Computer Tomography (CT) is a standard procedure in hospitals, but so far, the technology has not been suitable for imaging extremely small objects. A team from the Technical University of Munich (TUM) describes a Nano-CT device that creates three-dimensional X-ray images at resolutions up to 100 nanometers. The first test application: Together with colleagues from the University of Kassel and Helmholtz-Zentrum Geesthacht the researchers analysed the locomotory system of a velvet worm.
During a CT analysis, the object under investigation is X-rayed and a detector measures the respective amount of radiation absorbed from various angles. Three-dimensional images of the inside of the object can be constructed based on several such measurements. Up until now, however, the technology reached its limits when it came to objects as small as the tiny, 0.4 millimeter long legs of the velvet worm (Onychophora).
High-resolution images of this magnitude required radiation from particle accelerators, yet there are only a few dozen such facilities in Europe. Approaches suitable for the typical laboratory still had to struggle with low resolutions, or the samples investigated had to be made of certain materials and could not exceed a certain size. The reason was often the use of X-ray optics. Put simply, X-ray optics focus X-ray radiation similar to the way optical lenses focus light – but they also have several limitations.
The TUM Nano-CT system is based on a newly developed X-ray source, which generates a particularly focused beam, without relying on X-ray optics. In combination with an extremely low-noise detector, the device produces images that approach the resolution possible with a scanning electron microscope, while also capturing structures under the surface of the object under investigation.
“Our system has decisive advantages compared to CTs using X-ray optics,” says TUM scientist Mark Müller, lead author of the PNAS article. “We can make tomographies of significantly larger samples and we are more flexible in terms of the materials that can be investigated.”
Like so many other imaging instruments, the Nano-CT system was developed and installed at the Munich School of BioEngineering (MSB). This TUM interdisciplinary research centre is Europe’s thematically most comprehensive university facility for the intersection of medicine, engineering sciences and natural sciences. “Our goal in the development of the Nano-CT system is not only to be able to investigate biological samples, such as the leg of the velvet worm,” says Franz Pfeiffer, TUM Professor for Biomedical Physics, Director of the MSB, and a Fellow at the TUM Institute for Advanced Study (TUM-IAS).
“In the future, this technology will also make biomedical investigations possible. Thus, for example, we will be able to examine tissue samples to clarify whether or not a tumour is malignant. A non-destructive and three-dimensional image of the tissue with a resolution like that of the Nano-CT can also provide new insights into the microscopic development of widespread illnesses such as cancer.”

TUMhttps://tinyurl.com/y9x4jycu

Pilot study by Brigham investigators finds that an innovative care-delivery program helped 81 percent of participants achieve blood pressure control in seven weeks.
Hypertension, or high blood pressure, is a widespread clinical problem affecting nearly half of all adults. Despite the serious consequences that can result from hypertension, which puts patients at increased risk for heart attacks, strokes and other cardiovascular events, elevated blood pressures often remain untreated or undertreated for years, and the control rate for hypertension hovers at just 50 percent. Seeing opportunities for improvement, innovators and clinicians at Brigham and Women’s Hospital have developed a new home-based, care-delivery program aimed to improve hypertension control rates quickly and at significantly lower cost than traditional, office-based blood pressure programs. The new approach, piloted among 130 participants, helped 81 percent of patients bring their blood pressures under control in, on average, just seven weeks.
“This is a striking result, especially given the very short time frame in which control was reached: an average of seven weeks,” said corresponding author Naomi Fisher, MD, director of the Hypertension Service and Hypertension Specialty Clinic at the Brigham. “There are a few notable healthcare systems that have matched or exceeded this control rate, but most clinical practices do not approach this rate of success.”  
To overcome some of the challenges that clinical practices face, Fisher and colleagues combined several innovative strategies to create their program. Enrolled participants each received a Bluetooth-enabled blood pressure device that could automatically transmit the blood pressure measurements patients took at home into their electronic medical records. Patients had easy and frequent access to “patient navigators”—non-physicians who had been trained to use a clinical algorithm developed by hypertension specialists. The program enabled rapid assessment and medication dosage adjustments for the patients.
The pilot was conducted as a prospective cohort study. The team enrolled 130 patients whose blood pressure was uncontrolled (greater than 140/90 mmHg). Patients were recruited from two clinics to test efficacy in two settings: a Brigham primary care clinic (800 Huntington Ave.), and the Brigham’s Watkins Cardiovascular Clinic. All adults were eligible except pregnant women and those with advanced kidney disease. Enrolled patients were given a Bluetooth-enabled blood pressure device and taught how to use it. Patients were instructed to measure their blood pressure at home twice daily in duplicate. Medication adjustments were made every two weeks until home blood pressure was controlled at <135/85 mmHg.
The team’s next step will be to scale up the program to test its generalizability and sustainability. With this approach, the team anticipates significant cost effectiveness and cost savings, in addition to the prevention of cardiovascular events and death from treating hypertension more intensively in men and women.
“The time-honoured model of treating hypertension via traditional visits to the doctor is neither effective nor sustainable,” said Fisher. “Development of innovative solutions to manage hypertension effectively and efficiently, and thus reduce the cardiovascular risk burden in larger populations, is critical. Organizations can and should develop and adopt innovative technologies to create sustainable solutions for the control of hypertension.”

Brigham and Women’s Hospitalhttps://tinyurl.com/yatadjyf

A review of research studies that assessed alarm accuracy and/or clinical relevance in hospitalized patients published over a 30-year period found low proportions of clinically relevant patient alarms.
The findings underscore the need for more rigorous alarm intervention research as hospitals work to meet Joint Commission requirements to reduce unnecessary alarms and implement new practice standards related to electrocardiographic (ECG) monitoring from the American Heart Association.
“Measurement of Physiological Monitor Alarm Accuracy and Clinical Relevance in Intensive Care Units” examined the approaches used to measure alarm accuracy and/or clinical relevance of physiological monitor alarms in intensive care units (ICUs).
The integrative review also compared proportions of inaccurate and clinically irrelevant alarms reported in the studies, which were published from 1986 through 2015. When clinically irrelevant alarms were compared as a percentage of total annotated alarms, most studies revealed that only 5 to 13 percent were clinically relevant; however, the definitions of clinical relevance were inconsistent across studies, which made clinical relevance of alarms difficult to determine.
Co-author Halley Ruppel, RN, MS, is a PhD candidate at Yale University School of Nursing, West Haven, Connecticut, and a Robert Wood Johnson Foundation Future of Nursing scholar. She worked with Yale nursing professors Marjorie Funk, PhD, RN, and Robin Whittemore, PhD, APRN, on the article.
Advances in monitoring technology may have improved the accuracy of alarm systems and simplified much of the data collection but haven’t affected the clinical relevance of alarms.
“Clinical relevance can be a subjective term, and interventions should focus on reducing clinically irrelevant alarms, with careful consideration for how clinical relevance is defined and measured,” Ruppel said. “Especially in ICUs, nurses may use alarms to help them track changes in a patient’s condition. Clinical relevance should reflect alarms that may be informative, even if not immediately actionable or corresponding to a life-threatening incident.”
For the review, the authors conducted an in-depth search of five databases for relevant articles, analysing more than 1,700 records before identifying 12 studies that met the inclusion criteria.
The review follows the recent publication of “Update to Practice Standards for Electrocardiographic Monitoring in Hospital Settings: A Scientific Statement From the American Heart Association.” The comprehensive document provides an interprofessional, comprehensive review of evidence and recommendations for indications, duration and implementation of continuous ECG monitoring of hospitalized patients. The updated practice standards address several emerging issues related to ECG monitoring, including the overuse of arrhythmia monitoring among a variety of patient populations and alarm management.
“Alarms have become ubiquitous in ICUs, but inaccurate or clinically irrelevant alarms remain a threat to patient safety,” said Funk, who also served as a co-author of the AHA statement. “Further research is needed to ensure that we are providing the best-quality monitoring for those who truly benefit from this diagnostic intervention.”

American Association of Critical-Care Nurseshttps://tinyurl.com/y7pf9m2r

Routine oral care to treat gum disease (periodontitis) may play a role in reducing inflammation and toxins in the blood (endotoxemia) and improving cognitive function in people with liver cirrhosis.
Cirrhosis, which is a growing epidemic in the U.S., is the presence of scar tissue on the liver. When severe, it can lead to liver failure. Complications of cirrhosis can include infections throughout the body and hepatic encephalopathy, a build-up of toxins in the brain caused by advanced liver disease. Symptoms of hepatic encephalopathy include confusion, mood changes and impaired cognitive function.
Previous research shows that people with cirrhosis have changes in gut and salivary microbiota— bacteria that populate the gastrointestinal tract and mouth—which can lead to gum disease and a higher risk of cirrhosis-related complications. In addition, studies have found that people with cirrhosis have increased levels of inflammation throughout the body, which is associated with hepatic encephalopathy.
Researchers studied two groups of volunteers that had cirrhosis and mild-to-moderate periodontitis. One group received periodontal care (“treated”), including teeth cleaning and removal of bacteria toxins from the teeth and gums. The other group was not treated for gum disease (“untreated”). The research team collected blood, saliva and stool samples before and 30 days after treatment. Each volunteer took standardized tests to measure cognitive function before and after treatment.
The treated group, especially those with hepatic encephalopathy, had increased levels of beneficial gut bacteria that could reduce inflammation, as well as lower levels of endotoxin-producing bacteria in the saliva when compared to the untreated group. The untreated group, on the other hand, demonstrated an increase in endotoxin levels in the blood over the same time period. The improvement in the treated group “could be related to a reduction in oral inflammation leading to lower systemic inflammation, or due to [less harmful bacteria] being swallowed and affecting the gut microbiota,” the research team wrote.
Cognitive function also improved in the treated group, suggesting that the reduced inflammation levels in the body may minimize some of the symptoms of hepatic encephalopathy in people who are already receiving  standard-of-care therapies for the condition. This finding is relevant because there are no further therapies approved by the U.S. Food and Drug Administration to alleviate cognition problems in this population, the researchers said. “The oral cavity could represent a treatment target to reduce inflammation and endotoxemia in patients with cirrhosis to improve clinical outcomes.”

The American Physiological Societyhttps://tinyurl.com/y9xyw3rj

As part of their partnership, the European Society of Radiology (ESR) and Siemens Healthineers will, for the first time, offer a joint discussion platform for all aspects relating to the digitalization of radiology at the European Congress of Radiology, which will take place between February 27 and March 3, 2019, in Vienna, Austria. In the Siemens Healthineers Digital Experience Hall, experts from academia and industry will be available for open exchanges in a range of interactive discussion formats and will provide insights into their current research and development to make the influence of digitalization on the radiology of the future more tangible. The discussion topics were selected in advance by the ECR participants as part of an online survey. The respondents chose artificial intelligence (AI), big data and augmented and virtual reality. Visitors to the Siemens Healthineers Digital Experience Hall will be able to, among other things, experience augmented reality solutions firsthand and create their own AI applications.
Digitalization has, for several years now, been a major topic at every radiology congress. Given the growing importance of big data applications and artificial intelligence – Siemens Healthineers has already launched 40 AI-based solutions and secured around 500 machine learning patents – a wide range of predictions are circulating regarding the significance of the potential changes for the occupational profile and range of tasks of radiologists. But what will the real consequences of increasing digitalization be for their daily work? This is what the ESR, together with the congress participants and Siemens Healthineers, wants to find out at ECR 2019. The Siemens Healthineers Digital Experience Hall offers visitors the chance to discuss the opportunities presented by digitalization in radiology for physicians, healthcare professionals and patients, as well as to address the subject of digitalization for healthcare as a whole. In the hall, the speakers will provide insights into their latest development work and present new innovative technologies, such as a digital twin of the heart. In addition to a wide range of discussion formats, numerous visionary application examples will be able to be both experienced and understood with all the senses.
“The digitalization of healthcare is essentially a fundamental transformation process that will affect every one of us. There are currently three major paradigm shifts taking place, each influencing the other: More precise diagnostics and therapies leveraging large amounts of data, a more active role for patients, and the growing importance of digital technologies such as artificial intelligence. Only those who understand and approach these transformation processes actively will be able to shape the future of healthcare,” said Christoph Zindel, President of Diagnostic Imaging at Siemens Healthineers.
"We are very pleased that Siemens Healthineers has not only placed the future topics of radiology – digitalization, artificial intelligence, big data and augmented reality – at the forefront of its corporate focus but is also giving our congress guests the opportunity to talk to both renowned medical technology experts and one another about the development of their discipline at ECR 2019. Today, I would like to invite all ECR participants to visit the Siemens Healthineers Digital Experience Hall to discuss the opportunities presented by digitalization in radiology and to experience innovative digitalization applications for themselves," said ESR President Professor Lorenzo E. Derchi from Genoa, Italy.
The Siemens Healthineers Digital Experience Hall is located right next to the entrance to the Austria Center Vienna and will be open from Thursday, February 28, 2019, to Saturday, March 2, 2019, from 10 a.m. to 6 p.m. In addition, Siemens Healthineers will also be showcasing a broad overview of its current digital products and all its novel medical imaging developments at Booth 511 at the ECR industrial exhibition in Hall Expo X5.

www.myesr.org      www.healthcare.siemens.com