Critical reviews in biomedical engineering
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Sepsis is a clinical entity in which complex inflammatory and physiological processes are mobilized, not only across a range of cellular and molecular interactions, but also in clinically relevant physiological signals accessible at the bedside. There is a need for a mechanistic understanding that links the clinical phenomenon of physiologic variability with the underlying patterns of the biology of inflammation, and we assert that this can be facilitated through the use of dynamic mathematical and computational modeling. An iterative approach of laboratory experimentation and mathematical/computational modeling has the potential to integrate cellular biology, physiology, control theory, and systems engineering across biological scales, yielding insights into the control structures that govern mechanisms by which phenomena, detected as biological patterns, are produced. This approach can represent hypotheses in the formal language of mathematics and computation, and link behaviors that cross scales and domains, thereby offering the opportunity to better explain, diagnose, and intervene in the care of the septic patient.
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The control and management of inflammation is a key aspect of clinical care for critical illnesses such as sepsis. In an ideal reaction to injury, the inflammatory response provokes a strong enough response to heal the injury and then restores homeostasis. When inflammation becomes dysregulated, a persistent inflammatory state can lead to significant deleterious effects and clinical challenges. ⋯ We present our efforts in modeling the human endotoxemia response with a particular focus on physiologic variability. Through modeling, with a focus ultimately on translational applications, we obtain more fundamental understanding of relevant physiological processes. And by taking advantage of the information embedded in biological rhythms, ranging in time scale from high-frequency autonomic oscillations reflected in heart rate variability to circadian rhythms in inflammatory mediators, we gain insight into the underlying physiology.
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Crit Rev Biomed Eng · Jan 2012
ReviewBrain shift compensation and neurosurgical image fusion using intraoperative MRI: current status and future challenges.
Navigation systems are commonly used in neurosurgical operating theaters. Generally, they either rely on the use of preoperative or intraoperative image data. ⋯ Together with an integration of functional data in the navigation such as diffusion tensor imaging (DTI)-based fiber tracking or functional MRI, there is evidence that iMRI contributes to maximize extent of resection in glioma surgery with a preservation of neurological function. The following article summarizes the work flow and clinical impact of iMRI and functional navigation, as well as current problems and possible solutions.
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Crit Rev Biomed Eng · Jan 2012
ReviewSepsis through the eyes of an engineer -- why treatments have succeeded and failed.
The sepsis syndrome is an old phenomenon. A destructive response to a system disturbance, it manifests as widespread inflammation. Over the past two centuries, biomedical research has identified triggers and described components of the pathways that underlie the sepsis syndrome. ⋯ Patterned attempts to intervene in the natural history of the sepsis syndrome will be discussed in parallel with similar, hypothetical adjustments made to a model system from the engineering canon. This juxtaposition will facilitate our review of the history of sepsis science. Using the logic of systems engineering and network science, we propose a way forward.
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Crit Rev Biomed Eng · Jan 2011
ReviewBiomedical engineering strategies for peripheral nerve repair: surgical applications, state of the art, and future challenges.
Damage to the peripheral nervous system is surprisingly common and occurs primarily from trauma or a complication of surgery. Although recovery of nerve function occurs in many mild injuries, outcomes are often unsatisfactory following severe trauma. Nerve repair and regeneration presents unique clinical challenges and opportunities, and substantial contributions can be made through the informed application of biomedical engineering strategies. ⋯ In this fight for time, degeneration of the distal nerve support structure and target progresses, ultimately blunting complete functional recovery. Thus, the most pressing challenges in peripheral nerve repair include the development of tissue-engineered nerve grafts that match or exceed the performance of autografts, the ability to noninvasively assess nerve damage and track axonal regeneration, and approaches to maintain the efficacy of the distal pathway and targets during the regenerative process. Biomedical engineering strategies can address these issues to substantially contribute at both the basic and applied levels, improving surgical management and functional recovery following severe peripheral nerve injury.