No-Touch Radiofrequency Ablation Using Twin Cooled Wet Electrodes for Recurrent Hepatocellular Carcinoma Following Locoregional Treatments.

OBJECTIVE: To evaluate the therapeutic outcomes of no-touch radiofrequency ablation (NT-RFA) using twin cooled wet (TCW) electrodes in patients experiencing recurrent hepatocellular carcinoma (HCC) after undergoing locoregional treatments. MATERIALS AND METHODS: We conducted a prospective, single-arm study of NT-RFA involving 102 patients, with a total of 112 recurrent HCCs (each ≤ 3 cm). NT-RFA with TCW electrodes was implemented under the guidance of ultrasonography (US)-MR/CT fusion imaging. If NT-RFA application proved technically challenging, conversion to conventional tumor puncture RFA was permitted. The primary metric for evaluation was the mid-term cumulative incidence of local tumor progression (LTP) observed post-RFA. Cumulative LTP rates were estimated using the Kaplan-Meier method. Multivariable Cox proportional hazard regression was used to explore factors associated with LTP. Considering conversion cases from NT-RFA to conventional RFA, intention-to-treat (ITT; including all patients) and per-protocol (PP; including patients not requiring conversion to conventional RFA alone) analyses were performed. RESULTS: Conversion from NT-RFA to conventional RFA was necessary for 24 (21.4%) out of 112 tumors. Successful treatment was noted in 111 (99.1%) out of them. No major complications were reported among the patients. According to ITT analysis, the estimated cumulative incidences of LTP were 1.9%, 6.0%, and 6.0% at 1, 2, and 3 years post-RFA, respectively. In PP analysis, the cumulative incidence of LTP was 0.0%, 1.3%, and 1.3% at 1, 2, and 3 years, respectively. The number of previous locoregional HCC treatments (adjusted hazard ratio [aHR], 1.265 per 1 treatment increase; P = 0.004), total bilirubin (aHR, 7.477 per 1 mg/dL increase; P = 0.012), and safety margin ≤ 5 mm (aHR, 9.029; P = 0.016) were independently associated with LTP in ITT analysis. CONCLUSION: NT-RFA using TCW electrodes is a safe and effective treatment for recurrent HCC, with 6.0% (ITT analysis) and 1.3% (PP analysis) cumulative incidence of LTP at 2 and 3-year follow-ups.

Computational analysis of multichannel magnetothermal neural stimulation using magnetic resonator array.

Heating nanoparticles with a magnetic field could facilitate selective remote control of neural activity in deep tissue. However, current magnetothermal stimulation approaches are limited to single-channel stimulation. Here, we investigated various designs for multichannel magnetothermal stimulation based on an array of resonant coils that are driven by a single loop coil. Using a tuning capacitor that allows resonant coils to resonate at the operating frequency, each coil's ON and OFF resonance can be controlled, enabling us to select stimulation channels. We found that smaller inner diameters of resonant coils produce more localized magnetic fields while larger coils produce magnetic fields over a longer distance. The constructed multichannel resonant coil arrays can provide a high enough magnetic field intensity to raise the temperature of nanoparticles by 8 °C when we apply 35.2 W into the loop coil that is spaced 1 mm from the target neurons. This multichannel stimulation using a simple resonant circuit approach would be useful for clinical applications of magnetothermal neural stimulation.

Group-Chopping: An 8-Channel, 0.04% Gain Mismatch, 2.1 µW 0.017 mm2 Instrumentation Amplifier for Bio-Potential Recording.

An 8-channel AFE with a group-chopping instrumentation amplifier (GCIA) is proposed for bio-potential recording applications. The group-chopping technique cascades chopper switches to progressively swap channels and dynamically removes gain mismatch among all channels. An 8-phase non-overlapping clocking scheme is developed and achieves excellent between-channel gain mismatch characteristics. The dynamic offsets among all channels are mitigated by the GCIA as well. The GCIA is the first work that minimizes the gain mismatch across more than two channels. With the help of the group-chopping, combined with an area-efficient open-loop structure, the GCIA shows <0.04% between-channel gain mismatch, the lowest mismatch reported to date. The chip is fabricated in 0.18µm 1P6M CMOS, occupies only 0.017 mm2/Ch., consumes 2.1 µW/Ch. under 0.5 V supply and achieves an NEF of 2.1.

Body-Area Powering With Human Body-Coupled Power Transmission and Energy Harvesting ICs.

This paper presents the body-coupled power transmission and ambient energy harvesting ICs. The ICs utilize human body-coupling to deliver power to the entire body, and at the same time, harvest energy from ambient EM waves coupled through the body. The ICs improve the recovered power level by adapting to the varying skin-electrode interface parasitic impedance at both the TX and RX. To maximize the power output from the TX, the dynamic impedance matching is performed amidst environment-induced variations. At the RX, the Detuned Impedance Booster (DIB) and the Bulk Adaptation Rectifier (BAR) are proposed to improve the power recovery and extend the power coverage further. In order to ensure the maximum power extraction despite the loading variations, the Dual-Mode Buck-Boost Converter (DM-BBC) is proposed. The ICs fabricated in 40 nm 1P8M CMOS recover up to 100 µW from the body-coupled power transmission and 2.5 µW from the ambient body-coupled energy harvesting. The ICs achieve the full-body area power delivery, with the power harvested from the ambiance via the body-coupling mechanism independent of placements on the body. Both approaches show power sustainability for wearable electronics all around the human body.

An Active Concentric Electrode for Concurrent EEG Recording and Body-Coupled Communication (BCC) Data Transmission.

This paper presents a wearable active concentric electrode for concurrent EEG monitoring and Body-Coupled Communication (BCC) data transmission. A three-layer concentric electrode eliminates the usage of wires. A common mode averaging unit (CMAU) is proposed to cancel not only the continuous common-mode interference (CMI) but also the instantaneous CMI of up to 51Vpp. The localized potential matching technique removes the ground electrode. An open-loop programmable gain amplifier (OPPGA) with the pseudo-resistor-based RC-divider block is presented to save the silicon area. The presented work is the first reported so far to achieve the concurrent EEG signal recording and BCC-based data transmission. The proposed chip achieves 100 dB CMRR and 110 dB PSRR, occupies 0.044 mm2, and consumes 7.4 µW with an input-referred noise density of 26 nV/√Hz.

1225-Channel Neuromorphic Retinal-Prosthesis SoC With Localized Temperature-Regulation.

A 1225-Channel Neuromorphic Retinal Prosthesis (RP) SoC is presented. Existing RP SoCs directly convert light intensity to electrical stimulus, which limit the adoption of delicate stimulus patterns to increase visual acuity. Moreover, a conventional centralized image processor leads to the local hot spot that poses a risk to the nearby retinal cells. To solve these issues, the proposed SoC adopts a distributed Neuromorphic Image Processor (NMIP) located within each pixel that extracts the outline of the incoming image, which reduces current dispersion and stimulus power compared with light-intensity proportional stimulus pattern. A spike-based asynchronous digital operation results in the power consumption of 56.3 nW/Ch without local temperature hot spot. At every 5×5 pixels, the localized (49-point) temperature-regulation circuit limits the temperature increase of neighboring retinal cells to less than 1 °C, and the overall power consumption of the SoC to be less than that of the human eye. The 1225-channel SoC fabricated in 0.18 µm 1P6M CMOS occupies 15mm2 while consuming 2.7 mW, and is successfully verified with image reconstruction demonstration.

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.

Nerve cuff electrode using embedded magnets and its application to hypoglossal nerve stimulation.

OBJECTIVE: A novel nerve cuff electrode with embedded magnets was fabricated and developed. In this study, a pair of magnets was fully embedded and encapsulated in a liquid crystal polymer (LCP) substrate to utilize magnetic force in order to replace the conventional installing techniques of cuff electrodes. In vitro and in vivo experiments were conducted to evaluate the feasibility of the magnet-embedded nerve cuff electrode (MENCE). Lastly, several issues pertaining to the MENCE such as the cuff-to-nerve diameter ratio, the force of the magnets, and possible concerns were discussed in the discussion section. APPROACH: Electrochemical impedance spectrum and cyclic voltammetry assessments were conducted to measure the impedance and charge storage capacity of the cathodal phase (CSCc). The MENCE was installed onto the hypoglossal nerve (HN) of a rabbit and the movement of the genioglossus was recorded through C-arm fluoroscopy while the HN was stimulated by a pulsed current. MAIN RESULTS: The measured impedance was 0.638 âˆ  -67.8° kΩ at 1 kHz and 5.27 âˆ  -82.1° kΩ at 100 Hz. The average values of access resistance and cut-off frequency were 0.145 kΩ and 3.98 kHz, respectively. The CSCc of the electrode was measured as 1.69 mC cm-2 at the scan rate of 1 mV s-1. The movement of the genioglossus contraction was observed under a pulsed current with an amplitude level of 0.106 mA, a rate of 0.635 kHz, and a duration of 0.375 ms applied through the MENCE. SIGNIFICANCE: A few methods to close and secure cuff electrodes have been researched, but they are associated with several drawbacks. To overcome these, we used magnetic force as a closing method of the cuff electrode. The MENCE can be precisely installed on a target nerve without any surgical techniques such as suturing or molding. Furthermore, it is convenient to remove the installed MENCE because it requires little force to detach one magnet from the other, enabling repeatable installation and removal. We anticipate that the MENCE will become a very useful tool given its unique properties as a cuff electrode for neural engineering.

Advancements in fabrication process of microelectrode array for a retinal prosthesis using Liquid Crystal Polymer (LCP).

Liquid Crystal Polymer (LCP) has been considered as an alternative biomaterial for implantable biomedical devices primarily for its low moisture absorption rate compared with conventional polymers such as polyimide, parylene and silicone elastomers. A novel retinal prosthetic device based on monolithic encapsulation of LCP is being developed in which entire neural stimulation circuitries are integrated into a thin and eye-conformable structure. Micromachining techniques for fabrication of a LCP retinal electrode array have been previously reported. In this research, however, for being used as a part of the LCP-based retinal implant, we developed advanced fabrication process of LCP retinal electrode through new approaches such as electroplating and laser-machining in order to achieve higher mechanical robustness, long-term reliability and flexibility. Thickened metal tracks could contribute to higher mechanical strength as well as higher long-term reliability when combined with laser-ablation process by allowing high-pressure lamination. Laser-thinning technique could improve the flexibility of LCP electrode.