A coronavirus disease 2019 (COVID-19) patient with bilateral orchitis.

During the development of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV2), a myriad of complications has emerged and although rare, several genitourinary complications have been reported. The bulk of these complications have been secondary to hypercoagulable states, such as priapism. Previous SARS family infections have caused orchitis, though no adult cases of orchitis have been reported. We describe a novel case of SARS-CoV2 bilateral orchitis in a previously healthy 37-year-old male who presented for testicular pain with constitutional symptoms. Additionally, there was no epididymitis associated with the bilateral orchitis. Based on both data in SARS-CoV2 infected males and previous data from prior SARS infections, spermatocyte function may be compromised secondary to this infection. With the various symptoms associated with this virulent pathogen, we characterize the potential complications and importance of fertility follow up.

Cholesterol embolization and arterial occlusion from the Heimlich maneuver.

The Heimlich maneuver is a lifesaving bystander intervention to assist an individual with airway obstruction however, cholesterol embolization syndrome is a rare, but serious potential complication of the Heimlich maneuver. We present the case of the 56-year-old female presenting to the emergency department with acute right foot pain following performance of the Heimlich maneuver who was found to have distal arterial occlusion resulting from cholesterol embolization syndrome. The patient underwent right popliteal artery exploration, right popliteal and tibial thrombectomy, and popliteal patch angioplasty resulting in restoration of blood flow to her right foot.

Arthropod Assault: A Case Report of Brown Recluse Envenomation in a Training Environment.

Spider bites are a common emergency department complaint, accounting for ~21% of noncanine bites, injuries, and stings. Military service members, more so than most civilian personnel, are exposed to conditions that place them at increased risk for envenomation, stings, and bites. We present the case of an active duty service member working in a relatively austere environment who presented to a level 1 trauma center with a lesion consistent with a bite from a brown recluse spider, or Loxosceles reclusa.

A prospective study in severely injured patients reveals an altered gut microbiome is associated with transfusion volume.

BACKGROUND: Traumatic injury can lead to a compromised intestinal epithelial barrier and inflammation. While alterations in the gut microbiome of critically injured patients may influence clinical outcomes, the impact of trauma on gut microbial composition is unknown. Our objective was to determine if the gut microbiome is altered in severely injured patients and begin to characterize changes in the gut microbiome due to time and therapeutic intervention. METHODS: We conducted a prospective, observational study in adult patients (n = 72) sustaining severe injury admitted to a Level I Trauma Center. Healthy volunteers (n = 13) were also examined. Fecal specimens were collected on admission to the emergency department and at 3, 7, 10, and 13 days (±2 days) following injury. Microbial DNA was isolated for 16s rRNA sequencing, and α and ß diversities were estimated, according to taxonomic classification against the Greengenes database. RESULTS: The gut microbiome of trauma patients was altered on admission (i.e., within 30 minutes following injury) compared to healthy volunteers. Patients with an unchanged gut microbiome on admission were transfused more RBCs than those with an altered gut microbiome (p < 0.001). Although the gut microbiome started to return to a ß-diversity profile similar to that of healthy volunteers over time, it remained different from healthy controls. Alternatively, α diversity initially increased postinjury, but subsequently decreased during the hospitalization. Injured patients on admission had a decreased abundance of traditionally beneficial microbial phyla (e.g., Firmicutes) with a concomitant decrease in opportunistic phyla (e.g., Proteobacteria) compared to healthy controls (p < 0.05). Large amounts of blood products and RBCs were both associated with higher α diversity (p < 0.001) and a ß diversity clustering closer to healthy controls. CONCLUSION: The human gut microbiome changes early after trauma and may be aided by early massive transfusion. Ultimately, the gut microbiome of trauma patients may provide valuable diagnostic and therapeutic insight for the improvement of outcomes postinjury. LEVEL OF EVIDENCE: Prognostic and Epidemiological, level III.

A personalized sensor-controlled microstimulator system for arm rehabilitation poststroke. Part 1: System architecture.

OBJECTIVES: For rehabilitation of the poststroke upper limb in seven subjects, an external sensor-based system controls the timing of five to seven microstimulators implanted near radial nerve branches or their motor points to sequentially extend the elbow, wrist, and fingers with thumb extension and abduction, enabled at the subject's own pace. We hypothesize this system will support sequential activation of affected upper limb muscles intended to improve functional recovery. MATERIALS AND METHODS: Presented here is a personalized sensor-controlled stimulation system, including its architecture, sensor design, and testing of equipment specific to this study, including coils and sensors. RESULTS: All electrical and magnetic tests, and safety tests per International Electrotechnical Commission 60601-1 passed. One sensor type displayed a vulnerability to drop. CONCLUSIONS: The new control system tested safe, met requirements, and allowed each subject to activate the system at their own pace, making the rehabilitation process more acceptable and efficient.

Development of an implantable myoelectric sensor for advanced prosthesis control.

Modern hand and wrist prostheses afford a high level of mechanical sophistication, but the ability to control them in an intuitive and repeatable manner lags. Commercially available systems using surface electromyographic (EMG) or myoelectric control can supply at best two degrees of freedom (DOF), most often sequentially controlled. This limitation is partially due to the nature of surface-recorded EMG, for which the signal contains components from multiple muscle sources. We report here on the development of an implantable myoelectric sensor using EMG sensors that can be chronically implanted into an amputee's residual muscles. Because sensing occurs at the source of muscle contraction, a single principal component of EMG is detected by each sensor, corresponding to intent to move a particular effector. This system can potentially provide independent signal sources for control of individual effectors within a limb prosthesis. The use of implanted devices supports inter-day signal repeatability. We report on efforts in preparation for human clinical trials, including animal testing, and a first-in-human proof of principle demonstration where the subject was able to intuitively and simultaneously control two DOF in a hand and wrist prosthesis.

Review of electrical stimulation in cerebral palsy and recommendations for future directions.

Electrical stimulation (ES) for treatment of neuromuscular disorders is introduced. Various forms of ES are defined. Characteristics of cerebral palsy (CP) and treatment options are given. The clinical objectives of ES for CP treatment are stated. A review of the literature for treatment in CP is given. Several common themes within the literature and limitations in prior studies are explored. The majority of studies have used surface stimulation, which has several inherent limitations. To address these limitations, implanted devices may be used. Implanted device systems include percutaneous stimulation systems, and fully implantable leaded systems. While both of these technologies have advantages over surface stimulation, they also have their own limitations. To further address the limitations of percutaneous and fully implantable leaded systems, the Alfred Mann Foundation has developed a completely implantable, telemetered device known as the Radio Frequency Microstimulator (RFM). Results from a study using the RFM for arm rehabilitation in poststroke patients are given. A list of desirable design features for an ES system for CP is given. The next generation microstimulator device under development at the Alfred Mann Foundation is presented. This device may well serve the needs for ES in CP.

Impedance characterization of microarray recording electrodes in vitro.

The mechanisms underlying performance degradation of chronically implanted silicon microelectrode arrays in the central nervous system (CNS) remain unclear. Humoral and cellular components of the brain foreign body response were evaluated to determine whether their presence on the electrode surface results in increased electrical impedance. Iridium oxide microelectrode recording arrays were electrically characterized in saline, culture media with 10% fetal bovine serum, and coated with various CNS cell types isolated from rat brain. Electrochemical impedance spectroscopy and cyclic voltammetry were performed using a three-electrode system. Potential cycling caused an immediate decrease in electrical impedance, which increased with time toward precycling values, with the effect of cycling remaining significant for several days. The addition of serum caused a significant increase in impedance of up to 28% relative to the saline control. Microelectrodes coated with various cell types known to participate in the foreign body response caused a 20%-80% increase in impedance immediately after contact that remained constant or gradually increased for several weeks. Our findings suggest that the attachment of molecular and cellular species following microelectrode implantation into brain tissue likely contribute to increases in impedance, but do not appear sufficient to hinder recording performance.

Electrical stimulation of excitable tissue: design of efficacious and safe protocols.

The physical basis for electrical stimulation of excitable tissue, as used by electrophysiological researchers and clinicians in functional electrical stimulation, is presented with emphasis on the fundamental mechanisms of charge injection at the electrode/tissue interface. Faradaic and non-Faradaic charge transfer mechanisms are presented and contrasted. An electrical model of the electrode/tissue interface is given. The physical basis for the origin of electrode potentials is given. Various methods of controlling charge delivery during pulsing are presented. Electrochemical reversibility is discussed. Commonly used electrode materials and stimulation protocols are reviewed in terms of stimulation efficacy and safety. Principles of stimulation of excitable tissue are reviewed with emphasis on efficacy and safety. Mechanisms of damage to tissue and the electrode are reviewed.

Impedance characterization of microarray recording electrodes in vitro.

The mechanisms underlying performance degradation of electrodes chronically implanted in the central nervous system (CNS) remain unclear. Several components of the normal brain wound healing response were evaluated to determine if their presence correlates with increased electrical impedance that may be a factor in loss of device performance. Microelectrode recording arrays were electrically characterized in vitro in the presence of saline, culture media with 10% fetal bovine serum (FBS), and various CNS cell types isolated from Sprague-Dawley rats and cultured in media with 10% FBS. Electrochemical impedance spectroscopy (EIS) and cyclic voltammetry (CV) were performed using a three-electrode system. Potential cycling during CV caused an immediate decrease in electrical impedance, which increased with time toward the pre-cycling value, with the effect of cycling remaining significant for several days. The addition of serum caused a significant but not substantial increase in impedance. The inclusion of various cell types known to participate in the brain wound healing response caused a significant increase in impedance immediately after seeding on the order of 50%, and this value increased or remained constant for up to several weeks. It is unclear whether the magnitude of increased impedance is sufficient to account for loss of device performance.