CLEVELAND – As has become a tradition at the Cleveland Clinic Medical Innovation Summit, a panel of Cleveland Clinic practitioners on Wednesday unveiled the clinic's fourth annual much-anticipated Top 10 list of medical innovations expected to have a big impact on healthcare in 2010.

According to the Cleveland Clinic, the team responsible for selecting the list of breakthrough devices and therapies used a rigorous process to gather the opinions of leading Cleveland Clinic physicians and researchers, create a field of nominated innovative technologies for consideration, and develop a consensus perspective of what will be the Top 10 medical innovations for 2010. The team interviewed nearly 60 Cleveland Clinic experts to elicit their nominations. These interviews yielded nearly 100 nominations of emerging technologies.

Technologies that were nominated had to fit four major criteria:

Had to have significant clinical impact.

Have a high probability of commercial success.

Be in or exiting clinical trials to be available on the market sometime in 2010.

Have significant human interest in its application or benefits, and must have the ability to visualize human impact.

The Top 10 medical innovations for 2010 are in order from last to first:

10. Whole slide imaging for management of digital data in pathology. This technology converts glass slides into digital slides with "excellent" imaging quality that can be viewed, managed, stored, streamed over the Internet, and analyzed on a computer.

Presenter Kandice Kottke-Marchant, MD, PhD, chair of Pathology and Laboratory Medicine Institute at the Cleveland Clinic, said this new technology allows the pathologist to scan and digitize an entire slide, or group of slides, and send the images over the Internet to any consulting pathologist. She noted that the capability would be especially beneficial to smaller pathology groups because they will be able to share images for consultation.

9. Devices for occluding left atrial appendage to reduce stroke risk. The Cleveland Clinic said that in the past, new drugs have been sought to replace long-term warfarin therapy, but none have succeeded. In April, however, an FDA advisory panel voted in favor of approving a new device alternative to long-term use that can prevent clots from developing in patients with atrial fibrillation. A second device is being tested, with FDA approval expected in early 2010, the clinic noted.

During a 90-minute minimally-invasive procedure with one device, a tiny polyester-covered umbrella-shaped mesh device is snaked up via a catheter through a blood vessel in the groin into the right atrium of the heart and implanted permanently just behind or at the opening of the left atrial appendage. The body soon begins to form tissue over the implant, permanently closing off the appendage and eliminating the risk of forming blood clots there. The second device is a clip that is placed over the left atrial appendage, either during surgery or a minimally-invasive procedure, the clinic said.

Presenter Samir Kapadia, MD, an interventional cardiologist at Cleveland Clinic, said the devices offer "an incredible advancement in the field." Of course it requires some fine-tuning, he added, noting that the procedure itself was risky.

8. Oral Thrombopoeitin (TPO) receptor agonist that stimulates platelet production. According to the Cleveland Clinic, roughly 50,000 to 100,000 people in the U.S. are diagnosed with chronic immune thrombocytopenic purpura (ITP). The clinic said that the medical and ITP community welcomed the promising results of an international Phase III trial that were the basis of the recent approval of the first TPO receptor agonist to treat adults with ITP. The new drug works by stimulating the production of cells in bone marrow from platelet cells in the blood.

7. Outpatient diagnosis of sleep-related breathing disorders. According to the Cleveland Clinic, at-home testing devices for sleep apnea allow patients to be diagnosed in the comfort of their own bed, rather than in a sleep center.

6. Forced exercise to improve motor function in patients with Parkinson's disease. According to the Cleveland Clinic, tandem bike riding may be a new way of improving motor function in patients with Parkinson's. After pedaling at more than 90 revolutions per minute (RPM) for more than 50 miles in front while a friend with Parkinson's served as the stoker while pedaling in the back seat of the tandem bike, a scientist noticed that his friend's hand tremors had suddenly disappeared. A small eight-week study was launched to gauge the effects of forced exercise (tandem riding in which patients are forced to pedal 80-90 RPM) on Parkinson's symptoms. The results: 35% improvement in motor functioning for those patients who did the forced exercise compared to those exercisers who pedaled a stationary bike at their own pace.

5. Fertility preservation through oocyte (egg) cryopreservation. According to the Cleveland Clinic, oocyte cryopreservation, or egg freezing, can be used to put a healthy woman's biological clock on hold until years later when she is eventually ready to conceive. This procedure also gives women at risk of losing their fertility due to medical circumstances the chance to circumvent sterility brought on by cancer treatment or other medical maladies that damage childbearing potential, the clinic noted.

New cryopreservation techniques have been able to sidestep previous problems with egg freezing and protect the egg from "freezer burn" that previously compromised the integrity of the egg during freezing and thawing, the clinic said.

4. Non-Vitamin K antagonist oral anticoagulants. According to the Cleveland Clinic, two new non-vitamin K antagonist oral anticoagulants may end up being an alternative to warfarin. The new pill prevents venus thromboembolism (VTE) in patients undergoing hip or knee replacement.

VTEs are treated with anticoagulant therapy, however, problems with the drug's unpredictable effects, the need for close monitoring, long onset of action, and food and drug interactions have made warfarin therapy difficult to manage, the clinic said.

3. Continuous-flow ventricular assist devices. The newest versions of continuous-flow ventricular assist devices are "revolutionizing the transplant process," according to the Cleveland Clinic. Presenter James Young, MD, chair of the Endocrinology and Metabolism Institute at the Cleveland Clinic, provided some history about the ventricular assist devices, noting that the first device was implanted in 1966. Now, it appears that the devices may soon be more than just a bridge-to-transplant therapy, but rather a destination therapy. FDA approval for this indication is expected in 2010, the Cleveland Clinic noted.

"These devices have been a long time coming," Young said. "This year the explosion in implants of these devices has been due to a shift" from the large, bulky earlier versions to the smaller, easier to install continuous-flow devices.

2. Low-volume, low-pressure tracheal tube cuff to reduce ventilator-associated pneumonia (VAP). For patients who must be intubated, there is now an effective way to reduce serious pulmonary problems and save lives in the ICU, according to the Cleveland Clinic. A new low-volume, low-pressure endotracheal tube cuff with a special suction setup that provides effective airway seals at low pressure and allows all secretions to drain from the subglottic space just above the tube cuff, has recently been approved for use in the UK. FDA approval is expected later this year, the clinic said.

The new device "dramatically reduces the risk of VAP by providing continuous effective airway seals at low mucosal pressures," according to the clinic.

1. Bone conduction of sound for single-sided deafness (SSD). A new non-surgical, removable hearing and communication device that is designed to imperceptibly transmit sound via the tooth to help people with SSD regain their hearing when someone speaks toward the deaf ear is expected to get FDA approval next year.

According to the Cleveland Clinic, as a nearly-invisible digital audio device, the system consists of a small microphone unit worn behind the ear on the deaf side and a removable dental retainer-like device that contains electronics, a sealed, flat, rechargeable battery, wireless capability that picks up sound transmissions from the microphone unit, and a small actuator that converts those signals into vibratory energy.

Amanda Pedersen; 229-471-4212