Mar 30, 2018

Just a trace

The story

As your nose will tell you when you take a wrong turn on the wards, there’s a lot your eyes can’t perceive. The hunt is on to detect cancers before they show up on imaging or routine testing.

Seek and find

The best way to cure solid tumors is to cut them out early before they spread. CancerSEEK, a blood test that identifies circulating tumor DNA and common cancer proteins, accurately detected about 70% of cancers in 1,000 patients with non-metastatic disease while reliably excluding healthy controls. Sensitivity increased with cancer stage, and the test performed best on 5 cancers – ovarian, liver, stomach, pancreas, and esophageal – without established screening tests. At roughly $500 dollars per test, CancerSEEK is cheaper than many forms of imaging. Expect many rounds of prospective validation before the technology is ready for prime time.

Predict and prevent

Next-generation sequencing (NGS) allows oncologists to identify commonly mutated genes that are driving cancer growth. A study of 480 patients with acute myeloid leukemia (AML) used NGS to identify common mutations in each patient before and after chemotherapy. After treatment, those who achieved complete remission but had NGS evidence of cancer, termed molecular minimal residual disease (MRD), were 90% more likely to relapse (55% vs. 32%) than those who did not during 4-year follow-up. Researchers are actively investigating how MRD should be used in clinical decisions. 

The takeaway

With sensitivities of roughly 70% across both platforms, molecular testing still misses too many cancers and cancer recurrences. But the future for early detection is brighter than ever. 

Say it on rounds

When vacation is two night shifts away

You're ready to start now. Newly diagnosed HIV patients can relate. Investigators brought in-home HIV testing to 6,500 households in Lesotho, a high-HIV prevalence area. The almost 300 patients who tested positive were randomized to receive same-day antitretroviral therapy (ART) initiation or referral to a healthcare facility for future treatment. The same-day group was more likely to report to clinic for follow-up, and, at 1 year, 50% of the same day group achieved viral suppression compared to only 34% of the usual care group.

When you roll into work an hour late, and nobody seems to notice

Go with the flow. Less friction in a left ventricular assist device (LVAD) means that blood has less opportunity to clot. Two-year follow-up from MOMENTUM 3, which compared the HeartMate 3, a magnetically levitated centrifugal flow LVAD to the HeartMate 2, its traditional flow predecessor, found that the HeartMate 3 produced a lower stroke rate (10% vs 19%) and lower rate of reoperation for pump malfunction (2% vs. 17%). Many hope the HeartMate 3 will reduce all-too frequent complications in LVAD patients.

When you can’t decide: gym or happy hour?

Some decisions are hard. Choosing therapy for fibromyalgia shouldn't be. A single-center RCT of 225 patients with fibromyalgia found that patients enrolled in twice weekly tai chi therapy reported a 25 point decrease (out of 100 points) in fibromyalgia symptom scores compared to a 9 point drop for patients who performed a similar amount of aerobic exercise. Patients in the tai chi arm also reported less anxiety and better coping strategies. Both groups were able to wean down their use of opiates and other analgesics.

Brush up

Primary Sjögren’s syndrome

Your dry eyes are from too many shifts filled with computer screens and fluorescent lights, but patients with Sjögren’s syndrome face autoimmune attack against exocrine glands. Look for the classic triad of fatigue, joint pain, and dry mouth and eyes. Diagnosis rests on either serum detection of anti-SSA antibodies or a positive salivary gland biopsy combined with evidence of low salivary flow or low tear production. Patients are at high risk for other autoimmune diseases and face a 5-10% lifetime risk of B-cell lymphoma. About 30-40% of patients will develop systemic manifestations of disease.

What's the evidence

For muscarinic agonists in the treatment of Sjögren's symptoms? A 2010 systematic review of 37 trials found that both pilocarpine and cevimeline reduced dry mouth and dry eye symptoms compared to placebo. The most common side effect for the two medications is sweating, which can be minimized with gradual dose increases.

What your public health friends are talking about

Superbugs. A man in the UK presented with the nation's first known case of gonorrhea completely resistant to first-line treatment with azithromycin and ceftriaxone. It has this team spooked about sexual health clinics stocked with ertapenem.

Spread the word

Send your interns something to look forward to


Sign up at

Copyright © 2018 Scope Media, LLC. All rights reserved.