NO1, artificial retina system This year, the U.S. Food and Drug Administration (FDA) approved the use of a small implant to help patients who suffer from macular degeneration and retinitis pigmentosa (RP), which causes blindness. The artificial retina system, called Argus II, was approved by the FDA in February for patients with severe RP, a serious genetic condition that causes degenerative retinal disease. According to the Foundation Fighting Blindness, there are about 100,000 people in the United States with RP. Doctors can use this artificial retina system to implant an array of electrodes into a patient’s eye, and with the help of glasses with a video camera and a processor worn around the waist, the patient can see again and distinguish between light and dark. At least five other research groups around the world are known to be developing artificial retina systems. In July, a German company developed the AlphaIMS system, which received European approval. Previously, the company’s initial research results were satisfactory: for example, patients could recognize store signs, doorknobs and certain movements. NO2, genomic-guided diagnosis of solid tumors Back in 2011, researchers at Cleveland Medical Center published initial research results: studying DNA in prostate cancer by some method can help determine how the tumor is developing, and determine whether the tumor is more aggressive and needs immediate treatment, or is slow-growing and can be left under close observation. This genomic approach is also used to determine whether breast cancer patients need post-operative chemotherapy. Earlier this year, a much larger study confirmed that this approach is also applicable to prostate cancer. Together with genetic analysis, this technique has become quite widespread. As a result, the researchers believe that cancer research is entering a “new era”. Dr. Eric Klein, president of the Glickman Urological and Renal Society at Cleveland Medical Center and a member of the original research team, said 80 percent of cancer patients today are receiving standard treatment, but 20 percent are not. “There will come a day in the future when we can say to that 20 percent of cancer patients, ‘You can just take this more effective therapy,'” he said. Klein described how Cleveland Medical Center recruited 200 patients with solid tumors who were not receiving other treatments and turned their tumors over to Massachusetts-based genomic company FoundationMedicine for analysis. The company will provide treatment recommendations to each patient based on the genetic information collected on their tumor tissue. NO3: Reactive neurostimulator for intractable epilepsy In the United States, more than two million people have epilepsy, and nearly one-third of them end up with seizures for which treatment is ineffective. In February of this year, the FDA’s Neurology Advisory Panel recognized a reactive neurostimulator: a device implanted beneath the surface of the skull that analyzes the pattern of electrical signals generated by “seizure triggers in brain regions,” capturing seizure stimulation signals and short-circuiting them with rapid electrical impulses. This responsive neurostimulator, called NeuroPace, is similar to other neuromodulation devices on the market, including last year’s neuromodulation device for headaches, which can be implanted in the upper gums to relieve migraines or cluster headaches by sending electrical stimulation. NO4, hepatitis C antiviral oral drugs Hepatitis C is a viral infection of the liver. Over the past five years, hepatitis C treatments have evolved rapidly, with a variety of drugs with significantly higher cure rates approved by the FDA. Now, the FDA is about to approve a new oral drug to treat hepatitis C that will affect more than 3 million hepatitis C patients in the United States. The drug is called Sofosbuvir, and for the first time in a new generation of drugs, it not only significantly shortens the time required for treatment – typically down to 48 weeks – but also for the first time avoids the pain of interferon injections for patients. NO5, surgical decision support system Cleveland Medical Center anesthesiologist David Brown, chairman in charge of the Institute of Anesthesia, flew over Texas in a private jet about a decade ago when an idea came to him: Why not build a computer and air traffic controller system in the operating room, similar to the one used in airplanes, to send warnings and provide advice on how to operate the surgery? Based on this “inspiration,” Brown and Cleveland Medical Center have been testing the system in the operating room for the past three years. According to Brown, the system monitors patient vital signs and anesthesia status intraoperatively by running a series of algorithms that interface with all devices in the operating room. By using outcome-based, evidence-based data, the system sends warnings or alerts to doctors and nurses when problems may arise. “We also have equipped an operating room suite with a display similar to air traffic control that allows us to know in real time which patient may be on warning; and also which patient is in normal condition.” He said. These warning messages can be transmitted to communication tools such as central monitoring desks, operating rooms or iPhones. brown said that with the system, Cleveland Medical Center has seen improvements in areas such as maintaining postoperative blood pressure. “Doctors in their busyness may overlook phenomena that the computer can detect as long as there are significant statistical indications,” he said, adding, “As a monitor, the computer is actually more alert than a human because it doesn’t get bored or tired. Just program whatever you want to do, and it will do it.” NO6, fecal microbiota transplantation Transplanting feces from a healthy person into the colon of a patient? Sounds gross, but this method has proven to be very effective in treating certain intestinal infections, such as those caused by Clostridium difficile. This infection can cause frequent and severe cramps, abdominal pain and diarrhea, and patients are unable to carry on with their normal lives. It is estimated that C. difficile is directly responsible for 14,000 to 30,000 deaths and indirectly causes 100,000 deaths each year in the United States. To combat C. difficile infections, doctors typically treat with one or two powerful antibiotics, which are costly and sometimes ineffective. In the United States, there is a growing number of hospitals that perform fecal transplants, and they can be done in a variety of ways. The most common method is similar to a colonoscopy. The patient is sedated and anesthetized, and then liquefied donor stool is placed into the rectum through a tube. Fecal transplants can also be performed through a nasogastric tube, which is inserted through the nasal cavity and into the intestine through the pharynx; they can also be performed using an enema. Fecal transplantation is indicated for patients who have failed to respond to conventional therapy. Studies have shown that more than 90% of patients with Clostridium difficile infection who are ineffective with antibiotics or who are highly susceptible to relapse can improve after fecal transplantation. NO7, relaxin for acute heart failure The heart will fail if it cannot pump enough blood to meet the body’s needs. In the United States, heart failure kills 55,000 patients each year. In fact, heart failure is a chronic, persistent disease that cannot be cured and whose symptoms include difficulty breathing and edema. The new drug serelaxin is a synthetic version of the natural hormone “human relaxin-2”. In the near future, it may be used to relieve the symptoms of heart failure and reduce the risk of death. “Human relaxin-2 is present in both men and women and can cause an increase in heart pumping during pregnancy. more than 1,000 patients participated in an initial clinical trial of serelaxin, which was administered intravenously to patients within 48 hours of the onset of heart failure or heart attack. The results showed that serelaxin improved the patients’ symptoms of dyspnea. NO8, computer-assisted personalized sedation system Earlier this year, the FDA approved a device for automated sedation of patients undergoing colon cancer screening. This device can save money on anesthetics. With this device, non-anesthesiologist personnel can use the sedative isoproterenol during the screening process. The device monitors the patient’s vital signs and can alert the physician when abnormalities are detected, and can also wake up over-anesthetized patients through headphones. NO9, TMAO Assay: A New Biomarker for the Microbiome In a lab at the Lerner Research Institute at Cleveland Medical Center, cardiologist Stanley Hazen has been working on a new biomarker related to heart disease that may help identify people at risk for heart attack, stroke and death in ways that traditional risk factors and other screening tools cannot even this. This biomarker, called TMAO (N-trimethylamine oxide), is produced by intestinal bacteria that digest animal foods such as red meat and absorb it, and then process it through the liver. In all three clinical studies, heart disease risk was well predicted by TMAO – patients with the highest blood TMAO levels had a 2- to 2.5-fold higher risk of adverse events than those with the lowest blood TMAO levels. Hazen said the TMAO test has been licensed to Liposcience, a Raleigh-based diagnostic company, and can now be used in clinical trials to help identify people who may be at risk. “I think the immediate clinical benefit of this test is that it can help us identify people who need more aggressive treatment from a cardiovascular disease prevention perspective,” he said. “This test is important, but even more important is the phenomenon that gut bacteria are associated with heart disease. This phenomenon also implies the emergence of new intervention pathways, and these are also areas of interest to us.” NO10, B-cell receptor pathway inhibitors B cells are immune cells that produce antibodies to defend against infection and maintain long-term immunity in the body. But it can also become cancerous, leading to diseases such as Hodgkin’s lymphoma and leukemia. B-cell receptor pathway inhibitors are a new class of treatments that control cancer cell division by interfering with the proteins that allow cancer cells to grow and divide out of control. This offers new therapies for the treatment of cancer. Ibrutinib is one of the oral drugs in this class. The drug targets a protein called Bruton tyrosine kinase and is able to kill cancerous B cells while leaving normal immune cells intact, unlike other existing therapies. The U.S. FDA approved the new drug ibrutinib in August, the final step before the drug is brought to market.