A laser-activated antimicrobial offers hope for new treatments of bacterial infections, even those that are resistant to current drugs. Research published today in the open access journal BMC Microbiology describes the use of a dye, indocyanine green, which produces bacteria-killing chemicals when lit by a specific kind of laser light.

Michael Wilson led a team from UCL (University College London) who carried out experiments showing that activated indocyanine green is capable of killing a wide range of bacteria including Staphylococcus aureus, Streptococcus pyogenes and Pseudomonas aeruginosa. The dye is safe for humans. The strength of this new approach lies in the variety of ways in which the chemicals produced by the activated dye harm bacteria. As Wilson explains, this means that resistance is unlikely to develop, "The mechanism of killing is non-specific, with reactive oxygen species causing damage to many bacterial components, so resistance is unlikely to develop - even from repeated use". Michael Wilson's co-authors on the study include Ghada Omar and Sean Nair of the Division of Microbial Diseases, UCL Eastman Dental Institute.

The increasing occurrence of bacterial resistance is a well-known problem facing modern medicine. The laser-powered treatment described in the study will be useful in the treatment of infections that occur in wounds. According to Wilson "Infected wounds are responsible for significant morbidity and mortality, and an increase in the duration and the cost of hospital stay. The growing resistance to conventional antibiotics among organisms that infect wounds and burns makes such infections difficult to treat. The technique we are exploring is driven by the need to develop novel strategies to which pathogens will not easily develop resistance."

The laser used by the researchers emits 'near-infrared' light, which is known to be capable of producing heat. However, as Wilson describes, "Substantial killing of all of the bacteria tested was achieved without causing any temperature rise. The benefit of the laser described in this study is that it produces light that is more able to penetrate deep wounds, increasing the area cleansed".

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Notes:

1. Lethal photosensitization of wound-associated microbes using indocyanine green and near-infrared light
Ghada S Omar, Michael Wilson and Sean P Nair
BMC Microbiology (in press)
Article available at journal website: biomedcentral/bmcmicrobiol/
All articles are available free of charge, according to BioMed Central's open access policy.

2. BMC Microbiology is an open access journal publishing original peer-reviewed research articles in analytical and functional studies of prokaryotic and eukaryotic microorganisms, viruses and small parasites, as well as host and therapeutic responses to them. BMC Microbiology (ISSN 1471-2180) is indexed/tracked/covered by PubMed, MEDLINE, BIOSIS, CAS, Scopus, EMBASE, Thomson Scientific (ISI) and Google Scholar.

3. BioMed Central (biomedcentral/) is an independent online publishing house committed to providing immediate access without charge to the peer-reviewed biological and medical research it publishes. This commitment is based on the view that open access to research is essential to the rapid and efficient communication of science.

Source: Graeme Baldwin
BioMed Central

A series of studies published in the September Journal of Nuclear Medicine (JNM) show that molecular imaging plays a critical role in the evaluation and treatment planning for a broad spectrum of cancers, including thyroid cancer and lymphoma.

According to researchers, molecular imaging allows physicians to identify the severity and extent of disease and, in turn, provide patients with personalized care. In addition, molecular imaging allows doctors to see how effective a treatment is early in the process so that changes can be made to ensure the best treatment for each individual patient.

"For patients with thyroid cancer, 'one size fits all' no longer applies," said Ravinder Grewal, M.D., corresponding author of "The Effect of Posttherapy 131I- SPECT/CT on Risk Classification and Management of Patients with Differentiated Thyroid Cancer" and an assistant attending physician in nuclear medicine at Memorial Sloan-Kettering Cancer Center in New York. "Through molecular imaging, the paradigm is changing toward more tailored and customized management of treatment. As a result, we can see how far a disease has spread and spare the patient from additional examination, time and radiation exposure."

For the study, researchers performed planar imaging and single-photon emission computed tomography (SPECT)/CT on 148 patients with thyroid cancer. The results showed that SPECT/CT provided information that reduced the need for additional cross-sectional imaging in 29 patients and redefined the initial risk of recurrence estimates in seven of 109 patients, thereby altering patient management recommendations in terms of frequency and intensity of follow-up studies.

In another study, researchers in Germany used positron emission tomography (PET)/CT with the radiotracer 68Ga-DOTATATE to evaluate the effectiveness of molecular imaging in monitoring patients with neuroendocrine tumors after undergoing peptide receptor radionuclide treatment. This study evaluated 33 patients at baseline and three months after treatment began. The findings suggest that PET/CT may contribute to the early prediction of treatment outcome in patients with neuroendocrine tumors.

"This molecular imaging technique can help doctors to classify patients according to their prognosis and to choose a personalized follow-up strategy," said Alexander Haug, M.D., corresponding author of the study and a researcher at Ludwig-Maximilians-University, Munich, Germany. "With the use of specific biomarkers, nuclear medicine provides the unique opportunity to perform diagnosis and therapy with the same tracer compound and - with the use of different biomarkers - to provide personalized tissue characterization. Nuclear medicine will be essential for the work-up of cancer patients in the near future."

The third study also used molecular imaging to monitor treatment success and aid in planning. Researchers evaluated 104 patients with newly diagnosed Hodgkin lymphoma using fluorodeoxyglucose (FDG) PET after undergoing two cycles of chemotherapy treatment. Of these patients, 93 achieved complete remission after first-line therapy. During a median follow-up of 36 months, relapse or disease progression was seen in 22 patients. Researchers found that PET is an accurate and independent predictor of event-free survival in Hodgkin lymphoma patients.

"Our findings suggest that early interim FDG-PET may play a pivotal role in Hodgkin lymphoma treatment, tailoring the therapy to an individual level, providing a less toxic treatment for patients with a low risk of failure while attempting treatment intensification for patients regarded as high risk of failure on the basis of the PET findings," said Juliano Cerci, M.D., Division of Nuclear Medicine, Heart Institute (InCor), Medical School of the University of São Paulo, Brazil, and corresponding author of "18F-FDG PET After 2 Cycles of ABVD Predicts Event-Free Survival in Early and Advanced Hodgkin Lymphoma."

The fourth study investigated the role of 18F-FDG PET/CT for the early identification of response to therapy in patients with non-small cell lung cancer (NSCLC). Researchers studied 23 NSCLC patients who were treated with a molecular-targeted agent called epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) and used 18F-FDG PET/CT to monitor the disease before and at one week after administration of EGFR-TKI. Changes in tumor 18F-FDG uptake during treatment were measured by standardized uptake values. Six patients experienced partial response, while 16 patients had stable disease and one patient had progressive disease. The results of the study suggest that early during the course of therapy, 18F-FDG PET/CT can predict response to treatment in patients with NSCLC.

According to researchers, monitoring a patient's response to treatment can avoid unnecessary toxicity, as well as the cost of ineffective treatment. They also state that the results of the study are promising and consistent with the results of preclinical studies.

Authors of the scientific article, "18F-FDG PET After 2 Cycles of ABVD Predicts Event-Free Survival in Early and Advanced Hodgkin Lymphoma," include: Juliano J. Cerci, Felipe A. Pitella, Marisa Izaki, José Soares Junior, José C. Meneghetti, Department of Nuclear Medicine, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil; Luís F. Pracchia, Camila C.G. Linardi, Valeria Buccheri, Division of Hematology, Clinical Hospital of the University of São Paulo Medical School, São Paulo, Brazil; Dominique Delbeke, Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee; and Evelinda Trindade, Health Technology Assessment/Executive Direction, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil.

Authors of the scientific article, "68Ga-DOTATATE PET/CT for the Early Prediction of Response to Somatostatin Receptor-Mediated Radionuclide Therapy in Patients with Well-Differentiated Neuroendocrine Tumors," include: Alexander R. Haug, Björn Wängler, Christopher Uebleis, Paul Cumming, Peter Bartenstein, Reinhold Tiling, and Marcus Hacker, Department of Nuclear Medicine, Ludwig-Maximilians-University, Munich, Germany; Christoph J. Auernhammer, Burkhard Göke, Department of Internal Medicine II, Ludwig-Maximilians-University, Munich, Germany; and Gerwin P. Schmidt, Institute of Clinical Radiology, Ludwig-Maximilians-University, Munich, Germany.

Authors of the scientific article, "The Effect of Posttherapy 131I SPECT/CT on Risk Classification and Management of Patients with Differentiated Thyroid Cancer," include: Ravinder K. Grewal, Joseph Fox, Sunita Borkar, H. William Strauss, Steven M. Larson, and Heiko Schöder, Nuclear Medicine Service, Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York; R. Michael Tuttle, Endocrine Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York; and Joanne F. Chou, Mithat Gonen, Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York.

Authors of the scientific article, "Is 18F-FDG PET/CT Useful for the Early Prediction of Histopathologic Response to Neoadjuvant Erlotinib in Patients with Non-Small Cell Lung Cancer?" include: Tjeerd S. Aukema, Renato A. Valdés Olmos, Department of Nuclear Medicine, Haga Hospital, The Hague, The Netherlands; Ingrid Kappers, Houke M. Klomp, on behalf of the NEL Study Group, Department of Surgery, Haga Hospital, The Hague, The Netherlands; Henk E. Codrington, Department of Pulmonology, Haga Hospital, The Hague, The Netherlands; Harm van Tinteren, Department of Biometrics, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; and Renée van Pel, and Department of Pathology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.

Source:
Amy Shaw
Society of Nuclear Medicine

CVS Caremark (NYSE: CVS) discussed the role health IT is playing in optimizing the delivery of pharmacy health care at the HIMSS09 Annual Conference & Exhibition, in Chicago, IL. At the conference, Helena Foulkes, Executive Vice President at CVS Caremark, outlined how the company is evaluating and leveraging a variety of technologies to engage consumers and positively impact health outcomes and lower costs.

"In today's wired world, consumers are exposed to a lot of information about their health care options from a variety of sources and in a number of different formats," says Foulkes. "Given the complexities of the health care system in general, this fragmented approach can leave consumers confused and unsure about what they need to do to stay healthy. CVS Caremark's Proactive Pharmacy Care approach leverages a number of different technology tools to engage and educate our patients and their health care providers about their pharmacy health care needs earlier in the process."

Foulkes discussed how CVS Caremark implements technology to enhance health care outcomes and how the combination of health technology and customized face-to-face interaction can positively impact medication compliance and engage consumers in their own health care. The technologies Foulkes reviewed in her presentation include tools to help improve medication compliance, e-prescribing, electronic health records, and a proprietary tool to help CVS Caremark prioritize interventions and allow for timely, coordinated patient-specific health improvement and cost-savings opportunities.

Ms. Foulkes' presentation "Proactive Pharmacy Care: Leveraging Technology for Improved Outcomes" took place during the HIMSS'09 Annual Conference & Exhibition on Sunday, April 5th from 8:30 a.m. to 9:30 a.m. in room S100 at McCormick Place Convention Center in Chicago, IL.

About CVS Caremark

CVS Caremark is the largest provider of prescriptions in the nation. The Company fills or manages more than 1 billion prescriptions annually. Through its unmatched breadth of service offerings, CVS Caremark is transforming the delivery of health care services in the U.S. The Company is uniquely positioned to effectively manage costs and improve healthcare outcomes through its more than 6,900 CVS/pharmacy and Longs Drugs stores; its Caremark Pharmacy Services division (pharmacy benefit management, mail order and specialty pharmacy); its retail-based health clinic subsidiary, MinuteClinic; and its online pharmacy, CVS.

About HIMSS

The Healthcare Information and Management Systems Society (HIMSS) is the healthcare industry's membership organization exclusively focused on providing global leadership for the optimal use of healthcare information technology (IT) and management systems for the betterment of healthcare. Founded in 1961 with offices in Chicago, Washington D.C., Brussels, Singapore, and other locations across the United States and the globe, HIMSS represents more than 20,000 individual members and over 350 corporate members that collectively represent organizations employing millions of people. HIMSS frames and leads healthcare public policy and industry practices through its advocacy, educational and professional development initiatives designed to promote information and management systems' contributions to ensuring quality patient care.

Source: CVS Caremark

A recently published study of 4 year olds who had been fed Enfamil LIPIL® infant formula exclusively for their first 17 weeks of life has become the longest term analysis of its kind to demonstrate breastfed equivalent visual and IQ outcomes among formula fed infants.1 The study, which appeared in the journal Early Human Development, was funded by a grant from the National Institutes of Health.

"What this study means for parents is that we now have even longer term evidence that DHA and ARA supplementation at the levels in Enfamil LIPIL is associated with visual acuity and brain development benefits similar to breast milk," said Deborah Diersen-Schade, Ph.D., a research fellow at Mead Johnson Nutritionals. Previously, brain and eye development outcomes similar to breast milk had been followed in the same group of infants out to 18 months of age.2,3

DHA (docosahexaenoic acid) and ARA (arachidonic acid) are nutrients known as "long-chain polyunsaturated fatty acids (LCPUFA)" that are present in breast milk.

They are critical for development of the eyes, brain and central nervous system. They begin accumulating in the infant's tissues during gestation, especially during the third trimester. Recent evidence suggests that they continue to support the development of visual acuity throughout the first full year of life.4

Dr. Diersen Schade emphasized that the new study addresses two other issues that are important for parents and physicians -- those issues being DHA and ARA levels and control group outcomes.

"The levels of DHA and ARA in Enfamil LIPIL were derived from our evaluation of the levels of both nutrients in human milk worldwide," she said. "The results that Dr. Birch and her colleagues obtained from this analysis as well as earlier positive results from previous studies are based on formulas with DHA at those levels. Researchers who have conducted studies of infant formula that included lower levels have not consistently demonstrated improved outcomes when compared with formula not containing DHA and ARA." 5,6

Regarding control group outcomes, Diersen Schade explained that the recent Birch study, which enrolled infants born from 1993 to 1995, also included a control group of infants who received Enfamil with Iron as it was available at the time without DHA and ARA supplementation.

"There were significant differences in visual acuity and verbal IQ scores in the control group versus the breastfed group," she said. "That's important; but what's meaningful is that the similar outcomes for Enfamil LIPIL compared to breast milk were still observable at 4 years of age. Equally interesting, the DHA and ARA group was fed Enfamil LIPIL for only four months; yet their results were similar to infants who were breastfed on average for 10 months."

John Colombo, Ph.D., associate director for cognitive neuroscience and professor of psychology at the University of Kansas, said that the Birch study provides long-awaited data about the links between fatty acids in the infant diet and measures of cognitive function, such as IQ. "Quite simply, these data are the clearest evidence yet that show the beneficial effects of LCPUFA on cognitive and intellectual development -- and that LCPUFA should be part of the nutritional regimen in early life," he said. "These results suggest that formulas supplemented with these levels of LCPUFA produce gains in cognitive and intellectual function over formulas without these levels."

About Mead Johnson

Mead Johnson Nutritionals is a world leader in nutrition, dedicated to helping provide infants and children with the best start in life. Mead Johnson Nutritionals is a Bristol-Myers Squibb company.

References

1. Birch EE et al. Visual acuity and cognitive outcomes at 4 years of age in a double-blind, randomized trial of long-chain polyunsaturated fatty-acid supplemented infant formula. Early Hum Dev (2007), doi: 10.1016/j.earlhumdev.2006.11.003

2. Birch EE et al. A randomized controlled trial of early dietary supply of long-chain polyunsaturated fatty acids and mental development in term infants. Dev Med Child Neurol (2000); 42:174-81.

3. Hoffman DR, et al. Maturation of visual and mental function in 18-month old infants receiving dietary long-chain polyunsaturated fatty acids. FASEB J (2003); 17: A727-A728.

4. Morale SE et al. Duration of long-chain polyunsaturated fatty acids availability in the diet and visual acuity. Early Hum Dev (2005); 81, 197-203.

5. Auestad N et al. Visual, cognitive, and language assessments at 39 months: a follow-up study of children fed formulas containing long-chain polyunsaturated fatty acids to 1 year of age. Pediatrics (2003); 112: 177-83

6. Scott DT. Formula supplementation with long-chain polyunsaturated fatty acids: are there developmental benefits? Pediatrics (1998); 102: 59. (Electronic publication.)

Bristol-Myers Squibb
bms

Whatever their stance, organisations like the World Trade Organisation, environmental campaign groups and government departments all claim to be examining the 'risks' of GM crops. But according to new research, the key to solving disputes such as the GM crops trade conflict is a new approach to understanding these issues, one that drops the use of the word 'risk' as a collective term.

The findings, which are the result of a 5 year study carried out at SPRU at the University of Sussex, will be presented at a conference in Brighton on Tuesday 12 September. Dr Adrian Ely, a Research Fellow at SPRU, will present his talk on 'Typologies of incertitude as tools for policy analysis and policy making' at SPRU's 40th Anniversary conference on the Future of Science, Technology and Innovation Policy, which takes place next week from 11 to 13 September.

"A typology is just a way of understanding that things belong to different categories, and that we should distinguish between them," says Ely. "When people talk about risks, they are usually talking about aspects of risk, uncertainty, ambiguity and ignorance. Instead, we use the word incertitude to describe this collection of things, so that we address them all."

Ely explains that there are serious limits to using the idea of 'risk' to describe the potential problems associated with new developments in science and technology.

"Its all too easy to make the mistake of using quantitative risk assessment techniques to try to understand unknowns that are really uncertainties, when it is impossible for us to work out the probability that something will happen."

The typology was developed by Prof. Andy Stirling, also of SPRU. Stirling, Ely and others are using it to explore various science and technology related issues.

"I use this typology to understand the government's decisions around GM crops and foods. Most policy problems - for example, climate change, GM crops or nanotechnology - involve a situation in which we don't have a full understanding of the science in question. It's important for us to appreciate what we know and what we don't know in order to prioritise research and/or public engagement," says Ely. "That's where this typology can help."

The World Trade Organisation recently concluded that the EU had broken trade rules by failing to approve certain GM crops and foods produced in the USA. By considering the issues associated with risk, uncertainty, ambiguity and ignorance separately, he has been able to make sense of these events in a way that could be useful to policymakers internationally.

"There are so many complicated questions at play," says Ely, "Using a tool such as this helps us to break them down into manageable parts. "The USA and Europe have assessed the risks from GM crops in different ways. This has led to divergent policies internationally, with bitter trade disputes as a result. This research can help us to understand the sources of the trade conflict and to move towards ways of resolving them."

About the SCIENCE POLICY RESEARCH UNIT (SPRU)

SPRU is one of the world leaders in policy research on science, technology and innovation (STI) and its wider economic, social and environmental implications. Our mission is to deepen understanding of the place of science, technology and innovation in the global economy for the benefit of government, business and society.

SCIENCE POLICY RESEARCH UNIT (SPRU)
University of Sussex
Mantell Building
Falmer, Brighton
BN1 9RF
sussex.ac/spru/