e-HealthExpert.org - Primum non nocere

Kind of a cheat there with that last word, but the dCell Vascular Patch made by Tissue Regenix (York, UK) has received CE mark approval for sales in Europe. The dCELL® Vascular Patch is a sterile, non-cellular biological scaffold manufactured to the highest quality and safety standards from porcine pericardium which is intended to be permanently implanted into the human body for vascular repair. This product, and products like it, takes biological material from animals (pigs in this case) and through various processes strips out the material the human body would mount an immunological attack against while leaving the underlying structure, allowing grafts of things like heart valves without requiring immuno-suppresive drugs. Full press release: Tissue Regenix receives approval to commence sales of its lead product the dCELL® Vascular Patch... Product site: dCell Vascular Patch...... Dan Buckland

A team of researchers at King's College London has developed a brain scan which can purportedly detect autism in adults. The scan, which uses MRI to obtain images of the brain, can identify autism based on the physical makeup of grey matter in the brain. Results of an initial study involving the scan were published in the Journal of Neuroscience today. The team used an MRI scanner to take pictures of the brain's grey matter. A separate imaging technique was then used to reconstruct these scans into 3D images that could be assessed for structure, shape and thickness - all intricate measurements that reveal Autism Spectrum Disorder (ASD) at its root. The research studied 20 healthy adults, 20 adults with ASD, and 19 adults with ADHD. All participants were males aged between 20 and 68 years. After first being diagnosed by traditional methods (an IQ test, psychiatric interview, physical examination and blood test), scientists used the newly-developed brain scanning technique as a comparison. The brain scan was highly effective in identifying individuals with autism and may therefore provide a rapid diagnostic instrument, using biological signposts, to detect autism in the future. KCL's press release: Adult autism diagnosis by brain scan... Abstract in The Journal of Neuroscience: Describing the Brain in Autism in Five Dimensions - Magnetic Resonance Imaging-Assisted Diagnosis of Autism Spectrum Disorder Using a Multiparameter Classification Approach... Smit

Epocrates, one of the most well known medical programs for mobile devices, is offering its Essentials version for free to medical students for a limited time (normally $159). Compared to the Epocrates Rx, which has always been free, this version includes an infectious disease treatment guide, alternative (herbal) medicines, disease monographs and diagnostic and laboratory tests. This version of Epocrates is available for the iPhone/iPod touch, Palm, Blackberry, and Windows Mobile. Although you have to study medicine in the United States to be eligible, there doesn't seem to be any check for this during registration. The offer stands until August 31st. Link: Free Epocrates Essentials for Medical Students... (hat tip: iMedicalapps)... Wouter Stomp

Researchers from the University of Calgary have cultivated neurons on silicon microchips for the first time. They used neurons isolated from mollusc Lymnaea, also known as the great pond snail, and cultured them for 2 to 4 hours over apertures on the chips forming so-called gigaseals. The microchip allows for high quality signal recording of individual neurons cultured directly on the chip's surface. So far they have used it to monitor individual neurons only, but the technique theoretically allows for simultaneous monitoring of multiple individual neurons engaged in synaptic connectivity. This will lead to a better understanding of neuronal communication and synaptic plasticity. “This technical breakthrough means we can track subtle changes in brain activity at the level of ion channels and synaptic potentials, which are also the most suitable target sites for drug development in neurodegenerative diseases and neuropsychological disorders,” says Syed, professor and head of the Department of Cell Biology and Anatomy, member of the Hotchkiss Brain Institute and advisor to the Vice President Research on Biomedical Engineering Initiative of the U of C. In addition, the chips are automated, making them much easier to use than the traditional patch-clamp techniques used for neuronal studies. The findings are published online in this month's Biomedical Devices. Press release: Neurochip technology developed by Canadian team Article abstract: High-fidelity patch-clamp recordings from neurons cultured on a polymer microchip...... Wouter Stomp

It's an August tradition: Football training camps open, and we're treated to warnings about working out in the heat. In the past few years, however, when it comes to football, there's been a new emphasis on traumatic brain injury -- TBI. This has caught our eyes here at MedGadget. We've covered innovative impact-sensing helmet technology before (as well as smart helmets for temperature monitoring). But for the athlete with a concussion, what happens off the field? Unless a neurologist is involved, it's up to the players and trainers to follow guidelines or make guesses about when to return to play. Hopefully that will change, and a device like BrainScope will lead the way. When we first covered BrainScope, they were positioning their new device, based on controversial technology, as a sideline decision-making aide. Now their research seems to be focused on the weeks and months post-concussion: Electroencephalograph (EEG) is a decades-old technology that measures electrical activity in the brain from the surface of the scalp. But using it to study mild traumatic brain injury has been a challenge, in part because the technology is highly susceptible to noise, such as head movements, and it must be performed by a trained expert. Recently companies have developed more robust, portable devices, thanks to new sensors and advances in the algorithms used to process the data they collect. Such devices also require less training for those who use them. BrainScope, a startup based in Bethesda, MD, has developed one such device, which it is testing for athletic and military applications. In the new study, McCrea and collaborators used the BrainScope device to analyze brain activity in nearly 400 football players at the start of the season to determine baseline brain activity. Twenty-eight of those players sustained a concussion during the study period. These players had their brain activity measured again right after the incident, as well as days later. Scientists also gave the players tests currently used to assess concussion, including tests of cognitive function and balance. They then compared changes in brain activity in injured players to both noninjured players and nonathlete controls. "It turned out that symptoms, cognitive function, and balance had all returned to normal within the first week after a concussion," says McCrea. "But brain electrical activity remained abnormal at day eight." Brain activity returned to normal a month and a half later, when the next measurement was taken.... Nicholas Nicholas

A study by Milliman, an actuarial consulting firm, commissioned by the Society of Actuaries has concluded that errors from mechanical complication of devices, implants, or grafts cost the US economy over $1.1 billion in 2008. The point of the study was to calculate the total amount medical errors cost that year (that number came in at $19.5 billion) with medical devices causing the 3rd highest categorical total (pressure ulcers were #1 with a cost of just under $4 Billion). They calculated that 60,380 total errors cost on average $18,771 each. From the press release: The study also identifies the 10 medical errors that are most costly to the U.S. economy each year. Approximately 55 percent of the total error costs were the result of five common errors: * Pressure ulcers * Postoperative infections * Mechanical complications of devices, implants, or grafts * Postlaminectomy syndrome * Hemorrhages complicating a procedure The SOA and Milliman findings were based upon an analysis of an extensive claims database. Measurable costs of medical errors included increased medical costs, costs related to increased mortality rates, and costs related to lost productivity of an error. Society of Actuaries: Study Finds Medical Errors Annually Cost at Least $19.5 Billion Nationwide Full study :The Economic Measurement of Medical Errors (via WSJ)... Dan Buckland

Researchers at MIT's Spectroscopy Laboratory have announced that they are currently working on a Raman spectroscopy machine which can measure blood glucose without a blood sample. The machine sends infrared light through the skin to determine glucose levels in the interstitial fluid. In a paper published in the July 15 issue of Analytical Chemistry, the researchers described their algorithm for determining blood glucose levels based on the interstitial concentration. From MIT's press release: Researchers in the Spectroscopy Lab have been developing this technology for about 15 years. One of the major obstacles they have faced is that near-infrared light penetrates only about half a millimeter below the skin, so it measures the amount of glucose in the fluid that bathes skin cells (known as interstitial fluid), not the amount in the blood. To overcome this, the team came up with an algorithm that relates the two concentrations, allowing them to predict blood glucose levels from the glucose concentration in interstitial fluid. However, this calibration becomes more difficult immediately after the patient eats or drinks something sugary, because blood glucose soars rapidly, while it takes five to 10 minutes to see a corresponding surge in the interstitial fluid glucose levels. Therefore, interstitial fluid measurements do not give an accurate picture of what's happening in the bloodstream. To address that lag time, Barman and Kong developed a new calibration method, called Dynamic Concentration Correction (DCC), which incorporates the rate at which glucose diffuses from the blood into the interstitial fluid. In a study of 10 healthy volunteers, the researchers used DCC-calibrated Raman spectroscopy to significantly boost the accuracy of blood glucose measurements - an average improvement of 15 percent, and up to 30 percent in some subjects. Press release: Shining a light - literally - on diabetes... Abstract of the researchers' paper: Accurate Spectroscopic Calibration for Noninvasive Glucose Monitoring by Modeling the Physiological Glucose Dynamics... Smit

Researchers at the University of Jena, Germany have developed a prosthesis that may help reduce phantom limb pain. Phantom limb pain, which according to some studies may affect up to 80% of amputees, is an often intermittent, painful post-amputation sensation. This neuropathic pain is the result of a series of peripheral and central nervous system changes that follow amputation. It can be excruciating and is very difficult to treat. Professor Weiss and his team have modified a conventional hand prosthesis to relay sensory information from the prosthetic hand to the upper limb. The concept is that by providing sensory feedback, central nervous system reorganization can be reduced or reversed. The group reports positive results in the first patients tested and plans to further extend testing to as many patients as possible. Press release: Prosthesis with information at its fingertips (hat tip: Gizmag)... Aaron Rulseh

In a MedWatch posting, the FDA has recommended that physicians consider removal of retrievable Inferior Vena Cava (IVC) filters "as soon as protection from Pulmonary Embolism is no longer needed." Previously, in most places the standard of care regarding IVC filters was to consider placement to be irrevocable unless otherwise indicated. Since 2005, the FDA has received 921 device adverse event reports involving IVC filters, of which 328 involved device migration, 146 involved embolizations (detachment of device components), 70 involved perforation of the IVC, and 56 involved filter fracture. Some of these events led to adverse clinical outcomes in patients. These types of events may be related to a retrievable filter remaining in the body for long periods of time, beyond the time when the risk of pulmonary embolism (PE) has subsided. The FDA is concerned that these retrievable IVC filters, intended for short-term placement, are not always removed once a patient’s risk for PE subsides. Known long term risks associated with IVC filters include but are not limited to lower limb deep vein thrombosis (DVT), filter fracture, filter migration, filter embolization and IVC perforation. While it's nice to know the risks and attach numbers to the different kinds of (sometimes spectacular) device failures, our sense of the matter is IVC filters aren't placed on just anybody. These are patients that have failed medical management of DVT, have clotting disorders, or both. For many of these patients, the risk for PE will never "subside" so IVC removal isn't an appealing prospect. If the FDA (or some specialty society) could give guidelines as to how frequently these filters should be replaced, well, we'd be happy to report that good news. FDA: Inferior Vena Cava (IVC) Filters: Initial Communication: Risk of Adverse Events with Long Term Use... Dan Buckland

We at Medgadget love us some web apps. We're not too thrilled about home blood pressure management, though, as it tends to drive a lot of people unnecessarily to our emergency department for what turns out to be an expensive educational encounter. A new alternative is the web app at http://bp-chart.com/. On this site, you can log your BP measurements to your heart's content, store them, plot them, export them to Excel, or package readings for your doctor. You can even share blood pressure readings on Facebook and Twitter. The site's programmer, Mateusz Mucha, has made his data public (you can keep yours private). He also points to new data that online physician monitoring of BP leads to greater reductions over time. So give it a try! It's free. More at BP-Chart.com...... Nicholas Nicholas

Researchers at the University of Bordeaux, working on the problem of categorizing lifestream footage from body-mounted cameras, have stumbled upon a useful application -- objectively measuring the cognitive decline associated with dementia: Doctors usually rely on the accounts given by relatives or carers whose perception of whether a patient is better or worse can be coloured by all kinds of other factors. The data from a lifestreaming camera, on the other hand, can tell you exactly how many times a patient visited the kitchen on Wednesday, for example, and how that compared to the same period six months ago. The hope, say Karaman and co, is that this kind of data can be an important tool in evaluating the onset of dementia and the way it is advancing. More from this lab's research... (.pdf) (hat tip: MIT's Technology Review Physics arXiv blog)... Nicholas Nicholas

While current medical technology allows diabetics to closely monitor and manage their blood sugar levels, most patients need to prick their fingers multiple times a day to obtain blood samples. Researchers at the University of Tokyo and the BEANS Research Institute hope they can change that with new fluorescent hydrogel beads which glow at different intensities depending on glucose concentration. The researchers are currently testing the beads in mice, and hope to have a product which can monitor blood sugar without any patient intervention within ten years. From the University of Tokyo Magazine's Coverage: The material we chose for this purpose consists of a soft polyacrylamide “hydrogel,” a substance with the texture of gelatin that is chemically bound to an anthracene derivative containing boronic acid, which fluoresces when it binds to glucose in the blood. With the help of microfluidic device technology geared to the manipulation of tiny volumes of fluid, we succeeded in processing this material into uniform beads approximately 0.1 millimeter in diameter. Because the beads are uniform in diameter they can travel to every part of the body. Implanting these beads in the thin-skinned ear of a lab mouse enabled us to observe from the outside changes in the brightness of the beads as they reacted to changes in glucose concentration. We also succeeded in measuring peripheral blood glucose concentrations by observing the changing fluorescence of the beads through the skin. DigInfo TV's Coverage: Implantable blood sugar sensor... University of Tokyo Magazine: A Blood-Sugar Warning Light in Your Ear?! (pdf file; page 23) (hat tip: Engadget)... Smit

There is a new way to position patients for arthroscopic rotator cuffs and other surgeries on shoulder and clavicle. MAQUET has just unveiled a new surgical arm positioning system called Trimano 3D. Attached to the surgery table, the Trimano 3D allows orthopedic and trauma care surgeons to move the patient's arm to the desired location and orientation, and to fix it in place for the duration of a procedure. The support arm includes a sterile arm rest and adapter and is used to locate and hold the patient's arm securely in the required position throughout the operation. The unrestricted manoeuvrability of the Trimano, rapid and accurate repositioning can be carried out at any time during the operation. The patient's arm can also be lifted off the support and moved freely, in order to monitor the results of the operation. The initial preparation for the positioning of the patient's arm can be made in the induction room. The arm is positioned on the support arm and an arm pad. Then, in the operating theatre, the patient's arm is simply transferred from the arm pad onto the sterile arm rest. An adapter that was developed in parallel, makes it easy to mount the arm rest into place. It connects the arm rest with the support arm resulting in greater handling and control for the user. Link to demo video of Trimano 3D... Press release: MAQUET -- ASSIST SYSTEMS FOR THE OPERATING THEATRE...... Michael

Students commencing medical school and master's of medicine program at Stanford this year will all get an Apple iPad. The school is trialing a program to see whether the devices are practical to integrate into the academic curriculum. Before you dismiss this as medical education being sacrificied in the name of fanboy hype, consider this -- when some of our editors were in medical school, the semesterly (mandatory) fee for handouts and photocopies was about the cost of a lower-end iPad. And that was years ago. We can only imagine the charges now. So moving the medical education culture of endless handouts and notebooks over to a compact tablet device could be very smart. More from Stanford officials: The decision to provide the devices was prompted by a desire to give students flexible access to the content that they need whether it is a virtual cadaver in dissection lab, annotated lecture slides and videos in the classroom, or journal articles for evidence-based practice in clinic. “We want to explore the use of iPads and other technologies to help students access the enormous amount of medical knowledge that is being produced constantly,” said Charles Prober, MD, the school’s senior associate dean for medical education. “Part of the challenge facing medical students, and all doctors, is the overwhelming amount of information. Devices like the iPad may be able to help users access that pool of knowledge.” The school will monitor the use of the iPads through regular surveys to help determine how helpful they are to students, pointing out that past experiments with similar electronic devices, such as the Kindle, in academic settings haven’t been successful. “We really don’t know yet how the incoming medical students will use them,” said Henry Lowe, MD, senior associate dean for information resources and technology. But, as a physician using an iPad himself, he’s found the device to be extremely helpful and believes it is growing in popularity among doctors. “Physicians are a mobile group,” Lowe said. “They’re moving around from clinic to clinic, from patient to patient. … I’ve seen a variety of reports from across the country saying that physicians have seized on the iPad as a helpful device.” Press release: iPads to be distributed to incoming class by Stanford medical school ... More at SCOPE Blog...... Michael

Siemens has released a new "1.5" version of its popular Acuson SC2000 ultrasound system that features the eSie Measure Workflow Acceleration technology. This update aims to make things go smoother and faster in the examination room. -- eSie automates a lot of the tasks normally done manually, which allows clinicians to focus more on the exam and less on manipulating the ultrasound device. To streamline exam workflows both on the user level and in the entire lab, the Acuson SC2000 system offers eSieScan workflow protocols, which bring higher reproducibility and quality standards to the echocardiography workflow. Customizable according to user or department requirements, eSieScan workflow protocols dramatically reduce the need for user interaction and the number of keystrokes during the imaging process. IN Focus coherent imaging enables the user to focus on the entire field of view instead of a single focal zone. By using the power of 64 parallel receive beams, this technology dramatically improves image quality at all depths without any user intervention to ideally display the cardiac structure and motion for superior diagnostic volumetric imaging. IN Focus technology drives the imaging power of the 4Z1, 4V1 and the V5M transducer. Expanding its application versatility, the Acuson SC2000 system now features a new 5 MHz transesophageal probe, which is interchangeable with other Siemens ultrasound platforms to ensure maximum return on investment. Siemens’ Echo in a Heartbeat technology delivers vastly more diagnostic information than today’s conventional systems. Easily integrated into a routine adult echocardiography exam, it enables new workflow pathways to improve diagnostic efficiency. Non-stitched, real-time full-volume imaging provides wider access to patients and captures true physiologic information including color flow and accurate volume quantification for the left and right ventricle. In addition, the system features the Rapid Stress volume stress echo application, with full-volume acquisition in one single heartbeat per stage and auto-extraction of reference planes for comparison. The resulting volume stress workflow enables the only volume stress echo solution for patients with arrhythmia. Consequently, faster acquisition time and comprehensive review of all wall segments in one single capture leads to potentially improved accuracy and time savings. Press release: Siemens Demonstrates Improved Efficiency in Routine Echocardiography Exams at ESC Product page: ACUSON SC2000 ...... Michael

One of the big medical stories to emerge from the US engagement in Iraq is the improving recognition of TBI -- largely from IEDs (traumatic brain injury from improvised explosive devices). Now, BAE Systems, the big European defense contractor, has unveiled its latest concussion sensor for soldier helmets, named Headborne Energy Analysis and Diagnostic System (HEADS -- see what they did there?). About 7,000 1st generation sensors have already been installed in helmets of U.S. military warriors, but the new devices feature much more effective reporting capabilities that will hopefully help in getting medical attention quicker to those that need it. Some details from BAE's press release: The HEADS smart sensor is also designed to provide medical professionals with important data that may help determine the severity of a possible TBI. “With our Generation II HEADS sensor, we’re providing medical teams with a valuable diagnostic tool that utilizes radio frequency technology,” added Coltman. “With our new ‘smarter’ sensor, if a soldier is exposed to a blast, possibly sustaining a concussion, not only will the HEADS visual LED display be triggered at the time of the event, but once the soldier enters a specified area, such as forward operating base or dining facility, a series of strategically placed antennae will scan all available HEADS units and send data to a computer, identifying any soldiers who may have sustained a blast-related brain injury.” The sensor itself is small, lightweight and can be secured inside virtually any combat helmet. Although imperceptible to the wearer, it is designed to continuously collect critical, potentially lifesaving data, including impact direction, magnitude, duration, blast pressures, angular and linear accelerations as well as the exact times of single or multiple blast events. That information is then securely stored until it can be quickly downloaded and analyzed by medical teams using a simple USB or wireless connection. Compatible with most helmets, the HEADS sensor is unobtrusive and won’t interfere with additional helmet-mounted equipment soldiers may need, such as goggles and other sensors. Deliveries on the initial Generation II HEADS order are expected to begin in April 2011, and be completed by July 2011. Press release: BAE Systems Unveils Its Heads Generation II Helmet Sensor ... (hat tip: Gizmag)... Michael

Frederick, MD based Akonni Biosystems has announced issuance of a patent titled "Apparatus, system, and method for purifying nucleic acids." The method described by the patent utilizes the company's TruTip kits, which consist of pipette tips that contain a nucleic acid binding matrix in order to speed up the process of extracting DNA or RNA samples for PCR. From the press release: TruTip Extraction Kits were released to the market last November and are the latest products by Akonni Biosystems to be protected by a U.S. Patent. When used with Mettler Toledo RAININ EDP 3-Plus Advanced Electronic Pipettes with LTS, TruTip Extraction Kits are not only fast and easy to use, but will concentrate DNA/RNA on the order of 5 to 20 fold and offer the same yield and purity as traditional methods without requiring any major capital equipment. TruTip Extractions Kits are also available for Eppendorf’s epMotion liquid handling systems when ultra-rapid, hands-free automation and sample throughput from 16 to 384 extractions per day is important. Press release: U.S. Patent Issued for Akonni Biosystems' Ultra-Rapid Nucleic Acid Extraction Technology... Product page: TruTip™ Pipette Solutions Overview...... Smit

Everyone knows that if you hold and spin an object at the end of a string fast enough, the string will break, setting the object on a free trajectory. Switch the object for a baby in the womb and the string for the umbilical cord, and you've got yourself an idea for a patent. Oh, you must also go back in time to 1965 and have the mind of George and Charlotte Blonsky, the inventors of "Apparatus for Facilitating the Birth of a Child by Centrifugal Force". Now, "centrifugal force" is a bit of a misnomer, since the object at the end of the string just wants to fly in a straight line but can't due to the real centripetal force the string is exerting on it. Not having seen one of these in our local maternity ward, this editor suspects there might have been some negative effects associated with putting something like this into practice. Perhaps it was the side effects of spinning a child as its first worldly experience (though we certainly wouldn't have a shortage of astronauts), or maybe it was obstetricians that weren't into experiencing high G forces on a daily basis that shot down the project. Regardless, the march of progress is never ending yet does not follow a straight line. Maybe the inventors themselves climbed into their prototype and discovered that you might need something faster than a gentle playground spin for this to actually be remotely practical. United States Patent US3216423... (hat tip: Gizmodo)... Michael

Three-dimensional structures of proteins are determined by their amino acid sequences, but protein structure prediction remains a complex problem that requires massive amounts of computing power. For years, people from all over the world have been donating their computers' free processing time to Rosetta@home, which provides a screensaver that uses spare processor time to predict protein folding patterns. A group of researchers, however, thought that human intelligence might be better at solving these complex problems, so they developed a multiplayer online game, Foldit, in which accurate protein structure models are produced through gameplay. The game has an extensive motivation and reward structure with a score system, player statuses, ranks and forums. It turned out that humans were often very good at solving problems where computer algorithms would become stuck. Conversely, the computer performed better when starting from a simple linear chain of amino acids. Different players have different strengths, and by having team competitions, those strengths were combined to get the best results. For the article published in Nature, more than 57,000 players contributed through gameplay and feedback. The authors foresee this strategy being used in other scientific domains as well where human three-dimensional structural problem solving can be used. There is a video after the break. More from Ars Technica: Gamers beat algorithms at finding protein structures... Article abstract: Predicting protein structures with a multiplayer online game... Project website: Foldit: Solve Puzzles for Science...... Wouter Stomp

The Radiology Assistant has just released an iPhone/iPod/iPad app bringing the website's content to your mobile device. The Radiology Assistant is the educational web site of the Radiological Society of the Netherlands, focusing on common radiological issues in a problem oriented way for radiology residents and radiologists. It provides some excellent information on a large variety of topics, making it a great resource for radiology residents. The app optimizes content for small-screen viewing and makes it all available offline. For now the app is not optimized for viewing on the iPad yet, but the makers promise an update is on the way. iTunes link: The Radiology Assistant... Main website: The Radiology Assistant...... Wouter Stomp