Computers in your clothes? A milestone for wearable electronics

Researchers who are working to develop wearable electronics1 have reached a milestone: They are able to embroider circuits into fabric with 0.1 mm precision – the perfect size to integrate electronic components such as sensors and computer memory devices into clothing.

With this advance, the Ohio State University researchers have taken the next step toward the design of functional textiles – clothes that gather, store, or transmit digital information. With further development, the technology could lead to shirts that act as antennas for your smart phone or tablet, workout clothes that monitor your fitness level, sports equipment that monitors athletes’ performance, a bandage that tells your doctor how well the tissue beneath it is healing – or even a flexible fabric cap that senses activity in the brain2.

That last item is one that John Volakis, director of the ElectroScience Laboratory at Ohio State, and research scientist Asimina Kiourti are investigating. The idea is to make brain implants, which are under development to treat conditions fromepilepsy to addiction, more comfortable by eliminating the need for external wiring on the patient’s body3.

“A revolution is happening in the textile industry,” said Volakis, who is also the Roy & Lois Chope Chair Professor of Electrical Engineering at Ohio State. “We believe that functional textiles are an enabling technology for communications and sensing – and one day even medical applications like imaging and health monitoring.”

Recently, he and Kiourti refined their patented fabrication method to create prototype wearables at a fraction of the cost and in half the time as they could only two years ago. With new patents pending, they published4 the new results in the journalIEEE Antennas and Wireless Propagation Letters.

In Volakis’ lab, the functional textiles, also called “e-textiles,” are created in part on a typical tabletop sewing machine – the kind that fabric artisans and hobbyists might have at home. Like other modern sewing machines, it embroiders thread into fabric automatically based on a pattern loaded via a computer file. The researchers substitute the thread with fine silver metal wires that, once embroidered, feel the same as traditional thread to the touch.

“We started with a technology that is very well known – machine embroidery – and we asked, how can we functionalize embroidered shapes? How do we make them transmit signals at useful frequencies, like for cell phones or health sensors?” Volakis said. “Now, for the first time, we’ve achieved the accuracy of printed metal circuit boards, so our new goal is to take advantage of the precision to incorporate receivers and other electronic components.”

Patients with EGFR expressing non-small-cell lung cancer benefit most from necitumumab added to chemotherapy

Patients with epidermal growth factor receptor (EGFR) expressing advanced squamous non-small-cell lung cancer benefit most from necitumumab added to gemcitabine and cisplatin chemotherapy, according to a subgroup analysis from the SQUIRE trial presented today at the European Lung Cancer Conference (ELCC) 2016 in Geneva, Switzerland.1

The randomised phase III SQUIRE trial demonstrated that the addition of necitumumab to gemcitabine and cisplatin chemotherapy improved overall survival in patients with stage IV squamous non-small-cell lung cancer by 1.6 months compared to chemotherapy alone. The current study analysed outcomes in the subgroup of patients with EGFR expressing tumours compared to those with no EGFRs.

Out of 982 patients in the SQUIRE trial, 95% had EGFR expressing tumours and 5% had tumours with no EGFR protein. The addition of necitumumab to gemcitabine and cisplatin chemotherapy improved overall survival and progression free survival by 21% and 16%, respectively, as compared to chemotherapy alone in patients whose tumours expressed the EGFR protein. There was no benefit in patients with no EGFR in their tumours.

Dr Luis Paz-Ares, Chief of medical oncology at the University Hospital 12 De Octubre in Madrid, Spain, lead author, said: “Necitumumab is targeted at EGFR so it makes sense that the drug is active in patients with the receptor. Our analysis showed that the drug had no effect when the receptor was absent, presumably because there was no target to bind to. We cannot make robust conclusions because the subgroup of patients with negative EGFR was very small, but the hypothesis generated here is that those tumours do not respond well to necitumumab.”

“Based on this analysis, the European Medicines Agency has decided that necitumumab is approved only for patients with EGFR expressing tumours,” continued Paz-Ares. “On the other hand the US Food and Drug Administration has taken the more conservative approach which recognises that SQUIRE was designed for all-comers without prior selection, and this subgroup analysis is insufficient evidence to conclude that patients with EGFR negative tumours are not candidates.”

He concluded: “Our results need to be interpreted with caution. A confirmatory study in patients with EGFR negative tumours is needed to assess whether they are good candidates for necitumumab or not.”

Commenting on the findings, Prof Robert Pirker, programme director for lung cancer at the Vienna General Hospital in Vienna, Austria, not involved in the study, said: “This subgroup analysis shows that the effect of necitumumab was slightly greater in patients with EGFR expressing tumours than it was in the entire SQUIRE population. It indicates that immunohistochemical detection of the EGFR receptor improves clinical activity of necitumumab. The findings are consistent with previous studies suggesting that monoclonal antibodies in combination with chemotherapy work better in patients with EGFR expressing cells.”

Pirker added that a more thorough analysis is needed. He said: “Information on outcome of patients with cut-off levels higher than in the current analysis would be of interest. We also need to know the effect of necitumumab according to both percentages of positive cells and their staining intensity. This could be combined with fluorescence in situ hybridisation (FISH) analysis to detect gene amplification. This could give us a clearer picture of which patients benefit most from necitumumab.”

Antibiotics may have lasting impact on the immune system of children

Scientists want to know whether taking antibiotics early in life can disrupt your immune system function lifelong.

Regardless of our age, antibiotics at least temporarily wipe out many of the good gut bacteria, or microbiota, that help us digest and use food and eliminate waste. That may be particularly problematic for children because, up to about age 3, this useful group of bacteria also is helping educate their immune system about what to ignore and what to attack, said Dr. Leszek Ignatowicz, immunologist in the Center for Biotechnology and Genomic Medicine at the Medical College of Georgia at Augusta University.

That means early antibiotic use may also have a lasting impact on the diversity of children’s immune cells, specifically their T cells, that do both, potentially increasing their lifelong risk of inflammatory bowel disease, allergies and more, said Ignatowicz, principal investigator on a new $1.8 million grant from the National Institutes of Health that will help parse the impact.

“There has to be that balance, and we think that in the early stage of life, balance is achieved by the microbiota dynamically educating plenty of peacekeeping regulatory cells,” Ignatowicz said.

The grant is enabling scientists to give commonly used, broad-spectrum antibiotics to younger and older mice, look at what that does to the diversity of the T cells in the gut, how long any impact lasts and whether the long-term result is a host of potential diseases that can result from an overactive or underperforming immune system.

“We hypothesize that adult mice with a well-developed immune system will quickly rebuild their diversity as the flora rebuilds,” he said. “But we propose that in younger mice, this will not occur as completely as it does in adults. That could mean that in young children, instead of millions of different bacteria in the gut, their T cells only interact with say 100,000, which will impact their diversity,” Ignatowicz said.

T cells have the ability to call the immune system to action or keep it nonresponsive. The healthy gut has more of the peacekeeping regulatory T cells to ensure control of the more aggressive effector cells. Ignatowicz notes this does not make the immune system centered in the gut weak, just balanced, both poised to attack invaders and ignore useful guests, like the gut microbiota.

T cell education is supposed to work this way in the gut: Another type of immune cell, dendritic cells, literally holds up pieces of the bacteria mix – both from the individual and his/her environment, which essentially enables the immune system to grow accustomed to and accepting of the gut microbiota.

Without a diverse microbiota, T cells may never learn to ignore these common environmental triggers, so rather than helping prevent inflammation – an early sign of attack – T cells will be more likely to promote inflammation that can result in a host of so-called autoimmune diseases, where the body essentially attacks itself, including Crohn’s, psoriasis and rheumatoid arthritis.

However, an ample microbiota can even help convert some T cells that learned to be effectors in the thymus gland – where T cell education begins – to regulatory cells, he said.

In fact, another primary aim of the new studies is to determine what percentage of the regulatory cells come directly from the thymus and how many get converted to peacekeepers in the gut. There is conflicting data, but Ignatowicz thinks most come from the thymus, a tiny gland behind the breastbone, but still have plenty to learn when they get to the gut.

The fetus’ gut is sterile, so microbiota begin to populate with the act of birth. In fact babies born by C-section start out with a different colony of microorganisms than those who came through the reproductive tract since there are different bacteria in the two locales. The microbiota further develop based on what touches the baby and vice versa, even kisses, as well as the bacteria on the food the baby eats and in his environment.

Broad-spectrum antibiotics, which might be given for anything from a skin infection to bronchitis and tonsillitis, are notorious for wiping out the microbiota, which is why they often cause temporary diarrhea even in adults.

Microbiota also quite literally take up important gut space, leaving less room for invaders, such as the feces-borne bacterium C. difficile, which is often spread by touch and in health care settings, causing diarrhea, fever and abdominal pain. In fact, taking an antibiotic is one of the more common reasons hospitalized patients get C. difficile. In a laboratory setting at least, scientists have shown mice missing their normal microbiota will even colonize with flora from the lake or soil, Ignatowicz said. While the mice live with their new flora, there are problems with an underdeveloped immune system.

Atomically-thin sensor detects harmful air pollution in the home

Scientists from the University of Southampton, in partnership with the Japan Advanced Institute of Science and Technology (JAIST), have developed a graphene-based sensor that can detect harmful air pollution in the home with very low power consumption.

The sensor detects individual CO2 molecules and volatile organic compound (VOC) gas molecules found in building and interior materials, furniture and even household goods, which adversely affect our living in modern houses with good insulation.

These harmful chemical gases have low concentrations of ppb (parts per billion) levels and are extremely difficult to detect with current environmental sensor technology, which can only detect concentrations of parts per million (ppm).

In recent years, there has been an increase in health problems due to air pollution in personal living spaces, known as sick building syndrome (SBS), along with other conditions such as sick car and sick school syndromes.

The research group, led by Professor Hiroshi Mizuta, who holds a joint appointment at the University of Southampton and JAIST, and Dr Jian Sun and Assistant Professor Manoharan Muruganathan of JAIST, developed the sensor to detect individual CO2 molecules adsorbed (the bond of molecules from a gas to a surface) onto the suspended graphene (single atomic sheet of carbon atoms arranged in a honeycomb-like hexagonal crystal lattice structure) one by one by applying an electric field across the structure.

By monitoring the electrical resistance of the graphene beam, the adsorption and desorption (whereby a substance is released from or through a surface) processes of individual CO2 molecules onto the graphene were detected as ‘quantised’ changes in resistance (step-wise increase or decrease in resistance). In the study, published today in Science Advances, the journal of the American Association for the Advancement of Science (AAAS), a small volume of CO2 gas (equivalent to a concentration of approximately 30 ppb) was released and the detection time was only a few minutes.

Professor Mizuta said: “In contrast to the commercially available environmental monitoring tools, this extreme sensing technology enables us to realise significant miniaturisation, resulting in weight and cost reduction in addition to the remarkable improvement in the detection limit from the ppm levels to the ppb levels.”

Research group members, Dr Harold Chong from Southampton and Dr Marek Schmidt and Dr Jian Sun of JAIST, have also recently developed graphene-based switches (published in the March issue of Nanoscale, the journal of the Royal Society of Chemistry) using a uniquely thin film developed at the University of Southampton.

The switches, which require remarkably low voltages (below three volts), can be used to power electronic components on demand, greatly improving the battery lifetime of personal electronic devices.

Professor Mizuta and the research group are now aiming to bring the two technologies together to create ultra-low-power environmental sensor systems that can detect single molecules.

Heart attack patients more depressed but get less antidepressants

Heart attack patients are more depressed but are less often prescribed antidepressants than people who have not had a heart attack, according to research presented today at EuroHeartCare 2016 by Dr Barbro Kjellström, a researcher at the Karolinska Institute in Stockholm, Sweden.

“Stress related disorders such as depression and exhaustion are increasingly common and have been the main reason for long-term sick leave in Sweden for more than a decade,” said Dr Kjellström. “We know that stress and depression are big risk factors for heart attack and we confirmed this connection in our study. But what was new and astonishing was that heart attack patients less often receive treatment for depression.”

The research presented today was a substudy of the PAROKRANK study which found that periodontitis increased the risk of having a first myocardial infarction by 30%. The study included 805 patients under 75 years of age who had experienced a first myocardial infarction and 805 people without a myocardial infarction (the control group) matched for age, gender and where they lived.

Detailed information was collected on stress, depression and exhaustion using well established, validated questionnaires. Study participants were asked to grade the level of stress they felt at home and at work and about their economical situation. They were also asked about stressful events during the past year and their feeling of control in life, both at work and at home.

The study participants were 62 years old on average and 81% were men. The researchers found that 14% of patients had symptoms of depression compared to just 7% of controls. Symptoms of depression or exhaustion were associated with a doubled risk of heart attack. When the researchers looked at types of stress, they found that more patients than controls had experienced stress at home (18% compared to 11%) and at work (42% versus 32%). Even moderate levels of stress at home were associated with a doubled heart attack risk.

Dr Kjellström said: “Patients who had a heart attack had more stress both at work and at home but interestingly there was no difference between the two groups as regards to financial stress. Patients also reported that they had less control of their work situation. In addition, those who had a heart attack were more likely to be divorced whereas people in the control group more often lived with a partner.”

She continued: “When asked ‘Were you angry during the last 24 hours?’ many more patients said yes compared to controls. It appears that stress in life can also trigger feelings of anger in patients who have had a heart attack.”

Just 16% of heart attack patients with depression received antidepressants compared to 42% of controls with depression. Dr Kjellström said: “Our results suggest that heart attack patients are undertreated with antidepressants. When we looked at the participants in the study who had experienced depression we saw that more than twice as many controls as patients were prescribed antidepressant medication. We did not ask about cognitive therapies but it’s unlikely that the large gap in treatment was filled in this way.”

She continued: “It appears that patients who had a heart attack did not seek help for their depression, or if they did, their symptoms were not accurately recognised and managed. An important take home message is for clinicians to ask patients ‘How do you feel?’ and listen to the reply, rather than zoning out because they are stressed themselves.”

“There is no treatment for stress,” added Dr Kjellström. “If you have enough stress you might get exhaustion which, if not treated, can result in depression. This is an escalating scale. Prevention of stress, exhaustion and depression is the optimal goal and we should remember that these are risk factors for many other diseases than heart attack.”

Dr Kjellström concluded: “People today have stresses that did not exist before which may explain some of our findings. We’re always connected – people check their phones constantly during the day and even in the middle of the night. We don’t switch off and relax. The effects of this on our health need to be investigated further.”