HospiMedica International October 2016 by Globetech

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Vol.34 No.6 • 10/2016

L E A D E R DAILY CLINICAL NEWS

ISSN 0898-7270

Implantable System Treats Chronic Back Pain n implantable neurostimulation system helps treat disabling chronic low back pain (CLBP) via a handheld wireless remote control. The ReActiv8 is a small implantable neurostimulation system, which excites the nerves responsible for contracting the key muscles that stabilize the lower back. The device is indicated as an

Compact PET Scanner Adapts to Existing MRI Systems novel positron emission tomography (PET) scanner enables simultaneous molecular and functional imaging in existing third-party magnetic resonance imaging (MRI) systems. The NuPET in-bore PET scanner inserts into existing MRI instruments to create a powerful and flexible hybrid preclinical imaging platform that

combines the superior anatomical, structural, and functional information of MRI with the molecular sensitivity of PET, allowing researchers to simultaneously capture time-synchronized and highly complementary information. The PET/MRI combination aids in the measurement of multiple physiological processes with tissue contrast,

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Autonomous Surgical Robot Outperforms Human Hands

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Image: The STAR autonomous surgical robot

new technology optimizes the cervical cancer (CC) screening process into a single, three-minute painless optical scan. The Biop device is a probe inserted into the vaginal canal that

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optically identifies and classifies epithelium based cancers and pre-cancerous lesions.

urses trained in the use of pocket ultrasound devices can accurately calculate fluid retention in cardiac patients and dispense diuretic drugs accordingly, according to a new study. Researchers at the Norwegian University of Science and Technology (NTNU, Trondheim, Norway; www. ntnu.edu) and Levanger Hospital (Norway; https://hnt.no) conducted a study to evaluate the clinical influence of focused ultrasound of the

new guidewire adapts to unique, complex anatomies and improves measurement of fractional flow reserve (FFR) pressure differences across narrowed coronary arteries. The St. Jude Medical (SJM, St. Paul, MN, USA; www.sjm.com) PressureWire X Guidewire measurement system supports more accurate lesion

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Health IT . . . . . . . . . . . . . . . . 29 Industry News . . . . . . . . . . . . 33 International Calendar . . . . . 34

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Flexible Guidewire Improves Fractional Flow Reserve Measurement

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ndoluminal stenting to unblock the bowel before surgery could lead to fewer emergency bowel cancer patients needing a colostomy bag, according to a new study. Researchers at the Manchester Royal Infirmary (MRI, UK; www. cmft.nhs.uk/royal-infirmary.aspx), the University of Oxford (UK; www. oxford.ac.uk), and other institutions conducted a study involving 246 patients presenting in the emergency

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Optical Scanner Advances Cervical Cancer Screening

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Portable Ultrasound Detects Fluid Retention

new robotic system can perform surgery on soft tissue more effectively than a surgeon’s hands. Functions provided by the Smart Tissue Autonomous Robot (STAR) system include suturing, force sensing, submillimeter positioning, as well as fluorescent and 3D imaging.

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assessment during percutaneous coronary intervention (PCI) by providing physicians with a tip that can be shaped and re-shaped during the procedure, which enables it to be used to assess multiple lesions, even in patients with complex anatomy. The guidewire also provides enhanced Cont’d on page 3

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Implantable System Treats Chronic Back Pain cont’d from cover

adjunct to medical management of CLBP, and for pain relief in adults who have attempted at least on pervious medical management intervention and physical therapy. During the patient-controlled treatment sessions, ReActiv8 stimulation causes repetitive contractions of the key stabilizing muscles, support recovery from CLBP and its related symptoms. In similar to other exercise programs used to restore muscle control, ReActiv8 is applied twice a day in 30-minute sessions; over time, the stimulated contractions can help the brain and body learn how to restore muscle control and spine stabilization. The ReActiv8 is a product of Mainstay Medical (Dublin, Ireland; www.mainstay-medical.com), and has received the European Community CE mark of approval. “ReActiv8 is an innovative use of neurostimula-

tion for the treatment of chronic low back pain and the clinical data from the ReActiv8-A trial are compelling,” said neurosurgeon and neurostimulation expert Stefan Schu, MD, of Sana Hospital (Duisburg, Germany). “Neurosurgeons in Germany have a track record of embracing important innovations, and we are looking forward to offering ReActiv8 to patients who until now were facing the prospect of disabling chronic low back pain for the rest of their lives.” “We see several new chronic low back pain patients every week who are not indicated for surgery, and who meet the indications for ReActiv8,” said Robert Pflugmacher, MD, an orthopedic surgeon at University Hospital Bonn (Germany). “Rather than sending them home untreated, we now have an exciting new option we can offer them. As orthopedic surgeons, ReActiv8 meets our objective of addressing the underlying functional causes of chronic low back pain, and the straight-

forward implant procedure utilizes skills and techniques familiar to us.” Image: The implantation site of the ReActiv8 neurostimulator (Photo courtesy of Mainstay Medical).

Optical Scanner Advances Cervical Cancer Screening cont’d from cover

Once inserted, the probe scans the entire cervix; images and optical signatures are captured by integrated sensors and analyzed by a proprietary algorithm. The result is two images placed side-by-side on the physician’s screen; a high-resolution photograph of the patient’s cervix, and a thermal map indicating a precise classification and location of any diseased lesions. A panoramic photograph of the cervix from outside of the vaginal canal can also be taken, similar to that of a traditional colposcope. This can provide the practitioner with complete information of any other vaginal lesions, including any not on the cervix itself. The data is automatically uploaded to the electronic health record (EHR), and is also stored in a cloud-based proprietary database for follow up. Follow up exams are automatically compared to earlier exams, with any changes automatically noted. Biop can also be used in an ambulatory setting, allowing for mobile cervical screening, similar to mobile blood units and mobile breast cancer screening programs, This can be useful in areas where socialized medicine has created a long wait between an abnormal Pap and an appointment for a colposcopy, providing a better prognosis for women who have CC. The Biop device is under development by Biop Medical (Ramat Gan, Israel; www.biopmedical.com). “The Biop device is perfect for any setting, especially for doctors and nurses in rural areas who don’t have – and can’t afford – the fancy equipment usually needed to test for cervical cancer,” said Ilan Landesman, founder and CEO of Biop Medical. “It’s a big-data solution that can replace traditional methods of examining for cervical cancer.” In current clinical practice, the diagnosis of CC is mainly through the cervical screening followed by a necessary biopsy, but this method is labor consuming and expensive, and can only detect superficial lesions around the external cervical orifice. In contrast, PAI is sensitive to the abnormal angiogenesis deep in the biological tissue, and may be capable for the intact scanning both around the external orifice and in cervical canal. LINKXPRESS COM

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Flexible Guidewire Improves Fractional Flow Reserve Measurement cont’d from cover

durability and improved handling, in either a cabled or wireless configuration. “St. Jude Medical strives to provide physicians with fractional flow reserve pressure guidewire options that are backed by clinical data and match the handling performance of conventional workhorse PCI guidewires,” said Mark Carlson, MD, chief medical officer and vice president of global medical affairs at SJM. “The new PressureWire X guidewire shows our dedication to providing physicians with cost-effective, easy-to-use technologies that aid them in making the best treatment decisions for their patients.” “Fractional flow reserve has become an indispensable tool for assessing coronary lesions and making informed treatment decisions during percutaneous coronary intervention,” said Bernard De Bruyne, MD, of CVC Aalst (Belgium). “The improved design of the new PressureWire X guidewire tip will simplify the fractional flow reserve procedure by enabling access to lesions in

patients with tortuous, complex anatomy.” FFR is a physiological index used to determine the hemodynamic severity of atherosclerotic narrowing of the coronary arteries. It specifically identifies which coronary narrowing is responsible for the ischemic obstruction of the flow of blood to a patient’s heart muscle, and helps guide the interventional cardiologist in determining which lesions warrant stenting, resulting in improved patient outcomes and reduced health care costs. Image: The PressureWire X guidewire measurement system (Photo courtesy of SJM).

Portable Ultrasound Detects Fluid Retention cont’d from cover

pleural cavities and inferior vena cava (IVC) as performed by specialized nurses to assess volume status in 62 patients who visited the heart failure (HF) outpatient clinic at Levanger Hospital on a total of 119 occasions. The HF outpatients underwent laboratory testing, anamnesis, and clinical examination by two nurses with and without an ultrasound examination of the pleural cavities and IVC using a pocket-size imaging device, in tandem with a cardiologist. The results showed that diuretic dosing differed between the two teams in 31 out of 119 consultations, meaning that in 89 of the paired consultations, the ultrasound examination changed treatment protocol. The study was published in the March 2016 issue of Heart. “A pocket ultrasound device enables health personnel to detect signs of dehydration or worsening heart failure early, before the patient experiences symptoms of breathlessness, weight gain, and edema,” said lead author intensive care nurse Guri Gundersen. “Proper diuretic dose adjustment can quickly improve the patient’s condition and prevent episodes of acute exacerbation of the disease that would require hospitalization.” When the heart does not circulate blood normally, the kidneys receive less blood and filter less fluid out of the circulation into the urine. The extra fluid in the circulation congests in the lungs, the liver, around the eyes, and sometimes in the legs, and is the reason HF is also known as congestive heart failure.

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Compact PET Scanner Adapts to Existing MRI Systems cont’d from cover

quantitative accuracy, and study throughput. The NuPET scanner can be quickly inserted and removed, making integration into any high throughput MRI facility easy. Other features include support of powerful small animal gradients in a wide range of MRI systems at various field strengths; high spatial resolution and sensitivity; automatic PET/MRI coregistration; intuitive acquisition and reconstruction software; and a stand-alone PET imaging option for maximum flexibility and utilization. The NuPET scanner is a product of Cubresa (Winnipeg, Canada; www.cubresa.com), and has been approved by the U.S. Food and Drug Administration (FDA). “The NuPET system will provide scientists with the ability to monitor structural, functional, and molecular changes under identical physiological conditions, since changes are observed at the same time,” said George Abe, CEO of Cubresa. “This gives scientists confidence when evaluating multimodal data, and could potentially reduce the number of animals required to reach scientific conclusions.” “Simultaneous PET/MRI lets us discover new relationships between functional and molecular

supervised, autonomous robot can perform surgery on soft tissue more effectively than a surgeon’s hands, or even a surgeon assisted by a robot, according to a latest study. Developed at the Sheikh Zayed Institute for Pediatric Surgical Innovation at Children’s National Health System (Washington, DC, USA; www.childrensnational.org), the Smart Tissue Autonomous Robot (STAR) system consists of tools for suturing, as well as fluorescent and three-dimensional (3D) imaging, force sensing, and submillimeter positioning. For example, the robot’s tracking system combines near-infrared (NIR) fluorescent marking with a plenoptic camera to create 3D images of the target tissue. The images are then processed to enable accurate, uninhibited tracking of tissue deformation during the surgery. Another piece of software, an intelligent algorithm, combines with the tracking system to guide and autonomously adjust (in real time) the surgical V

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processes during development of new drugs and disease diagnostics,” said Steven Beyea, PhD, of the Biomedical Translational Imaging Centre (BIOTIC) at the Izaak Walton Killam Health Centre (Halifax, Canada). “An example is that with our NuPET system, we can now correlate metabolic and vascular changes due to cancer, which will enable us to understand the impact of novel therapeutics.” Simultaneous PET/MRI imaging offers a solution to many challenges that face researchers who wish to correlate biochemical and physiological changes in their subjects. Image: The NuPET scanner inserted into a MRI bore (Photo courtesy of Cubresa).

Autonomous Surgical Robot Outperforms Human Hands

plan as the tissue moves around and changes. The researchers tested STAR in an anastomosis procedure, which involved connecting tubular intestinal loops in live pigs. They then compared metrics of the anastomosis, including consistency of suturing informed by the average suture spacing, the pressure at which the anastomosis leaked, the number of mistakes that required removing the needle from the tissue, completion time, and lumen reduction in intestinal anastomoses. The results showed that when compared to manual laparoscopic surgery and robotic assisted surgery (RAS), the outcome of the supervised autonomous procedures was superior in both ex vivo porcine tissues and in living pigs. According the researchers, the results demonstrate the potential of such autonomous robots in improving the efficacy, consistency, functional outcome, and accessibility of surgical techniques. The study was published on May 4, 2016, in Science Translational Medicine. “STAR is a supervised robot that effectively removes the surgeon’s hands from the procedure, and instead, the surgeon supervises the robots autonomously planned and performed stitching or suturing,” said senior author pediatric surgeon Peter Kim, MD, vice president of the Sheikh Zayed Institute. “The intention is not to replace surgeons, but to improve results by complementing human skills with enhanced vision, dexterity, and machine intelligence.”

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ISSN 0898-7270 Vol.34 No.5 • Published, under license, by Globetech Media LLC Copyright © 2016. All rights reserved. Reproduction in any form is forbidden without express permission. Teknopress Yayıncılık ve Ticaret Ltd. S¸ti. adına ˙Imtiyaz Sahibi: M. Geren • Yazı is¸leri Müdürü: Ersin Köklü Müs¸ ir Dervis¸ ˙Ibrahim Sok. 5/4, Esentepe, 34394 S ¸ is¸ li, ˙Istanbul P. K. 1, AVPIM, 34001 ˙Istanbul • E-mail: Teknopress@yahoo.com Baskı: Promat Web Ofset Tesisi • Orhangazi Mahallesi 1673. Sokak, No: 34 • 34510 Esenyurt, B. Çekmece • ˙Istanbul Yerel süreli yayındır. Yılda sekiz kere yayınlanır, ücretsiz dag˘ıtılır.

HospiMedica International October/2016

Rapid Troponin Analyzer Assists Heart Attack Diagnosis novel hand-held blood testing device delivers cardiac troponin I (cTnI) results in less than 10 minutes at the point of care (POC). The Royal Philips (Philips; Amsterdam, The Netherlands; www.philips.com) Minicare I-20 analyzer is based on proprietary magnotech biosensor technology, which measures target molecules in very low, picomolar concentrations using assay reagents contained in a disposable cartridge. A droplet of blood from a finger prick or venous whole blood tube can be applied directly on the cartridge; once applied, the blood is automatically drawn into the measurement chamber by capillary forces. The entire assay process is carried out by the controlled movement of the magnetic nano-particles within the cartridge, a process that captures only those molecules that relate to the specific antibodies on the particles. The active magnetic assay control enables a precision normally associated with large laboratory analyzers, and multiplexing capabilities offer the possibility of simultaneously testing for multiple markers from the same droplet of blood. The intuitive interface features incorporated fail-safes that guide the user throughout the entire process. In-built connectivity allows for direct transfer of the data to the laboratory or hospital information system (HIS) in order to update the patient electronic medical record (EMR). In addition, software upgrades are automatic using a remote service procedure, which reduces system down time. “The Minicare I-20 is designed to help care providers reduce time to treatment and reduce time to discharge of patients, thereby helping to decrease crowding in the emergency department and leading to better use of hospital resources,” said Marcel van Kasteel, CEO of Handheld Diagnostics at Philips. “Current guidelines for the diagnosis of myocardial infarction require blood test results of the biomarker cardiac troponin for the 90% of patients who present at the emergency department with chest pain, but are not diagnosed by an ECG,” said consultant chemical pathologist Paul Collinson, of St. George’s University Hospitals (London, UK; www.stgeorges.nhs.uk) NHS Foundation Trust. “Blood

samples are usually analyzed in the hospital laboratory, which can easily take more than an hour to get the result back to the ED physician. Point of care testing can significantly help to reduce the turnaround time.” Cardiac troponin T (cTnT) and troponin I (cTnI) are cardiac regulatory proteins that control the calcium mediated interaction between actin and myosin. The measurement of serum cTnI and cTnT is superior in terms of sensitivity and specificity to cardiac muscle enzyme measurements in the identification of cardiac muscle damage, and now accepted as the standard biochemical marker for the diagnosis of MI. Image: The Minicare I-20 analyzer (Photo courtesy of Royal Philips).

Copper Surfaces Can Destroy MRSA Pathogen Spread new study demonstrates that methicillin-resistant Staphylococcus aureus (MRSA) bacteria die on copper surfaces by a multifaceted attack of copper ions and reactive oxygen species (ROS). Researchers at the University of Southampton (United Kingdom; www. southampton.ac.uk) conducted a study to examine the efficacy of copper in combating contamination of surfaces by MRSA via fingertips, which dry rapidly and may be overlooked by cleaning regimes, unlike visible droplets. The bacteria can be deposited on a surface by one person touching it, or via contaminated body fluids, and subsequently picked up and spread to other surfaces, potentially causing thousands of infections. In a previous study by the same researchers, a simulated droplet contamination of MRSA – such as in a sneeze or a splash – was killed on copper and copper alloy surfaces within 90 minutes. The new study showed that the elimination of contamination of surfaces via finger was even faster, with a 5-log reduction of a hardy epidemic strain of MRSA (EMRSA-16) observed following 10 minutes of contact with copper, and 4-log reduction

HospiMedica International October/2016

observed on copper nickel and cartridge brass alloys within 15 minutes. The study was published in the April 2016 issue of Applied and Environmental Microbiology. “Our latest research shows that in simulated fingertip contamination of surfaces with millions of MRSA or MSSA, the cells can remain alive for long periods on non-antimicrobial surfaces – such as stainless steel – but are killed even more rapidly than droplet contamination on copper and copper alloys,” said lead author Sarah Warnes, PhD. “It’s important to understand the mechanism of copper’s antimicrobial efficacy because microorganisms have evolved various mechanisms to convey resistance to disinfectants and antibiotics,” added study co-author Professor Bill Keevil, PhD. “Our work shows that copper targets various cellular sites, not only killing bacterial and viral pathogens, but also rapidly destroying their nucleic acid genetic material so there is no chance of mutation occurring and nothing to pass on to other microbes, a process called horizontal gene transfer. Consequently, this helps prevent breeding the next generation of superbug.” LINKXPRESS COM

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Lowering Systolic BP Targets Reduces Rate of Cardiovascular Events iming for a systolic blood pressure (SBP) target of less than 120 mm Hg in seniors results in significantly lower rates of major cardiovascular events and death. Researchers at Wake Forest Baptist Medical Center (Winston-Salem, NC, USA; www.wakehealth. edu), the University of Utah (Salt Lake City, USA; www.utah.edu), and other institutions conducted a study to evaluate the effects of SBP targets in 2,636 patients aged 75 years or older with hypertension, but without diabetes. Study participants were randomized to an SBP target of less than 120 mm Hg (intensive treatment group, 1,317 patients), or to an SBP target of less than 140 mm Hg (standard treatment group, 1,319 patients). The primary cardiovascular disease (CVD) outcome was a composite of nonfatal myocardial infarction (MI), acute coronary syndrome not resulting in a myocardial infarction, nonfatal stroke, non-

fatal acute decompensated heart failure, and death from cardiovascular causes. All-cause mortality was a secondary outcome. The results showed that at a median follow-up of 3.14 years, there were 102 events in the intensive treatment group compared to 148 events in the standard treatment group. There was also a significantly lower rate of allcause death (73 deaths versus 107 deaths, respectively). Additional analysis suggested that the benefit of intensive SBP control was consistent even among persons in this age range who were frail or had reduced gait speed. The overall rate of serious adverse events was not different between treatment groups. The study was published online on May 19, 2016, in JAMA. “Considering the high prevalence of hypertension among older persons, patients and their physicians may be inclined to underestimate the burden of hypertension or the benefits of lowering BP, re-

sulting in undertreatment,” concluded lead author Jeffrey Williamson, MD, MHS, of Wake Forest, and colleagues. “On average, the benefits that resulted from intensive therapy required treatment with one additional antihypertensive drug and additional early visits for dose titration and monitoring.” Image: A recent study showed lowering SBP reduces death rate (Photo courtesy of Wake Forest Baptist Medical Center).

Increased Diabetes Prevalence Due to Medical Advances new study has concluded that the global increase in type 1 diabetes (T1D) mellitus is directly linked to reduced natural selection resulting from improved medical care. Researchers at the University of Adelaide (UA; Australia; www.adelaide.edu.au) and the University of Zurich (UZH; Switzerland; www.uzh.ch) examined the prevalence of T1D in 118 countries and concurrent changes in life expectancy from 1950 to 2010 to test correlation of T1D to reduced natural selection, as measured by the Biological State Index. To do so, they first obtain country-speciﬁc estimates of T1D prevalence, life expectancy, obesity prevalence rate, urbanization rates, per capita sugars consumption, and per capita gross domestic product (GDP). The data obtained were then matched to T1D prevalence in all the countries, which were also grouped to study associations in different geographical regions. After applying the Biological State In-

dex to the data, they found that the rapid worldwide increase in T1D over the last few decades was directly linked with increases in human life expectancy, especially in Western countries, and therefore a reduction in natural selection. The study was published on March 2, 2106, in BMJ Open Diabetes Research & Care. “The current prevailing paradigm on the increasing prevalence of T1D is that environmental pressures are now able to trigger genotypes. Currently, medical gene intervention in modern medicine at this stage cannot remove T1D genes, and eugenics can offer no direction due to ethics issue,” concluded study co-author Wen-Peng You, PhD, of UA. “Study of T1D epidemiology based on prevalence/incidence T1D data of all age groups has become imperative, as it may offer optimal solution to address, or at least slow down, T1D genetic load increases in different populations.” “Natural selection is one of the major evolutionary forces that inform changes in our genes, across

populations and over generations. This is the first major disease we have shown that is accumulating due to a relaxation of natural selection over time,” said study co-author Professor Maciej Henneberg, PhD, of UA and UZH. “It’s unlikely this situation will ever be reversed, meaning that in order to overcome the problems associated with type 1 diabetes for our population, some form of gene therapy to repair the faulty genes may need to be considered.” Natural selection, one of the basic mechanisms of evolution, is the differential survival and fertility of individuals due to differences in phenotype that reflect genetic differences. In modern society, natural selection still acts on all members of a population, selecting those that have an increased reproductive success due to survival and/or fertility. The Biological State Index takes into account potential loss of reproductive success by dying at an earlier age. The effect of natural selection on contemporary populations is declining due to modern medicine. HospiMedica International October/2016

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Critical Care

Hand Hygiene Tool Significantly Decreases Hospital Acquired Infections novel solution to improve hand hygiene compliance developed by the Joint Commission Center for Transforming Healthcare (JCC; Oakbrook Terrace, IL, USA; www. centerfortransforminghealthcare.org) is associated with sustained reductions in healthcare associated infections (HAIs), according to a new study. Researchers at Memorial Hermann Health System (MHHS; Houston, TX, USA; www. memorialhermann.org) introduced the JCC webbased Targeted Solutions Tool (TST) for hand hygiene in 150 inpatient units in 12 system hospitals in 2010, and subsequently implemented a systemwide process improvement project that went on from October 2010 through December 2014. At project completion, the researchers collected and analyzed data on rates of intensive care unit (ICU) central line associated bloodstream infection (CLABSI) and ventilator associated pneumonia

(VAP) events throughout the time period. The results showed that based on 31,600 observations during the initial phase (October 2010 to May 2011), the MHHS system-wide hand hygiene compliance baseline rate averaged at 58.1%; during the improvement phase (June 2011 to November 2012), compliance averaged out at 84.4%; During the control phase (December 2012 to December 2014), compliance rose to 94.7% in the first 13 months, while compliance rose to 95.6% in the final 12 months of the program. Concomitantly, adult ICU CLABSI and VAP rates decreased by 49% and 45%, respectively. The study was in published in the January 2016 issue of the Joint Commission Journal on Quality and Patient Safety. “The TST enabled MHHS to measure compliance rates, identify reasons for noncompliance, implement tested interventions provided by the TST,

and sustain the improvements,” concluded lead authors M. Michael Shabot, MD, of MHHS, and Mark Chassin, MD, MPP, MPH, of the JCC, and colleagues. “MHHS substantially improved hand hygiene compliance in its hospitals and sustained high levels of compliance for 25 months following implementation.” The Targeted Solutions Tool (TST) is an innovative application that guides health care organizations through a step-by-step process that accurately measures an organization’s actual performance, identifies barriers to excellent performance, and directs them to proven solutions customized to address their particular barriers. For hand hygiene compliance, the TST describes a minimum number of times a health care worker should conduct hand hygiene when entering and exiting a patient’s room, defined as “wash in/wash out” phase.

Cardiac Cell Stimulation Could Provide Natural Pacemaker new study reveals that mechanical communication between cells plays an important role in cardiac physiology, and is essential for converting electrical pacing into synchronized beating. Researchers at the Israel Institute of Technology (Technion; Haifa, Israel; www1.technion.ac.il) developed a mechanical “cardiac cell” that generates periodic mechanical deformations in an underlying substrate, with the amplitude and direction of the mechanical deformations mimicking those generated by a beating cardiac cell. After a brief 10-minute training period, a neighboring cardiac cell synchronized its beat rate with that of the mechanical cell. According to the researchers, the study demonstrates mechanical communication between cells directly for the first time. Furthermore, the cardiac cell maintained the induced beating rate for more than one hour after mechanical stimulation was stopped, implying a longrange interaction of the stimulation that induces long-lasting alterations in interacting cells. Unlike electrical field stimulation, the long-term alterations provide a mechanism that has a more stable electromechanical delay. The mechanical coupling between cells could therefore ensure that the final outcome of action potential pacing is synchronized beating. The study was published on January 11, 2016, in Nature Physics. “We have shown that cells are able to communicate with each other mechanically by responding to deformations created by their neighbors. Cell-cell communication is essential for growth, development and function,” said assistant professor Shelly Tzlil, PhD, of the faculty of mechanical engineering. “Impaired mechanical communication will lead to arrhythmias even when electrical conduction is working properly. The medical implication is that adding mechanical elements to electrical pacemakers will significantly improve their efficiency.”

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Hydration Levels Can Affect Cardiovascular Health inor dehydration might promote cardiac disease and arterial hardening as much as smoking in young, healthy men, according to a new study. Researchers at Harokopio University (Kallithea, Greece; www.hua.gr), Alexandra University Hospital (Athens, Greece; www.hosp-alexandra.gr), and the University of Arkansas (Fayetteville, USA; www.uark.edu) conducted a crossover study in 10 young, healthy males (median age 24.3, median weight 80.8 kg, median BMI 24.3 kg/m2) to investigate if acute hypohydration affects endothelial and cardiovascular function. Each subject completed two measurements of endothelial function by flowmediated dilation (FMD) in euhydrated and hypohydrated states, separated by 24 hours.

Following baseline assessment, the participants completed 100 minutes of low-intensity intermittent walking exercise to achieve hypohydration of −2% of individual body mass; for the rest of the day, a standardized, low water content diet was provided. The following morning, hydration markers and endothelial function were recorded. The results showed decreased plasma volume (3.5 ± 1.8%), and increased plasma osmolality (mean 9 mmol/kg), accompanied by a 27% mean decrease in FMD. The study was published in the March 2016 issue of the European Journal of Nutrition. “You could be mildly dehydrated without knowing it while you have endothelial impairment similar to smoking a cigarette,” said corresponding author Stavros Kavouras, PhD, coordinator of the ex-

ercise science program at the University of Arkansas. “The degree of dehydration when these changes occur is at less than two percent dehydration, which is around the threshold when people start feeling thirsty.” Vascular endothelium is an active paracrine, endocrine, and autocrine organ that is indispensable for regulation of vascular tone and maintenance of vascular homeostasis. Endothelial dysfunction due to CVD risk factors promotes both the early and late mechanisms of atherosclerosis, including up-regulation of adhesion molecules, increased chemokine secretion and leukocyte adherence, increased cell permeability, enhanced low-density lipoprotein oxidation, platelet activation, cytokine elaboration, and vascular smooth muscle cell proliferation and migration.

Bactericidal Viruses May Prevent Medical Device Infections new study describes how bacteriophages can be enlisted to combat Proteus mirabilis, a bacterium that commonly encrusts and blocks urinary catheters. Researchers at the University of Brighton (United Kingdom; www.brighton.ac.uk), Queen Victoria Hospital (QVH; East Grinstead, United Kingdom; www.qvh.nhs.uk), and other institutions made in vitro models of the catheterized urinary tract, thus simulating a complete closed drainage system as used in clinical practice. The models were then used to mimic either an established infection or early colonization of the catheterized urinary tract, and to examine the outcomes of a single dose of a 3-phage cocktail. The researchers then measured the impact of the phage cocktail on the time taken for the catheters to block, as well as on levels of crystalline biofilm formation. The results showed that in models of established infection, phage treatment increased the time taken for catheters to block threefold, when compared to untreated controls. However, in models that simulated early-stage infection, the 3-phage treatment eradicated P. mirabilis and

prevented blockage entirely. A further analysis of catheters from models of established infection 10 hours after phage application demonstrated significantly reduced crystalline biofilm formation, but did not significantly reduce the level of planktonic cells in residual bladder urine. According to the researchers, the results show that bacteriophages are a promising strategy for the prevention of catheter blockage, but that delivering phages in sufficient numbers and within a key therapeutic window will be crucial for the successful application of the method. The study was published in the March 2016 issue of Antimicrobial Agents and Chemotherapy. “Our work provides good initial evidence that bacteriophage can treat infections caused by Proteus mirabilis, and prevent catheter blockage,” said lead author Brian Jones, PhD, head of research and development at QVH. “This could lead to new ways of managing patients fitted with urinary catheters, providing much benefit to a large number of patients, and also contribute to reducing antibiotic use and tackling resistance.” “We are still at a very early stage in this work,

and have a long way to go before we can be sure this will lead to an effective way to control these infections, but bacteriophage have been used extensively in other countries for decades, and the challenge of antibiotic resistance makes it important to look at using these promising alternatives to antibiotics,” concluded Dr. Jones. “We think an important issue will be in developing ways to deliver bacteriophage as needed, which is a key aim of our ongoing work.” V

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Critical Care

Wearable Biomedical Device Helps Combat Diabetes n innovative graphene-based patch is capable of noninvasive blood sugar monitoring and feedback therapy by analyzing human sweat. Developed by researchers at the Institute for Basic Science (IBS; Daejeon, Republic of Korea; www.ibs.re.kr) the patch integrates electrochemically-active and soft functional materials on a golddoped graphene and serpentine-shape gold mesh hybrid patch. The enzyme-based glucose sensor also enables systematic corrections of sweat glucose measurements as affected by pH and temperature, while a humidity sensor monitors the increase in relative humidity (RH). About 15 minutes are needed for the sweat-uptake layer of the patch to reach a RH over 80%, at which time glucose and pH measurements are initiated. If abnormally high levels of glucose are detected, drugs can be released into the bloodstream via loaded microneedles. In an experiment to test the patch on diabetic mice, microneedles pierced the

skin of the mouse near the abdomen, releasing Metformin into the bloodstream. The mice treated with microneedles showed a significant suppression of blood glucose concentrations with respect to control groups. The malleable, semi-transparent, skin-like appearance of the GP device also provides comfortable contact with human skin. The study was published on March 22, 2016, in Nature Nanotechnology. “Our wearable GP-based device is capable of not only sweat-based glucose and pH monitoring, but also controlled transcutaneous drug delivery through temperature-responsive microneedles,” said lead author Kim Dae-Hyeong, PhD, of the IBS Center for Nanoparticle Research. “One can easily replace the used microneedles with new ones. Treatment with Metformin through the skin is more efficient than that through the digestive system because the drug is directly introduced into metabolic circulation.” Type II diabetes affects some three million Koreans, with the figure increasing due to dietary pat-

terns and an aging society. The current treatments available to diabetics are painful, inconvenient and costly, and regular visits to a doctor and home testing kits are needed to record glucose levels. Patients also have to inject uncomfortable insulin shots to regulate glucose levels. According to IBS, the device could facilitate the process and reduce lengthy and expensive cycles of visiting doctors and pharmacies. Image: The GP-hybrid electrochemical device array (Photo courtesy of IBS Center for Nanoparticle Research).

Artificial Oxygenator Aids Critical Cardiopulmonary Care n innovative extracorporeal life support (ECLS) device acts as an intravenous lung, infusing oxygen and removing carbon dioxide (CO2) from the blood. The CardiacAssist TandemLung Oxygenator (TLO) is an intravenous oxygenator (IVOX), an injectionmolded device with a radial flow design that contains a bundle of poly-

methylpentene (PMP) hollow fiber membranes, in which blood is oxygenated and decarbonated. Gases, primarily oxygen, are supplied to interior lumens of the fibers, diffusing from the fiber wall to blood plasma to transfer oxygen to patients requiring urgent cardiac or respiratory support. At the same time, CO2 diffuses from the blood into the inner lumen of the

ED Discharge Factors Contribute To Outcomes in Older Patients eniors discharged from the emergency department (ED) with cognitive impairment, a change in disposition plan, low blood pressure, and elevated heart rate are more likely to be admitted to the intensive care unit (ICU) or to die within 7 days. Researchers at the University of California Los Angeles (UCLA; USA; www.ucla.edu), Kaiser Permanente Southern California (Pasadena, USA; www.kaiserpermanente. org), and other institutions examined 1,442,594 ED visit records among adults over 65 years of age discharged from any of 13 Kaiser Permanente hospitals in 2009-2010, rather than admitted to the hospital. A chart review of 300 randomly chosen patients who were admitted to the ICU or died within 7 days of discharge was then matched to 300 control patients who did not experience the outcome. Two emergency physicians blinded to study outcomes then reviewed the records and identified several

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characteristics that were associated with the combined poor outcome. These included a change in disposition plan from admit to discharge (directed by a physician or by the patient leaving the hospital against medical advice), acute or chronic cognitive impairment/mental status changes, and abnormal vital signs (systolic blood pressure below 120 and heart rate above 90). The study was published on March 2, 2016, in Annals of Emergency Medicine. “Emergency physicians must exercise extra caution when making the decision to admit or discharge a geriatric patient,” said lead author Gelareh Gabayan, MD, MSHS of the department of medicine at UCLA. “These patients tend to be more delicate than their younger counterparts. Even abnormal vital signs, like blood pressure and heart rate, are associated with potentially catastrophic events for patients who are discharged from the ER rather than admitted.”

fibers and is exhausted. A two-part polyurethane compound mechanically fixes the end of the hollow fiber membranes in place, creating a barrier between blood and gas pathways within the TLO. The device is designed for use with the TandemHeart blood pump, with a low priming volume protecting patients from the negative effects of diminished cardiac or respiratory function. The CardiacAssist TandemLung Oxygenator and TandemHeart blood pump are products of CardiacAssist (Pittsburgh, PA, USA; www.cardiacassist.com), and are intended for use in adult patients in

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need of ECLS during cardiopulmonary bypass procedures for a period of up to six hours. ECLS is a variation of cardiopulmonary bypass, but while cardiopulmonary bypass facilitates open-heart surgery for a number of hours, ECSL can maintain tissue oxygenation for weeks. As the technology advances, support functions other than gas exchange, such as liver, renal, and cardiac support, could also be provided by ECLS. Further improvements will allow application of ECLS to populations currently excluded from such support, such as those in need of systemic anticoagulation.

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Radiometer

The A7 provides analysis of FiO2, EtO2, CO2, N2O, auto-detection of five anesthetic agents, as well as BIS & NMT, and offers a range of ICU grade ventilation modes. Its digital gas mixer allows users to set the total flow and O2 percentage, or the O2 flow and the balance gas, respectively.

The PHYSIOGARD Touch 7 enables continuous ECG monitoring and 12-lead ECG diagnostic recording, as well as measurement of SpO2, NIBP and temperature. It features a large 7-inch touch screen for optimal display, and can directly transmit data during and after the intervention.

The TCM5 FLEX provides continuous measurement of oxygen and ventilation, and features a touch screen display for easy viewing of RT measurements. It allows data to be stored, shared and managed, and is suitable for neonate, pediatric, and adult ICU patients.

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Sepsis Plays Role in Late Mortality new study suggests that patients admitted to the hospital with sepsis suffered a 10% absolute increase in late death. Researchers at the University of Michigan (Ann Arbor, USA; www. umich.edu), Monash University (Melbourne, Australia; www.monash. edu.au), and other institutions conducted a study involving 960 patients 65 and older who were admitted to hospital with sepsis. The patients were matched to 777 adults not in hospital, 788 patients admitted with non-sepsis infection, and 504 patients admitted with acute sterile inflammatory conditions. The main outcome measures were late mortality and odds of death at various intervals. The results showed that sepsis was associated with a 22.1% absolute increase in late mortality relative to adults not in hospital, a 10.4% absolute increase relative to patients admitted with non-sepsis infection, and a 16.2% absolute increase relative to

patients admitted with sterile inflammatory conditions. Mortality remained higher for at least two years, relative to adults not in hospital. The study was published on May 17, 2016, in BMJ. “More than one in five patients who survives sepsis dies acutely within the next two years as a consequence of sepsis. Our findings do not refute the importance of baseline burden of co-morbidity to patients’ longterm outcomes after sepsis,” concluded senior author Theodore Iwashyna, MD, of Monash University, and colleagues, “they do, however, indicate that sepsis confers an additional risk of late mortality, above and beyond that predicted by status before sepsis alone.” Sepsis is characterized by a whole-body inflammatory state caused by an immune response to a serious infection, most commonly caused by bacteria, but also by fungi, viruses, as well as parasites in

the blood, urinary tract, lungs, skin, or other tissues. Common symptoms of sepsis include those related to a specific infection, but can be accompanied by high fevers, hot, flushed skin, elevated heart rate, hyperventilation, altered mental sta-

tus, swelling, and low blood pressure. Sepsis causes millions of deaths globally each year. Image: Sepsis infection caused by bacteria, which can lead to organ failure and death (Photo courtesy of the CDC).

HbA1C Blood Test Uncovers Undiagnosed Diabetes new study reveals that the hemoglobin A1C (HbA1C) test can effectively detect hidden disease among hospital patients admitted with hyperglycemia. Researchers from Touro University (Vallejo, CA, USA; www.tu.edu) and Ohio University Heritage College of Osteopathic Medicine (HCOM; Athens, USA; www.ohio.edu/medicine) conducted a retrospective review of medical records of 348 patients admitted with hyperglycemia to examine the use of HbA1c tests in identifying previously undiagnosed diabetes mellitus. Of those patients, 50 had no known history of diabetes, and among them 31 (62%) were given an HbA1C test. The results showed that 77% of the patients had

results consistent with diagnoses of diabetes (58 %) or prediabetes (19%). Seventeen (55%) of the 31 patients had a discharge diagnosis that included diabetes. Of the 19 patients with no known history of diabetes who did not have an HbA1c test, 2 (11%) received a discharge diagnosis that included diabetes. The study was published in the June 2016 issue of the Journal of the American Osteopathic Association. “We are missing opportunities to detect diabetes and initiate treatment for those patients to help manage that disease, which can reduce their longterm cost of care and disease burden,” said senior author Professor Jay Shubrook, DO, of HCOM. “From the osteopathic perspective of early detec-

tion equals better outcomes, it’s easy to make a case for hospital protocols to trigger an HbA1C test when hyperglycemia is detected to distinguish between transient hyperglycemia and chronic disease.” HbA1c refers to glycated hemoglobin, and is used to identify the average plasma glucose concentration over 8-12 weeks. For people without diabetes, the normal HbA1c range is 4-5.6%. HbA1c levels between 5.7% and 6.4% indicate increased risk of diabetes, and levels of 6.5% or higher indicate diabetes. The goal for diabetics is HbA1c levels less than 7%, which should be retested every three months to determine target level control. HospiMedica International October/2016

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Critical Care

Bioengineered Human Myocardium Successfully Regenerated new study shows that native cardiac extracellular matrix (ECM) scaffolds could support the seeding of human stem cell-derived cardiomyocytes in order to create functional myocardial-like tissue of multiple complexities. Researchers at Massachusetts General Hospital (MGH; Boston, MA, USA; www.massgeneral.org) and the Harvard Stem Cell Institute (HSCI; Cambridge, MA, USA; hsci.harvard.edu) conducted a study involving 73 donated human hearts that were determined to be unsuitable for transplantation. The first step involved decellularization of the hearts. A detailed characterization of the remaining cardiac scaffolds confirmed a high retention of matrix proteins, the preservation of coronary vascular and microvascular structures, and freedom from human leukocyte antigens that could induce rejection. The ECM scaffolds were then reseeded with human cardiomyocytes derived from induced pluripotent stem cells (iPSCs), and cultured in a bioreactor that delivered a nutrient solution and replicated some of the environmental conditions that envelope a living heart. The researchers succeeded in maintaining the cardiac tissue constructs in culture for 120 days, demonstrating definitive sarcomeric structure, cell and matrix deformation, contractile force, and electrical conduction. To show that functional myocardial tissue of hu-

man scale could be built using the platform, they then partially recellularized human whole-heart scaffolds with human induced iPSC-derived cardiomyocytes. Under the biomimetic culture, the seeded constructs developed forcegenerating human myocardial tissue and showed electrical conductivity, left ventricular pressure (LVP) development, and metabolic function. The study describing the process was published in the January 2016 issue of Circulation. “Regenerating a whole heart is most certainly a long-term goal that is several years away, so we are currently working on engineering a functional myocardial patch that could replace cardiac tissue damaged due a heart attack or heart failure,” said lead author Jacques Guyette, PhD, of the MGH Center for Regenerative Medicine (CRM). “Among the next steps that we are pursuing are improving methods to generate even more cardiac cells, optimizing bioreactor-based culture techniques to improve the maturation and function of engineered cardiac tissue, and electronically integrating regenerated tissue to function within the recipient’s heart.”

Image: A partially recellularized human whole-heart cardiac scaffold cultured in a bioreactor (Photo courtesy of MGH Center for Regenerative Medicine).

Cancer Patients Who Elect to Die at Home Live Longer erminal cancer patients who choose to die at home live longer than those who choose to die at a hospital, according to a new study. Researchers at the University of Tsukuba (Japan; www.tsukuba.ac.jp), Tohoku University (Japan; www. tohoku.ac.jp), and other institutions across Japan conducted a multicenter, prospective cohort study from September 2012 through April 2014 in 58 specialist palliative care services to explore the potential differences in the survival time of cancer patients dying at home or in a hospital. In all, the study recruited 2,426 patients, of which 2,069 patients were analyzed; 1,582 receiving hospital-based palliative care and 487 receiving homebased palliative care. The results revealed that eventually, 1,607 patients actually died in a hospital, and 462 patients died at home, with the survival time of patients who died at home significantly longer than the survival time of patients who died in a hospital. The median survival time was 13 days compared to 9 days in the daily prognosis group, and 36 days versus 29 days in the weekly prognosis group. No sig-

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nificant difference was found in the months’ prognosis group. The study was published on March 28, 2016, in Cancer. “Patients and their families tend to worry that home care won’t provide the quality of care that a hospital will. However, spending the last days or months at home doesn’t necessarily mean life would be shortened,” said lead author Jun Hamano, MD, an assistant professor of internal medicine at the University of Tsukuba. “Patients, families, and clinicians should be reassured that good home hospice care does not shorten patient life, and even may achieve longer survival.” Most patients with advanced cancer would prefer to die at home, and many people in the United States, United Kingdom, and other countries are realizing this wish. But in other countries, such as Japan, Germany, Greece, and Portugal a trend towards institutionalized dying persists. But despite trends, the most frequent location of death for those dying from cancer is still a hospital, with marked variations in the odds of home death depending on illness-related, individual, and environmental factors. LINKXPRESS COM

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User-Centered BP Monitor Provides Accurate 24-Hour Readings novel ambulatory blood pressure monitor (ABPM) provides noninvasive measures of central arterial blood pressure waveforms, central aortic blood pressures, and arterial stiffness indices. The Oscar 2 with SphygmoCor Inside technology is a light, compact monitor that uses motion tolerant algorithms and auto-intelligent inflation to reduce re-inflates and failed readings. The paired Orbit BP cuff, which uses an innovative stretch-sleeve design to maintain cuff placement and promote patient comfort, allows for noninvasive assessment of the central arterial pressure waveform and arterial stiffness, with a transfer function. The predictive superiority of central arterial pressure waveform analysis using SphygmoCor Inside technology over standard brachial blood pressure is primarily due to the closer proximity of the ascending aorta to important target organs such as the heart, brain, and kidney. The Oscar 2 also includes motion-tolerant technology to help eliminate ambulation and noise artifacts that can cause failed readings and the need for repeated studies. In addition, sub-diastolic waveform measurement delivers a fully featured physio-

logical waveform with accurate augmentation index. The ABPM monitor is also designed to be used with proprietary AccuWin Pro 4 software that allows data to be directly exported to a computer database for efficient programming, measurement analysis, and physician interpretation and report. The Oscar 2 was developed as part of a multi-year alliance between SunTech Medical (Morrisville, NC, USA; www.suntechmed.com) and AtCor Medical (West Ryde, Australia; www. atcormedical.com), and has received the European Community CE marking of approval. Central arterial blood pressure is the pressure in the aorta, thus representing the pressure that the heart has to pump against to get blood to flow to the rest of the body, including the blood vessels feeding the brain. It has been shown to more strongly relate to vascular disease and outcome – such as stroke and aneurysm – than traditional upper arm (brachial) blood pressure. It also can distinguish between the effects of different hypertension medications when upper arm blood pressure and pulse wave velocity do not. Image: The Oscar 2 with SphygmoCor Inside technology (Photo courtesy of courtesy SunTech Medical).

Most Smart Pump IV Infusion Errors Linked to Clinical Practice ore than half of intravenous (IV) infusion medications contained errors, with majority linked to deviations in hospital policy, according to a new study. Researchers at Brigham and Women’s Hospital (Boston, MA, USA; www.brighamandwomens.org), Concord Hospital (NH, USA; www. concordhospital.org), and other institutions conducted a study in ten hospitals in the United States to investigate the types and frequency of IV medication errors associated with smart pumps. Data were collected using a prospective point prevalence approach to capture errors associated with 1,164 smart pump IV administrations to 478 patients, with concurrent evaluation of their potential for harm. The results showed that of the observed infusions, 699 (60%) had one or more errors associated with their administration, but relatively few of these errors were potentially harmful. The most predominant errors were associated with violations of hospital infusion policy, and included the administration of unauthorized medications, bypassing the smart pump,

wrong rate of infusion, labelling errors, and bypassing the integrated drug library. The researchers suggested that most of these mistakes could be prevented if closed-loop systems, in which the smart pumps are automatically programmed with a medication order using the patient’s electronic health record (EHR), were implemented as policy. This would necessitate that a nurse verify the information on the smart pump and accept the data, including drug name, infusion rate, volume, and concentration, before the infusion could begin. The study was published on February 23, 2016, in BMJ Quality & Safety. Smart infusion pumps were developed to reduce adverse drug events and medication administration errors through built-in safety features, such as built-in drug libraries and dose error reduction systems. According to a national survey conducted by the American Society of Health-System Pharmacists (Bethesda, MD, USA; www.ashp.org), in 2012 77% of hospitals in the United States use smart pump technology. HospiMedica International October/2016

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Critical Care

Chemical ‘Sponges’ Soak Up Toxic Chemotherapy Drugs new device soaks up chemotherapy drugs before they can circulate widely throughout the body, enabling higher doses and limiting off-target effects in other organs. The ChemoFilter system, developed by researchers at the Lawrence Berkeley National Laboratory (LBL, Berkeley, CA, USA; www.lbl.gov) and the University of California (UC, Berkeley, USA; www.berkeley.edu), is comprised of a nickel-titanium metal frame (in a collapsible flower-petal array), attached to a thin polymer membrane that can be expanded out into a blood vessel from within a catheter. The polymer membrane contains polyethylene for strength and flexibility, as well as sulfonic acid, which has a negative electric charge that attracts and binds drug molecules. Certain types of chemotherapy drugs, such as doxorubicin, which is used to treat liver cancer, have a positive charge, so the polymer membrane material can bind the drugs via

their electric charge, while allowing other types of molecules to flow through. In a preclinical study, a ChemoFilter device was inserted into a pig and was found to reduce the peak concentration of the doxorubicin by about 85%. According to the researchers, the drug-capture system could also potentially be applied to antibiotic treatments. “Doxorubicin has been around for decades. It is very well understood, and it is also very toxic. If you get exposed to too much, when it goes through the heart you can go into heart failure,” said interventional neuroradiologist Steven Hetts, MD, of the University of California, San Francisco (UCSF; USA; www. ucsf.edu), inventor of the ChemoFilter, who specializes in treating eye tumors. “You can get very high concentrations of that chemotherapy in the eye and relatively low concentrations in the rest of the body, but some will wash through the eye and into the veins in the head, so you can have side effects from that.”

“We used to use this material for transporting protons in a fuel cell. I was really excited when I found out this could be used for chemotherapy - this was branching out in a totally different direction,” said lead researcher X. Chelsea Chen, PhD, a postdoctoral researcher at LBL. “We are actively searching for new materi-

als and mechanisms for the polymer membranes. Researchers are exploring the use of 3D-printed materials, for example, that can be coated with charged particles to attract and bind drug molecules.” Image: A close-up view of the ChemoFilter system (Photo courtesy Roy Kaltschmidt / LBL).

Smart Portable Device Monitors Pacemaker and ICD Patients portable monitoring device keeps pacemaker, implantable cardioverter defibrillator (ICD), and insertable cardiac monitor (ICM) patients connected to their physician anywhere in the world. The CardioMessenger Smart device provides secure, fully automatic transmission of vital information from a patient’s cardiac implant to their physician over a GSM cellular network, including automatic reports and fully customizable alerts that can be programmed to the physician’s specifications. The device transmits the data to the Biotronik Home Monitoring Service Center, using wireless, coded, telemetry daily or when triggered by an event, with a call back message for patients to enable physicians to contact them whenever necessary. BIOTRONIK Home Monitoring is intended to replace device interrogation during in-office follow-up visits, and to provide early detection of arrhythmias. It is available in over 55 countries, optimizing patient management in more than 3,800 clinics around the world. Among the fea-

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tures offered are intelligent early detection, customizable fully programmable alerts with options to specify alert thresholds and ranges, and callback alerts to notify the patient to contact the clinic. Biotronik Home Monitoring and the CardioMessenger Smart are products of Biotronik (Berlin, Germany; www.biotronik. com). “Biotronik pioneered modern wireless remote monitoring technologies in the year 2000 and we continue to invest in advancements that make life more enjoyable for patients living with cardiac conditions,” said Marlou Janssen, President of Biotronik. “The clinical and economic benefits of remote monitoring have been well established over a decade of clinical studies,” said Niraj Varma, MD, of the Cleveland Clinic (CC, OH, USA; www.my.clevelandclinic.org), lead investigator for the TRUST Trial. “But these benefits are only realized if patients consistently use the technology. When we make the remote monitoring process easy for patients, we increase the likelihood of patient adherence, which has been demonstrated to improve health outcomes.”

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The MODALIXX G202MDL is designed for enhanced clarity and brightness in LED-lit images offering user-friendly OSD, low power consumption, and a wide viewing angle. It is considered ideal for cath lab, MRI, CT, CR, PET scanners, RF rooms, C-arm, and portable X-ray applications.

The MAGNETOM Amira 1.5T offers the potential to shorten many exams and enable many patients to undergo scans in routine applications. It features DotGO MRI exam software to simplify protocol management and offer the right operating sequence for each scan to suit requirements.

The DX-D 100+ wireless mobile DR system is fully motorized and equipped with X-ray generator power of up to 50 kw for imaging dense areas. It features FreeView technology with collapsible telescopic arm and column for providing an unobstructed view while maneuvering.

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Advanced Mobile Stroke Unit Offers CT Imaging he world’s most comprehensive mobile stroke unit (MSU) has been equipped with a computerized tomography (CT) scanner capable of conducting and producing advanced quality imaging for stroke diagnosis and noninvasive imaging of blood vessels in the brain. The University of Tennessee (UT) College of Medicine (Memphis, USA; https://uthsc.edu/ Medicine) launched the MSU, the largest in the world, complete with an internal power source capable of matching regular electrical outlet access. Weighing in at more than 14 tons, it includes features and capabilities never before assembled for mobile deployment. These include a hospital-quality CT scanner with advanced imaging capabilities to not only allow brain imaging, but also high resolution CT-angiography, as it is equipped with a dedicated gantry that automatically moves the patient

to obtain images. Due to the advanced imaging capabilities, the MSU can bypass hospital emergency departments (EDs) and take patients directly to an endovascular catheterization laboratory, the operating room, a hospital stroke unit, or the neuro-intensive care unit. The MSU is staffed with fellowship-trained nurses certified as advanced neurovascular practitioners (ANVP-BC). The advanced CT capabilities will also help launch immediate treatment, including administration of tissue plasminogen activator (tPA) and the potent blood pressure drug nicardipine. “We are thrilled to have this medical first in Memphis. I want to stress that the Mobile Stroke Unit is a product of worldwide industry leaders brought together to create the first-of-its-kind vehicle,” said David Stern, MD, executive dean at the UT College of Medicine. “The goal of the mobile

stroke unit is to minimize morbidity and mortality, to have more patients walk out of the hospital fully functional. Time is everything for stroke treatment; the quicker we are able to assess and attend to a patient, the better his or her chances are for recovery.” “The Mobile Stroke Unit will be based in the heart of a 10-mile, most critical needs areas of Memphis with the highest incidence of stroke, but can be deployed within the entire metro region,” said Andrei Alexandrov, MD, chairman of the department of neurology at The UT Health Science Center. “We estimate that 300 patients will need to be treated by the Mobile Stroke Unit to prove its effectiveness over the course of three years. Our goal is a sustainable model for future funding and an overall lowering of morbidity and mortality through early treatment.”

Reduced CT Dose Effective in Joint Fracture Detection new study claims that computerized tomography (CT) scans for joint fractures can be performed with one-fourteenth the amount of radiation, without compromising image quality. Researchers at NYU Langone Medical Center (New York, NY, USA; www.med.nyu.edu) and Jamaica Hospital Medical Center (JHMC; NY, USA; https://jamaicahospital.org) used the reduced computed tomography in orthopedic injury (REDUCTION) protocol to determine the lowest dose necessary for detecting traumatic joint fractures. To do so, 50 fracture patients with clinical symptoms received ultra-low dose (0.03 msV) radiation CT scans, which were compared to a sample of agematched, similar fracture injuries where patients were evaluated with a standard CT scan dose (0.43 msV). The results showed 98% sensitivity and 89% specificity with the ultra-low dose CT scans, a detection rate, which is comparable to conventional CT-scans (98% sensitivity and 85% specificity),

when occult fractures were removed from the equation. Image quality was rated moderate to near perfect by orthopedic surgeons. The study was presented at the American Academy of Orthopedic Surgeons (AAOS) specialty day, held during March 2016 in Orlando (FL, USA). “We have taken a frequently used and necessary imaging test and made it safer,” said lead author and study presenter assistant professor of orthopedic surgery Sanjit Konda, MD, of NYU Langone, and director of orthopedic trauma at JHMC. “Providing patients with a CT scan with 14-times less radiation could have significant implications from a public health and safety standpoint.” “The ability to perform ultra-low dose radiation CT scans without compromising image quality demonstrates the comprehensive capabilities of this protocol,” said senior author Professor Kenneth Egol, MD, chief of the division of orthopedic trauma surgery at NYU Langone. “Patients who undergo a traumatic injury or suspected fracture have enough to worry about. Our research

makes radiation exposure among the least of their concerns.” CT scans help diagnose medical conditions including broken bones, cancers, internal bleeding, or signs of heart disease. Yet, despite its prevalent use, medical societies and federal agencies have been increasingly trying to reduce the number of unnecessary scans due to radiation’s link to an increased risk for cancer. While the overall risk is considered low, there is particular concern in performing CT scans on children. V

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New Ultrasound Method Could Increase Understanding Of Cancer Cells and Metastases esearchers have discovered a new ultrasound method, called isoacoustic focusing, that can be used to analyze and separate cells from blood. The new method developed at Lund University (Lund, Sweden; www. lunduniversity.lu.se) and Massachusetts Institute of Technology (MIT; Boston, MA, USA; http://web.mit.edu) exposes cells to ultrasound as they flow through a micro-channel inside a chip, and causes them to separate. The lateral movement of the cells enables the researchers to identify their acoustic properties, and could be used to detect the cell type, and distinguish between cancer cells of different origins. The study was published in the May 2016, issue of the online journal Nature Communications. The method could be used to measure the variation in the number of tumor cells in time and help determine whether medication can be effective in treatment or not. Per Augustsson, Department of Biomedical Engineering, Lund University (Lund, Sweden; www.lunduniversity.lu.se), said, “The vision is that our innovation will eventually be used in healthcare facilities, for example, to count and distinguish different types of cells in patients’ blood. It may seem odd that we are interested in the acoustic properties of blood cells and cancer cells. But we have been searching for new methods to separate cells in order to study them in more detail. Since we are looking for individual cells in a blood sample which

Ventilation Percussion Improves Cardiac MRI Accuracy novel ventilation technique allows cardiac magnetic resonance (CMR) imaging to be performed in virtual lack of motion. Developed at University Hospital Lausanne (CHUV; Switzerland; www. chuv.ch), the percussive ventilation (VP) technique involves the patients wearing a mask over their mouth, which is connected to a ventilator that delivers small volumes of air (percussions). Instead of the 10-15 large breaths patients would take naturally per minute, air is provided in 300-500 small VP pulses per minute. The air volumes inhaled are so small the chest does not move, allowing acquisition of higher quality images in less time. In a study designed to test the feasibility and tolerability of high frequency PV during CMR, the researchers recruited two patients, one healthy volunteer and one patient with a thymic lesion. The procedure was well tolerated, and there was no need to correct for respiratory motion. Lung volumes were “frozen” in full inspiration, allowing the researchers to see both coronary arteries and pulmonary vessels. The study was presented at EuroCMR, held during May 2016 in Florence, Italy. “The possibilities with high frequency PV are huge. You could run all the CMR sequences in one batch, which would be much faster; data could be acquired constantly with

HospiMedica International October/2016

fewer artifacts,” said lead author and study presenter Professor Juerg Schwitter, MD, director of the CHUV CMR Centre. “We might be able to use this technique for diagnosis of sicker patients, who find breath holding difficult and need the imaging to be done quickly.” “This technique would help us to collect high resolution images where we want millimetric precision, for example to localize scar in the myocardium or to see the anatomy of coronary arteries or valves and malformations,” added Professor Schwitter. “We could even imagine that if the patient is not breathing for 20 minutes, or even longer, this technique could give a precise 3D representation of cardiac structures and help guide electrophysiology procedures such as ablation.” CMR is a medical imaging technology for the non-invasive assessment of the function and structure of the cardiovascular system that is based on the same basic principles as magnetic resonance imaging (MRI), with optimizations that use rapid imaging sequences. As a result, CMR images are currently acquired in steps. Patients breathe in and then hold their breath for each image, then recover before repeating the process for the next image. PV could offer the potential to acquire all images in one go, with no need to correct for respiratory motion.

contains billions of cells, the smallest overlap in size between the cancer cell and other blood cells will lead to thousands of blood cells ‘contaminating’ the cancer cells extracted through the separation. This is why we have now developed iso-acoustic focusing.” Image: New ultrasound iso-acoustic technology could help increase awareness about the spread of cancer cells and metastases (Photo courtesy of Nature Communications / Lund University).

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The Melody III features C-arm rotation for switching from cranio-caudal to lateral views without readjusting vertical position. It is compatible with the BYM 3D biopsy system and has a frontal display for showing applied compression force, arm rotation angle and thickness of compression.

The NeuViz 128 features Quad Sampling for improved resolution, reduced artifact and extended scanning ranges. It delivers higher definition images with lower dose in the shortest time, and its powerful workstation reduces operating costs and improves workflow.

The SONON 300L features a convex array transducer, which allows for a wider field of view. It is supported by the SONON iOS and Android mobile app, which allows scanning with a smartphone or tablet, and transmitting images/recordings to any hospital via Wi-Fi, 3G, or LTE networks.

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PET Scans Track Progressive Stages of Alzheimer’s Disease new study reveals how positron emission tomography (PET) scans of Tau deposition can help track the progressive stages of Alzheimer’s disease (AD) in the brains of aging cognitively normal adults. Researchers at the University of California Berkeley (USA; www.berkeley.edu) and Lawrence Berkeley National Laboratory (LBL; Berkeley, CA, USA; www.lbl.gov) conducted a study to examine Tau deposition and retention patterns in 53 adults. Of these, 5 were young adults (20–26), 33 were cognitively healthy adults (64–90), and 15 were patients aged 53–77 who had been diagnosed with dementia resulting from probable AD. Tau deposition was measured using the PET agent (18)F-AV1451, in a method established by German researchers through post-mortem analysis of the brains of suspected AD patients. The results confirmed that with advancing age, tau protein accumulates in the medial temporal lobe, which hosts the hippocampus and the

memory center of the brain, and that higher levels of tau in the medial temporal lobe was associated with greater declines in episodic memory. PET detection of tau in other isocortical regions, such as the neocortex, required the presence of β-amyloid, and was associated with a decline in global cognitive function. The study also confirmed that the patterns of tracer retention corresponded well with Braak staging of neurofibrillary tau pathology. The study was published on March 2, 2016, in Neuron. “Braak staging was developed through data obtained from autopsies, but our study is the first to show the staging in people who are not only alive, but who have no signs of cognitive impairment,” said lead author Prof. William Jagust, PhD, of UC Berkeley and LBL. “Amyloid may somehow facilitate the spread of tau, or tau may initiate the deposition of amyloid. All I can say is that when amyloid starts to show up, we start to see tau in other parts of the brain, and that is when real problems begin.

We think that may be the beginning of symptomatic Alzheimer’s disease.” Tau is a microtubule protein important in maintaining the structure of neurons. They are abundant in neurons of the central nervous system (CNS) and are less common elsewhere, but are also expressed at very low levels in astrocytes and oligodendrocytes. Pathologies such as AD and Parkinson’s disease are associated with tau protein oligomers that have become misfolded and defective, and no longer stabilize microtubules properly. β-amyloid are peptides that are the main component of the amyloid plaques found in the brains of AD patients. It is believed that certain misfolded oligomers can induce other β-amyloid molecules to also take the misfolded oligomeric form, in a process similar to that of the tau protein, leading to a chain reaction akin to a prion infection that is toxic to nerve cells. There is some evidence that misfolded β-amyloid can also induce tau to misfold.

Radiation Detector Plate Improves Cancer Radiotherapy prototype detector plate placed in the radiation path (before the X-ray beam hits the patient) records a real-time map of the intensity of the radiotherapy (RT) beams. Developed by researchers at the University of Wollongong (UOW; Australia; www.uow.edu.au), the MagicPlate-512 (MP512) detector consists of a silicon monolithic diode array sandwiched between plastic sheets less than 1-mm thick, which measures the radiation dose during treatment with millisecond-by-millisecond precision. A proprietary algorithm determines the actual dose reaching the patient, based on the measured intensity of the Xray distribution in the beam. This can then be compared to the planned dose; if a mismatch exists, the RT could be automatically and immediately stopped. The MP512 detector is wire bonded on a print-

ed circuit board 0.5 mm thick and covered by a thin layer of resin to preserve it from moisture and chemical contamination, and to protect the bonding wires. The array contains 512 0.5×0.5 mm2 pixels with a pitch of 2 mm. It has been tested and validated in a simulated environment using different X-ray beam energies that are commonly used to treat cancer patients. The researchers found the plate did not interfere with the quality of RT and accurately recorded in real-time the transmission of the radiation beam. “Current procedures typically involve a test on a plastic dummy before the patient is treated, to verify the equipment is delivering the dose according to the oncologist’s treatment plan calculations,” said Ziyad Alrowaili, MSc, who developed the plate as part of his PhD thesis. “This is an intensive task and an additional workload for the medical physi-

cist. And despite the high levels of quality assurance, the clinician can’t routinely measure the dose accuracy directly during the patient treatment delivery and independently of the linear accelerator settings.” “A single patient treatment plan may contain thousands of parameters defining the variables involved, and this complexity makes it imperative that processes are in place to check and verify the X-ray equipment delivers the dose accurately,” added Martin Carolan, MD, director of radiation oncology medical physics at Illawarra Shoalhaven Local Health District (ISLHD; Australia; www.islhd.health.nsw.gov.au). “There are many layers of safeguards already in place to reduce the risk to the patient, but the concept of measuring the radiation dose distribution every day as it is delivered to the patient is elegant and appealing.”

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DTI Study: Damaged Brain Networks Possible Cause of Insomnia esearchers discover link between insomnia and altered integrity of the white matter tract in regions of the brain that regulate alertness, consciousness, and sleep. The study included 23 patients suffering from insomnia, and 30 healthy control subjects who were examined using a special Magnetic Resonance Imaging (MRI) sequencing technique called Diffusion Tensor Imaging (DTI). The patients and control subjects were also given questionnaires to evaluate their mental status, and sleep patterns. The questionnaires included the Insomnia Severity Index, the Pittsburgh Sleep Quality Index, the Self-Rating Depression Scale, and the Self-Rating Anxiety Scale. The researchers published their findings in the April 2016, online issue of the journal Radiology.

The researchers used MRI-DTI to analyze the white matter tracts in the insomnia patients and studied the relationship between abnormal white matter integrity and the duration and nature of the sleep disorder. The results of the study showed the insomnia patients had significantly reduced white matter integrity in several regions of the right brain, including the thalamus, compared to the healthy controls. The duration of patients’ insomnia, and the score they gave on the self-rated depression scale, was associated with abnormalities in the thalamus, and body corpus callosum. The cause of white matter integrity abnormalities in the insomnia patients could have been caused by loss of the protective myelin coating around nerve fibers.

Medical Imaging

Shumei Li, MS, Researcher at the Department of Medical Imaging, Guangdong No. 2 Provincial People’s Hospital (Guangzhou, China; www. gd2h.com), said, “Insomnia is a remarkably prevalent disorder. However, its causes and consequences remain elusive. White matter tracts are bundles of axons – or long fibers of nerve cells – that connect one part of the brain to another. If white matter tracts are impaired, communication between brain regions is disrupted. We used a new method called Tract-Based Spatial Statistics that is highly sensitive to the microstructure of the white matter tract and provides multiple diffusion measures. These impaired white matter tracts are mainly involved in the regulation of sleep and wakefulness, cognitive function and sensorimotor function The involvement of the thalamus in the pathology of insomnia is particularly critical, since the thalamus houses important constituents of the body’s biological clock.

Market Clearance for 3 New Mobile C-Arms he US Food and Drug Administration (FDA; Silver Spring, MD USA; www. fda.gov) has cleared three new system models of an established family of mobile C-arms. The C-arm systems are made by a leading flat-panel detector manufacturer who also recently released a new upgraded version of another, premium mobile C-arm system. The Siemens Healthcare (Erlan-

gen, Germany; www.healthcare. siemens.com) Cios Fusion, Cios Select, and Cios Connect mobile Carms use the same flat panel detectors as the existing Cios Alpha system. The Cios Fusion can use 30 cm x 30 cm, and 20 cm x 20 cm detectors and has most of the software and hardware features of the Cios Alpha, such as a touchscreen remote that can be used to control the C-arm inside the sterile work area. All mem-

Ultrasound System Provides Enhanced Elastography Functions n upgraded ultrasound system is now capable of providing both real-time tissue elastography (RTE) and point shear wave measurement (SWM) without changing probes. The upgraded Arietta V70 is a compact, lightweight ultrasound system with an ergonomic design that is equipped with multiple functions and a range of surgical transducers to support a variety of specific procedures in each diagnostic field. Multi-layered and single crystal technologies allow efficient transmission and reception of the ultrasound pulse with minimal energy loss, increasing both the sensitivity and clarity of the images. The use of symphonic technologies, from wave generation to image display, assures that all technologies are harmonized. The SWM feature automatically makes multiple shear wave propagation velocity (Vs) measurements within a region of Interest (ROI) with a single button press. An evaluation of the reliability of each Vs measure-

HospiMedica International October/2016

ment is made, and the percentage of correctly detected measurements is displayed as the Vs efficacy rate (VsN). RTE relative tissue stiffness is measured by calculating tissue strain, which is induced by light vibration of the probe. An auto frame selection (AFS) algorithm and an assist strain ratio (ASR) function automatically locate the ROIs needed for fat lesion ratio, which enhances workflow and efficiency for breast elastography studies. The Arietta V70 also supports comprehensive diagnosis of diffuse liver disease via RTE, providing a liver fibrosis index measurement function (LF Index) which reflects the degree of fibrosis, and SWM, which reflect the degree of fibrosis, inflammation, congestion, and jaundice. RTE is also compatible with contrast-enhanced ultrasound, so that it can be used during surgery as a supplemental aid for the detection of additional lesions. The Arietta V70 is a product of Hitachi Aloka Medical (Tokyo, Japan; www.hitachi-aloka.co.jp).

bers of the Cios family of C-arms feature automatic dose-performance adjustment. The Cios Connect weighs just over 248 kilos, and can display individual images simultaneously in subtracted, and X-ray views to enable physicians to optimize the presentation of contrast and bone. The Cios Select is a new entry-level system with a push button interface for a simplified workflow, and uses the Intelligent Dose Efficiency Algorithm (IDEAL) image-processing algorithm for continuous contrast and brightness adjustments. The systems also feature updated software that provides a large preview image to help operating room staff select image settings, and a single-touch metal correction function that enables the user to compensate

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for metal image components, and provides improved contrast for the representation of surrounding tissue. The Cios family also features the Alpha Live Graphical Overlay function in all operating modes. Martin B. Silverman, vice president X-ray Products, Siemens Healthcare, said, “With the addition of these three new mobile C-arms to the Cios family, Siemens Healthcare is proud to build on our tradition of Carm leadership. Our Cios family offers customers a complete product portfolio that meets their needs, regardless of facility type or budget. These expanded mobile C-arm offerings represent another example of how Siemens innovates to solve the daily real-world challenges facing hospitals and surgical centers.”

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The Discovery IQ PET/CT is powered by the GE LightBurst PET detector, which can perform scans at half the dose and in half the time compared to conventional systems. It offers an axial field-ofview of up to 26 cm, allowing radiologists to visualize smaller lesions with smaller doses.

The ARIETTA Prologue features rapid boot time, built-in battery and a monitor, which can be attached and detached freely. It can be used by combining it with the cart or the transducer tray, making it ideal for all sorts of examinations in various use environments.

The Apollo DRF Open table features a single-side suspended tabletop for direct and easy access to the patient from all sides, and a 43x43 cm flat panel detector for a high frame rate and low dose requirement. It also offers solutions for reducing the dose, making it ideal for a range of studies.

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Laser Technology Could Advance Thyroid Cancer Screening new, low-cost device could enable enhanced information and better diagnosis during thyroid nodule screening. A multidisciplinary team that includes The Institute for Photonic Sciences (ICFO; Barcelona, Spain; www.icfo.eu), Politecnico di Milano (Milan, Italy; www.polimi.it), the University of Birmingham (United Kingdom; www.birmingham.ac.uk), along with five other European institutions, are collaborating on the laser and ultrasound co-analyzer for thyroid nodules (LUCA) project, which combines two photonics systems, near-infrared (NIR) diffuse correlation spectroscopy and time-resolved spectroscopy, along with a ultrasound system and a probe that enables multimodal data acquisition. The project, launched to enhance screening of thyroid nodules for thyroid cancer, brings together clinical endocrinologists, radiologists, physicists, engineers, and industry players with the intention

of developing a low-cost, point-of-care clinical device. According to the project partners, LUCA represents an innovative new tool for cancer diagnosis, screening, and therapy, and as such could have a significant impact not only in the field of thyroid cancer, but also in additional areas of the body accessible to both techniques. “The device combines ultrasound and near-infrared diffuse optical technologies in a single device and a probe. By combining information about tissue hemodynamics, chemical constitution as well as anatomy, it will overcome the shortcomings of present techniques while screening for malign thyroid nodules,” said Prof. Turgut Durduran, PhD, of the ICFO, scientific coordinator of LUCA. “If successful, this will save millions of euros over the coming decades and improve the lives of millions of Europeans.” “A new tool made concomitantly with thyroid ultrasound may provide additional information to

help us distinguish between benign and malignant nodules,” said Mireia Mora, MD, of the August Pi i Sunyer Biomedical Research Institute (IDIBAPS; Barcelona, Spain), responsible for the clinical application of the tool. “This would allow a reduction in the number of surgeries for these reasons, and would have an important socio-economic impact, diminishing the number of surgeries and the associated comorbidities, as well as improving the quality of life of the patients affected.” Thyroid nodules are a common pathology, with a prevalence of around 5% in women and 1% in men, which increases to 19%–76% with diagnostic neck ultrasound. To exclude thyroid cancer when screening – which occurs in 5%–15% of cases – ultrasound is followed by fine-needle aspiration biopsy of suspicious nodules. In thyroid cancer, the sensitivity and specificity of this process are limited, with a large number of non-diagnostic and false positive results that lead to unnecessary surgery.

PET/CT Links Activity in the Stress Center Of the Brain to Risk of Future Heart Problems esearch results have shown that increased activity of the stress center of the brain is linked to a higher risk for cardiovascular events such as heart attacks, stroke, and death, and increased evidence of arterial inflammation. The goal of the study is to make an initial investigation into the mechanisms behind stress response and the risk of cardiovascular events using Positron Emission Tomography/Computed Tomography (PET/CT) imaging. The results were presented at the 65th Annual Scientific Session of the American College of Cardiology. The study is the first to use imaging to find a link between atherosclerotic disease and biochemical activity in the brain. The researchers at the Massachusetts General Hospital (MGH; Boston, MA, USA; www.massgeneral.org) used PET/CT scans of 293 patients with an average age of 55 years, to objectively measure activity in various brain regions, in the bone marrow, and arteries. The scanning pro-

cedure included the use of a radioactive tracer to find areas of increased metabolic activity. The researchers found a 14-fold increased risk of cardiovascular events for every unit increase in measured brain stress activity. During the 5-year study, 5% of patients with low stress center activity group suffered a cardiovascular event, compared to 35% of the patients with high stress center activity. The researchers concluded that the activation of bone marrow, arterial inflammation, and activation of the fear centers in the brain were linked to a mechanism that provoked cardiovascular events. Coauthor of the study, Ahmed Tawakol, MD, Massachusetts General, said, “Our study illuminates, for the first time, a relationship between activation of neural tissues – those associated with fear and stress – and subsequent heart disease events. There is a need to develop greater knowledge in terms of the mechanism that translates stress into cardiovascular disease risk, given the

prevalence and potency of stress as a risk factor. Over the past several years, it’s become clear that stress is not only a result of adversity but may itself also be an important cause of disease. The risks of heart disease linked to stress is on par with that for smoking, high blood pressure, high cholesterol and diabetes, yet relatively little is done to address this risk compared to other risk factors. We are hopeful studies like this bring us closer to understanding how stress may lead to heart disease.” V

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Medical Imaging

Optical System Reconstructs Virtual 3D Spinal Column novel diagnostic system offers stereo-radiographic imaging and three dimensional (3D) modeling tools particularly suited to orthopedic applications. The Biomod 3S system uses noninvasive optical information technology that is combined with classic two-dimensional (2D) radiographic images of the spine to yield a virtually reconstructed 3D model of the vertebral column that can provide clinicians with complete view of the patient’s spine. This allows a thorough and accurate evaluation of spinal deformities in diverse pathologies, such as scoliosis, kyphosis, vertebral compression, posture and balance anomalies, and dorsopathy, among others. The optical acquisition is realized simultaneously with frontal and sagittal full spine X-rays obtained from an existing radiological set-up, and therefore does not require any change in clinical routine or increased radiation exposure. Patented software performs an automatic correction of patient’s sway during acquisition, thus providing a complete evaluation of the spine and the pos-

ture in a minimum time input, with an average spinal reconstruction taking about five minutes. The Biomod 3S system was developed by AXS Medical, a division of Diagnostic Medical Systems (DMS; Mauguio, France; www.dms.com). The technology has also been adopted by Toshiba Medical Systems Europe (TMSE; www.toshiba-medical. eu) for OrthoMod 3D spinal imaging technology in order to provide information on rotations and twists in the spine that are not possible to evaluate in a traditional 2D setup. Before OrthoMod 3D, getting 3D information usually meant relying on a supplemental computerized tomography (CT) or magnetic resonance imaging (MRI) scan, which implied further radiation exposure. “The new spinal imaging solution is extremely accessible and it can be easily integrated into an existing R/F or RAD suite equipped with digital full spine,” said René Degros, business unit manager for X-Ray with TMSE. “It is particularly suited for practices focusing on radiology, pediatrics, orthopedics, and ambulatory surgery.”

Image: The Biomod 3S system (Photo courtesy of AXS Medical/DMS).

MR Tomography Helps Objectively Determine Breast Density n automated user-independent breast density (BD) measurement system based on magnetic resonance tomography (MRT) could provide diagnosis and risk assessment. Researchers at the Medical University of Vienna (Austria; www. meduniwien.ac.at) investigated the use of an automated user-independent quantitative volumetric (AUQV) MRT measurement system to compare it with qualitative and quantitative mammographic BD measurements. The study involved 43 women with normal mammogram results who were subjected to BD assessment with MRT using the Dixon technique; to test reproducibility, a second MRT after patient repositioning was performed. The system automatically calculated BD percentage. Qualitative and quantitative BD was estimated semi-automatically using a thresholding technique, and statistical tests were used to assess the agreement between the two AUQV MRT measurements and compare them with qualitative and quantitative MG BD estimations. The results showed a nearly perfect agreement of AUQV MR BD measurements between the 2 MRT exami-

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nations, which were significantly lower than quantitative and qualitative MG BD assessment. The study was presented at the European Congress of Radiologists (ECR), held during March 2016 in Vienna (Austria). “It works practically at the touch of a button and only takes a few minutes. There is also no need to provide contrast material,” said lead author and study presenter Georg Wengert, MD, of the department of radiology and nuclear medicine at the Medical University of Vienna. “For the first time worldwide, an objective measurement of breast density with fully automatic software and higher precision and reproducibility has been detected with this method, and a prototype currently exists.” Breast density is divided into four categories according to the guidelines of the American College of Radiology (ACR). Ranging from A to D, the risk of getting breast cancer is considered to be four to six times higher for a higher BD (C/heterogeneous and D/extremely dense). The density cannot be precisely measured using mammography and an ultrasound scan, and additionally a high breast density makes diagnosis more difficult. LINKXPRESS COM

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Wireless, Handheld Ultrasound Comes to iOS and Android novel mobile ultrasound scanner works with a mobile app, providing physicians with the freedom to perform ultrasound exams anywhere, anytime. The Clarius handheld ultrasound scanner is designed to be carried around for quick exams and to guide point-of-care procedures, such as nerve blocks and targeted injections. The device is constructed with a tough magnesium shell to withstand hospitals and other unpredictable environments, and is provided with a high quality, “pointand-shoot” simplicity similar to that of a mobile phone. Other features of the Clarius handheld scanner include automated gain and frequency settings and an intuitive user interface. The wireless device uses a secure point-to-point network to connect to the app on the selected device

(or devices), and is compatible with most iOS and Android smartphones and tablets. According to the developers, the affordable ultrasound solution will be able to bring ultrasound inside ambulances; will enable better women’s health in rural places; will reduce infection rates during procedures; and will enable physicians to solve health issues sooner. The Clarius handheld ultrasound scanner is a product of Clarius Mobile Health (Burnaby, BC, Canada; www.clarius.me), and is pending worldwide approval. “Physicians have been asking for a portable ultrasound system that works with their iPhone for some time. The challenge has been to make an affordable device that is small enough to carry around and that also produces great images,” said Laurent Pelissier, chairman and CEO of Clarius Mobile Health.

Image: The Clarius handheld ultrasound scanner (Photo courtesy of Clarius Mobile Health).

CT Study: High Coronary Calcium Score Linked to Increased Cancer Risk esearchers investigating heart CT scans of more than 6,000 people have found that a high coronary artery calcium score may result in a greater risk for cancer, chronic kidney disease, and COPD, besides increasing the risk for heart and vascular disease. Heart Computed Tomography (CT) scans are used for finding mineral density levels, or calcium scores, in blood vessels feeding into coronary arteries. Coronary calcium scores are a good predictor for the risk of stroke, and coronary heart disease. The study was not intended to look for, measure, or find cause/effect relationships between non-cardiovascular diseases and coronary calcium levels. The study was conducted by researchers at the Johns Hopkins University School of Medicine (Baltimore, MD; www.hopkinsmedicine.org) and other

universities, and was published online on March 9, 2016, in the journal Cardiovascular Imaging. The researchers made use of the Multi-Ethnic Study of Atherosclerosis (MESA) that included data from subjects in six different centers. The 6,814 people in the study were 45 to 84 years old, and without any signs of cardiovascular disease when the first heart CT scan and coronary calcium score calculation were made. Over a period of 10 years, through to 2012, the people returned for annual or more follow-up visits. At the end of the 10-year period 1,238 of the original participants were diagnosed with a variety of non-cardiovascular diseases, such as cancer, kidney disease, pneumonia, blood clot, dementia, hip fracture, and lung disease. The results found that among participants with coronary calcium scores

higher than 400, 36.9% were diagnosed with a non-cardiovascular disease. In contrast, only 11% of participants with no coronary artery calcium had such a disease. Chronic kidney disease was found in 395 participants, and Chronic Obstructive Pulmonary Disease (COPD) in 161 participants. Michael Blaha, MD, MPH, from the Ciccarone Center for the Prevention of Heart Disease at the Johns Hopkins University School of Medicine, said, “Plaque in the arteries is the result of cumulative damage and inflammation, and vulnerability to injury and chronic inflammation likely contributes to diseases like cancer, kidney and lung diseases, as well as cardiovascular disease. So it makes sense that the coronary calcium score – a measure of arterial aging – is predictive of non-cardiovascular diseases too.”

Multisite Ultrasound Study to Help Improve Pregnancy Outcomes esearchers are using microvascular ultrasound imaging equipment to study the microvascularization of the placenta, the elasticity of placental tissue, and its calcification content. The multisite study is part of an initiative to improve the understanding of the function of the placenta, and is being funded by a USD 2.725 million grant from the US National Institutes of Health (NIH). The researchers will use Toshiba America Medical

Systems (Tustin, CA, USA; www.medical.toshiba. com) Aplio 500 Platinum microvascular ultrasound systems for the study, which is taking place at the Eastern Virginia Medical School (EVMS; Norfolk, Virginia; www.evms.edu) Fetal Cardiovascular Center. The Aplio 500 Platinum system provides advanced visualization imaging, quantification and intervention, and will be used by EVMS for Superb Micro-Vascular Imaging (SMI) for noninvasive visu-

alization of small blood vessels, and low-velocity microvascular blood flow. The researchers at EVMS will use Toshiba’s Shear Wave Elastography (SWE) for noninvasive measurements of tissue stiffness, and Toshiba’s MicroPure visualization of microcalcifications, instead of gray scale imaging. The study is intended to help find new methods to predict, and minimize difficulties later in pregnancy, by studying the placenta during the early stages.

Highly-Sensitive Tracer for Use with MRI Scanners esearchers have revealed a new fluorinebased Magnetic Resonance Imaging (MRI) tracer that can efficiently track cells and molecules. The tracer will enable clinicians to track cells and visualize their behavior in living patients, and speed up the development of emerging treatments using stem cells and immune cells. The discovery was announced by researchers at the University of California, San Diego School of Medicine, (UCSD; San Diego, CA, USA; http://som.ucsd.edu), and published in the March, 14, 2016, online issue of Nature Materials.

The researchers were able to synthesize a new celllabeling probe using fluorine-19 that was taken up by targeted cells. The fluorine agent was then detected using an MRI scanner and allowed researchers to observe the movement of cells. The researchers increased the sensitivity of the agent by combining highly fluorinated nano-emulsions with magnetic properties of metals, and discovered that iron was effective at enhancing the signal of the fluorine MRI tracer. Iron is biologically friendlier and cheaper than gadolinium, a rare-earth metal used in proton MRI today. Senior author of the study, Eric T. Ahrens, PhD,

professor of radiology, said,“Fluorine-19 tracer agents are an emerging approach that produces positive signal hot-spot images with no background signal because there’s virtually no fluorine concentration in tissues. We have made a major leap in sensitivity. We have figured out how to dissolve and encapsulate metals inside the fluorine-based droplets. The net effect is to greatly amp up the MRI signal. 19F MRI aided by iron represents a significant advance in tracking cells in many emerging therapeutic areas, such as immunotherapy, stem cells and treating inflammation”. HospiMedica International October/2016

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The HD-500 features VIST, CHb enhancement, and structure/edge enhancement technologies to provide sharper images for a guaranteed accurate diagnosis and therapy. With a customizable report format, it is compatible with USB and DICOM, and qualified to meet high-end requirements.

The ACCUVAC Pro has a suction capacity of about 34 liters/minute at -0.8 bar, and offers four pre-defined settings. It carries out automatic function checks, provides quick visual and acoustic feedback, and has a lithium-ion rechargeable battery that does not require calibration.

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Obese Women Have Higher Asthma Prevalence sthma prevalence among obese women in the United States is almost double that of normal-weight women, but the same association is not seen in men, according to a new study. Researchers at the National Center for Health Statistics (NCHS; Atlanta, GA, USA; www.cdc.gov/ nchs), a part of the US Centers for Disease Control and Prevention (CDC; Atlanta, GA, USA; www. cdc.gov), conducted a retrospective study that analyzed data from the National Health and Nutrition Examination Survey (NHANES) across all adult age groups, in order to examine asthma prevalence and demographic and ethnic associations between 2001–2014. The results showed that obesity was significantly associated with higher asthma prevalence, and that overall asthma prevalence increased from 2001 (7.1%) to 2014 (9.2%). Obesity was associated with higher asthma prevalence rates among all age groups and racial groups, with the overall prevalence among adults at 8.8%, with 11.1% of obese

adults, 7.8% of overweight adults, and 7.1% of normal-weight adults having asthma. Asthma prevalence rates increased during the study time period among overweight adults, but not among adults who were obese or whose weight was normal. Demographically, the prevalence of current asthma among obese non-Hispanic whites was 10.9%, compared with 8.1% among normal-weight white adults. The prevalence among non-Hispanic black adults who were obese was 13.6%, compared with 6.6% in normal-weight blacks. And obese Hispanic adults had an asthma prevalence of 9.6%, versus 5.7% among normal-weight Hispanics. No significant differences in prevalence rates were seen between normal and overweight adults within any racial group. When examined by sex, obese women had 14.6% prevalence for current asthma, versus 7.9% for normal-weight women and 9.1% for overweight women; but prevalence did not differ significantly by weight status for men. The researchers observed that it has been suggested that sex-related differ-

ences in fat distribution may at least partly explain the largely gender-specific asthma risk associated with obesity, and that hormones secreted by ectopic fat may contribute to asthma. The study was published in the March 2016 issue of NCHS Data Brief. “Current asthma prevalence was higher among adults with obesity compared with adults in lower weight categories. This pattern was consistent across most demographic subgroups, except among men,” concluded lead author Lara Akinbami, MD, and colleagues. “The reasons for this are not clear; interestingly, asthma prevalence is higher in young boys than young girls, but this switches around the time of puberty. In adults, asthma prevalence is higher in women than men.” Obese patients also often exhibit asthma-like symptoms, arising from the effects of increased body mass index (BMI) on lung volumes, an increased effort to breathe, and the increased release of adipokines. The resulting breathlessness is a common finding in both asthma and obesity, creating a potential for misdiagnosis.

Mammograms May Help Screen for Heart Disease outine mammography screening for breast cancer may be a useful tool to identify coronary arterial calcification (CAC), according to a new study. Researchers at Mount Sinai St. Luke’s Hospital (New York, NY, USA; www.stlukeshospitalnyc.org) and the Icahn School of Medicine at Mount Sinai (New York, NY, USA; www.icahn.mssm.edu) conducted a study involving 292 women who had both digital mammography and non-contrast computerized tomography (CT) scans within one year of each other. Examination of the data showed that 42.5% of the women had evidence of breast arterial calcification. The mammograms were reviewed by a second radiologist, who was blinded to the CAC results found on the CT scans. Women with established cardiovascular disease

(CVD) were excluded. The results showed that the overall accuracy of breast arterial calcification for the presence of CAC was 70%, while 63% of the women with CAC also had breast arterial calcification. Among women younger than 60 years of age, breast arterial calcification showed a higher, 83% risk for CAC. Additional findings were that women with breast arterial calcification were older, had high blood pressure and chronic kidney disease (CKD), and were less likely to be smokers. The study was presented at the American College of Cardiology (ACC) 65th annual scientific session, held during April 2016 in Chicago (IL, USA). “This information is available on every mammogram, with no additional cost or radiation exposure, and our research suggests breast arterial calci-

fication is as good as the standard risk factor-based estimate for predicting risk,” said lead author Prof. Harvey Hecht, MD, director of cardiovascular imaging at Mount Sinai St. Luke’s Hospital. “Using this information would allow at-risk women to be referred for standard CAC scoring and to be able to start focusing on prevention – perhaps even taking a statin when it can make the most difference.” CAC is considered a very early sign of CVD, and the presence of breast arterial calcification appears to be an equivalent or stronger risk factor for CAC than other well-established CVD risk factors, such as high cholesterol, high blood pressure, and diabetes. Research has also shown a link between breast arterial calcification and atherosclerotic disease, as well as a relationship between the extent of calcified plaque in the mammary and coronary arteries. HospiMedica International October/2016

Versatile Camera System Offers Flexibility in Endoscopy compact flexible video endoscope system provides improved image quality and light emitting diode (LED) illumination. The Endocam Flex HD system is designed for physicians in private practice, specialist outpatient operating centers, accident and emergency units, and hospitals in general. A miniaturized design enables it to be used where there is no space for conventional large camera controllers. The system therefore comes with a C-mount lens for various adaptation options, and an integrated VESA 100 interface for wall mounting or attachment on the side of an equipment cart. An optional camera head is available for use with traditional rigid optical endoscopes. “Plug & Play” compatibility facilitates fitting of a large range of flexible sensor endoscopes to the camera controller. A total of six different sensor endoscopes are available for urology and pulmonology. For urology, options include a 2-channel sensor uretero-renoscope (the COBRA vision EF), a single-channel sensor ureterorenoscope (the BOA vision EF), and a sensor cystoscope. For pulmonology, options include a sensor bronchoscope for diagnostics, a sensor bronchoscope for therapy, and an optional slim line bronchoscope. The camera is paired to the Endolight Flex LED, which is characterized by low power consumption and very little heat. The LED light source is also very quiet, and therefore improves the working conditions in the operating room. An optional holder allows the camera controller and the light source to be adapted to a monitor. The Endocam Flex HD and Endolight Flex LED system are products of Richard Wolf (Knittlingen, Germany; www.richardwolf.com).

Image: The Endocam Flex HD system (Photo courtesy of Richard Wolf).

Procedure May Replace Colostomy Bags cont’d from cover

setting with left-sided colonic obstruction needing urgent decompression, and radiological features of a carcinoma. Patients were randomized to endoluminal stenting as a bridge to elective surgery performed 14 weeks later, or to surgical decompression. The results showed that 30-day post-operative mortality and length of hospital stay were similar with stenting and surgery. But while 69% of the emergency surgical decompression patients needed a colostomy bag, only 45% of the endoluminal stenting as a bridge to surgery needed one. Stenting also achieved relief of obstruction in 82% of patients and reduced stoma formation; there were no significant differences in oneyear mortality between groups. “This treatment isn’t suitable for everyone, but for those who are it could have a huge impact on their lives after surgery. Not needing a colostomy bag is likely to significantly improve the quality of life of patients,” added Martin Ledwick, head information nurse of Cancer Research UK (London; www.cancerresearchuk.org). A colostomy is an artificial opening (stoma) created surgically in the large intestine that allows the removal of feces out of the body, bypassing the rectum, to drain into a removable pouching system (the colostomy bag) that collects and contains the output for later disposal.

HospiMedica International October/2016

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PRODUCT NEWS SURGERY TABLE

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VIDEO LARYNGOSCOPE

PORTABLE SUCTION UNIT

DRE Medical

Karl Storz

Hersill

The DRE Torino 550 comes with durable casters and braking system for efficient transport to different surgical rooms during a procedure. It features a longitudinal slide up to 350mm, and its electronic adjustments allow surgeons to easily position the patient for various procedures.

The C-MAC features the Universal C-MAC system interface specially adapted to airway management and makes reprocessing possible up to 93 degrees centigrade. Other features include high stability and resistance to impact, and one-button control with BlueButton for documentation.

The V7 range of portable suction units comes with an ergonomically designed ABS case with handle, and rear anchorage tested to resist up to 10 g. It features an oil-free and zero maintenance piston pump, vacuum control knob and water-resistant on/off switch, and is available in four models.

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Minimally Invasive Solution Alleviates Chronic Tendinosis n innovative disposable surgical instrument uses targeted ultrasonic energy to address tendinosis of the shoulder and hip by removing soft tissue. The Tenex Health TX system is designed to execute percutaneous tenotomy in patients who suffer from soft tissue tendon pain. Following administration of a local anesthetic, gentle ultrasonic energy is used to safely breakdown and remove the damaged tissue via a MicroTip, which requires only a microincision to reach the damaged tissue. Because the incision is so small and the ultrasonic energy precisely treats only damaged tendon tissue, surrounding healthy tissue is left unharmed, and patients enjoy faster recovery times when compared to traditional open surgical procedures. The system is controlled by the proprietary Tenex Health TX console, a portable, self-contained device that includes a one-step, easy-load tubing set and a quick, one-touch prime cycle. Simple touch-

screen controls lead the operator through a treatment interface, with computer-guided programming instructions and at-a-glance parameter and user settings. The interface also includes smart safety features and a single-use, preassembled handpiece system to hold a disposable TX MicroTip. Two MicroTips are available, the TX1 and TX2, with the TX2 being an extended length version of the TX1 that allows physicians to complete the procedure in regions of the body not typically accessible by the shorter instrument. The most common problem is some soreness after the procedure, which can be treated with over-the-counter (OTC) pain medication, and typically lasts for a short period of time. The TX system is a product of Tenex Health (Lake Forest, CA, USA; www. tenexhealth.com), and has been approved by the US Food and Drug Administration (FDA). “The TX1 MicroTip has enjoyed tremendous clinical success in treating over 35,000 patients in

the US since its introduction in 2012,” said Bernard Morrey, MD, chief medical officer of Tenex Health. “Only a small portion has been treated with shoulder or hip tendinosis, due to the inaccessibility of the deeper tissues to the TX1 MicroTip. The length and design of the TX2 MicroTip is well poised to effectively treat a large number of patients with a spectrum of conditions in these anatomic areas.” “The TX System using the TX1 MicroTip has been used by physicians for the past few years and demonstrated to be effective in treating chronic tendinosis in a variety of body parts. The longer needle associated with the TX2 product will provide physicians the needed technology to definitively treat chronic tendinosis in the shoulder and hip,” said James Andrews, MD, of the Andrews Institute (Gulf Breeze, FL, USA). “Soft tissue injuries in both of these body parts are well suited to be treated through a minimally invasive approach using the TX2 product.”

Vitamin D Supplements Effect Fetal Bone Health Only in Winter new study concludes that recommended vitamin D supplementation during pregnancy has no significant effect on the bone density of babies during the summer months. Researchers at the University of Southampton (United Kingdom; www.southampton.ac.uk), the University of Oxford (United Kingdom; www.oxford.ac.uk), and other institutions participating in the Maternal Vitamin D Osteoporosis Study (MAVIDOS) conducted a randomized, placebo-controlled trial that recruited 1,134 pregnant women from three sites in the United Kingdom (Southampton, Oxford, and Sheffield) to assess whether neonates born to mothers supplemented with vitamin D during pregnancy have greater whole-body bone mineral content (BMC) at birth. Participants were randomly assigned to receive a vitamin D capsule containing cholecalciferol 1000 IU daily, or a matched placebo from 14 weeks’ gestation until delivery. The primary outcome was neonatal whole-body BMC, assessed within two

weeks of birth by dual-energy X-ray absorptiometry (DXA), analyzed in all randomly assigned neonates who had a usable DXA scan. Safety outcomes were assessed in all randomly assigned participants. The results showed that there was no significant difference in BMC and bone mass between the babies born to women supplemented with vitamin D and those who had taken placebo. Further analysis that took into account the season of birth showed that babies born during winter months to mothers who had taken vitamin D supplements had greater BMC than winter babies born to mothers who received the placebo. Furthermore, in mothers who gave birth in winter, vitamin D concentrations fell from 14 to 34 weeks’ gestation in the placebo group, but rose in the treatment group, suggesting that the supplementation may counteract the drop in the body’s normal levels of vitamin D caused by lack of sunlight when late pregnancy occurs in the winter months. The study was published on March 1, 2016, in the Lancet Di-

abetes & Endocrinology. “Since sunlight is our most important source of vitamin D, mothers’ levels of vitamin D tend to drop from summer to winter, and babies born in the winter months tend to have lower bone density than those born during the summer,” said study coauthor Prof. Nicholas Harvey, MD, of the University of Southampton. “Supplementing mothers with vitamin D during pregnancy counteracts the seasonal drop in maternal vitamin D levels and may help to ensure good bone development in these winter births.” Vitamin D is a group of fat-soluble secosteroids found in many dietary sources, such as fish, eggs, fortified milk, and cod liver oil. Although vitamin D is commonly called a vitamin, it is not actually an essential dietary vitamin in the strict sense, as it can be synthesized in adequate amounts by all mammals from sunlight. The major biologic function of vitamin D is to maintain normal blood levels of calcium and phosphorus. HospiMedica International October/2016

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Surgical Techniques

Lasers Help Breach Blood-Brain Barrier for Chemotherapy new study reveals that laser beams can disrupt the blood-brain barrier (BBB) for up to six weeks, modifying its permeability long enough for chemotherapy treatment. Researchers at Washington University School of Medicine (WUSTL; St. Louis, MO, USA; www. medschool.wustl.edu) conducted a study involving 20 patients with probable recurrent glioblastoma to test a novel hyperthemic method designed to induce temporary disruption of the peritumoral BBB as a potential means to enhance drug delivery. The first step involves magnetic resonance imaging (MRI)-guided interstitial thermal therapy to create a 3-millimeter incision in the BBB, through which a neurosurgeon can robotically insert a laser to heat up and kill brain tumor cells. To determine the degree and timing of peritumoral BBB disruption, dynamic contrast-enhanced brain MRI is used to calculate the vascular transfer constant (Ktrans) as a measure of permeability.

The results showed that Ktrans levels in the peritumoral region peaked immediately post laser ablation, followed by a gradual decline over the following four weeks. Serum levels of brain-specific enolase (BSE), which were also measured and used as an independent quantification of BBB disruption, increased shortly after laser ablation, and peaked at 1-3 weeks before decreasing back to baseline by six weeks. As part of the study, the chemotherapeutic agent doxorubicin was given intravenously to 13 patients in the weeks following the laser surgery. Preliminary data indicated that 12 of the patients showed no evidence of tumor progression during the 10week time frame of the study. One patient experienced tumor growth before chemotherapy was delivered; the tumor in another patient progressed after chemotherapy was administered. Most patients went home after one to two days, and none experienced severe complications. The study was pub-

lished on February 24, 2016, in PLOS One. “The laser treatment kept the blood-brain barrier open for four to six weeks, providing us with a therapeutic window of opportunity to deliver chemotherapy drugs to the patients,” said lead author Professor of neurosurgery Eric Leuthardt, MD. “This is crucial because most chemotherapy drugs can’t get past the protective barrier, greatly limiting treatment options for patients with brain tumors.” The BBB is comprised of specialized endothelial cells that form the capillary microvasculature of the central nervous system (CNS), and is essential for brain function. It selectively prevents substances from entering the blood and brain, only allowing such essential molecules as amino acids, oxygen, glucose and water through. On the other hand, it also poses the greatest impediment in the treatment of many CNS diseases because it commonly blocks entry of therapeutic compounds.

Bio-Expandable Bone Graft Could Help Spinal Surgery Patients n expandable, biodegradable graft could help metastatic spinal tumor patients recover from the surgical removal of bone segments and intervertebral discs, according to a new study. Researchers at the Mayo Clinic (Rochester, MN, USA; www.mayo clinic.org) have developed a bio-

degradable, hydrophilic, polymer graft that when surgically placed in the damaged vertebrae, expands to precisely fill the resected areas by absorbing bodily fluids. The graft is composed of two sections; a hollow hydrophilic scaffold made of crosslinked oligo(poly(ethylene glycol) fumarate) (OPF), and a stabilized polymer filler

3D Printed Cage Aids Lumbar Spinal Fixation new posterior lumbar cage made using additive manufacturing technology helps treat spinal conditions such as degenerative disc disease, spondylolisthesis, and degenerative scoliosis. The Tritanium PL posterior lumbar cage is the result of using a novel, highly porous titanium material that is manufactured via a three dimensional (3D) additive manufacturing process. It is designed for both bone ingrowth and biological fixation, when used with cancellous and/or corticocancellous autografts or allogenic bone grafts, and can be combined with supplemental lumbosacral spinal fixation systems (via a posterior approach) during fixation procedures. Tritanium PL Cages are offered in a variety of widths, lengths, heights, and lordotic angles, and are designed to adapt to a variety of patient anatomies as well as address the potential for subsidence into the endplates. Solidtipped, precisely angled serrations are designed for bidirectional fixation and maximal surface area for endplate contact with the implant. The Tritanium

HospiMedica International October/2016

PL Cage is a product of Stryker Corporation (Kalamazoo, MI, USA; www. stryker.com), and has been approved by the US Food and Drug Administration (FDA). “We are committed to offering a full range of innovative spinal products that allow surgeons to help their patients return to a more active lifestyle,” said Brad Paddock, president of the Stryker spine division. “Our advanced 3D additive manufacturing capabilities allow us to precisely manufacture the porous structures of Tritanium and specific implant geometries. We are pleased to bring this technology to our spine surgeon community and their patients.” Tritanium is an open-cell, highly porous, 3D Titanium matrix that can be used as an implant coating or on its own; the sponge-like matrix has architecture similar to that of cancellous bone. The name was first coined in the Star Trek [a popular, long-running science-fiction TV series] universe as an extremely hard element used in the construction of spaceship bulkheads.

material. To develop the graft, the researchers first identified a combination of materials that are biocompatible in animals, and which they believe will work in humans. To control the kinetics of the polymer graft expansion, the researchers made chemical changes to the filler to modify the degree and timing of the expansion, under conditions that mimicked the spinal column environment. The modulation of the molecular weight and charge of the polymer enabled them to tune the material’s properties so that the expansion rate was slow enough to enable surgeons to place it correctly, but fast enough so that it did not extend surgery

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times. The study was presented at the 251st national meeting & exposition of the American Chemical Society (ACS), held during March 2016 in San Diego (CA, USA). “The overall goal of this research is to find ways to treat people with metastatic spinal tumors; the spine is the most common site of skeletal metastases in cancer patients, but unlike current treatments, our approach is less invasive and is inexpensive,” said lead author and study presenter Lichun Lu, PhD. “When we designed this expandable tube, we wanted to be able to control the size of the graft so it would fit into the exact space left behind after removing the tumor.”

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PRODUCT NEWS SURGERY SUPPORT SYSTEM

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VIDEO LARYNGOSCOPE

BRONCHOSCOPE

Samarit Medical

Infinium Medical

SonoScape

The Double-Point Fixation support is designed to reduce existing safety-related problems during surgery in lateral positions. The stainless steel system weighs 2.3 kg / 5 lbs, and can be easily attached to the side of the surgery table.

The ClearVue features a 2MP full-view camera with video capability, a 3.5-inch high-resolution monitor, and rechargeable battery for extended use. It offers vacuum-packed disposable blades or reusable blades, which can be used up to 1,000 times, resulting in a low per patient cost.

The EB-330 offers superb image quality with electronic magnification functions to help doctors make accurate diagnoses. It can be configured for the HD- 330 endoscopic system, which is well suited for both hospitals and private practice.

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Mobile Container Sterilizes Surgical Instruments in Low-Resource Settings sterilization station built into a standard 20-foot steel shipping container houses all the equipment necessary to prepare surgical instruments for safe reuse, including a water system for decontamination and a solarpowered autoclave for steam sterilization. Developed by researchers at Rice University (Rice, Houston, TX, USA; www.rice.edu) and Association Soleil-Vapeur (Evreux, France; www.soleil-vapeur. org), the surgical intstrument processing unit, dubbed “The Sterile Box,” is capable of handling instruments from the moment they leave the operating room to the point they are sterile and ready to be reused for the next surgery. The sterile processing unit is self-sufficient in power and water and features an intake for contaminated instruments, decontamination, sterilization via non-electric steam sterilizers, and secure inventory storage. Solar panels and an electrical storage system power the container, including outlets for fans and for cellphone charging. Water distribution is provided by two tanks on the roof, with a hand pump to move water to one of the 200 liter tanks. The interior has two rooms: a foyer to separate the sterile

processing area from outsiders and the elements, and a main processing area divided into four stations. At the first station technicians decontaminate instruments in a three-basin sink to remove debris, soak them in an enzymatic detergent, and scrub with nylon brushes before a final rinse. At the second station an electric hotplate heats the steam autoclave that sterilizes the instruments; at the third, the instruments are dried on wire racks and then moved to the fourth station, a storage cabinet where they await the next surgery. A small window is provided to pass instruments between the processing area and the foyer. To validate the efficacy of the Sterile Box, the researchers ran 61 tests of decontamination and sterilization performance, demonstrating satisfactory decontamination and sterilization outcomes to support healthcare facilities in low resources settings. A study describing the Sterile Box was published on March 23, 2016, in PLoS ONE. “We tried to really think hard about social con-

text. We laid out the elements to minimize human error and water and energy requirements to the extent that we can. I really like that about our design,” said senior author Associate Professor of Business and Public Policy Douglas Schuler, PhD. “The Sterile Box may be suitable for other medical situations, including maternal and neonatal care, oral health care, and post-disaster relief.” Image: The Rice University Sterile Box for low-resource settings (Photo courtesy of Jeff Fitlow / Rice University).

Minimally Invasive Weight Loss Treatment Shows Promising Results ariatric arterial embolization (BAE) could offer individuals a viable, safe alternative to surgical weight-loss treatments, according to a new study. Researchers at the Johns Hopkins University School of Medicine (JHUSM; Baltimore, MD, USA; www.hopkinsmedicine.org) enrolled seven severely obese (but otherwise-healthy) adults with a body mass index (BMI) of 40-60 to the study. All study participants underwent BAE, and were concomitantly enrolled in a weight program so that they could understand and implement critical lifestyle and diet changes before and after BAE. The researchers also tracked weight loss, ghrelin levels, hunger and satiety assessments, quality-of-life,

blood pressure, and adverse events at the one, three, and six-month mark. The results showed that in all patients BAE was safe, with no major adverse events. In the first month following the procedure, study participants had an average excess-weight loss of 5.9%. After six months, the participants’ excess-weight loss increased to an average of 13.3%. All patients demonstrated a dramatic reduction in hunger levels, ghrelin levels trended down, and quality-of-life scores were improved. The study was presented at the Society of Interventional Radiology annual scientific meeting, held during April 2016 in Vancouver (BC, Canada). “Obesity is a highly prevalent, detrimental and costly disease in the US and abroad. Currently, in-

terventions to treat this condition include behavioral modifications, diet and exercise, medications, and surgery,” said study presenter Clifford Weiss, MD, director of interventional radiology research at JHUSM. BAE targets the fundus of the stomach, which produces the vast majority of ghrelin, the body’s most powerful hunger hormone. It is performed exclusively by interventional radiologists, who use image guidance and catheters to gain percutaneous access the specific blood vessels in this portion of the stomach. The physician then injects microscopic beads to decrease blood flow, thereby suppressing some of the body’s hunger signals, leading to reduced appetite and weight loss. HospiMedica International October/2016

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Surgical Techniques

New Device Shortens Chest-Tube Insertion Time novel one-handed thoracic portal opener dramatically shortens chest-tube insertion procedure time when treating pneumothorax. Developed by researchers of the BioDesign team at the Hebrew University (HUJI; Jerusalem, Israel; www.huji.ac.il) and Hadassah Medical Center (Jerusalem, Israel; www.hadassah-med.com), the ThoraXS is a closed, knife-shape device that permits fast penetration of the pleural space, and a mechanical opening mechanism that enables the rapid opening of a gateway in the thorax through which a chest tube (or intercostal drain) can be quickly inserted, usually in the area under the axilla where damage to internal organs can be avoided. In traumatic pneumothorax, larger bore tubes are inserted than in spontaneous pneumothorax, which are connected to a one-way valve system that allows air to escape, but not to re-enter, the chest. This may include a bottle of water that functions as a water seal, or a unidirectional Heimlich valve. Patients are evacuated with the chest tube in place for

further treatment in a hospital. Development of the ThoraXS was initiated following the recent wave of knifing terrorist attacks in Israel. “The current procedure involves two steps; a fast needle decompression of the cavity, followed by a slow, 15-minute procedure to insert the chest tube and secure the lung permanently,” said device co-developer Ariel Drori, MD, an internal medicine expert at Hadassah Medical Center. “Our students responded to terror attacks by developing life-saving medical devices, an approach that is the very essence of our BioDesign medical innovation program,” said Prof. Yaakov Nahmias, PhD, director of the HUJI BioDesign center for bioengineering. “ThoraXS is a life-saving innovation that exemplifies our commitment to helping the local and global communities through practical research and development projects.” Pneumothorax is a medical emergency resulting from an abnormal collection of air or gas in the pleural space that causes an uncoupling of

Open-Irrigated Catheter Aids Treatment of Atrial Flutter novel radiofrequency (RF) ablation catheter provides an elegant cooling platform for treating atrial flutter (AF), with robust handling capabilities. The Blazer open-irrigated (OI) RF ablation catheter is indicated for cardiac electrophysiological mapping, delivering diagnostic pacing stimuli, and RF ablation of sustained or recurrent type 1 AF in adult patients. Contraindications include patients with an active systemic infection; those with a mechanical prosthetic heart valve; patients unable to receive heparin or an alternative anticoagulant; patients who have vena cava embolic protection filter devices; those who are hemodynamically unstable; and those who have myxoma or an intracardiac thrombus. The ablation catheter features bidirectional steering, predictable trackability and torqueability, fine micromovement, and high tip stability and contact. A unique feature is Total Tip cooling, a technology to cool the catheter tip consistently during the procedure, thus improving the quality of the ablation lesion. The Blazer OI ablation catheter is intended for use

with the Maestro 4000 RF Controller and the MetriQ irrigation pump, and is available with a range of tip curve styles, including standard, large, extra-long, and asymmetric. The Blazer OI ablation catheter is a product of Boston Scientific (Natick, MA, USA; www.bostonscientific.com), and has been approved by the US Food and Drug Administration (FDA). “The Blazer open-irrigated catheter is safe and effective for the ablation of atrial flutter,” said Prof. Tom McElderry, MD, section chief of electrophysiology at the University of Alabama at Birmingham (UAB; USA), who participated in the BLOCk-CTI clinical trial of the device. Cardiac ablation is a procedure that is used to correct structural problems in the heart by scarring or destroying tissue that triggers an abnormal heart rhythm, especially supraventricular tachyarrhythmias such as AF, atrial fibrillation, and atrial tachycardia. The low-risk procedure takes 2–4 hours and is most often performed in an electrophysiology or a cardiac catheterization lab. It is successful in about 90% of the people who have it.

Image: The ThoraXS Pneumothorax device (Photo courtesy of the Hebrew University of Jerusalem).

the lung from the chest wall, causing it to collapse and resulting in suffocation. A traumatic pneumothorax

may result from either blunt trauma (such as an explosion) or a penetrating injury to the chest wall.

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PRODUCT NEWS CV DATA MANAGER

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POC TERMINAL

MEDICAL PANEL PC

Philips Healthcare

Advantech Europe

IEI Technology

The IntelliSpace Cardiovascular 2.1 provides access to images and information anytime, virtually anywhere. It includes a built-in cardiology timeline, which delivers a graphical, panoramic, and chronological overview to help streamline workflow and improve operational performance.

The POC-W181 features an 18.5-inch display and offers an Intel Core i7 processor, and a cable-free and fan-less design. It is designed for nursing carts, anesthesia and respiratory machines, and other medical equipment where an ultra-slim, lightweight design is required.

The POC-W22A-H81 features a 21.5-inch LED touch screen with IP65-compliant front bezel, antibacteria cover, and multi-touch support. It is powered by the 4th generation Intel Core i5/i3/Pentium CPU and comes with an optional 3-in-1 card reader (MSR, SCR and fingerprint).

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Motion Capture Sensors Help Detect Health Changes onitoring walking speed via unobtrusive radar and monitoring heart health by utilizing bed sensors can help maintain older adults’ health, according to new studies. Researchers at the University of Missouri (MU, Columbia, USA; www.missouri.edu) developed radar sensors that were used to monitor the walking speed of residents in ten Tiger Place (Columbia, MO, USA) retirement apartments over a period of two years. The radars were concealed in a wooden box and placed in the living room of each senior resident; monthly assessments by professionals were also conducted to establish if the residents were at risk for potential falls. The data collected by the healthcare staff were then compared to the data captured by the radar. The researchers also developed a bed sensor with the ability to continuously monitor heart rate, respiration rate, and overall cardiac activity. The sensor is constructed of a hydraulic transducer, in principal a flexible tube of water. It measures a ballistocardiogram (BCG; the mechanical effect of blood flowing through the body as a result of the heart beating). In the study, four such hydraulic transducers were placed under a mattress to capture cardiac data, with heartbeat detection based on the short-time energy of the BCG signal. The studies are slated for publication in the Journal of Ambient Intelligence and Smart Environments. “In-home sensors have the ability to capture early signs of health changes before older adults recognize problems themselves,” said Professor Marjorie Skubic, PhD, of the MU College of Engineering and director of the MU Center for Eldercare and Rehabilitation Technology. “The radar enhances our ability to monitor walking speed and determine if a senior has a fall risk; the bed sensors provide data on heart rate, respiration rate, and overall cardiac activity when a senior is sleeping. Both sensors are non-invasive and don’t require seniors to wear moni-

toring devices.” “Heart disease is a major cause of death for both men and women; having a sensor continuously monitoring heart rate provides a significant benefit for older adults,” added Professor Skubic. “The bed sensors also allow us to collect data on sleeping patterns – when people are in bed, how often they are in bed, and how long they are in bed. Similar to walking speed, sleep patterns can detect early signs of illness.” Image: Bed sensors, constructed of hydraulic transducers, are designed to monitor patient health (Photo courtesy of the University of Missouri).

New Enterprise Imaging Platform Introduced global enterprise diagnostic imaging and advanced visualization solutions provider has demonstrated the latest release of their Enterprise Imaging Platform that features thin-client, serverside processing, and simple diagnostic mobile access. The manufacturer made the announcement at the annual meeting of the American College of Radiology (ACR 2016), in Washington, DC, USA, on May 16 and 17, 2016. In April 2016, the Enterprise Imaging Platform (EIP) manufacturer signed two large deals for its EIP system that included 51 acute care and specialty hospitals in 5 US states, a network of more than 4,000 physicians, and more than 15 million interpreted exams, using the EIP,

during the terms of the contracts. The Visage Imaging (Richmond, VIC, Australia; www.visageimaging.com) Visage 7 EIP features an intelligent thin-client viewer for rapid streaming of server-side rendered images. The system provides radiologists and referring physicians with a customized, protocol-driven workflow for native viewing of multi-dimensional images on a single desktop. The Visage 7 features enterprise viewing and interpretation, image enablement of Electronic Health Records (EHR), Vendor Neutral Archives (VNA), Healthcare Information Exchange (HIE), portals, Radiology Information Systems, and Picture Archiving and Information Systems (RIS/PACS),

and mobile diagnostic access. Visage Imaging is a wholly owned subsidiary of Pro Medicus (Richmond, VIC, Australia; www. promed.com.au), which provides integrated software products and services to hospital, imaging centers and healthcare providers. Dr. Sam Hupert, CEO, Visage Imaging, said, “These new signings further demonstrate that Visage has unique technology ideally suited to address the enterprise imaging needs of the North American market. We look forward to discussing our differentiated experience and acclaimed technology with leading institutions at ACR 2016 as the industry continues to invest in enterprise imaging.” HospiMedica International October/2016

Health IT

Online Case Reviews Piloted by Cloud-Based PACS Platform

large UK society of musculoskeletal radiologists has announced that it will pilot a new platform to facilitate on-line discussions of cases between the society’s 400 members. The Picture Archiving and Communication System (PACS)-based platform developed by a UK healthcare communications technology company includes a zero-footprint fully diagnostic display of complete Digital Imaging and Communications in Medicine (DICOM) datasets, and a secure blog that enables radiologists to review and comment on patient cases. The PACSMail Cloud eMDT platform developed by Sybermedica (Cambridge, UK; www.sybermedica.com) will be accessible to radiologists from the website of the British Society of Skeletal Radiologists (BSSR; UK, www. bssr.org.uk) a professional body of more than 400 muculoskeletal (MSK) radiologists in the UK. The BSSR provides a UK national forum enabling radiologists to discuss issues related to MSK radiology imaging and practice. The PACSMail Cloud eMDT platform will enable BSSR members to review anonymized cases they have uploaded with other radiologists in the network. The platform enables multi-disciplinary teams of clinicians to share patient notes, and related diagnostic information online. The platform allows real-time collection and dissemination of clinical comments by using an innovative secure ‘Case Blog’. BSSR member radiologists will also be able to make use of the growing library of cases, as they are uploaded, for educational purposes.

New Options for Enterprise Workflow Solutions software company that provides enterprise medical imaging workflow solutions has announced that it has added new workflow features for the company’s routing and workflow management system. The company will also release a new enterprise version of the system in late summer 2016. The enterprise system will include a modular scalable architecture, and will support unrestricted Digital Imaging and Communications in Medicine (DICOM) message types. The new features will allow healthcare providers to enhance interoperability between multiple Picture Archiving and Communication Systems (PACS) systems, clinical Information Technology (IT) environments and a Vendor Neutral Archive (VNA). The new workflow capabilities of the Compass Routing and Workflow Manager, developed by Laurel Bridge Software (Newark, DE, USA; www.laurelbridge. com) include routing of HL7 messages, integration of a dictation system, DICOM load distribution and balancing, and transport of non-DICOM files. Laurel Bridge will present the enhancements at the annual meeting of the Society for Imaging Informatics in Medicine (SIIM) in Portland, OR, USA between June 29, and July 1, 2016. The Compass system can be integrated with other Laurel Bridge software to retrieve and normalize imaging studies from different facilities, VNAs or PACS systems. Mark Blair, CEO, Laurel Bridge Software, said, “The imaging workflow needs of healthcare providers are more complex than ever. We provide centralized, scalable solutions for ingesting, routing and retrieving all medical images across the clinical enterprise and the varied IT systems they encompass.”

Image: The PACSMail Cloud enables “zero footprint” viewing, storage, and reporting of patient case files (Photo courtesy of Sybermedica).

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Agreement on Health Data Interoperability Announced he US Department of Health and Human Services (HHS; Washington DC, USA; www.hhs.gov) has fostered an agreement on health data interoperability between providers and healthcare information technology (IT) firms. More than a dozen leading professional associations and stakeholder groups pledged to implement three core commitments that will improve the flow of health information to consumers and healthcare providers. The first commitment is to help consumers easily and securely access their electronic health record (EHR) information, direct it to any desired location, learn how their information can be shared and used, and be assured that this information will be effectively and safely used to benefit their health and that of their community. The second commitment is no information blocking by helping providers share personal EHR information with other providers and their patients whenever permitted by law, and not block EHR information, defined as knowingly and unreasonably

interfering with information sharing. The third commitment is to implement federally recognized, national interoperability standards, policies, guidance, and practices for electronic health information, and adopt best practices including those related to privacy and security. Many of the market leaders are embracing the Office of the National Coordinator for Health IT (ONC) Interoperability Standards Advisory, a coordinated catalog of existing and emerging standards and implementation specifications that is updated annually in order to keep pace with developments in the health IT industry. “Today I am announcing that companies providing 90% of electronic health records used by hospitals have made a public commitment to make data work better for consumers and providers,” said Sylvia Burwell, secretary of the HHS, at the annual meeting of the Healthcare Information and Management Systems Society (HIMSS). “Consumer access remains a challenge; it’s great to have an elec-

tronic record, but if that record can’t be easily accessed by doctors and patients because of funky technology, then we aren’t consistently seeing the benefit.” “We commend HHS for bringing so many stakeholders together, all of whom have an interest in using technology to result in a healthier and more efficient health care system,” said Steven Stack, MD, president of the American Medical Association (AMA; Chicago, IL, USA; www.ama-assn.org). Many of the biggest health IT developers have already committed to using standardized application programming interfaces and Health Level 7 (HL7) fast health care interoperability resources (FHIR), so that user-friendly devices, such as smartphone and tablet apps, can quickly be made market-ready and compatible with one another. The use of a single shared standard for communicating among devices will make it easier for consumers to access their test results, track progress in their care, and communicate with their providers.

Radimetrics Enterprise Platform Crafted for the Smaller Institution adimetrics Enterprise Platform was again the highlight of the European Congress of Radiology (ECR) but this year it has a new twist, or in the words of Mr. Bill Cavanaugh, Head of Global Informatics Strategy at Bayer Pharma Radiology (Whippany NJ; www.radiology.bayer.com), “Radimetrics, with our new Select Package, is a simple, affordable and scalable solution to help smaller institutions prepare for regulation while improving the performance of their radiology practices.” Bill Cavanaugh continued by explaining that Bayer Pharma Radiology had introduced a new version of the platform that helps radiologists manage radiation exposure by mitigating inefficiencies and achieving reproducible quality. It is used alongside MRI to monitor contrast dose, and in CT imaging, X-ray, interventional medicine, nuclear medicine and mammography to monitor radiation dose. It comes with tools to not only monitor radiation and contrast dose from scanners and injectors, but en-

ables the physician to manage patient dose history longitudinally. “Now we have a version of the product incorporating the specific needs of the smaller end of the market,” said Mr. Cavanaugh, explaining some of the benefits of this new version of the product. “We have brought in all of the best practices from leading healthcare institutions to transform our contrast injectors into smart connected devices within the broader hospital ecosystem, bringing efficiencies and patient-centered care to even the smallest users.” This latest version of Radimetrics also encompasses efforts to bring some of the best teaching practices from large teaching hospitals to the benefit of smaller practices. Registries are one of the latest initiatives to allow small institutions to benchmark themselves against what leading institutions. Mr. Cavanaugh cites the example of a registry being established in Germany currently. “In Germany, a new registry is under formation and we can poten-

tially compare data from an institution in Switzerland with data from a leader in Germany, as well as connecting them with what is happening in California, for example. It’s about sharing best practices.” Asked about the challenges associated with bringing a complex platform to the smaller institution, he added that it was a challenge that manifested in the art of software creation. Streamlining this complexity into a digestible format is done through the use of customizable dashboards that are preconfigured. “We’ve taken our learnings over recent years and simplified that down to five concise dashboards that are preconfigured with alerts that a small institution can use. If these institutions want to grow to more advanced capability then they can do that,” he pointed out. “It’s about quality, continuous improvement, patient safety and giving the physician time to focus on the patient because the software can be used intuitively and seamlessly.” HospiMedica International October/2016

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Health IT

Optimizing Surgical Workflow with Flat Panels he year’s European Congress of Radiology (ECR) was a prime opportunity for Thales (Neuilly sur Seine, France; www.thales group.com/en), the French multinational electronic systems company, to introduce its groundbreaking flat panel detectors and imaging solutions to radiology professionals gathered to learn more about state of the art technologies on offer this year. Jerome Tabourel, Marketing Director from Medical Radiology at Thales explained that at ECR, they were introducing a complete new product range for surgical applications. Hospital operations are evolving, he said, and the new emerging driver is the need for complementary products that help optimize workflow management. “Currently, the surgical market uses imaging intensifiers and in this respect Thales holds 50% market share. But now we are seeing a transition between imaging intensifiers and flat panel detectors,” he noted. With digital imaging and flat panel technology becoming ever more ubiquitous, the key global driver remains higher image quality with lower dose. At ECR, Thales unveiled its Pixium Surgical Imaging Suite that combines the high performance Pixium Surgical flat panel detectors with cuttingedge Image Chain Solution. The surgical market is extremely price demanding, Mr. Tabourel pointed out. “Basically we are introducing the 21 cm by 21 cm squared flat panel to re-

place the 9 inch tubes, and we are introducing the 30 cm by 30 cm panel to replace the 12 inch tubes.” In coming months, the company will launch a third product in the series of flat panel detectors. “Through an imaging chain solution we want to help our customers. It’s a software option that provides all the image processing at the level of surgical processing but it does not manage the interface with the system,” said Mr Tabourel. “These products will bring outstanding image quality in terms of processing, and compactness and this is a trend which over time will see flat panels replacing imaging intensifiers for surgical application.” Thales also introduced a new generation of flat panel detectors for digital radiography, which currently comprises a 43 cm by 43 cm square panel called the Pixium RAD 4343 C-E and G-E. He explained that this was a new generation detector for a fixed RAD room and it remains a mainstay of this segment, because of its flexibility and adaptability to any imaging solution. However, as workflow management changes, different systems are required. As a result, the Pixium Portable EZ coupled with the ArtPix Mobile EZ2GO tablet, allows technicians to take images di-

New Cloud PACS and Zero-Footprint Diagnostic Viewer he manufacturer of a leading cloud-based medical image management suite, has announced US FDA 510(k) approval of a next generation cloud PACS and HTML5 zero-footprint diagnostic viewer tools, with new features for image viewing, management, and interpretation. A global network of 70,000 users and 750+ providers exchange medical images using the platform that can eliminate the need for Virtual Private Networks (VPN), manual storage devices, and error-prone manual workflows. DICOM Grid (Phoenix, AZ, USA; www.dicomgrid.com), a healthcare Software as a Service (SaaS) company, announced the new DG PACS (Picture Archiving and Communications Systems) and DG Viewer that can be integrated into existing Health Information Exchanges (HIE), and Electronic Health Record (EHR) systems saving time, preventing redundant radiology exams, and minimizing radiation exposure for patients. The DG PACS uses configurable workflow rules for routing, a modality worklist, and integrated reporting tools, enabling organizations to man-

HospiMedica International October/2016

age medical images on-site, and offsite. The DG PACS has a cloud-based architecture enabling full diagnostic read-at-home mobile access, with teleradiology capabilities, using only a web browser. The DG Viewer enables fast diagnosis of trauma, and tele-stroke cases in an operating room during cardiovascular, orthopedic, and neurosurgery procedures. The viewer also facilitates collaboration, and consultation between clinicians. New features of the DG Viewer include annotation tools, a built-in meeting tool for review of live cases and consultations, hanging protocols and viewer customization, and 3D manipulation tools. Tyler Martin, executive director of Ambulatory Network Operations at the New England Baptist Hospital (NEBH; Boston, MA, USA; www. nebh.org), said, “Because both NEBH and outside studies are available in DICOM Grid, the physicians can easily hang priors performed at other facilities next to more recent studies done within the hospital. This streamlines their workflow, allowing them to more rapidly arrive at a treatment plan for the patient.”

rectly in patients’ rooms and to instantly view the clinical image. “Here we take a tablet which has uploaded all the post-processing software and the user can see the images in the operation room. They can also be sent directly to the PACS,” explained Mr. Tabourel. “This is of great benefit, as it significantly improves the workflow against legacy solutions. Now with a single tablet we can do all the examinations needed. This is completely changing how technicians are working.” Image: The Pixium surgical imaging suite (Photo courtesy of Thales).

Hospital News I

Ontario to Modernize Hospital Infrastructure Across Province he Canadian province of Ontario has announced that it will implement a CAD 12 billion investment plan in hospital infrastructure over a period of ten years. The health care infrastructure investments, part of the 2016 budget, will expand high-quality care access to 35 major hospital projects, which are under construction or in various stages of planning, such as the Mackenzie Health (Richmond Hill, ON, Canada; www.mackenziehealth.ca) Vaughan Hospital project; a new Providence Care (Kingston, ON, Canada; www. providencecare.ca) hospital in Kingston; expansion and redevelopment at Cambridge Memorial Hospital (ON, Canada; www.cmh.org), and renovation of acute and long- term care beds at Atikokan General Hospital (Canada;

www.aghospital.on.ca). The province will also grant CAD 50 million in new annual funding to assist qualifying hospitals in the repair and maintenance of their facilities, and a further CAD 345 million increase in operational funding for hospitals during fiscal year 2017-2017. The hospital investment plan is part of long-term investment in public infrastructure, the largest in the province’s history, totaling in all about CAD 160 billion over a 12-year period, and includes diverse projects such as roads, bridges, transit systems, schools, and hospitals. “Making these important investments in hospitals will ensure patients get the high-quality health care they need – when they need it,” said Dr. Eric Hoskins, Minister of Health

and Long-Term Care. “It is just one of the ways in which we are putting patients first, by improving the performance of our health care system while working to ensure it is sustainable to meet the future needs of Ontarians.” “Throughout Ontario, hospitals are often viewed as organizations that play an important role in local communities,” said Anthony Dale, president and CEO of the Ontario Hospital Association (Toronto, ON, Canada; www.oha.com). “Today’s

announcement will allow for continued modernization of Ontario hospitals, ensuring that state-of- the-art facilities exist for all Ontarians. The Ontario Hospital Association applauds the government for its continued commitment to and investment in patient and client-centered care.” Image: A concept rendition of the Mackenzie Health Vaughan Hospital project (Photo courtesy of Zeidler Partnership Architects).

Finnish Central Hospital to Undergo Major Modernization he European Investment Bank (Luxemburg; EIB, www.eib.org) has provided a long-term loan of ğ 55 million to the South Savo Social and Health Care Joint Authority to renovate and extend the Central Hospital campus in Mikkeli (Finland). The campus, situated in the center of the 55,000 municipality, will undergo a renovation and extension designed to consolidate healthcare and social services by providing a single site that can respond effectively to the care needs of the ageing population of the region. Among the changes will be a better configured infrastructure, which is expected to reduce service costs through shorter hospitalization periods, reduced waiting times, and improved use of scarce resources. Modernization and replacement of outdated buildings will also improve hygiene and safety conditions. The reforms will be implemented in five stages, and is due to be completed by 2020. The first stage will include the construction of new buildings with a gross area of approximately 19,000 m2, and reno-

vation of about 23,000 m2 of existing buildings. The hospital’s outpatient facilities will be completed first, and will include the transfer of the Mikkeli city health center clinic into the outpatient area of the hospital campus, with a significant part of social services and primary healthcare integrated functionally with specialized healthcare. The other stages of the programme will be implemented between 2017 and 2020, and will include new acute hospital services, a maternal and child health service facility and somatic wards, a dental clinic, and a mental health hospital. Construction of parking facilities began in April 2016, to be completed in the spring of 2017. The EIB loan will also finance the digitalization of healthcare services; and due to the reduced footprint and use of modern technologies and materials, the new, modernized buildings will actually reduce the overall size of the hospital premises by about 20%. “The European Investment Bank is committed to supporting long-term investment that will increase the supply of healthcare services and im-

prove access to healthcare; modernizing central hospitals is essential in order to secure a high level of healthcare provision and to keep costs under control,” said Jan Vapaavuori, vice-president of the EIB. “This programme will help to move Finland’s social and healthcare reform forward, and thus provide good practice and serve as a model to others.” Image: An artist’s rendition of the new central hospital campus in Mikkeli (Finland) (Photo courtesy of EIB).

New Cancer Hospital in China oncord Medical Services (CMS, Beijing, China; www.concordmedical.com) has announced the preliminary opening of Datong Meizhongjiahe Cancer Hospital (Shanxi Province, China). The 100-bed hospital is a Level-II specialty cancer hospital with radiation, imaging, test laboratory, radiotherapy, and diagnostic imaging equipment, including a linear accelerator and a magnetic resonance imaging (MRI) system. The hospital is the first wholly owned hospital in the projected Meizhongjiahe-branded network of

hospitals planned for Chinese Tier II and Tier III cities, and will complement CMS high-end hospitals in Tier I cities such as Beijing, Shanghai, and Guangzhou. As of December 31, 2015, CMS operated a network of 127 centers with 76 hospital partners that spanned 53 cities and 25 provinces and administrative regions in China. Under long-term arrangements with top-tier hospitals in China, the company provides radiotherapy and diagnostic imaging equipment and manages the daily operations of these centers, which are located on the premises of

its hospital partners. The Company also provides ongoing training to doctors and other medical professionals in its network of centers to ensure a high level of clinical care for patients. CMS is undergoing an expansion drive in the Chinese domestic market, and is currently establishing specialty cancer hospitals in Wuxi, Hangzhou, Taizhou, and Nanchang. In addition, as part of its high-end cancer hospital development strategy and oversea business extension, the company acquired Concord Cancer Hospital, a private hospital in Singapore in April 2015. HospiMedica International October/2016

Industry News

Hill-Rom Acquires Therapeutic Mattress Maker omfort Holdings subsidiary of Hill-Rom Inc. (Batesville, IN, USA; www.hill-rom. com) has acquired Anodyne Medical Device, Inc. Anodyne, also known as Tridien Medical (Coral Springs, FL, USA; www.tridien.com), produces medical therapeutic mattresses and chairs. Apart from hospital beds, support surfaces and mattresses, Hill-Rom also markets surgical equipment, including scalpels and surgical positioning tools, as well as respiratory care devices, such as a vest-based airway clearance

system. Tridien’s product range includes powered alternating pressure mattresses and non-powered mattresses that adjust to a patient’s weight and/or position, mattresses that distribute a patient’s weight evenly to prevent pressure ulcers, and a mattress that alternates pressure to treat pressure ulcers. CODI, which owns and manages a diverse family of established North American middle market businesses, maintains controlling ownership interests in each of its subsidiaries, and also held a majority stake in Tridien that was sold to Hill-Rom.

Sony Acquires Belgian Medical IP Video Solutions Provider ony Europe Ltd. (Weybridge, UK; www.pro.sony.eu) has acquired eSATURNUS NV (Leuven, Belgium; www.esaturnus. com), which provides clinical video over IP solutions in the medical field. Adam Fry, Vice President, Sony Professional, Sony Europe, commented, “Over the past few years, we’ve seen the requirements within hospitals significantly change. There is a constant need to maximize the investment hospitals make in clinical equipment. But with the advent of new technology and workflow solutions, it has never been more important to them to be able to invest in ‘future proofed’ installations, with a holistic and long-range view. This means hospitals are looking for endto-end and state-of-the-art workflows

that perform efficiently but that can also evolve over time. Together with eSATURNUS, Sony will aim to further develop smart, scalable and leading-edge clinical Video over IP workflow solutions in digitally-integrated operating room systems.” eSATURNUS' know-how of hospital operating room workflows, as well as IP-based video integration software, enables processing, control and distribution of multiple image sources combined with medical information. This, along with Sony’s imaging and AV/IT technologies in this field, will allow the combined company to develop further smart clinical video over IP solutions for inside and outside operating rooms. Sony plans to initially expand the business in Europe, followed by international deployment in the future.

Global Advanced Patient Monitoring Market Crosses USD 35 Billion Mark he global advanced patient monitoring market is worth USD 35.2 billion in 2016 and is being driven by the demand to integrate data processing capabilities and electronic medical records (EMR) transfer options, coupled with the increasing trend to upgrade to ambulatory and hand-held devices. These are the latest findings of Kalorama Information, (New York, NY, USA; www. kaloramainformation.com), an independent medical market research firm. The global advanced patient monitoring market includes products in the following segments: blood management and function monitors, cardiac event and function monitors, neurological event monitors, respiratory function monitors, and other ad-

HospiMedica International October/2016

vanced monitors. The market includes equipment and devices with wireless and remote technologies, patient data processing applications and features, and applications that transfer patient monitoring results to EMRs. The global advanced patient monitoring market continues to expand in the institutional as well as home segments of the health market, led by the US and European countries. New patient monitoring systems are being introduced in the market in response to the increased healthcare needs of an aging population, new wireless technologies, better video and monitoring technologies, cutting down of healthcare resources, focus on reducing hospital days, and improving costeffectiveness.

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

International Calendar, HospiMedica International P.O.Box 802214, Miami, FL 33280-2214, USA Fax: 1-954-893-0038 • E-mail: info@globetech.net

SEPTEMBER 2016 ERS 2016 – Annual Congress of European Respiratory Society. Sep 3-7; London, UK; Web: www.erscongress.org 35th Annual ESRA Congress 2016The European Society of Rergional Anaethesia and Pain Therapy. Sep 710; Maastricht, The Netherlands; Web: http://esraeurope.org/meetings EACMFS 2016- European Association for Cranio Maxillofacial Surgery Congress. Sep 13-16; London, UK; Web: www.2016.eacmfscongress.org 26th World Congress on Ultrasound in Obstetrics and Gynecology. Sep 25-28; Rome, Italy; Web: www.isuog.org

OCTOBER 2016 ESICM 2016 – 29th Annual Congress – European Society of Intensive Care Medicine. Oct 1-5; Milan, Italy; Web: www.esicm.org 11th Interventional MRI Symposium. Oct 7-8; Baltimore, USA; Web: www. HopkinsCME.edu 24th UEG Week – United European Gastroenterology. Oct 15-19; Vienna, Austria; Web: www.ueg.eu Cardiac Imaging 2016 - European Society of Cardiac Radiology. Oct 20-22; Krakow, Poland; Web: www. escr.org Euroson 2016 – Congress of the Eu-

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