Penoscrotal defect reconstruction using loco-regional flaps in treatment of extramammary Paget's disease: Experience and suggestion of a simplified algorithm.

BACKGROUND: Reconstruction of penoscrotal defects resulted from margin-controlled excision of extramammary Paget's disease (EMPD) remains challenging, due to its unpredictably varying extents. The present study aimed to investigate outcomes of reconstruction of penoscrotal defects following radical excision of EMPD and to introduce a simplified algorithm for selecting reconstruction strategies. METHODS: Patients with penoscrotal EMPD who were treated with wide excision and subsequent reconstruction from 2009 to 2020 were reviewed. Their demographics, operation-related characteristics, and postoperative outcomes were evaluated. RESULTS: In total, 46 patients with a mean age of 64.9 years (range, 44-85 years) were analyzed. An average size of defects was 129.6 cm2 (range, 8-900 cm2 ). The most frequently involving anatomical subunit was scrotum, followed by suprapubic area and penile shaft. Twenty-six patients had defects spanning multiple subunits. The most commonly used reconstruction methods for each anatomical subunit were internal pudendal artery perforator (IPAP) flaps and/or scrotal flaps for scrotal defects, superficial external pudendal artery perforator (SEPAP) flaps for suprapubic defects, and skin grafts for penile defects. In all but four cases, successful reconstruction was achieved with combination of those reconstruction options. No major complications developed except for one case of marginal flap necrosis. All patients were satisfied with their aesthetic and functional results. CONCLUSIONS: Diverse penoscrotal defects following excision of EMPD could be solidly reconstructed with combination of several loco-regional options. A simplified algorithm using in combination of IPAP flap, SEPAP flap, scrotal flap, and skin graft may enable efficient and reliable reconstruction of penoscrotal EMPD defects.

Emerging and upcoming therapies in insomnia.

Insomnia, commonly treated with benzodiazepine (BZD) receptor agonists, presents challenges due to associated serious side effects such as abuse and dependence. To address these concerns, many researches have been conducted to develop and advance both pharmacological and non-pharmacological interventions. Dual orexin receptor antagonists (DORAs), which include suvorexant, daridorexant and lemborexant, have recently been approved by United States Food and Drug Administration (US FDA) as a novel pharmacotherapeutic alternative. Unlike BZD receptor agonists that act as positive allosteric modulators of the gamma-aminobutyric acid type A subunit alpha 1 receptor, DORAs function by binding to both orexin receptor types 1 and 2, and inhibiting the action of the wake-promoting orexin neuropeptide. These drugs induce normal sleep without sleep stage change, do not impair attention and memory performance, and facilitate easier awakening. However, more real-world safety information is needed. Selective orexin-2 receptor antagonists (2-SORAs) is under clinical developments. This review provides an overview of the mechanism of action in relation to insomnia, pharmacokinetics, efficacy and safety information of DORAs and SORA. According to insomnia management guidelines, the first-line treatment for chronic insomnia is cognitive behavioral therapy for insomnia (CBT-I). Although it has proven effective in improving sleep-related quality of life, it has several restrictions limitations due to a face-to-face format. Recently, prescription digital therapy such as Somryst® was approved by US FDA. Somryst®, a smartphone app-based CBT-I, demonstrated meaningful responses in patients. However, digital limitations may impact scalability. Overall, these developments offer promising alternatives for insomnia treatment, emphasizing safety, efficacy, and accessibility.

Clean-In-Place (CIP) wastewater management using nanofiltration (NF)-forward osmosis (FO)-direct contact membrane distillation (DCMD): Effects of draw salt.

A substantial amount of water is being used during Clean-in-Place (CIP) operation, and is transformed into wastewater that can cause eutrophication to the nearby ecosystem. The present study proposed the Nanofiltration (NF) - Forward Osmosis (FO) - Direct Contact Membrane Distillation (DCMD) to recover the cleaning agents and reclaim freshwater from the model CIP wastewater. NF steps were suggested as prefiltration steps to remove organic compounds from the CIP wastewater. NF steps reduced the lactose and protein contents by 100 % and 95.6 %, respectively. The permeates from NF steps were further managed by the integrated FO-DCMD system. Several draw salts such as NaCl, KCl, MgCl2, and CaCl2 were compared to investigate the influence on FO and DCMD performance. It was found that monovalent salts (NaCl and KCl) outperformed the divalent salts (MgCl2 and CaCl2) in terms of water flux for both FO and DCMD. This can be attributed to the lower viscosity and higher mass transfer coefficient. In addition, the replenishment costs of each salt were evaluated since salts loss occurred during FO and DCMD operation. The cost evaluation revealed that NaCl is most the cheapest salts per reclaimed water. All of this observation indicates that NaCl is preferred in terms of water flux and replenishment cost. The NF permeate kept concentrated using the integrated FO-DCMD or single FO with 2 M of NaCl. Compared to a single FO that showed a consistent decline in draw solution concentration, FO-DCMD could maintain the concentration of the draw solution. Despite the constant concentration, flux decline of FO was observed due to fouling formation caused by the high-temperature operation. However, the FO-DCMD could accomplish the recovery of pure water. Finally, the cleaning agents recovered by the NF-FO-DCMD showed the cleaning efficacy comparable to the fresh NaOH. These results suggest the potential of the proposed system to manage the CIP wastewater.

Synergistic effects of 915 MHz microwave heating and essential oils on inactivation of foodborne pathogen in hot-chili sauce.

Essential oil is a food additive with antimicrobial properties but with limitations due to strong organoleptic properties. However, thermal treatments can be applied to reduce essential oil content while ensuring antimicrobial activities in food matrices. In this study, the inactivation efficiency of essential oils on E. coli O157:H7, Salmonella Typhimurium and Listeria monocytogenes in buffered peptone water (BPW) and hot-chili sauce was evaluated when coupled with 915 MHz microwave heating. Essential oils used in this study did not affect the dielectric properties and further heating rate of BPW and hot-chili sauce. The dielectric constant of BPW was 76.3 and dielectric loss factor was 30.9. In addition, it took 85 s to reach 100 °C for all samples. Among essential oils, synergistic microbial inactivation with microwave heating was observed from carvacrol (CL) and citral (CI), but not from eugenol (EU) and Carvone (CN). Specifically, CL and microwave heating (M) for 45 s showed the most effective inactivation (ca. 6 log reduction) for the pathogens in BPW. Similar trends were shown in hot-chili sauce. However, M + CI inactivation did not show synergistic effects in hot-chili sauce. Microwave heating time for hot-chilis sauce was 40 s. In propidium iodide uptake study, M + CL was found to cause most severe damage to cell membrane (758.5 of PI value for E. coli O157:H7) while M + CU and M + CN had little impact. In DiBAC4(3) test, CL resulted in the largest value (2.09 for E. coli O157:H7). These observations highlight that CL induces synergistic effects as it caused severe membrane damage along with destruction of membrane potential. The combined treatment did not show any significant difference in quality change compared to untreated hot-chili sauce (p > 0.05). The result indicates the potential application of CL and M combination for hot-chili sauce processes to ensure microbiological safety with acceptable quality.

Effect of temperature, wall shear stress, and NaOH concentration on cleaning effectiveness.

The objective of this research was to evaluate the effect of various operational parameters and their interaction on cleaning rate of NaOH. The parameters include wall shear stress, temperatures, and NaOH concentrations of cleaning fluid. The higher cleaning effectiveness for proteinaceous deposits was achieved at higher wall shear stress. The wall shear stress of 2.42 Pa removed over 90% of foulant after 10 min of operation, which was significantly higher than the removal of lower wall shear stress (0.84 and 0.39 Pa). Similarly, the cleaning rate increased with increase in temperature and concentration of cleaning solution. The use of cleaning solution (0.05% NaOH) at 65°C provided significantly higher cleaning rate than 25°C. A cleaning solution concentration of 0.5% NaOH provided significantly higher removal of foulant than 0% or 0.05% concentrations. However, analysis on the interaction between temperature and the wall shear stress suggested that the temperature above 45°C and wall shear stress above 0.65 Pa did not provide significant improvement in cleaning efficacy. When a cleaning solution temperature was maintained at 45°C, higher wall shear stress provided more rapid removal of the foulant when the cleaning agent concentration was 0.05% or 0.5%. In water rinse conducted without chemical agents, no much improvements in foulant removal were observed with increase in wall shear stress. The change of activation energy (Ea ) indicates that water rinse was sensitive to temperature change at higher wall shear stress. However, cleaning with cleaning agents was less sensitive to temperature variation compared to the water rinse. PRACTICAL APPLICATION: Considering the intense use of water and chemical compounds during cleaning operation, finding operating condition to ensure acceptable cleanness with minimized input is desired. Temperature, cleaning agent concentration, and wall shear stress are the major components to influence the cleaning efficacy. The result of the study demonstrates the potential for optimization of in-place cleaning by appropriate adjustments of the CIP operating parameters.

Recovery of cleaning agents from Clean-In-Place (CIP) wastewater using nanofiltration (NF) and direct contact membrane distillation (DCMD).

Increasing concerns about freshwater sources necessitate the management of wastewater, such as the wastewater generated from Clean-in-Place (CIP) operations. In this investigation, a membrane system composed of nanofiltration (NF) and direct contact membrane distillation (DCMD) was proposed to manage model dairy CIP wastewater that contained NaOH as an alkaline cleaning agent. During the NF step, prefiltration by a 4 kDa membrane or a 4 kDa membrane followed by a 200 Da membrane (4 kDa/200 Da) was used to remove the whey protein and lactose. With these two membranes in series of NF, the protein concentration was reduced by 92.4% and the lactose content was reduced to a non-detectable level when compared to the model CIP wastewater. Before concentrating the permeates from NF steps, three DCMD membranes (FR, Solupor, and ST) with different characteristics were evaluated to manage the NF permeates from 4 kDa or 200 Da NF. An increase in the feed temperature from 40 °C to 60 °C resulted in an increase in the water flux during DCMD operation, except for FR. In addition, it was found that ST generated the highest water flux when compared to the other membranes. Using ST and a feed temperature of 60 °C, the permeates from 4 kDa or 4 kDa/200 Da were continuously concentrated for 7 h with DCMD. During this concentration, there was no significant decline in flux. The cleaning effectiveness of the cleaning agent (NaOH) recovered by NF and DCMD was compared with a fresh cleaning solution using quartz crystal microbalance with dissipation (QCM-D). It was found that the cleaning agents recovered by 4 kDa/200 Da NF presented a statistically identical cleaning rate compared to fresh NaOH. This research highlights the potential of NF and DCMD to regenerate alkaline cleaning agents, while reclaiming water from dairy CIP wastewater.

Is Elective Nighttime Operation Associated With Adverse Outcomes? Analysis in Immediate Tissue Expander-Based Breast Reconstruction.

BACKGROUND: Despite the long-standing presumption that nighttime surgery could affect adverse outcomes, its association independent of patient's general condition and disease severity remains unclear. We hypothesized that conducting elective surgery for subjects with good physical status at nighttime was not associated with increased risks of postoperative complications and aimed to examine it in tissue-expander-insertion (TEI) operation for breast reconstruction. METHOD: Patients who underwent immediate unilateral TEI-based breast reconstruction between 2014 and 2019 were enrolled. They were categorized into 3 groups based on the starting time of the TEI operation: 8 am to 6 pm (group 1), 6 pm to 8 pm (group 2), and after 8 pm (group 3). The postoperative complication rates were compared among the groups. The independent associations of each variable, including the operation starting time and adverse outcomes, were analyzed. RESULTS: In total, 1458 patients were analyzed, including 970 in group 1, 358 in group 2, and 130 in group 3. The groups showed similar baseline characteristics regarding comorbidities and the American Society of Anesthesiologists classification. Compared with group 1, group 3 was associated with significantly increased rates of overall complications including infection, reoperation, and premature removal of the tissue expander. These differences retained influences in the multivariable analyses. Group 3 showed a significantly longer hospitalization period than the other 2 groups. The complication rates did not differ between groups 1 and 2. CONCLUSIONS: Conducting TEI operation at nighttime seems to be associated with increased risks of adverse postoperative outcomes compared with conducting it during regular working hours.

Nanogap-containing thermo-plasmonic nano-heaters for amplified photo-triggered tumor ablation at low laser power density.

Herein, nanogap amplified plasmonic heat-generators are fabricated by decorating Pt nanodots on gold nanospheres (GNSs@Pt@mPEG) by maintaining strategic nano-gaps (1-2 nm) and studied precisely for plasmonic photothermal therapy (PPTT) of colon cancer by passive tumor targeting. The surface modification of GNSs@Pt with poly(ethylene glycol) methyl ether thiol (mPEG) increases their accumulation in tumor cells and hence the GNSs@Pt@mPEG stay at the tumor site for a longer time. The nanogap amplified GNSs@Pt@mPEG (O.D. = 4.0) generated high plasmonic photothermal hyperthermia and utilized a low NIR power density (0.36 W cm-2) for the elimination of tumor cells in only 150 s of irradiation time and shows excellent colloidal and photo-stability. The predominant distribution of GNSs@Pt@mPEG caused effective tumor cell death and promoted uniform treatment on tumor sites. In vivo studies demonstrated that the GNSs@Pt@mPEG have very low toxicity, high biocompatibility, and thermal stability, stay longer at the tumor site, induce tumor cell death without side effects, and show significantly less uptake in other organs except for the spleen. The significant accumulations and longer stay suggested that they are favorable for tumor passive uptake and the possibility of enhanced PPTT after intravenous administration. The nano-particles were stable up to O.D. 200 and have at least 12 months shelf-life without losing colloidal stability or photothermal efficacy. These findings lay the groundwork for using GNSs@Pt@mPEG as a NIR light-responsive PPTT agent and demonstrated their potential for further use in clinical applications.

Hybrid Si-LiNbO3 microring electro-optically tunable resonators for active photonic devices.

Hybrid Si-LiNbO3 electro-optic tunable ring resonators have been proposed and demonstrated as a path to achieving ultracompact and high-speed electro-optic devices. Free standing single crystal LiNbO3 microplatelets (~mm long and ~1 µm thick) were obtained from a z-cut LiNbO3 substrate by ion implantation and thermal treatment. The platelets were transferred and thermally bonded on top of Si resonators that were fabricated in a Si-on-insulator platform by a 0.18 µm standard complementary metal-oxide-semiconductor process. For the hybrid microring resonator, a free spectral range of 16.5 nm, a finesse F of ~1.67 × 10², a Q-factor of ~1.68 × 104, and an effective r coefficient of ~1.7 pm/V were achieved for the TE mode. These values are in good agreement with the calculated results.

Comparison of flow characteristics in a bench-scale system with commercial-scale pipelines: Use of computational fluid dynamics (CFD).

The challenges for scale-up are often encountered in cleaning operations during the interpretation of data from clean-in-place (CIP) research. The objective of this investigation was to design and characterize flow characteristics in a bench-scale system in a manner that evaluates scale-up to a commercial-scale CIP operation. A bench-scale temperature-controlled vessel was designed for evaluation of in-place cleaning, and for development of scale-up parameters. The wall shear stress was selected as the parameter for the comparison, as it is the significant parameter associated with deposit removal. Using the traditional prediction models, the wall shear stress of bench-scale ranged 0.015 to 4.99 Pa with impeller speeds from 50 to 900 rpm. For the commercial-scale with 0.022 m of inside diameter, prediction ranged from 1.43 to 7.90 Pa with the mean fluid velocity from 0.72 to 1.67 m/s. Computational fluid dynamics (CFD) was used to predict wall shear stress on the surfaces within the bench-scale and commercial-scale systems. The predicted wall shear stress values ranged from 0.016 to 2.42 Pa for surfaces within the bench-scale system, and from 1.33 to 7.20 Pa for the commercial-scale system. The differences between two calculation methods are attributed to the averaging the magnitude over the whole area and the overestimation of friction coefficients employed in the traditional prediction. The results confirm that CFD provided more reliable wall shear stress estimates for surfaces of interest. The wall shear stress estimates for a bench-scale compare favorably to estimates for a commercial-scale pie section in a CIP system. PRACTICAL APPLICATION: The current investigation demonstrates that the computational fluid dynamics (CFD) simulation provides accurate estimates for the scale-up parameters. Both academic and industrial researchers will benefit from the proposed methodologies to compare the flow properties of the bench-scale and commercial-scale CIP operation that facilitate the practical implementation of the systems.

Erythropoiesis stimulating agent recommendation model using recurrent neural networks for patient with kidney failure with replacement therapy.

In patients with kidney failure with replacement therapy (KFRT), optimizing anemia management in these patients is a challenging problem because of the complexities of the underlying diseases and heterogeneous responses to erythropoiesis-stimulating agents (ESAs). Therefore, we propose a ESA dose recommendation model based on sequential awareness neural networks. Data from 466 KFRT patients (12,907 dialysis sessions) in seven tertiary-care general hospitals were included in the experiment. First, a Hb prediction model was developed to simulate longitudinal heterogeneous ESA and Hb interactions. Based on the prediction model as a prospective study simulator, we built an ESA dose recommendation model to predict the required amount of ESA dose to reach a target hemoglobin level after 30 days. Each model's performance was evaluated in the mean absolute error (MAE). The MAEs presenting the best results of the prediction and recommendation model were 0.59 (95% confidence interval: 0.56-0.62) g/dL and 43.2 µg (ESAs dose), respectively. Compared to the results in the real-world clinical data, the recommendation model achieved a reduction of ESA dose (Algorithm: 140 vs. Human: 150 µg/month, P < 0.001), a more stable monthly Hb difference (Algorithm: 0.6 vs. Human: 0.8 g/dL, P < 0.001), and an improved target Hb success rate (Algorithm: 79.5% vs. Human: 62.9% for previous month's Hb < 10.0 g/dL; Algorithm: 95.7% vs. Human:73.0% for previous month's Hb 10.0-12.0 g/dL). We developed an ESA dose recommendation model for optimizing anemia management in patients with KFRT and showed its potential effectiveness in a simulated prospective study.

Evolution of Morphological and Chemical Properties at p-n Junction of Cu(In,Ga)Se2 Solar Cells with Zn(O,S) Buffer Layer as a Function of KF Postdeposition Treatment Time.

We carried out KF postdeposition treatment (PDT) on a Cu(In,Ga)Se2 (CIGS) layer with a process time varying from 50 to 200 s. The highest CIGS solar-cell efficiency was achieved at a KF PDT process time of 50 s; in this condition, we observed the highest level of K element at the near-surface of the CIGS layer and the perfectly passivated pinholes on the CIGS surface. At process times above 150 s, the oversupplied KF agglomerated into large islands and was subsequently eliminated during the deposition of the chemical bath deposition (CBD)-Zn(O,S) buffer layer owing to the islands' water-soluble characteristics. As a result, the growth mechanism of the CBD-Zn(O,S) layer varied as a function of KF PDT process time. X-ray photoemission spectroscopy (XPS) measurements were used to examine the dependency of the chemical state on the KF PDT process time, and from the results, we formulated a chemical reaction model based on the shift in the elemental binding energy following deposition of the CBD-Zn(O,S) buffer layer. The chemical states of the K-In-Se phase, which have a beneficial effect on the solar-cell performance owing to the formation of durable and improved p-n junctions, are formed only at a KF PDT process time of 50 s. We derived band alignments from the XPS depth profiles by extracting the conduction- and valence-band offsets, and we used optical-pump-THz-probe spectroscopy to measure the ultrafast photocarrier lifetimes related to the defect states following KF PDT. Our key findings can be summarized as follows: (i) photocarrier transport is beneficial at a low barrier height, and (ii) the photocarrier lifetime increases when the K-In-Se phases are formed on the CIGS surface, which allows K+ ions to be effectively substituted into Cu vacancies.

Thermal and non-thermal treatment effects on Staphylococcus aureus biofilms formed at different temperatures and maturation periods.

The objective of this study was to investigate the effect of temperature and maturation period on the resistance of Staphylococcus aureus biofilms to thermal and non-thermal treatments. First, biofilm development was compared at three different temperatures (15, 25, and 37°C) for 5 days. The cell population at 15 and 25°C remained relatively consistent approximately at 6.3 log CFU/cm2, whereas 37°C resulted in the highest cell population on day 1 (7.6 log CFU/cm2) followed by a continual decline. Then, biofilm resistance to steam and sodium hypochlorite (NaOCl) treatments was evaluated. Obtained results highlighted that biofilms had different resistance to both treatments depending on development conditions. Specifically, steam treatment of 10 s eliminated 4.1 log CFU/cm2 of the biofilm formed at 25°C for 5 days. The same treatment inactivated over 5 log population of biofilms developed in other temperature and maturation period conditions. Treatment with NaOCl reduced approximately 1 log CFU/cm2 of biofilm cells developed at 25°C for 5 days. However, inactivation was found to be over 2 log CFU/cm2 under other development conditions. An extracellular polymeric substances (EPS) quantification using 96-well plates and stainless steel coupons was conducted. In the 96-well plate experiment, it was found that the highest amount of polysaccharide was secreted at 25°C (p < 0.05), while total biomass and protein contents were greatest at 37°C (p < 0.05). No significant difference in EPS content was observed for stainless steel, but the results displayed a similar trend to the 96-well plate. In particular, biofilms developed at 25°C tended to secret the highest amount of polysaccharide, which aligned with the current literature. This finding indicated that polysaccharide was the main contribution to the enhanced resistance of S. aureus biofilms. Overall, it was shown that biofilms formed at 25°C for 5 days exhibited the greatest resistance to thermal and nonthermal treatments due to the elevated exopolysaccharide secretion. This study demonstrates that temperature and maturation period significantly affect the resistance of S. aureus biofilms to thermal and non-thermal treatments.

Synergistic effect of 222-nm krypton-chlorine excilamp and mild heating combined treatment on inactivation of Escherichia coli O157:H7 and Salmonella Typhimurium in apple juice.

Simultaneous treatment with 222-nm KrCl excilamp and mild heating (EX-MH) at 45, 50 and 55 °C showed synergistic bactericidal effects on non-acid and acid adapted cells of Escherichia coli O157:H7 and Salmonella Typhimurium in apple juice. In particular, acid-adapted pathogens exhibited increased resistance to EX-MH compared to pathogenic bacteria that were not acid-adapted. Also, elucidation of the synergistic bactericidal mechanism of EX-MH was performed through several assays and this mechanism was described as follows: (i) when KrCl excilamp (EX) and mild heating (MH) are applied simultaneously, MH reversibly inactivates the antioxidant enzyme, superoxide dismutase (SOD), thereby increasing accumulation of reactive oxygen species (ROS) generated by EX and thus inducing synergistic ROS generation, (ii) ROS production induces lipid peroxidation occurrence in the cell membrane, (iii) this lipid peroxidation occurrence in the cell membrane induces synergistic destruction of cell membrane, resulting in synergistic cell death. While EX-MH of 45, 50, or 55 °C reduced E. coli O157:H7 (the pathogen most resistant to EX-MH) in apple juice by 5-log, the qualities such as color (L*, a*, and b*), total phenolic compounds (TPC), and DPPH free radical scavenging activity of apple juice did not change significantly (P > 0.05). This study not only suggests the applicability of EX-MH to the apple juice industry, but also can be used as baseline data for future relevant research.

Inhibition of Initial Attachment of Injured Salmonella Typhimurium onto Abiotic Surfaces.

Following sanitation interventions in food processing facilities, sublethally injured bacterial cells can remain on food contact surfaces. We investigated whether injured Salmonella Typhimurium cells can attach onto abiotic surfaces, which is the initial stage for further biofilm development. We utilized heat, UV, hydrogen peroxide, and lactic acid treatments, which are widely utilized by the food industry. Our results showed that heat, UV, and hydrogen peroxide did not effectively change populations of attached Salmonella Typhimurium. Cells treated with hydrogen peroxide had a slightly higher tendency to adhere to abiotic surfaces, although there was no significant difference between the populations of control and hydrogen peroxide-treated cells. However, lactic acid effectively reduced the number of Salmonella Typhimurium cells attached to stainless steel. We also compared physicochemical changes of Salmonella Typhimurium after application of lactic acid and used hydrogen peroxide as a positive control because only lactic acid showed a decreased tendency for attachment and hydrogen peroxide induced slightly higher numbers of attached bacteria cells. Extracellular polymeric substance produced by Salmonella Typhimurium was not detected in any treatment. Significant differences in hydrophobicity were not observed. Surface charges of cell membranes did not show relevant correlation with numbers of attached cells, whereas autoaggregation showed a positive correlation with attachment to stainless steel. Our results highlight that when lactic acid is applied in a food processing facility, it can effectively interfere with adhesion of injured Salmonella Typhimurium cells onto food contact surfaces.

Dynamic steering of in vitro cortical neurons using field stimulation.

Neurological disorders are often characterized by abnormal neuronal activity. In the case of epilepsy, this can manifest itself in the form of uncontrolled synchronous activity often in the form of bursting. Pattern steering is the ability to apply stimulation to a network that effectively changes its dynamical firing pattern. In an epileptic network, the stimulation would be used to move the seizing network from its abnormal state to a normal state. This idea is explored here in cultured networks of cortical neurons plated on microelectrode arrays. Stimulation was applied to the bath resulting in an electric field generated throughout the network. This field was verified as sub-threshold in strength using a finite element model simulation. Stimulated networks showed a significant suppression in the number of bursts and increase in the interburst interval as compared to control networks. This observed burst suppression suggests that the sub-threshold stimulating field moved networks from a state of high frequency bursting to a state of low frequency bursting.