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1.
PLoS Negl Trop Dis ; 15(10): e0009870, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34634052

RESUMO

Chagas disease, caused by the protozoan intracellular parasite Trypanosoma cruzi, is a highly neglected tropical disease, causing significant morbidity and mortality in central and south America. Current treatments are inadequate, and recent clinical trials of drugs inhibiting CYP51 have failed, exposing a lack of understanding of how to translate laboratory findings to the clinic. Following these failures many new model systems have been developed, both in vitro and in vivo, that provide improved understanding of the causes for clinical trial failures. Amongst these are in vitro rate-of-kill (RoK) assays that reveal how fast compounds kill intracellular parasites. Such assays have shown clear distinctions between the compounds that failed in clinical trials and the standard of care. However, the published RoK assays have some key drawbacks, including low time-resolution and inability to track the same cell population over time. Here, we present a new, live-imaging RoK assay for intracellular T. cruzi that overcomes these issues. We show that the assay is highly reproducible and report high time-resolution RoK data for key clinical compounds as well as new chemical entities. The data generated by this assay allow fast acting compounds to be prioritised for progression, the fate of individual parasites to be tracked, shifts of mode-of-action within series to be monitored, better PKPD modelling and selection of suitable partners for combination therapy.


Assuntos
Automação/métodos , Doença de Chagas/parasitologia , Avaliação Pré-Clínica de Medicamentos/métodos , Microscopia de Fluorescência/métodos , Tripanossomicidas/farmacologia , Trypanosoma cruzi/efeitos dos fármacos , Automação/instrumentação , Avaliação Pré-Clínica de Medicamentos/instrumentação , Humanos , Microscopia de Fluorescência/instrumentação , Trypanosoma cruzi/genética , Trypanosoma cruzi/fisiologia
2.
Proc Natl Acad Sci U S A ; 114(12): E2293-E2302, 2017 03 21.
Artigo em Inglês | MEDLINE | ID: mdl-28265064

RESUMO

Organ-on-a-chip systems are miniaturized microfluidic 3D human tissue and organ models designed to recapitulate the important biological and physiological parameters of their in vivo counterparts. They have recently emerged as a viable platform for personalized medicine and drug screening. These in vitro models, featuring biomimetic compositions, architectures, and functions, are expected to replace the conventional planar, static cell cultures and bridge the gap between the currently used preclinical animal models and the human body. Multiple organoid models may be further connected together through the microfluidics in a similar manner in which they are arranged in vivo, providing the capability to analyze multiorgan interactions. Although a wide variety of human organ-on-a-chip models have been created, there are limited efforts on the integration of multisensor systems. However, in situ continual measuring is critical in precise assessment of the microenvironment parameters and the dynamic responses of the organs to pharmaceutical compounds over extended periods of time. In addition, automated and noninvasive capability is strongly desired for long-term monitoring. Here, we report a fully integrated modular physical, biochemical, and optical sensing platform through a fluidics-routing breadboard, which operates organ-on-a-chip units in a continual, dynamic, and automated manner. We believe that this platform technology has paved a potential avenue to promote the performance of current organ-on-a-chip models in drug screening by integrating a multitude of real-time sensors to achieve automated in situ monitoring of biophysical and biochemical parameters.


Assuntos
Automação/métodos , Técnicas Biossensoriais/métodos , Avaliação Pré-Clínica de Medicamentos/métodos , Organoides/fisiologia , Automação/instrumentação , Técnicas Biossensoriais/instrumentação , Avaliação Pré-Clínica de Medicamentos/instrumentação , Coração/fisiologia , Humanos , Fígado/química , Fígado/fisiologia , Microfluídica , Modelos Biológicos , Miocárdio , Organoides/química , Organoides/efeitos dos fármacos
3.
Zhongguo Zhong Yao Za Zhi ; 40(19): 3697-702, 2015 Oct.
Artigo em Chinês | MEDLINE | ID: mdl-26975087

RESUMO

Aim at the two problems in the field of traditional Chinese medicine (TCM) mechanism elucidation, one is the lack of detailed biological processes information, next is the low efficient in constructing network models, we constructed an auxiliary elucidation system for the TCM mechanism and realize the automatic establishment of biological network model. This study used the Entity Grammar Systems (EGS) as the theoretical framework, integrated the data of formulae, herbs, chemical components, targets of component, biological reactions, signaling pathways and disease related proteins, established the formal models, wrote the reasoning engine, constructed the auxiliary elucidation system for the TCM mechanism elucidation. The platform provides an automatic modeling method for biological network model of TCM mechanism. It would be benefit to perform the in-depth research on TCM theory of natures and combination and provides the scientific references for R&D of TCM.


Assuntos
Automação/métodos , Medicamentos de Ervas Chinesas/química , Medicamentos de Ervas Chinesas/farmacologia , Plantas Medicinais/química , Animais , Automação/instrumentação , Bases de Dados Factuais , Redes Reguladoras de Genes , Humanos , Medicina Tradicional Chinesa
4.
Sensors (Basel) ; 14(8): 14932-70, 2014 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-25196004

RESUMO

Wireless home automation networks are gaining importance for smart homes. In this ambit, ZigBee networks play an important role. The ZigBee specification defines a default set of protocol stack parameters and mechanisms that is further refined by the ZigBee Home Automation application profile. In a holistic approach, we analyze how the network performance is affected with the tuning of parameters and mechanisms across multiple layers of the ZigBee protocol stack and investigate possible performance gains by implementing and testing alternative settings. The evaluations are carried out in a testbed of 57 TelosB motes. The results show that considerable performance improvements can be achieved by using alternative protocol stack configurations. From these results, we derive two improved protocol stack configurations for ZigBee wireless home automation networks that are validated in various network scenarios. In our experiments, these improved configurations yield a relative packet delivery ratio increase of up to 33.6%, a delay decrease of up to 66.6% and an improvement of the energy efficiency for battery powered devices of up to 48.7%, obtainable without incurring any overhead to the network.


Assuntos
Moradias Assistidas/métodos , Automação/instrumentação , Redes de Comunicação de Computadores/instrumentação , Tecnologia sem Fio/instrumentação , Fontes de Energia Elétrica , Processamento de Sinais Assistido por Computador/instrumentação
5.
Chin J Nat Med ; 12(7): 517-24, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25053551

RESUMO

AIM: To apply an integrated quality assessment strategy to investigate the quality of multiple Chinese commercial dry red wine samples. METHOD: A comprehensive method was developed by combining a high performance liquid chromatography-diode array detector-chemiluminescence (HPLC-DAD-CL) online hyphenated system with an HPLC-ESI-MS technique. RESULTS: Chromatographic and H2O2-scavenging active fingerprints of thirteen batches of different, commercially available Chinese dry red wine samples were obtained and analyzed. Twenty-five compounds, including eighteen antioxidants were identified and evaluated. The dominant and characteristic antioxidants in the samples were identified. The relationships between antioxidant potency and the cultivated variety of grape, producing area, cellaring period, and trade mark are also discussed. CONCLUSION: The results provide the feasibility for an integrated quality assessment strategy to be efficiently and objectively used in quality (especially antioxidant activity) assessment and identification of dry red wine.


Assuntos
Automação/métodos , Cromatografia Líquida de Alta Pressão/métodos , Espectrometria de Massas por Ionização por Electrospray/métodos , Vinho/análise , Antioxidantes/química , Automação/instrumentação , Cromatografia Líquida de Alta Pressão/instrumentação , Controle de Qualidade , Vinho/economia , Vinho/normas
6.
Food Chem ; 143: 465-71, 2014 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-24054268

RESUMO

The colorimetric determination of the concentration of phytochemicals in plant extract samples using a spotting automatic system, mobile phone camera and a computer with developed software for quantification is described. Method automation was achieved by using a robotic system for spotting. The instrument was set to disperse the appropriate aliquots of the reagents and sample on a Whatman paper sheet. Spots were photographed and analysed by ImageJ software or by applying the developed MatLab based algorithm. The developed assay was found to be effective, with a linear response at the concentration range of 0.03-0.25g/L for polyphenols. The detection limit of the proposed method is sub 0.03g/L. The paper microzone-based assays for flavonoids and amino acids/peptides were also developed and evaluated as applicable. Comparing the results with conventional PµZP methods demonstrates that both methods yield similar results. At the same time, the proposed method has an attractive advantage in analysis time and repeatability/reproducibility.


Assuntos
Automação/métodos , Processamento de Imagem Assistida por Computador/métodos , Fotografação/métodos , Extratos Vegetais/análise , Plantas/química , Aminoácidos/análise , Automação/instrumentação , Processamento de Imagem Assistida por Computador/instrumentação , Peptídeos/análise , Fotografação/instrumentação , Polifenóis/análise , Software
7.
Parasite Immunol ; 35(9-10): 302-13, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23581722

RESUMO

Helminth infections still represent a huge public health problem throughout the developing world and in the absence of vaccines control is based on periodic mass drug administration. Poor efficacy of some anthelmintics and concerns about emergence of drug resistance has highlighted the need for new drug discovery. Most current anthelmintics were discovered through in vivo screening of selected compounds in animal models but recent approaches have shifted towards screening for activity against adult or larval stages in vitro. Larvae are normally available in greater numbers than adults, can often be produced in vitro and are small enough for microplate assays. However, the manual visualization of drug effects in vitro is subjective, laborious and slow. This can be overcome by application of automated readouts including high-content imaging. Incorporated into robotically controlled HTS platforms such methods allow the very large compound collections being made available by the pharmaceutical industry or academic organizations to be screened against helminths for the first time, invigorating the drug discovery pipeline. Here, we review the status of whole-organism screens based on in vitro activity against living worms and highlight the recent progress towards automated image-based readouts.


Assuntos
Anti-Helmínticos/farmacologia , Automação/métodos , Avaliação Pré-Clínica de Medicamentos/métodos , Helmintos/efeitos dos fármacos , Animais , Automação/instrumentação , Avaliação Pré-Clínica de Medicamentos/instrumentação , Helmintos/citologia , Helmintos/fisiologia , Humanos , Larva/efeitos dos fármacos , Testes de Sensibilidade Parasitária
8.
Am Heart J ; 163(3): 365-71, 2012 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-22424006

RESUMO

BACKGROUND: The Cardiac Safety Research Consortium (CSRC) provides both "learning" and blinded "testing" digital electrocardiographic (ECG) data sets from thorough QT (TQT) studies annotated for submission to the US Food and Drug Administration (FDA) to developers of ECG analysis technologies. This article reports the first results from a blinded testing data set that examines developer reanalysis of original sponsor-reported core laboratory data. METHODS: A total of 11,925 anonymized ECGs including both moxifloxacin and placebo arms of a parallel-group TQT in 181 subjects were blindly analyzed using a novel ECG analysis algorithm applying intelligent automation. Developer-measured ECG intervals were submitted to CSRC for unblinding, temporal reconstruction of the TQT exposures, and statistical comparison to core laboratory findings previously submitted to FDA by the pharmaceutical sponsor. Primary comparisons included baseline-adjusted interval measurements, baseline- and placebo-adjusted moxifloxacin QTcF changes (ddQTcF), and associated variability measures. RESULTS: Developer and sponsor-reported baseline-adjusted data were similar with average differences <1 ms for all intervals. Both developer- and sponsor-reported data demonstrated assay sensitivity with similar ddQTcF changes. Average within-subject SD for triplicate QTcF measurements was significantly lower for developer- than sponsor-reported data (5.4 and 7.2 ms, respectively; P < .001). CONCLUSION: The virtually automated ECG algorithm used for this analysis produced similar yet less variable TQT results compared with the sponsor-reported study, without the use of a manual core laboratory. These findings indicate that CSRC ECG data sets can be useful for evaluating novel methods and algorithms for determining drug-induced QT/QTc prolongation. Although the results should not constitute endorsement of specific algorithms by either CSRC or FDA, the value of a public domain digital ECG warehouse to provide prospective, blinded comparisons of ECG technologies applied for QT/QTc measurement is illustrated.


Assuntos
Algoritmos , Automação/instrumentação , Compostos Aza/uso terapêutico , Eletrocardiografia/métodos , Síndrome do QT Longo/diagnóstico , Quinolinas/uso terapêutico , Anti-Infecciosos/uso terapêutico , Método Duplo-Cego , Eletrocardiografia/efeitos dos fármacos , Fluoroquinolonas , Seguimentos , Humanos , Síndrome do QT Longo/tratamento farmacológico , Síndrome do QT Longo/fisiopatologia , Moxifloxacina , Estudos Prospectivos , Reprodutibilidade dos Testes
9.
Methods Inf Med ; 49(4): 406-11, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-20405093

RESUMO

OBJECTIVES: Brief intervention helps to reduce alcohol abuse, but there is a need for accessible, cost-effective training of clinicians. This study evaluated STAR Workshop , a web-based training system that automates efficacious techniques for individualized coaching and authentic role-play practice. METHODS: We compared STAR Workshop to a web-based, self-guided e-book and a no-treatment control, for training the Engage for Change (E4C) brief intervention protocol. Subjects were medical and nursing students. Brief written skill probes tested subjects' performance of individual protocol steps, in different clinical scenarios, at three test times: pre-training, post-training, and post-delay (two weeks). Subjects also did live phone interviews with a standardized patient, post-delay. RESULTS: STAR subjects performed significantly better than both other groups. They showed significantly greater improvement from pre-training probes to post-training and post-delay probes. They scored significantly higher on post-delay phone interviews. CONCLUSION: STAR Workshop appears to be an accessible, cost-effective approach for training students to use the E4C protocol for brief intervention in alcohol abuse. It may also be useful for training other clinical interviewing protocols.


Assuntos
Automação/métodos , Avaliação Educacional , Desempenho de Papéis , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Ensino , Interface Usuário-Computador , Análise de Variância , Automação/instrumentação , Competência Clínica , Currículo , Educação , Escolaridade , Humanos , Internet , Estatística como Assunto , Estudantes de Medicina , Estudantes de Enfermagem , Fatores de Tempo
10.
J Neurosci Methods ; 169(1): 65-75, 2008 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-18243328

RESUMO

The Xenopus oocyte expression system has played an important role in the study of cellular proteins, particularly in the field of membrane physiology; expression of transporters and ion channels has significantly advanced our knowledge of these membrane proteins and the rapid and easy expression of mutants has been crucial in many structure-function studies. Xenopus oocytes are an expression system in many ligand-binding assays and in functional screening for ion channel modulators. Several commercially available automated technologies use this system, generating a demand for large numbers of oocytes injected with ion channel genes. Injection of oocytes with genetic material is generally carried out manually. Here we describe an automated system capable of injecting up to 600 oocytes per hour. Oocytes are contained in microplates with conical wells, a simple calibration procedure by the operator is required and pipette filling and oocyte injection are carried out automatically. Following intracellular injection of mRNA coding for ligand-gated ion channels close to 100% of oocytes tested positive for expression, and intranuclear injection of cDNA gave a rate of expression >50%. Moreover, we demonstrate that this method can also be successfully applied to inject zebrafish embryos and could be extended to other cell types.


Assuntos
Automação/métodos , Bioensaio/métodos , Técnicas Citológicas/métodos , DNA Complementar/farmacologia , Microinjeções/métodos , Oócitos/efeitos dos fármacos , RNA Mensageiro/farmacologia , Animais , Automação/instrumentação , Técnicas de Cultura de Células/métodos , Núcleo Celular/efeitos dos fármacos , Núcleo Celular/genética , Núcleo Celular/ultraestrutura , Técnicas Citológicas/instrumentação , DNA Complementar/genética , Avaliação Pré-Clínica de Medicamentos/métodos , Feminino , Canais Iônicos/efeitos dos fármacos , Canais Iônicos/genética , Microinjeções/instrumentação , Oócitos/citologia , Oócitos/metabolismo , RNA Mensageiro/genética , Xenopus laevis , Peixe-Zebra
11.
Resuscitation ; 67(1): 25-30, 2005 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-16159692

RESUMO

Lund University Cardiopulmonary Assist System (LUCAS) is a new gas-driven CPR device providing automatic chest compression and active decompression. This is a report of the first 100 consecutive cases treated with LUCAS due to out-of-hospital cardiac arrest (58% asystole, 42% ventricular fibrillation (VF)). Safety aspects were also investigated and it was found that LUCAS can be used safely regarding noise levels and oxygen concentrations within the ambulance. A crash test (10G) showed no displacement of the device from the manikin. Of the 71 patients with witnessed cardiac arrest, 39% received bystander CPR. In those 28 patients where LUCAS-CPR was initiated more than 15 min after the ambulance alarm and in the 29 unwitnessed cases, none survived for 30 days. Of the 43 witnessed cases treated with LUCAS within 15 min, 24 had VF and 15 (63%) of these cases achieved a stable return of spontaneous circulation (ROSC) and 6 (25%) of them survived with a good neurological recovery after 30 days; 5 (26%) of the 19 patients with asystole achieved ROSC and 1 (5%) survived for over 30 days. One patient where ROSC could not be achieved was transported with on-going LUCAS-CPR to the catheter laboratory and after PCI for an occluded LAD a stable ROSC occurred, but the patient never regained consciousness and died 15 days later. To conclude, establishment of an adequate cerebral circulation as quickly as possible after cardiac arrest is mandatory for a good outcome. In this report patients with a witnessed cardiac arrest receiving LUCAS-CPR within 15 min from the ambulance call had a 30-day survival of 25% in VF and 5% in asystole, but if the interval was more than 15 min, there were no 30-day survivors.


Assuntos
Automação/instrumentação , Reanimação Cardiopulmonar/instrumentação , Serviços Médicos de Emergência/métodos , Parada Cardíaca/mortalidade , Parada Cardíaca/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Reanimação Cardiopulmonar/métodos , Estudos de Coortes , Desenho de Equipamento , Equipamentos e Provisões , Feminino , Seguimentos , Massagem Cardíaca/instrumentação , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Segurança , Análise de Sobrevida , Suécia
12.
J Neurosci Methods ; 146(1): 76-83, 2005 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-15935223

RESUMO

Catalepsy tests performed in rodents treated with drugs that interfere with dopaminergic transmission have been widely used for the screening of drugs with therapeutic potential in the treatment of Parkinson's disease. The basic method for measuring catalepsy intensity is the "standard" bar test. We present here an easy to use microcontroller-based automatic system for recording bar test experiments. The design is simple, compact, and has a low cost. Recording intervals and total experimental time can be programmed within a wide range of values. The resulting catalepsy times are stored, and up to five simultaneous experiments can be recorded. A standard personal computer interface is included. The automated system also permits the elimination of human error associated with factors such as fatigue, distraction, and data transcription, occurring during manual recording. Furthermore, a uniform criterion for timing the cataleptic condition can be achieved. Correlation values between the results obtained with the automated system and those reported by two independent observers ranged between 0.88 and 0.99 (P<0.0001; three treatments, nine animals, 144 catalepsy time measurements).


Assuntos
Automação/métodos , Ciências do Comportamento/métodos , Catalepsia/diagnóstico , Eletrônica/métodos , Neurofisiologia/métodos , Processamento de Sinais Assistido por Computador/instrumentação , Animais , Artefatos , Automação/instrumentação , Ciências do Comportamento/instrumentação , Catalepsia/induzido quimicamente , Catalepsia/fisiopatologia , Avaliação Pré-Clínica de Medicamentos/instrumentação , Avaliação Pré-Clínica de Medicamentos/métodos , Eletrônica/instrumentação , Masculino , Neurofisiologia/instrumentação , Variações Dependentes do Observador , Ratos , Ratos Wistar , Software
13.
Photomed Laser Surg ; 22(3): 233-9, 2004 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-15315731

RESUMO

OBJECTIVE: Laser irradiation of cultured cells is a valuable technique for elucidating the mechanisms of low-level laser therapy, but is often tedious because of the need to manually change the position of the laser beam. Consequently, we developed a computer-based system that automatically moves a cell culture plate over a laser beam and times the exposure. BACKGROUND DATA: There are presently no commercial devices available for automated laser irradiation of cultured cells. Many investigators thus manually aim and time laser exposure, a time-consuming task that is prone to errors. MATERIALS AND METHODS: We used outdated, surplus computer components to construct a system for automated laser exposure of cultured cells. This design strategy makes the system quite inexpensive. RESULTS: Construction and operation of the system is described and an example of its use is presented. Alternate means of accomplishing automated laser irradiation are also presented. CONCLUSION: Inexpensive and relatively simple devices can be constructed for automated laser irradiation of cultured cells. These devices can eliminate the tedium and errors of manual laser exposure.


Assuntos
Automação/instrumentação , Terapia com Luz de Baixa Intensidade/instrumentação , Células Cultivadas , Computadores , Desenho de Equipamento , Fibroblastos/efeitos da radiação , Humanos , Software
15.
An. sist. sanit. Navar ; 27(2): 233-239, mayo 2004. tab
Artigo em Es | IBECS | ID: ibc-34528

RESUMO

Fundamento. Evaluar en un hospital terciario, el grado de utilización de una historia clínica informatizada (HCI), las opiniones de los profesionales sobre sus ventajas e inconvenientes y su nivel de satisfacción con la misma. Material y métodos. Encuesta enviada por correo a todos los médicos del Hospital Virgen del Camino en Pamplona. Resultados. De los 445 médicos del centro, contestaron la encuesta 174 (39 por ciento). De éstos, el 79 por ciento consideran que la HCI es mejor que la historia clínica tradicional, el 61 por ciento la utilizan para consultar e introducir datos de manera habitual y el 55 por ciento están muy de acuerdo con que la HCI ofrece ventajas para el paciente. Los principales problemas detectados son la posible pérdida de confidencialidad, y la falta de tiempo, de dotación informática y de mayor formación, para el manejo del programa. El 90 por ciento de los encuestados opina que se debe continuar con su implantación y sólo el 6 por ciento dice estar poco satisfecho con la aplicación. Conclusión. Existe una extendida utilización de la HCI entre los médicos del Hospital Virgen del Camino y su opinión sobre el programa puede considerarse globalmente favorable. Se deben desarrollar medidas para subsanar los problemas detectados mediante este estudio (AU)


Assuntos
Adulto , Feminino , Masculino , Pessoa de Meia-Idade , Humanos , Anamnese Homeopática , Coleta de Dados/métodos , Coleta de Dados , Atenção Terciária à Saúde , Processamento Eletrônico de Dados/organização & administração , Processamento Eletrônico de Dados , Automação/métodos , Automação/normas , Confidencialidade , Automação/classificação , Automação/economia , Automação/instrumentação , Educação/métodos , Educação/organização & administração
17.
J Neurosci Methods ; 132(1): 69-79, 2004 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-14687676

RESUMO

Xenopus laevis oocytes are used extensively in the study of ion channel coupled receptors. Efficient use of oocytes for ion channel characterization requires a system that is inherently stable, reproducible, minimizes drug volumes, and maximizes oocyte longevity. We have constructed a vertical flow oocyte recording chamber to address the aforesaid issues, where the oocyte is placed in a funnel-shaped chamber and perfused from the bottom of the funnel. The vertical rather than horizontal flow of perfusate results in an unusually stable environment for oocyte recording. Two-electrode voltage clamp recordings from a single oocyte are acquired easily and routinely over several hours while maintaining stable baseline currents and reproducible response profiles. Chamber characteristics were tested using a serotonin ligand-gated ion channel receptor (5-HT3R). Data obtained from this system corresponds well with published data. To further test the stability and reliability of this perfusion chamber, we constructed an automated oocyte perfusion system utilizing a commonly available HPLC autosampler. We were able to obtain dose-response curves for various 5-HT3AR ligands using the automated perfusion system with minimal user intervention. Such a system can easily satisfy need for automated oocyte electrophysiology in academic settings, especially small to medium sized laboratories.


Assuntos
Automação/instrumentação , Cultura em Câmaras de Difusão/instrumentação , Avaliação Pré-Clínica de Medicamentos/métodos , Eletrofisiologia , Oócitos/efeitos dos fármacos , Animais , Automação/métodos , Desenho Assistido por Computador , Cultura em Câmaras de Difusão/métodos , Relação Dose-Resposta a Droga , Condutividade Elétrica , Feminino , Humanos , Potenciais da Membrana/efeitos dos fármacos , Potenciais da Membrana/fisiologia , Microinjeções/métodos , Oócitos/fisiologia , Técnicas de Patch-Clamp , Perfusão/métodos , RNA Complementar/biossíntese , Receptores 5-HT3 de Serotonina/efeitos dos fármacos , Receptores 5-HT3 de Serotonina/genética , Receptores 5-HT3 de Serotonina/metabolismo , Serotonina/farmacologia , Xenopus laevis
18.
Neurosurgery ; 52(3): 572-80; discussion 579-80, 2003 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-12590681

RESUMO

OBJECTIVE: Programmable, multicontact, implanted stimulation devices represent an important advance in spinal cord stimulation for the management of pain. They facilitate the technical goal of covering areas of pain by stimulation-evoked paresthesiae. Adjustment after implantation requires major investments of time and effort, however, if the capabilities of these devices are to be used to full advantage. The objective of maximizing coverage should be met while using practitioners' time efficiently. METHODS: We have developed a patient-interactive, computerized system designed for greater ease and safety of operation, compared with the standard external devices used to control and adjust implanted pulse generators. The system automatically and rapidly presents to the patient the contact combinations and pulse parameters specified by the practitioner. The patient adjusts the amplitude of stimulation and then records drawings of stimulation paresthesiae (for comparison with pain drawings), followed by visual analog scale ratings for each setting. Test results are analyzed and sorted to determine the optimal settings. We compared the automated, patient-interactive system with traditional, practitioner-operated, manual programming methods in a randomized controlled trial at two study centers, with 44 patients. RESULTS: The automated, patient-interactive system yielded significantly (P < 0.0001) better technical results than did traditional manual methods, in achieving coverage of pain by stimulation paresthesiae (mean 100-point visual analog scale ratings of 70 and 46, respectively). The visual analog scale ratings were higher for automated testing for 38 patients, higher for manual testing for 0 patients, and equal (tied) for 6 patients. Multivariate analysis demonstrated that the advantage of automated testing occurred independently of practitioner experience; the advantage was significantly greater, however, for experienced patients. The rate of testing (number of settings tested per unit time) was significantly (P < 0.0001) greater for the automated system, in comparison with the rate with a human operator using traditional, manual, programming methods (mean of 0.73 settings/min versus 0.49 settings/min). The automated system also identified settings with improved estimated battery life (and corresponding anticipated cost savings). No complications were observed with automated testing; one complication (transient discomfort attributable to excessive stimulation) occurred with manual testing. CONCLUSION: Automated, patient-interactive adjustment of implanted spinal cord stimulators is significantly more effective and more efficient than traditional manual methods of adjustment. It offers not only improved clinical efficacy but also potential cost savings in extending implanted battery life. It has the additional potential advantages of standardization, quality control, and record keeping, to facilitate clinical research and patient care. It should enhance the clinical application of spinal cord stimulation for the treatment of chronic intractable pain.


Assuntos
Automação/instrumentação , Terapia por Estimulação Elétrica/efeitos adversos , Terapia por Estimulação Elétrica/instrumentação , Eletrodos Implantados/efeitos adversos , Manejo da Dor , Dor/fisiopatologia , Ajuste de Prótese/efeitos adversos , Ajuste de Prótese/instrumentação , Autocuidado/efeitos adversos , Autocuidado/instrumentação , Medula Espinal/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Medição da Dor , Terapia Assistida por Computador/instrumentação
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