All posts by medical

In Alexandria, The Anatomy Of A Near-Miss Police Shooting – The Hayride

June 29, 2020 medical

Youre about to see a video that was taken on Saturday in Alexandria, in front of Rapides Regional Medical Center. Nobody dies in the sequence youre about to see, but as you watch it youll surely envision exactly how that outcome could have resulted.

So here is some context on this, from the Alexandria Police Departments incident report. (Source: Alexandria Daily Town Talk)

An Alexandria police officer was injured Friday eveningwhile attempting to arrest three individuals for remaining on site after being asked to leave at Rapides Regional Medical Center.

According to a news release by the Alexandria Police Department, the officers involvement with the individuals began at approximately 9:28 p.m. Fridaywhen he observed a group of people in a vehicle near the hospital entrance playing loud music and disturbing people who were there for medical treatment.

The officer requested that they turn down the music. The group initially complied, however when the officer left the area they resumed playing loud music. Police say, the officer returned and instructed them to leave the property or face possible arrest.

A short time later the officer sawthe suspects back on hospital property at the entrance to the emergency room. At that time, the officer advised the suspects they were being arrested for remaining after forbidden.

According to the news release, after the first suspect was arrested, a second suspect resisted arrest, striking the officer multiple times and knocking the officer unconscious. At some point during the altercation the suspect, by his own admission, attempted to disarm the officer by taking the officers duty weapon from him.

Bystanders as well as backup police officers intervened. The officer used a Taser on the suspect, and all three suspects were taken into custody. The officer was treated for his injuries and released.

Those arrested include Jonathan Rhodes, 20, of Pineville, who was charged with remaining on premises after being forbidden, second degree battery of a police officer, attempted disarming of a police officer, and resisting by force or violence; Elijah McCall, 21, and Jena Fowler, 19, both of Alexandria, each of whom were charged with remaining on premises after being forbidden.

We arent going to go through all of it, but on Facebook and YouTube there are hundreds, even thousands, of comments suggesting that Jonathan Rhodes is a hero for fighting back against the policeman that he knocked down.

Stuff like this

Hes a hero. And a race-hustling Marxist revolutionary from Los Angeles paid his bail. Said race-hustling Marxist revolutionary went on TV in Alexandria to take credit for it, and to spread the dindunuffin line and called the police report a lie

He and his two idiot friends were sitting in a car in a hospital parking lot late on a Saturday night blaring rap music so loudly that hospital patients complained they couldnt sleep. If thats not a pristing example of a flaming, inconsiderate slimeball then one doesnt exist.

Cop comes over, tells him to turn the music down, he does, then turns it back up. Complaints recur, so cop comes back and tells him and his two idiot friends they have to leave or else they get arrested. He doesnt leave.

So the cop then does his job and arrests them. Theyre getting misdemeanor charges. Its a ticket. Nothing to fight over.

But this guy is so stupid that he escalates whats essentially a misdemeanor trespassing charge into a major felony by resisting arrest. And when the cop grabs his orange Sideshow Bob hair in an effort to get control of him so he can put the cuffs on, he proceeds to deck the cop, then jumps on top of him and beats the hell out of him while unholstering the cops weapon.

In the heat of that moment it would have been completely foreseeable, and not at all unjustifiable, if the cop had grabbed his gun and shot Rhodes dead. That might well have happened if a host of bystanders hadnt jumped in to separate the two.

Of course, the woman holding her camera phone on the scene to record it is yelling at the cops not to arrest the female because she didnt even do nothin, but she doesnt have a clue what shes talking about the female was going to be arrested for the initial charge of remaining after forbidden.

Everybody hates to see these police shooting incidents. But just about every one of them comes out of circumstances like this one. And while the police repeatedly get black eyes over the rare incidents in which somebody is shot by a cop, what were asking is that they take a beating from animals like Jonathan Rhodes who create situations that bring the police in the first place.

This could easily have become a Black Lives Matter moment. Had it become one, Jonathan Rhodes would have become a household name like George Floyd, Alton Sterling or Michael Brown. And if it had, all of the circumstances surrounding why it happened would have been swept aside while the whole country erupted into a fresh round of unrest.

Remember this debacle the next time youre asked to despise the police.

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In Alexandria, The Anatomy Of A Near-Miss Police Shooting - The Hayride

Anatomy

Grey’s Anatomy: Who is the scrub nurse Bohkee? – Metro

June 29, 2020 medical

Bohkee is the scrub nurse fans have seen on screen since Greys Anatomy began in 2005 (Picture: ABC)

Greys Anatomy fans have been taking the chance to rewatch the medical drama and some have realised how one character has been a silent part of the show the very start.

Bohkee is the loyal scrub nurse who has appeared in many of the OR surgeries weve watched take place in Seattle Grace Hospital (aka Grey Sloan Memorial Hospital).

However, she doesnt get to speak very much. In fact, shes only had a few lines ever since it started in 2005.

But that hasnt stopped her from building a large fan base thanks to her expressive reactions during surgeries.

Bohkee is played by Kathy C An, who is an actual scrub nurse in real-life.

A surgical nurses role is to prepare the operating room beforehand as well as to assist both during routine and difficult surgical procedures.

Some of the cast have even watched her at work during open-heart surgeries in Los Angeles when preparing for their roles on the show.

The character Bohkee has been a help to most of the major surgeons in the hospital,Preston Burke and Richard Webber being prime examples.

During the shooting at Seattle Grace, Bohkee was the nurse who passed Jackson Avery a tool to help save the life of Derek Shepherd during surgery with Cristina Yang.

And we know Bohkee speaks Korean as shown when she tells her husband, Jae, that DeLuca loves Meredith.

Actress Kathy is just as popular off-screen and has been praised by her co-stars.

In 2013 former star Sandra Oh (Yang) tweeted: The nurse in that scene, Bokhee, is a real surgical nurse.

Shes been with us since the beginning. Shes like my 2nd mom, shes the best.

Kathy has been in every season of the medical drama but also appeared in other TV shows such as Six Feet Under in 2011 and in Greys spin-off Private Practice where she assisted the surgery on Erica Warner (AJ Langer).

Got A Showbiz Story?

If youve got a celebrity story, video or pictures get in touch with the Metro.co.uk entertainment team by emailing us celebtips@metro.co.uk, calling 020 3615 2145 or by visiting our Submit Stuff page wed love to hear from you.

MORE: Greys Anatomy alum Sandra Oh reveals why Shonda Rhimes stopped her playing Olivia Pope on Scandal

MORE: Greys Anatomy stars Ellen Pompeo and T. R. Knight reunite as they take a knee at George Floyd protests

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Grey's Anatomy: Who is the scrub nurse Bohkee? - Metro

Anatomy

Early Thor Concept Art Imagines Grey’s Anatomy’s Kevin McKidd In The MCU – Screen Rant

June 29, 2020 medical

Newly resurfaced Thor concept art is based on Grey's Anatomy's Kevin McKidd, who was in the running before Chris Hemsworth landed the part.

Recently resurfacedThorconcept art imaginesGrey's Anatomyactor Kevin McKidd as the Marvel hero. Since his debut in his 2011 solo film, Thor has become a vital part of the Marvel Cinematic Universe. Though the second film in his standalone series,Thor: The Dark World, was a critical disappointment, he bounced back withThor: Ragnarok. It provided a lighter take on the character and segued into his relationship with the similarly eccentric Guardians of the Galaxy. Now, it's hard to imagine anyone but Chris Hemsworth in the role, as he's navigated Thor's character development with ease. However, Hemsworth wasn't the only actor up for the role.

At one point, McKidd was reportedly in the running for Thor. This was back in 2008, around the time McKidd joinedGrey's Anatomyas Owen Hunt. Though he didn't wind up getting the part of Thor, McKidd did eventually play a god, starring inPercy Jackson & the Olympians: The Lightning Thief as Poseidononly a couple years later. Another actor who nearly played Thor is Daniel Craig, who wasn't able to because of his role as James Bond. Other actors considered include Channing Tatum, Charlie Hunnam, and even Liam Hemsworth.

Related:Avengers: Actors Who Almost Played The Original 6 Heroes

Because so many actors were up for the role, it makes sense early concept art varied. Marvel Studios Visual Development co-founderCharlie Wen shared someThorconcept art on Instagram today, which was based on McKidd. The art was previously featured inThe Art of Thor, a Marvel artbook released in 2011. Check it out below:

It makes sense Wen specifies the art was based on McKidd rather than being a carbon copy. It only loosely looks like the actor, especially ten plus years after it was created. However, it does give a good idea of what McKidd might have looked like then with Thor's trademark long locks. Though McKidd didn't end up getting the Thor gig, it's not as though his career has tanked since. He's remained a fixture in the entertainment industry thanks to his ongoingGrey's Anatomyrole. At this point, he's even outlasted several original cast members.

All told, theThorconcept art offers a fascinating reminder of the complicated design process for superhero films. Not only do artists have to create a look for the character, they also have to take into consideration whichever actors are up for the role. Though it's interesting to see the basis for what McKidd might have looked like as Thor, it feels like the right person wound up with the role.

More:Avengers: Age of Ultron Foreshadowed Thors Infinity War Failure

Source: Charlie Wen

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Rebecca VanAcker is a news writer and evening editor at Screen Rant. She enjoys covering all things superhero, especially Marvel and the Arrowverse. In the past, shes written TV recaps for Screen Picks and reviews for Yahoo TV UK. Though Rebecca likes movies and other forms of storytelling, TV is her true passion, having written about it in some capacity since 2014. She especially loves female-driven shows like Parks and Recreation, Jane the Virgin, and Fleabag. A graduate of Michigan State University, Rebecca got her teaching certificate before falling in love with writing and the entertainment industry. She has a B.A. in English, and her longtime love of reading has followed her into adulthood. While she enjoys discovering new books, right now shes probably just re-reading Harry Potter for the millionth time. Her other hobbies include baking, anything Disney, and exploring with her dog, Beckett. You can follow Rebecca on Twitter @BecksVanAcker, or contact her directly at rvanacker23(at)gmail(dot)com.

Anatomy

Grey’s Anatomy: What Happened To Katherine Heigl’s Izzie – Screen Rant

June 29, 2020 medical

Grey's Anatomy finally gave closure to Katherine Heigl's Izzie Stevens in season 16 and here's what happened after Heigl left the show.

Greys Anatomy gave Katherine Heigl worldwide recognition thanks to her role as Izzie Stevens, but what happened to her after Heigls departure from the series? Created by Shonda Rhimes, Greys Anatomy debuted on ABC in 2005 and has been unstoppable ever since. The series was originally a mid-season replacement, but it was very well received by critics and audiences, which has allowed it to continue for years.

Like any other medical drama, Greys Anatomy follows the lives of surgical interns, residents, and attendings, who do their best to balance their professional and personal lives. The series is set in Seattle, at the fictional Seattle Grace Hospital (later Seattle Grace Mercy West Hospital), and is led by Meredith Grey (Ellen Pompeo), who along with Miranda Bailey (Chandra Wilson) and Richard Webber (James Pickens Jr) are the only characters from season 1 who are still part of the show. Greys Anatomy is now waiting for its 17th season, and season 16 saw another character from season 1 leave: Alex Karev (Justin Chambers), whose departure ended up revealing the fate of another character.

Related: Best TV Shows Of The Decade

Izzie Stevens, just like Meredith and Alex, started out as an intern at Seattle Grace Hospital, and grew close with Alex, with whom she had an on-again off-again relationship. When Izzie discovered she had cancer, Meredith suggested she had healthy eggs removed from her in case she wanted to have kids in the future, and she did so. Her treatment was complicated, and after discovering another tumor in her brain, Meredith and Derek gave away their wedding to Izzie and Alex, and so they got married. Izzie got better and went back to work, but was fired after giving the wrong dosage of medicine to a patient. Thinking Alex was partly to blame, she wrote him a letter and left, but later returned for a final PET scan and to ask Derek to write her a recommendation letter so she could get a job in Tacoma. After that, her relationship with Alex was broken, and she left.

Izzie later sent divorce papers to Alex, which he signed, and they moved on, though they still had feelings for each other. Season 16 of Greys Anatomy finally revealed what happened to her after leaving Seattle: Alex explained that when Meredith was about to lose her license, he reached out to Izzie so she could help her. He admitted it was an excuse to finally call her, and thats how he learned that Izzie has twins and they are also his. Alex leaves Seattle to live with Izzie and their children in Kansas, as she was a single mother. Izzie carried on with her career and is now a surgical oncologist, and she and Alex are shown to be building a life together as a family.

The scenes showing Izzie and Alexs new life were possible thanks to stand-ins, as neither Heigl nor Chambers returned for that (Chambers only lent his voice in this episode). Fan reaction to Izzies fate in Greys Anatomy was mixed: some liked that she was given a happy ending after all she went through, even if how it was portrayed wasnt exactly the best way to do it, while others feel it was disrespectful to their stories to have them end up like this, but at least the writers finally gave proper closure to her arc.

Next: What Happened To Katherine Heigl

Every Reveal About The Arrowverse's Batman (So Far)

Adrienne Tyler is a features writer for Screen Rant. She is an Audiovisual Communication graduate that wanted to be a filmmaker, but life had other plans (and it turned out great). Prior to Screen Rant, she wrote for Pop Wrapped, 4 Your Excitement (4YE), and D20Crit, where she was also a regular guest at Netfreaks podcast. She was also a contributor for FanSided's BamSmackPow and 1428 Elm. Adrienne is very into films and she enjoys a bit of everything: from superhero films, to heartbreaking dramas, to low-budget horror films. Every time she manages to commit to a TV show without getting bored, an angel gets its wings.

When she's not writing, you can find her trying to learn a new language, watching hockey (go Avs!... But also Caps and Leafs), or wondering what life would have been like had Pushing Daisies, Firefly, and Limitless not been cancelled. Breakfast food is life and coffee is what makes the world go round.

Guillermo del Toro said hi to her once. It was great.

"Vnligheten r ett sprk som de dva kan hra och de blinda kan se".

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Grey's Anatomy: What Happened To Katherine Heigl's Izzie - Screen Rant

Anatomy

18 Healthcare Augmented Reality and Virtual Reality Companies to Watch – HIT Consultant

June 29, 2020 medical

Augmented reality (AR) and virtual reality (VR) are redefining whats possible in healthcare, as well as other sectors. The 18 companies listed below are some of the top virtual and augmented reality companies in the medical industry.

Defining Augmented Reality

Augmentedreality is a technology that blends real-world elements with virtual ones. Forexample, a person might visit a trade show and aim their smartphone at adisplay to activate an AR experience that allows them to see acomputer-generated version of a product.

Thisapproach is particularly useful for getting people excited about prototypes orhelping them understand the potential of any item not yet finalized.

AR vs. VR: Whats The Difference?

Virtual reality is another buzz-worthy technology that continues to capture attention and fascinate people in the medical sector and outside of it. Although VR and AR have some similarities, theyre not the same.

Bothtechnologies typically respond to real-time changes, such as how a personmoves. Thus, the technologies need extremely low latency to work seamlessly forusers. Additionally, VR and AR seek to give people experiences that are notpossible to achieve quickly in the real world alone. For example, homefurnishing brand IKEA offered an AR app that allowed people to place virtualpieces in their homes to check dimensions.

However,whereas AR incorporates some versions of the actual environment into itsresults, VR aims to give people a completely immersive experience that beginsonce they strap on the required headsets. A person engaging with a VRexperience will see everything happening inside the headset, but the ARexperience happens by enhancing things within an individuals environment.

Another difference between VR and AR is that the latter arguably has a wider variety of possible applications in other industries, such as manufacturing. Its not practical for people who are working on a factory floor to all don VR headsets. However, they may use far less cumbersome AR-enabled glasses, goggles, or screens to assist with a broad assortment of tasks ranging from quality assurance to assembly.

The Potential, Benefits and Use Cases for AR and VR in Healthcare

Ananalysis from MarketsandMarkets profiled the expected growth of AR and VR in healthcarefrom 2017-2025. The company anticipates a combined annual growth rate of30.7%duringthe timeframe studied.

Theresplenty of potential for VR and AR in healthcare, but how might people use it,specifically?Surgical planning could become easier. Even the mostexperienced surgeons sometimes encounter surprises when operating on patients,but these high-tech solutions may make those instances less common.

Researchershave investigated using VR to educate patientsbeforetheir surgeries, too. For example, a person can see a digitized version oftheir brain, along with the problem a surgeon needs to fix and how they will doit.

Beyond teaching patients about the procedures they need, VR and AR can help surgeons plan their interventions, making them less likely to encounter surprises or feel unprepared. Some technologies show digital information appearing on top of a patients body in real-time.

Also,these technologies could improve training in medical school. Researchers atJohns Hopkins University embarked on an AR project that could see medicalstudents trade their anatomy apps for AR. An augmented reality tool displayed an internal viewof the bodyon top of a students physique. The technology also included agesture-sensitive user interface, allowing people to interact with the AR representation.

The Top Augmented and Virtual Reality Companies in Healthcare

Thepromises of medical augmented reality and virtual reality are compelling enoughto get anyone excited about whats possible. These companies intend to be atthe forefront of VR and AR healthcare.

Founded: 2012

Location: London, United Kingdom

Funding to Date: $9.6 million

Key Clients/Milestones: FundamentalVR was named one of Time Magazines best inventions for 2018 and got an Interactive Innovation Award at SXSW 2019. All of FundamentalVRs simulations are accredited by theRoyal College of Surgeons of England. The company also has a joint development agreementwith the Mayo Clinic.

Thiscompany offers flight simulator-like training for surgeons. The approach allowsthem to rehearse, practice and improve their surgical techniques in acontrolled environment that includes haptic elements for tactile feedback.Although the company has many virtual reality simulations, it also offers AR tech using Microsofts HoloLens technology. It allows users to work togetherthrough the simulations.

Founded:2016

Location: San Francisco, California

Funding to Date: $3 million

Key Clients/Milestones: Products are HIPAA-compliant and FDA-registered.

Thecompany uses evidence-based approaches to treat chronic pain through virtualreality simulations. Patients can do the treatment at home or in a localclinic. If done in a clinic, the treatment program lasts from four to 12 weeksbased on the patients individual needs.

Founded: 2016

Location: Oxford, United Kingdom

Funding to Date:13.2 million

Key Clients/Milestones:It has partnerships with the United Kingdoms National Health Service, as well as the McPin Foundation, which works to improve mental health research. OxfordVR also won the 2020 award in the Apps and Software categoryfor Best Mental Health Immersive Technology at the MedTech Visionaries Awards.

OxfordVRfocuses on virtual reality to relieve the symptoms of mental disorders andfears. For example, its fear of heights simulation reduced the issue inpatients by an average of 68%after only two hours of treatment.

Founded: 2014

Location:Arlington Heights, Illinois, and Yoqneam, Israel

Funding to Date: $25.1 million

Key Clients/Milestones: The company hasreceived FDA 501(k) clearancefor its headset. It will begin distributing its headsets throughout the U.S in early 2020 and plans to move into uses beyond spinal surgeries soon.

Thecompany has what it calls the first augmented reality guidance system forsurgery, known as xvision. The technology adds a 3D representation thatenables surgeons to see the patients anatomy through skin and tissue as ifthey had X-ray vision. When tested as surgeons placed spinal screws incadavers, the accuracy rate while using the VR headset was 98.9%.

Founded: 2010

Location: Los Angeles, California, and Cleveland, Ohio

Funding to Date: $9.6 million

Key Clients/Milestones: The Mayo Clinic, UCLA School of Medicine, St. Josephs Childrens Hospital and the Stanford School of Medicine are among the places that have used the companys technology so far.

SurgicalTheater created a surgical rehearsal platform for neurosurgicalprocedures called Precision VR. It allows for better preoperative planning.However, unlike some medical technology companies, this one has simulations apatient can go through with their health provider. For example, if a personfaces an operation for a brain tumor, they can see a VR scenario that shows theprocess.

Founded: 2012

Location: Santa Clara, California

Funding to Date: $14.3 million

Key Clients/Milestones: It has received FDA clearance. Institutions includingCincinnati Childrens Hospital, Primary Childrens Hospital, C.S. Mott Hospital, Lucile Packard Childrens Hospital have brought the technology into clinical use.

Thecompany offers an AR healthcare platform called True3D that facilitatesvisualizing and interacting with the organs and tissue for a specific patient.Users can also see medical imaging results along with the holograph-like imagesprovided by the technology.

Founded: 2016

Location: Brooklyn, New York

Funding to Date: $2.5 million

Key Clients/Milestones: Medivis counts Verizon, Microsoft and Magic Leap among its industry partners. Medivis also recently launched its program for patientsusing the U.S. Department of Veterans Affairs at the VA Palo Alto Medical Center. The goal of that initiative is to identify health applications that combine with 5G technology. West Coast also used the Medivs platform to help medical students learn anatomy.

The companycombines medical augmented reality with artificial intelligence (AI) to providehelpful presurgical information or details related to a persons anatomy. Itenvisions a time when healthcare providers can break free of the limitationsposed by 2D screens and instead bring information and tools to the real worldthrough 3D representations.

Founded: 2017

Location: Westminster, Colorado

Funding to Date: $17million

Key Clients/Milestones: St. Judes Childrens Research Hospital, the University of Michigan Health System, and Eastern Virginia Medical Center are some of the facilities that have used the Health Scholars platform so far.

Health Scholars offers VR medical training covering surgical skills, obstetrics, and resuscitation. The company also provides a learning management interface that enables educators to create simulations for students to use.

Founded: 2015

Location: Charlestown, Massachusetts

Funding to Date: $30 million

Key Clients/Milestones: It was the first surgical robotto receive FDA Breakthrough designation. Bill Gates is one of the companys backers.

Thecompany combines virtual reality with a surgical robot to result in minimallyinvasive procedures.

Founded: 2013

Location: London, United Kingdom

Funding to Date: $19.5 million.

Key Clients/Milestones: Touch Surgery received the Amazon Web Services Hot Startups Award, and it also got a Brandon Hall Silver Award in 2014. Residency programs at the Cleveland Clinic, Stanford School of Medicine, Harvard Medical School Teaching Hospital, and others use Touch Surgerys technology for training.

TouchSurgery offers more than 200 VR surgical simulations and videos across 17specialties that learners can access anywhere with an internet connection.

Founded: 2016

Location: Seattle, Washington

Funding to Date: $30 million

Key Clients/Milestones: Seattle Childrens Hospital and theUniversity of Washingtons Department of Neurological Surgery are two of the companys clinical research partners.

Thecompany blends human vision with computerized technology, enabling surgeons tosee the body in new, immersive ways and improving the success rates of theirprocedures.

Founded: 2005

Location: Chicago, Illinois

Funding to Date: $2.1 million

Key Clients/Milestones: The Cleveland Clinic, University of Calgary, Tufts University School of Medicine, and Johns Hopkins Medicine were some of the early adopters of ImmersiveTouchs technology.

ImmersiveTouchcreates 3D virtual reality models using a patients individualized medicalimaging data.

Founded: 2016

Location: Boston, Massachusetts

Funding to Date: $2 million

Key Clients/Milestones: OSSO VR was involved in a pilot program at Vanderbilt University Medical Center, and was a DocsF18 Innovation Award Winner.

Thiscompany specializes in using virtual reality to facilitate surgical trainingand assessments. It offers fully immersive VR experiences, complete with hapticfeedback.

Founded: 2017

Location: St. Louis, Missouri

Funding to Date: $7.4 million

Key Clients/Milestones: Was named one of the Top 10 Cardiovascular Device Companiesin 2019 by Med Tech Outlook

Thiscompany uses medical augmented reality to create a holographic visualization ofa patients anatomy. That image floats over the patient during interventionalprocedures, such as while treatingcardiac arrhythmias in a catheterlab.

Founded: 2016

Location: Taipei City, Taiwan, and Fairfax, Virginia

Funding to Date: $500,000

Key Clients/Milestones: Beijing University of Chinese Medicine, Kiang Wu Nursing College of Macau, and the Davao Medical School Foundation are some of the companys clients. Medical Augmented Intelligence counts Intel, NVIDIA, and Vive among its technology partners.

MedicalAugmented Intelligence offers immersive virtual reality training for anatomyand acupuncture, plus digital twin models for patient education.The patient-based models convert 2D medical images to VR models in less than 30seconds.

Developed: 2016

Location:Case Western Reserve University and Cleveland Clinic

Cost:The HoloAnatomy app is free, but the Microsoft HoloLens device that enables the app costs $3,000.

Key Clients/Milestones: It was a winner at the2016 Jackson Hole Wildlife Film Festival Science Media Awards

Althoughmost of this list consists of the top augmented and virtual reality healthcarecompanies, this entry is a bit different because its an app. When using aMicrosoft HoloLens device, people can go through a digitized, interactiveanatomy curriculum.

Founded: 2009

Location: Palo Alto, California

Funding to Date: $3.6 million

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18 Healthcare Augmented Reality and Virtual Reality Companies to Watch - HIT Consultant

Anatomy

CX 2020 LIVE: Surgeon-modified and custom-made endografts carve their place in juxtarenal aneurysm treatment – Vascular News

June 29, 2020 medical

Clockwise from top left: Roger Greenhalgh (London, UK), Stphan Haulon (Paris, France), Gustavo Oderich (Rochester, USA), Nikolaos Tsilimparis (Munich, Germany), Bijan Modarai (London, UK) and Said Abisi (London, UK). Click on the image to watch the Juxtarenal Aneursym Consesus session on demand.

During the last five weeks,CX 2020 LIVEhas attracted over 6,000 registrants from more than 120 countries.The topic of the 10th and final session was Juxtarenal Aneurysm Consensus. Experts covered cutting-edge developments in the field and tips and tricks for complex procedures. They also examined outcomes with a range of devices on the market.There was lively discussion reviewing surgeon-modified and custom-made fenestrated endografts and strong support for inner branch technology, backed by 79% of participants. Other topics covered include bridging stent grafts, balloon-expandable covered bridging stents, and off-the-shelf solutions for hostile necks. The session was chaired by Stphan Haulon (Paris, France) and moderated by Gustavo Oderich (Rochester, USA), who cautioned against being a staunch defender of one technique over another, as everything has a potential role.

Said Abisi (London, UK) reported on experience with inner branch technologies and noted that although endovascular aneurysm repair (EVAR) and branched endovascular aneurysm repair (BEVAR have good outcomes, they are limited by certain anatomical challenges which can make these procedures difficult. Fenestrated procedures in particular require very accurate planning and positioning, and vessel deformation due to infrarenal angulation and iliac tortuosity may result in unpredictable outcomes, he adds. In addition, traditional BEVAR with outer branches requires enough working lumen for the branches to open out and also requires long aortic coverage and a longer distance for bridging stents.

The researchers set out to examine a cohort of patients undergoing fenestrated and branched EVAR over the past two years, focusing on procedural outcomes to investigate the indications for use of inner branches.

Abisi summarised that inner branches have a good early outcome for the treatment of highly complex aortic aneurysms, adding that they are easy to use, adaptable to variable anatomy, and have demonstrable advantages compared to conventional technology. However, he noted that longer-term data are needed to determine their wider applicability.

Responding to a question from Oderich regarding patency concerns, Abisi outlined that this is why we are currently very cautious about selecting only those who are not suitable for standard fenestrated or branched, and concluded that, as a result, the data need to be monitored, with patients followed-up over the long term.

Tips and tricks for repairing a thoracoabdominal aortic aneurysm using an off-the-shelf device

Bijan Modarai (London, UK) presented a case that demonstrated the repair of a large thoracoabdominal aortic aneurysm using an off-the-shelf thoracoabdominal branched device. The Zenith t-Branch (Cook Medical) incorporates four downward-facing outer branches and is designed to be coupled in a modular fashion with proximal and distal components to allow treatment of a variety of aortic anatomies. Modarai noted that a number of markers on the stent graft facilitate accurate positioning, once it is placed inside the aorta. He described the techniques adopted, which ultimately led to successful sealing of the aneurysm.

Asked about what the best strategy is for preventing bridging stent failure, Modarai answered that the mode of failure is multifactorial. I do not think it is about saying whether it is best to use a balloon-expandable or self-expandable stent. I think it comes down to good quality control. He went on to explain that this means adequate sizing; ensuring that those branches are positioned in the optimal way so that the bridging distance is not very long; ensuring that the stent is [far] enough inside the branch so that there is adequate overlap, and to make sure that the stent is not too far deep into the target vessel.

In regards to the use of antiplatelet therapy, Modarai stated that because we do not have level one evidence, I tend to put these patients for at least a year, if not for life, on dual antiplatelet agents in the hope that all of those measures will reduce the chances of a stent occlusion but commented that a mistake that a lot of people make is to compare branches with fenestrations, which he said is like comparing apples with oranges.

A further question on the spinal complication rate, which Modarai highlighted was the most feared complication with these repairs, and how best to prevent it, led Modarai to remark that the rate of cord complication is related to the amount of the aorta that is covered. In terms of prevention, Modarai asserted that again, I think it is multifactorial; some of the repairs are worth staging.

Custom-made fenestrated endografts are first source for elective repair, but surgeon modification useful in emergencies

Nikolaos Tsilimparis (Munich, Germany) offered an insight into the technical success achieved through surgeon-modified fenestrated endografts compared to custom-made fenestrated endografts. His presentation revealed that surgeon-modified endografts have been associated with higher type 3 endoleaks and reintervention, but achieve similar long-term outcomes to the custom-made devices.

However, Tsilimparis noted that to directly measure up the two treatment options side-by-side could be seen as an unfair comparison, commenting that they are two different entities. In particular, he highlighted the role physician-modified endografts have to play in urgent aortic repairs, adding that custom-made devices should be seen as the first source for elective repair. This conclusion was echoed by Oderich who commented that he had raised a very important point, which is that sometimes you are in a tight spot where you cannot use an off the shelf device, or, it is not in the best interests of the patient.

Oderich asked Tsilimparis for his thoughts on the importance of gaining experience with FEVAR in general, and the importance of quality control in modifying a device, particularly with regard to sizing and planning. Tsilimparis commented that many surgeons had made the mistake of trying to learn the fenestrated endograft technique and how to modify the device simultaneously, rather than opting to use custom-made devices initially. This is a big challenge when you try to do both at once, Tsilimparis added. It is important in my eyes to start with easy cases with custom-made devices, and really rely on surgeon-modified [devices] if you have the experience with these, and also if you feel very comfortable with the stent grafts and the technique overall.

An audience member from India asked Tsilimparis why he felt there was a higher rate of type 3 endoleaks seen in surgeon-modified, compared to custom-made devices. Tsilimparis replied that there were some technical aspects to explain this disparity, including some differences in sealing techniques between both device types. He also commented that, often, surgeon-modified endografts may be used in cases where there is a further distance between the aortic wall to the stent graft, citing this as another possible cause.

New generation of bridging stent grafts addresses flexibility and deliverability

Following Tsilimparis, Eric Verhoeven (Nuremberg, Germany) then detailed his centres experience of the use of a new generation of bridging stent graftsthe BeGraft and BeGraft+ (Bentley), the former for use in fenestrations, and the latter in branched procedures. Verhoeven told the CX 2020 LIVE audience that these latest devices have a higher radial force than earlier generations, as well as an increased kink resistance.

Summarising his experience, Verhoeven welcomed the development of the new generation devices. He added: The transition with the target vessel is something to watch and sometimes you have to reline, and sometimes extend with a self-expandable stent to smoothen the transition zone.

Haulon remarked that he was surprised to see that everyone today is using balloon-expandable stents, to which Oderich concurred, adding and I think that reflects significant improvementby the industry to address the issue of flexibility of these stents and deliverability through a small profile.

Following Verhoevens presentation, polling revealed that 79% of the audience like the idea of using inner branched technology, with Haulon commenting: It seems that everyone believes that it is an interesting idea to use inner branches, so we need to evaluate those and hopefully we will have data to support the use of this new design in the near future.

Best balloon-expandable covered bridging stent depends on surgeon preference, target artery anatomy

Mauro Gargiulo (Bologna, Italy) compared a range of balloon-expandable covered bridging stents (BECS) for fenestrated and branched endovascular aneurysm repair procedures.

On the current indications for using BECS for fenestration, Gargiulo stated: All of us agree that the balloon-expandable stent graft is the choice, according to long-term results reported in the literature.

Regarding branched procedures, Gargiulo noted that while some literature indicates no difference in occlusion or reintervention comparing balloon-expandable and self-expandable stents, other work favours the self-expandable graft for these procedures.

In our centre, we use a balloon-expandable stent graft in all target artery anatomy expect renal arteries type B and D, Gargiulo reported, adding that a hybrid approach, with a self-expandable balloon distally and a balloon-expandable stent proximally results in an increase of renal artery patency and is a good option for type B and type D renal arteries.

Gargiulo then listed ideal features of a stent graft, including navigability, visibility, precise deployment, conformability, radial force, flaring attitude, and patency.

Considering the structural features and biomechanical properties of various devices on the market, Gargiulo summarised: The advantages of the iCAST/V12 [Getinge] are the precise deployment and the proven long-term results; the BeGraft , its good trackability, high flexibility, and the compatibility with the 6Fr sheath; and the VBX [Gore], its high flexibility, heparin-bonded bioactive surface, good trackability, and wide range of lengths.

I do not think there is a best BECS for all occasions, Gargiulo concluded. He detailed that for fenestration, surgeon preference, the aortic endograft device, and the target artery anatomy are all important factors, and for branched procedures, the surgeons preference, the cannulation of the branch from either brachial or femoral access, and the target artery anatomy are key.

Off-the-shelf endovascular solutions for the treatment of AAAs with a hostile neck

Jean-Paul de Vries (Groningen, the Netherlands) told the CX 2020 LIVE audience how to achieve durability with off-the-shelf solutions for the treatment of abdominal aortic aneurysms (AAAs) with a hostile neck while minimising hospital resource impact.By evaluating the seal zone of the three types of aortic necksadequate, hostile, and inadequateone can isolate the different needs in those necks and patients, de Vries noted.

He stated that, for the adequate neck, you only need seal, whereas in the hostile neck, you need additional strength, and in the inadequate neck, you need also to extend the seal to the juxtarenal or suprarenal aorta.

He recommended using the gold standard of endovascular aneurysm repair (EVAR) when there is an adequate seal zone, endosuture aneurysm repair (ESAR) in hostile necks , and a fenestrated or chimney device in an inadequate neck. With a chimney device, the advantage is there is no waiting time, it is off-the-shelf, and the total costs are lower compared to fenestrated devices. However, it is limited to a maximum of two chimneys, de Vries told the audience.

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CX 2020 LIVE: Surgeon-modified and custom-made endografts carve their place in juxtarenal aneurysm treatment - Vascular News

Physiology

UW researchers publish on the decline of the Western bumblebee – Oil City News

June 29, 2020 medical

Christy Bell, a Ph.D. student in the UW Department of Zoology and Physiology, observes a Western bumblebee. Bell and Lusha Tronstad, lead invertebrate zoologist with the Wyoming Natural Diversity Database, are co-authors of a paper about Western bumblebees. (Christy Bell)

CASPER, Wyo A University of Wyoming (UW) researcher and her Ph.D. student have spent the last three years studying the decline of the Western bumblebee. Their paper, titledWestern Bumble Bee: Declines in the United States and Range-Wide Information Gaps,was published online June 26 inEcosphere, according to a UW release Monday. The journal publishes papers from all subdisciplines of ecological science.

Lusha Tronstad, lead invertebrate zoologist with the Wyoming Natural Diversity Database (WYNDD), and Christy Bell, her Ph.D. student in the Department of Zoology and Physiology, have been working with a group of bumblebee experts to fill in gaps of missing information from previous data collected in the western United States. Their goal is to provide information on the Western bumblebee to the U.S. Fish and Wildlife Service while it considers listing this species under the U.S. Endangered Species Act, the university release said.

Tronstad and Bell are members of the Western Bumble Bee Working Group, a group of experts on the species which came together to pool knowledge on the species, Tronstad said. The paper highlights knowledge gaps, specifically the lack of sampling data in Alaska, northwestern Canada and the southwestern United States.

Article continues below...

The data we assembled will be used by the U.S. Fish and Wildlife Service to inform its decision on whether or not to protect the Western bumblebee under the U.S. Endangered Species Act, Tronstad said.At WYNDD our mission is to provide the most up-to-date data on which management decisions can be based.

The decline of the Western bumblebee is likely not limited to one culprit but, instead, due to several factors that interact such as pesticides, pathogens, climate change and habitat loss, said Tronstad. Western bumblebees were once the most abundant bumblebees on the West Coast of the U.S., but they are much less frequently observed there now. Pathogens (or parasites) are thought to be a major reason for their decline.

Tronstad said there are several things that homeowners or landowners can do to help this species of bumblebee survive and thrive.These include:

Tronstad said Bells research will continue this summer.

Read the full UW release here.

Other contributors to the paper are from the U.S. Geological Survey; U.S. Fish and Wildlife Service; Canadian Wildlife Service; Xerces Society for Invertebrate Conservation in Portland, Ore.; British Columbia Ministry of Environment and Climate Change Strategy; University of Hawaii-Hilo; U.S. Department of Agriculture; The Institute for Bird Populations; University of Vermont; Utah State University; Ohio State University; Denali National Park and Preserve; and the Royal Saskatchewan Museum.

How does research in biochemistry fit into the wider goals of the NIH? – Open Access Government

June 29, 2020 medical

Established in 1962, the National Institute of General Medical Sciences (NIGMS) supports basic research that increases understanding of biological processes while also laying the foundation for advances in disease diagnosis, treatment, and prevention in the U.S. NIGMS is headed by Director Jon R. Lorsch who oversees the Institutes $2.6 billion budget, which supports this research.

NIGMS supports more than 3,000 investigators and 4,500 research grants around 11% of the total number of research grants funded by the National Institutes of Health (NIH) as a whole. Additionally, it supports around 26% of the National Research Training Award (NRSA) trainees who receive assistance from NIH. It is organised into divisions that support research and research training in a range of different fields.

From 2018 onwards, NIGMS reorganised into three scientific divisions specifically: Biophysics, Biomedical Technology, and Computational Biosciences (BBCB); Genetics and Molecular, Cellular and Developmental Biology (GMCDB); and Pharmacology, Physiology, and Biological Chemistry (PPBC).

The latter of these divisions supports a broad spectrum of state-of-the-art research aimed at improving the molecular-level understanding of fundamental biological processes and discovering approaches to their control. Just some of the goals of this supported research include an improved understanding of drug action and of anaesthesia; mechanisms underlying responses to drugs; new methods and targets for drug discovery; an enhanced understanding of biological catalysis; knowledge of metabolic regulation and fundamental physiological processes; and the integration and application of basic physiological, pharmacological, and biochemical research to clinical issues in anaesthesia, clinical pharmacology, and trauma and burn injury.

The division itself has two components: The Biochemistry and Bio-related Chemistry Branch and the Pharmacological and Physiological Sciences Branch.

It is important to recognise the fundamentals of each branches focal point and what their individual goals are. Understanding the interactions between molecules thats chemistry. And understanding the chemistry that occurs in living organisms, however thats biochemistry. Furthermore, understanding how medicines work in the body and finding ways to make them work better and more effectively thats pharmacology. Studies in these areas are currently focussing on areas such as:

How enzymes generate cellular energy and facilitate chemical reactions.

How medicines are processed inside the body.

What roles natural substances such as fats and sugars play in our bodies.

How a persons genetic makeup can influence a drugs effectiveness.

How to use chemistry to design new medicines.

The possibility of finding new uses for existing medicines.1

The Biochemistry and Bio-related Chemistry Branch supports basic research in the following areas:

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How does research in biochemistry fit into the wider goals of the NIH? - Open Access Government

Physiology

Novel tool to inducibly knockout genes at cellular resolution in plants – Mirage News

June 29, 2020 medical

Genome editing techniques have revolutionized research in life sciences. The Mhnen group at the University of Helsinki took advantage of these techniques and developed a novel genetic tool for plant research that enables efficient generation of target gene knockouts in desired cell types and at desired times.

Most of the discoveries in the modern plant biology have originated from studies utilizing molecular biology or molecular genetic techniques. In this approach, mutation in a gene i.e. gene knockout reveals its role in a biological process. However, some genes are central players in plant physiology or development a mutation in these genes cause lethality or severe developmental defects. Typically, such mutants have several defects in their development and physiology, thus making it challenging to separate the primary defect from the secondary defects caused by the mutation.

To identify the primary defects of such, essential genes, researchers have developed various conditional gene manipulation systems. However, the challenge is, there are currently no genetic systems available to knockout a gene conditionally, completely or cell-type-specific manner. Such a system would enable identification of primary functions of the essential genes.

Research group led by Dr. Ari Pekka Mhnen is studying development of vascular cambium, a lateral meristem that produces wood in trees and in other plant species. Vascular cambium appears late in development, therefore knockouts in several essential genes cause strong phenotypes in plants long before the cambium has even been established. This makes the identification of the role of the essential genes in cambium development even more difficult than in younger part of plants.

To tackle the problem, Xin Wang, a PhD student in my lab decided to combine a tissue-specific inducible system developed earlier in my lab with the popular CRISPR-Cas9 genome editing system. With such a system, one could knockout genes in desired cells at desired times. Initially, I thought that the genome editing system might not be efficient enough to knockout target genes in the somatic cells. Luckily, he nevertheless decided to generate the system and test it in Arabidopsis thaliana. To my big surprise, the system worked efficiently and precisely in the targeted cells.

The inducible genome editing (IGE) system performed well with three different genes tested. These studies enabled the identification and confirmation of the precise function of the three genes in root development. The IGE system and these findings were published in Nature Plants. Additionally, beyond the published paper, the Mhnen lab has successfully tested the IGE system with several other target genes. Plasmids containing the IGE system has already been distributed to several other labs around the world, thus it is possible that the IGE system will be widely used within plant biology community. Perhaps, with help of IGE system, we will have better understanding how the essential genes function in plants.

Nature Plants: An inducible genome editing system for plants, doi: 10.1038/s41477-020-0695-2

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Novel tool to inducibly knockout genes at cellular resolution in plants - Mirage News

Physiology

Yale researchers find on-off switch for inflammation related to overeating – Yale News

June 29, 2020 medical

Researchers at Yale have identified a molecule that plays a key role in the bodys inflammatory response to overeating, which can lead to obesity, diabetes, and other metabolic diseases. The finding suggests that the molecule could be a promising therapeutic target to control this inflammation and keep metabolic diseases in check.

The study appears on June 29 in the Proceedings of the National Academy of Sciences.

When a person overeats, the body stores excess calories in the form of fat in the adipose tissue, or body fat, said lead author Xiaoyong Yang of Yale School of Medicine. As the amount of calories consumed continues to increase, this leads to inflammation in adipose tissue and the release of fatty acids into other tissues, including the liver and muscles.

This is dangerous, Yang said, and leads to metabolic disorders like diabetes.

Researchers were aware that overeating led to inflammation and metabolic diseases, but until now, they did not know the precise way that the bodys immune cells, such as macrophages which react to excess calorie consumption contributed to this process. The new research by Yang and team zeroed in on a pathway called O-GIcNAc signaling, which activates when a person overeats, instructing the cells to limit inflammation.

Inflammation happens when the bodys immune system reacts to injury or threat, and involves increased blood flow, capillary dilation, and an influx of white blood cells.

The body is smart, said Yang, associate professor of comparative medicine and of cellular & molecular physiology. It tries to protect against inflammation when fat builds up in the body. We discovered a key pathway that quenches inflammation caused by overnutrition.

In particular, the researchers found that OGT (O-GIcNAc transferase), an enzyme that activates GIcNAc signaling, was responsible for activating the bodys pro-inflammatory response by turning on or off a specific signaling pathway in macrophages.

The macrophage can be a good guy or a bad guy, Yang said. It becomes a bad guy in overnutrition, secreting a lot of inflammatory factors. In other contexts, its a good guy and has an anti-inflammatory effect. We found out that OGT tries to stop the macrophage from becoming a bad guy to stop the pro-inflammatory response.

Their finding suggests that OGT could be a target for new therapies to suppress inflammation and improve health.

The study also sheds light on the workings of glutamine and glucosamine, nutritional supplements recommended by doctors for arthritis and inflammation of the joints, Yang said. While researchers have known that these supplements promote O-GlcNAc signaling and reduce inflammation, they did not know how this process worked.

Our finding further implicates how glutamine and glucosamine suppress inflammation, Yang said.

Other members of the Yale research team include Dr. Gerald I. Shulman, Dr. Marie E. Robert, Rachel J. Perry, Yunfan Yang, Xiruo Li, Harding H. Luan, Bichen Zhang, Kaisi Zhang, Zongyu Li, Minnie Fu, Dongyan Zhang, Simeng Wang, Yuyang Liu, Joo Paulo Albuquerque, Qunxiang Ong, Rui Li, and Qi Wang.