Electrophysiological Monitoring Research Articles

Modified Selective Dorsal Rhizotomy Exposure Method for Adults With Spastic Paralysis of the Lower Limbs.

Spinal deformities are a common complication after selective dorsal rhizotomy (SDR). In this article, we introduce a more minimally invasive SDR procedure in adult patients with spastic paralysis of the lower limbs. In this retrospective analysis of SDR in 8 adult patients with spastic paralysis of the lower limbs, a modified exposure method was used during the surgery. Only the lower part of the L1 spinous process, upper part of the L2 spinous process, and part of the lamina were resected through L1-2 interlaminar approaches. The motor and sensory roots were found to be completely dependent on electrophysiological monitoring. The sensory roots of the target muscle groups were partially transected. All patients were followed up for 2-4 years. The degree of lower extremity spasm was assessed using the Gross Motor Function Classification Scale, Ashworth grading, Gross Motor Function Measure-66, joint range of motion, and electromyography analysis. All 8 patients were successfully operated with the help of intraoperative electrophysiological monitoring. The Ashworth score of the target muscles, Gross Motor Function Measure-66 score, and range of motion of the joints improved significantly after surgery. Two patients achieved cross-grade improvement in their Gross Motor Function Classification Scale scores. No persistent incision pain or spinal deformities were observed during follow-up. The interspinous process approach provides sufficient surgical space and reduced the damage to the bone structure of the spine. The electrophysiological monitoring protocol is suitable for adult patients with lower extremity spasm.

Flexible, Conductive Fabric‐Backed, Microneedle Electrodes for Electrophysiological Monitoring

AbstractMicroneedle‐based electrodes have attracted significant attention due to their potential applications in high‐quality, long‐term electrophysiological monitoring. In this study, micromoulding technology is used to develop a flexible, conductive fabric microneedle (CF–MN) electrode by bonding a conductive textile to polymeric microneedle arrays. The resulting electrode conforms to the curved surfaces of the body, and the use of a conductive textile backing reduces metallization time and costs by 50% over double‐sided dry electrodes. The electrode‐skin impedance of the CF–MN electrodes is significantly lower than that of gel electrodes over a wide frequency range, and tests on healthy volunteers, both at rest and under a range of ambulatory conditions, showed that the electrodes are capable of acquiring electrocardiography (ECG) and electromyography (EMG) signals that have a comparable kurtosis and signal‐to‐noise ratio to those recorded using conventional electrodes, but without the need for skin preparation or the use of a wet gel. The biomechanical properties of the electrode are also characterized. This is the first demonstration of CF–MN electrodes that can ultimately be integrated into clothing, which in turn can facilitate personalized cardiac health management by enabling continuous, long‐term ECG/EMG monitoring during daily activities.

Electromyographic predictors of abducens nerve palsy after endoscopic skull base surgery.

Recovery of abducens nerve palsy (ANP) after endoscopic endonasal skull base surgery (ESBS) has been shown to be potentially predicted by postoperative ophthalmological examination. Triggered electromyography (t-EMG) and free-run electromyography (f-EMG) activity provide an intraoperative assessment of abducens nerve function, but associations with long-term ANP outcomes have not been explored. The objective of this study was to describe intraoperative abducens EMG characteristics and determine whether these electrophysiological profiles are associated with immediately postoperative and long-term ANP outcomes after ESBS. The authors conducted a 5-year (2011-2016) retrospective case-control study of patients who underwent ESBS in whom the abducens nerve was stimulated (t-EMG). Electrophysiological metrics were compared between patients with a new postoperative ANP (cases) and those without ANP (controls). Pathologies included chordoma, pituitary adenoma, meningioma, cholesterol granuloma, and chondrosarcoma. Electrophysiological data included the presence of abnormal f-EMG activity, t-EMG stimulation voltage, stimulation threshold, evoked compound muscle action potential (CMAP) amplitude, onset latency, peak latency, and CMAP duration at various stages of the dissection. Controls were selected such that pathologies were similarly distributed between cases and controls. Fifty-six patients were included, 26 with new postoperative ANP and 30 controls without ANP. Abnormal f-EMG activity (28.0% vs 3.3%, p = 0.02) and lack of response to stimulation (27% vs 0%, p = 0.006) were more frequent in patients with immediately postoperative ANP than in controls. Patients with immediately postoperative ANP also had a lower median CMAP amplitude (35.0 vs 71.2 μV, p = 0.02) and longer onset latency (5.2 vs 2.8 msec, p = 0.04). Comparing patients with transient versus persistent ANP on follow-up, those with persistent ANP tended to have a lower CMAP amplitude (12.8 vs 57 μV, p = 0.07) and higher likelihood of not responding to stimulation at the end of the case (45.5% vs 7.1%, p = 0.06). Abnormal f-EMG was not associated with long-term ANP outcomes. The presence of f-EMG activity, lack of CMAP response to stimulation, decreased CMAP amplitude, and increased CMAP onset latency were associated with immediately postoperative ANP. Long-term ANP outcomes may be associated with t-EMG parameters, including whether the nerve is able to be stimulated once identified and CMAP amplitude. Future prospective studies may be designed to standardize abducens nerve electrophysiological monitoring protocols to further refine operative and prognostic utility.

Ionic hydrogels-based electronic skins for electrophysiological monitoring

Ionic hydrogels-based electronic skins for electrophysiological monitoring

Water-Responsive 3D Electronics for Smart Biological Interfaces.

Three-dimensional (3D) electronic systems with their potential for enhanced functionalities often require complex fabrication processes. This paper presents a water-based, stimuli-responsive approach for creating self-assembled 3D electronic systems, particularly suited for biorelated applications. We utilize laser scribing to programmatically shape a water-responsive bilayer, resulting in smart 3D electronic substrates. Control over the deformation direction, actuation time, and surface curvature of rolling structures is achieved by adjusting laser-scribing parameters, as validated through experiments and numerical simulations. Additionally, self-locking structures maintain the integrity of the 3D systems. This methodology enables the implementation of spiral twining electrodes for electrophysiological signal monitoring in plants. Furthermore, the integration of self-rolling electrodes onto peripheral nerves in a rodent model allows for stimulation and recording of in vivo neural activities with excellent biocompatibility. These innovations provide viable paths to next-generation 3D biointegrated electronic systems for life science studies and medical applications.

Thermally comfortable epidermal bioelectrodes based on ultrastretchable and passive radiative cooling e-textiles

On-skin electronics with excellent passive cooling performance are highly favorable in improving human thermal comfort and reducing cooling energy consumption, which has received less research attention recently. Herein, a permeable and skin-conformable electronic textile (e-textile) with remarkable passive radiative cooling (PRC) performance is developed for all-day multi-environment passive cooling and human electrophysiological monitoring. The excellent passive cooling performance is attributed to the evenly encapsulated Al2O3 microparticles and thermally-fused nano/micropores in the nonwoven styrene-ethylene-butylene-styrene (SEBS) elastomeric microfibers, thus high emissivity (maximum emissivity>97%) and efficient backscattering of ultraviolet-visible-near infrared radiation (sunlight reflectivity>90%) can be realized simultaneously, resulting in the superior radiative cooling capability at daytime (10.5 °C and 11.3 °C for sunny and cloudy weather, compared with the ambient environment) and at nighttime (7.0 °C compared to pure SEBS textiles). Moreover, the obtained PRC e-textiles printed with liquid metal can serve as thermally comfortable and skin-mountable bioelectrodes for monitoring high-fidelity electrophysiological signals (including electrocardiograph (ECG), surface electromyogram (sEMG), and electroencephalograph (EEG) signals even underwater). Thus, this ultrastretchable PRC e-textile provides a promising alternative for zero-energy cooling in health monitoring epidermal electronics.

Screen-Printed Piezoelectric Sensors on Tattoo Paper Combined with All-Printed High-Performance Organic Electrochemical Transistors for Electrophysiological Signal Monitoring.

This work demonstrates sensitive and low-cost piezoelectric sensors on skin-friendly, ultrathin, and conformable substrates combined with organic electrochemical transistors (OECTs) for the detection and amplification of alternating low-voltage input signals. The fully screen-printed (SP) piezoelectric sensors were manufactured on commercially available tattoo paper substrates, while the all-printed OECTs, relying on an extended gate electrode architecture, were manufactured either by solely using SP or by combining SP and aerosol jet printing (AJP) on PET substrates. Applying a low-voltage signal (±25 mV) to the gate electrode of the SP+AJP OECT results in approximately five times higher current modulation as compared to the fully SP reference OECT. The tattoo paper-based substrate enables transfer of the SP piezoelectric sensor to the skin, which in turn allows for radial pulse monitoring when combined with the SP+AJP OECT; this is possible due to the ability of the conformable sensor to convert mechanical vibrations into voltage signals along with the highly sensitive current modulation ability of the transistor device to further amplify the output signal. The results reported herein pave the way toward all-printed fully conformable wearable devices with high sensitivity to be further utilized for the real-time monitoring of electrophysiological signals.

Outcome predictors in a series of 40 patients after surgery for low-grade gliomas

ObjectiveLow grade gliomas (LGGs) account for 15 % of primary brain tumors. The paper has the aim to identifying prognostic factors affecting overall survival (OS) and progression-free survival (PFS), and to evaluate the outcome of patients. MethodsA total of 40 patients undergoing surgery for cerebral LGG (WHO grades I and II) at Our Institute were enrolled in the retrospective study. Inclusion criteria were: histological diagnosis of LGG, availability of complete clinical-instrumental documentation and follow-up data. For each patient, the following were analyzed: the clinical parameters in the preoperative and postoperative phases, the histological variant of the tumor, the extent of surgical resection (EOR) and any use of intraoperative methods, the Mib-1/Ki-67 proliferation index, the administration of adjuvant chemotherapy and/or radiotherapy and the occurrence of any complications. ResultsThe cohort included 14 males and 26 females. The independent predictors of OS at multivariate analysis were: age, pre-operative KPS, Ki67/Mib-1, EOR and adjuvant chemotherapy. With regard to PFS, statistical significance on multivariate analysis was observed for pre-operative KPS, Ki67/Mib-1, EOR, post-operative tumor volume and radiotherapy. An EOR < 80 % was confirmed as negative prognostic factor for both OS and PFS. Lastly, the pre-operative tumor volume and the use of Intra-operative Electrophysiological Monitoring were significantly associated with EOR. ConclusionIn this study, according to the literature, several prognostic factors determining the outcome of LGG patients, both in terms of OS and PFS, were confirmed. Knowing the impact of these parameters in terms of prognosis would guide the choice of treatment, which will necessarily be multidisciplinary and tailored.

Breakup-Free and Colorful Liquid Metal Thin Films via Electrochemical Oxidation.

Thin-film metal conductors featuring high conductivity and stretchability are basic building blocks for high-performance conformable electronics. Gallium-based liquid metals are attractive candidates for thin-film conductors due to their intrinsic stretchability and ease of processing. Moreover, the phase change nature of liquid metal provides an opportunity to create conformal electronics in a substrate-free manner. However, thin liquid metal films tend to break during the solid-to-liquid transition due to the high surface tension of liquid metal. Here, we created breakup-free liquid metal thin films by the electrochemical oxidation of solid gallium films. We show that electrochemical oxidation can enhance the mechanical strength of the gallium oxide layer and its interfacial adhesion to the gallium core. When heated to the liquid state, the oxidized gallium films can maintain their structural integrity on various solid substrates, hydrogels, and even the water surface. The solid-liquid phase change-induced stiffness decrease allowed the gallium films to be conformably attached to various nonplanar surfaces upon heating or water transfer printing. Moreover, we also found that enhanced electrochemical oxidation can result in the formation of structure color due to nanoporous structures on the film surface. We also demonstrate the applications of oxidized liquid metal films in functional electronics, electrophysiological monitoring, and tattoo art.

Comparative analysis of surgical techniques used to repair a closed sciatic nerve injury in patients undergoing total hip replacement

Introduction A variety of surgical techniques used to treat a closed sciatic nerve injury after total hip replacement (THR) require careful evaluation and comparison of short- and long-term outcomes of the complex management emphasizing a paucity of publications on the subject and a high social and economic role of the issue.The aim of the study was to compare outcomes of various surgical techniques used to treat closed sciatic nerve injuries afterTHR.Material and methods A total of 94 patients with closed sciatic nerves injuries associated with THR were divided into three groups. Microsurgical neurolysis of the sciatic nerve was produced for patients of Group I; patients of group II underwent microsurgical neurolysis of the sciatic nerve and electrical nerve stimulation; patients of group III had microsurgical neurolysis and electrical stimulation of the sciatic nerve with multichannel electrodes and segmental apparatus of the spinal cord at the conus and epiconus level. Clinical and neurological tests, dynamic electrophysiological monitoring were employed for clinical and functional evaluation.Results In In the postoperative period, positive dynamics in clinical and electrophysiological parameters with improved pain, lower limb functionality, increased amplitudes and decreased latency of M‑response with most positive changes observed in Group III compared to Group I and Group II (p &lt; 0.05).Discussion The function of the sciatic nerve restored in all patients with the most pronounced effect recorded in group III. The effect from the technique was associated with a simultaneous electrical stimulation of the trunk of the peripheral nerve and the segmental apparatus of the spinal cord causing synergetic effect on the structures.Conclusion The most effective method of surgical treatment was the use of Microsurgical neurolysis combined with two-level electrical stimulation was shown to be most effective and characterized by faster pain regression and positive dynamics in clinical and electrophysiological parameters in the affected lower limb of patients Group III.

P/Q type (Cav2.1) Calcium Channel Blocker ω-Agatoxin IVA Alters Cleaved Caspase-3 and BDNF Expressions in the Rat Brain and Suppresses Seizure Activity.

High-voltage-gated calcium channels have pivot role in the cellular and molecular mechanisms of various neurological disorders, including epilepsy. Similar to other calcium channels, P/Q-type calcium channels (Cav2.1) are also responsible for vesicle release at synaptic terminals. Up to date, there are very limited reports showing the mechanisms of Cav2.1 in epileptogenesis. In the present study, we investigated the anticonvulsive and neuroprotective effects of ω-agatoxin IVA, a specific Cav2.1 blocker, in a chemical kindling model of epileptogenesis. Righting reflex and inclined plane tests were used to assess motor coordination. Electroencephalography was recorded for electrophysiological monitoring of seizure activity in freely moving rats. Immunohistochemical analyses were performed for brain-derived neurotrophic factor (BDNF) and cleaved caspase-3 expressions in the prefrontal cortex, striatum, hippocampus, and thalamic nucleus. ω-Agatoxin IVA injected into the right lateral ventricle significantly prolonged the onset of seizures in a dose-dependent manner. In addition, repeated intraperitoneal administrations of ω-agatoxin IVA significantly suppressed the development of kindling and epileptic discharges without altering motor coordination. In addition, ω-agatoxin IVA significantly increased BDNF expressions, and decreased cleaved caspase-3 expressions in the brain when compared to PTZ + saline group. Our current study emphasizes the significance of the inhibition of P/Q type calcium channels by ω-agatoxin IVA, which suppresses the development of epileptogenesis and provides a new potential pathway for epilepsy treatment.

Lumbar Endoscopic Unilateral Laminotomy With Bilateral Decompression Surgery in Severe Lumbar Stenosis Under Electrophysiological Monitoring-Focused on Full-Visualized Trephine/Osteotome.

Although endoscopic drill has the advantages in manipulation and hemostasis, whose low efficiency and blurred vision reduce the efficacy of lumbar endoscopic unilateral laminotomy with bilateral decompression (LE-ULBD). The present study was designed to evaluate the safety and efficacy of full-visualized trephine/osteotome in the LE-ULBD surgery for severe lumbar stenosis. Fifty-seven severe lumbar stenosis patients who underwent LE-ULBD between January 2020 to January 2023 were enrolled, who were divided into drill and visualized trephine groups. The medical records including demographics, operative duration, intraoperative electrophysiological findings, postoperative hospital stay or hospital stay, postoperative outcomes and complications were retrospectively reviewed and analyzed. A total of 57 patients included 15 in drill and 42 in trephine group were enrolled in the study. There was significant difference in the pre- and postoperative visual analogue scale and Oswestry Disability Index scores in both groups (p < 0.05). The mean operative duration in the trephine group (101.05 ± 12.18 minutes) was shorter than that in the drill group (134.67 ± 9.68 minutes) (p < 0.05). There was no statistical difference between the 2 groups in electrophysiological monitoring, posthospital stays, postoperative outcomes and complications. Abnormal free-electromyography (EMG) were recorded in 2 (13.3%) and 5 patients (11.9%) in the drill and trephine group. Intraoperative somatosensory evoked potential changes occurred in 3 (20%) and 3 patients (7.1%) in the drill and trephine group and all patients recovered immediately when surgery ended. No serious complications and recurrence occurred in all the patients. Full-visualized trephine/osteotome has been approved to be convenient, safe and efficient in our study, which combined with translaminar inside-out technique and EMG monitoring especially free-EMG may offer a new choice in LE-ULBD surgery for lumbar stenosis patients.

Advances in Bioresorbable Triboelectric Nanogenerators.

With the growing demand for next-generation health care, the integration of electronic components into implantable medical devices (IMDs) has become a vital factor in achieving sophisticated healthcare functionalities such as electrophysiological monitoring and electroceuticals worldwide. However, these devices confront technological challenges concerning a noninvasive power supply and biosafe device removal. Addressing these challenges is crucial to ensure continuous operation and patient comfort and minimize the physical and economic burden on the patient and the healthcare system. This Review highlights the promising capabilities of bioresorbable triboelectric nanogenerators (B-TENGs) as temporary self-clearing power sources and self-powered IMDs. First, we present an overview of and progress in bioresorbable triboelectric energy harvesting devices, focusing on their working principles, materials development, and biodegradation mechanisms. Next, we examine the current state of on-demand transient implants and their biomedical applications. Finally, we address the current challenges and future perspectives of B-TENGs, aimed at expanding their technological scope and developing innovative solutions. This Review discusses advancements in materials science, chemistry, and microfabrication that can advance the scope of energy solutions available for IMDs. These innovations can potentially change the current health paradigm, contribute to enhanced longevity, and reshape the healthcare landscape soon.

Stretchable Multi‐Channel Ionotronic Electrodes for In Situ Dual‐Modal Monitoring of Muscle–Vascular Activity

AbstractIn situ dual‐modal detection of electrophysiology (EP) and blood oxygen (BO) during muscle–vascular activity is crucial for healthcare and human–machine interaction. It requires an integrated monitoring system: a transparent electrode for EP detection directly adhered to skin and a near‐infrared spectroscopy (NIRs) layer for BO detection. In particular, the multi‐channel, highly transparent, stretchable electrodes should be well developed. In this study, 16‐channel transparent ionotronic electrodes are fabricated based on a stretchable and printable ionogel, demonstrating excellent properties such as high transparency, large stretchability, wet adhesion, biocompatibility, softness, and long‐term stability. The electrode exhibits stable contact impedance for 24 h and a 2‐week periodic EP monitoring. The 16‐channel transparent ionotronic electrode outperforms stretchable gold electrodes by providing stable EP monitoring with minimal interference in NIRs for blood oxygen detection. An in situ negative correlation is found between EP intensity and blood oxygen level over time. This study paves the way for designing transparent ionotronics for synchronous optical‐related monitoring and highlights the potential use of an in situ dual‐modal monitoring system for the study of muscle–vascular coupling in neurocience and rehabilitation.

Positioning of epidural electrode for motor cortex stimulation in general anesthesia based on intraoperative electrophysiological monitoring to treat refractory trigeminal neuropathic pain

BackgroundMotor cortex stimulation (MCS) represents a treatment option for refractory trigeminal neuralgia (TGN). Usually, patients need to be awake during surgery to confirm a correct position of the epidural electrode above the motor cortex, reducing patient’s comfort.MethodEpidural cortical mapping (ECM) and motor evoked potentials (MEPs) were intraoperatively performed for correct localization of motor cortex under general anesthesia that provided comparable results to test stimulation after letting the patient to be awake during the operation.ConclusionIntraoperative ECM and MEPs facilitate a confirmation of correct MCS-electrode position above the motor cortex allowing the MCS-procedure to be performed under general anesthesia.

Posterior Fossa Tumors: Special Issue

This edition of APN is entirely dedicated to posterior fossa tumors. Very common in the daily routine of pediatric neurosurgeons, these tumors remain one of the most challenging pathologies we must face. The importance and complexity of the anatomical structures of the posterior fossa, associated with the enormous histological variety of neoplastic lesions in this region, make its therapeutic approach difficult and even more challenging. The degree of surgical resection plays a determining role in the prognosis and cure possibilities for the children with posterior fossa tumors; on the other hand, gross total resection is related to the much feared cerebellar mutism syndrome, related to serious cognitive and behavioral sequelae. Every pediatric neurosurgeon's nightmare, this subject deserves special attention in our edition. Ballestero and Juca review the literature, discuss the concepts of mutism, predisposing factors, pathophysiology, and available treatments.&#x0D; However, mutism prevention after surgical resection is essential. In addition to excellent mastery of microneurosurgery techniques and in-depth anatomical knowledge of the structures of the posterior fossa, pediatric neurosurgeons must use all the most advanced technologies to protect their patients and obtain the best results. Therefore, Kodangeski and Pinheiro discuss the use of electrophysiological monitoring during resection surgeries for posterior fossa tumors. Ahmed also emphasizes the importance of neuronavigation in these surgeries, as a significant tool to reduce morbidity and mortality.&#x0D; Around 70 to 90% of posterior fossa tumors present with hydrocephalus. The treatment of hydrocephalus before, during or after tumor resection is a very controversial subject, with different approaches among groups. Mandic retrospectively applies the success scores of endoscopic third ventriculocysternostomy in a group of patients with posterior fossa tumors and analyzes its efficiency.&#x0D; Costa pays special attention to posterior fossa ependymomas. Despite the explosion of genomic and epigenomic knowledge of these tumors in recent decades, surgery still plays an essential role in their treatment because the main objective as gross total resection represents a great technical challenge for the neurosurgeon.&#x0D; Besides to medulloblastomas, astrocytoma and ependymomas, more rarely other histological types can involve the posterior fossa and should be considered as differential diagnosis of these lesions. Therefore, Lopez presents clinical cases of choroid plexus papilloma and Rabelo Rodrigues reviews the cases of hemangioblastomas found in the literature.&#x0D; Even though posterior fossa tumors are predominant in children of preschool and school age, Dassi presents a series of cases in patients under two years of age, highlighting the histological characteristics and treatment strategies in this age group.&#x0D; The final result of this edition is a set of articles that highlight the complexity of posterior fossa tumors and the challenges of their treatment. Although these are the most common intracranial tumors in childhood and are part of the routine of every pediatric neurosurgery service, the war against those tumors has not been definitively won. We still lack greater understanding, and the exchange of experiences is increasingly necessary. We hope these articles can help all readers in their daily battles.&#x0D; Our special thanks to all the authors who worked on this edition and to the editorial staff who, with all their dedication, made it possible.&#x0D; Have an excellent read!

Perspective: Can intraoperative neurophysiological monitoring (IONM) limit errors associated with lumbar pedicle screw fusions/transforaminal lumbar interbody fusions (TLIF)?

We evaluated whether intraoperative neural monitoring (IONM), including somatosensory evoked potential monitoring (SEP), motor evoked potential monitoring (MEP), and electrophysiological monitoring (EMG), could reduce operative errors attributed to lumbar instrumented fusions, including minimally invasive (MI) transforaminal lumbar interbody fusion (TLIF)/open TLIF. Operative errors included retraction/stretch or cauda equina neural/cauda equina injuries that typically occurred during misplacement of interbody devices (IBD) and/or malpositioning of pedicle screws (PS). IONM decreased the incidence of intraoperative errors occurring during instrumented lumbar fusions (MI-TLIF/TLIF). In one series, significant loss of intraoperative SEP in 5 (4.3%) of 115 patients occurred after placing IBD; immediate removal of all IBD left just 2 patients with new neural deficits. In other series, firing of trigger EMG's (t-EMG) detected intraoperative PS malpositioning, prompted the immediate redirection of these screws, and reduced the need for reoperations. One t-EMG study required a reoperation in just 1 of 296 patients, while 6 reoperations were warranted out of 222 unmonitored patients. In another series, t-EMG reduced the pedicle screw breech rate to 7.78% (1723 PS) from a higher 11.25% for 1680 PS placed without t-EMG. A further study confirmed that MEP's picked up new motor deficits in 5 of 275 TLIF. SEP/MEP/EMG intraoperative monitoring appears to reduce the risk of surgical errors when placing interbody devices and PS during the performance of lumbar instrumented fusions (MI-TLIF/TLIF).However, IONM is only effective if spine surgeons use it, and immediately address significant intraoperative changes.

ICGA combined with EP monitoring in microclipping of cerebral aneurysms.

Cerebral aneurysm is one of the common cerebrovascular diseases in neurosurgery, and rupture of cerebral aneurysm is the most important cause of spontaneous subarachnoid hemorrhage. How to precisely clip the aneurysm has been a topic worth discussing, so the authors explore the value of ICGA combined with electrophysiological monitoring in the microclipping of cerebral aneurysms. Using the method of retrospective analysis of cases, 661 patients with cerebral aneurysms admitted to the Department of Neurosurgery, Zhongnan Hospital of Wuhan University, from 2021.8 to 2022.10 were studied, 390 patients with aneurysm clipping were included, and patients with Hunt-Hess classification ≥ 4 were excluded, and whether to use ICGA combined with EP in microclipping of the ruptured and unruptured aneurysm in pterional approach was investigated at the time of discharge, respectively. The MRS and total hospital days were compared to investigate the value of ICGA combined with EP in the microclipping of cerebral aneurysms. All 390 patients enrolled in the group had successful aneurysm clipping, 178 patients were screened for ruptured aneurysm pterional approach and 120 patients for unruptured aneurysm pterional approach access; the MRS at discharge was significantly lower in the ICGA combined with EP group than in the no-EP group for ruptured aneurysm pterional approach microclipping (p < 0.001), and the mean number of days in hospital was significantly lower (p < 0.01). Patients in the ICGA combined with EP group in microclipping of unruptured aneurysms with pterional approach also had significantly lower MRS at discharge compared with patients in the ICGA alone group (p < 0.001), with no statistically significant difference in the mean number of days in hospital (p = 0.09). In open cerebral aneurysm microclipping, ICGA combined with EP monitoring for both ruptured and unruptured aneurysms can effectively reduce the false-negative rate of ICGA, significantly reduce the incidence of postoperative neurological deficits, and shorten the total hospital stay to some extent. ICGA combined with EP monitoring may be an effective means to reduce the rate of false clipping of the penetrating vessels and to avoid stenosis or occlusion of the aneurysm-carrying artery and is worth promoting in microclipping of cerebral aneurysms except for Hunt-Hess ≥ 4.

An All‐Stretchable, Ultraviolet Protective, and Electromagnetic‐Interference‐Free E‐Textile

AbstractFlexible and skin‐mountable electronics have drawn tremendous research attention with the booming of smart medical systems and wearing technologies, however, their environmental adaptability to electromagnetic and solar radiation has long been neglected. Herein, a novel health monitoring e‐textile with robust ultraviolet (UV) protecting and strong electromagnetic interference (EMI) shielding performance is rationally developed on an ultraelastic and bilayered nonwoven textile. Via the respective incorporation of silver flake‐modified liquid metal (AgLM) and silver nanoparticles (AgNPs) on each side of a permeable substrate, a Janus sensing layer with electrophysiological monitoring function, Joule heating ability, and excellent EMI shielding capability (up to 38.5 dB in X band) is first fabricated. Elastic microfibers embedded with sensitive photochromic microcapsules are then in situ assembled on the bioelectric‐sensing layer, achieving a bilayered e‐textile with a reversible UV‐chromic property and an extraordinary UV protection factor (UPF) of 335.56. The developed all‐stretchable and UV‐EMI proof e‐textile is utilized as a safe and comfortable on‐skin electronic to provide point‐of‐care health regulation under complex UV/EMI radiative environments. Specifically, stable Joule heating performance and accurate monitoring of electrocardiogram (ECG) and surface electromyography (sEMG) are simultaneously obtained, demonstrating promising applications in multifunctional and robust wearing electronics.

Hypoxic-preconditioned mesenchymal stem cell-derived small extracellular vesicles promote the recovery of spinal cord injury by affecting the phenotype of astrocytes through the miR-21/JAK2/STAT3 pathway.

Secondary injury after spinal cord injury (SCI) is a major obstacle to their neurological recovery. Among them, changes in astrocyte phenotype regulate secondary injury dominated by neuroinflammation. Hypoxia-preconditioned mesenchymal stem cells (MSCs)-derived extracellular vesicle (H-EV) plays a multifaceted role in secondary injury by interacting with cellular components and signaling pathways. They possess anti-inflammatory properties, regulate oxidative stress, and modulate apoptotic pathways, promoting cell survival and reducing neuronal loss. Given the unique aspects of secondary injury, H-EV shows promise as a therapeutic approach to mitigate its devastating consequences. Our study aimed to determine whether H-EV could promote SCI repair by altering the phenotype of astrocytes. Rat bone marrow MSCs (BMSCs) and EVs secreted by them were extracted and characterized. After the SCI model was successfully constructed, EV and H-EV were administered into the tail vein of the rats, respectively, and then their motor function was evaluated by the Basso-Beattie-Bresnahan (BBB) score, Catwalk footprint analysis, and electrophysiological monitoring. The lesion size of the spinal cord was evaluated by hematoxylin-eosin (HE) staining. The key point was to use glial fibrillary acidic protein (GFAP) as a marker of reactive astrocytes to co-localize with A1-type marker complement C3 and A2-type marker S100A10, respectively, to observe phenotypic changes in astrocytes within tissues. The western blot (WB) of the spinal cord was also used to verify the results. We also compared the efficacy differences in apoptosis and inflammatory responses using terminal deoxynucleotidyl transferase dUTP terminal labeling (TUNEL) assay, WB, and enzyme-linked immunosorbent assay (ELISA). Experiments in vitro were also performed to verify the results. Subsequently, we performed microRNA (miRNA) sequencing analysis of EV and H-EV and carried out a series of knockdown and overexpression experiments to further validate the mechanism by which miRNA in H-EV plays a role in promoting astrocyte phenotypic changes, as well as the regulated signaling pathways, using WB both in vivo and in vitro. Our findings suggest that H-EV is more effective than EV in the recovery of motor function, anti-apoptosis, and anti-inflammatory effects after SCI, both in vivo and in vitro. More importantly, H-EV promoted the conversion of A1 astrocytes into A2 astrocytes more than EV. Moreover, miR-21, which was found to be highly expressed in H-EV by miRNA sequencing results, was also demonstrated to influence changes in astrocyte phenotype through a series of knockdown and overexpression experiments. At the same time, we also found that H-EV might affect astrocyte phenotypic alterations by delivering miR-21 targeting the JAK2/STAT3 signaling pathway. H-EV exerts neuroprotective effects by delivering miR-21 to promote astrocyte transformation from the A1 phenotype to the A2 phenotype, providing new targets and ideas for the treatment of SCI.