University of Missouri College of Engineering Dean and Bioengineering Professor Elizabeth Loboa and a team of colleagues recently discovered a way to slow and, in some cases, prevent the spread of MRSA while also regenerating new bone.

Methicillin resistant Staphylococcus aureus, or MRSA, infections are a critical problem in the medical world, including the area of regenerative medicine. This form of antibiotic-resistant staph infection can cause serious complications after typical invasive procedures and can be easily spread through skin-to-skin contact. MRSA is one of the foremost causes of osteomyelitis, a disease that inflames and destroys bone as well as surrounding soft tissue.

But University of Missouri College of Engineering Dean and Bioengineering Professor Elizabeth Loboa and a team of colleagues – Mahsa Mohiti-Asli and Casey Molina of the Joint Department of Biomedical Engineering at the University of North Carolina and North Carolina State University, Diteepeng Thamonwan of Silpakorn University in Thailand and Behnam Pourdeyhimi of NCSU – recently discovered a way to slow and, in some cases, prevent the spread of MRSA while also regenerating new bone.

Loboa and her colleagues discovered that by seeding the proper amount of silver into a biodegradable scaffold alongside bone-forming stem cells, they could still rapidly form bone while either inhibiting MRSA growth or killing the infection outright.

‘The silver ions go in and completely disrupt the MRSA cell machinery, and they can inhibit growth and kill the bacteria,’ Loboa said. ‘It’s a fine line. If you overuse too much of the silver, it’s bad for the mammalian cells. We want to make sure we don’t hurt our host cells but kill the bacterial cells.’

The threads of the bone-creating scaffold were coated with a silver ion-containing solution before testing. Silver has proven effective in undoing bacteria mechanically, making it harder for bacteria to develop immunity.

University of Missouri College of Engineering engineering.missouri.edu/2017/01/silver-ions-prove-effective-treating-killing-antibiotic-resistant-staph-infection/

Duke researchers have devised a computerized method to autonomously and quickly diagnose malaria with clinically relevant accuracy — a crucial step to successfully treating the disease and halting its spread.
In 2015 alone, malaria infected 214 million people worldwide, killing an estimated 438,000.

Malaria’s symptoms can look like many other diseases, and there are simply not enough well-trained field workers and functioning microscopes to keep pace with the parasite. While rapid diagnostic tests do exist, it is expensive to continuously purchase new tests. These tests also cannot tell how severe the infection is by tallying the number of infected cells, which is important for managing a patient’s recovery.

In a new study, engineers from Duke University report a method that uses computer deep learning’ and light-based, holographic scans to spot malaria-infected cells from a simple, untouched blood sample without any help from a human. The innovation could form the basis of a fast, reliable test that could be given by most anyone, anywhere in the field, which would be invaluable in the $2.7 billion-per-year global fight against the disease.

‘With this technique, the path is there to be able to process thousands of cells per minute,’ said Adam Wax, professor of biomedical engineering at Duke. ‘That’s a huge improvement to the 40 minutes it currently takes a field technician to stain, prepare and read a slide to personally look for infection.’
The new technique is based on a technology called quantitative phase spectroscopy. As a laser sweeps through the visible spectrum of light, sensors capture how each discrete light frequency interacts with a sample of blood. The resulting data captures a holographic image that provides a wide array of valuable information that can indicate a malarial infection.

‘We identified 23 parameters that are statistically significant for spotting malaria,’ said Han Sang Park, a doctoral student in Wax’s laboratory and first author on the paper. For example, as the disease progresses, red blood cells decrease in volume, lose haemoglobin and deform as the parasite within grows larger. This affects features such as cell volume, perimeter, shape and centre of mass.

‘However, none of the parameters were reliable more than 90 percent of the time on their own, so we decided to use them all,’ said Park.
‘To be adopted, any new diagnostic device has to be just as reliable as a trained field worker with a microscope,’ said Wax. ‘Otherwise, even with a 90 percent success rate, you’d still miss more than 20 million cases a year.’

To get a more accurate reading, Wax and Park turned to deep learning — a method by which computers teach themselves how to distinguish between different objects. By feeding data on more than 1,000 healthy and diseased cells into a computer, the deep learning program determined which sets of measurements at which thresholds most clearly distinguished healthy from diseased cells.

When they put the resulting algorithm to the test with hundreds of cells, it was able to correctly spot malaria 97 to 100 percent of the time — a number the researchers believe will increase as more cells are used to train the program. Because the technique breaks data-rich holograms down to just 23 numbers, tests can be easily transmitted in bulk, which is important for locations that often do not have reliable, fast internet connections, and that, in turn, could eliminate the need for each location to have its own computer for processing.
Wax and Park are now looking to develop the technology into a diagnostic device through a startup company called M2 Photonics Innovations. They hope to show that a device based on this technology would be accurate and cost-efficient enough to be useful in the field. Wax has also received funding to begin exploring the use of the technique for spotting cancerous cells in blood samples.

Duke University pratt.duke.edu/about/news/spotting-malaria

The biocompatible near-infrared 3D tracking system used to guide the suturing in the first smart tissue autonomous robot (STAR) surgery has the potential to improve manual and robot-assisted surgery and interventions through unobstructed 3D visibility and enhanced accuracy, according to a study. The study successfully demonstrates feasibility in live subjects (in-vivo) and demonstrates 3D tracking of tissue and surgical tools with millimeter accuracy in ex-vivo tests. More accurate and consistent suturing helps reduce leakage, which can improve surgical outcomes.

Authored by the development team from Sheikh Zayed Institute for Pediatric Surgical Innovation at Children’s National Health System and funded by the National Institutes of Health, the study explains the design of the 3D tracking system with near-infrared fluorescent (NIRF) markers and, using robotic experiments, compares its tracking accuracies against standard optical tracking methods. At speeds of 1 mm/second, the team observed tracking accuracies of 1.61 mm that degraded only to 1.71 mm when the markers were covered in blood and tissue.

‘A fundamental challenge in soft-tissue surgery is that target tissue moves and deforms, becomes occluded by blood or other tissue, which makes it difficult to differentiate from surrounding tissue,’ says Axel Krieger, Ph.D., senior author on the study and program lead for Smart Tools at the Sheikh Zayed Institute. ‘By enabling accurate tracking of tools and tissue in the surgical environment, this innovative work has the potential to improve many applications for manual and robot-assisted surgery.’

The system is made up of small biocompatible NIRF markers with a novel fused plenoptic and near-infrared (NIR) camera tracking system, enabling 3D tracking that can overcome blood and tissue occlusion in an uncontrolled, rapidly changing surgical environment. Krieger explains that the NIR imaging has the potential to overcome occlusion problems because NIR light penetrates deeper than visual light.

‘This work describes the ‘super human eyes’ and a bit of ‘intelligence’ of our STAR robotic system, making tasks such as soft tissue surgery on live subjects possible,’ explains Peter C. Kim, M.D., vice president and associate surgeon in chief of the Sheikh Zayed Institute.

EurekAlert www.eurekalert.org/pub_releases/2017-02/cnhs-b3t021717.php

Pulsed cavitation ultrasound (PCU) can be used to remotely soften human degenerative calcified biosprosthetic valves and may significantly improve the valve opening function, according to a study.
Olivier Villemain, MD, et al., examined the effects of PCU on human bioprosthetic heart valves that were removed from patients because they were heavily calcified and were non-functional. PCU, also called histotripsy, uses short-pulses of focused high pressure ultrasound to soften biological tissue. The ultrasound is delivered by a transducer that can be placed outside of the body and directed in a focused manner to the area of interest.
The removed valves were surgically implanted in sheep or were studied in an experimental bath apparatus in order to examine the longer-term effects of PCU. The researchers found that the PCU was able to soften the stiff calcified valves and improve the function of the valves. The amount of stenosis of the calcified aortic valves decreased by about two-fold on average in both the animal model and the experimental apparatus. The researchers believe that this new non-invasive approach has the potential to improve the outcome of patients with severe calcified bioprosthesis stenosis by avoiding risky surgical or transcatheter reintervention.
This study was designed as a proof of concept study and did not evaluate the potential risk of PCU causing pieces of the calcified aortic valve breaking off and causing an embolic stroke.
"The results of this experimental study must be regarded as provisional because neither the safety nor efficacy of this technique have been evaluated in humans," commented Douglas L. Mann, MD, FACC, editor-in-chief of JACC: Basic to Translational Science. "However, the concept of using high energy ultrasound to restore the function of calcified artificial tissue valves, analogous to the manner in which nephrologists use ultrasound to break up kidney stones, is both provocative and exciting. The ultrasound devices to perform this type of therapy exist today, so the ability to translate these concepts to patients can move very quickly."

American College of Cardiology www.acc.org/latest-in-cardiology/articles/2017/06/16/10/40/can-pulsed-cultivation-ultrasound-improve-valve-function?w_nav=LC

The 2017 edition of KIMES brought together a record number of exhibiting companies and visitors from Korea and 92 other countries. A total of 1292 exhibitors – a 12% increase over 2016 – from 41 countries presented over 30,000 products covering the full range of medical equipment, from radiology and medical imaging systems to emergency equipment, from surgical instruments to dental appliances, from medical information systems to disposables, as well as cosmetic and dermatology products. In addition, there was a growing medical device component section that numbered 198 manufacturing and service companies.

Korea’s vibrant medical industry sector was well represented with 579 exhibitors, followed by China (154), the United States (125), Germany (88) and Japan (62).

As last year, the show was held concurrently with Global Bio & Medical Plaza, hosted by KOTRA and acting as the principal global platform for facilitating cooperation and trading between Korean and foreign companies in the bio and medical industries. The event is designed to develop concrete business relationships and pursue potential contract opportunities between guests from abroad and Korean companies. This year it attracted 226 companies from 61 countries, including for the first time a strong delegation from the European Union Buyer’s Group.

Conference
A total of 180 sessions took place in the COEX Conference Centre during the show and covered a variety of topics, including the latest advances in medical device technology as well as government policies on the medical device market. The seminar programme was kicked off by keynote speaker Andrew Nordon of the World-first cancer detection programme.
www.kimes.kr