QorTek (United States)

Infections related to neuromodulation devices such as spinal cord stimulators (SCS) and intrathecal pumps (ITPs) present complex challenges due to potential complications such as localized infections, deep infections, sepsis, and neurological injury. Prompt diagnosis requires patients and providers to be educated on wound management and sepsis symptoms for immediate medical attention. Antibiotic therapy and duration vary based on infection severity, with deep infections often requiring device removal despite recent improvements in salvage rates with aggressive initial intervention. Deep infections necessitate timely diagnosis through imaging modalities such as magnetic resonance imaging (MRI) or computed tomography (CT), followed by device removal and culture-guided antibiotic therapy, often in collaboration with infectious disease specialists and spine surgeons. ITP infections pose similar challenges along with the risk of meningitis and may require careful management of medication withdrawal symptoms during emergent pump removal. Lab monitoring may aid treatment assessment, although negative cultures can occur due to post-antibiotic exposure. Postoperative recommendations stress standardized guidelines, patient education, and vigilant surveillance, with close follow-up crucial for early infection detection and intervention. Managing device-related infections demands a multi-specialty approach to minimize complications and optimize outcomes. This paper outlines best practices for diagnosing, managing, and treating neuromodulation device infections, focusing on guiding clinical decision-making from the onset of infection through treatment and potential reimplantation.

Background/ImportanceChronic coccydynia is a challenging condition to manage. Conflicting evidence exists regarding the role of the ganglion impar in coccygeal nociception. When conservative treatments fail, minimally invasive interventions at the ganglion impar may be effective in providing relief.ObjectivesTo evaluate the effectiveness and safety of ganglion impar blocks (GIBs) for the management of chronic coccydynia.Evidence reviewA systematic review and meta-analysis was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Relevant studies were identified through a comprehensive literature search of PubMed, Embase Classic+ Embase, CINAHL and the Web of Science in February 2024. Data on patient characteristics, intervention details, pain outcomes (measured by Visual Analog Scale and Numerical Pain Rating Scale) and adverse events were extracted. Meta-analysis was performed using standardized mean differences (SMDs) on scale of 0 to 10.FindingsSeventeen studies described 625 coccydynia patients treated with GIB. All studies reported some level of improvement of pain after GIB. The meta-analysis included 11 studies totaling 391 patients with a baseline pain score of 7.93 (7.81 to 8.04 95% CI). GIBs were effective in reducing coccygeal pain at short-term (up to 3 months), intermediate-term (3–6 months) and long-term (greater than 6 months) follow-up. SMDs were −2.73 (95% CI −3.45 to −2.01), −3.22 (95% CI −2.82 to −1.45), −1.86 (95% CI −2.58 to −1.15) at 3 months, 3–6 months and >6 months, respectively. No serious adverse events were noted. Grading of Recommendations Assessment, Development and Evaluation assessment indicated ‘very low’ certainty of evidence across all outcomes.ConclusionsNon-neurodestructive GIB may be a safe and potentially effective treatment option for patients with chronic, refractory coccydynia.PROSPERO registration numberCRD42024506056.

ContextNeuromodulation is an expanding field of study for headache treatment to reduce pain by targeting structures within the nervous system that are commonly involved in headache pathophysiology, such as the vagus nerve (VNS), occipital nerves, or sphenopalatine ganglion (SPG) for stimulation. Pharmaceutical medical therapies for abortive and prophylactic treatment, such as triptans, NSAIDs, beta-blockers, TCAs, and antiepileptics, are effective for some individuals, but the role that technology plays in investigating other therapeutic modalities is essential. Peripheral neuromodulation has gained popularity and FDA approval for use in treating certain headaches and migraine headache conditions, particularly in those who are refractory to treatment. Early trials found FDA approved neurostimulatory implant devices, including Cephaly and SpringTMS, improved patient-oriented outcomes with reductions in headaches per month (frequency) and severity.Evidence AcquisitionThis was a narrative review. The sources for this review are as follows: Searching on PubMed, Google Scholar, Medline, and ScienceDirect from 1990 - 2019 using keywords: Peripheral Neuromodulation, Headache, vagus nerve, occipital nerves, sphenopalatine ganglion.ResultsThe first noninvasive neurostimulator device approved for migraine treatment was the Cefaly device, an external trigeminal nerve stimulation device (e-TNS) that transcutaneously excites the supratrochlear and supraorbital branches of the ophthalmic nerve. The second noninvasive neurostimulation device receiving FDA approval was the single-pulse transcranial magnetic stimulator, SpringTMS, positioned at the occiput to treat migraine with aura. GammaCore is a handheld transcutaneous vagal nerve stimulator applied directly to the neck at home by the patient for treatment of cluster headache (CH) and migraine. Several other devices are in development for the treatment of headaches and target headache evolution at different levels and inputs. The Scion device is a caloric vestibular stimulator (CVS) which interfaces with the user through a set of small cones resting in the ear canal on either side and held in place by modified over-ear headphones. The pulsante SPG Microstimulator is a patient-controlled device implanted in the patient’s upper jaw via an hour-long oral procedure to target the sphenopalatine ganglion. The occipital nerve stimulator (ONS) is an invasive neuromodulation device for headache treatment that consists of an implanted pulse generator on the chest wall connected to a subcutaneous lead with 4 - 8 electrodes that is tunneled the occiput.ConclusionsThe aim of this review is to provide a comprehensive overview of the efficacy, preliminary outcomes, and limitations of neurostimulatory implants available for use in the US and those pending further development.

Future large-scale particle accelerators, for example, the Future Circular Collider (FCC), the Compact Linear Collider (CLIC) and the International Linear Collider (ILC), will require significant RF drive power on the order of 100 MW. Thus, an RF source with high efficiency is preferable to minimise the overall power required. Klystrons represent an attractive RF source, with the current state of the art operating at efficiencies of up to 70%. Such devices feature monotonic bunching, where at the output cavity, a number of electrons will not be in the main bunch, and instead will be present in the anti-bunch, and therefore not contributing to the output power. Therefore, novel bunching methods, such as the Core Oscillation Method (COM), are worthy of investigation. By allowing the core of the electron beam to bunch and de-bunch between successive cavities, the number of electrons contained in the final bunch can increase, and therefore improve the efficiency of the device. Numerical simulation of klystrons featuring COM will be presented, with efficiencies of up to 85% being predicted thus far.

Several corporations including QorTek and Boeing have both independently proposed variable sweep primary structures for future adaptive airframe structures as to enable miniaturized area dominance munitions and UAVs. Various new vehicle concepts must insert a high power actuator to overcome low speed aerodynamic forces within a limited packaging availability. In order to meet requirements for this and other UAV/UCAV/MMT missions, require a re-thinking on how to accomplish large motor torque/lb (rather than energy/lb) while integrating the speed and torque capability in a small package. The difficulty is highlighted by considering that piezo devices are nicely compact but can only deliver is typically 1-2ft-lb/lb; whereas SMA has potential of being lighter solution and can deliver 100-200 ft-lb/lb but has two problems: slow recovery and large weight penalty for thermal components. Fortunately, some munition applications have relatively modest control surface actuation bandwidth requirements. However, until now, the thermal aspect has been prohibitive. QorTek will present a new SMA-based motor that provides high torque/lb for UAV/UCAV/MMT systems. This unique motor design has eliminated the need for additional power components for thermal excitation (transient heating) of the SMA elements as to accomplish phase transition. The resulting package is the desirable lightweight and compact packaged solution to many air vehicle and munition needs. Moreover, the design eliminates the undesirable "snapping" action associated with SMA phase transition.

A witches' brew of controversy is bubbling up over the potential link between atrazine, one of the most widely used herbicides in the United States, and the decline of amphibians. The latest additions to the brew are new findings from developmental endocrinologist Tyrone Hayes's group at the University of California, Berkeley, suggesting that exposure to very low levels of atrazine in the wild is turning male frogs into hermaphrodites. But new experimental results in another frog species, to be presented by experimental toxicologist James Carr of Texas Tech University in Lubbock and other researchers at a meeting later this month, cast doubt on such low-dose effects. At stake could be continued regulatory approval for atrazine.

Orthodontic forces for sliding tooth movement during space closure are applied at a distance from the centre of resistance of the teeth. For this reason, the teeth will tip until contacts are established between the archwire and diagonally opposite corners of the bracket wings. They will also rotate until the wire contacts opposite corners of the ligature tie or the buccal shield with self-ligating brackets, and the base of the slot. Frictional forces measured with models that do not enable such movements may therefore not be representative of the clinical condition. To test this hypothesis, a dentoalveolar model that allowed accurate reproduction of the width of a material of similar elastic properties as the periodontal ligament (PDL) was fabricated. In addition, a device was designed that allowed accurate adjustment of the bracket slot in all three planes of space during mounting of the model in an Instron machine. Frictional forces during sliding of ceramic brackets with 0.022 x 0.028-inch bracket slots along 0.019 x 0.025-inch stainless steel wires were tested using models with simulated PDL widths of 0.00, 0.33, 0.67, and 1.00 mm. ANOVA detected a significant effect of PDL width on mean frictional force (P < 0.001). Pairwise comparisons at 0.05 significance level indicated no differences between the models without PDL and those with a width of 0.33 mm, and between models with PDL widths of 0.67 and 1.00 mm. However, the two models with smaller widths produced significantly lower frictional forces.

A flextensional actuator was designed using commercial multilayer stacked actuator so as to produce large displacements at intermediate force levels. The simple design chosen eliminated the need for bonding the actuators into the frame and permitted easy series connection of multiple units. To satisfy the need for a fiber grating tuning device to interrogate an array of Bragg grating fiber optic stress sensors, a tuning device using four series connected units was constructed. The unit performs well, but the actual measured amplification is less than theoretical expectation. The problem was traced to unwanted flexing of the simple original frame and a hinged more robust flexing beam construction was shown to eliminate the problem.