Archives: 10/2008

56754epo Medgadgets Sci Fi Writing Contest: Return of the Prose   Sponsored by EpocratesWe are excited to announce the third annual Medgadget Sci-Fi Writing Contest! The competition is designed to present to the public talented writers, among our readers and beyond, who imagine the future of medicine through fictional stories. Whether it is a hitherto unknown ethical dilemma that will come up many years from now, or an imaginary technology, we can’t wait to see this year’s entries! Our readers will recall the amazing set of stories that dazzled and stirred the imagination last year. Lets take a look at the future of medicine together again!
Just like last time, here are the rules:

  • Your fictional essay has to be 250-2500 words. Text. English language. No mp3′s with you reading your story and cool sound effects in the background, (at least, not this time). And no videos, flash, or jpg’s either.
  • Top entries will be printed here and thus, must be safe for work. That’s not to say we don’t love artsy violence and gratuitous love scenes, however. Just keep the language clean.
  • Judges will be blinded. Blinded by your dazzling prose, yes, but also to your identity. We are assembling an all-star judging panel, so you can be assured your work will be reviewed by accomplished writers, physicians, and a few fans of Battlestar Galactica. To help the Medgadget editorial team with grading your papers, we’ve invited Dr. Allen Roberts from GruntDoc, Dr. Val Jones from the newly opened Getting Better, and our good friend Amy Tenderich from Diabetes Mine to join us.
  • Submissions from anonymous bloggers and writers are accepted, but we will need an address or PO Box to send your prize!
  • This year’s competition is sponsored by Epocrates, whose mobile medical software solutions have been used by hundreds of thousands of clinicians and have been recognized as the industry’s leading software for many years now. Epocrates is generously donating to the winner the latest version of Epocrates Essentials Deluxe, a premium mobile suite of drugs, diseases and diagnostics that also features a medical dictionary, coding reference, clinical calculators and more, as well as the latest Palm® Tungsten™ E2 handheld.
  • 34563dem Medgadgets Sci Fi Writing Contest: Return of the Prose   Sponsored by Epocrates
    To learn more about the Epocrates Essentials Deluxe, check out this short product demo. All in all, Epocrates is offering an almost $500 package to the winner.
    34563dem2 Medgadgets Sci Fi Writing Contest: Return of the Prose   Sponsored by EpocratesIn addition, the winner will take home a box set The Complete Wreck (A Series of Unfortunate Events, Books 1-13) by Lemony Snicket, a gift from the Medgadget team.

  • Entries are due two weeks from now, on November 16th. Winners will be announced, and stories reprinted here on Medgadget, a week later. Send in your submissions to: scifi@medgadget.com.
  • That’s it! Get your thinking caps on and start typing! Feel free to browse our archives … for inspiration.

    43534me TIME Magazine Panders to Google Overlords, Silicon Valley Czars, Hollywood CharlatansThis is just a hoot! TIME magazine has released its guide to 50 Best Inventions of 2008, and the numero uno on the list, The Retail DNA Test, is not even an invention. Based on old technology, called SNP genotyping, retail DNA testing (also known as direct-to-consumer (DTC) genetic testing) is a growing industry with services that many consider to be of questionable value. Don’t take our word for it: we are just doctors who blog in pajamas. Take note instead from the Genetics and Public Policy Center at Johns Hopkins University, which has just received a two-year NIH grant to study the industry:

    Right now, [Gail Javitt, a principal investigator at the Genetics and Public Policy Center] explains, we know very little about the DTC landscape or how it will affect health and health care in the future. Genetic tests for more than 1,300 diseases or conditions are available clinically, and the number is growing rapidly. Theoretically, almost any genetic test for these diseases could be offered directly to consumers, and more than 30 companies already have entered the DTC genetic testing market, including major players Navigenics, 23andme, and deCODE…
    “There is a lot of hype and a lot of angst about how personal genome testing will play out in health care,” Javitt noted. “What’s missing are hard facts about this industry and its consumers, and what the public’s motivations for, and experiences with, these tests have been.”

    And if you read TIME magazine’s stupendous award announcement, you will notice that the editors are not even sure themselves:

    California and New York tried to block the tests on the grounds that they were not properly licensed, but have so far been unsuccessful. Others worry about how sharing one’s genetic data might affect close relatives who would prefer not to let a family history of schizophrenia or Lou Gehrig’s disease become public. And what if a potential mate demands to see your genome before getting serious? Such hypotheticals are endless. And some researchers argue that the tests are flawed. "The uncertainty is too great," says Dr. Muin Khoury, director of the National Office of Public Health Genomics at the Centers for Disease Control and Prevention, who argues that it is wrong to charge people for access to such preliminary and incomplete data. Many diseases stem from several different genes and are triggered by environmental factors. Since less than a tenth of our 20,000 genes have been correlated with any condition, it’s impossible to nail down exactly what component is genetic. "A little knowledge is a dangerous thing," says Dr. Alan Guttmacher of the National Institutes of Health.

    So what to make of the award announcement? We say, TIME was probably sucking up to people whose lives have become a never ending effort to hype things onto the common man. You see, whether you take 23andme’s Anne Wojcicki and her husband Sergei Brin (co-founder of a website Google.com, an advertising agency with no customer service), or 23andme’s investor movie mogul Harvey Weinstein, or Navigenic’s venture capitalist John Doerr, they feel that they are changing the world. But really, considering the hype, aren’t they more interested in making money and elevating themselves to the level of revolutionaries, than furthering medicine and its technology? Doing a genetic test is not like listening to an iPod, or watching Pulp Fiction. Has Weinstein ever heard of false positive medical results? How about that every test always has such results? And what about cost-benefit analysis, so important in medicine? Do you really believe that Wojcicki can explain why we do mammograms every year, but not chest X-rays? After all both can detect cancer…
    We say these VIPs have all the right to run their enterprises, but to say that what they offer is an important service and revolutionary service would be far off the mark. TIME can do it, but our modest team of medical tech enthusiasts just can’t.

    blue dolphin Blue Dolphin Dives into TracheaCook Medical is releasing its Ciaglia Blue Dolphin device for an elective percutaneous dilational tracheostomy (PDT), which combines balloon dilation and tracheal tube insertion into one step and promises easier and safer delivery.
    From the press release:

    The balloon minimizes pressure on the anterior tracheal wall and delivers an even and controlled radial dilation. This significantly reduces the downward force needed to create a tracheal stoma compared to traditional PDTs. Additionally, the device may minimize bleeding, ring fractures and posterior wall perforations by eliminating the need for a dilator to advance back and forth in the trachea, and by limiting soft tissue dissection to a simple skin incision. Due to the “elastic memory” of tissue, the stoma tightly contracts around the tracheostomy tube once the procedure is complete, providing the needed seal and tamponade effect to help prevent bleeding.

    From the product page:

    The set consists of a balloon-tipped catheter loading dilator assembly; Cook inflation device; wire guide; 18-gage introducer needle; 18-gage TFE sheath needle; needle holder cup; 14 French dilator; large full-body drape with clear plastic window; gauze pads; disposable syringe; measuring tape; disposable safety scalpel; and lubricating jelly. A separate, sterile tracheostomy tube is also included in an optional set.
    The tray contains the set components and other items necessary for a bedside procedure, including lidocaine; 22-, 25-, and 18-gage needles; double swivel connector; Chlorhexidine/alcohol prep solution; suture with needle; CSR wrap; and prep tray. A separate, sterile tracheostomy tube is also included in an optional tray.

    Press release: Cook Medical Introduces Ciaglia Blue Dolphin™ Percutaneous Dilational Tracheostomy Device…
    Product page: Ciaglia Blue Dolphin…

    chemsensor Electronic Nose for Chemical DetectionAnother day, another electronic nose. At the National Institute of Standards and Technology researchers are developing a chemical sensor that, in some ways, will mimic olfactory system in animals.
    From NIST:

    In animals, odorant molecules in the air enter the nostrils and bind with sensory neurons in the nose that convert the chemical interactions into an electrical signal that the brain interprets as a smell. In humans, there are about 350 types of sensory neurons and many copies of each type; dogs and mice have several hundreds more types of sensory neurons than that. Odor recognition proceeds in a step-by-step fashion where the chemical identity is gradually resolved: initial coarse information (e.g. ice-cream is fruit-flavored vs. chocolate) is refined over time to allow finer discrimination (strawberry vs. raspberry). This biological approach inspired the researchers to develop a parallel “divide and conquer” method for use with the electronic nose.
    The technology is based on interactions between chemical species and semiconducting sensing materials placed on top of MEMS microheater platforms developed at NIST. (See “NIST ‘Microhotplate’ May Help Search for Extraterrestrial Life,” NIST Tech Beat, Oct., 2001.) The electronic nose employed in the current work is comprised of eight types of sensors in the form of oxide films deposited on the surfaces of 16 microheaters, with two copies of each material. Precise control of the individual heating elements allows the scientists to treat each of them as a collection of “virtual” sensors at 350 temperature increments between 150 to 500 °C, increasing the number of sensors to about 5,600. The combination of the sensing films and the ability to vary the temperature gives the device the analytical equivalent of a snoot full of sensory neurons.
    Much like people detect and remember many different smells and use that knowledge to generalize about smells they haven’t encountered before, the electronic nose also needs to be trained to recognize the chemical signatures of different smells before it can deal with unknowns. The great advantage of this system, according to NIST researchers Barani Raman and Steve Semancik, is that you don’t need to expose the array to every chemical it could come in contact with in order to recognize and/or classify them. Breaking the identification process down into simple, small, discrete steps using the most information rich data also avoids ‘noisy’ portions of the sensor response, thereby incorporating robustness against the effects of sensor drift or aging.

    Press release: Sniffing Out a Better Chemical Sensor
    Medgadget’s electronic nose archives…

    43633fre High Flow Microcatheter from Cook Medical Goes Live
    Cook Medical won FDA approval for the firm’s MiraFlex™ High Flow catheter, which is indicated “for use in small vessel or superselective anatomy for diagnostic and interventional procedures,” according to the company.
    From the press release:

    With a generous .025 inch inner diameter, MiraFlex High Flow enables optimal coil delivery and can be used in combination with a wide variety of embolisation materials, including the top-selling MicroNester® and Tornado® Microcoils™ from Cook. A kink-resistant braided construction along the entire length of the catheter shaft to the radiopaque band provides improved torque response and traceability for quicker vessel selection, while maintaining optimal catheter visualisation. The braided design also contributes to the flexibility and durability of the catheter, which carries a rated burst pressure of 1000 psi and achieves the higher flow rates clinicians depend upon.
    Each MiraFlex High Flow microcatheter has a hydrophilic coating designed to greatly reduce surface friction, and is engineered with five durometer zones ranging from a stout proximal portion that delivers improved pushability and control, to a soft, flexible distal tip that reduces the risk of vessel trauma.

    Press release: Cook Medical Receives CE Mark Approval for MiraFlex™ High Flow Microcatheter
    Product brochure: MiraFlex Microcatheter

    knee3601 New Knee Replacement System,  Align 360, Gets FDA OKThe FDA has given Cardo Medical of Los Angeles marketing approval for the firm’s Align 360 Total Knee System, a device that the company says features a unique modular approach in implantation, done with common instruments familiar to surgeons:

    John Kuczynski, Cardo Medical’s Vice-President of Research and Development, commented, "The Align 360 Total Knee System is truly an advanced knee platform. Its femoral component features a funnel-shaped patella track that accommodates the quadriceps angle anatomy for both male and female patients, without the need for gender specific components which provides a tremendous inventory savings for all operating rooms. In addition, the anterior geometry of the femoral component has been designed to reduce antero-medial overhang of the femoral component, which has been clinically proven to be a cause of post-operative knee pain."

    knee3602 New Knee Replacement System,  Align 360, Gets FDA OK

    Dr. Andrew Brooks, Chairman and Chief Executive Officer of Cardo Medical stated, "We are pleased to have achieved this regulatory milestone and are excited to have rounded out our Align 360 platform. Our Total Knee System builds upon our Uni-compartmental and Patella-Femoral systems and is designed as a high performance treatment for tri-compartmental arthritis with choice of either a cruciate sparing or posterior stabilizing device. We now have a unique and comprehensive knee system which allows the surgeon to use matched instrumentation for surgical treatment of uni-compartmental, bi-compartmental and tri-compartmental arthritis. Our Align 360 platform boasts a common, modular instrument set and component design heritage and philosophy. Our novel, minimally invasive instrumentation is designed to enable surgeons to achieve superior surgical outcomes. Cardo Medical looks forward to introducing these and other orthopedic design innovations to the US market over the upcoming quarters."

    To learn more about the system, head to this product page: Align 360 Total Knee System
    Press release: Cardo Medical Announces FDA Clearance of the Align 360 Total Knee System
    Align 360 Surgical Technique (.pdf)…

    card swipe Hard Drive Technology Set to Detect DiseaseAt the University of Utah scientists are developing a machine that can identify a number of pathogens in a given sample, using a phenomenon called giant magnetoresistance. The researchers believe the technology can be made both accurate and small enough to resemble a credit card reader.
    The following is from the University of Utah statement:

    The new testing method makes use of "giant magnetoresistance," or GMR, a phenomenon discovered independently in 1988 by Albert Fert of France and Peter Grünberg of Germany. They shared the 2007 Nobel Prize in Physics for the discovery.
    Magnetoresistance is the change in a material’s resistance to electrical current when an external magnetic field is applied to the material. That change usually is not more than 1 percent. But some multilayer materials display a change in resistance of as much as 80 percent. That is giant magnetoresistance.
    In the first new study, Porter [Marc Porter, Utah Science, Technology and Research (USTAR) professor of chemistry, chemical engineering and bioengineering], Granger [Michael Granger, USTAR research scientist] and colleagues set the stage for using GMR devices to test medical, environmental or other biological samples.
    The prototype reader had four GMR devices: two sensors to detect changes to the magnetic fields of the sample spots, and two "reference elements" to distinguish how magnetic measurements were affected by temperature changes as opposed to the presence of disease indicators in medical samples.
    The prototype does not yet look like a credit card reader or card-swipe device. Instead, it is used to "read" a Pyrex glass sample stick about three-quarters-inch long and one-eighth-inch wide. Biological samples can be placed on the sample stick, which then is "scanned much like a credit card reader," Porter says.
    In the first study, instead of holding blood or other medical samples, the sample stick had 15 raised spots of iron-nickel "permalloy," a magnetic material that produces a magnetic signature read by GMR sensors.
    The study determined how measurements by the GMR sensors – the heart of a future card-swipe device – can be calibrated to account for variations in the size of the permalloy spots, the amount of separation between the sensors and the sample stick, and on the angle of the sample stick as it is scanned by the sensors.
    Those factors determine how consistently and accurately a card-swipe device would detect minute amounts of substances associated with diseases.
    In the second study, the sample stick’s alloy spots were replaced by the material that would be used on real medical test cards: microscopic spots or "addresses" of gold that were no longer than the smallest known bacterium. The widths were varied to test which size of addresses could be "read" most accurately.
    A substance named biotin or vitamin B-7 was bound chemically to the gold spots on the sample stick. Tiny drops of magnetic particles coated with streptavidin – a protein found in eggs – were placed on the gold spots.
    "The gold address has no magnetic signature," Granger says. "Once the particles are bound to it, GMR picks up that magnetic signature. It’s a proof of principle."
    The experiment was repeated hundreds of times with different concentrations of magnetic particles bound to the biological substance.
    "We could detect as few as 800 magnetic particles on an address," Porter says. "We believe that with further development, we can get down to single-particle detection."

    Full story: A Card-Swipe for Medical Tests
    Image: This green circuit board contains giant magnetoresistance (GMR) sensors (one sensor shown in expanded view) like those that “read” data on a computer hard drive. In a testing method demonstrated by University of Utah scientists, the board would serve as the heart of card-reader that would be used for medical or environmental tests. A credit card-like sample stick containing, blood, saliva, water or other liquids would be swiped through the reader, producing electrical currents that could indicate if any of the samples contained pollutants or substances associated with various diseases. Photo Credit: Michael Granger

    yet another imaging Optical Visualization at Nanoscale, Thanks to Algorithmic Image Averaging
    At the National Institute of Standards and Technology, a new imaging modality, based on relatively cheap optical microscopes and digital analysis, promises to visualize things at the nanoscale. The technology might help to optimize manufacturing of drug delivery nanoparticles, and other nanothingies, of the future.

    Optical microscopes are not widely considered for checking nanoscale (below 100 nanometers) dimensions because of the limitation imposed by wavelength of light—you can’t get a precise image with a probe three times the object’s size. NIST researcher Ravikiran Attota gets around this, paradoxically, by considering lots of “bad” (out-of-focus) images. “This imaging uses a set of blurry, out-of-focus optical images for nanometer dimensional measurement sensitivity,” he says. Instead of repeatedly focusing on a sample to acquire one best image, the new technique captures a series of images with an optical microscope at different focal positions and stacks them one on top of the other to create the TSOM image. A computer program Attota developed analyzes the image.
    While Attota believes this simple technique can be used in a variety of applications, he has worked with two. The TSOM image can compare two nanoscale objects such as silicon lines on an integrated circuit. The software “subtracts” one image from the other. This enables sensitivity to dimensional differences at the nanoscale—line height, width or side-wall angle. Each type of difference generates a distinct signal.
    TSOM has also been theoretically evaluated in another quality control application. Medical researchers are studying the use of gold nanoparticles to deliver advanced pharmaceuticals to specific locations within the human body. Perfect size will be critical. To address this application, a TSOM image of a gold nanoparticle can be taken and compared to a library of simulated images to obtain “best-match” images with the intent of determining if each nanoparticle passes or fails.
    This new imaging technology requires a research-quality optical microscope, a camera and a microscope stage that can move at preset distances. “The setup is easily under $50,000, which is much less expensive than electron or probe microscopes currently used for measuring materials at the nanoscale,” Attota explains. “This method is another approach to extend the range of optical microscopy from microscale to nanoscale dimensional analysis.” So far, sensitivity to a 3 nm difference in line widths has been demonstrated in the laboratory.

    Press release: Nanoscale Dimensioning Is Fast, Cheap with New NIST Optical Technique
    Image: This schematic (right) shows how a TSOM image is acquired. Using an optical microscope, several images of a 60 nanometer gold particle sample (shown in red) are taken at different focal positions and stacked together. The computer-created image on the left shows the resultant TSOM image.

    436342flu Self Powered Sensors: Electricity From Gas and Water
    Researchers at the Fraunhofer Technology Development Group (TEG) engineered a novel system that allows pressure fluctuation in fluids to be converted into electrical energy by piezoceramic elements. For now, this research will probably go into new sensors to monitor water pipes, but the development of self powered implantable medical devices might be the next step for this technology:

    Air compression systems can be found in many manufacturing operations. If a leak occurs anywhere in the system, the air pressure drops and production comes to a halt until the source of failure has been found. Sensors constantly monitor the pressure in order to keep costly fault-related losses to a minimum. At present, these sensors are either battery-driven or connected up by complex technical wiring. This often makes it very difficult or even impossible to install sensors in places that are hard to reach. Fraunhofer researchers from Stuttgart have developed a new technology that enables the production of energy-autonomous and thus low-maintenance sensors. “Our system is eminently suitable for sensors in pneumatic plants, as we can convert the kinetic energy from air or water into electricity,” explains José Israel Ramirez, who is doing research on this topic at the TEG. “The fluidic energy transducer generates electricity in the microwatt or milliwatt range. This is sufficient to supply cyclically operating sensors with enough energy to read out and transmit the relevant data.”
    The fluid-electricity conversion takes place in a fixed housing, through which the medium is fed on a course similar to that of blood circulating in the heart. The Coandã effect causes the constant stream of fluid to oscillate. This produces a periodic pressure fluctuation in the feedback branches, which are coupled to piezoceramics. “The piezoceramics convert the fluidic energy into electricity,” says group leader Axel Bindel, summarizing the principle. This fluidic conversion is simple and cost-efficient. “ We have the advantage that both air and water can be used to generate energy. What’s more, we don’t have any movable parts in our system. The structure can be produced in simple processes, and that saves costs.” The new technique can be applied to any system in which a fluid or a gas is guided through a fixed geometry – in supply networks or in medical engineering, for example. “Our objective is to be able to provide currently battery-driven devices, such as water meters, with an autonomous supply of energy in the near future, resulting in completely independent systems,” says Bindel. The TEG researchers will be presenting a prototype of the fluid transducer at the joint Fraunhofer stand at the electronica trade fair.

    Full story: The fluid transducer: electricity from gas and water…