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DAILY NEWS AND INFORMATION
FOR THE GLOBAL GRID COMMUNITY / JUNE 16, 2003: VOL. 2 NO. 24
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Special Features:
GRID FOR HEALTH: CAL-(IT)2 AND
UCSD TEAM UP
Dr. Brett Meyer, co-director of the UCSD Stroke Center, announces the $5
million, 5-year award and talks about the scope of the SPOTRIAS project. 5:05
6.5.2003 -- Pioneering techniques to extend time-critical treatment to
potential stroke patients - in larger numbers and to remote locations - will
begin at the University of California, San Diego (UCSD), Stroke Center with a
$5-million, 5-year grant from the National Institute of Neurological Diseases
and Stroke (NINDS) called the Specialized Program Of Translational Research In
Acute Stroke (SPOTRIAS).
Through a collaboration involving the California Institute for
Telecommunications and Information Technology [Cal-(IT)2], the UCSD Jacobs
School of Engineering, and the UCSD Stroke Center, physicians today
demonstrated the ability to evaluate potential stroke victims remotely. What's
significant about this is that now, by integrating and enhancing a set of
telecommunications and information technologies, the limited number of stroke
specialists can use their time much more efficiently to enhance the life
outcomes of a much larger number of potential stroke victims, not only in San
Diego but in areas reached by wireless technologies.
"We are delighted that this project provided an opportunity to not only
piece
together state-of-the-art technologies from Cal-(IT)2 industrial partners,"
says Ramesh Rao, "but also to enhance them in a unique way to provide a
solution that satisfied the needs of this project. We are convinced that what
we have learned from this experience is more broadly applicable." Rao, Cal-
(IT)2 UCSD Division Director and a professor of Electrical and Computer
Engineering in the Jacobs School, played a leading role in organizing this
collaboration. He adds that not only do Cal-(IT)2 industrial partners provide
funds to support research projects and student fellowships, but they also work
with faculty members to integrate their technologies with those of other
partners to create new capabilities.
UCSD Stroke Center director Dr. Patrick Lyden and San Diego Emergency
Medical
Services director Dr. James Dunford comment on the cutting-edge technologies.
1:36
This Multi-Media Telemedical Diagnostic System, as this capability is
known,
integrates expertise and advanced technologies in three areas - video
processing, real-time cellular packet-data transport, and medicine. The
prototype system provides an emergency room or clinic with access to medical
specialists in other locations by means of a common-place personal laptop
computer connected to the Internet via conditioned last-mile access loops and
next-generation QUALCOMM cdma2000 EV-DO cellular data transport technologies.
The system combines advanced video compression and synchronization
technologies from Path 1 Network Technologies Inc. (OTCBB: PNWK), new
technologies to guarantee the quality of service (QoS) for real-time video and
medical telemetry over IP networks, and new mobile wireless data
communications technologies. The unique innovations necessary to adapt the
technologies to the project include improvement of the wireless QoS mechanisms
to help ensure the quality of the video feed to the physician so as to enable
correct diagnosis.
"The projects at UCSD will go a long way to take acute stroke treatment out
to
more patients. Dr. Patrick Lyden and UCSD colleagues will find ways to widen
the window of opportunity for therapy, extend a helping hand to community
hospitals and improve emergency diagnostic procedures," said Mary Ellen
Michel, Ph.D., NINDS program director for the project.
Lyden, director of the UCSD Stroke Center and principal investigator of the
grant, notes that time is critical in stroke treatment. Every 53 seconds in
America, someone has a stroke, interrupting blood flow to the brain. Chances
of recovery are significantly improved if treatment begins within three hours
of stroke onset, but too many strokes result in death or severe disability due
to delays in diagnosis and treatment.
Dr. Meyer and Dr. Ramesh Rao, UCSD Division Director of Cal-(IT)2,
demonstrate
wireless Internet video technology that will permit long-distance, real-time
exams of possible stroke victims. 5:22
Only 30 percent of stroke victims arrive at the hospital in time to be
considered as candidates for an effective type of clot-busting therapy called
thrombolysis. Of these patients, about 20 percent actually receive the
therapy, often because physicians are unsure if the patient is an appropriate
candidate for the treatment.
Long-distance Consultation
Several community hospitals are expected to participate in a UCSD clinical
trial that utilizes this enhanced, broadband wireless Internet technology.
When a suspected stroke patient arrives in the emergency room, the local
physician will send live video of the patient to a wireless, laptop computer
operated by the on-call m ember of the UCSD stroke team. The UCSD stroke
specialist participates in the physical exam as it takes place, consults with
the community physician, and advises in administration of appropriate
drugs.
Ultrasound Diagnosis
To aid in timely stroke diagnosis, UCSD will also investigate the use of
contrast-enhanced ultrasound (CE-US) in a 288-patient clinical trial. This
non-invasive test is administered at the bedside to measure obstruction in
blood vessels. The investigators believe that CE-US will provide physicians
with immediate feedback to determine if the patient is an appropriate
candidate for thrombolytic therapy.
Brain Cooling
The grant will also support the use of a new ultrasound screening tool and
clinical trials using hypothermia - cooling of the brain - as a method to
extend the window of treatment effectiveness from three to six hours following
stroke onset.
INNERCOOL Therapies director of marketing Brad Klos demontrates
brain-cooling
intravascular catheter technology to be used in the trials. 1:30
"While these projects will aid early identification of stroke patients, we
would also like to extend the window for therapeutic intervention after acute
ischemic stroke beyond the current three-hour limit," Lyden said. "We may be
able to obtain the extra time with hypothermia. Cooling the brain could
preserve brain cells longer, allowing us to administer thrombolytic therapy up
to six hours after stroke onset."
Noting that surface cooling techniques such as ice water baths and
air-cooled
blankets cause complications and fail to adequately cool patients, Lyden is
utilizing INNERCOOL Therapies' catheter technology that allows intravascular
cooling methods. The catheters reside in the inferior vena cava and exchange
heat with the patient's blood, while pharmacological agents and surface
warming blankets lower the patient's thermoregulatory responses to prevent
shivering.
Additional information:
Cal-(IT)2, one of four institutes established through the California
Institutes for Science and Innovation initiative from Governor Gray Davis'
office in 2000, seeks to extend the reach of the Internet throughout the
physical world. Cal-(IT)2 teams faculty, students, and research professionals
from UCSD and UCI with scientists and engineers from leading California
companies to investigate how this future Internet will accelerate advances in
environmental science, civil infrastructure, intelligent transportation and
telematics, genomic medicine, the new media arts, and educational practices.
Cal-(IT)2 provides students early opportunities to work in teams with
technologists and practitioners in real-world environments, and engages with
large and startup companies to field test emerging commercial ideas as part of
larger-scale projects.
UCSD Stroke Center
The UCSD Stroke Center has been recognized by the University HealthSystem
Consortium (UHC) as one of the nation's top academic medical centers providing
stroke treatment. In a nationwide survey of 33 academic medical centers and
1,227 patients, the UCSD Stroke Center ranked second overall, measured against
a variety of clinical benchmarks, including complication and death rates,
length of hospitalization, diagnostic tests, and health counseling prior to
discharge. Recently, the UCSD Stroke Center was selected by NINDS as the site
for production of a national DVD to train medical professionals to in the use
of the NIH Stroke Scale. Lyden was named lead medical advisor for the NINDS
DVD project, which included two weeks of filming in February at UCSD Medical
Center in Hillcrest and on the UCSD campus in La Jolla. In addition to its
strong research and clinical components, the UCSD Stroke Center trains the
next generation of stroke specialists in a Stroke and Vascular Neurology
program that offers two physician fellowships each year.
NINDS, a division of the National Institutes of Health, at the Department
of
Health and Human Services, launched the SPOTRIAS program in an effort to
develop and offer more rapid diagnosis and clinical treatments to acute stroke
patients. UCSD is the third SPOTRIAS program to be funded, joining the
University of Texas Medical School at Houston and the University of
Cincinnati. NINDS plans to fund a total of 10 SPOTRIAS grants over the next
three years.
INNERCOOL
INNERCOOL was co-founded in 1998 by John Dobak, M.D., the company's
president
and CEO and an alumnus of the UCSD School of Medicine, and Juan Lasheras,
chair of Mechanical and Aerospace Engineering at the UCSD Jacobs School.
The Celsius Control System consists of an endovascular catheter, console
and
proprietary disposables. The distal portion of the catheter incorporates a
flexible Temperature Control Element (TCE) that is cooled or warmed with
saline solution circulated in a closed-loop manner from the console. When
placed in the inferior vena cava, the TCE exchanges thermal energy directly
with the blood, resulting in cooling or warming of the downstream organs and
body. The Celsius Control System does not infuse fluid into the patient, nor
is blood circulated outside of the body.
INNERCOOL received FDA clearance in January 2003 for the Celsius Control
System to induce, maintain and reverse mild hypothermia in neurosurgical
patients in surgery and recovery/intensive care.
This article reprinted from and courtesy of www.calit2.net
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