a Human Patient

An article in NYT reported that surgeons successfully transplanted a genetically altered kidney to a patient and found the organ worked normally.  The kidney was attached to a patient who had suffered brain death and was maintained on a ventilator.   The kidney's vessels were connected to the patient's femoral artery and vein and it lay outside the body while it was observed for 54 hours.  During the nearly three day it was observed it functioned normally, making urine and the waste product creatinine 'almost immediately' according to Dr. Robert Montgomery, the director of N.Y.U. Langone Transplant Institute who performed the procedure in September 2021.  This medical advance is the culmination of years of experimental work that started in the 60s and is a milestone in the quest to successful xenotransplantation which may help the lives of millions of patients around the world. 

Coronary Artery Calcium Scoring to Guide Statin Therapy

A paper published in JAMA Cardiology reports on findings of a multicenter, population based, prospective study that included 1,688 participants aged 45 to 75 years with no baseline ASCVD (Atherosclerotic Vascular Disease) or diabetes  who were at intermediate risk for ASCVD and with LDL levels of 70 mg/dl.  

The authors found that among the participants with CAC scores of 0, the presence of risk-enhancing factors was not associated with overall ASCVD risk that was higher than the recommended treatment threshold for the initiation of statin therapy.  

The results of this study support the use of CAC scoring as a tool in the evaluation of risk and to more accurately classify individuals with intermediate risk for ASCVD who might benefit from statin therapy.

In conclusion the use of CAC scoring was associated with significant improvements in the reclassification and discrimination of incident ASCVD. 

Whole Lung Irradiation as a Novel Treatment for Covid-19 Pneumonia

A study published in ScienceDirect reports on a novel treatment of 25 patients with proven Covid-19 pneumonia.  All patients diagnosis was proven with an RT-PCR test, had SpO2 less than 94% on room air and a respiratory frequency of less than 24 per minute.  Patients were treated in accordance with standard Covid-19 guidelines and received a single fraction of low dose radiation therapy (LDRT) of 0.5 Gy to both lungs within 10 days of the onset of symptoms and/or 5 days of hospital admission.

LDRT was well tolerated by all patients.  A significant improvement in oxygenation was noted.  Demand for supplemental oxygen showed also a significant reduction in the post-RT period with 88% recovering completely with 10 days and being discharged from the hospital in 6 days.  Three patients deteriorated and died.

The authors concluded that based on their initial experience, LDRT is a promising treatment in a select group of patients with moderate to severe Covid-19 pneumonia and should be further investigated by a larger series.

Single-view DBT and AI setup allows for effective screening mammography

A study published in Radiology determined that a single digital breast tomosynthesis (DBT) image in combination with artificial intelligence (AI) improves radiologists' productivity.

A retrospective study of 190 women with bilateral mediolateral oblique breast images that were acquired with a wide-angle DBT system was obtained.  The examination -based reader- average AUC was higher when interpreting results with AI support than when reading unaided.  The average sensitivity increased with AI support, whereas no differences in the specificity and reading time were detected.

The authors concluded that using a single-view DBT in conjunction with an AI setup could allow for more effective screening, especially in cancers detected, than using DBT alone.  

AI-Can Reduce Workload in Breast Cancer Screening

A study published in Radiology determined that an artificial intelligence (AI) algorithm could reduce the digital breast tomosynthesis (DBT) and mammography (DM) workload of radiologists without impacting diagnostic accuracy.

A total of 15,987 DM and DBT examinations (which included 98 screening-detected and 15 interval cancers from the 15,987 women were evaluated.  In comparison with the double reading of the DBT images, AI with DBT would result in 72.5% less workload, noninferior sensitivity, and a 16.7% lower recall rate.  Similar results were obtained for AI and DM. 

AI could obviate over 70% of radiologists' double reading thus enable DBT adoption in breast cancer screening programs.

Cardiac MRI in the Assessment of Pulmonary Hypertension

Cardiac Magnetic Resonance Imaging (CMR) is an effective tool for evaluating patients with pulmonary arterial hypertension (PAH), according to a new meta-analysis published in JACC: Cardiovascular Imaging.

The study's authors analyzed data from 22 different studies, covering nearly 2,000 patients with pulmonary hypertension.  There were 18 clinical worsening events and 8 deaths per 100 patient-years.

The researchers determined CMR to be a powerful tool for predicting clinical worsening in PHA patients, with every 1% decrease in right ventricular ejection fraction associated with a 4.9% increase in the risk of clinical worsening over the next 22 months and a 2.1% increase in the risk of mortality over the next 54 months.

The authors concluded that CMR can effectively predict clinical worsening in PHA patients.