For the first time, researchers have shown that using Magnetic Resonance Imaging (MRI) can effectively identify bone marrow cancer (myelofibrosis) in an experimental model. The finding may change the way this disease is diagnosed which is now through invasive bone marrow biopsies. Myelofibrosis is a slow evolving condition hallmarked by increased myeloid cells and in the case of primary myelofibrosis, with an excessive number of large bone marrow cells called megakaryocytes. The pathology also is characterized by structural abnormality of the bone marrow matrix, which at end-stage manifests in excessive deposition of reticulin fibres and cross-linked collagen in the bone marrow, suppression of normal blood cell development and bone marrow failure. Currently the diagnosis is made via an invasive bone marrow biopsy and histophatology to assess cellularity and reticulin deposition in the marrow. Researchers at Boston University School of Medicine (BUSM) led by Katya Ravid, PhD, designed and tested whether a T2-weighted MRI could detect bone marrow fibrosis in an experimental model. The group was able to show that an MRI could detect a pre-fibrotic state of the disease with a clear bright signal, as well as progressive myelofibrosis. The investigators proposed that the abundance of large megakaryocytes contribute to the signal, since in T2-weighted MR-images, increased water/proton content, as in increased cellularity, yield high (bright) MR-signal intensity. This is the first study to evaluate a T2-weighted MRI in an experimental model of myelofibrosis with examination of potential sources of the MRI signal, researchers said. “Our study provides proof-of-concept that this non-invasive modality can detect pre-fibrotic stages of the disease,” said Ravid, professor of medicine and biochemistry at BUSM. “It is intriguing to speculate that future pre-biopsy MRI of the human pathology might guide in some cases decisions on if and where to biopsy,” she added.
Boston University School of Medicinehttp://tinyurl.com/y74qq8pv
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Researchers at the University of Rochester Medical Center have developed a new imaging technique that could revolutionize how eye health and disease are assessed. The group is first to be able to make out individual cells at the back of the eye that are implicated in vision loss in diseases like glaucoma. They hope their new technique could prevent vision loss via earlier diagnosis and treatment for these diseases. In a study Ethan A. Rossi, Ph.D., assistant professor of Ophthalmology at the University of Pittsburgh School of Medicine, describes a new method to non-invasively image the human retina. The group, led by David Williams, Ph.D., Dean for Research in Arts, Sciences, and Engineering and the William G. Allyn Chair for Medical Optics at the University of Rochester, was able to distinguish individual retinal ganglion cells (RGCs), which bear most of the responsibility of relaying visual information to the brain. There has been a longstanding interest in imaging RGCs because their death causes vision loss in glaucoma, the second leading cause of acquired blindness worldwide. Despite great efforts, no one has successfully captured images of individual human RGCs, in part because they are nearly perfectly transparent. This new approach might eventually allow us to detect the loss of single ganglion cells. The sooner we can catch the loss, the better our chances of halting disease and preventing vision loss. Instead of imaging RGCs directly, glaucoma is currently diagnosed by assessing the thickness of the nerve fibres projecting from the RGCs to the brain. However, by the time a change is typically detected in the retinal nerve fibre thickness, a patient may have lost tens of thousands of RGCs or more. “In principle, this new approach might eventually allow us to detect the loss of single ganglion cells,” said Williams. “The sooner we can catch the loss, the better our chances of halting disease and preventing vision loss.” Rossi and his colleagues were able to see RGCs by modifying an existing technology – confocal adaptive optics scanning light ophthalmoscopy (AOSLO). They collected multiple images, varying the size and location of the detector they used to gather light scattered out of the retina for each image, and then combined those images. The technique, called multi-offset detection, was performed at the University of Rochester Medical Center in animals as well as volunteers with normal vision and patients with age-related macular degeneration.
The University of Rochester Medical Centerhttp://tinyurl.com/yc78dk4v
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Siemens Healthineers is joining forces with U.S.-based Imricor Medical Systems, Inc. to develop an integrated solution that combines the clinical benefits of real-time MRI scans with 3D-guided cardiac ablation. MRI-compatible devices are planned to be able to translate information on cardiac conduction, morphological substrates and individual patient anatomy into better treatment outcomes. This approach will potentially enable electrophysiologists around the world to treat heart arrhythmia without radiation and to use the visualization of soft tissue information obtained through MRI for this purpose. “We are very excited about this development partnership, since it is changing the way we look at ablation and its resulting physiological effects for higher precision and better treatment outcome,” explains Dr. Philipp Fischer, head of Cardiology at Siemens Healthineers. Steve Wedan, CEO of Imricor Medical Systems, Inc. describes the partnership’s objectives: “We are thrilled to partner with Siemens Healthineers with a goal of delivering comprehensive solutions for MRI-guided ablations. Together, we look forward to providing patients and physicians with MRI-compatible devices from Imricor that are fully integrated with Siemens’ iCMR-EP labs around the world. Our shared goal is to unlock the potential of interventional MRI for electrophysiology by providing better, faster, and less expensive treatment options.” Electrophysiology is one of the fastest growing fields within cardiology, especially the interventional therapy of complex arrhythmia such as atrial fibrillation (AFib/AF) and ventricular tachycardia (VT). The intervention itself involves inserting a special catheter into the heart to treat a cardiac conduction defect, a complex procedure in which optimum imaging is essential. “This partnership is planned to help us better translate patients’ individual pathophysiology into personalized treatment approaches. MRI guidance will not only minimize radiation exposure to patients and EP staff. This technology will enable more detailed insights into the target anatomy and tissue properties, and holds the potential to improve clinical outcomes in arrhythmia therapy,” explains Dr. Christoph Zindel, Senior Vice President and General Manager of Magnetic Resonance Imaging at Siemens Healthineers. “Together with our partner Imricor, we are committed to further developing EP solutions for the benefit of the rising population of arrhythmia patients”.
www.siemens.com/healthineers www.imricor.com
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B. Braun Melsungen AG, active in regional anesthesia and pain management, and Royal Philips, a global leader in ultrasound and image-guided therapy solutions, recently announced a multi-year strategic alliance to innovate ultrasound-guided regional anesthesia – a rapidly growing alternative to general anesthesia – and vascular access. Leveraging the companies’ combined deep clinical expertise and R&D capabilities, as well as sales and service channels, B. Braun and Philips are jointly developing and commercializing solutions to support anesthesiologists and hospitals in critical areas of regional anesthesia. These solutions are intended to enhance needle visualization and guidance, as well as optimize procedure workflow and resource planning. The alliance will also focus on vascular access procedures, such as those used to insert catheters into deeply seated veins as part of a catheter-based treatment. As a platform on which to implement their joint innovations, Philips and B. Braun are launching the new Xperius ultrasound system, which will be available in a cart and ultra-mobile tablet version. Based on the input of clinical experts, Xperius was specifically designed to support the needs in regional anesthesia at the point of care. The system offers an intuitive user interface and exceptional image quality for confident needle targeting and positioning, as well as ergonomic features such as the articulating arm. Xperius complements B. Braun´s innovative offering in the field of ultrasound guided regional anesthesia which includes the newly launched peripheral nerve block portfolio comprising Stimuplex® and Contiplex® Ultra 360®. It has also been specifically designed to support future innovations for needle visualization and guidance. The two companies will offer education, training, service and support that will enable anesthesiologists and healthcare providers to extract maximum benefit from the system. Regional anesthesia or analgesia involves the injection of an anesthetic in the proximity of a nerve, targeting areas of a patient’s body that are subject to surgical intervention. Regional anesthesia can have significant advantages over general anesthesia for both patients and hospitals. Patients undergoing regional anesthesia typically benefit from reduced opioid consumption and fewer side-effects, such as nausea. Moreover, regional anesthesia may lead to faster post-surgical recovery, allowing patients to ambulate or leave the hospital sooner, which benefits both patients and hospitals. However, regional anesthesia and especially peripheral nerve blocks are not easy to perform. Maximizing anesthetic effectiveness and preventing damage to the targeted nerve or other tissue structures depends on the accurate placement of the needle tip through which the anesthetic will be injected or a catheter will be placed. Hence, there is a real need for innovations that continually improve the safety, effectiveness, and efficiency of regional anesthesia procedures. “Our customers are looking for fully integrated system solutions that address all aspects of their everyday work in caring for patients, including the enhanced efficiency needed to meet ever-increasing demand for their services,” said Dr. Meinrad Lugan, Member of the Board for the Hospital Care Division at B. Braun. “This new alliance with Philips illustrates our commitment to sharing expertise, not only with our customers, but also with other key technology players, to meet healthcare needs and challenges faced today and into the future.” “Philips and B. Braun have a worldwide reputation for clinical innovations and a shared commitment to work with patients and care providers to optimize healthcare delivery and improve patient outcomes,” said Rob Cascella, Chief Business Leader of the Diagnosis & Treatment Businesses at Philips. “By partnering with B. Braun, we have created a solution for ultrasound-guided regional anesthesia comprising the Xperius ultrasound system, decision support software, echogenic needles, and a suite of services. We look forward to jointly developing further innovations. This new alliance is a great example of our commitment to partnering with industry leaders with complementary skills to increase our footprint in the therapy market.” The Xperius platform will be co-branded and sold via B. Braun’s global sales network, with Philips providing installation and service.
www.philips.com www.bbraun.com
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From September 6 – 8, 2017, the Queen Sirikit National Convention Center in Bangkok will again host MEDICAL FAIR THAILAND, 8th International Exhibition on Hospital, Diagnostic, Pharmaceutical, Medical & Rehabilitation Equipment & Supplies.
This year’s edition is set to be its largest, with more than 700 international exhibitors expected. A total of 17 national and country pavilions will present more than 5,000 state-of-the-art medical and healthcare products, equipment and solutions to a targeted audience of 10,000 medical and healthcare professionals. For the first time, Russia, India and the European Union will have country group exhibits at MEDICAL FAIR THAILAND.
Organized by Messe Düsseldorf Asia, the subsidiary of Messe Düsseldorf in Germany, MEDICAL FAIR THAILAND 2017 is part of the company’s “World of Medica” portfolio. The trade fair is the ideal platform for the dynamic marketplace of Thailand and Southeast Asia. Since its start in 2003, MEDICAL FAIR THAILAND has developed into the region’s No. 1 medical and healthcare event. With every event, the international participation is increasing, reflecting the growth of Thailand and the Southeast Asian region’s medical and healthcare industry. Leading the first participation at the exhibition with an official Indian national pavilion, Mr. Rajiv Nath from the Forum Coordinator for the Association of Indian Medical Device Industry (AiMED) commented: “MEDICAL FAIR THAILAND 2017 provides Indian companies with an unparalleled opportunity to leverage on the potential of Southeast Asia’s booming medical and healthcare industry. We are excited to be leading our members to this biggest regional platform, to connect and create strong bonds with businesses from around the region and all over the world.” Also debuting at MEDICAL FAIR THAILAND 2017 will be the European Union pavilion. Dr. Michael Pulch, Ambassador, European Union Delegation to Singapore, stated: “This presents an excellent opportunity for European companies specializing in healthcare and medical technologies. As Thailand is one of the leading Southeast Asian countries in the medical technologies industry, the participation of companies from the European Union at MEDICAL FAIR THAILAND 2017 will allow them to reach, connect and network with the right audience.”
Gernot Ringling, Managing Director of Messe Düsseldorf Asia, added: “With Thailand’s dynamic positioning as a leading medical and healthcare hub, which is being further enhanced as the country goes into full gear with Thailand 4.0, value creation and innovation will take centre stage. MEDICAL FAIR THAILAND 2017 will focus on rehabilitative care and connected healthcare, such as digital healthcare equipment and solutions as well as wearable technologies that are rapidly transforming the market. The technologies and innovations on display will contribute to the exhibition’s success as the most important resource and business platform for both international and regional suppliers from the medical and healthcare sectors, bringing together a truly global showcase of the best medical and healthcare devices, services and innovative solutions for both in-and out-patient and rehabilitative care.”
Thailand 4.0, as an economic model, is aiming to transform Thailand into an innovation-driven economy achieving upper-income status – with an emphasis on promoting technology, creativity and innovation in focused industries and changing from a production-based to a service-based economy. The medical and healthcare sectors have been selected alongside ten target industries as growth engines where additional policies will encourage further investment and development in the near future.
The exhibits will be complemented by an informative ancillary programme. The Advanced Rehab Technology Conference (ARTeC) 2017 on September 6 & 7 will focus on the theme of “Robotics for Mobility: Quality of Life for the Ageing World.” The conference will explore a series of topics on robotic rehabilitation from analysis to design and intervention, robots for balance and gait training and a symposium on locomotion robotic training for neurorehabilitation. Renowned leaders and industry experts from the U.S., Japan, Singapore and Thailand will participate, including Hermano Igo Krebs, Principal Research Scientist from the Mechanical Engineering Department at MIT. The two-day conference is jointly organized by the Royal College of Physiatrists of Thailand, the Thai Rehabilitation Medicine Association and Messe Düsseldorf Asia. The Dysphagia workshop on September 7 will address difficulties in swallowing – particularly for the elderly and offer evaluation and management programmes, indirect therapies and future rehabilitation treatments.
In addition, comprehensive and user-friendly business matching services dedicated to helping businesses identify and screen potential partners will be available for all exhibitors and visitors to find new partners and suppliers. This free service is particularly useful for companies looking to expand their business in the Southeast Asian region or to connect with international companies.
www.medicalfair-thailand.com
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The 2017 edition of KIMES brought together a record number of exhibiting companies and visitors from Korea and 92 other countries. A total of 1292 exhibitors – a 12% increase over 2016 – from 41 countries presented over 30,000 products covering the full range of medical equipment, from radiology and medical imaging systems to emergency equipment, from surgical instruments to dental appliances, from medical information systems to disposables, as well as cosmetic and dermatology products. In addition, there was a growing medical device component section that numbered 198 manufacturing and service companies.
Korea’s vibrant medical industry sector was well represented with 579 exhibitors, followed by China (154), the United States (125), Germany (88) and Japan (62).
As last year, the show was held concurrently with Global Bio & Medical Plaza, hosted by KOTRA and acting as the principal global platform for facilitating cooperation and trading between Korean and foreign companies in the bio and medical industries. The event is designed to develop concrete business relationships and pursue potential contract opportunities between guests from abroad and Korean companies. This year it attracted 226 companies from 61 countries, including for the first time a strong delegation from the European Union Buyer’s Group.
Conference A total of 180 sessions took place in the COEX Conference Centre during the show and covered a variety of topics, including the latest advances in medical device technology as well as government policies on the medical device market. The seminar programme was kicked off by keynote speaker Andrew Nordon of the World-first cancer detection programme.
www.kimes.kr
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In the last decade, mounting evidence has linked seizure-like activity in the brain to some of the cognitive decline seen in patients with Alzheimer’s disease. Patients with Alzheimer’s disease have an increased risk of epilepsy and nearly half may experience subclinical epileptic activity – disrupted electrical activity in the brain that doesn’t result in a seizure but which can be measured by electroencephalogram (EEG) or other brain scan technology. In a recent feasibility study, clinician-scientists at Beth Israel Deaconess Medical Center (BIDMC) tested an anti-epileptic drug for its potential impact on the brain activity of patients with mild Alzheimer’s disease. The team, led by Daniel Z. Press, MD, of the Berenson-Allen Center for Non-invasive Brain Stimulation at BIDMC, documented changes in patients’ EEGs that suggest the drug could have a beneficial effect. “In the field of Alzheimer’s disease research, there has been a major search for drugs to slow its progression,” said Press, an Instructor of Neurology in the Cognitive Neurology Unit at BIDMC and an Associate Professor of Neurology at Harvard Medical School. “If this abnormal electrical activity is leading to more damage, then suppressing it could potentially slow the progression of the disease.” In this double-blind within-subject study, a small group of patients with mild Alzheimer’s disease visited BIDMC three times. At each visit, patients were given a baseline (EEG) to measure the electrical activity in the brain. Next, patients were given injections containing either inactive placebo or the anti-seizure drug levetiracetam, at either a low dose (2.5 mg/kg) or a higher dose (7.5 mg/kg). Neither patients nor medical professionals knew which injections patients were receiving, but each patient eventually got one of each type, in a random order. After receiving the injection, patients underwent another EEG, then magnetic resonance imaging (MRI) – which measures blood flow in the brain, another way to quantify brain activity and determine where in the brain it is taking place. Finally, patients took a standardized cognitive test, designed to measure memory, executive functioning, naming, visuospatial ability and semantic function – capabilities all affected by Alzheimer’s disease. In the seven patients able to complete the study protocol successfully, Press and colleagues analysed changes in their EEGs. (Blood flow analysis from the MRI data is still underway.) Overall, higher doses of the anti-seizure drug appeared to normalize abnormalities seen in the patients’ EEG profiles. That is, researchers saw overall increases in brain wave frequencies that had been abnormally low in Alzheimer’s disease patients prior to receiving the higher dose of levetiracetam, and, likewise, saw decreases in those that had been abnormally high. “It’s worth noting, we did not demonstrate any improvement in cognitive function after a single dose of medication in this study,” said Press. “It’s too early to use the drug widely, but we’re preparing for a larger, longer study.”
Beth Israel Deaconess Medical Center www.bidmc.org/News/PRLandingPage/2017/June/Press-Anti-Epilepsy-Alzheimers.aspx
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Researchers at the University of Texas at Dallas have developed a wearable diagnostic biosensor that can detect three interconnected, diabetes-related compounds — cortisol, glucose and interleukin-6 — in perspired sweat for up to a week without loss of signal integrity. The team envisions that their wearable devices will contain a small transceiver to send data to an application installed on a cellphone. "Type 2 diabetes affects so many people. If you have to manage and regulate this chronic problem, these markers are the levers that will help you do that," said Dr. Shalini Prasad, professor of bioengineering in the Erik Jonsson School of Engineering and Computer Science. "We believe we’ve created the first diagnostic wearable that can monitor these compounds for up to a week, which goes beyond the type of single use monitors that are on the market today." Prasad and lead author Dr. Rujute Munje, a recent bioengineering PhD graduate, describe their wearable diagnostic biosensor that can detect three interconnected compounds — cortisol, glucose and interleukin-6 — in perspired sweat for up to a week without loss of signal integrity. "If a person has chronic stress, their cortisol levels increase, and their resulting insulin resistance will gradually drive their glucose levels out of the normal range," said Prasad, Cecil H. and Ida Green Professor in Systems Biology Science. "At that point, one could become pre-diabetic, which can progress to type 2 diabetes, and so on. If that happens, your body is under a state of inflammation, and this inflammatory marker, interleukin-6, will indicate that your organs are starting to be affected." Last October, Prasad and her research team confirmed they could measure glucose and cortisol in sweat. Several significant advances since then have allowed them to create a more practical, versatile tool. "We wanted to make a product more useful than something disposable after a single use," Prasad said. "It also has to require only your ambient sweat, not a huge amount. And it’s not enough to detect just one thing. Measuring multiple molecules in a combinatorial manner and tracking them over time allows us to tell a story about your health." One factor that facilitated their device’s progress was the use of room temperature ionic liquid (RTIL), a gel that serves to stabilize the microenvironment at the skin-cell surface so that a week’s worth of hourly readings can be taken without the performance degrading over time. "This greatly influences the cost model for the device — you’re buying four monitors per month instead of 30; you’re looking at a year’s supply of only about 50," Prasad said. "The RTIL also allows the detector to interface well with different skin types — the texture and quality of paediatric skin versus geriatric skin have created difficulties in prior models. The RTIL’s ionic characteristics make it somewhat like applying moisturizer to skin." Prasad’s team also determined that their biomarker measurements are reliable with a tiny amount of sweat — just 1 to 3 microliters, much less than the 25 to 50 previously believed necessary.
Scientists from the German Cancer Research Center (DKFZ), in collaboration with colleagues from Heidelberg University Hospital, have been able to visualize brain cancer using a novel MRI method. They use a simple sugar solution instead of conventional contrast agents, which can have side effects in the body. In magnetic resonance imaging (MRI), contrast agents are used to enhance the imaging of tissue structures. While they enhance signals in blood vessels and in spaces between cells, they do not reach the interior of the cell. By contrast, glucose is taken up and then broken down in the body cells. Tumour cells are particularly hungry for glucose in order to feed their high energy needs. By observing glucose metabolism activity it may therefore be possible to identify solid tumours or very aggressively growing tumour areas. Radiologists and physicists from the German Cancer Research Center (Deutsches Krebsforschungszentrum, DKFZ) in Heidelberg have now succeeded in employing this novel type of imaging. Conventional MRI is based on measuring the signals from protons in water. Since over 60 percent of our body is made up of water, this delivers a clear picture. Glucose is found at much lower levels in our body. In order to make it visible, the DKFZ researchers are therefore using an ultrahigh field scanner with 7 Tesla magnetic field strength and a special method to reinforce the glucose signal distinctly and selectively. This makes it possible to obtain sufficient signal strength in order to visualize changes in glucose levels in brain tissue after injection of a glucose solution. The underlying physical principle of this method is called magnetization transfer effect. While this effect has been known for decades, it hasn’t been possible so far to use it for glucose imaging in humans. In magnetization transfer, the signal from glucose protons is transferred to bodily water, which is measured in MRI. The effect is proportional to the local glucose level, thus reflecting regional changes in glucose levels. The amount of glucose needed for glucose measuring corresponds to about five sugar cubes. In the present work, physicist Patrick Schuenke and physician and physicist Daniel Paech have been able to observe the changes of glucose signals in healthy brain regions as well as pathogenic changes in human brain cancer. For decades now, scientists have used another measuring method, called positron emission tomography (PET), to visualize elevated glucose uptake in tumours. However, this method requires radioactively labelled glucose molecules. "Our glucose MRI does not require any radioactivity and therefore does not involve any radiation exposure for the patient," said Paech, who is the first author of the publication.
The German Cancer Research Center (Deutsches Krebsforschungszentrum, DKFZ) www.dkfz.de/en/presse/pressemitteilungen/2017/dkfz-pm-17-35-MRI-without-contrast-agents-with-sugar.php
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The immunotherapy nivolumab is kinder than chemotherapy for people with advanced head and neck cancer – easing many of the negative effects of the disease on patients’ quality of life. Both head and neck cancer and the treatment for it can have a huge impact on patients – affecting their speech, breathing, eating and drinking, facial appearance, and general wellbeing. All of this can cause substantial psychological, as well as physical, distress. But patients taking part in a major phase III clinical trial – led by researchers at The Institute of Cancer Research, London, and The Royal Marsden NHS Foundation Trust – reported that nivolumab helped them maintain a better quality of life for longer. By contrast, the same study also found that people treated with standard chemotherapies docetaxel, methotrexate or cetuximab reported a decline in quality of life from the start of treatment. Last year, the clinical trial of 361 patients found that nivolumab – which sparks the immune system into action against cancers – greatly increased survival for people with recurrent or metastatic head and neck cancer. But the drug was initially rejected by NICE in April this year and is currently under consultation before a final decision is due. The new results add to the growing body of evidence that immunotherapy can be a smarter, kinder treatment for people with cancer. In the latest study, 129 patients on the trial filled in questionnaires about their quality of life – covering physical symptoms, mental health and general wellbeing. While patients on chemotherapy judged their quality of life to be lower at nine and 15 weeks into the trial, patients on nivolumab gave consistently better ratings throughout. After nine weeks, patients given nivolumab reported that they were doing better than their counterparts on other treatments for a range of symptoms, including pain, sensory problems, appetite loss, tiredness and breathing problems. After 15 weeks, the list of beneficial effects was even longer, with patients taking nivolumab being less badly affected by nausea, insomnia and weight loss.
Institute of Cancer Research www.icr.ac.uk/news-archive/immunotherapy-kinder-than-chemotherapy-for-patients-with-head-and-neck-cancer
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