January 2015

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Jan 1, 2015 - Following Italy (where its first commercial implant was done in 2011) and ..... Medtronic released their newest ILR called LINQ in 2014.


January 2015 The Medical Technology Innovation Magazine Issue #5

LOST IN MEDICAL WEARABLES The blood sugar pioneers, new ECG wearables, securing the data

MEDICA 2014’S VIDEO COVERAGE The Year of mobile and Hyper realism

OUT-OF-THE-LAB MIND READING Emotiv.co’s Interview







Managing the consequences of the wearable invasion

Our selection of trendsetting news, from Siemens’s new 1.5 T Amira MRI to Embrace’s epilepsy wearable and biodegradable suture anchors










Out-of-the-lab EEG is getting real with products like Emotiv’s EPOC headset. We interviewed the start-up to talk about the medical applications of the device

Blood glucose, ECG, gait assessment, wearables are everywhere, while raising questions about interoperability or security

Mobile healthcare developments or hyper realistic imaging, find out more about the upcoming medical innovations in our Medica 2014’s video coverage

The Susruta Samhita: a written guide on 4th century BC aesthetic surgery

PRACTICAL INFORMATION Upcoming events and company index

Hamilton Medical on MedicalExpo.com


Corentin Thiercelin / Vincent Gérard



Anne Gulland is a UK-based freelance journalist who has been writing about health and medicine for 20 years. She has contributed to the British Medical Journal (BMJ), the Guardian and Nursing Times. She writes about global health for the BMJ as well as regularly contributes to its obituary section. She has also undertaken research for a BBC television program, Bizarre ER, about unusual illnesses and accidents.

Ludovic Nachury STAFF WRITERS

Brian Matthews / Erin Tallman / Natacha Truong CREATIVE STAFF

Geoffrey Boulay / Aude Ferriere / Karine Ganora CONTRIBUTORS

Racquel N.Cooper / Anne Gulland / Guy Ramsay MEDICALEXPO EXPERTS

Yannick Bamouan / Fabien Costabello / Luca Cerasani / Raafat Cheaytani / Gilles Ngamenye / Etienne Piccio ADVERTISING

Candida Bingemer / Jean-François Castellani / Jasmin Chavanne / Lucas Constant / Alexandra Jaulin / Francesca Mechelli / Emilio Migliarese MARKETING DIRECTOR

Isabelle Point-Falek CONTACTS

[email protected] [email protected]


GUY RAMSAY Guy Ramsay is a South African medical writer and is currently a PhD candidate at the École des Hautes Études en Sciences Sociales, Paris. His research focuses on generational responses to representations and performances of desire in contemporary France. He started his career as a biochemist but found he preferred writing about medical research than doing it himself. He has a masters from the University of Amsterdam and has written for a variety of magazines about medicine, nutrition and sexual health.

RACQUEL N. COOPER Racquel N. Cooper is an English freelance medical copywriter and translator based on the outskirts of Paris. She obtained her PhD in Molecular and Cellular Biology of Development from the Université Paris VII, Denis Diderot. Her curiosity for science and passion for the written word have morphed her into a diligent writer with over 10 years of experience in scientific and medical communications.

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EDITOR'S NOTE Managing the consequences of the wearable invasion Wearable devices are nearly everywhere. According to a GlobalWebIndex study, 7% of US consumers own a smart wristband, the most common form of fitness and health wearable. According to a Juniper Research study, the number of wearables is expected to triple by 2018, with the Far East and China becoming the key markets. At Medica 2014, world’s biggest medical device trade show, a booming number of exhibitors were displaying wearables. The wearable wave is breaking all around us. This issue’s special feature will help you keep from drowning. If you want a look at the future of medical wearables, read our articles on blood sugar and ECG devices. Wearables have evolved rapidly in these two fields; their successes and limitations hint at what’s next. In our article about interactions with hospitals, we also cover two key topics: how easily can a wearable interoperate with other medical systems and how can it provide only relevant information to avoid inundating doctors with data? We also interviewed a cybersecurity specialist to talk about protecting the most private kind of data—health data. Data management, security, interoperability, certifications, etc.—these are familiar issues for physicians, ones they are expected to resolve. What is brand new is the hitherto unknown doctor-patient relation it creates. By wearing and continuously accessing their device data, patients will certainly feel entitled to claim possession of their medical data. Wearable is not only about the device, but also about who wears and owns the information. In this issue, you will also find out more about innovations which have attracted recent attention. We interviewed Kim Du from Emotiv, the company in charge of the EPOC headset, a fascinating out-ofthe-lab EEG device. At Medica 2014, we got the opportunity to talk about lab diagnosis on a chip and panoramic endoscopy, or 4K imaging. Indeed, 4K endoscopy is one of the most eagerly-awaited technologies of 2015. As such, it’s a development you will read about in one of our upcoming issues.

Ludovic Nachury


Data management, security, interoperability, certifications,… these are well-known issues for physicians”

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THE BIONIC EYE LOOKS OVER THE WORLD Second Sight's Argus II Retinal Prosthesis System is reaching new milestones in the US and in Europe. Following Italy (where its first commercial implant was done in 2011) and Germany, France has agreed to reimburse the Second Sight’s device. In the US, a patient suffering from retinitis pigmentosa became the seventh patient to benefit from the Argus II.

Courtesy of Duke Medicine

The so-called “bionic eye” relies on a sensor implanted in the eye, able to catch light signals coming from a camera mounted on dedicated eyeglasses. In a press release related to this operation, Duke Medicine researchers, who developed the technologies used in the retinal prosthesis, explains that “the device will not restore normal eyesight, but instead provide a visual aid that could help [the patient] distinguish a door from a wall, or a crosswalk painted in a roadway”. 

Turning on a retinal prosthesis system at Duke Eye Center

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Courtesy of Empatica

Launched through the crowdfunding platform Indiegogo, Embrace is a new of its kind wearable device. Looking like a wristband watch, it tracks physiological stress, arousal, sleep,... Its manufacturer, Empatica, explains that the device relies on electrodermal activity, a skin activity linked to emotions-related brain areas.


It could therefore be used as a marker for epilepsy seizures, identifying early signs of a seizure. Empatica has partnered with the Epilepsy Foundation so that people with epilepsy using the device receive an alert when something unusual happens. These alerts can also be automatically forwarded through a smartphone to relatives or caregivers. The company also announced its intent to get the device FDA-certified. 

A health-tracking smartwatch able to detect epilepsy

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MOM, A LOW-COST ELECTRONICALLY-CONTROLLED INCUBATOR The mOm prototype has been designed to fight against premature child deaths in places where healthcare access is difficult, such as refugee camps. This inflatable incubator benefits for example from a small form factor, allowing mOms to be easily stored and transported. Simple electronic controls allow medical and even non-medical staff to ensure that the heat, light and humidity environment is set up to the levels required for premature children.

Courtesy of mOm

mOm’s inventor also emphasizes the fact that the product can be sanitized extremely fast, and can be operated without a main power source for almost 24 hours. The device, which has received the prestigious James Dyson award, is still at the project stage. 

mOm’s inventor explains how his product works

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ISOLATION STRETCHERS FOR EBOLA The new Savion’s bed has been thought of during the SRAS epidemic. And, because it has been released recently, was nicknamed “the Ebola bed”, as it fits well with the containment needs due to the recent surge of this disease.

Courtesy of Savion


The IS 736 uses a carbon filter and blower so that air circulates well inside the chamber: a patient can then stay inside long enough to be fully examined without risking expulsing potentially contaminated air. The transparent chamber is equipped with conduit sleeves and facilities easing the installation of monitoring equipment. Rechargeable batteries allow for 10 hours of autonomy. 

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A GEL TO STOP ANIMAL BLEEDING IN SECONDS Suneris’s Vetigel could turn severe bleeding a thing of the past for animals, and maybe later for humans. This veterinarian gel stimulates the clotting process by rapidly ensuring the accumulation of platelets binding to the site of the bleeding, accelerating this binding and creating a stable clot. According to Suneris, this whole process lasts no longer than a few seconds.

Courtesy of VetiGel

The Vetigel also differentiates as a sustainable, biocompatible product, providing maximum flexibility for follow-up care. At this stage, Suneris is looking for veterinarian willing to participate in clinical studies, but also states that the veterinary market should not be the only Vetigel’s market. 

Vetigel on Bloomberg News

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Courtesy of Konica Minolta

A 3.6 kg 17” by 17” digital radiography detector: here is what Konica is offering with its new AeroDR detector. This was made possible by removing the protective layer between the scintillator and the sensor panel, while using a long-lasting lithium ion capacitor rather than a lithium ion battery. Such a new design also allows for the device to benefit from a robust monocoque structure, as shown in the drop and pressure test video. According to Konica, the AeroDR should provide good radiation efficiency, with a high DQE at low dose. The product is also available in a 2.9 kg 14” by 17” format. 

9 Drop and pressure test for the AeroDR

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ROBOTIC HORSE-LIKE REHABILITATION Intelligent Motion’s Hirob intends to simplify the use of hippotherapy. Not only does this elegant piece of hardware replicates a horse’s walking movement, but its seat, shaped like a horse’s back, force the patient to maintain the stability of the upper body.

Courtesy of Intelligent Motion

Multiple automated choices are possible, with various horses’ movements generated via a robot, and the possibility to adjust speed and intensity. Even though a first clinical study indicates that the system is beneficial for patients with trunk instability suffering from neurological deficits, Intelligent Motion is also testing the Hirob with patients suffering from Parkinson’s disease, paraplegia, and orthopedic diseases. 

The Hirob at work

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SIEMENS SMARTENS 1.5 T MRI MRI is not only about the T race. With its 1.5 T Amira MRI, Siemens presents a product focused on patient comfort, efficiency, and sustainability. Inside an Amira, the sound pressure can be reduced by up to 97% compared to a standard 1.5 T MRI, and the bore can be illuminated. By using predefined settings and standardizing operations, 75% of examinations last no longer than 10 minutes.


Courtesy of Siemens

The Amira is also announced as eco-friendly. Not only does it use the zero helium boil-off technology, it can also save 30% energy during standby. The system weights 4.68 tons and fits in a 28 m² room. 

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SUTURE ANCHORS BECOME DEGRADABLE Researchers at the Fraunhofer Institute IFAM, in Germany, have developed small degradable body implants, which could limit the need for surgeries. Their degradable bone implants are presented as mechanically stable enough to ensure proper bone growth during the whole healing process, while being able to be gradually absorbed by the body.

Courtesy of Fraunhofer IFAM

The researchers have therefore chosen to use metal-ceramic composites: “Iron alloys corrode slowly and ensure high mechanical strength, while ceramic decomposes quickly, stimulates bone growth and aids the ingrowth of the implant”, said in a press release Dr. Philipp Imgrund, manager of the Medical Technology and Life Sciences business field at IFAM. 

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TREATING EPILEPSY THROUGH THE CHEEK A robot, a MRI system and 3D printed flexible needles: a team at US-based Vanderbilt University is assembling a high-tech kit to ease treatment of epilepsy. The idea here is to address seizures in a less invasive way than the current skull-drilling process, by operating through the cheek.


Courtesy of Vanderbilt University

Epilepsy can be treated by addressing the hippocampus. As it is located at the bottom of the brain, it could be operated with needles coming from the cheek. The Vanderbilt team has therefore designed flexible needles, made of a nickel-titanium MRI-compatible alloy, which could be guided by a robotic system inside an MRI. 

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A CANCER-DETECTING ELECTROSURGICAL KNIFE Removal of a tumor also requires the removal of surrounding healthy tissue, but surgeons often have a hard time distinguishing healthy and unhealthy tissue. A team from London’s Imperial College has developed an innovative solution, called the iKnife, which could reach the market soon. Courtesy of London's Imperial College

The iKnife combines an electrosurgical knife and a mass spectrometer. When the knife operates, it generates smoke, coming from the tissue. The spectrometer analyzes this smoke and compares the results to a reference library, enabling it to identify signatures of unhealthy tissues. Initial studies have shown 91% accuracy. The iKnife technology has recently been bought by US-based Waters Corporation. 

Computational and Systems Medicine and the iKnife

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TELEMONITORING PROVES WORTHY FOR CARDIAC PATIENTS Doctors working for the Geisinger Health System, a healthcare system which has implemented telemonitoring, have assessed in a study the impact of telemonitoring on patients with heart failure. 541 members were included in the sample.


Courtesy of InTouch Health

The study focused on the impact of total cost of care and on hospital admission and readmission rates. The results are suggesting that the odds of hospital admissions are much lower, by 23%, for patients using telemonitoring. The odds are even lowered for 90-days readmissions, which decreased 38%. 

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The Medical Avant-Garde

Emotiv: Out-of-the-lab Mind Reading By Ludovic Nachury

The boundary between medical and non-medical devices is becoming more and more blurry. Even sophisticated devices like EEG systems are faced with this issue. With its EPOC headset, Emotiv, a Californian start-up, has become the most vocal advocate of out-of-the lab EEG systems. Even though the EPOC is known to have been used for pure consumer application such as playing World of Warcraft, this product is ultimately an appealing scientific device. With 14 EEG channel locations, plus P3 and P4 locations and 9-axis inertial motion sensors, the EPOC can provide valuable information about the brain. At the same time, ease-of-use by non-medical professionals is favored, with smart electrodes technology or a wireless system forwarding the information to a smartphone. We interviewed Kim Du, Vice-President of Corporate Development for Emotiv, to try to understand why, among the 50,000 users of EPOC, some medical professionals pay such an interest to out-of-the-lab EEG systems.

Courtesy of Emotiv


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Several papers have been published about the product, with people using it for neurofeedback. The EPOC has been tested alongside the EEG standard system, with good results. As an example, the EPOC has been able to identify P300 signals [a key neurosignal to assess cognitive functions]. Again, we know it is not going to replace data collection from the brain scan of a clinic, but the data coming from an EPOC can be used for specific purposes.

It is not going to replace data collection from the brain scan of a clinic.” ME e-mag: The EPOC has generated interest from neuromarketers and even some people in the video gaming industry. From a healthcare standpoint, in which areas has it been used?


K.D.: Our product is used to understand performance, especially for kids with learning disability. But maybe the most spectacular health application lies in the braincomputer interface area. Proof-of-concept instructions have been developed to brain-control an electric wheelchair via an EPOC. And Philips and Accenture are using our product to give more freedom and autonomy to ALS patients, allowing them to initiate actions with their muscles or through mental activity. ME e-mag: One of the most intriguing uses of the EPOC I heard of was for a Mars exploration mission. What has surprised you the most in your community?

ME e-mag: An epilepsy study in Bhutan, helping ALS patients, the EPOC is indeed very close from being a medical device.

Courtesy of Emotiv

Kim Du: First of all, it is important to clarify one point: the EPOC is not a medically-approved device. We are not even thinking of getting it FDA-certified. EPOC cannot be used for diagnosis. Now, we now it has been used on multiple occasions to explore brain activity outside the lab.

K.D.: Well, the test for the Mars exploration project is not that surprising; having an EEG on a space station is not possible, but a product like ours can provide valuable information in such an environment. Another very interesting study is ongoing in Bhutan, where a group is working on epilepsy. The goal is to operate brain scans in place where it is hard to do EEG.

K.D.: Yes, in the US, it is not a medical device, but in other places, like Bhutan, it can provide some level of healthcare. ME e-mag: Coming back to the product, what have you included to ensure it can be used out of a lab, and how is it evolving?

Space telesurgery with the help of an EPOC

K.D.: We tried to get rid of the inconvenience of the gel. With an EPOC and its saline-based system, you don’t need to shave your hair. In the EPOC+, we added a proprietary wireless system, which allows you to have access safely to your EEG data on any Android or iOS device. Basically, the system does not require a specialist to be operated. We obviously have also included features for professionals, such as the compatibility between the data gathered by an EPOC and EEG data software, like Matlab.

Courtesy of Emotiv

MedicalExpo e-magazine: Since EPOC’s release, what kind of feedback did you receive from medical professionals?

ME e-mag: You also announced the Insight. How does it differentiate from your other products? K.D.: The Insight is a completely brand new technology. It benefits from hydrophilic sensor, able to auto-hydrate and providing better connectivity. It is a complete redesign of the system, with a new headset and new commercial-oriented functionalities.

Use of the Emotiv EPOC headset

Brain-control an electric wheelchair via an EPOC”

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A Lesson Learned From Blood Sugar Wearables Going Beyond The ‘At Risk’ Cardiac Patients Pacing In The Waiting Room Wearable Devices Start To Fit With Hospitals Securing Wearable Device Data Key Products

Special Feature


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Special Feature

A lesson learned from blood sugar wearables By Racquel N. Cooper

The field of glucose monitoring has advanced continuously in the last four decades, leading to the development of highly evolved blood glucose meters (BGMs), continuous glucose monitoring systems (CGMS), and noninvasive glucose monitoring (NGM) devices. Making diabetes management easier Traditionally, people with diabetes measure their blood glucose levels repeatedly throughout the day using a lancing device. This is uncomfortable for diabetics, leading to neglect in monitoring of blood glucose and poor diabetes management. CGMS enable diabetics to continuously monitor their glucose level, which has been shown to significantly lower their A1c levels, resulting in tremendous improvements in management.


Most commercially available CGMS rely on invasive techniques using finger-stick blood tests, as the CGMS still needs

to be calibrated many times by BGMs. Furthermore, the invasive sensor of CGMS must be replaced every few days. Additionally, there is associated patient discomfort and skin irritation. According to established healthcare guidelines CGM is approved only as a complementary device that cannot replace fingertip blood checks: this should be done 2-4 times daily to ensure that the CGMS remains calibrated and to confirm the CGMS information. Moreover, a conventional blood glucose reading should be done before making any therapeutic decisions. The current trend has shifted toward NGMbased CGMS, which not only alleviate the pain associated with glucose monitoring, but have an additional benefit of employing a smartphone as the receiver for CGMS. However, current NGM technologies encounter significant obstacles mainly related to inaccuracies stemming from environmental and physiological processes, such as body water content, temperature, poor correlation between blood glucose, and glucose in body fluids. Multi-sensor devices are currently being studied to detect and compensate for such disturbances responsible for the decreased accuracy. 

Evolution of blood glucose monitors

Courtesy of Gluco Track

Diabetes is increasing worldwide and has been declared a global epidemic by the World Health Organization (WHO). Glucose monitoring is an integral part of diabetes management, and maintaining the physiological blood glucose level is the only way for diabetics to avoid life-threatening complications.

The Gluco Track, a wearable glucose-measurement earlobe clip

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Courtesy of Senseonics

Courtesy of Dexcom

Replacing the finger prick for new, noninvasive technology Advancing technology and continued innovation promise to provide novel solutions for diabetes management. Companies are enthusiastic about developing glucose monitoring features in future wearable devices. Google is collaborating with Alcon (Novartis) to develop a smart contact lens that will be able to provide a continuous, minimally invasive measurement of the body’s glucose levels. The lens is designed to measure tear fluid in the eye and connects wirelessly with a mobile device. Speaking of the new smart contact lens, Dr. Gerald Bernstein, director of the Friedman Diabetes Institute at Beth Israel Medical Center in New York City said, “It’s not an easy thing to do. Do I think this is the ultimate answer? Probably not. But I do think it’s something worth pursuing. It is a lot more convenient than the current continuous monitor, which does the same thing.”


In the smart textiles arena, a team of researchers is using fiber optic sensors in a modified pair of socks to identify high temperature zones on the feet, stress areas around the joints, and high pressure points, parameters that are indicators of the potential development of ulcers. This information is then transferred via Bluetooth or Wi-Fi to a user’s phone or to a medical caregiver’s computer. Smart socks have the potential to provide in-depth, real-time data about the diabetic foot. Last but not least, Senseonics, an American company, has recently started a new generation CGM system based on fluorescence sensing technology. The company is currently investigating a nanotube-based glucose sensor, designed to be fully subcutaneously implanted for a year. With so many exciting new devices on the horizon, diabetes care and management can only become easier. 

Courtesy of iHealth

NovioSense, a Dutch company that has recently received a European patent for  a

tiny device that is placed in the eye to continuously measure glucose levels in tears, is also making fascinating progress. The device has yet to receive regulatory approvals, but the new patent should help move the device forward.

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Continuous glucose monitors Company/Product



FDA approval /CE mark

Minimally invasive glucose monitoring Abbott FreeStyle Libre Flash

Glucose levels read through a sensor that can be worn on the back of the upper arm for up to 14 days.

The sensor collects continuous glucose data from the interstitial fluid just beneath the skin’s surface. Using a handheld, color touch-screen reader device, users can scan the sensor patch to reveal real-time glucose values, trend arrows, and eight-hour trend graphs. Unlike other CGMS, no finger prick calibration is needed.

CE mark: September 2014

Medtronic Diabetes MiniMed Duo

A subdermal CGM sensor and insulin infusion site combined.

The world's first two-in-one breakthrough that combines a glucose sensor and insulin infusion set into one on-body device, simplifying integrated insulin pump therapy and continuous glucose monitoring.

CE mark: June 2014

Dexcom Platinum G4

The sensor is a small wire that is inserted under the skin of the abdomen and measures interstitial glucose values. These values are sent through the transmitter to the hand-held receiver where they are displayed for the user.

In addition to reporting interstitial glucose values every five minutes, the system reports trending information in real-time for up to seven days (the life of each sensor). With an average 85% accuracy with just two calibrations per day, the G4 is presented as about 10% more accurate than other FDA approved devices which average at about 73% accuracy. In addition, the device allows users to sync data via a USB port to a computer for better monitoring, or for sharing with doctors and caregivers.

FDA: October 2014 CE mark: June 2012

A G5 model is in development and a G6 is expected around 2017. Animas Vibe pump

The pump is fully integrated with the Dexcom G4 Platinum CGM. Such integration means that the pump can provide info on possible highs and lows within five minutes of a reading from the G4 Platinum.

FDA: December 2014 CE mark: June 2011

The Vibe is the first integrated pump and CGM system to win FDA approval.


A wearable, replaceable, continuous glucosesensing device, with an automatic sensor insertion mechanism. It is worn on the body and the sensor measures glucose in the interstitial fluid every few minutes for three to seven days.

A circular, three-wedge, closed-loop artificial pancreas that combines an insulin pump, a glucagon pump, and a continuous glucose monitor into a single unit.

Still under development

Non-invasive glucose monitoring


InfraV Smartwatch

Biometric sensors.

The first and only smart watch with non-invasive continuous blood glucose monitoring sensors. It will actively alert the wearer of impending decreases or increases in blood glucose levels.

Has not received FDA approval, therefore will be launched as a health and fitness aid, which is not recommended to diagnose or treat illness.

Integrity GlucoTrack DF-F

Uses ultrasonic, electromagnetic and thermal technologies.

A high-tech earlobe clip that measures glucose using three different technologies. Within a minute of being on the earlobe, GlucoTrack sends blood glucose data through a headphone-style cord to a smartphonesized handheld controller, where the glucose reading is displayed or even verbally announced.

CE mark: June 2013

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Special Feature

Going beyond the ‘at risk’ cardiac patients By Racquel N. Cooper

In recent years, technological advances have focused on increasing the efficiency, comfort, and convenience of ECG monitoring devices. Improvements in electronics, wireless communication, power supply, and data storage have simplified the use of ECG monitoring devices capable of continuously acquiring data for much longer periods of time. Moreover, these advances allow for the transmission of pertinent ECG data in real time, encouraging rapid analysis and timely clinical intervention.


Holter monitoring has been the gold standard of ambulatory ECG monitoring since 1961. It is usually recorded for 24 or 48 hours with 3- or 12-lead ECG configuration. Although patient participation is not needed in data transmission, the short duration of monitoring can be inadequate if symptoms are infrequent, patient noncompliance is frequent, the data are not analyzed in real time and in some cases, the relatively slow review of the records limit every-day clinical applicability. Furthermore, Holter monitors are often bulky and lack wireless connectivity.

Better tools for better cardiac outcomes

Some Holter monitors now have the ability to record for a period of 24 hours to up to 14 days. One example is the Custo flash 500 (Custo med), which has three electrodes, short integrated ECG wires and continuous ECG recording for up to seven days.

The devices currently used can be subdivided into two main categories: external and implantable. External devices consist of Holter monitors, ambulatory event monitors

AEMs are small, portable devices that store the recorded data and usually have a life span of up to 30 days. Data are transmitted wirelessly to a central monitoring station 

Courtesy of SuddenLife

Ambulatory outpatient ECG monitoring devices have rapidly evolved over the last few decades and identify life threatening and non-life threatening arrhythmias. The main purpose of these devices that enable longterm monitoring is to evaluate suspected arrhythmias that have not been detected by office or hospital-based monitoring.

(AEM, also known as loop recorders) and more recently, mobile cardiac outpatient telemetry and patch-type monitors. Implantable devices comprise pacemakers and implantable cardioverter defibrillators (ICDs) equipped with diagnostic features and implantable loop recorders (ILRs) (see boxed text).

The ZioPatch demonstration

Courtesy of Intelesens

Cardiac arrhythmias may be associated with serious conditions, such as stroke and syncope. Reliable electrocardiogram (ECG) monitoring is the cornerstone of arrhythmia diagnosis and management.

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and both physician and patient are notified based on pre-specified alerts. This is the first type of monitor providing immediate feedback to the physician and patient. Possible disadvantages of this method are that the patient must trigger the activation, unless an automatic trigger is built into the monitor and the storage capacity is limited, therefore events should be immediately transmitted. Zensor from Intelesens is a seven-day, 3-lead, cardiac event monitoring device equipped with full ECG viewing software. It is Wi-Fi enabled, non-invasive, and transmits data wirelessly to a remote database. In contrast to AEMs, mobile cardiac outpatient telemetry is completely automatic and requires no patient intervention to either capture or transmit ECG data. These systems typically use some sort of wireless technology (such as cellular phone networks) to transmit the data to the company’s central monitoring facility, where the ECG is analyzed in real-time. Examples include LifeWatch’s LifeStar ACT (Ambulatory Cardiac Telemetry) that uses an auto-trigger algorithm to detect atrial fibrillation (AF) and offers up to 30-days of realtime ECG monitoring, and the V Patch from Intelesens, which automatically detects and records events that are immediately available on the web-based platform. The rise of patches


Patch-type monitors provide real time feedback to the care provider or directly to the patient and are more useful in clinical practice. Due to higher patient compliance, they may drive immediate changes in medical therapy or patient care to improve clinical outcome.

The ZIO Patch is a small, single-channel, ECG monitor that continuously, discretely, and wirelessly measures heart rate for up to 14 days. The ZIO Service processes and analyzes the received ECG data before the report is provided to the clinician. First launched in the USA, the ZIO Service recently received CE mark and is now available in the UK. “The response to the launch of the ZIO Service in the UK has been fantastic, with the majority of Trusts in the UK embracing the technology,” said Martyn Dixon, Managing Director of CardioLogic Ltd. “The major teaching hospitals want it and leading stroke physicians have placed orders. At the moment, we don’t have patient reaction information to the ZIO; however, information from the States does show that patient compliance is high with the patch, due to its size and discreet nature.” LifeWatch’s Vital Signs Patch (VSP) is another example that recently received FDA 510(k) clearance. Once the VSP is activated and connected with the supporting system, it provides automation and alerts of key vital signs via continuous wireless monitoring. A further advance in ECG monitoring devices is demonstrated by the BodyGuardian Remote Monitoring System (Preventice), which combines three essential monitoring technologies - mobile cardiac telemetry, event monitoring and Holter monitoring - into one device. The BodyGuardian Remote Monitoring System uses algorithms to support remote monitoring for patients with cardiac arrhythmias for up to 30 days. A small body sensor attached to the patient’s chest collects ECG data then wirelessly transmits the information to physicians via mobile phone technology, providing a continual connection between patients and their care teams. 

Courtesy of Lifewatch


90 SECONDS TO IMPLANT A LINQ The ideal device provides continuous, long-term monitoring, 24 hours a day, 7 days a week with immediate feedback. Indeed, ILRs have been shown to be six times more likely than conventional monitoring to detect atrial fibrillation (AF) in patients who had just suffered ischemic stroke. However, implantable devices require an invasive procedure, thus limiting their use. Medtronic released their newest ILR called LINQ in 2014. This wireless device can be injected under the skin of an un-sedated patient in as little as 90 seconds. Enthusiasm among cardiologists is high. And, on paper, these devices hold promise for improving outcomes in patients at risk for stroke. The problem is that truly helping patients is not about implanting the device, but about the labor-intense process of data interpretation.

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Special Feature

Pacing in the waiting room by Guy Ramsay

So why perform gait assessment?


In clinical practice, gait assessment, either by trained observation, in a gait laboratory, or more recently, with a wearable device, is generally done to detect movement abnormalities, to estimate the patient’s risk of falling, or to assess physical recovery. As the first symptoms of many neurodegenerative disorders, for example Parkinson’s disease or multiple sclerosis include poor balance and a slower walking pace with shorter steps, gait assessment naturally has a role in diagnosis as well as in characterizing disease progression and severity. In Parkinson’s disease for example, stride length is correlated with disease

severity, so the ability to accurately quantify gait characteristics is particularly useful clinically speaking. Gait analysis is also integral to treatment planning in cerebral palsy and is used in the diagnosis of heart disease and osteoporosis. In stroke rehabilitation, it is employed to measure improvements and to set goals.

The emergence of small, portable devices offers a considerable leap in measurement accuracy compared to clinical observation, without the cost and inconvenience of a dedicated movement laboratory. Portable sensors provide rapid and precise data on functional gait impairment, which allows physiotherapy to be more finely tuned to each patient’s needs. The increased sensitivity of measurements also enables milder disabilities or subtle improvements after physiotherapy to be discerned, providing the opportunity for feedback and encouragement. Winning features of wearable gaitmeasuring devices Devices usually employ an array of different sensors to provide four-dimensional movement modeling and to overcome 

Courtesy of Noraxon

Benefits of wearable gait sensors

Courtesy of Noraxon

In the public imagination, gait laboratories – where biomechanical movement is captured by sensors and analyzed on the computer – are generally associated with improving the performance of top-class athletes. Yet undoubtedly, the real social contribution of gait analysis is in healthcare. The advent of small, simple, wirelessly linked, portable widgets, brimming with accelerometers and gyroscopes has meant that what was once the exclusive domain of a dedicated gait lab can now take place in doctors’ waiting rooms. A few minutes of pacing up and down in the waiting room thus takes on a whole new meaning for the doctor-patient interaction.

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Manufacturers of wearable gait assessment devices


Some of the more established companies producing wearable gait assessment devices include Noraxon, BTS Bioengineering and BioSensics in the US, Xsens in the Netherlands, and Tec Gihan in Japan. All of the these companies produce a range of wearable sensory devices and associated software including at least one product that can be used as a wearable sensor in hospitals and in doctors’ waiting rooms to perform gait analysis.

Conversely, the LEGSys device from BioSensics consists of two small devices that are worn around the calves, rather like men’s sock suspenders. They can provide a complete gait analysis within five minutes of use.

Courtesy of BTS

the limitations of individual sensor types. For example accelerometers, which provide three-dimensional motion sensing, are prone to fluctuation of offsets; gyroscopes, which measure rate of change of orientation, suffer from zero bias drift. Small size, wireless data transfer and low power consumption are all key features to limit impedance and improve practicality. The lower cost of the devices has also enabled widespread use in a host of different clinical, sporting, and research settings. Clinicians should, however, ensure that whatever wearable device they choose, it has received FDA or UL certification in the US or a CE certification for safety in Europe, and has been validated for accuracy on clinically relevant outcomes.

Indeed, some of the above companies have specifically developed products for this, which are simple to attach, affordable, and can produce data in minutes. The BTS G-Walk for example, is a Bluetoothlinked device, about the size of a clam-shell cellphone, which is attached via a belt to the patient’s waist where it records spatiotemporal parameters as well as pelvic rotations.

BTS G-Walk spatio-temporal data testing

The bottom line The advent of wearable gait analysis systems that provide accurate data after just minutes of walking in a confined space has considerable implications for general and hospital practice: while patients are waiting for their appointments, they can also be generating invaluable data, improving diagnosis, facilitating measurement of progression, and enabling doctors to set measureable goals. While admittedly, these devices will not make top-class athletes out of ordinary patients, they are indeed a very large and accurately measurable step in that direction. 

Courtesy of Hocoma


Valedo, a back pain therapy videogame developed with Xsens technology

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Special Feature

Wearable devices start to fit with hospitals

“Technology is taking over the measurement of the human body with sensors that continuously, conveniently, and precisely measure variables such as body temperature, pulse rate, blood pressure, ECG, blood sugar, blood oxygen, sleep patterns and many more,” according to Soreon’s report. Growing use by the hospital sector


But while the use of health wearables is currently mainly restricted to the motivated consumer who wants to track the number of steps they take or monitor their calorie consumption via their Fitbit or Jawbone, their use among doctors and other health care professionals is growing, particularly in the US. Earlier this year Oschner Health System opened the O-Bar at its Center for Primary

Care and Wellness in New Orleans. Here, a technology specialist assists patients who want to download health apps or buy devices. So far patients have downloaded 2000 apps, mostly focused on fitness, diet and women’s health and have purchased blood pressure cuffs, glucose monitors and fitness trackers.

Oschner O Bar, an hospital-based wearables bar

Scott Hague, director of development at UK based technology consultancy Integrated Change, says that wearables tailored to the hospital sector are showing the most promise. “There’s great potential for how wearables can interface with a hospital system and provide notifications for doctors and nurses,” he says. “They can be used to alert a nurse when a patient’s critical signs need to be checked. They can let the staff know when blood tests or drugs orders are ready,” he says. Courtesy of Zephyr

Wearable health technology is predicted to revolutionize the health care sector over the next few years. According to a report by the Swiss research institute Soreon Research, the worldwide market is set to grow to about US$41 billion by 2020, from its current US$2 billion.

Courtesy of Oschner

By Anne Gulland

Designed to be part of the system One such product is ZephyrLife, a patch worn by patients, which monitors blood glucose, blood pressure, body weight, and oxygen saturation. The device connects to a central system monitored by a 

How the ZephyrPSM was used to facilitate the Chilean miners rescue

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 doctor or nurse and as well as providing information, it also lets doctors know when changes in heart rhythm or breathing occur, for example. The patch can also be worn at home and could thus assist in early discharge. The device connects to a hub, which in turn transmits data to the hospital’s own systems. And because the readings are taken automatically, it eliminates any human error.

Courtesy of Epic

Leaf Healthcare, based in Utah in the US, has developed a wearable sensor to reduce the incidence of pressure ulcers by alerting nurses when patients need to be turned. Data collected by the sensor, which is placed on the patient’s body, are communicated wirelessly to central monitoring stations or mobile devices and track a patient’s tissue decompression.


Early days of health wearables While the potential for wearable devices is huge, challenges currently exist to their widespread adoption. Cost is one barrier, says Jeremy Schroetter, vice president/ healthcare chief technology officer of leader in software R&D services GlobalLogic. Another is interoperability: integrating a mobile system with the hospital’s current IT system.

“These kinds of integrations aren’t trivial as there is no common system everyone can plug into,” says Schroetter. “Interoperability is a huge problem, but a lot of the healthcare companies are looking at ways to solve this,” he adds. For example, Epic, an electronic health record market leader in the US, has partnered with Apple’s HealthKit to enable iPhone and iPad users to access their Epic medical records via Epic’s MyChart app. A report by consultants PwC, Health Wearables: The Early Days, considers that investments in software will be just as important as investments in hardware. Solutions to manage data overload Another huge challenge will be the amount of data generated, says Schroetter. “If you’re getting megabytes, gigabytes or even terabytes of data, there has to be a physician in the system that’s doing a review and providing feedback that other doctors can utilize so they don’t have to look at oodles of data,” he says. “A doctor doesn’t want to be looking at 50 different dashboards – the information has to be put into a format that’s actionable for the physician,” he says. Outsourcing the reading of scans to doctors in India and China is becoming more common in the US. Therefore, the same practice could emerge as a way of handling the huge task of data monitoring, says Schroetter. 

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Special Feature

Securing wearable device data by Guy Ramsay

MedicalExpo e-magazine: Just how sensitive is data from wearable devices? Yes it might be embarrassing, but is it really all that serious if data from a wearable monitor or a health app is hacked? Seyedmostafa Safavi: We categorize this as trespassing on the user’s privacy. Any negative personal information exposed on the Internet is at best only embarrassing. A breach in security with any health data can be serious. For example, insurance companies might refuse insurance if they knew you were in poor health. Or a business might be in trouble if its founder was ill and that information was leaked. With the recent Sony Entertainment hacks, data security has become an issue in the press and a headache for database administrators. Sensitive data generated by wearable devices are presumably no exception. Are there any particular security concerns with data from wearable devices? Are doctors doing enough to protect patient data?


We asked Seyedmostafa Safavi, a researcher at the Cyber Security Unit at the National University of Malaysia and co-author of a recent review on the subject to elaborate.

ME e-mag: Of all the stakeholders involved in data from wearable devices, is there a weak link? SS: Weak links emerge where the focus has been on making features faster, lighter, or cheaper at the expense of standardization and security. Security matters also need to be considered, as well as price and benefits. ME e-mag: Is the real risk of hacking wearable devices at the local, wireless level, or rather at the cellular connectivity level? SS: A risk emerges when an application developer or device manufacturer didn’t or

wouldn’t consider the possibility of a security breach. So there is a risk at both levels, both locally and regionally. Complete data encryption and using secure connectivity protocols, like VPN built-into the device, can ensure safer data transmission. ME e-mag: What should doctors be aware of when patents offer data from wearable devices? SS: Doctors have to be careful with data collection. They need to ensure that the data have been recorded in a standard manner and that the device has been certified for accuracy. ME e-mag: What can doctors do to ensure greater security of patient data? SS: If the hospital or clinic has an Information Security Management System (ISMS), doctors should adhere to that framework. If not, we would recommend a security awareness course. In general, the basic thing that doctors can do is to update their applications regularly, and to not share their user-IDs or passwords. ME e-mag: What degree of responsibility do doctors have for the protection of confidential data? SS: When we talk about confidential data, it can be digital or it can be non-digital. Both are confidential. You cannot just throw printed patient data into the dustbin. For the same reason, you shouldn’t be able to copy patient data onto a USB drive. A systematic process must be in place, starting with the data collection. If an ISMS is practiced in the hospital, doctors should find out about it. Our advice to doctors is to ensure that

security is updated, to employ firewalls and antivirus applications, and that the server must be designed and implemented with proper protections, both from online hacking and from unauthorized physical access. ME e-mag: What are the security certification requirements that cover data from wearable devices? SS: Since we are focusing on information privacy for wearable devices, we would recommend adhering to the Markle Common Framework guidelines. [Editor’s note: The Markle Foundation is a US-based organization whose mission is to “realize the potential of advances in information technology to address previously intractable public problems for the health, security, and economic wellbeing of all Americans.” The Markle Common Framework is a set of policy and technology practices that help medical professionals and consumers share personal health information while protecting privacy.] ME e-mag: Are the private clinical database-hosting services doing enough to ensure security? SS: In my opinion they are doing their best to prevent security flaws, but to have proper practices in place for security and privacy in the healthcare industry requires an endto-end risk management process. This includes risk assessment – a determination of the organization’s level of acceptable risk – and then deciding what controls must be implemented to reduce that risk to an acceptable level. In addition, they have to monitor, measure, and report compliance to security and privacy standards. 

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Even though the boundary between medical and non-medical devices is getting thinner, certification is still a key concern for wearable manufacturers. And not an easy one, as shown by the limited number of CE and FDA approved wearables. For example, the only certified product at Withings, one of the most renowned companies in this space, is their wireless blood pressure monitor.

This German company has chosen a unique positioning by providing a pre-certified platform for chronic disease telemedicine. Whether a company wants to develop a telemedicine infrastructure, portal, sensor, or mobile application, BodyTel can provide this component and ensure it will benefit from its European medical certification, easing access to market. Its key capacity lies in its information transmission knowledge, guaranteeing a safe and efficient data circulation.

This very easy-to-use device pairs with an Android or iOS smartphone via Bluetooth. The patient just has to wind up the blood pressure monitor around an inner arm to initiate the measurement and receive the data on a smartphone. These data can also be shared with the patient’s doctor. 

Courtesy of Moticon


OpenGo physio demonstration


The company also developed its own range of wearable products with various weight monitoring devices, a blood glucose monitor, and a blood pressure monitor. 

How to use a Withings blood pressure monitor

As each insole contains a battery compartment, it is completely autonomous, and is controlled wirelessly through a PC or a smartphone. Through a smartphone, it is possible to control the insole, and to start and stop recording. On the PC, data can be extensively analyzed with data management software. 

Courtesy of BodyTel

Courtesy of Withings

Moticon’s OpenGo may be the most complete wearable feet activity solution in the market. This sensor-rich insole contains 13 pressure sensing pads and a 3D accelerometer, able to provide information about weight, balance, and motion. The product can work in live or recording mode, and go to sleep mode to save energy.


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With its CardioSecur active, Personal MedSystems’s promise is to be able to tell a patient in less than a minute if he/she needs to do nothing, to plan a visit to the doctor, or to go see this doctor immediately. The system is a 12-lead ECG, working with four electrodes, plugged into an iPhone or an iPad.

Sensor-rich textiles are gaining more and more traction. One of the most interesting technologies comes from Sensoria, a US-based startup, and their “smart socks”. In each sock, three textile sensors are embedded under the plantar area, able to detect foot pressure. These data are transmitted, through conductive fibers relay, to an electronic-rich anklet. There, information are forwarded via Bluetooth to a mobile application.

Courtesy of Vigilant

It starts by storing a reference ECG. Further controls are therefore compared to this reference and, based on guidelines coming from the European Society of Cardiology, may trigger or not an alert. Data can be either stored on the iPhone/iPad or sent to a physician. 

This lightweight (less than 1 ounce) anklet is also equipped with a 3-axis accelerometer. Its battery can last 6 hours and is therefore well adapted for out-of-the-hospital monitoring. 

A German cardiologist explains how he was able to self-diagnose a cardiac event

Courtesy of Sensoria

A BEE TO MANAGE GLUCOSE LEVELS Improperly managing injection and blood sugar levels is a major risk for diabetic’s patients. With its Bee, Vigilant tries to provide them with a solution to easily record these data. After an injection, a patient just has to twist the device so that the exact blood sugar and injection level appears on the Bee’s small LED screen. By pushing a button, the patient sends via Bluetooth the information to a digital logbook hosted on his/her smartphone (Android and iOS). If the patient wants to, he/she can share this information with relatives and doctors. The Bee is compatible with 10 insulin pens. 

Sensoria explains how to wear the anklet


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PAIN RELIEF BECOMES WEARABLE Neurometrix’s Quell is one of the most fascinating pieces of technology in the wearable field. This device intends to fight chronic pain just by pushing a button.

Courtesy of NeuroMetrix

To use a Quell, a patient only needs to strap a band with electrodes on the upper calf. Then, pushing a button triggers a reaction which stimulates nerves, blocking pain signals. According to the company, relief can happen in 15 minutes. This FDA-approved device is also able to adapt to the activity of the user, by providing different levels of stimulation during the day (when the user is active) and at night (when the user is lying). With its rechargeable battery, a Quell’s autonomy can reach 40 hours. 

100% AUTOMATIC BODY MANAGER ? Few wearable devices have generated as much controversies as the GoBe. This product pretends to be a 100% automatic body manager, able for example to measure calories intake through the skin, without any logging.


Most of the medical comments regarding the GoBe doubt it can fulfill its promise but the promise of effortless calorie measurement grabbed a lot of attention. 

Courtesy of GoBe

To do so, the GoBe relies on a proprietary algorithm mixing data from three sources: a pulse sensor, to assess blood flow; an impedance sensor, to monitor fluid levels; and an accelerometer. Its funding came from a campaign on the crowdfunding platform IndieGogo.

GoBe : 100% automatic body manager

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Medica 2014


If you have attended the 2014 edition of Dusseldorf’s Medica tradeshow, you certainly will have noticed, besides the gigantic size of the event, the presence of wearable devices almost everywhere. As we are covering this trend in the special feature of this issue of the e-magazine, we have decided to focus our Medica’s video coverage on two other key trends : mobile developments and hyper realistic imaging. The wide range of medical tools designed to work with mobile devices was extremely impressive. Almost everyone has jumped into the mobile arena, from wearable rapid diagnosis start-ups such as OJ-Bio to big names like Samsung, organizing health data monitoring and transmission via a smartphone or a tablet. Medical imaging has also reached new heights. Barco has readied its Nexxis’s IP imaging management platform for the upcoming 4K hyper high-definition. And research institutes are working on new evolutions, such as Fraunhofer Institute’s panoramic endoscopy technology.



GE Voluson E10’s Hyper Realism


Intelesens Zensor’s Real Time ECG





Fraunhofer Institute’s Panoramic Endoscopy

Barco Nexxis’s 4K Readiness

Samsung/TapCheck’s Wireless Health

OJ-Bio’s Mobile Diagnosis on a Chip

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Imaging quality reached unprecedented levels at Medica 2014. Among the most spectacular system was GE’s new ultrasound imaging Voluson. The E10 provides both faster frame rates and resolutions for 2D, color, 3D and 4D imaging. It can reach 800 volumes per second, making possible 4D fetal heart examination. The system also improves orthogonal plane resolution, facilitating complex visualizations. Voluson’s probes have also evolved, with a new electronic curved convex matrix probe. Using more than 8,000 piezoelectric crystals, this probe can conduct efficiently ultrasound signals, while its heat level is managed by an active water cooling system. 


Courtesy of GE Healthcare

Everything is four times faster”

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Multiple ECG wearable devices were displayed during Medica. With its Zensor, Intelesens has been able to differentiate by providing a product both comprehensive and easy-to-use. This 3-lead ECG, respiratory and accelerometer device is able, through a Wi-Fi connection paired to a smartphone, to transfer both irregularities and continuous monitoring data with just one device, a feature the company boasts as unique. Its patches can be installed by general practitioners, or even by the patients. For two weeks, they will automatically send their data. During this period of time, the patient will only need to recharge the battery’s device. 

Event detection and full disclosure data on one device”

Courtesy of Intelesens


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To get an idea of what could be the near future of personal health recording, Samsung’s booth was a good place to go. Relying on the products of its partner TapCheck, the Korean company was displaying a complete ecosystem. With the TapCheck wearable products, patients can easily record, for example, their blood pressure level. Just by placing it near to a Samsung tablet, patients can then send this record to a health system shared with their doctor. Such a system only makes sense if the safety of the health data is fully guaranteed. TapCheck has therefore decided to rely on Orange’s cloud and data safety services. 

Helping the patient to easily store and record health information”

Courtesy of TAPcheck


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After 3D and 4K, panoramic views? If the Fraunhofer Institute succeeds in turning its research product into commercial systems, doctors may benefit from a new way of visualizing their patients’ organs. The project tries to apply to endoscopic imaging the same panoramic imaging process used by digital cameras: it stitches together pictures to provide a panoramic view. To be used in surgery, this stitching need to be done in a realtime. Therefore, the Fraunhofer Institute has developed a specific algorithm, using the power of a graphic processor. As of today, the project has been tested on phantom bladders, and should be tested soon on patients. 

Stitch pictures online and in real-time to become a map of the bladder”

Courtesy of Fraunhofer


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In 2012, Barco launched Nexxis, its video-over-IP digital operating room platform. At Medica, the Belgium company presented the evolutions making its solution 4K (4 times high-definition resolution) ready. Barco showed images processing devices, able to execute image composition and to mix 4K and non-4K images. It also presented a large and a small 4K display. As of today, 4K is still a technology-to-come in the operating room but, according to Barco, its democratization should happen soon. The company is hoping for 4K endoscopy to get into the market in 2015 and to become a standard in three to four years. 

4K will be driven by 4K endoscopy”


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One of Medica’s most elegant solutions may well be OJ-Bio’s diagnostic device. Their small disposable cassette is a fast, connected, and low-cost immunoassay device. It relies on a “surface acoustic wave chip”. Such a chip can detect a binding event: for example, for flu virus detection, proteins of the flu virus will bind to the chip, triggering an electronic signal turned into a result on the device. This result is then sent to a mobile phone. Low-cost and working with various immunoassays, these tests should last no more than five minutes. 

We combine a very sensitive biochip and a very small rapid low-cost device”


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The Susruta Samhita: a written guide th on 4 century BC aesthetic surgery

Mastering reconstructive surgical techniques today reflects the study of 4th century BC discoveries in India, notably on plastic surgeries of human facial anatomy. The renowned medical book Susruta Samhita, written by Susruta, the father of surgery, describes over 300 surgical procedures, 120 surgical instruments and classifies human surgery in eight categories.


The book remains the only authentic text on ancient Indian medicine, Ayurveda. After the appearance of the Susruta Samhita, Ayurvedic texts presented Susruta as a fully mythologized figure, for example as a descendant of Dhanvantari, the physician of the gods in Hindu mythology.

The book alone supports Susruta’s title, but the Father of Surgery was also the first medical man to have performed dissection of a human body and to describe the anatomy of the human being. However, he insisted upon training students in surgical techniques using fruits, vegetables and artificially prepared parts of the human body–he’s considered to be the first surgeon in the world to implement this method. The Susruta Samhita represents the equivalent of modern ‘free flap’ operations. Among the 300 procedures occurring at that time was rhinoplasty, now one of the most common operations. In Susruta’s time the operation provided a solution for those sentenced by the Hindu Laws of Manu. “The laws, that governed much of life in ancient India, dictated that the punitive measure for the crime of adultery was to have the offender's nose cut from the face.” (Persaud, 1997) Susruta’s surgical practices for repairing the mutilated nose–rhinoplasty– were adopted later by European surgeons under the name The Indian Method. While Susruta’s work was an important step for our surgeons, an evolution can obviously be noted when comparing the procedure for a rhinoplasty operation at that time with our current techniques. 

Courtesy of LACMA

Courtesy of Christian Medical College, Vellore

by Erin Tallman

4th century BC vs. 21st century rhinoplasty Susruta Samhita

Modern Rhinoplasty

(source the Internet Journal of Plastic Surgery)

(source A R D’Souza, London Facial Surgeons)

The portion of the nose to be covered should be first measured with a leaf. Then a piece of skin of the required size should be dissected from the living skin of the cheek, and turned back to cover the nose, keeping a small pedicle attached to the cheek.

History of rhinoplasty surgery dates back to ancient India where it all began. Today, growth in skill, training and technology available has resulted in two basic techniques:

The part of the nose to which the skin is to be attached should be made raw by cutting the nasal stump with a knife. The physician then should place the skin on the nose and stitch the two parts swiftly, keeping the skin properly elevated by inserting two tubes of eranda (the castor-oil plant) in the position of the nostrils, so that the new nose gets proper shape. The skin thus properly adjusted, it should then be sprinkled with a powder of licorice, red sandal-wood and barberry plant. Finally, it should be covered with cotton, and clean sesame oil should be constantly applied. When the skin has united and granulated, if the nose is too short or too long, the middle of the flap should be divided and an endeavor made to enlarge or shorten it.

• The closed rhinoplasty technique • The open rhinoplasty technique There are several variations centred on these two basic approaches, depending on what is required based on patient factors. It also depends on, the surgeons training and philosophy. Open rhinoplasty involves a cut in the midline partition of the nose called the columella and the rest of the incisions are inside the nose. The main advantage of open rhinoplasty technique is, excellent exposure of the nasal tip as well as rest of the nose. This gives the surgeon complete control over the procedure, particularly tip modification and reconstructing nasal valve etc. Closed rhinoplasty, is where all the cuts are made inside the nose.

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Practical Information UPCOMING EVENTS

UPCOMING EVENTS THE LEADING INTERNATIONAL DENTAL SHOW Held every two years in Cologne, the world’s leading trade show for the dental sector, presenting the entire range of products available. IDS 10-14 March 2015 Cologne, Germany

SOUTHEAST ASIAN HEALTHCARE & PHARMA SHOW SEACare 2015 6-8 April 2015 Kuala Lumpur, Malaysia

Southeast Asia’s most established trade show for the healthcare industry, also including a pharma and beauty focus.



CMEF 15-18 May 2015 Shanghai, China

The largest medical devices exhibition in the Asia-Pacific region, covering tens of thousands of products and providing services to the entire medical industry chain.

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Practical Information UPCOMING EVENTS

UPCOMING EVENTS THREE LEADING EVENTS AT THE SAME TIME Three market areas are represented at Salons Santé Autonomie: HopitalExpo, Health-ITExpo, and GerontHandicapExpo. Salons Santé Autonomie 19-21 May Paris, France


Hospitalar displays from the most sophisticated state-of-the-art medical technology up to more practical equipment.



FIME 5-7 August Miami, USA

Find products among the largest worldwide group of medical manufacturers and learn from seven educational conference tracks.

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Practical Information COMPANY INDEX







Integrated Change



Integrity Applications

Second Sight





Intelligent Motion











BTS Bioengineering

Leaf Healthcare

Tec Gihan



Vanderbilt University

Custo med




London's Imperial College

Waters Corporation











National University of Malaysia



Fraunhofer Institute




Geisinger Health Systems


Global Logic

Oschner Health System




Personal MedSystems



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Next Edition April 14, 2015 Techno-Caring of Elders + IDS 2015 Coverage

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