Mala colocación de electrodos: un desafío diagnóstico aún presente / Malposition of ECG electrodes; a continuing challenge

INTRODUCCIÓN: Se revisan los principales errores en la colocación de los electrodos para el registro del ECG. Se ilustran algunos de ellos y se comenta sobre los errores en los informes que pueden tener repercusiones en el diagnóstco clínico.

ABSTRAC: The main mistakes in the placement of electrodes during the recording of an ECG are reviewed. Some of them are illustrated and the consequences for clinical diagnosis are discussed.

Development of Paper Actuators Based on Carbon-Nanotube-Composite Paper.

We propose a unique soft actuator-a paper actuator-based on carbon-nanotube-composite paper (CNT-composite paper), which is a composite of carbon nanotubes (CNTs) and paper. CNT-composite paper has highly efficient properties because of the contained CNTs, such as high electrical conductivity and semiconducting properties. We are considering using CNT-composite paper for various devices. In this study, we successfully developed a paper actuator. We determined the structure of the paper actuator by referencing that of bucky-gel actuators. The actuator operates using the force generated by the movement of ions. In addition to making the paper actuator, we also attempted to improve its performance, using pressure as an index and an electronic scale to measure the pressure. We investigated the optimal dispersant for use in paper actuators, expecting the residual dispersant on the CNT-composite paper to affect the performance differently depending on the type of dispersant. Referring to research on bucky-gel actuators, we also found that the addition of carbon powder to the electrode layers is effective in improving the pressure for paper actuators. We believe that the paper actuator could be used in various situations due to its ease of processing.

High-Density EEG in Current Clinical Practice and Opportunities for the Future.

SUMMARY: High-density EEG (HD-EEG) recordings use a higher spatial sampling of scalp electrodes than a standard 10-20 low-density EEG montage. Although several studies have demonstrated improved localization of the epileptogenic cortex using HD-EEG, widespread implementation is impeded by cost, setup and interpretation time, and lack of specific or sufficient procedural billing codes. Despite these barriers, HD-EEG has been in use at several institutions for years. These centers have noted utility in a variety of clinical scenarios where increased spatial resolution from HD-EEG has been required, justifying the extra time and cost. We share select scenarios from several centers, using different recording techniques and software, where HD-EEG provided information above and beyond the standard low-density EEG. We include seven cases where HD-EEG contributed directly to current clinical care of epilepsy patients and highlight two novel techniques which suggest potential opportunities to improve future clinical care. Cases illustrate how HD-EEG allows clinicians to: case 1-lateralize falsely generalized interictal epileptiform discharges; case 2-improve localization of falsely generalized epileptic spasms; cases 3 and 4-improve localization of interictal epileptiform discharges in anatomic regions below the circumferential limit of standard low-density EEG coverage; case 5-improve noninvasive localization of the seizure onset zone in lesional epilepsy; cases 6 and 7-improve localization of the seizure onset zone to guide invasive investigation near eloquent cortex; case 8-identify epileptic fast oscillations; and case 9-map language cortex. Together, these nine cases illustrate that using both visual analysis and advanced techniques, HD-EEG can play an important role in clinical management.

Forging ahead: Update on radiofrequency ablation technology and techniques.

Innovations in radiofrequency (RF) ablation and nonablative techniques have led to significant advances in addressing complex arrhythmogenic substrates for a variety of cardiac arrhythmias. Anatomical challenges, deep substrate, and mid-myocardial locations may pose difficulties and decrease success rates using routine methods. In this review, we provide an update on novel RF technology and techniques including (a) high-power, low-duration ablation, (b) ablation facilitated by low-ionic irrigant, and (c) bipolar ablation. In addition, we review emerging technologies including electroporation, needle catheter ablation, and ablation with the lattice catheter.

Therapeutic Window of Deep Brain Stimulation Using Cathodic Monopolar, Bipolar, Semi-Bipolar, and Anodic Stimulation.

OBJECTIVES: To compare the therapeutic window (TW) of cathodic monopolar, bipolar, anodic monopolar, and a novel "semi-bipolar" stimulation in ten Parkinson's disease patients who underwent deep brain stimulation of the subthalamic nucleus. MATERIALS AND METHODS: Patients were assessed in the "OFF" L-dopa condition. Each upper limb was tested separately for therapeutic threshold, TW and side-effect threshold (SET). Battery consumption index (BCI) also was documented. RESULTS: Compared to cathodic stimulation, therapeutic threshold was significantly higher for anodic, bipolar, and semi-bipolar stimulation (3.8 ± 1.6 vs. 4.9 ± 2.1, 5.0 ± 1.9, and 5.2 ± 1.9 mA, p = 0.0006, 0.0002, and 0.008, respectively). SET was significantly higher for bipolar stimulation (10.9 ± 2.5 mA) vs. cathodic (6.8 ± 2.2 mA, p < 0.0001) and anodic stimulation (9.2 ± 2.6 mA, p = 0.005). The SET of anodic and semi-bipolar stimulation was significantly higher vs. cathodic stimulation (p < 0.0001). TW of cathodic stimulation (2.5 ± 1.5 mA) was significantly narrower vs. bipolar (5.4 ± 2.0 mA, p < 0.0001), semi-bipolar (4.6 ± 2.6 mA, p = 0.001) and anodic stimulation (4.3 ± 2.3 mA, p < 0.0001). Bipolar (p = 0.005) and semi-bipolar (p = 0.0005) stimulation had a significantly wider TW vs. anodic stimulation. BCI of cathodic stimulation (5.9 ± 1.3) was significantly lower compared to bipolar (13.7 ± 6.8, p < 0.0001), semi-bipolar (11.0 ± 4.3, p = 0.0005), and anodic stimulation (8.1 ± 3.0, p < 0.0001). Anodic BCI was significantly lower than bipolar (p = 0.005) and semi-bipolar (p = 0.0002) stimulation while semi-bipolar BCI was lower than bipolar stimulation (p = 0.0005). CONCLUSIONS: While awaiting further studies, our findings suggest that cathodic stimulation should be preferred in light of its reduced battery consumption, possibly followed by semi-bipolar in case of stimulation-induced side-effects.

Novel electrode technologies for neural recordings.

Neural recording electrode technologies have contributed considerably to neuroscience by enabling the extracellular detection of low-frequency local field potential oscillations and high-frequency action potentials of single units. Nevertheless, several long-standing limitations exist, including low multiplexity, deleterious chronic immune responses and long-term recording instability. Driven by initiatives encouraging the generation of novel neurotechnologies and the maturation of technologies to fabricate high-density electronics, novel electrode technologies are emerging. Here, we provide an overview of recently developed neural recording electrode technologies with high spatial integration, long-term stability and multiple functionalities. We describe how these emergent neurotechnologies can approach the ultimate goal of illuminating chronic brain activity with minimal disruption of the neural environment, thereby providing unprecedented opportunities for neuroscience research in the future.

Nanomaterial based electrochemical sensing of the biomarker serotonin: a comprehensive review.

This review (with 131 references) summarizes the progress made in the past years in the field of nanomaterial based sensing of serotonin (5-HT). An introduction summarizes the significant role of 5-HT as a biomarker for several major diseases, methods for its determination and the various kinds of nanomaterials for use in electrochemical sensing process relies principally on a precise choice of electrodes. The next main section covers nanomaterial based methods for sensing 5-HT, with subsections on electrodes modified with carbon nanotubes, graphene related materials, gold nanomaterials, and by other nanomaterials. A concluding section discusses future perspectives and current challenges of 5-HT determination. Graphical abstract Conceptual design of electrochemical sensing process of the biomarker serotonin by using nanomaterials and the role of 5-HTas biomarker in the body from preclinical to clincal.

The Next Paradigm Change in EEG Recording: What Will it Mean for EEG Technologists?

Several companies are developing an EEG recording system that uses dry, wireless electrodes, and one has recently been approved by the Food and Drug Administration (FDA) for medical use. Today, the quality of EEG signals recorded by these dry systems may not always match those of conventionally applied electrodes, but the gap is closing fast. As dry, wireless EEG systems find their way into hospitals and clinics over the next few years, the job of the EEG technologist will change. Dry systems can be placed on like a cap and, after a few minutes of adjustment, begin broadcasting EEG. No longer will it be as necessary to spend time meticulously measuring, cleaning, affixing, and adjusting electrodes on the scalp. This upcoming time of rapid change can be an opportunity to redefine the role of the EEG technologist.

Recent advances in molecular biomarkers for diabetes mellitus: a systematic review.

CONTEXT: Diabetes is a growing global metabolic epidemic. Current research is focussing on exploring how the biological processes and clinical outcomes of diabetes are related and developing novel biomarkers to measure these relationships, as this can subsequently improve diagnostic, therapeutic and management capacity. OBJECTIVE: The objective of this study is to identify the most recent advances in molecular biomarkers of diabetes and directions that warrant further research. METHODS: Using a systematic search strategy, the MEDLINE, CINAHL and OVID MEDLINE databases were canvassed for articles that investigated molecular biomarkers for diabetes. Initial selections were made based on article title, whilst final inclusion was informed by a critical appraisal of the full text of each article. RESULTS: The systematic search returned 246 records, of which 113 were unique. Following screening, 29 records were included in the final review. Three main research strategies (the development of novel technologies, broad biomarker panels, and targeted approaches) identified a number of potential biomarkers for diabetes including miR-126, C-reactive protein, 2-aminoadipic acid and betatrophin. CONCLUSION: The most promising research avenue identified is the detection and quantification of micro RNA. Further, the utilisation of functionalised electrodes as a means to detect biomarker compounds also warrants attention.

Recent progress in multi-electrode spike sorting methods.

In recent years, arrays of extracellular electrodes have been developed and manufactured to record simultaneously from hundreds of electrodes packed with a high density. These recordings should allow neuroscientists to reconstruct the individual activity of the neurons spiking in the vicinity of these electrodes, with the help of signal processing algorithms. Algorithms need to solve a source separation problem, also known as spike sorting. However, these new devices challenge the classical way to do spike sorting. Here we review different methods that have been developed to sort spikes from these large-scale recordings. We describe the common properties of these algorithms, as well as their main differences. Finally, we outline the issues that remain to be solved by future spike sorting algorithms.

Current status, key challenges and its solutions in the design and development of graphene based ORR catalysts for the microbial fuel cell applications.

Microbial fuel cells (MFC) are considered as the futuristic energy device that generates electricity from the catalytic degradation of biodegradable organic wastes using microbes, which exist in waste water. In MFCs, oxygen serves as a cathodic electron acceptor and oxygen reduction kinetics played a significant role in the determination of overall efficiency. A wide range of strategies have been developed for the preparation and substantial modification of oxygen reduction reaction (ORR) catalysts to improve the maximum volumetric power density of MFCs, in which the efforts on graphene based ORR catalysts are highly imperative. Although numerous research endeavors have been achieved in relation with the graphene based ORR catalysts applicable for MFCs, still their collective summary has not been developed, which hinders the acquirement of adequate knowledge on tuning the specific properties of said catalysts. The intension of this review is to outline the significant role of ORR catalysts, factors influencing the ORR activity, strategies behind the modifications of ORR catalysts and update the research efforts devoted on graphene based ORR catalysts. This review can be considered as a pertinent guide to understand the design and developmental strategies of competent graphene based ORR catalysts, which are not only applicable for MFCs but also for number of electrochemical applications.

Technological Advances in Deep Brain Stimulation.

Functional and stereotactic neurosurgery has always been regarded as a subspecialty based on and driven by technological advances. However until recently, the fundamentals of deep brain stimulation (DBS) hardware and software design had largely remained stagnant since its inception almost three decades ago. Recent improved understanding of disease processes in movement disorders as well clinician and patient demands has resulted in new avenues of development for DBS technology. This review describes new advances both related to hardware and software for neuromodulation. New electrode designs with segmented contacts now enable sophisticated shaping and sculpting of the field of stimulation, potentially allowing multi-target stimulation and avoidance of side effects. To avoid lengthy programming sessions utilising multiple lead contacts, new user-friendly software allows for computational modelling and individualised directed programming. Therapy delivery is being improved with the next generation of smaller profile, longer-lasting, re-chargeable implantable pulse generators (IPGs). These include IPGs capable of delivering constant current stimulation or personalised closed-loop adaptive stimulation. Post-implantation Magnetic Resonance Imaging (MRI) has long been an issue which has been partially overcome with 'MRI conditional devices' and has enabled verification of DBS lead location. Surgical technique is considering a shift from frame-based to frameless stereotaxy or greater role for robot assisted implantation. The challenge for these contemporary techniques however, will be in demonstrating equivalent safety and accuracy to conventional methods. We also discuss potential future direction utilising wireless technology allowing for miniaturisation of hardware.

Microscale microbial fuel cells: Advances and challenges.

The next generation of sustainable energy could come from microorganisms; evidence that it can be seen with the given rise of Electromicrobiology, the study of microorganisms' electrical properties. Many recent advances in electromicrobiology stem from studying microbial fuel cells (MFCs), which are gaining acceptance as a future alternative "green" energy technology and energy-efficient wastewater treatment method. MFCs are powered by living microorganisms with clean and sustainable features; they efficiently catalyse the degradation of a broad range of organic substrates under natural conditions. There is also increasing interest in photosynthetic MFCs designed to harness Earth's most abundant and promising energy source (solar irradiation). Despite their vast potential and promise, however, MFCs and photosynthetic MFCs have not yet successfully translated into commercial applications because they demonstrate persistent performance limitations and bottlenecks associated with scaling up. Instead, microscale MFCs have received increasing attention as a unique platform for various applications such as powering small portable electronic elements in remote locations, performing fundamental studies of microorganisms, screening bacterial strains, and toxicity detection in water. Furthermore, the stacking of miniaturized MFCs has been demonstrated to offer larger power densities than a single macroscale MFC in terms of scaling up. In this overview, we discuss recent achievements in microscale MFCs as well as their potential applications. Further scientific and technological challenges are also reviewed.

Advances in functional electrical stimulation (FES).

This review discusses the advancements that are needed to enhance the effects of electrical stimulation for restoring or assisting movement in humans with an injury/disease of the central nervous system. A complex model of the effects of electrical stimulation of peripheral systems is presented. The model indicates that both the motor and sensory systems are activated by electrical stimulation. We propose that a hierarchical hybrid controller may be suitable for functional electrical stimulation (FES) because this type of controller acts as a structural mimetic of its biological counterpart. Specific attention is given to the neural systems at the periphery with respect to the required electrodes and stimulators. Furthermore, we note that FES with surface electrodes is preferred for the therapy, although there is a definite advantage associated with implantable technology for life-long use. The last section of the review discusses the potential need to combine FES and robotic systems to provide assistance in some cases.

Anestesia para la craneotomía en el paciente consciente / Anesthesia for craniotomy in the conscious patient

La craneotomía en el paciente consciente (CPC) permite valorar los cambios neurológicos durante la obtención de mapas neurológicos en la cirugía de la epilepsia, la localización de los electrodos durante la cirugía de estimulación cerebral profunda y la extirpación tumoral en áreas elocuentes del cerebro. La CPC consciente es útil para realizar cirugía radical, minimizando el daño en las zonas funcionales del cerebro. El anestesiólogo debe asegurar un adecuado bienestar al paciente, una óptima analgesia y garantizar su colaboración. Se debe realizar una adecuada selección conjunta de los posibles candidatos con todos los profesionales implicados en el caso. El conocimiento de las distintas fases de esta forma de craneotomía, la coordinación y comunicación entre los especialistas, el dominio de la farmacología y de las técnicas anestésicas específicas, junto con la capacidad de comunicación psicoemocional con el paciente, son los determinantes del éxito del procedimiento, que debe someterse, además, a la cultura de seguridad. El objetivo de esta revisión es describir el tratamiento anestésico integral, las consideraciones neurofisiológicas y las complicaciones intraoperatorias de la CPC(AU)

Craniotomy in the conscious patient (CPC) enables the neurological changes to be assessed during the mapping in epilepsy surgery, the location of the electrodes during deep brain stimulation surgery, and tumor resection in eloquent areas of the brain. CPC is a useful technique for radical surgery in order to minimize the damage to the functional areas of the brain. The anesthesiologist must ensure, adequate patient comfort, analgesia and ensure optimal collaboration. The appropriate selection of potential candidates for CPC should be made jointly with all professionals involved in the case. Knowledge of the different phases of CPC, coordination and communication among specialists, the right management of the pharmacology, and anesthetic techniques specific to CPC, along with the ability of psycho-emotional communication with the patient, determine the success of the procedure to be performed in the culture of patient safety. The aim of this review was to describe the anesthetic management, comprehensive considerations, and intraoperative neurophysiological tests for CPC(AU)

Recent advances and challenges in the anode architecture and their modifications for the applications of microbial fuel cells.

Microbial fuel cells (MFC), the ergonomic technology connects the liaison of fuel cell architecture and biological resources. Many viable applications like wastewater treatment, biosensors and bioremediation can be made possible with the help of MFCs. This technology is still at its toddler stage and immense works are still in progress to increase the volumetric energy density of MFCs. The overall performance of MFC depends on the cardinal part of the system; anode. A number of anode materials are currently in research to adjudge the better one in terms of the startup time, power output and durability. A wide range of possibilities are now currently available in the fabrication and modification of anode materials to substantially increase the power performances. This review adumbrates the significant requirements of anodes that are essential to be fulfilled, encompasses the aspiring research efforts which have been devoted so far in the anode modification and fabrication strategies to increase the power output, durability and compatibility of the anode interface with the inoculated microorganisms.

Ambulatory electrocardiology.

About 50 years ago, Norman Jefferis Holter invented a device that opened the possibility of recording heart activity over long periods of time. This invention, together with the rapid developments in electronics, has enabled a revolutionary change in the diagnosis and management of cardiac diseases. Ambulatory cardiac monitors have decreased in size to the point of becoming wearable or implantable and are able to monitor heart activity for months or even years. In addition, new telecommunication systems allow clinicians to remotely access cardiac events and to respond within a short period of time. Novel advances in computing and algorithm development are expanding the clinical applications of ambulatory devices with more complex automatic interpretation of the electrocardiographic signal. This article reviews the state of the art of these techniques from both clinical and technical approaches, covering a historic perspective up to today, and discusses current applications, challenges, and future directions.

Recent advances in the efficient reduction of graphene oxide and its application as energy storage electrode materials.

Efficient reduction of graphene oxide (GO) by chemical, thermal, electrochemical, and photo-irradiation techniques has been reviewed. Particular emphasis has been directed towards the proposed reduction mechanisms of GO by different reducing agents and techniques. The advantages of using different kinds of reducing agents on the basis of their availability, cost-effectiveness, toxicity, and easy product isolation processes have also been studied extensively. We provide a detailed description of the improvement in physiochemical properties of reduced GO (RGO) compared to pure GO. For example, the electrical conductivity and electrochemical performance of electrochemically obtained RGO are much better than those of chemically or thermally RGO materials. We provide examples of how RGO has been used as supercapacitor electrode materials. Specific capacitance of GO increases after reduction and the value has been reported to be 100-300 F g(-1). We conclude by proposing new environmentally friendly types of reducing agents that can efficiently remove oxygen functionalities from the surface of GO.