HospiMedica International January 2020 by Globetech

V I S I T

World’s clinical neWs leader Vol.37 no.6 • 12 / 2019-1/2020

Radiotherapy for At-Risk Arrhythmia Patients

single, high dose of radiation therapy (RT) can dramatically reduce episodes of ventricular tachycardia (VT) for more than two years, according to a new study. Developed at the Washington University (WUSTL; St. Louis, MO, USA; www.wustl.edu) School of

issn 0898-7270

Control Measures Can Reduce ICU Bloodstream Infections by 80%

loodstream infections acquired in intensive care units (ICUs) across the United Kingdom dropped by 80% between 2007 and 2012, claims a new study. Researchers at King’s College London (KCL; United Kingdom; www.kcl.ac.uk), Guy’s and St

Thomas’ NHS Foundation Trust (London, United Kingdom; www. guysandstthomas.nhs.uk), and the Intensive Care National Audit and Research Centre (ICNARC; London, United Kingdom; www. icnarc.org) conducted a study that collected and analyzed data

Pocket Ultrasound Makes Imaging Accessible Anywhere Cont’d on page 7

Cont’d on page 5

Image: Courtesy of Butterfly Network

handheld ultrasoundon-chip single-probe whole body system is set to make imaging diagnostics universally accessible and affordable. The multimode (M-mode, B-mode, Color Doppler) Butterfly iQ ultrasound device, which is less than 15 cm. long and just over 300 gm. in weight, easily fits into a pocket and can connect to a handheld iPhone or iPad mobile device.

See article on page 4

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DAILy CLINICAL NEwS

Synthetic Blood Stems Massive Hemorrhages

n artificial blood that can be transfused into trauma patients regardless of their blood type can vastly improve their chances for survival, according to a new study. Developed at the National Defense Medical College (NDMC; Saitama, Japan; www.ndmc.ac.jp), Waseda University (Tokyo, Japan; www.waseda.jp), and Nara Medical University (Nara, Japan;

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Atrial Flow Regulator Manages Heart Failure

next-generation implantable shunt device treats heart failure (HF) or pulmonary hypertension (PH) symptoms by decompressing abnormal intra-atrial pressure. The Occlutech (Schaffhausen, Switzerland; www.occlutech.com) atrial flow regulator (AFR) HF Device is a double-disc shaped shunt placed in the septum between the left and right atriums, via a minimally invasive balloon atrial Cont’d on page 4

INSIDE

Novel Video Laryngoscope Helps Visualize key Anatomy

International Calendar . . 26

ext-generation laryngoscopes minimize strain and maximize performance for ear, nose and throat (enT) specialists and speech language pathologists.

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

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News Update . . . . . . . . . 10 Product News . . . . . 10-14

Orthopedic Robotic System Facilitates External Fixation

smart, robotic external fixation system addresses the two major challenges facing physicians – patient compliance and lack of real-time feedback. The OrthoSpin AutoStrut system is an external fixator based on the DePuy Synthes (West Chester,

PA, USA; www.depuysynthes.com) MaxFrame multi axial correction system, including all its parts and software; but with the six MaxFrame struts substituted by lengthadjustable motor-powered AutoStruts. Using MaxFrame 3D planning software, an accurate Cont’d on page 5

News Update . . . . . . . . . 16 Product News . . . . . .16-20

Health IT I

GLOBETECH >>> MEDIA <<<

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Pocket Ultrasound Makes Imaging Accessible Anywhere

HospiMedica International

handheld, single-probe whole body system is making ultrasound technology universally accessible and affordable. The Butterfly Network (New York, NY, USA; www.butterflynetwork.com) Butterfly iQ is a multi-mode (M-mode, B-mode, and Color Doppler) ultrasound device less than 15 centimeters long and weighing just 313 grams, allowing it to easily fit into a pocket. A rugged anodized aluminum body encases and protects the device, which connects via a USB or lightening cable to a standard handheld Apple iPhone or iPad mobile device. All data is stored and managed on the Butterfly iQ app and in the Butterfly Cloud with 256-bit encryption for tight monitoring and security. Butterfly IQ is programmed with 18 preset scanning programs, which enable diagnostic ultrasound imaging of peripheral vessels, including for carotid and arterial studies and procedural guidance; and cardiac, abdominal, urology, gynecological; fetal/obstetric, and musculoskeletal use. In addition, Butterfly Network has developed deep learning-based artificial intelligence (AI) applications that are tightly coupled to the hardware and assist clinicians with both image acquisition and interpretation, which will ulti-

Atrial Flow Regulator Manages Heart Failure

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septostomy (BAS) procedure, in order to create a restrictive atrial septal opening. Made of nickel-titanium (Nitinol), the AFR is intended to maintain a permanent interatrial fenestration of varying diameters (6-10 mm) secured by two discs. Depending on the indication (HF or PH), the shunt allows for the controlled flow of blood between the atria of V

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mately enable less skilled users to reliably extract life-saving insights from ultrasound. The Butterfly iQ is powered by capacitive micromachined ultrasonic transducer (CMUT) technology, which replaces the traditional piezoelectric transducer with a single silicon chip that incorporates an array of 9,000 programmable microelectromechanical systems (MEMS) sensors directly overlaid onto an integrated circuit encompassing the electronics backbone of a high performance ultrasound system, allowing it to emulate any type of transducer – linear, curved, or phased. An integrated 400 mAh Lithium Ion battery provides up to two hours of continuous use. “Just as putting a camera on a semiconductor chip made photography accessible to anyone with a smart phone and putting a computer on a chip enabled the revolution in personal computing before that,” said Jonathan Rothberg, founder and chairman of Butterfly Network. “Two-thirds of the world’s population has no access to medical imaging; that’s not ok. Butterfly’s Ultrasound-on-a-Chip technology enables a low-cost window into the human body, making high-quality diagnostic imaging accessible to anyone.”

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the heart. By maintaining the predetermined diameter shunt open in the intra-atrial septum, cardiac pressure is substantially reduced, resulting in a decompression of the heart chambers which leads to reduced HF and PH symptoms, and as a result to an improved exercise tolerance and to better quality of life (QOL). The AFR HF Device is manufactured in different sizes, allowing for a unique, patient-oriented, and individualized treatment. The Occlutech AFR Device has received the European Union CE mark of approval. “With CE mark approval of the Occlutech AFR we are taking another big step towards becoming a multi-franchise congenital and structural heart disease therapy provider,” said Sabine Bois, Co-CEO of Occlutech. “The Occlutech AFR with its efficacy, versatility, convenience, and safety has true potential to revolutionize the way heart failure patients are treated.” Unlike systemic blood pressure, pulmonary blood pressure reflects the pressure the heart exerts to pump blood from the right ventricle, which receives the oxygen-depleted blood, into the pulmonary arteries, and on to the left atrium. Normal pulmonary artery pressure is 8-20 mm Hg at rest (much lower than systemic blood pressure); if the pressure in the pulmonary artery is greater than 25 mm Hg at rest or 30 mmHg during physical activity, it is abnormally high and is called PH.

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ISSN 0898-7270

vol.37 No.6 • Published, under license, by Globetech Media llc copyright © 2020. all rights reserved. reproduction in any form is forbidden without express permission. Teknopress Yayıncılık ve Ticaret Ltd. şti. adına İmtiyaz Sahibi: M. Geren • Yazı işleri Müdürü: ersin Köklü Müşir derviş İbrahim sok. 5/4, esentepe, 34394 şişli, İstanbul P. K. 1, aVPiM, 34001 İstanbul • e-mail: Teknopress@yahoo.com Baskı: Postkom a.ş. • İpkas sanayi sitesi 3. etap c Blok • 34490 Başakşehir • İstanbul Yerel süreli yayındır. Yılda altı kere yayınlanır, ücretsiz dağıtılır.

HospiMedica International december/2019-January/2020

Control Measures Can Reduce ICU Bloodstream Infections by 80%

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HospiMedica International

cont’d from cover

on Methicillin-Resistant Staphylococcus aureus (MRSA), C. difficile, and vancomycin-resistant Enterococcus (VRE) infection from 1,189,142 patients admitted to all 276 NHS adult ICUs across England, Wales and Northern Ireland from 2007 to 2016. The results showed that MRSA admissions (per 1,000 patients) decreased from 38.8 to 13.1, and acquisitions decreased from 25.4 to 4.1; C. difficile admissions decreased from 10.6 to 4.2, and acquisitions decreased from 11.1 to 3.5; on the other hand, VRE admissions and acquisitions increased from 1.9 to 5.3 and 1.5 to 5.9, respectively. Reductions were seen for all main organisms, excluding VRE, with greatest reductions for MRSA (97%), Pseudomonas aeruginosa (80%), S. aureus (77%) and Candida spp (71%), but lower reductions for E. coli (54%) and Klebsiella (42%). The study was published on August 1, 2019, in Clinical Infectious Diseases. “The size of this reduction in many of the most serious ICU-acquired infections was frankly unexpected, particularly given that the

Orthopedic Robotic System Facilitates External Fixation

national focus during that time was recording reductions in MRSA and C. difficile,” said lead author Prof. Jonathan Edgeworth, MD, of KCL. “It implies that improvements in infection control practice were effectively implemented across the board by all members of the ICU team. It is notable these lower infection rates have been maintained since 2012, but we need to see if they can be reduced further.”

Image: Statistics from a new study show bloodstream ICU infections in the UK have dropped drastically (Photo courtesy of 123rf.com). visit us at

ARAB HEALTH

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Stand H1.G35

an accurate treatment plan is generated via advanced algorithms, eliminating the need for manual measurement, reducing procedural complexity, radiation exposure, overall costs, and treatment time. The patients’ treatment plan, which details how much each AutoStrut should be extended after a given amount of time, is downloaded to a control box, which then automatically extends the motorized struts at the pre-specified times. By automatically making the pre-programmed adjustments continuously and precisely, the system eliminates the need for patient education, training, and participation in making manual adjustments, thus delivering a better overall patient experience and reducing the need for time-consuming follow-ups. “Our robotic struts eliminate the need for manual adjustment, improve patient compliance, and the process is expected to be less painful,” said Oren Cohen, CEO of OrthoSpin (Misgav, Israel; www.orthospin.com). External fixation is a common treatment option for orthopedic-related problems: bone lengthening, setting complex fractures, and correcting deformities. As external fixation requires the patient to make multiple manual adjustments every day, significant patient training and involvement are required; many times, the patient does not fully or precisely comply with the mechanical adjustments, which results in errors and less than optimal clinical outcomes.

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PRODUCT NEWS

CT SYSTEM

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ULTRASOUND SYSTEM

ULTRASOUND PHANTOM

Canon Medical Systems

Esaote

CIRS

The Aquilion Start features automatic dose reduction and metal artifact reduction that help expand clinical capabilities. Its patient-friendly design increases efficiency and also ensures patient safety, helping to reduce stress.

The MyLab X8 features Virtual Navigator fusion imaging and QElaXto shearwave elastography. Other benefits include microV, QPack, exam automation tools like eScan, eDoppler and zero-click advanced functions.

The Model 054GS contains gray scale targets and improved sensitivity targets that exceed requirements in the ACR accreditation program. It provides tissue-mimicking properties, and is compatible with harmonic imaging.

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Novel Video Laryngoscope Helps Visualize key Anatomy

The Olympus Medical (Olympus; Tokyo, Japan; www.olympus-global. com) ENF-VH2 and ENF-V4 video rhino-laryngoscopes are designed to provide detailed images within a broad, luminous field of view. The ENF-VH2 produces high-resolution images that are HD-compatible, and the ENF-V4 offers a slim design with a diameter tip of 2.6 mm, allowing detailed observation of the mucosa via built-in narrow band imaging (NBI), which highlights minute vascular and mucosal patterns using only wavelengths absorbed by hemoglobin. The devices also promote patient comfort, which is especially important in swallowing evaluations as patients are required to eat and drink as part of the procedure. Slim and lightweight, both devices feature an ergonomic grip and control section that allows physicians and therapists to insert the tube more linearly in relation to the patient, thus helping to reduce friction between the scope and the mucosa and facilitate a smoother, more efficient insertion with either the left or right hand. The rhino-laryngoscopes continuously capture still images, automatically selecting the sharpest available image when the pre-freeze button is pressed. Both scopes can connect to the hospital electronic medical record (EMR) network using the Olympus nCare medical recorder and VaultStream medical content management system.

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“Probably the most exciting aspect of using video during swallowing examinations is that the patient becomes an active partner in the healing journey,” said Stephanie Dodson Mataya, MSc, CCC/SLP, an Olympus fiberoptic endoscopic evaluation of swallowing (FEES) educator. “The biofeedback mechanism is invaluable, allowing patients to see what’s happening as they swallow. The speech pathologists on our team are always pleased with advancements in handling and ergonomics.”

Manganese-Based Contrast Agent Could Make MRI Safer

novel Manganese-based contrast agent may provide tumor contrast enhancement comparable to that of gadolinium-based contrast agents (GBCAs), according to a new study. Developed at Massachusetts General Hospital (MGH; Boston, USA; www.massgeneral.org), Harvard Medical School (HMS; Boston, MA, USA; https://hms.harvard.edu), and the Institute for Innovation in Imaging (i3; Boston, MA. http://i3.mgh.harvard.edu), Mn-PyC3A takes advantage of the fact that unlike gadolinium, manganese is an essential element that is naturally found in the body. The Manganese in MnPyC3A is tightly bound to a chelating agent, which prevents it from interacting with cells or proteins in an adverse way, and also allows for rapid elimination from the body after the imaging exam. For the study, the researchers compared the efficacy of Mn-PyC3A to two state of the art GBCAs in detecting tumors in two mouse models, breast cancer and metastatic live cancer. They found that the tumor contrast enhancement provided by Mn-PyC3A was comparable to the performance of the two GBCAs. They also found that the fractional excretion and elimination of Mn-PyC3A in a rat model was superior to that of GBCAs, with 85% eliminated into the urine and the remaining 15 percent eliminated in the feces. The study was published on July 25, 2019, in Investigative Radiology. There are two forms of GBCAs; the less stable linear GBCAs, which are more toxic, and the more stable macrocyclic GBCAs, which is safer. It is has been established that gadolinium deposits in three main brain areas, the dentate nucleus of the cerebellum, the globus pallidus and the pulvinar. Outside of the brain, gadolinium deposition occurs in the kidney, where it can cause nephrogenic systemic fibrosis, a scleroderma-like disorder; this, however, occurs mostly in people with renal impairment. Harm from gadolinium deposition has not been established. HospiMedica International december/2019-January/2020

Ultrasound Acoustic Diffusion Detects Bone Density

novel ultrasound technique can provide a non-invasive way of evaluating osteoporosis risk by assessing microscale bone structure. Researchers at North Carolina State University (NC State; Raleigh, USA; www.ncsu.edu) and Charité University Medicine (Charité; Berlin, Germany; www.charite.de) conducted a numerical computational study to investigate the effect of cortical bone pore size and density on the acoustic diffusion constant of ultrasound multiple scattering. To do so, finite-difference time-domain simulations were conducted in cortical microstructures derived human proximal femur cross-sections, and modified by controlling the density and size of the pores. To do so, Gaussian pulses were transmitted, and the signals were recorded to obtain the backscattered intensity. The incoherent contribution of the backscattered intensity was then extracted to give access to the diffusion constant. The researchers found that at 8 MHz, significant differences were observed in media with different porous micro-architectures, with the diffusion constant monotonously influenced by either pore diameter or pore density. An increase in pore size and pore density resulted in a decrease in the diffusion constant, suggesting the potential of the proposed technique for the characterization of cortical microarchitecture. The study was published on August 8, 2019, in The Journal of the Acoustical Society of America. “We are at least years from clinical applications, but if the results hold up, we may have a way to monitor patients on a regular basis to determine the health of the bone,” said corresponding author Marie Muller, PhD, of the department of mechanical and aerospace engineering at NC State. “That means people can track their potential risk for osteoporosis without having to worry about the radiation exposure associated with X-rays. In addition, the technique could help researchers and health care providers de-

Radiotherapy for At-Risk Arrhythmia Patients

termine the effect of osteoporosis treatment efforts.” “One thing that’s exciting about these techniques is that we’ve taken one of ultrasound’s shortcomings and turned it to our advantage,” concluded Dr. Muller. “The shortcoming is the fact that ultrasound cannot give us clear images when used in complex media, such as bone. That’s because the ultrasound waves bounce all over the place in these complex environments, making it impossible to calculate how far they’ve traveled.” Long bones consist of a trabecular core and an outer compact cortical bone shell. The latter is highly dense, but is pervaded by elongated pores, which results in a porosity ranging between 3% and 28%. It has been previously shown that bone elastic modulus, toughness, and impact energy absorption capacity decrease as cortical porosity increases.

Image: Research suggests that ultrasound may be used to evaluate osteoporosis (Photo courtesy of iStockImage).

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Medicine, the noninvasive, outpatient procedure for treating VT is called EP-guided noninvasive cardiac radioablation (ENCORE). The novel therapy fuses electrocardiogram (ECG) and imaging data to pinpoint the scar tissue in the patient’s heart responsible for the arrhythmias, and then targets it with a single dose of stereotactic body radiation therapy (SBRT). ENCORE requires no general anesthesia, and allows patients to go home immediately after treatment. In a phase I/II prospective trial, 19 patients who had life-threatening VT were treated with a single fraction (25 Gy) of SBRT. ENCORE led to a 94% reduction in VT episodes in the first six months after SBRT, with longer-term follow-up data showing that the effect persisted in 78% of patients for more than two years; overall survival was 52% after the second year. Of the nine patients who died, six suffered from cardiac deaths (heart failure and VT recurrence) and three from non-cardiac deaths (accident, amiodarone toxicity, and pancreatic cancer). The study was presented at the 61st annual meeting of the American Society for Radiation Oncology (ASTRO), held during September 2019 in Chicago (IL, USA). “Patients come to us as a last line of defense. They have few or no other options. Often, the primary reason we are treating them is because they were too sick to have more catheter ablation,” said lead author and study presenter Clifford Robinson, MD, an associate professor of radiation oncology and cardiology at WUSTL. In VT, the electrical signals in the heart’s lower chambers misfire, crippling the relaxation and refilling process and producing rapid arrhythmias. First line treatment for VT includes pharmaceuticals and an implantable cardioverter defibrillator (ICD). Patients with recurrent VT often also undergo catheter ablation, which requires general anesthesia, takes up to nine hours to perform, holds a 5% mortality risk, and has a 50% chance that it won’t stop VT arrhythmias from recurring. If catheter ablation does not control the VT, patients are left with few options beyond a heart transplant.

HospiMedica International december/2019-January/2020

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PRODUCT NEWS

FLAT PANEL DETECTOR

MOBILE X-RAY

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FLUOR/RADIOGRAPHY SYSTEM

Konica Minolta Medical Imaging

Allengers Medical Systems

Siemens Healthineers

The AeroDR NS is compatible with any existing static RAD room and mobile RAD system. Its ImagePilot software can register patients, acquire and view images, perform measurements and reports and archive data.

The Mars 15 - 30 KW system is based on HF-X Ray generation technology and ensures elimination of motion artifacts due to lower exposure time. It is compact, lightweight and easy to move with a small footprint.

The Luminos Agile Max combines patient-side fluoroscopy and unlimited radiography into one system. The 2-in-1 system delivers highquality, low-dose dynamic and static images on all types of patients.

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Landauer and RaySafe Unveil New Radiation Safety Solutions

andauer (Glenwood, IL, USA; www.landauer.com) and RaySafe (Billdal, Sweden; www.raysafe.com) showcased several new products and services at the Radiological Society of North America (RSNA) 2019 Annual Meeting held on December 1-5 at McCormick Place in Chicago, USA. The RSNA Annual Meeting is the world's premier scientific and educational forum in radiology. RSNA 2019, “See Possibilities Together,” offered radiologists from around the world a vast array of education courses, plenary lectures and scientific paper and poster presentations featuring the latest trends, hot topics and cutting-edge research. This year, RSNA featured expanded AI, 3D printing, advanced visualization and hands-on opportunities. The specialty’s leading experts discussed the scientific innovations that are driving improvements in patient care and taking radiology in exciting new directions. At this year’s RSNA, Landauer and RaySafe exhibited several radiation safety and compliance solutions. Landauer is a global provider of technical and analytical services to determine occupational, patient and environmental radiation exposure and the leading domestic provider of outsourced medical physics services – both imaging and therapy. RaySafe is a global provider of X-ray quality assurance solutions to help

Made in USA

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protect patients and staff from unnecessary radiation. Its solutions are designed to minimize the need for user interaction, bringing simplicity and usability to the X-ray room. Landauer showcased Landauer Optimize, a new patient dose optimization solution that combines software and personal guidance from expert, dedicated medical physicists. Optimize is a cloudbased dose management solution with easy adoption by staff – only requiring about one hour a month to maintain. It features automated monitoring with customized analysis, right patient doses and maximum image quality. Developed by Landauer medical physicists, Optimize allows healthcare providers to focus on caring for patients rather than data – and to serve more patients safely, effectively and compliantly. RaySafe showcased the RaySafe 452 Radiation Survey Meter, a versatile, powerful tool that can be used for multiple situations, reducing the number of devices technicians need to carry, learn, and calibrate. It is the ideal tool to measure radiation in a wide variety of applications, including finding spilled isotopes, measuring scattered radiation from Xray machines, and linear accelerators. The RaySafe 452 does not require any corrections or manual settings, letting technicians focus on radiation protection rather than set-up. RaySafe also featured the RaySafe i3 Realvisit us at time Dosimeter System which measures and records radiation every second, providing instant feedback to help interventional radiology staff take steps to learn and adapt their behavARAB HEALTH ior to minimize unnecessary radiation expoStand S1.C57 sure. RaySafe i3 visualizes X-ray exposure in real time using easy-to-read bar graphs to indicate the dose rate for each individual user. The measurements are simultaneously stored for post-procedure analysis, to facilitate continued learning as well as to enable comparisons over time or between labs. Among other solutions showcased by RaySafe at RSNA 2019 was the RaySafe X2 Xray QA Test Device, a simple-to-operate test tool that lets technicians focus on the results versus set-up. The RaySafe X2 features a large touch-screen display showing all measured parameters. It does not require any special settings to handle different types of X-ray machines and offers sensors for R/F, MAM, CT, Survey and even light applications. HospiMedica International december/2019-January/2020

Specimen Radiography System Provides Instant Biopsy Verification

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Medical Imaging

next-generation specimen radiography system delivers enhanced image quality, improved workflow and immediate sample verification during breast-conserving surgeries. The Hologic (Bedford, MA, USA; www.hologic.com) Trident HD specimen radiography system has been engineered from the ground up to meet the demands of busy operating rooms (ORs), where space is at a premium. Features include an intuitive, high-resolution HD touchscreen display, a user-friendly control panel, a 16 x 18cm detector panel with amorphous selenium direct-capture technology, optional bar code scanning, and picture archiving and communication systems (PACS) integration. Integration of all the components together accelerates large specimen imaging procedures during breast conserving surgeries and mastectomies. An automatic exposure control (AEC) module optimized for breast excisions and core biopsies, and an advanced algorithm created specifically for breast specimen radiography processing and stereotactic breast biopsies support complete imaging of larger breast surgical specimens. Prior mammography or biopsy images can be displayed on the same monitor to speed comparison and analysis, resulting in reduced procedure time and improved workflow. Wireless integration supports advanced image sharing and transfer of patient records to PACS or a proprietary SecurView DX workstation – with a single touch. “The Trident HD system is a breakthrough solution that delivers the superior image quality clinicians have come to expect from Hologic products, helping to streamline workflows and reduce recalls while decreasing procedure times,” said Pete Valenti, president of breast and

Chest X-Ray AI Algorithm warns of Pneumothorax

skeletal health solutions at Hologic. “We are committed to identifying and addressing the challenges of our customers and their patients at every step of the breast health journey, and our expanding product portfolio is evidence of that commitment.” Specimen radiographs can help define the type, size, and extent of a tumor by using orthogonal views and radiographs to define its margins, allowing the surgeon to intra-operatively undertake an additional margin cavity shave, increasing the chance of a histologically clear margin at the first operation. It is important for both participating radiologists and pathologists to understand which radiologic features are correlated with histologic findings.

Image: The Trident HD specimen radiography system (Photo courtesy of Hologic).

n artificial intelligence (AI) system automatically issues a triage alert if pneumothorax (PNX) is detected on a chest X-ray (CXR). The Zebra Medical Vision (Shefayim, Israel; http:// zebra-med.com) HealthPNX AI algorithm detects abnormal findings suggestive of pneumothorax based on CXR or digital radiography scans, and issues an alert to notify the medical team. The AI network was trained using millions of CXR images in order to identify over 40 common clinical findings. Subsequent validation imaging studies demonstrated high rates of agreement between the HealthPNX algorithm and human radiologists, potentially increasing their confidence in making PNX diagnosis and reducing substantially turnaround time. In hospitals where Zebra Medical’s All-in-One (AI1) solution is integrated into the radiologist’s worklist, the scan is flagged so that the radiologist can address it in a timely manner, saving physicians more than 80% of the time taken to identify the acute condition compared to traditional First In First Out (FIFO) methodology. The AI1 Triage solution also addresses another acute condition, intracranial hemorrhage, by automatically evaluating head CTs. Other Zebra Medical AI algorithms can identify patients at risk of osteoporotic fractures and cardiovascular disease (CVD). Primary spontaneous pneumothorax is an abnormal accumulation of air in the pleural space that can result in the partial or complete collapse of a lung. It is likely due to the formation of small sacs of air (blebs) in lung tissue that rupture, causing air to leak into the pleural space, creating pressure that is manifest as chest pain on the side of the collapsed lung and shortness of breath. Often, people who experience a primary spontaneous pneumothorax have no prior sign of illness; the blebs themselves typically do not cause any symptoms and are visible only on medical imaging. Affected individuals may have one to more than thirty blebs.

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PRODUCT NEWS

VENTILATOR

ECG SYSTEM

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LACTATE METER

Philips Healthcare

Schiller

Nova Biomedical

The V60 Plus integrates both non-invasive ventilation (NIV) and high flow therapy (HFT) in a single device. It delivers a wide range of non-invasive support for patients, simplifying both workflow and device availability.

The CARDIOVIT CS-104 offers resting ECG with the analysis program ETM and ETM Sport, as well as exercise ECG. Both are available with optional arrhythmia detection, Vector ECG and Spirometry.

The StatStrip Xpress handheld POCT system brings lactate testing directly to the patient’s bedside. It provides a turnaround time of 13 seconds on a whole blood sample and can be easily operated by medical and nursing staff.

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Blood Flow Monitor Provides Continuous Cardiac Measures

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new fiberoptic probe monitors blood flow in the aorta during prolonged intensive care and surgical procedures, even in the smallest of patients. Developed by researchers at Flinders University (Adelaide, Australia; www.flinders.edu.au), the micro-medical continuous cardiac flow monitor combines a Bragg optical grating sensor and illumination from a 565 nm light emitting diode (LED) that also heats the blood. The fiberoptic probe measures the resulting variations in pulsatile blood flow due to the fluctuations in temperature, as detected by the Bragg grating sensor. The probe was tested at different flow rates (20-900 mL/min) in a simulated pulsatile cardiac circulation setup, with data compared to an in line time of flight ultrasound flow sensor. The results showed that the optical and ultrasonic signals correlated with Pearson coefficients ranging from −0.83 to −0.98 (dependent on the pulsatile frequency), and that the average flow as determined by ultrasound and the optical fiber sensor showed a parabolic relationship. A similar response resulted following abrupt step changes in flow induced by occlusion and release of the circuit tubing. According to the researchers, the sensor-catheter device could deliver accurate blood flow information in critically ill patients, from pre-term babies, to cardiac bypass patients. The study was published on May 18, 2019, in the Journal of Photonics. “The proof-of-concept prototype is potentially a low-cost device which has passed initial testing in a heart-lung machine,” said lead author Albert Ruiz Vargas, PhD. “It can be inserted through a small keyhole aperture in the skin into the femoral artery in individuals where

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heart function is compromised, and is so small it can even measure small changes in flow in the tiny blood vessels of infants. It’s a simple design, which can give readouts similar to a pulsating heartbeat response on a laptop or nearby screen.” Cardiovascular disease (CVD) is often associated with changes in cardiac flow, particularly hypertension and heart failure (HF). Decreased cardiac flow is associated with cardiomyopathy and HF; increased cardiac flow is associated with CVD during infection and sepsis.

Image: A new probe measures blood flow using optical heating (Photo courtesy of Flinders University).

Synthetic Blood Stems Massive Hemorrhages

www.naramed-u.ac.jp), the artificial blood contains hemoglobin vesicles (HbVs) and fibrinogen chain (dodecapeptide HHLGGAKQAGDV, H12)–coated, adenosine diphosphate (ADP) encapsulated liposomes that together, form a combination therapy that can substitute the red blood cells (RBCs) and platelets found in normal blood. The artificial blood can be stored at normal room temperatures for more than a year. To test the synthetic blood, the researchers first instigated thrombocytopenia in 10 rabbits by repeated blood withdrawal and isovolemic transfusion with autologous RBCs. Lethal traumatic hemorrhage was then induced by non-compressible penetrating liver injury. Subsequently, the encapsulated liposomes were administered to stop bleeding, achieving 100% hemostasis in all animals. The subsequent HbV administration rescued 75% of the rabbits

from fatal anemia. The study was published in the October 2019 issue of Transfusion. “The blood types of patients must be confirmed before they can receive transfusions, so emergency medical technicians and other health care workers are prohibited from transfusing blood in ambulances. Since blood type is not an issue with the artificial blood, injured patients can be treated before they arrive at hospitals, resulting in a higher survival rate,” said study co-author immunologist Manabu Kinoshita, PhD, of NDMC, to Asahi Shimbun. “It is difficult to stock a sufficient amount of blood for transfusions in such regions as remote islands. The artificial blood will be able to save the lives of people who otherwise could not be saved.” Blood shortage is a global healthcare problem, and is likely to become even more problematic as people live longer and donor numbers dwindle. HospiMedica International december/2019-January/2020

Advanced Electronic Vaporizer Delivers Desflurane Better

new vaporizer uses a combination of innovative technologies and a patented design to assure accurate Desflurane delivery, even at low flow rates. The Penlon (Abingdon, UK; www. penlon.com) Sigma EVA is specifically intended to provide a better way to deliver of Desflurane, an ether inhalational general anesthetic agent that it is gradually replacing isoflurane for human use, due to its low solubility in blood. Feature of the Sigma EVA include easy installation and use, a fast warm-up time, an improved filling system, and a 30-minute battery backup. It is compatible with Selectatec and Dräger (Lübeck, Germany; www.draeger.com) Auto-Exclusion mounting systems, which allows it be fitted to the vast majority of anaesthesia systems. Desflurane is structurally identical to isoflurane, except for the substitution of a fluorine atom for the chlorine atom on the -ethyl carbon. It’s relatively low boiling point (23.5°C) makes it extremely volatile; but as this temperature is close to ambient operating theater temperature, full vapor saturation cannot be guaranteed if a conventional vaporizer is employed. A vaporizer which heats the agent to 39°C at a pressure of two atmospheres is thus needed to ensure full vapor saturation, together with the addition of a carefully regulated amount of vapor to the fresh gas flow (FGF). “The Sigma EVA is a real achievement, using a combination of innovative technologies and a patented design that results in a product that delivers accurate agent delivery,” said Cliff Kersey, head of new product development at Penlon. “The newest addition to our vaporizer range, the Penlon Sigma EVA is an innovative electronic vaporizer that heats and

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maintains Desflurane to a constant temperature and pressure, delivering highly accurate output.” Desflurane has the lowest blood/gas solubility (0.42) of all common anesthetic agents, as compared to diethyl-ether (12); halothane (2.3); enflurane (1.9); isoflurane (1.3); sevoflurane (0.67); and nitrous oxide (0.47). The lower blood/gas solubility allows anesthetic alveolar concentration to remain near inspired concentration, permitting a rapid and large change, with precise control, in the anesthetic depth, and early awakening.

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The MaxBlend 2 features a backlit LCD and acrylic flow meter, smart alarms, DC port and extended battery life. It helps eliminate cross-contamination and provides measurements free from temperature, pressure, and humidity.

The iVue X12 features a plug and play design and a TFT display with optional touch-screen. It has a storage capacity of 480-hour graphic and tabular trends, 1,000 groups of NIBP measurements and 700 alarm events.

The 6600 series V2 is an adult oro-nasal (full face) CPAP/bi-level ventilation mask with anti-asphyxia valve (AAV), swivel port and headgear. It is designed for single patient use and is available in five sizes.

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Critical Care System Helps Monitor Urine Flow

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novel diagnostics system provides real-time monitoring of urine flow in critical care and peri-operative settings. The RenalSense (Jerusalem, Israel; www.renalsense.com) Clarity RMS system is an innovative system designed to continuously monitor urine flow. The system uses sophisticated sensor technology and proprietary algorithms in order to measure non-homogeneous, time-varying liquids, even in unstable, uncontrolled environments, automatically transmitting real-time data to medical staff on a 24/7 basis. The approach, which involves complex numeric techniques, is based on an in-depth understanding of fluid dynamics, thermodynamics, human physiology, and target environment properties. The patented sensor measures, analyzes, and interprets the continuously changing composition and flow volume of urine, generating a unique set of electronic signals that represent ongoing changes in renal function. Proprietary algorithms separate the “noise” from these signals with high sensitivity and stability, achieving clear recognition and correct interpretation of different processes in the extremely dynamic environment. Timely alerts of fluctuations provide an early warning sign of acute kidney injury (AKI) risk, facilitating rapid intervention. “We’ve known for years that urine output information is essential for management of critical care patients. The time has come for urine output to be monitored electronically in real-time, as is the standard practice for other vital signs in the ICU,” said Prof. John Kellum, MD, of the Univer-

sity of Pittsburgh Medical Center (UPMC, PA, USA; www.upmc.com). AKI is common among intensive care unit (ICU) patients, with a broad spectrum of clinical presentations ranging from mild to severe injury that may result in permanent and complete loss of renal function and high mortality. The underlying mechanisms of AKI include a decrease in the kidney’s ability to excrete nitrogenous waste, manage electrolytes, regulate intravascular volume, and assist with maintenance of the acid-base status via urine excretion. Image: A new urine flow monitor protects against kidney injury (Photo courtesy of RenalSense).

Opioid-Sparing Postoperative Pathway Effectively Controls Pain

new study shows that over-the-counter painkillers can reduce and even eliminate opioid use following minor surgical procedures. Researchers at the University of Michigan Health System (Ann Arbor, MI, USA; www.med.umich.edu) conducted a study involving 190 patients undergoing six surgical procedures, who were then offered the opportunity to participate in an opioid-sparing pain management pathway. The patients were advised to take a non-opioid pain reliever every three hours, alternating between 600 milligrams of ibuprofen and 650 mg of acetaminophen, and were provided with an opioid prescription (oxycodone), to be used if they experienced breakthrough pain. They were then surveyed postoperatively regarding opioid use and patient-reported outcome measures. The results showed that 52% of the patients used no opioids after surgery, with almost all of them (91%) agreeing that their pain was manageable. Patients who did use opioids were younger, reported higher pain scores, received larger rescue prescriptions, and were less likely to agree that their pain was manageable.

There were no other significant differences between opioid users and non-users. The study was published on May 31, 2019, in Journal of the American College of Surgeons (JACS). “Up to 10% of patients who take opioids for the first time after an operation develop long-term dependence, and this risk of dependence has been found to be associated with the size of the initial prescription,” concluded study co-author Michael Englesbe, MD. “The fundamental concept is that we as surgeons and dentists are gatekeepers to opioid exposure. Most heroin users and people at risk of overdose got their first exposure to opioids from a medical care provider.” Prescriptions of opioids for chronic pain have increased dramatically in the United States, a trend that has been accompanied by greatly increased levels of prescription opioid overdose, abuse, addiction, and diversion. While opioid therapy has been found to be associated with alleviation of pain in the short term, most opioid trials do not extend beyond six weeks, and are thus of limited relevance to long-term opioid use. HospiMedica International december/2019-January/2020

Ambulatory Patch Advances Remote Cardiac Monitoring

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Critical Care

patient-friendly cardiac patch provides non-invasive, diagnostically accurate, P-wave ambulatory arrhythmia detection and cardiac monitoring. The Bardy Diagnostics (Bardydx; Seattle, WA, USA; www.bardydx. com) Carnation Ambulatory Monitor (CAM) is an hourglass-shaped patch designed to be placed comfortably and discreetly on the center of the chest, along the sternum and directly over the heart, so as to provide optimum electrocardiogram (ECG) signal collection. The proprietary technology is combined with low-frequency and low-amplitude electrical signal detection to provide optimal, clear recording of the often difficult-to-detect P-wave, an ECG waveform signal that is essential for accurate arrhythmia diagnosis. Advanced engineering and design allow detection of different concurrent arrhythmias, such as atrial flutter (AFL) and paroxysmal atrial fibrillation (PAF). With a typical monitor, AFL may be obscured by the presence of atrial fibrillation (AF), resulting in inadequate treatments and increased costs and risks to the patient. The slim, lightweight patch (17.5X0.94 cm in size, 13 grams in weight) enables use during activities of daily living, including exercising and bathing. In addition, the CAM form factor is specifically designed to be female-friendly and rest comfortably in the cleavage for up to seven days. To further simplify diagnostics and reporting, BDxCONNECT, a companion patient management portal, provides healthcare professionals with a single system for creating, accessing, and managing patient CAM reports. BY linking the CAM patch to a suite of ECG analysis services and tools, BDxCONNECT can provide a single platform for sharing patient ECG data and reports, resulting in improved workflow and convenience for clinicians, an improved turnaround time, and real-time no-

Personal ECG Provides Multi-Dimensional Cardiac Insights

tifications and alerts when reports are ready. “Recognition of the CAM patch and our P-wave centric platform as a breakthrough in ECG monitoring is a direct reflection of our team’s dedication to developing and marketing inventive solutions that reveal the true message and meaning of a patient’s cardiac rhythm, messages that are frequently ignored or missed using existing technologies,” said Gust Bardy, MD, Founder and CEO of Bardydx, upon receiving the Frost & Sullivan award for technology innovation in remote cardiac monitoring. The ECG P-wave is a summation wave generated by the depolarization front as it transits the atria, representing atrial depolarization. Normally the right atrium depolarizes slightly earlier than left atrium since the depolarization wave originates in the sinoatrial node, in the high right atrium and then travels to and through the left atrium. Depolarization originating elsewhere in the atria results in P-waves with a different morphology from normal.

Image: The CAM patch discreetly monitors the heart (Photo courtesy of Bardydx).

n innovative six-lead electrocardiogram (ECG) device provides patients and their physicians with the ability to detect a broad range of cardiac conditions. The AliveCor (San Francisco, CA, USA; www.alivecor.com) KardiaMobile 6L is a ground-braking six-lead personal ECG device that can provide a detailed view into patients’ hearts, including detection of various arrhythmias that are leading indicators of cardiovascular disease (CVD). Consistent in design with the existing KardiaMobile personal ECG, the 6L sports an extra electrode on the bottom of the device, in addition to the two electrodes set on top. Users place their thumbs on each of the topside electrodes and the bottom electrode on the left knee or the ankle. This formation, known as the Einthoven Triangle, forms a three-way relationship of ECG leads across the limbs, placing the heart at the center, thus allowing cardiologists to view the electrical activity of the heart from six different perspectives (ECG leads I, II, II, aVL, aVR, and aVF). As a result, the 6L can detect atrial fibrillation (AF), bradycardia, tachycardia, as well as normal heart rhythm, over a period of just 30 seconds. In order to view the ECG, KardiaMobile 6L is paired via Bluetooth with a smartphone or tablet device, and the data is sent to the Kardia app for instant analysis. “KardiaMobile 6L is the most clinically valuable personal ECG ever created, and another significant step in AliveCor’s march to making heart care more convenient, more accessible, and less expensive than ever before,” said Ira Bahr, CEO of AliveCor. AF occurs when the heart’s two upper chambers beat erratically. In one form, paroxysmal AF, patients have bouts of erratic beats that begin spontaneously and usually last less than a week. AF can lead to serious adverse events such as thrombi traveling from the heart to obstruct arteries supplying the brain, causing stroke, or other parts of the body causing tissue damage.

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The HP 30 Neo is used to deliver small doses of medication from a variety of syringe sizes in acute care settings. It is recognized for safe, medication delivery to patients in the pediatric and NICUs, adult CCUs and ORs.

The Incu I offers high-level functionality and enhanced safety that supports a variety of tasks carried out in areas ranging from ICU to obstetric care. It features a touch-panel display, and reduces noise-related stress.

The Conquest Vertex features a calibrated vaporizer and a valve filter with bellows. The versatile unit is configurable for operating in low-, medium- and high-complexity environments, and is designed for surgical centers.

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Dynamic Brace Helps Restore Neck Motion to ALS Patients

n innovative robotic brace supports amyotrophic lateral sclerosis (ALS) patients, helping them to hold their heads upright and increase their range of motion. The robotic neck brace, developed at Columbia University (New York, NY, USA; www.columbia.edu), incorporates both sensors and actuators to adjust the head posture, and is capable of restoring roughly 70% of the active range of motion of the human head. Using a joystick interface, patients can actively adjust brace position – and thus head position – by controlling servo motors mounted on it. In addition, by placing motors with compliant springs at the joints, it can provide assistive forces to keep the head in a neutral configuration. And by simultaneous measurement of the motion with the sensors on the neck brace, and surface electromyography (EMG) of the neck muscles, it can also serve as a diagnostic tool to study impaired motion of the head and neck. To test the new brace, the researchers recruited 11 ALS patients and 10 healthy, age-matched subjects. Participants were asked to perform single-plane motions of the head-neck that included flexion-extension, lateral bending, and axial rotation. Each motion was performed in a cycle and was repeated five times at self-selected speeds. The results showed that patients with ALS use a different strategy of head-neck coordination compared to healthy subjects. ALS patients had a shorter period to reach the maximum flexion and an earlier EMG onset in the neck extensors when starting from neutral. Brace measures during activation of the neck muscles in the ALS patients were well correlated with clinically measured scores. According to the researchers, the measurements collected by the device can be used to better assess head drop and ALS disease progression. The study was published on August 7, 2019, in Annals of Clinical and Translational Neurology. “Prof. Agrawal and his team have investigated, for the first time, the muscle mechanisms in the neck muscles of patients with ALS. Their neck brace is such an important step in helping patients with ALS, a devastating and rapidly progressive terminal disease,” said study co-author Prof. Hiroshi Mitsumoto, MD, of the Columbia University Lou Gehrig ALS Center. ALS is a neurodegenerative disease characterized by progressive loss of muscle functions, leading to paralysis of the limbs and respiratory failure. Commonly known as Lou Gehrig’s disease, a defining feature of the disease is a dropped head due to declining neck muscle strength. Over the course of their illness, which can range from several months to more than 10 years, patients completely lose mobility of the head, settling in to a chin-on-chest posture that impairs speech, breathing, and swallowing. Current static neck braces become increasingly uncomfortable and ineffective as the disease progresses. LINkXPRESS COM

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HospiMedica International december/2019-January/2020

Saliva Dipstick Predicts Heart Failure Risk

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Critical Care

handheld diagnostic stick with embedded nano-sensors detects biomarkers that can accurately predict the risk of heart disease from saliva. The ESN Cleer (Melbourne, Australia; www.cleer.com.au) device, developed in collaboration with the Innovative Manufacturing Cooperative Research Centre (IMCRC; Melbourne, Australia; www.imcrc. org) and RMIT University (RMIT; Melbourne, Australia; www.rmit. edu.au), is based on sensing technology originally developed at the RMIT Micro Nano Research Facility. A combination of novel nanomaterials, micro-electrodes, and innovative surface treatments were used to create the sensors, which can be tailored to measure biomarkers of interest, from medically recognized inflammatory markers to proprietary panels that improve prediction accuracy. To use the device, the user unsnaps the top, which acts as a consumable saliva specimen collector and holds the biosensor array. The end is licked and replaced into the reusable electronics stick, which controls the analysis. After biomarker identification, the result is sent to a dedicated app installed onto a smartphone or tablet device. The app offers multifaceted features, including disease risk level detection report, immediate doctors communications support, an age/demographic statistical comparison, health tracking capabilities, health and wellbeing related informatics, a community interactive interface, and user feedback capabilities. “Of the 400 million people who suffer from cardiovascular disease globally, only sixteen% of cases are due to genetic traits. This underlines how much room there is to improve on screening and prevention, which is where this device could have such an impact,” said Leopoldt de Bruin, CEO of ESN Cleer. “We’re really pleased to be able to bring these strands together in addressing such a major global health challenge.” “Often, blood tests are only conducted after a heart failure episode. Such reactive testing is too late, leaving people with debilitating illness or leading to deaths,” said co-director of the RMIT Functional Materi-

als and Microsystems Research Group, Prof. Sharath Sriram, PhD. “The ESN Cleer device is able to measure biomarker concentrations a thousand times more accurately than levels founds in human bodily fluids. Prevention is always better than cure, which is where this technology comes in, adding accurate prediction to the mix.” Image: The two parts of the ESN device (Photo courtesy of Adam R. Thomas/RMIT).

Bioelectronic Therapy Device Exercises Heart Muscle

novel electroceutical device readjusts the myocardial electrical gradient in order to strengthen the weakened heart muscle of cardiomyopathy patients. Under development by Berlin Heals (Berlin, Germany; http://berlinheals.de), C-MIC cardiac microcurrent therapy is based on an implanted pulse generator that exercises the heart muscle using electricity, thus stimulating it to renew itself. In a minimally invasive procedure, a small microcurrent pulse generator is implanted via two small incisions. Two electrodes exit the pulse generator, one taking the form of an extensive patch on the outside of the heart muscle, while the other is placed inside the left ventricle. The system is designed to stimulate the affected heart muscle, causing it to regenerate. In a preclinical study at Hannover Medical School (Germany; www.mh-hannover.de) involving 12 sheep with chronic systolic heart failure, the continuous microcurrent therapy was associated with a strong improvement of left ventricular ejection fraction (LVEF), indicating reversal of cardiac remodeling and reduced myocardial inflammation. A first in human study of the C-MIC device at the Medical University of Vienna (MedUni; Austria; www.meduniwien.ac.at) revealed that after three months, the first patient treated showing initial signs of regeneration. The study was published in the April 2019 issue of The Journal of Heart and Lung Transplantation. In dilative cardiomyopathy, the heart muscle becomes pathologically enlarged so that it can no longer contract sufficiently. Current treatments attempt to stabilize such heart failure patients for as long as possible by means of optimized drug treatment or specialized pacemakers. The treatment of last resort for terminal heart failure is a heart transplant or mechanical replacement using a left ventricular assist device (LVAD).

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The CuratOR EX2620 reproduces surgical images using an energy-efficient LED backlight in bright operating rooms. A sleek design with fully flat protective glass and rounded corners offer comfort and safety in the OR.

The 1688 AIM 4K Platform features brilliant 4K resolution and fluorescence, auto-light technology, better ergonomics and seamless standardization. It offers bright, crystal-clear images for improved surgical visualization.

The Cell Saver 5+ is designed for use in procedures where medium- to high-volume blood loss occurs, such as trauma cases. It delivers moderate hematocrit and help remove traces of undesirable components.

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Nerve Transfer Helps Restore Upper Limb Function

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new study shows that nerve transfers in patients with tetraplegia can lead to significant upper limb functional improvement, especially when combined with tendon transfer. Researchers at Austin Health (Melbourne, Australia; www.austin.org.au) and Royal Melbourne Hospital (RMH; Australia; www.thermh.org.au) conducted a prospective study involving 16 patients with cervical spinal cord injury of motor level C5 and below, who underwent single or multiple nerve transfers in one or both upper limbs, sometimes combined with tendon transfers, for restoration of elbow extension, grasp, pinch, and hand opening. Study participants were assessed at 12 months and 24 months post-surgery, with the primary outcome measures being action research arm test (ARAT), grasp release test (GRT), and spinal cord independence measure (SCIM). In all, 27 limbs underwent 59 nerve transfers. In ten participants, nerve transfers were combined with tendon transfers. The results revealed that at 24 months, significant improvements from baseline in median ARAT total score and GRT total score observed. Mean total SCIM score, mean self-care SCIM score, and mobility in the room and toilet SCIM score improved by more than the minimal detectable change. Mean grasp strength was 3.2 kg in those who underwent distal nerve transfers, 2.8 kg in those who had proximal nerve transfers, and 3.9 kg in those who had tendon transfers. The study was published on July 4, 2019, in The Lancet. “Many spinal cord injury patients still have the ability to move their shoulders, bend their elbows, and expand their wrists. This means we have the nerves to these muscles at our disposal. It’s like unplugging the power source to the toaster and plugging it into the kettle instead,” said

lead author Natasha van Zyl, MBBS, of Austin Health, to Medscape. “The improvements in hand function we have achieved with nerve transfer have allowed patients to do their own personal care, handle money, feed themselves with normal utensils, hold a cup or glass and drink independently, and go to the toilet themselves.” A nerve transfer, in which a healthy nerve “donates” its connection to the spinal cord, can restore either motor or sensory function. The restoration may come, however, at the cost of movement or sensation in the location originally served by the donor nerve. Therefore, donor nerves are chosen carefully: In some cases, their function is considered less useful than the function to be regained. In other cases, the function of the donor nerve is redundant – that is, more than one nerve supplies the function of the donor nerve. And in some cases, function need not be sacrificed at all, as only certain fascicles of the donor nerve are divided and transferred. Image: New research with nerve transfers shows promise for patients with cervical spinal cord injuries (Photo courtesy of Medscape).

Three Complications Responsible for Half of Noncardiac Surgery Deaths

ajor bleeding, myocardial injury, and sepsis account for almost 45% of deaths occurring after noncardiac surgery, according to a new study. Researchers at McMaster University (Hamilton, ON, Canada; www.mcmaster.ca), Groote Schuur Hospital (Cape Town, South Africa; www.westerncape.gov.za/your_gov/163), Jagiellonian University (Krakow, Poland; www.uj.edu.pl), and other institutions in 14 countries conducted a prospective cohort study of 40,004 patients aged 45 years and older who underwent inpatient noncardiac surgery so as to examine the frequency and timing of death and its association with perioperative complications. The patients were monitored for complications until 30 days after surgery. The results revealed that overall, 1.8% of the patients died within 30 days of surgery. Of these, 0.7% of deaths occurred in the operating room;

69.9% occurred after surgery, during the index admission to the hospital; and 29.4% occurred after discharge from the hospital. Independent associations were found between eight complications and 30-day mortality. Major bleeding (17%), myocardial injury (15.9%), and sepsis (12%) had the largest attributable fractions. The study was published on July 29, 2019, in the Canadian Medical Association Journal (CMAJ). Patients are vulnerable to major adverse outcomes and a broad range of illnesses after hospital stay, and this period of heightened and generalized vulnerability to a spectrum of conditions has been called the posthospital syndrome. Readmissions are common with nearly one in five adults aged more than 65 readmitted within 30 days of discharge. Death is also common in this first month, during which rates of post-discharge mortality may exceed those of initial inpatient mortality. HospiMedica International december/2019-January/2020

Surgical Planning System Treats Complex Musculoskeletal Disease

novel orthopedics solution enables surgeons to obtain a clear three-dimensional (3D) visualization of a patient’s anatomy and develop a personalized surgical plan prior to entering the operating room. The 3D Systems (DDD; Rock Hill, SC, USA; www.3dsystems.com) VSP Orthopaedics solution is designed to help surgeons virtually plan a surgical procedure based on the patients’ actual anatomy, allowing the surgeon to essentially perform the surgery digitally before entering the operating room (OR). Following the online planning session, patient-specific models, personalized surgical tools, and unique instruments are designed and 3D printed for use within the sterile field. The system is intended for non acute, non-joint replacing osteotomies for adult patients in the distal femur, tibia, and non-sacrum pelvis. VSP Orthopaedics is part of the wider virtual surgical planning solution offered by 3D Systems, and can be combined with other areas of expertise to design and 3D print anatomical models and cutting guides. In uniquely integrates with the Onkos Surgical (Parsippany, NJ, USA; https://onkossurgical.com) My3D Personalized Solutions Platform, which has the capacity to precisely plan bone tumor resections, which in some cases allows for the preservation of the native joint. The solution can help improve surgical outcomes and save time in the operating room. “Our 3D printing technologies combined with the renowned expertise of our biomedical engineers, in collaboration with surgeons, can have a positive impact on a patient’s life, even before they ever enter the operating room,” said Radhika Krishnan, senior vice president of software and healthcare at DDD. “Based on the success we’ve seen with our personalized healthcare solutions in other surgical specialties, we are confident in the positive impact on patient care this technology will have for the orthopedic community.” “As an early stage investor in Onkos, 3D Systems understands our passion for developing innovation,” said Patrick Treacy, CEO of Onkos Surgical. “The VSP Orthopaedics System, which is available exclusively through our My3D Personalized Solutions platform, is a great example of how we’re harnessing the power of advanced surgical planning and personalization to create novel solutions that musculoskeletal patients deserve.” Image: Novel 3D software can help plan bone tumor resections (Photo courtesy of 3D Systems). V

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The Airpro is designed for the prevention of DVT, PE and secondary embolism. Widely applied to all types of major surgery, it is also suitable for alleviating limb edema, and lymphatic swelling.

The TGS system uses augmented reality technology for functional endoscopic sinus surgery procedures. It merges the pre-op plan with the endoscopic image to offer RT anatomical guidance directly on the monitor.

The ESU-400 features monopolar and bipolar functions to satisfy most surgical demands. It is used to make precise cuts and coagulation during surgical procedures in operating rooms and outpatient centers.

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Surgical Debridement Sufficient for Diabetic Foot Ulcers

new study concludes that surgical debridement of neuropathic diabetic foot ulcers (DFUs) with osteomyelitis is just as effective as using antibiotic-impregnated calcium sulfate (CAS) beads. Researchers at Nottingham University Hospitals (United Kingdom; www.nuh.nhs.uk) conducted a retrospective cohort study of 50 patients who underwent surgical debridement (SD) of neuropathic DFUs for osteomyelitis (from December 2015 to May 2016) in order to determine if antibiotic-impregnated CAS beads actually improved healing, as suggested by several recent case series. Study participants were divided into a SD group and a CAS group, which was treated with SD and subsequent implantation of vancomycin- and gentamicin-impregnated CAS beads. The results revealed that in the SD group, the mean time to healing was 5.8 months, while in the CAS group it was slightly faster, at 5.5 months. There were no significant differences in any other parameter, including ulcer healing, time to healing, reoperation rate, length of stay (LOS), or mortality between the two groups. The study was published in the June 2019 issue of Wounds. “Neuropathic foot ulcers are common and difficult to treat. CAS has been used for antibiotic delivery in the treatment of osteomyelitis; but few studies with a control group for comparison exist,” concluded Visit us at araB HealTH • stand Z5.c31

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lead author Andrew Peter Dekker, BMBS, BMedSci, and colleagues. “Surgical debridement alone may be as effective as supplementation with local antibiotics in a bioabsorbable carrier. Ulcer healing in patients treated with antibiotic-impregnated CAS beads did not show statistical significance.” Diabetes patients often suffer from nerve and circulation problems in the feet, which reduce their perception of pain. The nerve pathways that ensure 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, DFUs and infections may go unnoticed. Serious cases may even lead to amputation.

Early Menarche Associated with Increased Diabetes Risk

new study suggests that early onset of menstruation is associated with higher risk of type 2 diabetes mellitus (T2DM), but that the effect may be partially mediated by body mass index (BMI). Researchers at Zhengzhou University (Zhengzhou, China; http://english.zzu.edu.cn) conducted a study involving 15,346 postmenopausal women participating in the Henan province rural cohort study in order to determine if early menarche (i.e., under 14 years of age) is associated with an increased risk of T2DM, and to investigate whether the association was mediated by BMI adiposity. The results revealed that after adjusting for multiple confounders, the early menarche group had a higher risk of T2DM compared with the reference group (16-17 years of age). Likewise, the late onset group (women in whom menarche occurred later that 19 years of age) had a lower risk of T2DM. The researchers also found that BMI partially mediated the association between age at menarche and T2DM, and the proportion of the effect was 28%. The study was published on July 29, 2019, in Menopause. Age at menarche is frequently used to explore the association between developmental tempo during puberty and disease risk. Earlier menarche has been associated with some adverse outcomes, including obesity, cardiovascular disease, some types of cancer, and mortality. Increasing rates of T2D in recent decades have occurred in parallel with a decline in the average age at menarche, with several studies reporting adverse metabolic consequences of early sexual maturation, such as increased blood glucose levels, impaired glucose tolerance, and insulin resistance. Part of the association could be explained by increased adiposity. HospiMedica International december/2019-January/2020

Approximation kit Closes Microdiscectomy Disc Defects

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novel tissue sparing approximation system minimizes residual defects during herniated disc repair and improves procedural outcomes. The Anchor Orthopedics XT (Mississauga, Canada; www.anchorortho.com) AnchorKnot Tissue Approximation Kit is a set of surgical spinal devices that enable orthopedic surgeons and neurosurgeons to close tissue defects during minimally invasive microdiscectomy of herniated intervertebral discs in the lumbar spine, allowing surgical decompression with minimization of the annular incision and limiting the removal of tissue to include only the free fragments impinging on the nerve root. The kit is comprised of three sterile, single use devices: the Suture Passer, the Knot Pusher, and the Suture Cutter. The Suture Passer is designed for passing a preloaded non-absorbable ultra-high molecular weight (UHMW) polyethylene surgical suture through soft tissue. The Knot Pusher is a hand-held grip device, with a stainless steel shaft and a slotted tip that is used to push the pre-tied knot down to the tissue level. The Suture Cutter is used to cut the suture once the knot is secured in place. The deployment mechanism of the AnchorKnot tissue approximation kit is designed for simplicity, despite the difficult to reach anatomical location; on average, about five minutes of usage are needed during the procedure. “Microdiscectomy surgery allows a patient to return to a more

Conservative Slings Can Replace Surgery for Shoulder Fractures

new study suggests that performing surgery on the majority of displaced proximal humerus fractures (PHFs) in older adults may not be beneficial. Researchers at Tampere University Hospital (Finland; www.tays.fi), University Hospital (Stockholm, Sweden; www.karolinska.se), Aarhus University Hospital (Denmark; www.au.dk), and other institutions conducted a study involving 88 patients aged 60 years or older (the majority female) who were treated with a displaced 2-part anatomical neck PHF in six hospitals in Finland, Estonia, Sweden, and Denmark; all patients underwent rehabilitation under the supervision of a physiotherapist. The primary outcome measure was Disabilities of Arm, Shoulder, and Hand (DASH) score at two-year follow-up. The study showed no differences between operative treatment and non-operative treatment, based on a patient-reported outcome measure (PROM) or quality of life (QOL) score. No statistically or clinically significant differences in PROMs were observed between the operative and non-operative treatment groups. The results were already valid one year after treatment. The study was published on July 18, 2019, in PLOS Medicine. “The results are thought-provoking in that there is no difference between patients who underwent surgery and those who didn’t. Those who underwent surgery don’t have better shoulder function or less pain than those who didn’t,” said lead author Prof. Inger Mechlenburg, MD, of Aarhus University Hospital. “As there is no difference in the patients’ ability to carry out daily chores, their level of pain or quality of life with or without the displaced shoulder fracture surgery, then treatment with only a sling should be preferred, as the patients thereby avoid surgeryrelated pain and complications.” PHFs are among the most common fractures in the older adult population. The risk for having a PHF increases with age, especially after the age of 60 years, and most are associated with a low-energy fall. According to published literature, minimally displaced or 2-part fractures constitute between 77% and 84% of all fractures, for which non-operative treatment can be considered. Fracture comminution and displacement, especially in 3- and 4-part fractures, on the other hand, are considered to be potential indications for operative treatment.

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Surgical Techniques

healthy state, faster and with less pain; the AnchorKnot kit allows us to repair tissue defects with an elegant device,” said Nilesh Patel, MD, of Michigan Spine Clinic (Brownstown, USA). “This technology represents the next evolution in minimally invasive herniated disc repair. We are always looking to reduce the size of the tissue defect and we see it as a critical step towards our goal of and improving procedure outcomes.” A lumbar disc herniation is a tear in the outer, fibrous ring (annulus fibrosus) of an intervertebral disc that allows part of, or the entire, soft central portion to be forced out from between two vertebrae, causing back pain, and can also push on nerve roots causing pain, numbness and tingling, as well as weakness in one or both legs. Symptomatic lumbar disc herniation affects 1-2% of the population at some point in their lives, usually between 30-40 years of age, and is one of the most common and debilitating conditions of the spine.

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Continuous Fetal Monitor Could Prevent Millions of Stillbirths

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new study indicates that commercially available inertial sensors could potentially extract fetal heart rate (FHR) continuously and noninvasively. Under development at the Stevens Institute of Technology (Hoboken, NJ, USA; www.stevens.edu) and New York University (NYU, USA; www.nyu.edu), the new FHR monitor is based on seismo-cardiogram (SCG) and gyro-cardiogram (GCG) recordings collected from inertial sensors that are currently used to re-orient displayed images on a smartphone when it is rotated to a horizontal or vertical position. The monitor is based on a setup that picked up signals from inertial sensors placed at three points on the mother’s abdomen, and then extracts FHR from a fused cepstrum of recordings from all the sensors. The novel monitor was evaluated with experiments on ten pregnant women under supine, seated, and standing positions, with the results compared to simultaneously recorded fetal cardiotocography (fCTG) readings, which are based on Doppler ultrasound. When matching the two modalities, the reliability was found to be quite comparable, with the supine position showing the highest correlation. A further advantage is that the monitor measures fetal movements without the mother’s active participation. The researchers claim that being able to assess both FHR and movement at the same time could help rule out fetal distress. The study was published on July 24, 2019, in IEEE Sensors Journal. “Almost one-third of stillbirths occur in the absence of complicating factors; our device could let a pregnant woman know if her fetus is com-

promised and she needs to go to the doctor,” said senior author Negar Tavassolian, PhD, of the Stevens Institute of Technology. “Wearable inertial sensors could potentially be used to extract FHR outside the clinic, with accuracy and reliability metrics comparable to other modalities, such as fCTG. Our monitors are also completely passive, so there’s no health concern.” A normal FHR usually ranges from 120 to 160 beats per minute (bpm) in the in-utero period. It is measurable sonographically from around six weeks and the normal range varies during gestation, increasing to around 170 bpm at 10 weeks and decreasing from then to around 130 bpm at term.

Image: New research claims wearable monitors could detect fetal distress (Photo courtesy of Shutterstock).

Focal Laser Therapy Destroys Breast Tumors

minimally invasive procedure uses laser induced heat for focal destruction of breast fibroadenomas and tumors of up to two centimeters in size. The Novian Health (Chicago, Il, USA; https://novianhealth.com) Novilase Laser Therapy System consists of an 805 nanometer wavelength Laser diode source with an output of 1-8 watts, a power distribution unit with user accessible master power switch, an isolation transformer, and a thermal temperature to digital converter, all mounted in lightweight storage cart. To provide the therapy, a disposable sterile probe kit is used, consisting of a hollow stainless steel laser probe with an attached thermistor, a hollow stainless steel thermal probe with five embedded thermistors, and other accessories. The system is controlled via a computer running Windows 7 or better. During the procedure, ultrasound or x-ray image-guidance is used to insert the two small probes into and alongside the tumor. The laser

probe delivers laser energy to provide focal thermal energy, while the thermal probe monitors temperature at the edge of the desired ablation zone. Treatment times can range from 15 to 30 minutes, with the results confirmed by follow-up imaging. Studies have shown that more than 90% of malignant breast tumors are completely destroyed during one Novilase procedure, with patients reporting better health-related quality of life outcomes compared to lumpectomy. Fibroadenoma is the most widely spread breast benign tumor, with as much as 10% of women at risk of developing it in their lifetime; it also represents more than half of breast biopsies. It affects women of all ages, but is a lot more frequent with women under 30. The pathology is often found during a medical examination or by women doing their own palpation, and radiologic images using mammography and ultrasound are used to confirm the diagnosis. In some cases, a micro biopsy is necessary to confirm its benign nature. HospiMedica International december/2019-January/2020

Radial Artery Catheterization Suitable for Neuroendovascular Procedures

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Surgical Techniques

n alternative route of access to neuroendovascular procedures, via the radial artery, has a low rate of complications, according to a new study. The new study, led by researchers at Thomas Jefferson University Hospital (Philadelphia, PA, USA; www.jeffersonhospital.org), involved a retrospective analysis of 223 patients who underwent 233 consecutive neuroendovascular interventions via radial artery access. Among the participants, the researchers identified 98 patients who underwent both transradial and transfemoral cerebral angiograms. The incidence of perioperative and postprocedural complications was examined, as were clinical outcomes and patient satisfaction measures between the two groups. The results showed low overall incidence of complications across all procedures that were performed via transradial access. Only two patients had symptomatic radial artery spasm peri-procedurally, while none had iatrogenic complications, such as vessel dissection, stroke, and hemorrhage. For 10 cases that began with a transradial approach, the procedure could not be completed and femoral artery access had to be pursued instead. For diagnostic angiograms, transradial access procedure time was shorter than transfemoral access (18.8 versus 39.5 minutes, respectively). The study was published on July 17, 2019, in Stroke. “Radial artery catheterization is a safe and durable alternative to perform a wide range of neuroendovascular procedures, with a low rate of

Nanotube Carbon Fibers Can Rewire Damaged Hearts

new study shows that carbon nanotube fibers (CNTfs) can restore electrical conduction in the diseased myocardium, offering a potential long-term restorative solution. Researchers at the Texas Heart Institute (THI; Houston, TX, USA; www.texasheart.org), Rice University (Rice, Houston, TX, USA; www.rice.edu), and other institutions conducted open chest electrophysiology studies to examine the characteristics of CNTfs, which combine the mechanical properties of surgical suture materials and the conductive properties of metals, and their suitability as a restorative solution to impaired myocardial conduction. To do so, the researchers first used radiofrequency (RF) ablation to create an epicardial conduction delay. They then sutured CNTf sutures over the conduction block. The results revealed that in large animals (sheep), an improvement in conduction velocity using CNTf was demonstrated. In an acute rodent model, in which the CNTfs were surgically sewn across the right atrioventricular junction, ventricular pre-excitation was shown during sinus rhythm. All chronic cases demonstrated resumption of atrioventricular conduction, but these required atrial pacing. There was no gross or histopathologic evidence of toxicity. Ex-vivo electrical analysis of the CNTf-myocardial interface demonstrated contact impedance significantly lower than that of platinum iridium. The study was published on August 12, 2019, in Circulation: Arrhythmia and Electrophysiology. “Instead of shocking and defibrillating, we are actually correcting diseased conduction of the largest major pumping chamber of the heart by creating a bridge to bypass and conduct over a scarred area of a damaged heart,” said co-lead author cardiologist Mehdi Razavi, MD, of THI. “Our experiments provided the first scientific support for using a synthetic material-based treatment rather than a drug to treat the leading cause of sudden death in the United States and many developing countries around the world.” CNTfs are about a quarter of the thickness of a human hair, but still contain millions of microscopic nanotubes of pure carbon. The fibers, which are soft, flexible, and tough, also exhibit low electrical impedance. As such, they show potential for many applications, including helping Parkinson’s disease (PD) patients who require brain implants to treat their neurological conditions.

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complications,” concluded lead author Omaditya Khanna, MD, and colleagues. “On the whole, patients prefer transradial compared with transfemoral access. Patients reported shorter recovery times, and the majority of patients (945) would elect to have subsequent procedures performed via this route.” Interventional cardiologists have typically favored femoral catheter access because it involves a larger artery that is less prone to spasm, an event that can limit the ability to move medical devices through the catheter. Although the radial artery is closer to the surface and thus easier to access, it’s smaller size makes the radial approach more technically difficult, and requires the use of smaller equipment.

Image: A new study shows that radial artery access is preferred for neuroendovascular procedures (Photo courtesy of iStock).

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The LifeDataNet G2 ensures that the defibrillators are always ready to use and regularly informing about the status of all devices. Using a comfortable plug and play system, it automatically connects compatible AED devices.

The PDC-191 features an auto luminance stabilizer (ALS) that stabilizes brightness. The 1.3MP monitor reproduces optimized gray-scale tones and is compatible with DIN 6868-57 standard for brightness uniformity.

The Aestimax performs reading and reporting with easy and fast access to visualization modes and tools. It offers radiologists a range of options for viewing, analyzing, comparing, transferring and archiving digital images.

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wireless-Controlled Soft Neural Implant Stimulates Brain Cells

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soft neural implant operated by a smartphone can deliver multiple drugs and colored light to control Parkinson’s, Alzheimer’s, addiction, depression, and pain, according to a new study. Developed at the Korea Advanced Institute of Science and Technology (KAIST; Daejeon, Republic of Korea; www.kaist.edu), the University of Washington (UW; Seattle, USA; www.washington.edu) and the University of Colorado (Boulder, USA; www.colorado.edu), the neural implant includes a soft, ultrathin probe (the thickness of a human hair), which holds microfluidic channels and tiny LEDs, smaller than a grain of salt. The implant also holds ‘plug-n-play’ replaceable drug cartridges, which allows continuous neuropharmacology and photostimulation of the same brain circuits with unlimited drug doses and light delivery. Activation of the wireless implantable optofluidic brain probe is controlled with a simple user interface on any smartphone, providing neuroscientists with the ability to easily trigger any specific combination or precise sequencing of LED light and drug delivery, without being physically inside the laboratory, and even set up fully automated delivery. For the study, the researchers demonstrated the use of the probes by controlling locomotor activity in mice for over four weeks. The study was published on August 5, 2019, in Nature Biomedical Engineering. Photostimulation is the use of light to artificially activate biological

compounds, cells, tissues or even whole organisms. One form of photostimulation is optogenetics, which has shown significant promise in the treatment of a series of neurological disorders such as Parkinson’s disease and epilepsy by targeting specific cell types or neural circuits. So far, it has only been implemented for research purposes in the field of neurobiology, serving to reveal more about the mechanisms of specific disorders.

Image: Lego-like replaceable drug cartridges and LEDs help target specific neurons of interest (Photo courtesy of KAIST).

Tiny Polymer Stent Could Treat Pediatric Urethral Strictures

novel manufacturing technique can be used to fabricate stentlike microstructures with shape memory properties that are 40 times smaller than current stents. Developed by researchers at the Swiss Federal Institute of Technology (ETH; Zurich, Switzerland; www.ethz.ch), Politecnico di Milano (Italy; www.polimi.it), and Kantonnspital Aarau (Switzerland; www.ksa.ch), the manufacturing process uses three-dimensional (3D) printed sacrificial high-resolution micromolds that are produced by direct laser writing. The printed templates are then infused with polymers and set using ultraviolet (UV) light. The structure is then dissolved in a solvent bath, leading to a 3D printed microstructure that has shape memory properties. The method was used to manufacture 3D stents with minimum features of 5 µm, which is 40 times smaller than those reported to date. The polymer provides the stent’s shape-memory properties, which the researchers refer to as a fourth dimension (4D); even if the 3D construct is deformed, it remembers its original shape and returns to it when warm. The method can also be used to indirectly 3D and 4D soft micro-

robots constructed of gelatin helices filled with magnetic nanoparticles. The study describing the new manufacturing process was published on July 5, 2019, in Advanced Materials Technologies. “We’ve printed the world’s smallest stent with features that are 40 times smaller than any produced to date. Before human studies can be conducted to show whether they are suitable for helping children with congenital urinary tract defects, the stents must first be tested in animal models,” said lead author Carmela De Marco, PhD, of the ETH multi-scale robotics laboratory. “But the stents are still a long way from finding real-world application; however, the initial findings are promising. We firmly believe that our results can open the door to the development of new tools for minimally invasive surgery.” Approximately one in every thousand children develops a urethral stricture, including in fetuses. If a stent could be inserted to widen the constriction while the fetus is still in the womb, life-threatening levels of urine that accumulate in the bladder could be avoided. But while stents are regularly used to treat blocked coronary vessels, the urinary tract in fetuses is much narrower in comparison. HospiMedica International december/2019-January/2020

Elasticity Training Helps Artificial Intelligence Diagnose Breast Cancer

eaching artificial intelligence (AI) algorithms to identify the ultrasound elastic heterogeneity of a tumor can be used to distinguish benign tumors from their malignant counterparts, according to a new study. Researchers at the University of Southern California (USC; Los Angeles, USA; www.usc.edu), Rensselaer Polytechnic Institute (RPI; Troy, NY, USA; www.rpi.edu), and other institutions created physics-based models that simulated varying levels of the two key ultrasound properties of a cancerous breast tumor – elastic heterogeneity and nonlinear elastic response. They then used thousands of data inputs derived from the models in order to train a deep convolutional neural network (CNN) to classify tumors as malignant or benign. A 5-layer CNN was trained with 8,000 samples for heterogeneity, and a 4-layer CNN was trained with 4,000 samples for nonlinear elasticity. When queried on additional synthetic images, the CNNs achieved classification accuracies of 99.7%−99.9%. The researchers then applied the nonlinear elasticity classifier, which was trained entirely using simulated data, in order to classify displacement images obtained from ten patients with breast lesions; the CNN correctly classified eight out of ten cases. “The general consensus is these types of algorithms have a significant role to play, including from imaging professionals whom it will impact the most,” said senior author Prof. Assad Oberai, PhD, of the USC department of aerospace and mechanical engineering. “However, these algorithms will be most useful when they do not serve as black boxes, but instead, a tool that helps guide radiologists to more accurate conclusions.” Elastography relies on the generation of shear waves determined by the displacement of tissues induced by the force of a focused ultrasound beam or by external pressure. The shear waves are lateral waves, with a motion perpendicular to the direction of the generating force, traveling slowly, and are rapidly attenuated by tissue. The propagation velocity of the shear waves correlates with the elasticity of tissue. Image: A neural network classifies tumors using breast ultrasound elastography data (Photo courtesy of iStockPhoto). V

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The Hybridpixx 8MP LED monitor is considered ideal for reproduction of multiple images concurrently in the OR. The lightweight display delivers uniform images that can be scaled and maneuvered to highlight the most important patient images.

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Nanodrone Detects Toxic Gases in Hazardous Environments

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new study describes an innovative smelling nano aerial vehicle (SNAV) that can detect dangerous compounds in buildings that have collapsed due to earthquakes or explosions. Developed at the University of Barcelona (UB, Spain; www.ub.edu), the Institute for Bioengineering of Catalonia (IBEC; Barcelona, Spain; www.ibecbarcelona.eu) and Örebro University (ORU; Sweden;

www.oru.se), the SNAV nanodrone weighs just thirty-five grams, including two nanometric metal oxide semiconductor (MOX) gas sensors that can respond to carbon monoxide (CO), methane (CH4), and other organic volatile compounds such as ethanol, acetone and benzene, with a detection threshold on the order of one part per million in volume (PPMV), according to the gas and the sensor used. Due to its small form-factor, the SNAV is not hazardous to humans, thus enabling its use both in public areas and inside buildings, autonomously carrying out missions in hazardous environments inaccessible to terrestrial robots and bigger drones. To guide the SNAV, six radiofrequency transceivers, located in known positions, are used, which together with a transceiver in the nanodrone itself allows operators to fly it to a desired position using the built-in accelometers and gyroscopes. As a result, the SNAV is able to work in interior spaces, crossing holes and cracks, as well as in large areas—about 160 square meters—if the chemical emission source is hidden in areas which are hard to access, such as false ceilings, air duct systems, etc. In experiments conducted at ORU, the researchers were able to build a 3D map of the gas distribution and identify the most likely source location in less than three minutes, with a 1.38-2.05 meter accuracy. The study was published in the March 2019 issue of Sensors. “Terrestrial robots used to focus the searching on the field of chemical signaling-based localization. Today, the option of using nanodrones broadens the ability and quickness of the robots to move within an interior space and overcome obstacles such as stairs,” said senior author Santiago Marco, PhD, head of the intelligent signaling for sensor systems in bioengineering research group at UB-IBEC. “Another line we want to work on is the merge of data from multiple gas sensors to increase selectivity towards certain compounds of interest.”

Image: Javier Burgués (L) and Santiago Marco (R), of UB and IBEC, and the nanodrone (Photo courtesy of IBEC). HospiMedica International december/2019-January/2020

Innovative Smartband Predicts Pending Epileptic Seizures

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novel bracelet device detects motion patterns and physiological signals that may be associated with generalized tonic clonic (GTC) epileptic seizures. The Empatica (Cambridge, MA, USA; www.empatica.com) Embrace epilepsy smartband measures a range of electrodermal activity (EDA) data in order to quantify physiological changes that are related to sympathetic nervous system activity. An onboard algorithm continuously processes sensor data and make a decision about whether the data might indicate a GTC seizure. Embrace then sends a message to the smartphone application, which initiates calls and texts to summon a designated caregiver. The wearable biosensor device also captures, stores, and wirelessly transmits EDA data for future analysis. In a multi-site clinical study, 135 patients diagnosed with epilepsy underwent continuous monitoring with video electroencephalography (EEG), while simultaneously wearing an Empatica device, resulting in 6,530 hours of data recorded over 272 days, including documentation of 40 GTC seizures; the algorithm detected 100% of the seizures clinically labelled by at least two out of three independent epileptologists, who examined the video-EEG data without seeing any data used by Embrace. “Medical devices face a huge problem: they’re usually too bulky and uncomfortable, and people simply don’t want to wear them. Empatica took a different path. We wanted to design the world’s first medical device that could win a design award, while being used as a lifesaving product,” said Matteo Lai, CEO and co-founder of Empatica. A GTC (commonly known as a grand mal seizure) produces bilateral, convulsive, tonic and clonic muscle contractions. They typically start abruptly with either focal or generalized onset, with tonic contractions usually preceding clonic contractions. After these series of contractions, there is an extended post-ictal state where the person is unresponsive and commonly asleep, with loud snoring. Pronounced confusion is usually present upon awakening.

HospiMedica International december/2019-January/2020

International Calendar

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JANUARY 2020 ESOU 2020 – 17th Meeting of the EAU Section of Oncological Urology. Jan 17-19; dublin, ireland; Web: esou.uroweb.org ISET 2020 – International Symposium on Endovascular Therapy. Jan 22-25; Hollywood, Fl, Usa. Web: www.iset.org CACvS 2020 – Controversies & Updates in vascular Surgery. Jan 23-25; Paris, France; Web: cacvs.org Arab Health 2020. Jan 27-30; dubai, Uae; Web: www.arabhealthonline.com

FEBRUARY 2020 Critical Care Congress 2019 – 48th Annual Meeting of the Society of Critical Care Medicine (SCCM). Feb 16-19; orlando, Fl, Usa; Web: www.sccm.org Medical Japan 2020. Feb 26-28; osaka, Japan; Web: www.medical-jpn.jp

MARCH 2020 SAR 2020 – Annual Scientific Meeting of the Society of Abdominal Radiology. Mar 1-6; Maui, Hi, Usa; www.abdominalradiology.org Hospital Infrastructure Show 2020. Mar 4-7; Kuwait city, Kuwait; Web: www.hospitalinfrastructure show.com Medical Fair India 2020. Mar 5-7; Mumbai, india; Web: www.medicalfair-india.com APSCvIR 2020 – 15th Annual Meeting of the Asia Pacific Society of Cardiovascular and Interventional Radiology. Mar 5-9; Taipei; Web: www.apscvir2020.com Acute Cardiovascular Care 2020. Mar 7-9; athens, Greece; Web: www.escardio.org HIMSS20 Global Conference & Exhibition – Healthcare Information and Management Systems Society. March 9-13; orlando, Fl, Usa; Web: www.himssconference.org ECR 2020 – European Congress of Radiology. Mar 11-15; Vienna, austria; Web: www.myesr.org ExpoMED Eurasia 2020. Mar 19-21; istanbul, Turkey; Web: expomedistanbul.com KIMES 2020 – Korea International Medical &

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APRIL 2020 SAGES 2020 – Annual Meeting of the Society of American Gastrointestinal and Endoscopic Surgeons. apr 1-4; cleveland, oH, Usa; Web: www.sages2020.org wCO-IOF-ESCEO 2020 – world Congress on Osteoporosis, Osteoarthritis and Musculoskeletal Diseases. apr 2-5; Barcelona, spain: www.wco-iof-esceo.org ISUOG 2020 – 16th International Symposium of International Society of Ultrasound in Obstetrics and Gynecology. apr 3-5; cairo, egypt; Web: isuogsymposium2020.com

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MAY 2020 ARRS 2020 Annual Meeting – American Roentgen Ray Society. May 3-8; chicago, il, Usa; Web: www.arrs.org vietnam Medi-Pharm 2020. May 6-9; Hanoi, Vietnam; Web: vietnammedipharm.vn wCE 2020 – 14th world Congress on Endometriosis. May 8-11; shanghai, china; Web: endometriosis.ca/world-congress/wce2020 SPR 2020 – Annual Meeting of the Society for Pediatric Radiology. May 9-15; Miami, Fl, Usa; Web: www.pedrad.org

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