Archive for month: August, 2020

Peripheral intravenous cannula (PIVC) insertion in the emergency department can be reduced using a multimodal approach designed to support critical thinking and promote clinically appropriate peripheral intravenous cannula insertion and use.
The lead author of the study is Tracey Hawkins, Grad Cert (ENurse), in the Department of Emergency Medicine, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia.
The study, by Hawkins, et al, showed that multimodal intervention not only reduced PIVC placement in the ED, it also increased the percentage of PIVCs placed that were used. These findings suggest that this program benefits patients and health services alike, with potential for large cost savings. Ali Tann, BSN, RN, CEN a registered nurse in the emergency department at IU Health Methodist Hospital, Indianapolis, commented:
“Many PIVs are placed because we know that labs will be ordered, but may not be sure about fluids and/or meds and don’t want to stick the patient too many times. Simply stated, the more sticks the unhappier the patient. But ultimately, in order for PIV campaigns to be successful, there needs to be more consensus among the providers. In other words, if the gut works, use it!”

Medical Newshttps://tinyurl.com/y72ktac7

MIT researchers, working with scientists from Brigham and Women’s Hospital, have developed a new way to power and communicate with devices implanted deep within the human body. Such devices could be used to deliver drugs, monitor conditions inside the body, or treat disease by stimulating the brain with electricity or light.
The implants are powered by radio frequency waves, which can safely pass through human tissues. In tests in animals, the researchers showed that the waves can power devices located 10 centimeters deep in tissue, from a distance of 1 meter.
“Even though these tiny implantable devices have no batteries, we can now communicate with them from a distance outside the body. This opens up entirely new types of medical applications,” says Fadel Adib, an assistant professor in MIT’s Media Lab and a senior author of the paper, which will be presented at the Association for Computing Machinery Special Interest Group on Data Communication (SIGCOMM) conference in August.
Because they do not require a battery, the devices can be tiny. In this study, the researchers tested a prototype about the size of a grain of rice, but they anticipate that it could be made even smaller.
“Having the capacity to communicate with these systems without the need for a battery would be a significant advance. These devices could be compatible with sensing conditions as well as aiding in the delivery of a drug,” says Giovanni Traverso, an assistant professor at Brigham and Women’s Hospital (BWH), Harvard Medical School, a research affiliate at MIT’s Koch Institute for Integrative Cancer Research, and an author of the paper.
Medical devices that can be ingested or implanted in the body could offer doctors new ways to diagnose, monitor, and treat many diseases. Traverso’s lab is now working on a variety of ingestible systems that can be used to deliver drugs, monitor vital signs, and detect movement of the GI tract.
In the brain, implantable electrodes that deliver an electrical current are used for a technique known as deep brain stimulation, which is often used to treat Parkinson’s disease or epilepsy. These electrodes are now controlled by a pacemaker-like device implanted under the skin, which could be eliminated if wireless power is used. Wireless brain implants could also help deliver light to stimulate or inhibit neuron activity through optogenetics, which so far has not been adapted for use in humans but could be useful for treating many neurological disorders.
Currently, implantable medical devices, such as pacemakers, carry their own batteries, which occupy most of the space on the device and offer a limited lifespan. Adib, who envisions much smaller, battery-free devices, has been exploring the possibility of wirelessly powering implantable devices with radio waves emitted by antennas outside the body.

MIT
news.mit.edu/2018/wireless-system-power-devices-inside-body-0604

A novel positron emission tomography (PET) imaging method shows promise for noninvasively pinpointing sites of inflammation in people with inflammatory bowel disease (IBD), which includes ulcerative colitis and Crohn’s disease.
Amanda C. Freise, PhD, first author of the study and a lecturer at UCLA, explains the research and its significance.
The U.S. Centers for Disease Control states that approximately three million Americans reported being diagnosed with IBD in 2015 (latest data). Managing patients with chronic bowel inflammation can be challenging, relying on symptoms and invasive procedures such as colonoscopy and biopsy.
In a mouse model of colitis, this study uses PET imaging with antibody fragment probes (immunoPET) to target a specific subset of immune cells, the CD4+ T cells, which are characteristic of IBD.
“CD4 immunoPET could provide a non-invasive means to detect and localize sites of inflammation in the bowel and also provide image guidance for biopsies if needed,” explains Anna M. Wu, PhD, professor of Molecular and Medical Pharmacology at UCLA and director of the UCLA Jonsson Comprehensive Cancer Center’s Cancer Molecular Imaging Program, who headed the project and collaborated with Jonathan Braun, MD, and Arion Chatziioannou, PhD, also of UCLA. She adds, “Assessment of CD4 infiltration could also potentially provide a means for detection of subclinical disease, before symptoms occur, and provide a readout as to the efficacy of therapeutic interventions.”
A zirconium-89 (89Zr)-labe7lled anti-CD4 engineered antibody fragment [GK1.5 cDb] was used for non-invasive imaging of the distribution of CD4+ T cells in the mice with induced colitis, and it successfully detected CD4+ T cells in the colon, ceca and mesenteric lymph nodes. The study demonstrates that CD4 immunoPET of IBD warrants further investigation and has the potential to guide development of antibody-based imaging in humans with IBD.
Wu points out that the ability to directly image immune responses could have wide applications, saying, “It could unlock our ability to assess inflammation in a broad spectrum of disease areas, including oncology and immune-oncology, auto-immunity, cardiovascular disease, neuroinflammation, and more. ImmunoPET is a robust and general platform for visualization of highly specific molecular targets.”

Society of Nuclear Medicine and Molecular Imaging
www.snmmi.org/NewsPublications/NewsDetail.aspx?ItemNumber=29170

A new way of seeing when heavy wound scars are forming, and providing doctors the chance to intervene, has been developed by scientists from Nanyang Technological University, Singapore (NTU Singapore) and Northwestern University in the United States.
Clinicians currently find it difficult to predict how scars will develop following surgery or after a burn wound, without resorting to invasive testing.
Using new nanoparticles, the joint research team has shown in animals and human skin samples the potential to quickly and accurately predict whether a wound is likely to lead to excessive scarring as occurs in keloids and skin contractures.
If necessary, doctors can then take conventional preventive measures to reduce scar formation, such as using silicon sheets to keep a wound flat and moist.
In developed countries alone, about 100 million patients will form scars annually, arising from 80 million elective and trauma surgery operations. In Singapore, an estimated 400,000 people (1 in 12 people undergoing procedures) develop scars each year due to surgery.
Excessive scarring can dramatically affect a patient’s quality of life, both physically and psychologically, as the scars can impede movement and activity, and can be painful when stretched
The new technique was developed by a team led by Assistant Professor Xu Chenjie from NTU’s School of Chemical and Biomedical Engineering, nanoscience expert Professor Chad A Mirkin from Northwestern University, United States, and Dr Amy S Paller, Chair of Dermatology at Northwestern University Feinberg School of Medicine.
The new detection method uses thousands of nanoparticles called NanoFlares, which have DNA strands attached to their surfaces like a ball of spikes.
These nanoparticles are applied to closed wounds using a cream. After the nanoparticles have penetrated the skin cells for 24 hours, a handheld fluorescence microscope is used to look for signals given out by the nanoparticles’ interaction with target biomarkers inside the skin cells.
If fluorescence signals are detected, they indicate abnormal scarring activity and preventive action can be taken to hopefully avoid heavier scarring.
Currently, apart from the visual examination of mature scars, the only other tool to detect skin diseases accurately is to perform a biopsy, where a skin tissue sample is extracted and sent for laboratory testing.
These biopsies may be painful and inconvenient for patients, as an open wound also risks infections and needs sutures which must be removed later
Assistant Professor Xu Chenjie said: “When our bioengineered nanoparticles are applied on the skin, they will penetrate up to 2mm below the skin surface and enter scar cells.”
“Upon binding with a specific tell-tale gene released by the scar cells, smaller DNA spikes are knocked loose and light up under the microscope like little light flares. The more flares we see, the more scarring activity there is.”
These NanoFlares are made by coating Northwestern’s patented gold nanoparticles with tiny DNA strands targeting particular genes. It has shown negligible toxicity or side effects when tested on mice, rabbits and on human skin samples.
Dr Amy S Paller, who is also the Director of Northwestern University Skin Disease Research Centre, said: “Beyond clinical observation, the gold standard for both clinical diagnosis and translational research of skin disorders is a biopsy.
“This technology is an exciting first step towards having a non-invasive way to detect increases or decreases in gene expression. NanoFlares may prove to be a new tool to facilitate sub-phenotyping of disease based on expression patterns and leveraging gene expression changes as a sensitive way to detect early treatment responses.”

Nanyang Technology University
media.ntu.edu.sg/NewsReleases/Pages/newsdetail.aspx?news=858001b3-7530-442a-a728-4e6abc115539

Five percent more cardiac infarctions detected and 11 percent fewer patients suffering a relapse. That is the result of a study of more than 80,000 patients in which two cardiac damage markers (conventional troponin and the newer, high-sensitive troponin T) were compared with each other.
“This can serve to motivate hospitals that have not yet adopted the high-sensitive troponin T. It is more sensitive, and a heart attack can be identified earlier,” says Maria Odqvist, a doctoral student at the Institute of Medicine at Sahlgrenska Academy and the lead author of the study “It’s also possible to determine if the problem is not a heart attack and where the patient’s chest pain is due to something else.”
The study, which is a collaboration with Karolinska Institutet, encompasses all patients who suffered heart attacks in Sweden during the 2009–2013 period. A total of 87,879 people were studied, of which 40,746 were diagnosed using high-sensitive troponin T and 47,133 were tested using conventional troponin. The groups were similar in terms of gender and age distribution and other types of illness in the patients’ history.
Similar studies have been carried out before but then on selected groups of patients, which were treated primarily in cardiac intensive care departments. This study also included patients treated in other departments to collect a broader range of cases.
Chest pain is one of the most common reasons people seek emergency medical care. To determine if a person has suffered a cardiac infarction, symptoms are assessed partly on the basis of chest pain and partly with an electrocardiogram taken to detect typical changes consistent with a heart attack.
In addition, a blood test is taken to measure levels of the protein troponin or else high-sensitive troponin T, both of which are biomarkers for heart damage. Elevated troponin values indicate that cells in parts of the heart have died from lack of oxygen after a heart attack impeded the flow of blood.
The current study showed that the more sensitive marker, troponin T, detected five percent more heart attacks, although with no impact on survival. On the other hand, the number of heart attack victims suffering a relapse was 11 percent lower in that group.
When high-sensitive troponin T started being introduced in 2009, there was concern about spending of health care resources in general and that interventions and treatments for the group of patients with suspected heart attacks would increase.
"We could see a small increase in the number of coronary angiography and balloon blasts, which are associated with finding more cardiac infractions, but the increase is quite modest”, says Maria Odqvist.

University of Gothenburgwww.gu.se/english/about_the_university/news-calendar/News_detail//increased-safety-in-diagnosing-cardiac-infarction-with-more-sensitive-analytical-method.cid1571664