In an important step toward endoscopic diagnosis of cancer, researchers have developed a handheld fibre optic probe that can be used to perform multiple nonlinear imaging techniques without the need for tissue staining. The new multimodal imaging probe uses an ultrafast laser to create nonlinear optical effects in tissue that can reveal cancer and other diseases.

Today, cancer is typically diagnosed by removing a bit of tissue with a biopsy and then sending that tissue to a specially trained pathologist who stains the tissue and uses a microscope to look for cancerous cells. The ability for doctors to skip the biopsy and use a multimodal imaging endoscope to diagnose cancer on the spot would save valuable time and could also allow surgeons to more easily differentiate between cancerous and healthy tissue during surgery.

With the new probe, imaging techniques that previously required bulky table-top instruments can be performed with a handheld device measuring only 8 millimeters in diameter, about the same diameter as a ballpoint pen. If miniaturized further, the probe could easily be integrated into an endoscope for nonlinear multimodal imaging inside the body.

‘We hope that, one day, multimodal endoscopic imaging techniques could help doctors make quick decisions during surgery, without the need for taking biopsies, using staining treatments or performing complex histopathological procedures,’ said Jurgen Popp, from Leibniz Institute of Photonic Technology in Jena, Germany and the paper’s lead author.

It is the first miniaturized probe for multimodal biological imaging to incorporate a multicore imaging fibre, a type of optical fibre consisting of several thousand light-guiding elements. This special imaging fibre allowed the researchers to keep all moving parts and electric power outside of the probe head, making the probe easy and safe to use in the body.

The researchers have tested the probe with many types of tissue samples, but because it is currently designed for forward view mode, the primary applications of the probe would likely include skin, brain or head and neck surgery. They are working on implementing a side view mode that could be used to investigate hollow organs and arteries such as the colon, bladder or aorta.

‘The new probe serves as a miniaturized microscope that uses near-infrared lasers to investigate tissue,’ said Popp. ‘Different components of biological tissue react differently to the excitation lasers, and their unique response gives us information about the molecular composition and morphology within the tissue.’

The handheld multimodal imaging probe can simultaneously acquire several types of images: coherent anti-stokes Raman scattering, second harmonic generation and two-photon excited auto-fluorescence. These nonlinear imaging techniques have been shown to be useful for clinical diagnostics, including identifying cancerous cells, but it has been difficult to miniaturize the required instrumentation for use inside the body.

The probe’s reduced size comes from its use of gradient index, or GRIN, lenses to focus the laser light. Compared to traditional spherical lenses that use complicated shaped surfaces to focus light, GRIN lenses can be made very small because they focus light through continuous refractive index changes within the lens material. Popp’s research team collaborated with scientists from Grintech Gmbh who designed GRIN lenses only 1.8 millimetres in diameter and helped incorporate the robust lens assembly into a small aluminium housing.

The Optical Society
http://www.osa.org/en-us/about_osa/newsroom/news_releases/2017/new_fiber_optic_probe_brings_endoscopic_diagnosis/

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