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Introduction: Many COVID-19 patients need prolonged artificial ventilation. Skeletal muscle wastes rapidly when deprived of neural activation, and in ventilated patients the diaphragm muscle begins to atrophy within 24 hours (ventilator induced diaphragmatic dysfunction, VIDD). This profoundly weakens the diaphragm, complicating the weaning of the patient off the ventilator, and increasing the risk of complications such as bacterial pneumonia. 40% of the total duration of mechanical ventilation in ITU patients is accounted for by the weaning period, after the initial illness has resolved. Prevention of VIDD would therefore both improve individual outcomes, and also release ITU capacity. We aim to prevent VIDD by exercising the diaphragm with electrical stimulation of the nerves that control it. Evidence suggests that muscle wasting can be prevented by quite low levels of exercise (e.g. 200 contractions per day). Materials / Methods: The diaphragm is activated by the phrenic nerves, formed from branches of the C3-C5 nerve roots in the neck. These nerves may be electrically stimulated in the lower neck. An electrode array is positioned on each side of the neck using surface landmarks. The system automatically determines the best electrode to use in each array. Sensors built into the ventilatory circuit are monitored both to match stimulation to the respiratory cycle and to determine the effects of stimulation. Result(s): We have designed and built a prototype system for unsupervised noninvasive phrenic nerve stimulation. The system delivers one contraction every 7 minutes, synchronised to early inspiration so as not to disrupt ventilation. Electrode impedances are measured before each stimulus, and the closed loop system continuously monitors the effects of stimulation on airflow and adjusts stimulation parameters to compensate for changes in coupling, for example due to head movement. Discussion(s): This stimulator system overcomes several limitations of existing solutions, namely the resource implications and risk profile of invasive electrodes, and the requirement for supervised operation. While invasive systems are applied selectively for these reasons, routine use of our system can be envisaged. This system was inspired by COVID-19 patients but is not limited to them, and has broad applicability to ventilated intensive care patients in general, for example patients with traumatic brain injury. Conclusion(s): Non-invasive stimulation of the phrenic nerves using pressure-free skin surface electrodes is feasible and safe. It offers the potential for prevention of VIDD and thereby faster ventilator weaning and shorter stay on ITU. Clinical trials are planned in 2022. Learning Objectives: After this presentation delegates should be aware of: 1. Ventilation induced diaphragm dysfunction (VIDD) and its importance in patients having lengthy periods of ventilation, as in many cases of COVID-19. 2. The fact that low levels of activity can maintain the condition of skeletal muscles including the diaphragm muscle 3. The potential for noninvasive stimulation of the phrenic nerves to provide 'diaphragm exercise' and prevent VIDD. Keywords: phrenic nerve stimulation, diaphragm, ventilation, COVID-19Copyright © 2022
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Introduction: Peripheral nerve stimulation (PNS) is an emerging modality for treatment of chronic pain. We describe the positive outcome with PNS of a patient whose surgical intervention for severe bilateral glenohumeral osteoarthritis was delayed to COVID-19 restrictions. Materials / Methods: 66 year-old male with severe bilateral glenohumeral osteoarthritis needed bilateral total shoulder arthroplasty however surgical intervention was delayed for months by COVID-19 restrictions. Conservative therapies including physical therapy, intra-articular injections, and oral opioids had previously failed thus we offered PNS. Placement of the right suprascapular PNS system was followed 2 weeks later by left suprascapular PNS system placement. The systems were placed without complication under ultrasound guidance with leads overlying the suprascapular nerves inferior to the suprascapular notch. [Formula presented] Results: At 2 weeks right shoulder pain was reduced by 60% while left shoulder pain was reduced by 70%. His pain decreased by 90% at 4 weeks. Most remarkably he noted significant increases in quality of life and improved independence in daily activities. Discussion(s): Osteoarthritis (OA) is a common cause of joint pain and dysfunction, a result of progressive mechanical and biochemical joint degeneration. OA results in a U.S. economic burden of $130 billion annually(1) with shoulder OA affecting over 30% of U.S. adults over 60 years old(2). COVID-19 delays in surgical cases, as with our patient, extends nationwide with a projected backlog of 1 million total joint and spine cases by 2022(3). Peripheral nerve stimulation originates from the gate control theory noted in 1965. PNS works through activation of large diameter fibers that attenuate nociceptive signaling in the dorsal horn. Through stimulation of afferent fibers, peripherally-induced plasticity can reverse central features of chronic pain. PNS is used in treatment of an expanding multitude of conditions such as peripheral neuralgia and complex regional pain syndrome. PNS involves targeting specific nerve trunks with electrical stimulation, providing directed therapy with a less invasive approach. Pain relief is expected to last beyond treatment duration and in a majority of cases lasts for one year or more. Studies of percutaneous PNS systems propose the prolonged relief following interim treatment periods results from a widened therapeutic window. Selective activation of Aalpha and Abeta fibers generate comfortable sensations in the painful area initiating a cascade of analgesic mechanisms from the periphery to the dorsal horn and cortex. Conclusion(s): An increasing number of studies continue to show significant pain relief with use of PNS(3)(4) providing an exciting opportunity for patients who fail conservative therapies. Learning Objectives: 1.) Highlight the use of emerging pain treatment modalities while navigating healthcare systems affected by COVID-19 2.) Highlight the use of peripheral nerve stimulation (PNS) for chronic pain syndromes typically treated surgically 3.) Showcase the quality of pain relief achieved by less invasive, interim treatments such as peripheral nerve stimulation (PNS). Keywords: peripheral nerve stimulation Copyright © 2022
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Introduction: The design and first results of a transcutaneous electrical stimulator of the vagus nerve for the treatment of Refractory Epilepsy are discussed. Method(s): The device developed is based on the STM32L073CZ microcontroller and can generate fully configurable monopolar or bipolar stimuli, so that the electrical therapy can be adjusted to each patient following the therapeutic strategy designed by their doctor. The start time and duration of each therapeutic session are stored in an internal memory of the device, as well as the instants in which the contact of the electrodes is poor, or the therapeutic session is aborted. In this way, the doctor in charge can review what happened once the information is downloaded to a personal computer. Using 3D printing techniques, a plastic support for the electrodes was developed that allows the automatic adjustment of these to the left ear of the subject undergoing treatment;this ensures placement of the electrodes on the correct ear and proper contact of the electrodes with the skin. The operation of the device is easy, each session starts by pressing a button and ends automatically when the programmed time expires, the intervention of the subject undergoing treatment is minimal and thus stress is avoided. Result(s): 20 prototypes were built and passed technical tests in accordance with IEC 60601-1 and IEC 60601-2-10 standards. The results were satisfactory and thus it is guaranteed that the proposed solution is safe for patients and the techniques used are in the state of the art within this medical technology. The Cuban regulatory body approved a trial with 18 humans to test the effectiveness of the device developed;each patient will be under treatment for nine months, but not all began simultaneously due to restrictions put in place by the COVID-19 pandemic. Electrical stimulation was set as follows: bipolar square pulses of 200 microseconds duration at 25 Hz;three 60-minute sessions per day. A patient is considered as treatment's responder monthly crisis frequency decrease more than 50% that he suffered before starting treatment. To date, six patients have completed the trial, five with significant improvement. The other twelve patients are in treatment and after the third month the Monthly Seizure Frequency has decreased in all of them. Conclusion(s): The proposed solution has been effective in the first six patients ending the trial. Without concluding the study, the proposed solution seems an outstanding therapeutic solution. Copyright © 2022
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Background: Recently, different side effects have been observed after using antiviral drugs before activation of the immune system. Therefore, it is very important to use effective and non-invasive therapy with fewer side effects for infected virus treatment. Method(s): In this study, we designated a new device termed a Life Restoration Device (LRD). The main function of LRD is to generate electric frequencies with lower and safer potential. These frequencies can effectively destroy the biological elements in the viruses, such as nucleic acid materials and viral cell membranes, but not the cellular plasma membrane of the infected eukaryotic cells. Result(s): A designated glass tube was prepared for this purpose. The infected cell culture was located in the cell culture media, and propagated viruses were poured into the glass tube. Additionally, two nickel-coated copper rods were inserted into both ends of the tube inside the cell culture media. Afterward, the two nickel-coated copper rods were connected to the LRD. Using LRD, lower potential electric frequencies were generated and applied for 30 min and 60 min time points. The treatment of the cell culture containing MERS-CoV and SARS-CoV-2 with LRD for 30 min significantly reduced the viral infectivity by 83% and 22%, respectively. After 60 min of treatment with LRD, the infectivity of MERS-CoV and SARS-CoV-2 viruses was reduced by 21% and 1%, respectively. Furthermore, HIV and HBV-infected blood showed a 95.5% and 100% viral inhibition rate after 2 h exposure to LRD. Additionally, based on the results of the electron microscopy of treated H5N1 virus and western blot analysis data of different types of viruses, the nucleic acid components of the treated viruses were reduced compared to the non-treated viruses. The low-power electric frequencies produced by LRD can reduce the fluidity and osmosis of the viral envelope but not the plasma membrane of the infected cells. Conclusion(s): Treatment of different types of pathogenic viruses with electric stimulation produced by LRD is a new alternative to safe therapy but needs further investigations. The results of this study are important to develop an effective, safe, and alternative viral therapy. Copyright © 2022 Bentham Science Publishers.
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Introduction: Insomnia disorder (ID) and major depressive disorder (MDD) are highly comorbid, above 80% of MDD patients have insomnia disorder. Acupuncture as a major complementary and alternative medicine (CAM) therapy, is utilized extensively in Asia to treat mental health disorders.Transcutaneous electrical cranial-auricular stimulation (TECAS) is a potential new type of acupuncture treatment for MDD and ID which combines the scalp points and auricular points most commonly used by acupuncturists. It has the advantages of portability, quantifiable stimulation parameters and comfort, especially for home treatment under the normal situation of COVID-19, which can avoid the risk of infection due to frequent hospital trips. Materials / Methods: 10 ID-MDD patients were treated by TECAS which was administered at the bilateral auricular acupoints, Bai Hui (GV-20) and Yin Tang (GV-29) (waveform:4/20 Hz, wave width: 0.2ms+/-30%) for twice a day last 8 weeks. Pittsburgh Sleep Quality Index (PSQI) and Hamilton Depression Rating Scale(HAMD) of ID-MDD patients were evaluated before and after treatment. Result(s): HAMD-17 scores of 10 patients were lower at 4 and 8 weeks than before TECAS treatment, and the reduction was greater at 4 weeks than at 8 weeks. PSQI scores of 8 patients decreased at 4 and 8 weeks compared with before treatment, and the decrease was greater in the fourth week than in the 8th week. Insomnia of 2 patients improved at 4 weeks of treatment, but became worse in the 8th week as before treatment.7 out of 10 patients showed full insomnia response (50% reduction in PSQI) and 8 patients showed full depression response (50% reduction in HAMD-17 scores). Discussion(s): We suggest TECAS is a good therapeutic strategy to modulate the vagus nerve and trigeminal nerve propagate through electrical stimulation projected by neurons from peripheral sites to the central nervous system. Furthermore, we speculate that TECAS can make the trigeminal nerve afferent fibers and vagus nerve auricular branch carry messages from head facial stimulation to NTS, locus coeruleus, raphe nucleus, medullary reticular activating system and structure of the thalamus, and then to feel, edge, cortical and subcortical structures, so the electrical stimulation subcortical can cause direct regulation, namely the change of cortical excitability. Conclusion(s): These preliminary results in this group of CID-MDD patients are encouraging and need to be replicated in prospective sham-controlled studies with larger sample sizes. In addition, for patients with insomnia and depression, it is important to consider combining TECAS with psychotherapy to avoid the interference of acute negative emergency events. Acknowledgements: The support of National Key R&D Program of China (No.2018YFC1705800) and Key Laboratory of Acupuncture and Chronobiology of Sichuan Province(No.2021004) for this project is gratefully acknowledged. Learning Objectives: 1. To provide a new non-drug method for acupuncture treatment of insomnia and depression;2. Provide preliminary experimental results for the large-sample experimental design of TECAS for the treatment of insomnia and depression;3. Compared with previous studies on insomnia and depression, the regularity and characteristics of TECAS in treating insomnia and depression were found. Keywords: Transcutaneous Electrical Cranial-Auricular Stimulation (TECAS), insomnia disorder, a case series, acupuncture, Major Depressive Disorder Copyright © 2022
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COVID-19 produces persistent and prolonged effects, also in the motor function, and its rehabilitation is often complex and challenging. Electrical stimulation (ES) could have an important impact in the rehabilitation of persons with COVID-19. Neuromuscular electrical stimulation (NMES) and functional electrical stimulation (FES) have been proposed as alternatives for motor function rehabilitation in persons with COVID-19. The aim of this study was to systematically review the articles published to date dealing therapeutic effects of NMES and FES in the motor rehabilitation of people with COVID-19. A systematic search of electronic databases was conducted, and articles related to the use of electrical stimulation in persons with COVID-19 for motor recovery were included. A total of 53 citations were found, of which 11 were eligible for inclusion. Considering the action mechanism of ES, and its effectiveness in similar cases, it could be an effective technique for the rehabilitation of motor function in persons with COVID-19. However, it is necessary to carry out clinical trials to confirm this hypothesis. In addition, FES, and more specifically FES cycling, could have additional beneficial effects over NMES.
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The proceedings contain 53 papers. The topics discussed include: evoked sensations with sinusoidal transcutaneous electrical stimulation at different frequencies;IMU triggered FES for robotic gait training;trans-spinal electrical stimulation for improving trunk and sitting function in tetraplegics with cervical cord injury;a combined approach to CNS excitation for hand rehabilitation: a case study using spinal stimulation and BCI;analysis of the movements generated by a multi-field FES device for upper extremity rehabilitation;and neuromuscular and functional electrical stimulation for motor recovery after COVID-19: systematic review.
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COVID-19 presented a renewed awareness of the importance of smell, including the striking impact of smell loss on daily functioning, as well as the lack of available evidencebased interventions to improve smell. While medical and surgical treatments exist for inflammatory-related smell loss, interventions to treat loss due to other etiologies are limited. Given the role of the intranasal trigeminal system in smell function, we conducted a proof-of-concept study to determine the effects of electrical stimulation of the trigeminal nerve (TNS) on sensitivity to phenyl ethyl alcohol (PEA) and guaiacol (GUA), 2 odorants with low and high trigeminal properties, respectively. TNS is an emerging form of “bottom-up” brain stimulation in which low-level electrical current is delivered to superficial trigeminal nerve branches innervating the face and forehead. Twenty healthy adults (8M/12F, 27±8.1 years old) were recruited from MUSC and the surrounding community to participate in this double-blind, placebo-controlled, pilot. PEA and GUA thresholds were determined at baseline, immediately postintervention, and again 30-min post-intervention. In a randomized cross-over design, participants received active and sham TNS on separate visits. Results indicated a significant stimulation x odor x time interaction (F[2,76]=3.56, p=.024, η 2=.093). Detection of GUA, but not PEA, was significantly enhanced by active, but not sham, TNS (16% and 9% increase from baseline at the 1st and 2nd follow-up time points respectively). TNS is safe, noninvasive, inexpensive, and easy to administer, rendering it highly scalable. Future study should determine the full effects and durability of TNS on smell function across different stimulation parameters, odorants, and patient populations.
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This case report involves a 47-year-old male who presented to the emergency department (ED) with a positive coronavirus disease 2019 (COVID-19) test and symptoms of Guillain-Barré syndrome (GBS). Electrodiagnostic (EDX) studies reported an acute inflammatory demyelinating polyradiculoneuropathy (AIDP). The patient underwent intravenous immune globulin (IVIG) treatment and four weeks of acute inpatient rehabilitation with some functional improvement but remained unable to ambulate independently at discharge.
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Background: Cardiac injury associated with cytokine release occurs in almost 20% of SARS-CoV-2 positive patients during hospitalization and mortality is particularly high in these patients. Cardiac enzyme (e.g. troponin or creatinine kinase (CK)) elevations are a frequently reported finding, indicating myocardial damage and arrhythmias are the cause for ICU transfer in up to 12% of patients. However, the mechanistic role of COVID19 associated cytokine-storm for the concomitant cardiac dysfunction and associated arrhythmias is unclear. In addition, the role of anti-inflammatory therapy approaches to mitigate this cardiac dysfunction remains elusive. Methods: We investigated the effects of COVID19-associated inflammatory response on cardiac cellular function as well as its cardiac arrhythmogenic potential in rat and induced pluripotent stem cell derived cardiomyocytes (iPSc-CM). Moreover, we evaluated the therapeutic potential of the IL1-beta antagonist Canakinumab using state of the art in-vitro confocal and ratiometric high-throughput microscopy. Results: Isolated rat ventricular cardiomyocytes were exposed to control or COVID19 plasma from intensive care unit patients with severe ARDS and impaired cardiac function (LVEF 41±5%;1/3 of patients on veno-venous extracorporeal membrane oxygenation;CK 154±43 U/l). Cardiomyocytes showed decreased Ca2+ transient amplitudes and altered baseline Ca2+ concentrations leading to impaired cellular contractile function upon electrical field-stimulation and exposure to patient plasma (n=276 control and 359 COVID19 cells;Fura). In addition, we used iPSc-CM to explore the long-term effect of patient plasma on cardiac electrical and mechanical function in a translational setting (24h incubation;Fluo). In iPSc, spontaneous Ca2+ release events (i.e. Ca2+ waves and Ca2+ sparks) were more likely to occur upon incubation with COVID19 plasma and nuclear as well as cytosolic Ca2+ release were altered. Co-incubation with Canakinumab had no effect on pro-arrhythmogenic Ca2+ release or Ca2+ signaling during excitation-contraction coupling but influenced cellular automaticity upon prolonged electrical stimulation. Conclusion: Plasma derived from COVID19 patients exerts acute cardiodepressant and chronic pro-arrhythmogenic effects in rat and iPS-derived cardiomyocytes. Chronic co-incubation with Canakinumab had no beneficial effect on cellular Ca2+ signaling during excitation-contraction coupling.
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AIMS: To compare current General Medical Practitioner treatment as usual (TAU) for the treatment of female urinary incontinence with a novel disposable home electro-stimulation device (Pelviva). METHODS: Open label, Primary Care post-market evaluation. 86 women with urinary incontinence were randomly assigned to one of two 12-week treatments: TAU or Pelviva for 30 min every other day plus TAU. Outcome measures included ICIQ-UI (primary), PISQ-IR, PGI-S / PGI-I and FSFI (secondary) at recruitment and immediately after intervention, 1-h pad test at recruitment and usage diaries throughout. RESULTS: Pelviva plus TAU produced significantly better outcome than TAU alone: 3 versus 1 point for ICIQ-UI (Difference - 1.8 95% CI: - 3.5 to - 0.1, P = 0.033). Significant differences were also observed for PGI-I at both 6 weeks (P = 0.001) and 12 weeks (P < 0.001). In the Pelviva group, 17% of women described themselves as feeling very much better and 54% a little or much better compared to 0% and 15% in the TAU. Overall PISQ-IR score reached statistical significance (P = 0.032) seemingly related to impact (P = 0.027). No other outcome measures reached statistical significance. Premature termination due to COVID-19 meant only 86 women were recruited from a sample size of 264. TAU did not reflect NICE guidelines. CONCLUSIONS: This study suggests Pelviva is more successful than TAU in treating urinary incontinence in Primary Care. The study had reduced power due to early termination due to COVID-19 and suggests TAU does not follow NICE guidelines.