Ultrasound technology is taking to the skies with the Essex & Herts Air Ambulance Trust, a charity that provides a free, life-saving Helicopter Emergency Medical Service for the critically ill and injured of Essex, Hertfordshire and the surrounding areas. Stuart Elms, Clinical Director of the Trust, explained: ‘We operate two helicopters crewed by full-time pre-hospital care doctors and critical care paramedics who can be rushed to the scene of an incident with highly specialized and advanced life-saving equipment and pharmacy. As part of our practice, we are moving towards using ultrasound for management of cardiac arrest and advanced life support. Working with expert sites such as the Essex Cardiothoracic Centre at Basildon, Harefield Hospital and SonoSite, our aim is to train our critical care paramedics to use point-of-care ultrasound, allowing us to tailor our cardiac care even more accurately.’ ‘SonoSite is a world leader in point-of-care ultrasound, and its hand-carried iViz instrument lends itself perfectly to pre-hospital use, both in the aircraft and at the scene. The system is small and portable with a good screen that gives a brilliant view, and can be used one handed. The preset views allow rapid set-up and scanning, and are supported by a training mode that allows comparison of normal and abnormal pathology. Ultimately, we also hope to take advantage of the system’s mobile computing capacity to automatically upload data to electronic patient report forms prior to arrival at the hospital. Our aim is to make as much use of ultrasound as we currently do of stethoscopes – whether they are cardiac, medical or trauma patients – helping to improve outcomes.’

www.sonosite.com

For medics on the battlefield and doctors in remote or developing parts of the world, getting rapid access to the drugs needed to treat patients can be challenging. Biopharmaceutical drugs, which are used in a wide range of therapies including vaccines and treatments for diabetes and cancer, are typically produced in large, centralized fermentation plants. This means they must be transported to the treatment site, which can be expensive, time-consuming, and challenging to execute in areas with poor supply chains.
Now a portable production system, designed to manufacture a range of biopharmaceuticals on demand, has been developed by researchers at MIT, with funding from the Defense Advanced Research Projects Agency (DARPA).
In a paper the researchers demonstrate that the system can be used to produce a single dose of treatment from a compact device containing a small droplet of cells in a liquid.

In this way, the system could ultimately be carried onto the battlefield and used to produce treatments at the point of care. It could also be used to manufacture a vaccine to prevent a disease outbreak in a remote village, according to senior author Tim Lu, an associate professor of biological engineering and electrical engineering and computer science, and head of the Synthetic Biology Group at MIT’s Research Laboratory of Electronics.
‘Imagine you were on Mars or in a remote desert, without access to a full formulary, you could program the yeast to produce drugs on demand locally,’ Lu says.

The system is based on a programmable strain of yeast, Pichia pastoris, which can be induced to express one of two therapeutic proteins when exposed to a particular chemical trigger. The researchers chose P. pastoris because it can grow to very high densities on simple and inexpensive carbon sources, and is able to express large amounts of protein.

‘We altered the yeast so it could be more easily genetically modified, and could include more than one therapeutic in its repertoire,’ Lu says.
When the researchers exposed the modified yeast to estrogen β-estradiol, the cells expressed recombinant human growth hormone (rHGH). In contrast, when they exposed the cells to methanol, the yeast expressed the protein interferon.
The cells are held within a millimeter-scale table-top microbioreactor, containing a microfluidic chip, which was originally developed by Rajeev Ram, a professor of electrical engineering at MIT, and his team, and then commercialized by Kevin Lee – an MIT graduate and co-author – through a spin-off company.
A liquid containing the desired chemical trigger is first fed into the reactor, to mix with the cells.

Inside the reactor, the cell-and-chemical mixture is surrounded on three sides by polycarbonate; on the fourth side is a flexible and gas-permeable silicone rubber membrane. By pressurizing the gas above this membrane, the researchers are able to gently massage the liquid droplet to ensure its contents are fully mixed together.
‘This makes sure that the one milliliter (of liquid) is homogenous, and that is important because diffusion at these small scales, where there is no turbulence, takes a surprisingly long time,’ says Ram, who was also a senior author of the paper.
Because the membrane is gas permeable, it allows oxygen to flow through to the cells, while any carbon dioxide they produce can be easily extracted.
The device continuously monitors conditions within the microfluidic chip, including oxygen levels, temperature, and pH, to ensure the optimum environment for cell growth. It also monitors cell density.
If the yeast is required to produce a different protein, the liquid is simply flushed through a filter, leaving the cells behind. Fresh liquid containing a new chemical trigger can then be added, to stimulate production of the next protein.
Although other research teams have previously attempted to build microbioreactors, these have not have not had the ability to retain the protein-producing cells while flushing out the liquid they are mixed with, Ram says. ‘You want to keep the cells because they are your factory,’ he says. ‘But you also want to rapidly change their chemical environment, in order to change the trigger for protein production.’

The researchers are now investigating the use of the system in combinatorial treatments, in which multiple therapeutics, such as antibodies, are used together.
Combining multiple therapeutics in this way can be expensive if each requires its own production line, Lu says.
‘But if you could engineer a single strain, or maybe even a consortia of strains that grow together, to manufacture combinations of biologics or antibodies, that could be a very powerful way of producing these drugs at a reasonable cost,’ he says.

MIT news.mit.edu/2016/portable-device-produces-biopharmaceuticals-on-demand-0729

A team of Oxford University researchers has developed a technique that could improve heart scans for patients, giving more information about the heart than traditional scans and without any injections, making them safer and faster.
The group of medical, physics and engineering researchers are based at the Oxford Centre for Clinical Magnetic Resonance Research (OCMR). They are using a property of hydrogen atoms to create a pixel-by-pixel map of the heart, called a T1-map, which allows examination of healthy and diseased heart tissue in greater detail than before.
Currently, stress scans of the heart using magnetic resonance imaging (MRI) require patients to be injected with two substances. Adenosine is a medication injected into the patient that causes effects similar to exercise during the scan. Gadolinium – a rare earth heavy metal – is injected as a contrast agent to highlight areas of the heart suffering from decreased blood flow under exercise conditions.
Patients with severe kidney failure – who are usually at higher risk for heart disease – cannot clear Gadolinium and often are unable to benefit from a full MRI scan of the heart. T1-maps can potentially solve this problem in the future.
Dr Alexander Liu, who leads the research with the guidance of his supervisors – Dr. Vanessa Ferreira, Dr. Stefan Piechnik and Professor Neubauer (the centre director), explained: We wanted to see if using T1 mapping can give clearer, more clinically-useful results compared to traditional MRI scans that require injections of contrast agents. On traditional MRI scans, doctors are judging relative shades of light and dark on a scan, and even the most experienced specialists can disagree on what the image is showing them. T1 maps provide an objective number, which can be coded in colours, and may be less subjective. Additionally, patients with severe kidney failure – who are usually at higher risk for heart disease – cannot clear Gadolinium and often are unable to benefit from a full MRI scan of the heart. T1-maps can potentially solve this problem in the future.’
In physics, T1 is the time constant that describes how quickly atoms return to normal thermodynamic state after being affected by radio waves and strong magnetic fields. Just like measuring body temperature in Celsius or Fahrenheit, the numbers themselves may not mean much, but any deviation from established normal ranges can suggest disease. In the case of T1 mapping, long T1 times indicate the presence of more water, something found in a number of heart conditions, including areas of the heart suffering from lack of blood supply due to blocked arteries. A T1-map just helps to visualize T1 values across the heart and find the precise location of the problem. It takes around three minutes to map the whole heart, and the values it measures are turned into a colour map, giving doctors an image which is potentially quicker to understand with less subjective interpretation.
Dr Stefan Piechnik developed the specific T1 mapping technique at Oxford, named ShMOLLI. He said: T1 mapping allows us to look in finer detail at the heart in a non-invasive way, which has not been possible before. We can now get results without Gadolinium, meaning we have a technique that is safer and quicker and can be used with more people. The results are also less dependent on interpreting the images – medics have something based on hard numbers.’

Oxford University http://tinyurl.com/h4ruhca

The Health Industry Summit (tHIS) 2016 was held in Shanghai at the National Exhibition and Convention Centre from 17 to 20 April.

The organizer posted a record 380,000 entry scans, 216,784 professional visitors and more than 55,000 exhibiting staff to the venue over four days. In preparation of the large concentration of visitors, the city of Shanghai initiated its municipal level security mechanism and increased the frequency of the subway to divert the large crowds and dense traffic to the venue. Hotels were also fully booked in Shanghai during the event period.
Only in its second edition, tHIS has already been firmly established as the world’s largest health industry event with over 330,000 square meters of exhibition space and 107 individual conferences.
Key events included China’s three top medical equipment and pharmaceutical exhibitions (CMEF, PHARMCHINA and API China) and the leading healthcare investment forum – Healthcare China 2016. This year’s investment forum was co-organized by Reed Sinopharm, JP Morgan Asset management, CICC and Sinopharm Capital and was attended by more than 700 selected investors and institutions.
The exhibition featured the entire industry value chain and presented some of the latest cutting edge technology including genetic diagnostics, rehabilitation robotics, wearable tech, 3D printing and more.
6,900 exhibiting companies from 30 countries were at the show presenting tens of thousands of products and services. Well-known healthcare equipment giants like GE, United Imaging, Siemens, Philips and Mindray as well as major pharmaceutical groups in China like Sinopharm, Shanghai Pharma and CR Pharmaceuticals were in attendance with major stand presence.
Natural Health and Nutrition Expo were among the fastest growing segments in the portfolio, helped by the expected population boom in light of the reversal of the single child policy as well as a growing health-conscious middle class in China.
With the start of China’s 13th Five-year plan in 2016, the ‘Health China 2020’ programme focusing on the co-development of healthcare, pharmaceutical production and health insurance has put the health industry among the top priorities for development in China and part of the national strategy.
Companies in China not traditionally associated with healthcare have also shifted major investment and resources into the sector, many renaming their company in the process to reflect this focus in industry coverage. International giants with the likes of Alibaba, Lenovo, Fosun and Wanda Group have all taken a foothold into key segments of the industry in anticipation of major opportunities in the future.
The Health Industry Summit is organized by Reed Sinopharm, a joint venture between the world’s leading event organizer Reed Exhibitions and China’s leading state-owned pharmaceutical group Sinopharm. Its next edition will be held in May 2017 in Shanghai.

www.thishealthsummit.com/en/index.jhtml

A congenital condition called pectus excavatum, in which a child’s breastbone is sunken into the chest, can be corrected through minimally invasive surgery, but pain control after the operation can be a challenge. A Mayo Clinic study has found an effective way to control pain and reduce opioid painkiller use after surgery: sending children home with catheters that infuse a non-narcotic nerve-blocking drug called a paravertebral blockade. Use of the blocks shortens hospital stays and reduces opioid use after surgery, the researchers discovered.
The study focused on pain control after children receive a Nuss procedure, in which small incisions are made and a stainless steel or titanium bar is placed under the sternum to reshape the chest wall. Researchers looked at the cases of 132 children who had Nuss surgery from 2010 through 2015. Of those, 114 received paravertebral catheters and continued receiving the infusions for two to five days after returning home. Eighteen were instead given an epidural.
Use of paravertebral catheters cut the median hospital stay by roughly a day and a half from 120 hours to 80 hours, the researchers found. Opioid painkiller consumption also decreased. Opioids can have significant side effects that slow recovery after surgery, including drowsiness, light-headedness, nausea, constipation and risk of falls.
‘Our operation is minimally invasive, but it produces major changes in the chest wall. Pain was an issue for our patients, but this new technique has solved the problem. It’s better than an epidural, because it’s reliable, and kids can go home with it. For the first time, we consistently deliver on our promise to minimize pain,’ says co-author Christopher Moir, M.D., a pediatric and thoracic surgeon in the Mayo Clinic Children’s Center.
Chest wall deformities are fairly common. Pectus excavatum, also called funnel chest, is the most frequent. The sunken breastbone is noticeable when a child is born and typically worsens during the adolescent growth spurt. Even mild cases can cause children to feel self-conscious. Severe cases can interfere with heart and lung function.
Epidurals have been a standard method to manage pain after pectus excavatum surgery, but they are stopped before children leave the hospital, and severe pain may persist after that. Many hospitals, including Mayo Clinic, have been using other options, such as nerve blocks, patient-controlled painkiller delivery and non-narcotic painkiller injections. There has been little consistent data on pain outcomes.
‘This study puts solid data to what we see each day in the hospital and what families tell us. Paravertebal catheters work,’ Dr. Moir says.

Mayo Clinichttp://tinyurl.com/zqbbaz5