Dutch hospital Admiraal De Ruyter Ziekenhuis (ADRZ), based in Goes, and Siemens Healthineers have signed an agreement to build and supply equipment for six operating theatres, including a hybrid OR. Siemens will build the new building complex with its partner companies Engie and Jan Snel. Under a Managed Equipment Service (MES) agreement, Siemens will also equip the new operating theatres with medical systems and service and update the equipment for ten years. Once the construction work is completed, Siemens will act as lessor, leasing both the new building and the medical systems to ADRZ. This model will enable ADRZ to handle a major investment without providing too high financing capital.
Earlier this year, the hospital operator and Siemens have entered into a similar agreement to build ADRZ’s new Nuclear Medicine Centre in Goes. Also in this case, Siemens will be involved in the construction and will supply the medical systems on an MES basis.
With 2,200 employees and 23,000 hospitalizations annually, ADRZ is the biggest hospital in the Zeeland Province in the southern part of the Netherlands. The new complex housing six operating theatres should be completed in February 2017. The total project cost is more than EUR 10 million.
All the theatres are set up the same, which in turn results in uniform running lines and logical order. For a surgeon, it makes no difference in which operating theatre he or she is working; every room is set up the same way. This also applies for the medical equipment. This set-up is supposed to provide for best possible patient safety and to support the medical staff to achieve the highest possible medical outcome.
‘This is a next step in upgrading the care infrastructure at ADRZ. After a period of austerity and reorientation this is literally and figuratively the next building block of the new ADRZ. We are delighted with our partner Siemens, who is supporting us in developing and implementing such a technically complex infrastructure. In this case it involves six operating theatres, whereby quality and safety for our patients are key aspects,’ said Claudia Brandenburg, Chairperson of the Board of Directors of ADRZ.
‘We at Siemens Healthineers intend to be the enabler for our healthcare partners. For this, our partnership with ADRZ is an excellent example: with our customized, long-term MES partnership, we enable ADRZ to continuously take advantage of state-of-the-art technology and processes within an affordable model. At the same time, ADRZ is able to concentrate on its medical core competence. By this collaborative model, we jointly drive operational performance and ultimately patient outcomes,’ said Sourabh Pagaria, Head of Enterprise Services at Siemens Healthineers.

www.siemens.com

Paediatric researchers have devised an innovative, safe and minimally invasive procedure that helps relieve rare but potentially life-threatening airway blockages occurring in children who had surgery for congenital heart defects.
The physician-researchers developed new imaging tools and used minimally invasive catheterization techniques to treat plastic bronchitis, a condition in which abnormal circulation causes lymphatic fluid to dry into solid casts that clog a child’s airways.
The study, which describes the pathophysiological mechanism of plastic bronchitis and a treatment approach, arose from collaboration between Maxim Itkin, MD, an associate professor of Radiology in the Perelman School of Medicine at the University of Pennsylvania, and Yoav Dori, MD, a pediatric cardiologist in the Cardiac Center at The Children’s Hospital of Philadelphia (CHOP). They co-lead a specialized team dedicated to the care of lymphatic disorders as part of the Center for Lymphatic Imaging and Interventions at The Children’s Hospital of Philadelphia and the Hospital of the University of Pennsylvania.
‘This is a new treatment option for children with plastic bronchitis and has the potential to offer long-term improvement of this condition,’ said Dori. ‘This procedure may even provide cure and avoid the need for a heart transplant.’
The current study builds on the team’s 2014 article in Pediatrics, the first case report of the successful use of their technique in a patient with plastic bronchitis. ‘We have expanded on that study to report short-term outcomes in a larger group and to share insights into the development of plastic bronchitis, which has been poorly understood,’ said Itkin. In addition to heart patients, children and adults with idiopathic plastic bronchitis, in which the cause is unknown, have also been treated successfully using these techniques.
Itkin and Dori discovered that the primary cause of plastic bronchitis is a lymphatic flow disorder, due to abnormal lymphatic flow into lung tissue. Because physical examinations and conventional imaging may not provide specific findings, lymphatic flow disorders often go undiagnosed.
Over the past several years, Itkin and Dori developed a customized form of magnetic resonance imaging (MRI), called dynamic contrast enhanced MR lymphangiogram, to visualize the anatomy and flow pattern of a patient’s lymphatic system. This technique allows clinicians to locate the site at which lymph leaks into the airways.
Plastic bronchitis may occur in children as a rare complication of early-childhood heart surgeries used for single-ventricle disease, in which one of the heart’s pumping chambers is severely underdeveloped. Approximately 5 percent of children surviving this surgery experience plastic bronchitis because the surgery alters venous and lymphatic pressure. The authors argue that this altered pressure may interact with pre-existing anatomical differences in the patients’ lymphatic vessels.
The abnormal circulation causes lymph to ooze backward into a child’s airways, drying into a caulk-like cast formation that takes the shape of the airways. The first sign of plastic bronchitis may be when a child coughs out the cast. However, if unable to cough it up, a child may suffer fatal asphyxiation.
After identifying the leakage site in a lymphatic vessel, the lymphatic team intervenes, using a technique called lymphatic embolization. Through small catheters, the team blocks the abnormal flow with a variety of tools: coils, iodized oil, and covered stents, based on an individual patient’s needs.
In the current report, the team was able to perform lymphatic embolization in 17 of their 18 patients, ranging from age 2 to age 15 (median age 8.6 years). Fifteen of those 17 patients had significant improvements in cast formation, in some cases being cast-free longer than two years. Patients had transient side effects of abdominal pain and hypotension (low blood pressure), but the authors reported the procedure appeared safe in their patient group.

The Children’s Hospital of Philadelphia http://tinyurl.com/hjr4jps

Rice University students have created a prototype of a device to monitor the pulse and oxygen levels of a fetus undergoing endoscopic fetal surgery in a mother’s womb.
The WombOx team of senior engineering students worked in close collaboration with the Texas Children’s Fetal Center to create their device, which miniaturizes the components found in a pulse oximeter commonly clipped to a patient’s finger in a doctor’s office.
Pulse oximeters ‘see’ oxygen levels in the blood by comparing light from a source to the light that reaches a detector on the other side of the finger. The instrument can calculate oxygen saturation by how much light it senses is absorbed by the tissue.
That kind of information hasn’t been available to doctors working to help fetuses suffering from congenital defects such as spina bifida, the incomplete closure of the backbone around the spinal cord.
Texas Children’s Hospital is pioneering efforts to treat such conditions through the endoscopic procedure known as fetoscopic surgery. During surgery, doctors are able to monitor the health of a fetus through ultrasound, but that only gives them a basic heartbeat. Knowing oxygen levels in the blood is critical when doctors need to act quickly to help a fetus in distress, and the WombOx device shows potential for providing such data in real time.
To build the prototype, the bioengineering students, Claudia Iriondo, Thomas Loughlin, Samir Saidi and Kathryn Wallace, worked closely with Dr. Magdalena Sanz Cortes, an associate professor of obstetrics and gynecology at Baylor College of Medicine and a clinician at the Texas Children’s Pavilion for Women, as well as their Rice faculty adviser, engineering lecturer Eric Richardson. It is the product of their capstone design project, required of most senior engineering students at Rice.
A few weeks after winning the top Willy Revolution Award, a $5,000 prize presented at Rice’s annual Engineering Design Showcase for innovation in design, and days before commencement, the team spent a morning in a device-testing suite at the Pavilion for Women to watch their prototype in action.
‘This project was challenging because of the size of the instruments that we work with,’ Sanz Cortes said. ‘When we started talking about the whole project, we talked about the size of a pulse oximeter. Transforming that into the size of the device they have created is very challenging.
‘The other challenging part was the mechanics, how to design something that is safe enough for the baby and can be compatible with our surgeries. It’s not a trivial matter, and they did a great job,’ she said.
At first glance, the device is a loop of wire on a hollow stick. But a closer look reveals that the wire is a special hybrid that expands to a predetermined shape at the correct temperature. It carries LEDs and a photodetector on miniature circuit boards that illuminate and sense the flow of blood through the tissue underneath.
The loop is packaged in a retractable sheath that fits through the small incision made in fetoscopic surgeries. The WombOx device is used like all other endoscopic tools, with a miniature camera. The idea is to insert the tube into the mother’s womb and extend the loop. Once it expands, doctors use the video feed to guide the loop around a limb and gently tighten it, putting the sensors in place to monitor the fetus throughout the surgical procedure.
‘Our design, like other endoscopic tools, is intended for single use,’ Iriondo explained. The device is durable enough to withstand unsheathing, expansion in the womb, attachment to the fetus and resheathing during removal.’

Rice University http://tinyurl.com/z3p6dmc

When ketamine is used for general anesthesia, two connected parts of the cortex turn to ‘isolated cognitive islands.’
It’s a topic that has long captivated doctors, scientists and the public – what exactly happens in your brain when you’re oblivious on the operating table?
Some anesthesia drugs work in a straightforward manner by dampening down neurons in the brain. The mechanism of one anesthetic, however, has proved elusive: ketamine.
Certain doses of ketamine induce general anesthesia, though brain activity can still be robust, says Cynthia Chestek, Ph.D., co-senior author of a new study in neuroimage.
Ketamine is used often in patient care and in laboratory settings. The new paper examines the neurological mechanisms at work during ketamine anesthesia.
Co-senior authors Chestek and anesthesiologist George Mashour, M.D., Ph.D., led the research team, which took precise measurements down to the level of neurons in animal models.
‘We found that general anesthesia reflects a communication breakdown in the cortex, even though sensory information is getting processed,’ Mashour says. ‘But the processing appears to occur in isolated cognitive islands.’
Two adjacent parts of the brain that work together in the waking state simply stop talking to each other under general anaesthesia. When awake, communication between the primary somatosensory cortex and the primary motor cortex is critical to normal function.
‘This supports the idea that what anesthesia does to cause unconsciousness is interrupt communication between brain areas, stopping the processing of higher-level information,’ says first author Karen Schroeder, a doctoral candidate in the U-M Department of Biomedical Engineering. ‘This was the first time anyone directly observed the interruption between the two areas using individual neurons.’
Chestek’s biomedical engineering lab focuses on brain machine interfaces, recording activity of neurons and reading motor commands and sensory information in real time.
So her team got on board to measure both areas of the brain, which kept firing during anesthesia.
‘As soon as we injected ketamine, the sensory information disappeared from the motor cortex. Normally these areas are tightly connected.’
The group plans to continue this work, turning next to investigate the level of anesthesia at which these changes in communication start to occur. They’re also looking into what the groups of neurons are doing under anesthesia when they are still active but no longer communicating with each other.
‘These insights could potentially improve our ability to monitor patients’ level of consciousness,’ Schroeder says.

University of Michiganhttp://tinyurl.com/z96b64d

A multicenter team of researchers led by Barbara Murphy, MD, of the Icahn School of Medicine at Mount Sinai has identified a panel of genes which can help predict whether a transplanted kidney will later develop fibrosis, an injury which can cause the organ to fail.

Researchers in the Genomics of Chronic Allograft Rejection (GoCAR) study obtained biopsy samples from transplanted kidneys three months and twelve months after transplantation. Using microarray, a method by which the expression levels of a large numbers of genes or proteins can be measured simultaneously, the researchers determined which genes were correlated with biopsy samples which had an increased Chronic Allograft Damage Index (CADI) score at the 12-month biopsy. The CADI score is a measure of the level of fibrosis in the transplanted kidney. The researchers then narrowed the genes down to a predictive gene set that identified patients at risk for decline in renal function and loss of the transplanted kidney beyond one year. The rate of correlation of the identified gene set with damage was greater than the clinico-pathological variables currently used in practice to identify kidney transplant recipients at risk of allograft damage and loss.

‘This is the first finding of its kind,’ said Barbara Murphy, System Chair of Medicine for the Mount Sinai Health System and Murray M. Rosenberg Professor of Medicine (Nephrology) at the Icahn School of Medicine at Mount Sinai, and the lead investigator on the study. ‘By helping us better understand the causes of damage to transplanted kidneys, this study has the potential to change how we monitor and manage all renal transplant patients.’

‘The study offers the potential to identify renal transplant recipients at risk for a loss of the new organ prior to the development of irreversible damage,’ said Dr. Murphy. ‘This would mean that doctors might eventually have the opportunity to change the therapeutic treatment approach in order to prevent fibrosis from progressing at all.’

Mount Sinai Health System www.mountsinai.org/about-us/newsroom/press-releases/mount-sinai-researchers-identify-way-to-predict-and-prevent-damage-in-donated-kidneys