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Research solves pancreatic cancer mystery

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A NEW technique to study tissue samples in 3D has revealed that pancreatic cancers can start and grow in two distinct ways, solving a decades-old mystery of how tumours form.

The new method could help researchers to get more information from tissue biopsies and may lead to improved treatments for pancreatic cancers. The technique was developed by scientists at the Francis Crick Institute, and their results are published in Nature. The work was supported by the European Research Council and core funding from the MRC (one of the Crick’s founding partners).

The pancreas is a crucial organ that sits behind our stomach and plays a key role in digestion. It relies on a network of ducts linking it to other digestive organs, and the most common pancreatic cancers are found in the ducts. However, until now it has only been possible to see 2D slices of these ductal cancers, which contained an unexplained variety of abnormal shapes.

“To investigate the origins of pancreatic cancer, we spent six years developing a new method to analyse cancer biopsies in three dimensions,” explains Dr Hendrik Messal from the Francis Crick Institute, co-lead author of the research paper. “This technique revealed that cancers develop in the duct walls and either grow inwards or outwards depending on the size of the duct. This explains the mysterious shape differences that we’ve been seeing in 2D slices for decades.”

By analysing developing cancers in 3D, the team defined two distinct types of cancer formation: ‘endophytic’ tumours which grow inwards and ‘exophytic’ tumours which grow outwards. To find out what makes cancer cells grow in a particular way, they analysed detailed 3D images and worked with biophysicists at the Crick who created sophisticated computer models.

“We made a simulation of the ducts, describing individual cell geometry to understand tissue shape,” explains biophysicist Dr Silvanus Alt, co-lead author of the paper. “The model and experimental results both confirmed that cancer grew outwards when the diameter of the duct was less than approximately 20 micrometres, around a fiftieth of a millimetre.”

The work was made possible by an interdisciplinary collaboration between two research groups at the Crick, led by Dr Axel Behrens and Dr Guillaume Salbreux. Axel’s group works on stem cells and pancreatic cancer, while Guillaume focuses on using physics to understand biological processes.

“I think we first started discussing this when we bumped into each other in the bike shed,” says Axel. “It’s amazing what can come out of a chance encounter, we now have a patented technique to see the three-dimensional shapes of cancers and a biophysical understanding of the emergence of tumours. Now that we know pancreatic cancer can develop in these two different ways, we can start looking at whether one is likely to be more aggressive or spread in a different way. Many years from now, this could lead to improved diagnostic or treatment options.”

The team also applied the technique to other organs and found that cancers in the airways of the lungs and ducts in the liver behave in the same way. This shows that the mechanism the teams discovered is not specific to the pancreas and also applies to other cancers.

“Both the data and our models indicate that the two different mechanisms of tumour growth are purely down to the innate physics of the system,” explains Dr Guillaume Salbreux. “Like most cancers, ductal pancreatic cancer starts with a single defective cell that starts dividing. We found that very quickly, when there are only a few cells, the tumour has already started to grow either inwards or outwards depending on duct diameter. Defining this fundamental process will help us to better understand how cancer grows in many places across the body.”

Dr Mariana Delfino-Machin, Programme Manager for Cancer at the MRC, said: “Pancreatic cancer remains a very difficult disease to treat but understanding that it can grow in different ways will inform the development of more accurate treatments in the future.

“These findings came about thanks to researchers working in very different fields coming together to successfully tackle the same problem.”

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Health

Coronavirus update and face mask shortage

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THE OUTBREAK of coronavirus in China continues to evolve and cases have been reported in over 20 countries around the world.
Although the risk to the public remains moderate, Wales’ medical authorities continue to plan and implement targeted services so that they can mount a swift and proportionate response.
Following weeks of preparation, the virology laboratory at University Hospital of Wales commenced testing for COVID-19 on February 7.
Before this, Public Health England undertook testing.
Wales’ Chief Medical Officer, Dr Frank Atherton, said: “I would like to thank Public Health Wales for their expertise and dedication in providing this important testing service and for developing and supporting the wider NHS response. More than 100 people have so far been tested in Wales and we have had no confirmed cases to date.
“I wrote to the NHS in the week ending February 7, advising on the importance of immediate implementation of community assessment and testing services and the establishment of Coronavirus Testing Units separate from Emergency Departments.
“Implementing community assessment and testing services allows for people with mild symptoms to remain self-isolated at home where they are attended by trained clinical professionals who can assess their health and undertake the necessary tests.”
Dr Atherton continued: “Coronavirus Testing Units will ensure that individuals who present to our acute hospitals because of concerns they are at risk can receive prompt assessment in an area separate from Emergency Departments. Both measures benefit the individuals without impacting on the day to day services provided by our NHS.
The advice for travellers remains unchanged – all travellers who develop flu-like symptoms however mild, (these symptoms could be a fever, a cough, or difficulty breathing) within 14 days of returning from mainland China, Thailand, Japan, Republic of Korea, Hong Kong, Taiwan, Singapore, Malaysia or Macau, should self-isolate at home immediately and call NHS Direct Wales or 111, if available in their area. It is important to note that travellers from Wuhan and Hubei province should self-isolate for 14 days, even if they do not have symptoms, due to the increased risk from that area.”
As for what steps the public can take to reduce the risk of transmission, those remain the same as for any respiratory virus. Dr Atherton said: “The advice is to catch it, bin it, kill it and wash your hands.
“I will continue to coordinate action with my fellow UK Chief Medical Officers in response to the developing situation. I will keep you regularly informed of developments.”
FACE MASK SHORTAGE HITS DENTISTS
The British Dental Association (BDA) has warned the shortage of face masks sparked by the coronavirus outbreak now poses an imminent risk of disruption to UK dental services unless officials and industry are prepared to ease rationing.
The Association reports it has been inundated by calls from member practices unclear on their options, in the wake of panic buying and supply problems. The People’s Republic of China is the world’s leading manufacturer of sanitary masks, and several suppliers have tripled their prices since January.
Based on contact with leading suppliers the BDA reports a ‘one size fits all’ model of rationing has now already left practices unable to order more than 2 boxes of masks per day (ie: 100 masks) irrespective of their size.
The Association estimates a single surgery in a typical NHS practice, seeing around 28 patients per day, will be getting through 5 boxes of masks a week. Private practices, which typically see fewer patients, are consuming half as many, around 2.5 boxes a week.
While smaller practices may be able to maintain viability on permitted orders of 10 boxes per week (2 per working day), even ‘two-chair’ NHS practices are now likely to use up their allocation completely.
The BDA is dealing with enquires from practices with up to 13 chairs.
‘Single-handed’ practices make up less than 20% of all UK providers.
Under the current guidance, Health Technical Memorandum 01-05 (HTM 01-05), all dental professionals operating in England should wear Personal Protective Equipment (PPE) including disposable face masks, clinical gloves, household gloves, plastic disposable aprons, and eye protection.
In Scotland, practitioners are permitted to use disposable masks or reusable visors interchangeably.
The BDA has indicated it will ask the Welsh Government and NHS England to invoke force majeure clauses in NHS contracts should the situation deteriorate further, to protect multiple practices left unable to meet their contractual targets in the event of disruption.
BDA Chair Mick Armstrong said: “In recent weeks dentists have been hit by panic buying, clumsy rationing and naked profiteering. Sadly a ‘one size fits all’ approach from suppliers is leaving many larger practices with few options.
“Our abiding interest is the safety of our patients, who face imminent disruption to their care.
“Unless we see a rapid increase in supply, dentists without face masks will have little choice but to down drills.”

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Community

Extended park and ride service for Glangwili Hospital

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An extended shuttle service will run directly between Nantyci car park and Glangwili Hospital starting Monday 3 February.

This service, funded by Hywel Dda University Health Board (UHB), is in response to staff feedback following a temporary suspension of parking measures at both Glangwili and Prince Philip hospitals.

The Carmarthen park and ride service PR2 will leave Nantyci car park (SA31 3SA) at 0700, then every half hour from 1830 to 2130. The buses will return from the hospital at 0714 then every half hour from 1844 to 2144.

Andrew Carruthers, Director of Operations at Hywel Dda UHB, said: “Following the temporary suspension of parking measures at Glangwili and Prince Philip hospitals we immediately spoke with our staff to find out what could be put in place to reduce the number of staff who have no alternative but to park on site.

“The operating hours of the park and ride were a recurrent theme for Glangwili staff with many saying that they couldn’t make use of it if they worked shifts.

“We hope to see many more of our staff using the park and ride following our investment to extend the hours while we continue to explore further options to help alleviate parking pressures at Glangwili.”

The PR1 park and ride service will continue its current operating hours between 0730 to 1825, departing Nantyci on the hour and on the half hour towards the hospital via the town centre. The PR1 service will leave Glangwili Hospital to return to Nantyci at quarter past and quarter to the hour.

For passengers starting their journey at Nantyci car park, parking remains free and bus travel to and from the town centre (service PR1) or the hospital (services PR1 and PR2) will be only £1 for a day return ticket, with free travel for children under 16 if accompanied by an adult. This journey is free for all Hywel Dda employees, simply show your ID badge.

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Health

Life of Carmarthen mother turned on its head after starring in TV health series

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A Carmarthen woman who starred in a health and fitness TV programme last year is urging people to put their names forward for the new series.

Annaly Jones’ life has been turned on its head after being selected to take part as one five leaders on S4C’s FFIT Cymru last April. Viewers followed Annaly’s progress closely as she managed to lose two stone in just seven weeks by following bespoke fitness and food plans provided by a team of experts from the show.

She has continued her progress since by eating healthily and limiting takeaways and snacks, swapping wine for lower calorie drinks on nights out and exercising regularly. Last September, she completed the Cardiff 10k run with two of her fellow leaders from the show, Matthew and David.

Prior to appearing on the show, the busy single mother struggled to find time to exercise and cook healthy meals, while working two jobs and raising her three sons.

Annaly said: “I used to try different diets – Weight Watchers, Slimming World, and I would reach a certain level and reward myself with a bottle of wine and a takeaway and after a while I would just go back to eating how I was before. I wasn’t doing any exercise either, I didn’t have the confidence to go the gym because the perception was that everyone was healthy and thin.

“I decided to enter FFIT Cymru because one of my friends had applied the year before, and looking back now, I’m so glad I did. It’s changed my life altogether, the way I think about food, exercise and about myself generally.

“I’m still not the size I want to be, I’d like to go down one more size, but I can go clothes shopping now knowing that the clothes look better on me than last year. I don’t stick to the diet completely and I don’t stop myself from having fun or having the odd takeaway. If I eat something that’s a bit naughty, I work it off in a different way, by making sure my other meals that day are healthy, or doing some exercise.

“I understand now which foods are healthy but also tasty. I’ve learnt to like myself too – I deserve to be happy and to be successful.”

Since the series ended last year, Annaly has also made a big change in her career, by moving to Nantgaredig to take over the lease of the Railway Hotel, with friend Melanie Phillips Rees. Annaly believes that her starring role in the TV series gave her the confidence boost she needed to make such a big decision.

“We took over on the first of October and it’s been brilliant,” she added. “We have some fantastic locals supporting us and there’s no mention of Dry January!

“It was a massive step for me to do FFIT Cymru, and it’s given me this ‘why not’ attitude. I’ve definitely rediscovered a lot of my self-confidence since then. When we were offered the lease of the pub, I thought, ‘why not?’. I think not trying at all is worse than trying something and failing.

“I’ve had a career change, I’ve moved house and I’ve carried on losing weight – I’m just happier in myself now.

“I could inspire just one person to go for it and apply for the show this year, I’d be so chuffed. It was an amazing experience, one that you only get to do once. I’m a bit jealous of the ones who get to do it this year to be honest!”

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