A simple, novel solution to identify and protect ureter during surgery

AllotropeMedical, a Houston based medical startup has devised StimSite, a novel, hand-held, single use device that precisely identifies ureter during surgery; thus, eliminating the need for ureteral stenting.

It is specifically useful in all gynecological, colorectal and oncosurgeries. Gynecological surgery accounts for 50% of all iatrogenic ureteric injuries  

It is estimated that around 3 million surgeries performed in US annually, require an identification of ureter. The rate of ureteric injuries is around 2% with disastrous consequences and the total healthcare burden of this complication is about $3.2B every year.

It is also estimated that about 30% surgical time is spent on identifying the ureter.

The surgeon can simply place the tip of the device in the vicinity of the ureter and with a push of a button, the ureter goes into contraction and the full length of ureter towards kidney and bladder can be identified.

There is no other smooth muscle structure in that anatomical region, so the device specifically identifies ureter only.

The device is single use, battery operated and avoids additional procedures like cystoscopy on the operation table.

Allotrope aims to initially market the device for two high volume procedures, Hyterectomy (750,000 in US) and colon resection (300,000 cases). The current alpha prototype is a hand held, stand alone device that can be used in both open and minimal invasive surgeries. The company plans to enter the Robotic market in future by designing device for their platforms.

Currently, StemSite is at pre-FDA state, but plans to get FDA clearance through the 510(k) pathway, and entering the marketplace by first quarter of 2019.

Allotrope has recently won second place in MedTech Innovator’s 2017 competition, among 600 startups.

Here is a video by Allotrope showing the functioning of the device. 

Finally, a ‘Heart Patch’ to mend your broken heart

We are one step closer to the goal of repairing dead heart muscle in human beings, because of a research breakthrough by biomedical engineers at Duke University. The researchers have succeeded in creating a fully functioning artificial human heart muscle large enough to patch the area typically seen in patients who have suffered a heart attack.

The study was published on line in Nature Communications on November 28, 2017.

Ilia Shadrin, a biomedical engineering doctoral student at Duke University and first author on the study said in a newsletter, "Right now, virtually all existing therapies are aimed at reducing the symptoms from the damage that's already been done to the heart, but no approaches have been able to replace the muscle that's lost, because once it's dead, it does not grow back on its own. This is a way that we could replace lost muscle with tissue made outside the body."

It is estimated that around 12 million people worldwide suffer for myocardial infarction and continue living with the damaged tissue that could not contract or send electrical signals, both of which are necessary for proper heart function.

The heart patch is grown from human pluripotent stem cells and contains a myriad of different type of cells like cardiomyocytes, fibroblasts, and endothelial and smooth muscle cells, to create a tissue patch similar to functioning heart muscle. The patch can secrete enzymes and growth hormone that could help in recovering from the ischemic damage.

All these cells are put in specific combination in a jelly-like substance, where they reorganize and grow into functioning tissue. Each individual tissue patch has to be ‘custom made’ in separate container that needs a rocking and swaying motion, instead of being static.

Currently, these patches have been successfully implanted into animal hearts. The researchers have to make many modifications to create the same tissue for human heart like increasing the thickness and vascularization.

Here is the video by Duke University showing the patch contracting on its own, a 3D visualization of the patch’s cells, and the rocking bath that proved critical to the heart patch’s record-breaking size.

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News from RSNA 2017: How Utilization of Artificial Intelligence Will Impact Radiology

Artificial intelligence (AI) has become a permanent fixture in medical practice and if you are attending a recent conference, you will see or hear the words like deep learning, machine learning or artificial neural networks everywhere.

It is going to forever change how physicians work and will help in increasing workflow efficiency, improve diagnosis by new algorithm and totally change the way the patients and physicians interact.

AI is particularly useful in field of radiology, as it can scan thousands of X-rays or images in minutes, compare it with old reports and will act as a second set of eyes to confirm the physicians's diagnosis  and not replace physicians as feared.

Adam Flanders, M.D., co-director, neuroradiology and vice-chair of informatics at Jefferson University Hospitals, Philadelphia, and chair of the RSNA Radiology Informatics Committee, discusses the impact of AI at Radiological Society of North America annual meeting( RSNA) 2017. 

Watch the video here.

On the go blood glucose monitoring by inbuilt Glucometer in Smartphone Case

With a wide array of features like GPS, depth perception and many health-related features like BP and ECG monitoring, Smartphones have become indispensable part of our daily lives. They are the health gadgets of future. But, so far nothing was much developed for diabetics, other than the use of  phone screen to display results of continuous glucose monitoring on the screen.

Engineers at the University of California San Diego have cleverly integrated a glucose monitor in the smartphone case and app, that will enable diabetic patients to record and track their blood glucose readings, whether they’re at home or on the go.

Currently, there is no way for people with diabetes to check the blood glucose when they are out of the house or travelling. They must pack the whole kit and carry it along with them.

Patrick Mercier, a professor of electrical and computer engineering at UC San Diego is the brain behind this new gadget. “Integrating blood glucose sensing into a smartphone would eliminate the need for patients to carry a separate device,” said Patrick Mercier, he said in a news release. “An added benefit is the ability to autonomously store, process and send blood glucose readings from the phone to a care provider or cloud service.”

The new device is named GPhone, and has two main parts. A slim, aesthetically designed, 3D printed case that fits over the smartphone with a permanent, reusable sensor at the top left corner.

The sensor has to be activated by one-time use enzyme packed pellets that magnetically attach to the sensor.

To run a test, a user has to activate the sensor by dispensing a pellet on it, followed by adding a drop of blood to the now activated sensor. The sensor measures the glucose concentration and wireless send it via a Bluetooth to a custom designed android app, that displays the results on the screen.

The user can communicate the results with his healthcare provider or store it in icloud, to track it over a long period of time.

The pellet is discarded after use and the sensor is deactivated. A 3D printed stylus with capacity of 30 pellets store them, and remains attached to the side of the case.

The pellet contains enzyme called glucose oxidase which reacts with glucose and generates an electrical signal in proportion to glucose levels that is picked by the sensor’s electrode.

The work is currently at proof of concept stage. Joseph Wang, nanoengineering professor and his other colleagues dream of integrating the monitor with the smartphone instead of case. They are also working currently to reduce the amount of blood needed for testing and bringing down the cost of the pellets, which are costlier than usual test strips.

The work was recently published in Biosensors and Bioelectronics.

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All Media: Courtesy UC San Diego Newsletter

$10 Microchip by Duke and Stanford turns 2-D Ultrasound Machines to 3-D Imaging Devices

Researchers from Duke University and Stanford University have designed a $10 microchip to make a simple 3D ultrasound imaging device that produces 3D scans similar in quality to CT or MRI scans using your regular 2D ultrasound machine.

The researchers and physicians from Duke demonstrated their device on Oct. 31 at the American College of Emergency Physicians (ACEP) Research Forum in Washington, D.C. 

The budget microchip is roughly the size of a fingernail, and like a Nintendo Wii video game controller, the chip registers the probe’s orientation, then uses software to seamlessly stitch hundreds of individual slices of the anatomy together in three dimensions to give an instant 3-D model similar in quality to a CT scan or MRI. And the better the ultrasound machine being used, the higher the quality of the generated 3D image.

The chip can be added to your regular 2D ultrasound armament by using a 3D printed clip on attachment. 3D ultrasound machines can cost around $250,000, around five times more than their 2D counterparts.

 Joshua Broder, M.D., an emergency physician and associate professor of surgery at Duke Health and one of the creators of the technology got the idea behind the chip while playing Nintendo games with his son

After working on the chip for a year, he took sketches to Duke’s Pratt School of Engineering, connecting with then-undergraduate Matt Morgan, and biomedical engineering instructors and professors Carl Herickhoff and Jeremy Dahl, who have since taken positions at Stanford where they continue to develop the device.

The team has used Duke’s own 3-D printing labs to create a prototype, in the form of a streamlined plastic holster that slips onto the ultrasound probe. A physician can use the probe as a regular 2D probe or add the 3-D capability by simply snapping on a plastic attachment containing the location-sensing microchip. To get the best 3-D images, the team also devised a plastic stand to help steady the probe as the user hones in on one part of the anatomy.

The microchip and the ultrasound probe connect via computer cables to a laptop programmed for the device. As the user scans, the computer program whips up a 3-D model in seconds.

Both Duke and Stanford are testing the technology in clinical trials to determine how it fits in the flow of patient care. The creators believe some of the most promising uses could be when CT scans or MRIs are not available, in rural or developing areas, or when they are too risky.

“Instead of looking through a keyhole to understand what’s in the room, we can open a door and see everything in front of us.”

This upgrade is especially important for babies and trauma patients who cannot be moved. The team has already received a grant from Emergency Medicine Foundation and General Electric to conduct clinical trials for application of the device to located bleeding vessels in trauma patients.

The quality of resulting 3D model is comparable to images produced by a 3D sonography machine, CT scan or MRI scan.”

Clinical trials are already on the way to test the technology in real life applications and emergency scenarios.

Here is a video in which Dr.Broder demonstrate the device .

Apple launches its Heart Study to identify irregular heart rhythm

Apple announced the launch of its previously stated Heart Study with the release of the Heart Study app. The Apple Heart Study app is an innovative research study that uses data from Apple Watch to identify irregular heart rhythms, including those from potentially serious heart conditions such as atrial fibrillation (AFib). This study is being conducted in collaboration with Stanford Medicine to accelerate discovery in heart science.

Anyone who is 22 years or older, resident of US and owns an apple watch series 1 or newer can download the app. As a part of study, the app will collect data throughout the day, and monitor your heart rate and rhythm. It notifies you on your iPhone and apple watch, if an irregularity is detected .

After the notification, you’ll receive a free video consultation on your iPhone with the study’s medical professionals for further analysis. - The video consultation connects you with a board-certified, licensed primary care provider- 24 hours a day, 7 days a week.

In some cases, you will also receive a BioTelemetry electrocardiogram (ECG) patch for additional monitoring. The patch is mailed to study participants at no cost, and required to be worn for 7 days. The data will be analyzed to see if patient is suffering from Afib or other problems of irregular rhythm.

“Through the Apple Heart Study, Stanford Medicine faculty will explore how technology like Apple Watch’s heart rate sensor can help usher in a new era of proactive health care central to our Precision Health approach,” said Lloyd Minor, Dean of Stanford University School of Medicine. “We’re excited to work with Apple on this breakthrough heart study.”

To monitor and calculate the rate and rhythm, Apple Watch’s sensor uses LED lights flashing hundreds of times per second and light-sensitive photodiodes to detect the amount of blood flowing through the wrist as an indicator of the heart’s activity. The data gathered along with Apple’s powerful software algorithms identifies an irregular heart rhythm.

This method which is also used in other wearables, is considered less sensitive than ECG sensors. So, the ability of Apple watch to detect arrhythmias would be a giant leap in wearables market.

Recently, AlivCor has launched FDA approved KardiaBand, a single-lead ECG device for the Apple Watch.

Press release from Apple

Download the app here

Media Courtesy: Apple