PITTSBURGH (KDKA) In a dish sits a human liver.

Not removed from a person, but created from scratch.

Its not like wahoo and the next morning you think, ah, Im gonna make a human liver,' says Dr. Alejandro Soto-Gutirrez of the Pittsburgh Liver Research Center.

It took five years of trial and error but using stem cells, genetic and tissue engineering, organ cultures and a team of experts in these areas, the researchers have come up with this.

Alexandra Collin de Lhortet, Ph.D. of the University of Pittsburgh School of Medicine explains the process.

A rat liver gets stripped of its cells so that only the connective tissue remains.

From a small piece of human skin, the scientists pluck out stem cells and coax them into becoming human liver cells and the cells are collected.

Then theyre injected into the chamber, called a bioreactor, where they take up residence in the empty rat liver.

The entire process from gathering the cells to make a liver, to get to this point, where you have an actual mini human liver in a bioreactor, takes several months.

It will stay alive, or viable, for only a few days.

But in that short time, the researchers can try different medicines to treat the diseased liver.

You could test any sort of therapeutic by simply injecting this chemical through the system, says Dr. Collin.

In the past, animal livers played a role in this kind of research but human livers didnt always respond in the same way.

With this system, the cells have had genetic modification to recreate diseases, for example, fatty liver, a growing problem in the United States.

This technology has the potential for personalized medicine. From your skin cells, they could grow your own mini liver to figure out which medicines would work for you.

I believe its a very good biological tool to screen treatments that are not otherwise being tested in humans themselves because its dangerous, says Dr. Soto.

As its designed, it would be a long stretch to create livers for transplantation.

If you mean how far we are to make actual livers for people, I think we are very far away. Were probably many years away. But this is a good step, Dr. Soto says.

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After 5 Years Of Trials, Doctors Create Human Liver From Scratch - CBS Pittsburgh

AUSTIN, Texas, Oct. 3, 2019 /PRNewswire/ -- Partners in Health (https://partners-in-health.com/) announced it would celebrate its one-year anniversary with an upcoming Open House event. All past and present patients of Dr. Rhodes are welcome to attend, as is anyone interested in learning about the practice and her medical colleagues. The Open House is slated for Thursday, October 10 from 5:30 to 8:00 p.m., at 631 West 38th Street, Suite 5, and will include snacks from Austin's famous Tacoman 512 Taco Truck, wine and beverages, healthy living door prizes and more. Dr. Rhodes asks that guests rsvp online before attending.

"It's almost unbelievable to me that Partners in Health has reached its first anniversary," said Dr. Rhodes. "I started the concierge medical practice as a way to be more deeply involved in my patients' care a way to provide them 24/7 personalized healthcare. It was a dream of mine, and I'm so excited to celebrate that dream's reality."

Partners in Health: Precision Genomic Medicine

Partners in Health is a private concierge health practice that features the services of internist physician Dr. Rhodes and her staff, and is one of the first Internal Medicine practices in the Austin area to integrate a precision genomic medicine program (genetic testing) into its overall care plan.

Precision Medicine is a new medical approach that allows doctors to tailor their care to each patient's unique genetic makeup, giving doctors important tools that allow them to prevent, diagnose and treat a wide range of diseases. The science behind genomic medicine continues to evolve rapidly, but is based on the basic concept of the human genetic blueprint. The body is made up of trillions of cells that are defined by 3.2 billion DNA base pairs. Those pairs are the foundation of body health and wellness.

Until recently, genetic sequencing was a costly technique that was rarely covered by insurance and reserved for severely ill patients. It is now more widely understood by health professionals that predictive testing not only saves money over the long term, but also saves lives. Dr. Rhodes is currently working with a variety of high quality, FDA-approved labs who use advanced sequencing techniques to provide scientifically proven, actionable information that she can use in her patients' care.

"One of my goals for the concierge practice has always been to include Precision Genomic Medicine," said Dr. Rhodes. "I'm working toward 100 percent participation in this program over the next year, as it is one of the easiest actions patients can take to understand and improve their overall health. When we know what problems we should be looking for, it's much easier to find and treat them."

Learn more about Dr. Rhodes and Genomic Medicine HERE.

About Partners in Health

Partners in Health is a personalized internal medicine concierge practice created by Dr. Roxana Rhodes to serve the Austin community. A native Texan and third generation Texas physician, Dr. Rhodes has over two decades experience as primary care doctor and an educator. Partners in Health reflects Dr. Rhodes guiding belief that all patients experience far better health outcomes when patients are engaged in their own care, in an ongoing compassionate and collaborative effort with their healthcare providers. Learn more at: http://www.Partners-in-Health.com.

Media Contact:

Roxana Rhodes, MD512-423-1831223598@email4pr.com

SOURCE Dr. Roxana Rhodes

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Dr. Roxana Rhodes Marks One Year Anniversary of Concierge Medical Practice With Open House Celebration - PRNewswire

The child was critically ill. The treating team at Children's National Hospital in Washington, DC, was stumped and worried that time was running out. Every test was coming back negative.

Genetics was called in to look for chromosomal mutations that might suggest the source of the problems. The geneticist recommended whole-exome sequencing, which tells a story based not only on all of the child's genes, but on two additional sources as well: the mother's and the father's genes.

They found something they weren't looking for. The father, the worried man in the waiting room who raised this child, wasn't the biological father. In genomics it's called an "incidental finding," and it raises huge ethical questions: Do you reveal this to the parents? Only to the mother? Or, if the results don't affect the child's care, do you even tell anyone?

In this case, the team called on the hospital's ethics committee for help.

Monisha Samanta Kisling, MS

"What made it really complicated here is that the father was actually the primary caregiver and was really, really involved with the child," explains Monisha Samanta Kisling, MS, a genetic counselor who has worked at Children's National for 7 years. Plus, the father was the legal parent and responsible for the family as a provider, including securing the child's health insurance. Disclosing this information could have a lasting, lifelong effect.

"He has dedicated his life to and does everything for the child. You're really at risk of causing potential serious conflict for this family, and potentially for this kid who really needs that support system," Kisling says.

If you think this scenario is an outlier, you're mistaken. Various studies have estimated rates of false paternity at between 1% and 10%.[1]

The field of genomics calls misattributed paternity or in some cases, simply paternity a "secondary" or incidental finding. Perhaps, but it's certainly difficult to ignore.

"In a lot of cases, it's just very hard to hide that information with the report that you have," Kisling explains, because the variants that a geneticist discovers in the child's DNA don't match up at all with the father's genes. "If the child didn't inherit any of the variance from the father, that would throw in some question marks, right?"

Paternity might be incidental, but it's clearly significant. This information whether a father is truly a child's biological father can change families in an instant.

Whether to disclose poses a dilemma that can feel fraught. Telling a man that he's not the father of his child can have devastating consequences: He might leave the family. The standard in pediatrics is to practice medicine "in the best interest of the child"[2]; first and foremost is the child's well-being. That means keeping the focus on the child and their future.

Still, because there are really no data about how these shocking disclosures affect families, doctors are truly in the dark about how to handle these tricky scenarios.

"It's hard to make these decisions because we may not know the families that well. We don't necessarily know what's the right decision for them," Kisling says. She believes clinics should approach each family with fresh eyes, because every couple is different.

"I think withholding information can feel paternalistic," Kisling says. "We don't want to say, 'Hey, I don't think you can handle this information.' That's not necessarily our judgment call to make. Overall, it's just a really, really tough decision."

Read the original here:
'You're Not the Father': A Moral Dilemma in Genetic Testing - Medscape

Knowing your family history is the first preventative step any woman can take to avoid a diagnosis of ovarian cancer.

BY Dr. Gizelka David-West

As a gynecologic oncologist, this is an all too familiar conversation. Ovarian cancer is the fifth leading cause of cancer death in women, making it the deadliest of all gynecologic cancers with no screening tool. These facts are exactly why we advocate for preventative measures for ovarian cancer and the four other gynecologic cancers cervical, uterine, vaginal and vulvar.

Knowing your family history is the first preventative step any woman can take to avoid a diagnosis of ovarian cancer. Twenty to 25% of all cases of ovarian cancer are due to genetic mutations, with BRCA mutations accounting for about 16% of those cases and 5% being other mutations. Harboring a mutation in the BRCA 1 or BRCA2 gene increases a womans risk of developing ovarian cancer by 60% or 40%, respectively. With genetic testing and a confirmed mutation, we can prevent this disease with risk reducing surgeries that remove the fallopian tubes and ovaries, dramatically reducing this risk of cancer. Knowing your genetic profile can also help prevent recurrence of this deadly disease with targeted therapies that have been proven to prolong life without disease recurrence or progression.

Next up on the list of gynecologic cancers are three of the five, which fall into the category of HPV related cancers cervical, vulvar and vaginal cancers. With the development of the HPV vaccine, now available to women up to the age of 45, we can prevent these cancers and have the potential to eradicate them. Seems like a no brainer to call your local gynecologist and get vaccinated not only does the vaccine prevent these cancers, it prevents and can help treat the pre-cancer called dysplasia, which transforms into cancer of these organs if left untreated over time.

Finally, uterine cancer, a subset of which is endometrial cancer, is the most common of the gynecologic cancers. Although it is expected that 62,000 new cases of endometrial cancer will be diagnosed this year, it can potentially be prevented. A major risk factor for endometrial cancer is higher than normal estrogen stimulating the uterus this can come from our fat tissue and women who are overweight or obese, have a much higher risk of developing this cancer. Additionally, extra estrogen exposure can come from hormone replacement therapy, which some women may start using in the peri- and post-menopause phase of life. Genetics also play a role in uterine cancer and women with a confirmed diagnosis of Lynch Syndrome have up to a 60% risk of developing this cancer.

I focus my prevention strategies for endometrial cancer on encouraging my patients to maintain a normal range body mass index with regular healthy diet and exercise. If exploring hormone replacement therapy to use with caution the lowest doses for the shortest amount of time. And of course, genetic testing is recommended if strong personal or family history suggestive of Lynch Syndrome.

I hope this post has been informative and provides tools to help you share knowledge this month on preventing gynecologic cancers! To learn more about gynecologic cancers, genetics, clinical trials and survivorship, I encourage you to visit the Foundation for Womens Cancer website and share what you learn with your family, friends and colleagues.

Gizelka David-West, MD, is a practicing gynecologic oncologist, and attending and assistant professor at the Westchester Medical Center in Hawthorne, NY. David-West completed medical school at the University of Miami Miller School of Medicine; residency in obstetrics and gynecology at Mount Sinai School of Medicine; and a fellowship program in gynecologic oncology at New York University. She is also a member of the Society of Gynecologic Oncology (SGO) and on the communications committee for SGO and the Foundation for Womens Cancer. She is also the lead singer for the gynecologic cancer advocacy band N.E.D.

Read more:
What You Need to Know About Preventing Gynecologic Cancers - Curetoday.com

Photo Credit: Alamy Stock Photo

Baby boomers, the more than 75 million peoplein the U.S. born between 1944 and 1964,are starting to retire.As this generation ages and requires more advanced healthcare, the demand for healthcare occupationsis expected to grow at a breakneck pace.

According to the Bureau of Labor Statistics, between 2016 and 2026, the projected employment growth among healthcare jobs is 15.3 percent, far outpacing the national average of 7.4 percent. In fact, more than half of the top 20 fastest-growing occupations in the U.S. are related to healthcare. For example, home health aide positions are expected to increase 47.3 percent and personal care aide positions are expected to increase 38.6 percent by 2026. Fortunately for job seekers,not all healthcare-related occupations require a medical school degree. For individuals just starting out in their careers or looking to change industries, healthcare could be an excellent opportunity.

Interestingly, the growth in healthcare positions is not evenly distributed throughout the U.S. Among the largest U.S. states, Pennsylvania, Massachusetts, Ohio, and Michigan have disproportionately high concentrations of healthcare jobs. California, Texas, and Washington, on the other hand, have below average concentrations of these jobs.

At the local level, the technology hubs of San Jose, Seattle, and San Francisco have some of the lowest concentrations of healthcareprofessionals while Southern metros like Greenville and Charlottesville have higher concentrations. Wages for healthcare positions also tend to be highest in the Northeast and the West Coast, and lowest in the South. For example, median annual wages range from $88,630 in California to $52,530 in Mississippi.

While the highest-paying jobs among healthcare practitioners do require going to medical school, there are still many high-paying jobs that dont require a medical degree. For instance, the median annual wage for healthcare practitioners and related occupations in the U.S. is $66,440, compared to the overall median annual wage of $38,640 for all occupations.These positions not only benefit society, but they are also in high demand and well compensated.

To find which healthcare jobs have the highest salaries without requiring a medical degree, tutoring firm HeyTutoranalyzed data from the U.S. Bureau of Labor Statistics Occupational Employment Statistics and Employment Projections surveys. Its researchers looked only at healthcare practitioners and technical occupations requiring a masters degree or less. These 10 in-demand jobs all make over $75,000 per year.

Working in collaboration with a dentist, dental hygienistsassist patients by cleaning teeth, taking x-rays, and assessing oral health for signs of diseases such as gingivitis. In addition to having at least an associates degree, all dental hygienists must be licensed to practice. Half of dental hygienists work part-time, so this could be a good career path for a parent or caregiver. Dental hygienists have the highest total employment on this list.

Nuclear medicine technologistssupport physicians by preparing and administering radioactive chemicals to patients in order to diagnose health issues or provide treatment. For example, certain diagnostic tests like PET scans require the patient to ingest radioactive drugs to detect abnormalities like tumors. For some patients, radioactive drugs can be used for treatment instead of surgery. Even though nuclear medicine technologists have the lowest projected employment growth on this list, it is still higher than the projected growth rate for all occupations.

Speech-language pathologistsassistchildren and adults who struggle with speech or swallowing disorders. This occupation involves creating custom treatment plans for patients, which might include strengthening throat muscles, teaching vocabulary, or coaching patients on how to make sounds. Speech-language pathologists usually work in schools or hospitals.

One of the biggest determinants of health risks is family medical history. Genetic counselors analyze an individuals family medical history to analyze therisk of different genetic disorders and birth defects that could be inherited. Genetic counselors can assess risks for individuals ofany age, from infancy through adulthood. Genetic counselors have the lowest total employment on this list.

Radiation therapistswork in hospitals and other healthcare facilities to administer radiation treatments used toshrinkcancerous tumors. They must take precautions to ensure that only the desired area of treatment is targeted for the radiation, without affecting the rest of the body. Radiation therapists must have an associates degree, and some states require a license or certification exam.

Occupational therapists provide therapeutic services to ill or injured patients of all ages by integrating everyday activities into a holistic treatment plan. For example, occupational therapists might teach a patient with cerebral palsy how to get dressed or a child who struggles with fine motor skills how to hold a pencil. Occupational therapists might recommend special equipment like wheelchairs, identify improvements that can be made to the home or workplace, or teach new skills that all help improve quality of life for their patients.

Nurse midwivesare part of a subset known as advanced practice registered nurses (APRNs). Nurse midwives assist women in reproductive health by performing gynecological exams, offering prenatal care, and delivering babies. As with most of the other professions on this list, nurse midwives consult with physicians frequently to coordinate patients treatment.

Another type of APRN, nurse practitionershave many of the same responsibilities as a physician and can serve as a primary care provider. Nurse practitioners often focus on a specific age group, such as pediatric orgeriatric health. Nurse practitioners perform medical examinations, administer treatment, and counsel patients on health and wellness. Projected employment growth is 36.1 percent, significantly higher than the projected growth rate of 7.4 percentfor all occupations.

Physician assistants(PAs) work in a variety of healthcare settings to examine patients, diagnose illnesses, prescribe medication, and interpret diagnostic tests. PAs work under the supervision of a physician, but the amount of supervision required varies in each state. PAs must obtain a masters degree and a license in order to practice. Physician assistants have the highest projected employment growth on this list.

The third type of advanced practice nurse, nurse anesthetists are trained to provide anesthesia and pain management to patients undergoing surgery. The nurse anesthetist also stays with the patient for the duration of the procedure to check vitals and adjust the anesthesia if needed. Nurse anesthetists must earn a masters degree, a license, and a certification in order to practice. In addition, certified registered nurse anesthetists (CRNAs) must take a Continued Professional Certification (CPC) Program every 4 years in order to remain active.

The data used in this analysis is from the U.S. Bureau of Labor Statistics Occupational Employment Statistics and Employment Projections surveys. To find the highest-paying healthcare occupations that dont require a professional degree, only Healthcare Practitioners and Technical Occupationswere considered. Occupations requiring a professional degree were filtered out. The remaining occupations were ordered by their median annual wage for 2018 (rounded to the nearest thousand). Median annual wages and total employment are for 2018; whereas, the projected employment growth is for 2016-2026. Wage data cover non-farm wage and salary workers and does not cover the self-employed, owners and partners in unincorporated firms, or household workers.

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The Highest-Paying Healthcare Jobs That Don't Require a Medical School Degree - KMVU Fox 26 Medford

MedicalResearch.com Interview with:

Dr Ranjit Manchanda MD, MRCOG, PhDProfessor & Consultant Gynaecological OncologistNHS Innovation Accelerator (NIA) FellowIntegrated Academic Training Programme DirectorLondon Specialty School of Obstetrics & Gynaecology, Health Education EnglandCancer Research UK, Barts Centre | Queen Mary University of LondonDepartment of Gynaecological Oncology | Barts Health NHS Trust, Royal London HospitalLondon

MedicalResearch.com: What is the background for this study?

Response: Current national and international guidelines recommend genetic-testing (for BRCA genes) in women with breast cancer (BC) who fulfil recognised/established clinical criteria which are based on a history of cancer in the patient and family. However 50% of BRCA carriers do not fulfil these criteria. Thus the current family-history or clinical-criteria based approach misses half the people at risk. Additionally only 20%-30% of patients eligible tend to get referred for and access BRCA testing. Newer genes like PALB2 which cause breast cancer have been identified and can also be tested for.

Knowing a patients mutation status (carrier identification) can have a number of benefits. After unilateral breast cancer, mutations carriers can choose contralateral prophylactic-mastectomy (CPM) or preventative mastectomy of the second breast to reduce their risk of developing contralateral breast cancer. Additionally they can opt for surgical prevention for ovarian-cancer (OC). Cancer affected carriers may become eligible for novel drugs (like poly-adenosine-diphosphate-ribose-polymerase (PARP) inhibitors) and other precision-medicine based novel drug therapies through clinical trials. A major advantage of genetic-testing is enabling testing relatives of breast cancer mutation carriers, to identify unaffected relatives carrying mutations who can benefit from early diagnosis and cancer prevention.

Testing everyone instead of being restricted by family history will identify many more mutation carriers and their family members who can benefit from precision prevention. A large proportion of these cancers are preventable in known unaffected mutations carriers.

MedicalResearch.com: What are the main findings?

Response: In our study we compare two strategies of genetic testing in women with breast cancer.

Strategy-1: All women with breast cancer undergo BRCA1/BRCA2/PALB2 testing (multi gene testing).

Strategy-2: This is current practice where only those women who fulfil current family-history based clinical-criteria undergo BRCA-testing.

For the first time we show that moving to a strategy for multigene testing for all women with breast cancer diagnosed annually (irrespective of family history or any criteria) can prevent an additional 1142 breast cancer and 959 ovarian cancer cases and 633 (breast/ovarian cancer) deaths in the UK; and prevent 5,478 breast cancer and 4,275 ovarian cancer cases and 2,406 (breast/ovarian cancer) deaths in the USA.

We have performed a comprehensive cost-effectiveness analysis and show that this new strategy would remain well below UK/NICE (National Institute of Health & Care Excellence) and US cost-effectiveness thresholds which are 20,000-30,000/QALY (quality adjusted life year) and $100,000/QALY respectively. The incremental cost-effectiveness ratios are 10,464/QALY (from a payer-perspective) or 7,216/QALY (from a societal-perspective) in the UK or $65,661/QALY (form a payer-perspective) or $61,618/QALY (from a societal-perspective) in USA women.

MedicalResearch.com: What should readers take away from your report?

Response: Our findings support changing current policy to expand genetic-testing to multigene testing (BRCA1, BRCA2 and PALB2 mutations) for all women with breast cancer. This approach will save many more lives and is cost-effective.

A similar approach has recently been implemented for ovarian cancer over the last few years and now we need to do it in breast cancer too.

Oncologists, surgeons and clinical nurse-specialists may need to provide pre-test counselling and genetic-testing, with genetic-services focusing on post-test counselling and support for women found to carry gene mutations. Such a model has been implemented in ovarian cancer pathways. There are other models too which have been successfully used to deliver genetic testing and counselling in ovarian cancer and can be extrapolated or explored for breast cancer. Implementation will need to be accompanied by a process of training and education for relevant clinicians/health professionals involved in the breast cancer care pathway so that they can understand the implications for management.

Costs of testing are falling and technological advances can now deliver large volume high throughput genetic testing. All this provides huge new opportunities for cancer prevention and changes in the way we deliver cancer genetic testing in health care. This approach can ensure that more women can take preventative action to minimise their future cancer risk through prevention or early diagnosis options.

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: What is needed is development and evaluation of implementation models and pathways to deliver this. Newer context specific delivery models will be needed for implementing this approach.

We are interested in evaluating and undertaking analysis in other countries too and also in the development and evaluation of context specific implementation pathways for unselected testing at breast cancer diagnosis including in low and middle income countries.

Disclosures these are listed in the paper. Please see paper.

I have received research funding from The Eve Appeal and Cancer Research UK into population testing and from Barts & the London Charity and Rosetree Charity outside this work, as well as an honorarium for grant review from Israel National Institute for Health Policy Research and honorarium for advisory board meeting for MSD and Astrazeneca. My work is supported through a NHS Innovation Accelerator Fellowship.

Disclosures from other co-authors-

Dr Buist and Dr Bowels- Grants from NCI. Dr Evans- Honorarium from Astrazeneca and grants from Manchester National Institute of Health Research Biomedical Research Centre. Dr Eccles- Grants from Cancer Research UK. Dr Cuzick and Dr Brentnall- Grants from Cancer Research UK.

Citation:

Sun L, Brentnall A, Patel S, et al. A Cost-effectiveness Analysis of Multigene Testing for All Patients With Breast Cancer.JAMA Oncol.Published online October 03, 2019. doi:10.1001/jamaoncol.2019.3323

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Study Finds Multigene Testing For All Women With Breast Cancer Can Save Lives and Money - MedicalResearch.com