Development of a miniaturized, reconnectable, and implantable multichannel connector.

Objective. Connectors for implantable neural prosthetic systems provide several advantages such as simplification of surgery, safe replacement of implanted devices, and modular design of the implant systems. With the rapid advancement of technologies for neural implants, miniaturized multichannel implantable connectors are also required. In this study, we propose a reconnectable and area-efficient multichannel implantable connector.Approach. A female-to-female adapter was fabricated using the thermal-press bonding of micropatterned liquid crystal polymer films. A bump inside the adapter enabled a reliable electrical connection by increasing the contact pressure between the contact pads of the adapter and the inserted cable. After connection, the adapter is enclosed in a metal case sealed with silicone elastomer packing. With different sizes of the packings, leakage current tests were performed under accelerated conditions to determine the optimal design for long-term reliability. Repeated connection tests were performed to verify the durability and reconnectability of the fabricated connector. The connector was implanted in rats, and the leakage currents were monitored to evaluate the stability of the connectorin vivo. Main results. The fabricated four- and eight-channel implantable connectors, assembled with the metal cases, had a diameter and length of 6 and 17 mm, respectively. Further, the contact resistances of the four- and eight-channel connectors were 53.2 and 75.2 mΩ, respectively. The electrical contact remained stable during repeated connection tests (50 times). The fabricated connectors with packings having 125%, 137%, and 150% volume ratios to the internal space of the metal case failed after 14, 88, and 14 d, respectively, in a 75 °C saline environment. In animal tests with rats, the connector maintained low leakage current levels for up to 92 d.Significance. An implantable and reconnectable multichannel connector was developed and evaluated. The feasibility of the proposed connector was evaluated in terms of electrical and mechanical characteristics as well as sealing performance. The proposed connector is expected to have potential applications in implantable neural prosthetic systems.

The Long-Term Functional Effect of Thrombectomy on Patients with Middle Cerebral Artery Occlusion Who Exhibit Moderate to Severe Disability.

Background and Objectives: Endovascular thrombectomy (EVT is an emerging gold standard treatment for acute cerebral infarction and may allow functional improvement after subacute cerebral infarction. However, the long-term functional benefits of EVT in patients with moderate to severe disability remain unclear. We investigated the effects of EVT on the activities of daily living (ADL), handicap, gait, and eating in patients with middle cerebral artery (MCA) occlusion who exhibited moderate to severe disability (score of 3-5 on the modified Rankin scale (mRS)) due to stroke, up to six months after onset. Materials and Methods: This retrospective longitudinal case-control study assessed 45 patients with MCA occlusion who exhibited moderate to severe disability (mRS score ≥ 3): 15 underwent EVT and 30 served as controls. Clinical assessments were conducted at two weeks (12-16 days), four weeks (26-30 days), and six months (180-210 days) after stroke onset. Functional assessments comprised the Korean version of the modified Barthel index (MBI), mRS, functional ambulation category (FAC), and dysphagia outcome severity scale (DOSS) to assess disability, handicap, gait, and eating. Results: The MBI, mRS, FAC, and DOSS scores all improved significantly (all p < 0.05) in the EVT group, compared to the controls. Conclusions: EVT has favorable effects on performing routine ADL, the handicap itself, walking, and eating. Therefore, EVT is recommended for patients with acute MCA occlusion, including those with severe disability at the initial assessment.

Totally implantable enzymatic biofuel cell and brain stimulator operating in bird through wireless communication.

Animals digest food to fuel brain neurometabolism via cellular respiration. This study demonstrates the combination of a biofuel cell (BFC) and an animal brain stimulator (ABS) implanted in a pigeon. Glucose oxidation and oxygen reduction in an enzymatic BFC supplied electrical power to the ABS. Power from the BFC reached 0.12 mW in vitro and 0.08 mW in vivo using only the natural glucose and oxygen in the pigeon's body. A power management integrated circuit is used to harvest energy from the in vivo BFC at a rate of 28.4 mJ over 10 min, which is sufficient for intermittent neurostimulation.

A handheld neural stimulation controller for avian navigation guided by remote control.

BACKGROUND: Animal learning based on brain stimulation is an application in a brain-computer interface. Especially for birds, such a stimulation system should be sufficiently light without interfering with movements of wings. OBJECTIVE: We proposed a fully-implantable system for wirelessly navigating a pigeon. In this paper, we report a handheld neural stimulation controller for this avian navigation guided by remote control. METHODS: The handheld controller employs ZigBee to control pigeon's behaviors through brain stimulation. ZigBee can manipulate brain stimulation remotely while powered by batteries. Additionally, simple switches enable users to customize parameters of stimuli like a gamepad. These handheld and user-friendly interfaces make it easy to use the controller while a pigeon flies in open areas. RESULTS: An electrode was inserted into a nucleus (formatio reticularis medialis mesencephalic) of a pigeon and connected to a stimulator fully-implanted in the pigeon's back. Receiving signals sent from the controller, the stimulator supplied biphasic pulses with a duration of 0.080 ms and an amplitude of 0.400 mA to the nucleus. When the nucleus was stimulated, a 180-degree turning-left behavior of the pigeon was consistently observed. CONCLUSIONS: The feasibility of remote avian navigation using the controller was successfully verified.

The Role of digital subtraction angiography in the ventricular spot sign on the computed tomography angiography.

OBJECTIVE: The spot sign on computed tomography angiography is little known about the relationship between the spot sign and the results of cerebral angiography We retrospectively analyzed the spot sign, digital subtraction angiography results, and other factors. MATERIAL AND METHODS: From December 2009 to May 2014, DSA was performed in 52 ICH patients with non-specific location or abnormalities on CTA findings. 26 of those patients, whose initial CTA showed the spot sign, were analyzed. Two groups, one with the spot sign in the ventricle (Group A) and others with the spot sign in another location (Group B) were statistically compared. RESULTS: The mean age of the study subjects was 46.9 years (range, 15 to 80 years) and the percentage of males was 53.8%. Thirteen of 26 patients had ICH without intraventricular hemorrhage, and 6 patients had co-existing IVH. In 17 cases, the DSA results were negative. Seven patients were diagnosed with pseudoaneurysms, and two cases showed developmental venous anomalies. Group A consisted of the 8 patients (30.8%) who showed the spot sign in a ventricle. The number of pseudoaneurysms was statistically significantly higher in Group A than in Group B (71.4% versus 28.6%; OR, 13.3; 95% CI, 1.7-103.8 P = 0.014). All three patients who underwent endovascular treatment were members of Group A (P = 0.022), whereas most (92.3%) of those in Group B underwent surgical evacuation. (P = 0.030). CONCLUSION: When CTA shows the spot sign in a ventricle, it is a clue that an existing underlying vascular lesion requires endovascular treatment.

Significance of intracranial pressure monitoring after early decompressive craniectomy in patients with severe traumatic brain injury.

OBJECTIVE: Early decompressive craniectomy (DC) has been used as the first stage treatment to prevent secondary injuries in cases of severe traumatic brain injury (TBI). Postoperative management is the major factor that influences outcome. The aim of this study is to investigate the effect of postoperative management, using intracranial pressure (ICP) monitoring and including consecutive DC on the other side, on the two-week mortality in severe TBI patients treated with early DC. METHODS: Seventy-eight patients with severe TBI [Glasgow Coma Scale (GCS) score <9] underwent early DC were retrospectively investigated. Among 78 patients with early DC, 53 patients were managed by conventional medical treatments and the other, 25 patients were treated under the guidance of ICP monitoring, placed during early DC. In the ICP monitoring group, consecutive DC on the other side were performed on 11 patients due to a high ICP of greater than 30 mm Hg and failure to respond to any other medical treatments. RESULTS: The two-week mortality rate was significantly different between two groups [50.9% (27 patients) and 24% (6 patients), respectively, p=0.025]. After adjusting for confounding factors, including sex, low GCS score, and pupillary abnormalities, ICP monitoring was associated with a 78% lower likelihood of 2-week mortality (p=0.021). CONCLUSION: ICP monitoring in conjunction with postoperative treatment, after early DC, is associated with a significantly reduced risk of death.

Neurolysis for meralgia paresthetica.

OBJECTIVE: Meralgia paresthetica (MP) is a syndrome of pain and/or dysesthesia in the anterolateral thigh that is caused by an entrapment of the lateral femoral cutaneous nerve (LFCN) at its pelvic exit. Despite early accounts of MP, there is still no consensus concerning the effectiveness of neurolysis or transaction treatments in the long-term relief for medically refractory patients with MP. We retrospectively analyzed available long-term results of LFCN neurolysis for medically refractory MP in an effort to clarify this issue. METHODS: During the last 7 years, 11 patients who had neurolysis for MP were enrolled in this study. Nerve entrapment was confirmed preoperatively by electrophysiological studies or a positive response to local anesthetic injection. Decompression of the LFCN was performed at the level of the iliac fascia, inguinal ligament, and fascia of the thigh distally. The outcome of surgery was assessed 8 weeks after the procedure followed at regular intervals if symptoms persisted. RESULTS: Twelve decompression procedures were performed in 11 patients over a 7-year period. The average duration of symptoms was 8.5 months (range, 4-15 months). The average follow-up period was 33 months (range, 12-60 months). Complete and partial symptom improvement were noted in nine (81.8%) and two (18.2%) cases, respectively. No recurrence was reported. CONCLUSION: Neurolysis of the LFCN can provide adequate pain relief with minimal complications for medically refractory MP. To achieve a good outcome in neurolysis for MP, an accurate diagnosis with careful examination and repeated blocks of the LFCN, along with electrodiagnosis seems to be essential. Possible variation in the course of the LFCN and thorough decompression along the course of the LFCN should be kept in mind in planning decompression surgery for MP.

Hypothermia blocks ischemic changes in ubiquitin distribution and levels following stroke.

Dysfunction of the ubiquitin-proteasome system has recently been linked to stroke. Ischemia may cause increased protein misfolding and inhibit the proteasome, shifting the balance from free ubiquitin to conjugated ubiquitin. In this study, we examine the effect of hypothermia on the distribution of total and free ubiquitin, as well as the levels of conjugated ubiquitin after experimental stroke using a focal cerebral ischemia model. We show that hypothermia prevents redistribution of ubiquitin following ischemia, largely through preservation of intracellular cytoplasmic free ubiquitin. We also show that hypothermia blocks the increase in conjugated ubiquitin observed after stroke. Our data indicate that hypothermia's neuroprotection is mediated, in part, through preservation of ubiquitin-proteasome system function.

Intraspinal extradural teratoma mimicking neural sheath tumor in infant.

INTRODUCTION: An intraspinal teratoma that is located entirely extradurally is unusual both in children and in adults. CASE HISTORY: The authors present a case of an 8-month-old male infant with an extradurally arising intraspinal mature teratoma located from T-2 to T-4, who had suffered from progressive paraparesis (grade 1). The patient did not have any stigmata or anomalies suggesting spinal dysraphism. Spinal MRI showed a cystic extradural mass markedly compressing the dural sac. On operation, the only way of getting sufficient space for exposure of the whole tumor was to perform hemilaminectomies with preservation of facetal areas to prevent postoperative instability. The tumor was well encapsulated and located entirely extradurally, and the cystic portion was occupied with yellowish fluid. The site of tumor occurrence was the spinal root sheath, mimicking a neural sheath tumor. Paraparesis had improved markedly to grade 4 by the time of the neurological examination 3 months after operation.

Posteroventral pallidotomy in medically intractable postapoplectic monochorea: case report.

BACKGROUND: Posteroventral pallidotomy is a widely accepted surgical procedure for treating medically intractable Parkinson's disease and Levo-dopa induced dyskinesia. In the surgical treatment of hyperkinetic movement disorders, generalized dystonia has recently become a favorable indication of posteroventral pallidotomy. However, a commonly recognized surgical procedure for treating choreiform movement disorders has not yet been established. Here we present an unusual experience of a posteroventral pallidotomy performed to treat a medically intractable monochorea caused by a vascular insult on the basal ganglia. METHODS: A 63-year-old female presented with choreiform movement of the left upper limb that she had suffered for 5 months. She was found to have a hemorrhagic infarction in the right putaminal area. No other abnormal lesions were shown by magnetic resonance imaging except for a widening of the right cerebellopontine cistern because of an acoustic neurinoma removed 5 years previously. Despite medication with a dopamine antagonist, choreiform movement of the left limb had not improved, and the patient complained of rigidity and slowness of ambulation owing to the side effects of the medicine. A right posteroventral pallidotomy was performed with macrostimulation for a physiologic confirmation of the globus pallidus internus (GPi), which is the conventional target for Parkinson's disease. After coagulating the GPi target, the choreiform movement of the contralateral upper limb was completely abolished. RESULTS: The postoperative course was uneventful and no recurrence of chorea was observed over a follow-up period of 6 months. CONCLUSIONS: Stereotactic surgery for hyperkinetic movement disorders is not as common a procedure as that used for treating Parkinson's disease. Furthermore, there have been few reports of pallidal surgery for treating the chorea caused by an ischemic insult. However, on the basis of the current concept that varying types of hyperkinetic disorders may have a common pathophysiological mechanism, a posteroventral pallidotomy may be an alternative surgical procedure for treating medically intractable postapoplectic chorea like in an occasion of dystonia.