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Archive for category: E-News

E-News

New cardiac catheter combines light and ultrasound to measure plaques

, 26 August 2020/in E-News /by 3wmedia

To win the battle against heart disease, cardiologists need better ways to identify the composition of plaque most likely to rupture and cause a heart attack. Angiography allows them to examine blood vessels for constricted regions by injecting them with a contrast agent before X-raying them. But because plaque does not always result in constricted vessels, angiography can miss dangerous buildups of plaque. Intravascular ultrasound can penetrate the buildup to identify depth, but lacks the ability to identify some of the finer details about risk of plaque rupture.
This new catheter probe combines intravascular ultrasound (IVUS) with fluorescence lifetime imaging (FLIm) to image the tiny arteries of a living heart.
Professor Laura Marcu’s lab in the Department of Biomedical Engineering at UC Davis has now combined intravascular ultrasound with fluorescence lifetime imaging (FLIm) in a single catheter probe that can image the tiny arteries of a living heart. The new catheter can simultaneously retrieve structural and biochemical information about arterial plaque that could more reliably predict heart attacks.
An optical fibre in the catheter sends short laser pulses into surrounding tissue, which fluoresces with tiny flashes of light in return. Different kinds of tissue (collagen, proteins, lipids) emit different amounts of fluorescence.
At the same time, an ultrasound probe in the catheter records structural information about the blood vessel.
The combination FLIm-IVUS imaging catheter provides a comprehensive insight into how atherosclerotic plaque forms, aiding diagnosis and providing a way to measure how plaques shrink in response to therapy.
The new catheter has been tested in living swine hearts and samples of human coronary arteries.
The catheter used in the study is flexible enough to access coronary arteries in a living human following standard procedures. It does not require any injected fluorescent tracers or any special modification of the catheterization procedures.
The new technique could not only improve understanding of mechanisms behind plaque rupture – an event with fatal consequences- but also the diagnosis and treatment of patients with heart disease.
Marcu’s group is currently working to obtain FDA approval to test this new intravascular technology on human patients.

UC Davishttps://tinyurl.com/y7we7uva

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Telemedicine provides accurate diagnosis of rare cause of blindness in preemies

, 26 August 2020/in E-News /by 3wmedia

Accurately detecting a rare but devastating cause of blindness in premature babies can be done as effectively with telemedicine as with traditional, in-person eye exams, a study suggests. This is believed to be the first study to directly compare the two approaches.
The finding could enable more blindness-preventing treatment for infants born in rural and other areas where there are few ophthalmologists trained to detect the condition, called retinopathy of prematurity, or ROP. Musician Stevie Wonder went blind due to this condition.
“A lack of access to trained ophthalmologists with experience diagnosing ROP sadly prevents many premature infants from receiving much-needed screening, both in developed and developing countries,” said the study’s lead researcher, Michael F. Chiang, M.D., a professor of ophthalmology and medical informatics & clinical epidemiology in the OHSU School of Medicine and a paediatric ophthalmologist at OHSU’s Elks Children’s Eye Clinic.
Retinopathy of prematurity is caused by abnormal blood vessel growth near the retina, the light-sensitive portion in the back of an eye.
Some U.S. medical associations recommend an in-person exam, which involves a special magnifying device that shines light into a baby’s dilated eye, to diagnose the condition. But trained professionals aren’t always easy to find in rural areas and developing countries.
The research team compared the accuracy of in-person exams with digital eye images that were remotely evaluated by professionals. They partnered with seven medical institutions to examine the eyes of 281 infants who were at risk for the condition. Each eye was evaluated both in-person and remotely with a wide-angle telemedicine image.
The researchers found there was no difference in the overall accuracy between the two evaluation methods. In-person examiners were found to be slightly better at accurately diagnosing the condition’s later-stage development, but the research team concluded telemedicine could be used to diagnose clinically significant cases of retinopathy of prematurity.
OHSU School of Medicinenews.ohsu.edu/2018/04/06/telemedicine-provides-accurate-diagnosis-of-rare-cause-of-blindness-in-preemies

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3D Mammography costs less than digital mammography

, 26 August 2020/in E-News /by 3wmedia

Although digital breast tomosynthesis (DBT), or 3-D mammography, costs more than a digital mammography (DM) screening, it actually may help rein in cancer screening costs, according to preliminary findings (PD7-05) presented by researchers from the Perelman School of Medicine. The group analysed 46,483 screening episodes – a single screening mammogram and all subsequent breast diagnosis related costs for the following year – in two hospitals within the University of Pennsylvania Health System in 2012 and 2013.
“Early detection is critical to saving lives and lowering costs,” said senior author Emily F. Conant, MD, chief of Breast Imaging at Penn Medicine. “Fortunately, breast imaging is more precise than ever thanks to DBT. Despite its higher initial cost, DBT is increasingly being embraced by radiologists nationwide. If you look at expenses associated with breast diagnosis in the following year after initial screening, DBT is more cost effective in terms of health system or population level screening.”
Previous studies modelling outcomes have demonstrated that DBT can be cost effective. In this study, the authors analysed actual costs and patient outcomes within a single health system where both DM and DBT screening occurred. They excluded any episodes in which the patient had a prior breast cancer diagnosis or reached 90 years of age before the end of the follow-up period. DM represented 53 percent of the episodes and DBT represented 47 percent. Fifty three percent of women studied received DM and 47 percent received DBT.
They tested DBT and DM according to four outcomes – true positive (TP), true negative (TN), false positive (FP), and false negative (FN) rates – by comparing the Breast Imaging Reporting and Data System (BI-RADS) score (assigned at screening with data about subsequent cancer diagnosis).
DBT was a more effective screening method. Compared to DM episodes, DBT episodes had lower FP (8.6% vs. 10.8%) and higher TN (90.9% vs. 88.7%, p<0.001) rates. (There were no statistically significant differences between DBT and DM episodes with respect to TP and FN rates.)
Although it screened more effectively, DBT did cost more than DM. Overall, average episode costs were higher for DBT compared to DM ($378.02 vs. $286.62). This difference was driven by higher average screening costs ($215.94 vs. $155.76), which approximated the additional charge for DBT, as well as follow-up costs ($23.67 vs. $12.11). There was no significant difference in costs between DBT and DM episodes within the diagnosis or cancer treatment windows.
DM and DBT episodes had roughly the same average episode costs per woman screened for FP ($67.75 vs. $65.71), FN ($4.63 vs. $5.60) and TP ($85.80 vs. $65.15) outcomes despite the higher cost per individual DBT study. The higher costs for TN ($219.84 vs. $150.16) outcomes approximated the higher CMS (Centers for Medicam and Medicinal Services) charge for DBT.
Penn Medicinehttps://tinyurl.com/y7nemu7g

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Molecular basis for increased cardiovascular disease in older women

Cardiology, women's health, 26 August 2020/in E-News /by 3wmedia

Researchers have discovered the molecular basis for the increased incidence of cardiovascular diseases in older women. The study found that older women had mitochondrial dysfunction, reduced antioxidant proteins, and increased inflammation.
Previous studies have shown sex differences in the age at which cardiovascular diseases occur. Ischemic heart disease, for example, develops on average seven to ten years later in women compared with men. It occurs three to four times more often in men than in women below the age of 60 years, but after the age of 75, most patients are women.
It is not clear why many women are protected from cardiovascular disease at a young age but are more susceptible after menopause. Estrogen levels may play a role but the mechanism is unknown. This study looked at molecular changes in the cells of the heart that happen with ageing, and how they differ between men and women.
Specifically, the researchers looked at healthy hearts to see if there are sex differences in mitochondrial function and inflammation during ageing. Heart tissue was obtained from seven women and seven men aged 17 to 40 years, and from eight women and nine men aged 50 to 68 years. The researchers measured levels of proteins involved in inflammation and in the function of the mitochondria.
The researchers found that the levels of Sirt1, a protein that is important for the function of the mitochondria, are higher in young women compared to young men. In the older hearts, Sirt1 levels had decreased in women but not in men. Expression of superoxide dismutase 2, an antioxidant protein in the mitochondria, was higher in young females than males but the difference was no longer present with age.
In addition, the expression of catalase, an enzyme that protects cells from oxidative damage, was higher in young females than males but again the difference was lost with age.
With age, female hearts shifted from an anti-inflammatory to a pro-inflammatory environment. Compared to young men, young women had higher levels of anti-inflammatory cytokines such as interleukin 10 – but this difference was lost with age. Levels of macrophages, which promote inflammation, increased with age in women but not in men.
Dr Maria Luisa Barcena De Arellano, scientific researcher, Institute of Gender Medicine, Charité University Medicine Berlin, Germany, said: “Our study provides a molecular explanation for the increased incidence of cardiovascular diseases in older women.”

European Society of Cardiology
https://tinyurl.com/y8zah7gn

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Study casts doubt on ketamine nasal sprays for depression

, 26 August 2020/in E-News /by 3wmedia

Researchers from the Black Dog Institute and UNSW Sydney have questioned the efficacy and safety of intranasal ketamine for depression, with their pilot trial stopped early due to poor side effects in patients.
Nasal spray devices have been touted as a promising way to deliver ketamine to patients with treatment-resistant depression, with this application easier to use and less invasive than other clinical delivery methods such as injections.
Yet contrary to previous trials, this latest study reveals the unpredictable nature of intranasal ketamine tolerance from one person to the next.
“It’s clear that the intranasal method of ketamine delivery is not as simple as it first seemed,” said lead author UNSW Professor Colleen Loo, who is based at Black Dog Institute.
“Many factors are at play when it comes to nasal spray ketamine treatments. Absorption will vary between people and can fluctuate on any given day within an individual based on such things as mucous levels in the nose and the specific application technique used.”
The pilot trial aimed to test the feasibility of repeated doses of ketamine through an intranasal device amongst 10 participants with severe depression, ahead of a larger randomised controlled trial.
Participants were first given extensive training in proper self-administration techniques before receiving either a course of eight ketamine treatments or an active control over a period of four weeks, under supervision at the study centre.
Following initial reactions to the nasal spray, the dosage was adjusted amongst study patients to include longer time intervals between sprays.
However, the pilot study was eventually suspended after testing with five participants due to unexpected problems with tolerability. Side effects included high blood pressure, psychotic-like effects and motor incoordination that left some participants unable to continue to self-administer the spray.  
“Intranasal ketamine delivery is very potent as it bypasses metabolic pathways, and ketamine is rapidly absorbed into the bloodstream,” said Professor Loo.
“But as our findings show, this can lead to problems with high peak levels of ketamine in some people causing problematic side effects.
“Other recent studies have questioned whether changes to ketamine’s composition after being metabolised into derivative compounds may actually deliver useful therapeutic effects.
“It remains unclear whether ketamine nasal sprays can be safely relied upon as a treatment for patients with severe depression.”
University of New South Walesnewsroom.unsw.edu.au/news/health/study-casts-doubt-ketamine-nasal-sprays-depression

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New antifungal provides hope in fight against superbugs

, 26 August 2020/in E-News /by 3wmedia

Microscopic yeast have been wreaking havoc in hospitals around the world—creeping into catheters, ventilator tubes, and IV lines—and causing deadly invasive infection. One culprit species, Candida auris, is resistant to many antifungals, meaning once a person is infected, there are limited treatment options. But in a recent Antimicrobial Agents and Chemotherapy study, researchers confirmed a new drug compound kills drug-resistant C. auris, both in the laboratory and in a mouse model that mimics human infection.
APX001, the prodrug of the active moiety APX001A, is currently in clinical development by Amplyx Pharmaceuticals. It works through a novel mechanism of action. Unlike other antifungal agents that poke holes in yeast cell membranes or inhibit sterol synthesis, the new drug targets an enzyme called Gwt1, which is required for anchoring critical proteins to the fungal cell wall. This means C. auris can’t grow properly and has a harder time forming drug-resistant fungal biofilms that are a stubborn source of hospital outbreaks. Gwt1 is highly conserved across fungal species, suggesting the new drug could treat a broad range of fungal infections.
“The drug is first in a new class of antifungals, which could help stave off drug resistance. Even the most troublesome strains are unlikely to have developed workarounds for its mechanism of action,” said study lead Mahmoud A. Ghannoum, PhD, professor of dermatology at Case Western Reserve University School of Medicine and director of the Center for Medical Mycology at Case Western Reserve University and University Hospitals Cleveland Medical Center.
In the new study, Ghannoum’s team tested the drug against 16 different C. auris strains, collected from infected patients in Germany, Japan, South Korea, and India. When they exposed the isolates to the new drug, they found it more potent than nine other currently available antifungals. According to the authors, the concentration of study drug needed to kill C. auris growing in laboratory dishes was “eight-fold lower than the next most active drug, anidulafungin, and more than 30-fold lower than all other compounds tested.”
The researchers also developed a new mouse model of invasive C. auris infection for the study. Said Ghannoum, “To help the discovery of effective drugs it will be necessary to have an animal model that mimics this infection. Our work helps this process in two ways: first we developed the needed animal model that mimics the infection caused by this devastating yeast, and second, we used the developed model to show the drug is effective in treating this infection.”
Ghannoum studied immunocompromised mice infected with C. auris via their tail vein—similar to very sick humans in hospitals who experience bloodstream infections. Infected mice treated with APX001 and anidulafungin had significant reductions in kidney and lung fungal burden two days post-treatment, compared to control animals. APX001 also significantly decreased fungal burden in the brain, consistent with brain penetration, whereas reduction with anidulafungin did not reach significance. The results suggest the new drug could help treat even the most invasive infections.
According to Ghannoum, the most exciting element of the study is that it brings a promising antifungal one step closer to patients. It helps lay the foundation for phase 2 clinical trials that study that study the safety and efficacy of new drugs in patients with fungal infections. There is an urgent need for such studies, as C. auris infection has become a serious threat to healthcare facilities worldwide—and resistance to commercially available antifungal drugs is rising.
Case Western Reserve University Medical Schoolcasemed.case.edu/cwrumed360/news-releases/release.cfm?news_id=906&news_category=8

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A new portable gel that could save an injured eye

, 26 August 2020/in E-News /by 3wmedia

When a soldier sustains a traumatic eye injury on the battlefield, any delay in treatment may lead to permanent vision loss. With medical facilities potentially far away and no existing tools to prevent deterioration, medics are in a high-stakes race against the clock.
A multidisciplinary team of scientists and engineers at USC are close to solving the problem. They have developed a reversible, temperature-sensitive temporary seal that changes from a fluid to a super-strong semi-solid when applied to the eye. When the patient is ready for surgery to permanently close the injury, doctors can remove the seal by adding cool water.
“If you look at historical data over the last several decades, the rate of war-related ocular injuries has steadily increased from a fraction of a percent to as high as 10 to 15 percent. Some of that can be attributed to changes in warfare, especially with the use of improvised explosive devices,” said corresponding author John Whalen, assistant professor of research ophthalmology at the USC Roski Eye Institute and member of the USC Institute for Biomedical Therapeutics. “When the Department of Defense asked the scientific community to develop novel approaches to treating ocular injuries, we immediately thought of an advanced material we had previously worked with as a possible adhesive for a retinal implant.”
The material the group was working with for retinal implants was a hydrogel called PNIPAM, poly(N-isopropylacrylamide), which had a unique attribute that made it a natural fit for this application: when cooled, the hydrogel became a liquid for easy application, and when heated, it became a viscous semi-solid with strong adhesion. All that was needed was some tailoring.
“Since the initial hydrogel’s transition temperature was very close to the temperature of the human eye, we had to modify its properties to ensure that it would form a solid seal as soon as the gel was applied to the eye by a soldier or medic,” said lead author Niki Bayat, a doctoral candidate in the Mork Family Department of Chemical Engineering and Materials Science at USC Viterbi. “Providing a perfect, yet reversible seal, the smart hydrogel shows promise for the next generation of tissue adhesives.”
When an ophthalmologist is ready to repair the eye, the hydrogel can be extracted by applying cool water and converting it back to a less adhesive state.
The research team also developed a special syringe for the hydrogel that would be easy to use on the front lines and capable of quickly cooling the hydrogel before application. The syringe has a cooling chamber filled with calcium ammonium nitrate crystals — the type used in instant ice cold packs. By adding water to the chamber, the crystals activate and cool the hydrogel to operating temperatures within 30 seconds.
“We were able to optimize the delivery device so that it not only rapidly cools the hydrogel but also holds it at that temperature, giving users a 10-minute window to fill penetrations in the eye,” Whalen said. “It’s very simple to use — almost like caulking a bathroom seal.”
The customized seal and delivery device will also reduce the amount of time it takes to close penetrating eye injuries overall.
“This temporary intervention could decrease repair time from 30 minutes or longer to less than five minutes, freeing up valuable time for first responders and trauma units,” said principal investigator Mark Humayun, University Professor of Ophthalmology and co-director of the USC Roski Eye Institute, director of the USC Institute for Biomedical Therapeutics and a professor of biomedical engineering at USC Viterbi.
University of Southern Californiahttps://tinyurl.com/y8eurz42

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Probiotics useful in the fight against infection prevention

, 26 August 2020/in E-News /by 3wmedia

Probiotics may be a relatively safe, simple, and low-cost solution for preventing Clostridium difficile infections (CDI) in hospital settings, according to two studies. Both studies show that treating patients who received antibiotics with multi-strain probiotics, cut down on CDI incidence rates over time.
"While it’s not a perfect solution for a bacterium that has proven very difficult to prevent and treat, probiotics could offer patients another line of defence," said Bradley Johnston, PhD, associate professor of epidemiology at Dalhousie University in Canada and lead author of one of the studies. "We worked with clinical trialists from 12 countries that willingly shared their data with us to conduct what is known as an individual patient data meta-analysis and we demonstrated that we should be considering probiotics as a viable strategy for preventing CDI in patients."
The research led out of Dalhousie University in Canada conducted a synthesis of randomized controlled trials to determine whether probiotics reduced the odds of CDI in adults and children. It found that probiotics reduced the odds of CDI by about two-thirds in both their non-adjusted and adjusted models (adjusting for age, sex, hospitalization status, use of multiple antibiotics, and exposure to high-risk antibiotics). Additionally, they found that compared to no probiotics, multi-species probiotics were more beneficial than single-species probiotics.
This study analyzed 18 eligible randomized controlled trials that included patient data for 6,851 participants comparing probiotics to placebo or no treatment and that reported CDI as an outcome. Probiotics were especially effective among participants taking two or more antibiotics and in settings where the risk of CDI was greater than five percent.
A second project conducted by Cook County Health & Hospitals System at a separate tertiary care medical center, in which a single-center before-after quality improvement intervention was evaluated, found that probiotics provided a delayed benefit in reducing CDI. During the intervention period, there was a trend toward a lower incidence in CDI in the second six months, compared to the first six months. The authors speculate that the postponed benefit could be attributed to the time required for environmental contamination with spores of C. difficile to be brought under control.
"There is an expanding number of options to prevent or treat the often serious and costly infections caused by C. difficile," said William Trick, MD, a clinician at Cook County Health & Hospitals System and lead author of the study. "Probiotics are one option that is low cost, relatively safe, and likely beneficial in the long-run."
Trick and his team compared 12-month baseline and intervention periods. Patients in the study received capsules containing a three-strain probiotic mixture, to be taken within 12 hours of their antibiotics. The primary outcome of the study was the incidence of hospital-onset CDI among participants.
While this study showed the benefits of implementing probiotics as a strategy against CDI, it also highlighted the limitations in this approach. For instance, during a real-world quality improvement intervention, getting a probiotic agent to the right patients at the right time was challenging and led to incomplete use of the intervention. Also, the beneficial results are unlikely to match those reported in randomized controlled trials (RCTs). It is critical that interventions are tested in routine practice settings to uncover implementation challenges and to evaluate the replicability of results from RCTs in different settings.

The Society for Healthcare Epidemiology of America (SHEA)www.shea-online.org/index.php/journal-news/press-room/press-release-archives/588-probiotics-useful-in-the-fight-against-infection-prevention

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Canon Medical Systems Corporation acquires Fysicon B.V.

, 26 August 2020/in E-News /by 3wmedia

Fysicon announced on March 7 that it has been acquired by Canon Medical Systems Corporation.

Linda Elberse, CEO of Fysicon: "Being part of a major player as Canon Medical Systems Corporation gives us the opportunity to cover all parts of the world with our innovative systems. Now Canon Medical has completed the image by adding Fysicon’s new developed hemodynamic monitoring system “QMAPP”, the sophisticated device management system “DataLinQ” and the cloud based image distribution software “EVOCS" and last but not least Fysicon’s knowledge of connectivity and workflow management. Canon Medical is a strong brand name and a leading supplier, that will help us take the next steps into strengthening and growing our footprint in the global market. Furthermore we will keep developing new technologies and exploring new areas in the medical field together with our new parent company. We are very proud to have joined forces!”

Toshio Takiguchi, President of Canon Medical Systems, said: “We are really pleased that we can provide new clinical value to patients and medical professionals by combining Fysicon’s advanced technologies with our systems.“ 

About Fysicon
Fysicon was founded in 1996 and employs approximately 40 employees. The company is headquartered in the Netherlands (Oss) and has a subsidiary in the UK. Hospitals around the world are using Fysicon’s hardware and software to streamline cardiac workflows and manage their data exchange.
Fysicon designs, develops and produces innovative medical technologies in the areas of structural heart disease and medical imaging for hospitals, research institutes and industry. Both hardware as well as software are developed and produced in-house, to guarantee the highest level of quality.  Fysicon challenges healthcare by developing innovative, intuitive and high quality medical solutions for healthcare professionals empowering them to treat patients faster, better and more cost effective.www.fysicon.com 

About Canon Medical Sytems Corporation
Canon Medical offers a full range of diagnostic medical imaging solutions including Ultrasound, CT, X-Ray, and MR, across the globe. On January 4, 2018, Toshiba Medical changed its company name to Canon Medical Systems Corporation. In line with our continued Made for Life philosophy, patients are at the heart of everything we do. Our mission is to provide medical professionals with solutions that support their efforts in contributing to the health and wellbeing of patients worldwide so that together our industry-leading solutions deliver an enriched quality of life.https://global.medical.canon

 

 

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Breakthrough technology to further understand eye damage from eclipse

, 26 August 2020/in E-News /by 3wmedia

In a first-of-its-kind study, Mount Sinai researchers are using adaptive optics (AO) to analyse retinal eye damage from the August solar eclipse on a cellular level. The research could help doctors develop a deeper understanding of this rare condition, called solar retinopathy, which has no currently accepted treatment.
Adaptive optics is a sophisticated technology that allows clinicians to examine microscopic structures of the eye in living patients with extreme detail in real time. Before the development of AO, researchers could only see this level of detail on glass slides with a microscope.
“We have never seen the cellular damage from an eclipse because this event rarely happens and we haven’t had this type of advanced technology to examine solar retinopathy until recently,” said lead investigator Avnish Deobhakta, MD, Assistant Professor of Ophthalmology at the Icahn School of Medicine at Mount Sinai. “NYEE is one of the few sites in North America with access to this technology, and using this to get an exact look at the patient’s retinal damage on such a precise level will help clinicians better understand the condition.”
Mount Sinai investigators used AO imaging on a patient who looked at the sun during the eclipse for 21 seconds without protective eyewear. Four hours later, the patient developed blurry distortion in both eyes and could only see the colour black. NYEE specialists examined her three days later and found she had burned a hole in her retinas and diagnosed her with solar retinopathy and photochemical burns.
Using this technology, researchers obtained high-resolution images of the damaged photoreceptors, which may provide a deeper understanding of the condition that could one day lead to the development of treatments.
“It’s exciting to be able to see such a correlation between the patient’s symptoms and the photoreceptor injury on a cellular level.  Hopefully this research allows us to potentially develop future therapies for solar retinopathy and other forms of photic injury to the retina,” said Chris Wu, MD, a resident physician at New York Eye and Ear Infirmary of Mount Sinai. “This study can prepare doctors and patients for the next eclipse in 2024, and make them more informed of the risks of directly viewing the sun without protective eyewear.”
Mount Sinai Health Systemhttps://tinyurl.com/y8cge588

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