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https://www.readbyqxmd.com/read/29651998/high-resolution-local-field-potentials-measured-with-deep-brain-stimulation-arrays
#1
Simeng Zhang, Allison T Connolly, Lauren Madden, Jerrold L Vitek, Matthew D Johnson
Local field potential (LFP) recordings along a deep brain stimulation (DBS) lead can provide useful feedback for titrating DBS therapy. However, conventional DBS leads with four cylindrical macroelectrodes likely undersample the spatial distribution of sinks and sources in a given brain region. In this study, we investigated the spectral power and spatial feature sizes of LFP activity in non-human primate subthalamic nucleus and globus pallidus using chronically implanted 32-channel directional DBS arrays.
 
 Approach: Subthalamic nucleus and globus pallidus LFP signals were recorded from directional DBS arrays in the resting state and during a reach-and-retrieval task in two non-human primates in naïve and parkinsonian conditions...
April 13, 2018: Journal of Neural Engineering
https://www.readbyqxmd.com/read/29491185/mechanical-circulatory-support-device-heart-hysteretic-interaction-can-predict-left-ventricular-end-diastolic-pressure
#2
Brian Y Chang, Steven P Keller, Sonya S Bhavsar, Noam Josephy, Elazer R Edelman
The full potential of mechanical circulatory systems in the treatment of cardiogenic shock is impeded by the lack of accurate measures of cardiac function to guide clinicians in determining when to initiate and how to optimally titrate support. The left ventricular end diastolic pressure (LVEDP) is an established metric of cardiac function that refers to the pressure in the left ventricle at the end of ventricular filling and immediately before ventricular contraction. In clinical practice, LVEDP is typically only inferred from, and poorly correlates with, the pulmonary capillary wedge pressure (PCWP)...
February 28, 2018: Science Translational Medicine
https://www.readbyqxmd.com/read/29455335/evaluating-the-safety-and-tolerability-of-sacubitril-valsartan-for-hfref-managed-within-a-pharmacist-clinic
#3
Elizabeth K Pogge, Lindsay E Davis
OBJECTIVE: The objective of this research was to describe the use of pharmacist-managed sacubitril/valsartan therapy in a multi-center, outpatient cardiac group. BACKGROUND: Sacubitril/valsartan, an angiotensin receptor-neprilysin inhibitor (ARNi), is a novel agent for the treatment of heart failure. An ARNi is recommended by national guidelines to be used in place of angiotensin-converting enzyme inhibitor (ACEi) or angiotensin receptor blocker (ARB) therapy for patients who remain symptomatic...
April 2018: American Journal of Cardiovascular Drugs: Drugs, Devices, and Other Interventions
https://www.readbyqxmd.com/read/29359558/insulin-detection-using-a-corona-phase-molecular-recognition-site-on-single-walled-carbon-nanotubes
#4
Gili Bisker, Naveed A Bakh, Michael A Lee, Jiyoung Ahn, Minkyung Park, Ellen B O'Connell, Nicole M Iverson, Michael S Strano
Corona phase molecular recognition (CoPhMoRe) is a technique whereby an external, adsorbed phase around a colloidal nanoparticle is selected such that its molecular conformation or interaction recognizes a specific target analyte. In this work, we employ a high-throughput screening of a library of poly(ethylene glycol) (PEG)-conjugated lipids adsorbed onto near-infrared fluorescent single-walled carbon nanotubes to discover a corona phase selective for insulin. We find that a C16 -PEG(2000 Da)-ceramide causes a 62% fluorescent intensity decrease of the (10,2) chirality nanotube in the presence of 20 μg/mL insulin...
February 23, 2018: ACS Sensors
https://www.readbyqxmd.com/read/29272974/home-oxygen-therapy-re-thinking-the-role-of-devices
#5
REVIEW
Andrea S Melani, Piersante Sestini, Paola Rottoli
A range of devices are available for delivering and monitoring home oxygen therapy (HOT). Guidelines do not give indications for the choice of the delivery device but recommend the use of an ambulatory system in subjects on HOT whilst walking. Areas covered: We provide a clinical overview of HOT and review traditional and newer delivery and monitoring devices for HOT. Despite relevant technology advancements, clinicians, faced with many challenges when they prescribe oxygen therapy, often remain familiar to traditional devices and continuous flow delivery of oxygen...
March 2018: Expert Review of Clinical Pharmacology
https://www.readbyqxmd.com/read/29239148/effects-of-closed-loop-intravenous-anesthesia-guided-by-the-bispectral-index-in-adult-patients-on-emergence-delirium-a-randomized-controlled-study
#6
Antonella Cotoia, Lucia Mirabella, Renata Beck, Pompeo Matrella, Valentina Assenzo, Thierry Chazot, Gilda Cinnella, Ngai Liu, Michele Dambrosio
BACKGROUND: Emergence delirium (ED) is an acute change in cognition after general anesthesia (GA) occurring in operative room, recovery room or in postanesthesia care. The automated propofolremifentanil titration by Bispectral index (BIS) (AutoTIVA) avoids period of deep (BIS<40) anesthesia and could potentially decrease the ED. The aim of this study was to evaluate ED in surgical patients under AutoTIVA, manual titration of propofol-remifentanil (ManualTIVA) or volatile BIS-guided GA...
December 13, 2017: Minerva Anestesiologica
https://www.readbyqxmd.com/read/29210791/design-and-evaluation-of-a-closed-loop-anesthesia-system-with-robust-control-and-safety-system
#7
Nicholas West, Klaske van Heusden, Matthias Görges, Sonia Brodie, Aryannah Rollinson, Christian L Petersen, Guy A Dumont, J Mark Ansermino, Richard N Merchant
BACKGROUND: Closed-loop control of anesthesia involves continual adjustment of drug infusion rates according to measured clinical effect. The NeuroSENSE monitor provides an electroencephalographic measure of depth of hypnosis (wavelet-based anesthetic value for central nervous system monitoring [WAVCNS]). It has previously been used as feedback for closed-loop control of propofol, in a system designed using robust control engineering principles, which implements features specifically designed to ensure patient safety...
November 22, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29077707/a-novel-controller-based-on-state-transition-models-for-closed-loop-vagus-nerve-stimulation-application-to-heart-rate-regulation
#8
Hector M Romero-Ugalde, Virginie Le Rolle, Jean-Luc Bonnet, Christine Henry, Alain Bel, Philippe Mabo, Guy Carrault, Alfredo I Hernández
Vagus nerve stimulation (VNS) is an established adjunctive therapy for pharmacologically refractory epilepsy and depression and is currently in active clinical research for other applications. In current clinical studies, VNS is delivered in an open-loop approach, where VNS parameters are defined during a manual titration phase. However, the physiological response to a given VNS configuration shows significant inter and intra-patient variability and may significantly evolve through time. VNS closed-loop approaches, allowing for the optimization of the therapy in an adaptive manner, may be necessary to improve efficacy while reducing side effects...
2017: PloS One
https://www.readbyqxmd.com/read/28729473/automatic-versus-manual-oxygen-administration-in-the-emergency-department
#9
Erwan L'Her, Patricia Dias, Maelenn Gouillou, Anne Riou, Luc Souquiere, Nicolas Paleiron, Patrick Archambault, Pierre-Alexandre Bouchard, François Lellouche
Oxygen is commonly administered in hospitals, with poor adherence to treatment recommendations.We conducted a multicentre randomised controlled study in patients admitted to the emergency department requiring O2 ≥3 L·min(-1) Patients were randomised to automated closed-loop or manual O2 titration during 3 h. Patients were stratified according to arterial carbon dioxide tension (PaCO2 ) (hypoxaemic PaCO2 ≤45 mmHg; or hypercapnic PaCO2 >45-≤55 mmHg) and study centre. Arterial oxygen saturation measured by pulse oximetry (SpO2 ) goals were 92-96% for hypoxaemic, or 88-92% for hypercapnic patients...
July 2017: European Respiratory Journal: Official Journal of the European Society for Clinical Respiratory Physiology
https://www.readbyqxmd.com/read/28537969/thoracic-epidural-analgesia-with-levobupivacaine-reduces-remifentanil-and-propofol-consumption-evaluated-by-closed-loop-titration-guided-by-the-bispectral-index-a-double-blind-placebo-controlled-study
#10
RANDOMIZED CONTROLLED TRIAL
Virginie Dumans-Nizard, Morgan Le Guen, Edouard Sage, Thierry Chazot, Marc Fischler, Ngai Liu
BACKGROUND: Thoracic epidural analgesia (TEA) combined with general anesthesia decreases anesthetic requirements by half when hemodynamic criteria are used for the titration of analgesia. We therefore determined the impact of TEA on anesthetic requirements, when a closed-loop controller was used allowing the automated coadministration of propofol-remifentanil guided solely by the Bispectral index. METHODS: This single-center double-blind study enrolled patients scheduled for elective posterolateral thoracotomy using TEA...
August 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28523978/closed-loop-neuromodulation-systems-next-generation-treatments-for-psychiatric-illness
#11
Meng-Chen Lo, Alik S Widge
Despite deep brain stimulation's positive early results in psychiatric disorders, well-designed clinical trials have yielded inconsistent clinical outcomes. One path to more reliable benefit is closed-loop therapy: stimulation that is automatically adjusted by a device or algorithm in response to changes in the patient's electrical brain activity. These interventions may provide more precise and patient-specific treatments. This article first introduces the available closed-loop neuromodulation platforms, which have shown clinical efficacy in epilepsy and strong early results in movement disorders...
April 2017: International Review of Psychiatry
https://www.readbyqxmd.com/read/28368937/physician-directed-versus-computerized-closed-loop-control-of-blood-pressure-using-phenylephrine-in-a-swine-model
#12
Nicole Ribeiro Marques, William E Whitehead, Upendar R Kallu, Michael P Kinsky, Joe S Funston, Taoufik Wassar, Muzna N Khan, Mindy Milosch, Daniel Jupiter, Karolos Grigoriadis, George C Kramer
BACKGROUND: Vasopressors provide a rapid and effective approach to correct hypotension in the perioperative setting. Our group developed a closed-loop control (CLC) system that titrates phenylephrine (PHP) based on the mean arterial pressure (MAP) during general anesthesia. As a means of evaluating system competence, we compared the performance of the automated CLC with physicians. We hypothesized that our CLC algorithm more effectively maintains blood pressure at a specified target with less blood pressure variability and reduces the dose of PHP required...
July 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28265453/automated-closed-loop-resuscitation-of-multiple-hemorrhages-a-comparison-between-fuzzy-logic-and-decision-table-controllers-in-a-sheep-model
#13
Nicole Ribeiro Marques, Brent J Ford, Muzna N Khan, Michael Kinsky, Donald J Deyo, William J Mileski, Hao Ying, George C Kramer
BACKGROUND: Hemorrhagic shock is the leading cause of trauma-related death in the military setting. Definitive surgical treatment of a combat casualty can be delayed and life-saving fluid resuscitation might be necessary in the field. Therefore, improved resuscitation strategies are critically needed for prolonged field and en route care. We developed an automated closed-loop control system capable of titrating fluid infusion to a target endpoint. We used the system to compare the performance of a decision table algorithm (DT) and a fuzzy logic controller (FL) to rescue and maintain the mean arterial pressure (MAP) at a target level during hemorrhages...
2017: Disaster and Military Medicine
https://www.readbyqxmd.com/read/28256109/protein-nmr-studies-of-substrate-binding-to-human-blood-group-a-and-b-glycosyltransferases
#14
Lena Lisbeth Grimm, Sophie Weissbach, Friedemann Flügge, Nora Begemann, Monica M Palcic, Thomas Peters
Donor and acceptor substrate binding to human blood group A and B glycosyltransferases (GTA, GTB) has been studied by a variety of protein NMR experiments. Prior crystallographic studies had shown these enzymes to adopt an open conformation in the absence of substrates. Binding either of the donor substrate UDP-Gal or of UDP induces a semiclosed conformation. In the presence of both donor and acceptor substrates, the enzymes shift towards a closed conformation with ordering of an internal loop and the C-terminal residues, which then completely cover the donor-binding pocket...
July 4, 2017: Chembiochem: a European Journal of Chemical Biology
https://www.readbyqxmd.com/read/28124225/feasibility-of-automated-titration-of-vasopressor-infusions-using-a-novel-closed-loop-controller
#15
Joseph Rinehart, Michael Ma, Michael-David Calderon, Maxime Cannesson
Blood pressure management is a central concern in critical care patients. For a variety of reasons, titration of vasopressor infusions may be an ideal use-case for computer assistance. Using our previous experience gained in the bench-to-bedside development of a computer-assisted fluid management system, we have developed a novel controller for this purpose. The aim of this preliminary study was to assess the feasibility of using this controller in simulated patients to maintain a target blood pressure in both stable and variable blood-pressure scenarios...
February 2018: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/27794080/automatic-oxygen-titration-during-walking-in-subjects-with-copd-a-randomized-crossover-controlled-study
#16
RANDOMIZED CONTROLLED TRIAL
François Lellouche, Erwan L'Her, Pierre-Alexandre Bouchard, Cynthia Brouillard, François Maltais
BACKGROUND: Arterial oxygen desaturation frequently occurs in patients with COPD during daily activities at home. Oxygen flow is usually set at fixed and low rates for ambulatory patients. We evaluated an innovative closed-loop system (FreeO2) that automatically adjusts the oxygen flow to the patient's needs in subjects with COPD during walking followed by recovery time, such as during ambulatory conditions. METHODS: Patients with COPD who exhibited oxygen desaturation on exertion were included in the study...
November 2016: Respiratory Care
https://www.readbyqxmd.com/read/27748121/chemical-inhibition-of-human-thymidylate-kinase-and-structural-insights-into-the-phosphate-binding-loop-and-ligand-induced-degradation
#17
Yi-Hsuan Chen, Hua-Yi Hsu, Ming-Tyng Yeh, Chen-Cheng Chen, Chang-Yu Huang, Ying-Hsuan Chung, Zee-Fen Chang, Wei-Chen Kuo, Nei-Li Chan, Jui-Hsia Weng, Bon-Chu Chung, Yu-Ju Chen, Cheng-Bang Jian, Ching-Chieh Shen, Hwan-Ching Tai, Sheh-Yi Sheu, Jim-Min Fang
Targeting thymidylate kinase (TMPK) that catalyzes the phosphotransfer reaction for formation of dTDP from dTMP is a new strategy for anticancer treatment. This study is to understand the inhibitory mechanism of a previously identified human TMPK (hTMPK) inhibitor YMU1 (1a) by molecular docking, isothermal titration calorimetry, and photoaffinity labeling. The molecular dynamics simulation suggests that 1a prefers binding at the catalytic site of hTMPK, whereas the hTMPK inhibitors that bear pyridino[d]isothiazolone or benzo[d]isothiazolone core structure in lieu of the dimethylpyridine-fused isothiazolone moiety in 1a can have access to both the ATP-binding and catalytic sites...
November 10, 2016: Journal of Medicinal Chemistry
https://www.readbyqxmd.com/read/27739259/deinococcus-radiodurans-dr2231-is-a-two-metal-ion-mechanism-hydrolase-with-exclusive-activity-on-dutp
#18
Cristiano S Mota, Ana Maria D Gonçalves, Daniele de Sanctis
DR2231 from Deinococcus radiodurans was previously functionally and structurally characterized as an all-α NTP pyrophosphohydrolase with specific dUTPase activity. dUTPases have a central role in the regulation of dUTP intracellular levels and dTTP nucleotide metabolism. DR2231 presents a conserved dimetal catalytic site, similar to all-α dimeric dUTPases, but contrary to these enzymes, it is unable to process dUDP. In this article, we present functional and structural evidence of single-point mutations that affect directly or indirectly the enzyme catalysis and provide a complete description of the all-α NTP pyrophosphohydrolase mechanism...
December 2016: FEBS Journal
https://www.readbyqxmd.com/read/27600131/protocolized-resuscitation-of-burn-patients
#19
REVIEW
Leopoldo C Cancio, Jose Salinas, George C Kramer
Fluid resuscitation of burn patients is commonly initiated using modified Brooke or Parkland formula. The fluid infusion rate is titrated up or down hourly to maintain adequate urine output and other endpoints. Over-resuscitation leads to morbid complications. Adherence to paper-based protocols, flow sheets, and clinical practice guidelines is associated with decreased fluid resuscitation volumes and complications. Computerized tools assist providers. Although completely autonomous closed-loop control of resuscitation has been demonstrated in animal models of burn shock, the major advantages of open-loop and decision-support systems are identifying trends, enhancing situational awareness, and encouraging burn team communication...
October 2016: Critical Care Clinics
https://www.readbyqxmd.com/read/27543528/pilot-study-of-closed-loop-anaesthesia-for-liver-transplantation
#20
A Restoux, S Grassin-Delyle, N Liu, C Paugam-Burtz, J Mantz, M Le Guen
BACKGROUND: Automated titration of propofol and remifentanil guided by the bispectral index (BIS) has been used for numerous surgical procedures. Orthotopic liver transplantation (OLT) uniquely combines major changes in circulating volume, an anhepatic phase, and ischaemia-reperfusion syndrome. We assessed the behaviour of this automated controller during OLT. METHODS: Adult patients undergoing OLT were included in this pilot study. Consumption of propofol and remifentanil was calculated for each surgery period (dissection, anhepatic, and liver reperfusion phases)...
September 2016: British Journal of Anaesthesia
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