Cancer Surgery Innovation

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I usually don’t write about new technology until its actually available in the marketplace. However, photoacoustic microscopy is likely to be available in the near future and has a potential benefit that’s important enough to be worth knowing.

One of the classic problems with cancer is that the surgeon can’t see which cells are cancerous.  That means, when they do surgery to remove cancer, they may not get all of the cancerous cells on the first try.

The surgical response has been to talk extra tissue around the margins of the tumor to try to ensure getting all of the cells.  As I like to tell people, if that involves taking a little extra skin tissue, that’s probably OK. A little extra brain tissue, maybe not so much.

The inability to visualize which cells are cancerous helps to make treatment of certain cancers particularly difficult. Obvious examples are brain, prostate and pancreatic cancer. Biopsies depend on sampling tissue, and it’s possible for samples to miss cancer cells. However, complete removal of an organ can be problematic as well.

There are various research projects to try to develop tools to eliminate this problem.

  • Immunotherapy involves using a virus to identify and mark cancer cells, enabling the body’s immune system to eliminate the cells without surgery. The problem is that it can have side effects, including attacking cells you want to keep (heart tissue, liver, etc.). Duke University has been one of the leaders in this field for brain tumors. MD Anderson Cancer Center has been a leader in other cancer forms (pancreatic, prostate).
  • Coloring cancer cells to make them more readily visible. There was a recent clinical trial at UPenn on this method.
  • Photoacoustic microscopy.

This last procedure has been under development at the Optical Imaging Lab (formerly based at Washington University, St. Louis; as of the first of this year, at Caltech) for breast cancer surgery.

  • Cancer tissue has a larger nuclei than normal breast tissue
  • Cancer tissue is packed more tightly than normal breast tissue
  • Using sound to cause tissue to vibrate, the surgeon can see which cells have with characteristics while surgery is in progress. This improves the odds that he will remove all malignant tissue while minimizing removal of good tissue, and reduces the need for follow-on surgeries.

That’s particularly important for “breast-conservation” or lumpectomy procedures. It may have value with other cancer forms.

Because photoacoustic microscopy is an imaging procedure, approval by the FDA is expected to be faster than for pharmaceuticals or surgical procedures that actually contact the body. Thus, this is a method that could be available for use relatively soon.


Sources:

  1. Lihong V. Wang et al. Fast Label-free Multi-layered Histology-like Imaging of Human Breast Cancer by Photoacoustic Microscopy. Science Advances, May 2017 DOI: 10.1126/sciadv.1602168
  2. California Institute of Technology. “Cutting down on cancer surgeries: New microscopy technique could reduce repeat surgeries for breast cancer patients.” ScienceDaily. ScienceDaily, 17 May 2017. <www.sciencedaily.com/releases/2017/05/170517154728.htm>.

What you need to know about breast implants

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There are some nasty surprises associated with implants. If you’re thinking about them, ben_franklinyou need to have a serious conversation with your doctor. If he or she seems unaware of these issues, find another doctor.

A New York Times article today discusses a rare form of cancer that seems to be caused by implants. The problems are particularly linked to implants that have a textured shell or covering. Presumably, the texturing was introduced to help the implant stay in place. The theory now is that the roughness triggers inflammation that can facilitate cancer. The disease originates in scar tissue that builds around the implant.

The cancer is breast implant-associated anaplastic large-cell lymphoma. It’s a cancer of the immune system that is easily treated if detected early, but can (and has been) fatal if not.

The first case of this disease was reported ion 1997. The FDA reports that it has known about this since 2011, but refers to disease as rare. However, the FDA’s reporting system is strictly voluntary, and there is some evidence that a majority of doctors are unfamiliar with this cancer version. One study reports that only 30% of doctors who do implants discuss this risk with their patients.

Right now, the burden of protection from this disease appears to fall on the patient.

The FDA released an advisory statement to doctors on March 21st, 2017, six years after the topic first came up. The American Society of Plastic Surgeons republished the information from the FDA to its members after the FDA statement was released. That’s how new this is.

That’s one reason why it’s likely that there have been misdiagnosed cases, and that the incidence of this disease is under reported.

Another reason for misdiagnosis is that detection of this disease isn’t simple. The Anderson Cancer Center provides this guidance:

Because other diseases and cancers of the breast can cause similar symptoms, implant-associated ALCL is often a difficult diagnosis. Symptoms can vary from person to person.

More common symptoms include:

  • A spontaneous fluid collection in the breast, developing many months or years after receiving a breast implant
  • Redness and swelling of the breast around an implant that is not from an infection

Less common symptoms:

  • Contraction of the scar tissue capsule surrounding the breast implant

If you have one or more of these symptoms, it does not mean you have implant-associated ALCL. However, it is important to discuss any symptoms with your doctor since they may indicate other health problems.

So how many cases are there, really?

There are enough cases that one major cancer center brags about their expertise in this form of cancer:

MD Anderson’s Breast Center cares for more patients with breast implant-associated anaplastic large cell lymphoma (ALCL) than almost any other center in the United States.

There are two other facts buried in the Times article that women — and the people who love them — need to know:

  • Implants often require follow-on surgery. The additional surgery may be more expensive than the original, and may not be covered by insurance even if it is medically necessary. There are law suits pending.
  • The first line of treatment for implant-associated ALCL is REMOVAL OF THE IMPLANT. Based on case studies, that’s something else that some doctors don’t know.

It’s critical to find a competent doctor. Don’t feel bashful about changing doctors if you’re not sure the first one you see has the experience and knowledge you need. Ask questions. It’s your life at stake.

Happy Mother’s Day!


Sources:

  1. Denise Grady, “A Shocking Diagnosis: Breast Implants ‘Gave Me Cancer’,” The New York Times, 14 May 2017.
  2. US Food and Drug Administration, “Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL). https://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/BreastImplants/ucm239995.htm
  3. MD Anderson Cancer Center, “Implant Associated Anaplastic Large Cell Lymphoma.” https://www.mdanderson.org/cancer-types/implant-associated-anaplastic-large-cell-lymphoma.html
  4. Mark Clemons, MD, “Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL),” American Society of Plastic Surgeons. https://www.plasticsurgery.org/for-medical-professionals/quality-and-registries/bia-alcl-by-the-numbers
  5. Garry Brody et. al., “Anaplastic Large Cell Lymphoma (ALCL) Occurring in Women with Breast Implants: Analysis of 173 Cases,” Plastic & Reconstructive Surgery 135(3) · December 2014, DOI: 10.1097/PRS.0000000000001033

 

Rehab Robots!

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“Injury” is a uselessly unspecific term. It covers a range from simple scrapes to complex concussions that mean a lifetime of suffering. Some things are generally true about injuries:

  • They’re unexpected.
  • They can happen at anyone at any age.
  • Complexity of the injury and age can prolong recovery time.

Toyota has embarked on a new program, the manufacture of robots designed to help people recover from and cope with serious injury.

As reported in PC Magazine:

Toyota wants to solve that problem with a robot rental system. The first of these was demonstrated yesterday when the company launched a walk assist system rental service. The robot is called the Welwalk WW-1

000, and it’s designed to help in the rehabilitation of anyone suffering with lower limb paralysis. While that could happen at any age, leg weakness is common following a stroke.

539178-toyota-welwalk-robot-system.jpg

The initial system is designed for clinics serving large numbers of patients, but there is a vision of a home version of the robotic leg that could be an on-going help with personal mobility.

Unlike Toshiba’s disastrous flirtation with nuclear energy, Toyota is using core technology in a way that will benefit a large number of people across the globe and for which there should be substantial demand for decades to come. I’m looking forward to seeing what they do next.


Sources:

  1. Matthew Humphries, “Toyota Launches Rehabilitation Robot Rental Service,” PC Magazine, 13 April 2017. http://www.pcmag.com/news/353042/toyota-launches-rehabilitation-robot-rental-service?utm_source=email&utm_campaign=dailynews&utm_medium=title

Flame retardants, household dust, and thyroid cancer

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A new report from Duke University finds an explanation for increases in the frequencyth of thyroid cancer in household dust.

“Thyroid cancer is the fastest increasing cancer in the U.S., with most of the increase in new cases being papillary thyroid cancer” [PTC], said the study’s lead investigator, Julie Ann Sosa, M.D., MA, professor of surgery and medicine at Duke University School of Medicine in Durham, N.C. “Recent studies suggest that environmental factors may, in part, be responsible for this increase.” (1)

Prior studies have shown that some flame retardants used in the home and in vehicles have a similar chemical structure to thyroid hormones and can disrupt thyroid function.

The study measured the content of household dust as well as the incidence of chemicals in blood samples taken from occupants.  The study used a post facto experimental design with test and control groups.  All of the 140 participants lived in their homes for more than 11 years.

This study established that these flame retardants

  1. Appear in household dust in measurable quantities, where they can be inhaled by occupants and
  2. The level of two of them found in dust and blood samples are associated with the probability of having PTC.

The two problem chemicals identified in the study as elevating cancer risk belong to a class of chemicals, polybrominated diphenyl ethers (PBDEs).

  • Decabromodiphenyl ether (BDE-209). This is the most commonly used retardant, and appears to double the risk for thyroid cancer.
  • Tris(2-chloroethyl) phosphate (TCEP).

Participants with high levels of TCEP in their house dust were more than four times as likely to have larger, more aggressive tumors that extended beyond the thyroid, according to the study.

Participants with high levels of BDE-209 in their blood were 14 times more likely to have a version of the cancer that tends to be more aggressive.

Why should you care?  These chemicals are used as flame retardants in plastics (including TV cabinets), furniture, drapery backing, some carpets and in consumer electronics, both in home and in automobiles.  Both exposure to these chemicals and the prevalence of thyroid cancer are increasing.

Note:  This research was funded by Fred and Alice Stanback, the Duke Cancer Institute, and the Nicholas School of the Environment at Duke University, and not by industry sources.

What you need to consider:

  • Do you have a home air purification system? Not something that makes the air smell nice, but something that removes dust and other particles from what you breath. Maybe it’s time to invest or upgrade.
  • Read the labels on what you buy.

 


Sources:

  1. The Endocrine Society. “Exposure to common flame retardants may raise the risk of papillary thyroid cancer.” ScienceDaily. ScienceDaily, 2 April 2017. <www.sciencedaily.com/releases/2017/04/170402111311.htm>.
  2. US Environmental Protection Agency, “Technical Fact Sheet — Polybrominated Diphenyl Ethers (PBDEs) and Polybrominated Bophenyls (PBBs),” January 2014.
  3. Wikipedia, “Decabromodiphenyl ether.” https://en.wikipedia.org/wiki/Decabromodiphenyl_ether

Internet Insecurity Revisited

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Your applications encrypt your data.  You’re protected, right?ben_franklin

Wrong.

There are three things you need to know about the latest round of papers made public by Wikileaks:

  • The CIA (in some cases in partnership with UK’s MI5) developed ways to hack device operating systems. The devices include all types of computers and cell phones, networked TVs, car onboard systems — basically everything anyone uses that’s connected to the Internet. The operating systems affected are Windows, Android and Apple.
  • The hack allows the user to read data as it is entered (typed or oral), before it is encrypted.  Everything.
  • The hack allows users to control devices and use them for spying on device owners.
  • The CIA may have LOST CONTROL of these hacks, meaning that they are out in the public domain where others can use them.

The CIA might not care about you, but are there others who might want your bank account?

The revelations have shocked experts.

Still, the amount of smartphone vulnerabilities and exploits detailed in these documents was shocking even to experts. “It certainly seems that in the CIA toolkit there were more zero-day exploits” – an exploitable vulnerability in software not known to the manufacturer – “than we’d estimated,” Jason Healey, a director at the Atlantic Council think tank, told Wired Magazine. He added: “If the CIA has this many, we would expect the NSA to have several times more.”(3)

Early reports are that the documents published by Wikileaks appear authentic.  None of the companies involved have commented on the situation. Nor do there appear to be any patches immediately in the offing.  After all, none of the players is yet admitting that they have something to patch.

Some writers see a bright side in these revelations: the decision to hack operating systems means that data encryption tools work.  That may or may not be true.  We don’t know what is still to be revealed.

Security problems aren’t under control or going away.

“Anybody who thinks that the Manning and Snowden problems were one-offs is just dead wrong,’’ said Joel Brenner, former head of U.S. counterintelligence at the office of the Director of National Intelligence. “Ben Franklin said three people can keep a secret if two of them are dead. If secrets are shared on systems in which thousands of people have access to them, that may really not be a secret anymore. This problem is not going away, and it’s a condition of our existence.’’(4)

I’ve said that nothing on the Internet is private, but this takes that statement to an entirely new level.  Nothing you type or speak into an Internet connected device is private. 

Ben Franklin was indeed a very wise man.


Sources:

  1. Sharon Profis and Sean Hollister, “WikiLeaks and how the CIA sees your WhatsApp messages, explained,” CNet, 7 March 2017. https://www.cnet.com/how-to/wikileaks-cia-hack-phone-tv-router-vault-7-year-zero-weeping-angel/?ftag=CAD3c77551&bhid=25995825932822145966367556179766
  2. Jose Pagliery, “Wikileaks claims to reveal how CIA hacks TVs and phones all over the world,” CNN Tech, 7 March 2017. http://money.cnn.com/2017/03/07/technology/wikileaks-cia-hacking/
  3. Trevor Timm, “WikiLeaks says the CIA can use your TV to spy on you. But there’s good news,” The Guardian, 7 March 2017. https://www.theguardian.com/commentisfree/2017/mar/07/wikileaks-says-the-cia-can-use-your-tv-to-spy-on-you-but-theres-good-news
  4. Devlin Barrett, “FBI prepares for new hunt for WikiLeaks’ source,” The Washington Post, 7 March 2017.

Self-Driving Cars that Aren’t

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The promise of technology and the reality aren’t necessarily the same thing.

Self-driving vehicles have received a lot of media attention in recent months. There are test programs involving self-driving taxis, consumer vehicles, and even tractor trailers. The notion of technology that limits the harm caused by human fatigue and distracted driving is attractive.(1)

However, we have several recent examples of failures in that technology. A recent race on a closed track in Brazil ended with a crash.(2,3)  A Tesla driver was killed when his car ran into a tractor trailer.

Google, an early advocate of self-driving technology, stopped publishing statistics on accidents involving these cars earlier this year.(4)

Mearian writing in Computer World argues that driving conditions vary broadly, that unusual driving conditions happen, and that it is virtually impossible to write computer code that could anticipate every possible situation.

For that reason, there will be a need for a vehicle in an emergency to revert to human control. In turn, the human driver has to be awake and alert to the situation and able to take immediate control of the vehicle. The change in control has to happen in a second.  There’s no time for someone to set aside a computer or wake up from a nap.

I had wondered how a self-driving vehicle could identify a flooded underpass. Right now, it seems it can’t. 

If you need a driver for a self-driving vehicle, what’s the financial benefit of investing in self-driving technology? Doubtless there will be improvements in sensor and in AI technology in the future that might make a truly driverless car possible.  Not now. Not soon.

The other issue to resolve is liability when accidents occur. When a driverless car is in an accident, who is responsible for damages — the owner or the software company? In the absence of legislation, the courts will have to decide.


Sources:

  1. Adrienne LaFrance, “Self-Driving Cars Could Save 300,000 Lives Per Decade in America,” The Atlantic, 29 September 2015.  https://www.theatlantic.com/technology/archive/2015/09/self-driving-cars-could-save-300000-lives-per-decade-in-america/407956/
  2. Brett Williams, “The first ever self-driving car race ended in a crash,” Mashable, 21 February 2017.  http://mashable.com/2017/02/21/roborace-self-driving-car-race/#71If1LtYH5qm
  3. Jon Fingas, “Self-driving car race finishes with a crash,” engaget, 19 February 2017. https://www.engadget.com/2017/02/19/self-driving-car-race-ends-with-crash/
  4. Alison Grizwold, “Uber’s self-driving cars are already getting into scrapes on the streets of Pittsburgh,” qz.com, 4 October 2016. https://qz.com/798092/a-self-driving-uber-car-went-the-wrong-way-on-a-one-way-street-in-pittsburgh/
  5. Steve Kovach, “Google quietly stopped publishing monthly accident reports for its self driving cars,” Business Insider, 18 January 2017.  http://www.businessinsider.com/waymo-ends-publishing-self-driving-car-accident-reports-website-2017-1
  6. Lucas Mearian, “Here’s why self-driving cars may never really be self-driving,” Computer World, 23 February 2017. http://www.computerworld.com/article/3171160/car-tech/heres-why-self-driving-cars-may-never-really-be-self-driving.html?idg_eid=924f88aa70ca725c377f676e86c50805&email_SHA1_lc=5da7a5c0444324767d30bc1b4a01ed4a20fc2f0d&utm_source=Sailthru&utm_medium=email&utm_campaign=Computerworld%20First%20Look%202017-02-23&utm_term=computerworld_dailynews

The Radiation Legacy of WWII

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Radiation is a part of American life.  Everyone gets some.  A few “lucky” ones get a lot  more.

North St. Louis County, Missouri, is peppered with sites identified by the US Army Corp of Engineers as radioactive.  It’s the legacy of uranium processing for nuclear arms programs in World War II.  Uranium waste was dumped into a landfill near the St. Louis airport (Lambert Field).  However, the area is subject to flooding by Coldwater Creek, and that has spread radioactive material to parks and yards across North County.

The result: North County has been turned into a cancer hotspot, and shown in the map below.  Some of the cancers seen in this area are extraordinarily cancer_cases_1242rare.

Coldwater Creek drains into the Missouri River above the juncture with the Mississippi River, and just above the intake for drinking water for the City of St. Louis.

There have been a number of law suits file over the last 6 years, with some thrown out by various judges and some still active.

OK, that’s known, at least to local residents.  Whether it has had an impact on tourism or on convention traffic isn’t known.

However, St. Louis was only one processing center,  There were five others:

  • Tanawanda, New York (on the Niagara River upstream from Niagara Falls)
  • Deepwater, New Jersey (on the Delaware River across from Wilmington, Delaware)
  • Canonsburg, Pennsylvania (south of Pittsburgh)
  • Oak Ridge, Tennessee (near Knoxville)
  • Cleveland, Ohio (on Lake Erie)

There are radiation issues in all of these communities.  In many cases, the coverage is old enough that current residents may not even be aware of the problem.  A 2006 article labeled Canonsburg as “the most radioactive town in America.”

That said, some level of radioactivity exists in all areas of the US.  The map below is from a civilian volunteer monitoring program (the Radiation Network).  Unfortunately, none of the civilian volunteers appear to be focusing on historical problem sites.

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Take-aways

Knowledge is safety.  The more you know about where you live and where your kids play, the better you can try to protect yourself and them.


Sources: