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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

Pembrokeshire residents urged to take a virtual GP consultation when offered

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PEMBROKESHIRE residents are being urged to take up the offer of a virtual consultation, over the phone or video call with their GP, to help Keep Wales Safe during the current lockdown ‘stay at home’ restrictions.

The way we access local NHS services is changing, with more ways in which you can consult your doctor or nurse. Most surgeries now offer telephone as well as electronic advice consultations in the first instance. Following your advice call, a face to face appointment may be organised, but video consultations are also available. You can now speak to a doctor or healthcare professional using the video camera in your smartphone, tablet or computer and a connection to the internet. This is often more convenient and can save you time, as you will not need to travel for a face-to-face appointment. The system used is confidential and secure.

In a recent YouGov survey carried out for the Welsh Government’s Keep Wales Safe campaign only 27% of residents in Mid and West Wales had made use of the GP virtual service over the past 12 months with just 57% having heard of the service. However, 88% believed it was important to have access to a remote GP consultation once they had learnt of its existence.

Jill Paterson, Director of Primary Care, Community and Long Term Care at Hywel Dda University Health Board, said: “If you are offered a video consultation appointment this is because your Health Care Professional has indicated that is it safe and appropriate to do so. Your video appointment will be confidential and will not be recorded. If you require support please contact your GP surgery using the number provided in the appointment confirmation.”

She continued: “By putting off small problems or regular appointments you could potentially be putting more strain on NHS emergency services so please, help us to help you, do not put anything off. Local GP surgeries are open and are there to offer medical advice and consult patients.”

After being offered a video consultation you will be sent a letter, email or text with details of your appointment. This communication will contain details of the service that has requested to see you by video and have provided a web address link. You can type or copy the web address link into a web browser via an internet enabled device and this will take you to the video clinic waiting area.

  • In order to access your virtual appointment, you will need:
  • Access to a device that will allow you to access the internet. You should use Google Chrome or Microsoft Edge web browser on a desktop or laptop, or on an Android tablet or smartphone or Safari web browser on an Apple iMac, MacBook, iPad, or iPhone.
  • Your device will need a webcam (camera), speakers and microphone.
  • A good internet connection (if you can watch a YouTube video, this is good indication that you have a good connection).
  • An internet usage plan that is sufficient to cover the data consumption of a video call – ideally use a Wi-Fi connection if you have this available.

Sixty two percent of those surveyed by YouGov in Mid and West Wales said they will continue to access NHS services using the new ways that have been introduced as a result of the pandemic. The new methods include making more use of pharmacists; virtual GP consultations and using the NHS 111 online and telephone services.

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Health

All local hospitals to become smoke-free from March

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PEOPLE living across Carmarthenshire, Ceredigion and Pembrokeshire are being reminded that today marks just two weeks until all hospital grounds in the three counties become smoke-free.

New laws, being introduced across Wales on Monday 1st March, build on the smoking ban introduced in 2007, and will result in all parts of Glangwili, Bronglais, Withybush and Prince Philip hospitals becoming smoke-free.

The law will also apply to all other Health Board run facilities.

The move is part of a national drive to create a healthier Wales and healthier future by protecting everyone from harmful, second-hand smoke, supporting those trying to quit, as well as reducing the normalisation of smoking, which is why the smoke-free law includes schools, public playgrounds, and outdoor areas of children’s daycare and childminding settings.

Anyone found breaking the law by smoking on these grounds could face a £100 fine.

Ros Jervis, Director of Public Health at Hywel Dda UHB, said: “This is great news for people in the three counties and Wales as a whole. Preventing people smoking on our hospital grounds will promote healthier care environments, protect hospital users from harmful second-hand smoke and support those using NHS services to quit.”

“We know the harms smoking can do to health, so I look forward to having the backing of our staff, patients and visitors, to ensure we all play our part in building a healthier Wales for the future.

Many smokers have already been motivated to give up smoking due to the COVID-19 pandemic and it is hoped this new legislation will encourage even more to do so. We have learnt that smoking can increase the risk of contracting COVID-19 and also the severity of the disease.

Quitting with support provides the best chance of stopping smoking for good, which is why we are making smoking support services available to those who would like help.

The Hywel Dda Healthy Lifestyle and Wellbeing Team (Smoking) can provide expert and confidential NHS behavioural support and access to medication to help stop smoking or access to stop smoking medication.  Support is currently provided via telephone.  The service can be contacted via 0300 303 9652, which is a freephone number.

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Health

Over £10m being spent on 84 new ambulances in Wales

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THE WELSH AMBULANCE SERVICE will receive 84 new operational vehicles thanks to a £10.9M investment from the Welsh Government.

The Minister for Health and Social Services, Vaughan Gething has also announced a further £1.6m in funding to the Emergency Medical Retrieval and Transfer Service (EMRTS) to expand the service into a 24/7 operation and establish the Critical Care Transfer Service. This is additional money following the £1.7m already given to the service. This service will support the national transfer of critically ill adults across Wales.

The Emergency Medical Retrieval and Transfer Service (EMRTS) provides consultant and critical care practitioner-delivered pre-hospital critical care across Wales. It was launched at the end of April 2015 and is a partnership between Wales Air Ambulance Charity, Welsh Government and NHS Wales.

The funding will be used to fund three specialist critical care ambulances and will see investment in equipment to support the expansion of the EMRTS service

Minister for Health and Social Services, Vaughan Gething, said: “The Welsh Ambulance Service has experienced a huge surge in demand on its services due to the Covid-19 pandemic. The funding announced today will allow the service to upgrade its existing fleet, allowing the service to deliver the best care for people in Wales.

“I’m also pleased to announce further funding which will establish a new Critical Care Transfer Service and see the expansion of EMRTS to a 24/7 operation, in partnership with the Wales Air Ambulance Charity.”

Chris Turley, the Welsh Ambulance Service’s Executive Director of Finance, said: “Our ambulances and response cars in Wales are some of the most modern and well equipped in the UK and this funding will allow us to continue to replace our vehicles as they reach the end of their working life

“Modern ambulances are essential in order that we can continue to provide the best treatment and patient experience possible.

“They’re also important for staff who spend the majority of their working day out and about in the community.
“It’s never been more important than ever to have a fleet which keeps the wheels turning on our ambulance service, and we’re grateful to Welsh Government for its continued support.”

Professor David Lockey, EMRTS National Director, said: “The funding has allowed us to extend our critical care provision into a 24/7 service. This, along with our partnership with the Wales Air Ambulance Charity, has helped us improve equality of access to rapid emergency-department standard care across the country.

“In addition, the funding for three specialist critical care ambulances will give us the capacity to support colleagues across NHS Wales with the transfer of critically ill patients between hospitals by road.

“We are very grateful for the ongoing support from Welsh Government, which has allowed our service to grow and make a significant contribution to critical care in Wales.”

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