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Lambie CJ, Moura SP, Eftekari SC, Sears LA, Donnelly D'AT, Shaffrey EC, Dingle AM. Social media analysis of pain outcomes following targeted muscle reinnervation. J Plast Reconstr Aesthet Surg 2024; 91:236-240. [PMID: 38428231 DOI: 10.1016/j.bjps.2024.02.051] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 02/04/2024] [Indexed: 03/03/2024]
Abstract
AIM Targeted muscle reinnervation (TMR) was developed to improve myoelectric prosthesis control for amputees; however, it has become an area of interest in pain modulation. Evidences indicate that this procedure alleviates chronic pain in amputees. The primary objective of this study was to use social media analysis to understand patients' post-operative pain, satisfaction, and recovery time after TMR. METHODS Data were collected from one Facebook group via posts and comments referencing TMR. Posts published between January 1, 2020, and March 24, 2023 were analyzed. Data collected included pain prior to surgery, pain in immediate post-op period, and change in pain after surgery. RESULTS Forty-three individuals commented on their TMR experience. Among them, 31 had favorable surgical outcomes, 7 felt that the surgery worsened their pain or there was no significant change in their pain levels, and 5 commented during the initial post-operative period. Twenty-four patients described their pain in the immediate post-operative period and all patients said that the post-operative pain was worse than chronic pain. Among the 28 authors who commented on overall reduction in chronic pain, 24 reported that TMR reduced their pain, whereas 4 reported no change or worsened pain. CONCLUSIONS The number of patients (24) who reported improvement in chronic pain aligns with the results in current literature suggesting that TMR is a viable treatment option for pain management. With the current medical management of similar conditions, up to 80% of patients remain unsatisfied with pain management. This analysis supports the evidence that TMR is an effective treatment for patients experiencing post-amputation pain.
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Affiliation(s)
- Caden J Lambie
- Division of Plastics and Reconstructive Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, 600 Highland Ave, Madison, WI 53792, USA.
| | - Steven P Moura
- Division of Plastics and Reconstructive Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, 600 Highland Ave, Madison, WI 53792, USA
| | - Sahand C Eftekari
- Division of Plastics and Reconstructive Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, 600 Highland Ave, Madison, WI 53792, USA
| | - Lucas A Sears
- Division of Plastics and Reconstructive Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, 600 Highland Ave, Madison, WI 53792, USA
| | - D 'Andrea T Donnelly
- Division of Plastics and Reconstructive Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, 600 Highland Ave, Madison, WI 53792, USA
| | - Ellen C Shaffrey
- Division of Plastics and Reconstructive Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, 600 Highland Ave, Madison, WI 53792, USA
| | - Aaron M Dingle
- Division of Plastics and Reconstructive Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, 600 Highland Ave, Madison, WI 53792, USA
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Shaffrey EC, Zeng W, Nicksic PJ, Eftekari SC, Frank JM, Dingle AM, Poore SO. Perforator Dissection Porcine Abdominal Model: A Novel Simulator to Improve Microsurgical Training. J Reconstr Microsurg 2024. [PMID: 38395058 DOI: 10.1055/s-0044-1779719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Abstract
BACKGROUND Perforator dissection and flap elevation are routinely performed for microsurgical reconstruction; however, there is a steep learning curve to mastering these technical skills. Though live porcine models have been utilized as microsurgical training models, significant drawbacks limit their use. We recently developed a latex-perfused, nonliving, porcine abdomen perforator dissection simulation and described its anatomic similarity to the human deep inferior epigastric artery flap. The purpose was to assess the change in resident confidence in performing key operative steps of flap elevation and perforator dissection and obtain feedback on model realism and utility. METHODS Seventeen plastic and reconstructive surgery resident physicians (postgraduate years 1-6) at a single institution participated in a perforator dissection session utilizing the simulation model. Each resident completed pre- and postactivity surveys to assess interval change in confidence in operating. The postactivity survey also asked residents to answer questions regarding their perception of the model's anatomic and surgical realism and utility in microsurgical training. RESULTS Following a practice session using the latex-perfused, nonliving porcine abdomen, resident confidence was significantly increased in performing all key operative steps and the procedure overall (p = 0.001). All residents (n = 17, 100%) believed the model would improve "trainees' ability to perform perforator dissection in the operating room." Perforator, fascial, and pedicle anatomy were reported to be "Very" similar to human anatomy, with a median Likert score (MLS) of 4. Additionally, six out of the eight surgical steps were noted to be "Very" realistic, with only "Flap Design" and "Fascial Closure" found to be "Moderately" realistic with an MLS of 3. CONCLUSION The latex-infused porcine abdominal model is a novel, realistic simulation for microsurgical trainee perforator dissection practice. This model offers a suitable substitute for perforator dissection practice, as its implementation within a microsurgery training course improves resident comfort and confidence.
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Affiliation(s)
- Ellen C Shaffrey
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Weifeng Zeng
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Peter J Nicksic
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Sahand C Eftekari
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Jennifer M Frank
- Department of Animal and Dairy Sciences, UW-Madison CALS, Madison, Wisconsin
| | - Aaron M Dingle
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Samuel O Poore
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Fahl WE, Nkana ZH, Gitter MM, Zeng W, Dingle AM. Significantly Improved Cold Preservation of Rat Hind Limb Vascularized Composite Allografts Using the New PrC-210 Free Radical Scavenger. Int J Mol Sci 2024; 25:1609. [PMID: 38338887 PMCID: PMC10855741 DOI: 10.3390/ijms25031609] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/24/2024] [Accepted: 01/25/2024] [Indexed: 02/12/2024] Open
Abstract
Vascularized composite allotransplantation (VCA) represents a promising reconstructive solution primarily conducted to improve quality of life. However, tissue damage caused by cold-ischemia (CI) storage prior to transplant represents a major factor limiting widespread application. This study investigates the addition of the novel free radical scavenger PrC-210 to UW Organ Preservation Solution (UW Solution) to suppress CI-induced skeletal muscle injury in a rat hind limb amputation model. Lewis rats received systemic perfusion of UW solution +/- PrC-210 (0 mM control, 10 mM, 20 mM, 30 mM, or 40 mM), followed by bilateral transfemoral amputation. Limbs were stored in 40 mL of the same perfusate at 4 °C for 48 h. Muscle punch biopsies were taken at set times over the 48 h cold-storage period and analyzed for caspase-3,7 activity, cytochrome C levels, and qualitative histology. A single 15 s perfusion of PrC-210-containing UW Solution conferred a dose-dependent reduction in CI-induced muscle cell death over 48 h. In the presence of PrC-210, muscle cell mitochondrial cytochrome C release was equivalent to 0 h controls, with profound reductions in the caspase-3,7 apoptotic marker that correlated with limb histology. PrC-210 conferred complete prevention of ROS-induced mitochondrial lysis in vitro, as measured by cytochrome C release. We conclude that the addition of 30 mM PrC210 to UW Solution conferred the most consistent reduction in CI limb damage, and it warrants further investigation for clinical application in the VCA setting.
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Affiliation(s)
- William E. Fahl
- Wisconsin Institute of Medical Research, University of Wisconsin-Madison, 111 Highland Ave., Madison, WI 53705, USA;
| | - Zeeda H. Nkana
- Division of Plastic Surgery, Department of Surgery, University of Wisconsin-Madison, 600 Highland Ave., Madison, WI 53705, USA; (Z.H.N.); (W.Z.); (A.M.D.)
| | - Maya M. Gitter
- Wisconsin Institute of Medical Research, University of Wisconsin-Madison, 111 Highland Ave., Madison, WI 53705, USA;
| | - Weifeng Zeng
- Division of Plastic Surgery, Department of Surgery, University of Wisconsin-Madison, 600 Highland Ave., Madison, WI 53705, USA; (Z.H.N.); (W.Z.); (A.M.D.)
| | - Aaron M. Dingle
- Division of Plastic Surgery, Department of Surgery, University of Wisconsin-Madison, 600 Highland Ave., Madison, WI 53705, USA; (Z.H.N.); (W.Z.); (A.M.D.)
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Shaffrey EC, Zeng W, Nicksic PJ, Eftekari SC, Frank JM, Dingle AM, Poore SO. Latex-Infused Porcine Abdominal Model: A Novel Microsurgery Simulator for Deep Inferior Epigastric Perforator Dissection. J Reconstr Microsurg 2024; 40:23-29. [PMID: 37023768 DOI: 10.1055/s-0043-1768218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
BACKGROUND Perforator dissection and flap elevation are routinely performed for microsurgical reconstruction; however, there is a steep learning curve to mastering these technical skills. Though live porcine models have been utilized as a microsurgical training model, there are significant drawbacks that limit their use, including cost, limited ability for repetition, and obstacles associated with animal care. Here we describe the creation of a novel perforator dissection model using latex augmented non-living porcine abdominal walls. We provide anatomic measurements that demonstrate valuable similarities and differences to human anatomy to maximize microsurgical trainee practice. METHODS Six latex-infused porcine abdomens were dissected based on the deep cranial epigastric artery (DCEA). Dissection was centered over the abdominal wall mid-segment between the second and fourth nipple line. Dissection steps included exposure of lateral and medial row perforators, incision of anterior rectus sheath with perforator dissection, and dissection of DCEA pedicle. DCEA pedicle and perforator measurements were compared with deep inferior epigastric artery (DIEA) data in the literature. RESULTS An average of seven perforators were consistently identified within each flap. Assembly of the model was performed quickly and allowed for two training sessions per specimen. Porcine abdominal walls demonstrate similar DCEA pedicle (2.6 ± 0.21 mm) and perforator (1.0 ± 0.18 mm) size compared with a human's DIEA (2.7 ± 0.27 mm, 1.1 ± 0.85 mm). CONCLUSION The latex-infused porcine abdominal model is a novel, realistic simulation for perforator dissection practice for microsurgical trainees. Impact on resident comfort and confidence within a microsurgical training course is forthcoming.
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Affiliation(s)
- Ellen C Shaffrey
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Weifeng Zeng
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Peter J Nicksic
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Sahand C Eftekari
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Jennifer M Frank
- Department of Animal and Dairy Sciences, University of Wisconsin-Madison College of Agricultural and Life Sciences, Madison, Wisconsin
| | - Aaron M Dingle
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Samuel O Poore
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Nicksic PJ, Donnelly DT, Zeng W, Seitz AJ, Poore SO, Suminski AJ, Dingle AM. Trigeminal or peripheral nerve stimulation improves functional outcomes of nerve recovery in a rodent forelimb gap repair model. J Plast Reconstr Aesthet Surg 2024; 88:57-65. [PMID: 37952438 DOI: 10.1016/j.bjps.2023.10.118] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/10/2023] [Accepted: 10/20/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND The hypothesis of this study was that trigeminal nerve stimulation (TNS) or peripheral nerve stimulation (PNS) could improve functional outcomes of peripheral nerve injury in a rat forelimb model when compared to control rats not receiving electrical stimulation (ES). While PNS is known to improve outcomes after nerve surgery, the role of TNS has not been explored. METHODS Lewis rats were trained to perform a reach and grasp task before receiving a 2 mm gap repair of the ulnar and median nerves and randomized into four treatment groups: (1) sham injury, (2) nerve injury with sham ES, (3) nerve injury with PNS, and (4) nerve injury with TNS. Functional motor (median pull force and percent success in motor task) and sensory metrics (forelimb paw withdrawal thresholds) were collected both pre-injury and throughout rehabilitation. Nerves stained using Gomori's trichrome were assessed quantitatively and qualitatively. RESULTS The sham ES group did not recover their pre-injury baseline functional outcomes. In contrast, the TNS and PNS groups fully recovered following injury, with no difference in functional outcomes between the pre-injury baseline and the final week of rehabilitation (P > 0.05, all). Histomorphology results demonstrated no quantitative difference, but qualitative differences in architecture were evident. CONCLUSIONS Electrical stimulation of the trigeminal nerve or the injured nerve improved the functional outcomes of nerve regeneration in rodents. Histomorphology results of nerves from the TNS group support the proposed central mechanisms. This is an important step in translating this therapy as an adjunct, non-invasive treatment for high, mixed nerve injuries in humans.
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Affiliation(s)
- Peter J Nicksic
- University of Wisconsin, Division of Plastic and Reconstructive Surgery, Madison, WI, United States
| | - D'Andrea T Donnelly
- University of Wisconsin, Division of Plastic and Reconstructive Surgery, Madison, WI, United States
| | - Weifeng Zeng
- University of Wisconsin, Division of Plastic and Reconstructive Surgery, Madison, WI, United States
| | - Allison J Seitz
- University of Wisconsin, Division of Plastic and Reconstructive Surgery, Madison, WI, United States
| | - Samuel O Poore
- University of Wisconsin, Division of Plastic and Reconstructive Surgery, Madison, WI, United States
| | - Aaron J Suminski
- University of Wisconsin, Department of Neurological Surgery, Madison, WI, United States; Wisconsin Institute for Translational Neuroengineering, Madison, WI, United States
| | - Aaron M Dingle
- University of Wisconsin, Division of Plastic and Reconstructive Surgery, Madison, WI, United States.
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Donnelly DT, Nicksic PJ, Zeng W, Dingle AM, Poore SO. Evaluation of a Full-Time Microsurgeon Educator on Resident Training, Research Collaboration, and Grant Funding. J Reconstr Microsurg 2023; 39:648-654. [PMID: 37040796 DOI: 10.1055/s-0043-1767678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
BACKGROUND The value of a fully trained microsurgeon dedicated to a laboratory setting at an academic institution is largely unknown. Microsurgery training lacks a national standard despite its highly complicated nature. Our study aims to evaluate the impact of a single laboratory-dedicated microsurgeon on the microsurgical training of integrated plastic surgery residents and collaborative efforts in research. METHOD We devised a three-faceted microsurgical training curriculum, including a collaborative multi-institutional microsurgery course, novel high-fidelity simulator models, and a dedicated microsurgeon. We cataloged grant funding achieved through support to other divisions' protocols. Time, in hours, spent on training and the number of anastomoses completed with the microsurgical educator in a laboratory setting over a 4-year period (2017-2021) were evaluated. Resident independence scores were collected from attending microsurgeons to quantify the translation of microsurgical training. RESULTS Purchasing and maintenance costs of rats in our rodent facility decreased by $16,533.60 as 198 rats were replaced by our models. The residents who participated in our novel microsurgical training program were able to independently perform anastomoses in the OR by their postgraduate year 6. Additionally, the surgical support offered by our laboratory-dedicated microsurgeon led to a total of $24,171,921 in grant funding between 2017 and 2020. CONCLUSION Hiring an expert microsurgical educator to train residents in a laboratory has proved promising in accelerating microsurgical mastery. Novel training modules, alternatives to animal models, save resources in housing and animal costs. The addition of a research-oriented-microsurgeon has improved collaborative efforts to advance a range of surgical fields.
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Affiliation(s)
- D'Andrea T Donnelly
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Peter J Nicksic
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Weifeng Zeng
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Aaron M Dingle
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Samuel O Poore
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Eftekari SC, Sears L, Moura SP, Garelick S, Donnelly DT, Shaffrey EC, Dingle AM. A framework for understanding prosthetic embodiment for the plastic surgeon. J Plast Reconstr Aesthet Surg 2023; 84:469-486. [PMID: 37418846 DOI: 10.1016/j.bjps.2023.06.041] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 05/17/2023] [Accepted: 06/09/2023] [Indexed: 07/09/2023]
Abstract
Plastic surgeons play a critical role in the management of amputations and are uniquely positioned to improve the lives and functional abilities of patients with limb loss. The embodiment of a prosthesis describes how effectively it replaces a missing limb and is an important aspect of patient care. Despite its importance, the current prosthetics literature lacks a formal definition of embodiment, and descriptions are often vague or incomplete. In this narrative review, we assess the current literature on prosthetic embodiment to explore the main mechanisms of embodiment and how each allows a prosthesis to interface with the human body. In doing so, we provide a comprehensive, holistic framework for understanding this concept.
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Affiliation(s)
- Sahand C Eftekari
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Lucas Sears
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Steven P Moura
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Sydney Garelick
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - D'Andrea T Donnelly
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Ellen C Shaffrey
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Aaron M Dingle
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
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Suminski AJ, Rajala AZ, Birn RM, Mueller EM, Malone ME, Ness JP, Filla C, Brunner K, McMillan AB, Poore SO, Williams JC, Murali D, Brzeczkowski A, Hurley SA, Dingle AM, Zeng W, Lake WB, Ludwig KA, Populin LC. Vagus nerve stimulation in the non-human primate: implantation methodology, characterization of nerve anatomy, target engagement and experimental applications. Bioelectron Med 2023; 9:9. [PMID: 37118841 PMCID: PMC10148417 DOI: 10.1186/s42234-023-00111-8] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 04/19/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND Vagus nerve stimulation (VNS) is a FDA approved therapy regularly used to treat a variety of neurological disorders that impact the central nervous system (CNS) including epilepsy and stroke. Putatively, the therapeutic efficacy of VNS results from its action on neuromodulatory centers via projections of the vagus nerve to the solitary tract nucleus. Currently, there is not an established large animal model that facilitates detailed mechanistic studies exploring how VNS impacts the function of the CNS, especially during complex behaviors requiring motor action and decision making. METHODS We describe the anatomical organization, surgical methodology to implant VNS electrodes on the left gagus nerve and characterization of target engagement/neural interface properties in a non-human primate (NHP) model of VNS that permits chronic stimulation over long periods of time. Furthermore, we describe the results of pilot experiments in a small number of NHPs to demonstrate how this preparation might be used in an animal model capable of performing complex motor and decision making tasks. RESULTS VNS electrode impedance remained constant over months suggesting a stable interface. VNS elicited robust activation of the vagus nerve which resulted in decreases of respiration rate and/or partial pressure of carbon dioxide in expired air, but not changes in heart rate in both awake and anesthetized NHPs. CONCLUSIONS We anticipate that this preparation will be very useful to study the mechanisms underlying the effects of VNS for the treatment of conditions such as epilepsy and depression, for which VNS is extensively used, as well as for the study of the neurobiological basis underlying higher order functions such as learning and memory.
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Affiliation(s)
- Aaron J Suminski
- Department of Neurological Surgery, University of Wisconsin-Madison, Madison, WI, USA
- Wisconsin Institute for Translational Neuroengineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Abigail Z Rajala
- Department of Neuroscience, University of Wisconsin-Madison, 1111 Highland Ave, Madison, WI, 53705, USA
| | - Rasmus M Birn
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, USA
| | - Ellie M Mueller
- Department of Neuroscience, University of Wisconsin-Madison, 1111 Highland Ave, Madison, WI, 53705, USA
| | - Margaret E Malone
- Department of Neuroscience, University of Wisconsin-Madison, 1111 Highland Ave, Madison, WI, 53705, USA
| | - Jared P Ness
- Wisconsin Institute for Translational Neuroengineering, University of Wisconsin-Madison, Madison, WI, USA
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Caitlyn Filla
- Department of Neuroscience, University of Wisconsin-Madison, 1111 Highland Ave, Madison, WI, 53705, USA
| | - Kevin Brunner
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Alan B McMillan
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA
| | - Samuel O Poore
- Division of Plastic Surgery, University of Wisconsin-Madison, Madison, WI, USA
| | - Justin C Williams
- Department of Neurological Surgery, University of Wisconsin-Madison, Madison, WI, USA
- Wisconsin Institute for Translational Neuroengineering, University of Wisconsin-Madison, Madison, WI, USA
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Dhanabalan Murali
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA
| | - Andrea Brzeczkowski
- Department of Neurological Surgery, University of Wisconsin-Madison, Madison, WI, USA
- Wisconsin Institute for Translational Neuroengineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Samuel A Hurley
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Aaron M Dingle
- Division of Plastic Surgery, University of Wisconsin-Madison, Madison, WI, USA
| | - Weifeng Zeng
- Division of Plastic Surgery, University of Wisconsin-Madison, Madison, WI, USA
| | - Wendell B Lake
- Department of Neurological Surgery, University of Wisconsin-Madison, Madison, WI, USA
- Wisconsin Institute for Translational Neuroengineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Kip A Ludwig
- Department of Neurological Surgery, University of Wisconsin-Madison, Madison, WI, USA
- Wisconsin Institute for Translational Neuroengineering, University of Wisconsin-Madison, Madison, WI, USA
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Luis C Populin
- Department of Neuroscience, University of Wisconsin-Madison, 1111 Highland Ave, Madison, WI, 53705, USA.
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Verma N, Le T, Mudge J, Nicksic PJ, Xistris L, Kasole M, Shoffstall AJ, Poore SO, Ludwig KA, Dingle AM. Efficacy of bone stimulators in large-animal models and humans may be limited by weak electric fields reaching fracture. Sci Rep 2022; 12:21798. [PMID: 36526728 PMCID: PMC9758190 DOI: 10.1038/s41598-022-26215-w] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
Noninvasive electronic bone growth stimulators (EBGSs) have been in clinical use for decades. However, systematic reviews show inconsistent and limited clinical efficacy. Further, noninvasive EBGS studies in small animals, where the stimulation electrode is closer to the fracture site, have shown promising efficacy, which has not translated to large animals or humans. We propose that this is due to the weaker electric fields reaching the fracture site when scaling from small animals to large animals and humans. To address this gap, we measured the electric field strength reaching the bone during noninvasive EBGS therapy in human and sheep cadaver legs and in finite element method (FEM) models of human and sheep legs. During application of 1100 V/m with an external EBGS, only 21 V/m reached the fracture site in humans. Substantially weaker electric fields reached the fracture site during the later stages of healing and at increased bone depths. To augment the electric field strength reaching the fracture site during noninvasive EBGS therapy, we introduced the Injectrode, an injectable electrode that spans the distance between the bone and subcutaneous tissue. Our study lays the groundwork to improve the efficacy of noninvasive EBGSs by increasing the electric field strength reaching the fracture site.
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Affiliation(s)
- Nishant Verma
- grid.14003.360000 0001 2167 3675Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI USA ,grid.14003.360000 0001 2167 3675Wisconsin Institute for Translational Neuroengineering (WITNe), University of Wisconsin-Madison, Madison, WI USA
| | - Todd Le
- grid.14003.360000 0001 2167 3675Division of Plastic Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI USA
| | - Jonah Mudge
- grid.14003.360000 0001 2167 3675Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI USA ,grid.14003.360000 0001 2167 3675Wisconsin Institute for Translational Neuroengineering (WITNe), University of Wisconsin-Madison, Madison, WI USA
| | - Peter J. Nicksic
- grid.14003.360000 0001 2167 3675Division of Plastic Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI USA
| | - Lillian Xistris
- grid.14003.360000 0001 2167 3675Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI USA ,grid.14003.360000 0001 2167 3675Wisconsin Institute for Translational Neuroengineering (WITNe), University of Wisconsin-Madison, Madison, WI USA ,grid.14003.360000 0001 2167 3675Division of Plastic Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI USA
| | - Maisha Kasole
- grid.14003.360000 0001 2167 3675Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI USA ,grid.14003.360000 0001 2167 3675Wisconsin Institute for Translational Neuroengineering (WITNe), University of Wisconsin-Madison, Madison, WI USA
| | - Andrew J. Shoffstall
- grid.67105.350000 0001 2164 3847Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH USA ,grid.410349.b0000 0004 5912 6484Advanced Platform Technology Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH USA
| | - Samuel O. Poore
- grid.14003.360000 0001 2167 3675Division of Plastic Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI USA
| | - Kip A. Ludwig
- grid.14003.360000 0001 2167 3675Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI USA ,grid.14003.360000 0001 2167 3675Wisconsin Institute for Translational Neuroengineering (WITNe), University of Wisconsin-Madison, Madison, WI USA ,grid.14003.360000 0001 2167 3675Department of Neurological Surgery, University of Wisconsin-Madison, Madison, WI USA
| | - Aaron M. Dingle
- grid.14003.360000 0001 2167 3675Division of Plastic Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI USA
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10
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Smith RM, Rathore S, Donnelly D, Nicksic PJ, Poore SO, Dingle AM. Diversity Drives Innovation: The Impact of Female-Driven Publications. Aesthet Surg J 2022; 42:1470-1481. [PMID: 35640257 DOI: 10.1093/asj/sjac137] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Gender disparities are pervasive in academic plastic surgery. Previous research demonstrates articles authored by women receive fewer citations than those written by men, suggesting the presence of implicit gender bias. OBJECTIVES The aim of this study was to describe current citation trends in plastic surgery literature and assess gender bias. The expectation was that women would be cited less frequently than their male peers. METHODS Articles published between 2017 and 2019 were collected from 8 representative plastic surgery journals stratified by impact factor. Names of primary and senior authors of the 50 most cited articles per year per journal were collected and author gender was determined via online database and internet search. The median numbers of citations by primary and senior author gender were compared by Kruskal-Wallis test. RESULTS Among 1167 articles, women wrote 27.3% as primary author and 18% as senior author. Women-authored articles were cited as often as those authored by men (P > 0.05) across all journal tiers. Articles with a female primary and male senior author had significantly more citations than articles with a male primary author (P = 0.038). CONCLUSIONS No implicit gender bias was identified in citation trends, a finding unique to plastic surgery. Women primary authors are cited more often than male primary authors despite women comprising a small fraction of authorship overall. Additionally, variegated authorship pairings outperformed homogeneous ones. Therefore, increasing gender diversity within plastic surgery academia remains critical.
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Affiliation(s)
- Rachel M Smith
- Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Srishti Rathore
- University of Wisconsin School of Medicine and Public Health Division of Plastic Surgery, Madison, WI, USA
| | - D'Andrea Donnelly
- University of Wisconsin School of Medicine and Public Health Division of Plastic Surgery, Madison, WI, USA
| | - Peter J Nicksic
- University of Wisconsin School of Medicine and Public Health Division of Plastic Surgery, Madison, WI, USA
| | - Samuel O Poore
- University of Wisconsin School of Medicine and Public Health Division of Plastic Surgery, Madison, WI, USA
| | - Aaron M Dingle
- University of Wisconsin School of Medicine and Public Health Division of Plastic Surgery, Madison, WI, USA
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11
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Treb K, Ji X, Feng M, Zhang R, Periyasamy S, Laeseke PF, Dingle AM, Brace CL, Li K. A C-arm photon counting CT prototype with volumetric coverage using multi-sweep step-and-shoot acquisitions. Phys Med Biol 2022; 67:10.1088/1361-6560/ac950d. [PMID: 36162399 PMCID: PMC9623602 DOI: 10.1088/1361-6560/ac950d] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 09/26/2022] [Indexed: 11/12/2022]
Abstract
Objective.Existing clinical C-arm interventional systems use scintillator-based energy-integrating flat panel detectors (FPDs) to generate cone-beam CT (CBCT) images. Despite its volumetric coverage, FPD-CBCT does not provide sufficient low-contrast detectability desired for certain interventional procedures. The purpose of this work was to develop a C-arm photon counting detector (PCD) CT system with a step-and-shoot data acquisition method to further improve the tomographic imaging performance of interventional systems.Approach.As a proof-of-concept, a cadmium telluride-based 51 cm × 0.6 cm PCD was mounted in front of a FPD in an Artis Zee biplane system. A total of 10 C-arm sweeps (5 forward and 5 backward) were prescribed. A motorized patient table prototype was synchronized with the C-arm system such that it translates the object by a designated distance during the sub-second rest time in between gantry sweeps. To evaluate whether this multi-sweep step-and-shoot acquisition strategy can generate high-quality and volumetric PCD-CT images without geometric distortion artifacts, experiments were performed using physical phantoms, a human cadaver head, and anin vivoswine subject. Comparison with FPD-CT was made under matched narrow beam collimation and radiation dose conditions.Main results.Compared with FPD-CT images, PCD-CT images had lower noise and improved visualization of low-contrast lesion models, as well as improved visibility of small iodinated blood vessels. Fine structures were visualized more clearly by the PCD-CT than the highest-available resolution provided by FPD-CBCT and MDCT. No perceivable geometric distortion artifacts were observed in the multi-planar PCD-CT images.Significance.This work is the first demonstration of the feasibility of high-quality and multi-planar (volumetric) PCD-CT imaging with a rotating C-arm gantry.
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Affiliation(s)
- Kevin Treb
- Department of Medical Physics, School of Medicine and Public Health, University of Wisconsin-Madison, 1111 Highland Avenue, Madison, WI 53705, USA
| | - Xu Ji
- Department of Medical Physics, School of Medicine and Public Health, University of Wisconsin-Madison, 1111 Highland Avenue, Madison, WI 53705, USA
| | - Mang Feng
- Department of Medical Physics, School of Medicine and Public Health, University of Wisconsin-Madison, 1111 Highland Avenue, Madison, WI 53705, USA
| | - Ran Zhang
- Department of Medical Physics, School of Medicine and Public Health, University of Wisconsin-Madison, 1111 Highland Avenue, Madison, WI 53705, USA
| | - Sarvesh Periyasamy
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53792, USA
| | - Paul F. Laeseke
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53792, USA
| | - Aaron M. Dingle
- Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53792, USA
| | - Christopher L. Brace
- Department of Biomedical Engineering, University of Wisconsin-Madison, 1415 Engineering Drive, Madison, WI, 53706, USA
| | - Ke Li
- Department of Medical Physics, School of Medicine and Public Health, University of Wisconsin-Madison, 1111 Highland Avenue, Madison, WI 53705, USA
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53792, USA
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12
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Wood KL, Fonseca MIA, Gunderson KA, Nkana ZH, Israel JS, Poore SO, Dingle AM. Local Environment Induces Differential Gene Expression in Regenerating Nerves. J Surg Res 2022; 278:418-432. [PMID: 35618492 DOI: 10.1016/j.jss.2022.04.017] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 03/18/2022] [Accepted: 04/07/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Approximately 80% of amputations are complicated by neuromas. Methods for neuroma management include nerve translocation into bone and implantation into skeletal muscle grafts, which have also facilitated the development of regenerative neural interfaces to enable fixation of prosthetics with motor and sensory feedback. However, molecular-level differences between nerves in these environments have not been investigated. This study aimed to elucidate the physiology of regenerating nerves in different settings by assessing gene expression. MATERIALS AND METHODS New Zealand white rabbits underwent transfemoral amputation with sciatic nerve transposition into the femur or tacked to skeletal muscle. At 5 wk, ribonucleic acid (RNA) sequencing of samples of distal nerve terminating in bone or muscle and nerve of the contralateral limb (control) identified differentially expressed genes (DEGs) and biochemical pathways (α = 0.05). RESULTS Three samples of nerve housed in bone, four of nerve tacked to muscle, and seven naïve controls were analyzed. Relative to controls, nerve housed in bone had little within-group variation and 13,028 DEGs, and nerve tacked to muscle had dramatic within-group variation and 12,811 DEGs. These samples upregulated the following pathways: lysosome, phagosome, antigen processing/presentation, and cell adhesion molecule. Relative to nerve housed in bone, nerve tacked to muscle had 12,526 DEGs, demonstrating upregulation of pathways of B-cell receptor signaling, focal adhesion, natural killer-cell mediated cytotoxicity, leukocyte transendothelial migration, and extracellular matrix-receptor interactions. CONCLUSIONS Nerve housed in bone has a more predictable molecular profile than does nerve tacked to muscle. Thus, the intramedullary canal may provide a more reliable setting for neuroma prevention and neural interfacing.
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Affiliation(s)
- Kasey Leigh Wood
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Marina I Adrianzen Fonseca
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Kirsten A Gunderson
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Zeeda H Nkana
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Jacqueline S Israel
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Samuel O Poore
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Aaron M Dingle
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
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13
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Warden AM, Soteropulos CE, Eftekari SC, Nicksic PJ, Dingle AM, Poore SO. To Decline or Accept: A Guide for Determining the Legitimacy of Academic Conference Invitations. Ann Plast Surg 2022; 89:8-16. [PMID: 35502938 DOI: 10.1097/sap.0000000000003180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
IMPORTANCE After the rise of predatory journals characterized by false claims of legitimacy and a pay-to-publish model, similar "predatory conferences" have become increasingly common. The email inbox of an academic physician can be filled with daily announcements encouraging conference attendance, abstract submission, and often panel or keynote speaker invitations. It therefore becomes important for the plastic surgeon to be able to discern whether these invitations are from "predatory" conferences or legitimate career advancement opportunities, especially early in practice. OBJECTIVE To aid the invited physician in determining the legitimacy of a conference, we aimed to characterize objective features of conferences for which email invitations have been received and use this information to build a decision-making guide. DESIGN We analyzed all conference invitations received by the email of one academic plastic surgeon in a 4-month period. These conferences were organized into 3 groups based on affiliation with known professional societies. The following information was collected if available: affiliation with a professional society, type of invitation, conference location, conference format (in-person, virtual, or hybrid), conference title, conference fees, conference organizer, associated journals or publishers, abstract journal submission, grammar, headshots, time to abstract review, and acceptance. RESULTS There were 56 unique conference invitations. These were categorized into 15 affiliated conferences, 28 unaffiliated conferences, and 17 conferences of undetermined affiliation. Unaffiliated conferences were more likely to solicit speaker invitations ( P < 0.001), claim to be "international" ( P = 0.001), send emails with grammatical errors ( P < 0.001), use unprofessional headshots on the conference Web site ( P < 0.001), and have reduced virtual conference fees ( P = 0.0032) as compared with conferences affiliated with known professional societies. When comparing the attendance and presenter fees of in-person venues, there was no significant difference between affiliated and unaffiliated conferences ( P = 0.973, P = 0.604). Affiliated conferences were more likely to take place in the United States ( P = 0.014). CONCLUSIONS AND RELEVANCE We present a method to quickly assess the legitimacy of an academic meeting by way of a few important questions. Based on our findings, emails soliciting conference speakers, claims of international presence, grammatical errors, unprofessional headshots, and reduced virtual conference fees are all characteristics that should raise red flags.
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Affiliation(s)
- Aleah M Warden
- From the Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
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14
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Nicksic PJ, Donnelly DT, Verma N, Setiz AJ, Shoffstall AJ, Ludwig KA, Dingle AM, Poore SO. Electrical Stimulation of Acute Fractures: A Narrative Review of Stimulation Protocols and Device Specifications. Front Bioeng Biotechnol 2022; 10:879187. [PMID: 35721861 PMCID: PMC9201474 DOI: 10.3389/fbioe.2022.879187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 04/26/2022] [Indexed: 11/13/2022] Open
Abstract
Orthopedic fractures have a significant impact on patients in the form of economic loss and functional impairment. Beyond the standard methods of reduction and fixation, one adjunct that has been explored since the late 1970s is electrical stimulation. Despite robust evidence for efficacy in the preclinical arena, human trials have mixed results, and this technology is not widely accepted. The purpose of this review is to examine the body of literature supporting electrical stimulation for the purpose of fracture healing in humans with an emphasis on device specifications and stimulation protocols and delineate a minimum reporting checklist for future studies of this type. We have isolated 12 studies that pertain to the administration of electrical stimulation for the purpose of augmenting fracture healing in humans. Of these, one was a direct current electrical stimulation study. Six studies utilized pulsed electromagnetic field therapy and five used capacitive coupling. When examining these studies, the device specifications were heterogenous and often incomplete in what they reported, which rendered studies unrepeatable. The stimulation protocols also varied greatly study to study. To demonstrate efficacy of electrical stimulation for fractures, the authors recommend isolating a fracture type that is prone to nonunion to maximize the electrical stimulation effect, a homogenous study population so as to not dilute the effect of electrical stimulation, and increasing scientific rigor in the form of pre-registration, blinding, and sham controls. Finally, we introduce the critical components of minimum device specification reporting for repeatability of studies of this type.
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Affiliation(s)
- Peter J. Nicksic
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - D’Andrea T. Donnelly
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Nishant Verma
- Department of Biomedical Engineering, University of Wisconsin—Madison, Madison, WI, United States
- Wisconsin Institute for Translational Neuroengineering (WITNe), University of Wisconsin—Madison, Madison, WI, United States
| | - Allison J. Setiz
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Andrew J. Shoffstall
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States
- APT Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, United States
| | - Kip A. Ludwig
- Department of Biomedical Engineering, University of Wisconsin—Madison, Madison, WI, United States
- Wisconsin Institute for Translational Neuroengineering (WITNe), University of Wisconsin—Madison, Madison, WI, United States
- Department of Neurological Surgery, University of Wisconsin—Madison, Madison, WI, United States
| | - Aaron M. Dingle
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Samuel O. Poore
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
- *Correspondence: Samuel O. Poore,
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15
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Dingle AM, Moxon K, Shokur S, Strauss I. Editorial: Getting Neuroprosthetics Out of the Lab: Improving the Human-Machine Interactions to Restore Sensory-Motor Functions. Front Robot AI 2022; 9:928383. [PMID: 35694207 PMCID: PMC9175017 DOI: 10.3389/frobt.2022.928383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 05/09/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Aaron M. Dingle
- Division of Plastic Surgery, Department of Surgery, University of Wisconsin- Madison, Madison, WI, United States
- *Correspondence: Aaron M. Dingle,
| | - Karen Moxon
- Department of Biomedical Engineering, University of California at Davis, Davis, CA, United States
| | - Solaiman Shokur
- École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Ivo Strauss
- Department of Excellence in Robotics and A.I, Scuola Superiore Sant’Anna, Pisa, Italy
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16
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Karczewski AM, Zeng W, Stratchko LM, Bachus KN, Poore SO, Dingle AM. Clinical Basis for Creating an Osseointegrated Neural Interface. Front Neurosci 2022; 16:828593. [PMID: 35495044 PMCID: PMC9039253 DOI: 10.3389/fnins.2022.828593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 03/16/2022] [Indexed: 11/13/2022] Open
Abstract
As technology continues to improve within the neuroprosthetic landscape, there has been a paradigm shift in the approach to amputation and surgical implementation of haptic neural prosthesis for limb restoration. The Osseointegrated Neural Interface (ONI) is a proposed solution involving the transposition of terminal nerves into the medullary canal of long bones. This design combines concepts of neuroma formation and prevention with osseointegration to provide a stable environment for conduction of neural signals for sophisticated prosthetic control. While this concept has previously been explored in animal models, it has yet to be explored in humans. This anatomic study used three upper limb and three lower limb cadavers to assess the clinical feasibility of creating an ONI in humans. Anatomical measurement of the major peripheral nerves- circumference, length, and depth- were performed as they are critical for electrode design and rerouting of the nerves into the long bones. CT imaging was used for morphologic bone evaluation and virtual implantation of two osseointegrated implants were performed to assess the amount of residual medullary space available for housing the neural interfacing hardware. Use of a small stem osseointegrated implant was found to reduce bone removal and provide more intramedullary space than a traditional implant; however, the higher the amputation site, the less medullary space was available regardless of implant type. Thus the stability of the endoprosthesis must be maximized while still maintaining enough residual space for the interface components. The results from this study provide an anatomic basis required for establishing a clinically applicable ONI in humans. They may serve as a guide for surgical implementation of an osseointegrated endoprosthesis with intramedullary electrodes for prosthetic control.
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Affiliation(s)
- Alison M. Karczewski
- Division of Plastic Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Weifeng Zeng
- Division of Plastic Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Lindsay M. Stratchko
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
- *Correspondence: Lindsay M. Stratchko,
| | - Kent N. Bachus
- George E. Wahlen Department of Veterans Affairs Medical Center and the Department of Orthopaedics, University of Utah Orthopaedic Center, Salt Lake City, UT, United States
| | - Samuel O. Poore
- Division of Plastic Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Aaron M. Dingle
- Division of Plastic Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
- Aaron M. Dingle,
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17
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Nicksic PJ, Donnelly DT, Hesse M, Bedi S, Verma N, Seitz AJ, Shoffstall AJ, Ludwig KA, Dingle AM, Poore SO. Electronic Bone Growth Stimulators for Augmentation of Osteogenesis in In Vitro and In Vivo Models: A Narrative Review of Electrical Stimulation Mechanisms and Device Specifications. Front Bioeng Biotechnol 2022; 10:793945. [PMID: 35237571 PMCID: PMC8882968 DOI: 10.3389/fbioe.2022.793945] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 10/12/2021] [Accepted: 01/17/2022] [Indexed: 01/23/2023] Open
Abstract
Since the piezoelectric quality of bone was discovered in 1957, scientists have applied exogenous electrical stimulation for the purpose of healing. Despite the efforts made over the past 60 years, electronic bone growth stimulators are not in common clinical use. Reasons for this include high cost and lack of faith in the efficacy of bone growth stimulators on behalf of clinicians. The purpose of this narrative review is to examine the preclinical body of literature supporting electrical stimulation and its effect on bone properties and elucidate gaps in clinical translation with an emphasis on device specifications and mechanisms of action. When examining these studies, trends become apparent. In vitro and small animal studies are successful in inducing osteogenesis with all electrical stimulation modalities: direct current, pulsed electromagnetic field, and capacitive coupling. However, large animal studies are largely unsuccessful with the non-invasive modalities. This may be due to issues of scale and thickness of tissue planes with varying levels of resistivity, not present in small animal models. Additionally, it is difficult to draw conclusions from studies due to the varying units of stimulation strength and stimulation protocols and incomplete device specification reporting. To better understand the disconnect between the large and small animal model, the authors recommend increasing scientific rigor for these studies and reporting a novel minimum set of parameters depending on the stimulation modality.
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Affiliation(s)
- Peter J. Nicksic
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - D’Andrea T. Donnelly
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Madison Hesse
- Des Moines University School of Medicine and Health Sciences, Des Moines, IA, United States
| | - Simran Bedi
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States,Department of Biomedical Engineering, University of Wisconsin—Madison, Madison, WI, United States
| | - Nishant Verma
- Department of Biomedical Engineering, University of Wisconsin—Madison, Madison, WI, United States,Wisconsin Institute for Translational Neuroengineering (WITNe), Madison, WI, United States
| | - Allison J. Seitz
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Andrew J. Shoffstall
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States
| | - Kip A. Ludwig
- Department of Biomedical Engineering, University of Wisconsin—Madison, Madison, WI, United States,Wisconsin Institute for Translational Neuroengineering (WITNe), Madison, WI, United States
| | - Aaron M. Dingle
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Samuel O. Poore
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States,*Correspondence: Samuel O. Poore,
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18
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Karczewski AM, Dingle AM, Poore SO. Osseointegration of Extremity Prostheses: A Primer for the Plastic Surgeon. Plast Reconstr Surg 2022; 149:150e-151e. [PMID: 34855705 DOI: 10.1097/prs.0000000000008644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
| | | | - Samuel O Poore
- Division of Plastic Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wis
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19
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Feng M, Ji X, Zhang R, Treb K, Dingle AM, Li K. An experimental method to correct low-frequency concentric artifacts in photon counting CT. Phys Med Biol 2021; 66. [PMID: 34315142 DOI: 10.1088/1361-6560/ac1833] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 04/06/2021] [Accepted: 07/27/2021] [Indexed: 11/12/2022]
Abstract
Large-area photon counting detectors (PCDs) are usually built by tiling multiple semiconductor panels that often have slightly different spectral responses to input x-rays. As a result of this spectral inconsistency, experimental PCD-CT images of large, human-sized objects may show high-frequency ring artifacts and low-frequency band artifacts. Due to the much larger width of the bands compared with the rings, the concentric artifact problem in PCD-CT images of human-sized objects cannot be adequately addressed by conventional CT ring correction methods. This work presents an experimental method to correct the concentric artifacts in PCD-CT. The method is applicable to not only energy-discriminating PCDs with multiple bins but also PCDs with only a single threshold controller. Its principle is similar to the two-step beam hardening correction method, except that the proposed method uses pixel-specific polynomial functions to address the spectral inconsistency problem across the detector plane. The pixel-specific polynomial coefficients were experimentally calibrated using 15 acrylic sheets and 6 aluminum sheets of known thicknesses. The pixel-specific polynomial functions were used to convert the measured PCD-CT projection data to acrylic- and aluminum-equivalent thicknesses that are energy-independent. The proposed method was experimentally evaluated using a human cadaver head and multiple physical phantoms: two of them contain iodine and one phantom contains dual K-edge contrast materials (gadolinium and iodine). The results show that the proposed method can effectively remove the low-frequency concentric artifacts in PCD-CT images while reducing beam hardening artifacts. In contrast, the conventional CT ring correction algorithm did not adequately address the low-frequency band artifacts. Compared with the direct material decomposition-based correction method, the proposed method not only relaxes the requirement of multi-energy bins but also generates images with lower noise and fewer concentric artifacts.
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Affiliation(s)
- Mang Feng
- Department of Medical Physics, University of Wisconsin-Madison, 1111 Highland Avenue, Madison, WI 53705, United States of America
| | - Xu Ji
- Department of Medical Physics, University of Wisconsin-Madison, 1111 Highland Avenue, Madison, WI 53705, United States of America
| | - Ran Zhang
- Department of Medical Physics, University of Wisconsin-Madison, 1111 Highland Avenue, Madison, WI 53705, United States of America
| | - Kevin Treb
- Department of Medical Physics, University of Wisconsin-Madison, 1111 Highland Avenue, Madison, WI 53705, United States of America
| | - Aaron M Dingle
- Department of Surgery, University of Wisconsin-Madison, WI 53792, United States of America
| | - Ke Li
- Department of Medical Physics, University of Wisconsin-Madison, 1111 Highland Avenue, Madison, WI 53705, United States of America.,Department of Radiology, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53792, United States of America
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20
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Karczewski AM, Dingle AM, Poore SO. The Need to Work Arm in Arm: Calling for Collaboration in Delivering Neuroprosthetic Limb Replacements. Front Neurorobot 2021; 15:711028. [PMID: 34366820 PMCID: PMC8334559 DOI: 10.3389/fnbot.2021.711028] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 06/22/2021] [Indexed: 11/21/2022] Open
Abstract
Over the last few decades there has been a push to enhance the use of advanced prosthetics within the fields of biomedical engineering, neuroscience, and surgery. Through the development of peripheral neural interfaces and invasive electrodes, an individual's own nervous system can be used to control a prosthesis. With novel improvements in neural recording and signal decoding, this intimate communication has paved the way for bidirectional and intuitive control of prostheses. While various collaborations between engineers and surgeons have led to considerable success with motor control and pain management, it has been significantly more challenging to restore sensation. Many of the existing peripheral neural interfaces have demonstrated success in one of these modalities; however, none are currently able to fully restore limb function. Though this is in part due to the complexity of the human somatosensory system and stability of bioelectronics, the fragmentary and as-yet uncoordinated nature of the neuroprosthetic industry further complicates this advancement. In this review, we provide a comprehensive overview of the current field of neuroprosthetics and explore potential strategies to address its unique challenges. These include exploration of electrodes, surgical techniques, control methods, and prosthetic technology. Additionally, we propose a new approach to optimizing prosthetic limb function and facilitating clinical application by capitalizing on available resources. It is incumbent upon academia and industry to encourage collaboration and utilization of different peripheral neural interfaces in combination with each other to create versatile limbs that not only improve function but quality of life. Despite the rapidly evolving technology, if the field continues to work in divided "silos," we will delay achieving the critical, valuable outcome: creating a prosthetic limb that is right for the patient and positively affects their life.
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Affiliation(s)
| | - Aaron M. Dingle
- Division of Plastic Surgery, Department of Surgery, University of Wisconsin–Madison, Madison, WI, United States
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21
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Settell ML, Pelot NA, Knudsen BE, Dingle AM, McConico AL, Nicolai EN, Trevathan JK, Ezzell JA, Ross EK, Gustafson KJ, Shoffstall AJ, Williams JC, Zeng W, Poore SO, Populin LC, Suminski AJ, Grill WM, Ludwig KA. Corrigendum: Functional vagotopy in the cervical vagus nerve of the domestic pig: implications for the study of vagus nerve stimulation (2020 J. Neural Eng.17 026022). J Neural Eng 2021; 18. [PMID: 34096889 DOI: 10.1088/1741-2552/ac01ff] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 05/17/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Megan L Settell
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, United States of America.,Mayo Clinic, Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN, United States of America
| | - Nicole A Pelot
- Department of Biomedical Engineering, Duke University, Durham, NC, United States of America
| | - Bruce E Knudsen
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, United States of America.,Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, United States of America
| | - Aaron M Dingle
- Division of Plastic Surgery, Department of Surgery, University of Wisconsin-Madison, Madison, WI, United States of America
| | - Andrea L McConico
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, United States of America
| | - Evan N Nicolai
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, United States of America.,Mayo Clinic, Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN, United States of America
| | - James K Trevathan
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, United States of America.,Mayo Clinic, Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN, United States of America
| | - J Ashley Ezzell
- Histology Research Core, University of North Carolina School of Medicine, Chapel Hill, NC, United States of America.,Department of Cell Biology and Physiology, University of North Carolina School of Medicine, Chapel Hill, NC, United States of America
| | - Erika K Ross
- Abbott Neuromodulation, Plano, TX, United States of America
| | - Kenneth J Gustafson
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States of America.,Louis Stokes Cleveland VA Medical Center, Cleveland, OH, United States of America
| | - Andrew J Shoffstall
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States of America.,Louis Stokes Cleveland VA Medical Center, Cleveland, OH, United States of America
| | - Justin C Williams
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, United States of America.,Department of Neurosurgery, University of Wisconsin-Madison, Madison, WI, United States of America
| | - Weifeng Zeng
- Division of Plastic Surgery, Department of Surgery, University of Wisconsin-Madison, Madison, WI, United States of America
| | - Samuel O Poore
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, United States of America.,Division of Plastic Surgery, Department of Surgery, University of Wisconsin-Madison, Madison, WI, United States of America.,Department of Surgery, University of Wisconsin-Madison, Madison, WI, United States of America.,University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America
| | - Luis C Populin
- Department of Neuroscience, University of Wisconsin-Madison, Madison, WI, United States of America
| | - Aaron J Suminski
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, United States of America.,Department of Neurosurgery, University of Wisconsin-Madison, Madison, WI, United States of America
| | - Warren M Grill
- Department of Biomedical Engineering, Duke University, Durham, NC, United States of America.,Department of Electrical and Computer Engineering, Duke University, Durham, NC, United States of America.,Department of Neurobiology, Duke University, Durham, NC, United States of America.,Department of Neurosurgery, Duke University, Durham, NC, United States of America
| | - Kip A Ludwig
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, United States of America.,Department of Neurosurgery, University of Wisconsin-Madison, Madison, WI, United States of America
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22
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Odorico SK, Shulzhenko NO, Zeng W, Dingle AM, Francis DO, Poore SO. Effect of Nimodipine and Botulinum Toxin A on Peripheral Nerve Regeneration in Rats: A Pilot Study. J Surg Res 2021; 264:208-221. [PMID: 33838405 DOI: 10.1016/j.jss.2021.02.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 05/04/2020] [Revised: 01/05/2021] [Accepted: 02/27/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Peripheral nerve damage is a frequent problem, with an estimated 2.8%-5.0% of trauma admissions involving peripheral nerve injury. End-to-end, tension-free microsurgical repair (neurorrhaphy) is the current gold standard treatment for complete transection (neurotmesis). While neurorrhaphy reapproximates the nerve, it does not address the complex molecular regenerative process. Evidence suggests that botulinum toxin A (BTX) and nimodipine (NDP) may improve functional recovery, but mechanisms of action remain unknown. METHODS This research investigates BTX and NDP for their novel capacity to improve neural regeneration in the setting of neurorrhaphy using a Lewis rat tibial nerve neurotmesis model. In a triple-masked, placebo-controlled, randomized study design, we compared functional (rotarod, horizontal ladder walk), electrophysiological (conduction velocity, duration), and stereological (axon count, density) outcomes of rats treated with: NDP+saline injection, BTX+NDP, Saline+placebo, and BTX+placebo. Additional controls included sham surgery +/- BTX. RESULTS NDP+saline outperformed other treatment groups in the ladder walk. This group had the fewest deep slips (15.07% versus 30.77% in BTX+NDP, P = 0.122), and the most correct steps (70.53% versus 55.58% in BTX+NDP, P = 0.149) in functional testing. NDP+saline also had the fastest nerve conduction velocity (0.811m/s versus 0.598m/s in BTX+NDP, P = 0.126) among treatment groups. BTX+NDP had the highest axon count (10,012.36 versus 7,738.18 in NDP+Saline, P = 0.009). CONCLUSION This study is the first to test NDP with BTX in a multimodal assessment of nerve recovery following neurotmesis and neurorrhaphy. NDP outperformed BTX+NDP functionally. Future work will focus on nimodipine in an effort to improve nerve recovery in trauma patients.
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Affiliation(s)
- Scott K Odorico
- University of Wisconsin School of Medicine and Public Health, Division of Plastic Surgery, Department of Surgery, Madison, Wisconsin
| | - Nikita O Shulzhenko
- University of Wisconsin School of Medicine and Public Health, Division of Plastic Surgery, Department of Surgery, Madison, Wisconsin
| | - Weifeng Zeng
- University of Wisconsin School of Medicine and Public Health, Division of Plastic Surgery, Department of Surgery, Madison, Wisconsin
| | - Aaron M Dingle
- University of Wisconsin School of Medicine and Public Health, Division of Plastic Surgery, Department of Surgery, Madison, Wisconsin
| | - David O Francis
- University of Wisconsin School of Medicine and Public Health, Division of Otolaryngology, Department of Surgery, Madison, Wisconsin; University of Wisconsin School of Medicine and Public Health, Wisconsin Surgical Outcomes Research Program, Department of Surgery, Madison, Wisconsin
| | - Samuel O Poore
- University of Wisconsin School of Medicine and Public Health, Division of Plastic Surgery, Department of Surgery, Madison, Wisconsin.
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23
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Millevolte AXT, Dingle AM, Ness JP, Novello J, Zeng W, Lu Y, Minor RL, Nemke B, Markel MD, Suminski AJ, Williams JC, Poore SO. Improving the Selectivity of an Osseointegrated Neural Interface: Proof of Concept For Housing Sieve Electrode Arrays in the Medullary Canal of Long Bones. Front Neurosci 2021; 15:613844. [PMID: 33790731 PMCID: PMC8006940 DOI: 10.3389/fnins.2021.613844] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 10/04/2020] [Accepted: 02/16/2021] [Indexed: 01/15/2023] Open
Abstract
Sieve electrodes stand poised to deliver the selectivity required for driving advanced prosthetics but are considered inherently invasive and lack the stability required for a chronic solution. This proof of concept experiment investigates the potential for the housing and engagement of a sieve electrode within the medullary canal as part of an osseointegrated neural interface (ONI) for greater selectivity toward improving prosthetic control. The working hypotheses are that (A) the addition of a sieve interface to a cuff electrode housed within the medullary canal of the femur as part of an ONI would be capable of measuring efferent and afferent compound nerve action potentials (CNAPs) through a greater number of channels; (B) that signaling improves over time; and (C) that stimulation at this interface generates measurable cortical somatosensory evoked potentials through a greater number of channels. The modified ONI was tested in a rabbit (n = 1) amputation model over 12 weeks, comparing the sieve component to the cuff, and subsequently compared to historical data. Efferent CNAPs were successfully recorded from the sieve demonstrating physiological improvements in CNAPs between weeks 3 and 5, and somatosensory cortical responses recorded at 12 weeks postoperatively. This demonstrates that sieve electrodes can be housed and function within the medullary canal, demonstrated by improved nerve engagement and distinct cortical sensory feedback. This data presents the conceptual framework for housing more sophisticated sieve electrodes in bone as part of an ONI for improving selectivity with percutaneous connectivity toward improved prosthetic control.
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Affiliation(s)
- Augusto X T Millevolte
- Division of Plastic Surgery, Department of Surgery, University of Wisconsin - Madison, Madison, WI, United States.,Department of Biomedical Engineering, College of Engineering, University of Wisconsin - Madison, Madison, WI, United States
| | - Aaron M Dingle
- Division of Plastic Surgery, Department of Surgery, University of Wisconsin - Madison, Madison, WI, United States
| | - Jared P Ness
- Department of Biomedical Engineering, College of Engineering, University of Wisconsin - Madison, Madison, WI, United States
| | - Joseph Novello
- Department of Biomedical Engineering, College of Engineering, University of Wisconsin - Madison, Madison, WI, United States
| | - Weifeng Zeng
- Division of Plastic Surgery, Department of Surgery, University of Wisconsin - Madison, Madison, WI, United States
| | - Yan Lu
- Department of Medical Sciences, University of Wisconsin - Madison, Madison, WI, United States
| | - Rashea L Minor
- Department of Medical Sciences, University of Wisconsin - Madison, Madison, WI, United States
| | - Brett Nemke
- Department of Medical Sciences, University of Wisconsin - Madison, Madison, WI, United States
| | - Mark D Markel
- Department of Medical Sciences, University of Wisconsin - Madison, Madison, WI, United States
| | - Aaron J Suminski
- Department of Biomedical Engineering, College of Engineering, University of Wisconsin - Madison, Madison, WI, United States.,Department of Medical Sciences, University of Wisconsin - Madison, Madison, WI, United States.,Department of Neurological Surgery, University of Wisconsin - Madison, Madison, WI, United States
| | - Justin C Williams
- Department of Biomedical Engineering, College of Engineering, University of Wisconsin - Madison, Madison, WI, United States.,Department of Neurological Surgery, University of Wisconsin - Madison, Madison, WI, United States
| | - Samuel O Poore
- Division of Plastic Surgery, Department of Surgery, University of Wisconsin - Madison, Madison, WI, United States.,Department of Biomedical Engineering, College of Engineering, University of Wisconsin - Madison, Madison, WI, United States
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24
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Nkana ZH, Wood KL, Karczewski AM, Gunderson KA, Lyon SM, Dingle AM, Poore SO. Evaluation of Racial Disparities in Postoperative Outcomes Following Breast Reconstruction at a Single Institution in Wisconsin. WMJ 2021; 120:S42-S47. [PMID: 33819402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Breast cancer is the most common cancer in women in Wisconsin. Evidence demonstrates that non-White racial minorities in the United States exhibit a higher mortality rate and more advanced or aggressive presentations of the disease than their White counterparts. Postmastectomy breast reconstruction remains essential to the treatment and recovery of these patients; however, racial disparities in the receipt of reconstruction are evident. This study evaluates the presence of racial disparities in postoperative outcomes of breast reconstruction at a single institution in Wisconsin. METHODS An institutional review board-exempt retrospective study of postoperative outcomes was performed using a single institution's National Surgical Quality Improvement Program Registry to identify patients who underwent autologous or prosthesis-based breast reconstruction following mastectomy. Patient demographic, preoperative, operative, and postoperative variables were recorded. Postoperative outcomes in relation to self-reported race were evaluated using univariate analysis and propensity score matching. RESULTS A total of 1,140 patients were included (1,092 White vs 48 non-White), with fewer non-White patients undergoing reconstruction. Patients of non-White race demonstrated a higher incidence of morbid obesity (4.4% White vs 12.5% non-White, P = 0.010) and bleeding disorders (0.3% White vs 4.2% non-White, P < 0.001). No association between self-reported race and postoperative complication was found. CONCLUSION This study did not reveal racial disparities in postoperative outcomes of breast reconstruction at a single institution in Wisconsin; however, non-White patients were less likely to undergo reconstruction. Further research into the underlying causes of unequal access to care, influence of insurance, effect of structural racism, and impact of physician- and patient-associated factors is warranted.
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Affiliation(s)
- Zeeda H Nkana
- University of Wisconsin School of Medicine and Public Health, Division of Plastic Surgery, Madison, Wisconsin
| | - Kasey Leigh Wood
- University of Wisconsin School of Medicine and Public Health, Division of Plastic Surgery, Madison, Wisconsin
| | - Alison M Karczewski
- University of Wisconsin School of Medicine and Public Health, Division of Plastic Surgery, Madison, Wisconsin
| | - Kirsten A Gunderson
- University of Wisconsin School of Medicine and Public Health, Division of Plastic Surgery, Madison, Wisconsin
| | - Sarah M Lyon
- University of Wisconsin School of Medicine and Public Health, Division of Plastic Surgery, Madison, Wisconsin
| | - Aaron M Dingle
- University of Wisconsin School of Medicine and Public Health, Division of Plastic Surgery, Madison, Wisconsin
| | - Samuel O Poore
- University of Wisconsin School of Medicine and Public Health, Division of Plastic Surgery, Madison, Wisconsin,
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25
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Dingle AM, Ness JP, Novello J, Millevolte AXT, Zeng W, Sanchez R, Nemke B, Lu Y, Suminski AJ, Markel MD, Williams JC, Poore SO. Experimental Basis for Creating an Osseointegrated Neural Interface for Prosthetic Control: A Pilot Study in Rabbits. Mil Med 2020; 185:462-469. [PMID: 32074371 DOI: 10.1093/milmed/usz246] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION While debate persists over how to best prevent or treat amputation neuromas, the more pressing question of how to best marry residual nerves to state-of-the-art robotic prostheses for naturalistic control of a replacement limb has come to the fore. One potential solution involves the transposition of terminal nerve ends into the medullary canal of long bones, creating the neural interface within the bone. Nerve transposition into bone is a long-practiced, clinically relevant treatment for painful neuromas. Despite neuropathic pain relief, the physiological capacity of transposed nerves to conduct motor and sensory signals required for prosthesis control remains unknown. This pilot study addresses the hypotheses that (1) bone provides stability to transposed nerves and (2) nerves transposed into bone remain physiologically active, as they relate to the creation of an osseointegrated neural interface. METHODS New Zealand white rabbits received transfemoral amputation, with the sciatic nerve transposed into the femur. RESULTS Morphological examination demonstrates that nerves remain stable within the medullary canal, while compound nerve action potentials evoked by electrical stimulation of the residual nerve within the bone could be achieved at 12 weeks (p < 0.0005). CONCLUSION Transposed nerves retain a degree of physiological function suitable for creating an osseointegrated neural interface.
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Affiliation(s)
- Aaron M Dingle
- Division of Plastic Surgery, Department of Surgery, University of Wisconsin-Madison, 600 Highland Avenue, Madison WI 53792
| | - Jared P Ness
- Department of Biomedical Engineering, College of Engineering, University of Wisconsin-Madison, 600 Highland Avenue, Madison WI 53792
| | - Joseph Novello
- Department of Biomedical Engineering, College of Engineering, University of Wisconsin-Madison, 600 Highland Avenue, Madison WI 53792
| | - Augusto X T Millevolte
- Division of Plastic Surgery, Department of Surgery, University of Wisconsin-Madison, 600 Highland Avenue, Madison WI 53792
| | - Weifeng Zeng
- Division of Plastic Surgery, Department of Surgery, University of Wisconsin-Madison, 600 Highland Avenue, Madison WI 53792
| | - Ruston Sanchez
- Division of Plastic Surgery, Department of Surgery, University of Wisconsin-Madison, 600 Highland Avenue, Madison WI 53792
| | - Brett Nemke
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, 600 Highland Avenue, Madison WI 53792
| | - Yan Lu
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, 600 Highland Avenue, Madison WI 53792
| | - Aaron J Suminski
- Department of Biomedical Engineering, College of Engineering, University of Wisconsin-Madison, 600 Highland Avenue, Madison WI 53792.,Department of Neurological Surgery, University of Wisconsin-Madison, 600 Highland Avenue, Madison WI 53792
| | - Mark D Markel
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, 600 Highland Avenue, Madison WI 53792
| | - Justin C Williams
- Department of Biomedical Engineering, College of Engineering, University of Wisconsin-Madison, 600 Highland Avenue, Madison WI 53792
| | - Samuel O Poore
- Division of Plastic Surgery, Department of Surgery, University of Wisconsin-Madison, 600 Highland Avenue, Madison WI 53792.,Department of Biomedical Engineering, College of Engineering, University of Wisconsin-Madison, 600 Highland Avenue, Madison WI 53792
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26
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Zeng W, Gunderson KA, Sanchez RJ, Albano NJ, Nkana ZH, Thadikonda KM, Dingle AM, Poore SO. The Blue-Blood Porcine Chest Wall: A Novel Microsurgery Training Simulator for Internal Mammary Vessel Dissection and Anastomosis. J Reconstr Microsurg 2020; 37:353-356. [PMID: 32957156 DOI: 10.1055/s-0040-1716859] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Preparation of the internal mammary artery (IMA) is a critical step in autologous breast reconstruction. Intraoperatively, there is limited opportunity for residents to practice this skill. Porcine models provide highly realistic simulation for vascular surgery; however, use of live laboratory pigs is expensive, inconvenient, and offers limited opportunity for repetitive training. We aimed to develop an inexpensive and effective training model for IMA preparation. This article describes creation of a novel microsurgical model using cadaveric chest walls of Wisconsin Miniature Swine embedded in a modified mannequin thorax and augmented with a blue-blood perfusion system. METHODS Anatomic comparison: five porcine chest walls were dissected, and various anatomic measurements were made for anatomic comparison to existing human data in the literature. Model assembly: the chest wall is prepared by cannulating the proximal and distal ends of the internal mammary vessels with angiocatheters, which are then connected to the blue-blood perfusion system. The model is assembled in four layers including: (1) a mannequin thorax with a window removed to expose the first to fourth intercostal spaces, bilaterally, (2) a layer of foam simulating fat, (3) the perfused pig chest wall, and (4) a second mannequin shell placed posteriorly for support. RESULTS The porcine chest walls are similar to humans with regards to vessel size and location. This model can be assembled quickly, with a one-time approximate cost of $55.00, and allows for six training sessions per specimen. The model allows residents to practice the key steps of IMA preparation including dissection, elevation of perichondria, and vascular anastomosis while working at a depth that closely simulates the human thorax. Continuous blue-blood perfusion provides immediate feedback on anastomosis quality. CONCLUSION Overall, this novel model can provide inexpensive and realistic simulation of internal mammary vessel preparation and anastomosis.
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Affiliation(s)
- Weifeng Zeng
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Kirsten A Gunderson
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Ruston J Sanchez
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Nicholas J Albano
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Zeeda H Nkana
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Kishan M Thadikonda
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Aaron M Dingle
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Samuel O Poore
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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27
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Yap KK, Gerrand YW, Dingle AM, Yeoh GC, Morrison WA, Mitchell GM. Liver sinusoidal endothelial cells promote the differentiation and survival of mouse vascularised hepatobiliary organoids. Biomaterials 2020; 251:120091. [PMID: 32408048 DOI: 10.1016/j.biomaterials.2020.120091] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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: 10/14/2019] [Revised: 04/15/2020] [Accepted: 05/02/2020] [Indexed: 02/08/2023]
Abstract
The structural and physiological complexity of currently available liver organoids is limited, thereby reducing their relevance for drug studies, disease modelling, and regenerative therapy. In this study we combined mouse liver progenitor cells (LPCs) with mouse liver sinusoidal endothelial cells (LSECs) to generate hepatobiliary organoids with liver-specific vasculature. Organoids consisting of 5x103 cells were created from either LPCs, or a 1:1 combination of LPC/LSECs. LPC organoids demonstrated mild hepatobiliary differentiation in vitro with minimal morphological change; in contrast LPC/LSEC organoids developed clusters of polygonal hepatocyte-like cells and biliary ducts over a 7 day period. Hepatic (albumin, CPS1, CYP3A11) and biliary (GGT1) genes were significantly upregulated in LPC/LSEC organoids compared to LPC organoids over 7 days, as was albumin secretion. LPC/LSEC organoids also had significantly higher in vitro viability compared to LPC organoids. LPC and LPC/LSEC organoids were transplanted into vascularised chambers created in Fah-/-/Rag2-/-/Il2rg-/- mice (50 LPC organoids, containing 2.5x105 LPCs, and 100 LPC/LSEC organoids, containing 2.5x105 LPCs). At 2 weeks, minimal LPCs survived in chambers with LPC organoids, but robust hepatobiliary ductular tissue was present in LPC/LSEC organoids. Morphometric analysis demonstrated a 115-fold increase in HNF4α+ cells in LPC/LSEC organoid chambers (17.26 ± 4.34 cells/mm2 vs 0.15 ± 0.15 cells/mm2, p = 0.018), and 42-fold increase in Sox9+ cells in LPC/LSEC organoid chambers (28.29 ± 6.05 cells/mm2 vs 0.67 ± 0.67 cells/mm2, p = 0.011). This study presents a novel method to develop vascularised hepatobiliary organoids, with both in vitro and in vivo results confirming that incorporating LSECs with LPCs into organoids significantly increases the differentiation of hepatobiliary tissue within organoids and their survival post-transplantation.
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Affiliation(s)
- Kiryu K Yap
- O'Brien Institute, Department of St Vincent's Institute, Victoria, Australia; University of Melbourne Department of Surgery, St Vincent's Hospital Melbourne, Victoria, Australia.
| | - Yi-Wen Gerrand
- O'Brien Institute, Department of St Vincent's Institute, Victoria, Australia
| | - Aaron M Dingle
- O'Brien Institute, Department of St Vincent's Institute, Victoria, Australia
| | - George C Yeoh
- Harry Perkins Institute of Medical Research & Centre for Medical Research, University of Western Australia, Western Australia, Australia
| | - Wayne A Morrison
- O'Brien Institute, Department of St Vincent's Institute, Victoria, Australia; University of Melbourne Department of Surgery, St Vincent's Hospital Melbourne, Victoria, Australia; Australian Catholic University, Victoria, Australia
| | - Geraldine M Mitchell
- O'Brien Institute, Department of St Vincent's Institute, Victoria, Australia; University of Melbourne Department of Surgery, St Vincent's Hospital Melbourne, Victoria, Australia; Australian Catholic University, Victoria, Australia
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28
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Settell ML, Pelot NA, Knudsen BE, Dingle AM, McConico AL, Nicolai EN, Trevathan JK, Ezzell JA, Ross EK, Gustafson KJ, Shoffstall AJ, Williams JC, Zeng W, Poore SO, Populin LC, Suminski AJ, Grill WM, Ludwig KA. Functional vagotopy in the cervical vagus nerve of the domestic pig: implications for the study of vagus nerve stimulation. J Neural Eng 2020; 17:026022. [PMID: 32108590 PMCID: PMC7306215 DOI: 10.1088/1741-2552/ab7ad4] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Given current clinical interest in vagus nerve stimulation (VNS), there are surprisingly few studies characterizing the anatomy of the vagus nerve in large animal models as it pertains to on-and off-target engagement of local fibers. We sought to address this gap by evaluating vagal anatomy in the pig, whose vagus nerve organization and size approximates the human vagus nerve. APPROACH Here we combined microdissection, histology, and immunohistochemistry to provide data on key features across the cervical vagus nerve in a swine model, and compare our results to other animal models (mouse, rat, dog, non-human primate) and humans. MAIN RESULTS In a swine model we quantified the nerve diameter, number and diameter of fascicles, and distance of fascicles from the epineural surface where stimulating electrodes are placed. We also characterized the relative locations of the superior and recurrent laryngeal branches of the vagus nerve that have been implicated in therapy limiting side effects with common electrode placement. We identified key variants across the cohort that may be important for VNS with respect to changing sympathetic/parasympathetic tone, such as cross-connections to the sympathetic trunk. We discovered that cell bodies of pseudo-unipolar cells aggregate together to form a very distinct grouping within the nodose ganglion. This distinct grouping gives rise to a larger number of smaller fascicles as one moves caudally down the vagus nerve. This often leads to a distinct bimodal organization, or 'vagotopy'. This vagotopy was supported by immunohistochemistry where approximately half of the fascicles were immunoreactive for choline acetyltransferase, and reactive fascicles were generally grouped in one half of the nerve. SIGNIFICANCE The vagotopy observed via histology may be advantageous to exploit in design of electrodes/stimulation paradigms. We also placed our data in context of historic and recent histology spanning multiple models, thus providing a comprehensive resource to understand similarities and differences across species.
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Affiliation(s)
- Megan L Settell
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, United States of America
- Mayo Clinic, Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN, United States of America
| | - Nicole A Pelot
- Department of Biomedical Engineering, Duke University, Durham, NC, United States of America
| | - Bruce E Knudsen
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, United States of America
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, United States of America
| | - Aaron M Dingle
- Division of Plastic Surgery, Department of Surgery, University of Wisconsin-Madison, Madison, WI, United States of America
| | - Andrea L McConico
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, United States of America
| | - Evan N Nicolai
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, United States of America
- Mayo Clinic, Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN, United States of America
| | - James K Trevathan
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, United States of America
- Mayo Clinic, Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN, United States of America
| | - J Ashley Ezzell
- Histology Research Core, University of North Carolina School of Medicine, Durham, NC, United States of America
- Department of Cell Biology and Physiology, University of North Carolina School of Medicine, Durham, NC, United States of America
| | - Erika K Ross
- Abbott Neuromodulation, Plano, TX, United States of America
| | - Kenneth J Gustafson
- Department of Biomedical Engineering, Western Reserve University, Cleveland, OH, United States of America
- Louis Stokes Cleveland VA Medical Center, Cleveland, OH, United States of America
| | - Andrew J Shoffstall
- Department of Biomedical Engineering, Western Reserve University, Cleveland, OH, United States of America
- Louis Stokes Cleveland VA Medical Center, Cleveland, OH, United States of America
| | - Justin C Williams
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, United States of America
- Department of Neurosurgery, University of Wisconsin-Madison, Madison, WI, United States of America
| | - Weifeng Zeng
- Division of Plastic Surgery, Department of Surgery, University of Wisconsin-Madison, Madison, WI, United States of America
| | - Samuel O Poore
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, United States of America
- Division of Plastic Surgery, Department of Surgery, University of Wisconsin-Madison, Madison, WI, United States of America
- Department of Surgery, University of Wisconsin-Madison, Madison, WI, United States of America
- University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America
| | - Luis C Populin
- Department of Neuroscience, University of Wisconsin-Madison, Madison, WI, United States of America
| | - Aaron J Suminski
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, United States of America
- Department of Neurosurgery, University of Wisconsin-Madison, Madison, WI, United States of America
| | - Warren M Grill
- Department of Biomedical Engineering, Duke University, Durham, NC, United States of America
- Department of Electrical and Computer Engineering, Duke University, Durham, NC, United States of America
- Department of Neurobiology, Duke University, Durham, NC, United States of America
- Department of Neurosurgery, Duke University, Durham, NC, United States of America
| | - Kip A Ludwig
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, United States of America
- Department of Neurosurgery, University of Wisconsin-Madison, Madison, WI, United States of America
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Kim H, Dingle AM, Ness JP, Baek DH, Bong J, Lee IK, Shulzhenko NO, Zeng W, Israel JS, Pisaniello JA, Millevolte AX, Park DW, Suminski AJ, Jung YH, Williams JC, Poore SO, Ma Z. Cuff and sieve electrode (CASE): The combination of neural electrodes for bi-directional peripheral nerve interfacing. J Neurosci Methods 2020; 336:108602. [DOI: 10.1016/j.jneumeth.2020.108602] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 01/21/2020] [Accepted: 01/21/2020] [Indexed: 10/25/2022]
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Dingle AM, Ness JP, Novello J, Israel JS, Sanchez R, Millevolte AXT, Brodnick S, Krugner-Higby L, Nemke B, Lu Y, Suminski AJ, Markel MD, Williams JC, Poore SO. Methodology for creating a chronic osseointegrated neural interface for prosthetic control in rabbits. J Neurosci Methods 2019; 331:108504. [PMID: 31711884 DOI: 10.1016/j.jneumeth.2019.108504] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 02/11/2019] [Revised: 11/04/2019] [Accepted: 11/07/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Chronic stability and high degrees of selectivity are both essential but somewhat juxtaposed components for creating an implantable bi-directional PNI capable of controlling of a prosthetic limb. While the more invasive implantable electrode arrays provide greater specificity, they are less stable over time due to compliance mismatch with the dynamic soft tissue environment in which the interface is created. NEW METHOD This paper takes the surgical approach of transposing nerves into bone to create neural interface within the medullary canal of long bones, an osseointegrated neural interface, to provide greater stability for implantable electrodes. In this context, we describe the surgical model for transfemoral amputation with transposition of the sciatic nerve into the medullary canal in rabbits. We investigate the capacity to create a neural interface within the medullary canal histolomorphologically. In a separate proof of concept experiment, we quantify the chronic physiological capacity of transposed nerves to conduct compound nerve action potentials evoked via an Osseointegrated Neural Interface. COMPARISON WITH EXISTING METHOD(S) The rabbit serves as an important animal model for both amputation neuroma and osseointegration research, but is underutilized for the exploration neural interfacing in an amputation setting. RESULTS Our findings demonstrate that transposed nerves remain stable over 12 weeks. Creating a neural interface within the medullary canal is possible and does not impede nerve regeneration or physiological capacity. CONCLUSIONS This article represents the first evidence that an Osseointegrated Neural Interface can be surgically created, capable of chronic stimulation/recording from amputated nerves required for future prosthetic control.
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Affiliation(s)
- Aaron M Dingle
- Division of Plastic Surgery, Department of Surgery, University of Wisconsin - Madison, Madison, WI, United States
| | - Jared P Ness
- Department of Biomedical Engineering, College of Engineering, University of Wisconsin - Madison, Madison, WI, United States
| | - Joseph Novello
- Department of Biomedical Engineering, College of Engineering, University of Wisconsin - Madison, Madison, WI, United States
| | - Jacqueline S Israel
- Division of Plastic Surgery, Department of Surgery, University of Wisconsin - Madison, Madison, WI, United States
| | - Ruston Sanchez
- Division of Plastic Surgery, Department of Surgery, University of Wisconsin - Madison, Madison, WI, United States
| | - Augusto X T Millevolte
- Division of Plastic Surgery, Department of Surgery, University of Wisconsin - Madison, Madison, WI, United States
| | - Sarah Brodnick
- Department of Biomedical Engineering, College of Engineering, University of Wisconsin - Madison, Madison, WI, United States
| | - Lisa Krugner-Higby
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin - Madison, Madison, WI, United States
| | - Brett Nemke
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin - Madison, Madison, WI, United States
| | - Yan Lu
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin - Madison, Madison, WI, United States
| | - Aaron J Suminski
- Department of Biomedical Engineering, College of Engineering, University of Wisconsin - Madison, Madison, WI, United States; Department of Neurological Surgery, University of Wisconsin - Madison, Madison, WI, United States
| | - Mark D Markel
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin - Madison, Madison, WI, United States
| | - Justin C Williams
- Department of Biomedical Engineering, College of Engineering, University of Wisconsin - Madison, Madison, WI, United States
| | - Samuel O Poore
- Division of Plastic Surgery, Department of Surgery, University of Wisconsin - Madison, Madison, WI, United States; Department of Biomedical Engineering, College of Engineering, University of Wisconsin - Madison, Madison, WI, United States.
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Suminski AJ, Ness JP, Zeng W, Novello J, Brodnick SK, Pisaniello J, Dingle AM, Poore SO, Lake WB, Williams JC. Characterizing cortical responses evoked by electrical stimulation of the mouse infraorbital nerve. Annu Int Conf IEEE Eng Med Biol Soc 2018; 2018:4756-4759. [PMID: 30441412 DOI: 10.1109/embc.2018.8513175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In recent years, the trigeminal nerve (CN V) has become a popular target for neuromodulation therapies to treat of a variety of diseases due to its access to neuromodulatory centers. Despite promising preclinical and clinical data, the mechanism of action of trigeminal nerve stimulation (TNS) remains in question. In this work, we describe the development and evaluation of a neural interface targeting the mouse trigeminal nerve with the goal of enabling future mechanistic research on TNS. We performed experiments designed to evaluate the ability of a peripheral nerve interface (i.e. cuff electrode) to stimulate the infraorbital branch of the trigeminal nerve. We found that both artificial and naturalistic stimulation of the trigeminal nerve elicited robust cortical responses in the somatosensory cortex that scaled with increases in stimulus amplitude. These results suggest that an infraorbital nerve interface is a suitable candidate for examining the neural mechanisms of TNS in the mouse.
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Zeng W, Shulzhenko NO, Dingle AM, Poore SO. Precise One-Suture Needle-Guided Technique for Window Creation in Supermicrosurgical End-to-Side Anastomosis. J Reconstr Microsurg 2018; 34:e1-e2. [PMID: 30121050 DOI: 10.1055/s-0038-1667361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Weifeng Zeng
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Nikita O Shulzhenko
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Aaron M Dingle
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Samuel O Poore
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Dingle AM, Yap KK, Gerrand YW, Taylor CJ, Keramidaris E, Lokmic Z, Kong AM, Peters HL, Morrison WA, Mitchell GM. Characterization of isolated liver sinusoidal endothelial cells for liver bioengineering. Angiogenesis 2018; 21:581-597. [PMID: 29582235 DOI: 10.1007/s10456-018-9610-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [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: 09/13/2017] [Accepted: 03/14/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND The liver sinusoidal capillaries play a pivotal role in liver regeneration, suggesting they may be beneficial in liver bioengineering. This study isolated mouse liver sinusoidal endothelial cells (LSECs) and determined their ability to form capillary networks in vitro and in vivo for liver tissue engineering purposes. METHODS AND RESULTS In vitro LSECs were isolated from adult C57BL/6 mouse livers. Immunofluorescence labelling indicated they were LYVE-1+/CD32b+/FactorVIII+/CD31-. Scanning electron microscopy of LSECs revealed the presence of characteristic sieve plates at 2 days. LSECs formed tubes and sprouts in the tubulogenesis assay, similar to human microvascular endothelial cells (HMEC); and formed capillaries with lumens when implanted in a porous collagen scaffold in vitro. LSECs were able to form spheroids, and in the spheroid gel sandwich assay produced significantly increased numbers (p = 0.0011) of capillary-like sprouts at 24 h compared to HMEC spheroids. Supernatant from LSEC spheroids demonstrated significantly greater levels of vascular endothelial growth factor-A and C (VEGF-A, VEGF-C) and hepatocyte growth factor (HGF) compared to LSEC monolayers (p = 0.0167; p = 0.0017; and p < 0.0001, respectively), at 2 days, which was maintained to 4 days for HGF (p = 0.0017) and VEGF-A (p = 0.0051). In vivo isolated mouse LSECs were prepared as single cell suspensions of 500,000 cells, or as spheroids of 5000 cells (100 spheroids) and implanted in SCID mouse bilateral vascularized tissue engineering chambers for 2 weeks. Immunohistochemistry identified implanted LSECs forming LYVE-1+/CD31- vessels. In LSEC implanted constructs, overall lymphatic vessel growth was increased (not significantly), whilst host-derived CD31+ blood vessel growth increased significantly (p = 0.0127) compared to non-implanted controls. LSEC labelled with the fluorescent tag DiI prior to implantation formed capillaries in vivo and maintained LYVE-1 and CD32b markers to 2 weeks. CONCLUSION Isolated mouse LSECs express a panel of vascular-related cell markers and demonstrate substantial vascular capillary-forming ability in vitro and in vivo. Their production of liver growth factors VEGF-A, VEGF-C and HGF enable these cells to exert a growth stimulus post-transplantation on the in vivo host-derived capillary bed, reinforcing their pro-regenerative capabilities for liver tissue engineering studies.
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Affiliation(s)
- A M Dingle
- O'Brien Institute Department, St Vincent's Institute of Medical Research, Melbourne, Australia.,Department of Surgery, St Vincent's Hospital, University of Melbourne, Melbourne, Australia
| | - K K Yap
- O'Brien Institute Department, St Vincent's Institute of Medical Research, Melbourne, Australia.,Department of Surgery, St Vincent's Hospital, University of Melbourne, Melbourne, Australia
| | - Y-W Gerrand
- O'Brien Institute Department, St Vincent's Institute of Medical Research, Melbourne, Australia.,Faculty of Health Sciences, Australian Catholic University, Melbourne, Australia
| | - C J Taylor
- O'Brien Institute Department, St Vincent's Institute of Medical Research, Melbourne, Australia.,Department of Surgery, St Vincent's Hospital, University of Melbourne, Melbourne, Australia.,Faculty of Health Sciences, Australian Catholic University, Melbourne, Australia
| | - E Keramidaris
- O'Brien Institute Department, St Vincent's Institute of Medical Research, Melbourne, Australia
| | - Z Lokmic
- Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Australia.,Department of Paediatrics and Nursing, University of Melbourne, Melbourne, Australia
| | - A M Kong
- O'Brien Institute Department, St Vincent's Institute of Medical Research, Melbourne, Australia
| | - H L Peters
- Department of Paediatrics and Nursing, University of Melbourne, Melbourne, Australia.,Royal Children's Hospital, Melbourne, Australia
| | - W A Morrison
- O'Brien Institute Department, St Vincent's Institute of Medical Research, Melbourne, Australia.,Department of Surgery, St Vincent's Hospital, University of Melbourne, Melbourne, Australia.,Faculty of Health Sciences, Australian Catholic University, Melbourne, Australia
| | - G M Mitchell
- O'Brien Institute Department, St Vincent's Institute of Medical Research, Melbourne, Australia. .,Department of Surgery, St Vincent's Hospital, University of Melbourne, Melbourne, Australia. .,Faculty of Health Sciences, Australian Catholic University, Melbourne, Australia.
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Yap KK, Dingle AM, Palmer JA, Dhillon RS, Lokmic Z, Penington AJ, Yeoh GC, Morrison WA, Mitchell GM. Enhanced liver progenitor cell survival and differentiation in vivo by spheroid implantation in a vascularized tissue engineering chamber. Biomaterials 2013; 34:3992-4001. [DOI: 10.1016/j.biomaterials.2013.02.011] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2013] [Accepted: 02/06/2013] [Indexed: 12/24/2022]
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Tilkorn DJ, Davies EM, Keramidaris E, Dingle AM, Gerrand YW, Taylor CJ, Han XL, Palmer JA, Penington AJ, Mitchell CA, Morrison WA, Dusting GJ, Mitchell GM. The in vitro preconditioning of myoblasts to enhance subsequent survival in an in vivo tissue engineering chamber model. Biomaterials 2012; 33:3868-79. [PMID: 22369961 DOI: 10.1016/j.biomaterials.2012.02.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Accepted: 02/02/2012] [Indexed: 12/27/2022]
Abstract
The effects of in vitro preconditioning protocols on the ultimate survival of myoblasts implanted in an in vivo tissue engineering chamber were examined. In vitro testing: L6 myoblasts were preconditioned by heat (42 °C; 1.5 h); hypoxia (<8% O(2); 1.5 h); or nitric oxide donors: S-nitroso-N-acetylpenicillamine (SNAP, 200 μM, 1.5 h) or 1-[N-(2-aminoethyl)-N-(2-aminoethyl)amino]-diazen-1-ium-1,2-diolate (DETA-NONOate, 500 μM, 7 h). Following a rest phase preconditioned cells were exposed to 24 h hypoxia, and demonstrated minimal overall cell loss, whilst controls (not preconditioned, but exposed to 24 h hypoxia) demonstrated a 44% cell loss. Phosphoimmunoblot analysis of pro-survival signaling pathways revealed significant activation of serine threonine kinase Akt with DETA-NONOate (p < 0.01) and heat preconditioning (p < 0.05). DETA-NONOate also activated ERK 1/2 signaling (p < 0.05). In vivo implantation: 100,000 preconditioned (heat, hypoxia, or DETA-NONOate) myoblasts were implanted in SCID mouse tissue engineering chambers. 100,000 (not preconditioned) myoblasts were implanted in control chambers. At 3 weeks, morphometric assessment of surviving myoblasts indicated myoblast percent volume (p = 0.012) and myoblasts/mm(2) (p = 0.0005) overall significantly increased in preconditioned myoblast chambers compared to control, with DETA-NONOate-preconditioned myoblasts demonstrating the greatest increase in survival (p = 0.007 and p = 0.001 respectively). DETA-NONOate therefore has potential therapeutic benefits to significantly improve survival of transplanted cells.
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Affiliation(s)
- Daniel J Tilkorn
- Department of Plastic Surgery, Burn Center, Hand Center, BG-University-Hospital Bergmannsheil, Ruhr-University Bochum, Germany
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Zdolsek JM, Morrison WA, Dingle AM, Palmer JA, Penington AJ, Mitchell GM. An “off the shelf” vascular allograft supports angiogenic growth in three-dimensional tissue engineering. J Vasc Surg 2011; 53:435-44. [DOI: 10.1016/j.jvs.2010.08.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2010] [Revised: 06/25/2010] [Accepted: 08/08/2010] [Indexed: 02/05/2023]
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Tilkorn DJ, Bedogni A, Keramidaris E, Han X, Palmer JA, Dingle AM, Cowling BS, Williams MD, McKay SM, Pepe L, Deftereos A, Morrison WA, Penington AJ, Mitchell GM. Implanted Myoblast Survival Is Dependent on the Degree of Vascularization in a Novel Delayed Implantation/Prevascularization Tissue Engineering Model. Tissue Eng Part A 2010; 16:165-78. [DOI: 10.1089/ten.tea.2009.0075] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Daniel J. Tilkorn
- Department of Plastic Surgery, Burn Center, Hand Center, BG-University-Hospital Bergmannsheil, Ruhr-University Bochum, Germany
| | - Alberto Bedogni
- Unit of Dentistry and Maxillofacial Surgery, University of Verona, Verona, Italy
| | - Effie Keramidaris
- Bernard O'Brien Institute of Microsurgery and University of Melbourne, Department of Surgery at St. Vincent's Hospital, Melbourne, Australia
| | - XiaoLian Han
- Bernard O'Brien Institute of Microsurgery and University of Melbourne, Department of Surgery at St. Vincent's Hospital, Melbourne, Australia
| | - Jason A. Palmer
- Bernard O'Brien Institute of Microsurgery and University of Melbourne, Department of Surgery at St. Vincent's Hospital, Melbourne, Australia
| | - Aaron M. Dingle
- Bernard O'Brien Institute of Microsurgery and University of Melbourne, Department of Surgery at St. Vincent's Hospital, Melbourne, Australia
| | | | - Michael D. Williams
- Bernard O'Brien Institute of Microsurgery and University of Melbourne, Department of Surgery at St. Vincent's Hospital, Melbourne, Australia
| | - Sue M. McKay
- Experimental, Medical, and Surgical Unit, St. Vincent's Hospital, Melbourne, Australia
| | - Liliana Pepe
- Experimental, Medical, and Surgical Unit, St. Vincent's Hospital, Melbourne, Australia
| | - Anna Deftereos
- Experimental, Medical, and Surgical Unit, St. Vincent's Hospital, Melbourne, Australia
| | - Wayne A. Morrison
- Bernard O'Brien Institute of Microsurgery and University of Melbourne, Department of Surgery at St. Vincent's Hospital, Melbourne, Australia
| | - Anthony J. Penington
- Bernard O'Brien Institute of Microsurgery and University of Melbourne, Department of Surgery at St. Vincent's Hospital, Melbourne, Australia
| | - Geraldine M. Mitchell
- Bernard O'Brien Institute of Microsurgery and University of Melbourne, Department of Surgery at St. Vincent's Hospital, Melbourne, Australia
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