Editor's Note: In recent years, a large number of revolutionary technological innovations have brought about earth-shaking changes in the medical field. Recently, a foreign report based on the current medical market in 2009~2014 lists 10 new medical technologies with huge growth potential, such as capsule endoscopy, drug delivery systems, molecular diagnostics and targeted therapy, mobile medical, etc. The valuation is as high as $454.3 billion. In this issue, we selected six of the most promising technologies in the future, and invited experts from relevant fields to interpret and look forward to it.

Interviewed experts:

Liu Side, Deputy Director, Department of Gastroenterology, Nanfang Hospital, Southern Medical University

Yu Changxuan, deputy director of the Oncology Department, Southern Hospital of Southern Medical University

Zhang Lihai, deputy director of the Orthopaedic Hospital of the General Hospital of the People's Liberation Army and director of the trauma ward

Liu Qingjun, deputy director of the Department of Biomedical Engineering, Zhejiang University

Assistant to the Dean of Peking University People's Hospital and Director of the Information Center Liu Fan

Image diagnosis, relieve pain

Representative: Capsule endoscopy

The above report shows that 2/5 (about 177.8 billion US dollars) of the top ten medical new technology market share comes from medical diagnostic techniques, including nuclear medicine imaging, capsule endoscopy and so on.

According to a report released by Frost & Sullivan Consulting, the medical imaging technology has shortened the imaging time to a few seconds in the past decade. The images are three-dimensional and full-color, which can largely replace the past biopsy. . For example, nuclear medicine imaging technology lays the foundation for non-invasive examination of liver fibrosis; capsule endoscopy protects patients from pain. Liu Side said that the capsule gastroscope is slightly larger than the ordinary capsule and has a large rice camera. After swallowing, it takes a picture at two speeds per second and sends the photo to the external image recorder in real time, with the stool discharged after 6-8 hours. The doctor can analyze the collected photos to see the status of the gastrointestinal tract at a glance. "Capsule gastroscope even realizes home inspection, and then sends photos to doctors with mobile phones and computers, it may be early detection of stomach cancer, etc." But it also has drawbacks, such as 50,000 photos taken in 8 hours, 70% is not Diagnostic value, and there is a blind spot. These problems need to be solved by manufacturers and doctors. â–²

Molecular diagnosis, localization of cancer

Representative: Molecular Targeted Therapy

The top science journal Nature Genetics listed molecular diagnostics as the top of the top ten health technologies a few years ago. It plays a huge role in the prevention, diagnosis and individualized treatment of genetic diseases, infectious diseases and tumors.

Taking tumors as an example, the Global Cancer Report 2014 issued by WHO pointed out that in 2012, the number of cancer deaths in China was 2.2 million, accounting for 26.8% of the global total. The therapeutic effect of cancer patients in China is still not satisfactory. The solution is to improve early diagnosis and precise treatment of advanced tumors. You Chang Xuan said that about 80% of lung cancer patients were in advanced stage and lost their chance of surgery. Traditional chemotherapy is a "trial and error treatment", often choose a chemotherapy regimen according to the guidelines, evaluate the curative effect after 2 cycles of treatment, continue the original plan if it is effective, and change the plan if it is invalid. This mode has poor efficacy and side effects. You Changxuan said: "Research shows that the occurrence and development of tumors are often related to genetic abnormalities. For example, lung cancer, especially lung adenocarcinoma, has specific driving genes. To clarify the driving genes, molecular diagnosis is needed to help." The gene, given targeted molecular targeted therapy, has good curative effect and small side effects. For example, patients with advanced lung cancer carrying EGFR-sensitive mutant genes are given EGFR-TKI (such as gefitinib, erlotinib, etc.) targeted therapy, the disease control rate can reach 90%, patients do not need hospitalization, and the quality of life is very high. Many pharmaceutical companies have therefore joined the field, and the molecular diagnostics market has grown at an annual rate of 15% to 18%. â–²

Minimally invasive technique to reduce wounds

Representative: minimally invasive internal fixation

In 1987, French doctor Murray completed the world's first laparoscopic cholecystectomy, creating a new era of minimally invasive surgery. For decades, from gastrointestinal endoscopy to laparoscopy, the concept of minimally invasive surgery has penetrated into various medical fields. Some foreign scholars have referred to minimally invasive surgery, genetic engineering, and organ transplantation as the three mainstreams of medical development in the 21st century.

Orthopedic minimally invasive techniques are leading the way. Taking the most common intertrochanteric fractures in elderly patients with osteoporosis as an example, Zhang Lihai said that in the past, dynamic hip screws were used, which was fixed by “plate-making”. The wounds were large, and patients needed to stay in bed for a long time, which easily induced thrombosis. "In our hospital statistics, the perioperative mortality of hip fractures in the elderly is about 6%, even higher than that of malignant tumors." Subsequently, the development of minimally invasive devices such as gamma nails overcome the problem of large surgical incisions, but can not hurt the bones. Complete reset. In this regard, Tang Peifu, dean of the Orthopaedic Hospital of the General Hospital of the People's Liberation Army, designed the medial support intramedullary nail and added a fixation to the inside of the injured bone by minimally invasive internal fixation. This technology allows patients to avoid death complications early, and is certified and approved by the State Food and Drug Administration and promoted in China. ▲

Drug delivery system, on-demand

Representative: Nanocrystal technology

Foreign reports show that drugs with drug delivery systems (DDS) have a market share of about $110.8 billion. Early studies of DDS focused on slow-release formulations, allowing patients to stay for a longer period of time with a single shot. For example, leuprolide acetate microspheres, triptorelin microspheres, and risperidone microspheres are widely used in the treatment of tumors, metabolic diseases, and psychosis.

In recent years, the main goal of DDS research has been to compensate for bioavailability defects caused by the chemical structure of the drug itself. For example, the intestinal retention technology developed by AvMax in the United States allows the drug to stay in the small intestine with the best bioavailability, maintain the effect on Helicobacter pylori, and treat peptic ulcer. Elan's nanocrystal drug delivery technology contains an excipient that prevents aggregation and improves dissolution, solves the problem of timing administration, synchronizes drug delivery with human rhythm, and maintains a 24-hour balanced blood level. It has produced effects in the treatment of hypertension. Recently, Stephen Morton of the Massachusetts Institute of Technology developed a dual-drug, time-lapse nano-delivery system for cancer treatment to prevent cancer cells from resisting chemotherapeutic drugs. It can be seen that nanotechnology is an important direction for the development of DDS. â–²

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