Signal Generation, Acquisition, and Processing in Brain Machine Interfaces: A Unified Review.

Brain machine interfaces (BMIs), or brain computer interfaces (BCIs), are devices that act as a medium for communications between the brain and the computer. It is an emerging field with numerous applications in domains of prosthetic devices, robotics, communication technology, gaming, education, and security. It is noted in such a multidisciplinary field, many reviews have surveyed on various focused subfields of interest, such as neural signaling, microelectrode fabrication, and signal classification algorithms. A unified review is lacking to cover and link all the relevant areas in this field. Herein, this review intends to connect on the relevant areas that circumscribe BMIs to present a unified script that may help enhance our understanding of BMIs. Specifically, this article discusses signal generation within the cortex, signal acquisition using invasive, non-invasive, or hybrid techniques, and the signal processing domain. The latest development is surveyed in this field, particularly in the last decade, with discussions regarding the challenges and possible solutions to allow swift disruption of BMI products in the commercial market.

Corynebacterium jeikeium endocarditis: A case report and comprehensive review of an underestimated infection.

Diphtheroids are gram-positive pleomorphic bacilli in the family of Coryneform bacteria. These organisms are present as part of the human flora. Past practice habits had been to consider them as contaminants when isolated from clinical samples. Corynebacterium jeikeium is one of the most clinically important nondiphtherial Corynebacteria that can cause different forms of infections specifically in patients with underlying risk factors and co-morbidities including immunocompromised subjects. Through this article, we present a 67-year-old gentleman with extensive co-morbidities including heart failure with reduced ejection fraction and ESRD on hemodialysis through a femoral catheter who presented with chest pain and fatigue. Further investigation confirmed diagnosis of C. jeikeium endocarditis. We go on to review previously reported cases of C. jeikeium endocarditis and we will discuss different aspects of C. jeikeium infection with a focus on microbiology, pathophysiology, and treatment.

Safety and Efficacy of Exercise Training in Patients With an Implantable Cardioverter-Defibrillator: A Meta-Analysis.

OBJECTIVES: In this study, the authors performed a meta-analysis of currently available comparative prospective studies to assess the efficacy and safety of exercise training in heart failure (HF) patients with implantable cardioverter-defibrillators (ICD). BACKGROUND: ICDs have been shown to improve survival in patients with HF. However, many patients with ICDs experience fear of shocks and avoid physical activity. Few data exist for efficacy and safety of exercise training in HF patients with ICDs. METHODS: Prospective parallel arm trials with control and exercise training groups that evaluated the efficacy of exercise training in patients with ICDs were included in the meta-analysis. Outcomes of interest were difference in the change in cardiorespiratory fitness (CRF) (ml/kg/min) between exercise and control group and the likelihood of ICD shocks among exercise training compared with that among control participants on follow-up. RESULTS: We included study level data from 6 trials (5 randomized controlled trials and 1 nonrandomized controlled trial). In the pooled analysis, ICD patients undergoing exercise training had significant improvement in CRF (weighted mean difference: 1.98 ml/kg/min; 95% confidence interval [CI]: 0.58 to 3.38). The likelihood of ICD shocks on follow-up was also significantly lower among exercise training than among control participants (pooled odds ratio: 0.47; 95% CI: 0.24 to 0.91). CONCLUSIONS: Among patients with HF and ICD implantation, exercise training was associated with significant improvement in CRF and lower likelihood of ICD shocks.

Continuous Dose-Response Association Between Sedentary Time and Risk for Cardiovascular Disease: A Meta-analysis.

IMPORTANCE: Prior studies suggest that higher sedentary time is associated with a greater risk for cardiovascular disease (CVD). However, the quantitative, dose-response association between sedentary time and CVD risk is not known. OBJECTIVE: To determine the categorical and quantitative dose-response association between sedentary time and CVD risk. DATA SOURCES: Two independent investigators searched the MEDLINE and EMBASE databases for all studies published before July 6, 2015, that evaluated the association between sedentary time and incident CVD. STUDY SELECTION: Prospective cohort studies with participants 18 years or older that reported the association between sedentary time and incident CVD were included. DATA EXTRACTION AND SYNTHESIS: Two independent investigators performed the data extraction and collection using a standardized form. The study quality was assessed using the Newcastle-Ottawa Scale. The categorical dose-response association was evaluated by comparing the pooled hazard ratio (HR) for incident CVD associated with different levels of sedentary time (vs lowest sedentary time) across studies. The continuous dose-response association was assessed using random-effects generalized least squares spline models. Data were collected from April 5 to July 6, 2015. MAIN OUTCOMES AND MEASURES: Incident CVD (coronary heart disease, including nonfatal myocardial infarction, stroke, and cardiovascular mortality). RESULTS: Nine prospective cohort studies with 720 425 unique participants (57.1% women; 42.9% men; mean age, 54.5 years) and 25 769 unique cardiovascular events and a median follow-up of 11 years were included. In categorical analyses, compared with the lowest sedentary time category (median, 2.5 h/d), participants in the highest sedentary time category (median, 12.5 h/d) had an increased risk for CVD (HR, 1.14; 95% CI, 1.09-1.19). However, no apparent risk associated with intermediate levels of sedentary time (HR for 7.5 h/d, 1.02; 95% CI, 0.96-1.08) was found. In continuous analyses, a nonlinear association between sedentary time and incident CVD was found (P for nonlinearity < .001), with an increased risk observed for more than 10 hours of sedentary time per day (pooled HR, 1.08; 95% CI, 1.00-1.14). CONCLUSIONS AND RELEVANCE: The association between sedentary time and the risk for CVD is nonlinear with an increased risk only at very high levels. These findings could have implications for guideline recommendations regarding the risks related to sedentary behavior.

Effect of treatment with rosiglitazone on high-sensitivity cardiac troponin levels among patients with type 2 diabetes mellitus.

OBJECTIVE: To assess the impact of intermediate-term treatment with rosiglitazone on high-sensitivity cardiac troponin T levels among patients with type 2 diabetes mellitus with or at high risk of coronary artery disease. METHODS: High-sensitivity cardiac troponin T level was measured at baseline and after 6 months of study treatment in a randomized trial comparing rosiglitazone versus placebo in patients with type 2 diabetes and prevalent cardiovascular disease or multiple cardiovascular disease risk factors. Univariable and multivariable linear regression analyses were performed to assess the effect of rosiglitazone versus placebo on high-sensitivity cardiac troponin T levels. RESULTS: The study included 150 randomized participants, of whom 106 had paired baseline and end-of-study blood samples for analysis (mean age: 56 ± 8 years, 42% women; 8.8 years average type 2 diabetes duration; mean haemoglobin A1c of 7.5). Almost all study participants (93%) had detectable high-sensitivity cardiac troponin T (⩾ 3 ng/L) at baseline, including 23% with high-sensitivity cardiac troponin T levels exceeding the threshold commonly used to diagnose myocardial infarction (⩾ 14 ng/L). Change in high-sensitivity cardiac troponin T levels from baseline to follow-up was not significantly different between rosiglitazone and placebo groups (p = 0.316). CONCLUSION: Rosiglitazone did not impact high-sensitivity cardiac troponin T levels, adding to the growing body of literature suggesting that the incremental heart failure risk associated with rosiglitazone is not mediated by direct myocardial injury.

A Safety Evaluation of Empagliflozin for the Treatment of Type 2 Diabetes.

INTRODUCTION: Empagliflozin is a sodium glucose co-transporter 2 inhibitor used to improve glycemic control in adults with type 2 diabetes mellitus (T2DM) by enhancing urinary glucose excretion. Empagliflozin is effective at lowering glycosylated hemoglobin and was recently proven superior to placebo for reduction of cardiovascular disease (CVD) risk. As with any new drug, there are safety considerations that inform its potential use in patients with T2DM. AREAS COVERED: Here, we evaluate the safety of empagliflozin and provide an expert opinion as to its current and future role in the treatment of patients with T2DM. A search of the English language literature was performed using PubMed search terms: "empagliflozin", "sodium glucose cotransporter 2 inhibitors", and "drug safety". Articles and bibliographies relevant to the subject were reviewed and additional references known to the authors were included. EXPERT OPINION: The evidence for empagliflozin is robust with regard to glycemic efficacy and safety. Low risk of hypoglycemia, absence of weight gain, and demonstrated cardiovascular risk reduction support its consideration as a first line medication in addition to metformin for patients with T2DM and CVD. Ongoing trials will continue to address the safety and efficacy of empagliflozin and expand our clinical knowledge of this medication.