Coupled Eulerian-Lagrangian model prediction of neural tissue strain during microelectrode insertion.

Objective.Implanted neural microelectrodes are an important tool for recording from and stimulating the cerebral cortex. The performance of chronically implanted devices, however, is often hindered by the development of a reactive tissue response. Previous computational models have investigated brain strain from micromotions of neural electrodes after they have been inserted, to investigate design parameters that might minimize triggers to the reactive tissue response. However, these models ignore tissue damage created during device insertion, an important contributing factor to the severity of inflammation. The objective of this study was to evaluate the effect of electrode geometry, insertion speed, and surface friction on brain tissue strain during insertion.Approach. Using a coupled Eulerian-Lagrangian approach, we developed a 3D finite element model (FEM) that simulates the dynamic insertion of a neural microelectrode in brain tissue. Geometry was varied to investigate tip bluntness, cross-sectional shape, and shank thickness. Insertion velocities were varied from 1 to 8 m s-1. Friction was varied from frictionless to 0.4. Tissue strain and potential microvasculature hemorrhage radius were evaluated for brain regions along the electrode shank and near its tip.Main results. Sharper tips resulted in higher mean max principal strains near the tip except for the bluntest tip on the square cross-section electrode, which exhibited high compressive strain values due to stress concentrations at the corners. The potential vascular damage radius around the electrode was primarily a function of the shank diameter, with smaller shank diameters resulting in smaller distributions of radial strain around the electrode. However, the square shank interaction with the tip taper length caused unique strain distributions that increased the damage radius in some cases. Faster insertion velocities created more strain near the tip but less strain along the shank. Increased friction between the brain and electrode created more strain near the electrode tip and along the shank, but frictionless interactions resulted in increased tearing of brain tissue near the tip.Significance. These results demonstrate the first dynamic FEM study of neural electrode insertion, identifying design factors that can reduce tissue strain and potentially mitigate initial reactive tissue responses due to traumatic microelectrode array insertion.

Electrical rejuvenation of chronically implanted macroelectrodes in nonhuman primates.

Objective.Electrodes chronically implanted in the brain undergo complex changes over time that can lower the signal to noise ratio (SNR) of recorded signals and reduce the amount of energy delivered to the tissue during therapeutic stimulation, both of which are relevant for the development of robust, closed-loop control systems. Several factors have been identified that link changes in the electrode-tissue interface (ETI) to increased impedance and degraded performance in micro- and macro-electrodes. Previous studies have demonstrated that brief pulses applied every few days can restore SNR to near baseline levels during microelectrode recordings in rodents, a process referred to as electrical rejuvenation. However, electrical rejuvenation has not been tested in clinically relevant macroelectrode designs in large animal models, which could serve as preliminary data for translation of this technique. Here, several variations of this approach were tested to characterize parameters for optimization.Approach. Alternating-current (AC) and direct-current (DC) electrical rejuvenation methods were explored in three electrode types, chronically implanted in two adult male nonhuman primates (NHP) (Macaca mulatta), which included epidural electrocorticography (ECoG) electrodes and penetrating deep-brain stimulation (DBS) electrodes. Electrochemical impedance spectroscopy (EIS) was performed before and after each rejuvenation paradigm as a gold standard measure of impedance, as well as at subsequent intervals to longitudinally track the evolution of the ETI. Stochastic error modeling was performed to assess the standard deviation of the impedance data, and consistency with the Kramers-Kronig relations was assessed to evaluate the stationarity of EIS measurement.Main results. AC and DC rejuvenation were found to quickly reduce impedance and minimize the tissue component of the ETI on all three electrode types, with DC and low-frequency AC producing the largest impedance drops and reduction of the tissue component in Nyquist plots. The effects of a single rejuvenation session were found to last from several days to over 1 week, and all rejuvenation pulses induced no observable changes to the animals' behavior.Significance. These results demonstrate the effectiveness of electrical rejuvenation for diminishing the impact of chronic ETI changes in NHP with clinically relevant macroelectrode designs.

Radiation exposure to comforters and carers during paediatric molecular radiotherapy.

BACKGROUND: To show whether the incidental radiation exposure received by comforters and carers of children undergoing molecular radiotherapy was kept as low as reasonably achievable and was within English national dose constraints. PROCEDURE: The radiation exposure of adult comforters and carers was routinely monitored with a whole body personal dose meter while the child was in hospital. Data were collected on iodine-131 meta-iodobenzylguanidine (131 I-mIBG), lutetium-177 DOTATATE (177 Lu-DOTATATE), and iodine-131 sodium iodide (131 I-NaI) treatments. RESULTS: Data were available for 50 treatments with high-administered activity double-infusion 131 I-mIBG and 12 single administrations; 15 177 Lu-DOTATATE treatments and 28 131 I-NaI administrations. The median age was 7 years (1-18). The median administered activity of: 131 I-mIBG was 16.2 GBq (6.8-59 GBq) for double infusion patients and 8.1 GBq (5.26-16.25 GBq) for single administrations; 177 Lu-DOTATATE was 7.2 GBq (2.5-7.5 GBq); and 131 I-NaI was 3 GBq for thyroid remnant ablation and 5.5 GBq for cancer therapy. The median number of comforters and carers for all administrations was 2 (range 1-9). The median exposure values for comforters and carers for high-administered activity 131 I-mIBG administrations was 302 µSv (0-5282 µSv); for single fraction 131 I-mIBG 163 µSv (3-3104 µSv); 177 Lu-DOTATATE 6 µSv (1-79 µSv); and 131 I-NaI 37 µSv (0-274 µSv). Only one of the comforters and carers exceeded the dose constraint of 5 mSv. CONCLUSIONS: Doses to comforters and carers were in all but one case within the dose constraint nationally recommended by the Health Protection Agency, now part of Public Health England. New evidence is presented which show that comforter and carer radiation exposure levels from paediatric molecular radiotherapy in routine clinical practice are acceptably low. Pediatr Blood Cancer 2015;62:235-239. © 2014 Wiley Periodicals, Inc.

Transcatheter gelfoam embolization of posttraumatic bleeding pseudoaneurysms.

Diagnostic angiography combined with transcatheter therapeutic embolization is a simple and effective means of treating complex clinical situations associated with posttraumatic hemorrhage. Bleeding pseudoaneurysms, even when large, can be readily managed by this combined modality with resultant decrease in morbidity and hospital stay. Five patients with posttraumatic pseudoaneurysms are presented. All five were treated by transcatheter therapeutic embolization with Gelfoam. Of these five cases, three involved extremities, one involved the retroperitoneal space, and the last was of renal origin. Two of the five cases still required surgical intervention after initial successful therapeutic embolization, one for recurrent bleeding from collaterals and the other for evacuation of a massive pseudoaneurysm which was causing distraction of fracture fragments. The early use of angiography in suspected cases of posttraumatic hemorrhage, together with careful evaluation of potential collateral supply, is stressed. The use of transcatheter therapeutic embolization in the extremities as presented here is yet another example of the ever-broadening applicability of this technique.

The radiology corner. Bouveret's syndrome.

A case of gallstone obturation of the duodenal bulb is presented. The general topic of gallstone ileus is briefly discussed and a review of the reported cases of Bouveret's syndrome is presented. The radiographic criteria for diagnosis of these entities are emphasized.