Real-Time Non-Invasive Imaging and Detection of Spreading Depolarizations through EEG: An Ultra-Light Explainable Deep Learning Approach.

A core aim of neurocritical care is to prevent secondary brain injury. Spreading depolarizations (SDs) have been identified as an important independent cause of secondary brain injury. SDs are usually detected using invasive electrocorticography recorded at high sampling frequency.

Microdialysis in Abdominal Organ Transplantation and the Potential for Integration with Dynamic Preservation Platforms and Post Transplant Monitoring.

The perpetual organ shortage crisis worldwide has meant a paradigm shift in global thinking with subsequent expansion of the accepted criteria for an organ donor to meet the demand. Robust pre-transplant organ viability assessment is the next great challenge in the field of transplantation today. Organ preservation in the nature of static cold storage has reached its limits, and machine perfusion both cold and warm offers theoretically superior preservation and the potential to assess organs.

Computational Modeling as a Tool to Drive the Development of a Novel, Chemical Device for Monitoring the Injured Brain and Body.

Real-time measurement of dynamic changes, occurring in the brain and other parts of the body, is useful for the detection and tracked progression of disease and injury. Chemical monitoring of such phenomena exists but is not commonplace, due to the penetrative nature of devices, the lack of continuous measurement, and the inflammatory responses that require pharmacological treatment to alleviate. Soft, flexible devices that more closely match the moduli and shape of monitored tissue and allow for surface microdialysis provide a viable alternative.

Dexamethasone-Enhanced Continuous Online Microdialysis for Neuromonitoring of O after Brain Injury.

Traumatic brain injury (TBI) is a major public health crisis in many regions of the world. Severe TBI may cause a primary brain lesion with a surrounding penumbra of tissue that is vulnerable to secondary injury. Secondary injury presents as progressive expansion of the lesion, possibly leading to severe disability, a persistent vegetive state, or death.

A shortened surface electromyography recording is sufficient to facilitate home fasciculation assessment.

Introduction/aims: Fasciculations are an early clinical hallmark of amyotrophic lateral sclerosis (ALS), amenable to detection by high-density surface electromyography (HDSEMG). In conjunction with the Surface Potential Quantification Engine (SPiQE), HDSEMG offers improved spatial resolution for the analysis of fasciculations. This study aims to establish an optimal recording duration to enable longitudinal remote monitoring in the home.

A LoC Ion Imaging Platform for Spatio-Temporal Characterisation of Ion-Selective Membranes.

In this paper, a complete Lab-on-Chip (LoC) ion imaging platform for analysing Ion-Selective Membranes (ISM) using CMOS ISFET arrays is presented. An array of 128 × 128 ISFET pixels is employed with each pixel featuring 4 transistors to bias the ISFET to a common drain amplifier. Column-level 2-step readout circuits are designed to compensate for array offset variations in a range of up to ±1 V.

Validation of Dexamethasone-Enhanced Continuous-Online Microdialysis for Monitoring Glucose for 10 Days after Brain Injury.

Traumatic brain injury (TBI) induces a pathophysiologic state that can be worsened by secondary injury. Monitoring brain metabolism with intracranial microdialysis can provide clinical insights to limit secondary injury in the days following TBI. Recent enhancements to microdialysis include the implementation of continuously operating electrochemical biosensors for monitoring the dialysate sample stream in real time and dexamethasone retrodialysis to mitigate the tissue response to probe insertion.

Development and Evaluation of a Method for Automated Detection of Spreading Depolarizations in the Injured Human Brain.

Background: Spreading depolarizations (SDs) occur in some 60% of patients receiving intensive care following severe traumatic brain injury and often occur at a higher incidence following serious subarachnoid hemorrhage and malignant hemisphere stroke (MHS); they are independently associated with worse clinical outcome. Detection of SDs to guide clinical management, as is now being advocated, currently requires continuous and skilled monitoring of the electrocorticogram (ECoG), frequently extending over many days.

Methods: We developed and evaluated in two clinical intensive care units (ICU) a software routine capable of detecting SDs both in real time at the bedside and retrospectively and also capable of displaying patterns of their occurrence with time.

First-recruited motor units adopt a faster phenotype in amyotrophic lateral sclerosis.

Key Points: Amyotrophic lateral sclerosis (ALS) is an incurable neurodegenerative disorder of motor neurons, carrying a short survival. High-density motor unit recordings permit analysis of motor unit size (amplitude) and firing behaviour (afterhyperpolarization duration and muscle fibre conduction velocity). Serial recordings from biceps brachii indicated that motor units fired faster and with greater amplitude as disease progressed.

Non-invasive measurement of fasciculation frequency demonstrates diagnostic accuracy in amyotrophic lateral sclerosis.

Delayed diagnosis of amyotrophic lateral sclerosis prevents early entry into clinical trials at a time when neuroprotective therapies would be most effective. Fasciculations are an early hallmark of amyotrophic lateral sclerosis, preceding muscle weakness and atrophy. To assess the potential diagnostic utility of fasciculations measured by high-density surface electromyography, we carried out 30-min biceps brachii recordings in 39 patients with amyotrophic lateral sclerosis, 7 patients with benign fasciculation syndrome, 1 patient with multifocal motor neuropathy and 17 healthy individuals.

Randomized blinded trial of automated REBOA during CPR in a porcine model of cardiac arrest.

Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) reportedly elevates arterial blood pressure (ABP) during non-traumatic cardiac arrest.

Objectives: This randomized, blinded trial of cardiac arrest in pigs evaluated the effect of automated REBOA two minutes after balloon inflation on ABP (primary endpoint) as well as arterial blood gas values and markers of cerebral haemodynamics and metabolism.

Methods: Twenty anesthetized pigs were randomized to REBOA inflation or sham-inflation (n = 10 in each group) followed by insertion of invasive monitoring and a novel, automated REBOA catheter (NEURESCUE® Catheter & NEURESCUE® Assistant).

Fasciculation analysis reveals a novel parameter that correlates with predicted survival in amyotrophic lateral sclerosis.

Introduction: Prognostic uncertainty in amyotrophic lateral sclerosis (ALS) confounds clinical management planning, patient counseling, and trial stratification. Fasciculations are an early clinical hallmark of disease and can be quantified noninvasively. Using an innovative analytical method, we correlated novel fasciculation parameters with a predictive survival model.

The rise and fall of fasciculations in amyotrophic lateral sclerosis.

Amyotrophic lateral sclerosis is a devastating neurodegenerative disease with a median survival of 3 years from symptom onset. Accessible and reliable biomarkers of motor neuron decline are urgently needed to quicken the pace of drug discovery. Fasciculations represent an early pathophysiological hallmark of amyotrophic lateral sclerosis and can be reliably detected by high-density surface electromyography.

Traumatic brain injury neuroelectrochemical monitoring: behind-the-ear micro-instrument and cloud application.

Background: Traumatic Brain Injury (TBI) is a leading cause of fatality and disability worldwide, partly due to the occurrence of secondary injury and late interventions. Correct diagnosis and timely monitoring ensure effective medical intervention aimed at improving clinical outcome. However, due to the limitations in size and cost of current ambulatory bioinstruments, they cannot be used to monitor patients who may still be at risk of secondary injury outside the ICU.

Fasciculations demonstrate daytime consistency in amyotrophic lateral sclerosis.

Introduction: Fasciculations represent early neuronal hyperexcitability in amyotrophic lateral sclerosis (ALS). To aid calibration as a disease biomarker, we set out to characterize the daytime variability of fasciculation firing.

Methods: Fasciculation awareness scores were compiled from 19 ALS patients.

Complementary Metal-Oxide-Semiconductor Potentiometric Field-Effect Transistor Array Platform Using Sensor Learning for Multi-ion Imaging.

This work describes an array of 1024 ion-sensitive field-effect transistors (ISFETs) using sensor-learning techniques to perform multi-ion imaging for concurrent detection of potassium, sodium, calcium, and hydrogen. Analyte-specific ionophore membranes are deposited on the surface of the ISFET array chip, yielding pixels with quasi-Nernstian sensitivity to K, Na, or Ca. Uncoated pixels display pH sensitivity from the standard SiN passivation layer.

Real-time neurochemical measurement of dynamic metabolic events during cardiac arrest and resuscitation in a porcine model.

This work describes a fully-integrated portable microfluidic analysis system for real-time monitoring of dynamic changes in glucose and lactate occurring in the brain as a result of cardiac arrest and resuscitation. Brain metabolites are sampled using FDA-approved microdialysis probes and coupled to a high-temporal resolution 3D printed microfluidic chip housing glucose and lactate biosensors. The microfluidic biosensors are integrated with a wireless 2-channel potentiostat forming a compact analysis system that is ideal for use in a crowded operating theatre.

Preprocessing surface EMG data removes voluntary muscle activity and enhances SPiQE fasciculation analysis.

Objectives: Fasciculations are a clinical hallmark of amyotrophic lateral sclerosis (ALS). The Surface Potential Quantification Engine (SPiQE) is a novel analytical tool to identify fasciculation potentials from high-density surface electromyography (HDSEMG). This method was accurate on relaxed recordings amidst fluctuating noise levels.

Portable Microfluidic Biosensing System for Real-Time Analysis of Microdialysate in Transplant Kidneys.

Currently, there is a severe shortage of donor kidneys that are fit for transplantation, due in part to a lack of adequate viability assessment tools for transplant organs. This work presents the integration of a novel wireless two-channel amperometric potentiostat with microneedle-based glucose and lactate biosensors housed in a 3D printed chip to create a microfluidic biosensing system that is genuinely portable. The wireless potentiostat transmits data via Bluetooth to an Android app running on a tablet.