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World Leader
• UK hospital ship RFA Argus
• French news blackout for
delivers medics, vehicles & more
artificial hearts
• France will help build more
• MRI has potential for
treatment centres in Guinea
See Page 7
New biospleen blood cleansing excites experts Molecular diagnostics for infectious diseases takes a forward leap netic beads through the channels A new extracorporeal nanotech
to cleanse the blood, which is then device addresses the root cause
returned to the patient. of sepsis by removing pathogens
Dr Super and his colleagues and endotoxins simultaneously
tested the device on anaesthetised from blood even before their
laboratory rats infected with blood- identification – this genetically
stream infections that human sepsis engineered mannose-binding lec-
patients experience. Approximately tin protein can also latch on to
90% of live S.aureus and E. coli pathogens were removed within 60 the Ebola virus.
minutes. Rats were challenged with lethal doses of endotoxin and 90% Report: Cynthia E Keen
of the biospleen-treated rats sur-vived, while only 14% of the control Sepsis is on the rise worldwide, in all
likelihood exceeding the 2003-2013 Tests of human blood in vitro estimates of 18 million cases. 30-50% removed more than ninety per- of patients die, whether treated in a Harvar
cent of key sepsis pathogens when high-tech intensive care unit (ICU) the blood flowed through a single or a resource-constrained hospi- Image demonstrates the effectiveness of the genetically engineered protein-coated magnetic beads binding to pathogens. Here, the
device at a rate of half to one litre tal ward. In developing countries, magnetic beads (128 nm) are bound to two pathogens (E. coli on the left and S. aureus on the right)
sepsis causes 60-80% of all deaths Dr Super advised that many (source: Global Sepsis Alliance). It as much as 9% for every hour dialysis, that can rapidly remove ing sugars for 500 million years. devices could be linked together also kills around six million infants before a correct antibiotic therapy is microorganisms and endotoxins It's a very robust pathogen capture to obtain levels required for human and young children and 100,000 administered – the device offers the from the blood without the need mechanism,' he explained. new mothers annually.
potential to rapidly treat systemic to first identify the source of the Because other immune system Continued on page 2
No specific anti-sepsis drugs blood infections and prevent sepsis infection and without altering blood proteins can bind to the MBL tail are commercially available. Thus progression.
contents – and it has exceeded our and activate clotting and organ dam- the presentation from Harvard ‘The biospleen device addresses expectations, by being able to filter age, Dr Super used genetic engi- University's Wyss Institute for the root cause of sepsis by removing these out in a matter of hours.' neering tools to remove the tail Biologically Inspired Engineering pathogens and endotoxins simul- and graft on a similar one from in Boston of a dialysis-like blood taneously,' principal investigator Magnetic micro-bead magic
an antibody protein that does not cleansing biospleen device that Michael Super PhD, Senior Staff The biospleen unit uses magnetic cause these problems. This geneti-can filter live and dead pathogens Scientist, told European Hospital. nanobeads coated with a geneti- cally engineered ‘secret sauce' pro- from human blood, generated tre- ‘Blood pathogen load is known cally engineered human opsonin – tein binds the pattern of sugar on mendous excitement at the 6th to be a major contributor to both mannose-binding lectin (MBL) that the surface of the pathogens – more Annual Molecular Diagnostics for disease severity and mortality in binds to a wide variety of patho- than 100 different species, but does NEWS & MANAGEMENT Infectious Disease conference held patients with sepsis. Many patients gens. In its innate state, MBL has a not bind to mammalian host cells. in Washington, D.C. in late August*. respond to appropriately targeted branch-like ‘head' and a stick-like Dr Super described how the engi- ULTRASOUND Inspired by the spleen, the extra- antibiotic therapies that work exclu- ‘tail'. In the body, the head binds to neered MBL ‘secret sauce' protein RADIOLOGY 9-14 corporeal blood-cleansing device is sively by lowering the number of specific sugars on the surfaces of is attached to magnetic beads 128 CARDIOLOGY 15-16 revolutionary in its ability to con- live pathogens, but antibiotic ther- all types of bacteria, fungi, viruses, nanometers in diameter. The beads tinuously remove pathogens and apy does not treat endotoxins in a protozoa and toxins. The tail cues are added to blood removed from SURGERY 17toxins from blood without first iden- patient's blood. Therefore, we set the immune system to destroy them. the patient and bind to the patho- LABORATORY 18-20 tifying the infectious agent. Time is out to develop an extracorporeal ‘The protein is part of the innate gen. Magnets in the biospleen device INFECTION CONTROL 21-23 vital – sepsis mortality rates increase blood-cleansing therapy, similar to immune system that has been bind- pull the now pathogen-coated mag-



The potential of cardiovascular magnetic resonance imaging Cardiomyopathy – the chameleon disease private
MRI benefits and potential should be communicated better suffer this condition, and contin- Jeanette Esther Schulz-Menger
ue training, might experience life- and to a wider clinical audience to be used more frequently has chaired cardiovascular magnetic threatening arrhythmias, which may resonance imaging at the Experimental lead to sudden cardiac death.
and Clinical Research Centre (ECRC) in Cardiomyopathy is a disease with image of the heart, which allows
Moreover, cardiac MRI is increas- Professor Schulz-Menger is par- Berlin since 2008. The Max Delbrück many faces, a ‘chameleon', according us to evaluate the actual pumping ingly used to examine the hearts ticularly pleased that other disci- Centre (MDC) and Charité jointly operate to Professor Jeanette Schulz-Menger. performance.' of professional athletes, although plines have begun to recognise the the centre. The professor's research As Head of the working group In dilated cardiomyopathy – the this particular area has not yet value of this: ‘Cardiac MRI is used focus is on the evaluation of myocardial Cardiac MRI at Charité, Campus pathological enlargement of the been acknowledged in the relevant for risk stratification purposes in damage with cardiac MRI. A driving force Buch and head of Non-invasive heart muscle – MRI is used to guidelines. Here, the task of cardiac non-cardiac diseases.' In certain lung behind the implementation of a 7T MRI Cardiac Imaging at Helios-Klinikum identify the cause of the condition, MRI is to show whether a heart is diseases such as sarcoidosis MRI scanner at MDC, she also sets great store Buch, Berlin, she uses cardiac MRI such as perfusion problems, inflam- enlarged due to intensive activity or can contribute to a more complete by translating MRI research results into to understand the disease better. mations or scar tissue. ‘Scar tissue due to a hypertrophic cardiomyo- picture of the patient status. ‘Many clinical practice.
‘Cardiac MRI plays different roles in is easily visualised with contrast- young sarcoidosis patients die of the diagnosis of the different forms enhanced techniques,' she said. This While echocardiography can sudden cardiac death due to con- of cardiomyopathy,' the professor is of utmost importance because visualise a thickened heart mus- duction disorders,' she explained. cardiac involvement in 40 percent explained during our EH interview. patients with scar tissue on the cle, unlike MRI it cannot unam- Conventional diagnostic methods, of patients. Cardiac MRI could iden- The ‘crucial feature' of this imag- myocardium are at a higher risk of biguously identify cardiomyopathy. however, detect only eight per- tify these patients – ‘and,' Professor ing modality is its ability ‘to differen- sudden cardiac death or on-going Furthermore MRI can identify heart cent of cardiac involvement, while Schulz-Menger said, ‘that's great'. tiate possible myocardial damages' weakening of the heart muscle. muscle inflammation. Athletes who pathological studies have shown She would like to see MRI used in all forms of this cardiac disease, more frequently and in a more tar- she pointed out, even when the MR image of myocarditis with fibrotic changes (white signal)
MR image of hypertrophic cardiomyopathy
geted fashion, but that would need pump function of the heart is intact. its benefits and the potential to be Even if echocardiography, for exam- communicated better to a wider ple, recorded normal cardiac per- clinical audience. Close relatives of formance in a patient, cardiac MRI patients with hypertrophic cardio- can detect scar tissues and inflam- myopathy also need to undergo an MRI scan because there could be a Cardiac MRI is the modality of familial predisposition for the dis- choice to record right ventricular ease. ‘If I am serious about diagnos- pump function, because echocar- tics, each relative has to have a car- diography cannot handle the com- diac MRI,' the professor pointed out, plex anatomy of the right heart. particularly since echocardiography ‘The right ventricle is shaped like a is known for its poor detection of backpack –it simply does not fit in early signs of a hypertrophic car- any geometrical assumption,' Prof. diomyopathy. Additionally, a cardiac Schulz-Menger explained. While MRI scan is indicated when contra- echocardiography tries to cut the dicting findings are reported, for right ventricle into many sections to example when an ECG yields differ- be able to calculate pump function, ent data than the echocardiography.
she added, ‘MRI can generate a 3-D Spain's Institute for Cardiovascular Research Stepping towards CD disease prevention physical activity, among others. funding for biomedical research. ogies for molecular-resolution 11,255 subjects, 6,028 men/5,227 Report: Dr Eduardo de la Sota
Led by Dr Valentín Fuster, The CNIC research is grouped into imaging that can identify and women. Dr Hermida concludes that Cardiovascular disease develops in a Spanish Institute for Cardiovascular three departments:
characterise vulnerable plaques. mean SBP, but not daytime clini- slow and subclinical manner over Research (CNIC) was founded • Vascular biology and inflam- Combined with epidemiologic cally measured BP, is a significant decades, only to manifest sudden- because – despite enormous advanc- mation (VBI). Here the com- analyses, this approach pro- and independent prognostic marker ly and unexpectedly. Prevention is es in diagnosis and treatment over plex interactions between vides invaluable information of cardiovascular disease morbidity crucial, both before and after clini- the last 20 years – cardiovascular the components of on underlying molecular and mortality. These findings indi- cal appearance, and evidence is diseases remain the major cause of circulating blood mechanisms of dis- cate ABPM (Asleep Blood Pressure ample of the effectiveness of early death in the developed world. The and the vascular ease, leading to Measurement) is a clinical necessity detection of at-risk individuals and costs generated in economic, social tools for accurate to accurately detect abnormal sleep- lifestyle modifications or pharmaco- and human terms are also immense. diagnosis and time BP and assess cardiovascular logical approaches. In response, the Spanish targeted drug disease risk.
However, those approaches Government, through the Carlos III In the second study, Dr M J Sanz require time, perseverance, and con- Institute of Health, created the CNIC from the University of Valencia), pre- tinuous development. Special focus to amalgamate the best Spanish 19th World sented a study to address effective must be made in e.g. diet, weight cardiovascular research and provide strategies to treat and prevent ath- control (obesity is a disease) and a modern infrastructure and ample erosclerosis, using combined con- Disease in centrations of Rosuvastatin (Rosu) Boston, MA, and bexarotene (Bex) on angio- topics ranged tensin II (Ang-II)-induced arterial Medical Lighting System
from clinical mononuclear cell (MC) recruitment. and disease.
Research data suggest that com- • Cardiovascular to evaluation and bined administration of Rosu+Bex development and stratification techniques at suboptimal doses may constitute repair (CDR). Researchers and molecular and cellular an alternative therapy to control are investigating cell-cell inter- biology, including neurohumoral, vascular inflammation, minimising MEDICA - DÜSSELDORF actions and signalling pathways immunological and genetic studies. the appearance of drug-associated 12- 15 Nov 2014Hall 10 Stand E 31 operating during heart morpho- The most relevant studies presented adverse effects.
genesis and vascular develop- approached cardiovascular disease Thus, CD prevention is advanc- STARLED3 NX
ment, the origin and mainte- prevention and prognostic algo- ing slowly, but showing clear evi- nance of the pluripotent state, rithms. These included two interest- dence that physical and mental SURGICAL LED LAMP FOR UNIVERSAL APPLICATIONS
and the metabolic regulation ing Spanish studies.
hygiene, medical controls, educa- Rechargeable battery powered system on demand and repair of the adult cardio- In the first, according to Dr R C tion and healthcare information will vascular system.
Hermida from the University of minimise mortality and morbidity Bologna – ITALY • Atherothrombosis, imaging and Vigo, sleep blood pressure (SBP) is of cardiovascular diseases, which ph +39 051 721844 info@acem.it - www.acem.it epidemiology. This department an independent predictor of cardio- cause much suffering, mortality and develops non-invasive technol- vascular events. That study involved EUROPEAN HOSPITAL Vol 23 Issue 5/14
2nd artificial heart implanted in France Firm imposes press embargo over new transplants Another patient in the final stages of heart failure has received an artificial heart at Nantes University
Hospital Centre, according to Carmat, the manufacturer of the device. John Brosky reports

Carmat announced, in a press release, ing implantations after the media for the implantation procedure at
its active recruitment of two more circus that followed the news of the CHU-Nantes.
patients to complete its first-in-
first implantation and the subse- The first patient, Claude Dany, human clinical trial of the artificial quent death of the patient 74 days 76, lived 74 days, which, noted lead heart against a primary endpoint later. The company's stock price surgeon Christian Latremouille MD, of 30-day survival with secondary jumped on the first news and then from the Hôpital Georges-Pompidou criteria for assessing the impact of fell dramatically with the death of in Paris, widely exceeded the end the reinvigorated blood supply from the patient and statements by the point for the safety study.
the mechanical heart on internal inventor of the mechanical heart, After a four-month review of the organs. ‘We warmly thank, particu- renowned cardiac surgeon Alain device and the causes of death of larly today, the experienced team Carpentier MD, that the device had the first patient, French authorities at CHU-Nantes,' stated Carmat CEO stopped abruptly.
approved the continuation of the Marcello Conviti. ‘Passing this step One of the surgeons who par- clinical trial for safety and feasibility. was made possible thanks to their ticipated in the implantation pro- In its press release, Carmat reported confidence as well as that of our cedure, Daniel Duveau MD, said that two independent control com- participants, partners and investors.' that the heart did not stop brutally. mittees monitoring the trial had met The company was forced to issue ‘During two hours, each time the on 4 September 2014 and issued a Carmat's artificial heart
stant blood supply.
the press release after the newspa- device stopped, the system did eve- report approving a continuation of Carmat repeated in its press per Liberation reported a second rything it could to restart the pump. the trial for the final two patients.
to supply power and the second to release that, in conformance with Despite a possible dysfunction, the The Carmat artificial heart is the monitor device performance. good clinical practices, there would Although the news leak was system intelligently demonstrated its first device to completely replace It is also the first artificial heart be no reporting of results of any reported by all French media, none capabilities,' he said, comparing the a human heart and is fully con- capable of adapting the blood sup- of the implantations until the end could report any further detail about action to that of a doctor performing tained within the thorax requiring ply according to a patient's activity, of this safety and feasibility trial, the patient's condition. The compa- a cardiac massage.
no external pumps. Only two wires varying from three to nine litres per unless required by ‘particular cir- ny imposed a news blackout regard- Dr Duveau was the lead surgeon exit the body at the abdomen, one minute, rather than having a con- Low energy, cold light, long life A surgical led lamp illuminates countless conditions The lamp is ergonomic, easy to the I-Sense control panel – cov-move and to position and suitable ering light intensity, DoF (depth The Starled3 NX suits many applica-
The model has three reflectors for the laminar flows of the operat- of field), Size (light spot diameter tions in the operating theatre and producing a blended and intense ing theatre.' adjustment), Sync (optional - to diagnoses in, for example, gynae- cone of light, focused through The Endo function (light for synchronise controls of the Acem cology, dermatology and general automatic adjustment of the light endoscopy) also enables the lamp's Medical Company's combined lamps spot diameter, the firm points out. valuable use during Minimally when also used for exams or proce-‘The slim, practical, compact design invasive surgery. Other functions duresC). makes it perfect for several uses. include touch-screen adjusted via Details: www.acem.it ‘The lamp grants a homogeneous and shadow-less light thanks to its special LED optics created by ACEM Medical Company, which directs light beams at best according to the needs,' the Italian manu- facturer reports. ‘The vis- ual area is perfectly illu- minated assuring both excellent visual comfort and working condi- tions. Its next genera-tion LEDs produce an unparalleled quality of light with a colour tem- perature (CCT) of 4.500 °K and a colour render- ing index (CRI) of 95.' Light intensity is 130.000 lux with low energy consumption of 69W, and the life cycle of their LEDs is around an impressive 50,000 hours.

Source: http://acem.it/upload/doc-articoli/europ%20hospital10-11-14.pdf

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Resident & Student Association rESidENt PrESidENt'S MESSagE 2012 Brings New Projects for aaEM/rSa Teresa M. Ross, MDAAEM/RSA President JM is a 35yo female with a history of recurrent calcium chloride, etomidate, fentanyl, furosemide, ketorolac, migraines. labetalol, ondansetron, phenytoin, prochlorperazine and rabies immunoglobulin.6 The majority of the medications are for iv use,

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The ownership of U.S. industrial forestlands has dramatically changed since the 1980s. Whereas forest product companies had been the dominant owner of such lands and sent that timber to their mills, now the lands are owned by investment management organizations and trusts that manage the land to maximize returns. Some of these organizations, however, are delivering returns and helping to conserve the land.