Microstructured Thin Film Nitinol for a Neurovascular Flow-Diverter

Hierarchical graph contrastive learning of local and global presentation for multimodal sentiment analysis

Multi-modal sentiment analysis (MSA) aims to regress or classify the overall sentiment of utterances through acoustic, visual, and textual cues. However, most of the existing efforts have focused on developing the expressive ability of neural networks to learn the representation of multi-modal information within a single utterance, without considering the global co-occurrence characteristics of the dataset. To alleviate the above issue, in this paper, we propose a novel hierarchical graph contrastive learning framework for MSA, aiming to explore the local and global representations of a single utterance for multimodal sentiment extraction and the intricate relations between them. Specifically, regarding to each modality, we extract the discrete embedding representation of each modality, which includes the global co-occurrence features of each modality. Based on it, for each utterance, we build two graphs: local level graph and global level graph to account for the level-specific sentiment implications. Then, two graph contrastive learning strategies is adopted to explore the different potential presentations based on graph augmentations respectively. Furthermore, we design a cross-level comparative learning for learning local and global potential representations of complex relationships.

Two-Tier Compatibility of Superelastic Bicrystal Micropillar at Grain Boundary

Both crystallographic compatibility and grain engineering are super critical to the functionality of shape memory alloys, especially at micro- and nanoscales. Here, we report a bicrystal CuAl₂₄Mn₉ micropillar engraved at a high-angle grain boundary (GB) that exhibits enhanced reversibility under very demanding driving stress (about 600 MPa) over 10 000 transformation cycles despite its lattice parameters are far from satisfying any crystallographic compatibility conditions. We propose a new compatibility criterion regarding the GB for textured shape memory alloys, which suggests that the formation of GB compatible twin laminates in neighboring textured grains activates an interlock mechanism, which prevents dislocations from slipping across GB.

Endosaccular Flow Disruption: A New Frontier in Endovascular Aneurysm Management

Flow modification has caused a paradigm shift in the management of intracranial aneurysms. Since the FDA approval of the Pipeline Embolization Device (Medtronic, Dublin, Ireland) in 2011, it has grown to become the modality of choice for a range of carefully selected lesions, previously not amenable to conventional endovascular techniques. While the vast majority of flow-diverting stents operate from within the parent artery (ie, endoluminal stents), providing a scaffold for endothelial cells growth at the aneurysmal neck while inducing intra-aneurysmal thrombosis, a smaller subset of endosaccular flow disruptors act from within the lesions themselves. To date, these devices have been used mostly in Europe, while only utilized on a trial basis in North America. To the best of our knowledge, there has been no dedicated review of these devices. We therefore sought to present a comprehensive review of currently available endosaccular flow disruptors along with high-resolution schematics, presented with up-to-date available literature discussing their technical indications, procedural safety, and reported outcomes.

Damage control of caval injuries in a porcine model using a retrievable Rescue stent

OBJECTIVE

Early hemorrhage control before the operating room is essential to reduce the significant mortality associated with traumatic injuries of the vena cava. Conventional approaches present logistical challenges on the battlefield or in the trauma bay. A retrievable stent graft would allow rapid hemorrhage control in the preoperative setting when endovascular expertise is not immediately available and without committing a patient to the limitations of current permanent stents. This study details a refined retrievable Rescue stent for percutaneous delivery that was examined in a porcine survival model of penetrating caval hemorrhage.

METHODS

A retrievable caval stent was reduced in delivery profile to a 9F sheath using finite element analysis. The final stent was constructed with a "petal and stem" design using nitinol wire followed by covering with polytetrafluoroethylene. Seven Yorkshire pigs (79-86 kg) underwent 22F injury of the infrarenal vena cava with intentional class II hemorrhage (1200 mL). Percutaneous deployment of the Rescue stent was used to temporize hemorrhage for 60 minutes, followed by resuscitation with cell saver blood and permanent caval repair. Hemorrhage control was documented with photography and angiography. Vital signs were recorded and laboratory values were measured out to 48 hours postoperatively. Data were examined with a repeated-measures analysis of variance.

RESULTS

The profile of the caval Rescue stent was successfully reduced from 16F to 9F while remaining within fracture and shape memory limits for nitinol. In addition, both rapid deployment and recapture were preserved. Following intentional hemorrhage after caval injury, animals revealed a significant drop in mean arterial pressure (average, 30 mm Hg), acidosis, and elevated lactate level compared with before injury. Compared with uncontrolled hemorrhage, which resulted in death in <9 minutes, the Rescue stent achieved hemorrhage control in <1 minute after venous access in all seven animals. All animals were successfully recovered after permanent repair. There was no significant change in levels of transaminases, bilirubin, creatinine, or hemoglobin at 48 hours compared with preinjury baseline.

CONCLUSIONS

A retrievable Rescue stent achieved rapid percutaneous hemorrhage control after a significant traumatic injury of the vena cava and allowed successful recovery of all injured animals. Further development of this approach may have utility in preoperative damage control of caval injuries.

The Future of Cardiovascular Stents: Bioresorbable and Integrated Biosensor Technology

Cardiovascular disease is the greatest cause of death worldwide. Atherosclerosis is the underlying pathology responsible for two thirds of these deaths. It is the age-dependent process of "furring of the arteries." In many scenarios the disease is caused by poor diet, high blood pressure, and genetic risk factors, and is exacerbated by obesity, diabetes, and sedentary lifestyle. Current pharmacological anti-atherosclerotic modalities still fail to control the disease and improvements in clinical interventions are urgently required. Blocked atherosclerotic arteries are routinely treated in hospitals with an expandable metal stent. However, stented vessels are often silently re-blocked by developing "in-stent restenosis," a wound response, in which the vessel's lumen renarrows by excess proliferation of vascular smooth muscle cells, termed hyperplasia. Herein, the current stent technology and the future of biosensing devices to overcome in-stent restenosis are reviewed. Second, with advances in nanofabrication, new sensing methods and how researchers are investigating ways to integrate biosensors within stents are highlighted. The future of implantable medical devices in the context of the emerging "Internet of Things" and how this will significantly influence future biosensor technology for future generations are also discussed.

Fully Printed, Wireless, Stretchable Implantable Biosystem toward Batteryless, Real-Time Monitoring of Cerebral Aneurysm Hemodynamics

This study introduces a high-throughput, large-scale manufacturing method that uses aerosol jet 3D printing for a fully printed stretchable, wireless electronics. A comprehensive study of nanoink preparation and parameter optimization enables a low-profile, multilayer printing of a high-performance, capacitance flow sensor. The core printing process involves direct, microstructured patterning of biocompatible silver nanoparticles and polyimide. The optimized fabrication approach allows for transfer of highly conductive, patterned silver nanoparticle films to a soft elastomeric substrate. Stretchable mechanics modeling and seamless integration with an implantable stent display a highly stretchable and flexible sensor, deployable by a catheter for extremely low-profile, conformal insertion in a blood vessel. Optimization of a transient, wireless inductive coupling method allows for wireless detection of biomimetic cerebral aneurysm hemodynamics with the maximum readout distance of 6 cm through meat. In vitro demonstrations include wireless monitoring of flow rates (0.05-1 m s-1) in highly contoured and narrow human neurovascular models. Collectively, this work shows the potential of the printed biosystem to offer a high throughput, additive manufacturing of stretchable electronics with advances toward batteryless, real-time wireless monitoring of cerebral aneurysm hemodynamics.

Directly Accessible and Transferrable Nanofluidic Systems for Biomolecule Manipulation

Molecular detection and manipulation via nanofluidic systems offers new routes for single-molecule analysis to study epigenetic mechanisms and genetic mutation of disease. For detection of single biological molecule, many types of nanomicrofluidic systems have been utilized. Typically, mechanical tethering, fluidic pressure, chemical interactions, or electrical forces allow controllable attraction, enrichment, confinement, and elongation of target molecules. The currently available methods, however, are unable to offer both molecular manipulation and direct and concurrent assessment of target molecules in the system due to the nature of enclosed channels and associated fluidic components. Here, we introduce a wafer-scale nanofluidic system that incorporates an array of accessible open nanochannels and nano-microtrappers to enrich and elongate target molecules (DNA) via the combination of an electric field and hydrodynamic force. The open nanofluidic system allows easy access, direct observation, and manipulation of molecules in the nanochannels. The presence of a stretched single DNA and the efficacy of the nanofluidic system are studied by fluorescence microscopy and atomic force microscopy. Hybrid integration of the nanodevice fabrication with a material transfer printing technique enables to design a highly flexible and transferrable nanofluidic system after molecular concentration.

A novel customizable stent graft that contains a stretchable ePTFE with a laser-welded nitinol stent

Customizable medical devices have recently attracted attentions both in dental and orthopedic device fields, which can tailor to the patients' anatomy to reduce the length of surgery time and to improve the clinical outcomes. However, development of the patient specific endovascular device still remains challenging due to the limitations in current 3D printing technology, specifically for the stent grafts. Therefore, our group has investigated the feasibility of a highly stretchable expanded-polytetrafluoroethylene (ePTFE) tube as a customizable graft material with the laser-welded nitinol backbone. In this study, a highly stretchable ePTFE tube was evaluated in terms of mechanical behaviors, in vitro biocompatibility of ePTFE with various stretchiness levels, and capability for the integration with the laser-welded customizable nitinol stent backbone. A prototype stent graft for the swine's venous size was successfully constructed and tested in the porcine model. This study demonstrates the ability of ePTFE tube to customize the stent graft without any significant issue, for example, sweating through the stretched pores in the ePTFE tube, as well as in vivo feasibility of the device for bleeding control. This novel customizable stent graft would offer possibilities for a wide range of both current and next-generation endovascular applications for the treatment in vascular injuries or diseases. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 911-923, 2019.

Stretchable, Implantable, Nanostructured Flow-Diverter System for Quantification of Intra-aneurysmal Hemodynamics

Random weakening of an intracranial blood vessel results in abnormal blood flow into an aneurysmal sac. Recent advancements show that an implantable flow diverter, integrated with a medical stent, enables a highly effective treatment of cerebral aneurysms by guiding blood flow into the normal vessel path. None of such treatment systems, however, offers post-treatment monitoring to assess the progress of sac occlusion. Therefore, physicians rely heavily on either angiography or magnetic resonance imaging. Both methods require a dedicated facility with sophisticated equipment settings and time-consuming, cumbersome procedures. In this paper, we introduce an implantable, stretchable, nanostructured flow-sensor system for quantification of intra-aneurysmal hemodynamics. The open-mesh membrane device is capable of effective implantation in complex neurovascular vessels with extreme stretchability (500% radial stretching) and bendability (180° with 0.75 mm radius of curvature) for monitoring of the treatment progress. A collection of quantitative mechanics, fluid dynamics, and experimental studies establish the fundamental aspects of design criteria for a highly compliant, implantable device. Hemocompatibility study using fresh ovine blood captures the device feasibility for long-term insertion in a blood vessel, showing less platelet deposition compared to that in existing implantable materials. In vitro demonstrations of three types of flow sensors show quantification of intra-aneurysmal blood flow in a pig aorta and the capability of observation of aneurysm treatment with a great sensitivity (detection limit as small as 0.032 m/s). Overall, this work describes a mechanically soft flow-diverter system that offers an effective treatment of aneurysms with an active monitoring of intra-aneurysmal hemodynamics.

Soft Material-Enabled, Flexible Hybrid Electronics for Medicine, Healthcare, and Human-Machine Interfaces

Flexible hybrid electronics (FHE), designed in wearable and implantable configurations, have enormous applications in advanced healthcare, rapid disease diagnostics, and persistent human-machine interfaces. Soft, contoured geometries and time-dynamic deformation of the targeted tissues require high flexibility and stretchability of the integrated bioelectronics. Recent progress in developing and engineering soft materials has provided a unique opportunity to design various types of mechanically compliant and deformable systems. Here, we summarize the required properties of soft materials and their characteristics for configuring sensing and substrate components in wearable and implantable devices and systems. Details of functionality and sensitivity of the recently developed FHE are discussed with the application areas in medicine, healthcare, and machine interactions. This review concludes with a discussion on limitations of current materials, key requirements for next generation materials, and new application areas.

Soft, conformal bioelectronics for a wireless human-wheelchair interface

There are more than 3 million people in the world whose mobility relies on wheelchairs. Recent advancement on engineering technology enables more intuitive, easy-to-use rehabilitation systems. A human-machine interface that uses non-invasive, electrophysiological signals can allow a systematic interaction between human and devices; for example, eye movement-based wheelchair control. However, the existing machine-interface platforms are obtrusive, uncomfortable, and often cause skin irritations as they require a metal electrode affixed to the skin with a gel and acrylic pad. Here, we introduce a bioelectronic system that makes dry, conformal contact to the skin. The mechanically comfortable sensor records high-fidelity electrooculograms, comparable to the conventional gel electrode. Quantitative signal analysis and infrared thermographs show the advantages of the soft biosensor for an ergonomic human-machine interface. A classification algorithm with an optimized set of features shows the accuracy of 94% with five eye movements. A Bluetooth-enabled system incorporating the soft bioelectronics demonstrates a precise, hands-free control of a robotic wheelchair via electrooculograms.