Transonic Signs Joint Venture with Nipro Corporation

Transonic Nipro Corporation Officers Sign Joint Venture

Nipro Corporation (Osaka, Japan) and Transonic Systems Inc. (New York, USA) have formed a joint venture under which Nipro will receive exclusive marketing and sales rights for all non-OEM Transonic products in Japan. Through this exciting venture, Nipro and Transonic expect to combine their synergies to propel their similar Missions – to Provide Innovative and Patient-oriented Solutions for Healthier Lives (Nipro), and to Advance Meaningful Measurements (Transonic).

Nipro and Transonic have already partnered for more than a decade to establish best practices for hemodialysis patients in Japan. Now the Nipro-Transonic JV will provide a critical link between Transonic’s USA R&D and manufacturing operations and Japan where the Nipro–Transonic JV will import, register, and service all products. Nipro’s superior marketing, sales and customer support network will serve as the exclusive distribution channel, both for existing Transonic products in Japan as well as for Transonic’s more innovative technologies yet to be introduced to the Japanese market.

For More Information Contact:

For Nipro Corporation: 
Kimihito Minoura, Minoura-kimihito@nipro.co.jp; phone: +81-6-6372-2331

For Transonic Systems Inc.: 
Miriam Tenorio, Miriam.tenorio@transonic.com; phone: +1-607-257-5300

 

 

 

 


Lamb Research model shows promise in prevention of asphyxiation and cardiac complications for pre-term deliveries

Fetal Sheep Model with Flowprobe Instrumentation Sites

Diagram of preterm sheep model Flowprobe instrumentation

Measurement of blood flow in chronically-instrumented fetal sheep has been used extensively in pregnancy research to study fetal growth, metabolism and changes associated with parturition.
A recent publication by Professor Smolich and his colleagues from the Australia Heart Research Group, Murdoch Childrens’ Research Institute, in Parkville, Australia uses the pregnant sheep model to investigate the onset of asphyxia during the non-respiring interval between clamping the umbilical cord and post birth ventilation. They know that, experimentally, clamping the cord for 2 minutes in preterm lambs will increase hemodynamic changes during the birth transition. They sought to determine whether these changes are related to development of asphyxia after cord clamping, or can be avoided with a shorter clamp-to-ventilation interval.

For their study, 12 preterm fetal lambs (gestation 127 ± 2 days) were anesthetized and then instrumented with:

  • 3 mm Transonic Flowprobes on the left and right carotid arteries;
  • For right ventricular (RV) output, 8-10 mm Transonic Flowprobe was applied to the ductus arteriosus and 4-6 mm Flowprobe was applied to the left pulmonary artery.
  • For left ventricular (LV) output, 4-6 mm Transonic Flowprobe was applied to the brachiocephalic trunk & 6 mm Flowprobe was applied to the aortic isthmus.
  • Superior vena cava, and aortic and pulmonary trunk catheters were inserted for fluid administration, pressure measurement and blood gas analysis.

Fetal hemodynamics were recorded continuously as each fetus was delivered onto its ewe’s abdomen. In 8 fetuses, the umbilical cord was clamped for 1.5 minutes before ventilation, with aortic sampling at 15, 30, 45, and 60 seconds. In four fetuses, the umbilical cord was clamped for 0.5 minutes before ventilation with sampling every 15 seconds.

The researchers found that when the umbilical cord was clamped for 1.5-minutes, asphyxia, exhibited by bradycardia and left ventricular output falling by 60% and right ventricular output falling by 50%, was evident at ≥ 45 seconds. After the onset of ventilation, tachycardia ensued along with four- and three-fold surges in left ventricular and right ventricular outputs respectively.
In contrast, heart rate and outputs remained stable after 0.5-min cord clamping, with no post-ventilation change in heart rate or RV output, and a lesser rise in LV output (22%, P < 0.005).

These results led the group to conclude that, in preterm lambs, rapid development of asphyxia within 45 seconds in the cord clamp-to-ventilation interval increased hemodynamic changes during the birth transition. This was reduced with a shorter (0.5 min) cord clamp-to-ventilation interval.

REFERENCE:
Smolich JJ, Kenna KR, Cheung MM3, Onset of asphyxial state in nonrespiring interval between cord clamping and ventilation increases hemodynamic lability of birth transition in preterm lambs, J Appl Physiol (1985). 2015; 118(6): 675-83. Transonic Reference # 11105A)

 

Download
Smolich’s papers

 

 

 

 


Dr. Fady T. Charbel to be Recognized for his Contributions to Cerebrovascular Surgery

Dr. Fady T. Charbel

Fady. T. Charbel, M.D., F.A.C.S

Download Flow Assisted Surgical Techniques during Cerebrovascular Surgery.

For his championing of quantitative measurements before, during and after cerebrovascular neurosurgery, Dr. Charbel, Head of the Department of Neurosurgery and Chief of the Neurovascular Section at the University of Illinois at Chicago, has been chosen to receive the prestigious 2017 Cushing Award for Technical Excellence and Innovation in Neurosurgery from the American Association of Neurosurgeons (AANS). The award recognizes Dr. Charbel’s development of intra- and perioperative blood flow measurement concepts, as well as his adoption of and championing of ultrasonic transit-time technology for real-time intraoperative quantitative measurements of intracranial vessels. The award will be presented to Dr. Charbel at the Society’s annual meeting in Los Angeles from April 22-26th.

During the late 1980s, while he was a fellow at Henry Ford Hospital in Detroit, Dr. Charbel began his pioneering exploration of quantitative measurements of cerebral flow. He would visit the Detroit morgue where he would set up test flow systems to measure blood flow through cerebral vessels with early Transonic Flowprobes. 

Charbel-Micro-Flowprobe Designed

A few years later, Dr. Charbel collaborated with Transonic Systems to co-invent the Charbel Micro-Flowprobe® that features a bayonet handle that can be used with a surgical microscope. The Flowprobe is applied to cerebral vessels for on-the-spot measurements of flow to help guide the surgery. It helps surgeons achieve optimal clip placement to completely obliterate an aneurysm without compromising flow in parent vessels and distal branches, and thus preventing a devastating intraoperative stroke. The probe also provides on-the-spot quantitative information in extracranial to intracranial (EC-IC) bypass procedures, arteriovenous malfunction obliterations (ATMs), dural fistula obliterations and tumor resection surgeries.

F.A.S.T.

Dr. Charbel coined the phrase and acronym Flow-assisted Surgical Technique in Cerebrovascular Surgery (F.A.S.T.) to describe his use of flow measurement to guide his surgical procedures. He has traveled the globe tirelessly championing quantitative flow measurements to guide optimal surgical decision making. His publications number in the hundreds. He has inaugurated an International Flow Symposium at which esteemed cerebrovascular neurosurgeons gather to present cases, and discuss issues and challenges. Furthermore, he has conducted hands-on workshops to teach proper flow measurement techniques.

NOVA

After he was able to quantify blood flow during surgery, Dr Charbel was continually frustrated by the fact that there was no way to determine the volume of blood flow in vessels outside of the operating room. He recognized a need for a non-invasive method to quantify blood flow before and after treatment. Undeterred, Dr. Charbel formed a multi-disciplinary team of physicians and scientists at the University of Illinois who developed a software platform that creates a 3D imaging model that works with Magnetic Resonance Imaging (MRI) data to provides images of individual vessels along with blood flow measurement data. NOVA quantitative MRA now gives stroke specialists a powerful tool to quantify cerebral hemodynamics and help assess their patients’ risk of stroke as well as range of other cerebrovascular conditions. For his accomplishment in bringing quantification of flow to cerebrovascular neurosurgery Dr. Charbel is truly a flow measurement pioneer.

Harvey Williams Cushing: Father of Neurosurgery
 

Harvey Williams Cushing: Father of NeurosurgeryBorn in Cleveland, Ohio in 1869, as the youngest of ten children, Harvey Williams Cushing was an early surgical pioneer. He is known, along with Ernest Sachs, as the "father of neurosurgery." Cushing’s early education was at Cleveland’s Manual Training School. He then went to Yale for his undergraduate degree and to Harvard for his M.D. degree. His residency was at Johns Hopkins Hospital where he was mentored by the famous surgeon William Stewart Halsted.

During the first decades of the 20th century, first in Baltimore in private practice, and then as professors at Johns Hopkins and Harvard Medical School, Dr. Cushing developed many of the basic surgical techniques for operating on the brain and was the world's leading teacher of neurosurgeons. Through his influence neurology and neurosurgery emerged as distinct surgical disciplines. His many pioneering accomplishments included:

  • Using X-rays to diagnose brain tumors;
  • Using electrical stimuli for study of the human sensory cortex;
  • Operating under local anesthesia;
  • Helping to develop an electrocautery tool with William T. Bovie;
  • Developing, during World War I, a surgical magnet to extract fragments of shrapnel that were lodged within the brains of wounded soldiers;
  • Identifying Cushing’s syndrome, a tumor of the pituitary;
  • Development of many surgical instruments including the Cushing forceps.

His accomplishments brought Cushing much acclaim and many awards including a 1926 Pulitzer Prize for his biography of Sir William Osler. He was also a candidate for the Nobel Prize in Physiology or Medicine more than 38 times.

 

 

 


Young Scientist Awarded Funding from the British Heart Foundation to Tackle Kidney Disease

Choosing a career in science has become almost as uncertain as following a career in the arts.  None-the-less, Maarten Koeners, PhD. (Bristol U., UK) is following his passion in the physiological sciences and meeting success!  The British Heart Foundation is funding and showcasing Dr. Koeners’ exploration into the root causes of kidney disease. He wants to find out how kidney disease develops and worsens over time, and how it can be slowed down and even stopped. He says: “I am hoping to make new breakthroughs, contributing to a cure for chronic kidney disease. We need to understand how and why someone develops chronic kidney disease and others don’t.”

In an article published on the British Foundation’s website Heart Matters. Dr. Koeners adds: “My ultimate aim is to go through the whole process identifying, measuring and testing something that would help us develop new treatments, or improve diagnosis, or both. Diagnostic techniques are important too – because better diagnosis means a patient can then be treated in an earlier phase of the disease and/or monitored closely to see which treatment they will need.”

Using Telemetry to Study Physiology

To do this, he’s studying how kidneys communicate with regulatory systems of the body. 
He is using telemetry systems to measure kidney function, blood pressure, blood flow, tissue oxygenation, and nerve activity in rats. Although telemetry has already been used to measure pressure, Koeners is now using it to also record kidney tissue oxygenation and blood flow simultaneously. This is unprecedented. Transonic’s Senior Research Product Manager reports that Dr. Koeners has helped to incorporate an oxygen sensor into his EndoGear protocol and will be the first to measure true volume blood flow with transit-time probes by telemetry in unrestrained rats. He plans to instrument four rats with two 1 mm probes each to simultaneously record renal and carotid blood flow, systemic pressure and pO2 (oxygen partial pressure; dissolved oxygen in the blood). 

High Blood Pressure and Oxygen Consumption Are Research Focus

Dr. Koeners notes that more than 65 percent of CKD patients have high blood pressure so he is trying to find a way to effectively control blood pressure to lower the incidence of kidney disease. Another focus of Dr. Koeners research is kidney oxygenation. Although the kidneys represent just one per cent of body weight they use 10 percent of the body’s oxygen. All this lends itself to the kidney not having the oxygen levels it needs to function so Dr. Koeners is looking at how this is related to the development of chronic kidney disease.

Dr. Koeners is also involved in tests of potential new treatments and says that he wants to be able to translate the results he finds into real benefits for patients with CKD. His research is funded by the British Heart Foundation through a project grant and an intermediate basic science research fellowship. He has recently accepted a Senior Research Fellowship at University of Exeter Medical School, UK. 

To read more see: www.bhf.org.uk/ckd

 

 

 


Detecting Dysfunctional Hemodialysis Catheters

The Hemodialysis Monitor’s Underused Capability

Hemodialysis Catheter
 

It is well known that central venous catheters (CVCs) are prone to thrombosis and infection, yet the rate of central venous catheter use during the first 90 days of an end-stage renal disease (ESRD) patient’s hemodialysis treatment remains unacceptably high at nearly 80 percent. The Fistula First-Catheter Last (FFCL) Initiative underscores inherent dangers of CVCs and seeks to decrease the use of long-term catheters (>90 days) to less than 10 percent.
KDOQI Guidelines define central venous catheter dysfunction as failure to attain and maintain blood flow sufficient to perform hemodialysis without significantly lengthening hemodialysis treatment. The Guidelines recommend catheter blood flow be maintained at more than 300 mL/min to ensure adequate hemodialysis.

Ensuring the Hemodialysis Prescribed Dose Delivery Through Catheters
Two potential problems can impede the optimum use of catheters for dialysis delivery.

  1. A tissue flap and/or fibrin sheath can block the lumen of the catheter’s arterial entry port and could cause a severe drop in dialysis dose delivery.
  2. The close proximity of the catheter’s arterial entry and venous return ports make recirculation likely. High recirculation can result in underdialysis.

The Hemodialysis Monitor’s Test for Delivered Blood Flow
By simply comparing the dialysis pump’s flow reading with the Transonic’s Delivered Blood Flow reading the hemodialysis nurse or tech can check if catheter blood flow is more than 300 mL/min to ensure adequate hemodialysis as recommended by the KDOQI Guidelines.

Testing for Recirculation to Optimize Dialysis Delivery
The Transonic’ Hemodialysis Monitor can also be used to measure recirculation in catheters as well as in AV accesses. If recirculation is unacceptably high, the dialysis delivery parameters (time, pump setting etc.) can be adjusted to compensate for recirculation and deliver the optimum prescribed dose of dialysis to the patient. If the dialysis lines to the catheter are found to be inadvertently reversed, correcting them might also correct high recirculation.

Recirculation/Delivered Blood Flow Standing Orders for Catheter Hemodialysis Patients
For those patients who have had hemodialysis initiated with a catheter or whose prevalent access is a catheter, a standing order is recommended that would order the use of the Transonic Hemodialysis Monitor to measure recirculation in the catheter and delivered blood so that catheter placement and dialysis delivery is optimized in the ESRD patient.

Case Report:
Transonic Hemodialysis Monitor Detects Hemolysis Risk

 

65-year old male with ESRD undergoing hemodialysis with a central venous catheter.  The patient also has a newly created AV fistula in his upper arm on the same side as the catheter.  The blood lines were in the reversed position.  The pump was set to 350 mL/min.  However, the Delivered Blood Flow as measured with a Transonic Hemodialysis Monitor only registered 310 ml/min.  The lines were checked to see that they were not kinked.  The recirculation was then measured.  The recirculation was 43%.  The test was not repeated with the blood lines changed to the normal position due to no blood return from the arterial hub when the catheter holding solution was attempted to be fully withdrawn pre-dialysis initiation. The care team now had Delivered Flow and Recirculation to share with the nephrologist and vascular access care team to evaluate the feasibility of using the AV fistula and removing the catheter or having the dysfunctional catheter replaced.   

Take Home
Catheter patient treatment can be optimized with the Hemodialysis Monitor’s Delivered Flow and Recirculation measurements.