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15 NOVEMBER 2017 3 @ MEDICA S P E C I A L I S S U E : M E D I C A L , T E C H N I C A L , P H A R M A C E U T I C A L , I N D U S T R I A L N E W S D U S S E L D O R F W E D N E S D AY 1 5 N O V E M B E R 2 0 1 7 CRISPR system embeds images in DNA 19th century horse gallops through bacterial DNA encoding information using the CRISPR-Cas adaptation system to this latest work and it took several days to do the recordings. ‘Going forward,’ Shipman contin- ued, ‘we’d like to see this work used as the basis for building living bio- logical recording devices that might function as a research or medical diagnostic tool.’ Seth Shipman PhD is a neuroscientist and postdoctoral fellow in Genetics at Harvard Medical School and a member of a team at the Wyss Institute for Biologically Inspired Engineering. Shipman gained his doctorate through his focus on Neuroscience, at the University of California, San Francisco. His key interests lie in genetics and the advancing understanding of brain function. WWW. H E A LT H C A R E - I N - E U R O P E . C O M Report: By Mark Nicholls A research team in the United States has developed a revolutionary tech- nique that has encoded an image and short film in living cells. Scientists at the Wyss Institute for Biologically Inspired Engineering and Harvard Medical School (HMS) used CRISPR gene editing to encode the image and film in DNA, using this as a medium to store information and produce a code that relates to the individual pixels of each image. The team hopes to use the technique to create ‘molecular recorders’, an approach ultimately to lead to better methods to generate cells for regen- erative therapy, disease modelling and drug testing. For the research, the HMS group inserted a gif – five frames of a horse galloping - into the DNA of bacteria and then sequenced the bacterial DNA to retrieve the gif and the image, verifying that the microbes had incorporated the data as intended. The images chosen were of a human hand (because it has the type of intricate data the research- ers hope to use in future experi- ments) and a galloping horse by 19th century British photography pioneer Eadweard Muybridge, because it has a timing component that could help to understand better how a cell and its environment may change over time. The bacteria acquired data frame by frame The team used still and moving images because they represent con- strained and clearly defined data sets. The film also gave the bacteria a chance to acquire information frame by frame. The breakthrough follows work in 2016 when the HMS team built the first molecular recorder based on the CRISPR system. The recorder allows cells to acquire elements of chronologically provided, DNA-encoded information that gen- erate a memory in a bacterium’s genome. The information is stored as an array of sequences in the CRISPR locus and can be recalled and used to reconstruct a timeline of events. The latest breakthrough con- firmed the scientists’ ability to engi- neer CRISPR system-based technol- ogy that enables the chronological recording of digital information in living bacteria. The CRISPR system helps bacteria develop immunity against viruses in their environments. Capturing viral DNA molecules Dr Seth Shipman, a postdoctoral fel- low in Genetics at HMS, explained that, as a memory of survived infec- tions, it captures viral DNA mol- ecules and generates short ‘spacer’ sequences from them, which it then adds as new elements upstream of previous elements in a growing array located in the bacterial genomes’ CRISPR locus. The CRISPR-Cas9 protein – a widely used genome-engineering tool – uses this memory to destroy the same viruses when they return, but other parts of the CRISPR system have not so far been much exploited. In this study, the scientists showed that two proteins of the CRISPR sys- tem, Cas1 and Cas2, which they had engineered into a molecular record- ing tool, together with new under- standing of the sequence require- ments for optimal spacers, enables a significantly scaled-up potential for acquiring memories and depositing them in the genome as information. ‘We designed strategies that essentially translate the digital infor- mation contained in each pixel of an image or frame into a DNA code that, with additional sequences, is incorporated into spacers,’ Shipman explained. ‘Each frame thus becomes a collection of spacers. We then provided spacer collections for con- secutive frames chronologically to a population of bacteria, which, using Cas1/Cas2 activity, added them to the CRISPR arrays in their genomes. After retrieving all arrays again from the bacterial population by DNA sequencing, we finally could recon- struct all frames of the galloping horse movie and the order in which they appeared.’ Effectively, to read the information back, the researchers sequenced the bacterial DNA and used a computer code to unscramble the genetic infor- mation. ‘We took on this research because we see the potential for cells to gather information about their own biology and their environment,’ Shipman said. ‘For that to happen, we need a way to capture and store information within a cell while it’s still alive – that’s what we are testing.’ It took researchers three to four years to go from the idea of cells What’s the difference between Aquasonic®100and those other gels?Clarity, reliability, and economy.Aquasonic 100 Ultrasound Transmission GelThe clarity that sonographers havecounted on for over fifty years.ISO 13485:2003Visit us at Hall 9 Stand D41© 2017 Parker Laboratories, Inc.ACEMS.p.A.HALL 10 - STAND E 31
2 W E D N E S D AY @ M E D I C A Envisioning the future of patient monitoring The distance is within reach 30 years ago, monitoring in most intensive care environments was via an ECG display with a numeric value for heart rate combined with intermittent manual measurements of blood pressure. Advances in technology have greatly increased monitoring parameters. Eight, for example, are included in the current minimum standards for monitoring under anaesthesia but more than ten further sensors are routinely available. * Mindray, which specialises in patient monitoring & life support, in-vitro diagnostics, and imaging systems, is headquartered in Shenzhen, China, and employs nearly 7,600 people internationally. Here, the company looks at present and future technological developments for intensive care. the All advances technological come paradoxes. with Patient monitoring is a multifarious process involving con- tex- tual acquisition and interpreta- tion of patient-related data as well as the performance of diagnostic tasks. While the exponential growth in the number of parameters provides clinicians with more patient informa- tion to base their diagnosis on, it also makes decision-making a more com- plex process. Clinicians must hunt for the most relevant pieces out of a vast amount of data that often comes unprocessed and unorganised. The question is: how to recon- cile this paradox? The clinical set- ting is in urgent need of decision support. Especially when the acu- ity of today’s clinical environment frequently necessitates real-time decision-making, prompt response to life-threatening events, and han- dling of a variety of medical devic- es. In this sense, patient monitoring might become a valuable tool, if it can reduce the cognitive workload of the stressed clinician and ease BeneVision’s interoperability platform builds bridges between stand-alone devices and data sources the decision-making process. We need, in a word, a monitoring system that liberates clinical expertise. With BeneVision N Series Patient Monitor, Mindray is envisioning the future of patient monitoring with a humble yet ambitious start. Centralised data management Current monitoring systems do not lack data. What is lacking is the ability to convert that data into intel- ligence—intelligence that enhances clinical expertise with a complete and accurate view of patient condi- tions. Combining physiological data The BeneLink Interfacing Module integrates monitored data from other bedside devices Intelligent decision support What if monitoring systems can be more intelligent? What if their assis- tance goes beyond raw information to software entities enriched with deci- sion support? BeneVision envisions more possibilities of patient monitor- ing with powerful decision support tools such as ST Graphic, HemoSight, SepsisSight, BoA Dashboard and EWS scoring. These tools summarise com- plex clinical measurements such as rSO2, ICG, PiCCO, AG, RM, BIS, NMT, etc. and translate it into visualised graphic display, so that clinicians can grasp patient conditions at a glance. For example, HemoSight helps cli- nicians make decisions through sets of hemodynamic assistance applications, with visualisation and infographics of hemodynamic parameters. ST Graphic and real-time QT/QTc analysis help clinicians recognise subtle cardiac changes and make early diagnosis and treatment. Mindray believes the best way to predict the future is to create it. The revolutionary BeneVision N Series is designed to liberate clinical exper- tise with maximum decision support throughout the entire patient moni- toring process, from data acquisition, interpretation to its application in decision-making. * Source: American Society of Anesthesiologist; Recommendations for Standards of Monitoring during Anesthesia and Recovery Mindray is at Medica Hall 9 / Stand A74-A78 extracted by a patient monitor with information located in computerised records of medical history, drug ther- apy, laboratory and radiological test- ing, integrated patient information can provide early warning of health concerns and optimised management of diseases. In this way, clinicians can spend more time with patients and less time hunting and gathering information. BeneVision’s originated interopera- bility platform works exactly this way. It builds bridges between stand-alone devices and data sources to enable more informed decision-making and seamless informatics flow. With a powerful iView medical PC inside, BeneVision runs applications inde- pendently to bring all patient infor- mation on the same screen such as medical imaging and laboratory records. Besides, the BeneLink Interfacing Module integrates monitored data from other bedside devices, and fur- ther transmits to external system by HL7. Seamless informatics flow BeneVision’s powerful data integra- tion capacity also allows it to be the centre of the seamless informat- ics workflow complemented by the T1 transport solution. The compact T1 monitor follows the patient con- tinuously and seamlessly anywhere, anytime. T1 combines the MPM mod- ule and transport monitor together, with plug and play capability with BeneVision N Series host monitors. Together they constitute a data net- work that streamlines workflow, enhances patient safety and opti- mises resources for clinicians. Another improvement to clini- cal workflow BeneVision offers is the SmartPager technology. With SmartPager, clinicians can receive real- time patient conditions on mobile devices such as mobile phones and tablets. This way patient data is con- stantly monitored and readily avail- able to clinicians wherever they are. Shadowless, clear and homogeneous A light that’s just right Generating a shadowless, clear and homogeneous light assures clarity of the surgical site. Thanks to next gen- eration LEDs, the Italian firm Acem reports that its ‘Starled5 NX produces a perfect illumination under every condition generating an IR-free light, an excellent colour temperature and a practically endless life cycle at low consumptions. ‘The 43 LEDs in the system are circularly positioned and divided into five reflectors (with seven LEDs each) and another eight LEDs are radially placed around the handle. The lamp produces in this way a high illumina- tion level of 130.000 lux (160.000 lux optional) for a steady life cycle of about 50.000 hours. ‘Acris is the extraordinary and inno- vative system realised by Acem that ensures, due to the use of a micropro- cessor, the control of electrical curves typical of LEDs to remain unaltered over time but maintaining a long life cycle. The colour rendering index of Starled5 NX is 95 and its colour tem- perature 4.500 °K. (Optional: Variable colour temperature from 3.700 °K to 4.700 °K continuous). ‘ Focused and ambient To achieve a correct illumination according to different surgical needs the lamp can produce focused and ambient light. Due to its special optics, the light field focusing system adjusts the lightspot diameter accu- rately, assuring an excellent sharpness of details in the operating area, the firm reports. Ambient light is man- aged by the Endo function. ‘This technology allows visual com- fort as well as correct exposure of the surrounding environ- ment thanks to its particular light beam coming from the upper part of the lamp.’ This model is particularly suitable for minimally invasive surgery and ideal for preparation and surgical opera- tions plus patient monitoring. The lamp is also to move the lat- handles easy with eral assuring stability and constant illumi- nation even during movement, the manufacturer adds. ‘Its ergonomic and practical design takes into consid- eration sanitary requirements essen- tial for the operating room. For this reason Starled5 NX has been manu- factured with a smooth and resistant material that makes cleaning quick, easy and complete. Its removable and sterilisable central handle can house a video camera, on demand, shooting Acem is at Medica Hall 10 / Stand E31 43 LEDs are circularly positioned and divided into five reflectors surgical operations accurately (alter- natively the video camera can be placed on a separate arm). ‘The lamp shape assures visual comfort and is particularly suitable for laminar flows in the operating room. All the functions of this model are managed by the handy, digital and easy-to-read I – SENSE control panel on the cardanic structure.’ EH @ MEDICA No 3 2017 Made in Francewww.ecmscan.comECHO CONTROL MEDICALPortable ultrasound Hall 9 Stand B 47
W E D N E S D AY @ M E D I C A 3 The interdisciplinary challenge Evaluating ICU care for cancer patients Progressive treatments offer new chances for cancer patients, but also could result in as yet unknown complications. The number of cancer patients transferred to the ICU for cancer-specific and internal medicine related reasons is on the increase. Caring for them on the ICU is a complex challenge, with interdisciplinary cooperation playing an essential part. Lena Petzold reports Schellongowski points out. ‘The majority of these patients have solid tumours and are in the ICU for obser- vation and post-operative care for a number of days. However, a sig- nificant number of patients is also admitted due to internal complica- tions from cancer and their treatment. Three to four percent of all patients on intensive care wards have haema- tological cancers, such as leukaemia or lymphoma. In these cases, cancer- specific, internal complications are the most common reason for admission.’ Patients in the early stages of a cancerous disease are in particular need of intensive care. Five to six percent of cancer patients with solid tumours are admitted to the ICU for primary surgical care in the early stage of the disease. For haematological patients the number is significantly higher. Especially among patients with aggressive, haematological cancers, up to 18% require intensive medical care during the early disease stage, either because complications have led to organ dysfunction or because aggressive treatment given at the start has caused secondary complications, which ultimately also lead to organ dysfunction. n r e t a M . F n e i W i n U d e M : e c r u o S is an Assoc. Prof. Peter Schellongowski MD, internal medicine and intensive care specialist and senior ICU consultant at Vienna’s Medical University. He heads the working group on haemato-oncological intensive care medicine at the Austrian Society for Internal Medicine and General Intensive Care and Emergency Medicine (ÖGIAIN). Along with coordination of the ‘Register for Critically Ill Cancer Patients of the iCHOP Initiative’ he also heads the YELENNA Study on acute respiratory distress syndrome in cancer patients, for which he recently received the ESICM Young Investigator Award. we must simultaneously administer chemotherapy. ‘Occasionally, we cannot deter- mine with any certainty whether pulmonary complications were caused by infection or by the disease itself. This complicates treatment, because chemotherapy can aggravate an infection. At the same time, chemo- therapy cannot be suspended for too long, which is why we need to act with a lot of differentiation and need to carry out an intensive diagnostic investigation. ‘Close cooperation between hae- matologists and oncologists is there- fore of extraordinary importance and very desirable,’ Schellongowski emphasises. ‘It’s scientifically well doc- umented that intensive care patients with cancer, who receive intensive interdisciplinary care, have a better outcome” E-Mail: peter.schellongowski@ meduniwien.ac.at Certain criteria need to be met for the admission of a cancer patient to the ICU, according to Dr Peter Schellongowski, specialist in internal medicine and intensive care special- ist and senior consultant in the ICU at Vienna’s Medical University. The Austrian ICU specialises in the care of critically ill cancer patients suffering from, for instance, acute respiratory failure and infection related problems such as sepsis or toxic reaction. ‘We need to consider several factors when deciding whether critically ill cancer patients should be cared for in the ICU. Apart from the patient’s general condition, we must evalu- ate the probability of surviving acute organ failure(s) along with the expect- ed long-term survival and therapy options after intensive care. Intensive care treatment can be very strenuous and even traumatising and can affect the remaining quality of life, which is why the admission criteria are important,’ Schellongowski explains. Patients in the early stage of a disease, which is still treatable, and whose life expectancy is likely to be more than a year; patients who should receive curative treatment, and patients in remission from their primary disease, are usually always admitted. They are given a so-called full code manage- ment, meaning that they will receive the entire range of intensive care treatments available. However, if treat- ment options have been exhausted or intensive care is unlikely to improve a patient’s life expectancy or condition we would refrain from treatment. For patients receiving pal- liative care who may have a good chance of longer-term survival due to treatment progression, admission to the ICU can also make sense. This would be the case, for instance, for patients with low-grade non-Hodgkin Lymphoma. Intensive care treatment is also offered to patients in partial remission, such as patients in partial remission from multiple myeloma or solid tumours, as a long- term prog- nosis can be achieved in a palliative setting. ‘The group of patients who may benefit from intensive care continuous- ly expands due to the broad range of cancer treatments available. Oncology is continuously evolving, making the exchange of information and a close cooperation between intensive care medics and oncologists so important: it guarantees the best treatment for the patient,’ Schellongowski explains. Close examination Despite structured criteria and guide- lines, the decision-making process on treatment and admission objectives is often very complex. ‘A minimum “one-year survival” objective obvious- ly does not mean that a patient with an 11-months survival prognosis will immediately fall outside the scope. Each case is intensively examined under various aspects.’ That includes a conversation with the patient, though it might not always be possible. ‘In intensive care medicine, the patient’s ability to com- municate and make decisions is often EH @ MEDICA No 3 2017 A a G K . o C & G A k r e w r e g ä r D f o y s e t r u o C Patients in the early disease stage, those who should receive curative treatment and patients in remission from their primary disease, are usually admitted to the ICU and given so-called full code management severely impaired and, whilst living wills are helpful, they are not yet that widespread. The window of oppor- tunity to make treatment decisions is also often tight. In each case, we aim to act to the best of our knowledge and in a patient’s best interest. ‘If the situation is not clear-cut,’ he added, ‘we often start a so-called ICU trial. This multi-day treatment trial examines whether the patient responds positively to the treatment. Then we decide if it makes sense to continue with intensive care.’ In some cases, previously defined, limited intensive care treatment is considered, with certain procedures such as intubation being excluded. ‘A study has confirmed that this approach also helps a large number of patients to survive, and that survivors suffer from the anticipated post inten- sive care syndrome (leading to anxiety, depression or post-traumatic stress syndrome) no more frequently than patients without therapy limitations.’ Outside of specialist centres, cancer patients are also frequently admitted to intensive care wards. ‘Unfortunately, the availability of data is not optimal. Based on available figures, we assume that every sixth to eighth patient on a European inten- sive care ward is a cancer patient,’ Specific treatment The most common cause for ICU admission is acute respiratory failure, followed by complications from sepsis. Haematological diseases in particu- lar often lead to pulmonary complica- tions, because infections or complica- tions arising from leukaemia mean the lungs no longer function normally. It is essential to take the cancer back- ground into account for diagnosis as well as empirical treatment. ‘With infectious complications arising from an aggressive cancer there is often a special range of pathogens involved. Most often we treat for several poten- tial infectious causes, but sometimes Signs of higher intelligence High quality picture output provides deeper insights Ikegami᾿s medical equipment incorporates the most advanced video technology. High-performance Cameras, Recorders and Monitors used in conjunction with surgical microscopes or endoscopes reproduce clear, natural and brillant images – even now in 4K resolution. www.ikegami.de . medical@ikegami.de 13 – 16 Nov 2017 Please visit us in Hall 10/B12
4 W E D N E S D AY @ M E D I C A Human study of a novel PPG-based non-invasive sensor Manometry v. BioBeat A preliminary human study was conducted to validate an advanced wearable sensor which has been developed by the start-up company BioBeat Technologies Ltd, comparing it to the common manometry method. The 2015 guidelines of the European Society of Hypertension on the requirements of the International Protocol (revision 2010) were used to define the difference between the commonly used device and the new one. ‘This proprietary technology allows recording a pure PPG signal,’ the company explains, ‘together with an algorithm that continuously analyses and shows several physi- ological parameters, including Heart Rate (HR), SPO2, Changes of Systolic Blood Pressure (SBP), Changes of Diastolic Blood Pressure (DBP), Stroke Volume (SV), Cardiac Output (CO), Cardiac Index (CI), Systemic Vascular Resistance (SVR), Respiratory rate (RR), HR variability, and more. Together with Dr Yoram Newman, from the sports clinic of the Meir Medical Centre, Kfar Saba, Israel, they performed blood pressure (BP) ergometry tests during physical effort run with 57 healthy males/females aged 18-70 years. The BioBeat wireless watch, transmitting to a tablet application, was attached to each volunteer’s wrist, continuously recording all measurements. During the ergometer bicycle test, BP and ECG measurements can detect any changes, as evidence of cardiac distress resulting from rela- tive oxygen deficit. In the study, BP was measured before and every 1-2 minutes throughout the test, using the common manual sphygmoma- nometer, and in parallel the BioBeat watch. After the study, participants rested and clinic physicians again measured BP values. When comparing BP measure- ments from the manometry method to BioBeat, the latter sensor and Exclusively at Medica Watch and App launch Hall 16 (Israeli Pavilion) Booth G41 application achieved accuracy in the 96-98% level range – readings with- in the 95% level defined as accept- able by the European International Protocol for BP devices – which means BioBeat can be formally used as an accurate and reliable BP meas- uring device. The researchers also note that these accurate results were achieved using a wearable watch that simulta- neously and continuously measures several other parameters, enabling a simple and efficient way to measure complex vital signs. ‘So far, these complex parameters could have been BioBeat BP measurements passed the International Protocol (revision 2010) requirements measured only with highly expensive, labour intense devices and instru- ments, performed and interpreted only by highly skilled health person- nel,’ the firm observes. ‘The simplic- ity of BioBeat, and independence of human performance in recording measurements, may change the way we monitor these parameters in the near future.’ Additional benefits of BioBeat, it adds, include the wireless configura- tion (i.e. no wires between sensor on the subject and monitoring system); reducing motion errors caused by patient movement; health personnel not needed for sensor placement; low power needs – the system can run from a commercial battery. More human studies will aim to establish further the capabilities of LTC (Ret) Arik Eisenkraft MD MHA CMO of BioBeat. Dr. Eisenkraft, is also a researcher at the Institute for Research in Military Medicine, leading research efforts on future trauma and emergency medicine & pre-hospital care this technology. Several other stud- ies will be published soon. Based on initial results, a request for an FDA approval (510K Class 2) is pending. Comparing BioBeat measurements to International Protocol (revision 2010) requirements. Difference BioBeat SBP % of all measurements BioBeat DBP % of all measurements International Protocol (revision 2010) requirements ≤ 5 mmHg ≤ 10 mmHg ≤ 15 mmHg 275 75.3% 321 87.5% 75% 320 88% 350 95.3% 90% 345 99.9% 365 99.5% 96% Sensor technologies in medicine Breathing air systems How can newborn babies benefit from sensors with chip technology and what might the future hold for sensor data? Samuel Wehrli, Product Manager for Gas Flow at Sensirion AG in Switzerland explained during our EH interview at the MST Conference held in Dortmund. Samuel Wehrli: ‘Sensirion has com- mitted itself to advancing sensor technology by equipping sensors with microchips. Sensors deliver important information in very differ- ent areas. In medical technology, the use of chip technologies is opening up brand new, exciting solutions. My team and I are part of this develop- ment.’ Why should sensors be equipped with chip technology? ‘Chip technology is utilised to pro- cess signals, or to calculate. Fusing it with sensors results in a signal that fits with a standardised protocol. Sensors with chip technology can therefore deliver the best possible information. ‘What’s more, chip technology is particularly scalable and suitable for mass production. Sensors equipped with chips can also be produced in the smallest format, a combination which leads to a significantly bet- With experience in micro-sensors development, physicist Samuel Wehrli joined Sensirion in 2007. In 2013 he became product manager of the company’s Gas Flow branch. ter and more stable product. The fusion with chip technology results in a high-quality, yet affordable mass market product for the customer.’ Sensirion is at Medica Hall 8a / Stand H19 What makes a good sensor? ‘In the first instance, it’s the quality of the signal. The more precise the measurements, the better the sensor. When used with chip technologies, the signal colour and signal qual- Sensirion’s neonatal flow sensors ity respectively are often very good, as the electrical wiring used is very compact, which reduces the failure proneness enormously. ‘Technical processing also plays an important part. A sensor works within a system; the more functions can be integrated into the sensor, such as calibration for example, the more precise the information deliv- ered. If breathing air is measured, for instance, the customer receives added value if they know how many litres per minute flow through the sensor rather than just being shown a curve, as is still the case with older generations of sensors.’ Where are sensors used in health- care? ‘In medicine, we work with flow sen- sor technology intensively, i.e. with the above-mentioned measurements of inhaled and exhaled air. Thanks to digitisation and new measuring procedures the precise monitoring of breathing air in medicine is becoming increasingly more detailed and opens up a broad field of opportunity for sensor technology. Neonatology is one of the new areas of applica- tion. Sensirion have developed a very small and light sensor in cooperation with some manufacturers of ventila- tors. A typical sensor is about the size of two matchboxes – too big for a newborn baby – which just about fits into a hand. Consequently, the new sensor is much smaller and impacts on breathing as little as possible due to its low weight. It also facilitates better monitoring of respiratory flow in young children.’ How and where else could sensors be used? ‘For the sensitive topic of hygiene standards in hospitals; sensors can contribute towards adherence to standards. Admittedly this is a challenge, as sensors come into contact with pathogens through human breathing air. This can be dealt with in two different ways: “single use” sensors, which are disposed of and which need to be available in large quanti- ties at low cost, or sensors that can be sterilised and prepared for multi- ple use with wash or steam sterilisers. If the latter is the case, each sensor must be robust enough to withstand the intensive sterilisation procedure without damage, around 50 times. Both solutions prevent the transmis- sion of pathogens.’ What is the future of sensor tech- nology? ‘There are many approaches as to how sensor technology can be advanced. One example is anaes- thesia. Here the equipment mixes air with additional oxygen; the more precisely this concentration can be controlled and adjusted via sensor technology, the better for the patient. Sensor technology can be used wher- ever gas is in motion, i.e. for oxygen, CO2 or other substances.’ EH @ MEDICA No 3 2017
W E D N E S D AY @ M E D I C A 5 A bed suitable for wash tunnels The gentle patient lifter Dewert is at Medica Hall 14 / Stand D34 Among products demonstrated at Medica 2017 will be those from DewertOkin GmbH, which manufac- tures and sells single and double drives, lifting columns, control keypads and control units, prod- ucts that are used for bedding, seating, medical and office applica- tion. The firm’s MEGAMAT 12 extra- quiet single drive for hospitals and nursing beds features wash-tunnel resistance on request. ‘With the new Accu-Control control unit, patient lifters can be gently moved even while under heavy loads. The newly designed BUS control unit ensures a significant streamlining of the plan- ning and commissioning processes,’ the firm reports. ‘These innovations not only con- sistently expand our product port- folio, they also provide manufac- turers of medical technology with real added value,’ said Khalid Fariad, product manager at Dewert, refer- ring to the MEGAMAT 12 single drive. This delivers increased pressure and pulling forces while emitting Sensor technology can be used wherever gas is in motion, i.e. for oxygen, CO2 or other substances Data protection continues to cause heated debates. How do you manage data produced by sensors? ‘With our products, the end cus- tomer is responsible for data usage. There is a clear line between sen- sor technology and data process- ing. Data processing requires special licences, which creates a clear divide. Nevertheless, this data – if it is pro- cessed reliably and with protection – holds a lot of opportunities. ‘Currently, the doctor evaluates the data selectively on a monitor and checks, for instance, whether a patient’s breathing is okay during their ward round. If this data was saved in the Cloud, it could be ana- lysed retrospectively, or cases could be compared and important insights obtained. However, at the moment this is still a long way off.’ EH @ MEDICA No 3 2017 The MEGAMAT 12 single drive delivers increased pressure and pulling forces while emitting less noise during operations ‘The new Dewert BUS control unit can automatically detect all connect- ed peripherals such as drives, hand- sets or sensors. The entire system can then be commissioned quickly and easily.’ Additionally, this new control unit can be configured using software. ‘So manufacturers can now inde- pendently define motion profiles and perform optimisation loops by them- selves. It is also possible to adjust all controls without changing the hardware, since the buttons can be assigned to various functions without any physical change to the handset.’ Dewert’s Accu-Control control unit is powered by rechargeable batteries and needs fewer charging cycles less noise during operations, the firm adds. ‘It features an integrated emergency release function and a washable option.’ The system does not need to be removed from a bed before the bed is cleaned in a washing tunnel, which the company points out, saves significant time. ‘The Accu-Control mobile control unit for patient lifters has soft-start and soft-stop f u n c t i o n s that pre- vent abrupt movements, even when under heavy loads, thus enabling the patient’s position to be changed comfortably,’ the Dewert report continues. ‘Control buttons are attached directly to the housing so that it is easier for nurses to operate the lifter. The unit is powered by recharge- able batteries and needs fewer charging cycles and more executable move- ments charge. per H b m k i n G e rt O e r w u r c e : D o S Investing in .our future growth The BBI Group is investing £14m in a new global headquarters to boost capacit. and long-term growth. The BBI Group (BBI), a trusted partner to some of the world’s leading diagnostic and healthcare organisations for over 30 years, is bringing together three of its existing UK manufacturing locations into one, resulting in more knowledge and expertise under one roof, and centralising its manufacturing and development activities. What you can expect from the new headquarters: + A long-term partner that can grow with .ou – our significantly larger site can support your future growth. + Peace of mind – high qualit. and consistent products, ever. time. The site is certified to world recognised Quality System, ISO 13485:2016. + More knowledge and expertise under one roof – bringing together an experienced workforce to collaborate in delivering the best result for your test. Protec brings movement into X-ray A motorised PRS 500 B X-ray system, added to the portfolio of Protec, spe- cialist in traditional analogue X-ray film processing machines, ‘combines efficiency, high work precision and optimum operating comfort,’ the manufacturer reports. ‘In addition to the user-friendly touch display, it also offers an automatic retraction of the tubular column, which adapts to the position of the bucky in the wall stand or table. The X-ray workflow is optimised, thus shortening the duration of the pro- cess and greatly increasing precision and ease of use. X-ray systems and X-ray tables in the fields of human and veterinary medicine.’ The CONAXX 2 software, devel- oped in-house and tried and tested and continuously enhanced, leads to a perfect X-ray image in just a few clicks, Protec adds. ‘Workflows. or individual steps, can be designed that are highly effi- cient and individualised by automa- tion,’ the company points out. An outstanding innovation in the Conaxx 2 software is Professional Image Tuning, or PIT for short. You can select the optics and quality of Protec is at Medica Hall 12 / Stand A63 ‘In addition, we see the system as a combination of robust construc- tion and high design standards, adds Björn Salwat, Managing Director Commercial at Protec. With a strong global orientation, Protec offers a holistic product port- folio to meet the highest internation- al standards, the firm points out. ‘It comprises highly compact analogue film processing machines, detectors, software and, since 2009, complete your images individually and auto- matically store the ideal image pro- cessing for you. ‘Above all, the premise of intui- tive user guidance comes into its own here, as touch screens, intuitive symbols and user-friendly handling enhance the software of each X-ray system and increase the operating convenience to an optimum. Visit us at HALL 3A stand 3AB02-1 Contact us to find out more about how the new headquarters can assist your future growth: www.the-bbigroup.com/futuregrowth +44 (0)2920 767 499 info@the-bbigroup.com
Working together to deliver the future of measurements and monitoring Philips and Masimo have teamed up to provide a noninvasive, continuous, and real-time, hemoglobin (SpHb®) monitoring solution that seamlessly integrates into your workspace. Our patient monitoring solution combines the innovative monitoring capabilities of Philips IntelliVue with the advanced Masimo rainbow SET™, so you can experience: • Insights on real-time changes, or lack of changes, in a patient’s hemoglobin concentration throughout the course of a case • Seamless connectivity without adding new equipment to your workspace • Operational and cost efficiencies from enhanced workflow Now includes pulse CO-Oximetry, SpHb, PVi®, SpOC™, SpCO® and SpMet® measurements. Philips and Masimo. Focusing on continuous measurement monitoring so you can deliver better patient care. PLEASE VISIT US AT MEDICA 2017 HALL 9/ D60 Learn more about enhancing your patient monitoring with advanced blood measurement technology at www.philips.co.uk/healthcare/resources/landing/masimo Continuous measurement monitoring
Working together to deliver the future of measurements and monitoring Philips and Masimo have teamed up to provide a noninvasive, continuous, and real-time, hemoglobin (SpHb®) monitoring solution that seamlessly integrates into your workspace. Our patient monitoring solution combines the innovative monitoring capabilities of Philips IntelliVue with the advanced Masimo rainbow SET™, so you can experience: • Insights on real-time changes, or lack of changes, in a patient’s hemoglobin concentration throughout the course of a case • Seamless connectivity without adding new equipment to your workspace • Operational and cost efficiencies from enhanced workflow Philips and Masimo. Focusing on continuous measurement monitoring so you can deliver better patient care. Now includes pulse CO-Ox- imetry, SpHb, PVi®, SpOC™, SpCO® and SpMet® meas- urements. PLEASE VISIT US AT MEDICA 2017 HALL 9/ D60 Learn more about enhancing your patient monitoring with advanced blood measurement technology at www.philips.co.uk/healthcare/resources/landing/masimo Continuous measurement monitoring
8 W E D N E S D AY @ M E D I C A Re-named ‘additive manufacturing’ and making products increasingly functional and creative. The 3-D printing revolution Making money? 3-D printing prices will drop dramatically.; then hospitals will have 3-D printers to customise implants or surgical instruments Warsaw, Ind.-based Zimmer-Biomet Inc., which began developing prod- ucts 15 years ago. Using what is called a build plate, industrial 3-D printing involves build- ing up micro layers of titanium pow- der that are burned with a laser to solidify the powder into a metal with nano-precision to match the design model. By the end of 2015 manufacturers had installed around 300 machines for 3-D printing of implantable pros- theses. Whereas in 2010 there were just four 3-D-printed implantable devices approved by the United States Food & Drug Administration, by 2014 twenty-five products had been FDA approved. According to Kevin Lobo, CEO at orthopaedics leader Stryker Corporation, additive manufacturing is ‘having an impact on our knee business as well as spine, and we have a huge line up of other divisions with ideas and prototypes to get into 3-D printer titanium product’. In 2016 Stryker began construc- tion of its second 3-D printing facility in Cork, Ireland. Orthopaedics market specialist Ali Madani, from Avicenne Medical in Paris, said that titanium spinal cages made by additive manufacturing pro- cesses constitute the most dynamic orthopaedic segment and that these products are steadily eroding the market share for polymer-based PEEK cages. In Europe, Madani pointed out that Italy is home to the most advanced companies in additive manufacturing where challengers like Lima Corporate, based in San Daniele del Friuli, and Milan-based Adler Ortho have invested massively in the technology and each year sell thousands of 3-D printed hip cups, shoulder implants, knee tibial plates, or mini-hip stems. Robin Stamp, the associate man- ager for Advanced Technology at Stryker Orthopaedics explained that for over 20 years, Stryker has milled and machined metal implants using complicated, multi-step manufac- turing processes based on coating materials with rigid requirements that limit design options. ‘What 3-D printing does is give design freedom, an ability to try exotic designs, build channels into the surface, create roughness, give a product any feature needed for essentially the same cost as building a standard model,’ he said. ‘Where we are really seeing a difference is in the speed of design iterations.’ Instead of a product development cycle of 18 to 24 months with a high cost for making changes, he said that today, using additive manufac- turing, his group can produce a design and within one week, give the part to a panel of surgeons and rapidly iterate, based on the panel’s suggestions to further develop the design. ‘This is phenomenally powerful,’ he said. ‘We are capable of doing so many more iterations, putting much more functionality and creativity into products.’ printers first became feasible, aca- demic projects made up 80 percent of the activity. Device designers in industry quick- ly caught up, calling it ‘additive man- ufacturing’ instead of 3-D printing. While this year more than $3 billion will be spent as companies find new applications to convert traditional manufacturing processes, this invest- ment is expected to reach $20 billion annually in just a few more years. Zadpoor notes that medical devic- es today account for 40 percent of that spending ‘… because there is such a great added value to these products that justify the increased cost associated with the technology’. The pioneer in additive manufactur- ing applied to orthopaedic devices is Report John Brosky Inexpensive and readily available, 3-D printers accelerate innovation in the design of medical devices from university laboratories to the factory floor. At the Delft Technical University they call themselves the Bio-Inspired Technology Group, or BITE. And their claim to fame is in having cre- ated DragonFlex, the world’s first steerable surgical instrument made entirely by 3-D printing. While the prototype is more likely to earn doctoral degrees for the inventors than to win a CE certifica- tion for use by surgeons, it demon- strates the emerging robustness for 3-D printing technology. ‘It’s cheap, it’s accessible, and 3-D printing helps students to rap- idly try out their product ideas,’ said Robert Webster, a visiting speaker at TU Delft from Vanderbilt University School of Engineering. ‘As the prices come down dra- matically and performance goes up, it’s reasonable to think that in a few years, the idea of a hospital having a 3-D printer in the basement to create on demand patient-specific implants or customised instruments for sur- gery, is absolutely feasible,’ he said. ‘The hospital could take any scan, print it and create a 3-D model.’ According to Amir Zadpoor, Director Additive Manufacturing Lab at TU-Delft, when rapid prototyping using 3-D of the Advances in vocal pathology diagnoses New voice app to detect diseases A new app measuring the biomechanics of the voice could impact on the market of ENT and speech pathology products, Mélisande Rouger reports app offers information that has a far better correlation with the clinic than the previously used technologies,’ he pointed out. As reported, Voice Clinical Systems works by taking a sample of the patient’s voice fed directly into a tablet or smartphone. The recording is then sent directly to an online server, for analysis. The information extracted is then returned shortly to the sender in the shape of a record, which is tailored to the on-going investigation. This mobile approach enables phy- sicians to record samples anywhere without the heavy, costly equipment usually needed for voice analysis. ‘Voice analysis systems currently used Acoustic tools that provide glottal source analysis, which are traditionally used in the diagnosis of vocal chords pathology, could soon become obso- lete due to a recently launched app that has introduced a highly reliable and entirely mobile technology. Called Voice Clinical Systems, the new device uses the self designed Wave Tracking technology, which focuses on the signal emitted from the patient’s lips. The patient only has to speak for three seconds, directly into a tablet or smart- phone, and a diagnosis follows within minutes. The app is likely to resonate in the vocal chords pathology world, as its correlation with the clinic is unheard of, according to Dr Carlos Ramirez, a Madrid-based ENT physician, who co-developed the app. ‘The information we are extract- ing has nothing to do with what we’ve used previously. Until now, the analysis we have used had very little clinical correlation; these tools were not describ- ing the pathology the patient might have been suffering. Our require hardware and a computer, which is only available at the health- care facilities,’ Ramirez said. ‘Mobility offers flexibility and brings advanced voice analysis technology to places which may not have had the necessary infrastructure before.’ The app offers three types of medical reports, which can differ- entiate between organic and func- tional pathology. All patient data are anonymized and the reports only fea- ture the age and gender of the patient. The one-page long basic report is called the clinical screening; this can be used by primary care professionals and general practitioners to help them refer patients to specialists. It includes straightforward colour- coded graphs, in which red is pathol- ogy and green normal. For patients in need of follow-up, specialists may use the intermediate report, which provides them with an alteration index. Information contained in this report may be particularly useful in patients who have received polyp surgery or are undergoing rehabilitation to correct a functional defect. The three-page report is a more complete document, and will help ENT and speech therapists to help diag- nose pathology with a high degree of subtlety. Because voice can be an indication of neurologic disor- ders before any other symptoms develop, neurologists may also use the app for the early detec- tion of Parkinson’s disease. The app only targets HC pro- fessionals for the moment, but Carlos Ramírez Calvo MD co-directs the ENT department at Vithas Nuestra Señora de América Hospital and is co-director of the Pablo Iglesias ENT Clinic in Madrid. He is a founding member of IFMEC, a company dedicated to innovation and training in medicine and surgery. He is also a founding member of Voice Clinical Systems. it may become available to patients within two years, Ramirez said. ‘In that case doctors will still have to interpret the report, but,’ he surmises, ‘patients could definitely go visit a specialist with their report in hand.’ The cost of the report ranges between €10 and 20. Launched in English and Spanish in December, the app has been used in two private institutions in Madrid and has already received positive feedback from physicians who have tested it at various institutions across Spain. Ramirez: ‘Voice Clinical Systems has been tested to check its correspond- ence with clinical diagnosis in 2,000 cases; the correspondence with the clinic has been higher in 99% of the cases.’ The app (Android and iOS) can be down- loaded here: http://www.voicecs.com EH @ MEDICA No 3 2017
W E D N E S D AY @ M E D I C A 9 Teleradiology provider wants to include pathology in the equation Integrate technologies to upgrade reports As the demand for imaging studies booms and digital pathology takes off, it is becoming necessary to look at the interactions between radiology and pathology in telemedicine, an expert explained during the Radiology Triangle Madrid meeting early this year. Demand for teleradiology services is growing fast and the business is expected to generate US$3.8 billion in 2019. ‘We exist because of the increas- ing gap between the demand for imaging work and current possi- bilities,’ said Alexander Böhmcker, CEO of Telemedicine Clinic (TMC), a teleradiology provider with a net- work of 195 radiologists in Sweden, the United Kingdom and Australia. ‘Small hospitals now have a huge challenge to attract talent locally.’ Organisational issues apart, telera- diology makes sense when there is a need for sub-specialisation, the busi- nessman told key radiologists from Spain and overseas – all personally invited to the meeting. ‘This is how we can connect many different cases from different hospitals and route them to the best available specialist. The main advantage of teleradiology is sub-specialisation, because it leads to increased effectiveness and better outcomes.’ Sub-specialisation is also relevant for telepathology, an emerging area that TMC has started developing with a network of seven patholo- gists, who provide reporting services, second opinion and training services. The company has issued 40,000 digital histopathology reports so far and it is keen to develop a synergy between radiology and pathology in the future. ‘When we think about the inte- gration of teleradiology and tele- pathology, we also think of applied sub-specialisation to pathology,’ he pointed out. Sub-specialisation may be even more important in pathology because pathologists often wonder who checks the results afterwards. Having second readings and the radi- ologist providing an opinion on their reports would be of tremendous help.’ In the literature there is a large amount of evidence for specific needs for radiology and pathology integration, e.g. in breast cancer, lung diseases, bone and soft tis- sue diseases and prostate cancer, Böhmcker argued. ‘It’s about using the report data in larger cohorts and clinical efficiency, as well as improv- ing the reporting environment and the preparation of tumour boards. It can also help in data mining and research.’ Integrating pathology results into the teleradiology report makes sense from a referring clinician and patient perspective, and matches the needs of the customers, Böhmcker explained. ‘There are situations in which hospitals ask for both services at the same time.’ Combining telera- diology and telepathology in a single report would be relevant in areas such as mammography. ‘Once the biopsy has been per- formed, and before the pathologist creates his or her initial report, he/ she would have access to the radiol- ogy report. After the interpretation of the study by the pathologist, a New tech secures mobile IT for roving medics Healthcare goes out and about New technology being deployed across the National Health Service in central England is helping to give more secure mobile systems to healthcare professionals, Mark Nicholls reports The partnership between Toshiba and the Birmingham CrossCity Clinical Commissioning Group (CCG) is bringing the work of health and social care organisations closer together. One of the initiatives planned for the Birmingham area is the introduc- tion of Toshiba Mobile Zero Client (TMZC) to its laptops, which as a result have no hard drive and no local operating system or memory. Instead, they utilise the health sys- tem’s existing virtual platforms to access and process information. Ciaron Hoye, Head of Digital for Birmingham and Solihull Clinical Commissioning Groups, explained that, with the CCG moving the local data and applications that healthcare professionals use to the cloud - and giving them access to it through the cloud using virtual platforms - the CCG is breaking down the ‘siloed structure’ between health and social care organisations to create a more connected digital ecosystem. EH @ MEDICA No 3 2017 This gives practitioners a faster, more holistic view of a patient’s his- tory and personal information and is also more secure at a time when health systems have been among organisations vulnerable to cyber attacks over the last couple of years. ‘Our patients don’t see the bound- aries between these organisations,’ Hoye pointed out. ‘They expect a joined-up service where their per- sonal information follows them to each appointment – allowing seam- less healthcare. ‘Because the devices are mobile, we’re giving our workforce the tools they need to meet the increasing demand for a more flexible health- care service. ‘Patients will see a reduction in time spent in and between appoint- ments, as diagnostic information will be more readily available. Instead of waiting for records to be shared between practices - the informa- tion will follow the patient, enabling quicker and better-informed diag- nosis.’ With healthcare professionals increasingly working from the field, the CCG believes the TMZC solution will enable them to access need- ed information wherever they are, and simultaneously record patient information records with up to date statistics when they are being seen. Another advantage is that, because no information is stored on the laptops once they are turned off, healthcare providers can share mobile devices and still have access to all the information and applica- tions they need through the virtu- alised desktop. Additional security features allow the device to remotely be deactivated and reduce the risk of sensitive data being misplaced in the field should it be lost or stolen. A challenge IT departments face in supporting a mobile workforce is securing the sensitive and personal information across multiple devices and a widening network, which can mean investing in expensive Mobile Device Management solutions (MDM). ‘However, because data is virtually stored when using zero cli- ent solutions, sophisticated security packages are unnecessary because it can all easily be managed in the cloud,” added Hoye. Toshiba and the CCG have worked closely to identify a solu- tion that not only helps create a more connected digital ecosystem, but also supports its increasing need for more mobile and flexible work- ing practices. Following a successful user acceptance test, the technology will be rolled out across the CCG final consensus report would be cre- ated.’ Pathology results could easily be added to the structured report, to evaluate discrepancies between the reports of both specialists. ‘In the end,’ Böhmcker said, ‘we would have an integrated report combining all the available clinical data. We would have a pathology summary with key images, the same as for radiology.’ TMC is currently working with two Swedish hospitals on two reporting platforms and technical solutions to combine both pathology and radiolo- gy findings. Using common reporting platforms would enable specialists to exchange information and feedback before and after they read each other’s reports. It would also grant the provider direct access to the final report and improve its adherence to outcome. ‘While a teleradiology company can be very far from the outcome results, an integrated solution can bring it very close,’ Böhmcker point- ed out. Developing common reporting platforms requires a lot of technical effort and the models used by TMC are locally based. The company is now working on a scalable solution. Another challenge is that the structured report (SR) is still not very popular among radiologists, despite its benefits over free text, according to Böhmcker. ‘The SR first appeared in the litera- ture in 1922, but its application today remains limited. However, standardis- ing information offers many oppor- tunities, for instance better com- munication and the possibility to perform data mining for peer review, audit, teaching and research. And most importantly, clinicians like it.’ To help radiologists switch to the SR, TMC is working on making it user-friendlier by clearing some of its unused sections and using voice commands. Teleradiology, on the contrary, has become more accepted Alexander Böhmcker, CEO of the Telemedicine Clinic (TMC), completed his Lic.oec. degree at the University St. Gallen, Switzerland and his MBA at ESADE in Spain. Prior to joining Telemedicine Clinic he had Business Development and Finance leadership roles in the Deutsche Bank, BMW and GFT. He joined TMC in 2008, managing in close collaboration with the co-founders. Today the firm leads European teleradiology and pathology, providing around 120 hospitals in Scandinavia and the UK with diagnostic reports, delivered by a network of over 200 sub-specialist radiologists and pathologists. He is also co-founder of the Spanish Chapter of ‘Conscious Capitalism’. ever since its introduction in 2009. ‘Acceptance has grown,’ he con- firmed. ‘The discussion is no longer on whether we want to have tel- eradiology or not, but rather what’s the best combination – onsite and remote radiology, and when and how to best use teleradiology.’ Teleradiology still needs to over- come a number of difficulties includ- ing access to clinical information, communication with the referring physician and outcome access. ‘This stresses the importance of integrated technologies and struc- tured reports. Image transfer is not an issue anymore,’ Böhmcker con- cluded. (MR) Ciaron Hoye is Head of Digital for the Birmingham and Solihull Clinical Commissioning Groups, and is also the Digital Workstream lead for the Sustainability and Transformation Plan within the region. Within the industry he was a developer, before moving to the NHS. Having led a number of projects from large scale Virtualisations, to smaller innovations into the use of technology to support healthcare, his current focus is on the use of cognitive computing and personalised healthcare. increasingly operating from the field, a trend that IT departments must support to ensure sensitive patient and business critical data is kept secure. However, mobile working practices bring with it an increased risk of sensitive data being lost or stolen.’ TMZC safeguards the technology by storing data away from the device, making it only accessible through its existing cloud-based virtual desktop infrastructure solution. ‘This removes the threat of mal- ware being stored on devices,’ Sims added, ‘as well as nullifying con- cerns about data being compromised should a device be lost or stolen.’ David Sims is Toshiba’s Solutions Sales Specialist. With over 22 years’ experience in telecommunications, he specialises in mobility, IOT/M2M and security solutions. Prior to employment at Toshiba, he had held various roles in the telecommuni- cations industry. area – which covers a million health and social care patients over a large urban environment. A future development, he said, could be wearable devices used to monitor individuals away from hos- pitals to collect information about their health. David Sims, Solutions Sales Specialist with Toshiba, said the com- pany is also helping to explore how Internet of Things (IoT) can transform wellness care in the Birmingham area, and how ‘the huge volume of data that devices such as wearables can be utilised for proactive healthcare.’ Challenges in mobile healthcare ‘Last year healthcare was the fifth most targeted industry in cyber- attacks,’ Sims pointed out. ‘At the same time healthcare staff are
1 0 W E D N E S D AY @ M E D I C A Navigated ultrasound The best intraoperative imaging technique New navigation imaging and neurophysiological stimulation techniques enable an approach to brain tumours long considered unresectable before and during surgery, but not one does it quite as well as ultrasound, according to a leading Spanish neurosurgeon. Unlike intraoperative magnetic res- onance imaging (MRI), which requires 20-30 minutes time to adjust to pre- surgical images, it takes a little over two minutes (2 minutes 19 seconds) for intraoperative ultrasound to over- lap with previous images. Because it is so fast, ultrasound can be repeated as many times as necessary, enabling the surgeon to detect brain shift and evaluate how much tumour is left, almost instantly. ‘Ultrasound has changed the way we operate on patients. When I’m done resecting, I check if the tumour has been fully removed, or if there is any residual. In 14% of the cases, ultrasound helps to resect fur- ther, which significantly improves our results. Extensive resection tremen- dously increases patient survival and prognosis,’ de Quintana pointed out. Intraoperative imaging enables to safely excise tumours long thought to be unresectable. At Santa Creu i Sant Pau Hospital, ultrasound has helped de Quintana to successfully carry out surgery in 10-20 patients of the 40-50 patients he operates on annually. Another benefit of ultrasound compared to other intraoperative techniques is that it is cheap and easily moveable across the hospital, without losing too much in image quality. After studying hundreds of cases over two years, de Quintana observed that ultrasound had achieved 78% of correlation with pre-surgery MRI. ‘That’s a totally acceptable perfor- mance for intraoperative imaging,’ Report: Mélisande Rouger Resecting an entire tumour and determining brain shift remain chal- lenging for surgeons in brain can- cer surgery. However, they are like- lier to overcome these difficulties if they use intraoperative ultrasound, according to Dr Cristian de Quintana Schmidt, neuro oncologist at Santa Creu i Sant Pau Hospital in Barcelona. ‘Neuro navigated ultrasound provides the surgeon with confidence in the assessment of resection accuracy and in the determination of brain shift,’ he said. Last August, during the World Awake brain surgery – Intraoperative image. Example of a patient monitoring three languages (Catalan, Spanish and English) Congress of Neurosurgery in Istanbul, de Quintana presented the results of a prospective two-year study on ultrasound use in intra-axial tumours. For surgeons, brain shift is a major problem. Even if they use pre surgical imaging to help plan surgery, the brain will change during the intervention; it will lose liquid and volume, shift shape and move, and ultimately make it harder for surgeons to perform. The single-use cervical rotating biopsy punch he confirmed. Ultrasound is particu- larly helpful in visualising metastases, which are less infiltrative than glioma and usually easier to resect. Last but not least, the learning curve is much faster than with MRI. ‘All you need is a bit of experience. Ultrasound is not a complicated tech- nique, but you need good equipment and good probes.’ All these benefits have convinced the researcher that ultrasound is the best imaging tool in his arsenal. ‘Based on image quality, time, ease of use and cost, ultrasound is the most effi- cient intraoperative imaging technique at our disposal.’ Nevertheless de Quintana stressed the role of functional MR and tractog- raphy in the pre surgical setting. ‘We are increasingly using these techniques to help prepare for surgery,’ he said. ‘They remain crucial to be able to localise tumour and determine our approach, in order to resect as much tumour as possible without damaging neurological function.’ Tractography, in particular, is instru- mental in visualising subcortical neural tracts and understanding how the tumour relates to surrounding struc- tures. The technique relies on 3-D modelling based on data collected by diffusion-weighted images, and uses colour to image functions such Tactography of a German and English speaking patient Cristian de Quintana Schmidt MD is responsible of neuro-oncology in the department of surgery at Santa Creu i Sant Pau Hospital in Barcelona, Spain. He is a specialist in highly complex brain tumour resection and an expert in technological advances in this field. His publications, courses and conference presentations number more than a hundred. as language, vision and motion. This information is then sent to the neuro navigator to facilitate surgery. De Quintana also highlighted the role of neurophysiological stimula- tion during surgery to help distinguish functional areas of the brain and eval- uate patient response. Brain mapping in tumours located in or close to key areas generating motion, vision and speech or linked to memory enables assessment of response while the patient is awake or asleep. A surgeon, neurophysiologist and neuropsychologist usually perform this stage of treatment together. Once the patient is asleep, the medical team will gently wake him or her up to perform brain mapping and ask him/ her to carry out tasks. Doctors then perform tumoural resection, and close up the patient when he/she is asleep or sedated. Dermatology added to a fine portfolio DTR Medical Ltd is at Medica Hall 16 / Stand F42 » A new Cervical Rotating Biopsy Punch featuring a low profile jaw was ‘designed to provide specialists with better access to the transfor- mation zone,’ DTR Medical reports, adding that the punch offers a 360° rotation for flexible positioning and the sharp metal jaw to ensure a clean cut, delivering the clinician with the best possible view and the assurance of achieving biopsies first time. The Cusco Specula, available in Small XXLong, is also new. This aids in examining a wider spectrum while providing the patient with enhanced comfort and experience, the manu- facturer adds. ‘Featuring insulation performance, the specula also helps to achieve patient and user safety. ’The company’s full collection for improved ENT/maxillofacial, gynaecology, gen- eral surgery, orthopaedic, ophthal- mology, neurosurgery and, most recently dermatology, is on show now. Great Britain: Mark Nicholls. Malta: Moira Mizzi. Spain: Mélisande Rouger, Eduardo de la Sota. The Netherlands: Madeleine van de Wouw. USA: Cynthia E. Keen, i.t. Communications, Lisa Chamoff. Subscriptions Liane Kaiser, Theodor-Althoff-Str. 45, 45133 Essen, Germany Subscription rate 6 issues: 42 Euro, Single copy: 7 Euro. Send order and cheque to: European Hospital Subscription Dept Printed by: druckpartner, Essen, Germany Publication frequency: bi-monthly Representatives China & Hongkong: Gavin Hua, Sun China Media Co, Ltd. Phone: +86-0755-81 324 036 E-Mail: gavin_hua@163.com Germany, Austria, Switzerland: Ralf Mateblowski Phone: +49 6735 912 993, E-Mail: rm@european-hospital.com France, Italy, Spain: Eric Jund Phone: +33 493 58 77 43, E-Mail: ej@european-hospital.com GB, Scandinavia, BeNeLux: Simon Kramer Phone/Fax: +31 180 6200 20 E-Mail: sk@european-hospital.com Israel: Hannah Wizer, International Media Dep. of El-Ron Adv. & PR Co., Ltd., Phone: +972-3-6 955 367 E-Mail: hw@european-hospital.com South Korea: CH Park, MCI Phone: +82 2 730 1234, E-Mail: mci@unitel.co.kr Taiwan: Charles Yang, Phone: +886 4 232 236 33, E-Mail: medianet@ms13.hinet.net USA & Canada: Hanna Politis, Media International Phone: +1 301 869 66 10, E-Mail: hanna@media-intl.com All company, brand and product names in this pub- lication are the property of their respective holders. Users must obtain permission from those holders before copying or using the owner’s trademarks, product and company names or logos. EH @ MEDICA No 3 2017 Editor-in-Chief: Brenda Marsh Art Director: Olaf Skrober Editorial team: Wolfgang Behrends, Lena Petzold, Marcel Rasch Senior Writer: John Brosky Executive Director: Daniela Zimmermann Founded by Heinz-Jürgen Witzke ISSN 0942-9085 Correspondents Austria: Michael Kraßnitzer, Christian Pruszinsky. China: Nat Whitney France: Jane MacDougall. Germany: Anja Behringer, Annette Bus, Walter Depner, Brigitte Dinkloh, Cornelia Wels-Maug, Holger Zorn.
W E D N E S D AY @ M E D I C A 1 1 Healthcare firm boosts capacity for long-term growth Wales gains firm’s £14m global headquarters Celebrating a 30th anni- versary, and with over 450 members of staff across 10 glob- al facilities, the BBI Group (BBI), which partners some of the world’s leading diagnostic and healthcare organisations, is creating a new £14 million global headquar- ters in Wales, United Kingdom. This new site unites three of its existing UK manufacturing locations under one roof, thus also amalgamating knowledge, expertise and develop- ment activities. Company divisions BBI Solutions focuses on immunoas- say development and manufacturing services, providing an extensive port- folio of products and technologies to the international diagnostic market. BBInnovations develops global net- works with academic and industry partners to bring early and mid-stage technologies and products BBI Detection specialises in the development and supply of innova- tive technologies for rapid sampling and identification of bio-threats, The new site will have ISO 13485:2016 certification rent and future customers providing increased capacity opportunities that far exceed its existing manufacturing facilities, the firm adds. The new site will also be certified to world recog- nised Quality Management System, ISO 13485:2016, providing peace of mind to customers. Lyn Rees, The BBI Group CEO commented: ‘The aim of the new site is to establish a world-class facil- ity that will provide the capacity for our customers’ growing businesses and keeps us ahead of the regula- tory changes that are being driven through our market. ‘BBI has seen significant growth in Europe, USA and China and, as we continue to penetrate these markets, the new headquarters will give us the pedigree to compete more effec- tively. We look forward to welcoming our customers to the new headquar- ters when we open in 2018.’ explosives and narcotics for military, first responder and security markets. BBI Healthcare - Launched in 2006 with a diabetes product, in 2008 this division was merged with Alere firm Cedar Health, which brought the Balance Activ brand into the port- folio. Today the division develops, manufactures and distributes health- care products that include women¹s health, energy and digestive prod- ucts, to consumer retail, healthcare professional and export markets. ‘BBI Healthcare,’ the company reports, ‘has grown to be a multi- million pound business with an ener- getic and innovative team of over 40 personnel delivering new products, strong brands and education into retail, and primary and secondary care markets. The significantly larger site allows BBI to continue to grow with its cur- Solid IT hard- ware and communication When Taiwan-based Adlink acquired Penta, the buyer benefited from 20 year’s experience in design and hard- ware manufacturing. Today, Adlink provides state-of-the-art computing products such as advanced TCA pro- cessor blades and platforms, com- pact PCI/PlusIO, VPX blades, indus- trial SBCs, motherboards and chas- sis, plus embedded flash storage, computer-on-modules, rugged small form factor SBCs & systems, fan- less embedded computer, wireless internet gateways, and SEMA cloud. The firm’s IMPS product lines include ‘Adlink products also support mul- tiple operating systems and include comprehensive and easy-to-use soft- ware packages and services,’ the manufacturer confirms. Medical panel computers The medical panel computers and monitors have been designed with optimum viewing capabilities and hygienic fully-sealed and easily clean- able housings, suitable for patient vital sign monitoring, nursing care, clinical diagnosis, PACS, anaesthesia monitoring and OR documentation. Adlink is at Medica Hall 10 / Stand F40 The MLC 5 medi- cal panel computer is designed for digitally integrated operating to enable theatres easy access to PACS images, EHRS and other relevant patient data. The device allows surgeons to manage the patient’s vital parameters and other critical information during sur- gery’, Adlink explains. ‘The MLC 5 therefore is ideally used to simplify surgical patient data monitoring with superior graphic processing capabili- ties. industrial mobile handheld comput- ers, smart panels, smart touch com- puters, industrial & panel PCs, medi- cal PCs & display. All these products and compo- nents are governed by strict revision control, medical regulations and risk analysis, and the firm emphasises that it also ensures support for cus- tomers who want to integrate the medical product solutions into their own medical systems. BBI is at Medica Hall 3A / Stand 3AB02-1 Transfer to the global headquar- ters of existing operations will begin very early in the New Year. www.the-bbigroup.com/futuregrowth » Top quality single- use suctions » Single Use Surgical is at Medica Hall 16 / Stand F42 UK hospitals’ concerns over the clean- ing practices involving fine lumen instruments, and how it posed a high risk of cross contamination between patients, the company points out. ‘Since then, we have developed the widest range of high quality and spe- cialist single-use suctions capturing The single-use Diathermy Abbey Needle improves visibility at the surgical site during submucosal diathermy (SMD), turbinectomy and breast surgery the same look, feel and functionality as the reusable equivalent.’ The manufacturer makes prod- ucts with stainless steel tubes rather than aluminium, which, it reports, has helped it to become a leading single-use medical device specialist. The range spans many specialties including ENT, head and neck, gynae- cology, laparoscopy, general and vas- cular surgery. A pioneering single-use Diathermy Abbey Needle with suction that helps surgeons improve performance and outcomes during a range of pro- cedures is on show at this year’s Medica. Developed by Single Use Surgical, the firm reports that the device improves visibility at the surgi- cal site during submucosal diathermy (SMD), turbinectomy and breast sur- gery. ‘It offers a unique combination of precise cauterisation and targeted suction helping to remove surgical smoke and reduce the risks associ- ated with reprocessing a reusable monopolar device,’ the firm explains. Single Use Surgical was estab- lished in 2001 as a direct response to EH @ MEDICA No 3 2017 t. +44 (0)2920 767 800e. info@susl.co.ukFollow usFind us in Hall 16 Stand F42The widest range of single use suctions.www.susl.co.uk