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Debelle A, Hesta M, de Rooster H, Bianchini E, Vanhoestenberghe A, Stock E, Vanderperren K, Polis I, Smets H, Cury J, Acuña V, Delchambre A, Innocenti B, Devière J, Nonclercq A. Impact of adaptive gastric electrical stimulation on weight, food intake, and food intake rate in dogs. Artif Organs 2021; 46:1055-1067. [PMID: 34932224 DOI: 10.1111/aor.14156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 11/04/2021] [Accepted: 12/07/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Gastric electrical stimulation (GES) has been studied for decades as a promising treatment for obesity. Stimulation pulses with fixed amplitude and pulse width are usually applied, but these have limitations with regard to overcoming habituation to GES and inter-subject variation. This study aims to analyze the efficacy of an adaptive GES protocol for reducing food intake and maintaining lean weight in dogs. METHODS Six beagle dogs were implanted with a remotely programmable gastric stimulator. An adaptive protocol was designed to increase the stimulation energy proportionally to the excess of food consumption, with respect to the dogs' maintenance energy requirements. After surgery and habituation to experimental conditions, the dogs went through both a control and a stimulation period of 4 weeks each, in a randomized order. The stimulation parameters were adapted daily. Body weight, food intake, food intake rate, and postprandial cutaneous electrogastrograms (EGG) were recorded to assess the effect of adaptive GES. RESULTS Adaptive GES decreased food intake and food intake rate (p < 0.05) resulting in weight maintenance. In the absence of GES, the dogs gained weight (p < 0.05). Postprandial EGG dominant frequency was accelerated by GES (p < 0.05). The strategy of adapting the stimulation energy was effective in causing significant mid-term changes. CONCLUSION Adaptive GES is effective for reducing food intake and maintaining lean weight. The proposed adaptive strategy may offer benefits to counter habituation and adapt to inter-subject variation in clinical use of GES for obesity.
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Affiliation(s)
- Adrien Debelle
- Bio, Electro and Mechanical Systems Department, Ecole polytechnique de Bruxelles, Université libre de Bruxelles, Brussels, Belgium
| | - Myriam Hesta
- Department of Veterinary Medical Imaging and Small Animal Orthopedics, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - Hilde de Rooster
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - Erika Bianchini
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - Anne Vanhoestenberghe
- Aspire Centre for Rehabilitation Engineering and Assistive Technology, Department of Materials and Tissue, University College London, Stanmore, UK
| | - Emmelie Stock
- Department of Veterinary Medical Imaging and Small Animal Orthopedics, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - Katrien Vanderperren
- Department of Veterinary Medical Imaging and Small Animal Orthopedics, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - Ingeborgh Polis
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - Hugo Smets
- Bio, Electro and Mechanical Systems Department, Ecole polytechnique de Bruxelles, Université libre de Bruxelles, Brussels, Belgium
| | - Joaquin Cury
- Bio, Electro and Mechanical Systems Department, Ecole polytechnique de Bruxelles, Université libre de Bruxelles, Brussels, Belgium
| | - Vicente Acuña
- Bio, Electro and Mechanical Systems Department, Ecole polytechnique de Bruxelles, Université libre de Bruxelles, Brussels, Belgium
| | - Alain Delchambre
- Bio, Electro and Mechanical Systems Department, Ecole polytechnique de Bruxelles, Université libre de Bruxelles, Brussels, Belgium
| | - Bernardo Innocenti
- Bio, Electro and Mechanical Systems Department, Ecole polytechnique de Bruxelles, Université libre de Bruxelles, Brussels, Belgium
| | - Jacques Devière
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Antoine Nonclercq
- Bio, Electro and Mechanical Systems Department, Ecole polytechnique de Bruxelles, Université libre de Bruxelles, Brussels, Belgium
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Jiang D, Liu F, Lancashire HT, Perkins TA, Schormans M, Vanhoestenberghe A, Donaldson NDN, Demosthenous A. A Versatile Hermetically Sealed Microelectronic Implant for Peripheral Nerve Stimulation Applications. Front Neurosci 2021; 15:681021. [PMID: 34366773 PMCID: PMC8339274 DOI: 10.3389/fnins.2021.681021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 06/15/2021] [Indexed: 11/25/2022] Open
Abstract
This article presents a versatile neurostimulation platform featuring a fully implantable multi-channel neural stimulator for chronic experimental studies with freely moving large animal models involving peripheral nerves. The implant is hermetically sealed in a ceramic enclosure and encapsulated in medical grade silicone rubber, and then underwent active tests at accelerated aging conditions at 100°C for 15 consecutive days. The stimulator microelectronics are implemented in a 0.6-μm CMOS technology, with a crosstalk reduction scheme to minimize cross-channel interference, and high-speed power and data telemetry for battery-less operation. A wearable transmitter equipped with a Bluetooth Low Energy radio link, and a custom graphical user interface provide real-time, remotely controlled stimulation. Three parallel stimulators provide independent stimulation on three channels, where each stimulator supports six stimulating sites and two return sites through multiplexing, hence the implant can facilitate stimulation at up to 36 different electrode pairs. The design of the electronics, method of hermetic packaging and electrical performance as well as in vitro testing with electrodes in saline are presented.
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Affiliation(s)
- Dai Jiang
- Department of Electronic and Electrical Engineering, University College London, London, United Kingdom
| | - Fangqi Liu
- Department of Electronic and Electrical Engineering, University College London, London, United Kingdom
| | - Henry T Lancashire
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Timothy A Perkins
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Matthew Schormans
- Department of Electronic and Electrical Engineering, University College London, London, United Kingdom
| | - Anne Vanhoestenberghe
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom.,Division of Surgery and Interventional Science, Aspire Centre for Rehabilitation Engineering and Assistive Technology, University College London, London, United Kingdom
| | - Nicholas De N Donaldson
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Andreas Demosthenous
- Department of Electronic and Electrical Engineering, University College London, London, United Kingdom
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Debelle A, de Rooster H, Bianchini E, Lonys L, Huberland F, Vanhoestenberghe A, Lambert P, Acuña V, Smets H, Giannotta F, Delchambre A, Sandersen C, Bolen G, Egyptien S, Deleuze S, Devière J, Nonclercq A. Optimization and assessment of a novel gastric electrode anchoring system designed to be implanted by minimally invasive surgery. Med Eng Phys 2021; 92:93-101. [PMID: 34167717 DOI: 10.1016/j.medengphy.2021.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 04/27/2021] [Accepted: 05/05/2021] [Indexed: 11/16/2022]
Abstract
A novel electrode anchoring design and its implantation procedure, aiming for a minimally invasive solution for gastric electrical stimulation, are presented. The system comprises an anchor made of a flexible body embedding two needle-shaped electrodes. The electrodes can easily switch from a parallel position - to pierce the stomach - to a diverging position - enabling them to remain firmly anchored into the muscular layer of the stomach. Key device parameters governing anchoring stability were assessed on a traction test bench, and optimal values were derived. The device was then implanted in six dogs by open surgery to assess its anchoring durability in vivo. Computed tomography images showed that the electrodes remained well placed within the dogs' gastric wall over the entire assessment period (more than one year). Finally, a prototype of a surgical tool for the minimally invasive device placement was manufactured, and the anchoring procedure was tested on a dog cadaver, providing the proof of concept of the minimally invasive implantation procedure. The use of our electrode anchoring system in long-term gastric electrical stimulation is promising in terms of implantation stability (the anchor withstands a force up to 0.81 N), durability (the anchor remains onto the stomach over one year) and minimal invasiveness of the procedure (the diameter of the percutaneous access is smaller than 12 mm). Moreover, the proposed design could have clinical applications in other hollow organs, such as the urinary bladder.
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Affiliation(s)
- Adrien Debelle
- Bio, Electro and Mechanical Systems Department (BEAMS), Ecole Polytechnique de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium.
| | - Hilde de Rooster
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - Erika Bianchini
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - Laurent Lonys
- Bio, Electro and Mechanical Systems Department (BEAMS), Ecole Polytechnique de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - François Huberland
- Bio, Electro and Mechanical Systems Department (BEAMS), Ecole Polytechnique de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Anne Vanhoestenberghe
- Aspire Centre for Rehabilitation Engineering and Assistive Technology, Department of Materials and Tissue, University College London, Stanmore, United Kingdom
| | - Pierre Lambert
- Transfers, Interfaces and Processes Department (TIPS), Ecole Polytechnique de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Vicente Acuña
- Bio, Electro and Mechanical Systems Department (BEAMS), Ecole Polytechnique de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Hugo Smets
- Bio, Electro and Mechanical Systems Department (BEAMS), Ecole Polytechnique de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Fabrizio Giannotta
- Bio, Electro and Mechanical Systems Department (BEAMS), Ecole Polytechnique de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Alain Delchambre
- Bio, Electro and Mechanical Systems Department (BEAMS), Ecole Polytechnique de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Charlotte Sandersen
- Fundamental and Applied Research for Animal & Health (FARAH), Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Liege, Liege, Belgium
| | - Geraldine Bolen
- Fundamental and Applied Research for Animal & Health (FARAH), Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Liege, Liege, Belgium
| | - Sophie Egyptien
- Fundamental and Applied Research for Animal & Health (FARAH), Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Liege, Liege, Belgium
| | - Stefan Deleuze
- Fundamental and Applied Research for Animal & Health (FARAH), Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Liege, Liege, Belgium
| | - Jacques Devière
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, Erasmus University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Antoine Nonclercq
- Bio, Electro and Mechanical Systems Department (BEAMS), Ecole Polytechnique de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
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Schiemer JF, Merchel D, Stumm K, Hoffmann KP, Baumgart J, Kneist W. Translational development and pre-clinical evaluation of prototype gastrointestinal mock-up devices: only robotic placement of plastic? J Med Eng Technol 2020; 44:108-113. [PMID: 32367762 DOI: 10.1080/03091902.2020.1742394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background: The aim of this study was to address the vision of wireless theranostic devices distributed along the gastrointestinal (GI) tract by defining design requirements, developing prototype mock-ups, and establishing a minimally invasive surgical approach for the implantation process.Methods: Questionnaires for contextual analysis and use case scenarios addressing the technical issues of an implantable GI device, a possible scenario for implantation, preparation and calibration of a device, and therapeutic usage by professionals and patients were completed and discussed by an interdisciplinary team of surgeons, engineers, and product designers. Two acute porcine experiments were conducted with a robotic surgical system under general anaesthesia.Results: A variety of requirements for the design and implantation of implantable devices for modulating GI motility were defined. Five prototype implant mock-ups were three-dimensional (3D)-printed from black polymer material (width 22.32 mm, height 7.66 mm) and successfully implanted on the stomach, duodenum, jejunum, ileum, and colon using the robotic surgical system, without any complications.Conclusions: Our study shows the development and successful pre-clinical evaluation of a reliable device design with a minimally invasive implantation approach. Several stages of device development, including pre-clinical tests, characterisation of clinical requirements, regulatory affairs, and marketing issues should be managed side by side.
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Affiliation(s)
- Jonas F Schiemer
- Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Dana Merchel
- Wilddesign GmbH & Co. KG, Gelsenkirchen, Germany
| | - Karen Stumm
- Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.,Translational Animal Research Center, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Klaus-Peter Hoffmann
- Department of Biomedical Engineering, Fraunhofer Institute for Biomedical Engineering, St. Ingbert, Germany
| | - Jan Baumgart
- Translational Animal Research Center, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Werner Kneist
- Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.,Department of General and Visceral Surgery, St. Georg Hospital Eisenach, Eisenach, Germany
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Jang Y, Kim SM, Kim KJ, Sim HJ, Kim BJ, Park JW, Baughman RH, Ruhparwar A, Kim SJ. Self-Powered Coiled Carbon-Nanotube Yarn Sensor for Gastric Electronics. ACS Sens 2019; 4:2893-2899. [PMID: 31525897 DOI: 10.1021/acssensors.9b01180] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The strong peristaltic contraction of the stomach facilitates mixing and emptying of ingested food, which occurs rhythmically at approximately 3 cycles/min (cpm) in humans. Generally, most patients with gastroparesis show gastric electrical dysrhythmia that is disrupted electrical signals controlling gastric contractions. For treatment of gastric electrical dysrhythmia, in vivo electrical impulses to the stomach via an implanted gastric stimulator have been known to restore these gastric deformations. Nevertheless, improved sensors to monitor gastric contractions are still needed in current gastric stimulators. Recently, we have developed a new technology converting mechanical motion to electrical energy by using stretch-induced capacitance changes of a coiled carbon-nanotube (CNT) yarn. For its potential use as a gastric deformation sensor, the performance of a coiled CNT yarn was evaluated in several biological fluids. For a sinusoidal stretch to 30%, the peak-to-peak open-circuit voltage (OCV) was consistently generated at frequencies below 0.1 Hz. This sinusoidal variation in OCV augmented as the strain increased from 10 to 30%. In an in vitro artificial gastric system, the OCV was approximately linearly proportional to the balloon volume, which can monitor periodic deformations of the balloon at 2, 3, and 4 cpm as shown for human gastric deformations. Moreover, stretchy coiled yarns generate the peak electrical voltage and power when deformed. The present study shows that a self-powered CNT yarn sensor can not only monitor the changes in frequency and amplitude of volumetric change but also generate electrical power by periodic deformations of the balloon. Therefore, it seems possible to automatically deliver accurate electrical impulses according to real-time evaluation of a patient's gastric deformation based on information on the frequency, amplitude, and rate of the OCV from CNT yarn.
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Affiliation(s)
| | | | | | | | | | | | - Ray H. Baughman
- Alan G. MacDiarmid NanoTech Institute, University of Texas at Dallas, Richardson, Texas 75083, United States
| | - Arjang Ruhparwar
- Department of Cardiac Surgery, Heart Center, University Hospital Heidelberg, Heidelberg 69120, Germany
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Abstract
In this Editor's Review, articles published in 2017 are organized by category and summarized. We provide a brief reflection of the research and progress in artificial organs intended to advance and better human life while providing insight for continued application of these technologies and methods. Artificial Organs continues in the original mission of its founders "to foster communications in the field of artificial organs on an international level." Artificial Organs continues to publish developments and clinical applications of artificial organ technologies in this broad and expanding field of organ Replacement, Recovery, and Regeneration from all over the world. Peer-reviewed Special Issues this year included contributions from the 12th International Conference on Pediatric Mechanical Circulatory Support Systems and Pediatric Cardiopulmonary Perfusion edited by Dr. Akif Undar, Artificial Oxygen Carriers edited by Drs. Akira Kawaguchi and Jan Simoni, the 24th Congress of the International Society for Mechanical Circulatory Support edited by Dr. Toru Masuzawa, Challenges in the Field of Biomedical Devices: A Multidisciplinary Perspective edited by Dr. Vincenzo Piemonte and colleagues and Functional Electrical Stimulation edited by Dr. Winfried Mayr and colleagues. We take this time also to express our gratitude to our authors for offering their work to this journal. We offer our very special thanks to our reviewers who give so generously of time and expertise to review, critique, and especially provide meaningful suggestions to the author's work whether eventually accepted or rejected. Without these excellent and dedicated reviewers the quality expected from such a journal could not be possible. We also express our special thanks to our Publisher, John Wiley & Sons for their expert attention and support in the production and marketing of Artificial Organs. We look forward to reporting further advances in the coming years.
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Affiliation(s)
| | - Milos Popovic
- Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada
| | - Winfried Mayr
- Medical University Vienna, Center for Medical Physics and Biomedical Engineering, Vienna, Austria
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