A team of doctors led by Karen L. Kotloff, M.D., University of Maryland School of Medicine (UMSOM), Center for Vaccine Development and Global Health (CVD), has performed a clinical trial involving multiple hospitals that tested the effectiveness of applying a topical antibiotic known as mupirocin for prevention of Staphylococcus aureus (SA) infection in babies in the neonatal intensive care unit (NICU). In this study, between 10 and 45 percent of infants became colonized with SA in the eight NICUs across the country that participated in this study. A 5-day course of mupirocin was applied to the skin and nasal passages of the infants in the NICU who tested positive for SA. The results indicate mupirocin is safe and highly effective in eliminating SA from the skin and nasal passages of these infants. More than 90 percent of the treated infants tested negative for SA after treatment, indicating effective “decolonization” in response to mupirocin. This is the first randomized multicentre clinical trial to demonstrate the effectiveness and safety of mupirocin in infants, including those born prematurely, and to show that this treatment reduced colonization by both SA that are susceptible to commonly used antibiotics (MSSA) and those that are not (MRSA). SA are bacteria that are commonly present on the skin and mucous membranes without causing disease. When bacteria live in the body without causing disease, this is referred to as colonization. Infants who become colonized with SA while hospitalized are at increased risk of developing life-threatening infections. Therefore, this treatment is likely to reduce clinical infection in infants. The effect of a course of mupirocin lasted for at least two to three weeks. “Staph aureus is a leading cause of sepsis in young children admitted to the NICU. Sepsis, which is systemic infection, can be fatal in infants. Thus, preventing these infections is very important in managing risk for babies in the NICU who are fragile and struggling with multiple medical problems,” said Dr. Kotloff. This is the first study to test the safety and efficacy of mupirocin use in the NICU using a randomized controlled trial.
University of Maryland School of Medicine
https://tinyurl.com/yatqk822
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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
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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.
www.IDTechEx.com/diabetes
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A new study led by ANU has discovered a promising way to significantly lower doses of X-rays that has the potential to revolutionize 3D medical imaging and make screening for early signs of disease much cheaper and safer. The research team, which involved the European Synchrotron Radiation Facility and Monash University, built upon an unconventional imaging approach known as “ghost imaging” to take 3D X-ray images of an object’s interior that is opaque to visible light. Lead researcher Dr Andrew Kingston said the study was the first to achieve 3D X-ray imaging using the ghost imaging approach, which has the potential to make 3D medical imaging much cheaper, safer and more accessible. “The beauty of using the ghost imaging technique for 3D imaging is that most of the X-ray dose is not even directed towards the object you want to capture – that’s the ghostly nature of what we’re doing,” said Dr Kingston from the ANU Research School of Physics and Engineering. “There’s great potential to significantly lower doses of X-rays in medical imaging with 3D ghost imaging and to really improve early detection of diseases like breast cancer.” Too much radiation from medical X-ray imaging can increase cancer risk, which limits how often patients can be tested with CT systems, 3D mammography for breast cancer screening and other 3D X-ray approaches. “A variation of our approach doesn’t require an X-ray camera at all, just a sensor – this would make a 3D medical imaging setup much cheaper,” Dr Kingston said. The proof-of-concept approach took a 3D ghost image of a simple object of 5.6mm diameter at a relatively low resolution of about 0.1mm. The researchers devised a new ghost imaging measurement system that used a series of X-ray beams with patterns. Each beam was then split into two identical beams. The pattern was recorded in the primary beam, which acted as a reference since it never passed through the object that the researchers were imaging. The secondary beam passed through the object, with only the total X-ray transmission measured by a single sensor. The researchers then used a computer to create a 2D X-ray projection image of the object from these measurements. This process was repeated with the object at different orientations to construct a 3D image. “Our most important innovation is to extend this 2D concept to achieve 3D imaging of the interior of objects that are opaque to visible light,” Dr Kingston said. “3D X-ray ghost imaging, or ghost tomography, is a completely new field, so there’s an opportunity for the scientific community and industry to work together to explore and develop this exciting innovation.” Co-researcher Professor David Paganin from Monash University said the team’s achievement could be compared to the early days of electron microscopes, which could only achieve a magnification of 14 times. “This result was not as good as could be obtained with even the crudest of glass lenses using visible light,” he said. “However, the microscope using electrons rather than light had the potential – realised only after decades of subsequent development – to see individual atoms, which are much tinier than an ordinary microscope using visible light can see.”
Australian National Universityhttps://tinyurl.com/y7xeop7k
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Nearly two decades ago, Dr. Jeffrey Cadeddu was watching TV when a lightbulb went off. The program showed teens using magnetic studs to avoid piercings in their lips, and Dr. Cadeddu, a surgeon, realized the same principle could be applied to his work, reducing the number of incisions and resultant scars. This summer Dr. Cadeddu performed the first of several magnet-assisted prostate cancer surgeries he has now done. “Every hole you create in a patient has a risk associated with it. Every incision means increased pain, increased risk of hitting a blood vessel,” said Dr. Cadeddu, Professor of Urology and Surgery at UT Southwestern Medical Center and a member of the Harold C. Simmons Comprehensive Cancer Center. Dr. Cadeddu and his colleagues spent years developing the concept of magnetic-assisted surgery. Though another company subsequently took up the mantel, when the FDA approved the first commercial magnetic-assisted laparoscopic surgery system, Dr. Cadeddu was delighted to make UT Southwestern one of the few medical centres in the country – and the first in Texas – to put the magnetic surgery device to use. In magnetic surgery, multiple operative devices are inserted through an access point and then the magnetic device is controlled by a magnet on the skin over the abdomen. By contrast, conventional laparoscopic or robotic surgery requires an incision for each tool. Prostate cancer surgery is typically performed with a robotic system that requires six incisions for the various surgical instruments and camera. “Going forward, five incisions or likely even less may become standard for this procedure,” Dr. Cadeddu said.
UTSouthwestern Medical Centerhttps://tinyurl.com/yb4nzvkg
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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."
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A new and extremely sensitive method of measuring ultrasound could revolutionise everything from medical devices to unmanned vehicles. Researchers at The University of Queensland have combined modern nanofabrication and nanophotonics techniques to build the ultraprecise ultrasound sensors on a silicon chip. Professor Warwick Bowen, from UQ’s Precision Sensing Initiative and the Australian Centre for Engineered Quantum Systems, said the development could usher in a host of exciting new technologies. “This is a major step forward, since accurate ultrasound measurement is critical for a range of applications,” he said. “Ultrasound is used for medical ultrasound, often to examine pregnant women, as well as for high resolution biomedical imaging to detect tumours and other anomalies. It’s also commonly used for spatial applications, like in the sonar imaging of underwater objects or in the navigation of unmanned aerial vehicles. Improving these applications requires smaller, higher precision sensors and, with this new technique, that’s exactly what we’ve been able to develop.” The technology is so sensitive that it can hear, for the first time, the miniscule random forces from surrounding air molecules. “We’ve developed a near perfect ultrasound detector, hitting the limits of what the technology is capable of achieving,” Professor Bowen said. “We’re now able to measure ultrasound waves that apply tiny forces – comparable to the gravitational force on a virus – and we can do this with sensors smaller than a millimetre across.” Research leader Dr Sahar Basiri-Esfahani, now at Swansea University, said the accuracy of the technology could change how scientists understand biology. “We’ll soon have the ability to listen to the sound emitted by living bacteria and cells,” she said. “This could fundamentally improve our understanding of how these small biological systems function. A deeper understanding of these biological systems may lead to new treatments, so we’re looking forward to seeing what future applications emerge.”
University of Queensland
www.uq.edu.au/news/article/2019/01/ultra-ultrasound-revolutionise-technology
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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
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The antibiotic-resistant Acinetobacter baumannii bacterium is one of the most globally harmful bacteria that causes nosocomial infections. Researchers at the University of Turku have discovered that the bacterium attaches to plastic medical devices using tiny finger-like structures. The researchers were able to develop antibodies that prevent the bacterial spread. Infections related to hospitals and medical devices form major healthcare problems worldwide. These infections are associated with the ability of pathogens to colonise both biotic and abiotic surfaces. The research group discovered a unique molecular mechanism that enables Acinetobacter baumannii and related pathogenic bacteria to colonise medical devices. This mechanism enables the bacteria to spread in hospitals. Acinetobacter baumannii is capable of colonising medical devices by means of archaic chaperone-usher (ACU) pili. Using X-ray crystallography, the researchers found three finger-like loops at the tips of the pili. These “fingers” stick extremely tightly to hydrophobic plastics which are commonly used in medical devices and tools. – We believe that these fingers are attached into small cavities on the surfaces. This hypothesis could explain why the bacteria spread and attach so strongly to so many different hydrophobic materials, notes Zavialov. The researchers produced antibodies that bind to the tips of the pili and completely block the bacterial attachment and biofilm formation. Another antibiotic-resistant pathogen, Pseudomonas aeruginosa, has similar pili, and it forms similar biofilms. The researchers predict that the means suggested for battling A. baumannii might also be applied to control the spread of P. aeruginosa infections and possibly also battle against several other pathogens that use ACU pili.
University of Turkuwww.utu.fi/en/news/news/Pages/Hospital-Superbug-Uses-Tiny-Sticky-Fingers-to-Infect-Medical-Tools-and-Devices.aspx
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The marketing of direct-to-consumer “neurotechnologies” can be enticing: apps that diagnose a mental state, and brain devices that improve cognition or “read” one’s emotional state. However, many of these increasingly popular products aren’t fully supported by science and have little to no regulatory oversight, which poses potential health risks to the public. In a new piece published in the journal Science this week, two bioethicists from Penn Medicine and the University of British Columbia suggest the creation of a working group that would further study, monitor, and provide guidance for this growing industry – which is expected to top $3 billion (€2.63 billion) by 2020. “There’s a real thirst for knowledge about the efficacy of these products from the public, which remains unclear because of this lack of oversight and gap in knowledge,” said lead author Anna Wexler, PhD, an instructor in the department of Medical Ethics and Health Policy at the Perelman School of Medicine at the University of Pennsylvania. “We believe a diverse, dedicated group would help back up or refute claims made by companies, determine what’s safe, better understand their use among consumers, and address possible ethical concerns.” The group, made up of researchers, ethicists, funders, and industry experts, among others, the authors wrote, would serve as a clearinghouse for regulatory agencies, such as the U.S. Food and Drug Administration (FDA) and the Federal Trade Commission (FTC), third-party organizations that monitor advertising claims, industry, social and medical scientists, funding agencies, and the public at large. While some of these techniques are used in clinical and research laboratory settings – for example, electroencephalography (EEG) devices are used to diagnose and treat epilepsy — many consumer-grade versions of neurotechnology devices are only loosely based in science. It is unclear whether the laboratory data collected to test them is applicable to consumer-grade products, leading many in the scientific world to question the efficacy, and advocate for increased regulation of these readily available techniques and products. For example, some consumer neurostimulation devices may pose dangers, such as skin burns. There are also potential psychological harms from many consumer EEG devices that purport to “read” one’s emotional state. “If a consumer EEG device erroneously shows that an individual is in a stressed state, this may cause him or her to become stressed or to enact this stressed state, resulting in unwarranted psychological harm,” the authors wrote. Also, a smartphone wellness app that diagnoses symptoms of depression does so without medical support structures, such as a psychologist or mental health counsellor.
Penn Medicinehttps://tinyurl.com/ydfk5fdg
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