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Study Examines MRI Use in Improving Quality of Treatment for Prostate Cancer

Wednesday, July 6th, 2016

MRI-SCANNER IMAGE www.newcures.info

A recent clinical study concluded that Magnetic Resonance Imaging (MRI) guided brachytherapy achieves high quality implants and allows more accurate identification and sparing from radiation of critical anatomy than ultrasound-based treatment planning.

Details of the study, presented at The World Congress of Brachytherapy meeting in San Francisco last month. were provided by C4 Imaging LLC based on data covering 47 patients treated with prostate brachytherapy.

The study was conducted at the MD Anderson Cancer Center, Houston, TX and was presented by Pierre Blanchard MD, PhD. C4 Imaging’s Sirius MRI Markers were utilized to assess the location of radioactive seeds implanted during prostate brachytherapy.

The study concluded that MRI guided brachytherapy achieves high quality implants and allows more accurate identification and sparing from radiation of critical anatomy than ultrasound based treatment planning.

Brachytherapy, or radioactive seed implantation, is a cost-effective option for the curative treatment of prostate cancer. It involves implanting around 100 radioactive seeds into the prostate. Its popularity has increased due to its effectiveness, convenience, low incidence of erectile dysfunction, and minimal invasiveness.

Radiation released from the seeds penetrates the prostate tissue at a limited distance, with most of the radiation concentrated within the prostate. Outcomes after brachytherapy can be excellent but depend greatly on the quality of the implant.

“I believe the data presented on MRI-guided prostate brachytherapy shows that it leads to a high quality implant that avoids delivering radiation to critical anatomical structures around the prostate,” said Steven J. Frank MD, Founder and Chairman of C4 Imaging. “If seeds can be more readily localized with MRI it would lead to more effective treatment and better patient outcomes.”

C4 Imaging is a technology company focused on developing medical devices that enable clinicians to more accurately perform image-guided procedures.

SKIN BEAUTY

Henry Sapiecha

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Ancient form of therapy Fire cupping is believed to promote healing & improve blood circulation.Pros & cons with dangers outlined here..

THINGS A DOCTOR SOMETIMES DOES NOT TELL YOU

Tuesday, February 19th, 2013

FAULTY MEDICAL PROCEDURES & ARTIFICIAL BODY PARTS RIFE

THE note sent by a doctor to several executives at Johnson & Johnson was blunt: an artificial hip sold by the company was so poorly designed that the company should slow its marketing until it understood why patients were getting hurt.

A faulty hip replacement a doctor removed from a patient.

The doctor, who also worked as a consultant to Johnson & Johnson, wrote the note nearly two years before the company recalled the device in 2010. And it was far from the only early warning those executives got from doctors who were paid consultants. Still, the company’s DePuy orthopedic unit plowed ahead, and those consultants never sounded a public alarm to other doctors, who kept implanting the device.
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The memos have recently emerged during the trial of the first of more than 10,000 patient lawsuits brought against Johnson & Johnson over the hip implant device, the Articular Surface Replacement, or A.S.R. The company has insisted that it acted responsibly in determining when to halt its sale. But plaintiffs’ lawyers have offered a portrait of executives who put profits ahead of patients, even scuttling a plan to fix the implant because it cost too much.

It might not be surprising to find that executives acted to protect a company’s bottom line. Still, the Johnson & Johnson episode is also illuminating a broader medical issue: while experts say that doctors have an ethical obligation to warn their peers about bad drugs or medical devices, they often do not do so.

“Questioning the status quo in medicine is not easy,” said Dr. Harlan Krumholz, a professor at Yale School of Medicine.

Physicians may remain silent for a variety of reasons, he and other experts said. They may fear that speaking out could get them sued or believe that a product problem was an anomaly or their fault.
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Doctors also have an aversion to reporting. For instance, while the Food and Drug Administration relies on physicians to help monitor product safety by alerting the agency to adverse patient reactions, doctors usually do not make such filings, saying they are too busy for the paperwork.

“The standard in the medical community is not to report,” said Dr. Robert Hauser, a cardiologist who, along with a colleague, warned other doctors in 2005 about a defective heart implant.

There is another reason doctors may choose to remain silent, experts say: their financial ties to a drug or device maker.

For years, such consulting payments have raised concerns about the impact of money on a doctor’s decision about which drugs to prescribe or how to interpret research findings. Money can also shift a physician’s sense of loyalty, said George Loewenstein, a professor at Carnegie Mellon University who has studied medical conflict-of-interest policies. “If someone has been paying you or employing you, it is very difficult to blow the whistle,” said Professor Loewenstein, who teaches economics and psychology. “It offends our sense of loyalty.”
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Dr. Krumholz said he also believed that such loyalties were between a doctor and a company’s executives, rather than with a company or its brand. Over time, a physician may come to see his relationships with those officials in terms of friendship, while companies see an influential doctor as an asset who helps develop products and boost sales.

For a consultant, breaking those ties can carry a cost. For example, when Dr. Lawrence D. Dorr, an orthopedic specialist, warned fellow surgeons in an open letter in 2008 that a hip implant made by Zimmer Holdings was flawed, he became the subject of a whisper campaign that questioned his skills as a surgeon.

“The first thing that a company does is to put out a campaign that a surgeon does not know how to operate,” said Dr. Dorr, who was a consultant to Zimmer when he wrote the letter. “It hurt my practice for a year.”

TRADITIONALLY, doctors have brought problems to the attention of colleagues by conducting research and publishing their findings in a medical journal. The advantage of that system helps ensure the credibility of study data and protects a researcher from random attack, said Dr. David Blumenthal, the president of the Commonwealth Fund, a group that studies health policy issues.
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But getting a study published can take a year or two; some Johnson & Johnson consultants did publish studies about the hip’s flaws, but they largely appeared after it had been recalled.

Dr. Blumenthal said there was probably a need for more immediate ways for doctors to share their concerns, like forums supported by professional medical organizations. Another approach would be to have companies hire doctors as consultants whose sole concern was product safety, Professor Loewenstein said.

The results of not speaking out are playing out in a Los Angeles courtroom, where the first Johnson & Johnson hip case is unfolding. In the years before the implant’s recall, a British physician, Dr. Antoni Nargol, and a colleague were among those who tried to alert surgeons to the problem.

But the silence of other doctors apparently gave company executives the upper hand; in meetings with Dr. Nargol, they said that he seemed to be the only doctor having trouble.

He said recently, “They told me there were no other problems.”
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Sourced & published by Henry Sapiecha

MITRALCLIP HEART REPAIR SYSTEM GIVES BETTER QUALITY OF LIFE TO THIS PATIENT

Thursday, January 24th, 2013

American-led MitralClip System gives new hope to heart problem patients

Heart patient Dan Theuerkauf has a new lease on life thanks to new technology.

TINANA’S Dan Theuerkauf in Queensland Australia happily describes himself as a “miracle man” after becoming the 12th person in Queensland to receive a revolutionary heart operation that saved his life.
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In October, the 56-year-old excavator and trucking business owner was chosen as one of just 150 people in Australia and New Zealand to take part in the multi-million dollar American-led MitralClip System ANZ clinical trial now being conducted at Brisbane’s Prince Charles Hospital in Queensland.

“I had a heart attack in 2004 when I was 48 and they discovered it wasn’t possible to give me a stent to fix my blocked arteries so I got five bypasses done on four arteries instead,” Mr Theuerkauf said yesterday.

Doctors later found the heart attack had caused the mitral valve in his heart to leak, causing shortness of breath.

When the Prince Charles heart specialist phoned to say he might fit the trial of the new clip, it changed Dan’s life.

After days of stringent tests, Dan Theuerkauf finally found himself heading into theatre in Brisbane on October 14.

Four hours later, the three-pronged clip had been pushed up through his groin, a hole bored into his heart cavity and two clips attached to the leaky valve.

The operation was televised and transmitted to the other hospitals.

“I had absolutely no pain afterwards and feel like a new man. What is even more astounding is the op was 100% successful in stopping the leak when the doctors had banked on 90%.”

A metal probe used to insert the clips is now being shared among three major Australian hospitals

Sourced from the local chronicle paper & published by Henry Sapiecha

Further reading below-

Atlanta, GA (updated)Much-anticipated results from the Endovascular Valve Edge-to-Edge Repair Study (EVEREST) II show that the novel MitraClip (Abbott) device—a percutaneous version of edge-to-edge mitral-valve repair—may lead to fewer early adverse events than traditional valve repair or replacement, with “noninferior” efficacy out to one year.
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The results were presented here during the opening late-breaking clinical-trials session of the American College of Cardiology 2010 Scientific Sessions/i2 Summit. “The MitraClip procedure is an important therapeutic option for selected patients with significant mitral regurgitation, given the demonstrated safety, effectiveness, and clinical benefit,” investigators for the trial conclude.

Speaking with heartwire, lead investigator Dr Ted Feldman (Evanston Hospital, IL) characterized the clip not as something that would supplant surgery but as an additional option for patients deemed suitable for this percutaneous approach. “The cases that are most likely to be successful are the ones where the jet of the mitral regurgitation is central and relatively discrete and when there is a flail leaflet, where the gap between the two leaflets is not too great.”

Dr Ted Feldman
Dr Ted Feldman

During the late-breaking clinical-trials session, Feldman acknowledged that patients in EVEREST II were a highly selected group, but that close attention to appropriate selection is also key for surgical patients.

And in the past, he continued, “many [patients] have been excluded because they are not good candidates for surgery; we have an algorithm now that traditionally only involved medicine, repair, and replacement. And today we have another option.”

The MitraClip device emulates the edge-to-edge repair technique pioneered surgically by Dr Ottavio Alfieri, in which the free edge of the anterior mitral-valve leaflet is joined to the posterior leaflet, creating a point of permanent coaptation and a double orifice. With the MitraClip, the device is threaded via the femoral vein to the right atrium and passed into the left atrium via transseptal puncture. The device is then passed through the mitral valve into the left ventricle. When the clip is deployed, it essentially clothes-pegs the free edge of the anterior mitral-valve leaflet to the posterior leaflet, creating a point of permanent coaptation.

Results from earlier studies established the safety and feasibility of the procedure, but EVEREST II is the first trial to directly compare outcomes with the device against the gold standard, surgery, in a randomized trial.
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RESTORING SIGHT TO BLIND PEOPLE WITH RETINAL LIGHT POWERED PROTHESIS IMPLANT

Wednesday, May 23rd, 2012

RESTORING SIGHT TO BLIND PEOPLE IS NOW A REALTY WITH IMPLANT

Age-related macular degeneration is the leading cause of blindness in North America, while retinitis pigmentosa causes approximately 1.5 million people worldwide to lose their sight every year. Individuals afflicted with retinal degenerative diseases such as these might someday be able to see again, however, thanks to a device being developed at California’s Stanford University. Scientists there are working on a retinal prosthesis, that uses what could almost be described as miniature solar panels to turn light signals into nerve impulses.

The system consists of a camera- and microprocessor-equipped pair of goggles, and a small photovoltaic chip that is implanted beneath the retina.

The output of the camera is displayed on a miniature LCD screen, located on the inside surface of the goggles. That screen is special, however – it emits pulses of infra-red laser light, that correspond to the images it’s displaying. Photodiodes on the chip register those pulses, and in turn stimulate retinal neurons. In theory, this firing of the neurons should produce visual images in the brain, as would occur if they had been stimulated by visible light.

“It works like the solar panels on your roof, converting light into electric current,” said Dr. Daniel Palanker, associate professor of ophthalmology. “But instead of the current flowing to your refrigerator, it flows into your retina.”

Palanker’s team has created a chip about the size of a pencil point, which is thinner than a human hair, and contains hundreds of the photodiodes. These were tested using retinas from both sighted rats, and rats that were blind in a fashion similar to human degenerative blindness – the retinal neurons were still present, but were generally inactive. While the chips in the blind retinas didn’t respond to visible light (unlike those in the sighted retinas), they did respond to the near-infrared light. “They didn’t respond to normal light, but they did to infrared,” said Palanker. “This way the sight is restored with our system.”

The photovoltaic chip is implanted under the retina in a blind rat (upper right corner) – it is comprised of an array of photodiodes (center and lower left) (Image: Palanker Laboratory/Stanford University)

The scientists are currently testing the technology on live rats, and state that it so far looks as if the electrical signals are indeed reaching the rats’ brains. They are now looking for a sponsor for human trials. Palanker notes that the system doesn’t allow for color vision, however, and that what vision is does provide would be “far from normal.”

While other retinal prostheses are also in development, these reportedly involve more in the way of hardware such as coils or antennas being implanted in the eye. Most of the technology used in the light-based Stanford system, by contrast, is located in the goggles.

A paper on the research was published this week, in the journal Nature Photonics

Sourced & published by Henry Sapiecha

FR REVASCULARIZATION DEVICE SUCCESSFUL IN REMOVING CLOTS

Sunday, March 4th, 2012

NEW DEVICE FOR REMOVING BLOOD CLOTS FAR SUPERIOR TO EXISTING FDA APPROVED METHODS

A new approach to stroke treatment initially developed by Dr. Jeffrey Saver’s group at the UCLA Stroke Center combines the ability to restore circulation and remove clots using only a single device … and it’s showing significant promise in trials. In a study comparing the Covidien Solitaire FR Revascularization Device with the FDA-approved Merci Retriever, the device successfully and safely treated roughly 60 percent of stroke patients, compared to roughly 30 percent when the Merci Retriever was used.

Such treatment is intended to minimize brain damage due to lack of oxygen and/or glucose in patients presenting with blockage of large intracranial blood vessels – particularly those for whom the use of clot-dissolving drugs is not advisable.

Roughly speaking, there are four main steps in the operation:

1. Poke a hole in the clot with a microcatheter (roughly 2.5 mm/0.1-inch in diameter).

2. Slide the Solitaire device through the microcatheter until it extends on either side of the clot.

3. Slide the microcatheter back so that the Solitaire device expands and traps the clot.

4. Pull the Solitaire device back to the end of the microcatheter, and use suction to remove the clot from the blood vessel.

Various stages in the revascularization and clot removal procedure are shown in the picture gallery.

The Solitaire With the Intention For Thrombectomy (SWIFT) study was designed to compare the results of using the Solitaire on acute stroke patients with the FDA-approved Merci Retriever. The Merci Retriever functions like a corkscrew that snares and removes a clot, but has a tendency to uncoil and lose the clot.

The SWIFT study was ended prematurely because of the remarkable effectiveness of the Solitaire device. One hundred and forty-four patients with acute ischemic stroke who either were not candidates for clot-busting drugs or in whom they had been ineffective were chosen for the study. Patients were a mixed lot, but both treatment groups were very similar. The patients were randomly assigned to be treated with the Solitaire or with the Merci devices.

The results:

    • Reestablishment of blood flow occurred in 83% of the Solitaire treatments versus 48.1% of the Merci treatments
    • Reestablishment of blood flow without symptoms due to intracranial hemorrhage occurred in 60.7% of the Solitaire treatments versus 24.1% of the Merci group

The Solitaire group had lower mortality at 3 months: 17.2% versus 38.2% for the Merci treated patients

  • Good mental/motor functioning was restored within 90 days in 58.2% of Solitaire patients as compared to 33.3% of Merci patients

“Initial treatment with Solitaire rather than Merci is associated with more frequent reperfusion, less symptomatic intracranial hemorrhage, reduced mortality, and increased good neurologic outcomes,” says Dr. Saver. More simply put, the Solitaire device does its job more effectively and causes fewer problems while doing it.

The Solitaire is now approved for use in the Interventional Management of Stroke trial study. This is a stage III clinical trial, started in 2006, whose purpose is to examine if a combination of clot-busting drugs and intra-arterial therapy is more effective than clot-busting drugs alone. Among the intra-arterial therapies is the Merci Retriever. Even though over 675 of the 900 patients participating in the trial have already been studied, it has been expanded to include the Solitaire as an intra-arterial treatment for the remainder of the study.

Inclusion in the IMS clinical trial study reflects the enthusiastic response of the neurological medical community for the results of the SWIFT study. Hopefully the FDA will put Solitaire on the fast track as well.

Sources: UCLA, Covidien

Published by Henry Sapiecha

SELF PROPELLED WIRELESS IMPLANT INTO BLOOD STREAM

Sunday, March 4th, 2012

MEDICAL IMPLANT INTO BLOOD STREAM WITH SELF POWERED WIRELESS GADGET

With the wait still on for a miniaturization ray to allow some Fantastic Voyage-style medical procedures by doctors in submarines, tiny electronic implants capable of traveling in the bloodstream show much more promise. While the miniaturization of electronic and mechanical components now makes such devices feasible, the lack of a comparable reduction in battery size has held things back. Now engineers at Stanford University have demonstrated a tiny, self-propelled medical device that would be wirelessly powered from outside the body, enabling devices small enough to move through the bloodstream.

While the benefits of medical implants have already been realized with devices such as artificial pacemakers and cochlear implants, which are stationary within the body, energy storage continues to limit such devices. With half of the volume of implants often consumed by the battery, the locations in which they can be placed are limited. Additionally, batteries also need to be periodically replaced, which generally requires a surgical procedure.

Developing implants capable of traveling through the bloodstream not only requires an energy source to power the device’s medical functions, but also its propulsion system – something that today’s batteries are unable to deliver in a form factor that is small enough to fit inside arteries.

The obvious approach would be to remove the battery from the device altogether and look to wireless electromagnetic power delivery. This is just what many scientists have been working on for fifty years. While such wireless power transmission technology has recently entered the mainstream through wireless chargers for consumer devices such as mobile phones, it wasn’t believed the technology could be made small enough to be compatible with tiny implantable devices.

The problem is that, according to mathematical models, high frequency waves that would require antennas small enough to be used in such devices were believed to dissipate quickly in human tissue, fading exponentially the deeper they go. At the same time, antennas to harness enough power from low-frequency signals, which are able to penetrate the human body well, would need to be a few centimeters in diameter, making them OK for larger devices, but too large to fit in all but the biggest arteries.

However, when electrical engineer Ada Poon looked at the models more closely she realized they were calculated assuming that human muscle, fat and bone were generally good conductors of electricity. Realizing that human tissue is actually a poor conductor of electricity but that radio waves could still move through it, Poon decided to redo the models with human tissue as a type of insulator called a dielectric. Her new calculations revealed that high-frequency waves travel much farther in human tissue than previously thought.

“When we extended things to higher frequencies using a simple model of tissue we realized that the optimal frequency for wireless powering is actually around one gigahertz,” said Poon, “about 100 times higher than previously thought.”

This meant that antennae inside the body could be 100 times smaller while delivering the same amount of power. This finding enabled Poon to create an antenna of coiled wire small enough to be placed inside the body and receive power from a radio transmitter outside the body. The transmitter and the antenna are magnetically coupled so that any change in current flow in the transmitter induces a voltage in the coiled wire.

Poon has created two types of wirelessly powered devices that are able to propel themselves through the bloodstream. One creates a directional force by driving an electrical current directly through the blood to push itself forward at a velocity of just over half a centimeter (0.2 inches) a second. The second type switches current back-and-forth in a wire loop to produce a swishing motion to propel the device forward.

Poon’s research could finally enable the development of medical implants capable of traveling through the bloodstream to deliver drugs to a specific area, perform analyses, and maybe even zap blood clots or remove plaque from arteries.

“There is considerable room for improvement and much work remains before these devices are ready for medical applications,” said Poon. “But for the first time in decades the possibility seems closer than ever.”

Poon recently demonstrated one of her tiny, wirelessly powered, self-propelled devices at the International Solid-State Circuits Conference (ISSCC). The animation below produced by Carlos Suarez at StrongBox3d shows how such a device might move through the bloodstream.

Source: Stanford University

Sourced & published by Henry Sapiecha

ROBOTICS TO DO SURGERY ON HUMANS

Monday, January 16th, 2012

Open-source project intends to advance robotic surgery


A couple of years ago, the Willow Garage robotics company gave ten of its PR2 robots away to deserving research groups. The idea behind the project was that these groups would use the PR2s for robotics research, then share their discoveries with each other, thus advancing the field farther than would be possible if they each had to build their own unique robots from scratch. Now, a similar but unrelated project is underway, and this time the robots are designed specifically to perform surgery.

Sourced & published by Henry Sapiecha

CUTTING OUT BABIES MAY BE BETTER FOR YOU AND THE BABY???

Saturday, August 13th, 2011

IS CAESAREAN THE WAY TO GO FOR DELIVERING NEW BORNES?

FOR years, women have been labelled ”too posh to push” for choosing caesarean births without medical reasons, but a controversial new study suggests they may be picking a better path for themselves and their babies.

Dr Stephen Robson, an associate professor of obstetrics at Australian National University, is recruiting 1000 pregnant women to test the long-held view that vaginal deliveries are better than caesareans for healthy women with uncomplicated pregnancies.

The study, which requires 500 women choosing a caesarean and 500 planning a vaginal birth, will look at psychological and physical outcomes for the women and their babies, including depression and breastfeeding rates.

Dr Robson said that although an estimated 10,000 Australian women chose to have caesareans each year without medical reasons, no one had ever comprehensively studied their outcomes because research tended to focus on women with problems. ”From a medical point of view, it’s difficult to counsel people because no one can give a reasonable comparison of what the risks are for women who are otherwise healthy,” he said.

Dr Robson said a study published in The Lancet in 2000, which compared caesareans with vaginal deliveries for babies in the breech position unexpectedly found that women in the caesarean group did slightly better overall than women in the vaginal group. The results left doctors around the world wondering if surgical deliveries could be better for healthy women.

”It dawned on people, what if it turns out to be safer to have a caesarean birth if you’re a healthy mother? … What would that mean? How would that affect society? The topic led to great discussion at a meeting I was at recently where one cheeky guy said, ‘Maybe we could do away with labour wards forever and save hundreds of millions of dollars,’ ” he said.

”Depending on what we find, there is a profound sense that maybe this will lead to an unanticipated and staggering finding.”

Current research cited by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists says caesareans in healthy women may reduce the chance of injuries that lead to incontinence and difficulty with sex while also reducing the risk of their baby dying or getting cerebral palsy.

On the other hand, the college says it may slightly increase the risk of death for mothers while also increasing their risk of placenta accreta in future pregnancies – a serious complication that can cause significant blood loss. The recovery time is also longer compared with a vaginal delivery.

President of the college, Dr Rupert Sherwood, encouraged women to take part in the study.

Sourced & published by Henry Sapiecha

GIVING YOUR SKIN TO MAKE MORE BLOOD FOR YOU USING STEM CELLS

Sunday, March 27th, 2011

Making blood from human skin

By Grant Banks

03:48 November 14, 2010

Blood transfusions may one day come from blood produced from a patient's skin

Blood transfusions may one day come from blood produced from a patient’s skin

A new technique that allows blood to be made directly from skin cells has been discovered. The pioneering approach by Canadian researchers uses human skin stem cells to create blood stem cells without an intermediate step that previously was thought necessary.

Until now to make blood stem cells, the building blocks for a variety human cells (called pluripotent stem cells) have been used as a steppingstone a process. This has proven largely inefficient, but research led by Mick Bhatia, scientific director ofMcMaster’s Stem Cell and Cancer Research Instituteat the Michael G DeGroote School of Medicine, has shown that making blood from skin can be achieved in a one step process.

Cynthia Dunbar, head of the molecular hematopoiesis at the U.S National Institutes of Health said: “Bhatia’s approach detours around the pluripotent stem cell stage and thus avoids many safety issues, increases efficiency, and also has the major benefit of producing adult-type l blood cells instead of fetal blood cells, a major advantage compared to the thus far disappointing attempts to produce blood cells from human embryonic stem cells or induced pluripotent stem cells.”

The discovery was replicated several times over two years using human skin from both the young and the elderly to prove it works for any age of person.

The approach could be used for creating blood for surgery or treating conditions like anemia from a patch of the patient’s skin. Other potential applications include generating bone marrow and improved treatment of leukaemia and other types of cancer, including solid tumors.

“We have shown this works using human skin. We know how it works and believe we can even improve on the process,” Bhatia said. “We’ll now go on to work on developing other types of human cell types from skin, as we already have encouraging evidence.”

“This finding will no doubt be met with excitement in the research and medical communities,” said Michael Rudnicki, director of The Stem Cell Network. “It’s been nearly 50 years since blood stem cells were first identified here in Canada and it’s fitting that this incredible new discovery should have happened here as well.”

The research was published in Nature on November 7.

Sourced & published by Henry Sapiecha