Search Results (13)

Background/Objectives: Cardiac implantable electronic devices (CIEDs) can prevent ventricular arrhythmia-related sudden cardiac death but cause paradoxical discomfort that impairs daily living and quality of life. No management guidelines exist for reducing pain, improving motion around the CIED implantation site, or preventing shoulder contractures. We evaluated the impact of continuous successive shoulder rehabilitation programs for CIED patients on reducing shoulder pain, improving shoulder range of motion, and patient satisfaction in daily living. Methods: In this prospective observational study, patients who had received CIED implantation underwent shoulder rehabilitation therapy with education during hospitalization from the day post-CIED implantation. After in-hospital rehabilitation, patients chose to undergo successive shoulder rehabilitation from their home and after 4 weeks in the outpatient clinic (rehabilitation group, n = 68) or not (non-rehabilitation group, n = 33). Pain and shoulder function was assessed using the Visual Analog Scale (VAS) and Disability of the Arm, Shoulder, and Hand (DASH) scores, respectively, the day following CIED implantation and at 1–3 months postoperatively. Patient satisfaction was evaluated using the 36-item Short Form Survey (SF-36). Outcomes were compared between groups. Results: VAS pain scores significantly decreased, while DASH scores substantially improved in the rehabilitation group compared to the non-rehabilitation group. Although the SF-36 subdomains were similar between groups, the rehabilitation group showed a better health-related quality of life trend. No complications were observed following post-CIED rehabilitation. Conclusions: Shoulder rehabilitation therapy with successive education after CIED implantation significantly improved pain and shoulder function. Definitive guidelines and long-term outcomes should be investigated further. Full article

The main subject of the current review is a specific subtype of headache, which is related to shunt over-drainage and slit ventricle syndrome, in pediatric patients harboring an implanted shunt device for the management of hydrocephalus. This clinical entity, along with its impairment regarding the quality of life of the affected individuals, is generally underestimated. This is partly due to the absence of universally agreed-upon diagnostic criteria, as well as due to a misunderstanding of the interactions among the implicated pathophysiological mechanisms. A lot of attempts have been performed to propose an integrative model, aiming at the determination of all the offending mechanisms of the shunt over-drainage syndrome, as well as the determination of all the clinical characteristics and related symptomatology that accompany these secondary headaches. This subcategory of headache, named postural dependent headache, can be associated with nausea, vomiting, and/or radiological signs of slim ventricles and/or subdural collections. The ultimate goal of our review is to draw clinicians’ attention, especially that of those that are managing pediatric patients with permanent, long-standing, ventriculoperitoneal, or, less commonly, ventriculoatrial shunts. We attempted to elucidate all clinical and neurological characteristics that are inherently related to this type of headache, as well as to highlight the current management options. This specific subgroup of patients may eventually suffer from severe, intractable headaches, which may negatively impair their quality of daily living. In the absence of any other clinical condition that could be incriminated as the cause of the headache, shunt over-drainage should not be overlooked. On the contrary, it should be seriously taken into consideration, and its management should be added to the therapeutic armamentarium of such cases, which are difficult to be handled. Full article

The Future of Energy is focused on the consolidation of new energy technologies. Among them, Fuel Cells (FCs) are on the Energy Agenda due to their potential to reduce the demand for fossil fuel and greenhouse gas emissions, their higher efficiency (as fuel cells do not use combustion, their efficiency is not linked to their maximum operating temperature) and simplicity and absence of moving parts. Additionally, low-power FCs have been identified as the target technology to replace conventional batteries in portable applications, which can have recreational, professional, and military purposes. More recently, low-power FCs have also been identified as an alternative to conventional batteries for medical devices and have been used in the medical field both in implantable devices and as micro-power sources. The most used power supply for implantable medical devices (IMD) is lithium batteries. However, despite its higher lifetime, this is far from enough to meet the patient’s needs since these batteries are replaced through surgeries. Based on the close synergetic connection between humans and microorganisms, microbial fuel cells (MFCs) were targeted as the replacement technology for batteries in IMD since they can convert the chemical energy from molecules presented in a living organism into electrical energy. Therefore, MFCs offer the following advantages over lithium batteries: they do not need to be replaced, avoiding subjecting IMD users to different surgeries and decreasing medical costs; they do not need external recharging as they operate as long as the fuel is supplied, by the body fluids; they are a more environmentally friendly technology, decreasing the carbon dioxide and other greenhouse gases emissions resulting from the utilization of fossil fuels and the dependency on fossil fuels and common batteries. However, they are complex systems involving electrochemical reactions, mass and charge transfer, and microorganisms, which affect their power outputs. Additionally, to achieve the desired levels of energy density needed for real applications, an MFC system must overcome some challenges, such as high costs and low power outputs and lifetime. Full article

The general improvement in life expectancy and standard of living makes it easier for patients to get access to routine medical exams and is anticipated to increase the prevalence of several degenerative joint illnesses. In addition, it is anticipated that their incidence will increase both nationally and internationally, which will raise the demand for novel and long-lasting implantable devices in the field of orthopedics. The current review’s goals are to define what constitutes a biocompatible orthopedic implant in terms of in vitro biocompatibility testing and to clarify important concepts and definitions that are already in use. The demand for materials and implants made of various tissues is now increasing, and the ongoing advancement of in vitro cell culture studies is a reliable practical tool for examining the biocompatibility of potential implantable materials. In vitro biocompatibility research has been reduced and, in most cases, diminished to laboratory studies that no longer or drastically reduce animal sacrifice as a response to the well-known three “Rs” (“reduction”, “refinement”, and “replacement”) introduced to literature by English academics in the 1960s. As technology advances at an astounding rate, a new generation of gene-activating biomaterials tailored for specific people and disease conditions might emerge in the near future. Full article

Ventricular assist devices (VAD) have gained popularity in the pediatric population during recent years, as more and more children require a heart transplant due to improved palliation methods, allowing congenital heart defect patients and children with cardiomyopathies to live longer. Eventually, these children may require heart transplantation, and ventricular assist devices provide a bridge to transplantation in these cases. The FDA has so far approved two types of device: pulsatile and continuous flow (non-pulsatile), which can be axial and centrifugal. Potential eligible studies were searched in three databases: Medline, Embase, and ScienceDirect. Our endeavor retrieved 16 eligible studies focusing on five ventricular assist devices in children. We critically reviewed ventricular assist devices approved for pediatric use in terms of implant indication, main adverse effects, and outcomes. The main adverse effects associated with these devices have been noted to be thromboembolism, infection, bleeding, and hemolysis. However, utilizing left VAD early on, before end-organ dysfunction and deterioration of heart function, may give the patient enough time to recuperate before considering a more long-term solution for ventricular support. Full article

Survival after implant of a left ventricular assist device (LVAD) continues to improve for patients with end-stage heart failure. Meanwhile, more patients are implanted with a destination therapy, rather than bridge-to-transplant, indication, meaning the population of patients living long-term on LVADs will continue to grow. Non-LVAD healthcare providers will encounter such patients in their scope of practice, and familiarity and comfort with the physiology and operation of these devices and common problems is essential. This review article describes the history, development, and operation of the modern LVAD. Common LVAD-related complications such as bleeding, infection, stroke, and right heart failure are reviewed and an approach to the patient with an LVAD is suggested. Nominal operating parameters and device response to various physiologic conditions, including hypo- and hypervolemia, hypertension, and device failure, are reviewed. Full article

The world population growth and average life expectancy rise have increased the number of people suffering from non-communicable diseases, namely osteoarthritis, a disorder that causes a significant increase in the years lived with disability. Many people who suffer from osteoarthritis undergo replacement surgery. Despite the relatively high success rate, around 10% of patients require revision surgeries, mostly because existing implant technologies lack sensing devices capable of monitoring the bone–implant interface. Among the several monitoring methodologies already proposed as substitutes for traditional imaging methods, cosurface capacitive sensing systems hold the potential to monitor the bone–implant fixation states, a mandatory capability for long-term implant survival. A multifaceted study is offered here, which covers research on the following points: (1) the ability of a cosurface capacitor network to effectively monitor bone loosening in extended peri-implant regions and according to different stimulation frequencies; (2) the ability of these capacitive architectures to provide effective sensing in interfaces with hydroxyapatite-based layers; (3) the ability to control the operation of cosurface capacitive networks using extracorporeal informatic systems. In vitro tests were performed using a web-based network sensor composed of striped and interdigitated capacitive sensors. Hydroxyapatite-based layers have a minor effect on determining the fixation states; the effective operation of a sensor network-based solution communicating through a web server hosted on Raspberry Pi was shown. Previous studies highlight the inability of current bone–implant fixation monitoring methods to significantly reduce the number of revision surgeries, as well as promising results of capacitive sensing systems to monitor micro-scale and macro-scale bone–interface states. In this study, we found that extracorporeal informatic systems enable continuous patient monitoring using cosurface capacitive networks with or without hydroxyapatite-based layers. Findings presented here represent significant advancements toward the design of future multifunctional smart implants. Full article

Deacetylated chitin derivatives have been widely studied for tissue engineering purposes. This study aimed to compare the efficacy of an injectable product containing a 50% deacetylated chitin derivative (BoneReg-Inject™) and an existing product (chronOS Inject^®) serving as a predicate device. A sheep model with a critical size drill hole in the tibial plateau was used. Holes of 8 mm diameter and 30 mm length were drilled bilaterally into the proximal area of the tibia and BoneReg-Inject™ or chronOS Inject^® were injected into the right leg holes. Comparison of resorption and bone formation in vivo was made by X-ray micro-CT and histological evaluation after a live phase of 12 weeks. Long-term effects of BoneReg-Inject™ were studied using a 13-month live period. Significant differences were observed in (1) amount of new bone within implant (p < 0.001), higher in BoneReg-Inject^TM, (2) signs of cartilage tissue (p = 0.003), more pronounced in BoneReg-Inject^TM, and (3) signs of fibrous tissue (p < 0.001), less pronounced in BoneReg-Inject^TM. Mineral content at 13 months postoperative was significantly higher than at 12 weeks (p < 0.001 and p < 0.05, for implant core and rim, respectively). The data demonstrate the potential of deacetylated chitin derivatives to stimulate bone formation. Full article

Soft biomimetic electronic devices primarily comprise an electronic skin (e-skin) capable of implementing various wearable/implantable applications such as soft human–machine interfaces, epidermal healthcare systems, and neuroprosthetics owing to its high mechanical flexibility, tissue conformability, and multifunctionality. The conformal contact of the e-skin with living tissues enables more precise analyses of physiological signals, even in the long term, as compared to rigid electronic devices. In this regard, e-skin can be considered as a promising formfactor for developing highly sensitive and transparent pressure sensors. Specifically, to minimize the modulus mismatch at the biotic–abiotic interface, transparent-conductive hydrogels have been used as electrodes with exceptional pressing durability. However, critical issues such as dehydration and low compatibility with elastomers remain a challenge. In this paper, we propose a skin-like transparent polymer-hydrogel hybrid pressure sensor (HPS) with microstructures based on the polyacrylamide/sodium-alginate hydrogel and p-PVDF-HFP-DBP polymer. The encapsulated HPS achieves conformal contact with skin due to its intrinsically stretchable, highly transparent, widely sensitive, and anti-dehydrative properties. We believe that the HPS is a promising candidate for a robust transparent epidermal stretchable-skin device. Full article

Flexible electronics is one of the most attractive and anticipated markets in the internet-of-things era, covering a broad range of practical and industrial applications from displays and energy harvesting to health care devices. The mechanical flexibility, combined with high performance electronics, and integrated on a soft substrate offer unprecedented functionality for biomedical applications. This paper presents a brief snapshot on the materials of choice for niche flexible bio-implanted devices that address the requirements for both biodegradable and long-term operational streams. The paper also discusses potential future research directions in this rapidly growing field. Full article

HIV-1 is a chronic disease managed by strictly adhering to daily antiretroviral therapy (ART). However, not all people living with HIV-1 have access to ART, and those with access may not adhere to treatment regimens increasing viral load and disease progression. Here, a subcutaneous nanofluidic implant was used as a long-acting (LA) drug delivery platform to address these issues. The device was loaded with tenofovir alafenamide (TAF) and implanted in treatment-naïve simian HIV (SHIV)-positive nonhuman primates (NHP) for a month. We monitored intracellular tenofovir-diphosphate (TFV-DP) concentration in the target cells, peripheral blood mononuclear cells (PBMC). The concentrations of TFV-DP were maintained at a median of 391.0 fmol/10⁶ cells (IQR, 243.0 to 509.0 fmol/10⁶ cells) for the duration of the study. Further, we achieved drug penetration into lymphatic tissues, known for persistent HIV-1 replication. Moreover, we observed a first-phase viral load decay of −1.14 ± 0.81 log₁₀ copies/mL (95% CI, −0.30 to −2.23 log₁₀ copies/mL), similar to −1.08 log₁₀ copies/mL decay observed in humans. Thus, LA TAF delivered from our nanofluidic implant had similar effects as oral TAF dosing with a lower dose, with potential as a platform for LA ART. Full article

In-vivo sensors yield valuable medical information by measuring directly on the living tissue of a patient. These devices can be surface or implant devices. Electrical activity in the body, from organs or muscles can be measured using surface electrodes. For short term internal devices, catheters are used. These include cardiac catheter (in blood vessels) and bladder catheters. Due to the size and shape of the catheters, silicon devices provided an excellent solution for sensors. Since many cardiac catheters are disposable, the high volume has led to lower prices of the silicon sensors. Many catheters use a single sensor, but silicon offers the opportunity to have multi sensors in a single catheter, while maintaining small size. The cardiac catheter is usually inserted for a maximum of 72 h. Some devices may be used for a short-to-medium period to monitor parameters after an operation or injury (1–4 weeks). Increasingly, sensing, and actuating, devices are being applied to longer term implants for monitoring a range of parameters for chronic conditions. Devices for longer term implantation presented additional challenges due to the harshness of the environment and the stricter regulations for biocompatibility and safety. This paper will examine the three main areas of application for in-vivo devices: surface devices and short/medium-term and long-term implants. The issues of biocompatibility and safety will be discussed. Full article

Optogenetics is a new neuroscience technology, consisting of biological technology that activates a nerve by light and engineering technology that transmits light to the nerve. In order to transmit light to the target nerve, fiber optics or light-emitting devices have been inserted into the living body, while the motions or emotions of freely moving animals can be controlled using a wirelessly operated optoelectronic device. However, in order to keep optoelectronic devices small in size and operational for a long time in vivo, the need for a thin but robust protective layer has emerged. In this paper, we developed a protective layer, consisting of Parylene and silicone that can protect soft optoelectronic devices inside saline solution for a long time. A chemical vapor deposited Parylene C film between the polydimethylsiloxane layers showed promising optical, mechanical, and water-barrier properties. We expect that these protective layers can be used as an encapsulation film on bio-implantable devices, including wireless optogenetic applications. Full article