HospiMedica International March 2019

V I S I T

WORLD’S

CLINICAL NEWS

Vol.37 No.1 • 2-3 / 2019

LEADER DAILY CLINICAL NEWS

ISSN 0898-7270

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Reduced Oxygen Supplementation Recommended for Most Critical Care Patients

new self-administered device induces weight loss and improves glycemic control in overweight and obese patients. The Epitomee Medical (Caesarea; Israel; www.epitomeemedical.com) capsule is a drug-free, ingestible capsule that contains a biodegradable

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new guidance statement reports that supplemental oxygen is not always indicated for acutely ill patients, and may contribute to higher mortality.

An expert panel from McMaster University (Hamilton, ON, Canada; www.mcmaster.ca), Stel-

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lenbosch University (SU, South Africa; www.sun.ac.za), University Hospitals of Geneva (Switzerland; www.hug-ge.ch), and other institutions convened to evaluated a recent systematic review and meta-analysis of 25 randomized controlled trials in order to devel-

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Speed-of-Sound Ultrasound Can Improve Breast Cancer Detection novel ultrasound imaging method using speed-of-sound (SoS) technology, based on the principle that the speed of the sound echo is determined by the density and rigidity of tissues, can improve the distinction of benign breast tumors from malignant ones, thereby avoiding unnecessary biopsies.

Image: Courtesy of Orçun Göksel / ETH

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MRI Implant Monitors Processes in the Brain new study describes how a minimally invasive implantable magnetic resonance imaging (MRI) sensor can detect electrical activity or optical luminescence in the brain. Developed at the Massachusetts Institute of Technology (MIT, Cambridge, MA, USA; www.mit.edu), the new sensor is basically a tiny antenna that detects radio waves emitted by the nuclei of hydrogen atoms

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New Incubator Protects Most Vulnerable Infants novel incubator system for neonatal intensive care units (nICUs) incorporates synthetic amniotic fluid in a self-regulating, sterile, submersion bath. The Amnion Life (Newport, CA, USA; https://amnion.life) AmnioBed is a neonatal incubator system that features an amniotic fluid submersion bath that simulates the mother’s womb, providing a potentially ideal environment to

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Stereotactic Radiosurgery Detector Validates Dosimetric Treatment

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n innovative diode-based device addresses the growing need for quality assurance (QA) during stereotactic radiosurgery (SRS), replacing traditional filmbased and stand-alone measurement methods.

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

New Global Network Improves Access to Diagnostic Insights

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uest Diagnostics, a leading provider of diagnostic services, together with other similar providers, have announce the formation and launch of the Global Diagnostics Network, a strategic working group of diagnostic laboratories, each committed to un-

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leashing and sharing local innovation to increase global access to diagnostic science, information, and services in order to improve the delivery of global healthcare.

GDN initiatives will benefit patients, healthcare providers, referring practitioners, pharmaceutical Cont’d on page 5

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

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HospiMedica International

Reduced Oxygen Supplementation Recommended for Most Critical Care Patients

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www.hospimedica.com A GLOBETECH PUBLICATION

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develop recommendations for supplemental oxygen therapy in critically ill patients, surgical patients with sepsis, hospitalized patients, or patients en-route to hospital in an ambulance. Postoperative, obstetric, and pediatric patients were not included in the review.

The systematic review, which was published in The Lancet in April 2018, found that supplemental oxygen in inpatients with normal oxygen saturation increases mortality, and recommended that oxygen should be administered conservatively.

The international panel of experts made several key recommendations, including maintaining peripheral oxygen saturation (SpO2) at or below 96% in patients on supplemental oxygen; in patients with acute myocardial infarction (MI) or stroke, oxygen should not be administered if the initial SpO2 is higher 92%.

The guidance recommendations were published on October 24, 2018, in BMJ. “It is a longstanding cultural norm to provide supplemental oxygen to sick patients, regardless of their blood oxygen saturation. A recent systematic review and meta-analysis has shown that too much supplemental oxygen increases mortality for medical patients in hospital,” concluded lead author Reed Siemieniuk, MD, PhD, of McMaster University, and colleagues. “A target SpO2 range of 90-94% seems reasonable for

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most patients, and 88-92% for patients at risk of hypercapnic respiratory failure seems wide enough to allow for normal fluctuation, and is likely low enough to avoid harm.”

The reasons as to why excessive supplemental oxygen increases mortality remain uncertain. Excessive oxygen can lead to reduced cardiac output, vasoconstriction, inflammation, and oxidative stress. In addition, excessive oxygen might lead to falsely reassuring SpO2 values and make it difficult to recognize when a patient’s condition worsens.

Image: A new study claims that supplemental oxygen is detrimental to hospital inpatients (Photo courtesy of Getty Images).

MRI Implant Monitors Processes in the Brain cont’d from cover

emitted by the nuclei of hydrogen atoms in water present in brain tissues. The inductively coupled resonant sensor is initially tuned to the radio frequency emitted by the hydrogen atoms. When a local electromagnetic or photonic event occurs, the MRI signal of the sensor is modified, no longer matching the frequency of the hydrogen atoms. The coil-based transducers can then be detected via an MRI scanner, enabling the remote sensing of biological fields.

The sensor requires neither onboard power nor wired connectivity, and is sensitive enough to detect potentials on the millivolt scale, comparable to what biological tissue generates, especially in the brain. It can thus detect electrical impulses fired by single neurons (action potentials), or local field potentials produced by a group of neurons. The sensor can also detect light emitted by cells engineered to express the protein luciferase, allowing researchers to determine if the genes were successfully incorporated by measuring the light produced. The study was published

on October 22, 2018, in Nature Biomedical Engineering.

“If the sensors were on the order of hundreds of microns, which is what the modeling suggests is in the future for this technology, then you could imagine taking a syringe and distributing a whole bunch of them and just leaving them there,” said senior author Professor Alan Jasanoff, PhD. “What this would do is provide many local readouts by having sensors distributed all over the tissue. It could also be used to monitor electromagnetic phenomena elsewhere in the body, including muscle contractions or cardiac activity.”

Biological electromagnetic fields arise throughout all tissue depths and types, and are associated with physiological processes and signaling in organs of the body. Currently, the most accurate way to monitor electrical activity in the brain is by inserting an electrode, which is an invasive and potentially harmful method. Electroencephalography (EEG) is a noninvasive way to measure electrical activity in the brain, but cannot pinpoint the origin of the activity.

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ISSN 0898-7270 Vol.37 No.1 • Published, under license, by Globetech Media LLC Copyright © 2019. All rights reserved. Reproduction in any form is forbidden without express permission.

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Speed-of-Sound Ultrasound Can Improve Breast Cancer Detection new ultrasound imaging method based on speed-of-sound (SoS) can help distinguish benign breast tumors from malignant ones.

Developed by researchers at the Swiss Federal Institute of Technology (ETH; Zurich, Switzerland; www.ethz.ch) and University Hospital Zürich (USZ; Switzerland; www.en.usz.ch), the new method relies on the principle that the density and rigidity of tissues determines the speed of the sound echo. Since tumors are more rigid than their surrounding tissue, sound travels 3% faster (on average) in malignant tissues than in healthy tissues, and 1.5% faster than in benign tumors. Image reconstruction strategy is based on measuring the differential time-of-flight measurements due to displacement of the ultrasound wave propagation paths.

The method requires single-sided access to the tissue, and can be applied to conventional ultrasound equipment, and for a range of transducers and applications. In clinical trials involving breast cancer imag-

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ing, the proposed method successfully improved contrast ratio from 0.37 to 0.67 for even high noise levels (50%) during Fourier-domain reconstruction. The enhanced contrast images cannot only detect the presence of tumors, but can also aid in distinguishing benign tumors from malignant ones. The study was published on October 26, 2018, in Physics in Medicine and Biology.

“Ultrasound is successful because it is safe, portable and inexpensive.

Our goal is to provide physicians with a better tool for decision-making during routine checks, and to avoid unnecessary biopsies,” said senior author Orçun Göksel, PhD, of ETH Zurich. “Our technology preserves these advantages while addressing the main limitation of conventional ultrasound, image quality, which is still a problem for diagnosis in many clinical cases. Compared with conventional ultrasound, our images are much easier to interpret.”

New Global Network Improves Access to Diagnostic Insights cont’d from cover

pharmaceutical innovators, government agencies, non-governmental organizations (NGOs), and academic institutions. Starting priority areas of focus include a global launch platform for high quality companion diagnostics and the creation of an emerging pathogen preparedness network in order to expedite infectious disease research and response. Additional initiatives will be rolled out based on regional and global priorities.

“The Global Diagnostics Network (GDN; www.globaldiagnosticsnetwork. com) will help solve some of the world’s most pressing healthcare challenges by enabling fast and consistent access to leading diagnostic innovations and best practices,” said Steve Rusckowski, chairman, president, and CEO of Quest Diagnostics (Madison, NJ, USA; www.QuestDiagnostics. com). “As we met with regional lab leaders over the past year, it became

clear that we can accelerate the development and delivery of advanced diagnostics and diagnostic insights by bringing together our peers and sharing best practices.” “The GDN collaboration will open up new opportunities by removing silos around unique knowledge and resources,” said Carrie Eglinton Manner, senior VP of advanced diagnostics at Quest Diagnostics. “We see this as a pragmatic approach to driving growth and excellence for all network members, while providing customers global access to innovations in diagnostics science, information, and service delivery.”

In addition to Quest Diagnostics, charter members of the GDN are Al Borg Medical Laboratories (Jeddah, Saudi Arabia), Dasa (Sao Paolo, Brazil), GC Labs (Yongin-Si, South Korea), KingMed Diagnostics (Hong Kong, China), Primary Health Care (Sydney, Australia), and SYNLAB (Munich, Germany).

Stereotactic Radiosurgery Detector Validates Dosimetric Treatment cont’d from cover

The Sun Nuclear (SNC; Melbourne, FL, USA; www.sunnuclear.com) SRS MapCHECK device is based on a high density diode array designed to replace film and single point dosimeters for patient specific and endto-end QA. The 2.47mm detector grid provides a 0.5mm resolution using 1,013 SunPoint 2 diodes set in a 2D array, providing both absolute and relative dose in a single measurement. MapCHECK inserts into the rotatable StereoPHAN phantom, with angular dependence, field size, and pulse rate accounted for any angle. SRS MapCHECK works with static, rotational, non-coplanar, flattening filter free (FFF), and cone and multileaf collimator (MLC) fields of 1 - 6 and 10MV. The accompanying SNC Patient software allows rapid analysis of QA measurements against the SRS treatment planning system (TPS), comparing radiotherapy (RT) dose distribution of the TPS file to the actual measured values. Users can query various points from the dose distribution, including absolute dose, absolute and relative dose difference between measured and planned dose data, and location relative to isocenter. Measurements use standard RT dose comparison metrics: gamma analysis, dose difference analysis, and sub-millimeter distance criterion.

“The SRS MapCHECK is an effective tool for patient-specific and end-to-end stereotactic QA. It shows good agreement with film dosimetry for field sizes ranging from seven centimeters to half a centimeter,” said Brett Miller, MSc, DABR, of the University of Tennessee Medical Center (Knoxville, USA).

SRS is used to treat functional abnormalities and small tumors of the brain, delivering precisely targeted RT in fewer high-dose treatments than traditional RT, which can help preserve healthy tissue. When SRS is used to treat body tumors, it is called stereotactic body radiotherapy (SBRT). Both SRS and SBRT are image-guided RT, relying on three-dimensional (3D) imaging and localization techniques, immobilization systems for precise patient position during therapy, and highly focused gamma-ray or x-ray beams that converge on the tumor.

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PRODUCT NEWS CT SCANNER

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R/F SYSTEM

DR SYSTEM

Siemens Healthineers

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The SOMATOM Edge Plus offers diagnostic imaging with reproducible accuracy. Its gamechanging workflow automation simplifies scan preparation and helps achieve new levels of precision.

The Raffine-i features high image quality, exceptional workflow efficiency and effective dose control. Its wide tabletop combines excellent mobility with the highest level of safety and comfort.

The Optima XR646 HD offers multiple configurations that adapt to the user’s needs. It uses Helix advanced image processing to deliver sharp detail and consistent performance in X-ray.

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New Positioning Platform Improves Imaging Efficiencies novel patient-positioning solution specializes in obtaining multiple weightbearing views of the lower extremities. The Clear Image Devices (Caledonia, MI, USA; www.clearimagedevices.com) Multiview Positioning Platform is designed to obtain multiple weight-bearing full weight-bearing anteroposterior (AP) lateral, oblique, and other anatomical views of the lower limbs in minutes. A combination of four imaging-panel placement locations and two grab bars that provide patient stability make it easy for radiology staff to position patients weighing up to 350 kg quickly and safely, including those with mobility issues.

Other features include easy portability due to built-in rollers and grab bars, a sturdy construction made of a germ-resistant, nonporous material that cleans easily, and proven compatibility with virtually all digital radiography (DR) and computed radiography (CR) systems, including systems form Siemens, Ysio, GE Flash Pad, Philips Wireless, GE, Canon, Carestream, Fuji, Konica Minolta Aero, AGFA, Shi-

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madzu, and Samsung.

“We created the Multiview in collaboration with a leading medical imaging facility. It is designed to eliminate considerable patient movement and costly retakes, and improve patient satisfaction,” said Ellen Mooney, manager of Clear Image Devices. “The Multiview Positioning Platform cuts imaging time in half. It allows radiographers to obtain multiple views in minutes to save significant time for lower-extremity studies. Early feedback from radiographers indicates that the platform works perfectly and is saving them valuable time.”

Patients presenting for radiology procedures are often older, more obese and suffer from a range of comorbidities that inhibit correct positioning, an important factor in attaining quality diagnostic images and ensuring patient safety and comfort. Advances in radiology often necessitate lengthier and more multifaceted procedures; when combined with complex patients, increased risk of negative respiratory events, cardiovascular compro-

mise, and nerve and soft tissue injury, the result is often evident in awkward positioning, injury and other complications.

Image: A versatile patient positioning solution reduces times (Photo courtesy of Clear Image Devices).

Fluorescence Imaging Device Aids Wound Treatment novel wound imaging device digitally captures and documents fluorescence information from wounds and surrounding tissue using still images and videos in real-time.

The MolecuLight (Toronto, Canada; www.moleculight.com) MolecuLight i:X is intended for point of care (POC) visualization and quantitative tracking of bacterial contamination, wound healing, and connective tissue remodeling of surgical sites and wounds, based on the detection of intrinsic fluorescence signals emitted by tissues and microbes when illuminated with specific wavelengths of light, without the need of contrast agents. Images can be captured and documented as either still images or videos of wounds, including in the surrounding areas where potentially harmful bacteria may be lurking.

MolecuLight i:X emits a precise wavelength of safe violet light, which interacts with the wound tissue and bacteria causing the wound and surrounding skin to emit a green fluorescence, while potentially

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harmful bacteria emit a red fluorescence. The device captures these red and green fluorescence signals in real time using specialized optical components to filter out the violet light, displaying the resultant image immediately on-screen. The MolecuLight i:X is precisely calibrated to detect fluorescent bacteria at levels higher than 104 CFU/g on a quantitative scale, or predominantly moderate to heavy growth on a semiquantitative scale.

MolecuLight i:X illuminates the wound with a narrow band of violet light that causes endogenous fluorophores in the bacteria to fluoresce.

Susceptible bacteria include Staphylocccus aureus and MRSA; Pseudomonas aeruginosa; Escherichia coli; Coagulase-negative staphylococci; multiple Enterococcus species; multiple Proteus species; Klebsiella pneumonia; Beta-hemolytic streptococci (Group B); and multiple Enterobacter species. It is recommended that imaging be performed after surface blood has been removed from the wound bed and peri-wound areas.

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Automated System Identifies Dense Breast Tissue deep-learning (DL) automated model can assess dense breast tissue in mammograms as reliably as expert radiologists, claims a new study.

Developed by researchers at The Massachusetts Institute of Technology (MIT, Cambridge, MA, USA; www.mit.edu) and Harvard Medical School (HMS; Boston, MA, USA; https://hms.harvard.edu), the DL model is based on a deep convolutional neural network (CNN) trained to assess breast imaging reporting and data system (BI-RADS) breast density – i.e. fatty, scattered, heterogeneous, and dense – based on the expert interpretation of 41,479 digital screening mammograms obtained in 27,684 women from January 2009 to May 2011. The algorithm was then tested on a held-out test set of 8,677 mammograms in 5,741 women.

In addition, five radiologists performed a reader study on 500 mammograms randomly selected from the test set. Finally, the algorithm was implemented in routine clinical practice, where eight radiologists reviewed 10,763 consecutive mammograms assessed with the model.

Agreement on BI-RADS category was compared for three sets of readings: radiologists in the test set, radiologists working in consensus in the reader study set, and radiologists in the clinical implementation set. The readings were compared across 5,000 bootstrap samples to assess significance.

The results revealed that the DL model showed good agreement with radiologists in the test set, and with radiologists in consensus in the reader study set. In addition, there was very good agreement with the radiologists in the clinical implementation set; for binary categorization of dense or nondense breasts, 10,149 of 10,763 (94%) of DL assessments were accepted by the interpreting radiologist. On all four BI-RADS categories, the DL algorithm matched radiologists’ assessments at 90%. The study was published on October 16, 2018, in Radiology.

“Breast density is an independent risk factor that drives how we communicate with women about their cancer risk. Our motivation was to create an accurate and consistent tool that can be shared and used across health care systems,” said study author PhD student Adam Yala, of the MIT Computer Science and Artificial Intelligence Laboratory (CSAIL). “When radiologists pull up a scan at their workstations, they’ll see the model’s assigned rating, which they then accept or reject. It takes less than a second per image ... [and it can be] easily and cheaply scaled throughout hospitals.”

It is estimated that more than 40% of women have dense breast tissue, which alone increases the risk of breast cancer. Moreover, dense tissue can mask cancers on the mammogram, making screening more difficult.

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Image: An artificial intelligence algorithm can detect dense breast tissue (Photo courtesy of MIT).

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PRODUCT NEWS X-RAY SYSTEM

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CT SCANNER

ULTRASOUND SYSTEM

Fujifilm

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SonoScape

The FDR Smart X offers ceiling-suspended as well as a floor-mounted X-ray tube options for use with the upright stand and table. It is compatible with the latest D-EVO II series DR panels.

The ANATOM 128-slice scanner features PowerLink, which reduces the cost of carbon brush and slip ring maintenance. It is capable of achieving fast acquisition images for patients with optimized dose.

The X3 offers a range of transducers to fit every clinical application and exam mode.

Featuring a laptop design, it comes with a new platform for more efficient scanning and clear image quality.

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Post-Treatment PSA Level May Predict RT Outcomes rostate-specific antigen (PSA) levels three months after radiotherapy (RT) are strong markers of prostate cancer outcomes, according to a new study.

Researchers at the University of California, San Diego (UCSD, USA; www.ucsd.edu) and Dana-Farber Cancer Institute (Boston, MA, USA; www.dana-farber.org) conducted a study involving 5,783 patients with intermediate-risk or high-risk localized prostate cancer diagnosed in the years 2000-2015 and treated with RT and androgen deprivation therapy. The aim of the study was to examine the association between threemonth post-RT PSA level and biochemical progression-free survival (bPFS), prostate cancer-specific survival (PCSS), and overall survival (OS).

In all, there were 2,651 patients with intermediate-risk and 3,132 with high-risk disease, with about 11% harboring a three-month PSA level higher than 0.50 ng/mL, which was found to be strongly associated with each outcome, as compared to patients with a three-month PSA value lower than 0.10 ng/mL. When the groups were analyzed separately, three-month PSA level was found to be predictive of OS in the high-risk group, but not in the intermediate-risk group. The study was

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published on May 4, 2018, in Cancer.

“The three month post RT PSA level appears to be a strong prognostic biomarker for bPFS, PCSS, and OS in patients with intermediate risk and high risk prostate cancer, particularly those with high risk disease,” concluded lead author Alex Bryant, BSc, of the UCSD department of VISIT US AT radiation medicine and applied sciences, and colleagues. “The three month PSA measureEXPO X4/404 ment may augment clinical decision making and holds promise as a potential surrogate endpoint in clinical trials.”

PSA is a glycoprotein enzyme secreted by the epithelial cells of the prostate gland, and is encoded in humans by the kallikrein3 (KLK3) gene. PSA is produced for the ejaculate, where it liquefies semen in the seminal coagulum, allowing sperm to swim freely; it is also believed to be involved in dissolving cervical mucus, allowing the entry of sperm into the uterus. PSA is present in small quantities in the serum of men with healthy prostates, but is elevated in the presence of prostate cancer, prostatitis or benign prostatic hyperplasia (BPH).

Image: A new study suggests that PSA levels can help evaluate radiotherapy success (Photo courtesy of Getty Images).

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PRODUCT NEWS ECG SYSTEM

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PULMONARY TESTING UNIT

SMART BATTERY KIT

Aerotel Medical Systems

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The HeartView P12/8 Mobile is a 12 or 8 lead ECG recorder/transmitter. It enables the transmission of data from any place, at any time via cellular network to a cardiac call center for immediate diagnosis.

The HypAir offers a range of pulmonary function tests in a single system and the ability to upgrade over time. It features open circuit spirometry, lung volumes, diffusion, respiratory mechanics and more.

The Smart Battery Kit provides safe power and remote power monitoring and management. It provides remote access to battery info without client PC and a fast charging battery to reduce waiting time.

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New Incubator Protects Most Vulnerable Infants cont’d from cover

nurture premature infants. The synthetic amniotic fluid is produced using water purified through six medical grade filters, eliminating all harmful substances, bacteria, and viruses. The purified water is then dosed with electrolyte and minerals (found naturally in amniotic fluid) via a dosing pump to create sterile, synthetic amniotic fluid.

Features include a built-in system for temperature and osmolality that warms the water to the proper temperature; based on the age of the infant, operators have the option to choose the level of osmolality that they want. Sensors placed under the infant’s chin ensure fluid in the bath never goes above the chin level, and fluid clarity sensors beneath the pelvic area detect stool defecated by the infant, leading to automatic flushing and replacement with fresh fluid. The fluid in the bath is also continuously circulated through an ultraviolet (UV) filter and heat source to maintain sterility and temperature.

In addition, the AmnioBed includes an infant seat with a harness that straps the infant’s chest and pelvis in place, so the infant cannot accidentally get fully submerged; a monitoring cap that covers most of the scalp that incorporates a skin temperature sensor, an O2 level monitoring sensor, and several openings over the fontanelles for ultrasound probe placement; and another monitor for the mother which provides direct audio/video feedback from inside the incubator to a proprietary app, so the mother can keep in constant contact with the infant.

“The AmnioBed has the potential to reduce the length of stay for infants and to improve the rate of weight gain and growth in the NICU, thus saving significant direct costs of short and long-term visits, in addi-

tion to providing infants with improved health and comfort,” said Amir Fassihi, MD, founder and CEO of Amnion Life. “The AmnioBed will prove to be advantageous over radiant warmer beds and convection warmed incubators in offering improved thermoregulation, hydration, and skin protection, helping to reduce complications and save lives, while also reducing costs.”

Amniotic fluid, generated by maternal plasma, is a protective liquid contained in the amniotic sac that serves both as a cushion for the growing fetus and as a means to facilitate the exchange of nutrients, water, and biochemical products between mother and fetus. When fetal kidneys begin to function in about week 16, fetal urine also contributes to the fluid. Amniotic fluid initially contains mainly water and electrolytes, but by about the 12-14th week the liquid also contains proteins, carbohydrates, lipids, and urea, all of which aid in the growth of the fetus.

Image: The AmnioBed amniotic neonatal incubator system (Photo courtesy of Amnion Life).

Compression Sleeve Regulates Lymphatic Disorders novel armsleeve with juxtaposing compression bands helps lymphedema and lipedema patients enjoy an improved quality of life. The medi (Bayreuth, Germany; www.medi.de) circaid juxtafit essentials armsleeve is a compression wrap with patented technology designed to apply graduated pressure from the wrist to the upper arm.

Made of a soft, breathable fabric, the armsleeve consists of a series of juxtapositioned inelastic bands extending from the central portion of the wrap that cover the arm from the wrist to the axilla. The arm section bands are composed of 63% Nylon, 32% Polyurethane, and 5% Elastane; the elbow strap is composed of 55% Nylon, 40% Polyurethane, and 5% Elastane. Both contain silver to prevent odor and bacterial spread.

The distinct juxtaposing bands provide a patented built-in-pressure system (BPS) that enables multiple, measurable, targeted compression

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ranges in a single product. The single patient, reusable, non-invasive, non-sterile armsleeve is available in both left and right arm variants, three different lengths, and six sizes in order to provide optimal comfort and efficacy. Custom versions are also available, as well as ready-to-wear and custom options for hand compression. The armband is easily donned and doffed for bathing and skin care.

Lymphedema is an accumulation of fluid in tissues commonly caused by abnormalities in the lymphatic system or removal or damage to the lymph nodes. Symptoms include swelling, recurrent cellulitis, loss of physical function, psychological stress and diminished qualify of life.

Lymphedema cannot be cured and is typically managed through combined therapies of manual lymph drainage, multilayer bandaging, decongestive exercise, skin care, and long-term self-management.

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Rapid Fluid Resuscitation Tool Helps Combat Septic Shock hand-powered rapid infuser delivers crystalloid and colloid resuscitative fluids to patients with critical conditions such as sepsis and hypovolemic shock.

The 410 Medical (Durham, NC, USA; www.410medical.com) LifeFlow Rapid Infuser is a single-use device with an intravenous (IV) administration tubing set and a levered compression handle used to deliver crystalloid and colloid fluids into the patient’s bloodstream. When manually compressing the handle to actuate the syringe, fluid is delivered from a container to the patient; the device automatically refills when the handle is released. The infuser also includes a clear canopy, through which the graduations and contents of the syringe can be viewed during use.

In a study of the device conducted by 410 Medical at the University of North Carolina (UNC; Chapel Hill, USA; www.unc.edu), using LifeFlow in patients in need resulted in lower expected mortality (10 fewer deaths per 500 cases), when compared to standard IV fluid delivery methods, as well as lower expected hospital costs, a lower required use of mechanical ventilation (24% versus 31%), a decreased average hospital and intensive care unit (ICU) length of stay, and decreased use of vasopressors (17% vs 21%). The study was published on October 26, 2018, in Open Access Emergency Medicine.

“Unfortunately, the current tools available to give a rapid fluid bolus aren’t very effective, and often don’t allow us to correct hypotension quickly,” said lead author Mark Piehl, MD, of UNC, co-founder and chief medical officer of 410 Medical. “The analytical model developed in this study demonstrated the benefit of a INTERACTIVE novel device that facilitates earlier DIGITAL EDITION fluid bolus completion and better adherence to sepsis bundles.”

Hypovolemic shock, the most common type of shock, is a lifethreatening condition that results when more than one-fifth of the blood volume is lost, making it impossible for the heart to pump a sufficient amount of blood to the body, leading to organ failure. The condition requires immediate emergency medical attention, with young children and older adults being the most susceptible.

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Image: The LifeFlow rapid infuser for patients who require an urgent fluid bolus (Photo courtesy of 410 Medical).

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NEW: RUSSIAN EDITION

HospiMedica International February-March/2019

English

Website Editions: Spanish Russian

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PRODUCT NEWS RESUSCITATION UNIT

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ANESTHESIA MACHINE

WEARABLE DEFIBRILLATOR

Atom Medical

Dräger Medical

Zoll Medical

The Resusci Flow neonate resuscitation unit allows the user to control the inspiratory time.

The unit can also administer oxygen and provide manual ventilation through an endotracheal tube.

The Dräger Fabius plus XL provides therapy and monitoring capabilities in a compact, versatile package. It offers expanded capabilities with additional monitors, gas cylinders and other accessories.

The wearable defibrillator monitors the patient, automatically detects life-threatening arrhythmias, and provides immediate treatment. It is designed specifically for in-hospital use in VT/VF patients.

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Mixing Muscle Relaxants and Anesthetics Raises Respiratory Risk new study concludes that administering neuromuscular blocking drugs during general anesthesia (GA) is associated with an increased risk of postoperative pulmonary complications.

Researchers at Munich Technical University (TUM; Germany; www.tum.de), Karolinska Institutet (KI; Solna, Sweden; www.ki.se), the University of Liverpool (United Kingdom; www.liv.ac.uk), and other institutions conducted a multicenter observational study to assess if neuromuscular blocking agent use is associated with postoperative pulmonary complications. To do so, they collected data from 22,803 patients who received anesthesia for any in-hospital procedure – except cardiac surgery – conducted in 211 hospitals in 28 European countries over the course of a year.

Patient characteristics, surgical and anesthetic details, and chart review at discharge were prospectively collected over two weeks.

Each patient also had a postoperative physical examination within three days of surgery for

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adverse pulmonary events. Overall, about three quarters of all patients (17,150 people) were treated with neuromuscular blocking agents. The most common respiratory complications were a transient reduced lung capacity for oxygen absorption (5.2%), and infections of the lung and respiratory tract (2.5%).

The results showed that patients receiving neuromuscular blocking agents while under GA had a significantly higher (4.4%) risk of developing any type of respiratory complication. The study also showed that neither neuromuscular monitoring, nor the administration of reversal agents reduced the risk. The researchers are now planning to implement more targeted studies in order to identify the underlying mechanisms behind their findings.

The study was published on September 14, 2018, in Lancet Respiratory Medicine.

“Neuromuscular blocking agents have made surgery considerably safer and more effective since their introduction. These drugs are particularly needed when operating on a

patient’s chest or abdomen. They are also used to protect the vocal cords from injury when a tube is placed in the airway to allow artificial ventilation,” said senior author Professor Manfred Blobner, MD, of TUM. “Patients undergoing minor surgical procedures that do not necessarily require neuromuscular blocking drugs might benefit from avoiding them. Using devices like laryngeal masks for anesthesia instead of tracheal tubes that go past the vocal cords could prove helpful as well.”

Image: A new study asserts that mixing muscle relaxants and anesthetics can lead to pulmonary complications (Photo courtesy of iStock).

Microbubble Scrubber Actively Removes Biofilms new antiseptic system harnesses the power of microbubbles to propel rigid diatoms through the surface of tough biofilms, disrupting their internal structure. Researchers at the University of Illinois at Urbana-Champaign (UIUC; USA; www.illinois.edu), the Korea Institute of Industrial Technology (KITECH; Gyeonggi-do, South Korea; www.kitech.re.kr), and other institutions have developed a system that uses hollow, cylinder-shaped diatom biosilicas and blended hydrogen peroxide (H2O2) and manganese oxide (MnO2) nanosheets. In an antiseptic H2O2 solution, the diatoms discharge oxygen gas bubbles, becoming self-motile and propelling the rigid diatoms forward with enough force to fracture the matrix of the biofilm.

The disrupted extracellular polymeric substances (EPS) allow the H2O2 molecules to diffuse into the biofilm structure, delivering a powerful antiseptic deathblow to the microbes and fungus living inside. According to the researchers, the H2O2 microbubble scrubber could potentially provide a unique and powerful tool to augment current efforts to disinfect

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and clean a wide array of biofouled products and devices. The study was published on August 14, 2018, in Applied Materials and Interfaces.

“Most of us get those black or yellow spots in our showers at home.

Those spots are biofilms and most of us know it takes a lot of energy to scrub them away,” said study co-author professor of chemical and biomolecular engineering Hyunjoon Kong, PhD, of UIUC. “Imagine trying to do this inside the confined space of the tubing of a medical device or implant. It would be very difficult.”

Biofilms protect bacterial communities in part because the EPS that form the biofilm matrix serve as a diffusion barrier, limiting antibiotic penetration. The diffusive barrier also results in nutrient gradients, causing decreased growth and metabolic inactivity in parts of the biofilm community, allowing persister cells to arise. Persister cell formation is most observed in Gram-negative bacterial biofilms, as their cell membranes are composed of lipopolysaccharides that further limit antibiotic penetration.

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Critical Care

Laryngeal Tubes Beat Intubation After Heart Attack atients with out-of-hospital cardiac arrest (OHCA) fare better with initial laryngeal tube (LT) insertion than endotracheal intubation (ETI), according to a new study.

Researchers at the University of Texas (UT) Health Science Center (UTH; Houston, USA; www.uth.edu), the U.S. National Heart, Lung, and Blood Institute (NHLBI; Bethesda, MD, USA; www.nhlbi. nih.gov), and other institutions conducted a study involving 3,004 adults (median age 64 years, 60.9% men) who experienced OHCA and were treated by emergency medical service (EMS) agencies, including advanced airway management. The 27 EMS agencies were randomized to an initial airway management strategy involving LT (1,505 patients), or ETI (1,499 patients), with crossover to the alternate strategy at 3-5 month intervals. The primary outcome was 72hour survival.

The results revealed that 72-hour survival was 18.3% in the LT group, compared to 15.4% in the ETI group. Secondary outcomes, including return of spontaneous circulation (ROSC), survival to hospital discharge, favorable neurological status at hospital discharge, and adverse events, showed a consistent superiority of LT over ETI. No major differences in airway swelling, oropharyngeal or hypopharyngeal injury, or pneumonia or pneumonitis were identified. Rates of initial airway success were 90.3% with LT and 51.6% with ETI. The study was published on August 28, 2018, in Journal of the American Medical Association (JAMA).

“During resuscitation, opening the airway and having proper access to it is a key factor for the survival of someone who goes into cardiac arrest outside of a hospital. But one of the burning questions in prehospital emergency care has been, ‘Which is the best airway device?’”

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said study co-author George Sopko, MD, MPH, of the NHLBI. “This study demonstrated that just by managing the airway well in the early stage of resuscitation, we could save more than 10,000 lives every year.”

Numerous studies have highlighted the challenges facing paramedic ETI, including significant rates of tube misplacement or dislodgement, need for multiple ETI attempts, and insertion failure. ETI has also been associated with iatrogenic hyperventilation and chest compression interruptions. Alternatives to ETI include supraglottic airway (SGA) devices, which include the LT, a laryngeal mask airway, esophageal-tracheal combitube, and others. While offering ventilatory characteristics similar to ETI, SGA insertion is rapid, simple, requires less training.

Image: Lead author Dr. Henry Wang holding a laryngeal tube (Photo courtesy of Rob Cahill/ UTHSCSA).

Functional Light Source Destroys Bacteria by Mimicking Sunlight new light emitting diode (LED) offers eco-friendly sterilization by maximizing the 405nm wavelength to cause bacteria to die.

The LG Innotek (Seoul, South Korea; www.lginnotek.co.kr) Hygienic Light LED solution is designed to imitate the sterilization effect of sunlight with LED indoor lighting at the 405nm wavelength. The light excites naturally occurring porphyrins inside the bacteria, causing them to produce reactive oxygen species (ROS), which then inactivate the bacteria. According to a sterilization power test conducted by Korea Conformity Laboratories (KCL; Seoul, Korea; www.kcl.re.kr) , Hygienic Light LED can kill 99.9% of Escherichia coli bacteria exposed to it.

Using the LG Innotek Hygienic Light LED visible disinfection lighting, indoor spaces can be easily sterilized without having to use any chemicals.

Sterilization power can be adjusted according to the ambient light conditions by using a dimmer. Lighting manufacturers can efficiently produce different lighting fixtures using the LED supplied by LG Innotek, including flat panel, tube, and down lamps. Hygienic Light LED does not have any negative effect on the eyes or skin, and meets photobiological safety standard IEC62471 of the International Electrotechnical Commission.

“Visible Disinfection Lighting is an innovative solution that will brighten up our living space and at the same time sterilize it safely and conveniently,” said Song June-O, vice president of the LG Innotek LED business unit. “In fact, LG Innotek has already installed this product in the coffin rooms of funeral halls and waste storage rooms in Yonsei University Severance Hospital Seoul as a trial. The product has received positive responses as it enhances the sterilization effect and gives a psychological relief at the same time.”

The 405 nm wavelength is a high-intensity narrow spectrum (HINS) visible indigo-colored light that appears to the human eye as violet, a color for which a human eye has a very limited sensitivity. It is very close to 400 nm, the wavelength of ultraviolet (UV) light, bordering on the very extreme of human vision.

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HEAT THERAPY SYSTEM

PATIENT MONITOR

Nova Biomedical

Cincinnati Sub-Zero

Biocare Electronics

The Stat EMS is designed for glucose, ketone, lactate, hematocrit and hemoglobin testing. All tests use tiny capillary blood samples, with lablike results in as little as six seconds.

The Micro-Temp LT heat therapy system allows the caregiver to set the water temperature and apply a therapy pad.

Key features include safety alarms, as well as a self-calibrating microprocessor.

The PM-900 features a color TFT screen along with a user-friendly interface design. It offers 480 hours graphic and tabular trends, 1,000 pieces of NIBP record storage, and 700 pieces of alarm review.

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Wireless Solution Meets Rising Demands of Home Monitoring n upgraded monitoring solution allows clinicians to track a patient’s vital signs, body posture, and activity levels, all at the same time and regardless of patient location. The Vital Connect (Campbell, CA, USA; www.vitalconnect.com) Vista Solution is comprised of the VistaTablet, a handheld mobile relay device, and the VitalPatch biosensor, a wireless, fully disposable biosensor that measures eight vital signs in realtime. Vista Solution allows physiological data for all patients to be easily accessible through an accompanying cloud-based application or viewed directly on the VistaTablet, supporting timely remote analysis by caregivers for patients, regardless if they are in the hospital or at home.

The heart of the system is the VitalPatch biosensor, which monitors heart rate, heart rate variability, respiratory rate, single-lead electrocardiogram (ECG), skin temperature, body posture, fall detection, and activity.

The patch is powered by a disposable zinc air battery designed to hold up for 120 hours, in line with the U.S. national average for a patient length of stay of 4.5 days. VitalPatch can also be used beyond the hospital walls where continuous monitoring is needed, including post-discharge monitoring, remote patient monitoring, and in clinical trials.

Proprietary SensorFusion algorithms process thousands of data points per minute to produce accurate, robust measurements, which are then transmitted wirelessly via Wi-Fi to the VitalConnect Platform, an innovative solution that integrates the biosensor with mobile and cloud-based software and analytics so that patients can be monitored around the clock. Patients can be discharged from the hospital with the VitalPatch already stuck to the skin, and their status will be continuously updated on the VitalConnect Platform and the VistaTablet in real-time.

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“For acute care and the aging population, home hospital programs offer an affordable solution to healthcare that works for providers and patients,” said Nersi Nazari, PhD, CEO and founder of VitalConnect. “With the implementation of VistaTablet, we are able to offer an easy-to-use mobile interface for physicians and patients to simultaneously monitor vital signs in real-time, allowing patients to recover at home while still under the care of their doctor.”

As a result of increasing healthcare costs, an increasing aging population, and demonstrated improved patient outcomes with advanced remote monitoring technologies, healthcare providers are beginning to shift eligible patients toward home care programs. Remote and continuous monitoring have shown a reduction in readmissions, improved patient outcomes, and overall decrease in cost of care compared to a traditional hospital stay.

Image: An adhesive connected patch monitors vital signs (Photo courtesy of Vital Connect).

Patient Positioning Sensor Protects against Pressure Sores n enhanced wireless patient sensor enables nurses at the point of care (POC) to confirm the patient turn they just completed adequately protects against pressure injuries. The Leaf Healthcare (Pleasanton, CA, USA; www.leafhealthcare.com) Patient Monitoring System (PMS) is based on a wireless sensor designed to continuously monitor activity and position in order to identify patients that can benefit from repositioning. The PMS tracks patient movement and activity in bed-bound, chair-bound, and ambulatory patients, and notifies staff when a patient needs to be turned, thus improving patient mobility, reducing pressure injury rates, helping nurses prioritize care and improve unit workflow, and saving hospitals non-reimbursed costs associated with the treatment of pressure injuries.

The enhanced patient sensor now includes an onboard indicator that

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allows caregivers to confirm the patient’s status without needing to refer to the external data monitors typically located at ward nursing stations.

When a caregiver gently taps the sensor twice, indicator lights momentarily flash to provide real-time turn status. The lights warn nurses when patients require turning and when they are overdue for a turn. A recent anonymous survey of nurses who have used the POC sensor found that more than 83% feel the sensor is “very easy,” or “easy” to use.

Pressure ulcers are lesions caused by factors such as unrelieved pressure, friction, humidity, shearing forces, temperature, age, continence, and medication. They can occur in any part of the body, but especially over bony or cartilaginous areas such as the sacrum, elbows, knees, and ankles. Although often prevented and treatable if found early, pressure ulcers can be very difficult to prevent in the frail and elderly, wheelchair users and terminally ill patients.

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PRODUCT NEWS MEDICAL MONITOR

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WOUND THERAPY SYSTEM

SUPPORT ARM SYSTEM

Ampronix

Lifotronic Technology

Derungs Licht

The Sony LMD-X310MT is designed for color video images in 3D/2D from endoscopic/laparoscopic cameras and surgical microscopes. Its design is for ORs, surgical centers, clinics and doctors' offices.

The Negative Pressure Wound Therapy system accelerates healing and reduces infection. It removes infectious materials, reduces edema, bacterial load and wound margins, and increases blood flow.

The TENO support arm system is for holding exam luminaires, minor surgery lights and for flat screens or patient multimedia systems. Its adjustable arm allows optimum support and it is easy to clean.

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Ingestible Capsule Prompts Weight Loss cont’d from cover

biodegradable shape-shifting gel scaffold, which mechanically resists peristaltic waves as they progress through the stomach wall after eating.

Triggered by stomach pH level, the mechanical resistance stimulates mechanoreceptors that create a sense of satiety, stalling gastric emptying. The gel scaffold acts on the stomach tissue for a period of several hours before it dissolves, thus avoiding stomach adaptation.

The treatment, which is administered twice daily, is intended for overweight or slightly obese persons with a body mass index (BMI) of 25-35 kg/m2 who seeks effective and safe assistance in weight loss. In a recent phase 2 study involving 52 patients, the average excess body weight loss was -21.8%, average BMI declined from 33 to 31, and waist circumference was reduced by 4.41 cm. Moreover, 80% of those patients who were hypertensive became normalized at week 12, and in 53% of pre-diabetic patients, fasting glucose was reduced from 104 to 92 and HbA1C% was reduced from 6.03 to 5.6.

“This self-use concept of the Epitomee capsule could represent a new direction in the way we treat overweight and obesity and could be very encouraging to many of my patients,” said Professor Haim Shirin, MD, director of the Institute of Gastroenterology, Liver Diseases, and Nutrition at Assaf Harofeh Medical Center (Beer Yaakov; Israel), who present-

ed the study at the IsraeLIVE Endoscopy International conference, held during October 2018 in Haifa (Israel). “We were happy to see that there were no serious treatment-related adverse events and that the treatment was well tolerated.”

“Our solution is unique, and the only one that can actually be scaled up to treat billions of people who can benefit from it. Our device can deliver a range of benefits that impact health, wellness and quality of life, from weight loss and glycemic control to body shaping and circumference reduction. We are now working on making it available to the relevant patients in the market,” said Dan Hashimshony, MD, CEO of Epitomee. “Thanks to this work we can now go further in our investigations and complete our advanced phase 2. This will bring the Capsule closer to people who seek a safe and simple clinical weight loss solution.”

Peristalsis is a radially symmetrical contraction and relaxation of muscles that propagate in a wave down a muscular tube, in an anterograde fashion. In much of the gastrointestinal (GI) tract, smooth muscle contracts in sequence to produce a peristaltic wave, which forces a bolus of food along it. Peristaltic movement is initiated by circular smooth muscles contracting behind the chewed material to prevent it from moving back into the mouth, followed by a contraction of longitudinal smooth muscles, which pushes the digested food forward.

Fixation System Helps Mend Fractured Thigh Bones n innovative nailing system provides new options for the surgical treatment of a wide variety of femoral shaft, subtrochanteric and impending pathologic fractures.

The DePuy Synthes (West Chester, PA, USA; www.depuysynthes. com) Femoral Recon Nail (FRN) system is a state-of-the-art intramedullary nailing system comprised of titanium intramedullary nailing implants designed to provide stabilization of femoral shaft and neck fractures, as well as system specific insertion instruments. Nailing implants are offered in a range of dimensions and in left- and right-hand-

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oriented versions, which enable both Piriformis Fossa and a Greater Trochanter entry points for the insertion of the nailing implant into the femur, and locking options that accommodate varying preferences.

Radiolucent insertion handles aim to reduce surgical complexity and facilitate intraoperative and X-ray visualization, and assist with guide wire placement. In addition, the FRN system addresses a potential operative complication called distal cortical impingement, which is often the result of the curve of the patient’s femoral anatomy being greater than the curve of the nail.

“I believe the DePuy Synthes Femoral Recon Nail System offers the most streamlined insertion instruments on the market,” said professor of orthopedic surgery Pete Nowotarski, MD, of the University of Tennessee College of Medicine (Chattanooga, USA).

An intramedullary nail is a metal rod forced into the medullary cavity of a bone so as to form a self-contained internal splint that stabilizes the fracture. This is often done for fractures of the tibia, femur, and humerus. Advantages include more exact alignment of the fractured bones for faster healing and earlier weight-bearing, earlier joint motion for reduced stiffness, and a more natural-like motion in uninjured muscles and neighboring joints.

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New Total Shoulder Implant Improves Joint Access new stemless total shoulder system uses an aspherical head design that provides increased exposure to the glenoid and minimal bone removal. The Arthrosurface (Franklin, MA, USA; www.arthrosurface.com) OVOMotion Shoulder Arthroplasty System is a stemless total shoulder system with an inlay socket design intended for patients with painful and/or severely disabled shoulder joints as a result of arthritis, traumatic events, or avascular necrosis (AVN). The system is comprised of a chrome-cobalt ovoid-shaped articular component with seven offset choices and a titanium plasma spray undercoating, and a cannulated titanium fixation component that connects to the ovoid head with a Morse taper.

The surgical technique involves off-axis preparation of the glenoid fossa using a three-dimensional (3D) mapping system. Following a series of reaming and trialing, best fit is determined. Once the socket is reamed to the correct depth, tunnels are drilled for the peg holes and perforations are made in the bone bed. Bone cement is then placed and pressurized using a silicon finger sleeve and the shoulder implant is seated and impacted into place. The construct provides biomechanical stability, immobile fixation, and a stress bearing contact where it’s most needed, at the bone/prosthetic interface.

“With the new system, the additional 12.5mm of bone removed from the humeral head has truly improved the technical portion of the procedure. This allows for easier visual and manual access of the glenoid,” said Michael Gombosh, MD, of South Florida International Orthopaedics (Miami, USA). “With improved visualization, you are able to obtain a more accurate assessment of the morphology and wear pattern within the glenoid, but also establish improved access for glenoid preparation and release of the posterior capsule.”

The glenoid fossa is a shallow, pyriform articular cartilaginous surface, with its margins attached to the fibrocartilaginous glenoid labrum, thus deepening the cavity. Together with the humerus, it forms the glenohumeral joint, which is reinforced by the rotator cuff. Due to its shallow angle, the glenoid cavity allows the shoulder joint to have

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the greatest mobility of all joints in the body, with 120 degrees of unassisted flexion. To maintain its stability, strong glenohumeral ligaments and muscles help hold the humerus in place.

Image: An x-ray image of the stemless OVOMotion implant system (Photo courtesy of Arthrosurface).

Tibial Nerve Neuromodulator Regulates Active Bladders safe, minimally invasive system offers durable and significant improvements for over active bladder (OAB) patients. The BlueWind Medical (Herzliya, Israel; www.bluewindmedical. com) Renova iStim is an implantable, miniature, wireless platform for percutaneous neuromodulation (PTNM) of the tibial nerve, which is located near the ankle. The gentle electrical pulse is thought to indirectly activate the central nervous system, helping alleviate OAB symptoms such as urinary frequency (UF) and urinary urge incontinence (UUI) episodes. The device, which is powered wirelessly by an external control unit for just 30 minutes, can be used while performing daily tasks without interruption.

A prospective study conducted in four clinical centers in the United Kingdom and the Netherlands, and results of a six-month follow-up that included 20 of the 36 pilot study patients, showed a sustained high responder rate, comparable with response rates typical of sacral nerve stimulation (SNS). Three years after implantation of the Renova iStim device, 75% of the study patients experienced at least a 50% long-term reduction in OAB symptoms, and durable, long-term UUI relief. No severe adverse events were reported throughout the follow-up study.

“The 36-month study results confirm that the Renova iStim system provides robust and effective long-term performance that could help millions of patients in the management of OAB,” said Efi Cohen Arazi, CEO of RainbowMD (Herzeliya Pituach, Israel; www.rainbowmd.com), and chairman of the board of BlueWind Medical. “We believe BlueWind has highly differentiated wireless neuromodulation, and this data provides strong evidence of the potential for this technology in OAB and other indications.”

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SURGICAL DISPLAY

MOBILE C-ARM

Erbe Elektromedizin

Barco

GE Healthcare

The VIO 300 D delivers the lowest effective adjusted power output in all modes, including both CUT and COAG. It also features spark recognition technology that detects the formation of micro-electric arcs.

The MDSC-8427 provides a double user interface for smooth control of screen/layout configurations. The touch screen offers four dedicated and programmable shortcut buttons.

The OEC One provides detailed images on a 27-inch display mounted on an articulating arm with five ranges of motion for various procedures. It also allows for adjustments to manage imaging as needed.

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Implantable Mesh Device Treats Refractory Angina sing a procedure similar to a coronary stent implantation, a novel stent addresses refractory angina (RA) by narrowing the coronary sinus, creating backflow pressure into the heart.

The Neovasc (Richmond, Canada; www.neovasc.com) Neovasc Reducer System is comprised of the Reducer, a stainless steel, hourglassshaped mesh that is three millimeters in diameter at its smallest point, which is delivered premounted on a proprietary balloon catheter. In a standard percutaneous coronary intervention (PCI) procedure, a catheter is inserted in the patient’s groin area, delivering the Reducer inside the coronary sinus; the procedure is usually completed in 20 minutes. Within six to eight weeks, tissue grows over the mesh, narrowing the coronary sinus.

The narrowing creates a resistance backflow pressure, which provides relief of RA symptoms by altering blood flow in the heart’s circulatory system, thereby increasing the perfusion of oxygenated blood to ischemic areas of the myocardium. A nonrandomized study involving 15 patients with RA who were treated with the device showed a significant improvement in symptoms, which was maintained at three years of follow-up. Patency of all the devices was documented by means of

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computed tomographic (CT) angiography, and showed no evidence of device migration.

Refractory angina currently affects over two million patients worldwide, who typically experience severe chest pain from even minor physical exertion, and as a result lead restricted lives. The incidence of RA is growing, yet these patients have largely exhausted available treatment options. But occlusion of the coronary sinus, the major venous drainage of the left heart, results in preservation of the endocardial to epicardial perfusion ratio and reduction of myocardial infarction size.

Image: The Neovasc hourglass-shaped reducer system (Photo courtesy of Neovasc).

Magnetic Bracelet Device Effectively Manages Reflux bracelet made of miniature magnetic beads helps relieve symptoms of gastroesophageal reflux disease (GERD) and improves patient’s quality of life (QOL).

A product of Ethicon Endo-Surgery (Ethicon, Cincinnati, OH, USA; www.ethicon.com), the LINX Reflux Management System is made of a series of titanium beads, each with its own magnetic core, connected together with independent titanium wires so as to form a ring-shaped magnetic sphincter augmentation (MSA) device. The device is implanted during a laparoscopic procedure and wrapped around the lower esophageal sphincter (LES). The magnetic forces between the beads help keep a weakened LES closed, preventing a reversed flow of stomach contents.

When eating, the magnetic force between the beads is overcome by the high pressures formed by the body’s swallowing forces, and the device expands to accommodate ingestion of food or liquid. Once the food passes though the LES, the device returns to its resting state. The reversible LINX MSA device can thus provide a simple and effective treatment option for GERD, preserving gastric anatomy, establishing normal physiological function, and relieving patients of dependence on medication.

In a new study comparing the LINX device to proton pump inhibitors

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(PPIs; the standard of medical care for GERD treatment), 89% of LINX patients achieved relief from moderate to severe regurgitation, compared to 10% of those treated with twice-daily omeprazole; 81% had an improved QOL, compared to 8% of the omeprazole patients; and 81% of LINX patients reported satisfaction with their current condition, versus just two percent of patients treated with twice-daily omeprazole.

“Patients experiencing regurgitation, despite proton-pump inhibitor therapy, actually did extremely well with an anti-reflux procedure, magnetic sphincter augmentation, using the LINX device,” said study co-author gastrointestinal surgeon Reginald Bell, MD, of the Institute of Esophageal and Reflux Surgery (Englewood, CO, USA). “When the physiology of GERD is recognized – that it is due to a mechanical defect in the sphincter – it makes sense that patients would indeed respond to the procedure.”

In GERD patients, the esophageal sphincter is weakened and does not close tightly, allowing digestive juices to return and irritate the esophageal lining. Treatment options include lifestyle changes and medications, such as over-the-counter antacids, PPIs, and a surgical fundoplication, in which the excess stomach tissue is folded around the esophagus and sewn in place to strengthen the LES. HospiMedica International February-March/2019

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Surgical Techniques

Versatile System Makes Robotic Surgery More Accessible compact design expands the potential of robotic surgery by providing an adaptable system that is portable, transportable, and affordable. The CMR Surgical (Cambridge, United Kingdom; https://cmrsurgical.com) Versius surgical robotic system is designed to mimic the human arm using a unique four-axis wrist joint. The proprietary, patented form factor provides freedom in port placement, with the added benefits of fully wristed 5.8 mm instruments, three-dimensional (3D) HD vision, easy-to adopt instrument control, and a choice of ergonomic working positions that reduce stress and fatigue. This is made possible because of its small form factor, modular design, and individually cart-mounted arms.

Every Versius arm is embedded with advanced collaborative robotics that allow surgical teams to move the arms while the surgeon is operating, adding increased access should it be required, and all without disturbing the surgeon and the procedure. Versius can also be easily moved between operating rooms and even hospitals, and is quick to set up. Its small footprint, just 38X38 centimeters, allows it to fit easily into the existing surgical workflow across a range of surgical specialties.

“When science wants to solve a problem, it often turns to nature. We

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Hydrogel Injections Customize Cartilage Repair novel bioprinting device can build three-dimensional (3D) bioscaffolds capable of regenerating deficient cartilage tissue, according to a new study. Developed at the University of Melbourne (Melbourne, Australia; www.unimelb.edu.au), St. Vincent’s Hospital (Melbourne, Australia; www.svhm.org.au), and other institutions, the handheld BioPen 3D additive printing device can extrude hydrogel in a core/shell manner that preserves cell viability during the biofabrication process. For the study, human adipose derived mesenchymal stem cells (hADSCs) were harvested from the infra-patellar fat pad of donor patients affected by osteoarthritis, and cultured in the presence of chondrogenic stimuli for eight weeks in vitro.

In order to prove that they can be utilized for biofabrication of human cartilage, the hADSCs were laden in gelatin methacrylate (GelMa) and hyaluronic acid methacrylate (HAMa) hydrogels, and subsequently extruded via the BioPen to generate bioscaffolds that formed hyaline-like cartilage. To control the size and shape of the BioPen scaffolds, the researchers used polydimethylsiloxane (PDMS) cylindrical molds to create a desired shape with regulated cell numbers. Immediately after extrusion, samples were irradiated with ultraviolet (UV) light for polymerization.

Capacity to produce hyaline-like neocartilage was analyzed via histology, gene, and protein expression analysis. Neocartilage formation was defined by protein localization and organization of the main components of hyaline cartilage, and a series of mechanical loading tests for compression and atomic force microscopy (AFM) were used to determine surface topology and physical properties with time. The results revealed generation of mature fibrillary collagen after eight weeks of chondrogenesis. The study was published on August 21, 2018, in Biofabrication.

“A comprehensive characterization including gene and protein expression analyses, immunohistology, confocal microscopy, second harmonic generation, light sheet imaging, atomic force mycroscopy and mechanical unconfined compression demonstrated that our strategy resulted in human hyaline-like cartilage formation,” concluded senior author Claudia Di Bella, PhD, of the University of Melbourne, and colleagues. “Our in situ biofabrication approach represents an innovation with important implications for customizing cartilage repair in patients with cartilage injuries and osteoarthritis.”

Regenerating robust articular hyaline-like cartilage is a key priority in musculoskeletal tissue engineering in order to prevent cost-intensive degenerative osteoarthritis that limits quality of life. The integration of mesenchymal stem cells and 3D printing technologies has shown significant promise in bone tissue engineering, but the key challenge remains in transferring the bench-based technology to the operating room for real-time applications.

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took our inspiration from the human arm, the greatest surgical tool in history,” said Luke Hares, chief technology officer at CMR. “Whereas traditional industrial robotic arms are large and the wrists have three joints, our robot is the same size as a human arm and has four wrist joints, giving the surgeon an unprecedented level of freedom to operate on the patient from whatever angle they want, versatility, and reach.”

“In Versius, we’ve designed a next-generation robotic system that’s sufficiently versatile that it can help perform the vast majority of laparoscopic cases,” said Martin Frost, CEO of CMR Surgical. “The groundbreaking design, coupled with genuine affordability, means that patients everywhere have the potential to benefit from the advantages of minimal access surgery. Versius is a great example of British innovation, and its launch represents a pivotal moment in the next chapter of surgery and patient care.”

Image: A four-wristed surgical robot mimics the human hand (Photo courtesy of CMR Surgical).

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The 1650 Special Edition has a more stable base and new column design, offering better access to surgical areas. The 1650 model also offers versatile positions, making it ideal for general surgery needs.

The ACEMSO15F offers 110,000 LUX and low power consumption. Its LED layout provides visual comfort and produces a uniform, homogeneous and shadowless light, making it ideal for many uses.

The DE605 is a special purpose, ultra HD digital video camera combined with a high magnification lens and multiple ultra-bright LEDs. It can easily focus on distant and up-close targets.

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Novel Biomaterial Prevents Post-Surgical Adhesion new study shows how an innovative polyelectrolyte complex (PEC) can provide a barrier that prevents adhesions in post-operative complications.

Researchers at Rutgers University (Piscataway, NJ, USA; www. rutgers.edu) have developed a PEC film composed of an optimal ratio of chitosan and polygalacturonic acid (PgA) that can prevent post-surgical intra-peritoneal adhesion formation. The design is based on the fact that oppositely charged polymers, with negative functional groups – such as carboxylate and sulfate – have a demonstrated inhibitory effect on adhesions of macrophages, lymphocytes, platelets, and fibroblasts. Chitosan-PgA PEC film can thus prevent adhesions by providing a physical barrier that stops wound surfaces from joining.

The non-toxic, material complex can be used for both laparoscopic and laparotomy surgeries, since it is flexible and reasonably strong. Processing is completely aqueous based and does not require any toxic solvent, and the result is both biocompatible and biodegradable, dissolving within one to two weeks. In addition, substrate-cells electrostatic interactions with the film itself also help prevent adhesions, as the surfaces are non-permissive for viable fibroblast and macrophage attachment.

The study was published in the August 2018 issue of Technology.

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Adhesions are fibrous bridges that form between tissues and organs in abdominal, pericardial, and peridural spaces as a result of surgery, injury, inflammation, or infection. Adhesion can cause extreme pain discomfort, reduced mobility, difficulty breathing, and infertility. The success rates of available anti-adhesive barriers are still low, and there is a need for development of more effective biomaterials to significantly reduce adhesions.

Image: Live cells (a) outside PEC barrier (b) indicate it does not create a toxic environment (Photo courtesy of Noshir Langrana/ Rutgers).

Silicone Breast Implants Associated with Rare Diseases new study reveals that silicone implants are associated with rare diseases, autoimmune disorders, and other conditions, although a causative relationship was not established.

Researchers at the University of Texas MD Anderson Cancer Center (MD Anderson; Houston, USA; www.mdanderson.org) conducted a multicenter cohort study that analyzed large post-approval studies (LPAS) initiated by the U.S. Food and Drug Administration (FDA) in order to monitor long-term implant-related outcomes and systemic harms of silicone and saline breast implants placed during primary, revision, augmentation, or reconstruction surgery. Systemic harms, self-harm, reproductive outcomes, and implant-related complications were analyzed by implant composition and operative indication.

LPAS data was available for 99,993 patients, with 56% of the implants made of silicone. Silicone implants were associated with higher rates of Sjogren syndrome, scleroderma, rheumatoid arthritis, stillbirth, and melanoma. The study found no correlation between breast implants and suicide or fibromyalgia. There were higher patient-reported rates of stillbirth, preterm birth, and neonatal intensive care unit (nICU) admittance, but no association with miscarriage. Lower self-reported rate of

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birth defects or congenital malformation were found among women with silicone implants.

Regarding short-term outcomes, rupture was significantly higher for saline implants (2.5% versus 0.5%), while capsular contracture was higher for silicone ones (5% versus 2.8%). At seven years from primary augmentation, the overall reoperation rate stood at 11.7%, while for revision breast reconstruction the reoperation rate was 25%. One case of breast implant associated with anaplastic large cell lymphoma was reported. Capsular contracture occurred in 7.2% of primary augmentations and 12.7% of primary reconstructions. The study was published on September 18, 2018, in Annals of Surgery.

A breast implant is a prosthesis used to change the size, shape, and contour of a woman’s breast. There are two general types of breast implant devices, defined by their filler. Saline implants are composed of an elastomer silicone shell filled with sterile saline solution during surgery; the silicone implant has an elastomer silicone shell pre-filled with viscous silicone gel.

The two approved manufacturers of silicone gel-filled breast implants in the United States are Allergan (Irvine, CA, USA; www.allergan.com) and Mentor (Santa Barbara, CA, USA; www.mentorwwllc.com).

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Surgical Techniques

Robotic Total Knee Replacement System Optimizes Implant Fit and Alignment dvanced software and robotic-assisted instrumentation tailor total knee replacement (TKR) procedures to the patient’s unique anatomy. The OMNI life science (OMNI; Raynham, MA, USA; www.omnils.com) OMNIBotics System is a computer controlled, robotic-assisted TKR technology designed to relieve the pain caused by joint degeneration due to osteoarthritis. OMNIBotics Bone Morphing technology is used to quickly build and display a three-dimensional (3D) model of patient anatomy in real-time. Using the 3D imaging model, the surgeon can then accurately plan implant fit and alignment before bone resections are initiated.

The surgeon is not dependent on making a pre-operative plan based on computerized tomography (CT) scans or X-rays.

Well-defined algorithms and adjustable resection guides enable the surgeon to accurately reconstruct the mechanical axis of the patient’s leg with the aid of APEX software, which alongside a proprietary robotic cutting guide directs the surgeons where to execute femoral resections. During surgery, a real time assessment of limb alignment and soft tissue tension is made that verifies the pre-determined surgical plan is being followed. In addition, an Active Spacer system enables the surgeon to predictively balance the ligaments through dynamic real-time feedback across the entire range of motion to maximize patient outcomes.

“With many studies indicating that a significant percentage of knee replacement patients are not fully satisfied with the results, OMNIBotics Active Spacer technology provides the surgeon with a quantitative tool to plan bone cuts to address the resulting ligament balance,” said Christian Joly, vice president of Robotics at OMNI. “We believe that this advanced robotic device is helping increase surgeon confidence, improve

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consistency, and reduce the number of soft tissue releases by creating a customized patient-specific procedure.”

“It’s been great to be able to check the accuracy of the surgery and make adjustments to perfect the angles and alignment of each step of surgery. This is so much more personalized and accurate than the traditional knee replacements done elsewhere,” said Brigham Redd, MD, of Liljenquist & Redd Orthopedic Surgery (Idaho Falls, ID, USA). “It’s exciting to offer the most advanced technology to my patients and see them come back feeling even better than they do after a traditional knee replacement, and to be confident that their knee replacement will last even longer because of the precise and individualized alignment.”

Image: A novel robotic-guided TKR system uses guides to precisely direct bone resection (Photo courtesy of OMNI).

Cryoablation System Effective for Esophageal Disorders novel balloon cryosurgical tool treats Barrett’s esophagus (BE) and esophageal squamous cell neoplasia (ESCN) effectively and with low patient discomfort. The Pentax Medical (Tokyo, Japan; www.pentaxmedical.com) C2 CryoBalloon ablation system is a designed to ablate unwanted tissue by application of extreme cold during endoscopy. The system is comprised of a sterile balloon catheter, a controller unit, and a nitrous oxide (NO) cartridge. Treatment sites are selected by adjusting endoscope and controller positions, with the tissue to be ablated then visualized through the inflated balloon. Once in contact with the tissue, the balloon is inflated with NO, rapidly cooling it and ablating unwanted tissue. The NO then exhausts through the controller.

Operation of the system is intuitive, fast (15-30 minutes per procedure), and cost-effective, and also eliminates the need for precise sizing and multiple deployment steps due to the real-time visualization of the esophagus during treatment. The system is compatible with commercially available endoscopes with a minimum working channel inner diameter of 3.7 mm and length of 100 cm. According to clinical studies, 95% of patients treated with the C2 CryoBalloon achieve complete eradication of dysplasia, and 90% have complete eradication of intestinal metaplasia through two years.

Barrett’s Esophagus develops as a result of chronic injury from gastroesophageal reflux disease (GERD), which causes metaplasia of the normal squamous epithelium lining of the esophagus, replacing them with goblet cells, which are usually found lower in the gastrointestinal tract. Cryoballoon technology offers shorter procedure times than point-by-point radiofrequency (RF) ablation, and better treatment outcomes than drug therapy. It has been shown to improve quality of life for patients and significantly reduce paroxysmal (sporadic) AF symptoms, such as palpitations, fatigue, rapid heartbeat, swelling, and syncope.

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MEDICAL DISPLAY

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The Nexxis for the integrated digital OR allows the sharing of video/audio in/outside the OR. It has been built to be ready for any new technology, and meets every requirement of any surgical procedure.

The PDC-WP240 features a 24-inch screen, high contrast ratio, wide viewing angle, and internal power supply. It is suitable for use in critical hospital environments, such as ORs and ICUs.

The RaySafe OneQA application helps achieve compliance while improving the quality and safety of the X-ray equipment. OneQA pairs with the RaySafe X2 or X2 Solo to streamline data collection.

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Custom-Designed Prosthetic Foot Mimics Natural Walking low-cost passive prosthetic foot can be individually tailored so that the user’s walk is similar to that of an able-bodied gait. Developed by researchers at The Massachusetts Institute of Technology (MIT, Cambridge, MA, USA; www.mit.edu), the prosthetic foot is based on a mathematical model that describes stiffness, motion, and shape of the foot, and also relates to how the lower leg moves while the foot is in contact with the ground. The researchers first consulted an existing dataset of measurements of steps taken by an able-bodied walker with a given body size and weight. Ground reaction forces and the changing center of pressure experienced by a walker’s foot as it rocked from heel to toe were measured, predicting how a user’s lower leg would translate through a single step.

Using the mathematical model, the researchers then tuned the stiffness and geometry of the simulated prosthetic foot to produce a lowerleg trajectory that was close to that of the able-bodied swing. To develop the prosthetic foot itself, they decided not to replicate an anatomic human foot, but rather take a different approach, one based on their realization that amputees who have lost a limb below the knee cannot feel what a prosthetic foot does, as it is not connected to the nervous system, and therefore, there is no interaction.

The resulting foot shape looks similar to the side-view of a toboggan ski, and can be customized using just a few select variables such as body weight and size, which are modified in the genetic algorithm. The prosthesis’ plantar section is made from machined nylon, a material chosen

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for its energy-storage capability. To test the prototype model, the researchers produced several feet for volunteers in India. They estimate that the foot, if manufactured on a wide scale, could cost an order of magnitude less than existing products. The study was published in the March 2018 issue of the Journal of Mechanisms and Robotics.

The researchers have partnered with Vibram (Albizzate, Italy; https://vibram.com), which manufactures rubber outsoles for flexible hiking boots and running shoes that look like feet. The company is designing a life-like covering for the team’s prosthesis that will also give the foot some traction over muddy or slippery surfaces. The researchers plan to test the prosthetics and coverings on volunteers in India in Spring 2018.

Image: Prototype prosthetic feet on Indian volunteers (Photo courtesy of MIT).

Smartphone Technology Advances Implanted Hearing Aid Performance nnovative cochlear implant technology allows people with hearing loss to directly control and monitor their hearing on any compatible iOS or Android smartphone. People with hearing deficits that have received a Cochlear (Centennial, CO, USA; www.cochlear.com) implant that features the Nucleus 7 Sound Processor can now control their hearing with the Nucleus Smart App from a compatible Android or iOS device. Recipients can now stream sound directly from a compatible device directly to their Nucleus 7 Sound Processor, and can also control, monitor, and customize their hearing settings, view personalized hearing information, and even locate a missing sound processor, all from the convenience of their smartphone.

Unique features include Hearing Tracker, which records coil-offs time (when the sound processor coil does not detect the implant coil) and time in speech (the amount of time spent in speech environments, including FM radio and streaming audio); the Find My Processor feature,

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which helps locate a lost sound processor by using location services to determine the last place it was connected to the paired device (such as in the playground or in the car); and Forward Focus, a user-activated algorithm that reduces distracting noise coming from behind a person so they can more easily enjoy a face-to-face conversation in a challenging listening environment, such as a noisy restaurant.

In a normal ear, sound vibrations in the air lead to resonant vibrations of the basilar membrane inside the cochlea. The movement of hair cells, located all along the basilar membrane, creates an electrical disturbance that can be picked up by the surrounding nerve cells, allowing the brain to interpret the nerve activity and determine what sound frequency is being heard. The cochlear implant bypasses the hair cells and stimulates the cochlear nerves directly using electrical impulses. This allows the brain to interpret the frequency of sound as it would if the hair cells of the basilar membrane were functioning properly.

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Workstation Supports Customer-Driven Imaging Workflow

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new imaging workstation offers a single, intuitive interface for efficient radiography, fluoroscopy, mammography, and full leg/full spine (FLFS) imaging. The Agfa Healthcare (Mortsel, Belgium; www.agfahealthcare.com) MUSICA Acquisition Workstation was designed to meet the needs and tasks of technologists, radiologists, and imaging facilities, incorporating multiple innovations that facilitate flexibility and customization. Workflows can be easily tailored to users, so that frequent tasks are the most easiest to complete, using just a few taps on the touch screen to identify a patient, initiate an exam, control image quality, and more. The user interface keeps the amount of distracting visual clutter to a minimum, providing a smooth patient and user experience.

All MUSICA Workstation workflows are intuitive and efficient, providing dedicated exam protocols that are available for dynamic imaging, including both fluoroscopy and rapid sequence imaging. Dedicated tools have been optimized for specific mammography screening or diagnostic workflows. The MUSICA NE DES W Acquisition Workstation provides IGN image processing for all Agfa digital radiology (DR) and computed general radiography (CR) systems, offering diagnostic confidence, and excellent and consistent images that meet WORLD’S MEDICAL PRODUCT MARKETPLACE user preferences, including body part or patient position, and for any collimation.

“We are focused on enabling intelSIGN UP ligent radiography at the modality levFOR FREE! el, building in quality, safety and productivity features to improve the imaging experience of patients and staff,” said VP of imaging at Agfa Louis Kuitenbrouwer. “The name ‘MUSICA’ has been synonymous with quality imaging for decades, thanks to our ‘gold-standard’ image processing software. And while the software is the ‘brains’ of the imaging workflow, the Acquisition Workstation is the nerve center.”

The MUSICA Acquisition Workstation meets Exposure Index and integrating healthcare enterprise (IHE) guidelines and is digital imaging and communications in medicine (DICOM) compliant. It also supports the IHE Radiation Exposure Monitoring (REM) profile, enabling structured dose reports to be sent directly to the picture archiving and communication Connecting Buyers with system (PACS) or to dose monitoring Suppliers Worldwide systems. It can also be connected to the hospital radiology information sysReach new sources of supply tem (RIS) and PACS, providing radiolIdentify latest products and technologies ogists with fast access to images and Send inquiries directly to suppliers comfortable and quick reading with Receive latest product alerts consistent image presentation.

Chat live with suppliers

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Image: The MUSICA Acquisition Workstation together with the DR800 system (Photo courtesy of Agfa HealthCare).

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TradeMed provides a sophisticated yet easy-to-use global B2B platform for sourcing medical equipment. TradeMed connects buyers and sellers worldwide through a safe, secure and dynamic network. Solely dedicated to medical products, TradeMed is the premier choice for medical suppliers, hospital decisionmakers and buyers worldwide, regardless of size or budget.

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DIGITAL ACQUISITION VIEWER

Zebra Technologies

Sun Nuclear/Gammex

Vieworks

The Motion C5m allows users to send patient data to the care team without ever leaving the patient. It ensures no downtime and comes with an integrated barcode scanner and 4G XLTE mobile broadband.

The SunCHECK 2.0 provides flexible workflow automation for fully integrated and independent radiation therapy QA. It allows for management of all patient and machine QA in the same place.

The VXvue Mammo with PureImpact offers automatic image processing and labeling according to each position. It offers easy registration, userfriendly editing, and is DICOM 3.0 compatible.

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Bitmap-Based 3D Printed Models Are More Accurate new study describes how extremely detailed physical three-dimensional (3D) models can be generated directly from volumetric data stacks.

Developed by Isomics (Cambridge, MA, USA; www.isomics.com), the Max Planck Institute of Colloids and Interfaces (MPIKG; Potsdam, Germany; www.mpikg.mpg.de), the Wyss Institute for Biologically Inspired Engineering (Boston, MA, USA; wyss.harvard.edu), and other in-

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stitutions, the new 3D modeling technique is designed to solve the problem of current .stl surface mesh file formats, which are created using traditional image thresholding and isosurface extraction. Since such workflows are extremely time consuming, the resulting 3D-printed models can fail to accurately depict anatomical details of interest.

The new method uses a bitmap-based workflow that does not require a data segmentation step, and thus capable of generating rapid and highly accurate physical models directly from volumetric data. The threshold-free approach bypasses isosurface creation and traditional mesh slicing algorithms, limited file sizes, and artificial filtering or obscuring of data. In addition, using binary bitmap slices as input to the 3D printers allows for physical rendering of functional gradients native to the volumetric data sets, such as stiffness and optical transparency, providing biomechanically accurate models. The study was published on June 1, 2018, in 3D Printing and Additive Manufacturing.

“By lowering barriers to the visualization of fine details in biorealistic 3D-printed models, we hope to broaden access to this technology for a wide range of medical professionals and patients,” concluded senior author James Weaver, PhD, of the Wyss Institute, and colleagues. 3Dprinted models for pre-surgical planning are used in almost all surgical subspecialties, allowing for a precise planning and simulation of the surgical approach, incision, and hardware sizing and placement. Physical 3D models can also serve as cutting guides for resection and as templates for the shaping of reconstruction hardware, implants, and prostheses so as to fit a patient’s anatomy. 3D printing can also capture patient variability for education and training and provide easily interpretable visual guides for improving doctor–patient communication.

Image: A new method allows 3D models to be printed directly from the dataset (Photo courtesy of James Weaver).

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Health IT

Organic Electrochemical Sensor Detects Metabolites Directly ow-cost sensors made from semiconducting plastic could be used to diagnose and monitor a wide range of health conditions, claims a new study. Developed at King Abdullah University of Science and Technology (KAUST; Thuwal, Kingdom of Saudi Arabia; www.kaust.edu.sa), Centre Microélectronique de Provence (CMP; Gardanne, France; www.mines-stetienne.fr), and other institutions, the novel sensor is based on the ion-to-electron transducing qualities of an electron-transporting (n-type) all-polymer organic semiconductor, which incorporates hydrophilic side chains to enhance ion transport/injection, as well as to facilitate enzyme conjugation.

The micrometer-scale platform absorbs ions produced during enzymatic reactions, causing it to swell when in contact with body liquids such as sweat, tears, or blood. The result is a selective, sensitive, and fast metabolite sensor. When the sensors are merged into more complex circuits, such as transistors, the signal can be amplified and respond to tiny fluctuations in metabolite concentration, leading to significantly higher sensitivity compared to traditional sensors made of metal electrodes, and without the need for a reference electrode.

Initial tests of the sensors were used to measure levels of lactate, a significant metabolite in cellular metabolic pathways associated with several critical health care conditions. According to the researchers, the sensor can also be easily modified to detect other major metabolites, such as glucose or cholesterol, by incorporating the appropriate enzymes into the platform, with the possible concentration range that the sensor can detect adjusted by changing device geometry. The study was published on June 22, 2018, in Science Advances.

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Synthesized X-Ray Images Help Train Artificial Intelligence Programs new study describes how computer generated X-rays can be used to augment artificial intelligence (AI) training sets. In order to generate and continually improve artificial X-rays, researchers at the University of Toronto (Canada; www.utoronto.ca) used deep convolutional generative adversarial network (DCGAN) algorithms, which are made up of two networks: one that generates the images, and the other that tries to discriminate synthetic images from real images. The two networks are continuously trained until they reach a point in which the discriminator cannot differentiate real images from synthesized ones. Once a sufficient number of artificial X-rays are created, they are used to train another DCGAN that can classify the images accordingly.

The researchers then compared the accuracy of the artificially augmented dataset to the original one when fed through their AI system, and found that classification accuracy improved by 20% for common conditions. The study was presented at the IEEE International Conference on Acoustics, Speech and Signal Processing, held during April 2018 in Calgary (Canada).

“In a sense, we are using machine learning to do machine learning,” said senior author and study presenter Professor Shahrokh Valaee, PhD, of the Machine Intelligence in Medicine Lab (MIMLab). “We are creating simulated X-rays that reflect certain rare conditions so that we can combine them with real X-rays to have a sufficiently large database to train the neural networks to identify these conditions in other X-rays.”

“Deep learning only works if the volume of training data is large enough, and this is one way to ensure we have neural networks that can classify images with high precision,” concluded Professor Valaee.

“We’ve been able to show that artificial data generated by deep convolutional GANs can be used to augment real datasets. This provides a greater quantity of data for training and improves the performance of these systems in identifying rare conditions.”

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“This is the first time that it’s been possible to use an electron accepting polymer that can be tailored to improve communication with the enzymes. It opens up new directions in biosensing, where materials can be designed to interact with a specific metabolite, resulting in far more sensitive and selective sensors,” said lead author chemical engineer Anna Maria Pappa, PhD, of CMP. “An implantable device could allow us to monitor the metabolic activity of the brain in real time under stress conditions, such as during or immediately before a seizure, and could be used to predict seizures or to assess treatment.”

Since the sensor does not consist of metals such as gold or platinum, it can be manufactured at a lower cost and can be easily incorporated in flexible and stretchable substrates, enabling their implementation in wearable or implantable sensing applications.

Image: A semiconducting plastic sensor can monitor metabolites directly (Photo courtesy of KAUST).

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

International Calendar HospiMedica International E-mail: info@globetech.net Yellow-highlighted listings are available at US$500 for a 12-month period.

FEBRUARY 2019 CACVS 2019 – Controversies & Updates in Vascular Surgery. Feb 7-9; Paris, France; Web: cacvs.org HIMSS19 Global Conference & Exhibition – Healthcare Information and Management Systems Society. Feb 11-15; Orlando, FL, USA; Web: www.himssconference.org Critical Care Congress 2019 – 48th Annual Meeting of the Society of Critical Care Medicine (SCCM). Feb 17-20; San Francisco, CA, USA; Web: www.sccm.org Medical Japan 2019. Feb 20-22; Osaka, Japan; Web: www.medical-jpn.jp Medical Fair India 2019. Feb 21-23; New Delhi, India; Web: www.medicalfair-india.com 15th WINFOCUS World Congress on Ultrasound in Emergency & Critical Care. Feb 2124; Dubai, UAE; Web: winfocus.org/winfocus15th-world-congress APSCVIR 2019 – 14th Annual Meeting of the Asia Pacific Congress of Cardiovascular and Interventional Radiology. Feb 21-24; Bali, Indonesia; Web: apscvir2019.com ECR 2019 – European Congress of Radiology. Feb 27-Mar 3; Vienna, Austria; Web: www.myesr.org MARCH 2019 Acute Cardiovascular Care 2019. Mar 2-4; Malaga, Spain; Web: www.escardio.org AAEM19 – 25th Annual Scientific Assembly of the American Academy of Emergency Medicine. Mar 9-13; Las Vegas, NV, USA; Web: www.aaem.org/aaem19 AAOS 2019 – Annual Meeting of the American Academy of Orthopaedic Surgeons. Mar 1216; Las Vegas, NV, USA; Web: www.aaos.org KIMES 2019 – 35th Korea International Medical & Hospital Equipment Show. Mar 14-17;

Seoul, Korea; Web: www.kimes.kr EAU19 – 34th Annual Congress of the European Association of Urology. Mar 15-19; Barcelona, Spain; Web: eaucongress.uroweb.org ACC.19 – American College of Cardiology’s 68th Annual Scientific Session & Expo. Mar 16-18; New Orleans, LA, USA; Web: accscientificsession.acc.org EHRA – Annual Congress of the European Heart Rhythm Association. Mar 17-19; Lisbon, Portugal; Web: www.escardio.org SAR 2019 – Annual Scientific Meeting of the Society of Abdominal Radiology. Mar 17-22; Orlando, FL, USA; www.abdominalradiology.org ISICEM 2019 – 39th International Symposium on Intensive Care and Emergency Medicine.

Mar 19-22; Brussels, Belgium; Web: www.intensive.org Africa MedExpo 2019. Mar 21-23; Addis Ababa, Ethiopia; Web: expogr.com/ethiopia/medexpo ENDO 2019 – Endocrine Society’s Annual Meeting & Expo. Mar 23-26; New Orleans, LA, USA; Web: www.endocrine.org/endo2019 SIR 2019 – 44th Annual Meeting of the Society of Interventional Radiology. Mar 23-28; Austin, TX, USA; Web: www.sirmeeting.org Asia Health 2019. Mar 26-28; Singapore; Web: www.medlabasia.com ExpoMed Eurasia 2019. Mar 28-30; Istanbul, Turkey; Web: expomedistanbul.com

APRIL 2019 Gulf Health Exhibition & Conference 2019.

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International Calendar sterdam, The Netherlands; Web: ehaweb.org CARS 2019 – 33rd International Conference of Computer Assisted Radiology & Surgery. Jun 17-22; Rennes, France; Web: www.cars2019.org ESPNIC 2019 – 30th Annual Meeting of the European Society of Paediatric and Neonatal Intensive Care. June 18-21; Salzburg, Austria; Web: espnic2019.kenes.com FIME 2019 – Florida International Medical Exhibition. Jun 26-28; Miami Beach, FL, USA; Web: www.fimeshow.com Medical Taiwan 2019. Jun 27-30; Taipei, Taiwan; Web: www.medicaltaiwan.com.tw

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AUGUST 2019 WCS 2019 – 48th World Congress of Surgery.

Aug 11-15; Krakow, Poland; Web: www. wcs2019.org SEPTEMBER 2019 ESC Congress 2019 – European Society of Cardiology. Aug 29-Sep 4; Paris, France: Web: www.escardio.org Medical Fair China 2019. Sep 6-8; Suzhou, China; Web: www.medicalfair.cn WFUMB 2019 – 17th World Federation for Ultrasound in Medicine and Biology Congress.

Sep 6-9; Melbourne, Australia; Web: www. wfumb2019.org Medical Fair Thailand 2019. Sep 11-13; Bangkok, Thailand; Web: www.medicalfair-thailand.com ESRA 2019 – 38th Annual Congress of the European Society of Regional Anaesthesia and Pain Therapy. Sep 11-14; Bilbao, Spain; Web: esra-congress.com CIRSE 2019 – Annual Congress of the Cardiovascular and Interventional Radiological Society of Europe. Sep 22-25; Lisbon, Portugal; Web: www.cirse.org ESVS 2019 – 33rd Annual Meeting of the European Society for Vascular Surgery. Sep 2327; Hamburg, Germany; Web: www.esvs.org Medic East Africa 2019. Sep 24-26; Nairobi, Kenya; Web: www.mediceastafrica.com ExpoMedical 2019. Sep 25-27; Buenos Aires, Argentina; Web: www.expomedical.com.ar 2019 SDMS Annual Conference – Society of Diagnostic Medical Sonography. Sep 26-29; V

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OCTOBER 2019 ESMRMB 2019 – 37th Annual Meeting of the European Society for Magnetic Resonance in Medicine and Biology. Oct 3-5; Rotterdam, The Netherlands; Web: www.esmrmb.org EANM 2019 – 32nd Annual Congress of the European Association of Nuclear Medicine. Oct 12-16; Barcelona, Spain; Web: www.eanm.org ISUOG World Congress 2019 – International Society of Ultrasound in Obstetrics & Gynecology.

Oct 13-16; Berlin, Germany; Web: www.isuog.org 14th World Congress of Intensive Care 2019 – World Federation of Societies of Intensive and Critical Care Medicine. Oct 14-18; Melbourne, Australia; Web: www.worldcongress intensivecare2019.com UEG Week 2019 – United European Gastroenterology. Oct 19-23; Barcelona, Spain; Web: www.ueg.eu ESCR Annual Scientific Meeting 2019 – European Society of Cardiovascular Radiology.

Oct 24-26; Antwerp, Belgium; Web: www.escr.org CMEF Autumn 2019 – China International Medical Equipment Fair. Oct 29-Nov 1; Shanghai, China; Web: www.cmef.com.cn

NOVEMBER 2019 43rd World Hospital Congress of the International Hospital Federation 2019. Nov 7-9; Muscat, Oman; Web: worldhospitalcongress.org APSR 2019 – 24th Congress of the Asian Pacific Society of Respirology. Nov 14-17; Hanoi, Vietnam; Web: www.apsresp.org MEDICA 2019. Nov 18-21; Dusseldorf, Germany; Web: www.medica-tradefair.com

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