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Breakthrough in Cardiology: Medtronic's Cardiac pacemakers without leads June 27, 2016 14:25

Photo Credit: iStockPhoto

 

 

 

 

 

 

 

 

 

For decades patients who have had a slow heart rate have been managed with a pacemaker with leads being implanted into the right ventricle and right atrium. The procedure requires some type of anesthesia and use of x-rays to ensure that the lead placement was correct. In most cases, the subclavian vein in the neck is percutaneously cannulated through which the lead is placed in the heart. The lead is then hooked up to a generator, which is then placed underneath the collarbone. The device is fairly large and once the pacemaker is inserted, there are many lifestyle restrictions
         

This procedure is effective for treatment of slow heart rate but is also fraught with complications like lead dislodgement, cracks in the lead and infections, which account for 2-10 percent of cases. When the leads fail to work, removal is a very difficult and exhaustive procedure with potentially life threatening complications like ventricular rupture. Over the years, millions of Americans have received these pacemakers. Since the 1980s, pacemaker technology has not changed much.
 
   
 
Medtronic Micra leadless pacemaker  Photo Credit: Courtesy of Medgadget However, just last year researchers developed a lead-less pacemaker, the size of a large vitamin pill. This wireless miniaturized battery controlled pacemaker can be implanted directly into the right heart muscle via the femoral vein within 10-20 minutes. The pacemaker is secured into the heart muscle by hooks or a screw. The device contains a sensor electrode inside the metal clad device that detects all the heart information and relays it to the generator, which provides the necessary cardiac stimulation to keep the heart beating at the set rate. The lithium battery in this miniature device is estimated to last 7-12 years. The entire wireless device can easily be retrieved via a catheter if a new battery is required.

This novel pacemaker based on nano technology has eliminated scars and an incision on the patient’s chest. Further there are no restrictions on physical activity nor are there any problems associated with malfunctioning leads. The FDA just approved the first wireless pacemaker (Micra) last month for use in the USA. Several large clinical trials are now in progress to test this particular device.
 
At the moment the Micra pacemaker is a great option for patients who need stimulation of only a single chamber. The Micra pacemaker has been tested and approved to be safe in presence of MRI scanners. One can walk through airport metal security without any interference to the pacemaker. Use of this pacemaker will cut down on hospital admission, the surgeon and anesthesiologist fees, and the need for x-ray during the procedure.

The only downside is the cost of this device. It is estimated that this wireless pacemaker will cost anywhere from $10,000- $15,000 which is many times more expensive than the conventional pacemakers which cost about $2,500. With cost cutting measures in most hospitals, there is concern that these devices may not catch on fast. Further Medicare has already stated that it has no extra budget and it is not known if it will pay for the extra cost.


Graham Medical Provides Reliable EMS Solutions June 21, 2016 10:14

 


Graham Medical's innovative patient rescue and transport units go where stretchers cannot. Their latest design features a fluid barrier and vertical nylon straps for added strength and versatility. The MegaMover® is a compact, cost effective, portable transport unit used to transport, transfer or rescue patients from areas inaccessible to stretchers. The nonwoven, latex-free construction hold up to 1000 lbs. and has 14 handles for ergonomic lifting.

Now available with PowerGripTM handles for added comfort and durability.

MegaMover® 350i Barrier Sheet 

Graham Field's MegaMover® 350i Barrier sheet can either be used as a ultra-durable unit that can transfer patients up to 350 lbs. or as a blanket for warmth or protective equipment cover. The nonwoven/poly material acts as a fluid barrier to prevent any cross-contamination.

MegaMover® Plus

The MegaMover® Plus is a durable, compact, cost effective, portable transport unit used to transport, transfer or rescue patients from areas inaccessible to stretchers. The Plus accepts standard backboards for immobilization. The gray color provides decreased visibility where security is vital. Now available with PowerGripTM handles for added comfort and durability.

MegaMover® Select™

The MegaMover® Select™ Transport Unit features multi-positioned handles allowing the user to select the handle that offers the safest and most comfortable position for transporting patients. It excels when maneuvering stairs by allowing the user to select a higher position handle or a lower position handle to enhance leverage.

MegaMover® Transport Chair The MegaMover® Transport Chair is made of strong nonwoven material with 8 reinforced nylon yellow straps for ergonomic lifting. The Chair weighs only 10 oz., rolls to the size of a water bottle and can transport up 350 lbs. Ideal for carrying patients in areas of limited space, narrow hallways or down stairs.

Now available with PowerGripTM handles for added comfort and durability.


Top 10 Innovations for 2015 July 16, 2015 17:45

Which are the up-and-coming technologies and which will have the biggest impact on healthcare in 2015?

Cleveland Clinic's culture of innovation naturally fosters a good deal of discussion about new "game changing" technologies and which ones will have the greatest impact each year. The passion of our clinicians and researchers for getting the best care for patients drives a continuous dialogue on what state-of-the art medical technologies are just over the horizon.

This book was developed to share outside Cleveland Clinic what our clinical leaders are saying to each other and what innovations they feel will help shape healthcare over the next 12 months.

#1 Mobile Stroke Treatment Unit

Each year in the United States, nearly 800,000 people suffer a stroke, or a brain attack. This occurs when an artery that supplies blood to part of the brain becomes blocked or ruptures and leads to bleeding in the brain.  In ischemic strokes, a blood clot is the triggering event, while the remaining 10 percent of strokes are called hemorrhagic and a burst blood vessel or aneurysm is typically the cause.
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    #2 Dengue Vaccine

    All it takes is one bite: Dengue is a debilitating virus that’s transmitted to humans by the bite of an Aedes aegypti mosquito that has previously bitten a person infected with the dengue virus. 

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      #3 The New Art of Blood Collection and Diagnosis

      With the advent of science, blood became a key diagnostic element. Withdrawn from the body, it was isolated and studied. Today, phlebotomy, the process of opening a vein and collecting blood for testing and diagnosis, is regularly used to measure cells, lipids, proteins, sugars, hormones, tumor markers and other blood components. 

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        #4 PCSK9 Inhibitors for Cholesterol Reduction

        Cholesterol, a soft, waxy substance present in cells throughout the body, serves many important functions. However, elevated levels of certain forms of cholesterol are some of the primary drivers in the development of coronary heart disease. .

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          #5 Antibody Drug Conjugates

          Scientists have learned more about cancer in the last two decades than had been learned in all the centuries preceding. And even though one million people in the United States develop cancer annually, tremendous advances have been made in cancer biology that have led to significant progress not only in cancer prevention and early detection but in cancer treatment as well. 

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            #6 Immune Checkpoint Inhibitors

            The immune system’s collection of organs, special cells, and molecules is on constant alert to protect us from dangerous infection and disease and keep us healthy. It responds to antigens, or foreign bodies, in a highly coordinated process that employs several types of cells to circulate around the body, scanning for cellular abnormalities and infections.

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              #7 Leadless Cardiac Pacemaker

              The adult heart usually beats between 60 and 100 times a minute at rest, but if a person has bradycardia, a slower than normal heart rate, it indicates a problem with the heart’s electrical system. 

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                #8 New Medications for Idiopathic Pulmonary Fibrosis

                The lungs are remarkable organs made of spongy tissue that supply oxygen, the life-sustaining gas needed by the body. As the only internal organs that are exposed to the external environment, they are vulnerable to a variety of ailments. Some, like asthma, bronchitis, or even certain cancers, can be cured. However, when it comes to idiopathic pulmonary fibrosis, or IPF, eventual death is a certainty unless the lungs are replaced.

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                  #9 Intraoperative Radiation Therapy for Breast Cancer

                  The American Cancer Society estimates that this year about 233,000 new cases of invasive breast cancer will occur among women in the United States. In addition, approximately 63,000 new cases of noninvasive breast cancer—the earliest form—will occur among women in 2014. It’s also projected that 40,000 women will die from breast cancer this year. 

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                    #10 Angiotensin-Receptor Neprilysin Inhibitor for Heart Failure

                    Heart failure is caused by a weakening of the heart’s ability to pump blood. Between 500,000 and 900,000 new cases of heart failure are diagnosed each year in the United States. This debilitating ailment is now the most common diagnosis in Medicare patients and accounts for 55,000 deaths annually. 

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                    Diabetes: 'smart insulin patch' could revolutionize glucose control July 16, 2015 17:38

                    Patients with diabetes have to control their blood sugar by regularly pricking their finger and giving themselves insulin shots. The procedure is painful and imprecise - injecting the wrong amount of insulin can lead to serious complications, and in some cases, coma and death.
                    smart insulin patch
                    The researchers aim to develop a smart insulin patch that would only need to be changed every few days. Image credit: Zhen Gu

                     

                    Now, the development of a "smart insulin patch" could one day make such an ordeal a thing of the past for the millions of Americans who suffer from diabetes, according to the team behind the innovation, which includes members from the University of North Carolina (UNC) in Chapel Hill and NC State in Raleigh.

                    The smart patch - a square sliver of tape no larger than a penny - has more than a hundred microneedles, each about the size of an eyelash, containing tiny reservoirs of insulin and glucose-sensing enzymes.

                    The device - which can be placed anywhere on the body - senses when blood sugar levels get too high and rapidly discharges the right amount of insulin into the bloodstream.

                    In the Proceedings of the National Academy of Sciences, the diabetes doctors and biomedical engineers that invented the painless patch describe how they tested it in a mouse model of type 1 diabetes and showed it lowered blood glucose for several hours.

                    While it shows great promise, it is too early to say if and when the patch can be used in human patients - the team says more tests and then clinical trials are needed.

                    Patch mimics body's own system for generating insulin

                    The smart insulin patch works by mimicking the body's own system for generating insulin - the beta cells of the pancreas - which produce and store insulin in tiny sacs or vesicles. They also sense changes in blood sugar and signal insulin to be released from the vesicles as needed.

                    The team constructed artificial vesicles that perform in a similar way out of two natural materials - hyaluronic acid (HA) used in cosmetics and 2-nitroimidazole (NI), an organic compound used in diagnostics.

                    Together, the two compounds form a molecule that is water-loving at one end (the HA part) and water-repellent at the other (the NI part). Groups of the molecule self-assemble into vesicles - rather like oil droplets do in water - with the water repellent ends on the inside and the water-loving ends on the outside.

                    The researchers found they could insert a core of solid insulin and enzymes designed to detect glucose into the artificial vesicles, which in large numbers formed millions of bubble-like nanostructures, each 100 times smaller than the thickness of human hair.

                    When they tested the intelligent insulin nanoparticles in the lab, the team found they responded to raised blood sugar. The excess glucose molecules entered the artificial vesicles, using up oxygen as the enzymes on board converted them into gluconic acid. This reduction in oxygen or "hypoxia" makes the water-repellent NI end of the molecules that make up the vesicles become water-loving, and the vesicles dissolve and release insulin into the bloodstream.

                    Patch kept blood sugar normal in diabetic mice for hours

                    The next step for the researchers was to find a way to administer the artificial vesicles to diabetes patients. This is when they turned to the idea of tiny microneedles incorporated into a patch, rather than rely on the large needles or catheters of the "closed-loop systems" of other approaches to glucose-sensitive insulin delivery.

                    They eventually produced a silicon strip with over a hundred microneedles that pierce the skin and tap into the blood flowing in the underlying capillaries. Each microneedle contains a reservoir of the artificial vesicles.

                    The team tested the invention in a mouse model of type 1 diabetes. They gave one group of mice a standard insulin injection - the levels dropped to normal but then quickly rose to hyperglycemic levels.

                    But when they treated another group of diabetic mice with the patch, their blood sugar levels normalized within half an hour and stayed that way for several hours.

                    The researchers also found that by varying the dose of enzyme, they could fine-tune the patch to alter glucose levels within certain ranges.

                    A 'game changer' for diabetes patients

                    Mice are less sensitive to insulin than humans, so the researchers believe that the patches could last even longer in human patients. The researchers aim to develop a smart insulin patch that would only need to be changed every few days.

                    Such a prospect would be a "game changer" for diabetes patients, explains co-senior author John Buse, a professor of medicine and past president of the American Diabetes Association:

                    "The hard part of diabetes care is not the insulin shots, or the blood sugar checks, or the diet but the fact that you have to do them all several times a day every day for the rest of your life."

                    Co-senior author Zhen Gu, a professor in biomedical engineering, says:

                    "We have designed a patch for diabetes that works fast, is easy to use, and is made from nontoxic, biocompatible materials. The whole system can be personalized to account for a diabetic's weight and sensitivity to insulin, so we could make the smart patch even smarter."

                    There are more than 387 million people with diabetes worldwide, and the number is predicted to rise to 592 million by 2035.

                    Funds from the NC TraCS Institute and the American Diabetes Association helped finance the research.

                    Meanwhile, MNT recently learned how a new screening tool identified a drug that could target an underlying cellular cause of type 2 diabetes that leads to insulin resistance.

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                    What is a “smart” syringe? By 2020, you’ll be getting all your shots with one April 27, 2015 16:30

                    Since the Talk

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                    In the small village of Roka in western Cambodia, 272 people have tested positive for HIV since the end of 2014. Among those diagnosed: an 82-year-old celibate Buddhist monk, several babies and 19 members of the same family. This tragic outbreak has been traced to a source: Yem Chrin, a popular medical practitioner who operated []


                    mPowering the Apple ResearchKit: How Max Little put a Parkinson’s app on the iPhone April 27, 2015 16:26

                    Fellows Friday

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                    This week, Apple turned the iPhone into a medical research tool with the launch of ResearchKit. This open-source framework, described in the video above, lets a medical researcher set up a project to gather anonymous patient data on diseases like asthma, breast cancer and diabetes. Using their own smartphones, patients who join a project can []


                    How genetic engineering can fight disease, reduce insecticide use and enhance food security: Pamela Ronald speaks at TED2015 April 27, 2015 16:22

                    Live from TED

                    on

                    Pamela Ronald is here to talk about her work as a plant geneticist, about her work “studying genes that make plants resistant to disease and tolerant of stress.” But first, she’d like to introduce us to her husband. “This is Raoul. He’s an organic farmer,” she says. “People say, ‘Really? An organic farmer and a plant geneticist? []