Snapshots

131st Congress of the German Society of Surgery (DGCH)

Berlin. A new examination technique that measures brain activity with light rays and converts them into images could make tumor brain surgery even safer. The so-called “intraoperative optical imaging” (IOI) shows for the first time sensible areas to be protected during an operation where important functions such as feeling, movement, vision or language are located. Initial experiences with the IOI in tumor surgery were presented at the 131st Congress of the German Society of Surgery (DGCH) that took place in Berlin from 25 to 28 March 2014.

It is the aim of brain cancer surgery to completely remove the tumor, ideally together with a small part of the adjacent healthy tissue in order to collect possible cell nests that may also have settled there. However healthy tissue should be spared if it is responsible for important functions such as emotion, speech, movement or vision.

Brain tumor tissue can currently be rendered visible with dyes, magnetic resonance imaging, computer tomography or ultrasound. “Unfortunately we cannot see what functions healthy tissue is responsible for”, said Professor Dr. Gabriele Schackert, Director of the Department of Neurosurgery at the University Hospital Carl Gustav Carus Dresden. “This knowledge is important in order to operate even more precisely”. The light technology IOI should help with this. Although the brain does not light up when we use it, each brain activity is accompanied by an increase in blood flow. This in turn changes the light absorption when the surface of the brain is irradiated with a lamp, i.e., an increased brain activity increases the absorption and IOI has made use of this phenomenon.

In order to be able to make important areas of the brain visible using this technique, the research team of Gabriele Schackert and Stephan Sobottka initially stimulated a nerve on the body surface of the anesthetized patient. “In our study, we administered gentle electrical stimulus to the median nerve which runs along the inside of the forearm and is responsible for the sense of feeling in the hand”, said Schackert. A reflex response of the N. medianus delivers the impulse to a higher-level center in the brain that is responsible for feeling. This in turn results in an increased perfusion of blood in this area of the brain.

A camera, integrated in the surgical microscope, films the light-irradiated surface of the brain during this process. The camera is fitted with a filter, only allowing light wavelengths to pass through at which the blood exhibits a strong absorption. A computer converts this information into images and within 10–15 min a two-dimensional map is produced in which the activated brain region is visible.

“The pictures are accurate and reliable”, explains Professor Schackert, after IOI was tested on 41 patients. “Using this we can identify important brain functions in almost real time”. Prior to this the Dresden researchers succeeded in localizing the center responsible for vision by shining light in the patients’ eyes to irritate the optic nerve.

The neurosurgeon is aware that patients with brain tumors are anxious that they might suffer losses in speech, movement or vision. “In order to preserve the patient’s quality of life, it is therefore very important to operate as sparingly as possible”, she says. If the IOI proves itself in clinical practice, it will be an important development for the safety of patients.

“Maintaining functional integrity is one of the basic aims of surgery”, explains Professor Dr. Joachim Jähne, President of DGCH. Improved imaging techniques in neurosurgery could have a pacemaker function for other surgical disciplines. New developments in intraoperative imaging, including the IOI method, were the subject of a session on the DGCH Congress on 26 March 2014 (source: DGCH).

For more information please visit:

http://www.egms.de/static/en/meetings/dgch2014/14dgch232.shtml

(26.05.2014)

Original publications:

• Sobottka SB, Meyer T, Kirsch M, Koch E, Steinmeier R, Morgenstern U, Schackert G. Intraoperative optical imaging of intrinsic signals: a reliable method for visualizing stimulated functional brain areas during surgery. J Neurosurg 2013;119(4):853–63.

• Sobottka SB, Meyer T, Kirsch M, Reiss G, Koch E, Morgenstern U, Schackert G. Assessment of visual function during brain surgery near the visual cortex by intraoperative optical imaging. Biomed Tech (Berl) 2013;58(3):249–56.

SPIE Photonics West: Winners of the 2014 Prism Awards for Photonics Innovation

San Francisco, February 2014. Sponsored by SPIE, the International Society for Optics and Photonics, and Photonics Media, the annual Prism Awards recognize photonic products that break with conventional ideas, solve problems, and improve life through the application of light-based technologies. This year’s award ceremony was attended by 340 industry executives, analysts, technologists, and investors from around the world.

The winners included innovative new tools that improve the accuracy of medical devices, expand the capabilities of three-dimensional (3D) printing and manufacturing systems, improve the ability to detect hazardous substances, and enable the next generation of 3D video projection. They were selected for nine categories representing large and small companies from five countries:

• Category of Advanced Manufacturing

• Category of Defense and Security

• Category of Detectors, Sensing, Imaging, and Cameras

• Category of Industrial Lasers

• Category of Life Sciences and Biophotonics

• Category of Optics and Optical Components

• Category of other Light Sources

• Category of Scientific Lasers

• Category of Test, Measurement, Metrology.

Results were determined by a panel of expert judges, and announced by presenters from leading companies across the photonics industry.

In the Category of Life Sciences and Biophotonics, AccuVein Inc. was awarded for its AV400 Vein Illuminator – a handheld, augmented-reality, laser camera that detects and projects a vein map on a patient’s skin. It uses hemoglobin’s IR absorption and an arrangement of scanned lasers to detect and re-project a vein map directly onto a patient’s skin. AV400’s technology allows the vein illumination device to be lightweight (<10 ounces, 283.5 g), non-contact, accurate, permanently aligned, and movement tolerant (source: SPIE & Photonics Media).

More information can be found at:

http://www.photonicsprismaward.com/winners.aspx

(28.05.2014)

Laser cuts bone: AOT AG wins Pioneer Award 2014

Zurich, April 2014. The start-up AOT AG has won the Pioneer Award 2014 sponsored by Technopark^® Zurich and the Zurich Cantonal Bank. The prize was awarded this year for the 24th time and recognizes technological innovations that are, thanks to pioneering entrepreneurial achievement, on the brink of market entry.

AOT develops medical devices and tools for operations in which one or more bones are deliberately cut to correct misalignments, for example, in the skull and facial area. The first product developed by AOT is a computer-assisted laser osteotome, operated by robots, called CARLO (= computer-assisted, robot-guided laser osteotome).

This innovative medical device cuts bone without contact during complex operative procedures on the head or in other complex operations. CARLO enables new sectional geometries, is extremely precise, promotes rapid healing and raises the level of safety.

The market entry is planned for no later than early 2016. A further study is planned for this summer to verify the increased precision and a number of new safety systems. The final clinical trials are planned for 2015. Priority target markets will be public hospitals and private clinics.

AOT was founded as a spin-off of the High-tech Research Center of the University of Basel in 2011 by two oral and maxillo-facial surgeons, Prof. Dr. Dr. Hans-Florian Zeilhofer and PD Dr. Philipp Jürgens, the software and robotics engineer, Prof. Dr. Philippe Cattin, and the laser physicist, Dr. Alfredo Bruno. In the meantime, AOT in Basel has nine employees and as of March this year, the company is a certified manufacturer of medical devices according to DIN 13485:2012 (source: Pioneer Award – Technopark^® Zurich, Zurich Cantonal Bank).

Detailed information about the Pioneer Award can be found at:

http://www.pionierpreis.ch/index.cfm?&content=home

(28.05.2014)

Keck Foundation award for biomedical imaging

The W. M. Keck Foundation’s Medical Research Program has presented a grant for $1 million to Angelique Louie, a Professor and Vice Chair of the Department of Biomedical Engineering at University of California, Davis (UC Davis). The grant will help fund her project “In vivo 3D imaging using bioluminescent gene reporters and MRI”, which she is undertaking in collaboration with Yohei Yokobayashi, an associate professor also in the Department of Biomedical Engineering; and Jared Shaw, an associate professor in the Department of Chemistry.

“The project proposes novel technology that will facilitate the detection of gene expression in deep, opaque tissues”, Louie explained. “With such technology, we’ll be able to apply the power of noninvasive imaging to a myriad of new biomedical applications.”

Louie earned an undergraduate degree in Electrical Engineering at UC Davis, and then developed an affinity for biomedical applications while studying fiber optics during her Master’s degree work at University of California, Los Angeles. She obtained a doctorate in 1994 at UC Irvine’s Beckman Laser Institute, where she concentrated on the biomedical side of optical imaging with lasers. Post-doctorate studies took place at California Institute of Technology (Caltech), where she worked in imaging and the development of enzymes inhibitors; this led to a project involving the creation of contrast agents for imaging. Louie then investigated her academic options and quickly became intrigued by the new, up-and-coming imaging department at UC Davis. She joined the College of Engineering’s Department of Biomedical Engineering in 2002, which has proven to be an excellent fit.

She has continued her work with imaging techniques and the design of probes to characterize molecular phenomena in diseased and normal states, with the goal of helping clinicians better understand what causes – and how to prevent – cardiovascular disease, retinal degeneration and tumor formation. She is particularly interested in the monitoring of heart disease, in order to detect vulnerable arterial plaques at risk for rupture before they can cause a heart attack or stroke.

The Keck Foundation grant is part of the university’s first comprehensive fundraising campaign – The Campaign for UC Davis – which has raised $1.071 billion from 106,184 donors (source: American Association for the Advancement of Science).

The full press release can be found at:

http://www.eurekalert.org/pub_releases/2014-03/uoc--kfa030714.php

(28.05.2014)

Sonnenfeld Foundation for the promotion of medical research in Berlin – New deadline in 2014

The purpose of the foundation is to promote research and the application of modern diagnostic and treatment methods used in human medicine. Within this framework, it can, for example, support the development of modern medical equipment with funds, procure equipment and provide appropriate facilities.

In detail this signifies:

• Funding of research projects, for example, providing materials or equipment, thereby acknowledging that the study of modern diagnostic and treatment methods is only possible with the help of specific basic research.

• Granting scholarships for students studying for a doctorate in a medicine-related subject.

Funding is only available for projects and doctorate studies in the Berlin area.

New funding requests should be submitted in writing only, in sevenfold copy (applications by email or fax will not be accepted) until the 2nd October 2014 (date of receipt). Applications arriving after October 2, 2014 will not be processed!

Detailed information can be found at:

http://www.sonnenfeld-stiftung.de/

(28.05.2014)

NPI commends Fast-Track Action Committee on Optics and Photonics’ recommendations

Washington, April 2014. The National Photonics Initiative (NPI), a collaborative alliance seeking to raise awareness of photonics and drive US funding and investment in key photonics-driven fields, applauded a report prepared by the Fast-Track Action Committee on Optics and Photonics (FTAC-OP) for the Committee on Science of National Science and Technology Council that outlined opportunities for federal investment and interagency cooperation in basic and early applied research in optics and photonics.

The report, “Building a Brighter Future with Optics and Photonics”, includes recommendations in two categories, research opportunities and capability opportunities, and provides therefore critical framework for federal investment in optics and photonics.

Among the recommendations made by the FTAC-OP is the need for accessible fabrication facilities, a concept strongly supported by the NPI (source: The National Photonics Initiative).

The full report can be found at:

http://www.whitehouse.gov/sites/default/files/microsites/ostp/NSTC/ftac-op_pssc_20140417.pdf

(28.05.2014)

A 3.4 km long X-ray laser

Smaller, faster, more intense: The European XFEL is a research facility currently under construction in the Hamburg area, Germany. From 2017 on, it will generate extremely intense X-ray flashes to be used by researchers from all over the world.

The European XFEL will open up areas of research that were previously inaccessible. Using the X-ray flashes of the European XFEL, scientists will be able to map the atomic details of viruses, decipher the molecular composition of cells, take 3D images of the nanoworld, film chemical reactions and study processes such as those occurring deep inside planets.

To generate the X-ray flashes, bunches of electrons will first be accelerated to high energies and then directed through special arrangements of magnets (undulators). In the process, the particles will emit radiation that is increasingly amplified until an extremely short and intense X-ray flash is finally created.

The European XFEL will generate X-ray radiation with properties similar to those of laser light. There will be several light sources with different characteristics. Many international research groups will be continually coming and going, staying for a couple of days or a few weeks and making use of sophisticated scientific instruments to conduct their experiments.

At present, Denmark, France, Germany, Greece, Hungary, Italy, Poland, Russia, Slovakia, Spain, Sweden, and Switzerland are participating in the construction and operation of the European XFEL.

The construction costs of the facility which include the commissioning amount to more than one billion euros. As the host country, Germany (the Federal Government, Hamburg and Schleswig-Holstein) covers 54% of these costs. Russia bears 23% and the other international partners between 1 and 3.5%. To a great extent, the European XFEL facility will be realized by means of in-kind contributions by shareholders and partners (source: European XFEL GmbH).

Further information and latest news can be found at:

http://www.xfel.eu

(26.05.2014)

Biosafety

Modified viruses from research laboratories that allow transfer of bird flu to mammals by air, prompted a renewed debate last year on biosafety. The main focus of the debate is how the misuse of research results by bioterrorists can be avoided. Experiments on the mutability of pathogens are essential as a preparatory measure for new waves of infection which are often caused by natural changes in viruses and bacteria, and increase their hazard potential. However, the know-how necessary to make pathogens dangerous for humans could be also abused to produce biological weapons. In addition to infection biology, research and technical developments in the life sciences can also carry the potential for abuse if they bear the potential to impair the health of humans, livestock and crops.

Biohazard sign (© George Hodan @ PublicDomainPictures.net).

How should we deal with research that contributes to medical progress or other socially important goals, but at the same time could be misused by bio-terrorists:

• Are voluntary codes of conduct sufficient to raise awareness about the risk potential and the measures to keep them at a minimum in researchers, financial bodies promoting research and those publishing research findings?

• Under what circumstances could the abuse potential justify a decision not to carry out research or not to publish, and who should make such decisions?

• What concrete mechanisms are available to minimize the risks of abuse, and how can they be implemented? Are they appropriate and adequate, and what improvements can be made?

Against this background the German Federal Government has commissioned the German Ethics Council to draw up a statement on the subject “Bio-security and freedom of research – Research funding and handling of research results” (source: German Ethics Council).

The statement can be accessed (in German) at:

http://www.ethikrat.org/dateien/pdf/stellungnahme-biosicherheit.pdf

(04.06.2014)

The trigger for the debate were “controversial” studies from 2011 from two research groups, including the group of Ron Fouchier from the Erasmus Medical Center in Rotterdam and the group of Yoshihiro Kawaoka from the University of Wisconsin-Madison, where the H5N1 virus was manipulated, making it more transmissible.

More information about this topic can be found at:

http://www.hhs.gov/asl/testify/2012/04/t20120426a.html

(26.05.2014)

Germany: Private health insurance companies must pay alternative cancer treatment

Private health insurance companies must pay the costs for alternative cancer treatment methods if there are grounds to believe that they could slow down the progression of the disease or relieve discomfort. This is a decision that was passed by the Federal Supreme Court (Bundesgerichtshof, BGH) on 30.10.2013 (Case No. IV ZR 307/12). This ruling also applies to other life-threatening diseases and is applicable even when the chances of success are <50%.

A patient with advanced prostate cancer lodged an appeal against his insurance company. His health insurance refused to pay the cost of immunotherapy using dendritic cells (“Kieler vaccine”). As yet, this method of treatment has neither been accepted nor fully investigated by mainstream medicine.

However, according to the BGH, the insurance must pay. The judges ruled that in the case of incurable, life-threatening diseases, the question should not be posed as to whether a treatment will be successful. Any therapy that could result in a minimum level of success is objectively justifiable, given that it is based on a scientifically sound approach. This ruling makes the private health insurance liable for payment of the treatment.

Alternative methods that offer the prospect of cure should also be given preference over conventional medical therapies that only have a palliative effect (source: Medical legal consultancy network).

More information can be found at:

http://www.medizinrechts-beratungsnetz.de/mitgliederbereich/newsletter/#2

(26.05.2014)