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D'Souza RS, Barman R, Joseph A, Abd-Elsayed A. Evidence-Based Treatment of Painful Diabetic Neuropathy: a Systematic Review. Curr Pain Headache Rep 2022; 26:583-594. [PMID: 35716275 DOI: 10.1007/s11916-022-01061-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2022] [Indexed: 12/25/2022]
Abstract
PURPOSE OF REVIEW Painful diabetic neuropathy (PDN) manifests with pain typically in the distal lower extremities and can be challenging to treat. The authors appraised the literature for evidence on conservative, pharmacological, and neuromodulation treatment options for PDN. RECENT FINDINGS Intensive glycemic control with insulin in patients with type 1 diabetes may be associated with lower odds of distal symmetric polyneuropathy compared to patients who receive conventional insulin therapy. First-line pharmacologic therapy for PDN includes gabapentinoids (pregabalin and gabapentin) and duloxetine. Additional pharmacologic modalities that are approved by the Food and Drug Administration (FDA) but are considered second-line agents include tapentadol and 8% capsaicin patch, although studies have revealed modest treatment effects from these modalities. There is level I evidence on the use of dorsal column spinal cord stimulation (SCS) for treatment of PDN, delivering either a 10-kHz waveform or tonic waveform. In summary, this review provides an overview of treatment options for PDN. Furthermore, it provides updates on the level of evidence for SCS therapy in cases of PDN refractory to conventional medical therapy.
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Affiliation(s)
- Ryan S D'Souza
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ross Barman
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Amira Joseph
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Alaa Abd-Elsayed
- Department of Anesthesiology and Perioperative Medicine, University of Wisconsin, Madison, WI, USA.
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2
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Barman R, Detweiler M. Prevalence of Late Onset Stress Symptomatology (LOSS) in geriatric combat veterans and its relation with dementia: A Pilot Study. Eur Psychiatry 2022. [PMCID: PMC9568237 DOI: 10.1192/j.eurpsy.2022.1728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Introduction Late onset stress symptomatology (LOSS) is a relatively new concept in combat veterans, which includes repeated but not intrusive thoughts about combat-related experiences, irritability, or nightmares that do not cause impairment of daily functioning. Objectives The objectives of this study were to identify the LOSS phenomenon in geriatric combat veterans and to establish a correlation between LOSS and cognitive deficit ± major stressors. Methods The electronic database was searched for the last 2 years from starting the study with the hypothesis that the LOSS phenomenon has been diagnosed with sleep, anxiety, trauma-related, or impulse control related disorders. Records were examined for trauma-related symptoms, excluding major symptoms of trauma-related stressors. The veterans were assessed objectively using LOSS, PCL-5 (PTSD checklist for DSM-5), social readjustment rating scales, and MOCA (Montreal Cognitive Assessment scale) for cognitive screening. Results We reviewed 1329 patient records and identified 35 potential LOSS subjects. Four veterans were diagnosed with PTSD not otherwise specified, 2 with anxiety disorder unspecified, and 1 veteran with nightmare disorder. The majority (85%) of the veterans scored >40 in PCL-5, and only one veteran fulfilled the criteria for LOSS, who scored 67 on the LOSS scale. All the veterans scored ≤25 on MOCA with a significant deficit in recent recall. Conclusions Our study shows new onset stress-related symptoms are strongly associated with significant cognitive deficits and higher individual stress levels. The onset of PTSD symptoms in older combat veterans might have been correlated with the onset of cognitive deficits, as suggested by several other studies. Disclosure No significant relationships.
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3
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D'Souza RS, King R, Strand N, Barman R, Olatoye O. Sex Disparity Persists in Pain Medicine: A Cross-Sectional Study of Chairpersons Within ACGME-Accredited Chronic Pain Fellowship Programs in the United States. J Educ Perioper Med 2022; 24:E680. [PMID: 35707016 PMCID: PMC9176396 DOI: 10.46374/volxxiv_issue1_dsouza] [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] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
OBJECTIVE To compare the representation of female and male chairpersons and evaluate their respective demographic, academic, and program-related characteristics in academic chronic pain institutions. METHODS We identified all chronic pain fellowship programs that are accredited by the Accreditation Council for Graduate Medical Education (ACGME) on April 19, 2021. We queried institutional websites or contacted programs directly to identify the respective departmental/divisional program chairperson. We abstracted data on program chairpersons from public databases and performed statistical comparisons of demographic, academic, and program-related characteristics between female and male program chairpersons. RESULTS Of the 111 ACGME-accredited chronic pain fellowship programs, we identified the current chairperson at 87 programs (78.4%). There were 17 female chairpersons (19.5%) and 70 male chairpersons (80.5%). A higher proportion of female chairpersons reported an academic rank of assistant professor compared with male chairpersons (35.3% vs 11.4%, P = .027). Male chairpersons published more peer-reviewed articles compared with female chairpersons (median 32.0 vs 10.0 publications, P = .001). Concordantly, male chairpersons achieved a higher H-index score compared with female chairpersons (median 10.0 vs 3.0, P = .001). No differences were identified in other academic or program-related characteristics. CONCLUSION This cross-sectional study illuminates important details on sex-related differences in the chronic pain program chair role. Women chairpersons are underrepresented, have fewer peer-reviewed publications, and achieved a lower H-index score compared with male chairpersons. Establishing these baseline associations provides a reference for future studies to evaluate changes over time.
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Affiliation(s)
- Ryan S D'Souza
- and are Assistant Professors of Anesthesiology; and and are Residents in Anesthesiology in the Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Hospital, Rochester, MN
| | - Roderick King
- and are Assistant Professors of Anesthesiology; and and are Residents in Anesthesiology in the Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Hospital, Rochester, MN
| | - Natalie Strand
- is Assistant Professor of Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Hospital, Phoenix, AZ
| | - Ross Barman
- and are Assistant Professors of Anesthesiology; and and are Residents in Anesthesiology in the Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Hospital, Rochester, MN
| | - Oludare Olatoye
- and are Assistant Professors of Anesthesiology; and and are Residents in Anesthesiology in the Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Hospital, Rochester, MN
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4
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D'Souza RS, Peterson A, Barman R, Moman RN, Olatoye O. Radiation Use Trends During Spinal Cord Stimulator Placement Performed by Fellow Trainees. Pain Med 2021; 22:3100-3102. [PMID: 34255077 DOI: 10.1093/pm/pnab218] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Ryan S D'Souza
- Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Ashley Peterson
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Ross Barman
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Rajat N Moman
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Oludare Olatoye
- Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
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Barman R, Clark K, Olatoye O. Short-Term Lidocaine Infusion as a Non-Sedative Option to Maintain Ventilator Synchrony during Opioid Taper in a COVID-19 Patient. Pain Med 2021; 23:592-595. [PMID: 34672352 PMCID: PMC8574297 DOI: 10.1093/pm/pnab311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 10/14/2021] [Indexed: 01/18/2023]
Affiliation(s)
- Ross Barman
- Mayo Clinic Division of Anesthesiology & Perioperative Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Kathryn Clark
- Mayo Clinic Division of Anesthesiology & Perioperative Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Oludare Olatoye
- Mayo Clinic Division of Anesthesiology & Perioperative Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN.,Division of Pain Medicine, Mayo Clinic, Rochester, MN
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Karmakar S, Pathak R, Barman R, K R, Wadasadawala T, Sarin R. Toxicity and Dosimetric Analysis of Early Breast Cancer (EBC) Patients Treated with Ultra-Hypofractionated Weekly Radiotherapy (RT) and Simultaneous Integrated Tumor Bed Boost. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Bellinger AM, Jafari M, Grant TM, Zhang S, Slater HC, Wenger EA, Mo S, Lee YAL, Mazdiyasni H, Kogan L, Barman R, Cleveland C, Booth L, Bensel T, Minahan D, Hurowitz HM, Tai T, Daily J, Nikolic B, Wood L, Eckhoff PA, Langer R, Traverso G. Oral, ultra-long-lasting drug delivery: Application toward malaria elimination goals. Sci Transl Med 2017; 8:365ra157. [PMID: 27856796 DOI: 10.1126/scitranslmed.aag2374] [Citation(s) in RCA: 146] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 10/25/2016] [Indexed: 12/29/2022]
Abstract
Efforts at elimination of scourges, such as malaria, are limited by the logistic challenges of reaching large rural populations and ensuring patient adherence to adequate pharmacologic treatment. We have developed an oral, ultra-long-acting capsule that dissolves in the stomach and deploys a star-shaped dosage form that releases drug while assuming a geometry that prevents passage through the pylorus yet allows passage of food, enabling prolonged gastric residence. This gastric-resident, drug delivery dosage form releases small-molecule drugs for days to weeks and potentially longer. Upon dissolution of the macrostructure, the components can safely pass through the gastrointestinal tract. Clinical, radiographic, and endoscopic evaluation of a swine large-animal model that received these dosage forms showed no evidence of gastrointestinal obstruction or mucosal injury. We generated long-acting formulations for controlled release of ivermectin, a drug that targets malaria-transmitting mosquitoes, in the gastric environment and incorporated these into our dosage form, which then delivered a sustained therapeutic dose of ivermectin for up to 14 days in our swine model. Further, by using mathematical models of malaria transmission that incorporate the lethal effect of ivermectin against malaria-transmitting mosquitoes, we demonstrated that this system will boost the efficacy of mass drug administration toward malaria elimination goals. Encapsulated, gastric-resident dosage forms for ultra-long-acting drug delivery have the potential to revolutionize treatment options for malaria and other diseases that affect large populations around the globe for which treatment adherence is essential for efficacy.
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Affiliation(s)
- Andrew M Bellinger
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.,Lyndra Inc., Watertown, MA 02472, USA
| | - Mousa Jafari
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Tyler M Grant
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Lyndra Inc., Watertown, MA 02472, USA
| | - Shiyi Zhang
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Hannah C Slater
- Department of Infectious Disease Epidemiology, MRC (Medical Research Council) Centre for Outbreak Analysis and Modelling, Imperial College London, London, U.K
| | | | - Stacy Mo
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Young-Ah Lucy Lee
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Hormoz Mazdiyasni
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Lawrence Kogan
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Ross Barman
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Cody Cleveland
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Lucas Booth
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Taylor Bensel
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Daniel Minahan
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Haley M Hurowitz
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Tammy Tai
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Johanna Daily
- Division of Infectious Diseases, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Boris Nikolic
- Biomatics Capital, 1107 1st Avenue, Apartment 1305, Seattle, WA 98101, USA
| | - Lowell Wood
- Institute for Disease Modeling, Bellevue, WA 98005, USA
| | | | - Robert Langer
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA. .,Media Lab, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Giovanni Traverso
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA. .,Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.,Division of Gastroenterology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
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8
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Schoellhammer CM, Schroeder A, Maa R, Lauwers GY, Swiston A, Zervas M, Barman R, DiCiccio AM, Brugge WR, Anderson DG, Blankschtein D, Langer R, Traverso G. Ultrasound-mediated gastrointestinal drug delivery. Sci Transl Med 2016; 7:310ra168. [PMID: 26491078 DOI: 10.1126/scitranslmed.aaa5937] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
There is a significant clinical need for rapid and efficient delivery of drugs directly to the site of diseased tissues for the treatment of gastrointestinal (GI) pathologies, in particular, Crohn's and ulcerative colitis. However, complex therapeutic molecules cannot easily be delivered through the GI tract because of physiologic and structural barriers. We report the use of ultrasound as a modality for enhanced drug delivery to the GI tract, with an emphasis on rectal delivery. Ultrasound increased the absorption of model therapeutics inulin, hydrocortisone, and mesalamine two- to tenfold in ex vivo tissue, depending on location in the GI tract. In pigs, ultrasound induced transient cavitation with negligible heating, leading to an order of magnitude enhancement in the delivery of mesalamine, as well as successful systemic delivery of a macromolecule, insulin, with the expected hypoglycemic response. In a rodent model of chemically induced acute colitis, the addition of ultrasound to a daily mesalamine enema (compared to enema alone) resulted in superior clinical and histological scores of disease activity. In both animal models, ultrasound treatment was well tolerated and resulted in minimal tissue disruption, and in mice, there was no significant effect on histology, fecal score, or tissue inflammatory cytokine levels. The use of ultrasound to enhance GI drug delivery is safe in animals and could augment the efficacy of GI therapies and broaden the scope of agents that could be delivered locally and systemically through the GI tract for chronic conditions such as inflammatory bowel disease.
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Affiliation(s)
- Carl M Schoellhammer
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA. The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Avi Schroeder
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA. The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA. Faculty of Chemical Engineering, Technion-Israel Institute of Technology, Haifa 32000, Israel
| | - Ruby Maa
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Gregory Yves Lauwers
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Albert Swiston
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Michael Zervas
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Ross Barman
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Angela M DiCiccio
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - William R Brugge
- Division of Gastroenterology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Daniel G Anderson
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA. The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA. Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA 02139, USA. Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Daniel Blankschtein
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.
| | - Robert Langer
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA. The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA. Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA 02139, USA. Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.
| | - Giovanni Traverso
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA. The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA. Division of Gastroenterology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
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9
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Traverso G, Ciccarelli G, Schwartz S, Hughes T, Boettcher T, Barman R, Langer R, Swiston A. Physiologic Status Monitoring via the Gastrointestinal Tract. PLoS One 2015; 10:e0141666. [PMID: 26580216 PMCID: PMC4651338 DOI: 10.1371/journal.pone.0141666] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 10/12/2015] [Indexed: 11/18/2022] Open
Abstract
Reliable, real-time heart and respiratory rates are key vital signs used in evaluating the physiological status in many clinical and non-clinical settings. Measuring these vital signs generally requires superficial attachment of physically or logistically obtrusive sensors to subjects that may result in skin irritation or adversely influence subject performance. Given the broad acceptance of ingestible electronics, we developed an approach that enables vital sign monitoring internally from the gastrointestinal tract. Here we report initial proof-of-concept large animal (porcine) experiments and a robust processing algorithm that demonstrates the feasibility of this approach. Implementing vital sign monitoring as a stand-alone technology or in conjunction with other ingestible devices has the capacity to significantly aid telemedicine, optimize performance monitoring of athletes, military service members, and first-responders, as well as provide a facile method for rapid clinical evaluation and triage.
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Affiliation(s)
- G. Traverso
- Division of Gastroenterology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, United States of America
| | - G. Ciccarelli
- Bioengineering Systems and Technologies, Massachusetts Institute of Technology Lincoln Laboratory, Lexington, MA, 02420, United States of America
| | - S. Schwartz
- Bioengineering Systems and Technologies, Massachusetts Institute of Technology Lincoln Laboratory, Lexington, MA, 02420, United States of America
| | - T. Hughes
- Bioengineering Systems and Technologies, Massachusetts Institute of Technology Lincoln Laboratory, Lexington, MA, 02420, United States of America
| | - T. Boettcher
- Bioengineering Systems and Technologies, Massachusetts Institute of Technology Lincoln Laboratory, Lexington, MA, 02420, United States of America
| | - R. Barman
- Division of Gastroenterology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, United States of America
| | - R. Langer
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, United States of America
- * E-mail: (AS); (RL)
| | - A. Swiston
- Bioengineering Systems and Technologies, Massachusetts Institute of Technology Lincoln Laboratory, Lexington, MA, 02420, United States of America
- * E-mail: (AS); (RL)
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10
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Zhang S, Bellinger AM, Glettig DL, Barman R, Lee YAL, Zhu J, Cleveland C, Montgomery VA, Gu L, Nash LD, Maitland DJ, Langer R, Traverso G. A pH-responsive supramolecular polymer gel as an enteric elastomer for use in gastric devices. Nat Mater 2015; 14:1065-1071. [PMID: 26213897 PMCID: PMC4772966 DOI: 10.1038/nmat4355] [Citation(s) in RCA: 209] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Accepted: 06/17/2015] [Indexed: 05/19/2023]
Abstract
Devices resident in the stomach-used for a variety of clinical applications including nutritional modulation for bariatrics, ingestible electronics for diagnosis and monitoring, and gastric-retentive dosage forms for prolonged drug delivery-typically incorporate elastic polymers to compress the devices during delivery through the oesophagus and other narrow orifices in the digestive system. However, in the event of accidental device fracture or migration, the non-degradable nature of these materials risks intestinal obstruction. Here, we show that an elastic, pH-responsive supramolecular gel remains stable and elastic in the acidic environment of the stomach but can be dissolved in the neutral-pH environment of the small and large intestines. In a large animal model, prototype devices with these materials as the key component demonstrated prolonged gastric retention and safe passage. These enteric elastomers should increase the safety profile for a wide range of gastric-retentive devices.
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Affiliation(s)
- Shiyi Zhang
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Andrew M. Bellinger
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139
- Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115
| | - Dean L. Glettig
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Ross Barman
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139
- Division of Gastroenterology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114
| | - Young-Ah Lucy Lee
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Jiahua Zhu
- Center for Nanophase Materials Sciences, Oak Ridge National Laboratory, Oak Ridge, TN 37831
| | - Cody Cleveland
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Veronica A Montgomery
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Li Gu
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Landon D. Nash
- Department of Biomedical Engineering, Biomedical Device Laboratory, Texas A&M University, College Station, TX 77843
| | - Duncan J. Maitland
- Department of Biomedical Engineering, Biomedical Device Laboratory, Texas A&M University, College Station, TX 77843
| | - Robert Langer
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139
- Harvard–MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA 02139
- To whom correspondence may be addressed. or
| | - Giovanni Traverso
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139
- Division of Gastroenterology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114
- To whom correspondence may be addressed. or
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11
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Liang K, Traverso G, Lee HC, Ahsen OO, Wang Z, Potsaid B, Giacomelli M, Jayaraman V, Barman R, Cable A, Mashimo H, Langer R, Fujimoto JG. Ultrahigh speed en face OCT capsule for endoscopic imaging. Biomed Opt Express 2015; 6:1146-63. [PMID: 25909001 PMCID: PMC4399656 DOI: 10.1364/boe.6.001146] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 03/02/2015] [Accepted: 03/02/2015] [Indexed: 05/18/2023]
Abstract
Depth resolved and en face OCT visualization in vivo may have important clinical applications in endoscopy. We demonstrate a high speed, two-dimensional (2D) distal scanning capsule with a micromotor for fast rotary scanning and a pneumatic actuator for precision longitudinal scanning. Longitudinal position measurement and image registration were performed by optical tracking of the pneumatic scanner. The 2D scanning device enables high resolution imaging over a small field of view and is suitable for OCT as well as other scanning microscopies. Large field of view imaging for screening or surveillance applications can also be achieved by proximally pulling back or advancing the capsule while scanning the distal high-speed micromotor. Circumferential en face OCT was demonstrated in living swine at 250 Hz frame rate and 1 MHz A-scan rate using a MEMS tunable VCSEL light source at 1300 nm. Cross-sectional and en face OCT views of the upper and lower gastrointestinal tract were generated with precision distal pneumatic longitudinal actuation as well as proximal manual longitudinal actuation. These devices could enable clinical studies either as an adjunct to endoscopy, attached to an endoscope, or as a swallowed tethered capsule for non-endoscopic imaging without sedation. The combination of ultrahigh speed imaging and distal scanning capsule technology could enable both screening and surveillance applications.
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Affiliation(s)
- Kaicheng Liang
- Department of Electrical Engineering & Computer Science and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge MA,
USA
| | - Giovanni Traverso
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge MA,
USA
- Division of Gastroenterology, Massachusetts General Hospital, Boston MA,
USA
- Harvard Medical School, Boston MA,
USA
| | - Hsiang-Chieh Lee
- Department of Electrical Engineering & Computer Science and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge MA,
USA
| | - Osman Oguz Ahsen
- Department of Electrical Engineering & Computer Science and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge MA,
USA
| | - Zhao Wang
- Department of Electrical Engineering & Computer Science and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge MA,
USA
| | - Benjamin Potsaid
- Department of Electrical Engineering & Computer Science and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge MA,
USA
- Advanced Imaging Group, Thorlabs Inc., Newton NJ,
USA
| | - Michael Giacomelli
- Department of Electrical Engineering & Computer Science and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge MA,
USA
| | | | - Ross Barman
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge MA,
USA
| | - Alex Cable
- Advanced Imaging Group, Thorlabs Inc., Newton NJ,
USA
| | - Hiroshi Mashimo
- Harvard Medical School, Boston MA,
USA
- Veterans Affairs Boston Healthcare System, Boston MA,
USA
| | - Robert Langer
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge MA,
USA
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge MA,
USA
| | - James G. Fujimoto
- Department of Electrical Engineering & Computer Science and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge MA,
USA
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Schoellhammer CM, Srinivasan S, Barman R, Mo SH, Polat BE, Langer R, Blankschtein D. Applicability and safety of dual-frequency ultrasonic treatment for the transdermal delivery of drugs. J Control Release 2015; 202:93-100. [PMID: 25662228 DOI: 10.1016/j.jconrel.2015.02.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 01/29/2015] [Accepted: 02/02/2015] [Indexed: 12/21/2022]
Abstract
Low-frequency ultrasound presents an attractive method for transdermal drug delivery. The controlled, yet non-specific nature of enhancement broadens the range of therapeutics that can be delivered, while minimizing necessary reformulation efforts for differing compounds. Long and inconsistent treatment times, however, have partially limited the attractiveness of this method. Building on recent advances made in this area, the simultaneous use of low- and high-frequency ultrasound is explored in a physiologically relevant experimental setup to enable the translation of this treatment to testing in vivo. Dual-frequency ultrasound, utilizing 20kHz and 1MHz wavelengths simultaneously, was found to significantly enhance the size of localized transport regions (LTRs) in both in vitro and in vivo models while decreasing the necessary treatment time compared to 20kHz alone. Additionally, LTRs generated by treatment with 20kHz+1MHz were found to be more permeable than those generated with 20kHz alone. This was further corroborated with pore-size estimates utilizing hindered-transport theory, in which the pores in skin treated with 20kHz+1MHz were calculated to be significantly larger than the pores in skin treated with 20kHz alone. This demonstrates for the first time that LTRs generated with 20kHz+1MHz are also more permeable than those generated with 20kHz alone, which could broaden the range of therapeutics and doses administered transdermally. With regard to safety, treatment with 20kHz+1MHz both in vitro and in vivo appeared to result in no greater skin disruption than that observed in skin treated with 20kHz alone, an FDA-approved modality. This study demonstrates that dual-frequency ultrasound is more efficient and effective than single-frequency ultrasound and is well-tolerated in vivo.
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Affiliation(s)
- Carl M Schoellhammer
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Sharanya Srinivasan
- Department of Biology, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Ross Barman
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Stacy H Mo
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Baris E Polat
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Robert Langer
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.
| | - Daniel Blankschtein
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.
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13
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Medhi RN, Barman R, Medhi KC, Jois SS. Ultraviolet absorption and vibrational spectra of 2-fluoro-5-bromopyridine. Spectrochim Acta A Mol Biomol Spectrosc 2000; 56A:1523-1532. [PMID: 10907881 DOI: 10.1016/s1386-1425(99)00275-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The ultraviolet absorption spectrum in the range 340-185 nm in the vapour and solution phase has been measured for 2-fluoro-5-bromopyridine. Three fairly intense band systems identified as the pi* <-- pi transitions II, III and IV have been observed. A detailed vibronic analysis of the vapor and solution spectra is presented. The first system of bands is resolved into about sixty-two distinct vibronic bands in the vapour-phase spectrum. The 0,0 band is located at 35944 cm(-1). Two well-developed progressions, in which the excited state frequencies nu'25 (283 cm(-1)) and nu'19 (550 cm(-1)) are excited by several quanta, have been observed. The corresponding excited state vibrational and anharmonicity constants are found to be omega'i = 292 cm(-1), x'ii = 4.5 cm(-1) (i = 25) and omega'i = 563.8 cm(-1), x'ii = 6.9 cm(-1) (i = 19). The other two band systems show no vibronic structure, the band maxima being located at 48346 and 52701 cm(-1), respectively. The oscillator strength of the band systems in different solutions and the excited state dipole moments associated with the first two transitions have been determined by the solvent-shift method. The infrared spectrum in the region 4000-130 cm(-1) and the laser Raman spectrum of the molecule in the liquid state have been measured and a complete vibrational assignment of the observed frequencies is given. A correlation of the ground and excited state fundamental frequencies observed in the UV absorption spectrum with the Raman or infrared frequencies is presented.
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Affiliation(s)
- R N Medhi
- Department of Physics, Gauhati University, Guwahati, India
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Kochar AS, Barman R. Influence of labetalol, propranolol and practolol in patients with asthma. Eur J Respir Dis 1982; 63:591-593. [PMID: 6129154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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