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The potential for visually detectable clinical signs of anaemia and their correlation with the severity of the pathology have supported research on non-invasive prevention methods. Physical examination for a suspected diagnosis of anaemia is a practice performed by a specialist to evaluate the pallor of the exposed tissues. The aim of the research presented herein is to quantify and minimize the subjective nature of the examination of the palpebral conjunctiva, suggesting a method of diagnostic support and autonomous monitoring. Here we describe the methodology and system for extracting key data from the digital image of the conjunctiva, which is also based on analysis of the dominant colour classes. Effective features have been used herein to establish the inclusion of each image in a diagnosis probability class for anaemia. The images of the conjunctiva were taken using a new low cost and easy to use device, designed to optimize the properties of independence from ambient light. The performance of the system was tested either by extracting manually the palpebral conjunctiva from images or by extracting them in a semi-automatic way based on the SLIC Superpixel algorithm. Tests were conducted on images obtained from 102 people. The dataset was unbalanced, since many more samples of healthy people were available, as often happens in the medical field. The SMOTE and ROSE algorithms were evaluated to balance the dataset, and some classification algorithms for assessing the anaemic condition were tested, yielding very good results. Taking a photo of the palpebral conjunctiva can aid the decision whether a blood sample is needed or even whether a patient should inform a physician, considerably reducing the number of candidate subjects for blood sampling. It also could highlight the suspected anaemia, allowing screening for anaemia in a large number of people, even in resource-poor settings.

BackgroundPharmacotherapy is the first-line treatment option for Parkinson’s disease, and levodopa is considered the most effective drug for managing motor symptoms. However, side effects such as motor fluctuation and dyskinesia have been associated with levodopa treatment. For these conditions, alternative therapies, including invasive and non-invasive medical devices, may be helpful. This review sheds light on current progress in the development of devices to alleviate motor symptoms in Parkinson’s disease.MethodsWe first conducted a narrative literature review to obtain an overview of current invasive and non-invasive medical devices and thereafter performed a systematic review of recent randomized controlled trials (RCTs) of these devices.ResultsOur review revealed different characteristics of each device and their effectiveness for motor symptoms. Although invasive medical devices are usually highly effective, surgical procedures can be burdensome for patients and have serious side effects. In contrast, non-pharmacological/non-surgical devices have fewer complications. RCTs of non-invasive devices, especially non-invasive brain stimulation and mechanical peripheral stimulation devices, have proven effectiveness on motor symptoms. Nearly no non-invasive devices have yet received Food and Drug Administration certification or a CE mark.ConclusionInvasive and non-invasive medical devices have unique characteristics, and several RCTs have been conducted for each device. Invasive devices are more effective, while non-invasive devices are less effective and have lower hurdles and risks. It is important to understand the characteristics of each device and capitalize on these.

Contribution: This paper examines the literature dealing with the non-invasive estimate of anemia (NEA), and analyzes if the research is developing scientifically with adequate empirical validation. This paper reveals a trend in NEA studies towards an increasing interest in estimating anemia using conjunctiva pallor. Background: Supporting clinical developments and processes to reduce personal discomfort and allow extensive screening needs substantial efforts in researching non-invasive techniques to evaluate anemia. Research Questions: The main aims of this study are the analysis of the area of interest explored in the NEA literature, the evaluation of the peculiarities of papers, giving special consideration to empirical ones, examining them from the point of view of the daily improvement of doctors and healthcare personnel activities and the daily life of patients; and the identification of any considerable research gap to encourage further investigations on new topics. Methodology: The systematic mapping study has been elected as the optimal approach to probe the NEA literature since it defines a rigorous process for data retrieving and interpretation. Findings: Research in this sector is very active, especially in the most populated countries in the world and focuses on improving the technologies currently on the market and on proposing new solutions, especially portable and usable by everyone. A new trend in camera and smartphone-based devices is identified.

Anemia is a common public health disease diffused worldwide. In many cases it affects the daily lives of patients needing medical assistance and continuous monitoring. Medical literature states empirical evidence of a correlation between conjunctival pallor on physical examinations and its association with anemia diagnosis. Although humans exhibit a natural expertise in pattern recognition and associative skills based on hue properties, the variance of estimates is high, requiring blood sampling even for monitoring. To design automatic systems for the objective evaluation of pallor utilizing digital images of the conjunctiva, it is necessary to obtain reliable automatic segmentation of the eyelid conjunctiva. In this study, we propose a graph partitioning segmentation approach. The semantic segmentation procedure of a diagnostically meaningful region of interest has been proposed for exploiting normalized cuts for perceptual grouping, thereby introducing a bias towards spectrophotometry features of hemoglobin. The reliability of the identification of the region of interest is demonstrated both with standard metrics and by measuring the correlation between the color of the ROI and the hemoglobin level based on 94 samples distributed in relation to age, sex and hemoglobin concentration. The region of interest automatically segmented is suitable for diagnostic procedures based on quantitative hemoglobin estimation of exposed tissues of the conjunctiva.

Anemia is a global public health problem with major consequences for human health. About a quarter of the world population shows a hemoglobin concentration that is below the recommended thresholds. Non-invasive methods for monitoring and identifying potential risk of anemia and smartphone-based devices to perform this task are promising in addressing this pathology. We have considered some well-known studies carried out on this topic since the main purpose of this work was not to produce a review. The first group of papers describes the approaches for the clinical evaluation of anemia focused on different human exposed tissues, while we used a second group to overview some technologies, basic methods, and principles of operation of some devices and highlight some technical problems. Results extracted from the second group of papers examined were aggregated in two comparison tables. A growing interest in this topic is demonstrated by the increasing number of papers published recently. We believe we have identified several critical issues in the published studies, including those published by us. Just as an example, in many papers the dataset used is not described. With this paper we wish to open a discussion on these issues. Few papers have been sufficient to highlight differences in the experimental conditions and this makes the comparison of the results difficult. Differences are also found in the identification of the regions of interest in the tissue, descriptions of the datasets, and other boundary conditions. These critical issues are discussed together with open problems and common mistakes that probably we are making. We propose the definition of a road-map and a common agenda for research on this topic. In this sense, we want to highlight here some issues that seem worthy of common discussion and the subject of synergistic agreements. This paper, and in particular, the discussion could be the starting point for an open debate about the dissemination of our experiments and pave the way for further updates and improvements of what we have outlined.

Persistierende Gewichtsreduktion bei Übergewicht und Adipositas durch ein innovatives nicht-invasives Medizinprodukt und Beeinflussung des individuellen adipositas-assoziierten Risikos. Hintergrund: Die Gewichtsreduktionsprogramme bei Adipositas scheitern meist an der im Anschluss eintretenden erneuten Gewichtszunahme. Das Ziel dieser Arbeit war es daher die Hypothese zu untersuchen, ob ein neues intraorales nicht-invasives Medizinprodukt bei Nutzung zu jeder Mahlzeit, über eine Kauflächenreduktion, zu einer Gewichtsreduktion bei Patienten mit krankhafter Adipositas führt und ob das reduzierte Gewicht auf Dauer aufrechterhalten werden kann. Methoden: Hierzu wurden im Rahmen einer prospektiven, randomisierten, kontrollierten (Wartekontrollgruppe), einfach verblindeten, multizentrischen Pilot-Studie 35 übergewichtige Patienten mit mindestens 2 frustranen Abnehmversuchen rekrutiert (29 Frauen, 6 Männer, BMI: 32,2 [29,7 – 37,8]; Alter 47 Jahren [28 - 56]). Die Patienten trugen die Zahnschienen über einen Zeitraum von 3 Monaten zu jeder Mahlzeit und wurden in der Nachbeobachtungsphase von insgesamt 12 Monaten weiter begleitet, ohne die Schiene tragen zu dürfen. Während der Studie sollten sie keine Diät halten, essen was sie mögen und bis sie satt werden und keine Kalorien zählen. Ergebnisse: Durch die Zahnschiene erzielten die Patienten einen signifikanten Gewichtsverlust von initial 87,6 kg [80,5 - 101,3] um 1,5 kg [-2,6 bis -0,4] (p = 0.008) nach 1 Monat und nahmen weiter bis zum Ende der Tragedauer nach 3 Monaten um insgesamt 2,7 kg (-4,6 bis -0,8, p = 0,003) ab. Während der Wartekontrollzeit von 4,5 Monaten vor Schienenerhalt blieb das Körpergewicht der Patienten jeweils unverändert. Im intraindividuellen Vergleich nahmen sie nachfolgend nach 3 Monaten mit Schienenbenutzung signifikant ab (p = 0,011). Dies ist der Beweis dafür, dass es sich bei der Schienenbenutzung nicht um einen Placeboeffekt durch das Programm handelt. Anschließend hielten die Patienten ihr Gewicht über 12 Monate (p = 0.023). Über 73% der Patienten würden die Schiene weiterempfehlen bzw. 76,5% hätten die Schiene gerne über längere Tragedauer gehabt, je unabhängig von dem Ausmaß der Gewichtsreduktion. Weder Einschlussort noch sozioökonomischer Status hatten einen signifikanten Einfluss auf das Ausmaß der Gewichtsreduktion. Es traten keine relevanten unerwünschten Nebenwirkungen auf. Ursächlich für die Gewichtsreduktionen ist am ehesten die Modifizierung des Essverhaltens (Verlängerung der Mahlzeitdauer, Essen bis Sattwerden, weniger Zwischenmahlzeiten, p < 0.0007). Fazit: Dieses ist das erste nicht-invasive Medizinprodukt, das eine Gewichtsreduktion über eine Veränderung der Essgewohnheiten bewirkt. Besonders hervorzuheben ist, dass die Patienten bis zum Sattwerden essen durften und nachfolgend ihr Gewicht über 12 Monaten hielten. Somit wirkt die Schiene sogar über die eigentliche Tragedauer hinaus. Dieses Medizinprodukt stellt daher eine Alternative für bisher bekannte Gewichtsreduktionsprogramme dar und diese wird in einer größeren Folgestudie verifiziert., Background: The weight reduction programs for obesity usually fail due to the subsequent weight regain. The aim of this paper was to proof the hypothesis whether a new intraoral non-invasive medical device leads to a weight reduction in patients with obesity when used at every meal, via a chewing surface reduction, and whether the reduced weight can be maintained in the long term. Methods: In a prospective, randomized, controlled, single-blind, multicenter pilot study, 35 overweight patients with at least 2 frustrating weight loss trials were recruited (29 women, 6 men, BMI: 32.2 [29.7 - 37.8]; age 47 years [28 - 56]). The patients wore the splint for 3 months at every meal and were accompanied for a total of 12 months in the follow-up phase without being allowed to wear the splint. During the study they should not diet or count calories, eat what they like and until they are satisfied. Results: The patients achieved a significant weight loss from initial 87.6 kg [80.5 - 101.3] of 1.5 kg [-2.6 to -0.4] (p = 0.008) after 1 month and continued to lose 2.7 kg (-4.6 to -0.8, p = 0.003) after 3 months until the end of the wearing period. During the waiting control period of 4.5 months before getting the splint, the body weight of the patients remained unchanged. In an intraindividual comparison, they subsequently lost on weight significantly after 3 months of splint use (p = 0.011). Subsequently, the patients maintained their weight for 12 months (p = 0.023). More than 73% of the patients would recommend the splint and 76.5% would have liked to wear it for a longer period, regardless of the extent of the weight reduction. Neither inclusion location nor socioeconomic status had a significant influence on the extent of weight reduction. There were no relevant unwanted side effects. The most likely reason for the weight reductions is the modification of eating behaviour (extension of meal duration, eating until satiety, fewer snacks between meals, p < 0.0007). Conclusion: This is the first non-invasive medical device that causes weight loss by changing eating habits. The patients were allowed to eat until they sat down and subsequently kept their weight for more than 12 months. Thus the splint works even beyond the actual wearing time. This medical device represents an alternative to previously known weight reduction programs and schould be verified in a larger follow-up study.