A medical device for Cystic Fibrosis (CF) sufferers which lessens their exposure to infections resulting in fewer doctors’ visits, reduced antibiotic usage and shorter hospital stays, is expected to be market ready within two years.
University of Limerick (UL) inventors recently secured funding for the new percussion device that helps remove mucus from the airways and will, they hope, greatly improve the quality of life for cystic fibrosis patients.
Ireland has the highest incidence of CF in the world and CF is the most common, fatal hereditary disease in the United States.
Professor Colum Dunne, who is Foundation Chair and Director of Research at UL’s Graduate Entry Medical School (GEMS), explained the background to the development of the product.
‘Patients with respiratory diseases use various devices, which help the removal of mucus from the airways and the improvement of pulmonary or lung function. One example that we have focused on here is the CF patient airway, which is defective in ciliary function; resulting, due to ineffective removal, in a mucus-rich environment favouring growth of bacteria. These bacteria include potential pathogens, associated with chronic infection, decreased lung function and accelerated respiratory disease’.

Currently, there are percussion-based chest physiotherapy devices on the market, but according to Professor Dunne, these ‘can sometimes become reservoirs for the bacteria that cause infections in Cystic Fibrosis patients’. Because the new device, SoloPep, is disposable, it poses no threat of reinfection.
‘In our research, we have observed that compliance with hygiene practices for reusable devices, by patient, is potentially poor. As such, despite even excellent compliance with prescribed antimicrobial regimens, the devices may become colonised with problematic or opportunistic pathogenic microbes,’ Professor Dunne outlined.

‘The devices may, therefore, function as a reservoir that does not come into contact with the antimicrobial agents. Subsequently, re-infection may occur post-antimicrobial cessation by microbes present in the reservoir. Therefore, there is a need to develop novel inexpensive, single-use devices,’ he added.

‘Ireland has the highest per capita incidence of Cystic Fibrosis globally. Because of this, it is reasonable to expect treatment innovations generated by Irish researchers and carers. In this case, our studies included patient involvement from the outset and allowed us to develop something that is truly technologically disruptive. The design of this new positive expiratory pressure (PEP) device is clever and focused on the end user from the beginning. It removes significant risk for patients by improving their microbiology hygiene and safety,’ Professor Dunne added.

Dr Leonard O’Sullivan from UL’s School of Design is co-principal investigator for this device.
‘SoloPEP is a good example of user-centred design and it will have a dramatic impact on the quality of life of cystic fibrosis patients in a sector with significant commercial opportunity,’ he said.
‘This product has the potential to improve the lives of Cystic Fibrosis and other patients. But for that to happen the product must actually be available to them,’ Professor Dunne concluded.

University of Limerick www.ul.ie/gems/news/new-cystic-fibrosis-device-reduce-antibiotic-usage

Michigan Medicine researchers employ novel technology to monitor vulnerabilities for cardiovascular events, aid in diagnosis and treatment
Strokes and heart attacks often strike without warning. But, a unique application of a medical camera could one day help physicians know who is at risk for a cardiovascular event by providing a better view of potential problem areas.

‘The camera actually goes inside the vessels,’ says first author Luis Savastano, M.D., a Michigan Medicine resident neurosurgeon. ‘We can see with very high resolution the surface of the vessels and any lesions, such as a ruptured plaque, that could cause a stroke. This technology could possibly find the smoking gun’ lesion in patients with strokes of unknown cause, and may even be able to show which silent, but at-risk, plaques may cause a cardiovascular event in the future.’

The scanning fibre endoscope, or SFE, used in the study was invented and developed by co-author and University of Washington mechanical engineering research professor Eric Seibel, Ph.D.. He originally designed it for early cancer detection by clearly imaging cancer cells that are currently invisible with clinical endoscopes.

The Michigan Medicine team used the instrument for a new application: acquiring high-quality images of possible stroke-causing regions of the carotid artery that may not be detected with conventional radiological techniques.

Researchers generated images of human arteries using the SFE, which illuminates tissues with multiple laser beams, and digitally reconstructs high-definition images to determine the severity of atherosclerosis and other qualities of the vessel wall.

A unique application of a medical camera could one day help physicians know who is at risk for a cardiovascular event by providing a better view of potential problem areas.

‘In addition to discovering the cause of the stroke, the endoscope can also assist neurosurgeons with therapeutic interventions by guiding stent placement, releasing drugs and biomaterials and helping with surgeries,’ Seibel says.

In addition, the SFE uses fluorescence indicators to show key biological features associated with increased risk of stroke and heart attacks in the future.

‘The ability to identify and monitor the biological markers that render a plaque unstable and at risk for rupture could enable the detection of individuals within high-risk populations who are most likely to suffer from cardiovascular events, and therefore benefit the most from preventive treatment during the asymptomatic stage,’ says B. Gregory Thompson, M.D., professor of neurosurgery at the University of Michigan Medical School and a senior author on the new paper.

University of Michigan www.uofmhealth.org/news/archive/201702/laser-based-camera-improves-view-carotid-artery

Shorter wound healing time, fewer dressing changes and the opportunity for earlier discharge from the hospital. These are some of the benefits of negative pressure wound therapy to treat wound infections in connection with vascular surgery at the groin. The method, which has become increasingly common, is also cost-effective. This is shown in a thesis from Lund University in Sweden in which the method has undergone its first major scientific evaluation in deep perivascular groin infections after vascular surgery.

In connection with surgery, the patient is at risk of an infection in the surgical wound, and this is the second most common form of healthcare -associated infections in Sweden. However, despite the fact that wound therapy is a fundamental and crucial part of healthcare, there are relatively few scientific studies on the subject, and the level of expertise among healthcare practitioners is insufficient. This is argued by Christina Monsen, doctoral student at Lund University and registered nurse, specialising in wound therapy at the Skane University Hospital.

‘Personal experience is not enough to determine whether a certain wound therapy method actually works. But this is a difficult field of research, randomized trials in particular, especially when there is already strong beliefs and attitudes favouring one wound therapy among personal staff’, says Christina Monsen.

Christina Monsen’s current thesis compares the use of negative pressure wound therapy of infected wounds at the groin after vascular surgery with a previously established method: alginate dressings. The study is the first more extensive scientific evaluation of negative pressure techniques to treat infected wounds, and it has taken several years to execute.

‘On average, the wound healing time was almost cut in half for patients who received negative pressure wound therapy – from 104 days to 57. The in-hospital care time was also reduced by a week, to an average of 13 days compared to 20’, says Christina Monsen.

The negative pressure technique entails placing a foam sponge inside the cleaned wound, which is then covered by a tightly sealed plastic film. Through a small opening, a portable vacuum pump is attached, sucking up all the excess exudates while allowing the wound to gradually contract during the time of healing.

The groin is a commonly used point of entry during vascular surgery as it allows surgeons to reach several vital bodily systems and organs. At the same time, it involves an increased risk of infection because of its proximity to the intestinal bacterial flora. Refractory infections at the groin can in serious cases lead to amputation of the patient’s leg or even death.

Negative pressure wound therapy was introduced in Swedish hospital clinics just before the turn of the millennium, and has gradually grown. However, despite increasing use it has remained poorly scientifically evaluated.

The thesis also finds that negative pressure wound therapy requires fewer dressings and is cost-effective and timesaving for staff. The comparative studies, based on patient data from Skane University Hospital (SUS) in Malmo, were supplemented with interview studies. From these studies it emerged that the patients wanted to receive more knowledge and be more prepared on how to care for themselves after being discharged from the hospital, something which the clinic at SUS will now review.

Lund University www.med.lu.se/english/news_archive/161018_healing

EPFL researchers have developed an innovative cardiac support system in
the form of a small ring placed on the aorta. This device is less invasive than traditional methods and avoids problems of hemolysis and the need for
regular transfusions because it does not come into direct contact with the blood.
The heart is sometimes in a weakened state when recovering from certain diseases or while waiting for a transplant. To help the tired heart pump blood, researchers at EPFL’s Integrated Actuators Laboratory (LAI) came up with a clever solution. Their device is made up of three tiny rings made out of a material with special electrical properties. The device, called a Dielectric Electro Active polymer (DEAP), dilates when a current is applied and contracts when it is switched off . Because the reactions are immediate, the back-andforth movement can be controlled in real time.
The researchers’ innovation was to place these rings around the aorta – the body’s main artery – at the exact spot where it exits the left ventricle. Each ring has two electrodes that are drawn together by an electrostatic force whenever the electric field is activated. ‘The electrodes squeeze the polymer as they come together,’ said Jonathan Chavanne, a PhD student at the LAI. ‘Yet because this material is incompressible, its volume remains constant. So its surface area increases and stores up elastic energy.’
The electrical pulse is provided to the device by magnetic induction. Each of the three rings contracts in turn, in a movement reminiscent of an earthworm. This series of contractions, called peristalsis, creates a wave that moves the liquid inside the artery. This double action – simultaneously vertical and horizontal – helps the heart pump and transport blood.
‘This method does not require us to enter the heart,’ said Yves Perriard, he director of the LAI. ‘This means it is significantly less invasive
than other cardiac support systems, which work by implanting valves or screw pumps inside the ventricle.’
In addition, by avoiding direct contact with the blood, this new solution eliminates the risk of excessive hemolysis, in which enough red blood cells are destroyed that regular transfusions may be required. And because the system is powered by magnetic induction, there are no wires coming out of the body.
The invention is currently in the prototype stage and has several more hurdles to overcome. The researchers plan to improve the device’s performance before testing it on a liquid with similar fluidic properties to those of the blood, such as glycerol. The team has been in contact with the University Hospital of Bern, where clinical trials could be conducted.

EPFL http://tinyurl.com/hxa53ss

Ottawa researchers have validated a rule that could safely take a third of chest pain patients in the emergency department off heart monitors, according to a study. Implementing this made-in-Ottawa rule could free up these monitored beds for sicker patients and reduce wait times.
‘Chest pain is one of the most common reasons people visit Canadian emergency departments, with around 800,000 visits a year,’ said Dr. Venkatesh Thiruganasambandamoorthy, lead author of the study and a scientist and emergency physician at The Ottawa Hospital and an assistant professor at the University of Ottawa.
About 70 percent of chest pain patients who come to the emergency department are put in beds with heart monitors in order to detect potentially dangerous arrhythmia. However, previous studies have shown that this condition is rare, with less than two percent of chest pain patients experiencing it during their stay.
This is why Ottawa researchers had previously developed a simple, highly sensitive tool to identify those patients who can be safely removed from heart monitors. According to the Ottawa Chest Pain Cardiac Monitoring Rule, patients can be removed if they have no current chest pain and there are no significant abnormalities in the electrocardiogram reading.
Patients are normally taken off the monitor after about eight hours, when they are discharged home. Applying this rule will allow patients to be taken off monitors much sooner. If implemented when they first arrive, the rule will allow them to be redirected to a non-monitored area of the emergency department.
To verify the rule, researchers observed chest pain patients in the emergency department. Then they tested whether the tool could accurately predict which patients had needed to stay on heart monitors because of irregular heartbeat.
They found that 15 of the 1,125 patients admitted to The Ottawa Hospital emergency departments for chest pain between November 2013 and April 2015 experienced irregular heartbeat during their eight-hour stay. The rule was able to predict with 100 percent accuracy the 15 patients who needed to stay on heart monitors. It also indicated that 36 percent of the 796 patients who were monitored during the study could have been safely removed from the monitors.
‘This rule now has the potential to take a large number of low risk chest pain patients off of heart monitors,’ said Dr, Thiruganasambandamoorthy. ‘We started using this rule in The Ottawa Hospital emergency departments a few months ago, and we’re watching the outcomes very closely. We have also spoken to several emergency departments across the country who are excited about bringing this rule into their hospitals.’

The Ottawa Hospital Research Institute http://tinyurl.com/j5dm7xl