Implantation Strategy Research Articles

Refining computer-assisted SEEG planning with spatial priors - A novel comparison of implantation strategies across adult and paediatric centres.

Computer-assisted planning (CAP) allows faster SEEG planning and improves grey matter sampling, orthogonal drilling angles to the skull, reduces risk scores and minimises intracerebral electrode length. Incorporating prior SEEG trajectories enhances CAP planning, refining output with centre-specific practices. This study significantly expands on the previous work, compares priors libraries between two centres, and describes differences between SEEG in adults and children in these centres. 98 adults and 61 children who underwent SEEG implantation as part of epilepsy surgery investigations were included. Priors libraries were created for each population, clustered by target regions and subdivided by cortical approaches. The libraries were coregistered and quantitatively and qualitatively compared. The average number of implanted electrodes per patient was higher in paediatric patients than adults (13.6 vs 8.0). Paediatric implantations focused more on the insula than adult implantations (38.0 % vs 13.5 %), with similar proportions of electrodes implanted in the temporal and parietal lobes, and a higher proportion of adult electrodes in the frontal and orbitofrontal regions (40.6 % vs 24.0 %). Correspondence between the priors libraries was high. We present an example of a complex insular implantation planned with paediatric spatial priors and illustrate resultant SEEG recordings. The use of centre-specific spatial priors allows the incorporation of surgeon-specific and unit-specific preferences into automated planning. We compare implantation styles between a paediatric and an adult centre, discussing similarities and differences. This tool allows centres to compare practice and represents an effective way to analyse implantation strategies that is agnostic to method of implantation.

Multimodal surgical strategy for mixed refractory hypertonia in a patient with cerebral palsy: C1-2 puncture and pectoral pocket for baclofen pump implantation following lumbosacral ventral-dorsal rhizotomy. Illustrative case.

Intrathecal baclofen pump (ITBP) therapy has been successfully used to treat hypertonia in children with cerebral palsy (CP) since its Food and Drug Administration approval in 1984. CP affects multiple organ systems, leading to the accumulation of medical access and implantable devices, increasing the medical complexity of these children. The authors present the case of a patient with extreme surgical complexity and review the medical decision-making and surgical details. A 16-year-old male with a history of quadriplegic mixed hypertonia secondary to CP presented for ITBP replacement in the setting of pump end of service (EOS). The patient had short bowel syndrome (SBS) and severe scoliosis with a nonhealing costopelvic wound adjacent to the EOS pump. Intrathecal baclofen wean failed due to limited bioavailability from the SBS. The authors performed catheter placement to the skull base via a right C1-2 puncture and pectoral pump pocket creation. Treatment was well tolerated, with no procedural complications. Surgical complexity prompts creative problem-solving. It is critical to consider the nuances of each patient's history and body habitus to promote ITBP longevity. The authors present the case of a patient with CP who underwent catheter access via C1-2 puncture and pectoral pocket creation. In this case, surgery was effective, with an uncomplicated postoperative course. Surgeons should not hesitate to consider alternative implantation strategies in similar circumstances. https://thejns.org/doi/10.3171/CASE24427.

Challenges in Nasal Cartilage Tissue Engineering to Restore the Shape and Function of the Nose.

The repair of nasal septal cartilage is a key challenge in cosmetic and functional surgery of the nose, as it determines its shape and its respiratory function. Supporting the dorsum of the nose is essential for both the prevention of nasal obstruction and the restoration of the nose structure. Most surgical procedures to repair or modify the nasal septum focus on restoring the external aspect of the nose by placing a graft under the skin, without considering respiratory concerns. Tissue engineering offers a more satisfactory approach, in which both the structural and biological roles of the nose are restored. To achieve this goal, nasal cartilage engineering research has led to the development of scaffolds capable of accommodating cartilaginous extracellular matrix-producing cells, possessing mechanical properties close to those of the nasal septum, and retaining their structure after implantation in vivo. The combination of a non-resorbable core structure with suitable mechanical properties and a biocompatible hydrogel loaded with autologous chondrocytes or mesenchymal stem cells is a promising strategy. However, the stability and immunotolerance of these implants are crucial parameters to be monitored over the long term after in vivo implantation, to definitively assess the success of nasal cartilage tissue engineering. Here, we review the tissue engineering methods to repair nasal cartilage, focusing on the type and mechanical characteristics of the biomaterials; cell and implantation strategy; and the outcome with regard to cartilage repair. Impact statement Nasal septal cartilage is key to the cosmetic and function of the nose. To repair important damage to the nasal septum, current surgical techniques are complex and limited by graft source availability. Conversely, tissue engineering is a promising strategy to reproduce the dimensions and mechanical properties of the nose without causing donor site morbidity. This approach, however, remains overlooked for the reconstruction of the nasal septum compared with other cartilaginous tissues. This review describes the specific challenges associated with nasal cartilage repair and the pioneering studies leading to advances in the growing field of nose tissue engineering.

Procedural factors influencing successful coronary sinus reducer implantation for refractory angina: A single-centre experience.

Coronary sinus reducer (CSR) implantation is emerging as a novel effective percutaneous therapy for patients with refractory angina. Limited data exists examining the factors influencing successful CSR implantation. As CSR implantation becomes more widely adopted, a greater understanding of the procedural challenges which operators encounter is required. To evaluate the patient and procedural characteristics influencing successful CSR implantation. This was a retrospective cohort study of consecutive patients with refractory angina undergoing clinically indicated CSR implantation (February 2016 to August 2024) at a high-volume implanting centre in the UK. Patient and procedural characteristics affecting procedural difficulty were systematically analysed. Procedural difficulty was determined by 1) increasing total procedural time or 2) features of challenging equipment handling such as bellying, swan-necking or complete equipment fallout from the coronary sinus (CS). 102 out of 105 (97%) patients underwent a successful CSR implant at the first attempt. Patients had a high rate of previous revascularisation (PCI: 85%; CABG 64%) and diabetes (58%). Significant improvements in Canadian Cardiovascular Society (CCS) class were observed with 36% of patients improving by ≥2 CCS classes and 71% improving by ≥1 CCS class. A C- or non-C-shape of the CS was not associated with differences in procedural time (P=0.52). However, the presence of both a valve and ridge in the CS was associated with significantly longer procedural times (P=0.03). A ridge, alone or together with a valve, predicted features of procedural difficulty, such as bellying (ridge - OR: 2.69, P=0.02; valve and ridge - OR: 4.58, P=0.0006) and swan-necking (ridge - OR: 5.43, P=0.001; valve and ridge - OR: 4.74, P=0.002). Bellying, swan-necking, and complete fallout of equipment from the CS were associated with longer procedural times, but also with each other, suggesting their utility as indicators of procedural complexity. In our experience, CSR implantation is safe and associated with high rates of procedural success. However, patient and procedural factors can influence the difficulty of CSR implantation. The presence of a ridge may make implantation more challenging. Bellying, swan-necking and complete equipment fallout may indicate increased procedural complexity. Greater awareness of these features will encourage operators to remain vigilant and adapt their implantation strategy when encountering challenging cases.

Clinical Decision Making and Technical Approaches in Implantable Cardioverter-Defibrillator Procedures: A Step by Step Critical Appraisal of Literature.

The selection of an appropriate implantable cardioverter-defibrillator (ICD) type and implantation strategy involves a myriad of considerations. While transvenous ICDs are standard, the rise of non-transvenous options like subcutaneous ICDs and extravascular ICDs is notable for their lower complication rates. Historical preferences for dual chamber ICDs have shifted to single-chamber ICDs. Single-coil ICDs are preferred for easier extraction, and the use of the DF-4 connector is generally recommended. Cephalic cutdown is the preferred venous access technique, while axillary vein puncture is a viable alternative. The right ventricular apex remains the preferred lead position until further evidence on conduction system pacing emerges. Left-sided, subcutaneous ICD implantation is considered reliable, contingent on specific cases. A meticulous perioperative plan, including antibiotic prophylaxis and an antithrombotic regimen, is crucial for successful implantation.

Insights from Computational Fluid Dynamics and In Vitro Studies for Stent Protrusion in Iliac Vein: How Far Shall We Go?

These findings provide significant implications for the enhancement of iliac vein stent implantation strategies and stent design. The prevalent use of stents for treating Iliac Vein Compression Syndrome (IVCS) has shown efficacy, yet the associated clinical adverse events, including stent restenosis and postoperative thrombosis, are significant concerns. Up to now, the mechanism how the stent implantation induces the restenosis and DVT is still unclear. Our study hypothesizes that these adverse outcomes arise from altered blood flow dynamics following stent implantation. Employing computational modeling and medical imaging, we simulated IVCS after various stenting procedures to assess their impact on venous blood flow characteristics, including wall shear stress (WSS), residence time (RRT), and oscillatory shear index (OSI). Our findings reveal that a stent protruding into the vena cava impedes blood circulation, with increased protrusion exacerbating this obstruction. This is particularly evident at the vein bifurcation, where low WSS and elevated OSI and RRT are observed. Moreover, a higher stent strut density further obstructs blood flow, deteriorating the hemodynamic environment. Consequently, stent protrusion into the vena cava can enhance the likelihood of adverse post-surgical events. These insights have profound implications for optimizing iliac vein stent implantation techniques and stent design.

Numerical simulation of individualized flow diversion cerebral aneurysms treatment

AbstractFlow diverter implantation has emerged as a highly effective treatment for cerebral aneurysms. However, the variability in patient‐specific vascular anatomy necessitates detailed pre‐operative planning to mitigate potential complications arising from standard, one‐size‐fits‐all devices. To address these challenges, robust predictive simulation tools are essential for optimizing flow diverter design and implantation strategies tailored to the unique characteristics of each patient's anatomy. This study focuses on developing an advanced numerical simulation tool for modeling the mechanical behavior of braided flow diverters during crimping and navigation through patient‐specific vasculature. Using isogeometric analysis (IGA) with NURBS‐based representations in LS‐Dyna, the intricate deformations of the flow diverter wires during catheter crimping are captured with high accuracy. The patient‐specific vessel geometries, derived from imaging data, are integrated into the model to account for variations in vascular structure, ensuring precise alignment and controlled navigation of the device. The navigation process relies on optimizing the central axis of the blood vessel to minimize torsional stress on the flow diverter, reducing the risk of device malfunction or failure during deployment. By incorporating patient‐specific information, such as vessel curvature and tortuosity, the simulation tool enables the prediction of potential issues, thus allowing for intervention planning that is tailored to individual anatomy. This patient‐specific approach enhances the safety and efficacy of flow diverter implantation and serves as a foundation for improved device design prior to prototype development.

Five-year clinical outcomes of STEMI patients treated with a pre-specified bioresorbable vascular scaffold implantation technique: Final results of the BVS STEMI STRATEGY-IT

BackgroundData on Absorb bioresorbable vascular scaffold (BVS) use in patients presenting with ST-segment elevation myocardial infarction (STEMI) are limited. Furthermore, Absorb studies including STEMI patients lacked a prespecified implantation technique to optimize BVS deployment. This study examines the 5-year outcomes of BVS in STEMI patients using an optimized implantation strategy and the impact of prolonged dual antiplatelet therapy (DAPT). MethodsThe BVS STEMI STRATEGY-IT study is a prospective, non-randomized, single-arm multicenter trial (NCT02601781). It involved 505 STEMI patients undergoing primary percutaneous coronary intervention with a predefined BVS implantation protocol. Key endpoints were a 5-year device-oriented composite endpoint (DOCE) of cardiac death, target-vessel myocardial infarction (TV-MI), and ischemia-driven target lesion revascularization (ID-TLR). The study also compared outcomes based on DAPT duration (36 months vs. shorter). Results502 (99.4 %) patients completed the 5-year follow-up. DOCE rate was 2.4 %. ID-TLR, TV-MI, and cardiac death rates were 1.6 %, 0.8 %, and 0.6 %, respectively. No DOCE occurred between three and five years. Scaffold thrombosis (ScT) was 1 %, all occurring within 24 months. Longer-term DAPT significantly reduced DOCE (1.3 % vs. 4.3 %; HR: 0.29; 95 % CI: 0.1–0.9; p = 0.03) driven by a lower rate of TV-MI (0 % vs. 2.2 %; p = 0.018) compared to shorter-term DAPT, as well as ScT (0 % vs 2.7 %, p = 0.007). ConclusionsThis study shows favorable 5-year outcomes for BVS in selected STEMI patients with an optimized implantation strategy. Prolonged DAPT further improved outcomes, emphasizing its role in reducing adverse events during scaffold resorption. Further research is needed to assess newer-generation bioresorbable devices.

Mo Migration‐Induced Crystalline to Amorphous Conversion and Formation of RuMo/NiMoO4 Heterogeneous Nanoarray for Hydrazine‐Assisted Water Splitting at Large Current Density

AbstractManipulating the atomic structure of the catalyst and tailoring the dissociative water‐hydrogen bonding network at the catalyst‐electrolyte interface is essential for propelling alkaline hydrogen evolution reaction (HER) and hydrazine oxidation reaction (HzOR), but remains a great challenge. Herein, we constructed an advanced a‐RuMo/NiMoO4/NF heterogeneous electrocatalyst with amorphous RuMo alloy nanoclusters anchored to amorphous NiMoO4 skeletons on Ni foam by a heteroatom implantation strategy. Theoretical calculations and in situ Raman tests show that the amorphous and alloying structure of a‐RuMo/NiMoO4/NF not only induces the directional evolution of interfacial H2O, but also lowers the d‐band center (from −0.43 to −2.22 eV) of a‐RuMo/NiMoO4/NF, the Gibbs free energy of hydrogen adsorption (ΔGH*, from −1.29 to −0.06 eV), and the energy barrier of HzOR (ΔGN2(g)=1.50 eV to ΔGN2*=0.47 eV). Profiting from these favorable factors, the a‐RuMo/NiMoO4/NF exhibits excellent electrocatalytic performances, especially at large current densities, with an overpotential of 13 and 129 mV to reach 10 and 1000 mA cm−2 for HER. While for HzOR, it needs only −91 and 276 mV to deliver 10 and 500 mA cm−2, respectively. Further, the constructed a‐RuMo/NiMoO4/NF||a‐RuMo/NiMoO4/NF electrolyzer demands only 7 and 420 mV to afford 10 and 500 mA cm−2.

Mo Migration-Induced Crystalline to Amorphous Conversion and Formation of RuMo/NiMoO4 Heterogeneous Nanoarray for Hydrazine-Assisted Water Splitting at Large Current Density.

Manipulating the atomic structure of the catalyst and tailoring the dissociative water-hydrogen bonding network at the catalyst-electrolyte interface is essential for propelling alkaline hydrogen evolution reaction (HER) and hydrazine oxidation reaction (HzOR), but remains a great challenge. Herein, we constructed an advanced a-RuMo/NiMoO4/NF heterogeneous electrocatalyst with amorphous RuMo alloy nanoclusters anchored to amorphous NiMoO4 skeletons on Ni foam by a heteroatom implantation strategy. Theoretical calculations and in situ Raman tests show that the amorphous and alloying structure of a-RuMo/NiMoO4/NF not only induces the directional evolution of interfacial H2O, but also lowers the d-band center (from -0.43 to -2.22 eV) of a-RuMo/NiMoO4/NF, the Gibbs free energy of hydrogen adsorption (ΔGH*, from -1.29 to -0.06 eV), and the energy barrier of HzOR (ΔGN2(g)=1.50 eV to ΔGN2*=0.47 eV). Profiting from these favorable factors, the a-RuMo/NiMoO4/NF exhibits excellent electrocatalytic performances, especially at large current densities, with an overpotential of 13 and 129 mV to reach 10 and 1000 mA cm-2 for HER. While for HzOR, it needs only -91 and 276 mV to deliver 10 and 500 mA cm-2, respectively. Further, the constructed a-RuMo/NiMoO4/NF||a-RuMo/NiMoO4/NF electrolyzer demands only 7 and 420 mV to afford 10 and 500 mA cm-2.

The Suboptimal QLV Ratio May Indicate the Need for a Left Bundle Branch Area Pacing-Optimized Cardiac Resynchronization Therapy Upgrade.

Background: The QLV ratio (QLV/baseline QRS width) is an established intraoperative-measurable parameter during cardiac resynchronization therapy (CRT) device implantation, potentially predicting the efficacy of electrical resynchronization. Methods: Left bundle branch area pacing-optimized CRT (LOT-CRT) is a novel approach with the potential to improve both responder rate and responder level in the CRT candidate patient group, even when an optimal electro-anatomical left ventricular lead position is not achievable. In our observational study, 72 CRT-defibrillator candidate patients with a QRS duration of 160 ± 12 ms were consecutively implanted. Using a QLV-ratio-based implant strategy, 40 patients received a biventricular CRT device (Biv-CRT) with an optimal QLV ratio (≥70%). Twenty-eight patients with a suboptimal QLV ratio (<70%) were upgraded intraoperatively to a LOT-CRT system. Patients were followed for 12 months. Results: The postoperative results showed a significantly greater reduction in QRS width in the LOT-CRT patient group compared to the Biv-CRT patients (40.4 ± 14 ms vs. 32 ± 13 ms; p = 0.024). At 12 months, the LOT-CRT group also demonstrated a significantly greater improvement in left ventricular ejection fraction (14.9 ± 8% vs. 10.3 ± 7.4%; p = 0.001), and New York Heart Association functional class (1.2 ± 0.5 vs. 0.8 ± 0.4; p = 0.031), and a significant decrease in NT-pro-BNP levels (1863± 380 pg/mL vs. 1238 ± 412 pg/mL; p = 0.012). Notably, the LOT-CRT patients showed results comparable to Biv-CRT patients with a super-optimal QLV ratio (>80%) in terms of QRS width reduction and LVEF improvement. Conclusions: Our single-center study demonstrated the feasibility of a QLV-ratio-based implantation strategy during CRT implantation. Patients with a LOT-CRT system showed significant improvements, whereas Biv-CRT patients with a super-optimal QLV ratio may not be expected to benefit from an additional LOT-CRT upgrade.

Marmoset and human trophoblast stem cells differ in signaling requirements and recapitulate divergent modes of trophoblast invasion

Early human trophoblast development has remained elusive due to the inaccessibility of the early conceptus. Non-human primate models recapitulate many features of human development and allow access to early postimplantation stages. Here, we tracked the pre- to postimplantation transition of the trophoblast lineage in superficially implanting marmoset embryos invivo. We differentiated marmoset naive pluripotent stem cells into trophoblast stem cells (TSCs), which exhibited trophoblast-specific transcriptome, methylome, differentiation potential, and long-term self-renewal. Notably, human TSC culture conditions failed to support marmoset TSC derivation, instead inducing an extraembryonic mesoderm-like fate in marmoset cells. We show that combined MEK, TGF-β/NODAL, and histone deacetylase inhibition stabilizes a periimplantation trophoblast-like identity in marmoset TSCs. By contrast, these conditions differentiated human TSCs toward extravillous trophoblasts. Our work presents a paradigm to harness the evolutionary divergence in implantation strategies to elucidate human trophoblast development and invasion.

Elucidating the hemodynamic impact of residual stenosis post-carotid artery stenting: A numerical study.

Residual stenosis (RS) and hemodynamics demonstrate a significant correlation with postoperative in-stent restenosis/thrombosis following carotid artery stenting (CAS). This study endeavors to elucidate the potential associations between RS and adverse postoperative hemodynamic factors. This study utilized 46 patient-specific carotid artery models post-stenting, which were categorized into two groups based on the presence of RS: the normal group (N, n=23) and the RS group (RS, n=23). A comparative analysis was conducted to evaluate the discrepancies in geometry and adverse hemodynamic parameters, alongside investigating the potential correlation between hemodynamic and geometric parameters. The results reveal that a higher reflux flow volume is discernible in the RS group during low-velocity phases of the cardiac cycle, concomitant with an augmented extent of areas exposed to oscillatory shear stress and extended particle residence time. Moreover, the adverse hemodynamic parameters exhibit a positive correlation with the degree of stent expansion, stent length in the common carotid artery (CCA), and the distal slope of the RS. The distal slope and tortuosity of RS significantly influence the development of adverse hemodynamic conditions post-stenting, exacerbating the hemodynamic environment near the stenosis. Interestingly, while an extended stent length in the internal carotid artery (ICA) region improves hemodynamics by reducing flow disturbance, a longer stent in the CCA significantly worsens these conditions. Hence, it is prudent to analyze the characteristics of the local lesion regions to optimize the strategy for stent implantation.

Biomechanical Effects of Titanium Alloy Based Single versus Dual Cage Fusion Devices

Degenerative disc disease is an increasing problematic complication following lumbar fusion surgeries. Posterior lumbar interbody fusion (PLIF) is a well-established surgical method for spine stability following intervertebral disc removal. The position and number of titanium cages in PLIF are remain contingent on individual surgeon experience. Thus, a systemic investigation of the efficacy of titanium single mega cage versus two cages in treating degenerative lumbar spinal diseases is imperative. A biomechanical study was aimed to compare the stability achieved in PLIF through interbody reconstruction using a single mega cage (32 mm) Vs. a dual cage (22 mm). Normal intact finite element model of L3–L4 was developed based on computed tomography images from a healthy 27-year-old male volunteer. The study tested the intact model (Model A) and its surgically operated counterparts using four PLIF implantation methods: single transverse cage (Model B), single transverse cage with bone graft (Model C), dual transverse cage (Model D), and dual transverse cage with bone graft (Model E). Combined loads simulating physiological motions—flexion, extension, axial rotation, and lateral bending —were applied across all loading directions. The assessment includes all model range of motion (ROM), micromotion between the cage and endplate, and stress on the cage and internal fixation system (screw and rod). The ROM between Models B, C, D and E were consistently reduced by over 71% compared to intact Model A under all motion scenarios. Model D exhibited the highest peak stress of 115 MPa on the cage during flexion, surpassing Model C and E (Flexion) by fourfold. Model E demonstrated the lowest cage stress (20 MPa) during extension, outperforming the other models. Notably, Model E exhibited minimal endplate stress (2 MPa), cage stress (21 MPa), micromotion (13 µm) during extension, and screw-rod stress (56 MPa) during flexion, making it superior to other implantation methods. In the context of PLIF, Model E showed enhanced biomechanical stability, reducing ROM, stress on the endplates, cage, screw-rod system and micromotion. Alternatively, Model C may be a viable alternative in standard PLIF, especially in cases with limited intervertebral space, providing efficient clinical outcomes with shorter operative times and reduced costs and ease of implantation. Also, this computational study provides valuable understandings into optimizing cage implantation strategies for improved outcomes during PLIF.

Delayed Intervention’s Impact on Transcatheter Mitral Valve Implantation Strategy

Delayed Intervention’s Impact on Transcatheter Mitral Valve Implantation Strategy

Surgical Strategies for Renal Transplantation: A Pictorial Essay.

This pictorial essay aims to navigate through the complexities and challenges of renal transplantation (RT), by weaving together visual imagery with clinical insights within a comprehensive illustrative surgical guide. Herein, we provide a detailed visual exploration of the intricate anatomy and surgical processes necessary for both renal graft retrieval from the donor and also for an adequate implantation in the recipient. Regarding graft retrieval, after reviewing the relevant retroperitoneal surgical anatomy, and donor nephrectomy techniques, graft preservation and optimal backbench graft dissection principles were meticulously analyzed. Thereafter, the recipient surgical strategy for graft implantation was addressed, focusing on preoperative preparations, the site of implantation selection, exposure, operative bed dissection, graft revascularization, and urinary tract reconstruction. Careful donor and recipient selection, meticulous surgical execution, and rigorous postoperative management clearly hold a pivotal role in optimizing patient outcomes. Fostering a deeper understanding of the surgical nuances and clinical management practices that contribute to successful results post-RT, we hope to provide a useful practical tool for clinicians about to embark on the treacherous road of RT surgery. Innovative technologies and surgical practices that have already significantly improved the safety and effectiveness of RT stand testament to the importance of further scientific inquiry, conceptual developments, and clinical integration. Moving forward, it is essential that the medical community continues to refine these strategies and advocate for equitable access to transplantation, ensuring that advancements in the field translate into real-world benefits for all patients grappling with ESRD. The collaborative efforts of multidisciplinary teams are essential in addressing the complex clinical challenges associated with RT, with the ultimate goal of improving patient survival, enhancing graft longevity, and reducing healthcare disparities.

Three-Year Left Ventricular Assist Device Outcomes and Strategy After Heart Transplant Allocation Score Change

BackgroundThe United Network for Organ Sharing (UNOS) adopted new criteria for the heart allocation score on 10/18/2018 to reflect changing trends of candidates’ mortality while awaiting transplant. We examined the impact of these policy changes on rates of left ventricular assist device (LVAD) implantation and outcomes posttransplant from a relatively newer UNOS database. MethodsThe UNOS registry was used to identify first-time adult heart recipients with LVAD at listing or transplant who underwent transplantation between 1/1/2016 and 3/10/2020. Survival data was collected through 3/30/2023. Those listed prior to 10/18/2018 but transplanted after were excluded. Patients were divided into before or after change groups. Demographics and clinical parameters were compared. Survival was analyzed with Kaplan-Meier curves and log-rank tests. A p<0.05 was considered significant. ResultsWe identified 4387 heart recipients with LVAD in the before (n=3606) and after (n=781) score change eras. The after group had a lower rate of LVAD implantation while listed compared to the before group (20.4% vs 34.9%, p<0.0001), and were more likely to be female (25.1% vs 20.2%, p=0.002); in both groups, most recipients (62.8%) were white. There was significantly farther distance from the donor hospital to transplant center in the after group (264.4 NM vs 144.2NM, p<0.0001) and decreased waitlist days (84.9 ± 105.1 vs 369.2 ± 459.5, p<0.0001). Recipients in the after group were more likely to utilize ECMO (3.7% vs 0.5%, p<0.0001) and IV inotropes (19.1% vs 7.5%, p<0.0001), and receive a CDC increased-risk donor organ (37.9% vs 30.5%, p<0.0001). Survival at 3-years was comparable between the two groups. ConclusionsThe allocation score change in 2018 yielded considerable changes in mechanical circulatory support device implantation strategy and outcomes. The rate of LVAD implantation decreased with increased utilization of temporary mechanical circulatory support devices.

A Speech Neuroprosthesis in the Frontal Lobe and Hippocampus: Decoding High-Frequency Activity into Phonemes.

Loss of speech due to injury or disease is devastating. Here, we report a novel speech neuroprosthesis that artificially articulates building blocks of speech based on high-frequency activity in brain areas never harnessed for a neuroprosthesis before: anterior cingulate and orbitofrontal cortices, and hippocampus. A 37-year-old male neurosurgical epilepsy patient with intact speech, implanted with depth electrodes for clinical reasons only, silently controlled the neuroprosthesis almost immediately and in a natural way to voluntarily produce 2 vowel sounds. During the first set of trials, the participant made the neuroprosthesis produce the different vowel sounds artificially with 85% accuracy. In the following trials, performance improved consistently, which may be attributed to neuroplasticity. We show that a neuroprosthesis trained on overt speech data may be controlled silently. This may open the way for a novel strategy of neuroprosthesis implantation at earlier disease stages (eg, amyotrophic lateral sclerosis), while speech is intact, for improved training that still allows silent control at later stages. The results demonstrate clinical feasibility of direct decoding of high-frequency activity that includes spiking activity in the aforementioned areas for silent production of phonemes that may serve as a part of a neuroprosthesis for replacing lost speech control pathways.

Pressure-driven molecule implantation enabling ultrahigh-rate and ultralong-life zinc ion batteries

Durable cathode materials with high specific capacity are essential for aqueous zinc ion batteries (AZIBs). However, vanadium-based materials endure irreversible structural collapse, sluggish diffusion kinetics, and low working voltage. In this study, we propose a unique pressure-driven molecule implantation (PMI) strategy to fabricate a laminar organic–inorganic hybrid cathode (PMI-VO) for AZIBs by coupling polyaniline (PANI) with vanadium oxide. The bipolar protonation of implanted electroactive PANI provides abundant active sites for ion/electron transfer and Zn2+/H+ storage in PMI-VO. Importantly, the formed C-V-O interfacial coupling bonds in the cycling process effectively relieve the intercalation stress and strengthen the redox kinetics and structural integrity of V2O5. In situ infrared spectroscopy and theoretical calculations reveal the PMI-induced multiple ions storage mechanisms in the PMI-VO cathode. Accordingly, PMI-VO cathode performs a superior specific capacity of 522 mAh∙g−1 at 0.2 A∙g−1, a high operating voltage of 0.86 V, a high energy density (387.4 Wh∙kg−1), and splendid long-life stability (over 15,000 cycles at 20 A∙g−1 with 191 mAh∙g−1). Therefore, this pressure-driven molecule implantation strategy provides a pioneering method to fabricate superior cathode materials of advanced AZIBs.

Electrothermal-assisted all-weather solar steam generator based on hydrogel implantation strategy

Using solar energy to treat sewage is a feasible scheme to alleviate the shortage of water resources and reduce carbon emissions. However, the fluctuation of sunlight intensity poses a great challenge to the stability of the treatment process, which hinders its application in the actual water treatment scene. Herein, based on the adhesion of hydrogel, an electrothermal-assisted all-weather solar steam generator with sandwich structure was synthesized through hydrogel implantation strategy, in which polyacrylamide hydrogel with thermal grease-modified heating wires was implanted as the middle heat conduction layer, the photothermal evaporation layer as the upper layer and the waste heat evaporation layer as the bottom layer. The electrothermal assisted solar evaporator (EASE) perfectly achieves the superposition of photothermal and electrothermal effects, and can achieve high interfacial water evaporation performance under extremely low auxiliary working voltage. Applying a low voltage of 2 V to both ends of the evaporator can achieve a high evaporation rate of 4.58 kg m−2h−1 under 1 solar irradiation, which is similar to the sum of the evaporation rate under only 1 solar illumination (2.22 kg m−2h−1) and a 2 V voltage input (2.26 kg m−2h−1). More interestingly, the suitable thickness of the hydrogel layer not only ensures the transfer of heat between layers, but also weakens the heat loss caused by the water flow effect. The implantation strategy ensures the stability of the water structure and inhibits the hydrogen reaction of electrolytic water in the electrothermal process. This work provides an important theoretical and practical reference for the preparation of all-weather solar interface water purification equipment.