scholarly journals Evaluation of the Safety of Percutaneous Electrical Stimulation of the Phrenic and Femoral Nerves in a Chronic Porcine Model: A GLP Study

2020 ◽  
Author(s):  
John O’Mahony ◽  
Carlus Dingfelder ◽  
Igor Polyakov ◽  
Trace Jocewicz ◽  
Jennifer Mischke
Keyword(s):  
Electrical Stimulation ◽  
Porcine Model ◽  
Work Of Breathing ◽  
Animal Health ◽  
Femoral Nerve ◽  
Diaphragm Muscle ◽  
Study Endpoint ◽  
Diaphragm Pacing ◽  
Lead Placement ◽  
Histopathological Studies

ABSTRACTPurposeDiaphragm pacing has been proposed as a method to prevent ventilator-induced diaphragm dysfunction (VIDD) during mechanical ventilation (MV). The present study assessed the safety of lead deployment and control of diaphragm inspiratory work in synchrony with MV utilizing percutaneous electrical phrenic nerve stimulation (PEPNS) in a sedated and ventilated porcine model.MethodsThe ability to safely place PEPNS four-electrode leads near the femoral nerve using ultrasound visualization and electrical stimulation to guide lead placement using a through the needle (TTN) approach was assessed for 4 animals. The feasibility of using the PEPNS system to activate the diaphragm in synchrony with inspiration within a desired target Work of Breathing (WOB) between 0.3 and 0.7 joules/L over eight hours was tested using three of the four animals with the fourth used as a control. The ability to control WOB during inspiration was assessed for flow and pressure-controlled breaths using a flow and pressure sensor attached to the wye, the connector joining the inspiratory and expiratory limbs to the endotracheal tube. Overall health (moribundity) was assessed at baseline and throughout the study until Day 30 for the surviving animals. Gross pathology and histopathological studies were performed on the femoral nerves and diaphragm muscle tissue following termination of the animals at Day 30.ResultsThe lower bound estimate of the proportion of successful stimulation within the desired level of WOB was 95.1%, achieving the study endpoint. Triggering synchrony was statistically significant at <88ms (p<0.0001) with WOB able to be maintained between 0.3 and 0.7 joules/L. There was no evidence of tissue or nerve damage nor impact on overall animal health associated with lead placement or electrical stimulation.ConclusionThe PEPNS leads were found to be safe for their intended use and the PEPNS system met preestablished study endpoints for synchrony and stimulation efficacy.

Response of the diaphragm muscle to electrical stimulation of the phrenic nerve

1983 ◽  
Vol 58 (1) ◽  
pp. 92-100 ◽  
Author(s):  
Thomas E. Ciesielski ◽  
Yoshitaka Fukuda ◽  
William W. L. Glenn ◽  
Jack Gorfien ◽  
Kathryn Jeffery ◽  
...  
Keyword(s):  
Electrical Stimulation ◽  
Phrenic Nerve ◽  
High Frequency ◽  
Low Frequency ◽  
Diaphragm Muscle ◽  
Diaphragm Pacing ◽  
Frequency Group ◽  
Low Frequency Stimulation ◽  
Frequency Stimulation

✓ The histological, histochemical, and ultrastructural features of canine diaphragms subjected to pacing by high-frequency electrical stimulation (27 to 33 Hz) of the phrenic nerve are compared with unstimulated diaphragms and with diaphragms subjected to pacing by low-frequency stimulation (11 to 13 Hz). The high-frequency group showed a reduced tidal volume (fatigue) after long-term stimulation, and myopathic changes which included enlarged internal and sarcolemmal nuclei, ring fibers, moth-eaten fibers with irregular histochemical staining, core/targetoid fibers, and smearing and aggregation of Z-band material with electron microscopy. The low-frequency group did not develop a significant degree of fatigue or pathological changes, and showed histochemical evidence of transformation to fast-twitch (type II) fibers. Possible pathogenic mechanisms and their similarity to those in certain human neuromuscular diseases are discussed. The application of the findings resulting from high- and low-frequency stimulation to long-term diaphragm pacing in humans with chronic ventilatory insufficiency is also discussed.

Diaphragm Pacing by Electrical Stimulation of the Phrenic Nerve

Neurosurgery ◽  
1985 ◽  
Vol 17 (6) ◽  
pp. 974-984 ◽  
Author(s):  
William W. L. Glenn ◽  
Mildred L. Phelps
Keyword(s):  
Electrical Stimulation ◽  
Phrenic Nerve ◽  
Neuromuscular Disorders ◽  
Ventilatory Support ◽  
Historical Review ◽  
Diaphragm Muscle ◽  
Diaphragm Pacing ◽  
Ventilatory Insufficiency ◽  
Phrenic Nerves ◽  
Stimulation Of

Abstract Sophisticated techniques for electrical stimulation of excitable tissue to treat neuromuscular disorders rationally have been developed over the past 3 decades. A historical review shows that electricity has been applied to the phrenic nerves to activate the diaphragm for some 200 years. Of the contemporary methods for stimulating the phrenic nerve in cases of ventilatory insufficiency, the authors prefer stimulation of the phrenic nerve in the thorax using a platinum ribbon electrode placed behind the nerve and an attached subcutancously implanted radiofrequency (RF) receiver inductively coupled to an external RF transmitter. Instructions are given for implanting the electrode-receiver assembly, emphasizing atraumatic handling of the phrenic nerve and strict aseptic techniques. Diaphragm pacing is conducted with low frequency electrical stimulation at a slow repetition (respiratory) rate to condition the diaphragm muscle against fatigue and maintain it fatigue-free. Candidates for diaphragm pacing are those with ventilatory insufficiency due to malfunction of the respiratory control center or interruption of the upper motor neurons of the phrenic nerve. In the Yale series, there were 77 patients treated by diaphragm pacing; 63 (82%) started before 1981 and thus were available for follow-up for at least 5 years; 33 (52%) were paced for 5 to 10 years, and 15 (24%) were paced for 10 to 16. Long term stimulation of the phrenic nerves to pace the diaphragm is an effective method of ventilatory support in selected cases

Preliminary results of phase 2 trial of preoperative image guided intensity modulated proton radiation therapy (IMPT) with simultaneously integrated boost (SIB) to the high-risk margin for retroperitoneal sarcomas (RPS).

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 11550-11550
Author(s):  
Thomas F. DeLaney ◽  
John Thomas Mullen ◽  
Yen-Lin Chen ◽  
Ivy Ann Petersen ◽  
Andrew Justin Bishop ◽  
...  
Keyword(s):  
High Risk ◽  
Dose Escalation ◽  
Femoral Nerve ◽  
Study Endpoint ◽  
Primary Study ◽  
Tumor Control ◽  
Preoperative Radiation ◽  
X Rays ◽  
Lower Extremity Weakness ◽  
Disease Free

11550 Background: RPS often have local recurrence (LR) after surgery. Preoperative radiation (RT) to 50.4 Gy can reduce LR risk but is not uniformly effective, especially after (+) margin resections. Therefore, we conducted a multi-institutional, prospective Phase II study to assess efficacy and tolerability of preop IMPT with selective dose escalation to 63 GyRBE to the posterior RPS margin (clinical target volume [CTV] 2) at high risk for (+) margins to further reduce the risk of LR. This dose was tolerable in a prior phase I study (DeLaney T et al, 2017, PMID:28740917). Methods: Primary RPS patients (pts) >18 years received preop IMPT, 50.4 GyRBE in 28 fractions (fx) of 1.8 GyRBE to CTV1 (tumor plus adjacent tissue at risk of subclinical disease) with SIB to CTV2 to 63.0 GyRBE in 28 fx of 2.25 GyRBE. Pts with high-grade tumors could get chemotherapy(CTX) prior to IMPT. To avoid treatment delay, 11 fx of IMRT x-rays could be substituted for IMPT. Pts had restaging and surgery 4-8 weeks after IMPT. Primary study endpoint was local tumor control. Secondary endpoints included clinical and pathologic response, surgical margin status, and disease-free and overall survival. Results: We accrued 60 pts from January 2016 to February 2021. Histology: 35 liposarcoma(LPS) (19 dediff and 16 well diff), 22 leiomyosarcoma(LMS), and 3 undifferentiated pleomorphic sarcoma. IMPT was delivered per protocol in all pts. 51 pts have had surgery, 5 are awaiting surgery, and 4 had no surgery due to metastases(DM) on preop imaging. 22 pts had (+) margins. 2 pts had > 75% necrosis. With 23-month median (range 1-52 months) follow-up after start of RT, there were two LRs. A dediff LPS pt had a well diff LPS LR 26 months postop, resected, and is disease-free. A renal vein/IVC LMS pt treated with CTX and IMPT had LR and DM 4 months postop and died from disease. Surgical Clavien-Dindo morbidity scores: 0(21), 1(9), 2(8), 3a (4), 3b(4), 4a(2), 4(b)1, 5(2); the periop deaths were from sepsis(pneumonia) and duodenal ulcer. The grade 3-4 periop morbidity included abscess(3), treated by catheter(2) or operative(1) drainage, prolonged hospital stays (2 pts with IVC LMS), small bowel obstruction (1), and late sigmoid colon anastomotic failure (1). Readmissions for lymphopenia(1), pneumoperitoneum (1), and volume overload (1). One late neuropathy was seen in a Type II diabetic pt with transient postop weakness after femoral nerve dissection who later had significant lower extremity weakness 3.75 years postop. Study was amended to reduce IMPT dose in diabetic pts. Conclusions: Preoperative IMPT with selective dose escalation to 63 GyRBE to the high risk posterior RPS margin is feasible. Early local control results with this approach appear promising. Some peri-operative morbidity was noted but appears to be in the expected range for RPS resections. Clinical trial information: NCT01659203.

Surgical pericardial adhesions do not preclude minimally invasive epicardial pacemaker lead placement in an infant porcine model

2020 ◽  
Vol 31 (11) ◽  
pp. 2975-2981
Author(s):  
Rohan N. Kumthekar ◽  
Lok Sinha ◽  
Justin D. Opfermann ◽  
Paige Mass ◽  
Bradley C. Clark ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Porcine Model ◽  
Pacemaker Lead ◽  
Lead Placement ◽  
Pericardial Adhesions

scholarly journals Somatosensory Electrical Stimulation Does Not Improve Motor Coordination in Patients with Unilateral Knee Osteoarthritis

2019 ◽  
Vol 8 (2) ◽  
pp. 259
Author(s):  
Menno Veldman ◽  
Julia Item-Glatthorn ◽  
Rosa Visscher ◽  
Tibor Hortobágyi ◽  
Nicola Maffiuletti
Keyword(s):  
Electrical Stimulation ◽  
Knee Osteoarthritis ◽  
Neuronal Plasticity ◽  
Motor Coordination ◽  
Femoral Nerve ◽  
Low Frequency ◽  
Sensory Afferents ◽  
Explorative Study ◽  
Motor Component ◽  
Sensory Intervention

Non-surgical treatment of knee osteoarthritis (KOA) is often focused on the motor component of KOA even though there is evidence that sensory dysfunctions play an important role in the impaired control of the affected joint. Excitation of sensory afferents can increase motor function by exploiting the nervous system’s ability to adapt to changing environments (i.e., neuronal plasticity). Therefore, the aim of this study was to explore the acute effects of a single session (30 min) of sensory intervention targeting neuronal plasticity using low-frequency (10 Hz) somatosensory electrical stimulation (SES) of the femoral nerve. We evaluated the effects of SES on the position and force control of the affected knee and self-reported pain in KOA patients (n = 14) in a sham-controlled randomized trial. The results showed that SES did not improve measures of lower-limb motor coordination compared to sham stimulation in KOA patients, nor did it improve self-reported knee function and pain (all p > 0.05). In conclusion, despite sensory involvement in KOA, the sensory intervention used in the present explorative study did not relieve self-reported pain, which may underlie the absence of an effect on measures of motor coordination. In sum, the present explorative study showed that SES alone does not improve motor coordination in KOA patients.

scholarly journals Potentiation Increases Peak Twitch Torque by Enhancing Rates of Torque Development and Relaxation

2013 ◽  
Vol 38 ◽  
pp. 83-94 ◽  
Author(s):  
Christian Froyd ◽  
Fernando Gabe Beltrami ◽  
Jørgen Jensen ◽  
Timothy David Noakes
Keyword(s):  
Electrical Stimulation ◽  
Maximal Voluntary Contraction ◽  
Femoral Nerve ◽  
Voluntary Contraction ◽  
Physically Active ◽  
Isometric Maximal Voluntary Contraction ◽  
Rate Of Torque Development ◽  
Voluntary Contractions ◽  
Torque Development ◽  
Similar Peak

Abstract The aim of this study was to measure the extent to which potentiation changes in response to an isometric maximal voluntary contraction. Eleven physically active subjects participated in two separate studies. Single stimulus of electrical stimulation of the femoral nerve was used to measure torque at rest in unpotentiated quadriceps muscles (study 1 and 2), and potentiated quadriceps muscles torque in a 10 min period after a 5 s isometric maximal voluntary contraction of the quadriceps muscles (study 1). Additionally, potentiated quadriceps muscles torque was measured every min after a further 10 maximal voluntary contractions repeated every min (study 2). Electrical stimulation repeated several times without previous maximal voluntary contraction showed similar peak twitch torque. Peak twitch torque 4 s after a 5 s maximal voluntary contraction increased by 45±13% (study 1) and by 56±10% (study 2), the rate of torque development by 53±13% and 82±29%, and the rate of relaxation by 50±17% and 59±22%, respectively, but potentiation was lost already two min after a 5 s maximal voluntary contraction. There was a tendency for peak twitch torque to increase for the first five repeated maximal voluntary contractions, suggesting increased potentiation with additional maximal voluntary contractions. Correlations for peak twitch torque vs the rate of torque development and for the rate of relaxation were r2= 0.94 and r2=0.97. The correlation between peak twitch torque, the rate of torque development and the rate of relaxation suggests that potentiation is due to instantaneous changes in skeletal muscle contractility and relaxation.

ACCELERATING AXON GROWTH TO OVERCOME LIMITATIONS IN FUNCTIONAL RECOVERY AFTER PERIPHERAL NERVE INJURY

Neurosurgery ◽  
2009 ◽  
Vol 65 (suppl_4) ◽  
pp. A132-A144 ◽  
Author(s):  
Tessa Gordon ◽  
K. Ming Chan ◽  
Olawale A.R. Sulaiman ◽  
Esther Udina ◽  
Nasim Amirjani ◽  
...  
Keyword(s):  
Electrical Stimulation ◽  
Peripheral Nerve ◽  
Nerve Regeneration ◽  
Controlled Trial ◽  
Peripheral Nerve Regeneration ◽  
Femoral Nerve ◽  
Axon Growth ◽  
Cyclic Adenosine Monophosphate ◽  
Adenosine Monophosphate ◽  
Clinical Tool

Abstract OBJECTIVE Injured peripheral nerves regenerate at very slow rates. Therefore, proximal injury sites such as the brachial plexus still present major challenges, and the outcomes of conventional treatments remain poor. This is in part attributable to a progressive decline in the Schwann cells' ability to provide a supportive milieu for the growth cone to extend and to find the appropriate target. These challenges are compounded by the often considerable delay of regeneration across the site of nerve laceration. Recently, low-frequency electrical stimulation (as brief as an hour) has shown promise, as it significantly accelerated regeneration in animal models through speeding of axon growth across the injury site. METHODS To test whether this might be a useful clinical tool, we carried out a randomized controlled trial in patients who had experienced substantial axonal loss in the median nerve owing to severe compression in the carpal tunnel. To further elucidate the potential mechanisms, we applied rolipram, a cyclic adenosine monophosphate agonist, to rats after axotomy of the femoral nerve. RESULTS We demonstrated that effects similar to those observed in animal studies could also be attained in humans. The mechanisms of action of electrical stimulation likely operate through up-regulation of neurotrophic factors and cyclic adenosine monophosphate. Indeed, the application of rolipram significantly accelerated nerve regeneration. CONCLUSION With new mechanistic insights into the influencing factors of peripheral nerve regeneration, the novel treatments described above could form part of an armament of synergistic therapies that could make a meaningful difference to patients with peripheral nerve injuries.

Electrical Stimulation Accelerates Motor Functional Recovery in Autograft-Repaired 10 mm Femoral Nerve Gap in Rats

2009 ◽  
Vol 26 (10) ◽  
pp. 1805-1813 ◽  
Author(s):  
Jinghui Huang ◽  
Xueyu Hu ◽  
Lei Lu ◽  
Zhengxu Ye ◽  
Yuqing Wang ◽  
...  
Keyword(s):  
Electrical Stimulation ◽  
Functional Recovery ◽  
Femoral Nerve

Brief Transvertebral Electrical Stimulation of the Spinal Cord Improves the Specificity of Femoral Nerve Reinnervation

2012 ◽  
Vol 27 (3) ◽  
pp. 260-268 ◽  
Author(s):  
Colin K. Franz ◽  
Bhagat Singh ◽  
Jose A. Martinez ◽  
Douglas W. Zochodne ◽  
Rajiv Midha
Keyword(s):  
Spinal Cord ◽  
Electrical Stimulation ◽  
Femoral Nerve ◽  
Stimulation Of

scholarly journals Comparison of Three Techniques for Ultrasound-guided Femoral Nerve Catheter Insertion

2014 ◽  
Vol 121 (2) ◽  
pp. 239-248 ◽  
Author(s):  
Ehab Farag ◽  
Abdulkadir Atim ◽  
Raktim Ghosh ◽  
Maria Bauer ◽  
Thilak Sreenivasalu ◽  
...  
Keyword(s):  
Electrical Stimulation ◽  
Pain Score ◽  
Ultrasound Guidance ◽  
Femoral Nerve ◽  
Catheter Insertion ◽  
Verbal Response ◽  
Response Scale ◽  
Percentage Difference ◽  
Stimulating Catheter ◽  
Morphine Equivalent

Abstract Background: Ultrasound guidance for continuous femoral perineural catheters may be supplemented by electrical stimulation through a needle or through a stimulating catheter. The authors tested the primary hypothesis that ultrasound guidance alone is noninferior on both postoperative pain scores and opioid requirement and superior on at least one of the two. Second, the authors compared all interventions on insertion time and incremental cost. Methods: Patients having knee arthroplasty with femoral nerve catheters were randomly assigned to catheter insertion guided by: (1) ultrasound alone (n = 147); (2) ultrasound and electrical stimulation through the needle (n = 152); or (3) ultrasound and electrical stimulation through both the needle and catheter (n = 138). Noninferiority between any two interventions was defined for pain as not more than 0.5 points worse on a 0 to 10 verbal response scale and for opioid consumption as not more than 25% greater than the mean. Results: The stimulating needle group was significantly noninferior to the stimulating catheter group (difference [95% CI] in mean verbal response scale pain score [stimulating needle vs. stimulating catheter] of −0.16 [−0.61 to 0.29], P &lt; 0.001; percentage difference in mean IV morphine equivalent dose of −5% [−25 to 21%], P = 0.002) and to ultrasound-only group (difference in mean verbal response scale pain score of −0.28 [−0.72 to 0.16], P &lt; 0.001; percentage difference in mean IV morphine equivalent dose of −2% [−22 to 25%], P = 0.006). In addition, the use of ultrasound alone for femoral nerve catheter insertion was faster and cheaper than the other two methods. Conclusion: Ultrasound guidance alone without adding either stimulating needle or needle/catheter combination thus seems to be the best approach to femoral perineural catheters.

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