HospiMedica International May 2017

V I S I T

WORLD’S

CLINICAL NEWS

Vol.35 No.2 • 4-5/2017

LEADER DAILY CLINICAL NEWS

ISSN 0898-7270

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Removable Airway Stent Transforms Lung Surgery new knitted airway stent inspired by a pair of socks can be unraveled and completely removed once no longer needed. Developed by researchers at the Norwegian University of Science and Technology (NTNU; Trondheim, Norway; www. ntnu.edu), St. Olav’s Hospital (Trondheim, Norway; www.stolav.no), and

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Updated Guidelines Released for Preventing Surgical Site Infections he American College of Surgeons (Chicago, IL, USA; www.facs.org) and the Surgical Infection Society (East Northport, NY, USA; www. sisna.org) have updated the guidelines detailing the measures that patients, surgeons, and hospitals can use to prevent surgical site infection (SSI).

Issued dealt by the updated guide-

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lines’ recommendations include: Smokers and former smokers are at higher risk for SSIs. Surgeons should counsel patients to completely refrain from smoking for a minimum of four to six weeks before elective surgery.

Short-term blood glucose control before, during, and after surgery is Cont’d on page 5

Augmented-Reality Technique Enhances Surgical Navigation

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novel portable bone density scanner detects osteoporosis with 90% sensitivity and specificity, helping physicians arrive at an accurate diagnosis.

The Bindex is a pocket-sized tool for osteoporosis screening and diagnostics that provides bone density measurements comparable to those of standard axial dual-energy X-ray absorptiometry (DXA). It works by measuring the cortical thickness of

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new study suggests that one in three women with breast cancer detected by a mammogram may be treated unnecessarily.

Researchers at the Nordic Cochrane Centre (Copenhagen, Denmark; nordic.cochrane.org), the University of Oslo (Norway; www.uio.no), and the Norwegian Institute of Public Health (FHI, Oslo, Norway; www.fhi. no) conducted a cohort study to assess the association between biennial Cont’d on page 4

INSIDE Health IT . . . . . . . . . . . . . . . . 28 Industry News . . . . . . . . . . . . 33 International Calendar . . . . . 34

n innovative wound retraction and protection system helps thwart surgical site infections (SSIs). The Prescient Surgical (San Carlos, CA, USA; www.prescientsurgical.com) CleanCision device combines wound irrigation and protection,

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News Update . . . . . . . . . . . . . 6 Product News . . . . . . . . . .6-10

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Innovative Software Platform Screens Hearts in Children

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Point-of-Care Device Diagnoses Osteoporosis

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Wound-Irrigating Device Combats Surgical Infections

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One-Third of Breast Cancer Cases Treated Unnecessarily

Image: The new augmented-reality surgical navigation technology for spinal surgery

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n advanced augmented-reality technique, A based on combined 3D Xray and advanced optics, is helping surgeons perform open and minimally invasive image-guided procedures in spine, cranial, and trauma surgery.

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novel computer-aided auscultation (CAA) platform analyzes and classifies heart sounds in order to objectively detect heart murmurs.

The Computational Signal Detection Laboratories (CSD; Graz, Austria; www. emurmur.com/CSDlabs) eMurmur software platform analyzes and classifies heart sounds acquired via an electronic

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stethoscope, generating phonocardiograms (PCGs) that are transmitted by either Bluetooth or an audio cable to a mobile phone app. Once received by a Health Insurance Portability and Accountability Act (HIPAA)-compliant server, the results are displayed to the health care professional on a mobile device Cont’d on page 6

News Update . . . . . . . . . . . . 14 Product News . . . . . . . . 14-18

News Update . . . . . . . . . . . . 22 Product News . . . . . . . . .22-28

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Removable Airway Stent Transforms Lung Surgery cont’d from cover

other institutions, the self-expanding knitted metal stent is made of a single strand of memory alloy nitinol which can be unraveled into the thread from which it was made. The knitting technique also makes it possible to produce the stent for a variety of indications by varying thread thickness and mesh size, thus providing varying radial strengths, dimensions, and shapes, including Y-formation.

The stents are packed into delivery sheaths adjusted from standard vascular introducers, with an outer diameter of 6 French, and delivered by flexible bronchoscopy. In animal studies the new stent was easily and accurately deployed in the central airways, and remained fixed in the original position. It was later easy to unravel and completely remove from the airways without clinically significant complications. Granulation tissue induced by stent placement disappeared spontaneously

with the removal. The study was published in the Fall 2016 issue of European Respiratory Journal.

“It sounds simple once you know about it, but basically we tried different ways of removing stents. But it wasn’t until I saw a pair of old-fashioned rag socks that I had a Eureka moment. So that was it,” said senior author Professor Erney Mattsson, MD, PhD, of NTNU. Benign and malignant airway obstruction (MAO) may affect individuals at all ages. Treatment options are numerous, including interventional bronchoscopy, systemic treatment, and endobronchial and extrathoracic irradiation. Minimal invasive treatment using airway stents often represents a meaningful and life-saving palliation, with or without local or systemic supplementary therapy.

But the stents can migrate within the airways, cause granuloma formation, mucostasis, pneumo-

nia, mucosal ischemia and fistulas. A removable stent could thus serve an important function in subsequent recovery.

Image: A new airway stent is knitted from a single nitinol thread (Photo courtesy of NTNU).

Augmented-Reality Technique Enhances Surgical Navigation combination of three-dimensional (3D) X-ray and advanced optics provides surgeons with augmented-reality imaging during spine, cranial, and trauma surgical procedures.

The Royal Philips (Philips; Amsterdam, The Netherlands; www.philips.com) augmented-reality surgical navigation technology is designed to help surgeons perform image-guided open and minimally invasive spine surgery in a hybrid operating room (OR).

Due to the inherently reduced visibility of the spine and other structures during such procedures, surgeons rely on real-time imaging and navigation solutions in order to guide their surgical tools and implants. The same is true for minimally invasive cranial surgery and surgery on complex trauma fractures.

The new Philips technology adds additional capabilities to the company’s low-dose X-ray system, using high-resolution optical cameras mounted on the X-ray flat panel detector (FPD) to image the surface of the patient. It then combines the external view captured by the cameras and the internal 3D view of acquired by the X-ray system to construct an augmented-reality view of the patient’s external and internal anatomy, improving procedural planning, surgical tool navigation, and implant accuracy, as well as reducing procedure times.

The first pre-clinical study on the technology was undertaken as a collaboration between Philips, Karolinska University Hospital (Stockholm, Sweden; www.karolinska.se), Cincinnati Children’s Hospital Medical Center (OH, USA; www.cincinnati childrens.org), and eight other medical centers.

The results showed the technology to be significantly better with respect to overall accuracy (85%), when compared to pedicle screw placement without the technology (64%). The study was published in the November 2016 issue of Spine.

“This new technology allows us to intraoperatively make a high-resolution 3D image of the patient’s spine, plan the optimal device path, and subsequently place pedicle screws using the system’s fully-automatic augmented-reality navigation,” said study coauthor Stefan Skúlason, MD, of Landspitali University Hospital (Reykjavik, Iceland). “We can also check the overall result in 3D in the OR without the need to move the patient to a CT scanner. And all this can be done without any radiation exposure to the surgeon and with minimal dose to the patient.”

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HospiMedica International

One-Third of Breast Cancer Cases Treated Unnecessarily

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Publishers of: HospiMedica International • HospiMedica en Español HospiMedica China • Medical Imaging International • LabMedica International LabMedica en Español • LabMedica China • Bio Research International HospiMedica.com • MedImaging.net • LabMedica.com • BiotechDaily.com

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likely that one in every three invasive tumors and cases of DCIS diagnosed in women offered screening represent over-diagnosis,” concluded study coauthor Karsten Jorgensen, PhD, of the Nordic Cochrane Center, and colleagues. “Although mammograms in Denmark detected a lot more breast cancers, these were mostly small, early-stage tumors. The number of advanced cancers did not fall.”

DCIS is the most common type of non-invasive breast cancer, in which the abnormal cells are contained inside the milk ducts. If DCIS is not treated, it may eventually develop into invasive breast cancer, which can spread outside the ducts into the breast tissue and then possibly to other parts of the body.

Since DCIS cannot usually be felt as a breast lump or other breast change, most cases are diagnosed following routine screening with mammograms or ultrasound, appearing as micro-calcifications.

Image: Mammograms in women over 40 may contribute to overdiagnosis of breast cancer (Photo courtesy of Getty Images).

Point-of-Care Device Diagnoses Osteoporosis cont’d from cover

the tibia; the results, when combined with other patient data, are used to estimate the hip region’s bone mineral density, a parameter usually received via DXA devices used in hospitals. The Bindex can replace nearly 70% of DXA scans for patients under osteoporosis suspicion, with only 30% of patients requiring a subsequent full DXA scan.

The device measures cortical bone thickness in just 30 seconds, providing immediate warning signs of osteoporosis, and allowing medical decisions to be made without delay. Once the measurement has been made, the Bindex is connected to a laptop or desktop computer via USB for graphical display of the results. The Bindex device is a product of Bone Index (Bindex; Kuopio, Finland; www.bindex.fi), and has been approved by the U.S. Food and Drug Administration (FDA).

“Undiagnosed osteoporosis is a worldwide challenge; in the US alone osteoporosis is responsible for two million broken bones every year, costing over 19 billion dollars,” said Ossi Riekkinen, PhD, CEO of Bone Index. “One of the biggest challenges is the limited availability of osteoporosis diagnostics, since bone density scans are mostly performed in hospitals with large DXA X-ray machines that entail high costs. This is why Bindex is a game-changer.”

Osteoporosis is defined as a bone density of 2.5

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mammography screening and the size of detected tumors in women aged 35 to 84 years, measuring trends in the incidence of advanced (>20 mm) and non-advanced (≤20 mm) breast cancer tumors in both screened and non-screened women.

Two approaches were used to estimate the amount of over-diagnosis. The first compared the incidence of advance and non-advanced tumors among women aged 50-84 years in screening and nonscreening areas; the second compared the incidence for non-advanced tumors among women aged 3549, 50-69, and 70-84 years in screening and nonscreening areas. The researchers assumed that if screenings work as intended, the number of small, curable breast tumors should increase, reducing the number of large cancers by about the same amount.

The results revealed that screening was not associated with lower incidence of advanced tumors.

The first approach found 271 invasive breast cancer tumors and 179 ductal carcinoma in situ (DCIS) lesions over-diagnosed in 2010, an over-diagnosis rate of 24.4% (including DCIS) and 14.7% (excluding DCIS). The second approach, which accounted for regional differences in women younger than the screening age, found 711 invasive tumors and 180 cases of DCIS over-diagnosed in 2010, an over-diagnosis rate of 48.3% (including DCIS) and 38.6% (excluding DCIS). The study was published on January 10, 2017, in Annals of Internal Medicine.

“Breast cancer screening was not associated with a reduction in the incidence of advanced cancer. It is

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Image: The Bindex osteoporosis screening and diagnostics device (Photo courtesy of Bone Index)

standard deviations below that of a young adult, as measured by DXA. It is the most common reason for a broken bone among the elderly, and may be due to a lower than normal peak bone mass and a greater than normal bone loss. It is more common in women than men, with 2-8% of males and 938% of females affected after menopause, usually due to lower levels of estrogen.

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ISSN 0898-7270 Vol.35 No.2 • Published, under license, by Globetech Media LLC Copyright © 2017. All rights reserved. Reproduction in any form is forbidden without express permission.

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Updated Guidelines Released for Preventing Surgical Site Infections cont’d from cover

more important than long-term blood sugar maintenance. There now is high-quality evidence to support expanding blood sugar control to all patients, regardless of diabetic status.

Studies of individual procedures have shown promising results when using topical and local antibiotics to reduce infections.

Hair in the surgical site should be removed only if it would interfere with surgery, as shaving causes microscopic cuts and abrasions, resulting in disruption of the skin’s barrier defense against microorganisms. Clippers generally should be used instead of razors to remove hair.

Historically, guidelines have not recommended using antibiotic sutures to decrease SSIs, but there now is considerable evidence to support their use.

Double gloving decreases the risk of holes to the inner glove, so routine double gloving is recommended to protect the surgeon.

Early showering does not increase the risk of SSIs and can be encouraged at the surgeon’s discretion.

Wound-Irrigating Device Combats Surgical Infections

“SSIs are the most common and costly of all hospital-acquired infections, accounting for 20% of all hospital-acquired infections.

They occur in an estimated 2-5% of patients undergoing inpatient surgery,” concluded lead author Kristen Ban, MD, of ACS and Loyola University Medical Center (Maywood, IL, USA; www.loyolamedicine.org), and colleagues. “Guidelines serve as a starting point for the delivery of evidence-based care, but they are only useful if they are implemented successfully. Hospitals must engage individuals at all levels, from front-line providers to leadership.”

SSI’s are an important source, and may even be the most frequent healthcare-associated infection (HAI) after asymptomatic bacteriuria, representing a high burden on patients and hospitals in terms of

morbidity, mortality, prolonged length of hospital stay, and additional costs.

The guidelines were published in January 2017 issue of the Journal of the American College of Surgeons (JACS).

Image: New updated guidelines are designed to help reduce SSI rates (Photo courtesy of iStock).

PREMIER MULTIMEDIA PLATFORM SERVING THE WORLD’S HOSPITAL / MEDICAL COMMUNITY Anytime, Anywhere, On the Go...

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using a double-walled sheath that delivers a sterile irrigant solution and removes fluid from the wound edge. The irrigating wound retractor device is indicated for use in abdominal surgery for incisions 7-16 cm in diameter, during which it retracts the incision, irrigates the wound edge, and provides access to the abdominal cavity.

Fluid is delivered to the wound edges via gravitational feed from an external fluid bag connected with a Luer connector into the device, which is delivered to the wound edges through a permeable outer layer in the integrated sheath. The inner layer of the sheath, on the other hand, is impermeable to the fluids present in the surgical field. After coming into contact with the wound edge, the excess fluid is removed through a separate chamber within the sheath via connection to wall suction.

“Prescient’s mission is to bring down healthcare costs by targeting the risk of surgical site infection, which is linked to significant morbidity and mortality,” said Jonathan Coe, CEO of Prescient Surgical. “Hospitals are increasingly focusing on infection control to improve patient care as a primary goal. Prescient’s success with the CleanCision device bodes well for providers driven towards the ‘triple aim’ of quality of care, patient satisfaction, and reduced costs.”

SSIs are an important source, and may even be the most frequent healthcare-associated infection (HAI) after asymptomatic bacteriuria, representing a high burden on patients and hospitals in terms of morbidity, mortality, prolonged length of hospital stay, and additional costs. SSI is involved in about 2-5% of the 30 million surgeries conducted annually in the U.S., but can be as high as 15-50% in certain high-risk, contaminated procedures such as colorectal surgery.

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Innovative Software Platform Screens Hearts in Children cont’d from cover

where they can review, compare, consult, or add findings in an efficient and standardized way. In a pilot study of 106 children at the Children’s Hospital of Eastern Ontario (CHEO; Ottawa; Canada; www.cheo.on.ca), the eMurmur platform differentiated pathologic from innocent heart murmurs with a high sensitivity (87%) and specificity (100%), a positive predictive value of 100%, a negative predictive value of 90%, and high accuracy (94%), when compared with echocardiography, which is considered the gold standard for diagnosing murmurs. The study was published in the September 2016 issue of Congenital Heart Disease.

“We are providing a technology that elevates the current 200-year-old method of auscultation to a new, much-improved standard,” said Andreas Schriefl, PhD, CEO and founder of CSD Labs. “eMurmur is rapid, objective, accurate and fully

standardized in its ability to identify and classify heart murmurs.

There is a dire clinical need for our eMurmur platform, because the status quo of auscultation is prone to error and uncertainty, leading to stress for patients and medical professionals and waste in the system.” “eMurmur’s web portal offers medical professionals the capacity to retrieve a PDF report containing all of the above results, and enables integration into electronic patient files and hospital information systems,” concluded Dr. Schriefl. “Other unique benefits include e-consultation via the eMurmur web portal and heart sound-monitoring by comparing current with previous auscultation data, including recordings and all findings.”

eMurmur is powered by the CSD Labs’ proprietary Sounds Analysis and Diagnosis Engine (SADIE), a machine intelligence engine that replaces the subjectivity and variability out of auscultation analysis, supplanting it with objective, analytical clarity.

Image: A computer-aided auscultation platform analyzes heart sounds (Photo courtesy of CSD).

Oscillating Light Therapy Could Help Treat Alzheimer’s amma frequency light therapy could attenuate amyloid load and modify microglia in Alzheimer’s disease (AD), claims a new study. Researchers at the Massachusetts Institute of Technology (MIT; Cambridge, MA, USA; http:// web.mit.edu), Massachusetts General Hospital (MGH; Boston, USA; www.massgeneral.org), and other institutions conducted a study in mice genetically engineered to develop AD. Using optogenetics, the researchers induced gamma oscillations at 40 hertz in the hippocampus. After an hour of stimulation at 40 hertz, the researchers found that hippocampal levels of amyloid-β (Aβ) proteins fell by 40-50%; this effect was not observed at other frequencies.

The researchers then built a device comprised of a strip of light emitting diodes (LEDs) capable of being programmed to flicker at different frequencies and induce gamma oscillations in the brain when shone in the eyes. The flickering effect stimulates in-

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terneurons, cells that synchronize the gamma activity among brain cells to help them communicate with each other. The found, similarly, that one hour of exposure to the light flickering at 40 hertz set up gamma oscillations and halved Aβ levels in the visual cortex of mice in the early stages of AD; but the Aβ proteins returned to previous levels within 24 hours.

In further tests with longer exposure on mice in more advanced stages of Ad, the researchers found markedly reduced Aβ levels and plaque deposits.

They also found that the gamma oscillations reduced another hallmark of AD, abnormal tau proteins that form tangles in the brain. Finally, the researchers also showed that gamma oscillations caused the induction of genes associated with morphological transformation of microglia, with histological analysis confirming increased microglia colocalization with Aβ. The study was published on December 7, 2016, in Nature.

“More research needs to be done before we can

say if the therapy works for human patients with Alzheimer’s disease,” said senior author professor Li-Huei Tsai, PhD, of MIT. “It’s a big ‘if’,’ because so many things have been shown to work in mice, only to fail in humans. But if humans behave similarly to mice in response to this treatment, I would say the potential is just enormous, because it’s so noninvasive, and it’s so accessible.”

Networks of neurons in the brain fire in a coordinated fashion, generating rhythmic waves of electric activity that occur at different frequencies. In the 20-50 Hz range, gamma oscillations are involved in memory encoding and retrieval, perception, and attention. Animal studies show that they serve to synchronize intercolumnar input in the cat visual cortex. Other studies in experimental animals also pointed to the role of gamma oscillations in spatial and working memory. Changes in these brain waves have been seen in several brain disorders, including in patients with AD. HospiMedica International April-May/2017

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Catheter System Drains Recurrent Pleural Effusions novel catheter system enables patients to drain pleural fluid at home, instead of requiring them to return to the hospital for thoracentesis.

The PleurX catheter system consists of a catheter that is inserted in the chest wall for draining pleural effusions, or into the abdomen for malignant ascites, and proprietary drainage bottles. To drain pleural fluids, the free end of the catheter is connected to the drainage line on the external vacuum bottle, which then automatically draws out the fluid by pressure differential; a roller clamp controls flow on the drainage line. The kit also features a self-adhesive dressing used to maintain the catheter discrete and clean.

The PleurX catheter can also be used in place of a chest tube for the delivery of talc or bleomycin for chemical pleurodesis, offering an additional treatment option. Potential complications can include pneumothorax, re-expansion pulmonary edema, hypotension, circulatory collapse, and infection of the pleural space. It is also not recommended to drain more than 1,000 mL of fluid at any one time. The PleurX catheter system is a product of BD (Franklin Lakes, NJ, USA; www.bd.com), formerly known as Becton Dickinson, and has been approved by the U.S. Food and Drug Administration (FDA).

“BD can provide patients who suffer from recurrent pleural effusions due to congestive heart failure and other non-malignant recurrent pleural effusion etiologies with an option to manage their symptoms from the comfort of their home,” said Jim Leitl, worldwide vice president and general manager for interventional specialties at BD. “The system helps patients take control of their therapy by enabling them to manage fluid from pleural effusions outside of the hospital. Patients now have the option to potentially avoid the mental and physical toll of undergoing an additional hospital procedure.”

“Our research found that the PleurX catheter provided palliation of congestive heart failure patients’ pleural effusions and freedom from re-intervention equal to that of talc pleurodesis using thoracoscopy, while resulting in a shorter mean length of hospital stay,” said Richard Freeman, MD, regional chief medical officer of St.

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Vincent Indianapolis (IN, USA; www.stvincent.org/St-Vincent-Indianapolis).

“Lower rates of operative morbidity and readmission related to the pleural effusion were also seen in the PleurX catheter treatment group.”

Pleural effusion results in an excessive amount of fluid buildup in the space between the layers of pleura that surround the lung. The fluid may be categorized as either transudate, which is usually composed of ultrafiltrates of plasma resulting from an imbalance in vascular hydrostatic and oncotic forces in the chest (such as in heart failure or cirrhosis); or as exudate, which is typically produced by inflammatory conditions (such as lung infection or a malignancy). Exudative pleural effusions are usually more serious and difficult to treat.

Image: The PleurX catheter system for draining pleural effusions (Photo courtesy of BD).

Pressure Injuries Prevalence Has Decreased Dramatically 50% reduction in pressure injury prevalence in U.S. hospitals – and other acute care settings over the past decade – is ascribed to improved preventive practices, according to a new study.

Researchers at Hill-Rom (Batesville, IN, USA; www.hill-rom.com) conducted an International Pressure Ulcer Prevalence (IPUP) survey, using a population sample composed of 918,621 patients in the United States, with data spanning the years 2006 to 2015 collected from over 1,000 volunteer facilities. In each facility, internal clinical teams collected information during a predetermined 24-hour period, which included pressure injury prevalence, demographics, and other pertinent clinical information. Aggregate data was the analyzed.

The results revealed that the prevalence of pressure injuries decreased from 13.5% in 2006 to 9.3% in 2015 across all care settings, a relative reduction of 31%. Significant reductions were evident in facility-acquired prevalence (FAP), which measures new pressure injuries developing after the patient was admitted to hospital; FAP decreased from

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6.2%in 2006 to a range of 3.1-3.4% in 2013-2015, a 50% relative reduction. More than 90% of patients were reported from acute care settings, such as academic medical centers and community hospitals; in these settings, the FAP declined from 6.4% in 2006 to 2.9% in 2015.

Prevalence of pressure injuries varied in other settings, such as long-term acute care and rehabilitation centers, showed no clear-cut directional trends.

For example, while body weight increased in most care settings, patient age decreased. But based on the Braden score, a standard prediction scale, there was no significant change in the patients’ risk of pressure injury.

The study was published on December 13, 2016, in the Journal of Wound, Ostomy and Continence Nursing.

According to the survey, the greatest reductions in prevalence occurred between 2008 and 2009, most likely reflecting the change in payment policy by the U.S. Centers for Medicare and Medicaid Services (CMS, Baltimore, MD, USA; www.cms.gov), which discontinued acute care payments for ancillary care of hospital-acquired pressure injuries in 2008.

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Electrode Placement Patch Raises ECG Accuracy single-use patch that ensures the uniform placement of electrocardiogram (ECG) leads cuts down on inaccuracies and saves time. The Ennovea Medical (Columbus, OH, USA; www.ennoveamedical.com) CardioQuick Patch (CQP) is a single-use, disposable overlay that provides a reference point and designates the anatomical lines needed to guide proper electrode placement. Developed to assist accurate precordial ECG, the patch incorporates six preplaced electrodes, with each one provided with an adjustable positioning guide in order to customize electrode placement for patients of varying shapes and sizes.

The system also comes with four limb leads, and is compatible with both 3-lead and 4-lead ECG systems.

The CQP can stay on the patient for up to three days, ensuring that subsequent 12-lead ECGs are reproducible and accurate for patient trending analysis. A new study to evaluate CQP placement found a significant difference between the minimum time needed to place standard leads (66 seconds) and the CQP (39 seconds) method. And while the standard group exhibited significant lev-

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els of placement error, the CQP showed less intrapractitioner variability. The study was published in the November-December 2016 issue of the Journal of Electrocardiology.

“Any misdiagnosis from an erroneous ECG acquisition prevents timely medical intervention for the patient which, in worst case scenarios, increases the likelihood of morbidity and mortality,” said Robert Deans, director of Ennovea Medical.

“We’re hoping that this study and its accompanying data will finally prove to hospitals around the world that the CardioQuick Patch is the solution they’ve been looking for to solve this age-old clinical issue.”

The ECG provides vital diagnostic information for immediate clinical decision-making and to identify patients who develop changes, which make them candidates for early invasive coronary investigation. Since incorrect positioning of the precordial electrodes changes the ECG significantly, patients are at risk of potentially harmful therapeutic procedures. The only solution is proper precordial electrode placement, which requires training and an environment supporting precision.

Image: The CardioQuick Patch facilitates correct ECG electrode placement (Photo courtesy of Ennovea Medical).

Daily Aspirin Benefits Outweigh Gastrointestinal Bleeding Risk new study concludes that concerns about gastrointestinal (GI) bleeding events resulting from preventive low-dose aspirin are unfounded.

Researchers at Cardiff University (United Kingdom; Cardiff University, UK; www.cardiff.ac.uk) conducted a systematic review and meta-analysis of randomized controlled trials of aspirin, in which both total GI bleeding events and bleeds that eventually led to death had been reported. Principal investigators of studies in which fatal events had not been adequately described were contacted via email and asked for further details. In all, 11 trials were included in the meta-analysis.

The results revealed that the relative risk of major incident GI bleeding in patients randomized to low-dose aspirin was 1.55, and the risk of a bleed

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attributable to aspirin being fatal was 0.45. In all, there was no significant increase in the risk of a fatal GI bleed in patients who received prophylactic low-dose aspirin, and the substantive risk remains cerebral hemorrhage, which can be fatal or severely disabling, with an estimated risk of one death and one disabling stroke for every 1,000 people taking aspirin for ten years. The study was published on November 15, 2016, in Public Library of Science (PLOS).

“Although many people use aspirin daily to reduce the risk of health problems such as cancer and heart disease, the wider use of the drug is severely limited because of the side effect of bleeding from the stomach,” concluded lead author Professor Peter Elwood, PhD, of the Cardiff University Institute of Primary Care & Public Health. “With our study

showing that there is no increased risk of death from stomach bleeding in people who take regular aspirin, we hope there will be better confidence in the drug and wider use of it by older people.”

Aspirin (acetylsalicylic acid) is a salicylate drug often used as an analgesic to relieve aches and pains, as an antipyretic to reduce fever, and as antiinflammatory medication. Aspirin’s efficacy as an anticlotting agent and its widespread use as a preventive treatment for heart attacks and strokes have turned it into one of the most widely used medications in the world. The widespread adoption of aspirin for primary cancer and vascular prevention is hampered by concerns of toxicity, in particular major GI bleeding, but unlike heart attacks, stroke, and cancer, GI bleeding is an acute event, usually followed by complete recovery.

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Critical Care

Antibiotic Management Strategies Fail to Curb Resistance new study concludes that neither of the two current antibiotic regimens employed in hospitals can effectively mitigate antibiotic resistance.

Researchers at the University of Exeter (United Kingdom; www.exeter.ac. uk), the University of Sydney (Australia; sydney.edu.au), and other institutions conducted a theoretical mathematical study to try and explain why recent clinical trials are unable to resolve the highly controversial issue of which strategy to combat antibiotic resistance is superior - antibiotic cycling or mixing. Cycling implements the restriction and prioritization of different antibiotics at different times in hospitals; in antibiotic mixing, appropriate antibiotics are allocated to patients in a random fashion.

The researchers concluded, based on almost four million patient days of treatment tracked in the clinical trials, that the literature that showed support for the theoretical optimality of mixing was misplaced, and that clinical datasets cannot choose between the

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two. Their analysis is consistent with an emerging pattern that shows that neither cycling nor mixing are better than the other at mitigating pathogen selection for antibiotic resistance. The study was published on January 17, 2017, in Molecular Biology and Evolution.

“Mathematically speaking, it was very clear early in this study that antibiotic mixing was not the optimal way of allocating antibiotic to patients, yet this is what some clinicians have come believe,” said lead author Professor Robert Beardmore, PhD, of Exeter University. “But communicating this was difficult, given the complexity of the mathematical ideas. In the end, the real mathematical optimum is little more than common sense: get the right drugs to the right patients as soon as possible.”

“It is clear that information-rich, personalized protocols can outperform antibiotic cycling and mixing in mathematical models, but even this conclusion can depend on nuanced model circumstances,” said study co-author

Rafael Pena-Miller, PhD, of Exeter University. “In the doomsday scenario that multi-drug resistance is endemic and present in every infection before the patient begins treatment, it matters little which treatment patients are given.

But before that stark situation arises, targeting appropriate treatment at as many individuals as possible outperforms both mixing and cycling.”

“Personalized medicine is rapidly becoming a reality with dramatic increases in the availability of clinical testing at the point of care,” added senior author Professor Jon Iredell, MD, of the University of Sydney. “Antibiotic use in severe infection remains one of the most powerful interventions in medicine, and intelligent use of antibi-

otics is essential to optimize immediate patient outcomes and to preserve longterm benefits.”

The researchers therefore recommend that individualized treatments, both pathogen-specific and patient-specific, may be a necessity to properly optimize antibiotic use. By using computer models to study different personalized medicine scenarios, they advocate the use of devices that target infections based on rapid diagnoses of the pathogen responsible for the infection from molecular signatures or blood cultures.

Image: A new study shows current hospital strategies to combat antibiotic resistance may be ineffectual (Photo courtesy of Shutterstock).

One-Third of AF Patients Cease Anticoagulation Treatment any patients undergoing warfarin therapy for atrial fibrillation (AF) discontinue it within the first year, according to a new study.

Researchers at Henry Ford Hospital (Detroit, MI, USA; www.henryford. com), the University of Michigan Health System (U-M; Ann Arbor, MI, USA; www.med.umich.edu), and other institutions conducted a study involving 734 patients with non-valvular AF who participated in the Michigan anticoagulation quality improvement initiative experience; all of the patients started warfarin treatment between 2011 and 2013. The researchers explored treatment discontinuation rates, including in patients scheduled for electrical cardioversion (ECV) or radiofrequency ablation (RFA) procedures.

The results showed that within one year, nearly 37% of the patients stopped taking the anticoagulation drug. Among those that underwent ECV or RFA the discontinuation rate was even higher, with more than 54% off warfarin after one year. A second predictive factor for drug cessation was low time in the therapeutic range during the first year of therapy.

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tion. The study was published on January 4, 2017, in JAMA Cardiology.

“It’s unclear why these patients stopped taking warfarin; the drug’s side effects, such as bruising, may play a role. People taking warfarin must also undergo routine blood tests; some people may stop taking the drug to avoid having to do this,” said senior author cardiologist James Froehlich, MD, of U-M. “We need to understand why they are stopping warfarin and figure out what other medications might be better adhered to in order to prevent strokes.”

Warfarin, commercualy known as Coumadin, decreases blood coagulation by inhibiting vitamin K epoxide reductase, an enzyme that recycles oxidized vitamin K to its reduced form after it has participated in the carboxylation of several blood coagulation proteins, mainly prothrombin and factor VII. It was initially introduced in 1948 as a pesticide against vermin, and is still popular for this purpose. In the early 1950’s warfarin was found to be effective and relatively safe for preventing thrombosis and embolism in many disorders. It is the most widely prescribed oral anticoagulant drug in North America.

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Critical Care

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Closed-Loop Patch Provides Prolonged Heparin Delivery new study describes a transcutaneous patch that can sense activated thrombin and release heparin on demand to prevent coagulation and thrombii.

Developed by researchers at North Carolina State University (NC State, Raleigh, USA; www.ncsu.edu) and the University of North Carolina (UNC, Chapel Hill, USA; www.unc. edu), the new patch incorporates multiple polymer microneedles that unite hyaluronic acid (HA) and heparin. The polymer is modified to be responsive to thrombin, an enzyme that initiates clotting in the blood.

When elevated levels of thrombin enzymes in the bloodstream contact the microneedle, they break the specific amino acid chains that bind the heparin to HA, releasing it into the blood stream.

The researchers tested the HA-Heparin smart patch in a mouse model.

In the first experiment, mice were left untreated, given a shot of heparin, or given the HA-heparin smart patch; they were injected with a fatal

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dose of thrombin 10 minutes later.

Fifteen minutes after the thrombin injection, only the mice that received no treatment died. In a second experiment, thrombin was injected six hours after surgical treatment. Fifteen minutes later, all of the mice with the HA-Heparin smart patch were fine, but 80% of the mice that received the thrombin shot had died. The study was published on November 25, 2016, in Advanced Materials.

“Our goal was to generate a patch that can monitor a patient’s blood and release additional drugs when necessary; effectively, a self-regulating system,” said co-corresponding author Zhen Gu, PhD, an associate professor in the joint biomedical engineering program at NC State and UNC. “We’re excited about the possibility of using a closed-loop, self-regulating smart patch to help treat a condition that affects thousands of people every year, while hopefully also driving down treatment costs. We’re now looking for funding to perform additional preclinical testing.”

“We will further enhance the loading amount of drug in the patch.

The amount of heparin in a patch can be tailored to a patient’s specific needs and replaced daily, or less often, as needed,” said co-lead author Jicheng Yu, MSc, a Ph.D. student in Dr. Gu’s lab. “But the amount of Heparin being released into the patient at any given moment will be determined by the thrombin levels in the patient’s blood.”

Heparin is a highly sulfated glycosaminoglycan, widely used as an injectable anticoagulant, and has the

highest negative charge density of any known biological molecule. Although it is used principally for anticoagulation, its true physiological role in the body remains unclear, as blood anticoagulation is achieved mostly by heparin-sulfate proteoglycans. It has been proposed that the main purpose of heparin is defense against invading bacteria and other foreign materials, and not anticoagulation.

Image: A close-up of the thrombin-responsive smart patch (Photo courtesy of UNC).

Influenza Vaccinations Reduce Dialysis Hospitalization Rates emodialysis patients who skipped their influenza vaccine were significantly more likely to be hospitalized than those who were vaccinated, according to a new study.

Researchers at Fresenius Kidney Care North America (Waltham, MA, USA; www.freseniuskidneycare.com) conducted a study that tracked flu vaccination and hospitalization rates during three flu seasons at Fresenius Kidney Care dialysis centers, where the patients received their hemodialysis therapy. These included 158,326 patients in 2013-2014; 202,793 in 2014-2015; and 220,203 in 20152016. The researchers then calculated hospitalization rate per patientyear and rate ratio (RR), and found that 60.1%, 75.6%, and 80.4% of the patients for each season were vaccinated, respectively.

An analysis of the results revealed that patients who skipped vaccination were 53% more likely to be hospitalized during the flu season the first year, 87% more likely to be hospitalized the second year, and 158% more likely to be hospitalized the third year.

Based on these results, the researchers called for an aggressive pro-

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gram for promoting flu vaccination among dialysis patients. The study was presented at the annual Kidney Week meeting, held during November 2016 in Chicago (IL, USA).

“While almost everyone should be vaccinated against influenza, people with kidney failure who are on dialysis are at high risk for complications if they get sick, which is why it is vital they get the flu vaccine every year,” said lead author biostatistician Nien Chen Li, MPH, MS, MA. “We’re gratified to see that our patients are increasingly choosing to be vaccinated.”

“The results of this research suggest that aggressive programs to promote flu vaccination makes a significant difference in keeping kidney patients healthy and out of the hospital,” said Frank Maddux, MS, chief medical officer and executive VP for clinical and scientific affairs at Fresenius Medical Care. “We make it easy for patients by offering the flu vaccine at the clinic where they receive their care and explaining to them why the flu shot is important to their health.

More and more patients are taking advantage of these crisis-preventing vaccinations.”

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Critical Care

Frequent Simulation-Based Training Improves CPR Proficiency low dose, high frequency psychomotor simulation training model improves cardiopulmonary resuscitation (CPR) skills among hospital staff, according to a new study.

Researchers at the University of Alabama (Birmingham, USA; www.uab.edu) placed two American Heart Association (AHA) resuscitation quality improvement (RQI) mobile simulation stations in the emergency departments (EDs) of UAB Hospitals, and quarterly training simulations were then integrated into the normal duties of 150 ED nurses, beginning in June 2015. The researchers then measured simulated and clinically delivered CPR quality metrics before and one year following implementation, using RQI data and automated external defibrillator (AEDs) equipped with thoracic impedance.

The results showed that when compared to

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baseline data, use of the mobile simulation stations for one year was associated with an improvement in the number of compressions with both adequate recoil and depth. In addition, an analysis of 4,513 sessions of clinically delivered CPR before and 4,781 sessions after one year of RQI implementation demonstrated an association with improved chest compression fraction (CCF). The study was presented at the AHA scientific sessions, held during November 2016 in New Orleans (LA, USA).

“High-quality CPR is essential for functional survival from cardiac arrest; however, the opportunity to perform CPR is too infrequent currently to maintain proficiency for most providers,” said lead author Michael Kurz, MD, MSc, of the UAB department of emergency medicine. “Low dose, high frequency psychomotor simulation has demonstrated maintenance

of CPR proficiency among inpatient providers.”

The 2010 AHA guidelines for hands-only CPR call for at least 100 chest compressions per minute for at least two minutes, at a depth of at least two inches in the center of the victim’s chest prior to using an AED machine.

Image: A nurse practicing CPR to meet RQI requirements (Photo courtesy of the AHA).

Nasal Rinse May Help Relieve Asthma Symptoms imple nasal rinses could provide relief of chest and breathlessness symptoms afflicting asthma patients, according to a new study. Researchers at Heartlands Hospital (Birmingham, UK; www.heartofengland.nhs.uk) and Birmingham Regional Severe Asthma Services (UK; www.severeasthmabirmingham.co.uk) conducted a study involving 30 patients with severe asthma and rhinosinusitis who were taught to rinse their nasal passages with a saline rinse. The impact

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of saline rinsing on nasal and chest symptoms and scores were evaluated using the asthma control questionnaire (ACQ), which gauges patientreported bronchodilator use, wheeze, nighttime breathlessness symptoms, and forced expiratory volume in one second (FEV1).

Symptoms were assessed once before starting treatment and once again three months later. The researchers found that after three months, 88% of the patients reported improved nasal symptoms, 62% re-

Novel Infusion Pump Allows Drug Delivery During MRI Scans novel infusion pump compatible with magnetic resonance imaging (MRI) devices enables patients dependent on intravenous (IV) medication to undergo scanning.

The MRidium 3860+ infusion pump system is designed to provide a seamless approach that enables accurate, safe, and dependable IV medication and fluid delivery before, during, and after an MRI scan. A broad range of infusion rates support differing patient needs, including low levels for sedating children and infants in order to immobilize them during an MRI scan, mid-levels for continued IV infusion of medications to critically-ill patients, and high levels in the event of emergency situations.

The system incorporates a nonmagnetic motor with a broad range of fluid flow control – from 0.1 to 1,400 mL per hour in order – to ensure the safe and predictable delivery of IV fluids during the MRI procedure. The IV

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infusion pump system also includes a proprietary single-use IV tubing sets, a non-magnetic pole, and a lithium battery, allowing it to be operated dependably in the presence of 0.2T to 3T magnets, up to a fully operational 10,000 gauss-line. Optional upgrades include a remote control, a sidecar, and an oxygen saturation pulse oximetry (SpO2) monitor.

The device also includes dose error reduction system (DERS) software, which enables users to create a unique drug library and establish nominal values and limits for dose and concentration for specified infusion protocols.

With DERS, patient safety and user convenience are supported by userprogrammed infusion hard (maximum and minimum) and soft (user confirmed) limits. The MRidium 3860+ infusion pump system is a product Iradimed (Winter Springs, FL, USA; www.iradimed.com), and has been approved by the U.S. Food and Drug Administration (FDA).

ported improved chest symptoms, 69% showed a clinically measured and significant decrease in nasal symptoms, and 83% showed clinically significant improved ACQ scores.

The study was presented at the British Thoracic Society winter meeting, held during December 2016 in London (United Kingdom).

“Two thirds of patients with severe asthma also suffer with rhinitis; this can lead to nasal congestion, forcing patients to adopt abnormal breathing patterns such as mouth breathing, which exposes the airways to cold dehumidified air,” said lead author physiotherapist Anita Clarke, of Birmingham Regional Severe Asthma Services. “Nasal irrigation can certainly help reduce nasal symptoms

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and also reduce asthma symptoms.

The ability to ‘nose breathe’ is an essential part of an efficient breathing pattern, and this study shows the treatment can provide the added benefit of helping people with asthma feel they can breathe more easily.”

Asthmais defined as a long-term inflammatory disease of the airways of the lungs. It is characterized by variable and recurring symptoms, reversible airflow obstruction, and bronchospasm. Symptoms include episodes of wheezing, coughing, chest tightness, and shortness of breath. These episodes may occur a few times a day or a few times per week. Diagnosis is usually based on the pattern of symptoms, response to therapy over time, and spirometry.

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CPAP SYSTEM

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The HeartSave PAD for emergency medicine only delivers an electric shock if life-threatening fibrillation is actually detected. It uses easy-to-understand voice prompts to guide the user through the rescue procedure, thus eliminating the possibility of the device being operated incorrectly.

The RESmart BPAP 20T/25T30T is a customized solution for obstructive sleep apnea and respiratory disease, and delivers therapy pressure as well as maintains synchrony. Its unique sensitivity setting ensures user-device synchrony and maximizes user compliance.

The stress lite digital HD+ includes a digital trolley, all-in-one computer with wireless keyboard and printer, RS232 port, Bluetooth, dedicated software, and a HD+ ECG wireless unit. The system is capable of handling a wide range of ergometers and easy management of stress exams.

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Heart Failure Risk Outweighs Stroke in CKD Patients hronic kidney disease (CKD) patients are at a risk of heart failure (HF) that is as high as for coronary heart disease (CHD), whereas stroke risk is only slightly elevated, according to a new study. Researchers at the University of Washington (UW; Seattle, USA; www.washington. edu), Tufts Medical Center (Boston, MA, USA; www.tuftsmedicalcenter.org), and other institutions conducted a study to determine absolute rates and comparative risk differences of incident HF, CHD, and stroke in CKD patients. In all, 14,462 participants were pooled from three studies: the Jackson Heart Study, the Cardiovascular Health Study, and the Multi-Ethnic Study of Atherosclerosis. Main outcome and measures were incidence rates (IRs) and risk differences comparing partici-

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pants with and without CKD. The results revealed that CKD patients had a 2.3 per 1,000 person-year greater risk than those without CKD for both HF and CHD. For stroke, the risk difference was 0.8 per 1,000 per person-year in CKD, versus no CKD. Risks were particularly high for African American and Hispanic participants, with adjusted risk differences in those with CKD for HF of 3.5 and 7.8 per 1,000 person-years, respectively. The study was published on December 21, 2016, in JAMA Cardiology. “Cardiovascular disease is the leading cause of morbidity and mortality in patients with CKD. Understanding the relative contributions of cardiovascular disease event types to the excess burden of cardiovascular disease is important for de-

veloping effective strategies to improve outcomes,� concluded lead author Nisha Bansal, MD, MAS, of the UW Kidney Research Institute, and colleagues.

CKD is the progressive loss of kidney function over a period of months or years, identified by the presence of creatinine, a breakdown product of muscle metabolism. Higher levels of creatinine indicate a lower glomerular filtration rate (GFR), resulting in a decreased capability of the kidneys to excrete waste products. Symptoms are not specific, and might include feeling generally unwell or a reduced appetite. Professional guidelines classify severity of CKD in five stages, culminating in endend-stage renal disease (ESRD), a severe illness with poor life expectancy if left untreated.

Connected Dose Inhaler Optimizes Respiratory Care

Blood Products Are Unaffected by Drone Transport

novel embedded metered dose inhaler (eMDI) enables improved adherence and real-time monitoring of asthma and chronic obstructive pulmonary disorder (COPD) patients. The H&T Presspart (Blackburn, United Kingdom; www.presspart.com) eMDI is an intuitive, connected eMDI that tracks, records, and shares data on both preventive and relief medications, thus empowering patients in their self-care and improving adherence. The connected data also aids real-time monitoring of medication use and symptom flareups by caregivers. Sensors within the inhaler track the date and time of medication use as well as the quality of delivery, which is recorded in onboard memory and also shared wirelessly Bluetooth, syncing with the BreatheSmart app.

The BreatheSmart app can thus provide users and caregivers customized reminders, real-time alerts and updates on medication usage, weekly and monthly summary reports which can be shared with family, caregivers and/or healthcare providers, and secure, automatic, realtime electronic medical record (EMR) integration.

Features of the device include embedded sensors to detect medication use and quality of medication administration, an embedded mechanical or electronic dose count and an intuitive and discrete design. Operation is consistent with standard puffer MDI operation, and is compatible with any canister. Battery life is consistent with the product shelf life, meaning that there is no need for replacement parts and no recharging or battery changes. In addition, the device incorporates a mechanical dose counter to allow pharmaceutical companies to transition current products to connected devices more easily.

new study proves that blood products can maintain stable temperature and cellular integrity while being transported by drones.

Researchers at Johns Hopkins University School of Medicine (JHU; Baltimore, MD, USA; www.hopkinsmedicine.org/com) conducted a study to examine the effects of drone transportation on a range of blood products used for transfusion. They first purchased six units of red blood cells (RBCs), six units of platelets, and six units of unthawed plasma from the American Red Cross (Washington, DC, USA; www.redcross.org), and packed them into a 4.75 liter cooler, taking into consideration the weight restrictions of the commercial DJI (Shenzhen, China; www.dji.com) S900 transport drone. To make room for the cooler, the researchers removed the built-in camera mount.

For each test, the S900 drone was flown by remote control a distance of 1320 kilometers at an altitude of 100 meters above ground, which took up to 26.5 minutes. To maintain temperature for the red blood cells, platelets, and plasma units, the researchers used wet ice, pre-calibrated thermal packs, and dry ice for each type of blood product, respectively.

Following the flight, all samples were transported to the JHU, where the researchers centrifuged the red blood cells units and check them for hemolysis; the platelets were checked for changes in pH, platelet count, and mean platelet volume (MPV); and the frozen plasma units were examined for evidence of air bubbles, which would indicate thawing. The results showed no evidence of any adverse changes, and the temperature of all units was maintained during transport and flight. The study was published on November 16, 2016, in Transfusion.

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Critical Care

3D Printing Provides Customized Insoles for Diabetics new technique to digitalize the mechanical properties of insoles and use three-dimensional (3D) printing to manufacture them could help avoid diabetic foot ulcers.

Developed by researchers at the Fraunhofer Institute for Mechanics of Materials (IWM; Freiburg, Germany; www.en.iwm.fraunhofer.de) and the Fraunhofer Institute for Environmental, Safety, and Energy Technology (UMSICHT; Oberhausen, Germany; www.umsicht.fraunhofer.de), laser-assisted construction of customized footwear (LAUF) is based on the physical properties of thermoplastic polyurethane (TPU). The optimization of the 3D structure and shape of TPU, when used for insoles, determines how soft or rigid the insoles are.

3D foot mapping data is processed using application-oriented load simulations to resolve which structures are needed, and where to achieve the desired properties in the insole. The data is then sent to the 3D printer, where the insoles are printed using selective additive laser sintering. Once an insole has been printed, it is returned the IWM, where it is tested to the point of failure using tensile, abrasion, and bending tests. The first prototypes have already been produced in this way, and the researchers predict that within a few years, insoles can be produced at greatly reduced cost.

“Digital foot mapping is already common practice. As part of this project, we have now also completely digitalized the insole production process.

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Using newly developed software, the orthopedic shoemaker can design an insole for an individual patient and can print out the result on a 3D printer,” said Tobias Ziegler, PhD, of the IWM. “Where does an insole need to be soft, or more rigid? By altering the structure type, we can precisely determine the rigidity of the insole.”

Diabetes patients often suffer from nerve and circulation problems in the feet, which reduce their perception of pain. The nerve pathways that ensure

Mild Electric Current Disrupts Bacterial Biofilms novel wound-healing technology uses an electrochemical scaffold (e-scaffold) and enhanced antibiotic susceptibility to eradicate biofilms and persister cells.

Researchers at Washington State University (Spokane, WA, USA; https:// spokane.wsu.edu) used an e-scaffold made out of conductive carbon fabric and a mild electrical current to produce a low, constant concentration of hydrogen peroxide (H2O2, an effective disinfectant) at the e-scaffold surface. The H2O2 disrupts the biofilm matrix and damages the bacteria cell walls and DNA, which allows better antibiotic penetration and efficacy against subpopulations of persister cells that survive treatment and are able to grow and multiply, resulting in chronic infections.

The researchers found that the escaffold enhanced tobramycin susceptibility in P. aeruginosa biofilms, which reached a maximum susceptibility at 40 μg/ml tobramycin, leading to complete elimination. In addition, the e-scaffold eradicated persister cells in the biofilms, leaving no viable cells. The study was published on November 23, 2016, in npj Biofilms and Microbiomes.

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“Similar to the way that penicillin was discovered by accident, the research to develop the e-scaffold actually came out of a failed attempt to improve fuel cells,” said lead author Professor Haluk Beyenal, PhD, of the WSU School of Chemical Engineering and Bioengineering. “As engineers, we are always trying to find solutions to a problem, so we decided to use bad cathodes to control biofilm growth, and it worked. Our inspiration came from the fundamental work to understand its mechanism.”

Biofilms protect bacterial communities in part because the extracellular polymeric substances (EPS) that form the biofilm matrix serve as a diffusion barrier that limits antibiotic penetration and immobilizes antibiotics. The diffusive barrier also results in nutrient gradients, causing decreased growth and metabolic inactivity in parts of the biofilm community, which allows persister cells to arise. Increased persister cell formation is particularly observed in Gramnegative bacterial biofilms, as their cell membranes are composed of lipopolysaccharides that further limit antibiotic penetration.

that weight is automatically transferred from one foot to the other during prolonged standing are disrupted, and as a result, diabetics do not notice that their toes, heels, or the balls of their feet are too heavily loaded. The foot receives no relief, and pressure sores, ulcers, and infections may go unnoticed.

Serious cases may even lead to amputation.

Image: Three-dimensional printing can manufacture precise insoles for diabetic patients (Photo courtesy of UMSICHT).

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The iXRS AirDRc features a radiographic stand with four motorized joints and pre-programmed data for automatic positioning. A total of seven safety sensors are located over the U-arm, detector and tube slide for controlling the speed or positioning in order to protect against collision.

The MAGNETOM Vida offers fewer rescans, predictable scheduling and consistent personalized exams for clinical routines and research. It has an all-new magnet and system architecture, as well as various features to serve the demands in highend clinical imaging and in clinical research.

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Research Indicates Brain Imaging May Predict Response to Psychotherapy review of current research on the topic indicates that brain scans may in the future be used to help clinicians predict the response to psychotherapy, of patients with various anxiety and depression-related disorders.

The review was published in the November/December 2016 issue of the journal Harvard Review of Psychiatry. For example, specific “neuroimaging markers” could be used to help predict whether a patient with Major Depressive Disorder (MDD) and similar diagnoses will respond well to psychotherapy, or whether they need psychotherapy, or even medications.

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The researchers found 40 studies that included patients with various diagnoses such as MDD, Obsessive-Compulsive Disorder (OCD), and Post-Traumatic Stress Disorder. Some of the researchers used structural brain imaging, while others used functional scans that can visualize brain activity.

The studies found that psychotherapy response could be linked to activity in the amygdala and the anterior insula. Higher activity in the amygdala of patients with MDD indicated an increased likelihood of response to psychotherapy. Patients with anxiety disorders and less activity in the amygdala were also likely to have improved psychotherapy outcomes.

Lead author of the study, Dr. Trisha Chakrabarty, University of British Columbia (UBC; Vancouver, BC, Canada; www.ubc.ca), said, “While some brain areas have emerged as potential candidate markers, there are still many barriers that preclude their clinical use. Future studies of psychotherapy response may focus further on these individual regions as predictive markers. Additionally, future biomarker studies may focus on pretreatment functional connectivity between these regions, as affective experience is modulated via reciprocal connections between brain areas such as the ACC and amygdala.”

Microscopic Sensor Helps Tailor Radiology Treatments new sensor measures radiation doses at the individual cell level, enabling clinicians to obtain a complete picture of how much damage each cell has in-

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curred following treatment.

Developed by researchers at SINTEF (Trodheim, Norway; www. sintef.no), the University of Wollongong (UOW; Australia; www.uow.

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edu.au), and other institutions, the new sensor is as small as a cancer cell, a feat achieved by using a technology called semiconductor processing. The measuring instrument thus contains a sheet of microsensors placed side-by side, all mounted on a silicon base. The sensors are also encapsulated in a plastic material that mimics human tissue, so that the radiation dose measured by the sensors is almost identical to that absorbed by real cancer cells.

The dispersal of mixed radiation fields across a given area enables the sensors to provide an image of the location within the cell that absorbs the highest levels of radiation. The sensor was recently tested at the European Synchrotron Radiation Facility (ESRF; Grenoble, France; www.esrf.eu), and was found to be capable of measuring true radiation doses absorbed by tissue, and with a better spatial resolution than existing equipment. The researchers are now working to provide more precise quantification of

the radiation doses absorbed by cancer tissue, and reduce the damage incurred by healthy tissue.

“The most important component of the new sensor is the element silicon, which is a semiconductor with radiation detection properties. When radiation counteracts with silicon the energy is converted into a measurable electrical signal. The magnitude of the signal indicates the intensity of the radiation,” said SINTEF researcher physicist Angela Kok, PhD. “It appears that proton therapy produces better outcomes for some types of cancer than traditional radiotherapies. There currently exist no sensors capable of measuring radiation of this kind, but we realized that our technology could be adapted to develop sensors with the right specifications,” added SINTEF research scientist Marco Povoli, PhD. “The fabrication process required more development to optimize the reliability of the results, but we overcame this challenge within a few months.”

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Head and Neck Cancer Patients Can Benefit from Increased Radiation Therapy esearchers have shown that treating head and neck cancer patients twice daily with radiation therapy, combined with chemotherapy, could benefit these patients and save more lives.

The study included patients with mouth, throat, or voice box tumors that already spread to adjacent tissue. The twice-daily treatment, called hyperfractionated radiotherapy, enables patients to receive a higher dose, and more effective radiotherapy treatment, possibly without increasing side effects.

The study was led by researchers at the Gustave Roussy Cancer Center (Villejuif Cedex, France; www.gustaveroussy.fr/en) and carried out together with the European CanCer Organization (ECCO; www.ecco-org.eu). The results were presented at the European Cancer Congress 2017 meeting.

The researchers used data from 117 different trials, and 28,804 patients worldwide for their study, and were able to compare 16 different treatments.

The results showed that hyperfractionated radiotherapy together with chemotherapy, reduced cancer deaths by 20% compared with standard oncedaily radiotherapy and chemotherapy. The treatment also reduced the risk of the cancer deteriorating by 23%.

Study leader, Dr Claire Petit, Gustave Roussy Cancer Center, said, “There are a number of new treatments that have shown promise in head and neck cancer trials. This large study has enabled us to compare several of these treatments to see which is best overall in terms of reducing mortality. Some of the studies we looked at did not include data on side effects; others did not follow patients long enough to pick up long-term side effects. This will be the focus of more research over the next year. Moreover, the method we used, network meta-analysis, which combines direct and indirect treatment comparisons, is a new method that needs to be interpreted with prudence. However, this is an important finding for this group of patients who have a higher risk of their cancer recurring following treatment.”

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Image: The researchers have found that hyperfractionated radiotherapy, and increased radiation therapy could save the lives of more head and neck cancer patients (Photo courtesy of Drugs Information Online).

Cardiac Imaging Helps Detect Residual Septal Defects sing transesophageal echocardiography (TEE) could help surgeons identify intramural ventricular septal defects (VSDs) in real-time, according to a new study. Researchers at the Children’s Hospital of Philadelphia (CHOP; PA, USA; www.chop.edu) conducted a study to evaluate the ability of TEE to identify intramural VSDs occurring during surgical repair of heart defects in children with congenital heart disease (CHD). To do so, they collected intraoperative TEE and postoperative transthoracic echocardiography (TTE) data in 337 pediatric patients that underwent biventricular repair of conotruncal anomalies between 2006 and 2013. TEE ability to accurately identify residual defects was assessed using postoperative TTE as the reference imaging modality.

The results showed that intramural VSDs occurred in 34 of the patients evaluated; 19 were identified by both TTE and TEE, and 15 were identified by TTE alone. Of the VSDs requiring reintervention, 6 of 7 intra-

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mural VSDs and all 5 peripatch VSDs were identified by intraoperative TEE. In addition, TEE guided the intraoperative decision to return to cardiopulmonary bypass in an attempt to close residual defects in 12 patients with intramural VSDs and in 4 patients with peripatch VSDs; 10 of the intramural VSDs and all 4 peripatch VSDs resolved or became smaller on final intraoperative TEE. The study was published in the September 2016 issue of Journal of Thoracic and Cardiovascular Surgery.

TEE is an alternative method for performing an echocardiogram, using a probe containing an ultrasound transducer at its tip that is passed into the esophagus. Unlike standard echocardiograms, the transducer is close to the upper chambers of the heart, providing very clear images of the heart structures and valves. TEE is often used in people with a thicker chest wall, in the obese, and to provide information during surgery to repair heart valves, a tear in the aorta, or congenital heart lesions.

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PRODUCT NEWS CONTRAST DELIVERY SYSTEM

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DIGITAL X-RAY

CT SCANNER

Guerbet

Control-X Medical

Philips Healthcare

The Illumena features a new console, touch screen and display for a clearer and cleaner user interface. It allows the user to switch between cardio, angio and CT modes with one touch, and deliver advanced patient care across an increasingly broad spectrum of patients and procedures.

The Perform-X ATC features an elevating four-way table for selectable automatic procedures, including auto-tracking, APR positioning and selectable parking positions. Other benefits include a motorized wall stand and tube stand, and a motorized tilting mechanism for angulated studies.

The Access CT includes features that simplify and automate the user’s routine, helping providers maintain and increase their referral base. The advanced applications on its console allow hospitals to stretch their clinical capabilities from routine imaging to more advanced applications.

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Capsule Endoscope System Images Small Bowel nnovative technology provides a novel 360º panoramic lateral image of the small bowel to assist in the detection of subtle abnormalities.

The CapsoVision (Saratoga, CA, USA; www.capsovision.com) CapsoCam Plus system consists of the capsule endoscope, a capsule retrieval kit, a data access system, and proprietary software that all work together to provide a streamlined examination of the small bowel, with comprehensive 360 degree imaging. In contrast to end-facing cameras that only provide a limited view of the mucosa, the CapsoCam Plus uses four laterally oriented cameras to provide a full 360° panoramic image of the mucosa.

CapsoCam Plus uses a large-capacity onboard storage system that eliminates the need for external receiver equipment. The onboard storage design makes capsule administration

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faster and easier, while eliminating risks associated with radio frequency (RF) signals. To extract the images and other data collected during a CapsoCam Plus examination, users simply place the retrieved capsule into the CapsoAccess system, and click download. The data is then easily accessed using the CapsoView software, available for both Microsoft Windows and Mac OSX operating systems.

“Without the need for capital equipment, the barriers to entry are significantly reduced, and physicians can perform more capsule endoscopy procedures more flexibly while minimizing expenses related to staffing and exam room time,” said Johnny Wang, President of CapsoVision.

“We’re hopeful that our unique technology is able to make a positive impact in the United States, for both patients and clinicians.”

Image: The CapsoCam Plus offers 360º imaging technology (Photo courtesy of CapsoVision).

Capsule endoscopy uses a tiny camera inside an ingestible capsule to take pictures and videos of the gastrointestinal (GI) tract. As the capsule travels through the digestive tract, the camera takes thousands of pic-

tures that are usually transmitted wirelessly to a recorder. Capsule endoscopy is preferred for screening the small intestines, or when traditional colonoscopy or upper endoscopy are difficult or contraindicated.

Graphene Can Also Function As MRI Contrast Agent etal-free fluorinated graphene may soon find a new use as a contrast agent for magnetic resonance imaging (MRI), according to a new study. Developed by researchers at Rice University (Rice, Houston, TX, USA; www. rice.edu), the Indian Institute of Science (Bangalore; www.iisc.ac.in), and other institutions, the metal-free, dual modal contrast agents are based on fluorographene quantum dots, nanoparticle disks of graphene that are decorated with fluorine atoms and organic molecules to make them magnetic. The nanoparticles can be manufactured in less than a day, using micron-sized sheets of fluorinated and oxidized graphene.

When the sheets are added to a solvent and

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stirred for several hours, they break into smaller pieces, or dots. According to the researchers, the fluorographene quantum dots could be particularly useful as MRI contrast agents because they could be targeted to specific kinds of tissue. An additional advantage is that since the dots are composed of carbon, hydrogen, oxygen, and fluorine, there are no signs of toxicity, as evidenced by cell culture tests.

The study was published on October 21, 2016, in Particle and Particle Systems Characterization.

“There are tried-and-true methods for attaching biomarkers to carbon nanoparticles, so one could easily envision using these quantum dots to develop tissue-specific contrast agents,” said senior author Professor Pulickel Ajayan, PhD, of Rice University.

“For example, this method could be used to selectively target specific types of cancer or brain lesions caused by Alzheimer’s disease. That kind of specificity isn’t available with today’s contrast agents.”

“We worked with a team from MD Anderson cancer center to assess the cytocompatibility of fluorinated graphene oxide quantum dots,” added lead author Sruthi Radhakrishnan, MSc, a graduate student at the Rice department of materials science and nanoengineering. “We used a test that measures metabolic activity of cell cultures and detects toxicity as a drop in metabolic activity. We incubated quantum dots in kidney cell cultures for up to three days and found no significant cell death in the cultures, even at the highest concentrations.”

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Medical Imaging

Next Generation Endoscopy System Provides Superior Visualization state-of-the-art image-enhanced endoscopy system allows differentiation of mucosal surfaces and vessel structures within the gastrointestinal (GI) tract. The Fujifilm (Tokyo, Japan; www.fujifilm.com) ELUXEO endoscopy system is powered by unique 4-LED multi light technology that combines different wavelengths and specific intensified light spectra created by an integrated light source. This allows healthcare professionals to easily switch between three imaging modes: white light (WL), blue light imaging (BLI) and linked color imaging (LCI). Each light mode utilizes a unique light spectrum to improve the visualization of specific structures in the GI tract.

For example, BLI, which has a shorter wavelength than WL, is better absorbed by hemoglobin; this increased absorption makes it easier to detect blood vessels and differentiate between tissue layers, without having to use a real-time filter. The ELUXEO also offers X135 multi zoom technology to optimally magnify structures and further aid in diagnosis and treatment planning. It also comes

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equipped with a flexibility adjuster, and has a smaller bending radius to enhance maneuverability and maximize patient comfort.

In addition, a new training module which instructs users on the application of BLI for detecting Barrett’s oesophagus (BO) provides an interactive training tool that enables endoscopists to see how well they detect and delineate early neoplasia, how they perform compared to other experts in the field, and how technologies like BLI may further improve their clinical practice.

“ELUXEO system and its outstanding 4-LED Multi Light technology was developed in cooperation with healthcare experts to achieve optimal results when choosing imaging modes such as BLI”, said Nadja Scheuringer, marketing manager of the endoscopy systems division at Fujifilm. “The new endoscopy series was built on Fujifilm’s heritage and long-standing expertise in medical imaging, and underlines our commitment of being a trusted partner for healthcare professionals in hospitals, clinics, and private practices.”

“During the procedure, the BLI mode is particularly beneficial for making an immediate treatment decision,” said Professor Alessandro Repici, MD, director of the endoscopy unit at the Humanitas Research Hospital (Milan, Italy) one of the first users of the system in clinical practice. “It facilitates the identification of lesions, inflammations and early stages of colorectal cancers, makes diagnosis easier and more precise and thus contributes to improve patient outcomes.”

Image: The 4-LED light source of the ELUXEO endoscopy system (Photo courtesy of Fujifilm).

Multi-Purpose X-Ray Room Enhances Diagnostic Flexibility new direct radiography (DR) solution provides enhanced flexibility in diagnostics through direct digital dynamic remote-controlled fluoroscopy and radiography.

The Agfa Healthcare (Mortsel, Belgium; www. agfahealthcare.com) DR 800 is a high-productivity, robust, and reliable radiography solution that integrates innovative features and direct image capture capabilities with versatile panel formats to offer high quality radioscopy and fluoroscopy in supine and upright positions. The highly customizable DR 800 can be equipped with high-frequency fluoroscopy generator options of 50, 65 or 80 kW, and with advanced cesium iodide (CsI) detector panel technology for high-speed, high-resolution, imaging at low dose.

Smooth operation is achieved with the aid of ZeroForce Technology, which enables manual movement of the tube head in all directions quickly, and with almost zero effort; the tube head also holds a touch screen display. Other feature include a 180 cm image-receptor distance (SID) and auto positioning presets for chest imaging; an automated, fully motorized wall stand bucky with vertical tracking with the tube; a console for patient-side positioning; and a wireless console for remote control, a compressor cone, and an auto-switching anti-scatter grid.

The DR 800 offers the option of full leg full spine (FLFS) with EasyStitch technology that applies fully automated single focus technology to minimize distortions. Angular tracking is available for use in dedicated exams, while motorized movement of the wall stand and tube head provides accurate stitching capabilities for high precision in images. An optional overlay for the height-adjustable table and floating top allows FLFS right on the table.

The DR 800 comes with Multi-Scale Image Contrast Amplification (MUSICA) high-speed, multi-scale image processing, which can also process moving images. Along with enhanced

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noise suppression and superb brightness control, Dynamic MUSICA enhances both image quality and workflow for radiographers and radiologists in skeletal, thorax, abdomen, weight bearing x-ray exams, as well as fluoroscopy exams, such as barium studies, arthrograms, cystograms, myelography, and catheter placement.

“High-quality imaging supports informed diagnosis and treatment decisions, critical for value-based care,” said Louis Kuitenbrouwer, vice president imaging division of Agfa HealthCare. “With the DR 800, we are using our experience and innovation to create a versatile solution – a ‘jack of all trades’ that can be configured to match the user’s specific needs. Playing a key role in assuring optimum patient care, the DR 800 supports radiology within the care continuum.”

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Image: The DR 800 direct radiography solution (Photo courtesy of Agfa Healthcare).

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Carestream Health

The RadPRO Mobile 40kW FLEX PLUS incorporates a telescopic column for safe and easy transport and effortless positioning. Its width makes it ideal for restricted spaces and corridors, and its mobility and power-saving advantages make it suitable for hospitals, clinics, and universities.

The DC-70 Exp helps detect abnormalities in technically difficult patients, and offers touch gesture feature to improve workflow. It features auto measurement packages to reduce scan time, standardize exam protocols, and enhance productivity with added patient focus in cardiac practice.

The DRX-Revolution shrinks to just over four feet tall to provide complete visibility when moving it to any location. Its long tubehead reach gives easy access to the patient in crowded rooms, and its powerful dual motor drive makes forward or reverse movements effortless.

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Adding Color to Ultrasound Helps Differentiate Structures new study describes how novel algorithms incorporate color identification into grey ultrasound (US) images, helping to differentiate fine details.

Developed by University of Rochester (NY, USA; www.rochester.edu) researcher Professor Kevin Parker, PhD, the mathematical model is used to characterize US scattering behavior and visualize the results as color-coding of the B-scan image. The methodology, which uses a set of mathematical functions devised in 1890 by the great mathematician Charles Hermite of France, approximates the pulse-echo formation in typical situations. Professor Parker recognized that the Gaussian weighted Hermite functions closely approximated ultrasound pulses.

Currently, medical US imaging scanners typically display the envelope of the reflected signal

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on a log scale in shades of grey. But the properties of this image and speckle patterns result in an inability to differentiate between different scattering sources that may have fundamentally different frequency-dependent scattering cross sections. The new class of images, termed H-scan, can reveal information otherwise hidden in the conventional envelope display. The study was published in the June 2016 issue of Physics in Medicine & Biology.

“If you look at an ultrasound image of the liver, there are so many things in there – veins, arteries, biliary ducts, liver cells, perhaps some scar tissue – and they’re all just displayed as black and white blobs,” said Professor Parker, of the department of electrical and computer engineering. “If there’s a large artery, it’s easy to see the wall and the blood inside. But at the finer levels of detail, it is often im-

possible to tell if you’re looking at a smaller artery or 10 little cells.”

“By letting us see things we can’t see now, it could be very important to individual patients. I realized if we used these, it would make our analyses of ultrasound scattering easier,” concluded Professor Parker. “So now, instead of ultrasound images showing all of these tissue structures as black and white objects, we can now classify them mathematically (by their size) and assign unique colors to unique types of scatterers.”

Ultrasound uses pulses of high-frequency sound waves that bounce back echoes when they strike cells or arteries; these echoes are also known as scattered waves. With few exceptions – such as Doppler-enhanced ultrasound imaging of blood flow – those features consist of varying shades of black, white, and gray reflecting different densities.

IMRT Causes Fewer Bowel and Bladder Problems in Women esearchers at Yonsei University (Seoul, South Korea; www.yonsei.ac.kr), the University of Texas MD Anderson Cancer Center (Houston, USA; www.mdanderson.org), and other institutions conducted a multi-center, international study to assess the impact of IMRT, as compared to standard four-field radiation therapy (RT), in 278 patients with cervical or endometrial cancer who received pelvic RT post-operatively at cancer centers in the United States, Canada, Japan, and Korea. Patients were randomly assigned to receive standard RT or IMRT. The patients were evaluated during the RT treatments via multiple patient questionnaires in order to determine acute toxicities in the GI and GU systems, as well as patient quality-of-life (QOL). The patients were stratified based upon RT dose (45 Gy or 50.4 Gy), use of chemotherapy (no chemotherapy or five cycles of weekly cisplatin at 40 mg/m2), and disease site. The researchers then compared changes in average scores on the questionnaires from baseline to five weeks following RT start, us-

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ing two-way t-tests.

The results showed that women in the IMRT arm experienced significantly fewer bowel-related toxicity than patients who received standard RT, as indicated by smaller average declines in their Expanded Prostate Cancer Index Composite (EPIC) bowel domain scores. Analysis of sub-scales within the EPIC determined that IMRT patients experienced less severe declines in bowel function, but not bowel bother. IMRT patients also experienced fewer high-level adverse events following treatment, including diarrhea.

Urinary side effects at five weeks from treatment were less prevalent among patients who received IMRT, as indicated by significantly smaller declines in average EPIC urinary domain scores for the IMRT arm. Furthermore, outcome index scores demonstrated fewer declines in health-related QOL following IMRT compared to standard RT. Patients treated with IMRT also had less change in physical wellbeing and additional concerns. The study was presented at the annual

meeting of the American Society for Radiation Oncology (ASTRO), held during September 2016 in Boston (MA, USA).

“Many radiation oncologists already use IMRT for women undergoing pelvic radiation, but this research provides data that using IMRT, which is a more resource-intensive treatment, makes a real difference to patients receiving radiation therapy to the pelvic area,” said lead author professor Ann Klopp, MD, PhD, of the MD Anderson Cancer Center. “When performed by an experienced radiation oncology team, IMRT reduces the risk of short-term bowel and bladder side effects for patients with endometrial and cervical cancer.”

IMRT uses advanced technology to manipulate photon and proton beams so that they conform to the shape of a tumor. The radiation intensity of each beam is controlled, and the beam shape changes throughout each treatment, with the goal of adapting the radiation dose to the target and to avoid or reduce exposure of healthy tissue in order to limit the side effects of treatment.

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Medical Imaging

Intraoperative Ultrasound Good for Open, Laparoscopic and Robotic Surgery

By Becky McCall, Contributing Editor s the only established cross-section imaging tool in the operation room for diagnosis and image-guided treatment, intraoperative ultrasound (IOUS) is honed to the demands of open, laparoscopic and robotic surgery where continuous monitoring is needed to guide operations and update diagnostic information for the surgical team.

Images provided through IOUS scanning have a limited field of view of the anatomy, but through real-time, high-resolution, and magnification, a diagnosis can be made or confirmed for a pre-surgical impression using a percutaneous scanning approach.

SonoScape produces the S9 portable US unit that can be used intraoperatively. This unit incorporates recent advances in IOUS including broadband transducers with high-resolution imaging and specially designed smaller footprint probes, which enable IOUS to acquire the best possible image within a limited space. In addition, software-driven techniques specifically for US provide better imaging and a greater range of applications than in previous generations.

Dr Ji-Bin Liu, MD, Professor of Radiology, and Director, Special Training Programs at Jefferson Ultrasound and Radiology Education Institute, Philadelphia, PA, is an expert in the use of IOUS. He points out that current US machines are smaller, more portable and technologically superior. He has recently used the S9 portable US unit from SonoScape for ultrasound-guided research project in the operating room at the Thomas Jefferson University Hospital.

“The use of dynamic scanning techniques with superior imaging quality can overcome any limitation that might be associated with IOUS requiring a small opening and area,” he said, adding that, “If a more complete image of a larger structure is sought, multiple images acquired using IOUS can be combined to create a larger and more complete picture.”

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Fewer artefacts and spotting sub-millilitre tumours Unlike conventional pre-surgical imaging, the unique and superior imaging produced by IOUS as used on SonoScape equipment, is associated with fewer artefacts to hinder the image display because the transducer is placed directly on the surface of the organ. By doing so, IOUS visually displaces other organs and avoids bowel gases as well as bone structures.

One of the most common applications of IOUS is in imaging the liver, which is commonly done through open-surgery. Dr Liu explains that, “When scanning the liver with the transabdominal method, chest ribs and bowel gases can increase the difficulty of seeing it clearly, but with an intraoperative probe it can be placed directly on the liver during open surgery and provide a complete and detailed image of the liver, biliary duct, and pancreas associated with surrounding structures.”

IOUS also facilitates the radiologist and surgeon for answering questions about the tumour during the management of hepatic neoplasms. Because IOUS helps detect exact tumour location, margin,

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invasion of major blood vessels or not, and feasibility of resection, sub-millilitre tumours and tumour thrombosis in the portal vein to be spotted that could otherwise be missed by transabdominal ultrasound, or other modalities.

Detecting tumours that are often missed has particular relevance to pancreatic tumours that can be late to show symptoms, grow rapidly and be too deep for transabdominal US transducers to image.

These tumours also prove difficult to confirm for resection by pre-surgical scanning, however, IOUS provides a means of determining if the tumour resection is possible or whether it has invaded a major blood vessel, aiding decision-making.

Another application of IOUS that can be used on SonoScape’s equipment is in detecting tumour thrombosis in the portal vein, which could be missed by other modalities and transabdominal US. Detection of such tumours by IOUS would change the operation procedure and prognosis, Dr Liu pointed out.

“For example, if a tumour thrombosis of the vessels is detected, it implies that the tumour has already spread through that blood vessel to another location, increasing the staging for that tumour,” he said.

Likewise, efficient detection can ensure resection is confined to tumour and not healthy tissue.

Renal tumours may have multiple focal lesions that can be small and subcapsular, and due to tumour location, damage to the kidney during partial nephrectomy is a real concern. “IOUS, mitigates this fear significantly by accurately localising tumour for resection,” he added.

As minimally invasive procedures become more commonplace, laparoscopic IOUS is made possible

Image: SonoScape’s S9 portable ultrasound system.

with specially designed transducers that are both rigid and flexible. Although the probe is harder to maneuver once inside the body cavities, this method provides the same imaging capabilities as open-surgery IOUS and is minimally invasive for the patient as an important benefit.

Finally, considerable advances are being made with IOUS being introduced into robotic surgery and sharing the same benefits as seen in laparoscopic and open surgery. Robotic surgery is now at the point where small, highly manipulative and specialised instruments can be inserted into the operational field including use of a robotic US probe.

This technique using smaller, robotically controlled instruments offers a less invasive procedure for the patient with more accuracy and capabilities by these. The Thomas Jefferson University Hospital has successfully applied robotic ultrasound in robotic surgery during partial nephrectomy. “No doubt, we will see the continued evolution and development of IOUS in surgical applications for the ultimate goal of improving patient care,” Dr Liu commented.

Image: IOUS in use for guiding interventional procedure

Medical Imaging

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Mammograms Contribute to Over-Diagnosis of Breast Cancer new study casts further doubt on the value of universal mammogram screening for breast cancer in women over the age of 40.

Researchers at the Dartmouth Institute for Health Policy and Clinical Practice (DTI; Lebanon, NH, USA; http://tdi.dartmouth.edu), the Geisel School of Medicine (Hanover, NH, USA; www.geiselmed.dartmouth.edu), and the U.S. National Cancer Institute (NCI, Rockville, MD, USA; www.cancer.gov) used data from the Surveillance, Epidemiology, and End Results (SEER) program from 1975 to 2012 to calculate the tumor-size distribution and size-specific incidence of breast cancer among women 40 years of age or older.

The researchers then calculated size-specific cancer case fatality rate for two time periods: a baseline period before the implementation of widespread screening mammography (1975-1979), and a period encompassing the most recent years, for which 10 years of follow-up data were available (2000-2002). The data

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was used to track how many cancers were found when small (under two centimeters), versus large, when they are presumably more life-threatening, assuming that if the true number of breast cancer cases is stable, an increase would indicate over-diagnosis.

The results showed that after the advent of screening mammography, detected breast tumors that were small increased from 36% to 68%, while detected tumors that were large decreased from 64% to 32%.

The researchers concluded that if disease burden was stable, only 30 of the 162 additional small tumors per 100,000 women that were diagnosed were expected to progress to become large, implying that the remaining 132 cases were over-diagnosed, and would never have led to clinical symptoms. The study was published on October 13, 2016, in the New England Journal of Medicine (NEJM).

“The magnitude of the imbalance indicates that women were considerably more likely to have tumors that were over-diagnosed than to have

earlier detection of a tumor that was destined to become large,” concluded lead author H. Gilbert Welch, MD, MPH, of DTI, and colleagues.

“However, with respect to only these large tumors, the decline in the sizespecific case fatality rate suggests that improved treatment was responsible for at least two thirds of the reduction in breast cancer mortality.”

“We get credit for curing disease that would never have harmed the patient. We receive positive feedback from patients thanking us for ‘saving

my life,’ alarming feedback from patients with ‘missed diagnoses,’ and no feedback at all from patients whose cancer was over-diagnosed,” wrote Professor Joann G. Elmore, MD, MPH, in an accompanying editorial. “The mantras ‘all cancers are life-threatening’ and ‘when in doubt, cut it out’ require revision.”

Image: Mammograms in women over 40 may contribute to over-diagnosis of breast cancer (Photo courtesy of Getty Images).

PET Imaging Could Improve Cancer Treatment ositron emission tomography (PET) tracking of liposomal nanomedicines could be used to validate drug delivery, according to a new study.

Developed by researcher at King’s College London (KCL; United Kingdom; www.kcl.ac.uk) Shaare Zedek Medical Center (Jerusalem, Israel; www.szmc.org.il), and other institutions, the PET radio-labeling method exploits the metal-chelating properties of certain drugs – bisphosphonates such as alendronate, and anthracyclines such as doxorubicin – and widely used ionophores in order to achieve excellent radio-labeling yields, purities, and stabilities with 89Zr, 52Mn, and 64Cu, and without needing to modify the nanomedicine components.

Imaging with PET in mouse models of breast and ovarian cancer showed that the drugs accumulate in tumors and metastatic tissues in varying therapeutic concentrations, and in most cases, at levels well above those in normal tissues. According to the study, in one mouse strain the nanomedicines unexpectedly showed up in the uterus, a result that would not have been detected without the PET imaging study. The study

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was published on October 26, 2016, in ACS Nano.

“This technique allows quantification of the biodistribution of a radio-labeled stealth liposomal nanomedicine containing alendronate that shows high uptake in primary tumors and metastatic organs,” concluded senior author Rafael Torres Martin de Rosales, PhD, of KCL, and colleagues.

“The versatility, efficiency, simplicity, and GMP compatibility of this method may enable submicrodosing imaging studies of liposomal nanomedicines containing chelating drugs in humans, and may have clinical impact by facilitating the introduction of image-guided therapeutic strategies.”

Chelation involves the formation or presence of two or more separate coordinate bonds between a polydentate (multiple bonded) ligand and the single central atom of a metallic ion.

The ligands are usually organic compounds, known as chelants or chelating agents. Chelation is useful for delivering nutritional supplements, in chelation therapy to remove toxic metals from the body, as contrast agents in MRI and PET scanning, in manufacturing using homogeneous catalysts, and in fertilizers.

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Medical Imaging

Novel Technique Uses Lasers To Image Living Tissues new imaging technique uses tiny embedded particles to illuminate cellular structures in deep tissue and other dense and opaque materials.Developed by researchers at the Massachusetts Institute of Technology (MIT, Cambridge, MA, USA; http://web.mit.edu), Massachusetts General Hospital (MGH; Boston, USA; www.massgeneral.org), and the Jožef Stefan Institute (Ljubljana, Slovenia; www.ijs.si/ijsw), the particles are made from lead iodide perovskite, a material that absorbs and traps light efficiently. When a laser beam is projected at the particles, they emit a normal, diffuse fluorescent light. But if the incoming laser’s power is tuned to certain threshold, the particles will instantly generate laser light.

The tiny, 6-micron-long particles have a rod-shaped geometry – much like chopsticks – and can allow a specific wavelength of light to bounce back and forth along the particles’ length, resulting in images that can be captured at resolutions six times higher than current fluorescence-

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based microscopes. According to the researchers, the optical technique, called LAser particle Stimulated Emission (LASE) microscopy, could be used to image a specific focal plane, or a particular layer of biological tissue. The study was published on November 4, 2016, in Physical Review Letters.

“Theoretically, scientists can shine a laser beam into a three-dimensional sample of tissue embedded throughout with laser particles, and use a lens to focus the beam at a specific depth,” said lead author MIT graduate student Frederick Sangyeon Cho, MSc. “Only those particles in the beam’s focus will absorb enough light or energy to turn on as lasers themselves. All other particles upstream of the path’s beam should absorb less energy and only emit fluorescent light.”

Perovskite, named after Russian mineralogist Lev Perovski (1792– 1856), is composed of calcium titanate, and was discovered in the Ural Mountains by Gustav Rose in 1839. Perovskites have excellent light-emitting properties, and have

Innovative Imaging Platform Combines Optical and Digital Enhancements combination of digital and optical enhancements provides a more accurate in vivo endoscopic diagnosis through improved vessel and mucosal pattern characterization. The Pentax Medical (Tokyo, Japan; www.pentaxmedical. com) OPTIVISTA EPK-i7010 highdefinition (HD) video processor combines digital (i-scan Surface and Tone) image enhancement processing technology and i-scan optical enhancement (i-scan OE) to display the surface structures of blood vessels, glandular ducts, mucosal membrane, and vascular patterns. The conjoining of optical and digital features support the early detection, demarcation, and characterization of multiple aspects of tissue structure.

A new optical filter produces bandwidth-limiting light, which allows the clinicians to switch seamlessly amongst HD+ white light and three different i-scan modes. The OPTIVISTA EPK-i7010 HD video processor is designed to work together with the Pentax i10 HD+ endoscopes series and MagniView optical zoom endoscopes. The platform is also capable of performing video

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recording, thus enabling capture of HD+ video files onto a USB storage device, with supplemental audio recording captured through an external microphone.

An intuitive touch screen control allow for simple and efficient operation, with freeze scan technology that automatically selects the sharpest picture for users’ records. By integrating the video and audio capture functionality, there is no requirement for further recording devices or software.

OPTIVISTA also serves as a powerful teaching platform via TwinMode, aiding the interpretation of image-enhanced endoscopy by providing simultaneous comparison of side-byside images. The simultaneous comparison is particularly useful for demonstrating the appropriate characterization of lesions.

“This is just one of a series of exciting product launches for Pentax Medical this year. We are looking to increase our support to consultants across GI, ENT, and bronchoscopy by adding to our product portfolio over the coming months,” said Rainer Burkard, President EMEA of Pentax Medical.

been used to make light-emitting diodes and optically pumped lasers.

They may also be used to design solution-processed lasers that can be tuned across the entire visible and near infrared (NIR) spectrum by

changing the chemical composition of the perovskite film.

Image: Researchers found embedded nanoparticles could improve regular microscopes six-fold (Photo courtesy of MIT).

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VIDEO INTUBATIONSCOPE

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Atmos Medizintechnik

Medcom Flow

Rudolf Riester

The ATMOS S 351 uses sensor technology for 100% precise vacuum setting and processor-controlled regulation automatism for absolutely stable vacuum. It starts automatically when secretion has to be extracted and stops when the secretion has been removed.

The A10 features a true color LCD that can be tilted for different view angles and is capable of photographing, recording and storage of real-time video output. Designed for difficult airway intubation, it is ideal for us in anesthesia, ICU and emergency departments.

The Otoscope fiber-optics enable high resolution, high contrast images at small dimensions to facilitate an accurate diagnosis. The application of high-quality materials for manufacturing the device reduces the risk of damage and need for repair services.

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Angled Support Catheter Assists Peripheral Vascular Procedures

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new angled support catheter assists clinicians during endovascular procedures to treat complex peripheral artery disease

(PAD).

The Medtronic (Dublin, Ireland; www.medtronic.com) TrailBlazer angled peripheral support catheter is an over-the-wire single lumen seamless catheter designed for high visibility, optimal wire support, and ease of lesion entry for difficult to cross lesions. Thanks to the atraumatic tapered tip, a lubricious inner layer, and CrossCoat hydrophilic coating on the distal 40 cm, TrailBalizer can smoothly track through challenging vasculature. To enhance fluoroscopic visibility, the TrailBlazer .014”, .018”, and .035” guidewire compatible devices have three embedded radiopaque marker bands and a radiopaque shaft.

The TrailBlazer is designed to not only support a guidewire during access to peripheral arteries, but also to enable delivery of solutions and diagnostic agents. The catheter features a braided stainless steel shaft for robust pushability and kink resist-

ance, and a 25 and 30 degree angled tapered tip to access and cross complex lesions. Both the .014” and .018” TrailBlazer support catheters can fit coaxially through the .035” support catheter for increased reach and higher pushability.

“Medtronic is committed to providing physicians with meaningful innovations and therapy choices to enhance their peripherImage: The TrailBlazer angled peripheral al treatment algorithm,” said Mark support catheter (Photo courtesy of Medtronic).

Pacyna, vice president and general manager of the peripheral business ies of the pelvis and legs. The most common sympat Medtronic. “Working with physicians, we have toms of PAD are cramping, pain, or tiredness in the extended the Medtronic TrailBlazer support leg or hip muscles while walking or climbing stairs, catheter portfolio to offer a broad suite of angled opwhich is temporarily relieved by rest. PAD sufferers tions for treatment of complex lesions both above have four to five times more risk of heart attack or and below the knee.” stroke, and if left untreated, it can lead to gangrene PAD is a narrowing of the peripheral arteries due and amputation. to atherosclerosis, and is most common in the arter-

Tissue Properties Should Direct Breast Implant Selection new study concludes that tissue-based planning (TBP) is the superior approach to primary breast augmentation implant size selection. Researchers at the University of Texas (UT) Southwestern Medical Center (Dallas, USA; www.utsouthwestern.edu) and McMaster University (Hamilton, Canada; www.mcmaster.ca) conducted a literature review of the methods used by plastic surgeons to select the appropriate implant size for primary breast augmentation surgery. The implant size selection systems were divided into three groups: (1) Implants chosen based solely on the patient’s or surgeon’s preference; (2) Implants chosen using dimensional analysis systems in order to establish a desired result; (3) Implants chosen using TBP, with measurements used to set clear boundaries for implant selection based on clinical

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guidelines, with limited to no flexibility.

The researchers reported that while 33 implant size selection systems were included in the final analysis, only four reported clinical outcomes that could be compared to accepted literature values or industry standards. The articles that described TBP systems were of highest methodologic quality, when compared to those that stressed desire of the patient and/or surgeon, and those that did not use breast measurement. The study was published in the November 2016 issue of Plastic and Reconstructive Surgery.

“The top ten studies based on methodological quality all used patients’ breast dimensions before selecting final implant dimensions, and this should now be considered standard of practice based on our analysis,” concluded study authors William

Adams Jr. MD, and Daniel Mckee, MD. “Going forward, new published systems should use rigorous quantitative methods so that comparisons can be made in terms of patient outcomes.”

A breast implant is a prosthesis used to change the size, shape, and contour of a woman’s breast.

There are three general types of breast implantw, defined by their filler – saline solution, silicone gel, and composite filler. The saline implant has an elastomer silicone shell filled with sterile saline solution during surgery; the silicone implant has an elastomer silicone shell pre-filled with viscous silicone gel; and the alternative composition implants featured miscellaneous fillers, such as soy oil, polypropylene string, etc. Composite implants are banned in the United States and Europe due to associated health risks and complications.

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Salted Surgical Mask Deactivates Aerosol Viruses novel salt coating on the fiber surface of a surgical mask dissolves upon exposure to virus aerosols and recrystallizes during drying, destroying the pathogens.

Developed by researchers at the University of Alberta (Edmonton, Canada; www.ualberta.ca) and Kyung Hee University (Seoul, South Korea; www. khu.ac.kr), the universal, reusable virus deactivation system is based on common sodium chloride salt that coats the fibrous filtration unit of the surgical mask. When an aerosol droplet carrying the influenza virus contacts the treated filter, the droplet absorbs the salt on the filter. The virus is exposed to increasing concentrations of salt as the droplet evaporates, suffering fatal physical damage when the salt returns to its crystalized state.

In a series of experiments, viruses captured on the salt-coated filters show a rapid decrease in infectivity compared to a more gradual decrease when placed on bare filters. The salt-coated filters proved especially effective in deactivating influenza viruses, regardless of subtypes and even following storage in harsh environmental conditions. The researchers suggest that the technique can be applied in broad-spectrum, airborne pathogen prevention devices in preparation for combatting epidemic and pandemic respiratory diseases. The study was published on January 4, 2017, in Scientific Reports.

“Our salt-coated filter unit can promise the development of long-term, stable, versatile airborne pathogen negation systems, without safety concerns,” said Professor Hyo-Jick Choi, PhD, of the University of Alberta department of chemical and materials engineering. “We believe that salt-recrystallization based virus deactivation system can contribute to global health by providing a more reliable means of preventing transmission and infection of pandemic or epidemic diseases and bioterrorism.”

Past experiences with severe acute respiratory syndrome (SARS), H1N1 swine influenza, and Middle East respiratory syndrome (MERS) indicate that surgical masks are widely adopted by the public as a personal protective measure, despite an ongoing controversy on their effectiveness. However, in the lack of a system to deactivate the collected pathogens, safety concerns naturally arise about secondary infection and contamination from virus-laden filter media during utilization and disposal. The main alternative, the N95 respirator, requires training prior to use, must be expertly fitted to address the risk of face seal leakage, and must be disposed of as biohazard.

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Image: Chinese citizens examining surgical masks during the SARS epidemic (Photo courtesy of Getty Images).

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ELECTROSURGICAL GENERATOR

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Mercury Medical

Bovie Medical

B. Braun

The Face-Cradle prone support system is meant for use in prone position surgeries to offer the clinician greater visibility of the patient’s face. Its fully adjustable cushion set can accommodate most adult head sizes, and offers greater patient stability.

The Ultimate Generator three-in-one energy source offers cold helium plasma compatibility, and standard monopolar/bipolar functions. Its plug-and-play feature offers flexibility and convenience, and allows for independent adjustment of power and gas flow levels.

The Full HD 3-Chip Camera offers six times higher resolution than conventional cameras and delivers lag-free images, even with rapid movements. It provides impressive color depth and red differentiation, and allows important camera functions to be easily activated by remote control.

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Novel Endoscopy Technology Improves Hemostatic Clipping new tool improves hemostatic clipping procedures during gastrointestinal (GI) endoscopy, helping to prevent and halt bleeding. The Resolution 360 Clip is intended for placement within the GI tract for the endoscopic marking and hemostasis during treatment of mucosal and sub-mucosal defects such as peptic ulcers, polyps, and diverticulosis of the colon. The pre-loaded, radiopaque, single-use clip consists of stainless steel capsule and clip arms, a chromecobalt yoke, and a styrene tension breaker. The clip jaws are engineered so that they can be opened and closed up to five times prior to deployment, aiding in precise positioning of the clip at the lesion site.

A key feature is a 32-wire braided catheter that enables rotation in small, controlled movements in both directions, enabling the clip to be more accurately placed at the intended site. A rotation control knob built into the ergonomic handle provides tactile and deployment feedback for 1:1 controlled rotation while maintaining the handle in check, thus

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preserving clip angulation during controlled placement in tortuous anatomy. The Resolution 360 Clip is a product of Boston Scientific (Natick, MA, USA; www.bostonscientific.com), and is available in 155cm and 235cm working lengths.

“We are always striving to improve our technology so that physicians have the tools they need to diagnose and treat gastrointestinal disease more easily and effectively,” said Art Butcher, senior VP and president of endoscopy at Boston Scientific.

“Building on the legacy Resolution Clip and its clinically proven technology, the expanded portfolio now offers physicians more hemostatic clipping options to consider in different clinical situations and patient anatomies.”

“The Resolution 360 Clip gives me the unique advantage of controlling the movement and placement of the clip, while also maneuvering the scope during the clipping procedure,” said David CarrLocke, MD, chief of the division of digestive diseases at Mount Sinai Beth Israel Medical Center (New York, NY, USA). “The ability to have com-

plete control can help improve the accuracy of clip placement and the speed of the procedure, particularly in complex cases.”

Image: The Resolution 360 Clip for GI endoscopy (Photo courtesy of Boston Scientific).

Single-Port Platform Advances Minimally Invasive Surgery n innovative single-port surgical platform emulates conventional multi-port laparoscopy, enabling surgeons to perform procedural steps in a comfortable and secure approach.

The symphonX Surgical Platform enables surgeons to manipulate two laparoscopic instruments at the same time, using controls outside of the body that accurately triangulate the instruments. The design closely mimics traditional laparoscopic equipment, so that the surgeon feels as if he is operating two different tools, each in their own trocar, in a more ergonomic fashion and with fewer complications. Additional benefits include lower usage of analgesics and fewer readmissions for hernias and incision-site infections.

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The symphonX Surgical Platform is compatible with a standard 15 mm laparoscopic trocar. The first commercial procedure, with symphonX in the United States a gallbladder extraction, was performed by Professor Santiago Horgan, MD, chief of minimally invasive surgery at UC San Diego Health (UCSD; CA, USA). The symphonX Surgical Platform is a product of Fortimedix Surgical (Nuth, The Netherlands; www.fortimedix.com), and has been approved by the U.S. Food and Drug Administration (FDA).

“We are thrilled to formally launch the symphonX Surgical Platform in the United States, which we believe has the potential to deliver on the promise of single-port surgery and elevate the standard of care in laparoscopy,” said Tom Dempsey, VP Sales of Fortimedix Surgical. “Our early clinical ex-

perience underlines its potential for improved patient satisfaction and health outcomes, including fewer port-site complications, less post-operative pain, faster recovery and exceptional cosmesis.”

Single-port laparoscopic surgery is used to perform many types of surgery, including adjustable gastric banding, appendectomy, cholecystectomy, hernia repair, hysterectomy, and others. When compared with traditional multi-port laparoscopic techniques, benefits include less postoperative pain, less blood loss, faster recovery time, and better cosmetic results. Despite the potential advantages, there may also be complications, including significant postoperative pain, injury to organs, bleeding, infection, incisional hernia, intestinal adhesions, and scarring.

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Surgical Techniques

Same-Day Discharge Safe for Appendicitis Patients atients who undergo laparoscopic appendectomy do not experience higher postoperative complications or readmission rates when discharged on the same day of their operation, according to a new study.

Researchers at the University of California, Los Angeles (UCLA; USA; www.ucla.edu) and Kaiser Permanente (Woodland Hills, CA, USA; https:// healthy.kaiserpermanente.org) conducted a retrospective study of 12,703 adult patients from 14 Southern California Region Kaiser Permanente medical centers who underwent laparoscopic appendectomy for acute, non-perforated appendicitis between 2010 and 2014. The researchers compared outcomes in 6,710 patients discharged on the day of surgery with 5,993 patients who were hospitalized overnight.

Main outcomes and measures included readmission and complication rates, and postoperative diagnostic or therapeutic radiology visits. The results showed that patients in the same-day discharge group had a lower rate of readmission within 30 days (2.2%), when compared with the hospitalized group (3.1%). In both groups, postoperative rates of visits to emergency or radiology department for diagnostic or therapeutic imaging studies were similar. Postoperative general surgery department visits were slightly higher in the hospitalized group. The

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study was published on November 15, 2016, in the Journal of the American College of Surgeons.

“Advances in early recognition and treatment of the disease process and minimally invasive techniques have allowed for some of the inflammatory response and the trauma from surgical treatment to be lessened and recovery to be faster; as a result, patients can get back to their lives much sooner,” said lead author colorectal surgeon Armen Aboulian, MD, of Kaiser Permanente Woodland Hills.

“In general, recovery at home is preferred by most patients, and sleeping in your own bed has benefits that are difficult to measure.”

“Now up to 60% of non-perforated acute appendicitis patients at Kaiser Permanente are treated without an overnight stay,” concluded Dr. Aboulian. “Two hundred years ago, the diagnosis of appendicitis had more than a 60% mortality rate.

Now these patients are treated and don’t even have to spend the night in the hospital. Medical treatment for this disorder has come a long way.”

Appendectomy is the surgical removal of the vermiform appendix. The procedure is normally performed as an emergency procedure, when the patient is suffering from acute appendicitis. In the absence of surgical facilities, intravenous antibiotics are used to delay or avoid the onset of sepsis. In some cases the appendicitis resolves completely; more often, an inflammatory mass forms around the appendix, causing transruptural flotation.

Image: Research shows appendicitis patients can be safely discharged home on the day of surgery (Photo courtesy of Shutterstock).

Nanofiber Coating Prevents Prosthetic Joint Infections novel coating made with antibiotic-releasing nanofibers has the potential to prevent some of the serious bacterial infections related to total joint replacement surgery.

Developed by researchers at Johns Hopkins University (JHU; Baltimore, MD, USA; www.jhu.edu), the thin, biodegradable plastic coating is composed of a nanofiber mesh embedded in a thin film, both made of biodegradable polymers. The coating is loaded with multiple antibiotics, including rifampin and combinations of vancomycin, daptomycin or linezolid. Vancomycin, daptomycin, or linezolid are released for seven to 14 days, and rifampin over three to five days, thus deploying two antibiotics against a potential infection and ensuring rifampin was never present as a single agent.

This was necessary, since rifampin, while demonstrating excellent anti-biofilm activity, cannot be used alone, as bacteria rapidly develop resistance. The researchers tried different combinations of drugs for coating titanium Kirschner wires – a pin used in orthopedic surgery to fix bone in place after wrist fractures –

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and inserted them into the knee joints of anesthetized mice. They then introduced a strain of phospholuminent Staphylococcus aureus in order to noninvasively track infection over time.

The results showed that after 14 days of infection in the mice that received an antibiotic-free coating on the pins, all had abundant bacteria present in the infected tissue around the knee joint, and 80% had bacteria on the surface of the implant. In contrast, after the same time period in the mice that received pins with either linezolid-rifampin or daptomycin-rifampin coatings, none of the mice had detectable bacteria, either on the implants or in the surrounding tissue. The study was published on October 24, 2016, in Proceedings of the National Academy of Sciences (PNAS).

“We were able to completely eradicate infection with this coating.

Most other approaches only decrease the number of bacteria, but don’t generally or reliably prevent infections,” said co-senior study author Lloyd Miller, MD, PhD, an associate professor of dermatology and orthopedic surgery at the JHU School

of Medicine. “We can potentially coat any metallic implant that we put into patients, from prosthetic joints, rods, screws and plates, to pacemakers, implantable defibrillators, and dental hardware.”

An estimated 1-2% of hip and knee replacement surgeries are followed by infections linked to the for-

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mation of biofilms that adhere to the surface, forming a dense, impenetrable matrix of proteins, sugars, and DNA. These infections are very difficult to treat and, in many cases of chronic infection, prostheses must be removed and patients placed on long courses of antibiotics before a new prosthesis can be implanted.

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TREATMENT LIGHT

ELECTROMAGNETIC SWL SYSTEM

Buffalo Filter

Derungs Licht

Direx Medical Systems

The PlumePen Elite is significantly smaller than competitive models and similar in size to standard models. It provides up to 25% more flow and features a one-piece button design to limit fluid ingress, aiding in the prevention of sticking buttons.

The SATURN LED allows for the physician to adjust the light precisely on the size of the site to be treated. It allows a large working area to be viewed at a glance through an extended illuminated field and then refocused for exact diagnosis.

The Integra combines a fluoroscopy system, treatment table and shockwave unit for effective fragmentation and accurate imaging. It replaces the need to rotate the X-ray unit, while a user-friendly console enables complete control of the procedure and image processing functions.

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Next-Generation Surgical Stapler Navigates Small Spaces small profile, articulating surgical stapling platform offers freedom of movement during minimally invasive surgery.

The Dextera Surgical (Redwood City, CA, USA; www.dexterasurgical.com) MicroCutter 5/80 is a five-millimeter surgical stapler that articulates to 80 degrees in each direction, which helps reduce the amount of dissection and tissue handling required for positioning staples in confined spaces, thus enabling access in difficult-to-reach anatomy. The thin shaft, small anvil and jaws, and 80° of articulation improve visibility when used for thoracic, pediatric, urologic surgery, and other minimally invasive procedures.

The MicroCutter 5/80 utilizes an innovative three-dimensional (3D) staple design, which allows large surface contact area between the staple and tissue. The cartridge-based device uses “D” shaped staples, which are stamped from stainless steel and

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left connected to a metal strip, eliminating the need for plastic drivers and allowing tighter spacing between individual staples.

When the device is fired, the wedge interacts directly with the Image: The MicroCutter 5/80 surgical stapler each staple on the strip; the staples (Photo courtesy of Dextera Surgical). are guided into their final shape by mimicking the path of a suture sive surgery forward.” needle through tissue.

“The MicroCutter demonstrated excellent he“We are pleased to have reached this milestone mostasis,” said Joel Dunning, MD, of James Cook and to now be able to offer both white and blue reUniversity Hospital (Middlesbrough, United Kingloads for thin and medium tissue, which broadens dom), who uses the stapler to perform a variety of the applicability of the MicroCutter 5/80 to a surgical procedures. “This device has made it easiwider number of procedures,” says Julian er to perform less-invasive approaches to thoracic Nikolchev, president and CEO of Dextera Surgical. surgery including both uniportal and microlobecto“We are very excited to be working with highly remy techniques, which lead to reduced pain and spected pioneers aligned with our goal of enabling shorter hospital stays.” cutting-edge procedures that push minimally inva-

Cortisol Levels in Hair Can Predict IVF Success levated levels of the stress hormone cortisol in hair can significantly predict the likelihood of pregnancy in women undergoing in vitro fertilization (IVF) treatment, according to a new study.

Researchers at the University of Nottingham (United Kingdom; www.nottingham.ac.uk) conducted a study involving 135 women (mean age 34.5 years) recruited from a fertility clinic in Nottingham (United Kingdom) between December 2012 and April 2014; following IVF treatment, 60% of the women became pregnant. Salivary cortisol samples were collected over two days, on waking, 30 minutes after waking, and at 10 pm at night; 88 women also provided hair samples for the measurement of cortisol.

After analyzing both types of cortisol data, the researchers found that short-term salivary cortisol measurements were not related to pregnancy results. In contrast, 27% of the variance in pregnancy

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outcome was accounted for by hair cortisol concentrations, after controlling for other known factors linked to IVF success such as age, body mass index (BMI), number of eggs retrieved, and number of eggs fertilized. The study was published on August 30, 2016, in Psychoneuroendocrinology.

“We know that many factors will influence the likelihood of IVF success and, at this stage, we do not fully understand all of the factors that influence whether treatment works or not. However, optimizing patient’s chances of IVF success is key, and this research suggests that reducing cortisol in the months prior to treatment may play an important part in conception,” concluded lead author Adam Massey, MD. “The good news for patients is that well known lifestyle changes may help to lower cortisol and therefore optimize the likelihood they will get pregnant.”

“Researchers have been interested in the role that cortisol may play in determining reproductive

outcomes for some time now, not least because cortisol is typically elevated in relation to stress,” said senior author Kavita Vedhara, PhD, of the division of primary care. “While these results do not specifically implicate stress, they do provide preliminary evidence that long term cortisol levels are associated with a reduced likelihood of conceiving. A range of factors is likely to account for that, stress being one possibility.”

Cortisol is a well-known stress hormone, and until recently could only be measured within a short time span. But by measuring levels in about 100 strands of hair clipped from the scalp, cortisol levels can be assessed as a retrospective biological indicator of stress over the past three months, indicating chronic or accumulated stress.

Studies have also demonstrated interactions with factors associated with health disparities such as racial/ethnic identity, sex, and socioeconomic status (SES).

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Surgical Techniques

Brain Swelling Simulator Guides TBI Emergency Care new tool can minimize potential complications of decompressive craniectomy by helping surgeons select the optimal opening needed to help relieve swelling after traumatic brain injury (TBI). Researchers at the University of Oxford (United Kingdom; www. oxford.ac.uk) and Stanford University (CA, USA; www.stanford.edu) conducted a study to examine the potential stresses generated by brain swelling and the evolution of the bulging shape associated with the process. To do so, they reviewed medical scans showing the amount of swelling for different types of TBI lesions. They then created mathematical estimates to help predict how an injury would affect different parts of the brain.

Once they were done designing the system, then ran different scenarios through the simulation to explore stress areas created during the decompressive craniectomy procedure.

They found that while the elastic energy of brain matter decreases

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throughout the process, large stresses develop close to the craniectomy opening. At the point of contact, the stresses exhibit a singularity similar to the ones found in the classic punch indentation problem, with zones of either high shear stresses or high neuronal axon stretching.

They then studied the stresses generated by brain swelling and the evolution of the bulging shape associated with the process, and concluded that serious damage occurred if axons expanded near or above 30%. The resulting simulation graphically displays stress singularities in different parts of the brain. Severe trauma is shown in red, areas that sustained mild damage in green, and safe areas are blue, thus giving surgeons a visual guide to decide on the best place to perform the decompressive craniectomy. The study was published on September 21, 2016, in Physical Review Letters.

“When a swelling soft solid is rigidly constrained on all sides except for a circular opening, it will bulge out to expand as observed during de-

Special Lithotripsy Fiber Protects Deflected Scopes novel holmium laser fiber has a ball tip that can glide through a fully deflected endoscope in one easy, non-damaging step. The Dornier GentleFlex is designed to efficiently transfer the holmium laser beam within the fiber core, achieving maximum power transmissions as a result of a proprietary quartz ferrule fiber design, which both boosts and extends the effectiveness of the optical fiber when used for treating kidney stones. A specially designed ball tip at the end of the fiber allows physicians to easily slide it through a curved (deflected) endoscope bore, without risking damage to the internal chamber of the scope.

The GentleFlex holmium laser fiber enhances results when used with the Dornier Medilas H Solvo and UroPulse holmium lasers by providing an optimal optical and mechanical connection between the fiber and laser, and by matching the laser system’s proprietary parameters.

A smart fiber recognition system further augments laser performance and overall patient results. The Dornier

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GentleFlex laser fiber and Medilas H Solvo and UroPulse holmium lasers are products of Dornier MedTech (Munich, Germany; www.dornier. com).

“The Dornier GentleFlex is the second laser innovation that Dornier has brought to market in the last six months,” said Abel Ang, CEO of Dornier MedTech. “Dornier Medtech is focused on creating innovative technologies that provide urologists safe, flexible, versatile and durable options to improve ease of use and handling of medical equipment.”

The holmium: YAG laser is a solidstate, pulsed laser that emits light at 2100 nm. It combines features of carbon dioxide (CO2) and neodymium:YAG lasers by providing both tissue cutting and coagulation in a single device. And since the holmium wavelength can be transmitted down optical fibers, it is especially suited for endoscopic surgery. Tissue ablation occurs superficially, providing for precise incision with a thermal injury zone ranging from 0.5-1 mm, providing a level of coagulation sufficient for adequate hemostasis.

compressive craniectomy, a surgical procedure used to reduce stresses in swollen brains,” concluded senior author Ellen Kuhl, PhD, of the living matter laboratory at Stanford University, and colleagues. “This tool can minimize potential complications by

telling surgeons the optimal place to cut and how large the hole should be, depending on the type of injury.”

Image: A simulation for 10% brain swelling after a decompressive craniectomy (Photo courtesy of PRL).

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IMAGE MANAGEMENT SOFTWARE

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Xoran Technologies

The PDC-W210 features a high contrast ratio, wide viewing angle, and gloved operation responsiveness. The monitor is equipped with a hotkey for switching between DICOM and Gamma calibration, and is ideal for use in critical hospital environments, such as ORs and ICUs.

The 3Di Cloud cloud-based software turns any Internet-connected PC into a comprehensive image processing workstation. It allows instant access to imaging data with advanced reformatting and viewing tools, as well as powerful computer processing in a cloud environment.

The XoranConnect complements MiniCAT and provides online viewing, off-site archival and backup of images, with easy access for both physician and patient. It safely archives data and allows easy access to images remotely via a compatible PC, regardless of geographic location.

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3D Morphing Predicts Future Human Skeletal Anatomy ew interactive three-dimensional (3D) models of human joints show how common medical complaints have arisen, and how humans are likely to evolve in the future. Created at the University of Oxford (United Kingdom; www.oxford.ac.uk), the 3D computer models were generated by compiling 128-slice computerized tomography (CT) scans of bones from humans, early hominids, primates, and dinosaurs. In all, the researchers scanned 224 bone specimens, spanning 350 million years from the Devonian period to the modern day.

They then used spatial engineering and mathematical methods to provided new insights into morphological trends associated with common orthopedic complaints, such as anterior knee pain and shoulder pain.

For example, as species evolved from moving around on four legs to standing up on two, the so-called neck of the thigh bone grew broader to support the extra weight; and the thicker the neck of the thigh bone,

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the more likely it is that arthritis will develop. In the shoulder, the researchers found that an anatomical gap through which tendons and blood vessels normally pass through got narrower over time, making it more difficult for tendons to move, which could explain why some people experience pain when they reach overhead.

The samples used in the study were of joints located in the shoulders, hips, and knees of amphibious reptiles dinosaurs, shrews, tupaiae, lemurs, primates, A. Afarensis (known as Lucy), Homo Erectus (the Turkana Boy), and Neanderthals. By comparing the modern and ancient samples, the researchers hope to gain a better insight into the origins and solutions to common orthopedic complaints. In addition, extrapolation of these morphologic trends has allowed the 3D

Image: The evolution of the hip joint (Photo courtesy of Oxford University/OOEG).

printing of possible future skeletal shapes as humans evolve.

“Throughout our lineage we have been adapting the shape of our joints, which leads to a range of new challenges for orthopedic surgeons. Recently there has been an increase in common problems such as anterior knee pain, and shoulder pain when reaching overhead, which led us to look at how joints

originally came to look and function the way they do,” said lead author Paul Monk, MD, PhD, of the Oxford Orthopaedic Evolutionary Group (OOEG). “These models will enable us to identify the root causes of many modern joint conditions, as well as enabling us to anticipate future problems that are likely to begin to appear based on lifestyle and genetic changes.”

New Software Corrects Metal Artifacts in CT Images esearchers in the US have compared the ability of iMAR, dual-energy virtual monochromatic imaging, and a combined technique, to correct imaging artifacts resulting from metal orthopedic and dental implants.

Iterative Metal Artifact Reduction (iMAR), and dual-energy virtual monochromatic imaging, are two software techniques that clinicians use to compensate for artifacts created by metal implants during Computed Tomography (CT) imaging scans.

The researchers from the Mayo Clinic (Rochester, MN, USA; www.mayoclinic.org) also used a third technique that combines iMAR and

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virtual monochrome imaging. The metal artifact reduction software can be used directly from the CT scanner console. Each implant type causes different artifacts. For example, the metal in tooth fillings and artificial joints can block CT from imaging surrounding tissue, and can cause beam hardening, beam scattering, non-linear partial volume effects, and photon starvation. The results are severe streaking and shadows on the CT scans that prevent radiologists from accurately reading the images.

The results were presented at the annual Radiological Society of North America (RSNA2016), and

showed that iMAR was better at eliminating artifacts for implants of the hip and knee, while for dental implants dual-energy virtual monochromatic imaging was more effective. In dental imaging iMAR actually introduced additional artifacts. A combination of both techniques was found most effective for spinal implants. Medical physicist Lifeng Yu, PhD, at the Mayo Clinic, said, “Metal artifacts are the most challenging unsolved problem in the 40-year history of CT scans. While the processed images are a great improvement over the originals, the techniques are still not perfect, and the final outcome is case by case.”

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LCD Display Sets Universal Standard for Medical Imaging

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new solution aids in the transition of imaging systems dependent on cathode ray tube (CRT) displays to liquid crystal diode (LCD). The Modalixx LCD display solution converts small matrix pictures from legacy analog modalities to two megapixel digital images, without compromising image integrity, while providing at the same time a more realistic and brighter resolution, lower power consumption, no radiation, fewer repairs than CRTs, low cost of ownership, a longer life span, less weight, and most importantly, compatibility with all modalities and any video signal parameter.

Optional solutions are available for mounting the Modalixx LCD display on almost any medical modality system.

The universal solution is compatible with cardiac catheterization labs, magnetic resonance imaging (MRI), computerized tomography (CT), and radiofrequency (RF) treatment rooms, mobile C-Arms, positron emission tomography (PET) scanners, and nuclear medicine. Modalixx can synchronize to an existing technology set-up via a set of inputs that includes 1-5 co-axial BNC connectors and 15 pin D-Sub connectors, providing a broad range of analog connectivity. The Modalixx LCD display system is a product of Ampronix (Irvine, CA, USA; www. ampronix.com), and is compatible with systems from Eizo, GE, Phillips, Siemens, and Toshiba, among others.

WORLD’S MEDICAL “Ampronix is at the crossroads of this new age. We believe it is imperative to make the best technology at with the lowest possible price point whenever possible,” said Jamie Nguyen, senior communications specialist at Ampronix. “Our Modalixx display screens were created so health organizations only need to replace CRT screens instead of entire modalities, allowing clients to both save time and lives.”

Universal standards for CRT medical grade displays do not exist, making the replacement of the CRT display with an LCD problematic, in terms of compatibility with legacy modalities. While the CRT/LCD transition took place five years ago in most developed regions, including Japan, Western Europe, and North America. But developing countries are still using CRTs in a wide range of applications, and their transition is projected to follow within the next 10 years, to be completely replaced by their successor, the lighter, cost-effective and versatile LCD.

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The MR2217 features backlight stabilization for accurate reviews and an easy to share screen with 60-degree swivel capabilities. It is easy to clean with a vent-less design that minimizes trapping of dirt, and is built to address the needs of healthcare professionals.

The AeroDR Portable Retrofit turns an existing portable X-ray unit into a digital wireless solution.

It has a very small footprint, which allows for installation and storage inside the cassette storage bin, and is completely self-contained and includes two long-life batteries.

The ChromaPaxx 17C2D4G160 HD integrates a 17-inch display and digital recorder to capture video/images via S-Video or Composite and record in three formats. It is suitable for recording/displaying videos and images for endoscopy, surgical applications, and X-ray procedures.

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Automated Registry Monitoring Speeds Clinical Safety Surveillance new study claims that implementing automated, web-based surveillance of medical devices can help spot potential safety problems with less delay. Researchers at Lahey Hospital and Medical Center (Burlington, MA, USA; www.lahey.org), Vanderbilt University Medical Center (VUMC, Nashville, TN, USA; www.mc.vanderbilt.edu), and other institutions conducted a prospective, propensity-matched study to evaluate a strategy of active surveillance of the U.S. CathPCI Registry to evaluate the Cardinal Health (Dublin, OH, USA; www.cardinalhealth.com) Mynx extravascular vascular-closure device (VCD), implanted following percutaneous coronary intervention (PCI) procedures with femoral access.

The researchers used an integrated clinical-data surveillance system to compare the Mynx device with alternative VCDs, with the primary outcome being any vascular complication, a composite of access-site bleeding, access-site hematoma, retroperitoneal bleeding, or any vascular complication requiring intervention. Secondary end points were access-site bleeding requiring treatment and postprocedural blood transfusion. In all, the researchers analyzed data from 73,124 patients who received Mynx devices from January 1, 2011, to September 30, 2013.

The results showed the Mynx device was associated with a significantly greater risk of any vascular complication (1.2%) than were alternative VCDs (0.8%); there was also a significantly greater risk of access-site bleeding and transfusion. The relative risks were greater in three pre-specified high-risk subgroups: patients with diabetes, those 70 years of age or older, and women. The initial alerts occurred within the first 12 months of monitoring, and were confirmed in an independent sample of 48,992 patients. The study was published on January 25, 2017, in the New England Journal of Medicine (NEJM).

“The takeaway is we were able to detect a safety signal fairly quickly. When it comes to post-market safety surveillance for medical devices, you have to be really timely in your safety alerting for it to matter,” said senior author profes-

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sor of biomedical informatics, medicine, and biostatistics Michael Matheny, MD, MPH, MS. “In our world, nine months is quick enough that if you could get the signal to the FDA, they could act on it.”

The surveillance system developed is called DELTA, for Data Extraction and Longitudinal Trend Analysis, and is freely available as open-source software.

The system performs automated safety analyses and comparative effectiveness studies prospectively, as patient outcomes are electronically documented and uploaded to the system. When DELTA finds potential safety issues, it sends alerts to users via email. DELTA can be adapted for surveillance of medical devices and drugs, and for quality profiling of clinical services and individual clinicians.

Image: The Mynx VCD has a higher risk of vascular complications than other VCDs (Photo courtesy of Cardinal Health).

Innovative Virtual Reality Tool Under Development esearchers are in the process of developing a tool that combines a virtual reality headset and anatomical 3D modeling of imaging data, to enable clinicians to navigate through the colon and search for polyps and other tumors.

The tool is one several innovations resulting from several decades of research that is currently focused on developing software to help doctors, surgeons, and radiologists perform diagnoses and make decisions using 3D modeling, Virtual Reality (VR) and big data.

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The researchers from the GE Healthcare (Chalfont St Giles, Buckinghamshire, UK; www. gehealthcare.co.uk) Global Center of Excellence in Medical Imaging Software are located in Buc, France, and are using images from GE scanners for targeted 3D modeling of organs in the human body using virtual reality, and VR headsets.

The new technology enables a clinician to observe an organ or structure from all angles, in crosssectional view, in 3D and in flat mode. In addition, a surgeon can combine this with the use of a 3D

printer to be able to handle a replica of an organ before an operation. The researchers are using the Internet cloud to share images from 30,000 imaging scanners for their research that also includes machine-learning techniques.

Software Director, Jérôme Gonichon, at GE Healthcare, said, “This is an ongoing development process. Today, we are collecting data from the way that we are using our equipment so that we can improve it. Tomorrow, we can teach the machine to recognize cancer by itself.”

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3D-Printing Technique Fabricates Microphysiological Devices ulti-material three-dimensional (3D) printing may one day be used to design organs-on-chips that match the properties of a specific disease, or even an individual patient’s cells. Researchers at Harvard University (Cambridge, MA, USA; www.harvard.edu) have developed a new technique to fabricate instrumented cardiac microphysiological devices (MPDs) that uses a mix of six functional inks that are based on piezo-resistive, high-conductance, biocompatible soft materials. By using 3D printing, the researchers were able to print a physiomimetic, laminar cardiac tissue MPD that integrates soft strain sensors into the micro-architecture of the tissue, all in a single, continuous procedure.

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The chip contains multiple wells, each with separate tissues and integrated sensors, which allows the researchers to study many engineered cardiac tissues at once. To demonstrate the efficacy of the device, the researchers first validated that the embedded sensors provided non-invasive, electronic readouts of tissue contractile stresses inside cell incubator environments. They then used the MPD to study drug responses, as well as the contractile development of human stem cell-derived laminar cardiac tissues over four weeks. The study was published on October 24, 2016, in Nature Materials.

“Researchers are often left working in the dark when it comes to gradual changes that occur during

Soft Robotics Mimic Human Muscle Function nnovative reconfigurable robots powered by muscle-like actuators could be used in assistive wearable devices for physical rehabilitation.

Under development at Ecole Polytechnique Fédérale de Lausanne (EPFL; Switzerland; www.epfl.ch), the actuator prototypes include both linear and bending actuators with varying geometric parameters that can be used in diverse soft robotic systems for a wide set of assistive wearable technologies, including replicating the motion of several parts of the human body. The soft robots are made of elastomers such as silicon and rubber, and are controlled by changing air pressure in specially designed compartments, or modules, which also serve as the robot’s body.

The cucumber-shaped actuators can stretch up to around five or six times their normal length and bend in two directions, depending on the model. The soft robots are designed for use on the human body, with potential implementations including a wide variety of bioinspired and biomimetic systems, such as devices to assist gripping and manipulation of fragile objects. For example, one of the designs is a belt made of several inflatable components, which holds patients upright during rehabilitation exercises and guides their movements. A study describing the soft robotics was published on September

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27, 2016, in Nature - Scientific Reports.

“Our robot designs focus largely on safety. There’s very little risk of getting hurt if you’re wearing an exoskeleton made up of soft materials, for example,” said Professor Jamie Paik, PhD, director of the EPFL Reconfigurable Robotics Lab (RRL).

“We conducted numerous simulations and developed a model for predicting how the actuators deform as a function of their shape, thickness, and the materials they’re made of,” said lead author Gunjan Agarwal, PhD. “Elastomer structures are highly resilient but difficult to control. We need to be able to predict how, and in which direction, they deform. And because these soft robots are easy to produce but difficult to model, our step-by-step design tools are now available online for roboticists and students.”

Image: Soft robots can be spatially manipulated using air pressure (Photo courtesy of EPFL).

cardiac tissue development and maturation, because there has been a lack of easy, non-invasive ways to measure the tissue functional performance,” said lead author Johan Ulrik Lind, PhD. “These integrated sensors allow researchers to continuously collect data while tissues mature and improve their contractility. Similarly, they will enable studies of gradual effects of chronic exposure to toxins.”

“Our microfabrication approach opens new avenues for in vitro tissue engineering, toxicology, and drug screening research,” said study co-author professor of bioengineering and applied physics Kit Parker, PhD. “Translating microphysiological devices into truly valuable platforms for studying human health and disease requires that we address both data acquisition and manufacturing of our devices. This work offers new potential solutions to both of these central challenges.”

MPDs, also known as organs-onchips, mimic the structure and function of native tissue in-vitro and have emerged as a promising alternative to traditional animal testing; but the fabrication and data collection process is expensive and laborious. Currently, these devices are built in clean rooms using a complex, multi-step lithographic process, and collecting data requires microscopy or high-speed cameras, since they do not have integrated sensors.

Image: Close up of 3D printer printing heart-on-a-chip MPD (Photo courtesy of Harvard University).

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World-Class Medical Center Inaugurated in San Diego he new Jacobs Medical Center (La Jolla, CA, USA; http:// health.ucsd.edu/jacobs) combines renowned physician-scientists and care teams, precision medicine, clinical trials, and creative arts and culinary offerings to provide an extraordinary healing experience for patients and families. The 10-story, 245-bed hospital, built by UC San Diego Health (CA, USA; http:// health.ucsd.edu) at a cost of USD 943 million, represents the seamless integration of advanced imaging and surgical technologies with comforting environmental elements. Three specialty centers reside within the center: the Rady Pavilion for Women and Infants, the Pauline and Stanley Foster Pavilion for Cancer Care, and the Vassiliadis Family Pavilion for Advanced Surgery. The pavilions will treat everything from single and multiple births to the most complex malignancies and chronic diseases.

The second story surgery suites include intraoperative CT or MRI imaging capabilities, enabling surgeons to verify complete tumor removal during surgery and validate precise repair of neurologic, urologic, orthopedic, and other med-

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ical conditions. Patients will also have access to nearly 100 cancer subspecialists and dedicated support teams, such as respiratory and pain management experts. Clinical services are supported by a UCSD-based genomics diagnostic team capable of analyzing hundreds of genes to help formulate optimal treatment plans for individual patients.

The majority of the rooms feature floor-to-ceiling windows with panoramic views of San Diego. Inside each private room, patients will be able to use an iPad to control lighting, and temperature, as well as entertainment on an Apple TV. The iPads also allow patients to see photos and biographies of their clinical care team, when their next medical test is scheduled, and access a bedside medical chart. The sixth floor is designated for bone and stem cell transplantation patients, with full-unit air filtration to allow patients freedom of movement, exercise, and socialization.

“This hospital honors the vision of UC San Diego’s founders, who saw a need to integrate groundbreaking research and discovery with outstanding patient care,” said David Brenner, MD,

vice chancellor for health sciences and dean of the School of Medicine. “At Jacobs Medical Center, patients can experience the unique benefits of an academic health system, where physicians, researchers, and nurses work side-by-side to deliver the finest in modern medicine within a best-in-class patient care environment.”

“When we came here in 1966, the medical school was just starting, and there was no hospital,” said Irwin Jacobs, co-founder, former chair-

man and CEO of Qualcomm, who together with his wife donated USD 100 million to the center. “Today, it’s very exciting to see Jacobs Medical Center open. More and more, we’re learning how to bring results from basic research in biology and engineering to medicine, and to the patient.

This medical center is going to show how effective that kind of integrated care can be. Innovations will spread out from San Diego, and go all around the world.”

could analyze it to see the transition from health to disease.”

“When I found out that Dr. Saxon and body computing was an entity, I thought ‘Oh my god, this is perfect, I’d love to use my programming skills in the context of medicine,” said Ketetha Olengue, a medical student at the Keck School of Medicine and intern at the center, who programmed the app and is also featured

in the promotional video. “It’s exciting and it’s valuable because it’s just going to change the way people interact with their doctors. With an app like this, it allows you to talk to a doctor in the comfort of your own home.”

Virtual Care Clinic to Employ Avatar Doctors novel virtual care clinic under development by the University of Southern California (USC; Los Angeles, USA; www.usc. edu) could in future provide medical care over a digital platform.

The USC Center for Body Computing is developing the Virtual Care Clinic to facilitate a technology-connected health care system, with the ultimate objective being the digital cloning of all 1,500 experts and researchers from the USC Keck School of Medicine. One aspect of the clinic is the DocOn app – currently in the development stage-which will showcase the medical avatars. USC intends the app to be eventually available in several languages for user around the globe.

The first version of the app is focused on atrial fibrillation (AF). During the run-in period it will not diagnose AF, but instead will be educational, providing information on recent studies, medication, or treat-

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ments gathered from reputable medical research. The Virtual Care Clinic is not intended to replace regular visits with doctors, but instead give patients additional resources to learn about their health. The first virtual avatar is that of Leslie Saxon, MD, founder of the USC Center for Body Computing; the avatar gestures, furrows her eyebrows, and talks just like the doctor herself.

“In a way, what we’re doing with the virtual care clinic is we’re developing the operating system for health care. Most of the health care delivery in the United States and globally will be delivered over a digital platform, meaning not in person,” explained Dr. Saxon. “To visualize this new future, imagine that your smartphone is picking up even more data than it is now; knowing what you ate for dinner, your exercise routine, and your family medical history. All that data could be turned over to your doctor, who

Image: Dr. Leslie Saxon standing in a virtual doctor photo tent (Photo courtesy of Eddie Sakaki/USC).

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Industry News

Bracco Announces Strategic Investment in Radiology IT Developer racco Imaging S.p.A. (Milan, Italy; www.braccoimaging. com), which develops, manufactures and markets diagnostic imaging agents and solutions, has announced a strategic investment in PHS Technologies Group, LLC (Scottsdale, AZ, USA; www.dosemonitor.com), which is a division of PACSHealth, LLC (Scottsdale, AZ, USA; www. pacshealth.com), a medical software development company.

Bracco’s product and solution portfolio comprises all key diagnostic imaging modalities, along with various medical devices and advanced administration systems for contrast imaging products in the fields of radiology. PHS Technologies Group offers advanced solutions that enable hospitals to manage patient radiation exposure and comply with regulatory requirements and industry guidelines, while increasing efficiency and reducing cost.

Bracco’s strategic investment in PHS Technologies Group aims at expanding its portfolio of software applications for dose management to provide healthcare organizations with

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the information required to ensure patient safety, enhance imaging exam consistency, maintain regulatory compliance and monitor radiation dose at an enterprise level. The agreement also strengthens the partnership with PHS Technologies Group, allowing Bracco to enhance distribution efforts of NEXO[DOSE], a software application for automated patient radiation exposure data aggregation and reporting from multiple xray modalities.

"We are pleased to reinforce our partnership with PHS Technologies," said Fulvio Renoldi Bracco, Head of the Business Unit Imaging at Bracco Imaging.

"PHS Technologies Group is excited to expand its relationship with Bracco," said Mike Battin, Chief Operating Officer of PHS Technologies Group. "PHS is the OEM manufacturer for Bracco's NEXO[DOSE] product and will implement an expanded service and support offerings to the new markets. Furthermore, PHS will provide significant functional improvements to the application portfolio over the next 24 months."

B. Braun and Philips to Develop Ultrasound-Guided Anesthesia Systems . Braun Melsungen AG (Melsungen, Germany; www. bbraun.com) and Royal Philips (Amsterdam, Netherlands; www.philips.com) have entered into a multi-year strategic alliance to innovate ultrasound-guided regional anesthesia and vascular access. B. Braun and Philips will leverage on their combined clinical expertise and R&D capabilities, as well as sales and service channels in regional anesthesia and pain management and ultrasound and image guided therapy, to jointly develop and commercialize solutions to support anesthesiologists and hospitals in critical areas of regional anesthesia. These solutions aim to enhance needle visualization and guidance, as well as optimize procedure workflow and resource planning. The alliance will also focus on vascular access procedures, such as those used to insert catheters into deeply seated veins as part of a catheter-based treatment.

As a platform for implementing their joint innovations, both the companies will launch the new Xperius ultrasound system in a cart as well as ultra-mobile tablet version. Xperius has been specifically designed to support

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the needs in regional anesthesia at the point of care, based on the input provided by clinical experts. The system offers an intuitive user interface and exceptional image quality for confident needle targeting and positioning, as well as ergonomic features such as the articulating arm. The Xperius platform will be co-branded and sold through B. Braun’s global sales network, while Philips will provide installation and service. Both the companies will offer education, training, service and support to anesthesiologists and healthcare providers for using the Xperius platform.

“Our customers are looking for fully integrated system solutions that address all aspects of their everyday work in caring for patients, including the enhanced efficiency needed to meet ever-increasing demand for their services,” said Dr. Meinrad Lugan, Member of the Board for the Hospital Care Division at B. Braun.

“This new alliance with Philips illustrates our commitment to sharing expertise, not only with our customers, but also with other key technology players, to meet healthcare needs and challenges faced today and into the future.”

International Calendar For a free listing of your event, or a paid advertisement in this section, contact:

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JUNE 2017 EuroAnaesthesia 2017. Jun 3-5; Geneva, Switzerland; Web: www.esahq.org American Society of Clinical Oncology 2017 Annual Meeting. Jun 2-6; Chicago, USA; Web: http://am.asco.org Africa Health 2016. Jun 7-9; Johannesburg, South Africa; Web: www. africahealthexhibition.com EAES 2017 - 25th International Congress of the European Association for Endoscopic Surgery. Jun 14-17; Frankfurt, Germany; Web: http:// eaes.eu ESGAR 2017. Jun 20-23; Athens, Greece; Web: www.ergar.org JULY 2017 INAC 2017 – International Neonatology Association Conference. Jul 7-9; Lyon, France; Web: http://2017.worldneonatology.com AUGUST 2017 FIME 2017. Aug 1-3; Miami Beach, FL, USA; Web: www.fimeshow.com MEDEXPO AFRICA 2017. Aug 22-24; Dar-es-Salaam, Tanzania; Web: www.expogr.com/tanzania/medexpo ESC 2017 – European Society of Cardiology. Aug 26-30; Barcelona, Spain; Web: www.escardio.org SEPTEMBER 2017 Medical Fair Thailand 2017. Sep 8-9;

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International Calendar 25th UEG Week – United European Gastroenterology. Oct 28-Nov 1; Barcelona, Spain; Web: www.ueg.eu WFUMB 2017- World Federation for Ultrasound in Medicine and Biology.

Oct 13-17; Taipei, Taiwan; Web: www. wfumb.org

NOVEMBER 2017 MEDICA 2017. Nov 13-16; Dusseldorf, Germany; Web: www.medica.de RSNA 2017 – 103rd Meeting of Radiology Society of North America. Nov 26-Dec 1; Chicago, IL, USA; Web: www.rsna.org 22nd Congress of the APSR - Asian Pacific Society of Respirology. Nov 24-26; Sydney, Austrailia; Web: www. apsr2017.com 13th Congress – World Fed. Of Societies of Intensive and Critical Care Medicine. Nov 8-11; Rio de Janeiro, Brazil; Web: www.criticalcare2017.com.br DECEMBER 2017 Zdravookhraneniye 2016. Dec 4-8; Moscow, Russia; Web: www.zdravo-expo.ru/en MEDEXPO AFRICA 2017. Aug 22-24; Dar-es-Salaam, Tanzania; Web: www.expogr.com/tanzania/medexpo JANUARY 2018 2018 Gastrointestinal Cancers Symposium. Jan 18-20; San Francisco, CA, USA; Web: http://gicasym.org CACVS 2018 - Controversies & Updates in Vascular Surgery. Jan 25-27; Paris, France; Web: http://cacvs.org/en/ Arab Health 2018. Jan 29-Feb 1; Dubai, UAE; Web: www.arabhealth online.com ICID 2018 – 20th International ConV

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gress on Infectious Diseases. Jan 29-30; Sydney, Australia; Web: www. waset.org

FEBRUARY 2018 47th Annual Meeting of the Society for Critical Care Medicine (SCCM).

Feb 25-28; San Antonio, TX, USA; Web: www.sccm.org ISET 2018 – International Symposium on Endovascular Therapy. Feb 3-7; Hollywood, FL, USA; Web: www. iset.org 2018 AAP Annual Meeting- Association of Academic Psychiatrists. Feb 13-17; Atlanta, GA, USA; Web: www. physiatry.org MEDICAL JAPAN 2018. Feb 21-23; Osaka, Japan; Web: www.medical-jpn.jp MARCH 2018 HIMSS Annual Meeting 2018 - Health IT Conference and Exhibition. Mar 59 Las Vegas, NV, USA; Web: www. himssconference.org ExpoMED Eurasia 2018. Mar 22-25; Istanbul, Turkey; Web: www.expomedistanbul.com Annual EAU Congress 2018 - European Association of Urology. Mar 1620; Copenhagen, Denmark; Web: http://eau18.uroweb.org APRIL 2018 2018 ARRS Annual Meeting. Apr 2227; Washington, DC, USA; Web: www. arrs.org MAY 2018 ECTES 2018 – 19th European Congress of Trauma & Emergency Surgery. May 6-8; Valencia, Spain; Web: www.estesonline.org

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35

HospiMedica International April-May/2017

Advertising Index

Vol. 35 No.2 4-5/2017

Inq.No.

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