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Reporting on a small preliminary study, Johns Hopkins researchers say a simple blood test based on detection of tiny epigenetic alterations may reveal the earliest signs of pancreatic cancer, a disease that is nearly always fatal because it isn't usually discovered until it has spread to other parts of the body.

One of these days, there could well be a simple blood test that can help diagnose and track cancers. We aren't there yet, but a burst of research in this area shows we are getting a lot closer.

A quick and simple blood test could soon diagnose which cancer a patient has and how advanced the disease is, scientists said.

In this directed case study students follow a nurse practitioner and work with a diagnostics team to determine what is wrong with Tristan, an infant who comes to the clinic with multiple bruises. Students are given background and patient history, and are then given results of various blood tests ordered by the diagnostics team. The exercise emphasizes the physiological process of coagulation and the importance of various clotting factors, especially factor VIII. Students will be introduced to results from several blood tests, including: complete blood count, partial thromboplastin time, prothrombin time, metabolic panel, and factor VIII assay. The patient is ultimately diagnosed with severe hemophilia A and the case then introduces students to this disorder, the genetic determinants, the incidence, and ways to manage the disease. The data in this case are real and the story represents the medical history of an actual patient. Originally developed for pre-nursing students, this activity would also be suitable for majors in physiology or pre-medical students; it could also be used in an introductory genetics or biology course.

The test, dubbed VirScan, and research surrounding it is the subject of a new report published in the journal Science. For the study, scientists screened sera, a part of the blood, from 569 people in the U.S., South Africa, Thailand, and Peru and tested for more than 200 types of viruses.

An exciting new test might help us save antibiotics. Needing only a drop of blood, researchers at Duke have developed a rapid assay that can tell viral infections-which generally can't be treated-from bacterial ones that may benefit from antibiotics. While I don't usually write about drugs or products in development, this test piqued my interest and left me excited about its potential to help contain antibiotic overuse.

The idea of a general, quick and simple blood test for a diverse range of cancers just came closer to reality with news of a new study published in Nature Medicine.

Can't remember every viral infection you've ever had? Don't worry, your blood can. A new test surveys the antibodies present in a person's bloodstream to reveal a history of the viruses they've been infected with throughout their life. The method could be useful not only for diagnosing current and past illnesses, but for developing vaccines and studying links between viruses and chronic disease.

In the February 19, 2014 issue of Science Translational Medicine (Sci Transl Med. 2014 Feb 19;6(224):224ra24), Bettegowda and colleagues in the Sol Goldman Pancreatic Cancer Research center at Johns Hopkins report on an exciting approach to the detection of pancreatic cancer. Bettegowda and colleagues applied cutting edge DNA sequencing to blood samples from a large number of patients with a number of different cancers. They found that many cancers, even some small curable cancers, shed mutant DNA into the blood.

Using a patient's own stem cells, researchers have corrected the genetic alteration that causes sickle cell disease, a painful, disabling inherited blood disorder that affects mostly African-Americans. The corrected stem cells were coaxed into immature red blood cells in a test tube that then turned on a normal version of the gene

The researchers' approach to developing the method was adopted from food science, where it is used for control of complex industrial processes. Basically, it involves handling and analysing huge amounts of biological data in a holistic and explorative way. The researchers analysed all compounds a blood sample contains instead of - as is often done in health and medical science - examining what a single biomarker means in relation to a specific disease. "When a huge amount of relevant measurements from many individuals is used to assess health risks - here breast cancer - it creates very high quality information. The more measurements our analyses contain, the better the model handles complex problems," continued Professor Rasmus Bro.

In this interrupted case study, students shadow an endocrinologist as she tries to determine what is wrong with Angela Barber. Angela is a middle-aged woman presenting with symptoms suggestive of a thyroid issue. Students are given background information, patient history, and results from thyroid-specific blood tests. The exercise emphasizes the hypothalamic-pituitary-thyroid axis and particularly highlights the role of negative feedback. Students will use results from serum thyrotropin and thyroid hormone level tests, as well as patient symptoms, to come up with a diagnosis. In preparation for the diagnosis, students are asked to compare the endocrine profiles of patients with Graves' disease, Hashimoto's disease, iodine deficiency (primary hypothyroidism), and various tumors. The case was developed for college-level biology majors in a physiology course, but also has been used successfully for pre-nursing students in a non-majors anatomy and physiology course. Thus, this activity would be suitable for majors in physiology or pre-medical students, as well as allied health majors.

In this interrupted case study, students will help Dr. Gupta investigate and assess complications arising in one of her long-term patients, Jorge Alvarez. Jorge was diagnosed with Type II diabetes mellitus 10 years ago as documented in "Living the Sweet Life," an optional prequel case study also in the NCCSTS collection. Jorge has been working with Dr. Gupta to manage his condition, but this year he has come under additional stress, both emotionally and financially, and his health has deteriorated. Jorge now presents with several new signs and symptoms, including numbness, tingling and burning sensations, and a foot sore that just won't heal. Students will review the nervous system and assess Jorge's symptoms, vitals, and blood tests to determine if his diabetes has worsened. Students will also learn about tests used to diagnose types of neuropathy and consider which of them would be most beneficial for Jorge. In addition to a non-majors anatomy and physiology course, this case study may be appropriate for an introductory biology, nutrition/dietetics, or a sensory and perception course.

The Aedes aegypti mosquito is the major vector for transmission of numerous viral diseases, including yellow fever, dengue, and now, Zika. Interestingly, different subspecies of A. aegypti are known to exist in close proximity but with considerable genetic divergence between them. One major difference between a "forest" form and a "domestic" form is a strong preference in the latter subspecies for human over non-human blood biting. This difference was explored with genetic and neurophysiological approaches by a research group at Rockefeller University and published in a 2014 paper in Nature. This flipped case study uses parts of the Nature paper to focus on elements of the scientific method as well as evolutionary questions raised by the difference in biting preference between the two subspecies. Students prepare for class by watching a video that provides background information about the published study that forms the basis for the case. In class students then work in groups to develop a hypothesis, predictions and proposed experiments to test the idea of different biting preferences.

An elderly woman living independently with some help from her family is brought to the local emergency room because she is confused and vomiting. While her son suspects a stroke, a quick battery of laboratory tests indicates that her current problems are the result of impaired kidney function, an old-fashioned home remedy for ulcers, and her prescribed blood pressure medication. The combination of patient- and drug-related factors produces an acid-base disorder responsible for her confusion. This disorder further disrupts her kidney function. The case illustrates secretion and reabsorption processes in the kidney tubule which regulate plasma and urinary electrolytes (including calcium) and pH. The role of bicarbonate in maintaining systemic pH is emphasized. Interactions among the renal, respiratory and nervous systems in the regulation of systemic pH are also illustrated. Further, basic principles of pharmacotherapy and issues related to the appropriate use of medications are introduced. The case was developed for use in a physiology or human anatomy and physiology course, but it might be used in undergraduate nursing courses as well (e.g., pharmacology, pathophysiology).

This interrupted case study tells the story of Michael, a Harvard law graduate with a stressful job and a seemingly heavy drinking problem. Students are provided with background information, medical history, and lab results in order to guide them towards determining what is wrong with Michael. This study highlights cirrhosis and the effects of alcohol abuse on the liver. Before beginning the case study, students should have a background in the physiological role of the liver and the breakdown of hemoglobin. Students are asked to use the information provided for them in the case study to gather more information about liver cells and their functions, alcohol, and alcoholic liver damage. Ultimately, using multiple blood tests, the Maddrey's discriminant function (DF) score, and results from a magnetic resonance elastography (MRE), they will diagnose Michael with alcoholic cirrhosis. This case was developed for use in a non-majors physiology course, but could easily be used for a majors class.

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Common tests used in cancer diagnostics