<p>A global mapping of early stage medical technology companies has been implemented. The companies have emerging products within neurology and have undergone an evaluation by clinicians concerning the ability to provide clinical value for Swedish health care. The evaluation process has been executed by discussion with neurologists and neurosurgeons in combination with a literature survey. To limit the evaluation process, areas of stroke, traumatic brain injury, Parkinson’s disease, multiple sclerosis and epilepsy were chosen.</p><p>Some companies turn up to develop more requested products than others. Medfield Diagnostics AB, with their microwave screening product could in the future address the need for fast, accurate and accessible diagnosis of stroke and head trauma. The NBS system from Nexstim Ltd. has potential to provide clinical value by the ability of the products TMS technology to navigate in the brain. Elminda Ltd. product built of an evidence based rehabilitation platform could enhance recovery of patients with neurological disorders on an individual basis. BrainsGate Ltd. product to deliver drugs over the blood brain barrier provides totally new treatment options and NeuroSonix Ltd. ultrasound based product could assist the surgeon and decrease damageable embolic debris. Neurolife non-invasive solutions innovative device, which non-invasively measured the intracranial pressure, would be a totally new way to monitor patients.</p><p>A symposium was organized and three top ranked companies with stroke care products were invited to present their technology for Swedish clinicians in Stockholm. Participating companies were Nexstim Ltd., Elminda Ltd. and Medfield Diagnostics AB, who were all well received and considered to have interesting technologies with ability to provide clinical value.</p>

Vevs-karakterisering med høyoppløsning MAS MR spektroskopi Høyoppløsning MAS er en MR spektroskopisk metode som gir høyt oppløste spekter av faste materialer. I dette doktorgradsarbeidet har høyoppløsning MAS blitt anvendt på forskjellige typer humant vev. Det primære målet var å etablere en metode for å studere biokjemiske egenskaper i vevsprøver, med hovedvekt på vev fra brystkreftpasienter. Prøvepreparering før MAS analyser er enkelt sammenlignet med ekstraksjon. Vi har funnet at oppløsningen i spektrene, og dermed den oppnåelige biokjemiske informasjonen, er tilsvarende som i spekter fra ekstrakter av vevsprøver. En viktig fordel i forhold til ekstraksjons-metoder er at vevsprøven som studeres kan bevares slik at den kan vurderes ved andre metoder etterpå. Organer er gjerne satt sammen av forskjellige typer celler og vev og en slik heterogenitet vil ha betydning for den biokjemiske profilen, siden celler av forskjellig type kan ha forskjellig metabolisme. En del av prosjektet gikk ut på å optimalisere MR eksperimentene med hensyn på biokjemisk informasjon samtidig som at vevsprøven ble bevart for en patologisk undersøkelse. Lav temperatur under analysene ble funnet å være viktig for en slik bevaring av vevet. Vi oppnådde høyt oppløste spekter og har langt på vei kartlagt den kjemiske sammensetningen av intakte vevsprøver. Den metabolske profilen i brystkreftprøver viste en sammenheng med vevs-sammensetning bestemt ved patologi. MR spekter av biologisk materiale kan inneholde hundrevis av topper, og flere av disse kan henge sammen med sykdomsprosesser i vevet. Ved sammenligning av enkelt-topper mot kliniske funn kan man miste viktig informasjon i spektrene som er ikke er synlig for det blotte øyet. Multivariate analyser gjør det mulig å undersøke hele spektrene mot kliniske kjennetegn. I denne avhandlingen har prisipalkomponent-analyse blitt brukt til å korrelere MAS spektrene med pasientenes diagnoser og andre kliniske funn. En studie av livmorhalskreft omfattet vevsprøver fra åtte pasienter med livmorhalskreft og åtte kontroller. Prinsipalkomponent-analyse av MAS spektrene ga to klare grupperinger av de ulike spektrene i samsvar med prøvetype. Den kjemiske profilen bestemt med MAS har en sammenheng med de makroskopiske forandringene i kreftvev fra livmorhals. Hjerneautopsier fra pasienter med en sjelden neurodegenerativ sykdom som rammer barn (neuronal ceroid lipofuscinosis) ble undersøk på samme måte mot autopsier fra personer uten kjent sykdom i nervesystemet. To former av sykdommen var inkludert i studien som omfattet totalt 24 biopsier, og den formen som bryter ut tidligst lot seg skille fra de to andre gruppene. Vevsprøver fra denne gruppen inneholdt svært lite eller ikke påviselige mengder NAA, som syntetiseres og lagres i nevroner. Dette korrelerer med tap av nevroner som er observert hos slike pasienter. Den største studien inkluderte vevsprøver fra svulst og ikke-infiltrert vev (n=18) fra 85 brystkreftpasienter. MAS spekter fra disse prøvene ble undersøkt med hensyn på absolutt konsentrasjon av bestemte metabolitter og ved PCA med hensyn på sammenheng med flere kliniske parametere, som pasientens diagnose, svulstens størrelse og lymfeknutestatus hos pasienten. Det ble funnet flere trender til sammenhenger mellom MAS spekter og kliniske parametere. Det mest lovende resultatet med hensyn på fremtidig klinisk verdi var en mulig korrelasjon med lymfeknutestatus hos pasientgruppen med den vanligste formene for brystkreft. / Paper III is a preprint of an article published in NMR in Biomedicine. http://www.interscience.wiley.com

Atherosclerotic cardiovascular disease is the leading cause of death worldwide. To decrease mortality and morbidity in cardiovascular disease, the development of accurate, non-invasive methods for early diagnosis of atherosclerotic cardiac and vascular engagement is of considerable clinical interest. Cardiovascular ultrasound imaging is today the cornerstone in the routine evaluation of cardiovascular function and recent development has resulted in two new techniques, tissue velocity imaging (TVI) and speckle tracking, which allow objective quantification of cardiovascular function. TVI and speckle tracking are the basis for three new approaches to cardiac and vascular monitoring presented in this thesis: wave intensity wall analysis (WIWA), two-dimensional strain imaging in the common carotid artery, and the state diagram of the heart.   WIWA uses longitudinal and radial strain rate as input for calculations of wave intensity in the arterial wall. In this thesis, WIWA was validated against a commercially available wave intensity system, showing that speckle tracking-derived strain variables can be useful in wave intensity analysis. WIWA was further tested in patients with end stage renal disease and documented high mortality in cardiovascular disease. The latter study evaluated the effects of a single session of hemodialysis using WIWA and TVI variables and showed improved systolic function after hemodialysis. The results also indicated that preload-adjusted early systolic wave intensity obtained by the WIWA system may contribute in the assessment of left ventricular contractility in this patient category. Two-dimensional strain imaging in the common carotid artery is a new approach showing great potential to detect age-dependent differences in mechanical properties of the common carotid artery. Among the measured strain variables, global circumferential strain had the best discriminating performance and appeared to be superior to conventional measures of arterial stiffness such as elastic modulus and β stiffness index. The state diagram is a visualisation tool that provides a quantitative overview of the temporal interrelationship of mechanical events in the left and right ventricles. Case examples and a small clinical study showed that state diagrams clearly visualize cardiac function and can be useful in the detection of non ST-elevation myocardial infarction (NSTEMI).   Even though WIWA, two-dimensional strain imaging in the common carotid artery and the state diagram show potential to be useful in the evaluation of cardiovascular function, there still remains a considerable amount of work to be done before they can be used in the daily clinical practice. / QC 20100705

The sensitivity for observing physiological processes makes nuclear imaging an important tool in medical diagnostics. Different types of nuclear imaging modalities, with emphasis on the software components and image reconstructions, are presented in this thesis:  the Cardiotom for myocardial heart studies at the Karolinska University Hospital, the small animal Positron Emission Tomograph (PET) scanners for research and the SPECT, PET, spiral CT and Cardiotom demonstrators for the Royal Institute of Technology medical imaging laboratory. A modular and unified software platform has been developed for data representation, acquisition, visualization, reconstruction and presentation of the programs of the imaging devices mentioned above. The high performance 3D ML-EM and OS-EM iterative image reconstruction methods are implemented both on Cardiotom and miniPET scanners. As a result, the in-slice resolution of the first two prototypes of the Cardiotom today is the same as the formerly used filtered back-projection, however the in-depth resolution is considerably increased. Another improvement due to the new software is the shorter time that is required for data acquisition and image reconstruction. The new electronics with the newly developed software ensure images for medical diagnosis within 10 minutes from the start ofthe examination. The first system from the standardized production of the Cardiotom cameras is in the test phase. The performance parameters (sensitivity, spatial and energy resolution, coincidence time resolution) of the full ring mini PET camera are comparable to other small animal PETsystems. / QC20100721

Ever since the validation of the tissue velocity echocardiography (TVE) technique more than a decade ago the modality has been used rather successfully in various clinical situations, at rest as well as during stress echocardiography. Hitherto, dobutamine stress echocardiography has been the hallmark of all forms of stress procedures, now with TVE, quantification of the longitudinal motions of the left ventricle shows far superiority, with improved sensitivity and specificity in the functional diagnosis of coronary artery disease. Morever there has been continued interest in this technique for even assessing subclinical myocardial systolic and diastolic function in clinical scenarios like diabetes, hypertension and chronic kidney disease. The aim of the present study was to evaluate left ventricular myocardial functions by applying TVE in human subjects having type 2 diabetes with or without co-morbidities and during changing loading conditions. The effects of changing loading conditions were analyzed during hemodialysis and following oral administration of an AT1 receptor blocker. The studied subjects included individuals with diabetes as well as those with associated hypertension, coronary artery disease, microalbuminuria and end-stage renal disease. All patients with type 2 diabetes and co-morbidities underwent TVE enhanced dobutamine stress echocardiography while load dependant left ventricular functions were analyzed at rest. There were 270 subjects in the study of type 2 diabetes and associated cardiovascular diseases and 101 subjects in the study of changing loading conditions. Patients with type 2 diabetes revealed subclinical left ventricular dysfunction characterized by reduced functional reserve. This influence becomes quantitatively more pronounced in the presence of coexistent coronary artery disease and hypertension. The coexistence of type 2 diabetes and hypertension appears to have additive negative effect on both systolic and diastolic left ventricular function, even in the absence of coronary artery disease. The presence of microalbuminuria in type 2 diabetes patients does not worsen diminished myocardial functional reserve. A single session of hemodialysis improves left ventricular function in patients with end-stage renal disease only in the absence of type 2 diabetes and co-morbidities, while a single dose of an AT1 receptor blocker valsartan results in reduction of afterload and, subsequently, in improvement of left ventricular function. TVE appears to be a sensitive tool for objective assessment of left ventricular function and can be successfully applied for the clinical evaluation of the effect of type 2 diabetes and co-morbidities on myocardial performance. / QC 20100709

A global mapping of early stage medical technology companies has been implemented. The companies have emerging products within neurology and have undergone an evaluation by clinicians concerning the ability to provide clinical value for Swedish health care. The evaluation process has been executed by discussion with neurologists and neurosurgeons in combination with a literature survey. To limit the evaluation process, areas of stroke, traumatic brain injury, Parkinson’s disease, multiple sclerosis and epilepsy were chosen. Some companies turn up to develop more requested products than others. Medfield Diagnostics AB, with their microwave screening product could in the future address the need for fast, accurate and accessible diagnosis of stroke and head trauma. The NBS system from Nexstim Ltd. has potential to provide clinical value by the ability of the products TMS technology to navigate in the brain. Elminda Ltd. product built of an evidence based rehabilitation platform could enhance recovery of patients with neurological disorders on an individual basis. BrainsGate Ltd. product to deliver drugs over the blood brain barrier provides totally new treatment options and NeuroSonix Ltd. ultrasound based product could assist the surgeon and decrease damageable embolic debris. Neurolife non-invasive solutions innovative device, which non-invasively measured the intracranial pressure, would be a totally new way to monitor patients. A symposium was organized and three top ranked companies with stroke care products were invited to present their technology for Swedish clinicians in Stockholm. Participating companies were Nexstim Ltd., Elminda Ltd. and Medfield Diagnostics AB, who were all well received and considered to have interesting technologies with ability to provide clinical value.

Thesis (Ph.D.)--George Mason University, 2008. / Vita: p. 116. Thesis director: Jean Burley Moore. Submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Nursing. Title from PDF t.p. (viewed July 3, 2008). Includes bibliographical references (p. 108-115). Also issued in print.

Thesis--University of Florida. / Description based on print version record. Manuscript copy. Vita. Bibliography: leaves 181-191.

Thesis (M.S.)--Florida State University, 2004. / Advisor: Dr. Gary M. Fournier, Florida State University, College of Social Sciences, Dept. of Economics. Title and description from dissertation home page (Jan. 13, 2005). Includes bibliographical references.

Thesis (Ph. D.)--Illinois State University, 1980. / Title from title page screen, viewed Feb. 23, 2005. Dissertation Committee: Creta Sabine (chair), Ronald S. Halinski, John R. McCarthy, Kathryn W. Smith, Michael J. Svob. Includes bibliographical references (leaves 179-184) and abstract. Also available in print.