More for the feet

As I am one of the many runners out there that use insoles to correct defective positions while walking and running, I found this quite interesting.

At the University of Utah engineering professor Stacy Bamberg recently developed a smart insole that seems to resemble the high technology Nike shoes and other Nike products for running. In this case, it goes beyond that, as this insole could help patients with prosthetic legs and people in rehab to correct walking abnormalities after a fracture or hip replacement.

The device is called Rapid Rehab and consists of a personalized gel insole embedded with force sensors, accelerometers and gyroscopes to detect the way a person walks. Rapid Rehab also contains a wireless transmitter to send data from sensors to a custom application for your smartphone that tracks and provides immediate visual, audio or sensory feedback to the user. The current version specifically contains two force-sensitive resistors that track the pressure the foot exerts when it is on the ground, as well as an accelerometer and a gyroscope to measure foot position and angle.

Image: copyright U News Utah

At present, the insole Rapid Rehab is used by amputees who want to reduce the limp when using a prosthetic leg. However, Bamberg expects it to be also used by physiotherapists and their patients who have received a hip replacement or suffered a bone fracture and need to correct their gait, since Rapid Rehab has proven to be less expensive than a gait-analysis laboratory study, more accurate than subjective observations of a physiotherapist, and faster in providing feedback.

Source: http://unews.utah.edu/news_releases/utah-engineering-prof-invents-smart-insole-to-correct-walking-abnormalities/

A bionic foot made in Brussels

I had not written for a long time about one of my favorite topics: bionic limbs. Fortunately this morning I found an interesting story that also touched me in a particular way, since the engineers who have developed this idea live in my city, Brussels.

Indeed, research engineers at the Vrije Universiteit Brussel, have developed a new active transtibial prosthesis that mimics the natural movement of the ankle and using energy efficiently. Instead of using powerful engines which start and stop at every step, the system activates an electric motor continuously to continuous stretch a rubber band, which in turn is used by the foot as a source of motive power.

By reducing the total energy requirement of the prosthesis, you can use smaller batteries, reducing the overall weight of the device. Moreover, the smaller engines, quieter and more efficient can also simplify the design and implementation.

Check out the video, it's amazing how well it resembles the motion of an actual foot!

White Paper on AMP-Foot 2.0: Intact Mimicking Behavior with a Powered Ankle Prosthesis Transtibial

Treating liver cancer

I would like to write today about two different approaches to treat liver cancer, which have been recently presented in the news, both coming from Southampton in UK.

I read about the first one last 12th of November in BBC News. It is about a "chemo-bath", consisting of isolating the organ so the chemotherapy drugs don't reach other parts of the body. In words of Dr Brian Stedman, a consultant interventional radiologist at Southampton General Hospital: "To cut off an organ from the body for 60 minutes, soak it in a high dose of drug and then filter the blood almost completely clean before returning is truly groundbreaking."

The procedure was baptised as Chemosaturation with Percutaneous Hepatic Perfusion (CS-PHP) and it was used for the first time in UK in two patients with a cancer that had spread to the liver. The method had already been used in Germany, Italy, Ireland, France and the US. Furthermore, a study carried out in the US showed that patients who received this treatment survived 5 times longer than patients who received the best alternative care. 

Image copyright: DELCATH SYSTEMS INC - FORM 8-K - EX-99.1 - EXHIBIT 99.1 - June 3, 2011

This approach could save lives of patients whose cancer has spread to the liver from a primary tumor, for example the melanoma of the eye. Once the cancer reaches the liver, there is no effective treatment and survival is usually no more than four months, with one in ten patients living for a year. However, with this new treatment the time these melanoma patients can live is extended without the disease progressing.

In this new treatment the chemo drug is infused directly into the liver via catheter into the artery. Blood in the veins leading out of the liver is then captured and filtered through a specially designed, double-balloon catheter to filter out the drug before the cleaned blood is returned to the body. The approach allows the drug to be delivered, at a higher dosage than usual, directly to the liver and target the cancer tumor there, but in a minimally invasive manner.

Secondly, researchers at the University of Southampton led by Professor Salim Khako hepatology and Aymen Al Shamkhani immunologist, reported on 12th October that they will investigate how to boost innate immunity in humans to treat liver cancer. The idea is to stimulate the participation of NK cells (Natural Killer cells) to eliminate hepatocellular carcinoma cells.

Professor Khako highlights that hepatocellular carcinoma accounts for 90% of all primary liver tumors and to date is a very difficult condition to treat, in addition to being one of the growing mortal diseases in the world.

In a first phase the professor proposed a clinical trial using these NK cells in the treatment. He announced that three types of patients will have the formation of this cell stimulated to find the most appropriate method. When the team manages to find the most efficient system to stimulate NK cells, trials will be carried out in order to determine the best treatment for liver cancer, the university reported.

The BBC article:

http://www.bbc.co.uk/news/world-20270400

The power of your ear

For the first time, scientists have managed to connect a medical implant and feed it with the energy of a natural battery that we all carry in our inner ear. Yes, all mammals have in their inner ear an "endocochlear potential" similar to a battery. It is located in a chamber filled with ions that, with the aid of sound waves, produce electricity gradients which become auditory nerve signals processed by the brain. In words of the discovers at MIT: 

"The ear converts a mechanical force — the vibration of the eardrum — into an electrochemical signal that can be processed by the brain; the biological battery is the source of that signal’s current. Located in the part of the ear called the cochlea, the battery chamber is divided by a membrane, some of whose cells are specialized to pump ions. An imbalance of potassium and sodium ions on opposite sides of the membrane, together with the particular arrangement of the pumps, creates an electrical voltage." 

"We have known for 60 years that this battery exists and that it’s really important for normal hearing, but nobody has attempted to use this battery to power useful electronics." says Konstantina Stankovic, a researcher at Harvard-MIT Division of Health Sciencies and Technology. 

So far, they have managed to use this source of electricity to power a tiny device without affect hearing.

Image: Patrick P. Mercier - MIT website

This technique could be used to power small ear implants which assist people with hearing loss, to deliver drugs to the body or to feed other sensors. At present, the voltage and power are so weak that scientists had to design a mini converter circuit so the electricity could be exploited by a small electronic device (see the image for a close view into the device size).

http://web.mit.edu/newsoffice/2012/biological-battery-1107.html

To have your knees about you

Much has been said and written in the last months about the knee of the most famous tennis player in my country, Rafa Nadal. Thus, I would like to write today about recent advances in knee injuries diagnosis and knee replacement.

ConforMIS personalized knee replacement

ConforMIS is making knee replacement surgery more personal, creating custom knee implants that exactly match the patient's anatomy. The company uses a technology known as rapid prototyping plus additive manufacturing, which converts a three-dimensional computer design into a physical object. A similar tool that allows personalized implant design and creation is the Materialise Mimics Innovation Suite. ConforMIS believes that such implants can help perform the knee replacement surgery more quickly, more accurately and with less traumatic effects for the patient.

The knee replacement surgery repairs damage and relieve pain in patients with severe osteoarthritis or knee injuries. The total knee replacement involves the extraction of dead cartilage and bone from the surface of the knee joint, the hip bone, the shin bone and the patella, and then replace it with an artificial joint made of a combination of metal and plastic. A partial knee replacement can also be carried out in only one part of the joint.

Typically, the surgeon chooses an artificial joint among several options of different sizes. ConforMIS, however, creates a custom implant based on data provided by images of the knee joint of the patient, with a technology that the company callas iFit. ConforMIS transformed medical images coming from a CT or MRI scanner in a three-dimensional computer model with the aid of a computer design program (CAD), and then used the 3D model as a template to manufacture the implant.

http://medgadget.com/2012/10/conformis-launches-next-generation-patient-specific-total-knee-replacement-implant-system-video.html

Use infrared to determine knee injury

Applied measurement sensors based on infrared may be used to diagnose patients with injuries in the ligaments of the knee, said Ricardo Aguilar, Biomedical Engineering student at ITESM Campus Chihuahua.

The anterior cruciate ligament injury of the knee is a recurrent injury in athletes, as well as in automobile accidents, when the knee is impacted. The biggest problem however is not the difficulty of treating the injury, but the diagnosis of the degree of damage suffered by the patient, he said.

Currently the only way to diagnose the degree of injury is to perform surgery in the patient to detect low visual appreciation tissue conditions. The biomedical research center ITESM Campus Chihuahua started since April this year an investigation coordinated by the orthopedics at Hospital Christus Muguerza del Parque, to design a measurement system which allows detecting, through an analysis of "pivochips", the gravity of the existing knee injury.

In a study based on "pivochips", sensors of an electromyograph with accelerometers owned by the Biomedical Research Laboratory are connected to the patient's injured knee, which are capable of measuring muscle behavior and the affected area during some movements by using infrared sensors, so the degree of injury can be determined without the need to perform surgery.

OR Revolution

Brainlab a step ahead?

Brainlab has launched what we could describe as a super-sized iPad (42 inches) which allows manipulating medical images among other possibilities. They have called it "Buzz Digital OR", a system that integrates all intraoperative imaging. It can be used for viewing DICOM images, but it also performs video management, routing video between sources and destinations, and includes options for fast and easy documentation of surgical procedures. The HD display comes with an integrated sound system, webcam and microphone. It can connect with a multitude of video signals and route content to multiple, full-HD displays. All data can be relayed across the hospital IP network. Like the normal iPad, it has drag and drop functionality which, for example, makes easier to navigate through the different images. 

Indeed, 2012 is being a great year for Brainlab guys since last March they succeeded in winning the coveted 'red dot award', beating over 4515 designs in an international competition. For its benefits, Curve™ inspired the experts and was awarded the "red dot award: product design". Curve incorporates the latest in medical technology. This advanced surgical navigation system for the brain and the body includes the latest software for image-guided advanced 3D displays. Curve features a great ergonomics, two multi-touch terminals, digital HD, hi-fi and wi-fi.


Brainlab Digital Buzz, copyright Brainlab

Gesture Control Technology 

TedCas, a small Spanish company, has invented a system based on Kinect technology, the Xbox game console camera, which allows gestural control of computer applications in ORs and other environments, just as Tom Cruise did in the movie "Minority Report'. The application allows surgeons to use image guidance in the computer without touching it, thus decresing the possibility of bacterial transmission. The number of people who contract an infection each year in operating rooms is around 300,000 cases per year in Spain alone. If we talk about the European Union framework, this figure rises to four million, causing public administrations to spend billions. 

The Spanish system also helps to improve process efficiency in ORs or radiation therapy rooms. Right now there are three options: to have someone managing the computer from outside the room, or the surgeon comes out to do it himself, which is a bit tedious because you have to repeat the whole process of sterilization, or the screen is within the room itself which, despite being protected, remains a risk of infection. Thus, gestural control makes easier for the surgeon to control how the medical information is displayed during the operation. 

At Sunnybrook in Toronto surgeons can now benefit Kinect system during operations, as you can see in the video below:

Source: medgadget, http://www.brainlab.com/art/3401/6/brainlab-introduces-new-multi-touch-surgical-information-hub/

Medical device destroys itself leaving no trace in the body

Imagine an electronic device that releases the drug in the area where it is needed, measure your vital signs, treats a surgical wound and once done it has done its job it melts away ... All this without leaving a trace, as if it had never been in the body. A new class of devices grouped under the name of "transient electronics" is about to start a medical revolution. The first step was just taken by a group of engineers at Tufts University, in the United States, who successfully tested one of these biodegradable devices. The experiment was done with mice that were implanted with a device designed to deliver drugs and treat an infection. Not only did the treatment work, but also it barely left remmants of its presence in the organism three weeks later. With only a few tens of nanometers thick, the new circuits are easily dissolved in either water or other body fluids without causing damage.

In the same line, Abbot lab has recently introduced a new "stent", a new type of coronary implant which is also absorved when is no longer useful. It has a less sophisticated technology than that of the electronic devices, but it works similarily. Stents are a mesh-like tube of thin metal wire which are placed inside the artery to keep them open and facilitate blood flow after a heart attack has occurred. Stents have been placed permanently for years. The absorbable one, made ​​of a material used in sutures, allowes the vessel to dilate and contract in a more natural way, as your body needs it. For example when you are running and need more blood flow. At the end of ist lifetime, the stent is complety disolved and the blood vessel remains open without any other extra support.

Sources:

http://www.bbc.co.uk/news/health-19737125

http://www.abbott.com/news-media/press-releases/abbott-announces-international-launch-of-the-absorb-bioresorbable-vascular-scaffold.htm