Electrical Stimulation Research Articles

Efficacy and safety of sympathetic mapping and ablation of renal nerves for the treatment of hypertension (SMART): 6-month follow-up of a randomised, controlled trial

Previous trials of renal denervation (RDN) have been designed to investigate reduction of blood pressure (BP) as the primary efficacy endpoint using non-selective RDN without intraoperatively verified RDN success. It is an unmet clinical need to map renal nerves, selectively denervate renal sympathetic nerves, provide readouts for the interventionalists and avoid futile RDN. We aimed to examine the safety and efficacy of renal nerve mapping/selective renal denervation (msRDN) in patients with uncontrolled hypertension (HTN) and determine whether antihypertensive drug burden is reduced while office systolic BP (OSBP) is controlled to target level (＜140mmHg). We conducted a randomized, prospective, multicenter, single-blinded, sham-controlled trial. The study combined two efficacy endpoints at 6 months as primary outcomes: The control rate of patients with OSBP ＜140mmHg (non-inferior outcome) and change in the composite index of antihypertensive drugs (Drug Index) in the treatment versus Sham group (superior outcome). This design avoids confounding from excess drug-taking in the Sham group. Antihypertensive drug burden was assessed by a composite index constructed as: Class N (number of classes of antihypertensive drugs)×(sum of doses). 15 hospitals in China participated in the study and 220 patients were enrolled in a 1:1 ratio (msRDN vs Sham). The key inclusion criteria included: age (18-65 years old), history of essential HTN (at least 6 months), heart rate (≥70 bpm), OSBP (≥150mmHg and ≤180mmHg), ambulatory BP monitoring (ABPM, 24-h SBP ≥130mmHg or daytime SBP ≥135mmHg or nighttime SBP ≥120mmHg), renal artery stenosis (＜50%) and renal function (eGFR ＞45mL/min/1.73m2). The catheter with both stimulation and ablation functions was inserted in the distal renal main artery. The RDN site (hot spot) was selected if SBP increased (≥5mmHg) by intra-renal artery (RA) electrical stimulation; an adequate RDN was confirmed by repeated electronic stimulation if no increase in BP otherwise, a 2nd ablation was performed at the same site. At sites where there was decreased SBP (≥5mmHg, cold spot) or no BP response (neutral spot) to stimulation, no ablation was performed. The mapping, ablation and confirmation procedure was repeated until the entire renal main artery had been tested then either treated or avoided. AftermsRDN, patients had to follow a predefined, vigorous drug titration regimen in order to achieve target OSBP (＜140mmHg). Drug adherence was monitored by liquid chromatography-tandem mass spectrometry analysis using urine. This study is registered with ClinicalTrials.gov (NCT02761811) and 5-year follow-up is ongoing. Between July 8, 2016 and February 23, 2022, 611 patients were consented, 220 patients were enrolled in the study who received standardized antihypertensive drug treatments (at least two drugs) for at least 28 days, presented OSBP ≥150mmHg and ≤180mmHg and metall inclusion and exclusion criteria. In left RA and right RA, mapped sites were 8.2 (3.0) and 8.0 (2.7), hot/ablated sites were 3.7 (1.4) and 4.0 (1.6), cold spots were 2.4 (2.6) and 2.0 (2.2), neutral spots were 2.0 (2.1) and 2.0 (2.1), respectively. Hot, cold and neutral spots was 48.0%, 27.5% and 24.4% of total mapped sites, respectively. At 6M, the Control Rate of OSBP was comparable between msRDN and Sham group (95.4% vs 92.8%, p=0.429), achieved non-inferiority margin-10% (2.69%; 95% CI-4.11%, 9.83%, p ＜ 0.001 for non-inferiority); the change in Drug Index was significantly lower in msRDN group compared to Sham group (4.37 (6.65) vs 7.61 (10.31), p=0.010) and superior to Sham group (-3.25; 95% CI-5.56,-0.94, p=0.003), indicating msRDN patients need significantly fewer drugs to control OSBP ＜140mmHg. 24-hour ambulatory SBP decreased from 146.8 (13.9) mmHg by 10.8 (14.1) mmHg, and from 149.8 (12.8) mmHg by 10.0 (14.0) mmHg in msRDN and Sham groups, respectively (p<0.001 from Baseline; p>0.05 between groups). Safety profiles were comparable between msRDN and Sham groups, demonstrating the safety and efficacy of renal mapping/selective RDN to treat uncontrolled HTN. The msRDN therapy achieved the goals of reducing the drug burden of HTN patients and controlling OSBP <140mmHg, with only approximately four targeted ablations per renal main artery, much lower than in previous trials. SyMap Medical (Suzhou), LTD, Suzhou, China.

Neuropathic pain: Evidence based recommendations

Neuropathic pain continues to be a significant problem that lacks effective solutions for every single patient. In 2015, international guidelines (NeuPSIG) were published, while the French recommendations were updated in 2020. The purpose of this minireview is to provide an update on the process of developing evidence-based recommendations and explore potential changes to the current recommendations.Primary treatments for neuropathic pain include selective serotonin-norepinephrine reuptake inhibitors (SNRIs) such as duloxetine and venlafaxine, gabapentin, tricyclic antidepressants, as well as topical lidocaine and transcutaneous electrical nerve stimulation, which are specifically suggested for focal peripheral neuropathic pain. Pregabalin is a first line treatment according to international guidelines but second-line in the more recent French guidelines, due to lower efficacy seen in more recent studies and misuse risk. Additionally, tramadol, combination therapies, and psychotherapy as adjuncts are proposed second line; high-concentration capsaicin patches, and botulinum toxin A are proposed specifically for focal peripheral neuropathic pain.In cases where primary and secondary treatments prove insufficient, third-line options come into play. These include high-frequency repetitive transcranial magnetic stimulation (rTMS) targeting the motor cortex, spinal cord stimulation, and the use of strong opioids when no alternative is available.To ensure optimal management of neuropathic pain in real-life situations, it is imperative to disseminate these recommendations widely and secure the acceptance of practitioners. By doing so, we can bridge the gap between theory and practice, and enhance the overall care and treatment of individuals suffering from neuropathic pain.

Physiotherapy management of functional activity disorders of knee dekstra et cause post-op anterior cruciate ligament reconstruction

Introduction: anterior cruciate ligament injury is one of the common knee injuries among athletes, which can cause functional activity impairment of the knee, such as pain, edema, range of motion limitation, contracture, and anxiety. Anterior cruciate ligament reconstruction is a surgical procedure that aims to restore the stability and function of the knee. Patients who undergo Anterior cruciate ligament reconstruction require appropriate physiotherapy management to accelerate the healing and recovery process. Aim: this study aims to determine the physiotherapy management of functional activity disorders of the knee joints and the causes of postoperative anterior cruciate ligament reconstruction. Methods: this study used a case study method with a research subject of a 24-year-old male who suffered an anterior cruciate ligament injury on the right knee and underwent Anterior cruciate ligament reconstruction. Data were collected using instruments such as the VAS pain scale, goniometer to measure a range of motion, MMT to measure muscle strength, and international knee documentation committee questionnaire to measure functional activity. Results: showed a decrease in pain, an increase in range of motion, an increase in muscle strength, and an increase in functional activity on the right knee caused post-op Anterior cruciate ligament reconstruction after receiving physiotherapy intervention for 9 sessions. Conclusion: physiotherapy management given in the form of electrical muscle stimulation, prone hang, passive range of motion exercise, patella mobilization, isotonic &amp; isometric strengthening, and walking exercise, as well as education, can help overcome functional activity impairment on the right knee et cause post-op anterior cruciate ligament reconstruction.

Pole placement tuning of proportional integral derivative feedback controller for knee extension model

Functional electrical stimulation (FES) has shown potential in rehabilitative exercises for patients recovering from spinal cord injuries. In recent developments, conventional open-loop FES control techniques have evolved into closed-loop systems that employ feedback controllers for automation. However, closed-loop FES systems often face challenges due to muscle non-linear effects, such as fatigue, time delays, stiffness, and spasticity. Therefore, an accurate non-linear knee model is required during the design stage, and precise tuning of the feedback controller parameters is vital. A proportional– integral–derivative (PID) controller is commonly used as a feedback controller due to its simplicity and ease of implementation. However, most PID tuning methods are complex and time consuming. This paper investigates the viability of employing the pole placement technique for tuning a PID controller that regulates the non-linear knee extension model. The pole placement method aims to improve the control and adaptability of the PID controller in closed-loop FES systems, specifically by facilitating knee extension exercises. MATLAB Simulink was used to assess the effectiveness of this tuning approach. Results showed that the PID controller performed satisfactorily without non-linearities, but performance varied with the inclusion of specific non-linearities. The pole placement tuning method facilitated preliminary assessments of PID controller performance, preceding highly advanced optimization.

AI-powered Neuroprosthetics for brain-computer interfaces (BCIs)

Imagine a world where individuals with lost or impaired sensory or motor function can regain independence and control through technology. This is the promise of neuroprosthetics, a rapidly evolving field that bridges the gap between the nervous system and external devices. Neuroprosthetics encompass a range of implanted or external devices designed to: Substitute for a malfunctioning part of the nervous system. Assist in the recovery or enhancement of lost or impaired function. Augment existing capabilities, creating new possibilities. These devices interact with the nervous system using various methods, including: Electrical stimulation: Directly stimulating nerves or brain tissue to evoke desired responses. Recording brain activity: Capturing electrical signals generated by the brain for further processing and interpretation. Common applications of neuroprosthetics include: Cochlear implants: Restoring hearing in individuals with severe hearing loss. Deep brain stimulation (DBS): Treating movement disorders like Parkinson's disease and essential tremor. Bionic limbs: Providing control of prosthetic arms and legs for individuals with limb loss. Brain-computer interfaces (BCIs): Enabling communication and control of external devices using brain signals alone. Neuroprosthetics offer a glimpse into the future of medicine and technology. With ongoing advancements, these devices have the potential to revolutionize how we treat neurological conditions, restore lost abilities, and even enhance human potential. However, significant challenges remain, including ensuring long-term safety, improving accuracy and reliability, and addressing ethical considerations. As research continues, neuroprosthetics holds immense potential to improve the lives of millions and redefine what it means to be human. The integration of artificial intelligence (AI) with neuroprosthetics has marked a significant milestone in the development of brain-computer interfaces (BCIs). This emerging synergy aims to enhance the quality of life for individuals with disabilities by restoring lost sensory, motor, and cognitive functions. This review article explores the advancements in AI-powered neuroprosthetics for BCIs, focusing on their design, functionality, and the ethical considerations that accompany their integration into medical practice.

The effect of bioelectric and manual impressions on quality of complete dentures and quality of life: A cross over pilot study

PurposeTo compare the quality of complete dentures and quality of life of participants rehabilitated by using TENS (Transcutaneous electric nerve stimulation) facilitated impression making with manual impressions. Material and methodsTen completely edentulous participants were enrolled in the crossover, pilot study. Participants were randomized in 2 groups. Five participants in each group were rehabilitated by dentures fabricated with TENS facilitated definitive impression technique (group T) and conventional impression technique (group C). In group T, Bioelectric border molding was done for the participants, that uses electric stimulation of the nerves supplying the muscles. In group C, incremental border molding using modeling plastic impression compound was carried out. Participants in each group used the dentures for 3 months. After 3 months, OHIP-EDENT questionnaire responses were obtained from the participants to observe the oral health related quality of life. A dental specialist recorded denture quality by Kapur scoring criteria. After one month wash period, the treatment was swapped between the groups. OHIP-EDENT scores and Kapur score were recorded for the alternate dentures after 3 months of use. Descriptive analysis was followed by Mann Whitney test to compare the overall scores between group T and group C for OHIP-EDENT, the scores for individual domains of OHIP-EDENT, and Kapur score for denture evaluation (α = 0.05). ResultsThe overall OHIP-EDENT scores within each domain were less in group T when compared with the scores in group C and Kapur score for group T was more than group C. The difference was statistically significant i.e. P = 0.002 & 0.003 respectively. ConclusionsLess OHIP-EDENT scores in group T imply better perception of quality of life of individuals due to better performance of stomatognathic system. The higher Kapur scores in group T signifies better quality of dentures when TENS was used for definitive impression making.

Conservative Interventions for Urinary Incontinence on Postpartum Women: A Systematic Review and Meta-Analysis.

Urinary incontinence (UI) is common in postpartum women and can lead to a reduced quality of life and withdrawal from fitness and exercise activities. Conservative management interventions such as pelvic floor muscle training (PFMT), use of vaginal cones, and biofeedback have been recommended as first-line treatment. We aimed to explore the effects of conservative interventions on UI rate, severity, and incontinence-specific quality of life in postpartum women with UI. Nine databases were searched from inception to August 2022: PubMed, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials, CINAHL, Wanfang, China National Knowledge Infrastructure, China Biological Medicine, and VIP Journal Integration Platform. Randomized controlled trials examining the effects of conservative interventions on postpartum UI were included. Initial searches produced 1839 results, of which 17 studies were eligible. All included studies had a low to moderate risk of bias. Supervised PFMT and use of a vaginal cone were more effective than individual PFMT in decreasing rates of UI (odds ratio, 0.29; 95% CI, 0.14-0.61). Individual PFMT combined with acupuncture (mean difference, -1.91; 95% CI, -2.46 to -1.37) or electroacupuncture and supervised PFMT combined with moxibustion were more effective than individual supervised PFMT alone in improving the severity of symptoms. Furthermore, electrical stimulation and biofeedback combined with acupoint stimulation or core training were more effective than electrical stimulation and biofeedback alone. For improving the incontinence-specific quality of life, supervised PFMT was more efficacious than individual PFMT; electrical stimulation and biofeedback plus core training were more beneficial than electrical stimulation and biofeedback alone. Supervised PFMT and use of a vaginal cone were more beneficial in decreasing rates of UI compared with individual PFMT. Superior effects in decreasing UI severity may be achieved by combining PFMT or electrical simulation and biofeedback with other therapies. Electrical stimulation and biofeedback plus core training, as well as supervised PFMT, are most effective in improving incontinence-specific quality of life. Further research is required to provide more evidence on the efficacy of these therapies.

Efficacy and factors of myofascial release therapy combined with electrical and magnetic stimulation in the treatment of chronic pelvic pain syndrome

Abstract The objective of this study was to evaluate the efficacy and factors of myofascial release therapy combined with electrical and magnetic stimulation in the treatment of chronic pelvic pain syndrome (CPPS). A total of 79 female patients diagnosed with CPPS from January 2021 to December 2022 were prospectively analyzed. Every patient received 3 weeks of treatment which included myofascial release therapy combined with electrical and magnetic stimulation. The visual analog score (VAS) of pelvic floor muscle (PFM) trigger points (TrPs) and the changes in pelvic floor surface electromyography before and after treatment were compared. Multiple linear regression was used to analyze the influencing factors of each outcome index. There were significant differences in VASs of muscle TrPs before and after treatment (P &lt; 0.05). For the surface electromyography of PFMs, the differences in pre-baseline rest, post-baseline rest, isometric contractions for muscle endurance evaluation, and coefficient of variation were statistically significant (P &lt; 0.05). Linear regression analysis showed that disease course (X 1), dyspareunia (X 5), and urinary incontinence (X 6) were influencing factors for the decline of pre-baseline rest (r5 = 1.067, R 2 = 0.089), post-baseline rest (r1 = 0.055, r5 = 0.99, R 2 = 0.119), VASs of ischial spine (r5 = 0.916, R 2 = 0.102), obturator internus (r5 = 0.796, r6 = −0.703, R 2 = 0.245), and pubococcygeus (r5 = 0.885, R 2 = 0.149) after treatment in the CPPS group. This study confirmed that individualized myofascial release therapy combined with electrical and magnetic stimulation has significant efficacy for patients with CPPS. At the same time, it is more effective for CPPS patients with longer course of disease, dyspareunia, and without urinary incontinence.

Radiofrequency and Electrical Muscle Stimulation: A Synergistic Treatment That Achieves Lipolysis and Circumferential Waist Reduction in Non-Invasive Body Contouring

Abstract Background Surgeons and providers in aesthetic medicine seek non-invasive devices that can be utilized for safe, efficient and effective body contouring. Patient demand has propelled the development of novel devices that can simultaneously improve skin laxity, adipolysis along with stimulation of muscle hypertrophy. Objectives To determine the efficacy of body contouring after three treatments using the non-invasive Transform (InMode, Lake Forest, CA) device. Methods A prospective, multi-center study was performed. Outcomes evaluated include: standardized caliper and ultrasound measurements of abdominal skin/soft tissue thickness, waist circumference, histologic evaluation, patient comfort and satisfaction assessments. Results Forty-four patients were successfully enrolled in the study and completed the series of three treatments which involved combined electrical muscle stimulation (EMS) and non-invasive bipolar radiofrequency (RF). Abdominal ultrasound measurements reveal a decrease in soft-tissue thickness (average 3.1mm; p=0.001), there was a significant decrease in caliper measurements of peri-umbilical skin thickness (p&amp;lt;0.003) and the average reduction of abdominal circumference was 1.9cm (p&amp;lt;0.0001) three months after the treatment series. Histology confirmed subcutaneous adipolysis without damaging the dermal layer. Patients reported a high degree of satisfaction with the overall result (p=0.003) and that each of the three treatments were progressively more comfortable (p&amp;lt;0.005). Conclusions This study demonstrates that a series of simultaneous non-invasive RF with EMS treatments to the abdomen decreases subcutaneous soft tissue thickness of the treated area. These comfortable treatments ultimately result in a high degree of patient satisfaction at three months.

Effects of Adding Four Sessions of Ultrasound-Guided Percutaneous Electrical Nerve Stimulation to an Exercise Program in Patients with Shoulder Pain: A Randomized Controlled Trial

Objective: Percutaneous electrical nerve stimulation (PENS) appears to be effective for the treatment of musculoskeletal pain. The aim of this trial was to investigate the effects on disability and pain, as well as on the psychological aspects of adding PENS into an exercise program in patients with subacromial pain syndrome. Methods: A randomized, parallel-group clinical trial was conducted. Sixty patients with subacromial pain were allocated into exercise alone (n = 20), exercise plus PENS (n = 20), or exercise plus placebo PENS (n = 20) groups. Patients in all groups performed an exercise program twice daily for 3 weeks. Patients allocated to the PENS group also received four sessions of ultrasound-guided PENS targeting the axillar and suprascapular nerves. Patients allocated to the exercise plus placebo PENS received a sham PENS application. The primary outcome was related disability (Disabilities of the Arm, Shoulder, and Hand, DASH). Secondary outcomes included mean pain, anxiety levels, depressive symptoms, and sleep quality. They were assessed at baseline, one week after, and one and three months after. An analysis was performed using intention-to-treat with mixed-models ANCOVAs. Results: The results revealed no between-group differences for most outcomes (related disability: F = 0.292, p = 0.748, n2p = 0.011; anxiety: F = 0.780, p = 0.463, n2p = 0.027; depressive symptoms: F = 0.559, p = 0.575, n2p = 0.02; or sleep quality: F = 0.294, p = 0.747, n2p = 0.01); both groups experienced similar changes throughout the course of this study. Patients receiving exercise plus PENS exhibited greater improvement in shoulder pain at one month than those in the exercise (Δ −1.2, 95%CI −2.3 to −0.1) or the placebo (Δ −1.3, 95%CI −2.5 to −0.1) groups. Conclusions: The inclusion of four sessions of ultrasound-guided PENS targeting the axillar and suprascapular nerves into an exercise program did not result in better outcomes in our sample of patients with subacromial pain syndrome at one and three months after treatment.

A Wound Exudate‐Activated Yarn Battery for Antimicrobial Electrical Fabric Dressing

AbstractExcessive inflammation poses a major challenge to wound care, with massive exudation and bacterial infection being the prominent factors contributing to the inflammation. Current biomaterials can achieve passive or interactive wound repair through exudate absorption and anti‐infection. However, they cannot actively modulate the cellular behavior associated with skin wound repair. Inspired by the endogenous electric field (EF), the present study develops an antimicrobial and self‐powered electrical fabric dressing (EFD). An EFD with multifunctional properties of wound exudate collection, anti‐infection, and self‐powered electrical stimulation (ES) is assembled via weaving a series of hydrophilically modified cotton yarn‐based batteries. Upon contact with the wound, EFD absorbs the wound exudate owing to its high hydrophilicity and utilizes it as the natural electrolyte to activate the battery. With the endogenous power supply, the ES‐promoted polarization of macrophage, as well as the migration and proliferation of fibroblasts, enhancing the active wound repair process. Moreover, the dressings exhibit excellent antibacterial properties, attributable to the synergistic effects of the cationic polymer brushes on the cotton yarn and the anodic by‐product (magnesium hydroxide) during discharging. Thus, the wound exudate‐activated EFD can effectively manage wound exudates, prevent bacterial infection, and provide self‐powered electrotherapy to facilitate active wound tissue repair.

Impact of functional electrical stimulation on nerve-damaged muscles by quantifying fat infiltration using deep learning.

Quantitative imaging in life sciences has evolved into a powerful approach combining advanced microscopy acquisition and automated analysis of image data. The focus of the present study is on the imaging-based evaluation of the posterior cricoarytenoid muscle (PCA) influenced by long-term functional electrical stimulation (FES), which may assist the inspiration of patients with bilateral vocal fold paresis. To this end, muscle cross-sections of the PCA of sheep were examined by quantitative image analysis. Previous investigations of the muscle fibers and the collagen amount have not revealed signs of atrophy and fibrosis due to FES by a laryngeal pacemaker. It was therefore hypothesized that regardless of the stimulation parameters the fat in the muscle cross-sections would not be significantly altered. We here extending our previous investigations using quantitative imaging of intramuscular fat in cross-sections. In order to perform this analysis both reliably and faster than a qualitative evaluation and time-consuming manual annotation, the selection of the automated method was of crucial importance. To this end, our recently established deep neural network IMFSegNet, which provides more accurate results compared to standard machine learning approaches, was applied to more than 300 H&E stained muscle cross-sections from 22 sheep. It was found that there were no significant differences in the amount of intramuscular fat between the PCA with and without long-term FES, nor were any significant differences found between the low and high duty cycle stimulated groups. This study on a human-like animal model not only confirms the hypothesis that FES with the selected parameters has no negative impact on the PCA, but also demonstrates that objective and automated deep learning-based quantitative imaging is a powerful tool for such a challenging analysis.

Effects of flexor reflex stimulation on gait aspects in stroke patients: randomized clinical trial.

Gait deficits are very common after stroke and therefore an important aspect in poststroke rehabilitation. A currently little used method in gait rehabilitation after stroke is the activation of the flexor reflex (FR) by electrical stimulation of the sole of foot while walking. The aim of this study wasto investigate the effect of FR stimulation on gait performance and gait parameters in participants with stroke within a single session of flexor reflex stimulation using Incedo™. Twenty-five participants with subacute (n = 14) and chronic (n = 11) stroke were enrolled in the study. Motor functions were tested with a 10-m walk test (10mWT), a 2-min walk test (2minWT), and a gait analysis. These tests were performed with and without Incedo™ within a single session in randomized order. In the 10mWT, a significant difference was found between walking with Incedo™ (15.0 ± 8.5s) versus without Incedo™ (17.0 ± 11.4s, p = 0.01). Similarly, the 2minWT showed a significant improvement with Incedo™ use (90.0 ± 36.4m) compared to without Incedo™ (86.3 ± 36.8m, p = 0.03). These results indicate that while the improvements are statistically significant, they are modest and should be considered in the context of their clinical relevance. The gait parameters remained unchanged except for the step length. A subgroup analysis indicated that participants with subacute and chronic stroke responded similarly to the stimulation. There was a correlation between the degree of response to electrostimulation while walking and degree of improvement in 2minWT (r = 0.50, p = 0.01). This study is the first to examine FR activation effects in chronic stroke patients and suggests that stimulation effects are independent of the time since stroke. A larger controlled clinical trial is warranted that addresses issues as the necessary number of therapeutical sessions and for how long stimulation-induced improvements outlast the treatment period. The trial was retrospectively registered in German Clinical Trials Register. DRKS00021457. Date of registration: 29 June 2020.

A method for noninvasive electrical stimulation of the diaphragm

A method for noninvasive electrical stimulation of the diaphragm

Effects of transcutaneous electrical nerve stimulation on recovery of gastrointestinal motility after laparotomy: Arandomized controlled trial.

Postoperative Ileus (POI) negatively impacts patient outcomes and increases healthcare costs. Transcutaneous electrical nerve stimulation (TENS) has been found to improve gastrointestinal (GI) motility following abdominal surgery. However, its effectiveness in this context is not well-established. This study was designed to evaluate the role of TENS on the recovery of GI motility after exploratory laparotomy. Patients undergoing exploratory laparotomy were randomized in a 1:1 ratio into control (standard treatment alone) and experimental (standard treatment+TENS) arms. TENS was terminated after 6days or after the passage of stool or stoma movement. The primary outcome was time for the first passage of stool/functioning stoma. Non-passage of stool or nonfunctioning stoma beyond 6days was labeled as prolonged POI. Patients were monitored until discharge. Median (interquartile range) time to first passage of stool/functioning stoma was 82.6 (49-115) hours in the standard treatment group and 50 (22-70.6) hours in the TENS group [p<0.001]. Prolonged POI was noted in 11 patients in the standard treatment group (35.5%) and one in the TENS group (3.2%) [p=0.003]. Postoperative hospital stay was similar in the two groups. TENS resulted in early recovery of GI motility by shortening the duration of POI without any improvement in postoperative hospital stay. CTRI/2021/10/037054.

RETRACTION: Comparative effectiveness of low-level laser therapy and transcutaneous electrical nerve stimulation in symptomatic Temporomandibular Disorders: A Randomised Control Trial.

Batra, S. Srivastava, A., Shivakumar, G. C., Marrapodi, M. M., Herford, A. S., Cicciù, M., Minervini, G. (2023) Comparative effectiveness of low-level laser therapy and transcutaneous electrical nerve stimulation in symptomatic Temporomandibular Disorders: A Randomised Control Trial. Journal of Oral Rehabilitation, 50: 1185-1193. https://doi.org/10.1111/joor.13555 The above article, published online on 05 July 2023 in Wiley Online Library (wileyonlinelibrary.com), has been retracted by agreement between the journal Editor in Chief, Peter Svensson, and John Wiley and Sons Ltd. The retraction has been agreed following concerns raised by a third party about the ethical approval for the study described. The publisher contacted the authors, who provided a letter of ethical approval from People's College of Dental Sciences & Research Center, People's University, which did not match the ethical approval reported in the article. The authors reported that the study was initiated at Banaras Hindu University, but were not able to provide evidence of ethical approval from this institution. In addition, the authors did not provide an explanation for why the clinical trial was registered with Clinical Trial Registry-India retrospectively, which violates the journal's author guidelines that require authors to provide an explanation for retrospective registration of clinical trials. Following the investigation by the publisher, the journal has concluded this article did not follow the journal's requirements regarding ethical approval of clinical trials and registration of clinical trials, and so the journal must issue a retraction. Shivakumar, G. C. has stated that Marrapodi, M. M., Herford, A. S., Cicciù, M., and Minervini, G. were not involved in the investigation, data curation, conceptualization, methodology, or formal analysis of the clinical study. The authors disagree with this retraction.

Electroacupuncture at different intensities inhibits nociceptive discharges of wide dynamic range neurons in spinal dorsal horn of rats.

To observe the effect of electroacupuncture (EA) at different intensities on nociceptive discharges of wide dynamic range (WDR) neurons in the spinal dorsal horns (DHs) of rats, so as to explore its regulatory characteristics on nociceptive signals at the spinal level. A total of 25 male SD rats were used in the present study. A microelectrode array was used to record the discharge activity of WDR neurons in the lumbar spinal DHs of normal rats. After finding the WDR neuron, electrical stimulation (pulse width of 2 ms) was administered to the plantar receptive field (RF) for determining its response component of discharges according to the latency of action potential generation (Aβ ［0 to 20 ms］, Aδ ［20 to 90 ms］, C ［90 to 500 ms］ and post-discharge ［500 to 800 ms］). High-intensity electrical stimulation was continuously applied to the RF at the paw's plantar surface to induce DHs neuronal windup response. Subsequently, EA stimulation at different intensities (1 mA and 2 mA) was applied to the left "Zusanli"(ST36) at a frequency of 2 Hz/15 Hz for 10 min. The induction of WDR neuronal windup was then repeated under the same conditions. The quantity of nociceptive discharge components and the windup response of WDR neurons before and after EA stimulations at different intensities were compared. Compared to pre-EA, both EA1 mA and EA2 mA significantly reduced the number of Aδ and C component discharges of WDR neurons during stimulation, as well as post-discharge (P<0.01, P<0.001). The inhibitory rate of C component by EA2 mA was significantly higher than that by EA1 mA (P<0.05). Meanwhile, both EA1 mA and EA2 mA attenuated the windup response of WDR neurons (P<0.05, P<0.01), and the effect of EA2 mA was stronger than that of EA1 mA (P<0.05). Further analysis showed that when EA1 mA and EA2 mA respectively applied to both non-receptive field (non-RF) and RF, a significant reduction in the number of Aδ component, C component and post-discharge was observed (P<0.05, P<0.01). EA2 mA at the non-RF and RF demonstrated a significant inhibitory effect on the windup response of WDR neurons (P<0.01, P<0.05), but EA1 mA only at the non-RF showed a significant inhibitory effect on the windup response (P<0.01). EA can suppress nociceptive discharges of spinal DHs WDR neurons in rats. The inhibitory impact of EA is strongly correlated with the location and intensity of EA stimulation, and EA2 mA has a stronger inhibitory effect than EA1 mA.

Beyond static: Tracking the dynamic nature of water absorption and Young's modulus in IPMC devices

AbstractIonomeric polymer‐metal composites (IPMC) are advanced materials designed to mimic biological systems. Their performance depends on various factors, including electrical stimulus intensity, membrane hydration, ionic migration, and Young's modulus. However, there is a lack of studies in the literature investigating how the water absorption capacity and elastic modulus change over time in IPMCs. Understanding the hydration level variation as a function of time is essential because as this parameter deviates, the ionic migration capacity and Young's modulus also change, altering the device's electromechanical efficiency over time. To address this research gap, Nafion/Pt‐based IPMC devices exchanged with four monovalent cations (H+, Li+, Na+, and K+) and one ionic liquid (1‐butyl‐3‐methylimidazolium—BMIM+) were prepared, and a comprehensive investigation on how the water absorption capacity and Young's modulus vary as a function of time, relative humidity (RH), and counterion size was performed. The results revealed that the water uptake capacity is significantly higher and occurs more rapidly at higher RH levels and when the counterion's ionic radius decreases. Consequently, the time required for the device to reach osmotic equilibrium can range from 40 to 270 min, depending on the RH and counterion used. Furthermore, it was observed that the first natural frequency and Young's modulus also exhibit time‐dependent behavior. Under constant RH conditions, the mechanical properties of the IPMC can vary by up to 50% in less than 60 min. Notably, the combined results from water uptake capacity, Young's modulus, electrochemical impedance spectroscopy, and electromechanical response analyses (including blocking force, displacement, displacement rate, current, coulombic efficiency, and voltage) suggest that a morphological transformation within the polymer is likely to occur once RH exceeds 60%. This finding strengthens the hypothesis that ion migration is mainly influenced by their movement through Nafion's ionomeric channels rather than the filling of ionic agglomerates.

Advanced nerve regeneration enabled by neural conformal electronic stimulators enhancing mitochondrial transport

Addressing peripheral nerve defects remains a significant challenge in regenerative neurobiology. Autografts emerged as the gold-standard management, however, are hindered by limited availability and potential neuroma formation. Numerous recent studies report the potential of wireless electronic system for nerve defects repair. Unfortunately, few has met clinical needs for inadequate electrode precision, poor nerve entrapment and insufficient bioactivity of the matrix material. Herein, we present an advanced wireless electrical nerve stimulator, based on water-responsive self-curling silk membrane with excellent bioabsorbable and biocompatible properties. We constructed a unique bilayer structure with an oriented pre-stretched inner layer and a general silk membrane as outer layer. After wetting, the simultaneous contraction of inner layer and expansion of outer layer achieved controllable super-contraction from 2D flat surface to 3D structural reconfiguration. It enables shape-adaptive wrapping to cover around nerves, overcomes the technical obstacle of preparing electrodes on the inner wall of the conduit, and prevents electrode breakage caused by material expansion in water. The use of fork capacitor-like metal interface increases the contact points between the metal and the regenerating nerve, solving the challenge of inefficient and rough electrical stimulation methods in the past. Newly developed electronic stimulator is effective in restoring 10 mm rat sciatic nerve defects comparable to autologous grafts. The underlying mechanism involves that electric stimulation enhances anterograde mitochondrial transport to match energy demands. This newly introduced device thereby demonstrated the potential as a viable and efficacious alternative to autografts for enhancing peripheral nerve repair and functional recovery.

Pain control during intrauterine device insertion: Transcutaneous electrical nerve stimulation.

Current practice lacks effective periprocedural pain management during common gynecological procedures such as intrauterine device insertion, increasing the possibility of significant pain and adverse reaction to such procedures. Because of this, pain can often be a barrier for a patient in choosing a form of contraception that best serves them. Transcutaneous electrical nerve stimulation offers an option for effective pain control during intrauterine device insertion. This case review characterizes five cases where patients were offered transcutaneous electrical nerve stimulation for pain control during intrauterine device insertion. The patients reported a range of no pain to moderate pain during intrauterine device insertion and rated their pain experience as better compared with prior insertions. Although limited to a case review, our findings suggest a promising clinical indication for transcutaneous electrical nerve stimulation as a pain management strategy for intrauterine device insertion.