Therasense Will it impact a practitioner’s duty of candor in prosecution?
Potential of biomedical sensosr- Tønnessen - SINTEF · Potential of biomedical sensors: ......
Transcript of Potential of biomedical sensosr- Tønnessen - SINTEF · Potential of biomedical sensors: ......
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Potential of biomedical sensors: state of the art and futureperspectives
Tor Inge TønnessenThe Interventional Centre
Rikshospitalet
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The The oldold--timetime biosensorbiosensor
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The The futurefuture of of monitoringmonitoring
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Sensors are all around us
IndustryCounting, sorting, reading, tactile
CarsMotorTire pressureCollision activate air bag
OfficeHome
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Biosensor
A sensor used to obtain information about a life processBiosensors are devices that can detect and/or quantify molecules of interest. Sensing occurs when there is an interaction between the target molecule and a biological macromolecule (e.g. enzyme, antibody, receptor or DNA strand).
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What is a biosensor?What is a biosensor?
Broader definition: Sensing Broader definition: Sensing (measuring, monitoring) a functional (measuring, monitoring) a functional biological parameter in an organ or biological parameter in an organ or systemicallysystemicallyIn vitroIn vitro–– PointPoint--ofof--carecareEx vivoEx vivoIn vivoIn vivo
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Many types og tecnnology
Electrochemical
Fiberoptic
SS S S SS S S S
FructoseDehydrogenase
OctadecylMercaptan
Gold Electrode
S S S S S S S S S S S S S S S S S S S S S S S S S
PC and PEPhospholipid
Coenzyme Q6
SSS S S SS
COO-
NH 3+
COO-
COO-
NH 3+
NH 3+
2e-
D-Fructose 5-Keto-D-Fructose
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Time resolution
One time shot
Repeated measurements
Continous, real-time
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The evolution of glucose sensors
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Some defining events in the history of commercial biosensor development
Abbott acquires TheraSense for $1.2 billion2004
i-STAT acquired by Abbott for $392 million2003
LifeScan purchases Inverness Medical's glucose testing business for $1.3 billion2001
Merger of Roche and Boehringer Mannheim to form Roche Diagnostics1998
Launch of LifeScan FastTake blood glucose biosensor1998
Abbott acquires MediSense for $867 million1996
Glucocard launched1996
i-STAT launches hand-held blood analyser1992
Launch of the MediSense ExacTech blood glucose biosensor1987
First mediated amperometric glucose biosensor: ferrocene used with glucose oxidase for the detection of glucose (Cass et al., 1984)1984
First fibre optic-based biosensor for glucose (Schultz, 1982)1982
Miles Biostator: first bedside artificial pancreas1976
First commercial biosensor: Yellow Springs Instruments glucose biosensor1973–1975
First description of a biosensor: an amperometric enzyme electrode for glucose (Clark and Lyons, 1962)1962
Invention of the oxygen electrode (Clark, 1956)1956
First glass pH electrode1922
First report on the immobilisation of proteins: adsorption of invertase on activated charcoal1916
EventDate
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Our vision
BSD is dedicated to improving human safety and well-being through innovative, fast-working, cost effective and reliable disposable sensors for the medical, food, security, environmental and other diagnostic communities. It is envisioned that BSD sensors will be widely used in slaughterhouses, factories, hospitals, and doctor’s offices worldwide, with some applications extensively employed in homes and on battlefields throughout the world.
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Biosensors agains terrorism
- The Bush White House has endorsed a $3.25 billion Senate bill to beef up the United States' ability to detect and respond to biological and chemical attacks.
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Biosensors against obesity
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THE CANARY SINGS AGAINTHE CANARY SINGS AGAIN
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EarlyEarly warningwarning
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The everyday problem..The everyday problem..
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We obtain the global We obtain the global parametersparameters
but we do not but we do not know what know what happens in the happens in the organorgan
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Injury to most organs are Injury to most organs are detected too latedetected too late
Except for EKG, we do not have realExcept for EKG, we do not have real--time detection of organ injurytime detection of organ injuryMost organs reveal symptoms lateMost organs reveal symptoms lateIn the anesthetized patient and the In the anesthetized patient and the ICU patients, symptoms are absentICU patients, symptoms are absentReliable biosensors are badly neededReliable biosensors are badly needed
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Placement of a sensorPlacement of a sensor
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Why use a biosensor?
Early detection imply better prognosisContinuous measurements enable us to titrate treatment according to responseDiseases may be treated even before symptoms occur
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IschemiaMost prevalent cause of mortality and morbidity in the Western world (myocardial infarction, stroke, trauma)If ischemia is detected early it is most often reversibleExcept from EKG, there is no clinical method available for real-time monitoring of ischemiaIndirect methods (enzyme analysis etc) are often unspecific and slow
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The diagnosis of ischemia is often retrospective
We diagnose that the injury has occurred-but it is too late because the injury has become irreversible
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How do the cells try to survive without oxygen?
Reduce ”luxury metabolism” (O2 conformity)KidneyHeart
Deplete the storage of energy rich substancesSkeletal muscleLiver
Convert to anaerobic metabolism
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AnaerobicmetabolismDesperate attempt to survive until oxygen reappearsSecure a small energy productionSide effect: Acidification of the cells
Glucose
Pyruvate Lactate
NADH
H O
O
CO
NADNADH
ATPG
lycol
ysis
Kreb
scy
cle
Elec
tron
trans
port
2
2
2
+
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Intracellular acidosis
H+Proteins
Phosphate
HCO3-
CO2
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CO2 productionOxidative phosphorylation
Large productionRapid elimination by perfusing blood
Anaerobic metabolismLess CO2 produced, but it is not transported away due to lack of blood supply, and will accumulate in the organ H+ + HCO3
- ⇒ CO2
Glucose
Pyruvate Lactate
NADH
H O
O
CO
NADNADH
ATP
Glyc
olys
isKr
ebs
cycl
eEl
ectro
ntra
nspo
rt
2
2
2
+
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PCO2 during progressive flow reduction
Oxygen delivery, DO2 (ml/kg/min)0 10 20 30 40 50
PC
O2,
liver
sur
face
(Tor
r)
50
100
150
200
250
Oxy
gen
upta
ke, V
O2 (
ml/k
g/m
in)
0
2
4
6
8
10*
*
*
*
**
*
*A
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Monitoring of organ metabolism
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Monitoring of organ metabolism
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Principle of microdialysis
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Mikrodialyse (CMA 600)
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Microdialysis
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Looking closer…
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Ischemia in microsurgical free flap
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Neurotrend
pH
PCO2
PO2
Temperatur
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Neurotrendkateter
• Diameter 0,5 mm• Membranlengde < 2,5 cm• Må beskyttes mot lys• Trykkfølsomt
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Monitoring of organ metabolism
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Monitoring of organ metabolism
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DIEP-lapp(Deep inferior epigastric perforans)
• Fri lapp.• Hud og fettvev med tilhørende blodkar hentes
fra nedre del av abdomen. • Små kar anastomoseres.• Den hyppigste komplikasjonen er svikt i
blodforsyningen.• Klinisk vurdering kan være vanskelig og
sviktende blodforsyning kan oppdages sent.
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Venøs insuff.pCO2 pO2 DIEP 12 (sone 3): Laktat/pyruvat Reoperasjon
30.04.2002 01.05.2002 02.05.2002 03.05.2002 04.05.200200:00 00:00 00:00 00:00
0
5
10
15
0
20
40
60
80
L/P-ratiopCO2pO2
Reopr.
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First prototype 3-axis accelerometer sensor
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Heart Motion
• Heart motion measurements– Good precision– 3 axes: Full 3D motion pattern
• Motion abnormalities seen– Arrhythmias, fibrillation, influence
• More subtle changes: More sophisticated signal analysis needed– Ischemia seen as changes in frequency plots
Arrhythmia
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Frequency distribution in 2 sec time windows before and after occlusion
Frequency footprintBefore occlusion
Frequency footprintAfter occlusion
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Frequency Analysis. Spectrogram
LAD Occlusion
-Analysis of periodic signals-Sensitive to small changes-Ischemia changes pattern
Frequency [1/min]
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Cooperation with WL Gore
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IscAlert
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WhyWhy diddid so so fewfew succedsucced??
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Brain drainBrain drain
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Are Are wewe sleeping in an era of sleeping in an era of new new inventionsinventions??
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TryingTrying againagain and and againagain
Come on! It can‘t go
wrong every time...
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Not Not everyevery presentationpresentation isissuccessfulsuccessful