Tuesday, January 15, 2013
Pill-sized device provides rapid, detailed imaging of esophageal lining:
Physicians may soon have a new way to screen patients for Barrett’s esophagus, a precancerous condition usually caused by chronic exposure to stomach acid. Researchers at the Wellman Center for Photomedicine at Massachusetts General Hospital (MGH) have developed an imaging system enclosed in a capsule about the size of a multivitamin pill that creates detailed, microscopic images of the esophageal wall.
The system has several advantages over traditional endoscopy.
“This system gives us a convenient way to screen for Barrett’s that doesn’t require patient sedation, a specialized setting and equipment, or a physician who has been trained in endoscopy,” says Gary Tearney, MD, PhD, of the Wellman Center and the MGH Pathology Department, corresponding author of the report receiving online publication in Nature Medicine.
“By showing the three-dimensional, microscopic structure of the esophageal lining, it reveals much more detail than can be seen with even high-resolution endoscopy.”
The researchers tested the system in 13 unsedated participants — six known to have Barrett’s esophagus and seven healthy volunteers.
The physicians operating the system were able to image the entire esophagus in less than a minute, and a procedure involving four passes — two down the esophagus and two up — could be completed in around six minutes.
A typical endoscopic examination requires that the patient stay in the endoscopy unit for approximately 90 minutes.
The detailed microscopic images produced by the OFDI system revealed subsurface structures not easily seen with endoscopy and clearly distinguished the cellular changes that signify Barrett’s esophagus.
Study participants who had previously undergone endoscopy indicated they preferred the new procedure.
How it works
The system developed by Tearney and his colleagues involves a capsule containing optical frequency domain imaging (OFDI) technology — a rapidly rotating laser tip emitting a beam of near-infrared light and sensors that record light reflected back from the esophageal lining.
The capsule is attached to a string-like tether that connects to the imaging console and allows a physician or other health professional to control the system.
After the capsule is swallowed by a patient, it is carried down the esophagus by normal contraction of the surrounding muscles.
When the capsule reaches the entrance to the stomach, it can be pulled back up by the tether. OFDI images are taken throughout the capsule’s transit down and up the esophagus.
“The images produced have been some of the best we have seen of the esophagus,” says Tearney, a professor of Pathology at Harvard Medical School and an MGH Research Scholar.
“We originally were concerned that we might miss a lot of data because of the small size of the capsule; but we were surprised to find that, once the pill has been swallowed, it is firmly ‘grasped’ by the esophagus, allowing complete microscopic imaging of the entire wall. ‘
Other methods we have tried can compress the esophageal lining, making it difficult to obtain accurate, three-dimensional pictures. The capsule device provides additional key diagnostic information by making it possible to see the surface structure in greater detail”
Support for the study includes National Institutes of Health grants.
Tuesday, August 21, 2012
Molecular code for destroying/correcting defective RNA cracked:
University of Western Australia (UWA) scientists have cracked a molecular code that may open the way to destroying or correcting defective gene products, such as those that cause genetic disorders in humans.
The code determines the recognition of RNA molecules by a superfamily of RNA-binding proteins called pentatricopeptide repeat (PPR) proteins.
(When a gene is switched on, it is copied into RNA. This RNA is then used to make proteins that are required by the organism for all of its vital functions. If a gene is defective, its RNA copy and the proteins made from this will also be defective. This forms the basis of many terrible genetic disorders in humans.)
Revolutionizing disease treatment
RNA-binding PPR proteins could revolutionize the way we treat disease. Their secret is their versatility — they can find and bind a specific RNA molecule, and have the capacity to correct it if it is defective, or destroy it if it is detrimental. They can also help ramp up production of proteins required for growth and development.
The new paper in PLOS Genetics describes for the first time how PPR proteins recognize their RNA targets via an easy-to-understand code. This mechanism mimics the simplicity and predictability of pairing between DNA strands, but at a protein/RNA interface.
“Many PPR proteins are vitally important, but we don’t know what they do. Now we’ve cracked the code, we can find out,” said Australian ARC Centre for Excellence in Plant Energy Biology Director Ian Small.
“What’s more, we can now design our own synthetic proteins to target any RNA sequence we choose. This should allow us to control the expression of genes in new ways that just weren’t available before. The potential is really exciting.”
“This discovery was made in plants, but is applicable across many species as PPR proteins are found in humans and animals too,” says Professor Bond.
The breakthrough comes from an international, interdisciplinary research team including UWA researchers Professor Ian Small and Aaron Yap from the ARC Centre for Excellence in Plant Energy Biology and Professor Charlie Bond and Yee Seng Chong from UWA’s School of Chemistry and Biochemistry, along with Professor Alice Barkan’s team at the University of Oregon.
The research was publicly funded by the the ARC Centre for Excellence in Plant Energy Biology, the WA State Government in Australia, and the NSF in the U.S.
Wednesday, February 1, 2012
Saturday, April 16, 2011
We've seen all manner of medical robots 'round these parts, from bloodbots to surgical cyborgs. And now Dr. Thomas M. Hemmerling from McGill University Health Centre (who also helped develop the McSleepy anesthetic android) has created the world's first intubation robot. Called the Kepler Intubation System (KIS), it's a robotic arm with a video laryngoscope that's controlled via joystick -- allowing MDs to get their Dr. Mario on while sliding an endotracheal tube into any passed-out meatbag with minimal fuss and maximum safety. The first procedure using the device on a real, live human was a success, and clinical testing continues. We're not big on bots shoving anything anywhere (even if it does help us breathe while under the knife), but that's better than android appendages lobbing grenades our way.Permalink | McGill University Health Centre | Email this | Comments"
Friday, April 15, 2011
The designers began by making simple 2-D concentric ring structures, each ring formed from a DNA double helix. The concentric rings are bound together by means of strategically placed crossover points. These are regions where one of the strands in a given double helix switches to an adjacent ring, bridging the gap between concentric helices. Such crossovers help maintain the structure of concentric rings, preventing the DNA from extending.
Varying the number of nucleotides between crossover points and the placement of crossovers allows the designer to combine sharp and rounded elements in a single 2D form. The network of crossover points can also be designed to produce combinations of in-plane and out-of-plane curvature, allowing for curved 3D nanostructures.
Combining the method of concentric helices with non-B-form DNA (with 9-12 base pairs/turn) enabled the team to produce sophisticated forms, including spheres, hemispheres, ellipsoid shells, and a round-bottomed nanoflask.
Ref.: Hao Yan & Yan Liu et al., DNA Origami with Complex Curvatures in Three-Dimensional Space, Science, April 15, 2011"
Monday, March 28, 2011
Remember the fear mongering rhetoric about weapons of mass destruction and all sorts of other bogey men that sometimes led to war death and true destruction and other times to just animosity, hatred and counterproductive waste of time and resources?
This is exactly what we are witnessing today in Health Information Technology (HIT). Granted this is only a sideshow, while the main stage is occupied by the unprecedented Federal push to computerize medicine, but it has a very shrill voice and it seems to be confusing many good people. There are many legitimate questions that need to be asked, many strategies that should be debated, many errors that must be corrected, but the unsubstantiated, dogmatic and repetitive accusations directed towards HIT in general, EHR in particular, and chiefly at technology vendors and their employees, are borderline pathological in nature.
To be clear here, there are many practicing physicians and nurses who are either forced by an employer to use an EHR they dislike, have tried to use an EHR and didn’t enjoy the experience, or are opposed to the EHR concept on principle because the software has no return on investment in their situation, is not “ready for prime time” or is too closely aligned with the goals of the Federal government. These are all valid points of view and should be listened to and considered by policy makers as well as technology builders, and I have to confess that I do agree with much of what these practicing folks write and say, and as I said many times in the past, practicing physicians, i.e. those who see patients every day, are dangerously underrepresented in all HIT policy and technology decisions being made now at a federal level. Unfortunately, the practicing doctors’ message is being obscured and tainted by the “naysayers who predictably and monotonically chant the “HIT is evil” mantra at every opportunity” (quoting the famed HIT blogger, Mr. Histalk). These “self-proclaimed experts” and their incendiary and largely self-serving monologues are making it very easy to dismiss legitimate problems present in HIT policy and technology.
The #1 allegation against EHRs and those who build them is probably the one contending that EHRs kill people. HIT is supposedly an unauthorized human subject experiment which should be halted due to so many deaths and injuries. There is no evidence to support this assertion. Yes, there are several deaths documented, which have been associated with EHR software in one way or another, all in hospitals, but there is no documented evidence of mass injuries. The ugly truth is that people die in hospitals due to preventable errors of all types. They died before EHRs were introduced and they are still dying at similar rates after EHRs were installed. For every error attributed to software malfunction, there is a parallel error that can be attributed to lack of software or utilization of paper charts in general. For example, a software bug could cause records to end up in the wrong chart. How many times do paper records get filed in the wrong chart? How many times do paper records get misplaced never to be found again? How many times do paper charts disappear for long periods of time? Of course since paper is a passive medium, all errors arising from paper charts usage are directly attributable to users. When an EHR is used, some errors, not all and not most, are attributable to the software. Ergo, EHRs kill people while prior to EHRs people killed people. Net effect is the same, although fixing software bugs is a lot easier than remediating people’s error prone behaviors.
The #2 inflammatory allegation is squarely directed at the business entities that build and sell EHRs, and individually towards anybody associated with IT, whether at a hospital level or a vendor level. Supposedly, these dim-witted IT folks have no understanding of medical practice and a complete disregard for patient safety and human lives. I have no doubt that some IT folks would not score very well on Mensa tests and others may have little interest in anything other than their paycheck, and this is true about any randomly selected group of people, including clinicians. However, EHR vendors are for-profit technology companies, and as such have an overriding interest in creating revenue. You do not benefit your long term top-line by purposely selling defective products. Suggestions that EHRs should be produced by non-profits are a bit naive considering that this is health care we are talking about, and we all know how selfless, charitable and patient safety oriented other non-profits are in this industry. I would also like to point out the few and far between health care providers who are willing to treat Medicaid patients due to financial and business considerations. How are the sacred patient safety and human life considerations ranked by those providers? I would assume they come in right after staying in business, keeping the doors open and perhaps even an acceptable profit level. EHR vendors are no different.
As to hospital IT folks, the ones I had the pleasure of meeting always listed patient safety as their main concern. Was it just lip service? I don’t think so, but all I have is anecdotal evidence. In any case, the incompetence and profit concerns of hospital administrators who drive EHR deployments in hospitals and health systems, to the extent that they exist, are not indicative of HIT being murderous or evil. They are indicative of the need for transparency and learning from those that manage to deploy the same HIT tools successfully, and those do exist.
Moving on to #3, we find the widespread platitude contending that EHRs should be built “by doctors for doctors”. Guess what? Many are, and it doesn’t make those EHRs any better. Amongst the larger EHR vendors, there is none that does not employ physicians and some have dozens of MDs on staff and hundreds of other clinicians. Many medium and smaller EHR companies were founded, and some are still owned, by physicians. There are two issues here. One is that most physicians fully employed by technology companies are not practicing anymore and I am not certain they ever did after residency. I have personally witnessed multiple times the huge disconnect between the professional IT physicians and those seeing 30 patients each day. Couple that with the “I’m a doctor, so I know best” attitude, and you are guaranteed an academic product that will have little value in the “real world”. The second issue is that most physicians know as much about IT as engineers know about medicine. With very few exceptions, commercial EHRs should not be built by doctors as a side hobby. They should be built by professional software designers and builders with extensive input and guidance from customers, just like quality products are built in all other industries. And by customers, I don’t mean “ivory tower informatics experts” who happen to have an MD after their name. I mean hard working, six days a week, frazzled and discouraged, practicing doctors and nurses.
Finally the #4 issue is the perpetual cry from various quarters that EHRs should come under FDA supervision. I strongly agree. Any instrument used in the delivery of medical care should be supervised to an appropriate degree, and maybe such transparent supervision would put an end to the fictional assertions that EHRs are guilty of mass murder. Done right, FDA supervision will definitely help folks make better product choices and deploy and use EHR technology in more beneficial ways. With the recent proliferation of “certified” EHRs, triggered in large part by the glow of HITECH money, FDA supervision could also serve to separate the wheat from the increasing amounts of chaff. It is also useful to remember that people are killed every day by FDA approved drugs and devices due to improper use, human error, negligence, criminal intent and product faults that the FDA missed.
In conclusion I would be remiss if I did not mention the multiple legitimate complaints regarding EHR usability and utility. While there is much work to be done, many errors to be addressed and much technology innovation to be applied, the form and function of EHRs is ultimately dictated by the environment in which they are used. The business of medicine (a.k.a. billing) dictated most of the box-clicking nature of older EMRs and the new population health, cost cutting and research focus emanating from the Federal government will just increase the demand for structured data elements and the accompanying clicking on boxes. EHR vendors will build whatever customers are willing to buy. It is infinitely easier to build an EHR without click-boxes and templates, than it is to build one that records and maintains hundreds of templates, customizations, vocabularies, cross-walks, guide-lines, protocols and analytics to slice and dice everything. Vendors would be more than happy to just give you a blank text box where you can type, scribble or dictate to your heart’s content. But guess what every single physician looking to buy an EHR is asking right after the price question? “How many templates does your system have for my specialty?” The structure of EHRs is a symptom of quite a different problem and it will not be resolved until the root cause is addressed. So the lunatic fringe notwithstanding, EHR vendors are not out there to torture you or kill your patients. They are out there to sell you products and services and make some money in the process – just like Apple, Microsoft, Google, IBM, and you – and they build the products based on what the customer says he wants and what the Government says they must.
And no, you don’t have to buy one if you choose not to………
Margalit Gur-Arie was COO at GenesysMD (Purkinje), an HIT company focusing on web based EHR/PMS and billing services for physicians. Prior to GenesysMD, Margalit was Director of Product Management at Essence/Purkinje and HIT Consultant for SSM Healthcare, a large non-profit hospital organization. She shares her thoughts about HIT topics and issues at her blog, On Healthcare Technology.
Wednesday, February 9, 2011
BeneChill (San Diego, CA) has partnered with Medtronic's Physio-Control division to release the RhinoChill IntraNasal Cooling System in Europe. As the name implies, RhinoChill cools the head and body via a nasal catheter and is designed for fast application on patients status post cardiac arrest, stroke or traumatic brain injury. The companies have also announced plans to develop 'additional applications for BeneChill and work towards making the RhinoChill System available in the U.S.'
More about the RhinoChill from a Medtronic press release:
The RhinoChill System uses a non-invasive nasal catheter that sprays a rapidly evaporating, inert coolant liquid into the nasal cavity, a large area situated beneath the brain that acts as a heat exchanger. As the liquid evaporates, heat is directly removed from the base of the skull and surrounding tissues via conduction and indirectly through the blood via convection.
The system is battery-powered, compact and does not require refrigeration, making it ideal for use in pre-hospital settings. Each coolant bottle holds enough liquid to cool a patient for 30 minutes at nominal flow, and bottles can be easily exchanged to maintain the cooling process.
A recently-published European clinical study4 has shown that when administered by Emergency Medical System (EMS) personnel as soon as they reach a cardiac arrest victim and continued during transport to hospital, the RhinoChill System effectively reduces body temperature by the time the victim reaches the hospital. Survival without loss of brain function was significantly improved in patients where resuscitation procedures and subsequent RhinoChill cooling were initiated within ten minutes of cardiac arrest, compared with patients who were not cooled in the pre-hospital setting.
Product page: RhinoChill Intra-Nasal Cooling System...