Saturday, January 25, 2020

FDA Approves Endobronchial Valves for Severe Emphysema

The US FDA has approved the Zephyr Endobronchial Valve System for treating severe emphysema patients, according to manufacturer Pulmonx Corp.

The Pulmonx Zephyr Endobronchial Valves are implantable bronchial valves indicated for the bronchoscopic treatment of adult patients with hyperinflation associated with severe emphysema in regions of the lung that have little to no collateral ventilation.

Zephyr is the first minimally-invasive device approved in the United States for treating patients with severe emphysema, a progressive and life-threatening form of COPD.

The approval is based on positive clinical data from the pivotal LIBERATE Study and two other multicenter randomized control trials. In the LIBERATE study, patients treated with Zephyr Valves were able to breathe easier, be more active and energetic, be less short of breath, and enjoy a significantly improved quality of life compared to patients who received medical management alone.

As stated in the Summary of Safety and Effectiveness Data, the FDA granted the Zephyr Valve an expedited review because it “represents a breakthrough technology as the device offers bronchoscopic lung volume reduction without surgery and its associated risks. This device offers significant clinically meaningful advantage over the current standard of care and, therefore, its availability is also in the best interest of patients.”

“Zephyr Valves are a major step forward in treating severe emphysema patients who consistently feel short of breath despite all the medications we can offer. I have seen Zephyr Valve-treated patients getting back to a more active life doing the things they enjoy. As a physician, it is very gratifying to have a new treatment that can restore a patient’s confidence and change their life for the long term,” said Gerard Criner, MD, FACP, FACCP, Chair and Professor of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, and lead investigator for the LIBERATE Study.

More than 15 million Americans suffer from COPD, and 3.5 million of those patients have emphysema. Despite using COPD medications, over one million emphysema patients continue to suffer symptoms of hyperinflation, in which air becomes trapped in the lungs and prevents new air from coming in, causing severe shortness of breath. The inability to get enough air often prevents these patients from doing simple daily activities, such as bathing, getting dressed, performing household chores and walking, without pausing to catch their breath. Until now, the only other options for these patients were highly invasive treatments such as lung volume reduction surgery or lung transplantation.

During a bronchoscopic procedure requiring no cutting or incisions, tiny Zephyr Valves are placed in the airways to occlude a diseased part of the lungs and reduce hyperinflation. This helps the healthier parts of the lungs to expand and lifts pressure off the diaphragm, thereby decreasing shortness of breath and making breathing easier.

Patients most likely to benefit from Zephyr Valve treatment can be identified with assessment tools also offered by Pulmonx.  Physicians use the Pulmonx Chartis Pulmonary Assessment System and StratX Lung Analysis Platform to help identify potential responders to Zephyr Valve treatment.

Since 2007, more than 14,000 patients have been treated with the Zephyr Valve worldwide. Zephyr Valve treatment is included in emphysema treatment guidance issued by leading health organizations worldwide, including the Global Initiative for Chronic Obstructive Lung Disease (GOLD) and the UK’s National Institute for Health and Care Excellence (NICE).



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Friday, September 06, 2019

Mesh electronics could make brain stimulation the new therapeutic norm

Implantable brain electrodes have been around for quite some time now, both for diagnosing and treating neuropsychiatric conditions like Parkinson’s disease. However, one limitation of conventional probes is their size and rigidity, compared to the soft, gelatinous consistency of the brain.

A new research paper offers a revolutionary solution: mesh electronics, which allows personalized electronics that mimic the neuron’s shape, size and texture, to be created for any brain-related disorder.
A traditional deep brain stimulation electrode (top panel) provokes an immune response in the brain while a mesh electronic interface (bottom panel) does not. The size and rigidity of the DBS electrode result in chronic inflammation causing glial scarring between brain tissue and electrode, degrading the neural interface. Mesh electronics evade the immune response due to cellular and sub-cellular features and bending stiffness resembling the brain itself. Image courtesy of Shaun Patel and Charles Lieber
A traditional deep brain stimulation electrode (top panel) provokes an immune response in the brain while a mesh electronic interface (bottom panel) does not. The size and rigidity of the DBS electrode result in chronic inflammation causing glial scarring between brain tissue and electrode, degrading the neural interface. Mesh electronics evade the immune response due to cellular and sub-cellular features and bending stiffness resembling the brain itself.

Why are implantable electrodes needed?

All neuroscientists agree that the foundation of cognition is the brain, including thinking, emotions, memory, judgment and decision-making. The same applies to all kinds of brain disorders, according to researcher. She became interested in this field after witnessing a 500 ms pulse of electricity conferring an impulsive risk-taker with the momentary ability to make a safer choice, without even knowing how it occurred. The alteration of cognitive thinking, in other words, happened below the level of consciousness.

However, it is difficult for scientists to trace behaviors to specific neurons or brain areas that are dysfunctional, though this could help discover where illnesses such as addiction, Alzheimer’s or Parkinson’s disease originate. Therapy for these conditions is currently limited to drugs and electrical stimulation via implantable electrodes.

Medical treatment is mostly with neuroactive drugs like L-dopa in Parkinson’s disease, which stills the quivering movements that make voluntary actions so difficult. However, the off-target or nonselective inhibition of L-dopa actions causes severe and even unacceptable side effects, on various body systems, including nausea, depression or arrhythmia.

The failure of drug treatment is an indication for electrode implantation to provide Deep Brain Stimulation (DBS). These work by sending automated pulses of electrical energy to paired implants, each about the size of a pencil, which is huge with respect to the brain. These FDA-approved electrodes must be implanted while the patient is awake and able to guide the surgeons during their calibration of the required current intensity that will stop the tremors.

Describing the effect of DBS, researcher  marvels, “Almost instantly, you can see the person regain control of their limbs.” However, these electrodes aren’t quite foolproof either, causing inadvertent stimulation of other brain areas at times, which causes disturbing adverse effects such as speech impediments. Just as bad, the brain has an active and vigilant immune system composed of neuroglial cells, which eventually disrupts the electrode’s efficient functioning by smothering it in a protective glial covering. This may also grow so large as to mechanically affect or even kill neighboring neurons. The limited device life caused by unnecessary continuous operation, and the lack of feedback which hampers operational efficiency, are other limitations. While many of these are being individually overcome, the rigid and imprecise neural interface is a basic restriction on further progress.

Implantable rigid electrodes vs mesh electronics

The increased rigidity of even the softest conventional probes causes several problems: chronic inflammation and scarring, mismatched stiffness which leads to a movement of the probe and neuron away from each other relatively quickly, and hinders tracking of the same neuron or circuit; and the solid probe lies uneasily on the quite differently shaped brain surface. This topological difference pushes neurons away from their rightful place, while also preventing repair of broken synaptic connections and blocking the free movement of chemicals in the brain environment.
Neuron-like electronics (red) mimic the shape, size, and flexibility of neurons (green), enabling them to maintain symbiosis with native brain tissue (Credit: Xiao Yang, Lieber Lab)
Neuron-like electronics (red) mimic the shape, size, and flexibility of neurons (green), enabling them to maintain symbiosis with native brain tissue
This is where Lieber has made a huge difference with ultra-flexible mesh electronics, which promise to deliver what he calls “precision electronic medicine”. These hardly activate an immune response, but remain very close to the cells they are intended to spy on. As such, they offer a way to obtain reliable information on the communication between individual neurons or its breakdown. This could help elucidate cross-talk between specific subsets of neurons. It is also necessary if any degree of precise regulation is to be achieved via feedback circuits, which requires a two-way transmission of information through the neural device. All this could produce a more accurate and detailed map of the brain circuitry. This could potentially open the door to the successful treatment of any brain disorder.
Moreover, Lieber’s mesh electrodes have a peculiar benefit in their ability to guide developing neurons to the right place, such as injured areas as following a stroke. They could potentially encourage directed neuronal migration to rebuild injured or degenerated areas, and integrate these cells into the right circuits, using differentially modulated successive pulses of electricity.

The risk – and the future

Lieber envisages other mind-blowing advances: special electrodes could be designed to provide precise control over prosthetic or paralyzed limbs, and this could serve as an efficient substitute for damaged brain connections, as well as autocalibration of the signal based on live feedback. He says, “If you could actually interact in a precise and long-term way and also provide feedback information, you could really communicate with the brain in the same way that the brain is communicating within itself.”

Other major would-be players in this field include Neuralink from Elon Musk, which aims at assisting paralyzed patients by providing a mind-computer interface so they can use their computers; Facebook which is looking at texting via word imaging; and Kernel from Brian Johnson, which is focused on increasing cognitive abilities. Lieber emphasizes that his desire is to help people who are sick – and even to prevent the aging-related decline in memory if possible. However, strict ethical control is mandatory lest such mind-altering power be misused. While the benefits are obvious, such as helping people overcome addiction or obsessive-compulsive disorder, the downside is equally plain – the patient’s thoughts are laid open to scrutiny, despite being the innermost stronghold of a person. Secondly, it raises the risk of putting memory, learning ability and other  desirable mental traits up on sale, for people who would like to enhance their brain capability.

Meanwhile, scientists like Lieber and Patel continue to refine mesh electronics, by increasing the number of electrodes that can be implanted, designing live feedback systems to enable continuous recalibration, and improving the processing of the voluminous data collected by the electrodes. They urge a blending of multiple disciplines to help advance neurotechnology to the point where it breaches the limit of machine-mind interface. Patel says, “The next frontier is really the merging of human cognition with machines.”

this is only for your information, kindly take the advice of your doctor for medicines, exercises and so on.   
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Sunday, February 24, 2019

New material to repair bone defects developed

Using near-infrared (NIR) light irradiation, researchers have developed a bio-material that can accelerate bone healing.

While thermal therapy has been traditionally used to treat bone regeneration, it has been proved inefficient in delivering the appropriate amount of heat to the correct part of the patient's body and may cause side effects such as surface burns.

On the other hand, NIR light is electromagnetic radiation with longer wavelengths than those of visible light. Due to higher transmittance through biological tissues, it has been used as a photo-thermal therapy to release heat.

Researchers developed an implantable bio-composite made of black phosphorus nanomaterial and a widely-used tissue-engineering chemical compound to repair bone defects and promote the growth of new bone, researcher reported on Saturday.

Phosphorus is one of the vital elements constituting about 1 per cent of the total human body weight. With the black phosphorus nano-material, the composite has shown a highly-efficient photo-thermal response.

Even when the composite is covered by a tissue barrier as thick as 7 mm, it can still increase the temperature under the NIR light irradiation.

In the experiments conducted on rats, researchers found that the most effective target temperature by the NIR light-trigger is between 39.5 and 40.5 degrees Celsius, only about 3 to 5 degrees higher than the normal human body temperature.

According to lead author, the composite has large clinical potential. It is biodegradable and can produce non-toxic end products such as water and carbon dioxide which can also serve as necessary bone ingredients.

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Monday, September 17, 2018

Our eyes have natural night vision mode

Our eyes have in-built night vision mode, say scientists who found that to see under starlight and moonlight, the retina changes both the software and hardware of its light-sensing cells. Retinal circuits that were thought to be unchanging and programmed for specific tasks are adaptable to different light conditions. However, scientists have now identified how the retina reprograms itself for low light.

“To see under starlight, biology has had to reach the limit of seeing an elementary particle from the universe, a single photon,” said an assistant professor. The findings, published in the journal  show that the reprogramming happens in retinal cells that are sensitive to motion. Even in the best lighting, identifying the presence and direction of a moving object is key to survival for most animals.

However, detecting motion with a single point of reference does not work very well. So, the retinas of vertebrates have four kinds of motion-sensitive cells, each specifically responsive to a motion that is up, down, right or left. In humans, these directional neurons account for about 4 percent of the cells that send signals from the retina to the brain.

In a study with mouse retinas conducted under a microscope equipped with night vision eye pieces in a very dark room, researchers found that the retinal cells sensitive to upward movement change their behaviour in low light. The ‘up’ neurons will fire upon detecting any kind of movement, not just upward.

When there is much less light available, a weak signal of motion from the ‘up’ neurons, coupled with a weak signal from any of the other directional cells can help the brain sense movement. The loss of motion perception is a common complaint in human patients with severe vision loss. The Dr. said this finding about the adaptability of retinal neurons may help the design of implantable retinal prosthetics in the future.

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