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Background: Bell palsy is a sudden facial nerve paralysis that affects many individuals annually. It significantly impacts patients and their families, leading to a reduced quality of life if left untreated. The International Classification of Functioning, Disability, and Health (ICF) framework focuses on outcome measures, functional limitations, and overall quality of life of the patients. Early diagnosis is crucial for effective management of the condition. In order to standardize clinical practice and contribute to recommendations of certain interventions, this paper focuses on the optimal dosage of physiotherapy intervention for Bell palsy patients, which includes exercise therapy and electrotherapy. Case presentation: An Indian 33-year-old male visited our physiotherapy department 15 days after being diagnosed with right-sided Bell palsy with unknown aetiology. His chief complaints were right-eye dryness, facial pain, drooping of the face, and difficulty performing facial activities. The outcome measures are the strength duration curve (SD curve), House-Brackmann grading, manual muscle testing, and visual analogue scale (VAS) scale. The physiotherapy intervention includes two primary components: electrotherapy and exercise therapy. Conclusion: The Kabat rehabilitation technique, along with nerve stimulation and an active exercise regimen, is significantly effective in treating Bell palsy, and the outcome measures show significant improvement with optimal therapy dosage. [ABSTRACT FROM AUTHOR]

Background: Transcranial direct current stimulation (tDCS) has recently become a novel and non-invasive treatment option for refractory epilepsy. Previous systematic reviews have suggested that tDCS may be effective in treating epilepsy, this study presents the first meta-analysis on its effectiveness. Methods: We searched PubMed, Embase, Cochrane Library, and Web of Science for relevant randomized controlled trials (RCTs) from database inception to May 2024. The Cochrane risk of bias tool RoB2.0 was used to assess the risk of bias. Primary outcomes included changes in seizure frequency from baseline and the proportion of patients with a ≥50% reduction in seizure frequency. Results: Of the 608 studies initially identified, 14 were finally included. The pooled results from the random-effects model indicated that tDCS significantly reduced seizure frequency (WMD 0.41, 95% CI 0.24, 0.59). Further subgroup analysis revealed that tDCS significantly reduced seizure frequency in temporal lobe epilepsy, and seizure frequency was more alleviated in studies that had treatment sessions of fewer than 5 times, and followed up within 2 months' post-treatment. Only four studies provided data on patients with a ≥50% reduction in seizure frequency, showing no significant difference (RR 2.96, 95% CI 0.85, 10.32). In the systematic review, three studies analyzed cognitive function changes after tDCS treatment, but none reported significant improvements. The most common side effect during tDCS treatment was transient tingling, and no patients required additional life-support measures due to side effects. Conclusion: The current meta-analysis on available trials indicates that tDCS can effectively reduce seizure frequency in the short term and is well-tolerated. However, its impact on cognitive improvement in epilepsy patients requires further investigation. Systematic review registration: https://inplasy.com/inplasy-2024-6-0033/, identifier INPLASY202460033. [ABSTRACT FROM AUTHOR]

Implantable electrical neurostimulators offer a promising avenue for treating neurological disorders. However, their dependency on a finite battery life limits their long‐term utility. Emerging transcutaneous ultrasound‐driven triboelectric nanogenerator (TENG) techniques provide solutions for converting external ultrasound waves into internal electricity. This study proposes an implantable ultrasound‐driven TENG (IU‐TENG) using polyether ether ketone (PEEK) for its exceptional stability inside a human body and acoustic impedance compatibility with human tissues. This IU‐TENG remarkably surpasses traditional titanium‐based encapsulation, resulting in a 99.94% efficiency in ultrasound transmission. In addition, PEEK contains numerous electron‐donating functional groups, making it suitable for TENG applications, particularly as a positive triboelectric layer. The device exhibits robust voltage outputs, reaching up to 11.50 and 8.75 V in water and in vivo, respectively, under body‐safe ultrasound intensities. Moreover, its ability to sustain a stable electrical output for over 300 min emphasizes the durability and mechanical resilience of PEEK. In vivo mouse models and ex vivo porcine tissue trials demonstrate the effectiveness of the IU‐TENG in nerve stimulation, showing its potential in medical treatments, enhancing the functionality and longevity of implantable medical devices. [ABSTRACT FROM AUTHOR]

Abstract Background Bell palsy is a sudden facial nerve paralysis that affects many individuals annually. It significantly impacts patients and their families, leading to a reduced quality of life if left untreated. The International Classification of Functioning, Disability, and Health (ICF) framework focuses on outcome measures, functional limitations, and overall quality of life of the patients. Early diagnosis is crucial for effective management of the condition. In order to standardize clinical practice and contribute to recommendations of certain interventions, this paper focuses on the optimal dosage of physiotherapy intervention for Bell palsy patients, which includes exercise therapy and electrotherapy. Case presentation An Indian 33-year-old male visited our physiotherapy department 15 days after being diagnosed with right-sided Bell palsy with unknown aetiology. His chief complaints were right-eye dryness, facial pain, drooping of the face, and difficulty performing facial activities. The outcome measures are the strength duration curve (SD curve), House-Brackmann grading, manual muscle testing, and visual analogue scale (VAS) scale. The physiotherapy intervention includes two primary components: electrotherapy and exercise therapy. Conclusion The Kabat rehabilitation technique, along with nerve stimulation and an active exercise regimen, is significantly effective in treating Bell palsy, and the outcome measures show significant improvement with optimal therapy dosage.

The measurement of skeletal muscle fatigue in response to cycling exercise is commonly done in isometric conditions, potentially limiting its ecological validity, and creating challenges in monitoring the time course of muscle fatigue across an exercise bout. This study aimed to determine if muscle fatigue could be reliably assessed by measuring quadriceps twitch force evoked while pedaling, using instrumented pedals. Nine participants completed three laboratory visits: a step incremental test to determine power output at lactate threshold, and on separate occasions, two constant‐intensity bouts at a power output 10% above lactate threshold. Femoral nerve electrical stimulation was applied to elicit quadriceps twitch force both while pedaling (dynamic) and at rest (isometric). The test–retest reliability of the dynamic twitch forces and the agreement between the dynamic and isometric twitch forces were evaluated. Dynamic twitch force was found to have excellent reliability in an unfatigued state (intraclass correlation coefficient (ICC) = 0.920 and mean coefficient of variation (CV) = 7.5%), and maintained good reliability at task failure (ICC = 0.846 and mean CV = 11.5%). When comparing dynamic to isometric twitch forces across the task, there was a greater relative decline in the dynamic condition (P = 0.001). However, when data were normalized to the 5 min timepoint when potentiation between conditions was presumed to be more similar, this difference disappeared (P = 0.207). The reliability of this method was shown to be commensurate with the gold standard method utilizing seated isometric dynamometers and offers a new avenue to monitor the kinetics of muscle fatigue during cycling in real time. Highlights: The measurement of skeletal muscle fatigue during cycling exercise typically requires stopping the exercise task, potentially confounding the measurement, and limiting the frequency at which measurements can be madeWe have developed a novel method of assessing skeletal muscle fatigue which can be done while allowing cycling exercise to continue uninterruptedThe reliability of this method was shown to be commensurate with the gold standard method utilizing seated isometric dynamometers [ABSTRACT FROM AUTHOR]

Introduction: Overactive bladder (OAB) is a symptom syndrome consisting of urgency, frequency, and nocturia. It is a common urologic disorder. Percutaneous posterior tibial nerve stimulation (PTNS) is a minimally invasive, well-tolerated, and effective treatment of OAB. Recently, transcutaneous PTN stimulation (TTNS) with surface electrodes has been used, which is non-invasive. This study examines and compares the efficacy of these two therapy methods. Methods: In this randomized clinical trial, 44 patients with OAB were randomly assigned to PTNS and TTNS groups. In both groups, the therapeutic interventions were performed thrice a week for four weeks, 12 sessions. Incontinence quality of life questionnaire (I-QOL) and OAB symptom score (OABSS) were evaluated before the intervention, then one week and four weeks after completing the sessions. Results: Of 44 patients (41 females and 3 males), the mean age of the subjects was 51.95 years in the PTNS group and 56.86 years in the TTNS group (P=0.9). In our study, the patients’ urinary symptoms and QOL improved in both groups over time. Both interventions had no significant difference (P=0.796, P=0.372, respectively). Conclusion: PTNS and TTNS effectively improved patients’ symptoms of OAB and their QOL. TTNS can be considered as effective as conventional PTNS and a less invasive alternative for PTNS in OAB treatment. [ABSTRACT FROM AUTHOR]

Overactive bladder (OAB) is a highly prevalent condition with significant associated comorbidities. Current management guidelines suggest the utilization of anticholinergic medication as a second line after nonpharmacological treatment. Tibial nerve stimulation (TNS), which has previously been thought to have been expensive and inaccessible, was relegated to a third-line therapy. However, given the recently discovered association between anticholinergic medication use and dementia as well as the recent FDA approval of transcutaneous tibial nerve stimulation (TTNS), there may be a need to revisit management guidelines. In this commentary, we identify the two types of TNS, percutaneous tibial nerve stimulation (PTNS) and TTNS and compare them with anticholinergics. By considering their respective efficacies, side-effects profiles, and associated costs, we make the case in this commentary for an update to guidelines that includes TNS as second-line OAB management ahead of anticholinergic medication. [ABSTRACT FROM AUTHOR]

BackgroundTranscranial direct current stimulation (tDCS) has recently become a novel and non-invasive treatment option for refractory epilepsy. Previous systematic reviews have suggested that tDCS may be effective in treating epilepsy, this study presents the first meta-analysis on its effectiveness.MethodsWe searched PubMed, Embase, Cochrane Library, and Web of Science for relevant randomized controlled trials (RCTs) from database inception to May 2024. The Cochrane risk of bias tool RoB2.0 was used to assess the risk of bias. Primary outcomes included changes in seizure frequency from baseline and the proportion of patients with a ≥50% reduction in seizure frequency.ResultsOf the 608 studies initially identified, 14 were finally included. The pooled results from the random-effects model indicated that tDCS significantly reduced seizure frequency (WMD 0.41, 95% CI 0.24, 0.59). Further subgroup analysis revealed that tDCS significantly reduced seizure frequency in temporal lobe epilepsy, and seizure frequency was more alleviated in studies that had treatment sessions of fewer than 5 times, and followed up within 2 months' post-treatment. Only four studies provided data on patients with a ≥50% reduction in seizure frequency, showing no significant difference (RR 2.96, 95% CI 0.85, 10.32). In the systematic review, three studies analyzed cognitive function changes after tDCS treatment, but none reported significant improvements. The most common side effect during tDCS treatment was transient tingling, and no patients required additional life-support measures due to side effects.ConclusionThe current meta-analysis on available trials indicates that tDCS can effectively reduce seizure frequency in the short term and is well-tolerated. However, its impact on cognitive improvement in epilepsy patients requires further investigation.Systematic review registrationhttps://inplasy.com/inplasy-2024-6-0033/, identifier INPLASY202460033.

Aim: The aim of this study was to evaluate the effect of different treatment modalities for temporomandibular joint (TMJ) pain and their relevance to chronic cervical pain after 12 months. Settings and Design: This was a randomized controlled trial. Materials and Methods: Forty-eight participants with chronic cervical and TMJ pain were selected using research diagnostic criteria and randomized into four groups (n = 12), which included control, soft splints, transcutaneous electrical nerve stimulation (TENS), and low-level laser (LLL). The cervical and TMJ pain was recorded using visual analog scale (VAS) scores at baseline, 3 months, 6 months, and 12 months. Occlusal equilibration was done for all groups except for the control. Statistical Analysis Used: The mean pain scores were statistically analyzed using one-way analysis of variance and post hoc test. Results: The mean VAS scores in TMJ pain patients between the four groups at baseline and at final follow-up were 7.27 ± 1.29 in Group 1, 7.53 ± 0.70 in Group 2, 7.76 ± 0.80 in Group 3, and 7.61 ± 0.61 in Group 4. The mean difference between Groups 1 and 3, Groups 1 and 4, and Groups 2 and 3 was statistically significant (P < 0.00). Pearson correlation test yielded a mild and negative correlation between TMJ and cervical pain. Conclusion: TENS and LLL were found to be equally effective in reducing pain in the jaw joint region, followed by soft splints, and there was no correlation between TMJ and cervical pain.

Objective: To establish relationship between train-of-four ratio and clinical signs including head lift during emergence from general anesthesia. Study Design: Cross Sectional Study. Place and Duration of Study: Combined Military Hospital, Rawalpindi Pakistan, from Apr to Sep 2021. Methodology: A total of 93 patients with age range 18-60 years and ASA (American society of Anesthesiologist's) physical Status I or I undergoing an elective procedure lasting more than 60 minutes under general anesthesia were included in study. Train-of-four ratio was calculated using a nerve stimulator at the time of extubation folowed by the appearance of each clinical sign. Results: Of 93 patients 63(67.7%) were males while 30(32.2%) were females with mean age 35.6±12.5 years. 77(82.7%) patients were graded as ASA-I and 16(17.2%) were graded as ASA-I. The mean duration of surgery was 83.5±8.3 mins however the mean TOFR was 0.35±1.1. At the appearance of each clinical sign mean TOFR was calculated and recorded. The results showed significant relationship between clinical signs (sustained head lift, ability to retain tongue depressor, hand grip 60% of control and ability to cough) and Train-of-four ratio. Conclusion: There is a significant relationship between clinical signs (sustained head lift, ability to retain tongue depressor, hand grip 60% of control and ability to cough) and Train-of-four ratio. [ABSTRACT FROM AUTHOR]

Objectives: This review aims to present recent innovations and advancements in attention-deficit/hyperactivity disorder (ADHD) care, encompassing international consensus statement, new medication formulations, digital therapeutics, and neurostimulation devices. Methods: A comprehensive literature search of relevant articles published in the past five years was conducted, emphasizing the evidence base, efficacy, safety, and practical implications of these advancements. Results: The World Federation of ADHD Consensus Statement offers an updated diagnostic and treatment framework rooted in global scientific evidence. There are several newer ADHD medication formulations, including a nonstimulant (Viloxazine extended release) and the first transdermal amphetamine patch approved to treat ADHD. These options offer some unique benefits to personalize treatment based on symptom profile, lifestyle, preferences, and response. Digital tools offer additional means to restructure environments for individuals with ADHD, reducing impairment and reliance on others. In addition, digital therapeutics enhance access, affordability, personalization, and feasibility of ADHD care, complementing or augmenting existing interventions. Trigeminal nerve stimulation emerges as a well-tolerated nonpharmacological, device-based treatment for pediatric ADHD, with initial trials indicating effect sizes comparable to nonstimulant medications. Conclusions: These innovations in ADHD care represent clinically significant new treatment options and opportunities for personalized care. Health care professionals should integrate these developments into clinical practice, mindful of individual patient and family needs and preferences. Future research should assess long-term outcomes, cost-effectiveness, and acceptability of these innovations. [ABSTRACT FROM AUTHOR]

While physical performance has long been thought to be limited only by physiological factors, many experiments denote that psychological ones can also influence it. Specifically, the deception paradigm investigates the effect of psychological factors on performance by manipulating a psychological variable unbeknownst to the subjects. For example, during a physical exercise performed to failure, previous results revealed an improvement in performance (i.e., holding time) when the clock shown to the subjects was deceptively slowed down. However, the underlying neurophysiological changes supporting this performance improvement due to deceptive time manipulation remain unknown. Here, we addressed this issue by investigating from a neuromuscular perspective the effect of a deceptive clock manipulation on a single‐joint isometric task conducted to failure in 24 healthy participants (11 females). Neuromuscular fatigue was assessed by pre‐ to post‐exercise changes in quadriceps maximal voluntary torque (Tmax), voluntary activation level (VAL), and potentiated twitch (TTW). Our main results indicated a significant performance improvement when the clock was slowed down (Biased: 356 ± 118 s vs. Normal: 332 ± 112 s, p =.036) but, surprisingly, without any difference in the associated neuromuscular fatigue (p >.05 and BF < 0.3 for Tmax, VAL, and TTW between both sessions). Computational modeling showed that, when observed, the holding time improvement was explained by a neuromuscular fatigue accumulation based on subjective rather than actual time. These results support a psychological influence on neuromuscular processes and contribute significantly to the literature on the mind–body influence, by challenging our understanding of fatigue. Limits of physical performance can be extended by psychological manipulation. However, the fundamental mechanisms underlying this phenomenon remain unclear. Here we explore the underlying neurophysiological changes that support performance improvement due to deceptive clock manipulation. Our results showed that fatigue accumulation followed subjective rather than real time for participants who improved their performance, thus allowing to overcome physical performance limits without increasing the generated neuromuscular fatigue. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to evaluate the effect of different treatment modalities for temporomandibular joint (TMJ) pain and their relevance to chronic cervical pain after 12 months. Settings and Design: This was a randomized controlled trial. Materials and Methods: Forty-eight participants with chronic cervical and TMJ pain were selected using research diagnostic criteria and randomized into four groups (n = 12), which included control, soft splints, transcutaneous electrical nerve stimulation (TENS), and low-level laser (LLL). The cervical and TMJ pain was recorded using visual analog scale (VAS) scores at baseline, 3 months, 6 months, and 12 months. Occlusal equilibration was done for all groups except for the control. Statistical Analysis Used: The mean pain scores were statistically analyzed using one-way analysis of variance and post hoc test. *Results: The mean VAS scores in TMJ pain patients between the four groups at baseline and at final follow-up were 7.27 ± 1.29 in Group 1, 7.53 ± 0.70 in Group 2, 7.76 ± 0.80 in Group 3, and 7.61 ± 0.61 in Group 4. The mean difference between Groups 1 and 3, Groups 1 and 4, and Groups 2 and 3 was statistically significant (P < 0.00). Pearson correlation test yielded a mild and negative correlation between TMJ and cervical pain. Conclusion: TENS and LLL were found to be equally effective in reducing pain in the jaw joint region, followed by soft splints, and there was no correlation between TMJ and cervical pain. [ABSTRACT FROM AUTHOR]

The restoration of sensory feedback is one of the current challenges in the field of prosthetics. This work, following the analysis of the various types of sensory feedback, aims to present a prototype device that could be used both for implantable applications to perform PNS and for wearable applications, performing TENS, to restore sensory feedback. The two systems are composed of three electronic boards that are presented in detail, as well as the bench tests carried out. To the authors' best knowledge, this work presents the first device that can be used in a dual scenario for restoring sensory feedback. Both the implantable and wearable versions respected the expected values regarding the stimulation parameters. In its implantable version, the proposed system allows simultaneous and independent stimulation of 30 channels. Furthermore, the capacity of the wearable version to elicit somatic sensations was evaluated on healthy participants demonstrating performance comparable with commercial solutions. [ABSTRACT FROM AUTHOR]

As medical research advances and technology rapidly develops, auricular acupuncture has emerged as a point of growing interest. This paper delves into the intricate anatomy of auricular points, their significance and therapeutic principles in traditional Chinese medicine (TCM), and the underlying mechanisms of auricular acupuncture in contemporary medicine. The aim is to delve deeply into this ancient and mysterious medical tradition, unveiling its multi-layered mysteries in the field of neurostimulation. The anatomical structure of auricular points is complex and delicate, and their unique neurovascular network grants them a special status in neurostimulation therapy. Through exploration of these anatomical features, we not only comprehend the position of auricular points in TCM theory but also provide a profound foundation for their modern medical applications. Through systematic review, we synthesize insights from traditional Chinese medical theory for modern medical research. Building upon anatomical and classical theoretical foundations, we focus on the mechanisms of auricular acupuncture as a unique neurostimulation therapy. This field encompasses neuroregulation, pain management, psychological wellbeing, metabolic disorders, and immune modulation. The latest clinical research not only confirms the efficacy of auricular stimulation in alleviating pain symptoms and modulating metabolic diseases at the endocrine level but also underscores its potential role in regulating patients’ psychological wellbeing. This article aims to promote a comprehensive understanding of auricular acupuncture by demonstrating its diverse applications and providing substantial evidence to support its broader adoption in clinical practice.

Introduction:: Posterior tibial nerve stimulation (PTNS) is currently offered to patients with refractory overactive bladder (OAB). We aim to evaluate the efficacy, safety and long-term continuation of PTNS over 11 years. Methods:: We conducted a retrospective cohort study on all patients who underwent PTNS from 2012 to 2023. The primary outcomes were change in urinary frequency over 24 hours, maximum voided volume (MVV), number of episodes of urgency urinary incontinence (UUI) and patient perception of intensity of urgency scale (PPIUS). Results:: We identified 81 patients. 83% of patients completed 12 treatments of PTNS, and 54% of those that did not complete their full course of treatment stated that this was due to inefficacy. 33% of patients underwent PTNS ‘top ups’ as needed. Only 1 patient reported an adverse effect of musculoskeletal leg pain.28% of patients reported a subjective improvement of their symptoms by 50% or more. There was an average reduction in daytime frequency by 0.6 episodes (p = 0.033), an increase in MVV by 13mls (p = 0.927), a reduction in UUI episodes each day by 0.7 (p = 0.008) and a reduction in average PPIUS by 0.4 (p = 0.024). Conclusion:: PTNS remains a safe treatment option for patients with refractory OAB with evidence of both subjective and objective improvement to most symptoms. The majority of our patients completed a 12-week cycle but only 1 in 3 chose to have further PTNS ‘top ups’ and only 1 in 5 are continuing with PTNS for long term management of their OAB.

Emerging therapies in bioelectronic medicine highlight the need for deeper understanding of electrode material performance in the context of tissue stimulation. Electrochemical properties are characterized on the benchtop, facilitating standardization across experiments. On-nerve electrochemistry differs from benchtop characterization and the relationship between electrochemical performance and nerve activation thresholds are not commonly established. This relationship is important in understanding differences between electrical stimulation requirements and electrode performance. We report functional electrochemistry as a follow-up to benchtop testing, describing a novel experimental approach for evaluating on-nerve electrochemical performance in the context of nerve activation. An ex-vivo rat sciatic nerve preparation was developed to quantify activation thresholds of fiber subtypes and electrode material charge injection limits for platinum iridium, iridium oxide, titanium nitride and PEDOT. Finally, we address experimental complexities arising in these studies, and demonstrate statistical solutions that support rigorous material performance comparisons for decision making in neural interface development.

Introduction: Peripheral neuroprostheses are aimed to restore loss of sensory and motor functions by interfacing axons in the peripheral nerves. Most common interfaces in neuroprostheses are electrodes that establish electrical connection with peripheral axons. However, some challenges arise related to long-term functionality, durability, and body response. Recently, focused ultrasound stimulation (FUS) has emerged as a non-invasive approach to modulate the nervous system. However, it is controversial whether FUS can induce axon depolarization. Methods: We have assessed FUS applied in vivo to the rat peripheral nerve, with two objectives: first, to test whether FUS activates peripheral nerves under different stimulation conditions, and second, to evaluate if FUS inflicts damage to the nerve. FUS was delivered with three ultrasound transducers (Sonic Concept H115, H107, and H102) covering the largest set of parameters examined for FUS of peripheral nerves so far. Results: We did not obtain reliable evoked action potentials in either nerves or muscles, under any FUS condition applied, neither over the skin nor directly to the nerve exposed. Additional experiments ex vivo and in vivo on mice, confirmed this conclusion. When FUS stimulation was applied directly to the exposed sciatic nerve, neuromuscular function decreased significantly, and recovered one week later, except for FUS at 0.25 MHz. Histologically, degenerating nerve fibers were observed, with a tendency to be higher with the lower FUS frequency. Discussion: Past reports on the ability of ultrasound to stimulate the peripheral nerve are controversial. After testing a wide range of FUS conditions, we conclude that it is not a reliable and safe method for stimulating the peripheral nerve. Special consideration should be taken, especially when low-frequency FUS is applied, as it may lead to nerve damage. [ABSTRACT FROM AUTHOR]

Cochlear implants are among the most successful neural prosthetic devices to date but exhibit poor frequency selectivity and the inability to consistently activate apical (low frequency) spiral ganglion neurons. These issues can limit hearing performance in many cochlear implant patients, especially for understanding speech in noisy environments and in perceiving or appreciating more complex inputs such as music and multiple talkers. For cochlear implants, electrical current must pass through the bony wall of the cochlea, leading to widespread activation of auditory nerve fibers. Cochlear implants also cannot be implanted in some individuals with an obstruction or severe malformations of the cochlea. Alternatively, intraneural stimulation delivered via an auditory nerve implant could provide direct contact with neural fibers and thus reduce unwanted current spread. More confined current during stimulation can increase selectivity of frequency fiber activation. Furthermore, devices such as the Utah Slanted Electrode Array can provide access to the full cross section of the auditory nerve, including low frequency fibers that are difficult to reach using a cochlear implant. However, further scientific and preclinical research of these Utah Slanted Electrode Array devices is limited by the lack of a chronic large animal model for the auditory nerve implant, especially one that leverages an appropriate surgical approach relevant for human translation. This paper presents a newly developed transbullar translabyrinthine surgical approach for implanting the auditory nerve implant into the cat auditory nerve. In our first of a series of studies, we demonstrate a surgical approach in non-recovery experiments that enables implantation of the auditory nerve implant into the auditory nerve, without damaging the device and enabling effective activation of the auditory nerve fibers, as measured by electrode impedances and electrically evoked auditory brainstemresponses. These positive resultsmotivate performing future chronic cat studies to assess the long-term stability and function of these auditory nerve implant devices, as well as development of novel stimulation strategies that can be translated to human patients. [ABSTRACT FROM AUTHOR]

Background: Cognitive dysfunction, including impairments in attention, memory, executive function, and processing speed. This study was developed to determine the effectiveness of transcutaneous auricular vagal nerve stimulation on cognitive impairment among subjects with anterior cerebral artery syndrome. Purpose: The purpose of the study is to compare and evaluate the effectiveness of two non-pharmacological methods of treatment for cognitive impairment patients with ACA syndrome. Material and Methods: The project was conducted as a pilot study in a private hospital in Chennai. The experimental group (group A) received transcutaneous auricular vagal nerve stimulation for 20 minutes and conventional strengthening exercises for the affected limb for 10 minutes. Group B got conventional cognitive training (20 minutes) and strengthening exercises (10 minutes). Following the four-week treatment, a post-test analysis was performed using the Montreal cognitive assessment scale. Results: The post-test analysis obtained a mean value of about 27.25 and SD 1.5 for group A, whereas group B revealed 22.75 ± 1.25, mean ± SD, and a significant P value of 0.004. Conclusion: Non-invasive transcutaneous auricular vagal nerve stimulation has been proven to be an effective approach for preventing vascular dementia. [ABSTRACT FROM AUTHOR]

Purpose The global prevalence of overactive bladder (OAB) is estimated at 11.8%. Despite existing treatment options such as sacral neuromodulation, a substantial number of patients remain untreated. One potential alternative is noninvasive transcutaneous electrical stimulation. This form of stimulation does not necessitate the implantation of an electrode, thereby eliminating the need for highly skilled surgeons, expensive implantable devices, or regular hospital visits. We hypothesized that alternative neural pathways can impact bladder contraction. Methods In this pilot study, we conducted transcutaneous electrical stimulation of the abdominal wall (T6-L1), the ear (vagus nerve), and the ankle (tibial nerve) of 3 anesthetized female Sprague-Dawley rats. Stimulation was administered within a range of 20 Hz to 20 kHz, and its impact on intravesical pressure was measured. We focused on 3 primary outcomes related to intravesical pressure: (1) the pressure change from the onset of a contraction to its peak, (2) the average duration of contraction, and (3) the number of contractions within a specified timeframe. These measurements were taken while the bladder was filled with either saline or acetic acid (serving as a model for OAB). Results Transcutaneous stimulation of the abdominal wall, ear, and ankle at a frequency of 20 Hz decreased the number of bladder contractions during infusion with acetic acid. As revealed by a comparison of various stimulation frequencies of the tibial nerve during bladder infusion with acetic acid, the duration of contraction was significantly shorter during stimulation at 1 kHz and 3 kHz relative to stimulation at 20 Hz (P = 0.025 and P = 0.044, respectively). Conclusions The application of transcutaneous electrical stimulation to the abdominal wall, ear, and tibial nerve could provide less invasive and more cost-effective treatment options for OAB relative to percutaneous tibial nerve stimulation and sacral neuromodulation. A follow-up study involving a larger sample size is recommended.

IntroductionPeripheral neuroprostheses are aimed to restore loss of sensory and motor functions by interfacing axons in the peripheral nerves. Most common interfaces in neuroprostheses are electrodes that establish electrical connection with peripheral axons. However, some challenges arise related to long-term functionality, durability, and body response. Recently, focused ultrasound stimulation (FUS) has emerged as a non-invasive approach to modulate the nervous system. However, it is controversial whether FUS can induce axon depolarization.MethodsWe have assessed FUS applied in vivo to the rat peripheral nerve, with two objectives: first, to test whether FUS activates peripheral nerves under different stimulation conditions, and second, to evaluate if FUS inflicts damage to the nerve. FUS was delivered with three ultrasound transducers (Sonic Concept H115, H107, and H102) covering the largest set of parameters examined for FUS of peripheral nerves so far.ResultsWe did not obtain reliable evoked action potentials in either nerves or muscles, under any FUS condition applied, neither over the skin nor directly to the nerve exposed. Additional experiments ex vivo and in vivo on mice, confirmed this conclusion. When FUS stimulation was applied directly to the exposed sciatic nerve, neuromuscular function decreased significantly, and recovered one week later, except for FUS at 0.25 MHz. Histologically, degenerating nerve fibers were observed, with a tendency to be higher with the lower FUS frequency.DiscussionPast reports on the ability of ultrasound to stimulate the peripheral nerve are controversial. After testing a wide range of FUS conditions, we conclude that it is not a reliable and safe method for stimulating the peripheral nerve. Special consideration should be taken, especially when low-frequency FUS is applied, as it may lead to nerve damage.

The carotid sinus nerve (CSN) is well known as mediating baroreflexes. However, studies of its detailed histological analysis are scant in the literature. Therefore, the current anatomical study sought to better elucidate the microanatomy of the CSN. Ten fresh frozen adult cadavers underwent dissection of the CSN. Then, it was harvested and submitted for histological and immunohistochemical staining. Specimens were all shown to be nerve fibers on histology and immunohistochemistry. We identified tyrosine hydroxylase positive fibers in all CSN specimens. These fibers were always found to be within the CSN and not on its surface i.e., epineurium. Based on our findings, the majority of fibers contained in the CSN are tyrosine positive in nature. Further studies are necessary to understand the true function of this autonomic nerve fibers. [ABSTRACT FROM AUTHOR]

Purpose: Chronic post-operative inguinal pain (CPIP) following inguinal hernia repair has been a major sequela affecting 4000–48000 patients annually. Optimal management of CPIP has been a challenge, and pharmacological management particularly with opioids has shown unsatisfactory results. The main objective of this systematic review is to investigate the safety and efficacy of neuromodulation as an alternative intervention for the management of post-operative inguinal pain. Methods: A literature search was conducted by three reviewers to identify all relevant studies on the use of neuromodulatory interventions for treating post-operative inguinal pain. Data on study characteristics, neuromodulatory modalities, and patient's clinical data such as pre/post-interventional pain scores and analgesic requirements were extracted and reported. Results: A total of 389 patients with 357 (95.9%) males and 15 (4.1%) females were evaluated. The mean age of study participants was 47.9 ± 10.4 years. There were 187 (48.1%) and 202 (51.9%) patients allocated to the control and trial groups, respectively. The most common neuromodulation modality was TENS (4, 36.4%), followed by SCS (3, 27.3%), PNS (3, 27.3%), and acupuncture-assisted (2, 18.2%). The overall mean follow-up duration of the entire cohort was 3.8 months. The mean difference between pre-operative and post-operative VAS scores in the trial groups was 4.65 (95% Confidence Interval [CI], 2.97, 6.33), which was statistically significant (P value < 0.05). Patient-reported outcome measures showed significant responsiveness toward their treatments. Conclusion: Nerve stimulation, in its many forms, is a safe and feasible option for the management of post-operative inguinal pain. [ABSTRACT FROM AUTHOR]

Purpose of Review: Overactive bladder (OAB) is a prevalent condition affecting 23% of the population in the USA. There are several options for third-line therapies (intradetrusoronabotulinumtoxinA injections, sacral (S3) nerve stimulation, and posterior tibial nerve stimulation (PTNS)), each with its own strengths and weaknesses. Recent Findings: Implantable tibial nerve stimulators (ITNS) are a new type of device based on PTNSprinciples; however, ITNS may carry several advantages over previous therapeutic modalities. Typically, ITNS is an office-based procedure obviating the need for general anesthesia or sedation. There is no need for frequent office visits or repeat procedures (as with intradetrusoronabotulinumtoxinA injections) once these devices are implanted. Summary: ITNS stimulators have enabled a much more flexible system of administering and managing tibial nerve stimulation. Not only does ITNS offer convenience, but it offers the ability to manipulate the frequency, length, and strength of stimulation sessions. This review describes the current available devices, published clinical data, and ongoing clinical trials for future devices. [ABSTRACT FROM AUTHOR]

Bioelectronic medicine uses electrical stimulation of the nervous system to improve health outcomes throughout the body primarily by regulating immune responses. This concept, however, has yet to be applied systematically to the auditory system. There is growing interest in how cochlear damage and associated neuroinflammation may contribute to hearing loss. In conjunction with recent findings, we propose here a new perspective, which could be applied alongside advancing technologies, to use auditory nerve (AN) stimulation to modulate immune responses in hearing health disorders and following surgeries for auditory implants. In this article we will: (1) review the mechanisms of inflammation in the auditory system in relation to various forms of hearing loss, (2) explore nerve stimulation to reduce inflammation throughout the body and how similar neural-immune circuits likely exist in the auditory system (3) summarize current methods for stimulating the auditory system, particularly the AN, and (4) propose future directions to use bioelectronic medicine to ameliorate harmful immune responses in the inner ear and auditory brainstem to treat refractory conditions. We will illustrate how current knowledge from bioelectronic medicine can be applied to AN stimulation to resolve inflammation associated with implantation and disease. Further, we suggest the necessary steps to get discoveries in this emerging field from bench to bedside. Our vision is a future for AN stimulation that includes additional protocols as well as advances in devices to target and engage neural-immune circuitry for therapeutic benefits.

Purpose: The global prevalence of overactive bladder (OAB) is estimated at 11.8%. Despite existing treatment options such as sacral neuromodulation, a substantial number of patients remain untreated. One potential alternative is noninvasive transcutaneous electrical stimulation. This form of stimulation does not necessitate the implantation of an electrode, thereby eliminating the need for highly skilled surgeons, expensive implantable devices, or regular hospital visits. We hypothesized that alternative neural pathways can impact bladder contraction. Methods: In this pilot study, we conducted transcutaneous electrical stimulation of the abdominal wall (T6-L1), the ear (vagus nerve), and the ankle (tibial nerve) of 3 anesthetized female Sprague-Dawley rats. Stimulation was administered within a range of 20 Hz to 20 kHz, and its impact on intravesical pressure was measured. We focused on 3 primary outcomes related to intravesical pressure: (1) the pressure change from the onset of a contraction to its peak, (2) the average duration of contraction, and (3) the number of contractions within a specified timeframe. These measurements were taken while the bladder was filled with either saline or acetic acid (serving as a model for OAB). Results: Transcutaneous stimulation of the abdominal wall, ear, and ankle at a frequency of 20 Hz decreased the number of bladder contractions during infusion with acetic acid. As revealed by a comparison of various stimulation frequencies of the tibial nerve during bladder infusion with acetic acid, the duration of contraction was significantly shorter during stimulation at 1 kHz and 3 kHz relative to stimulation at 20 Hz (P=0.025 and P=0.044, respectively). Conclusions: The application of transcutaneous electrical stimulation to the abdominal wall, ear, and tibial nerve could provide less invasive and more cost-effective treatment options for OAB relative to percutaneous tibial nerve stimulation and sacral neuromodulation. A follow-up study involving a larger sample size is recommended. [ABSTRACT FROM AUTHOR]

Patients with impaired quality of life associated with xerostomia need long-term treatment, and a nerve stimulator has the advantage of providing natural saliva and long-term management for patients with xerostomia by electrically stimulating the relevant secretory nerves to promote saliva production. A number of clinical trials have preliminarily demonstrated the efficacy of nerve electrical stimulation in the treatment of xerostomia. However, electrical stimulation has not yet become the mainstream treatment for xerostomia. Large prospective randomized controlled clinical trials are still needed to confirm its long-term effectiveness and safety. In addition, the design of nerve stimulators is of great significance for clinical application. The large volume and inconvenient treatment associated with the extra oral nerve stimulator and the first generation intraoral nerve stimulator hinder their clinical application and popularization. The second- and third-generation intraoral nerve stimulator devices are small, convenient to use and have great application prospects. Research on electrical nerve stimulators for xerostomia treatment is mainly concentrated in European and American countries, while there is very little domestic research. It is urgent to master the core technology for the research and development of electrical nerve stimulators. The innovation of miniaturization, efficient power supply, data feedback and packaging will be the key issues of electrical nerve stimulators in the future. In this paper, the treatment and research of electrical nerve stimulation for xerostomia are reviewed to provide a reference for related basic research and the clinical application of electrical stimulators treating xerostomia in China.

Abstract Background Neuroinflammation is an important driver of acute and chronic pain states. Therefore, targeting molecular mediators of neuroinflammation may present an opportunity for developing novel pain therapies. In preclinical models of neuroinflammatory pain, calcitonin gene-related peptide (CGRP), substance P and high mobility group box 1 protein (HMGB1) are molecules synthesized and released by sensory neurons which activate inflammation and pain. High-frequency electrical nerve stimulation (HFES) has achieved clinical success as an analgesic modality, but the underlying mechanism is unknown. Here, we reasoned that HFES inhibits neuroinflammatory mediator release by sensory neurons to reduce pain. Methods Utilizing in vitro and in vivo assays, we assessed the modulating effects of HFES on neuroinflammatory mediator release by activated sensory neurons. Dorsal root ganglia (DRG) neurons harvested from wildtype or transgenic mice expressing channelrhodopsin-2 (ChR2) were cultured on micro-electrode arrays, and effect of HFES on optogenetic- or capsaicin-induced neuroinflammatory mediator release was determined. Additionally, the effects of HFES on local neuroinflammatory mediator release and hyperalgesia was assessed in vivo using optogenetic paw stimulation and the neuropathic pain model of chronic constriction injury (CCI) of the sciatic nerve. Results Light- or capsaicin-evoked neuroinflammatory mediator release from cultured transgenic DRG sensory neurons was significantly reduced by concurrent HFES (10 kHz). In agreement with these findings, elevated levels of neuroinflammatory mediators were detected in the affected paw following optogenetic stimulation or CCI and were significantly attenuated using HFES (20.6 kHz for 10 min) delivered once daily for 3 days. Conclusion These studies reveal a previously unidentified mechanism for the pain-modulating effect of HFES in the setting of acute and chronic nerve injury. The results support the mechanistic insight that HFES may reset sensory neurons into a less pro-inflammatory state via inhibiting the release of neuroinflammatory mediators resulting in reduced inflammation and pain.

During esophagectomy, the vagus nerve is transected, which may add to the development of postoperative complications. The vagus nerve has been shown to attenuate inflammation and can be activated by a high-fat nutrition via the release of acetylcholine. This binds to α7 nicotinic acetylcholine receptors (α7nAChR) and inhibits α7nAChR-expressing inflammatory cells. This study investigates the role of the vagus nerve and the effect of high-fat nutrition on lipopolysaccharide (LPS)-induced lung injury in rats. Firstly, 48 rats were randomized in 4 groups as follows: sham (sparing vagus nerve), abdominal (selective) vagotomy, cervical vagotomy and cervical vagotomy with an α7nAChR-agonist. Secondly, 24 rats were randomized in 3 groups as follows: sham, sham with an α7nAChR-antagonist and cervical vagotomy with an α7nAChR-antagonist. Finally, 24 rats were randomized in 3 groups as follows: fasting, high-fat nutrition before sham and high-fat nutrition before selective vagotomy. Abdominal (selective) vagotomy did not impact histopathological lung injury (LIS) compared with the control (sham) group (p > 0.999). There was a trend in aggravation of LIS after cervical vagotomy (p = 0.051), even after an α7nAChR-agonist (p = 0.090). Cervical vagotomy with an α7nAChR-antagonist aggravated lung injury (p = 0.004). Furthermore, cervical vagotomy increased macrophages in bronchoalveolar lavage (BAL) fluid and negatively impacted pulmonary function. Other inflammatory cells, TNF-α and IL-6, in the BALF and serum were unaffected. High-fat nutrition reduced LIS after sham (p = 0.012) and selective vagotomy (p = 0.002) compared to fasting. vagotomy. This study underlines the role of the vagus nerve in lung injury and shows that vagus nerve stimulation using high-fat nutrition is effective in reducing lung injury, even after selective vagotomy. [ABSTRACT FROM AUTHOR]

Introduction: Sacral neuromodulation (SNM) is a treatment approved for use in several conditions including refractory overactive bladder (OAB) and voiding dysfunction. Chronic pelvic pain (CPP) is a debilitating condition for which treatment is often challenging. SNM shows promising effect in patients with refractory CPP. However, there is a lack of clear evidence, especially in long‐term outcomes. This systematic review will assess outcomes of SNM for treating CPP. Methods: A systematic search of MEDLINE, Embase, Cochrane Central and clinical trial databases was completed from database inception until January 14, 2022. Studies using original data investigating SNM in an adult population with CPP which recorded pre and posttreatment pain scores were selected. Primary outcome was numerical change in pain score. Secondary outcomes were quality of life assessment and change in medication use and all‐time complications of SNM. Risk of bias was assessed using the Newcastle Ottawa Tool for cohort studies. Results: Twenty‐six of 1026 identified articles were selected evaluating 853 patients with CPP. The implantation rate after test‐phase success was 64.3%. Significant improvement of pain scores was reported in 13 studies; three studies reported no significant change. WMD in pain scores on a 10‐point scale was −4.64 (95% confidence interval [CI] = −5.32 to −3.95, p < 0.00001) across 20 studies which were quantitatively synthesized: effects were maintained at long‐term follow‐up. Mean follow‐up was 42.5 months (0–59). Quality of life was measured by RAND SF‐36 and EQ‐5D questionnaires and all studies reported improvement in quality of life. One hundred and eighty‐nine complications were reported in 1555 patients (Clavien‐Dindo Grade I‐IIIb). Risk of bias ranged from low to high risk. Studies were case series and bias stemmed from selection bias and loss to follow‐up. Conclusion: Sacral Neuromodulation is a reasonably effective treatment of Chronic Pelvic Pain and significantly reduces pain and increases patients' quality of life with immediate to long‐term effects. [ABSTRACT FROM AUTHOR]

The restoration of sensory feedback is one of the current challenges in the field of prosthetics. This work, following the analysis of the various types of sensory feedback, aims to present a prototype device that could be used both for implantable applications to perform PNS and for wearable applications, performing TENS, to restore sensory feedback. The two systems are composed of three electronic boards that are presented in detail, as well as the bench tests carried out. To the authors’ best knowledge, this work presents the first device that can be used in a dual scenario for restoring sensory feedback. Both the implantable and wearable versions respected the expected values regarding the stimulation parameters. In its implantable version, the proposed system allows simultaneous and independent stimulation of 30 channels. Furthermore, the capacity of the wearable version to elicit somatic sensations was evaluated on healthy participants demonstrating performance comparable with commercial solutions.

Pendahuluan: Gangguan pemusatan perhatian dan hiperaktivitas (GPPH) masih menjadi masalah kesehatan jiwa di dunia dan angka kejadian GPPH masih cukup tinggi di Indonesia. Hingga kini, standar regimen yang digunakan adalah farmakoterapi dengan obat golongan psikostimulan yang dinilai kurang baik karena memiliki berbagai efek samping. Sebagai alternatif, terdapat inovasi terbaru, yaitu nerve stimulation, yang merupakan sebuah prosedur non-invasif dan dapat ditoleransi dengan baik. Nerve stimulation dapat dilakukan melalui rangsangan elektrik pada saraf trigeminus (Trigeminal Nerve Stimulation) dan saraf vagus (Vagus Nerve Stimulation). Tujuan: Mencari terapi alternatif dengan efektivitas tinggi dan efek samping minimal dalam tatalaksana GPPH. Metode: Pada literature review ini, dilakukan penelusuran kata kunci “nerve stimulation”, “transcutaneous vagus nerve stimulation”, “trigeminal nerve stimulation”, dan “GPPH” melalui beberapa search engine. Setelah itu, dilanjutkan dengan skrining dimana diperoleh 6 jurnal yang selanjutnya ditinjau secara seksama. Pembahasan: Pasien dengan GPPH mengalami gangguan regulasi neurotransmitter dimana terdapat penurunan dopamin, GABA dan norepinefrin. Penggunaan nerve stimulation dipercaya dapat menjadi terapi efektif untuk pasien GPPH. Uji klinis terhadap nerve stimulation pada saraf trigeminus telah menunjukan penurunan nilai ADHD-IV Rating Scale dan Conners Global Index. Stimulasi saraf vagus juga menunjukkan peningkatan produksi neurotransmitter GABA dan norepinefrin dengan cara merangsang beberapa regio di otak terutama nucleus tractus solitarius dan locus coeruleus. Kesimpulan: Salah satu terapi mutakhir yang dapat digunakan dalam pengobatan GPPH adalah dengan menggunakan alat nerve stimulator. Secara keseluruhan, nerve stimulation memberikan efek yang baik pada pengobatan GPPH. Terapi nerve stimulation relatif aman dengan efek samping minimal yang dapat ditoleransi pada mayoritas individu.

Objective: To compare the ultrasound-guided nerve block with ultrasound-guided nerve stimulation technique for obturator nerve block (ONB) in patients undergoing transurethral resection of bladder tumour (TURBT). Study Design: Prospective comparative study. Place and Duration of Study: Department of Anesthesiology, Nishtar Medical University/Hospital Multan from Jan to Jul 2019. Methodology: A total of 80 patients were divided into two groups. In Group-I, an ultrasound-guided nerve block was applied, while in Group-II, an ultrasound-guided nerve stimulation technique was applied for the block. Time of onset/ success of motor block and ease of approach were the primary study endpoints. At the same time, the surgeon and patient satisfaction were secondary endpoints. Results: Motor block onset time was 6.58±2.16 minutes in Group-II versus 12.41±2.39 minutes in Group-I (p-value

Sleep apnea disorder is a kind of abnormal respiratory disease occurring during sleep, covering a variety of types, among which the most common types are obstructive sleep apnea and central sleep apnea. Traditional treatment methods have certain limitations. In recent years, the nerve electrical stimulation therapy has developed rapidly and become a new choice for sleep apnea. This article intends to review the development and clinical application of nerve electrical stimulation therapy, in order to provide reference for clinical practice. [ABSTRACT FROM AUTHOR]

Rehabilitation and treatment of injuries is of high importance in returning the injured part to its normal position through rehabilitative exercises. The exercises should be based on mechanical and anatomical physiology through the physical and diagnostic test for each individual separately. Therefore, rehabilitation is a means of treating various injuries by using electrical stimulation of the nerve. For this aim, the researcher prepared rehabilitative exercises preceded by the use of electrical stimulation of the nerve in the rehabilitation of de Quervain syndrome. Through the researcher's access to many references and her visit to many treatment centers, she found that all rehabilitation programs are based on the repetition of certain exercises; therefore, the researcher decided to develop solutions to this problem. The researcher hypothesized that there are differences between the pre and post tests. The researcher further applied the exercises on a sample of (5) patients. The research concluded that the exercises preceded by the stimulation device in rehabilitating the de Quervain syndrome are effective, and recommended adopting the rehabilitative approach to physiotherapy centers. [ABSTRACT FROM AUTHOR]

Background: The various mechanisms involved in peripheral nerve regeneration, induced by exercise and electrical nerve stimulation, are still unclear. Objective: The aim of this review was to summarize the influence of physical exercise and/or electrical stimulation on peripheral nerve repair and regeneration and the variation of impact of intervention depending on timing, as well as kind and dosage of the intervention. A literature survey was conducted on PubMed, Scopus, and Web of Science, between February 2021 to July 2021, with an update in September 2022. Methodology: The literature search identified 101,386 articles with the keywords: "peripheral nerve" OR "neuropathy" AND "sprouting" OR "neuroapraxia" OR "axonotmesis" OR "neurotmesis" OR "muscle denervation" OR "denervated muscle" AND "rehabilitation" OR "physical activity" OR "physical exercise" OR "activity" OR "electrical stimulation". A total of 60 publications were included. Eligible studies were focused on evaluating the process of nerve repair (biopsy, electromyographic parameters or biomarker outcomes) after electrical stimulation or physical exercise interventions on humans or animals with peripheral sensory or motor nerve injury. Synthesis: This study shows that the literature, especially regarding preclinical research, is mainly in agreement that an early physical program with active exercise and/or electrical stimulation promotes axonal regenerative responses and prevents maladaptive response. This was evaluated by means of changes in electrophysiological recordings of CMAPs for latency amplitude, and the sciatic functional index (SFI). Furthermore, this type of activity can cause an increase in weight and in muscle fiber diameter. Nevertheless, some detrimental effects of exercising and electrical stimulation too early after nerve repair were recorded. Conclusion: In most preclinical studies, peripheral neuropathy function was associated with improvements after physical exercise and electrical stimulation. For humans, too little research has been conducted on this topic to reach a complete conclusion. This research supports the need for future studies to test the validity of a possible rehabilitation treatment in humans in cases of peripheral neuropathy to help nerve sprouting. [ABSTRACT FROM AUTHOR]

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Abstract Background Patients with lower limb fracture often have acute pain and discomfort from changes in position, and such pain affects early postoperative recovery. This study aimed to compare the applicability and effectiveness of ultrasound combined with nerve stimulator-guided lumbosacral plexus block (LSPB) in the supine versus lateral position during lower limb fracture surgery. Methods We included 126 patients who underwent elective internal fixation for lower limb fracture who were divided into the S group and the L group by the random number table method and underwent LSPB guided by ultrasound combined with a nerve stimulator in the supine and lateral positions, respectively. The primary outcome was the dose of sufentanil used in surgery. The secondary outcomes were the maximum VAS (visual analogue scale) pain score at position placing for LSPB, the time of position placing, the time for nerve block,the number of puncture attempts,the haemodynamic indicators, the VAS score at 1, 12, and 24 h following surgery, postoperative satisfactory degree to analgesia and adverse events related to nerve block. Results There was no statistically significant difference in dose of sufentanil used between the two groups(P = 0.142). The maximum VAS pain score at position placing(P 0.05). Conclusions Our study provides a more comfortable and better accepted anaesthetic regimen for patients undergoing lower limb fracture surgery. LSPB in the supine position is simple to apply and has definite anaesthetic effects. Additionally, it has a high level of postoperative analgesia and therefore should be widely applied. Trial registration The trial was registered prior to patient enrolment at the Chinese Clinical Trail Registry (Date:11/03/2021 Number: ChiCTR2100044117 ).

Background: Phrenic nerve injury is a devastating complication that results in significant morbidity and mortality. We developed a novel technique to localize the phrenic nerve and evaluate its success. Methods: Two groups of children underwent repeat sternotomy for a variety of indications. Group I (69 patients, nerve stimulator) and Group II (78 patients, no nerve stimulator). Results: There was no significant difference in the mean age and weight between the two groups: (6.4 ± 6.5 years vs. 5.6 ± 6.4 years; p = 0.65) and (25.2 ± 24.1 vs. 22.6 ± 22.1; p = 0.69), respectively. The two groups were comparable in the following procedures: pulmonary conduit replacement, bidirectional cavopulmonary anastomosis, aortic arch repair, and Fontan, while Group I had more pulmonary arterial branch reconstruction (p = 0.009) and Group II had more heart transplant patients (p = 0.001). There was no phrenic nerve injury in Group I, while there were 13 patients who suffered phrenic nerve injury in Group II (p < 0.001). No early mortality in Group I, while five patients died prior to discharge in Group II. Eleven patients underwent diaphragm plication in Group II (p = 0.001). The mean number of hours on the ventilator was significantly higher in Group II (137.3 ± 324.9) compared to Group I (17 ± 66.9), p < 0.001. Group II had a significantly longer length of ICU and hospital stays compared to Group I (p = 0.007 and p = 0.006 respectively). Conclusion: Phrenic nerve injury in children continues to be associated with significant morbidities and increased length of stay. The use of intraoperative phrenic nerve stimulator can be an effective way to localize the phrenic nerve and avoid its injury.

Abstract Background Loss of resistance (LOR) for epidural catheter placement has been utilized for almost a century. LOR is a subjective endpoint associated with a high failure rate. Nerve stimulation (NS) has been described as an objective method for confirming placement of an epidural catheter. We hypothesized that the addition of NS to LOR would improve the success of epidural catheter placement. Methods One-hundred patients were randomized to thoracic epidural analgesia (TEA) utilizing LOR-alone or loss of resistance plus nerve stimulation (LOR + NS). The primary endpoint was rate of success, defined as loss of sensation following test dose. Secondary endpoints included performance time. An intention-to-treat analysis was planned, but a per-protocol analysis was performed to investigate the success rate when stimulation was achieved. Results In the intention-to-treat analysis there was no difference in success rates (90% vs 82% [LOR + NS vs LOR-alone]; P = 0.39). The procedural time increased in the LOR + NS group (33.9 ± 12.8 vs 24.0 ± 8.0 min; P

Healing of wounds is delayed in Type 2 Diabetes Mellitus (T2DM), and new treatment approaches are urgently needed. Our earlier work showed that splenic pulsed focused ultrasound (pFUS) alters inflammatory cytokines in models of acute endotoxemia and pneumonia via modulation of the cholinergic anti-inflammatory pathway (CAP) (ref below). Based on these earlier results, we hypothesized that daily splenic exposure to pFUS during wound healing would accelerate closure rate via altered systemic cytokine titers. In this study, we applied non-invasive ultrasound directed to the spleen of a rodent model [Zucker Diabetic Sprague Dawley (ZDSD) rats] of T2DM with full thickness cutaneous excisional wounds in an attempt to accelerate wound healing via normalization of T2DM-driven aberrant cytokine expression. Daily (1x/day, Monday-Friday) pFUS pulses were targeted externally to the spleen area for 3 min over the course of 15 days. Wound diameter was measured daily, and levels of cytokines were evaluated in spleen and wound bed lysates. Non-invasive splenic pFUS accelerated wound closure by up to 4.5 days vs. sham controls. The time to heal in all treated groups was comparable to that of healthy rats from previously published studies (ref below), suggesting that the pFUS treatment restored a normal wound healing phenotype to the ZDSD rats. IL-6 was lower in stimulated spleen (-2.24 ± 0.81 Log2FC, p = 0.02) while L-selectin was higher in the wound bed of stimulated rodents (2.53 ± 0.72 Log2FC, p = 0.003). In summary, splenic pFUS accelerates healing in a T2DM rat model, demonstrating the potential of the method to provide a novel, non-invasive approach for wound care in diabetes. [ABSTRACT FROM AUTHOR]

Objective: Adductor spasmodic dysphonia (AdSD) is caused by hyperadduction of the vocal folds during phonation, resulting in a strained voice. Animal models are not yet used to elucidate this intractable disease because AdSD has a difficult pathology without a definitive origin. For the first step, we established an animal model with vocal fold hyperadduction and evaluated its validity by assessing laryngeal function.Methods: In this experimental animal study, three adult Japanese 20-week-old rabbits were used. The models were created using a combination of cricothyroid approximation, forced airflow, and electrical stimulation of the recurrent laryngeal nerves (RLNs). Cricothyroid approximation was added to produce a glottal slit. Thereafter, both RLNs were electrically stimulated to induce vocal fold hyperadduction. Finally, the left RLN was transected to relieve hyperadduction. The sound, endoscopic images, and subglottal pressure were recorded, and acoustic analysis was performed.Results: Subglottal pressure increased significantly, and the strained sound was produced after the electrical stimulation of the RLNs. After transecting the left RLN, the subglottal pressure decreased significantly, and the strained sound decreased. Acoustic analysis revealed an elevation of the standard deviation of F0 (SDF0) and degree of voice breaks (DVB) through stimulation of the RLNs, and degradation of SDF0 and DVB through RLN transection. Formant bands in the sound spectrogram were interrupted by the stimulation and appeared again after the RLN section.Conclusion: This study developed a rabbit model with vocal fold hyperadduction . The subglottal pressure and acoustic analysis of this model resembled the characteristics of patients with AdSD. This model could be helpful to elucidate the pathology of the larynx caused by hyperadduction, and evaluate and compare the treatments for strained phonation. [ABSTRACT FROM AUTHOR]

Human proficiency for bipedal locomotion relies on the structure and function of our feet, including the interplay between active muscles and passive structures acting on the toes during the propulsive phase of gait. However, our understanding of the relative contributions of these different structures remains incomplete. We aimed to determine the distinct toe-flexion torque-angle relationships of the plantar intrinsic muscles (PIMs), extrinsic muscles, and passive structures, therefore offering insight into their force-generating capabilities and importance for walking and running. Torque-angle data were twice collected from nine healthy individuals (6 males, 3 females; 28±5 years) using supramaximal transcutaneous electrical stimuli applied at two tibial nerve sites to distinguish between muscle-driven and passive toe-flexion torque about the metatarsophalangeal (MTP) joint. Innervating extrinsic muscles and PIMs concurrently produced peak torques (Hallux=3.05±0.70 Nm, MTP angle=48.0°±13.6°; Lesser Digits=3.19±0.98 Nm, MTP angle=42.6°±13.4°) exceeding by 208% (Hallux) and 150% (Lesser Digits), respectively, those from PIM stimulation alone. Notably, MTP joint angles pertinent to gait corresponded to the ascending limb of the active torque-angle relationship, with active muscle joint torques the dominant contributor over passive torques. The latter finding suggests that human toe flexors are well-adapted to generate the MTP joint torques that are necessary for walking and running. This further supports the notion that muscles acting within the foot play an important role in the foot's mechanical function and our ability to walk and run in an upright posture., (© 2024. Published by The Company of Biologists Ltd.)