New light-based technologies that facilitate a ‘look inside’ the human body using light – and without cutting into the tissue – promise to enable both compact, wearable devices for point-of-care diagnostics as well as powerful new systems that provide even more information and from even deeper under the skin.
Recent work and visionary future directions are detailed in a new open-access article by Antonio Pifferi and colleagues at the Politecnico di Milano and Istituto di Fotonica e Nanotechnologie CNR .
The article is part of a special section on Clinical Near-Infrared Spectroscopy and Imaging under Guest Editors Marco Ferrari (Universita degli Studi dell Aquila), Joseph Culver (Washington University School of Medicine in St. Louis), Yoko Hoshi (Hamamatsu University School of Medicine), and Heidrun Wabnitz (Physikalisch-Technische Bundesanstalt).
The desirability of noninvasively probing human tissues and their functions has sparked new physical concepts, theoretical models, instruments, measurement approaches, and applications, note the authors in ‘New frontiers in time-domain diffuse optics.’
We are at the dawn of the next generation of time-domain systems, with a breakthrough in performance, size, cost, and flexibility that has the potential for great impact on new and widespread applications, the authors assert. This breakthrough is enabled by impressive advancements in single-photon detection boosted by high-energy physics and positron-emission tomography systems.
In diffuse optical imaging, light is injected into the surface of a medium, such as the body. The light signal is re-emitted elsewhere on the surface and analysed as to how it has changed. The analysis yields information about the chemical composition of the tissues, their densities, and other aspects.
The simplest methods compare continuous-wave properties of the original signal and the re-emitted light.
Systems that also analyse frequency or time changes in the light signal provide additional data. Current state-of-the-art methods use technologies that enable time-to-digital conversion of the signal, providing even more detail.
Wearable time-domain devices already have been developed for continuous-wave systems, enabling studies in breast cancer detection, brain mapping, muscle monitoring, and non-invasive assessment of lipids, bone, and collagen. Time-domain techniques have also been used in non-destructive characterization of food, wood, pharmaceuticals, and semiconductor powers.
Over the next 20 years researchers envision that such systems will become smaller, making feasible their integration into wearable devices, and smarter, increasing their overall accuracy in detecting and identifying tissue components.
Future devices could be used in brain monitors or muscle oximeters, even for in vivo detection of the brain function during motor or cognitive tasks.
‘What makes the future technology unique is its potential to probe noninvasively and in greater depth into human functions and chemical composition, yet with simple personal appliances usable at home and compatible with normal life,’ Pifferi said. Currently unreachable organs and functions would be accessible, including the heart.
Quite surprisingly, Pifferi noted, after the thermometer and the blood pressure meter, not many other diagnostic devices for personal healthcare have been brought into the home.
‘The new smart sensors, interacting in the ambient environment and transmitting hidden internal information over the cloud, will populate the Internet of Things to the benefit of clinical, industrial, and consumer-level applications,’ he said.

SPIE http://tinyurl.com/j3v43kn

Researchers at the University of Adelaide are urging doctors and patients to refrain from using a specific steroid treatment to treat infertility in women unless clinically indicated, because of its links to miscarriage, preterm birth and birth defects.

Researchers from the University’s Robinson Research Institute, led by Professor Sarah Robertson, say widespread use of the drug is not warranted, given there is a high degree of suspicion that corticosteroid drugs – such as prednisolone – can interfere with embryo implantation, and may have harmful effects on pregnancy and the child.

Corticosteroids are increasingly used to treat infertility in women with repeated IVF failure and recurrent miscarriage. Many women receive the drug in the belief that reducing immune cells called ‘natural killer’ cells will facilitate a pregnancy. However, this belief is mistaken, as despite their alarming name these cells are actually required for healthy pregnancy.

Professor Robertson says there is a great deal of medical and consumer misunderstanding about the role of the immune system in fertility and healthy pregnancy.

‘Steroid drugs such as prednisolone act as immune suppressants, preventing the body’s immune system from responding to pregnancy. But by suppressing the natural immune response, these drugs may lead to further complications,’ Professor Robertson says.

‘The immune system plays a critical role in reproduction and fertility. Natural killer cells and other immune cells help to build a robust placenta to support healthy fetal growth. But if we suppress or bypass the body’s natural biology, there can be dire consequences that don’t appear until later,’ she says.

‘For example, suppression of the immune system through inappropriate use of these drugs is linked to impaired placental development, which in turn elevates the risk of miscarriage, preterm birth and birth defects.’

Research shows that women taking corticosteroids over the first trimester of pregnancy have a 64percent increase in miscarriage; the risk of preterm birth is more than doubled; and their children have an elevated risk of birth defects, including a 3-4 times greater risk of cleft palate.

‘Our main message to clinicians and to women hoping to achieve pregnancy is that they should be focused on achieving good-quality pregnancy and the life-time health of the child, not just getting pregnant,’ Professor Robertson says.

‘Corticosteroids such as prednisolone may impair healthy pregnancy, which may lead to poorer long-term outcomes for the baby.

‘We believe IVF doctors should not be offering this treatment to most patients, and should discuss concerns with women who request it.

‘The exception would be in specific cases where the patient has a diagnosed autoimmune condition, but those cases are rare,’ she says.

University of Adelaide www.adelaide.edu.au/news/news87602.html

The results of a study presented at the Annual European Congress of Rheumatology (EULAR) 2017 showed that low dose computed tomography (LD-CT) is more sensitive than conventional radiographs (X-rays) in the monitoring of disease progression in patients with Ankylosing Spondylitis (AS).
LD-CT, using a newly developed scoring method for assessing bone formation in AS patients, had previously been shown to be reliable and sensitive, with good consistency between different individuals interpreting the images.
In this latest study, designed to further validate LD-CT, a comparison of its ability to demonstrate the formation of new bony growths (known as syndesmophytes) and / or an increase in size of these syndesmophytes, showed that LD-CT consistently detected more AS patients with these signs of disease progression than conventional X-rays.1
“Standard dose computed tomography is a sensitive method for assessing structural changes in the spine in patients with AS,” said lead author Dr. Anoek de Koning from the Leiden University Medical Centre, Leiden, Netherlands. “However, its clinical utility has been limited due to its use of relatively high doses of ionising radiation.”
“Our findings support the use of LD-CT as a sensitive method for the assessment of new or growing syndesmophytes in future clinical research without exposing patients to high doses of radiation,” she concluded.
Comparing the percentage of patients with newly formed syndesmophytes, growth of existing syndesmophytes and the combination of both, scored by two separate investigators and as a consensus score, LD-CT detected more patients with progression in all comparisons. This was especially apparent where there was a higher number of new or growing syndesmophytes per patient.
With the strictest comparison of the consensus score for both LD-CT and X-rays, 30% of the patients showed bony proliferation (newly formed and growth) at 3 or more sites on LD-CT, compared with only 6% on conventional X-rays. Patients were recruited from the SIAS (Sensitive Imaging of Axial Spondyloarthritis) cohort from Leiden, the Netherlands and Herne, Germany. 50 AS patients were included based on modified New York criteria , the presence of one or more syndesmophytes on either the cervical and / or lumbar spine seen on X-ray, and one or more inflammatory lesions on an MRI of their whole spine.
Each of these patients had conventional X-rays of the lateral cervical and lumbar spine and LD-CT of the entire spine at baseline and two years. Two investigators independently assessed the images in separate sessions. Images were paired per patient, blinded to time order, patient information, and the result of the other imaging technique. For LD-CT, syndesmophytes were scored in the coronal and sagittal planes for all ‘‘quadrants’ per view, thus scoring 8 ‘‘quadrants’ per vertebral unit. The formation of new syndesmophytes, growth of existing syndesmophytes and the combination of both was calculated per quadrant. Syndesmophytes were scored as absent (score 0), <50% of the intervertebral disc height (IVDH) (score 1), ≥50% of the IVDH but no bridging (score 2) or as bridging the IVDH (score 3).2 Consensus about each of these outcomes was defined by agreement of both readers on the same vertebral level. Data were compared per reader and for the consensus score.

The European League Against Rheumatism
www.eular.org/congresspressreleases/Low-dose_CT_scanning_improves_assessment_of_Ankylosing_Spondylitis_patie.pdf

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

The American Society of Clinical Oncology (ASCO) hasissued a clinical practice guideline on human papillomavirus (HPV) vaccination for the prevention of cervical cancer. This is the first guideline on primary prevention of cervical cancer that is tailored to multiple regions of the world with different levels of socio-economic and structural resource settings, offering evidence-based guidance to health care providers worldwide.

The guideline includes specific recommendations according to four levels of resource settings: basic, limited, enhanced and maximal. The levels pertain to financial resources of a country or region, as well as the development of its health system – including personnel, infrastructure and access to services. The guideline complements ASCO’s two other global, resource-stratified guidelines on cervical cancer, also stratified to these four levels of resources.

Key guideline recommendations:

• In all environments and independent of the resource settings, two doses of human papillomavirus vaccine are recommended for girls ages 9 to 14 years, with an interval of at least 6 months and up to 12 to 15 months between doses.
• Girls who are HIV positive should receive three doses.
• For maximal and enhanced resource settings:
  • If girls are 15 years or older and have received their first dose before age 15, they may complete the two-dose series;
  • If they have not received the first dose before age 15, they should receive three doses;
  • In both scenarios vaccination may be given through age 26 years.
• For limited and basic resource settings: if sufficient resources remain after vaccinating girls 9 to 14 years, girls who received one dose may receive additional doses between ages 15 and 26 years.
• Vaccination of boys: in all settings, boys may be vaccinated, if there is at least a 50percent coverage in priority female target population, sufficient resources, and such vaccination is cost effective.

Cervical cancer is the fourth most common cancer among women worldwide, with less developed regions suffering a disproportionate burden from the disease. In fact, 85percent of cervical cancer diagnoses and 87percent of cervical cancer deaths occur in less developed regions, including parts of Africa and Latin America.

‘Because resource availability varies widely, both among and within countries, we need to adjust strategies to improve access to HPV vaccination everywhere,’ said Silvia de Sanjose, MD, PhD, co-chair of the Expert Panel that developed the guideline and head of the Cancer Epidemiology Research Program at Institut Catala d’Oncologia in Barcelona, Spain. ‘This guideline is unique in offering cervical cancer vaccination recommendations that can be adapted to different resource levels and we expect it to have a major impact on the global health community.’

ASCO www.asco.org/about-asco/press-center/news-releases/first-global-guidance-hpv-vaccination-cervical-cancer