The implementation of robotics in various aspects of life is becoming increasingly widespread, but nevertheless leads to conflicting opinions. Positive factors and arguments based on innovation, efficiency, precision and cost reduction have not yet succeeded in breaking down negative connotations and aspects such as the destruction of jobs, the investment required, difficulties in implementation and […]
A major new study in Radiology [1] shows that artificial intelligence (AI) is a promising tool for breast cancer detection in screening mammography programmes.
Technology helps discern subtle patterns in imaging
People with a history of allergic-like reactions to iodinated contrast media, which is used in a variety of X-ray-based procedures, such as CT and angiography, are susceptible to similar reactions from commonly used MRI contrast agents, according to a large, eight-year study published in the journal Radiology [1]. The study also found that premedication or […]
Researchers at MIT have shown how the efficiency of scintillators used in X-ray imaging can be improved by at least tenfold, and perhaps even a hundredfold, by changing the material’s surface to create certain nanoscale configurations, such as arrays of wave-like ridges.
Study suggests molecule offers improved specificity to monitor inflammation across many potential clinical applications
A new imaging technique for real 3D vascular ultrasound could become a key tool in strategies aimed at preventing cardiovascular disease in apparently healthy persons, complementing traditional risk parameters, such as cholesterol and high blood pressure. The new results, published in JACC: Cardiovascular Imaging [1] show that real 3D vascular ultrasound is reliable, accurate, and […]
Karen Miga, assistant professor of biomolecular engineering at UC Santa Cruz, co-led the Telomere-to-Telomere (T2T) Consortium, which has released the first complete, gapless assembly of a human genome sequence. (Photo by Carolyn Lagattuta)
The first truly complete sequence of a human genome, covering each chromosome from end to end with no gaps and unprecedented accuracy, is now accessible through the UCSC Genome Browser and is described in six papers published March 31 in Science.
Since the first working draft of a human genome sequence was assembled at UC Santa Cruz in 2000, genomics research has led to enormous advances in our understanding of human biology and disease. Nevertheless, crucial regions accounting for some 8% of the human genome have remained hidden from scientists for over 20 years due to the limitations of DNA sequencing technologies.
“Ever since we had the first draft human genome sequence, determining the exact sequence of complex genomic regions has been challenging,” said Evan Eichler, Ph.D., researcher at the University of Washington School of Medicine and T2T consortium co-chair. “I am thrilled that we got the job done. The complete blueprint is going to revolutionize the way we think about human genomic variation, disease and evolution.”
The sequencing and analysis were performed by a team of more than 100 people, the so-called Telemere-to-Telomere Consortium, or T2T, named for the telomeres that cap the ends of all chromosomes. T2T was initially set up in 2019 by Karen Miga, assistant professor of biomolecular engineering at UC Santa Cruz, and Adam Phillippy at the National Human Genome Research Institute (NHGRI).
The consortium’s gapless version of all 22 autosomes and the X sex chromosome is composed of 3.055 billion base pairs, the units from which chromosomes and our genes are built, and 19,969 protein-coding genes.
The new reference genome, called T2T-CHM13, adds nearly 200 million base pairs of novel DNA sequences, including 99 genes likely to code for proteins and nearly 2,000 candidate genes that need further study. It also corrects thousands of structural errors in the current reference sequence.
The researchers also released this week the complete sequence of a Y chromosome from a different source, which took nearly as long to assemble as the rest of the genome combined, said Nicolas Altemose, a postdoctoral fellow at the University of California, Berkeley, and a co-author of four new papers about the completed genome. The analysis of this new Y chromosome sequence will appear in a future publication.
“In the future, when someone has their genome sequenced, we will be able to identify all of the variants in their DNA and use that information to better guide their health care,” said Phillippy, one of the leaders of T2T and a senior investigator at NHGRI. “Truly finishing the human genome sequence was like putting on a new pair of glasses. Now that we can clearly see everything, we are one step closer to understanding what it all means.”
The gaps now filled by the new sequence include the entire short arms of five human chromosomes and cover some of the most complex regions of the genome. These include highly repetitive DNA sequences found in and around important chromosomal structures such as the telomeres at the ends of chromosomes and the centromeres that coordinate the separation of replicated chromosomes during cell division.
The new DNA sequences reveal never-before-seen detail about the region around the centromere. Variability within this region may also provide new evidence of how our human ancestors evolved in Africa.
“Uncovering the complete sequence of these formerly missing regions of the genome told us so much about how they’re organized, which was totally unknown for many chromosomes,” said Altemose. “Before, we just had the blurriest picture of what was there, and now it’s crystal clear down to single base pair resolution.”
The new sequence also reveals previously undetected segmental duplications, long stretches of DNA that are duplicated in the genome and are known to play important roles in evolution and disease.
“These parts of the human genome that we haven’t been able to study for 20-plus years are important to our understanding of how the genome works, genetic diseases, and human diversity and evolution,” Miga said.
Many of the newly revealed regions have important functions in the genome even if they do not include active genes.
What they found in and around the centromeres were layers of new sequences overlaying layers of older sequences, as if through evolution new centromere regions have been laid down repeatedly to bind to the kinetochore. The older regions are characterized by more random mutations and deletions, indicating they’re no longer used by the cell. The newer sequences where the kinetochore binds are much less variable, and also less methylated. The addition of a methyl group is an epigenetic tag that tends to silence genes.
All of the layers in and around the centromere are composed of repetitive lengths of DNA, based on a unit about 171 base pairs long, which is roughly the length of DNA that wraps around a group of proteins to form a nucleosome, keeping the DNA packaged and compact. These 171 base pair units form even larger repeat structures that are duplicated many times in tandem, building up a large region of repetitive sequences around the centromere.
DNA sequences around the centromere could also be used to trace human lineages back to our common ape ancestors, he noted.
“As you move away from the site of the active centromere, you get more and more degraded sequence, to the point where if you go out to the furthest shores of this sea of repetitive sequences, you start to see the ancient centromere that, perhaps, our distant primate ancestors used to bind to the kinetochore,” Altemose said. “It’s almost like layers of fossils.”
“There is a profound advantage to seeing the whole genome as a complete system. It puts us in a position to unravel how that system works,” said David Haussler, director of the UC Santa Cruz Genomics Institute. “We’ve gotten an enormous understanding of human biology and disease from having roughly 90 percent of the human genome, but there were many important aspects that lay hidden, out of view of science, because we did not have the technology to read those portions of the genome. Now we can stand at the top of the mountain and see all of the landscape below and get a complete picture of our human genetic heritage.”
The T2T genome sequence, representing the finished CHM13 genome plus the recently finished T2T Y chromosome (CHM13 includes an X but not a Y chromosome), is now a new reference genome in the UCSC Genome Browser. The T2T sequence is fully annotated in the browser, providing an efficient way for scientists to access and visualize a wealth of information associated with genes and other elements of the genome.
“We wanted to put the information out in a way that is accessible and familiar to researchers so they can begin to build on it and use all the tools and resources the browser provides,” Miga explained.
The new T2T reference genome will complement the standard human reference genome, known as Genome Reference Consortium build 38 (GRCh38), which had its origins in the publicly funded Human Genome Project and has been continually updated since the first draft in 2000.
“We’re adding a second complete genome, and then there will be more,” explained Haussler. “The next phase is to think about the reference for humanity’s genome as not being a single genome sequence. This is a profound transition, the harbinger of a new era in which we will eventually capture human diversity in an unbiased way.”
The T2T Consortium has now joined with the Human Pangenome Reference Consortium, which aims to create a new “human pangenome reference” based on the complete genome sequences of 350 individuals.
“Pangenomics is about capturing the diversity of the human population, and it’s also about ensuring we’ve captured the whole genome properly,” said Benedict Paten, associate professor of biomolecular engineering at UCSC’s Baskin School of Engineering, a coauthor of the T2T papers, and a leader of the pangenomics effort. “Without having a map of these difficult-to-sequence regions of the genome across multiple individuals, then we’re missing a huge amount of the variation present in our population. T2T sets us up to look across hundreds of genomes from telomere to telomere. It’s going to be great!”
The standard reference genome (GRCh38) does not represent any one individual but was assembled from multiple donors. Merging them into one linear sequence created artificial structures in the sequence. The Human Pangenome Project will make it possible to compare newly sequenced genomes to multiple complete genomes representing a range of human ancestries.
An important outcome of the new T2T sequence is enabling more accurate assessments of genetic variants. When human genomes are sequenced for clinical studies to understand the role of genetic variants in disease or to study genetic diversity within and between human populations, they are nearly always analyzed by aligning the sequencing results with the reference genome for comparison. The T2T variant team documented major improvements in identifying and interpreting genetic variants using the new T2T sequence compared to the standard human reference genome.
“The new human genome is incredibly accurate at the base level, allowing us to flag hundreds of thousands of variants that had been misinterpreted by mapping them to the standard reference. Many of these new variants are in genes known to contribute to disease. We can now spot those because we have a more complete and accurate reference genome,” Miga said.
Miga’s research has focused on satellite DNA, the long stretches of repetitive DNA sequences found mostly in and around telomeres and centromeres. The centromeres separate each chromosome into a short arm and a long arm and hold duplicated chromosomes together prior to cell division.
“The centromeres play a critical role in how chromosomes segregate properly during cell division, and we’ve known for some time now that they are misregulated in all kinds of human diseases. But we’ve never been able to study them at the sequence level,” Miga said. “By far the largest portion of new sequences added to the reference are centromere satellite DNAs. For the first time, we can study ‘base-by-base’ the sequences that define the centromere and can start to understand how it works.”
The T2T’s success is due to improved techniques for sequencing long stretches of DNA at once, which helps when determining the order of highly repetitive stretches of DNA. Among these are PacBio’s HiFi sequencing, which can read lengths of more than 20,000 base pairs with high accuracy. Technology developed by Oxford Nanopore Technologies, on the other hand, can read up to several million base pairs in sequence, though with less fidelity. For comparison, so-called next-generation sequencing by Illumina is limited to hundreds of base pairs.
“These new long-read DNA sequencing technologies are just incredible; they’re such game changers, not only for this repetitive DNA world, but because they allow you to sequence single long molecules of DNA,” Altemose said. “You can begin to ask questions at a level of resolution that just wasn’t possible before, not even with short-read sequencing methods.”
Miga is a co-corresponding author of the main Science paper along with Adam Phillippy at NHGRI and Evan Eichler at the University of Washington:
She is also a co-corresponding author of the papers on:
and a coauthor of the papers on:
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Harald Huber, Global VP for Product and Category Management at Pentax Medical
Twan Heesakkers: What new products are you bringing to the market this year?
Harald Huber: This year we will bring a couple of new things to the market. We would like to put more emphasis on the [PENTAX Medical] ONE Pulmo, by creating more public awareness of the product. The ONE Pulmo is a single-use bronchoscope, our first product in the single-use area. We also have the PlasmaTYPHOON+, our unique solution for endoscope drying and storage, which we will also push forward. Furthermore, we are working very hard on providing innovative solutions, instead of following the traditional way the endoscope business was set up, which was more into products and endoscopic processors. We want to bring our way of thinking forward, which is more focussed on developing solutions rather than pure product business. So we want to interconnect these things, for example the PlasmaTYPHOON+ is part of our hygiene commitment. We are calling this the ‘Power of Choice’. This Power of Choice will also apply to our single-use endoscopes and has a compelling advantage for our customers. The idea behind ‘Power of Choice’ is that we do not want to dictate to our customers what kind of procedure they have to do. We want to allow them the highest possible freedom to pick the right equipment for their procedure. That’s why we want to offer as many solutions as possible in different areas and move away from the traditional thinking about products.
The PENTAX Medical ONE Pulmo single-use bronchoscope.
TH: You mentioned the single-use bronchoscope – the PENTAX Medical ONE Pulmo for which you received the CE mark last year? Can you tell us a little more about this product; what sets it apart from similar competitors’ products?
HH: When we came up with this solution we thought, ‘if we, as PENTAX Medical, come up with a single-use bronchoscope how will it be different?’ As you know, our company produces reusable products and everybody will ask, why are we coming up with a single-use bronchoscope? And that’s again in line with our idea of providing the Power of Choice. So the difference, I think, to other single-use bronchoscopes that you see on the market is that this is probably the first one that is purely developed by an endoscope company. So, with our expertise in image development we were able to develop a camera in such a way that on one side its single-use, while on the other side it can provide comparable image quality to our reusable scopes. This is kind of the red line throughout the whole design process and differentiates us from the competition. It also continues with the design of the control body, with the handle actually. We want to provide a real Power of Choice. Doctors should not have to care if they use the single-use scope or the reusable one. They want to have the same familiar touch and feel that they are used to when doing an endoscopy procedure. That’s why we mimic the reusable scope, so it has the same properties of a reusable scope, and we develop it in such a way that it can be offered as a single-use solution.
The PENTAX Medical ONE Pulmo is a single-use bronchoscope with superior suction power and HD image quality. The sterile-packed scopes are ready to use. Manoeuvrability and device insertion are easy and intuitive, creating a seamless user experience.
TH: Besides offering the ‘Power of Choice’, what other reasons are behind PENTAX Medical choosing to develop a single-use disposable bronchoscope?
HH: ‘Choice’ is an important factor as to why we did this. The other thing is that there is of course concern about contamination. There are special patient populations where it definitely makes sense to go for a single-use scope. We know that it does not make sense for all patient populations. Also, you have the sustainability factor, you have the cost of cleaning, pricing of the product, etc. There are multiple factors which tell you that single-use doesn’t make sense for all patients. However, it makes sense for a certain population – for example patients who are immunocompromised. Imagine somebody who has a very high health risk if somehow cross infected with a germ that is transmitted during the procedure. For this patient do we go with a reusable cope or will we take a single-use scope? And that’s the doctor’s decision, but what we want to make sure as a provider/manufacturer that there is little difference in the choice of scope so the same quality of care can be provided to the patient. Because if you do it the other way around and you are a pure single-use provider you cannot offer this choice.
The PENTAX Medical Video Duodenoscopes ED32-i10 and ED34-i10T2 combine a sterile disposable elevator cap (DEC™) for single-patient use and simple disposal that advances cleaning capability of the duodenoscope to help reduce the risk of cross-contamination and improve patient care with High-Definition image quality for detailed endoscopic visualization during ERCP procedures.
Distal end of the PENTAX Medical Video Duodenoscope ED32-i10
TH: PENTAX Medical is leading the collaborative i-scan imaging processing project. Can you explain what this project is about and the purpose of it.
HH: “i-scan is one part of our general solutions approach. For i-scan there are different modalities which support doctors in each step of the diagnostic process. These i-scan modalities include SE – or Surface Enhancing mode – that improves detection, particularly of the shadowed parts of the lesion. There is TE – or Tone Enhancement – which helps in the characterization of the lesion by amplifying the colours so the doctors understand better what they are seeing and can make an informed medical decision. Then we have OE – or Optical Enhancement – an optical filter which helps in demarcation, to understand the actual size of the lesion in the macule that the doctor sees.
This is an example of how we support doctors each step of the way and that’s part of our solution-driven thinking. We are also involved with many physicians for the i-scan project all across Europe and some parts from the US. They add to the project by sharing their insights on how they can benefit from i-scan in their medical procedures. We also use this as part of our learning initiative. Whenever they have tricky images they have identified, they bring them to a forum where they can be discussed.
TH: PENTAX Medical has developed their own data management and software solutions for their medical imaging devices. Can you tell us more about these solutions?
HH: We are deprioritizing data management and hospital software solutions. We are now more focussed on a solutions approach by combining our products and services.
TH: PENTAX Medical’s latest image and video processor is the Optivista Plus. I understand it can also be used as an educational platform with its “TwinMode” setting. Can you tell us more about this device?
HH: The TwinMode is an interesting feature! As part of the educational setting, it is possible to show a previously recorded image on the screen so the doctor, or the students in training, can compare these images with the current ones they are seeing. So, for example with the i-scan project, images enhanced with one of the modalities can be compared to the same image without any enhancements. That’s how students learn when they can compare.
TH: What else is in the pipeline for PENTAX Medical?
HH: Our focus is set in the hygiene cosmos, where we have initiatives such as Power of Choice. We also have our World of Intelligence initiative that is focussed on the digital arena, like AI, which supports our solutions-driven approach. We ask the question, what kind of solution can we provide with our different products if you, the customer, combine them together. We have the processors and we have the scopes, we have the single-use scope, we have the semi disposable scopes, we have different image modalities which can be used in different combinations in order to provide the right solution for their particular case. So all that comes together with us being able to provide this choice for doctors.
As the world reflects on the urgent messages of the UN Climate Change Conference (COP26), hospital leaders are increasingly aware of their responsibility to advance the sustainability agenda. Research shows that if the world’s healthcare sector were a country, it would be the fifth-largest emitter of carbon emissions on the planet, according to the The […]
April 2024
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