Restoring Movement in Paralysis with a Bioelectronic Neural Bypass Approach: Current State and Future Directions.

Bioelectronic medicine is a rapidly growing field that explores targeted neuromodulation in new treatment options addressing both disease and injury. New bioelectronic methods are being developed to monitor and modulate neural activity directly. The therapeutic benefit of these approaches has been validated in recent clinical studies in various conditions, including paralysis. By using decoding and modulation strategies together, it is possible to restore lost function to those living with paralysis and other debilitating conditions by interpreting and rerouting signals around the affected portion of the nervous system. This, in effect, creates a bioelectronic "neural bypass" to serve the function of the damaged/degenerated network. By learning the language of neurons and using neural interface technology to tap into critical networks, new approaches to repairing or restoring function in areas impacted by disease or injury may become a reality.

Cracking the neural code, treating paralysis and the future of bioelectronic medicine.

The human nervous system is a vast network carrying not only sensory and movement information, but also information to and from our organs, intimately linking it to our overall health. Scientists and engineers have been working for decades to tap into this network and 'crack the neural code' by decoding neural signals and learning how to 'speak' the language of the nervous system. Progress has been made in developing neural decoding methods to decipher brain activity and bioelectronic technologies to treat rheumatoid arthritis, paralysis, epilepsy and for diagnosing brain-related diseases such as Parkinson's and Alzheimer's disease. In a recent first-in-human study involving paralysis, a paralysed male study participant regained movement in his hand, years after his injury, through the use of a bioelectronic neural bypass. This work combined neural decoding and neurostimulation methods to translate and re-route signals around damaged neural pathways within the central nervous system. By extending these methods to decipher neural messages in the peripheral nervous system, status information from our bodily functions and specific organs could be gained. This, one day, could allow real-time diagnostics to be performed to give us a deeper insight into a patient's condition, or potentially even predict disease or allow early diagnosis. The future of bioelectronic medicine is extremely bright and is wide open as new diagnostic and treatment options are developed for patients around the world.

Advanced technology meets mental health: how smartphones, textile electronics, and signal processing can serve mental health monitoring, diagnosis, and treatment.

Mental disorders, characterized by impaired emotional and mood balance, are common in the West. Recent surveys have found that millions of people (age 18?65) have experienced some kind of mental disorder, such as psychotic disorder, major depression, bipolar disorder, panic disorder, social phobia, and somatoform disorder [1]. Specifically, in 2010, 164.8 million people in Europe were affected by such illnesses [1].

Electronic laboratory notebooks progress and challenges in implementation.

Electronic laboratory notebooks (ELNs) are increasingly replacing paper notebooks in life science laboratories, including those in industry, academic settings, and hospitals. ELNs offer significant advantages over paper notebooks, but adopting them in a predominantly paper-based environment is usually disruptive. The benefits of ELN increase when they are integrated with other laboratory informatics tools such as laboratory information management systems, chromatography data systems, analytical instrumentation, and scientific data management systems, but there is no well-established path for effective integration of these tools. In this article, we review and evaluate some of the approaches that have been taken thus far and also some radical new methods of integration that are emerging.

The smartest materials: the future of nanoelectronics in medicine.

Electronics have become central to many aspects of biomedicine, ranging from fundamental biophysical studies of excitable tissues to medical monitoring and electronic implants to restore limb movement. The development of new materials and approaches is needed to enable enhanced tissue integration, interrogation, and stimulation and other functionalities. Nanoscale materials offer many avenues for progress in this respect. New classes of molecular-scale bioelectronic interfaces can be constructed using either one-dimensional nanostructures, such as nanowires and nanotubes, or two-dimensional nanostructures, such as graphene. Nanodevices can create ultrasensitive sensors and can be designed with spatial resolution as fine as the subcellular regime. Structures on the nanoscale can enable the development of engineered tissues within which sensing elements are integrated as closely as the nervous system within native tissues. In addition, the close integration of nanomaterials with cells and tissues will also allow the development of in vitro platforms for basic research or diagnostics. Such lab-on-a-chip systems could, for example, enable testing of the effects of candidate therapeutic molecules on intercellular, single-cell, and even intracellular physiology. Finally, advances in nanoelectronics can lead to extremely sophisticated smart materials with multifunctional capabilities, enabling the spectrum of biomedical possibilities from diagnostic studies to the creation of cyborgs.

Implantable hemodynamic monitors.

The evaluation and management of volume status in patients with heart failure is a challenge for most clinicians. In addition, such an evaluation is possible only during a personal clinician-patient interface. The ability to acquire hemodynamic data continuously with the help of implanted devices with remote monitoring capability can provide early warning of heart failure decompensation and thus may aid in preventing hospitalizations for heart failure. The data obtained also may improve the understanding of the disease process. It is important for the clinician treating patients who have heart failure to become acquainted with this type of technology and learn to interpret and use these data appropriately. This article reviews the implantable hemodynamics monitors currently available.

Battery lifetime in pallidal deep brain stimulation for dystonia.

BACKGROUND AND PURPOSE: The aim of the study was to analyse the lifetime of Soletra implantable pulse generators (IPG) in deep brain stimulation (DBS) of the globus pallidus internus (GPi) for dystonia, depending on stimulation parameters and the total electrical energy delivered (TEED) by the IPG. METHODS: In a prospective series of 20 patients with GPi DBS for dystonia, we recorded IPG longevity and stimulation parameters over time. An evaluation of the TEED was performed using the previously suggested equation [(voltage(2) × pulse width × frequency)/impedance] × 1 s. RESULTS: During median follow-up of 57 months (range 23-79 months), 64 IPGs were replaced because of battery depletion or end of life signal. We found a mean IPG longevity of 25.1 ± 10.1 (range 16-60) months, which was inversely correlated with the TEED (r = -0.72; P < 0.001). IPG longevity was not different between bipolar and monopolar stimulation (24.9 ± 10.8 vs. 25.4 ± 9.0 months, P = 0.76). Incongruously, the mean TEED applied throughout the lifetime cycle was significantly higher in patients with bipolar compared with monopolar stimulation (584 ± 213 vs. 387 ± 121 Joule; P < 0.01). CONCLUSIONS: Battery lifetime in GPi DBS for dystonia is substantially shorter compared with that reported in DBS for Parkinson's disease, caused by a considerably higher voltage and greater pulse width and therefore a higher TEED applied during the battery lifetime cycle. The commonly used equation to calculate TEED, however, seems to be correct only for monopolar, but not bipolar stimulation.

Accuracy of diagnoses delivered by an automated hand-held nerve conduction device in comparison to standard electrophysiological testing in patients with unilateral leg symptoms.

INTRODUCTION: Automated hand-held nerve conduction study (NCS) devices are being marketed for use in the diagnosis of lumbosacral radiculopathy (LSR). In this study we compared the specificity and sensitivity of a hand-held NCS device for the detection of LSR with standard electrodiagnostic study (EDX). METHODS: Fifty patients referred to a tertiary referral electromyography (EMG) laboratory for testing of predominantly unilateral leg symptoms (weakness, sensory complaints, and/or pain) were included in the investigation. Twenty-five normal "control" subjects were later recruited to calculate the specificity of the automated protocol. All patients underwent standard EDX and automated testing. RESULTS: Raw NCS data were comparable for both techniques; however, computer-generated interpretations delivered by the automated device showed high sensitivity with low specificity (i.e., many false positives) in both symptomatic patients and normal controls. CONCLUSIONS: The automated device accurately recorded raw data, but the interpretations provided were overly sensitive and lacked the specificity necessary for a screening or diagnostic examination.

The future of early disease detection? Applications of electronic nose technology in otolaryngology.

INTRODUCTION: Recent advances in electronic nose technology, and successful clinical applications, are facilitating the development of new methods for rapid, bedside diagnosis of disease. There is a real clinical need for such new diagnostic tools in otolaryngology. MATERIALS AND METHODS: We present a critical review of recent advances in electronic nose technology and current applications in otolaryngology. RESULTS: The literature reports evidence of accurate diagnosis of common otolaryngological conditions such as sinusitis (acute and chronic), chronic suppurative otitis media, otitis externa and nasal vestibulitis. A significant recent development is the successful identification of biofilm-producing versus non-biofilm-producing pseudomonas and staphylococcus species. CONCLUSION: Electronic nose technology holds significant potential for enabling rapid, non-invasive, bedside diagnosis of otolaryngological disease.