Fraunhofer-Gesellschaft zur Förderung der angewandten Forschung e.V. of München at MEDICA 2018 in Düsseldorf -- MEDICA - World Forum for Medicine

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MEDICA 2018 hall map (Hall 10): stand G05, stand H04

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Nov 12, 2018

Individualized therapy for patients with osteoporosis

More than six million people in Germany suffer from osteoporosis. The disease is characterized by chronic bone resorption, leading to frequent fractures as a consequence of the bone loss. In many cases, treating the condition with drugs does not work well, and people with osteoporosis often suffer from cardiovascular diseases at the same time. Research partners in the OsteoSys project are working toward customized, personalized treatment. Researchers at the Fraunhofer Institute for Applied Information Technology FIT are contributing, among other things, their development of a sample management system to the project. This system will be presented for the first time at the MEDICA 2018 trade fair in Düsseldorf.

Osteoporosis sufferers have to cope with bone loss, leading to frequent fractures and unstable, fragile bones. The risk of osteoporosis increases with age. Progressive loss of bone mass leads to complicated fractures, which often results in patients needing long-term care. Health insurance companies project this will cost billions as demographic change takes hold. In Germany, more than six million people already suffer from the widely prevalent disease – most particularly women, who make up 80 percent of the total.

Focusing on the interaction between bone metabolism and the cardiovascular system

Drug therapies are intended to inhibit bone depletion, but patients often do not respond to treatment. Studies also indicate a link between osteoporosis and cardiovascular diseases. Furthermore the primary therapy for loss of bone mass is to increase calcium intake, the mineral is said to increase the stability of the bones. But raising the dosage of the mineral can lead to calcium deposits in veins, leading potentially to an increased risk of vascular occlusion and heart attack. The OsteoSys project (see box “Overview of the OsteoSys project”) therefore aims to investigate the interactions between cardiovascular diseases, inflammation, and bone metabolism, with a view to providing patients with personalized therapy and minimizing drug-related side effects.

Whether genetic or epigenetic (the influence of the environment on genes), the scientists take factors at the level of cells or organs into account to develop biomarkers and algorithms that predict adverse effects and enable patients to receive individualized treatment. The role of the Fraunhofer FIT researchers in Sankt Augustin is to integrate data and create algorithms and models for the project. They are also establishing a sample management system and biobank management tools. “The software we develop to manage samples and laboratory procedures supports physicians in handling samples. Efficient data management supports our partners in their research work through the secure and traceable exchange of data, samples, and information,” says Carina Goretzky, a scientist at Fraunhofer FIT.

The sample management software platform will be on display at the Fraunhofer booth (Hall 10, Booth G05/H04) at the MEDICA trade fair in Düsseldorf from November 12 to 15.

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Nov 12, 2018

No chance for bacteria on implants

Hip and dental implant operations are routine. But not entirely risk-free. They may result in infection that is difficult to control with oral or intravenous antibiotics. In such cases, the implant will probably need to be replaced. Fraunhofer researchers can now apply a precisely matched drug directly to the replacement implant while significantly increasing the effectiveness of the antibiotic via a synergism with silver ions. Their research will be on display at the MEDICA and COMPAMED trade fairs in Düsseldorf from November 12 to 15, 2018 (Hall 8a, Booth P13).

Every step is painful – there’s no getting around a new artificial hip joint. But such operations carry the risk of bacteria getting into the wound and developing into severe infections. Normally these are treated with antibiotics. However, some germs are resistant to certain antibiotics, and administering a strong enough dose of oral or intravenous antibiotics to eliminate all the pathogens on the implant is often impossible. The implant becomes unstable and needs to be replaced. Just how can another infection be avoided?

Significantly increasing the antibiotic’s efficacy

As part of the “Synergy-Boost” project, researchers at the Fraunhofer Institutes for Manufacturing Technology and Advanced Materials IFAM, for Molecular Biology and Applied Ecology IME, for Cell Therapy and Immunology IZI, and for Toxicology and Experimental Medicine ITEM have together developed a technique for preventing further infection. “We apply the antibiotic needed directly to the second implant – bringing it right to the spot where it’s needed,” says Kai Borcherding, a scientist at Fraunhofer IFAM. “We also did research on how antibiotics and silver ions work synergistically, significantly increasing the efficacy of the drug.” While both the antibiotic and the silver ions can eliminate pathogens, their combined effect is much stronger than the sum of their individual effects – they reinforce each other.

Silver ions have long been known to substantially enhance the effect of antibiotics, but research into the mechanism has been limited to isolated experiments. The optimal ratio of silver ions to antibiotic molecules is dependent not only on the drug used, but also on which microorganism is to be killed. The researchers at Fraunhofer IME initially performed large-scale screenings. They investigated 20 different antibiotics with various ratios of silver ions and on four key pathogens – a total of more than 9000 tests – to identify the most effective combinations.

Selecting antibiotics for specific pathogens and applying them topically

If patients suffer from an infection and need a new hip joint or a new dental implant, the first thing the physician will do is to generate an antibiogram. Suitable sample material is taken, the microorganisms from it are cultivated and then analyzed to identify the appropriate antibiotic. This is a standard procedure. The physician then applies the appropriate antibiotic directly to the implant. “At Fraunhofer IFAM, we have already investigated how the antibiotics can be stored,and developed various coating methods to do this,” says Borcherding. The researchers have found a way to structure the surface so that it absorbs the antibiotic. In a vacuum, they apply the coating containing silver to the surface of the implant. Development of the coating process is now complete. Researchers at Fraunhofer IZI and Fraunhofer ITEM must now verify its efficacy. Researchers at Fraunhofer ITEM are also preparing the documentation required for approval of medical devices.

The scientists in the “Synergy-Boost” project are also attempting to answer a further question: Which natural substances from plants or trees might be suitable for synthesizing new antibiotics? The first results from Fraunhofer IZI are promising, but it will take several years before such antibiotics are ready for clinical trials.

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Nov 12, 2018

Treating the fear of spiders with augmented reality

Arachnophobia is the technical term for the fear of spiders. Approximately 3.5 to 6.1 percent of the population suffer from this phobia. Exposure therapy is the most common form of treatment. However, 60 to 80 percent of arachnophobes do not receive any therapy because of a lack of services. Others simply cannot bear the terror of facing up to real spiders. Together with partners, Fraunhofer researchers are developing a digital therapy system that is designed to facilitate treatment in the home environment and give sufferers a better sense of security. A demonstrator of the system will be exhibited at the MEDICA trade fair in Düsseldorf from November 12 to 15 (Hall 10, Booth G05/H04).

In Germany, there are no wild spiders that pose a threat to humans. But that does not stop many people panicking at the sight of one. Their bodies react with heart palpitations, shivering, dizziness, sweating and shortness of breath. Sometimes the psychological stress is so great, the fear so overwhelming, that sufferers of the phobia have to undergo therapy. Behavioral therapy approaches have proved most successful in treating arachnophobia. Exposure therapy, which involves confronting patients with one or more real spiders, is considered particularly effective. However, sufferers of the phobia often do not avail themselves of such treatments, either because exposure to the eight-legged creatures is a too terrifying prospect, or because of a lack of therapy options available where they live.

In the “DigiPhobie” project, researchers at the Fraunhofer Institute for Biomedical Engineering IBMT are working to remedy these problems in collaboration with Promotion Software GmbH, Saarland University and Saarland University Medical Center. They are developing a new kind of digital therapy system that is designed to enable exposure therapy in a domestic environment. It is based on the idea that by confronting the feared object in virtual or augmented reality, patients will find it easier to face their fears and be less intimidated by the prospect of starting treatment. The system comprises a digital therapy environment, wearable sensors and augmented reality (AR) glasses to be precise.

Exposure therapy in virtual reality

“We transfer real exposure therapy to the digital game system that runs on the data glasses. All therapy tasks are digitally simulated. The phobia sufferer can perform various challenges – such as catching a spider with a glass and a postcard or prodding one with their finger – in virtual reality,” says Dr. Frank Ihmig, scientist at Fraunhofer IBMT, describing the therapeutic approach. Ihmig and his team create the software for therapy management and the biofeedback control system, which consists of wearable sensors that measure the patient’s vital parameters during a session, such as their heart rate variability, skin conductance and breathing rate.

Calculating physiological fear responses with a machine learning algorithm

Out of the parameters measured, it is possible to extract features that indicate emotional stress. Using these stress features the researchers train a machine learning algorithm. “With the learning algorithm, we derive the patient’s physiological fear response and try in this way to determine the intensity of their fear. Alongside the subjective perception of the arachnophobe, this provides an objective measure of their fear response. This calculated measure is fed back into the digital therapy game, effectively creating a closed-loop system. In this way, we can adapt the therapy to the personal needs of the patient,” explains Ihmig. Game elements such as the size, number and distance of spiders, as well as the movement behavior of the arachnids, can be adjusted dynamically.

The Fraunhofer researchers use adhe­sive electrodes to measure ECG and skin conductance. Breathing is monitored with the aid of a chest strap with piezoelectric sensors. The measured signals are transmitted wirelessly via Bluetooth to the therapy management software. All data on the sessions and the course of the therapy is archived in the database and made available to therapists and clinical researchers for analysis.

Effectiveness to be determined in clinical study

In spring 2019, a validation study will begin to evaluate the effectiveness of the digital therapy. Similar approaches using virtual reality (VR) glasses have shown that good outcomes can be achieved with this form of therapy. The results of the analyses are to lay the foundation for further treatment concepts. It is conceivable, for example, that the therapy could be applied to other phobias such as the fear of snakes or cockroaches. “We hope that the results of the clinical study open up new perspectives for treating patients suffering from specific phobias,” says Ihmig.

On top of this, the results provide the basis for developing a kit containing the complete therapy set. “The long-term goal for patients is to be able to borrow the kit from their doctor’s office or pharmacy or medical equipment store and carry out individual sessions and exercises at home,” says Ihmig. The researcher and his team will be presenting the biofeedback system at the joint Fraunhofer booth (Hall 10, Booth G05/H04) at the MEDICA trade fair in Düsseldorf from November 12 to 15.
The German Federal Ministry of Education and Research (BMBF) is funding the “DigiPhobie” project, which runs from 2017 to the end of 2019, as part of its “Medical Engineering Solutions for Digital Health Care” initiative.

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Nov 12, 2018

Interactive shutter eyeglasses to replace eyepatch therapy

The standard treatment for so-called lazy eye (amblyopia) in children is to cover the nonimpaired eye with a patch. This trains the impaired eye to work harder. Such therapy is successful only when the patient wears the eyepatch for the prescribed period of time. This is often not the case, however, as many children feel self-conscious about wearing the patch and reject this form of treatment. A future alternative is electronic shutter eyeglasses that automatically darken the lens in front of the nonimpaired eye when the context is appropriate. These eyeglasses also have integrated sensors that provide young wearers with feedback on whether they are being worn in the correct position. Fraunhofer researchers will be exhibiting a functional model of the electronic shutter eyeglasses at the MEDICA trade fair in Düsseldorf from November 12 to 15 (Hall 10, Booth G05/H04).

Lazy eye is a common complaint among children. The standard treatment for this visual impairment – amblyopia, as ophthalmologists call it – is to cover up the good eye with a patch. This trains the lazy eye to work harder – and the brain to receive its signals. The sooner treatment begins, the greater the chances of recovery. However, there are two main drawbacks to this form of occlusion therapy: vision is spatially restricted, and children often experience the eyepatch as unsightly and therefore refuse to wear it. Moreover, such treatment is successful only when the eyepatch is worn for the prescribed period of time. In a collaborative project (see box “InsisT – project overview”), research and industry are aiming to achieve a decisive improvement in this often difficult therapy for young children. They hope that new interactive, context-dependent shutter eyeglasses with sensor-based feedback will increase treatment compliance for this complaint. This new technology covers up the patient’s good eye only when the situation is appropriate. During sport, for example, or other activities that demand good spatial vision, this function is deactivated so as to avoid any risk of accident.

Multimodal sensor system integrated in temples

Use and operation of the shutter eyeglasses are controlled by a multimodal sensor system integrated in the temples of the eyeglasses. Researchers at Fraunhofer Institute for Biomedical Engineering IBMT have developed this new technology along with a smartphone app to enable parents to monitor the treatment. All the data generated by this technology is compiled in a digital patient file system, which was also developed by the IBMT team. This web-based application is compliant with data-protection laws and can be accessed by the ophthalmologist in order to monitor, adjust and enhance treatment. For example, it tells the doctor if and when the patient has worn the eyeglasses – information that was never available with conventional treatment. “The data is uploaded to the app via Bluetooth and then securely archived in a cloud database,” explains Dr. Frank Ihmig, a scientist at Fraunhofer IBMT in St. Ingbert. “Our goal is to provide an individual, patient-based therapy.”

Boosting therapy acceptance

Data for real-time processing is generated by various sensors. These include temperature and skin-contact sensors to monitor the length of time and the position in which the eyeglasses have been worn. They also measure the occlusion phases, during which the LCD lenses are darkened. “This data is logged in an electronic memory device integrated in the eyeglass frames,” Ihmig explains. The eyeglass lenses are darkened by means of an electronically controlled shuttering system based on integrated liquid crystals. The frequency and duration of the occlusion therapy can be individually adjusted to each specific case. It is therefore more versatile than conventional eyepatch treatment. In this way, project partners hope to encourage young patients to wear the eyeglasses for the prescribed duration. The skin-contact sensors monitor whether the eyeglasses are being worn in the correct position and even provide the young wearer with child-friendly feedback. This can help increase acceptance for this form of therapy, too.

An acceleration sensor recognizes specific patterns of movement and can distinguish between different activities such as standing up, lying down, sitting down, walking, running, jumping, cycling and climbing stairs. “Our shutter eyeglasses are context-sensitive,” Ihmig explains. “This means that when the wearer is involved in energetic activities such as sport, for example, the mechanism for darkening the LCD lenses is deactivated, and they remain clear. This ensures full spatial vision and removes the risk of the wearer being involved in an accident.”

Initial tests with amblyopic children are scheduled for the second quarter of 2019. In addition, it is hoped that a validation study to be conducted toward the end of the project will confirm the medical benefits of the therapy.

Researchers have already developed a first functional model of the electronics for the new eyeglasses. The next step will be to make these smaller so they can be integrated in children’s eyeglass frames. In parallel, they are working to make the electronics more energy-efficient and thereby prolong battery life. The battery is recharged inductively, i.e., without a cable. The functional model will be on display at the joint Fraunhofer booth (Hall 10, Booth G05/H04) at the MEDICA trade fair in Düsseldorf from November 12 to 15.

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Oct 23, 2018

Fraunhofer FIT at MEDICA and COMPAMED: Electrowetting and Telemedicine

At MEDICA Fraunhofer FIT presents the teliFIT platform for telemedicine and telecoaching, a modular system that can be tailored to a wide range of application requirements and guarantees a very high level of data security. At COMPAMED we present our EWOD-BioPro system that combines electrowetting and confocal microscopy and thus makes it possible to observe the process of biochemical reactions at the single-molecule level.

An important aspect of pharmacology is to understand how active drug ingredients cross-react with endogenous molecules. But until now, such reactions could only be determined after the event. The precise details of the interacting factors remained unclear. Researchers at Fraunhofer FIT have developed a system that now allows monitoring biochemical reactions at the single-molecule level from start to finish. It is based on the physical effect of ElectroWetting-On-Dielectric (EWOD), widely used in micro-fluidics. Our EWOD-BioPro system is capable of merging reagent droplets as small as 150nl with very high precision. This allows us to monitor the reaction process using a confocal microscope adapted at FIT, and to record high-resolution measurements.

"For the first time we can observe the details of how the two droplets interact at the single-molecule level – thus allowing us to monitor the entire chain of events," says Lorenz Sparrenberg from the Fraunhofer Institute for Applied Information Technology
FIT, who is leading the research project.

Thus, we can study biological interactions under conditions closely resembling those that occur naturally in the human body. In pharmacology, for example, it is important to understand the effects of drug ingredients as precisely as possible and know when these effects occur. But the combination of EWOD and confocal microscopy may also be used to study the interaction between complementary DNA strands, antibodies and antigens, or enzyme-substrate reactions.

Conventional laboratory tests not only deliver less information but also require much higher quantities of the sample liquids, and take longer to perform. The typical duration of an enzymatic assay, for example, is around 15 – 20 minutes. The EWODBioPro
system can present the results within 30 seconds. It may thus be a further step  towards point-of-care diagnostics, where test are carried out at the bedside in hospitals or in the physician's office instead of sending samples to a central laboratory.

The EWOD-BioPro system will be presented at COMPAMED, in Düsseldorf, 12 – 15 November 2018, hall 8a, booth P13.

teliFIT – Intelligent platform for telemedicine and telecoaching

The teliFIT platform features a modular, expandable architecture. It can accommodate a multitude of user groups with their specific access rights and can easily be tailored to a wide range of design requirements, contents and functions. The platform's current functionalities may be grouped in five categories: Communication, Monitoring, Analysis, Smart Data Services and Safety & Security. Individual functions can be activated or extended as required.

Smart devices can be used to capture and upload data to the teliFIT platform. Processing results are presented in visually attractive charts, but also offer relevant context. For example, teliFIT offers a nutrition diary that automatically evaluates the calories taken in against the user's individual basic requirement. Actual intake is also evaluated in relation to agreed nutritional goals.

Data security has been a major design criterion for the teliFIT platform. Personal data is routinely encrypted and stored in a separate database. The teliFIT platform is hosted in Germany. Its resilience is checked regularly through external penetration tests. There is a stable code base that includes high quality software and architecture. Due to the use of state-of-the-art software technologies, the platform is easily scalable.

The teliFIT platform will be presented at MEDICA in Düsseldorf, 12 – 15 November 2018 (Fraunhofer-Gemeinschaftsstand, hall 10, booth G05).

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Oct 23, 2018

Artificial Intelligence for Optimal Patient Care

Artificial intelligence is defining medicine and opening up new possibilities for everyone involved on the path to individual health. At the MEDICA trade fair, from November 12 to 15, 2018 in Düsseldorf, Germany, researchers from Fraunhofer IGD will present new technology for virtual biopsies and cohort analysis that utilize artificial intelligence.

(Darmstadt/Düsseldorf) When a person is taken to the hospital - with a tumor in the head and neck region, for example - the first step is a comprehensive diagnosis: The shape and location of body structures such as organs, tissue and tumors need to be identified and highlighted in medical imaging data. However, with three-dimensional imaging, such as MRI or CT, doing this manually is extremely laborious and time-consuming. Special software developed by the Fraunhofer Institute for Computer Graphics Research will soon assist health professionals not just in this type of analysis of imaging data, but it will also automatically generate a “virtual biopsy”, localizing and highlighting the tumor, displaying it three-dimensionally and analyzing the data. This will allow the software to derive over a hundred parameters from the CT images of a head and neck tumor. Initial results show that this approach not only analyzes CT images more quickly, it also provides information that could only be obtained through a surgical procedure and subsequent lab testing of the biopsied tissue. Aside from imaging organs and body regions, artificial intelligence is making it possible to automatically segment and analyze imaging data that is difficult to interpret.

Diagnosis and treatment in the “Smart Hospital”

Another interesting question doctors face is whether there are noticeable connections between the person being treated and other people. To answer this, health professionals combine the data of people with similar clinical pictures or other similarities, such as age or gender, into cohorts. The researchers at Fraunhofer IGD have developed software to assist doctors in forming suitable cohorts, examines them for significant connections, visualizes the attributes, and facilitates and accelerates the identification of clinically relevant hypotheses. What took several hours to do manually will take this automatic process mere seconds - valuable time gained for treating the patient. Incorporating artificial intelligence in the search for a hypothesis
also ensures that a potentially critical factor is not overlooked.

More time for patients with a visual control station

Created by compiling all relevant parameters, the patient’s »digital twin« contributes to optimal care. Health@Hand, Fraunhofer IGD’s visual solution, combines all digitally available data, including the patient’s real-time vitals, into a graphic overview. As a digital control station, the system provides hospital staff with all relevant information with just a click and reprocesses it visually. This means necessary information is collected considerably more quickly. However, the control station is not content with just showing a single patient, rather it shows a live 3D model of the entire hospital ward, including inventory. Doctors and nurses can view the digital twin of the station on a PC or tablet and immediately know where, for example, a mobile X-ray machine is currently located. Key data for the entire ward can either be displayed all at once or viewed in detail - for a single room or over a given period, for example. The goal is to simplify ward monitoring, detect disturbances immediately and thus be able to intervene in time.

Preventive and follow-up care in the age of digital health

To analyze an individual’s health information, the Health@Hand system links together crucial data from different clinical data systems to make possible entirely new conclusions. Trends in the patient’s health can be identified sooner and prognoses for the treatment process made more quickly. To maintain a patient’s health even at home, continuously recorded vitals can be supplied directly to the system. This would be sensible for, say, diabetes: The doctor immediately sees when levels exceed normal range and can take appropriate action. Even vitals and activity data from wearables, such as fitness armbands or smartwatches, can be included in the system, allowing it to act as a personal health assistant and make a valuable contribution to prevention.

Fraunhofer IGD at MEDICA
Düsseldorf, November 12 - 15, 2018
Hall 10, Stand G05

At noon on Wednesday, November 14, 2018, Matthias Noll will be at the Medica Connected Healthcare Forum in Hall 15, Stand C24 to give a talk on »Augmented Reality in the OR«.

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