MIT researchers, working with scientists from Brigham and Women’s Hospital, have developed a new way to power and communicate with devices implanted deep within the human body. Such devices could be used to deliver drugs, monitor conditions inside the body, or treat disease by stimulating the brain with electricity or light.
The implants are powered by radio frequency waves, which can safely pass through human tissues. In tests in animals, the researchers showed that the waves can power devices located 10 centimeters deep in tissue, from a distance of 1 meter.
“Even though these tiny implantable devices have no batteries, we can now communicate with them from a distance outside the body. This opens up entirely new types of medical applications,” says Fadel Adib, an assistant professor in MIT’s Media Lab and a senior author of the paper, which will be presented at the Association for Computing Machinery Special Interest Group on Data Communication (SIGCOMM) conference in August.
Because they do not require a battery, the devices can be tiny. In this study, the researchers tested a prototype about the size of a grain of rice, but they anticipate that it could be made even smaller.
“Having the capacity to communicate with these systems without the need for a battery would be a significant advance. These devices could be compatible with sensing conditions as well as aiding in the delivery of a drug,” says Giovanni Traverso, an assistant professor at Brigham and Women’s Hospital (BWH), Harvard Medical School, a research affiliate at MIT’s Koch Institute for Integrative Cancer Research, and an author of the paper.
Medical devices that can be ingested or implanted in the body could offer doctors new ways to diagnose, monitor, and treat many diseases. Traverso’s lab is now working on a variety of ingestible systems that can be used to deliver drugs, monitor vital signs, and detect movement of the GI tract.
In the brain, implantable electrodes that deliver an electrical current are used for a technique known as deep brain stimulation, which is often used to treat Parkinson’s disease or epilepsy. These electrodes are now controlled by a pacemaker-like device implanted under the skin, which could be eliminated if wireless power is used. Wireless brain implants could also help deliver light to stimulate or inhibit neuron activity through optogenetics, which so far has not been adapted for use in humans but could be useful for treating many neurological disorders.
Currently, implantable medical devices, such as pacemakers, carry their own batteries, which occupy most of the space on the device and offer a limited lifespan. Adib, who envisions much smaller, battery-free devices, has been exploring the possibility of wirelessly powering implantable devices with radio waves emitted by antennas outside the body.

MIT
news.mit.edu/2018/wireless-system-power-devices-inside-body-0604

IDTechEx Research has recently released a new market report ‘Technology for Diabetes Management, 2019-2029: Technology, Players and Forecasts’, including details of glucose test strips, continuous glucose monitoring (CGM), insulin pumps, insulin pens, digital health / digital therapeutics, side effect management and diagnosis.

The report covers the entire landscape for diabetes management devices, including mature, emerging and future options. The report has been researched via primary interviews with companies, physicians and diabetic individuals to characterize and predict the technology landscape for diabetes devices over the coming decade. In total, activities of 75 companies are covered throughout the report, ranging from the largest players to technology developers and startups developing the next generation of device options.

Historically, diabetics have monitored their blood glucose concentration by using disposable biosensors; following a finger prick, a drop of blood is placed onto a glucose test strip, which is inserted into a reader to provide the result. Whilst billions of test strips are produced each year, this sector as seen profitability shrink due to changing medical subsidies and increased competition. Alternative options have been developed to enable continuous glucose monitoring. These involve devices that are typically worn on the skin, using a sensor on a small needle to test glucose in interstitial fluid. There are now approved devices from several key players, with this industry growing each year.

However, challenges still remain with glucose monitoring devices, with the ultimate aim of providing the best experience for diabetics. CGM devices in the past have been reliant on test strips for calibration, as well as still being invasive or implantable, leading to discomfort. This has led to many players investigating glucose monitoring options which are less invasive, whilst maintaining the required accuracy and reliability. In addition, the possibility of pairing CGM devices with insulin pumps for increasingly automated "closed-loop" systems is becoming increasingly closer. These goals have been in place for decades, and the report follows all the latest news, trends and outlook in each of these technology frontiers around diabetes management devices.

However, managing diabetes is about more than just monitoring glucose levels. The report also covers other aspects of diabetes technology landscape, including insulin delivery, the role of digital health in diabetes, technology for managing side effects, technology for diagnosis and reimbursement, funding and investment examples. The report then includes detailed market forecast following two different methodologies. The first involves the collection of revenue data from companies throughout the space, with historic data back to 2010 by company and by sector. This is then projected given a series of assumptions based on IDTechEx’s primary research efforts. The second forecast scenario involves looking at data for the diabetic population, including number of diabetics, split by type, percentage diagnosis, and then adoption rates by device type for each group. The two forecasts are then discussed and compared, providing with the reader with ample content from which to base business decisions and understand the dynamics in the space.

As discussed, the report is split into 8 main chapters, discussing each aspect of diabetes management technology (not including pharmaceutical options). Following an executive summary, detailing the main conclusions and discussion of the report, the report introduces the challenges and opportunities in diabetes management, as well as going through the main patent holders and filing trends in the space. Then, topic chapters of the report are as follows:
– Sensors for diabetes management: This chapter includes coverage of glucose sensing, from test strips and glucometers, to continuous glucose monitoring (CGM), and through to a discussion of emerging options in this space. In total, 37 different companies are mentioned in this section, ranging from the largest players in tests strips and CGM (e.g. Abbott, Roche, Medtronic, Dexcom, etc.) through to many emerging players or innovators attempting new approaches to glucose monitoring.
– Insulin delivery: This chapter covers techniques from traditional vial-and-syringe and insulin pens, to insulin pumps and towards closed loop insulin delivery alongside CGM. Key trends discussed in this section include the integration of different connectivity and technology integrated alongside both insulin pump and insulin pens, the links from these devices into wider digital health ecosystems and the adoption of newer devices (particularly insulin pumps) by territory and demographic.
– Digital health: Chronic diseases are a prominent early target for those in the digital health ecosystem, and digital health options for diabetes have been prominent. This chapter discusses activities from both the small and larger players, including major acquisitions and collaborations, in areas including diabetes management systems, device companion software and digital therapeutics.
– Side effect management: The majority of the costs associated with diabetes are around managing side effects. This section focuses on new technology options emerging around areas such as diabetic neuropathy, foot ulcers and ketoacidosis. This includes various wearable, flexible and textile-based technology options.
– Diabetes diagnosis: discussing the use of emerging technologies to aid the early detection of diabetes, thereby preventing long hospital stays and other complications.
– Reimbursement options, funding and investment examples: These final elements to the report fill in details which are important for the broader space. Reimbursement, whether through insurers, national healthcare initiatives or otherwise, is still critical for the majority of diabetes devices. Funding and investment are also present, as with any large, transforming industry.

Over 75 companies are mentioned in the report, including many primary interviews, a patent analysis of the key patent-holders, and revenue data where relevant.

A new study appearing finds that ketamine’s acute antidepressant effect requires opioid system activation, the first time that a receptor site has been shown in humans to be necessary for any antidepressant’s mechanism of action. While opioids have been used historically to treat depression, they are known to carry a high risk of dependence. Alan F. Schatzberg, M.D., who led this research at Stanford, cautions against widespread and repeated use of ketamine for depression treatment until more research can be done on both the mechanism of action and the risk of tolerance, abuse and dependence.
Previous research has found ketamine to have rapid-onset antidepressant effects. While the specific mechanism of action for these effects was unknown, it had been generally thought to be due to NMDA receptor antagonism. Since many efforts to develop NMDA antagonists as antidepressants have been unsuccessful, this new study aimed at determining the role of the opioid system in ketamine’s antidepressant and dissociative effects in adults with treatment-resistant depression.
Nolan R. Williams, M.D., and Boris D. Heifets, M.D., Ph.D., from Stanford University, co-first authors of the article, hypothesized that ketamine’s antidepressant effects may be related to intrinsic opioid receptor properties of ketamine. The study looked at whether use of naltrexone, an opioid blocker, prior to ketamine treatment would reduce the acute antidepressant effects of the ketamine or its dissociative effects. The researchers conducted a randomized double-blind crossover trial involving individuals with treatment-resistant depression. Participants received the opioid blocker or a placebo prior to ketamine infusion treatment. Twelve participants completed both conditions in randomized order.
Use of naltrexone dramatically blocked the antidepressant effects of the ketamine but not the dissociative effects, so the trial was halted at the interim analysis. Participants receiving the ketamine plus naltrexone experienced much less reduction in depression symptoms than participants receiving ketamine plus placebo. There were no differences in ketamine-induced dissociation between those receiving naltrexone or a placebo.

American Psychiatric Associationhttps://tinyurl.com/yaon4xuw

Infants with diabetes can drop insulin syringes. Researchers from Bergen and Exeter have been leading the work, which causes children worldwide to replace insulin syringes with tablets.
"All infants diagnosed with diabetes before 6-7 months of age should be given a rapid gene test to change treatment as soon as possible from insulin to sulfonylurea tablets. They can expect a long and very good effect of the treatment of blood sugar control, and the treatment is safe," says Professor Pål Rasmus Njølstad at the University of Bergen.
It was in 2004 discovered that relatively high doses of sulfonylurea tablets could be used to treat diabetes in infants. This principle has given a new life for children with this type of diabetes, because 90% can stop insulin injections and even achieve better blood sugar control, at least for one year without the same low blood sugar problem. However, it has been unknown whether this treatment can be maintained in the long term, especially as sulfonylureas fail in half of those with type 2 diabetes after five years of treatment.
The results are now available from an international multi-center study from centers in Bergen, Exeter, Rome, Paris, and Krakow. This included 81 people who 10 years ago had changed the treatment from insulin to sulfonylurea tablets. It was found that the failure effect of treatment, which is often seen in type 2 diabetes, rarely exists in this type of infant diabetes. Sulfonylurea is safe in this treatment, even with the relatively high doses needed. An excellent control of blood glucose was retained after ten years of treatment. Some children initially experienced a certain recovery of neurological features, but most of them did not have any clear improvement in the problems.
"These findings will give many children a new and better quality of life," says Njølstad. "This is one of the few examples of lasting effect of precision medicine."

ScienceDaily
www.sciencedaily.com/releases/2018/06/180607101013.htm

Among women with dense breast tissue, for whom traditional mammograms are less effective at detecting cancer, who request additional screening after a negative mammogram, abbreviated breast MRI (AB-MR) may be a valuable cancer detection tool. In a study of 195 asymptomatic women with dense breast tissue who had a negative mammogram within the previous 11 months, AB-MR detected five additional cancers after a negative screening mammography, according to preliminary findings from a Penn Medicine team presented this week at the Radiological Society of North America meeting in Chicago.
To put this in perspective, the cancer detection rate of mammography is roughly 4 cancers in 1,000 women who have a mammogram. Digital tomosynthesis (DBT), or 3D mammography, does slightly better, detecting approximately 25 percent more cancers, or roughly 5 cancers in 1,000 women screened. Based on the preliminary results at Penn Medicine, the cancer detection rate of AB-MR screening is 25 cancers per 1,000 patients. One in eight women in the United States will develop breast cancer at some point during their life.
“Having dense breast tissue makes it more difficult to detect a cancer on a mammogram,” said the study’s lead author, Susan Weinstein, MD, an associate professor of Radiology and the director of breast MRI at Penn Medicine. “Based on the literature and our results, women with dense breast tissue who desire supplemental screening, these results suggest that AB-MR may be a better option than other supplemental screening tests such as whole breast ultrasound.
The most common exam offered for asymptomatic patients seeking supplemental screening is a whole breast screening ultrasound examination. However, screening ultrasound examinations have higher rates of false positives, meaning more cases of positive screenings where no cancer is present.
Based on the results from Penn’s study, the AB-MR may be a better option. American Cancer Society guidelines currently recommend a full breast MRI, not an AB-MR, in women who, based on family history of breast or ovarian cancer and/or previous treatment for Hodgkin disease, have a 20 to 25 percent or greater lifetime risk of breast cancer.

Penn Medicinehttps://tinyurl.com/yd4hph83