Does Stepwise Voltage Ramping Protect the Kidney from Injury During Extracorporeal Shockwave Lithotripsy? Results of a Prospective Randomized Trial

BACKGROUND Renal damage is more frequent with new-generation lithotripters. However, animal studies suggest that voltage ramping minimizes the risk of complications following extracorporeal shock wave lithotripsy (SWL). In the clinical setting, the optimal voltage strategy remains unclear. OBJECTIVE To evaluate whether stepwise voltage ramping can protect the kidney from damage during SWL. DESIGN, SETTING, AND PARTICIPANTS A total of 418 patients with solitary or multiple unilateral kidney stones were randomized to receive SWL using a Modulith SLX-F2 lithotripter with either stepwise voltage ramping (n=213) or a fixed maximal voltage (n=205). INTERVENTION SWL. OUTCOMES MEASUREMENTS AND STATISTICAL ANALYSIS The primary outcome was sonographic evidence of renal hematomas. Secondary outcomes included levels of urinary markers of renal damage, stone disintegration, stone-free rate, and rates of secondary interventions within 3 mo of SWL. Descriptive statistics were used to compare clinical outcomes between the two groups. A logistic regression model was generated to assess predictors of hematomas. RESULTS AND LIMITATIONS Significantly fewer hematomas occurred in the ramping group(12/213, 5.6%) than in the fixed group (27/205, 13%; p=0.008). There was some evidence that the fixed group had higher urinary β2-microglobulin levels after SWL compared to the ramping group (p=0.06). Urinary microalbumin levels, stone disintegration, stone-free rate, and rates of secondary interventions did not significantly differ between the groups. The logistic regression model showed a significantly higher risk of renal hematomas in older patients (odds ratio [OR] 1.03, 95% confidence interval [CI] 1.00-1.05; p=0.04). Stepwise voltage ramping was associated with a lower risk of hematomas (OR 0.39, 95% CI 0.19-0.80; p=0.01). The study was limited by the use of ultrasound to detect hematomas. CONCLUSIONS In this prospective randomized study, stepwise voltage ramping during SWL was associated with a lower risk of renal damage compared to a fixed maximal voltage without compromising treatment effectiveness. PATIENT SUMMARY Lithotripsy is a noninvasive technique for urinary stone disintegration using ultrasonic energy. In this study, two voltage strategies are compared. The results show that a progressive increase in voltage during lithotripsy decreases the risk of renal hematomas while maintaining excellent outcomes. TRIAL REGISTRATION ISRCTN95762080.

Cellular hyper-excitability caused by mutations that alter the activation process of voltage-gated sodium channels.

Voltage-gated sodium channels (Nav) are widely expressed as macro-molecular complexes in both excitable and non-excitable tissues. In excitable tissues, the upstroke of the action potential is the result of the passage of a large and rapid influx of sodium ions through these channels. NaV dysfunction has been associated with an increasingly wide range of neurological, muscular and cardiac disorders. The purpose of this review is to summarize the recently identified sodium channel mutations that are linked to hyper-excitability phenotypes and associated with the alteration of the activation process of voltage gated sodium channels. Indeed, several clinical manifestations that demonstrate an alteration of tissue excitability were recently shown to be strongly associated with the presence of mutations that affect the activation process of the Nav. These emerging genotype-phenotype correlations have expanded the clinical spectrum of sodium channelopathies to include disorders which feature a hyper-excitability phenotype that may or may not be associated with a cardiomyopathy. The p.I141V mutation in SCN4A and SCN5A, as well as its homologous p.I136V mutation in SCN9A, are interesting examples of mutations that have been linked to inherited hyperexcitability myotonia, exercise-induced polymorphic ventricular arrhythmias and erythromelalgia, respectively. Regardless of which sodium channel isoform is investigated, the substitution of the isoleucine to valine in the locus 141 induces similar modifications in the biophysical properties of the Nav by shifting the voltage-dependence of steady state activation toward more negative potentials.

Post-translational modifications of voltage-gated sodium channels in chronic pain syndromes.

In the peripheral sensory nervous system the neuronal expression of voltage-gated sodium channels (Navs) is very important for the transmission of nociceptive information since they give rise to the upstroke of the action potential (AP). Navs are composed of nine different isoforms with distinct biophysical properties. Studying the mutations associated with the increase or absence of pain sensitivity in humans, as well as other expression studies, have highlighted Nav1.7, Nav1.8, and Nav1.9 as being the most important contributors to the control of nociceptive neuronal electrogenesis. Modulating their expression and/or function can impact the shape of the AP and consequently modify nociceptive transmission, a process that is observed in persistent pain conditions. Post-translational modification (PTM) of Navs is a well-known process that modifies their expression and function. In chronic pain syndromes, the release of inflammatory molecules into the direct environment of dorsal root ganglia (DRG) sensory neurons leads to an abnormal activation of enzymes that induce Navs PTM. The addition of small molecules, i.e., peptides, phosphoryl groups, ubiquitin moieties and/or carbohydrates, can modify the function of Navs in two different ways: via direct physical interference with Nav gating, or via the control of Nav trafficking. Both mechanisms have a profound impact on neuronal excitability. In this review we will discuss the role of Protein Kinase A, B, and C, Mitogen Activated Protein Kinases and Ca++/Calmodulin-dependent Kinase II in peripheral chronic pain syndromes. We will also discuss more recent findings that the ubiquitination of Nav1.7 by Nedd4-2 and the effect of methylglyoxal on Nav1.8 are also implicated in the development of experimental neuropathic pain. We will address the potential roles of other PTMs in chronic pain and highlight the need for further investigation of PTMs of Navs in order to develop new pharmacological tools to alleviate pain.

Modulation of high voltage -activated calcium channels by phosphorylation

High voltage-activated (HVA) calcium channels from rat brain and rabbit heart are expressed in Xenopus laevis oocytes and their modulation by protein kinases studied. A subtype of the HVA calcium current expressed by rat brain RNA is potentiated by the phospholipid- and calcium-dependent protein kinase (PKC). The calcium channel clone $\alpha\sb{\rm1C}$ from rabbit heart is modulated by the cAMP-dependent protein kinase (PKA), and another factor present in the cytoplasm.^ The HVA calcium channels from rat brain do not belong to the L-type subclass since they are insensensitive to dihydropyridine (DHP) agonists and antagonists. The expressed currents do contain a N-type fraction which is identified by inactivation at depolarized potentials, and a P-type fraction as defined by blockade by the venom of the funnel web spider Agelenopsis Aperta. A non N-type fraction of this current is potentiated, by using phorbol esters to activate PKC. This residual fraction of current resembles the newly described Q-type channel from cerebellar granule cells in its biophysical properties, and potentiation by activation of PKC.^ The $\alpha\sb{\rm1C}$ clone from rabbit heart is expressed in oocytes and single-channel currents are measured using the cell-attached and cell-excised patch clamp technique. The single-channel current runs down within two minutes after patch excision into normal saline bath solution. The catalytic subunit of PKA + MgATP is capable of reversing this rundown for over 15 minutes. There also appears to be an additional factor present in the cytoplasm necessary for channel activity as revealed in experiments where PKA failed to prevent rundown.^ These data are important in that these types of channels are involved in synaptic transmission at many different types of synapses. The mammalian synapse is not accessible for these types of studies, however, the oocyte expression system allows access to HVA calcium channels for the study of their modulation by phosphorylation. ^

Calcium-dependent mechanisms and long-term potentiation: Role of NMDA receptors, voltage -dependent calcium channels and persistent protein kinase activity

Long-term potentiation (LTP) is a rapidly induced and long lasting increase in synaptic strength and is the leading cellular model for learning and memory in the mammalian brain. LTP was first identified in the hippocampus, a structure implicated in memory formation. LTP induction is dependent on postsynaptic Ca2+ increases mediated by N-methyl-D-aspartate (NMDA) receptors. Activation of other postsynaptic routes of Ca2+ entry, such as voltage-dependent Ca2+ channels (VDCCs) have subsequently been shown to induce a long-lasting increase in synaptic strength. However, it is unknown if VDCC-induced LTP utilized similar cellular mechanisms as the classical NMDA receptor-dependent LTP and if these two forms of LTP display similar properties. This dissertation determines the similarities and differences in VDCC and NMDA receptor-dependent LTP in area CA1 of hippocampal slices and demonstrates that VDCCs and NMDA receptors activate similar cellular mechanisms, such as protein kinases, to induce LTP. However, VDCC and NMDA receptor activated LTP induction mechanisms are compartmentalized in the postsynaptic neuron, such that they do not interact. Consistent with activation properties of NMDA receptors and VDCCs, NMDA receptor and VDCC-dependent LTP have different induction properties. In contrast to NMDA-dependent LTP, VDCC-induced potentiation does not require evoked presynaptic stimulation or display input specificity. These results indicate that there are two different routes of postsynaptic Ca2+ which can induce LTP and the compartmentation of VDCCs and NMDA receptors and/or their resulting Ca2+ increases may account for the distinction between these LTP induction mechanisms.^ One of the molecular targets for postsynaptic Ca2+ that is required for the induction of LTP is protein kinases. Evidence for the role of protein kinase activity in LTP expression is either correlational or controversial. We have utilized a broad range and potent inhibitors of protein kinases to systematically examine the temporal requirement for protein kinases in the induction and expression of LTP. Our results indicate that there is a critical period of persistent protein kinase activity required for LTP induction activated by tetanic stimulation and extending until 20 min after HFS. In addition, our results suggest that protein kinase activity during and immediately after HFS is not sufficient for LTP induction. These results provide evidence for persistent and/or Ca2+ independent protein kinase activity involvement in LTP induction. ^

Temperature and time dependent threshold voltage characterization of AlGaN/GaN high electron mobility transistors

Relacionado con línea de investigación del GDS del ISOM ver http://www.isom.upm.es/dsemiconductores.php

Current Mode with RMS Voltage and Offset Control Loops for a Single-Phase Aircraft Inverter Suitable for Parallel and 3-Phase Operation Modes

Rms voltage regulation may be an attractive possibility for controlling power inverters. Combined with a Hall Effect sensor for current control, it keeps its parallel operation capability while increasing its noise immunity, which may lead to a reduction of the Total Harmonic Distortion (THD). Besides, as voltage regulation is designed in DC, a simple PI regulator can provide accurate voltage tracking. Nevertheless, this approach does not lack drawbacks. Its narrow voltage bandwidth makes transients last longer and it increases the voltage THD when feeding non-linear loads, such as rectifying stages. On the other hand, the implementation can fall into offset voltage error. Furthermore, the information of the output voltage phase is hidden for the control as well, making the synchronization of a 3-phase setup not trivial. This paper explains the concept, design and implementation of the whole control scheme, in an on board inverter able to run in parallel and within a 3-phase setup. Special attention is paid to solve the problems foreseen at implementation level: a third analog loop accounts for the offset level is added and a digital algorithm guarantees 3-phase voltage synchronization.

Signal analysis and feature generation for pattern identification of partial discharges in high-voltage equipment

This paper proposes a method for the identification of different partial discharges (PDs) sources through the analysis of a collection of PD signals acquired with a PD measurement system. This method, robust and sensitive enough to cope with noisy data and external interferences, combines the characterization of each signal from the collection, with a clustering procedure, the CLARA algorithm. Several features are proposed for the characterization of the signals, being the wavelet variances, the frequency estimated with the Prony method, and the energy, the most relevant for the performance of the clustering procedure. The result of the unsupervised classification is a set of clusters each containing those signals which are more similar to each other than to those in other clusters. The analysis of the classification results permits both the identification of different PD sources and the discrimination between original PD signals, reflections, noise and external interferences. The methods and graphical tools detailed in this paper have been coded and published as a contributed package of the R environment under a GNU/GPL license.

SMA-Based Muscle-Like Actuation in Biologically Inspired Robots: A State of the Art Review

New actuation technology in functional or "smart" materials has opened new horizons in robotics actuation systems. Materials such as piezo-electric fiber composites, electro-active polymers and shape memory alloys (SMA) are being investigated as promising alternatives to standard servomotor technology [52]. This paper focuses on the use of SMAs for building muscle-like actuators. SMAs are extremely cheap, easily available commercially and have the advantage of working at low voltages. The use of SMA provides a very interesting alternative to the mechanisms used by conventional actuators. SMAs allow to drastically reduce the size, weight and complexity of robotic systems. In fact, their large force-weight ratio, large life cycles, negligible volume, sensing capability and noise-free operation make possible the use of this technology for building a new class of actuation devices. Nonetheless, high power consumption and low bandwidth limit this technology for certain kind of applications. This presents a challenge that must be addressed from both materials and control perspectives in order to overcome these drawbacks. Here, the latter is tackled. It has been demonstrated that suitable control strategies and proper mechanical arrangements can dramatically improve on SMA performance, mostly in terms of actuation speed and limit cycles.

Combining series elastic actuation and magneto-rheological damping for the control of agile locomotion

All-terrain robot locomotion is an active topic of research. Search and rescue maneuvers and exploratory missions could benefit from robots with the abilities of real animals. However, technological barriers exist to ultimately achieving the actuation system, which is able to meet the exigent requirements of these robots. This paper describes the locomotioncontrol of a leg prototype, designed and developed to make a quadruped walk dynamically while exhibiting compliant interaction with the environment. The actuation system of the leg is based on the hybrid use of series elasticity and magneto-rheological dampers, which provide variable compliance for natural-looking motion and improved interaction with the ground. The locomotioncontrol architecture has been proposed to exploit natural leg dynamics in order to improve energy efficiency. Results show that the controller achieves a significant reduction in energy consumption during the leg swing phase thanks to the exploitation of inherent leg dynamics. Added to this, experiments with the real leg prototype show that the combined use of series elasticity and magneto-rheologicaldamping at the knee provide a 20 % reduction in the energy wasted in braking the knee during its extension in the leg stance phase.

Inverse kinematics of a 6 DoF human upper limb using ANFIS and ANN for anticipatory actuation in ADL-based physical Neurorehabilitation

Objective: This research is focused in the creation and validation of a solution to the inverse kinematics problem for a 6 degrees of freedom human upper limb. This system is intended to work within a realtime dysfunctional motion prediction system that allows anticipatory actuation in physical Neurorehabilitation under the assisted-as-needed paradigm. For this purpose, a multilayer perceptron-based and an ANFIS-based solution to the inverse kinematics problem are evaluated. Materials and methods: Both the multilayer perceptron-based and the ANFIS-based inverse kinematics methods have been trained with three-dimensional Cartesian positions corresponding to the end-effector of healthy human upper limbs that execute two different activities of the daily life: "serving water from a jar" and "picking up a bottle". Validation of the proposed methodologies has been performed by a 10 fold cross-validation procedure. Results: Once trained, the systems are able to map 3D positions of the end-effector to the corresponding healthy biomechanical configurations. A high mean correlation coefficient and a low root mean squared error have been found for both the multilayer perceptron and ANFIS-based methods. Conclusions: The obtained results indicate that both systems effectively solve the inverse kinematics problem, but, due to its low computational load, crucial in real-time applications, along with its high performance, a multilayer perceptron-based solution, consisting in 3 input neurons, 1 hidden layer with 3 neurons and 6 output neurons has been considered the most appropriated for the target application.

Voltage recovery in intermediate band solar cells

The intermediate band solar cell (IBSC) is based on a novel photovoltaic concept and has a limiting efficiency of 63.2%, which compares favorably with the 40.7% efficiency of a conventional, single junction solar cell. It is characterized by a material hosting a collection of energy levels within its bandgap, allowing the cell to exploit photons with sub-bandgap energies in a two-step absorption process, thus improving the utilization of the solar spectrum. However, these intermediate levels are often regarded as an inherent source of supplementary recombination, although this harmful effect can in theory be counteracted by the use of concentrated light. We present here a novel, low-temperature characterization technique using concentrated light that reveals how the initially enhanced recombination in the IBSC is reduced so that its open-circuit voltage is completely recovered and reaches that of a conventional solar cell.

High-efficiency voltage regulator and stabilizer for outdoor lighting installations

This paper presents a high performance system of regulation and stabilization of luminous flux for public street lighting installations. Its purpose is to reduce the luminous flux of the luminaries efficiently by reducing their voltage supply, resulting in the improvement of energy efficiency in the installation. The system is basically composed of electromagnetic components which provide robustness and high-performance to the device, as well as minimum maintenance requirements. However, the voltage regulation is based on the application of voltage steps. Aging studies of the luminaries have been carried out to analyze the impact of this discrete voltage regulation. A specific prototype of this voltage and stabilizer regulator have been in operation in a real outdoor lighting installation for more than one year.

Sensorless explicit model predictive control for multi-phase buck converters with variable output voltage

The purpose of this paper is to use the predictive control to take advantage of the future information in order to improve the reference tracking. The control attempts to increase the bandwidth of the conventional regulators by using the future information of the reference, which is supposed to be known in advance. A method for designing a controller is also proposed. A comparison in simulation with a conventional regulator is made controlling a four-phase Buck converter. Advantages and disadvantages are analyzed based on simulation results.

Comparison of V2IC control with voltage mode and current mode controls for high frequency (MHz) and very fast response applications

High switching frequencies (several MHz) allow the integration of low power DC/DC converters. Although, in theory, a high switching frequency would make possible to implement a conventional Voltage Mode control (VMC) or Peak Current Mode control (PCMC) with very high bandwidth, in practice, parasitic effects and robustness limits the applicability of these control techniques. This paper compares VMC and CMC techniques with the V2IC control. This control is based on two loops. The fast internal loop has information of the output capacitor current and the error voltage, providing fast dynamic response under load and voltage reference steps, while the slow external voltage loop provides accurate steady state regulation. This paper shows the fast dynamic response of the V2IC control under load and output voltage reference steps and its robustness operating with additional output capacitors added by the customer.