Evaluation of arteriovenous fistula for hemodialysis with a new generation digital stethoscope: a pilot study.

BACKGROUND AND AIMS: The management of complications of arteriovenous fistula (AVF) for hemodialysis, principally stenosis, remains a major challenge for clinicians with a substantial impact on health resources. Stenosis not infrequently preludes to thrombotic events with the loss of AVF functionality. A functioning AVF, when listened by a stethoscope, has a continuous systolic-diastolic low-frequency murmur, while with stenosis, the frequency of the murmur increases and the duration of diastolic component decreases, disappearing in severe stenosis. These evidences are strictly subjective and dependent from operator skill and experience. New generation digital stethoscopes are able to record sound and subsequently dedicated software allows to extract quantitative variables that characterize the sound in an absolutely objective and repeatable way. The aim of our study was to analyze with an appropriate software sounds from AVFs taken by a commercial digital stethoscope and to investigate the potentiality to develop an objective way to detect stenosis. METHODS: Between September 2022 and January 2023, 64 chronic hemodialysis (HD) patients were screened by two blinded experienced examiners for recognized criteria for stenosis by Doppler ultrasound (DUS) and, consequently, the sound coming from the AVFs using a 3 M™ Littmann® CORE Digital Stethoscope 8570 in standardized sites was recorded. The sound waves were transformed into quantitative variables (amplitude and frequency) using a sound analysis software. The practical usefulness of the core digital stethoscope for a quick identification of an AVF stenosis was further evaluated through a pragmatic trial. Eight young nephrologist trainees underwent a simple auscultatory training consisting of two sessions of sound auscultation focusing two times on a "normal" AVF sound by placing the digital stethoscope on a convenience site of a functional AVF. RESULTS: In 48 patients eligible, all sound components displayed, alone, a remarkable diagnostic capacity. More in detail, the AUC of the average power was 0.872 [95% CI 0.729-0.951], while that of the mean normalized frequency was 0.822 [95% 0.656-0.930]. From a total of 32 auscultations (eight different block sequences, each one comprising four auscultations), the young clinicians were able to identify the correct sound (stenosis/normal AVF) in 25 cases, corresponding to an overall accuracy of 78.12% (95% CI 60.03-90.72%). CONCLUSIONS: The analysis of sound waves by a digital stethoscope permitted us to distinguish between stenotic and no stenotic AVFs. The standardization of this technique and the introducing of data in a deep learning algorithm could allow an objective and fast method for a frequent monitoring of AVF.

FT-IR Analysis of Structural Changes in Ketoprofen Lysine Salt and KiOil Caused by a Pulsed Magnetic Field.

High-intensity, low-frequency magnetic fields (MFs) have been widely used in the treatment of diseases and in drug delivery, even though they could induce structural changes in pharmacological molecules. Morphological changes in ketoprofen and KiOil were investigated through Fourier-transform infrared spectroscopy (FT-IR). Unsupervised principal component analysis was carried out for data clustering. Clinical validation on 22 patients with lower back pain was managed using diamagnetic therapy plus topical ketoprofen or KiOil. The Numerical Rating Scale (NRS) and Short-Form Health Survey 36 (SF-36) were used to evaluate clinical and functional response. Ketoprofen showed clear clustering among samples exposed to MF (4000−650 cm−1), and in the narrow frequency band (1675−1475 cm−1), results evidenced structural changes which involved other excipients than ketoprofen. KiOil has evidenced structural modifications in the subcomponents of the formulation. Clinical treatment with ketoprofen showed an average NRS of 7.77 ± 2.25 before and an average NRS of 2.45 ± 2.38 after MF treatment. There was a statistically significant reduction in NRS (p = 0.003) and in SF-36 (p < 0.005). Patients treated with KiOil showed an average NRS of 7.59 ± 2.49 before treatment and an average NRS of 1.90 ± 2.26 after treatment (p < 0.005). SF-36 showed statistical significance for all items except limitations due to emotional problems. A high-intensity pulsed magnetic field is an adjunct to topical treatment in patients with localized pain, and the effect of MF does not evidence significant effects on the molecules.

Glucose biosensors in clinical practice: principles, limits and perspectives of currently used devices.

The demand of glucose monitoring devices and even of updated guidelines for the management of diabetic patients is dramatically increasing due to the progressive rise in the prevalence of diabetes mellitus and the need to prevent its complications. Even though the introduction of the first glucose sensor occurred decades ago, important advances both from the technological and clinical point of view have contributed to a substantial improvement in quality healthcare. This review aims to bring together purely technological and clinical aspects of interest in the field of glucose devices by proposing a roadmap in glucose monitoring and management of patients with diabetes. Also, it prospects other biological fluids to be examined as further options in diabetes care, and suggests, throughout the technology innovation process, future directions to improve the follow-up, treatment, and clinical outcomes of patients.

Objective bilateral tinnitus from palatal nystagmus. Audio and video features of a rare case of palatal myoclonus.

Tinnitus is one of the most represented otological symptom, affecting 15% of adults, worldwide. Literature describes subjective tinnitus when it's perceived by the patient only, and objective tinnitus when it's heard both, by patient and examiner. An objective tinnitus can be caused by a large variety of anomalies and diseases; one of them is Palatal Myoclonus, characterized by rhytmic movements of soft palatal muscles and, only occasionally, involving other near districts. Case presentation. We observed a rare case of essential palatal myoclonus in a 54 y.o. female, suffering from chronic objective bilateral tinnitus, since 35 years, who underwent a wide number of clinical evaluations over the years, without receiving any conclusive diagnosis. In this video, we illustrate all the districts involved in clonic movements: soft palate, larynx and nasal wings. At the same time, we report the spectrographic analysis of tinnitus, recorded in esternal ear canal, taken together with the muscle movements. Palatal Myoclonus has to be considered in the etiological diagnosis of each objective tinnitus and should always be investigated properly.

Ultrasonic Transducers Shaped in Archimedean and Fibonacci Spiral: A Comparison.

We developed and investigated a particular geometry of transducers, emulating the shape of bats' cochlea, to transmit and receive ultrasounds in the air. Their design involved the use of polyvinylidene fluoride (PVDF) as a piezoelectric material, thanks to its excellent conformability and flexibility. This material offers the primary requirements for sensing devices in applications such as sonar system or energy harvesting technology. The piezo film was folded according to both the Archimedean and Fibonacci spirals, and their performances were investigated in the frequency range from 20 kHz up to more than 80 kHz. The finite element analysis (FEA) of the proposed transducers highlighted the presence of multiple resonance vibrations, proved by the experimental measurements of the equivalent electric impedance and frequency response. Far-field radiation patterns demonstrated, horizontally and vertically, omnidirectional properties both as transmitters and receivers. All was enough to establish the best validity of the spiral shaped transducers for applications based on the bio sonar principle.

Modeling and Characterization of Scaling Factor of Flexible Spiral Coils for Wirelessly Powered Wearable Sensors.

Wearable sensors are a topic of interest in medical healthcare monitoring due to their compact size and portability. However, providing power to the wearable sensors for continuous health monitoring applications is a great challenge. As the batteries are bulky and require frequent charging, the integration of the wireless power transfer (WPT) module into wearable and implantable sensors is a popular alternative. The flexible sensors benefit by being wirelessly powered, as it not only expands an individual's range of motion, but also reduces the overall size and the energy needs. This paper presents the design, modeling, and experimental characterization of flexible square-shaped spiral coils with different scaling factors for WPT systems. The effects of coil scaling factor on inductance, capacitance, resistance, and the quality factor (Q-factor) are modeled, simulated, and experimentally validated for the case of flexible planar coils. The proposed analytical modeling is helpful to estimate the coil parameters without using the time-consuming Finite Element Method (FEM) simulation. The analytical modeling is presented in terms of the scaling factor to find the best-optimized coil dimensions with the maximum Q-factor. This paper also presents the effect of skin contact with the flexible coil in terms of the power transfer efficiency (PTE) to validate the suitability as a wearable sensor. The measurement results at 405 MHz show that when in contact with the skin, the 20 mm× 20 mm receiver (RX) coil achieves a 42% efficiency through the air media for a 10 mm distance between the transmitter (TX) and RX coils.

An Affordable Fabrication of a Zeolite-Based Capacitor for Gas Sensing.

The development of even more compact, inexpensive, and highly sensitive gas sensors is widespread, even though their performances are still limited and technological improvements are in continuous evolution. Zeolite is a class of material which has received particular attention in different applications due to its interesting adsorption/desorption capabilities. The behavior of a zeolite 4A modified capacitor has been investigated for the adsorption of nitrogen (N2), nitric oxide (NO) and 1,1-Difluoroethane (C2H4F2), which are of interest in the field of chemical, biological, radiological, and nuclear threats. Sample measurements were carried out in different environmental conditions, and the variation of the sensor electric capacitance was investigated. The dielectric properties were influenced by the type and concentration of gas species in the environment. Higher changes in capacitance were shown during the adsorption of dry air (+4.2%) and fluorinated gas (+7.3%), while lower dielectric variations were found upon exposure to N2 (-0.4%) and NO (-0.5%). The proposed approach pointed-out that a simple fabrication process may provide a convenient and affordable fabrication of reusable capacitive gas sensor.

Neural Modulation of the Primary Auditory Cortex by Intracortical Microstimulation with a Bio-Inspired Electronic System.

Nowadays, the majority of the progress in the development of implantable neuroprostheses has been achieved by improving the knowledge of brain functions so as to restore sensorial impairments. Intracortical microstimulation (ICMS) is a widely used technique to investigate site-specific cortical responses to electrical stimuli. Herein, we investigated the neural modulation induced in the primary auditory cortex (A1) by an acousto-electric transduction of ultrasonic signals using a bio-inspired intracortical microstimulator. The developed electronic system emulates the transduction of ultrasound signals in the cochlea, providing bio-inspired electrical stimuli. Firstly, we identified the receptive fields in the primary auditory cortex devoted to encoding ultrasonic waves at different frequencies, mapping each area with neurophysiological patterns. Subsequently, the activity elicited by bio-inspired ICMS in the previously identified areas, bypassing the sense organ, was investigated. The observed evoked response by microstimulation resulted as highly specific to the stimuli, and the spatiotemporal dynamics of neural oscillatory activity in the alpha, beta, and gamma waves were related to the stimuli preferred by the neurons at the stimulated site. The alpha waves modulated cortical excitability only during the activation of the specific tonotopic neuronal populations, inhibiting neural responses in unrelated areas. Greater neuronal activity in the posterior area of A1 was observed in the beta band, whereas a gamma rhythm was induced in the anterior A1. The results evidence that the proposed bio-inspired acousto-electric ICMS triggers high-frequency oscillations, encoding information about the stimulation sites and involving a large-scale integration in the brain.

Influence of the Fabrication Accuracy of Hot-Embossed PCL Scaffolds on Cell Growths.

Polycaprolactone (PCL) is a biocompatible and biodegradable polymer widely used for the realization of 3D scaffold for tissue engineering applications. The hot embossing technique (HE) allows the obtainment of PCL scaffolds with a regular array of micro pillars on their surface. The main drawback affecting this kind of micro fabrication process is that such structural superficial details can be damaged when detaching the replica from the mold. Therefore, the present study has focused on the optimization of the HE processes through the development of an analytical model for the prediction of the demolding force as a function of temperature. This model allowed calculating the minimum demolding force to obtain regular micropillars without defects. We demonstrated that the results obtained by the analytical model agree with the experimental data. To address the importance of controlling accurately the fabricated microstructures, we seeded on the PCL scaffolds human stromal cell line (HS-5) and monocytic leukemia cell line (THP-1) to evaluate how the presence of regular or deformed pillars affect cells viability. In vitro viability results, scanning electron and fluorescence microscope imaging analysis show that the HS-5 preferentially grows on regular microstructured surfaces, while the THP-1 on irregular microstructured ones.

EGFET-Based Sensors for Bioanalytical Applications: A Review.

Since the 1970s, a great deal of attention has been paid to the development of semiconductor-based biosensors because of the numerous advantages they offer, including high sensitivity, faster response time, miniaturization, and low-cost manufacturing for quick biospecific analysis with reusable features. Commercial biosensors have become highly desirable in the fields of medicine, food, and environmental monitoring as well as military applications, whereas increasing concerns about food safety and health issues have resulted in the introduction of novel legislative standards for these sensors. Numerous devices have been developed for monitoring biological processes such as nucleic acid hybridization, protein⁻protein interaction, antigen⁻antibody bonds, and substrate⁻enzyme reactions, just to name a few. Since the 1980s, scientific interest moved to the development of semiconductor-based devices, which also include integrated front-end electronics, such as the extended-gate field-effect transistor (EGFET) biosensor, one of the first miniaturized chemical sensors. This work is intended to be a review of the state of the art focused on the development of biosensors and chemosensors based on extended-gate field-effect transistor within the field of bioanalytical applications, which will highlight the most recent research reported in the literature. Moreover, a comparison among the diverse EGFET devices will be presented, giving particular attention to the materials and technologies.

Medical Devices for Pediatric Apnea Monitoring and Therapy: Past and New Trends.

Apnea in the pediatric population is associated with increased morbidity and mortality in a large number of developed as well as developing countries. It is even more prominent in preterm newborn infants and is commonly referred to as apnea of prematurity. Its current diagnosis and therapy involve the use of traditional technologies, which often result in discomfort to the infants due to the use of invasive devices attached to their sensitive skin, especially in overnight clinical sleep analysis (for over a 12- or 24-h period). Emerging trends for the point-of-care diagnosis of this sleep disorder are focused on the design of integrated devices for less complex and noninvasive monitoring. This paper presents a review of the state of the art of clinical technologies and methodologies for sleep apnea detection and their pros and cons, with particular focus on their working principles and relevance to pediatrics. Moreover, an in-depth discussion on emerging future technologies envisioned to be integral parts of the daily home-based applications is included in the paper.