Through My Eyes: Empowering my son to negotiate the 'autism cliff,' enter adult life

 For an autistic young person and their parents, transitioning into adulthood can be an exciting yet challenging time in their lives. In honor of Autism Awareness Month, here is the story of my experiences with transitioning my autistic son into adulthood. I also talk about navigating certain legal aspects and the “autism cliff” that many autistic young people and their families experience during this transition.

In our Through My Eyes series, we provide a platform for people to share how a particular medical condition has affected their life. By shining a spotlight on the physical and emotional, this series aims to raise awareness while providing practical advice and support to any readers who may be experiencing something similar.

Like many parents with young autistic children, my focus suddenly changed when my son received the diagnosis of autism spectrum disorder (ASD). After a long and arduous diagnostic process, I shifted from wondering if he had autism to searching for the services he needed to learn, grow, and manage autism-related challenges. This included in-home therapy, school-based services, and nutritional therapies.

Because of the time invested in researching and implementing various treatments, and the effort invested in advocating for my son, I didn’t have the mental bandwidth to think too far into the future.

But as he grew, I realized that even though he had experienced incredible progress throughout his journey, the challenges associated with autism would likely not end when he became a legal adult. This realization made planning for his future a new and urgent priority.

Autism advocates, including the Autistic Self Advocacy Network (ASAN), have called for a change from “Autism Awareness Month” to “Autism Acceptance Month” to encourage inclusion and increase support and opportunities for autistic individuals.

 IEP, transitions, and approaching the ‘autism cliff’

 Like many autistic students in the United States, my son’s educational journey from pre-school to high school graduation was mapped out with an Individualized Educational Program (IEP). An IEP is a legally binding document developed and instituted when a child meets the public school’s criteria for specialized education.

This document outlines the child’s needs and designs an educational program to meet those needs best, whether through speech and language therapy, occupational therapy, or the addition of support people like paraprofessionals to assist the child throughout the day.

With an IEP in place, a child’s educational journey does not have to end at 18. Instead, the young person and their parents can decide to continue attending school up to age 21.

This 18–21 period is considered one of “transitions”— and is designed to shift the young person from educational-centered to adult-oriented learning. Much of this includes teaching independent living and job skills.

In the United States, statistics suggest that 500,000 young adults with autism will transition into adulthood over the next 5 years.

Unfortunately, many schools don’t have the resources to develop transitions programs that fully address the needs of autistic students entering the adult world.

A Centers for Disease Control and Prevention (CDC) surveyTrusted Source using parent-reported data from the National Survey of Children’s Health found that autistic students were less likely to receive transition planning than children with other emotional or behavioral conditions.

Furthermore, even if a transitions program exists, it may not cover all the gaps in services that suddenly occur when the child reaches 18 years old. Parents often refer to this sudden loss of services as the autism cliff.

Building a bridge over the ‘autism cliff’

When faced with a sudden reduction or loss of services, parents of autistic children must build a bridge over that gap. And they may not always have the information and resources needed to construct it, which leaves them unsure about what to do next.

Fortunately, my son’s experience has been different due to the charter school for autism he attends. His school, Lakeland STAR School/Academy, was created in 2018 by a group of dedicated parents, educational professionals, and community members and supported by generous donors. STAR serves diverse learners in grades 7–12 and has a transitions-focused curriculum.

However, because autism ratesTrusted Source continue to rise, the school has seen tremendous growth. As space to enroll new students became limited, a need for a separate transitions program emerged.

To address this need, Lakeland STAR is now developing a transitions center with the help of community-based organizations, including Aspirus Health, Lakeland Union High School (LUHS), the Howard Young Foundation (HYF), and the HYF Women’s Legacy Council.

Scheduled to open in the fall of 2022, the center will offer transitions-based education, including independent living skills, job skills training, and related services. The new center will help my son and other autistic young adults bridge the gap over the autism cliff and into the adult world.

Still, through my experiences, I’ve learned that transitioning is more than just transition programs. It also includes critical legal aspects of becoming an adult regarding healthcare and finances.

Depending on the level of support the young person needs, these legal aspects may include deciding whether to pursue legal guardianship, financial power of attorney (POA), or power of health (POH). In the U.S., a parent must complete these documents before the young adult’s 18th birthday.

Why are these legal documents critical?

Over the years, I’ve heard many parents and caregivers explain the incredible challenges of navigating finances and healthcare after their autistic child reaches adulthood. And this is especially true if there are no legal documents in place that allows parents to have some oversight in their child’s decision-making after they turn 18.

Legal documents may be necessary because autism often affects executive functioning, expressive and receptive language skills, and social skills — leading to unforeseen challenges in the adult world.

For example, executive functioning challenges may make it difficult for an autistic person to organize their finances and pay bills on time. This could lead to loss of housing or referrals to debt collection agencies.

Autistic individuals may also have a higher risk of exploitation and victimization from others due to social difficulties. Because of this, they could experience fraud or other financial abuse without essential legal safeguards in place.

Additionally, expressive and receptive language challenges could lead to miscommunication with authorities, resulting in unwarranted legal issues.

Challenges with healthcare can also occur. For instance, in the U.S., medical professionals cannot discuss an adult’s medical situation with parents or caregivers without guardianship or active power of attorney for healthcare. So, an autistic person may not have the support they need in a medical emergency.

Although autistic adults who need minimal support can often handle many aspects of adult life on their own, it’s not always easy to determine this by the time they turn 18. Therefore, it’s often in the child’s best interest to establish legal documents until support people can fully understand the young person’s abilities.

Differences between guardianship and POA/POH

For some parents in the U.S., especially those who support an autistic child with significant verbal communication challenges, guardianship is the answer to this legal dilemma. However, obtaining this level of legal oversight can be a complicated process.

Often, you need a medical professional to declare that the autistic young person is unable to make their own decisions and then go through a detailed court process.

In addition, becoming your child’s guardian involves managing their finances and medical needs as a separate individual. Other parents have told me that managing guardianship is like a full-time job, but most consider it a labor of love.

Still, for many autistic adults, an active power of attorney for healthcare and finances is adequate because it allows some oversight on decisions yet leaves individuality and decision-making intact. These documents are drawn up by a lawyer and signed by the autistic person soon after reaching the age of 18.

In my son’s situation, although he needs minimal support, he was welcoming of the idea of giving his father and myself the ability to assist him financially and medically when required.

This acceptance of help may be partly due to his self-awareness — something that began evolving soon after I was transparent with him about his diagnosis at a young age. I believe this knowledge has helped him understand himself better and more easily identify areas in his life where he may need more assistance.

Transitioning into employment or post-secondary education

Autistic individuals have many strengths that make employment or attending college more than possible. Still, research from 2017 suggests that about 38%Trusted Source of autistic adults are unemployed. In addition, estimates indicate that only 17%Trusted Source of autistic students graduating from high school attend a 4-year university.

Still, a transitions program can help increase employment and post-secondary attendance for autistic individuals.

In my son’s situation, his school has helped by searching out job experiences in the community. However, these job experiences are slightly different than a typical employment experience.

For example, the employer is aware their new employee has ASD and will make accommodations to support their needs. In other cases, a job mentor will accompany the autistic employee when they start their job and slowly withdraw support as needed.

Source - Medical News Today

 

Through My Eyes: ADHD and avoidant restrictive eating

 Nadine Dirks shares her experience of avoidant restrictive eating as a symptom of attention deficit hyperactivity disorder (ADHD).

In our Through My Eyes series, we provide a platform for people to share how a particular medical condition has affected their life. By shining a spotlight on the physical and emotional, this series aims to raise awareness while providing practical advice and support to any readers who may be experiencing something similar.

For as long as I can recall I have been quite averse to certain foods. I hated the consistency of tomatoes, the texture and smell of bananas, and the way yogurt was just smooth. I just put it down to disliking certain foods — that was how my family saw it, too.

I would insist my sandwiches be made without butter because I didn’t like the coating on my tongue after eating it. I loathed touching raw meat, particularly chicken, because the smell drove me up the wall, and the texture felt almost slimy.

Jelly, processed meats, and anything with multiple components, like trifle, made my skin crawl. It was sensory overload and I couldn’t seem to process it. Some days I would get frustrated with myself because I would suddenly be overwhelmed even by foods I did enjoy, like avocado, eggs, or cheese.

I couldn’t understand why it was such an uphill battle just to eat something. The sense of overwhelm was so severe that I would unconsciously avoid eating after experiencing a reaction to a particular food.

I was diagnosed with ADHD in my mid-20s, and up until that point had no idea I was neurodiverse. Suddenly everything made sense — difficulties at school, being too talkative, struggling with focus and concentration, overthinking and anxiety, so many elements of my life made sense.

I had no idea just how severely ADHD had impacted my life, and how it affected my everyday experience. It was both a relief to finally have an answer for so many things I had experienced and incredibly frustrating and painful because I felt resentful about the difficulties I had faced.

I was upset because had I known sooner, I would likely have had better tools to deal with the disorder.

‘The texture, scent, consistency or appearance of a dish may unsettle me’

My therapist and I discussed my issues with sensory overload, which manifested in multiple ways — sensitivity to lights, loud sounds, crowded spaces, and even textures of my clothes and blankets.

It dawned on me that my issues with textures, smells and consistencies in relation to food could absolutely be due to ADHD. I decided to consult the internet, and found out about avoidant restrictive food intake disorder (ARFID), an eating disorder associated with those with ADHD and autism.

The research indicated it was similar to anorexia but with a key difference — people with ARFID have no interest in body weight, size, shape, or body image, which is commonly seen in people who deal with anorexia.

I had no idea that ADHD could play any kind of role in the issues I had faced with food all my life. I couldn’t really understand it or find an abundance of resources for the lay person about the connection between ADHD and disordered eating.

Some researchTrusted Source seems to indicate that sensory issues could be an important factor in ARFID. This is very much aligned with my experiences: I have no desire to lose weight, nor do I have any interest in my body image, but I tend to restrict my eating and lose weight anyway because of a severe reaction to food that causes major anxiety about eating.

I tend to worry and become anxious a long time before meals, when I go to new restaurants, or visit someone else’s home for a meal.

I worry that the texture, scent, consistency or even appearance of a dish may unsettle me to the point of not eating for hours on end.

‘It is so rare to hear about it‘

My therapist and I have discussed the issue at length and thankfully, as a neurodivergent woman herself, she truly understands and is able to speak and relate to me in a way that is comforting. Her recommendation to work with an occupational therapist to deal with the sensitivity has been helpful.

ARFID is exceptionally difficult to deal with because it completely shifts your life, and makes it difficult to socialize without being hyperfocused on the gaze of others. Generally speaking, people have no idea about ARFID so it can seem like someone is just being difficult or a picky eater, which is not the reality.

I wish I could just complete a meal without quitting because the smell was overwhelming — it is just not that simple to navigate.

It is a part of ADHD that is incredibly hard to navigate, it is difficult to explain to people. It is not something we talk about often when we speak about ADHD.

It is so rare to hear about ARFID that the general public seems puzzled when I attempt to explain my eating habits and their link to ADHD.

It isn’t seen as one of the main symptoms to look out for, and in my experience, it took multiple individuals commenting on my weight loss, and my own realization that I avoid multiple foods and often skip meals because I am overwhelmed by the sensory overload to become conscious of it.

After a significant battle with attempting to force myself to eat and just ending up overwhelmed and physically unwell, I decided to reach out to experts to discuss the experience I had been having.

My issues with eating and sensitivity around particular things seemed to be heightened when I was overwhelmed, in general. It seemed to exacerbate the symptoms.

One of the ways in which I have been able to manage my situation has been by consulting experts, prepping meals beforehand so I avoid feeling overwhelmed, and working with an occupational therapist to manage my sensory issues.

Talking about ADHD and restrictive eating ‘could be life-saving’

Neurodivergence is a complicated issue and one that is multifaceted. Our experiences would likely be easier, and our symptoms managed sooner if regarded holistically and not just as focus- and hyperactivity-related issues.

This would not make sensory issues go away entirely but it would provide the tools to better manage these sensitivities.

Assessing what situations I am fairly comfortable with and the things that distress me has allowed me to open up in a safe environment and slowly work on exposure therapy.

We need to have conversations about ADHD that are wide and varied. The condition isn’t the same for everyone, and it would help many if we viewed it holistically and treated the multiple parts of this disorder.

Having conversations about ADHD and comorbidities like ARFID could be life-saving to some, it could provide answers, and even encourage others to seek professional help for their disordered eating before it causes long-term effects on the body.

In my view, we have a long way to go in having open conversations without the stigma about these kinds of symptoms that everyone shies away from. No one wants to talk about disordered eating, yet it is stigmatized despite the fact that it is not a rarity.

Source - Medical News Today

 

Through My Eyes: Stem cell donation

 After being on a list of potential donors for 12 years or so, this past month saw me finally have the opportunity to give away some of my stem cells. The opportunity to experience first-hand a procedure I have read, written, and edited articles on at Medical News Today.

On paper, stem cell donation can sound a bit intimidating.

While donating blood may be easy to visualize, stem cells feel more abstract. The name conjures images of microscopes, laboratories, and horribly invasive procedures.

I am happy to report that there was nothing horrible about my experience at all! And while it was not exactly a walk in the park — more a run in a wood — it is something that I would encourage folks to consider if they are able to do so.

Joining the register

I can’t remember exactly when it was that I signed up on the stem cell register but 12 years ago feels about right.

At the time, I was working at a local hospital booking day surgery appointments for people. One day, some people from the charity came in to try and sign National Health Service employees and medical students up. It seemed like the thing to do at the time, and so my name was added to the register, joining over 800,000 others.

The charity in question was the British organization Anthony Nolan. They work to provide stem cells and bone marrow donations to patients with forms of blood cancer or blood disorders. The charity also supports research into new treatments for other conditions.

Why are stem cells so important?

To call stem cells “useful” would be doing them a disservice.

Stem cells are cells that do not yet have a specific role within the body. When they divide, they have the potential to develop into cells with a specific function. This process is known as differentiation. Each of the many different specialized cells of the adult human body were stem cells, to begin with.

Doctors and scientists can use stem cells to help treat certain conditions. Skin stem cells can aid with tissue regeneration to treat skin damage, and blood stem cells can form a crucial part of treatment for blood diseases such as leukemia.

Not only that, but researchers can also use stem cells in studies to either find out the causes of certain diseases or to develop new drug treatments for conditions.

Screening and preparation

A few months ago, I received a phone call asking if I would be interested in donating some cells to be used in a study.

With my consent given over the phone, it was time for me to move into uncharted territory.

The possibility of donating stem cells had always just been that: a possibility, a thought, an idea.

Certainly nothing as concrete or tangible as a trip up from Brighton to London for a health check.

Clinical staff provided more detailed information about what was coming so that I could provide written consent. Questions were asked to assess my likelihood of carrying any bloodborne diseases. Blood and urine samples were taken, my body mass index (BMI) was measured, and a COVID-19 test was carried out.

A common experience for people who work with health information articles is to feel as though you are developing whatever condition you have most recently written about. This can be useful from time to time.

I had an irregular-looking mole removed after working on a melanoma article, for instance. However, it can also leave you fearing the worst when all you have done is perhaps eaten too much beetroot.

This neuroticism made waiting for my health check results a slightly nervous affair. Thankfully, I was happy to discover that everything was okay. My fears of gross malnourishment due to a disorganized vegan diet proved to be completely unfounded.

I was on to the next stage of my donation journey. The hospital was ready and prepared to have me in to donate my stem cells. I now needed to prepare my body for the process.

Learning a new skill: G-CSF injections

From here on out, there will be quite a bit about injections and needles! If you want to avoid this and skip to the end, you can click on this link.

To improve the chances of collecting a good amount of stem cells, donors take a series of injections in the days running up to the collection date. The injections contain a protein called granulocyte colony stimulating factor (G-CSF), which helps boost levels of stem cells in the bloodstream.

I had never injected anything before. I am typically quite happy to receive injections — my COVID-19 vaccinations were wonderful — but being the person to push down on the syringe was quite a daunting prospect.

Thankfully a nurse walked me through the first day of injecting. They explained that I would need to inject two separate doses of G-CSF into either my thigh or belly once a day for 4 days, alternating between the two areas so as not to cause them to ache too much.

The process involved pinching flesh from the thigh or belly and injecting into that. When I was able to grab a good chunk, pushing down with the needle was a fairly simple task. At these times I could barely perceive it piercing my skin.

Once I had fully depressed the syringe, there was a click. Releasing my grip at this point would cause the needle to automatically retract, ready for disposal in the sharps bin the nurse had provided. All that was left was for me to do this one more time and that would be my injecting for the day.

I soon grew used to this new addition to my lunchtime routine. Stop work. Inject myself twice. Have a sandwich. Do some laundry. Return to work.

The only adverse effects were some slight body aches, particularly in my lower back, and a general feeling of being run down. These are typical for G-CSF injections.

Collecting stem cells and Pokémon

I reported to the hospital and was admitted to the apheresis unit at 2 p.m. for the “harvesting” of my stem cells. This term made it sound as though the procedure was going to be a brutal process straight out of a dystopian science fiction story. This was not the case!

After being assigned a bed and doing some preliminary checks, a nurse began to set things up.

All the heavy lifting was going to be done by a cell-separating machine. The nurse inserted a needle into a vein in my left arm from which my blood was drawn into the machine. The machine then separated the blood into its separate components: red blood cells, white blood cells, plasma, and platelets.

Once the blood was separated, the parts containing my precious stem cells were taken away, leaving the rest of the blood to return to me. The nurse inserted another needle into a vein in my right arm, and the blood was able to rejoin my bloodstream here from the machine.

After this had been set up, all that was left to do was wait while the machine did its thing with my blood. My left arm had to remain stationary, although I was permitted to squeeze a stress ball to aid circulation.

My right arm was free, however, to play Pokémon on my phone, turn the pages of my book, or struggle with eating the soup and rice pudding that came with my lunch.

From time to time, I would look over at the machine. I could see the tubes carrying blood into this strange device with its turning wheels and rhythmic humming. It really was like something out of a science fiction story, only tempered with the mundanity of waiting in a queue at the post office to send a parcel.

Overall, there was nowhere near the level of discomfort that the name “harvesting” had suggested. The sites on my arms where the needles went in were a bit sore and provided a dull ache throughout the procedure. My left forearm also felt as though I had been sitting on it at certain times, but a few squeezes of the stress ball soon sorted this out.

The other main side effect I experienced was a tingling sensation around my mouth. This is a fairly typical symptom of the blood thinner that the machine uses during the process to prevent the blood from clotting.

When this occurred, the nurse provided me with a calcium tablet, and within a few minutes, the symptom was gone.

I lay on the bed hooked up to the machine for 2 and a half hours in total. During that time, I caught many Pokémon, made great progress reading my book, and just about managed to eat my lunch without making too much of a mess.

The ache in my arms was a constant presence, but overshadowed significantly by how difficult it was to transport soup from a bowl to my mouth.

Heading home

At 5 p.m., the nurse was ready to discharge me. The needles were removed from my arms and a bag full of my stem cells was labeled and packed up, ready to go off to a laboratory.

The nurse advised me to drink plenty of water and to take things easy for the next few days. I felt tired, a little short of energy or enthusiasm for anything, but otherwise could feel no ill effects of my afternoon in the hospital.

It is typical for people to experience bone aches for a few days after the procedure, along with tiredness. This was the same for me, too.

I was fine to return to work as normal the following day, and the only adjustment I made to my routine was to skip playing soccer for a week.

The doctor who had seen me for my health check had explained that my spleen would have shrunk during the procedure, and avoiding contact sports would allow it time to return to its usual size without harm. This may have been the first time in my life I have actively considered my spleen’s well-being.

The following week, with spleen presumably back to its original size, I was happy to return to all of my usual pastimes!

A straightforward process, would recommend

Whenever I told someone I was going to be donating stem cells, quite a few people seemed impressed. Their reactions suggested that the whole process would be a great ordeal with significant levels of discomfort.

Thankfully, donating the stem cells was an effortless process, and my experience is one that has been shared by many others. Several testimonies are available to read on the Anthony Nolan website, and all echo the sentiment that the process is largely straightforward and not too painful.

Stem cells are a vital part of treatment for several serious conditions while also showing a lot of potential in the development of new therapies for currently untreatable diseases. As a result, it is very important for there to be people willing to donate their stem cells. Many will be able to save lives by joining a donation register.

My hope is that this article makes stem cell donation seem less scary and more accessible. I would certainly recommend that folks consider it if they are able to. And if you are lucky enough to be asked to donate, get some practice eating with one arm beforehand.

Source - Medical News Today

Children at risk of multiple sclerosis often go undetected in early stages

 Criteria used by neurologists to assess for multiple sclerosis (MS) in adults may fail to identify the illness in children with imaging suspicious for the disease, an oversight that could delay treatment of the disease at its earliest stages, according to a Rutgers study.

Magnetic resonance imaging (MRI) is the primary tool used for diagnosis of MS, and doctors have applied various standards over the years to classify those most likely to develop the disease. The most recent standard, known as the McDonald criteria, was last updated in 2017.

In some cases, imaging suspicious for MS is found incidentally before the disease manifests, a condition known as radiologically isolated syndrome (RIS). But after reviewing the MRIs of children with RIS, researchers determined these criteria are likely insufficient for pediatric patients.

"In our study, not all patients met the McDonald or Barkhof criteria [the current standard for diagnosing adult RIS], yet some went on to develop MS," said Vikram Bhise, director of Child Neurology and Developmental Disabilities at Rutgers Robert Wood Johnson Medical School, and lead author of the study published in the journal Multiple Sclerosis and Related Disorders. "This suggests that the criteria used to characterize RIS in adults might be insufficient for the younger population."

To determine if children with abnormal MRI findings would develop symptoms associated with MS, and to understand how diagnostic tools used for adults apply to children, researchers examined MR images of children suspected of having demyelination, damage to the protective myelin sheath that surrounds nerve fibers in the brain.

When the myelin sheath is damaged, nerve impulses slow or even stop, causing neurological issues. This damage appears as lesions -- white or gray spots -- on an MRI. There are many reasons for abnormal MRI findings; most don't represent demyelination. While not all patients with MRI findings typical of demyelination go on to develop MS, a substantial number do.

Study participants were identified through the U.S. Network of Pediatric Multiple Sclerosis Centers and Rutgers Robert Wood Johnson Medical School databases. Patients were between 7.6 years and 17.8 years of age, and each had MRI findings that showed demyelination.

None of the children in the study had physical or neurological symptoms common to MS -- such as blurred or loss of vision, vertigo or numbness or weakness in one or both legs -- at the time of their initial MRI. While the database didn't record why participants had been tested, Bhise said headaches were the most common reason.

Source: ScienceDaily

Lighting up tumors could help surgeons remove them more precisely

 A new technique that combines highly detailed, real-time images of inside the body with a type of infrared light has, for the first time, been used during surgery to differentiate between cancerous tumours and healthy tissue.

The pioneering technique, demonstrated in mice, has been developed by engineers at the Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS) at UCL and surgeons at Great Ormond Street Hospital (GOSH).

Researchers say, the development could have implications for treating neuroblastoma, which is the most common form of solid cancer tumour, other than brain tumours, found in children. Standard treatment typically involves surgery to completely remove cancerous cells, which can be difficult to see as they look similar to the surrounding healthy tissue.

For the study, published in Cancer Research, scientists at UCL and GOSH used a technique called 'molecular imaging' during surgery, where chemicals are injected into the bloodstream to act as imaging probes. These chemicals are attracted to cancerous cells in the body, and once attached, the probes light up through a process called 'fluorescence', which in turn lights up the tumour. The technique, used during preclinical testing in mice, successfully revealed part of a tumour that had not been removed during surgery.

Next the team wanted to test whether they could improve the visual quality of the images, by using a 'new' type of light, short wave infrared light (SWIR), that has only recently become accessible to scientists through new technology.

For this they used a special high definition camera to capture SWIR fluorescence. SWIR is invisible to the naked eye and has a longer wavelength than visible light, allowing it to penetrate deeper into the tissue to provide sharper, more detailed images. Using this technique, surgeons were able to distinguish between cancerous tumours and healthy tissue during the preclinical tests.

Team leader Dr Stefano Giuliani, Consultant Paediatric Surgeon at Great Ormond Street Hospital and Associate Professor at UCL Great Ormond Street Institute of Child Health, said: "Surgery to remove neuroblastoma requires a delicate balance. Remove too little and the tumour might grow back, but remove too much and the surgeon risks damaging the surrounding blood vessels, nerves and other healthy organs. This technique effectively lights up the tumour, allowing surgeons to remove it with unprecedented precision. We hope to be able to translate this innovative technology into clinical practice at GOSH as soon as possible to benefit the largest number of children with cancerous tumours."

Neuroblastoma is a devasting childhood cancer and accounts for 8-10% of all childhood cancers and around 15% of childhood deaths from cancer. In around a third of patients the cancer has already spread to other parts of the body at the time of diagnosis, making it harder to treat.

Source: Sciencedaily

Molecular imaging offers insight into chemo-brain

 A newly published literature review sheds light on how nuclear medicine brain imaging can help evaluate the biological changes that cause chemotherapy-related cognitive impairment (CRCI), commonly known as chemo-brain. Armed with this information, patients can understand better the changes in their cognitive status during and after treatment. This summary of findings was published ahead-of-print by The Journal of Nuclear Medicine.

CRCI describes a clinical condition characterized by memory and concentration impairment, difficulties with information processing and executive functioning, and mood and anxiety disorders. While CRCI has been widely investigated from a clinical perspective, little is known about the underlying biological mechanisms that cause chemo-brain.

"Nuclear medicine techniques can be used to investigate different physiopathological phenomena related to CRCI, such as cortical metabolism, dopamine transporter integrity, and neuroinflammation, with specific imaging probes," said Agostino Chiaravalloti, MD, PhD, professor of nuclear medicine and nuclear medicine physician in the Department of Biomedicine and Prevention at University Tor Vergata in Rome, Italy. "However, nuclear medicine tests are not commonly considered in the work-up of patients with CRCI-related manifestations."

To understand the current landscape of nuclear medicine and molecular imaging for chemo-brain, researchers undertook an extensive literature review. Following the PRISMA guidelines for literature searches, the researchers identified 22 relevant studies on two topics: 1) the effects of the most commonly used chemotherapy drugs on cognitive function and 2) the results of SPECT and PET examinations of CRCI. The findings confirmed the impact of chemotherapy drugs on cognitive function, such as impaired executive function, anxiety and trouble sleeping. They also highlighted the utility of various SPECT and PET imaging techniques to visualize glucose consumption, blood flow, or expression of receptors, all of which may play a role in CRCI.

In this context, nuclear medicine offers several instruments for the detailed evaluation of the physiopathological processes that underlie CRCI. "The findings presented could lead to a better understanding of the potential role of molecular imaging in the assessment of subtle changes in the brain after treatment and, possibly, in the monitoring of brain functions in patients treated with chemotherapy," stated Chiaravalloti.

Source: ScienceDaily

Detecting, predicting, and preventing aortic ruptures with computational modeling

 An abdominal aortic aneurysm (AAA) causes the wall of a person's aorta, the largest artery in the body, to weaken and bulge outward. If left untreated, it can continue to grow and eventually rupture, which can lead to life-threatening bleeding.

According to some estimates, up to 80% of patients who experience a ruptured AAA will die before they reach the hospital or during surgery. But early intervention can prevent rupture, improve outcomes, and avoid death.

In Physics of Fluids, by AIP Publishing, researchers from the Indian Institute of Technology (BHU) Varanasi and Indian Institute of Technology Kanpur made a computational model of the cardiovascular system in order to predict early AAA rupture and monitor patients' blood vessel conditions. The team investigated the effect of realistic, patient-specific AAA shapes on the hemodynamics of pulsatile Newtonian fluids in an aortofemoral artery under normal and diseased conditions.

Predicting the risk of AAA rupture involves a combination of imaging studies, such as ultrasound, CT scans, and MRI, and hemodynamics, as well as clinical factors such as age, sex, smoking history, and family history of AAA.

"If an AAA is detected early, treatment options such as surgical repair or endovascular stent grafting are available to prevent rupture," said the authors. "These treatments are both effective at reducing the risk of rupture and improving survival rates."

Using image-based computational blood dynamics, the researchers mimicked specific health conditions and investigated various hemodynamic parameters. Their patient-specific geometric models of a human aortofemoral artery were constructed from 3D medical imaging data. To solve the blood flow governing equations under the pulsating conditions caused by the heart's beating, they used finite element-based simulations.

The team found that aneurysm size alters the blood flow velocity distribution. In addition, flow separation occurs during systolic deceleration, and the vortex begins to travel in the aneurysm sac. Among other complex dynamics, this may influence the blood circulation of lower extremities.

"In the future, such computational work will help in development of digital twins of the cardiovascular system," said Kumar.

Digital twins are virtual patient representations that receive real-time updates on a variety of data variables and help doctors better forecast disease and choose the best course of therapy.

Source: ScienceDaily

Wearable ultrasound patch provide non-invasive deep tissue monitoring

 A team of engineers at the University of California San Diego has developed a stretchable ultrasonic array capable of serial, non-invasive, three-dimensional imaging of tissues as deep as four centimeters below the surface of human skin, at a spatial resolution of 0.5 millimeters. This new method provides a non-invasive, longer-term alternative to current methods, with improved penetration depth.

The research emerges from the lab of Sheng Xu, a professor of nanoengineering at UC San Diego Jacobs School of Engineering and corresponding author of the study. The paper, "Stretchable ultrasonic arrays for the three-dimensional mapping of the modulus of deep tissue," is published in the May 1, 2023 issue of Nature Biomedical Engineering.

"We invented a wearable device that can frequently evaluate the stiffness of human tissue," said Hongjie Hu, a postdoctoral researcher in the Xu group and study coauthor. "In particular, we integrated an array of ultrasound elements into a soft elastomer matrix and used wavy serpentine stretchable electrodes to connect these elements, enabling the device to conform to human skin for serial assessment of tissue stiffness."

The elastography monitoring system can provide serial, non-invasive and three-dimensional mapping of mechanical properties for deep tissues. This has several key applications:

• In medical research, serial data on pathological tissues can provide crucial information on the progression of diseases such as cancer, which normally causes cells to stiffen.
• Monitoring muscles, tendons and ligaments can help diagnose and treat sports injuries.
• Current treatments for liver and cardiovascular illnesses, along with some chemotherapy agents, may affect tissue stiffness. Continuous elastography could help assess the efficacy and delivery of these medications. This might aid in creating novel treatments.

In addition to monitoring cancerous tissues, this technology can also be applied in other scenarios:

• Monitoring of fibrosis and cirrhosis of the liver. By using this technology to evaluate the severity of liver fibrosis, medical professionals can accurately track the progression of the disease and determine the most appropriate course of treatment.
• Assessing musculoskeletal disorders such as tendonitis, tennis elbow and carpal tunnel syndrome. By monitoring changes in tissue stiffness, this technology can provide valuable insight into the progression of these conditions, allowing doctors to develop individualized treatment plans for their patients.
• Diagnosis and monitoring for myocardial ischemia. By monitoring arterial wall elasticity, doctors can identify early signs of the condition and make timely interventions to prevent further damage.

Wearable ultrasound patches accomplish the detection function of traditional ultrasound and also break through the limitations of traditional ultrasound technology, such as one-time testing, testing only within hospitals and the need for staff operation.

"This allows patients to continuously monitor their health status anytime, anywhere," said Hu.

This could help reduce misdiagnoses and fatalities, as well as significantly cutting costs by providing a non-invasive and low-cost alternative to traditional diagnostic procedures.

"This new wave of wearable ultrasound technology is driving a transformation in the healthcare monitoring field, improving patient outcomes, reducing healthcare costs and promoting the widespread adoption of point-of-care diagnosis," said Yuxiang Ma, a visiting student in the Xu group and study coauthor. "As this technology continues to develop, it is likely that we will see even more significant advances in the field of medical imaging and healthcare monitoring."

Source: ScienceDaily

Homo sapiens likely arose from multiple closely related populations

 In testing the genetic material of current populations in Africa and comparing against existing fossil evidence of early Homo sapiens populations there, researchers have uncovered a new model of human evolution -- overturning previous beliefs that a single African population gave rise to all humans. The new research was published today, May 17, in the journal Nature.

Although it is widely understood that Homo sapiens originated in Africa, uncertainty surrounds how branches of human evolution diverged and how people migrated across the continent, said Brenna Henn, professor of anthropology and the Genome Center at UC Davis, corresponding author of the research.

"This uncertainty is due to limited fossil and ancient genomic data, and to the fact that the fossil record does not always align with expectations from models built using modern DNA," she said. "This new research changes the origin of species."

Research co-led by Henn and Simon Gravel of McGill University tested a range of competing models of evolution and migration across Africa proposed in the paleoanthropological and genetics literature, incorporating population genome data from southern, eastern and western Africa.

The authors included newly sequenced genomes from 44 modern Nama individuals from southern Africa, an Indigenous population known to carry exceptional levels of genetic diversity compared to other modern groups. Researchers generated genetic data by collecting saliva samples from modern individuals going about their everyday business in their villages between 2012 and 2015.

The model suggests the earliest population split among early humans that is detectable in contemporary populations occurred 120,000 to 135,000 years ago, after two or more weakly genetically differentiated Homo populations had been mixing for hundreds of thousands of years. After the population split, people still migrated between the stem populations, creating a weakly structured stem. This offers a better explanation of genetic variation among individual humans and human groups than do previous models, the authors suggest.

"We are presenting something that people had never even tested before," Henn said of the research. "This moves anthropological science significantly forward."

"Previous more complicated models proposed contributions from archaic hominins, but this model indicates otherwise," said co-author Tim Weaver, UC Davis professor of anthropology. He has expertise in what early human fossils looked like and provided comparative research for the study.

The authors predict that, according to this model, 1-4% of genetic differentiation among contemporary human populations can be attributed to variation in the stem populations. This model may have important consequences for the interpretation of the fossil record. Owing to migration between the branches, these multiple lineages were probably morphologically similar, which means morphologically divergent hominid fossils (such as Homo naledi) are unlikely to represent branches that contributed to the evolution of Homo sapiens, the authors said.

Source: ScienceDaily