Severe length-dependent peripheral polyneuropathy in a patient with subacute combined spinal cord degeneration secondary to recreational nitrous oxide abuse: A case report and literature review.

Nitrous oxide abuse can have detrimental effects on the central and peripheral nervous systems. This case study report aims to demonstrate a combination of severe generalized sensorimotor polyneuropathy and cervical myelopathy related to vitamin B12 deficiency following nitrous oxide abuse. We present a clinical case study and literature review examining primary research-published between 2012 and 2022-reporting nitrous oxide abuse affecting the spinal cord (myelopathy) and peripheral nerves (polyneuropathy); 35 articles were included in the review with a total of 96 patients, where the mean "patients" age was 23.9 years and were in a 2:1 male/female ratio. Of the 96 cases, within the review, 56% of patients were diagnosed with polyneuropathy, most commonly impacting the nerves of the lower limb (62%), while 70% of patients were diagnosed with myelopathy, most commonly impacting the cervical region (78%) on the spinal cord. In our clinical case study, a 28-year-old male underwent a multitude of diagnostic investigations for bilateral "foot drop" and sense of lower limb stiffness as ongoing complications of a vitamin B12 deficiency secondary to recreational nitrous oxide abuse. Both the literature review and our case report emphasize the dangers of recreational nitrous oxide inhalation, colloquially termed "nanging" and the risks it presents to both the central and peripheral nervous systems, which is erroneously considered by many recreational drug users to be less harmful than other illicit substances.

Flexible Nanoarchitectonics for Biosensing and Physiological Monitoring Applications.

Flexible and implantable electronics hold tremendous promises for advanced healthcare applications, especially for physiological neural recording and modulations. Key requirements in neural interfaces include miniature dimensions for spatial physiological mapping and low impedance for recognizing small biopotential signals. Herein, a bottom-up mesoporous formation technique and a top-down microlithography process are integrated to create flexible and low-impedance mesoporous gold (Au) electrodes for biosensing and bioimplant applications. The mesoporous architectures developed on a thin and soft polymeric substrate provide excellent mechanical flexibility and stable electrical characteristics capable of sustaining multiple bending cycles. The large surface areas formed within the mesoporous network allow for high current density transfer in standard electrolytes, highly suitable for biological sensing applications as demonstrated in glucose sensors with an excellent detection limit of 1.95 µm and high sensitivity of 6.1 mA cm-2  µM-1 , which is approximately six times higher than that of benchmarking flat/non-porous films. The low impedance of less than 1 kΩ at 1 kHz in the as-synthesized mesoporous electrodes, along with their mechanical flexibility and durability, offer peripheral nerve recording functionalities that are successfully demonstrated in vivo. These features highlight the new possibilities of our novel flexible nanoarchitectonics for neuronal recording and modulation applications.

Wide bandgap semiconductor nanomembranes as a long-term biointerface for flexible, implanted neuromodulator.

Electrical neuron stimulation holds promise for treating chronic neurological disorders, including spinal cord injury, epilepsy, and Parkinson's disease. The implementation of ultrathin, flexible electrodes that can offer noninvasive attachment to soft neural tissues is a breakthrough for timely, continuous, programable, and spatial stimulations. With strict flexibility requirements in neural implanted stimulations, the use of conventional thick and bulky packages is no longer applicable, posing major technical issues such as short device lifetime and long-term stability. We introduce herein a concept of long-lived flexible neural electrodes using silicon carbide (SiC) nanomembranes as a faradic interface and thermal oxide thin films as an electrical barrier layer. The SiC nanomembranes were developed using a chemical vapor deposition (CVD) process at the wafer level, and thermal oxide was grown using a high-quality wet oxidation technique. The proposed material developments are highly scalable and compatible with MEMS technologies, facilitating the mass production of long-lived implanted bioelectrodes. Our experimental results showed excellent stability of the SiC/silicon dioxide (SiO2) bioelectronic system that can potentially last for several decades with well-maintained electronic properties in biofluid environments. We demonstrated the capability of the proposed material system for peripheral nerve stimulation in an animal model, showing muscle contraction responses comparable to those of a standard non-implanted nerve stimulation device. The design concept, scalable fabrication approach, and multimodal functionalities of SiC/SiO2 flexible electronics offer an exciting possibility for fundamental neuroscience studies, as well as for neural stimulation-based therapies.

Integrated, Transparent Silicon Carbide Electronics and Sensors for Radio Frequency Biomedical Therapy.

The integration of micro- and nanoelectronics into or onto biomedical devices can facilitate advanced diagnostics and treatments of digestive disorders, cardiovascular diseases, and cancers. Recent developments in gastrointestinal endoscopy and balloon catheter technologies introduce promising paths for minimally invasive surgeries to treat these diseases. However, current therapeutic endoscopy systems fail to meet requirements in multifunctionality, biocompatibility, and safety, particularly when integrated with bioelectronic devices. Here, we report materials, device designs, and assembly schemes for transparent and stable cubic silicon carbide (3C-SiC)-based bioelectronic systems that facilitate tissue ablation, with the capability for integration onto the tips of endoscopes. The excellent optical transparency of SiC-on-glass (SoG) allows for direct observation of areas of interest, with superior electronic functionalities that enable multiple biological sensing and stimulation capabilities to assist in electrical-based ablation procedures. Experimental studies on phantom, vegetable, and animal tissues demonstrated relatively short treatment times and low electric field required for effective lesion removal using our SoG bioelectronic system. In vivo experiments on an animal model were conducted to explore the versatility of SoG electrodes for peripheral nerve stimulation, showing an exciting possibility for the therapy of neural disorders through electrical excitation. The multifunctional features of SoG integrated devices indicate their high potential for minimally invasive, cost-effective, and outcome-enhanced surgical tools, across a wide range of biomedical applications.

Intramuscular stimulation of tibialis anterior in human subjects: the effects of discharge variability on force production and fatigue.

Continuous intramuscular stimulation of tibialis anterior (TA) was used to test the hypothesis that irregular trains of stimuli can increase force production and offset the magnitude of fatigue when compared with a continuous train of regular stimuli at an identical mean frequency (19 or 24 Hz). To achieve this, tungsten microelectrodes were inserted into the muscle belly into the motor point of the tibialis anterior muscle of able-bodied individuals (aged 19-50) and stimulated at current intensities ranging from 5 to 7 mA. The motor point was stimulated with a continuous train of regular stimulation at either 19 or 24 Hz (n = 11) or until the force declined below 25% of the peak force at the onset of stimulation. For the first seven subjects, no fatigue was exhibited, and thus, we simply compared the forces generated by the regular and irregular segments of the continuous train (120 sec for each segment). For four additional subjects, we delivered a higher frequency train (24 Hz) that elicited some fatigue. Once the force had declined below 25% of the initial peak force (which took between 140 and 210 sec), the continuous irregular train was integrated. Interestingly, for those subjects who exhibited muscular fatigue, force always began to rise again once the irregularity was incorporated into the continuous regular train of stimulation at the identical mean frequency (24 Hz). We conclude that incorporating irregularity into continuous trains of stimuli offers a significant advantage to the human neuromuscular system during both fatigued and nonfatigued states and could offer benefits to therapies such as functional electrical stimulation (FES).

Microstimulation of single human motor axons in the toe extensors: force production during long-lasting trains of irregular and regular stimuli.

Human motoneurones are known to discharge with a physiological variability of ~25% during voluntary contractions. Using microstimulation of single human motor axons, we have previously shown that delivering brief trains (10 pulses) of irregular stimuli, which incorporate discharge variability, generates greater contractile responses than trains of regular stimuli with identical mean frequency but zero variability. We tested the hypothesis that longer irregular (physiological) trains would produce greater contractile responses than regular (nonphysiological) trains of the same mean frequency (18 Hz) and duration (45 sec). Tungsten microelectrodes were inserted into the common peroneal nerve of human subjects, and single motor axons supplying the toe extensors (n = 14) were isolated. Irregular trains of stimuli showed greater contractile responses over identical mean frequencies in both fatigue-resistant and fatigable motor units, but because the forces were higher the rate of decline was higher. Nevertheless, forces produced by the irregular trains were significantly higher than those produced by the regular trains. We conclude that discharge irregularity augments force production during long as well as short trains of stimulation.

Comparison of the ballistic contractile responses generated during microstimulation of single human motor axons with brief irregular and regular stimuli.

INTRODUCTION: Ballistic contractions are induced by brief, high-frequency (60-100 Hz) trains of action potentials in motor axons. During ramp voluntary contractions, human motoneurons exhibit significant discharge variability of ∼20% and have been shown to be advantageous to the neuromuscular system. We hypothesized that ballistic contractions incorporating discharge variability would generate greater isometric forces than regular trains with zero variability. METHODS: High-impedance tungsten microelectrodes were inserted into human fibular nerve, and single motor axons were stimulated with both irregular and constant-frequency stimuli at mean frequencies ranging from 57.8 to 68.9 Hz. RESULTS: Irregular trains generated significantly greater isometric peak forces than regular trains over identical mean frequencies. CONCLUSIONS: The high forces generated by ballistic contractions are not based solely on high frequencies, but rather a combination of high firing rates and discharge irregularity. It appears that irregular ballistic trains take advantage of the "catchlike property" of muscle, allowing augmentation of force. Muscle Nerve 56: 292-297, 2017.

Comparison of contractile responses of single human motor units in the toe extensors during unloaded and loaded isotonic and isometric conditions.

Much of the repertoire of muscle function performed in everyday life involves isotonic dynamic movements, either with or without an additional load, yet most studies of single motor units measure isometric forces. To assess the effects of muscle load on the contractile response, we measured the contractile properties of single motor units supplying the toe extensors, assessed by intraneural microstimulation of single human motor axons, in isotonic, loaded isotonic, and isometric conditions. Tungsten microelectrodes were inserted into the common peroneal nerve, and single motor axons (n = 10) supplying the long toe extensors were electrically stimulated through the microelectrode. Displacement was measured from the distal phalanx of the toe with either an angular displacement transducer for the unloaded (i.e., no additional load) and loaded (addition of a 4-g mass) isotonic conditions or a force transducer for the isometric conditions. Mean twitch profiles were measured at 1 Hz for all conditions: rise time, fall time, and duration were shortest for the unloaded isotonic conditions and longest for the isometric conditions. Peak displacements were lower in the loaded than unloaded isotonic conditions, and the half-maximal response in the loaded condition was achieved at lower frequencies than in the unloaded isotonic condition. We have shown that the contractile responses of single motor units supplying the human toe extensors are influenced by how they are measured: twitches are much slower when measured in loaded than unloaded isotonic conditions and slowest when measured in isometric conditions.

Comparison of the contractile responses to irregular and regular trains of stimuli during microstimulation of single human motor axons.

During voluntary contractions, human motoneurons discharge with a physiological variability of ∼20%. However, studies that have measured the contractile responses to microstimulation of single motor axons have used regular trains of stimuli with no variability. We tested the hypothesis that irregular (physiological) trains of stimuli produce greater contractile responses than regular (nonphysiological) trains of identical mean frequency but zero variability. High-impedance tungsten microelectrodes were inserted into the common peroneal nerve and guided into fascicles supplying a toe extensor muscle. Selective microstimulation was achieved for 14 single motor axons. Contractile responses were measured via an angular displacement transducer over the relevant toe. After the responses to regular trains of 10 stimuli extending from 2 to 100 Hz were recorded, irregular trains of 10 stimuli, based on the interspike intervals recorded from single motor units during voluntary contractions, were delivered. Finally, the stimulation sequences were repeated following a 2-min period of continuous stimulation at 10 Hz to induce muscle fatigue. Regular trains of stimuli generated a sigmoidal increase in displacement with frequency, whereas irregular trains, emulating the firing of volitionally driven motoneurons, displayed significantly greater responses over the same frequency range (8-24 Hz). This was maintained even in the presence of fatigue. We conclude that physiological discharge variability, which incorporates short and long interspike intervals, offers an advantage to the neuromuscular system by allowing motor units to operate on a higher level of the contraction-frequency curve and taking advantage of catch-like properties in skeletal muscle.