Pub Date : 2019-03-01Epub Date: 2019-05-30DOI: 10.2217/bem-2019-0008
Aysegul Gunduz, Enrico Opri, Ro'ee Gilron, Vaclav Kremen, Gregory Worrell, Phil Starr, Kent Leyde, Timothy Denison
This perspective provides an overview of how risk can be effectively considered in physiological control loops that strive for semi-to-fully automated operation. The perspective first introduces the motivation, user needs and framework for the design of a physiological closed-loop controller. Then, we discuss specific risk areas and use examples from historical medical devices to illustrate the key concepts. Finally, we provide a design overview of an adaptive bidirectional brain-machine interface, currently undergoing human clinical studies, to synthesize the design principles in an exemplar application.
{"title":"Adding wisdom to 'smart' bioelectronic systems: a design framework for physiologic control including practical examples.","authors":"Aysegul Gunduz, Enrico Opri, Ro'ee Gilron, Vaclav Kremen, Gregory Worrell, Phil Starr, Kent Leyde, Timothy Denison","doi":"10.2217/bem-2019-0008","DOIUrl":"10.2217/bem-2019-0008","url":null,"abstract":"<p><p>This perspective provides an overview of how risk can be effectively considered in physiological control loops that strive for semi-to-fully automated operation. The perspective first introduces the motivation, user needs and framework for the design of a physiological closed-loop controller. Then, we discuss specific risk areas and use examples from historical medical devices to illustrate the key concepts. Finally, we provide a design overview of an adaptive bidirectional brain-machine interface, currently undergoing human clinical studies, to synthesize the design principles in an exemplar application.</p>","PeriodicalId":72364,"journal":{"name":"Bioelectronics in medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/9f/10/EMS107535.PMC7610621.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38886432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Heart failure (HF) is one of the most prevalent cardiovascular diseases and is associated with high morbidity and mortality. Mechanistically, HF is characterized by an overactive sympathetic nervous system and parasympathetic withdrawal, and this autonomic imbalance contributes to the progression of the disease. As such, modulation of autonomic nervous system by device-based therapy is an attractive treatment target. In this review, we discuss the role of autonomic nervous system dysfunction in the pathogenesis of HF and present the available evidence regarding vagus nerve stimulation for HF, with special emphasis on optimization of stimulation parameters. Finally, we discuss future avenues of research for neuromodulation in patients with HF.
{"title":"Vagus nerve stimulation for the treatment of heart failure","authors":"Z. Asad, S. Stavrakis","doi":"10.2217/BEM-2019-0012","DOIUrl":"https://doi.org/10.2217/BEM-2019-0012","url":null,"abstract":"Heart failure (HF) is one of the most prevalent cardiovascular diseases and is associated with high morbidity and mortality. Mechanistically, HF is characterized by an overactive sympathetic nervous system and parasympathetic withdrawal, and this autonomic imbalance contributes to the progression of the disease. As such, modulation of autonomic nervous system by device-based therapy is an attractive treatment target. In this review, we discuss the role of autonomic nervous system dysfunction in the pathogenesis of HF and present the available evidence regarding vagus nerve stimulation for HF, with special emphasis on optimization of stimulation parameters. Finally, we discuss future avenues of research for neuromodulation in patients with HF.","PeriodicalId":72364,"journal":{"name":"Bioelectronics in medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/BEM-2019-0012","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49193179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Over the last decade, significant advances in brain–machine interfaces have demonstrated that people with paralysis can control assistive technology such as computers, wheelchairs and bionic arms with their minds. However, due to the invasive surgery required to access the brain and implant electrodes, to date, no device has received commercial US FDA approval, and consequently there is no existing solution to return independence and mobility for the hundreds-of-millions of people paralyzed by stroke, spinal cord injury and motor neuron disease. But there is hope. We have developed a minimally invasive brain–machine interface that can access the brain using cortical vessels which mitigates the risks associated with open brain surgery.
{"title":"Removing the need for invasive brain surgery: the potential of stent electrodes","authors":"N. Opie, T. Oxley","doi":"10.2217/BEM-2019-0013","DOIUrl":"https://doi.org/10.2217/BEM-2019-0013","url":null,"abstract":"Over the last decade, significant advances in brain–machine interfaces have demonstrated that people with paralysis can control assistive technology such as computers, wheelchairs and bionic arms with their minds. However, due to the invasive surgery required to access the brain and implant electrodes, to date, no device has received commercial US FDA approval, and consequently there is no existing solution to return independence and mobility for the hundreds-of-millions of people paralyzed by stroke, spinal cord injury and motor neuron disease. But there is hope. We have developed a minimally invasive brain–machine interface that can access the brain using cortical vessels which mitigates the risks associated with open brain surgery.","PeriodicalId":72364,"journal":{"name":"Bioelectronics in medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/BEM-2019-0013","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44552447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Welcome to the 2nd Volume of Bioelectronics in Medicine","authors":"Alice Bough","doi":"10.2217/BEM-2018-0013","DOIUrl":"https://doi.org/10.2217/BEM-2018-0013","url":null,"abstract":"","PeriodicalId":72364,"journal":{"name":"Bioelectronics in medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47639439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ambalika S Tanak, S. Muthukumar, I. Hashim, S. Prasad
Aim: Novel electrochemical point-of-use biosensing device for rapid assessment of parathyroid hormone (PTH) levels has been developed. Materials & methods: The analytical nanobiosensor was designed by integrating unique high density semiconducting nanostructured arrays on a flexible sensing surface. Surface modification technique was tailored for enhancing the interaction of nanostructure–biological interface to capture the target PTH level. Results & conclusion: We demonstrate a rapid nanobiosensor to detect PTH in human serum, plasma and whole blood with a limit of detection of 1 pg/ml and a clinically relevant dynamic range from 1 to 1000 pg/ml. This is the first demonstration of detecting PTH as a point-of-use device devoid of sample pretreatment suitable in a surgical setting with high specificity to PTH.
{"title":"Rapid electrochemical device for single-drop point-of-use screening of parathyroid hormone","authors":"Ambalika S Tanak, S. Muthukumar, I. Hashim, S. Prasad","doi":"10.2217/BEM-2019-0011","DOIUrl":"https://doi.org/10.2217/BEM-2019-0011","url":null,"abstract":"Aim: Novel electrochemical point-of-use biosensing device for rapid assessment of parathyroid hormone (PTH) levels has been developed. Materials & methods: The analytical nanobiosensor was designed by integrating unique high density semiconducting nanostructured arrays on a flexible sensing surface. Surface modification technique was tailored for enhancing the interaction of nanostructure–biological interface to capture the target PTH level. Results & conclusion: We demonstrate a rapid nanobiosensor to detect PTH in human serum, plasma and whole blood with a limit of detection of 1 pg/ml and a clinically relevant dynamic range from 1 to 1000 pg/ml. This is the first demonstration of detecting PTH as a point-of-use device devoid of sample pretreatment suitable in a surgical setting with high specificity to PTH.","PeriodicalId":72364,"journal":{"name":"Bioelectronics in medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/BEM-2019-0011","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41824711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-01-01Epub Date: 2019-10-04DOI: 10.2217/bem-2019-0020
Narendra Bhadra, Tina Vrabec, Kevin Kilgore, Niloy Bhadra
Aim: To validate the use of motor activation thresholds (MoT) to titrate stimulation amplitudes for spinal cord stimulation in rodent models.
Methods: We recorded thresholds for MoT and sciatic compound action potentials in ten Sprague-Dawley rats implanted with epidural electrodes. Strength duration curves were fitted to the threshold values.
Results: Activation thresholds were in the same order for both MoT and sciatic compound action potentials.
Conclusion: Many of the large, myelinated fibers traversing the dorsal columns in the rodent spine are activated at similar current levels to MoT. Epidural stimulation in rodents needs to be applied at amplitudes close to MoT to activate these axons.
{"title":"Activation of the sciatic nerve evoked during epidural spinal cord stimulation in rodents.","authors":"Narendra Bhadra, Tina Vrabec, Kevin Kilgore, Niloy Bhadra","doi":"10.2217/bem-2019-0020","DOIUrl":"10.2217/bem-2019-0020","url":null,"abstract":"<p><strong>Aim: </strong>To validate the use of motor activation thresholds (MoT) to titrate stimulation amplitudes for spinal cord stimulation in rodent models.</p><p><strong>Methods: </strong>We recorded thresholds for MoT and sciatic compound action potentials in ten Sprague-Dawley rats implanted with epidural electrodes. Strength duration curves were fitted to the threshold values.</p><p><strong>Results: </strong>Activation thresholds were in the same order for both MoT and sciatic compound action potentials.</p><p><strong>Conclusion: </strong>Many of the large, myelinated fibers traversing the dorsal columns in the rodent spine are activated at similar current levels to MoT. Epidural stimulation in rodents needs to be applied at amplitudes close to MoT to activate these axons.</p>","PeriodicalId":72364,"journal":{"name":"Bioelectronics in medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11412300/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49089679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Epilepsy is one of the most prevalent chronic neurological conditions affecting approximately 0.5–2% of the population worldwide [1] . Patients with epilepsy repeatedly and unexpectedly experience sudden changes in behavior and or consciousness. Epileptic discharges can involve only a part of the brain, causing focal seizures, or the entire brain leading to generalized seizures. First-line treatment comprises pharmacotherapy with one or more anti-epileptic drugs. Several anti-epileptic drugs are currently available with distinct mechanisms of action and side effects. However, for an estimated third of epilepsy patients, seizures remain poorly controlled despite optimal medical management. After failure of at least two anti-epileptic drugs, patients suffer from drug-resistant epilepsy. For these patients, dedicated diagnostic workup in a specialized epilepsy center is warranted and other treatment options should be explored. The most effective treatment option for patients with refractory epilepsy is epilepsy surgery. Following a thorough presurgical evaluation, seizure freedom is obtained in approximately two thirds of patients with mesial temporal lobe epilepsy and half of patients with focal neocortical epilepsy [2] . Patients who are considered unsuitable surgery candidates should be considered for neurostimulation. Several types of neurostimulation have been developed including vagus nerve stimulation (VNS), deep brain stimulation and responsive neurostimulation. Availability may differ by region. Noninvasive neurostimulation techniques are also on the rise, aiming to avoid an invasive procedure and accompanying side effects. Invasive VNS is a neurostimulation therapy which activates vagal nerve fibers in the neck region by means of a helical electrode that is wound around the cervical vagus
{"title":"Is vagus nerve stimulation effective in the treatment of drug-resistant epilepsy?","authors":"A. Mertens, P. Boon, K. Vonck","doi":"10.2217/BEM-2019-0004","DOIUrl":"https://doi.org/10.2217/BEM-2019-0004","url":null,"abstract":"Epilepsy is one of the most prevalent chronic neurological conditions affecting approximately 0.5–2% of the population worldwide [1] . Patients with epilepsy repeatedly and unexpectedly experience sudden changes in behavior and or consciousness. Epileptic discharges can involve only a part of the brain, causing focal seizures, or the entire brain leading to generalized seizures. First-line treatment comprises pharmacotherapy with one or more anti-epileptic drugs. Several anti-epileptic drugs are currently available with distinct mechanisms of action and side effects. However, for an estimated third of epilepsy patients, seizures remain poorly controlled despite optimal medical management. After failure of at least two anti-epileptic drugs, patients suffer from drug-resistant epilepsy. For these patients, dedicated diagnostic workup in a specialized epilepsy center is warranted and other treatment options should be explored. The most effective treatment option for patients with refractory epilepsy is epilepsy surgery. Following a thorough presurgical evaluation, seizure freedom is obtained in approximately two thirds of patients with mesial temporal lobe epilepsy and half of patients with focal neocortical epilepsy [2] . Patients who are considered unsuitable surgery candidates should be considered for neurostimulation. Several types of neurostimulation have been developed including vagus nerve stimulation (VNS), deep brain stimulation and responsive neurostimulation. Availability may differ by region. Noninvasive neurostimulation techniques are also on the rise, aiming to avoid an invasive procedure and accompanying side effects. Invasive VNS is a neurostimulation therapy which activates vagal nerve fibers in the neck region by means of a helical electrode that is wound around the cervical vagus","PeriodicalId":72364,"journal":{"name":"Bioelectronics in medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/BEM-2019-0004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44638159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Professor John Furness speaks to Alice Bough, Commissioning Editor. Professor John Furness leads the Digestive Physiology and Nutrition Laboratory at the Florey Institute of Neuroscience and Mental Health and the University of Melbourne, where he has appointments in the Medical and Veterinary and Agricultural Sciences Faculties. His laboratory has worked for many years on the physiology of digestion, particularly its neuronal and endocrine control. A current emphasis of his work is on the relationships between diet, environment and gut health, and their implications for animal production and for human wellbeing. He is also investigating therapies for the treatment of inflammatory bowel disease and the roles of gut hormones. He has worked closely with the pharmaceutical, medical devices and animal production industries. He is one of the most highly cited Australian scientists. Google Scholar (January 2019) gives his h-index as 107, including 40,400 citations overall.
{"title":"Comparing pharmacological and bioelectronic approaches for the treatment of gastrointestinal disorders","authors":"J. Furness","doi":"10.2217/BEM-2019-0009","DOIUrl":"https://doi.org/10.2217/BEM-2019-0009","url":null,"abstract":"Professor John Furness speaks to Alice Bough, Commissioning Editor. Professor John Furness leads the Digestive Physiology and Nutrition Laboratory at the Florey Institute of Neuroscience and Mental Health and the University of Melbourne, where he has appointments in the Medical and Veterinary and Agricultural Sciences Faculties. His laboratory has worked for many years on the physiology of digestion, particularly its neuronal and endocrine control. A current emphasis of his work is on the relationships between diet, environment and gut health, and their implications for animal production and for human wellbeing. He is also investigating therapies for the treatment of inflammatory bowel disease and the roles of gut hormones. He has worked closely with the pharmaceutical, medical devices and animal production industries. He is one of the most highly cited Australian scientists. Google Scholar (January 2019) gives his h-index as 107, including 40,400 citations overall.","PeriodicalId":72364,"journal":{"name":"Bioelectronics in medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/BEM-2019-0009","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45843603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The potential of conductive hydrogel electrodes at the neural interface: an interview with Rylie Green","authors":"R. Green","doi":"10.2217/BEM-2019-0007","DOIUrl":"https://doi.org/10.2217/BEM-2019-0007","url":null,"abstract":"","PeriodicalId":72364,"journal":{"name":"Bioelectronics in medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/BEM-2019-0007","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43682124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Stochastic and periodic vagus nerve stimulation: how do they affect the heart?","authors":"Elizabeth M. Annoni, E. Tolkacheva","doi":"10.2217/BEM-2019-0005","DOIUrl":"https://doi.org/10.2217/BEM-2019-0005","url":null,"abstract":"","PeriodicalId":72364,"journal":{"name":"Bioelectronics in medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/BEM-2019-0005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46327120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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