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Bioelectronic medicine is a rapidly growing field that explores targeted neuromodulation in new treatment options addressing both disease and injury. New bioelectronic methods are being developed to monitor and modulate neural activity directly. The therapeutic benefit of these approaches has been validated in recent clinical studies in various conditions, including paralysis. By using decoding and modulation strategies together, it is possible to restore lost function to those living with paralysis and other debilitating conditions by interpreting and rerouting signals around the affected portion of the nervous system. This, in effect, creates a bioelectronic "neural bypass" to serve the function of the damaged/degenerated network. By learning the language of neurons and using neural interface technology to tap into critical networks, new approaches to repairing or restoring function in areas impacted by disease or injury may become a reality., (Copyright © 2019 Cold Spring Harbor Laboratory Press; all rights reserved.)

The human nervous system is a vast network carrying not only sensory and movement information, but also information to and from our organs, intimately linking it to our overall health. Scientists and engineers have been working for decades to tap into this network and 'crack the neural code' by decoding neural signals and learning how to 'speak' the language of the nervous system. Progress has been made in developing neural decoding methods to decipher brain activity and bioelectronic technologies to treat rheumatoid arthritis, paralysis, epilepsy and for diagnosing brain-related diseases such as Parkinson's and Alzheimer's disease. In a recent first-in-human study involving paralysis, a paralysed male study participant regained movement in his hand, years after his injury, through the use of a bioelectronic neural bypass. This work combined neural decoding and neurostimulation methods to translate and re-route signals around damaged neural pathways within the central nervous system. By extending these methods to decipher neural messages in the peripheral nervous system, status information from our bodily functions and specific organs could be gained. This, one day, could allow real-time diagnostics to be performed to give us a deeper insight into a patient's condition, or potentially even predict disease or allow early diagnosis. The future of bioelectronic medicine is extremely bright and is wide open as new diagnostic and treatment options are developed for patients around the world., (© 2017 The Association for the Publication of the Journal of Internal Medicine.)

Mental disorders, characterized by impaired emotional and mood balance, are common in the West. Recent surveys have found that millions of people (age 18?65) have experienced some kind of mental disorder, such as psychotic disorder, major depression, bipolar disorder, panic disorder, social phobia, and somatoform disorder [1]. Specifically, in 2010, 164.8 million people in Europe were affected by such illnesses [1].

Electronic laboratory notebooks (ELNs) are increasingly replacing paper notebooks in life science laboratories, including those in industry, academic settings, and hospitals. ELNs offer significant advantages over paper notebooks, but adopting them in a predominantly paper-based environment is usually disruptive. The benefits of ELN increase when they are integrated with other laboratory informatics tools such as laboratory information management systems, chromatography data systems, analytical instrumentation, and scientific data management systems, but there is no well-established path for effective integration of these tools. In this article, we review and evaluate some of the approaches that have been taken thus far and also some radical new methods of integration that are emerging.

Electronics have become central to many aspects of biomedicine, ranging from fundamental biophysical studies of excitable tissues to medical monitoring and electronic implants to restore limb movement. The development of new materials and approaches is needed to enable enhanced tissue integration, interrogation, and stimulation and other functionalities. Nanoscale materials offer many avenues for progress in this respect. New classes of molecular-scale bioelectronic interfaces can be constructed using either one-dimensional nanostructures, such as nanowires and nanotubes, or two-dimensional nanostructures, such as graphene. Nanodevices can create ultrasensitive sensors and can be designed with spatial resolution as fine as the subcellular regime. Structures on the nanoscale can enable the development of engineered tissues within which sensing elements are integrated as closely as the nervous system within native tissues. In addition, the close integration of nanomaterials with cells and tissues will also allow the development of in vitro platforms for basic research or diagnostics. Such lab-on-a-chip systems could, for example, enable testing of the effects of candidate therapeutic molecules on intercellular, single-cell, and even intracellular physiology. Finally, advances in nanoelectronics can lead to extremely sophisticated smart materials with multifunctional capabilities, enabling the spectrum of biomedical possibilities from diagnostic studies to the creation of cyborgs.

Background and Purpose: The aim of the study was to analyse the lifetime of Soletra implantable pulse generators (IPG) in deep brain stimulation (DBS) of the globus pallidus internus (GPi) for dystonia, depending on stimulation parameters and the total electrical energy delivered (TEED) by the IPG., Methods: In a prospective series of 20 patients with GPi DBS for dystonia, we recorded IPG longevity and stimulation parameters over time. An evaluation of the TEED was performed using the previously suggested equation [(voltage(2) × pulse width × frequency)/impedance] × 1 s., Results: During median follow-up of 57 months (range 23-79 months), 64 IPGs were replaced because of battery depletion or end of life signal. We found a mean IPG longevity of 25.1 ± 10.1 (range 16-60) months, which was inversely correlated with the TEED (r = -0.72; P < 0.001). IPG longevity was not different between bipolar and monopolar stimulation (24.9 ± 10.8 vs. 25.4 ± 9.0 months, P = 0.76). Incongruously, the mean TEED applied throughout the lifetime cycle was significantly higher in patients with bipolar compared with monopolar stimulation (584 ± 213 vs. 387 ± 121 Joule; P < 0.01)., Conclusions: Battery lifetime in GPi DBS for dystonia is substantially shorter compared with that reported in DBS for Parkinson's disease, caused by a considerably higher voltage and greater pulse width and therefore a higher TEED applied during the battery lifetime cycle. The commonly used equation to calculate TEED, however, seems to be correct only for monopolar, but not bipolar stimulation., (© 2010 The Author(s). European Journal of Neurology © 2010 EFNS.)

The evaluation and management of volume status in patients with heart failure is a challenge for most clinicians. In addition, such an evaluation is possible only during a personal clinician-patient interface. The ability to acquire hemodynamic data continuously with the help of implanted devices with remote monitoring capability can provide early warning of heart failure decompensation and thus may aid in preventing hospitalizations for heart failure. The data obtained also may improve the understanding of the disease process. It is important for the clinician treating patients who have heart failure to become acquainted with this type of technology and learn to interpret and use these data appropriately. This article reviews the implantable hemodynamics monitors currently available.

Introduction: Automated hand-held nerve conduction study (NCS) devices are being marketed for use in the diagnosis of lumbosacral radiculopathy (LSR). In this study we compared the specificity and sensitivity of a hand-held NCS device for the detection of LSR with standard electrodiagnostic study (EDX)., Methods: Fifty patients referred to a tertiary referral electromyography (EMG) laboratory for testing of predominantly unilateral leg symptoms (weakness, sensory complaints, and/or pain) were included in the investigation. Twenty-five normal "control" subjects were later recruited to calculate the specificity of the automated protocol. All patients underwent standard EDX and automated testing., Results: Raw NCS data were comparable for both techniques; however, computer-generated interpretations delivered by the automated device showed high sensitivity with low specificity (i.e., many false positives) in both symptomatic patients and normal controls., Conclusions: The automated device accurately recorded raw data, but the interpretations provided were overly sensitive and lacked the specificity necessary for a screening or diagnostic examination.

Neurally adjusted ventilatory assist or NAVA is a new assisted ventilatory mode which, in comparison with pressure support, leads to improved patient-ventilator synchrony and a more variable ventilatory pattern. It also improves arterial oxygenation. With NAVA, the electrical activity of the diaphragm is recorded through a nasogastric tube equipped with electrodes. This electrical activity is then used to pilot the ventilator. With NAVA, the patient's respiratory pattern controls the ventilator's timing of triggering and cycling as well as the magnitude of pressurization, which is proportional to inspiratory demand. The effect of NAVA on patient outcome remains to be determined through well-designed prospective studies.

Introduction: Recent advances in electronic nose technology, and successful clinical applications, are facilitating the development of new methods for rapid, bedside diagnosis of disease. There is a real clinical need for such new diagnostic tools in otolaryngology., Materials and Methods: We present a critical review of recent advances in electronic nose technology and current applications in otolaryngology., Results: The literature reports evidence of accurate diagnosis of common otolaryngological conditions such as sinusitis (acute and chronic), chronic suppurative otitis media, otitis externa and nasal vestibulitis. A significant recent development is the successful identification of biofilm-producing versus non-biofilm-producing pseudomonas and staphylococcus species., Conclusion: Electronic nose technology holds significant potential for enabling rapid, non-invasive, bedside diagnosis of otolaryngological disease.

Charge balancing is a major concern in functional electrical stimulation, since any excess charge accumulation over time leads to electrolysis with electrode dissolution and tissue destruction. Its major function is to ensure that the mean value of electrode voltage is kept within a safe level. However, it serves as a failure protection as well. This paper presents an overview on recent advances in this field, both passive and active (closed-loop) charge balancing techniques.

Inflammation often plays a key role in the perpetuation of pain. Chronic inflammatory conditions (e.g. osteoarthritis, immune system dysfunction, micro-circulatory disease, painful neuritis, and even heart disease) have increased as baby boomers age. Medicine's current anti-inflammatory choices are NSAIDs and steroids; the value in promoting cure and side effect risks of these medications are unclear and controversial, especially considering individual patient variations. Electricity has continuously been a powerful tool in medicine for thousands of years. All medical professionals are, to some degree, aware of electrotherapy; those who directly use electricity for treatment know of its anti-inflammatory effects. Electronic signal treatment (EST), as an extension of presently available technology, may reasonably have even more anti-inflammatory effects. EST is a digitally produced alternating current sinusoidal electronic signal with associated harmonics to produce theoretically reasonable and/or scientifically documented physiological effects when applied to the human body. These signals are produced by advanced electronics not possible even 10 to 15 years ago. The potential long-lasting anti-inflammatory effects of some electrical currents are based on basic physical and biochemical facts listed in the text below, namely that of stimulating and signaling effective and long-lasting anti-inflammatory effects in nerve and muscle cells. The safety of electrotherapeutic treatments in general and EST in particular has been established through extensive clinical use. The principles of physics have been largely de-emphasized in modern medicine in favor of chemistry. These electrical treatments, a familiar application of physics, thus represent powerful and appropriate elements of physicians' pain care armamentaria in the clinic and possibly for prescription for use at home to improve overall patient care and maintenance of quality of life via low-risk and potentially curative treatments.

To understand complex sensory-motor behavior related to object perception by echolocating bats, precise measurements are needed for echoes that bats actually listen to during flight. Recordings of echolocation broadcasts were made from flying bats with a miniature light-weight microphone and radio transmitter (Telemike) set at the position of the bat's ears and carried during flights to a landing point on a wall. Telemike recordings confirm that flying horseshoe bats (Rhinolophus ferrumequinum nippon) adjust the frequency of their sonar broadcasts to compensate for echo Doppler shifts. Returning constant frequency echoes were maintained at the bat's reference frequency +/-83 Hz during flight, indicating that the bats compensated for frequency changes with an accuracy equivalent to that at rest. The flying bats simultaneously compensate for increases in echo amplitude as target range becomes shorter. Flying bats thus receive echoes with both stabilized frequencies and stabilized amplitudes. Although it is widely understood that Doppler-shift frequency compensation facilitates detection of fluttering insects, approaches to a landing do not involve fluttering objects. Combined frequency and amplitude compensation may instead be for optimization of successive frequency modulated echoes for target range estimation to control approach and landing.

Electrical auditory brainstem responses (E-ABRs) of subjects with cochlear implants are used for monitoring the physiologic responses of early signal processing of the auditory system. Additionally, E-ABR measurements allow the diagnosis of retro-cochlear diseases. Therefore, E-ABR should be available in every cochlear implant center as a diagnostic tool. In this paper, we introduce a low-cost setup designed to perform an E-ABR as well as a conventional ABR for research purposes. The distributable form was developed with Matlab and the Matlab Compiler (The Mathworks Inc.). For the ABR, only a PC with a soundcard, conventional system headphones, and an EEG pre-amplifier are necessary; for E-ABR, in addition, an interface to the cochlea implant is required. For our purposes, we implemented an interface for the Combi 40+/Pulsar implant (MED-EL, Innsbruck).

The aim of this article is to give readers a general overview of the concepts involved in the latest generation of implantable hearing aids. A section on ear biomechanics has also been included to familiarize readers with the basic concepts involved. These devices have been developed over the last 20 years, driven by problems with conventional hearing aids and by advances in the understanding of middle-ear mechanics. The use of technology borrowed from cochlear implants has enabled the first generation of fully implantable aids to be trialled. The author examines the theoretical advantages and disadvantages of implantable hearing aids over conventional aids and then reviews the technology and clinical results of a range of devices that have been trialled.

The present status of the project aimed at the realization of an innovative wearable system-on-chip UWB radar for the cardiopulmonary monitoring is presented. The overall system consists of a wearable wireless interface including a fully integrated UWB radar for the detection of the heart beat and breath rates, and a IEEE 802.15.4 ZigBee low-power radio interface. The principle of operation of the UWB radar for the monitoring of the heart wall is summarized. With respect to the prior art, this paper reports the results of the experimental characterization of the intra-body channel loss, which has been carried out successfully in order to validate the theoretical model employed for the radar system analysis. Moreover, the main building blocks of the radar have been manufactured in 90 nm CMOS technology by ST-Microelectronics and the relevant performance are resulted in excellent agreement with those expected by post-layout simulations.

The electronics of a general biomedical device consist of energy delivery, analog-to-digital conversion, signal processing, and communication subsystems. Each of these blocks must be designed for minimum energy consumption. Specific design techniques, such as aggressive voltage scaling, dynamic power-performance management, and energy-efficient signaling, must be employed to adhere to the stringent energy constraint. The constraint itself is set by the energy source, so energy harvesting holds tremendous promise toward enabling sophisticated systems without straining user lifestyle. Further, once harvested, efficient delivery of the low-energy levels, as well as robust operation in the aggressive low-power modes, requires careful understanding and treatment of the specific design limitations that dominate this realm. We outline the performance and power constraints of biomedical devices, and present circuit techniques to achieve complete systems operating down to power levels of microwatts. In all cases, approaches that leverage advanced technology trends are emphasized.

The drug delivery device sector will be transformed by electronically controlled alternatives that will maximise user safety and medical effectiveness and open the way to the introduction of high-power, next-generation drugs. Current business partnerships will need to change to allow this to happen.

This paper describes the current situation concerning medical implants and suggests why the number of available devices is so limited. It then goes on to describe how a consortium was established from an EU network focussing specifically on Medical Devices. This consortium was successful in obtaining EU funding for the development of a range of medical implants that will help patients with specific disabilities relating to the nervous system, including deafness, blindness, lack of limb motion and urinary incontinence.

As well as being space saving, integrated passive components offer other opportunities for medical device applications. This article examines their advantages and looks at what the future holds.

Rationale and Objectives: The authors' purpose was to develop an electronic teaching module in nonpharmacologic analgesia and anxiolysis for use in the radiology department., Materials and Methods: The teaching document was derived from previous training courses validated by patient outcome. Skills in structured empathic attention and guidance of self-hypnotic relaxation were tested in a previous prospective, randomized study with 241 patients and shown to affect positively patients' perception of pain and anxiety. Patients undergoing hypnosis had the greatest relief and most hemodynamic stability. The skills applied also saved, on average, 17 minutes of procedure time and approximately $340 in sedation cost per case. With these validated behavioral skills, an electronic teaching module was constructed., Results: The mode of teaching reflected the content of teaching, which was achieved through a multimedia format containing text, audio, video, pictures, and animation. Advanced navigation tools put the students in control of their learning experience. Inclusion of experiential components, congruity of language with Ericksonian syntax, and provision of an electronic journal catered to the development of greater biobehavioral awareness., Conclusion: Electronic teaching modules for biobehavioral skill training are feasible and promise to reduce the time need for life interactions with instructors.

As advanced as today's critical care units are, changes in networks, computing platforms, instrumentation, human-machine interfaces, and software infrastructures and work being done in interoperability, process automation, and decision support all promise to alter both the structure and the operation of future critical unit settings. Although, as Yogi Berra said, "It's tough to make predictions, especially about the future," we can gain of a sense of the possibilities by studying emerging trends in each of these information technology-related areas. After describing notional physical and functional architectures for today's critical care units, this article provides a high-level overview of a number of trends in the areas listed above and provides the reader with starting points for further study. Although each of these trends may be fairly unremarkable when taken in isolation, when considered as a whole, the implications for critical care are profound. To that end, a final section of the article speculates on specific ways that these trends are likely to play themselves out in the context of tomorrow's critical care environments.

The most visible contributions of biomedical engineering to clinical practice involve instrumentation for diagnosis, therapy, and rehabilitation. Cell and tissue engineering also have emerged as clinical realities. In the next 25 years, advances in electronics, optics, materials, and miniaturization will accelerate development of more sophisticated devices for diagnosis and therapy, such as imaging and virtual surgery. The emerging new field of bioengineering-engineering based in the science of molecular cell biology-will greatly expand the scope of biomedical engineering to tackle challenges in molecular and genomic medicine.

Monitoring adherence with chronic opioid therapies is a critical yet often difficult task. Because chronic opioid therapy is often fraught with complex pharmacological, psychological, social, and legal issues, its application is often controversial or altogether avoided. Improved drug monitoring and surveillance may help reduce some of the reluctance to use chronic opioid therapy in patients with chronic pain states. We review the literature on patient adherence/compliance with chronic administration of opioids as well as novel methods by which adherence with opioid therapy can be measured.

This article outlines the up-to-date achievements of laser noninvasive clinical diagnostics. The outlook for its development and its close connection with the problems of physics, mathematics, and the electronic instrument-making industry are shown. The combined application of these disciplines in biology and medicine creates a novel integrated trend--medical physics.