Medical advances from the future, and past
Artificial intelligence, wearable sensors, yoga
January 1, 2020
Avoiding sleep medications with simple exercises
If you are having trouble sleeping at night, you might want to try a yoga class. Yoga and physical therapy (PT) are effective approaches to treating co-occurring sleep disturbance and back pain while reducing the need for medication, according to a new study by researchers at Boston Medical Center (BMC). Writing in the Journal of General Internal Medicine, they report significant improvements in sleep quality lasting 52 weeks after 12 weeks of yoga classes or one-on-one physical therapy. The researchers also found that participants with early improvements in pain after six weeks of treatment were three and a half times more likely to have improvements in sleep after the full 12-week treatment.
Sleep disturbance and insomnia are common among people with chronic low back pain. Previous research showed that 59% of people with chronic low back pain experience poor sleep quality and 53% are diagnosed with insomnia. Medications for both sleep and back pain can have serious side effects.
“Identifying holistic ways to treat these conditions could help decrease the reliance on these medications, as well as keep patients safer and more comfortable,” said lead study investigator Eric Roseen, who is an assistant professor of family medicine at Boston University School of Medicine.
The researchers conducted a randomized controlled trial with 320 adults with chronic low back pain. At the beginning of the study, more than 90% of these participants were found to suffer from poor sleep. Participants were assigned one of three different therapies: physical therapy, weekly yoga, or reading educational materials. Previous research discovered that yoga and PT are similarly effective for lowering pain and improving physical function, reducing the need for pain medication. In this study, results for sleep improvements were compared over a 12-week intervention period and after one year of follow-up.
Artificial intelligence may help determine if immunotherapy is appropriate
Currently, only about 20% of all patients with advanced cancer will actually benefit from costly immunotherapy. However, a new study is suggesting that simply analyzing previously unseen changes in patterns in CT scans may help identify those 20%. Scientists from the Case Western Reserve University, who previously pioneered the use of Artificial Intelligence (AI) to predict whether chemotherapy will be successful, are now reporting they that they can determine which patients with advanced lung cancer will benefit from immunotherapy using AI.
By examining CT scans taken when the lung cancer is first diagnosed compared to scans taken after the first two to three cycles of immunotherapy treatment, the team has discovered key information. They discovered that their machine-learning model could predict response in patients treated with different immune checkpoint inhibitors.
“Even though immunotherapy has changed the entire ecosystem of cancer, it also remains extremely expensive, about $200,000 per patient per year,” said study investigator Anant Madabhushi, with Center for Computational Imaging and Personalized Diagnostics (CCIPD) at Case Western Reserve, Cleveland, Ohio. “That’s part of the financial toxicity that comes along with cancer and results in about 42% of all new diagnosed cancer patients losing their life savings within a year of diagnosis.”
The researchers used CT scans from 50 patients to train the computer and create a mathematical algorithm to identify the changes in lesions. They were able show that the patterns on the CT scans that were most associated with a positive response to treatment and with overall patient survival were also later found to be closely associated with the arrangement of immune cells on the original diagnostic biopsies of those patients.
Wearable sensors may detect kidney problems
Scientists at Caltech have now come up with wearable sensors that can detect kidney problems. In a paper published in Nature Biotechnology, the researchers describe a mass-producible wearable sensor that can monitor levels of metabolites and nutrients in a person’s blood by analyzing their sweat. Previously developed sweat sensors mostly target compounds that appear in high concentrations, such as electrolytes, glucose and lactate. Researchers now report their current sensor is more sensitive than other devices and can detect sweat compounds of much lower concentrations, in addition to being easier to manufacture.
The development of these sensors would allow for continuously monitoring individuals with illnesses such as cardiovascular disease, diabetes or kidney disease. All of these conditions result in abnormal levels of nutrients or metabolites in the bloodstream. Patients would benefit from having their physician better informed of their condition, while also avoiding invasive and painful encounters with hypodermic needles.
“Such wearable sweat sensors have the potential to rapidly, continuously and noninvasively capture changes in health at molecular levels,” said lead study investigator Wei Gao, who is an assistant professor of medical engineering at Caltech, Pasadena, California. “They could enable personalized monitoring, early diagnosis, and timely intervention.”
Gao’s work is focused on developing devices based on microfluidics, a technology that manipulates tiny amounts of liquids, usually through channels less than a quarter of a millimeter in width. Microfluidics are ideal for an application of this sort because they minimize the influence of sweat evaporation and skin contamination on the sensing accuracy. As freshly supplied sweat flows through the microchannels, the device can make more accurate measurements of sweat and can capture temporal changes in concentrations.
The research team opted to have their sensor measure respiratory rate, heart rate and levels of uric acid and tyrosine. Tyrosine was chosen because it can be an indicator of metabolic disorders, liver disease, eating disorders and neuropsychiatric conditions. Uric acid was chosen because it is associated with gout, a painful joint condition that is on the rise globally. Gout occurs when high levels of uric acid in the body begin crystallizing in the joints, particularly those of the feet, causing irritation and inflammation.
John Schieszer is an award-winning national journalist and radio and podcast broadcaster of The Medical Minute. He can be reached at firstname.lastname@example.org.