Dear Editor,The latest Visian implantable collamer lens(ICL)with a central port design(Aquaport;model V4c)obviates the necessity for preoperative laser iridotomy or intraoperative iridectomy by allowing the free flow ...Dear Editor,The latest Visian implantable collamer lens(ICL)with a central port design(Aquaport;model V4c)obviates the necessity for preoperative laser iridotomy or intraoperative iridectomy by allowing the free flow of the aqueous humor between the sides of the intraocular lens.The design of Aquaport can also eliminate the complications associated with iridotomy and iridectomy.Therefore,the V4c ICL has the potential to significantly reduce the risk of pupillary block compared to its predecessors.展开更多
Bone injuries induced by accidents or bone-related disease have dramatically increased in the past decades.The application of biomaterials has become an inextricable part of treatment for new bone formation and regene...Bone injuries induced by accidents or bone-related disease have dramatically increased in the past decades.The application of biomaterials has become an inextricable part of treatment for new bone formation and regeneration.Different from traditional bone-regeneration materials,injectable biomaterials—ranging from bioceramics to polymers—have been applied as a means of promoting surgery with a minimal intervention approach.In this review,we summarize the most recent developments in minimally invasive implantable biomaterials for bone reconstruction and different ways to achieve osteogenesis,with a focus on injectable biomaterials for various applications in the orthopedic field.More specifically,bioceramics and polymeric materials,together with their applications in bone fracture healing,vertebral body augmentation,bone implant fixation,bone tumor therapy,and bone-defect-related infection treatment are reviewed in detail.Recent progress in injectable biomaterials with multiple functionalities and bioresponsive properties is also reviewed.Finally,we summarize the challenges in this field and future directions for clinical treatment.展开更多
Ultrasound neuromodulation is a powerful tool for brain investigation and holds great promise for treating brain diseases.However,due to the heterogeneous acoustic properties of skulls,existing ultrasound neuromodulat...Ultrasound neuromodulation is a powerful tool for brain investigation and holds great promise for treating brain diseases.However,due to the heterogeneous acoustic properties of skulls,existing ultrasound neuromodulation faces the challenge of severe transcranial acoustic attenuation.To overcome such limitations,we report an implantable bio-chip for visible and controllable mi-crowave-induced transcranial acoustic generation(MI-tAG).The bio-chip is soft,flexible,and biocompatible,with a thickness of 3mm,making it suitable for human intracranial implantation.The constituted fluid channels can cover an area of 50 mm×60 mm,enabling widefield neuronstimulation.The particles filled in the fluid channels have both high microwave absorption.ensuring efficient ultrasound generation,and magnetism,allowing noncontact and flexible ma-nipulation by external magnetic fields.The experimental results demonstrate that the optimal MI-tAG can be realized by the combination of particles arranged in a linear pattern and corre-sponding illumination via a linearly polarized microwave.Stability evaluation indicates that the particles can maintain a consistent acoustic intensity without degradation for at least seven days.The results of in vitro and in vivo experiments show that the MII-tAG can manipulate ultrasound sources and visibly locate them in real time.This study provides a potential innovative approach for future ultrasound neuromodulation,inspiring the development of more useful methods to advance brain research.This study introduces a promising innovative approach for transcranial acoustic generation,potentially inspiring the development of more effective methods for ad-vancing ultrasound neuromodulation.展开更多
AIM:To compare the accuracy of manual marking versus an image-guided system for toric implantable collamer lens(TICL)implantation and evaluate the short-term postoperative rotational stability of TICL and corneal surg...AIM:To compare the accuracy of manual marking versus an image-guided system for toric implantable collamer lens(TICL)implantation and evaluate the short-term postoperative rotational stability of TICL and corneal surgically induced astigmatism vector(SIA).METHODS:Retrospective analysis was conducted on eyes with TICL alignment achieved through manual marking(n=75)or VERION image-guided system-assisted marking(n=83).Each group was further classified into horizontal and vertical subgroups based on implant orientation.Additionally,patients were categorized into superior and temporal incision subgroups according to the position of main corneal incision.The misalignment and rotational stability of TICL were analyzed using slit-lamp anterior segment photography.Surgical predictability,efficacy,safety,and corneal SIA were also evaluated.RESULTS:In general,the TICL implantation with manual and digital image-guided systems all achieved robust predictability,efficacy,and safety.The misalignment of TICL was comparable between the manual and VERION groups(0.16°±3.97°vs 0.52°±5.59°,P=0.633),while a significant difference was observed in the absolute misalignment of TICL between the two groups(3.02°±2.55°vs 4.28°±3.61°,P=0.043).There were no significant differences in the distribution of TICL misalignment between the manual and VERION groups or between horizontal and vertical implant orientation groups(P>0.05).Furthermore,different orientations of TICL placement did not show statistically significant differences in rotational stability(P=0.46).Statistically significant differences were found in anterior corneal SIA between the manual and VERION groups(0.46±0.27 vs 0.33±0.21 D,P=0.001),especially for superior incision position(0.60±0.27 vs 0.35±0.23 D,P<0.0001).The anterior SIA exhibited a significant difference between superior and temporal incisions in the manual group(0.60±0.27 vs 0.35±0.20 D,P<0.0001).CONCLUSION:Compared with the conventional manual marking method,this study indicates that the digital image-guided system with VERION is safe and effective in TICL implantation.The digital system offers the advantage of minimizing corneal SIA compared to the manual method.展开更多
AIM:To predict the post-operative vault and the suitable size of the implantable collamer lens(ICL)by comparing the performance of multiple artificial intelligence(AI)algorithms.METHODS:A retrospective analysis of 83 ...AIM:To predict the post-operative vault and the suitable size of the implantable collamer lens(ICL)by comparing the performance of multiple artificial intelligence(AI)algorithms.METHODS:A retrospective analysis of 83 patients with 132 eyes was conducted from 2020 to 2023.All patients underwent implantation of EVO-V4C ICLs.ICLs were selected based on STAAR’s recommended formula.Postoperative vault values were measured using anterior segment optical coherence tomography(ASOCT).First,feature selection was performed on patients’preoperative examination parameters to identify those most closely related to postoperative vault and incorporate them into the machine learning model.Subsequently,four regression models,namely MLP,XGBoost,RFR,and KNN,were employed to predict the vault,and their predictive performances were compared.The ICL size was set as the prediction target,with the vault and other input features serving as new inputs for predicting the ICL size.RESULTS:Among all preoperative parameters,16 parameters were most closely related to postoperative vault and were included in the prediction model.In vault prediction,XGBoost performed the best in the regression model(R^(2)=0.9999),followed by MLP(R^(2)=0.9987)and RFR(R^(2)=0.8982),while the KNN model had the lowest predictive performance(R^(2)=0.3852).XGBoost achieved a prediction accuracy of 99.8%,MLP had a prediction accuracy of 98.9%,while RFR and KNN had accuracies of 87.1%and 57.4%,respectively.CONCLUSION:AI effectively predicts postoperative vault and determines ICL size.XGBoost outperforms other machine-learning algorithms tested.Its accurate predictions help ophthalmologists choose the right ICL size,ensuring proper vaulting.展开更多
Implantable temperature sensors are revolutionizing physiological monitoring and playing a crucial role in diagnostics,therapeutics,and life sciences research.This review classifies the materials used in these sensors...Implantable temperature sensors are revolutionizing physiological monitoring and playing a crucial role in diagnostics,therapeutics,and life sciences research.This review classifies the materials used in these sensors into three categories:metal-based,inorganic semiconductor,and organic semiconductor materials.Metal-based materials are widely used in medical and industrial applications due to their linearity,stability,and reliability.Inorganic semiconductors provide rapid response times and high miniaturization potential,making them promising for biomedical and environmental monitoring.Organic semiconductors offer high sensitivity and ease of processing,enabling the development of flexible and stretchable sensors.This review analyzes recent studies for each material type,covering design principles,performance characteristics,and applications,highlighting key advantages and challenges regarding miniaturization,sensitivity,response time,and biocompatibility.Furthermore,critical performance parameters of implantable temperature sensors based on different material types are summarized,providing valuable references for future sensor design and optimization.The future development of implantable temperature sensors is discussed,focusing on improving biocompatibility,long-term stability,and multifunctional integration.These advancements are expected to expand the application potential of implantable sensors in telemedicine and dynamic physiological monitoring.展开更多
BACKGROUND Cardiac resynchronization therapy(CRT)has been a major therapeutic advancement for patients with heart failure and electrical dyssynchrony.While CRT improves symptoms,reduces hospitalizations,and enhances s...BACKGROUND Cardiac resynchronization therapy(CRT)has been a major therapeutic advancement for patients with heart failure and electrical dyssynchrony.While CRT improves symptoms,reduces hospitalizations,and enhances survival,the role of implantable cardioverter-defibrillators(ICDs)alongside CRT in patients with non-ischemic cardiomyopathy(NICM)remains controversial.To evaluate and compare the outcomes of CRT with ICD(CRT-D)versus CRT with pacemaker-only(CRT-P)in individuals diagnosed with NICM,with a specific focus on the elderly.METHODS A comprehensive search of PubMed,Embase,and the Cochrane Central Register of Controlled Trials was conducted in January 2024.Studies comparing CRT-D and CRT-P in patients with NICM were included,with subgroup analyses focusing on patients aged 75 years and older.RESULTS Twelve studies,including two randomized clinical trials,with a total of 62,145 patients and 16,754 pooled death events(9,171 in CRT-D and 7,583 in CRT-P),were analyzed.CRT-D was associated with a significantly lower risk of all-cause mortality compared to CRT-P(pooled OR=0.72;95%CI:0.61-0.85;P<0.01),with significant heterogeneity(I2=83%).RCT subgroup analysis,was not statistically significant(pooled OR=0.82;95%CI:0.64-1.06;P=0.41;I2=0%).In patients older than 75 years,no significant difference in mortality risk was observed(pooled OR 0.96;95%CI:0.81-1.15;I2=39%).CONCLUSION Our meta-analysis suggests that the addition of ICD therapy to CRT in patients with NICM significantly reduces all-cause mortality.However,this benefit does not extend to cardiovascular mortality,likely due to the primary role of ICDs in preventing sudden cardiac death rather than other causes such as progressive heart failure.The survival advantage of CRT-D is most pronounced in younger patients,with those over 75 years of age deriving less benefit.This highlights the importance of careful patient selection,considering age and comorbidities,when deciding on ICD implantation in NICM patients.展开更多
Glioblastoma(GBM)is a highly infiltrative brain tumor.The treatment of GBM is challenging due to the existence of blood brain barrier,its highly invasive nature,and its heterogeneity.Given the limitations of conventio...Glioblastoma(GBM)is a highly infiltrative brain tumor.The treatment of GBM is challenging due to the existence of blood brain barrier,its highly invasive nature,and its heterogeneity.Given the limitations of conventional therapies,this Perspective explores the development trajectory of implantable devices,highlighting the advantages of current models.With the progression in research,these implantable devices certainly hold promising potential for GBM therapy.展开更多
Metal-bio-oxygen batteries establish a paradigmshifting energy architecture for biomedical implants,endowing these devices with extended service life in continuous physiological surveillance and precision theranostic ...Metal-bio-oxygen batteries establish a paradigmshifting energy architecture for biomedical implants,endowing these devices with extended service life in continuous physiological surveillance and precision theranostic operations.However,the conventional electrolytes in these semi-opened batteries fail to meet the requirements in biocompatibility and bio-safety for in vivo applications.Herein,we report a bio-compatible composite gel electrolyte for implanted Zn-O_(2) battery(ZOB),while also sustainably powering a mechanical sensor in vivo.This electrolyte composes a poly(L-lactide-co-epsilon-caprolactone)(PLCL)framework with a gelatin methacryloyl(GelMA)modification layer,and the salt in body fluid serves as ion transport carriers in the electrolyte.It displays an O_(2) impermeable property and lower polarization potentials as electrolyte in Zn||Zn symmetric cell.In vitro assay results demonstrate that the battery components illustrate excellent biocompatibility with negligible cytotoxicity.In vivo histopathological and hematological analyses further verified the biosafety of ZOB during operation,while capillary regeneration around the cathode ensured adequate oxygen supply for sustained performance.The assembled ZOB delivers a power density of 1.96μW/cm^(2) at 0.98 V in vivo,which also successfully powers an integrated hydrogel mechanical sensor and monitors cardiac signals in rats.The unique two-electron transfer pathway of oxygen reduction in blood has also been elucidated.This work offers a new insight into bio-compatible electrolyte design for next-generation implantable power sources,enabling robust implantable devices for healthcare technologies.展开更多
BACKGROUND This case report examines the challenges associated with removing a totally implantable venous access port(TIVAP)used for long-term chemotherapy in a patient with breast cancer.Prolonged use of TIVAPs can r...BACKGROUND This case report examines the challenges associated with removing a totally implantable venous access port(TIVAP)used for long-term chemotherapy in a patient with breast cancer.Prolonged use of TIVAPs can result in complications such as catheter kinking,thrombosis,and adhesions between the catheter and surrounding tissues,potentially complicating their removal.CASE SUMMARY A breast cancer patient with bone metastasis presented with difficulty aspirating blood from a TIVAP that had been placed in the right internal jugular vein for 3 years.Initial removal attempts at the Department of Venous Access Center were unsuccessful,likely due to adhesions,necessitating a subsequent successful catheter extraction in a hybrid operating room.Imaging revealed no abnor-malities,and the catheter was removed using a mosquito clamp to detach it from surrounding tissues.CONCLUSION This case highlights the challenges of removing TIVAPs inserted via the internal jugular vein,particularly when the catheter traverses the sternocleidomastoid muscle.Repeated neck movements might lead to significant adhesions around the catheter,complicating its removal.Careful consideration should be given during catheter placement to avoid muscle-related adhesions and facilitate smoother extraction in long-term use.展开更多
BACKGROUND Subcutaneous implantable cardioverter-defibrillator(S-ICD)implantation requires effective anesthesia.General anesthesia(GA)carries risks like hemodynamic instability,while ultrasound-guided intercostal nerv...BACKGROUND Subcutaneous implantable cardioverter-defibrillator(S-ICD)implantation requires effective anesthesia.General anesthesia(GA)carries risks like hemodynamic instability,while ultrasound-guided intercostal nerve block(US-ICNB)may offer better pain control.This study hypothesized US-ICNB is superior in perioperative safety and pain management.AIM To compare perioperative outcomes of GA and US-ICNB in S-ICD implantation.METHODS This retrospective single-center study included 64 patients who received S-ICD implantation between February 2021 and December 2024.They were divided into GA and US-ICNB groups based on anesthesia type.Demographic data,perioperative parameters(operation time,pain scores,analgesic usage),and postoperative outcomes(complications,defibrillation events)were collected and analyzed.Statistical tests were used to compare the two groups.RESULTS This study included 64 patients(20 in the GA group and 44 in the US-ICNB group).Baseline left ventricular ejection fraction was significantly lower in the US-ICNB group(39.20%±12.00%vs 56.20%±11.50%in GA,P<0.001),while American Society of Anesthesiologists scores and comorbidities were comparable.US-ICNB showed superior pain control,with significantly lower numeric rating scale scores at 6-48 hours(P<0.001)and fewer patients requiring analgesics(P=0.02).The US-ICNB group had shorter operation times(P<0.001),total hospital stays(P<0.001),and later first analgesia times(P<0.001).No anesthesia-related complications occurred in either group.CONCLUSION Both anesthetic methods were safe in the short term.However,US-ICNB was superior in reducing operation and hospital stay times and alleviating peri-operative pain.It has high safety in S-ICD implantation and deserves further clinical promotion,though large-scale,multi-center,randomized controlled trials are needed to confirm these findings.展开更多
BACKGROUND Central venous access is essential for administering chemotherapy in patients with gastrointestinal cancer.Peripherally inserted central catheters(PICC)and totally implantable venous access ports(TIVAP)are ...BACKGROUND Central venous access is essential for administering chemotherapy in patients with gastrointestinal cancer.Peripherally inserted central catheters(PICC)and totally implantable venous access ports(TIVAP)are widely used,but comparative data regarding their impact on catheter-related complications and quality of life(QoL)remain limited.AIM To evaluate the impact of TIVAPs compared with PICC on catheter-related complications and QoL in patients with gastrointestinal cancer undergoing chemotherapy.METHODS This retrospective study included adults with gastrointestinal cancer who underwent central venous access device insertion for chemotherapy at our institution between December 2021 and December 2024.Inclusion criteria encompassed indications for intermittent intravenous chemotherapy,anticipated treatment duration of≥12 weeks,an adequate preoperative hematologic profile,accessible upper body veins,and complete medical records.Patients were excluded if they had an anticipated survival of less than three months,active systemic infection,severe thrombosis or coagulopathy,communication barriers,or an urgent need for dialysis access.Patients were assigned to either the PICC or TIVAP group based on device type.Data collected included demographic variables,cancer characteristics,insertion procedure details,complications,and QoL,assessed via the EuroQol 5-Dimensions-3 levels,visual analogue scale,and the European Organization for Research and Treatment of Cancer QoL Questionnaire-Core 30.RESULTS A total of 346 patients were analyzed.Baseline demographic,clinical,and cancer characteristics were similar between groups.The TIVAP group demonstrated a significantly lower incidence of catheter-related complications than the PICC group,with no pneumothorax occurring in either group.QoL assessments at baseline were comparable.At one month,the TIVAP group exhibited significantly higher EuroQoL Five Dimensions health state scores and QLQ-C30 global health status scores.Multivariate analysis identified TIVAP use,catheter tip placement in the distal superior vena cava/right atrium,prophylactic antibiotic administration,and antimicrobial dressing application as independent protective factors associated with reduced complications and improved QoL.CONCLUSION In patients with gastrointestinal cancer undergoing chemotherapy,TIVAPs are associated with a lower incidence of catheter-related complications and improved QoL than PICCs.Optimal device selection,precise catheter tip positioning,and effective perioperative management are critical for minimizing complications and enhancing patient-reported outcomes during treatment.展开更多
Background:Cardiac implantable electronic devices(CIEDs)are essential for preventing sudden cardiac death in patients with cardiovascular diseases,but implantation procedures carry risks of complications such as infec...Background:Cardiac implantable electronic devices(CIEDs)are essential for preventing sudden cardiac death in patients with cardiovascular diseases,but implantation procedures carry risks of complications such as infection,hematoma,and bleeding,with incidence rates of 3–4%.Previous studies have examined individual risk factors separately,but integrated predictive models are lacking.We compared the predictive performance and interpretability of artificial neural network(ANN)and logistic regression models to evaluate their respective strengths in clinical risk assessment.Methods:This retrospective study analyzed data from 180 patients who underwent cardiac implantable electronic device(CIED)implantation in Taiwan between 2017 and 2018.To address class imbalance and enhance model training,the dataset was augmented to 540 records using the Synthetic Minority Oversampling Technique(SMOTE).A total of 13 clinical risk factors were evaluated(e.g.,age,body mass index(BMI),platelet count,left ventricular ejection fraction(LVEF),prothrombin time/international normalized ratio(PT/INR),hemoglobin(Hb),comorbidities,and antithrombotic use).Results:The most influential risk factors identified by the ANN model were platelet count,PT/INR,LVEF,Hb,and age.In the logistic regression analysis,reduced LVEF,lower hemoglobin levels,prolonged PT/INR,and lower BMI were significantly associated with an increased risk of complications.ANN model achieved a higher area under the curve(AUC=0.952)compared to the logistic regression model(AUC=0.802),indicating superior predictive performance.Additionally,the overall model quality was also higher for the ANN model(0.93)than for logistic regression(0.76).Conclusions:This study demonstrates that ANN models can effectively predict complications associated CIED procedures and identify critical preoperative risk factors.These findings support the use of ANN-based models for individualized risk stratification,enhancing procedural safety,improving patient outcomes,and potentially reducing healthcare costs associated with postoperative complications.展开更多
Phakic intraocular lens implantation has become one of the important means of correcting refractive errors today.Among them,the implantable collamer lens(ICL)is favored for its wide range of correction,excellent optic...Phakic intraocular lens implantation has become one of the important means of correcting refractive errors today.Among them,the implantable collamer lens(ICL)is favored for its wide range of correction,excellent optical quality,and high safety,but the risks of postoperative complications such as glaucoma and anterior subcapsular opacification still exist.Vault is an important indicator for evaluating the safety after ICL implantation,and its ideal state is crucial for preventing complications.Studies have shown that iris morphology has a significant impact on vault.In order to further optimize surgical outcomes and improve surgical safety,this review comprehensively reviews the research progress of iris-related parameters in ICL implantation and discusses the importance of various parameters in preoperative evaluation and postoperative follow-up.展开更多
Anesthesia plays a crucial role in regulating physiological states during medical procedures,but its effects on neural activity remain incompletely understood,particularly at the prefrontal cortical level.The prefront...Anesthesia plays a crucial role in regulating physiological states during medical procedures,but its effects on neural activity remain incompletely understood,particularly at the prefrontal cortical level.The prefrontal cortex is essential for various cognitive and motor functions,yet high-spatiotemporal-resolution electrodes at the cellular level remain challenging to develop,which has hindered the acquisition of detailed electrophysiological data from anesthetized subjects.Here,we design a 16-channel silicon-based microelectrode array(MEA),which,after modification with platinum black nanoparticles,exhibits significantly reduced impedance(22.5 kΩ)and increased phase(−33.5°),enhancing its electrical performance and electrophysiological signal detection capabilities.Using this modified MEA,we have recorded cellular-level neural activity during the recovery process of a rhesus macaque following prolonged anesthesia.Over a 660 s period,we observed a gradual increase in the neuronal firing rate in the F7 area,along with distinctive patterns in local field potentials across different frequency bands.Notably,power in the δ and θ bands increased continuously during recovery,highlighting their potential role in the transition from anesthesia to wakefulness.Our findings provide new insights into the dynamic recovery process of cortical neurons and offer a powerful tool for high-spatiotemporal-resolution neural monitoring in nonhuman primates.展开更多
Background:Ventricular arrhythmia is a common cause of mortality in adult congenital heart disease(ACHD).The beneficial effects of implantable cardioverter-defibrillators(ICD)in patients with ACHD have been demonstrat...Background:Ventricular arrhythmia is a common cause of mortality in adult congenital heart disease(ACHD).The beneficial effects of implantable cardioverter-defibrillators(ICD)in patients with ACHD have been demonstrated;however,evidence on this topic remains insufficient.This study aimed to assess the long-term outcomes after ICD implantation in the ACHD population.Methods:We retrospectively reviewed 35 consecutive patients with ACHD who underwent ICD implantation between December 2012 and August 2022.ICD implantation was classified as primary or secondary prevention.The long-term outcomes,including all-cause mortality,appropriate and inappropriate ICD therapy,and complications related to ICD implantation,were evaluated.Results:Among the 35 patients,18 patients underwent ICD implantation for primary prevention.During a median follow-up period of 1484 days,3 patients in the primary prevention group and 1 patient in the secondary prevention group died.The 2-and 5-year all-cause mortality rates were 6.2%and 13.6%,respectively.Two(11.1%)and 4(23.5%)patients in the primary and secondary prevention groups,respectively,received appropriate therapy.Six patients(17%)were administered inappropriate therapy,and 2 patients(5.7%)experienced device-related complications.Kaplan-Meier analysis revealed no significant differences in the all-cause mortality or the rates of appropriate and inappropriate therapy between the primary and secondary prevention groups(p=0.297,p=0.427,and p=0.490,respectively).Conclusions:The incidence of appropriate ICD therapy in patients with ACHD was considerably high and comparable to that observed in patients with acquired heart disease,both in primary and secondary prevention.ICD implantation for primary prevention as well as for secondary prevention may be important in patients with ACHD.展开更多
As cardiac implantable electronic devices(CIED)become more prevalent,it is important to acknowledge potential electromagnetic interference(EMI)from other sources,such as internal and external electronic devices and pr...As cardiac implantable electronic devices(CIED)become more prevalent,it is important to acknowledge potential electromagnetic interference(EMI)from other sources,such as internal and external electronic devices and procedures and its effect on these devices.EMI from other sources can potentially inhibit pacing and trigger shocks in permanent pacemakers(PPM)and implantable cardioverter defibrillators(ICD),respectively.This review analyzes potential EMI amongst CIED and left ventricular assist device,deep brain stimulators,spinal cord stimulators,transcutaneous electrical nerve stimulators,and throughout an array of procedures,such as endoscopy,bronchoscopy,and procedures involving electrocautery.Although there is evidence to support EMI from internal and external devices and during procedures,there is a lack of large multicenter studies,and,as a result,current management guidelines are based primarily on expert opinion and anecdotal experience.We aim to provide a general overview of PPM/ICD function,review documented EMI effect on these devices,and acknowledge current management of CIED interference.展开更多
AIM To test of the implantable-cardioverter-defibrillator is done at the time of implantation. We investigate if any testing should be performed.METHODS All consecutive patients between January 2006 and December 2008 ...AIM To test of the implantable-cardioverter-defibrillator is done at the time of implantation. We investigate if any testing should be performed.METHODS All consecutive patients between January 2006 and December 2008 undergoing implantable cardioverterdefibrillator(ICD) implantation/replacement(a total of 634 patients) were included in the retrospective study.RESULTS Sixteen patients(2.5%) were not tested(9 with LA/LVthrombus, 7 due to operator's decision). Analyzed were 618 patients [76% men, 66.4 + 11 years, 24% secondary prevention(SP), 46% with left ventricular ejection fraction(LVEF) < 20%, 56% had coronary artery disease(CAD)] undergoing defibrillation safety testing(SMT) with an energy of 21 + 2.3 J. In 22/618 patients(3.6%) induced ventricular fibrillation(VF) could not be terminated with maximum energy of the ICD. Six of those(27%) had successful SMT after system modification or shock lead repositioning, 14 patients(64%) received a subcutaneous electrode array. Younger age(P = 0.0003), non-CAD(P = 0.007) and VF as index event for SP(P = 0.05) were associated with a higher incidence of ineffective SMT. LVEF < 20% and incomplete revascularisation in patients with CAD had no impact on SMT.CONCLUSION Defibrillation testing is well-tolerated. An ineffective SMT occurred in 4% and two third of those needed implantation of a subcutaneous electrode array to passa SMT > 10 J.展开更多
BACKGROUND Cardiovascular implantable electronic devices(CIEDs)are implanted in an increasing number of patients each year,which has led to an increase in the risk of CIED infection.Antibacterial CIED envelopes locall...BACKGROUND Cardiovascular implantable electronic devices(CIEDs)are implanted in an increasing number of patients each year,which has led to an increase in the risk of CIED infection.Antibacterial CIED envelopes locally deliver antibiotics to the implant site over a short-term period and have been shown to reduce the risk of implant site infection.These envelopes are derived from either biologic or nonbiologic materials.There is a paucity of data examining patient risk profiles and outcomes from using these envelope materials in the clinical setting and comparing these results to patients receiving no envelope with their CIED implantation.AIM To evaluate risk profiles and outcomes of patients who underwent CIED procedures with an antibacterial envelope or no envelope.METHODS After obtaining Internal Review Board approval,the records of consecutive patients who underwent a CIED implantation procedure by a single physician between March 2017 and December 2019 were retrospectively collected from our hospital.A total of 248 patients within this period were identified and reviewed through 12 mo of follow up.The CIED procedures used either no envelope(n=57),a biologic envelope(CanGaroo®,Aziyo Biologics)that was pre-hydrated by the physician with vancomycin and gentamicin(n=89),or a non-biologic envelope(Tyrx^(TM),Medtronic)that was coated with a resorbable polymer containing the drug substances rifampin and minocycline by the manufacturer(n=102).Patient selection for receiving either no envelope or an envelope(and which envelope to use)was determined by the treating physician.Statistical analyses were performed between the 3 groups(CanGaroo,Tyrx,and no envelope),and also between the No Envelope and Any Envelope groups by an independent,experienced biostatistician.RESULTS On average,patients who received any envelope(biologic or non-biologic)were younger(70.7±14.0 vs 74.9±10.6,P=0.017),had a greater number of infection risk factors(81.2%vs 49.1%,P<0.001),received more high-powered devices(37.2%vs 5.8%,P=0.004),and were undergoing more reoperative procedures(47.1%vs 0.0%,P<0.001)than patients who received no envelope.Between the two envelopes,biologic envelopes tended to be used more often in higher risk patients(84.3%vs 78.4%)and reoperative procedures(62.9%vs 33.3%)than non-biologic envelopes.The rate of CIED implant site pocket infection was low(any envelope 0.5%vs no envelope 0.0%)and was statistically equivalent between the two envelope groups.Other reported adverse events(lead dislodgement,lead or pocket revision,device migration or erosion,twiddler’s syndrome,and erythema/fever)were low and statistically equivalent between groups(biologic 2.2%,non-biologic 3.9%,no envelope 1.8%).CONCLUSION CIED infection rates for biologic and non-biologic antibacterial envelopes are similar.Antibacterial envelopes may benefit patients who are higher risk for infection,however additional studies are warranted to confirm this.展开更多
Implantable bioelectronics for analyzing physiological biomarkers has recently been recognized as a promising technique in medical treatment or diagnostics. In this study, we developed a self-powered implantable skinl...Implantable bioelectronics for analyzing physiological biomarkers has recently been recognized as a promising technique in medical treatment or diagnostics. In this study, we developed a self-powered implantable skinlike glucometer for real-time detection of blood glucose level in vivo. Based on the piezo-enzymatic-reaction coupling effect of GOx@ZnO nanowire, the device under an applied deformation can actively output piezoelectric signal containing the glucose-detecting information. No external electricity power source or battery is needed for this device, and the outputting piezoelectric voltage acts as both the biosensing signal and electricity power. A practical application of the skin-like glucometer implanted in mouse body for detecting blood glucose level has been simply demonstrated. These results provide a new technique path for diabetes prophylaxis and treatment.展开更多
基金Supported by the National Key Research and Development Program(No.2019YFC1710200)the Shandong Province Pharmaceutical Technology Development Project(No.202107020970).
文摘Dear Editor,The latest Visian implantable collamer lens(ICL)with a central port design(Aquaport;model V4c)obviates the necessity for preoperative laser iridotomy or intraoperative iridectomy by allowing the free flow of the aqueous humor between the sides of the intraocular lens.The design of Aquaport can also eliminate the complications associated with iridotomy and iridectomy.Therefore,the V4c ICL has the potential to significantly reduce the risk of pupillary block compared to its predecessors.
基金supported by the National Natural Science Foundation of China(81925027,82002275,and 32271421)the Priority Academic Program Development of Jiangsu Higher Education Institutions.
文摘Bone injuries induced by accidents or bone-related disease have dramatically increased in the past decades.The application of biomaterials has become an inextricable part of treatment for new bone formation and regeneration.Different from traditional bone-regeneration materials,injectable biomaterials—ranging from bioceramics to polymers—have been applied as a means of promoting surgery with a minimal intervention approach.In this review,we summarize the most recent developments in minimally invasive implantable biomaterials for bone reconstruction and different ways to achieve osteogenesis,with a focus on injectable biomaterials for various applications in the orthopedic field.More specifically,bioceramics and polymeric materials,together with their applications in bone fracture healing,vertebral body augmentation,bone implant fixation,bone tumor therapy,and bone-defect-related infection treatment are reviewed in detail.Recent progress in injectable biomaterials with multiple functionalities and bioresponsive properties is also reviewed.Finally,we summarize the challenges in this field and future directions for clinical treatment.
基金supported by the National Key R&D Program of China under grant 2023YFF0715303in part by the National Natural Science Foundation of China under Grant Nos.62305148,62105140,62022037,and 61775028+2 种基金in part by the Department of Science and Technology of Guangdong Province under Grant Nos.2019ZT08Y191 and 2022B1212010003in part by the Shenzhen Science and Technology Program under Grant Nos.JCYJ20220530114010023,RCJC20231211090039066,20231116104616001,KQTD20190929172743294,JCYJ20230807093105010,RCBS20231211090802011in part by the Startup Grant from Southern University of Science and Technology under Grant No.PDJH2021C008.
文摘Ultrasound neuromodulation is a powerful tool for brain investigation and holds great promise for treating brain diseases.However,due to the heterogeneous acoustic properties of skulls,existing ultrasound neuromodulation faces the challenge of severe transcranial acoustic attenuation.To overcome such limitations,we report an implantable bio-chip for visible and controllable mi-crowave-induced transcranial acoustic generation(MI-tAG).The bio-chip is soft,flexible,and biocompatible,with a thickness of 3mm,making it suitable for human intracranial implantation.The constituted fluid channels can cover an area of 50 mm×60 mm,enabling widefield neuronstimulation.The particles filled in the fluid channels have both high microwave absorption.ensuring efficient ultrasound generation,and magnetism,allowing noncontact and flexible ma-nipulation by external magnetic fields.The experimental results demonstrate that the optimal MI-tAG can be realized by the combination of particles arranged in a linear pattern and corre-sponding illumination via a linearly polarized microwave.Stability evaluation indicates that the particles can maintain a consistent acoustic intensity without degradation for at least seven days.The results of in vitro and in vivo experiments show that the MII-tAG can manipulate ultrasound sources and visibly locate them in real time.This study provides a potential innovative approach for future ultrasound neuromodulation,inspiring the development of more useful methods to advance brain research.This study introduces a promising innovative approach for transcranial acoustic generation,potentially inspiring the development of more effective methods for ad-vancing ultrasound neuromodulation.
文摘AIM:To compare the accuracy of manual marking versus an image-guided system for toric implantable collamer lens(TICL)implantation and evaluate the short-term postoperative rotational stability of TICL and corneal surgically induced astigmatism vector(SIA).METHODS:Retrospective analysis was conducted on eyes with TICL alignment achieved through manual marking(n=75)or VERION image-guided system-assisted marking(n=83).Each group was further classified into horizontal and vertical subgroups based on implant orientation.Additionally,patients were categorized into superior and temporal incision subgroups according to the position of main corneal incision.The misalignment and rotational stability of TICL were analyzed using slit-lamp anterior segment photography.Surgical predictability,efficacy,safety,and corneal SIA were also evaluated.RESULTS:In general,the TICL implantation with manual and digital image-guided systems all achieved robust predictability,efficacy,and safety.The misalignment of TICL was comparable between the manual and VERION groups(0.16°±3.97°vs 0.52°±5.59°,P=0.633),while a significant difference was observed in the absolute misalignment of TICL between the two groups(3.02°±2.55°vs 4.28°±3.61°,P=0.043).There were no significant differences in the distribution of TICL misalignment between the manual and VERION groups or between horizontal and vertical implant orientation groups(P>0.05).Furthermore,different orientations of TICL placement did not show statistically significant differences in rotational stability(P=0.46).Statistically significant differences were found in anterior corneal SIA between the manual and VERION groups(0.46±0.27 vs 0.33±0.21 D,P=0.001),especially for superior incision position(0.60±0.27 vs 0.35±0.23 D,P<0.0001).The anterior SIA exhibited a significant difference between superior and temporal incisions in the manual group(0.60±0.27 vs 0.35±0.20 D,P<0.0001).CONCLUSION:Compared with the conventional manual marking method,this study indicates that the digital image-guided system with VERION is safe and effective in TICL implantation.The digital system offers the advantage of minimizing corneal SIA compared to the manual method.
基金Supported by the National Natural Science Foundation of China(No.82271100)the Jiangsu Science and Technology Support Program(No.BE2022805)the Clinical Skills Enhancement Program of Jiangsu Province Hospital(No.JSPH-MC-2022-24).
文摘AIM:To predict the post-operative vault and the suitable size of the implantable collamer lens(ICL)by comparing the performance of multiple artificial intelligence(AI)algorithms.METHODS:A retrospective analysis of 83 patients with 132 eyes was conducted from 2020 to 2023.All patients underwent implantation of EVO-V4C ICLs.ICLs were selected based on STAAR’s recommended formula.Postoperative vault values were measured using anterior segment optical coherence tomography(ASOCT).First,feature selection was performed on patients’preoperative examination parameters to identify those most closely related to postoperative vault and incorporate them into the machine learning model.Subsequently,four regression models,namely MLP,XGBoost,RFR,and KNN,were employed to predict the vault,and their predictive performances were compared.The ICL size was set as the prediction target,with the vault and other input features serving as new inputs for predicting the ICL size.RESULTS:Among all preoperative parameters,16 parameters were most closely related to postoperative vault and were included in the prediction model.In vault prediction,XGBoost performed the best in the regression model(R^(2)=0.9999),followed by MLP(R^(2)=0.9987)and RFR(R^(2)=0.8982),while the KNN model had the lowest predictive performance(R^(2)=0.3852).XGBoost achieved a prediction accuracy of 99.8%,MLP had a prediction accuracy of 98.9%,while RFR and KNN had accuracies of 87.1%and 57.4%,respectively.CONCLUSION:AI effectively predicts postoperative vault and determines ICL size.XGBoost outperforms other machine-learning algorithms tested.Its accurate predictions help ophthalmologists choose the right ICL size,ensuring proper vaulting.
基金supported by the National Natural Science Foundation of China(NSFC)(62422501)Beijing Nova Program(20230484254,20240484742)Hebei Natural Science Foundation(F2024105039).
文摘Implantable temperature sensors are revolutionizing physiological monitoring and playing a crucial role in diagnostics,therapeutics,and life sciences research.This review classifies the materials used in these sensors into three categories:metal-based,inorganic semiconductor,and organic semiconductor materials.Metal-based materials are widely used in medical and industrial applications due to their linearity,stability,and reliability.Inorganic semiconductors provide rapid response times and high miniaturization potential,making them promising for biomedical and environmental monitoring.Organic semiconductors offer high sensitivity and ease of processing,enabling the development of flexible and stretchable sensors.This review analyzes recent studies for each material type,covering design principles,performance characteristics,and applications,highlighting key advantages and challenges regarding miniaturization,sensitivity,response time,and biocompatibility.Furthermore,critical performance parameters of implantable temperature sensors based on different material types are summarized,providing valuable references for future sensor design and optimization.The future development of implantable temperature sensors is discussed,focusing on improving biocompatibility,long-term stability,and multifunctional integration.These advancements are expected to expand the application potential of implantable sensors in telemedicine and dynamic physiological monitoring.
文摘BACKGROUND Cardiac resynchronization therapy(CRT)has been a major therapeutic advancement for patients with heart failure and electrical dyssynchrony.While CRT improves symptoms,reduces hospitalizations,and enhances survival,the role of implantable cardioverter-defibrillators(ICDs)alongside CRT in patients with non-ischemic cardiomyopathy(NICM)remains controversial.To evaluate and compare the outcomes of CRT with ICD(CRT-D)versus CRT with pacemaker-only(CRT-P)in individuals diagnosed with NICM,with a specific focus on the elderly.METHODS A comprehensive search of PubMed,Embase,and the Cochrane Central Register of Controlled Trials was conducted in January 2024.Studies comparing CRT-D and CRT-P in patients with NICM were included,with subgroup analyses focusing on patients aged 75 years and older.RESULTS Twelve studies,including two randomized clinical trials,with a total of 62,145 patients and 16,754 pooled death events(9,171 in CRT-D and 7,583 in CRT-P),were analyzed.CRT-D was associated with a significantly lower risk of all-cause mortality compared to CRT-P(pooled OR=0.72;95%CI:0.61-0.85;P<0.01),with significant heterogeneity(I2=83%).RCT subgroup analysis,was not statistically significant(pooled OR=0.82;95%CI:0.64-1.06;P=0.41;I2=0%).In patients older than 75 years,no significant difference in mortality risk was observed(pooled OR 0.96;95%CI:0.81-1.15;I2=39%).CONCLUSION Our meta-analysis suggests that the addition of ICD therapy to CRT in patients with NICM significantly reduces all-cause mortality.However,this benefit does not extend to cardiovascular mortality,likely due to the primary role of ICDs in preventing sudden cardiac death rather than other causes such as progressive heart failure.The survival advantage of CRT-D is most pronounced in younger patients,with those over 75 years of age deriving less benefit.This highlights the importance of careful patient selection,considering age and comorbidities,when deciding on ICD implantation in NICM patients.
基金financially supported by the National Natural Science Foundation of China(U23A20591 and 52273158).
文摘Glioblastoma(GBM)is a highly infiltrative brain tumor.The treatment of GBM is challenging due to the existence of blood brain barrier,its highly invasive nature,and its heterogeneity.Given the limitations of conventional therapies,this Perspective explores the development trajectory of implantable devices,highlighting the advantages of current models.With the progression in research,these implantable devices certainly hold promising potential for GBM therapy.
基金supported by the National Natural Science Foundation of China(No.22179095)the Graduate Scientific Research Foundation of Jianghan University(No.KYCXJJ202423).
文摘Metal-bio-oxygen batteries establish a paradigmshifting energy architecture for biomedical implants,endowing these devices with extended service life in continuous physiological surveillance and precision theranostic operations.However,the conventional electrolytes in these semi-opened batteries fail to meet the requirements in biocompatibility and bio-safety for in vivo applications.Herein,we report a bio-compatible composite gel electrolyte for implanted Zn-O_(2) battery(ZOB),while also sustainably powering a mechanical sensor in vivo.This electrolyte composes a poly(L-lactide-co-epsilon-caprolactone)(PLCL)framework with a gelatin methacryloyl(GelMA)modification layer,and the salt in body fluid serves as ion transport carriers in the electrolyte.It displays an O_(2) impermeable property and lower polarization potentials as electrolyte in Zn||Zn symmetric cell.In vitro assay results demonstrate that the battery components illustrate excellent biocompatibility with negligible cytotoxicity.In vivo histopathological and hematological analyses further verified the biosafety of ZOB during operation,while capillary regeneration around the cathode ensured adequate oxygen supply for sustained performance.The assembled ZOB delivers a power density of 1.96μW/cm^(2) at 0.98 V in vivo,which also successfully powers an integrated hydrogel mechanical sensor and monitors cardiac signals in rats.The unique two-electron transfer pathway of oxygen reduction in blood has also been elucidated.This work offers a new insight into bio-compatible electrolyte design for next-generation implantable power sources,enabling robust implantable devices for healthcare technologies.
基金Supported by the Science and Technology Research Project of Jiangxi Provincial Education Department,No.GJJ2208202Science and Technology Program Project of Health Commission of Jiangxi Province,No.202510069+1 种基金Jiangxi Cancer Hospital Doctoral Start-up Fund,No.BSQDJ202309Jiangxi Province Gan Po Talent Support Program,No.20232BCJ23035.
文摘BACKGROUND This case report examines the challenges associated with removing a totally implantable venous access port(TIVAP)used for long-term chemotherapy in a patient with breast cancer.Prolonged use of TIVAPs can result in complications such as catheter kinking,thrombosis,and adhesions between the catheter and surrounding tissues,potentially complicating their removal.CASE SUMMARY A breast cancer patient with bone metastasis presented with difficulty aspirating blood from a TIVAP that had been placed in the right internal jugular vein for 3 years.Initial removal attempts at the Department of Venous Access Center were unsuccessful,likely due to adhesions,necessitating a subsequent successful catheter extraction in a hybrid operating room.Imaging revealed no abnor-malities,and the catheter was removed using a mosquito clamp to detach it from surrounding tissues.CONCLUSION This case highlights the challenges of removing TIVAPs inserted via the internal jugular vein,particularly when the catheter traverses the sternocleidomastoid muscle.Repeated neck movements might lead to significant adhesions around the catheter,complicating its removal.Careful consideration should be given during catheter placement to avoid muscle-related adhesions and facilitate smoother extraction in long-term use.
文摘BACKGROUND Subcutaneous implantable cardioverter-defibrillator(S-ICD)implantation requires effective anesthesia.General anesthesia(GA)carries risks like hemodynamic instability,while ultrasound-guided intercostal nerve block(US-ICNB)may offer better pain control.This study hypothesized US-ICNB is superior in perioperative safety and pain management.AIM To compare perioperative outcomes of GA and US-ICNB in S-ICD implantation.METHODS This retrospective single-center study included 64 patients who received S-ICD implantation between February 2021 and December 2024.They were divided into GA and US-ICNB groups based on anesthesia type.Demographic data,perioperative parameters(operation time,pain scores,analgesic usage),and postoperative outcomes(complications,defibrillation events)were collected and analyzed.Statistical tests were used to compare the two groups.RESULTS This study included 64 patients(20 in the GA group and 44 in the US-ICNB group).Baseline left ventricular ejection fraction was significantly lower in the US-ICNB group(39.20%±12.00%vs 56.20%±11.50%in GA,P<0.001),while American Society of Anesthesiologists scores and comorbidities were comparable.US-ICNB showed superior pain control,with significantly lower numeric rating scale scores at 6-48 hours(P<0.001)and fewer patients requiring analgesics(P=0.02).The US-ICNB group had shorter operation times(P<0.001),total hospital stays(P<0.001),and later first analgesia times(P<0.001).No anesthesia-related complications occurred in either group.CONCLUSION Both anesthetic methods were safe in the short term.However,US-ICNB was superior in reducing operation and hospital stay times and alleviating peri-operative pain.It has high safety in S-ICD implantation and deserves further clinical promotion,though large-scale,multi-center,randomized controlled trials are needed to confirm these findings.
文摘BACKGROUND Central venous access is essential for administering chemotherapy in patients with gastrointestinal cancer.Peripherally inserted central catheters(PICC)and totally implantable venous access ports(TIVAP)are widely used,but comparative data regarding their impact on catheter-related complications and quality of life(QoL)remain limited.AIM To evaluate the impact of TIVAPs compared with PICC on catheter-related complications and QoL in patients with gastrointestinal cancer undergoing chemotherapy.METHODS This retrospective study included adults with gastrointestinal cancer who underwent central venous access device insertion for chemotherapy at our institution between December 2021 and December 2024.Inclusion criteria encompassed indications for intermittent intravenous chemotherapy,anticipated treatment duration of≥12 weeks,an adequate preoperative hematologic profile,accessible upper body veins,and complete medical records.Patients were excluded if they had an anticipated survival of less than three months,active systemic infection,severe thrombosis or coagulopathy,communication barriers,or an urgent need for dialysis access.Patients were assigned to either the PICC or TIVAP group based on device type.Data collected included demographic variables,cancer characteristics,insertion procedure details,complications,and QoL,assessed via the EuroQol 5-Dimensions-3 levels,visual analogue scale,and the European Organization for Research and Treatment of Cancer QoL Questionnaire-Core 30.RESULTS A total of 346 patients were analyzed.Baseline demographic,clinical,and cancer characteristics were similar between groups.The TIVAP group demonstrated a significantly lower incidence of catheter-related complications than the PICC group,with no pneumothorax occurring in either group.QoL assessments at baseline were comparable.At one month,the TIVAP group exhibited significantly higher EuroQoL Five Dimensions health state scores and QLQ-C30 global health status scores.Multivariate analysis identified TIVAP use,catheter tip placement in the distal superior vena cava/right atrium,prophylactic antibiotic administration,and antimicrobial dressing application as independent protective factors associated with reduced complications and improved QoL.CONCLUSION In patients with gastrointestinal cancer undergoing chemotherapy,TIVAPs are associated with a lower incidence of catheter-related complications and improved QoL than PICCs.Optimal device selection,precise catheter tip positioning,and effective perioperative management are critical for minimizing complications and enhancing patient-reported outcomes during treatment.
文摘Background:Cardiac implantable electronic devices(CIEDs)are essential for preventing sudden cardiac death in patients with cardiovascular diseases,but implantation procedures carry risks of complications such as infection,hematoma,and bleeding,with incidence rates of 3–4%.Previous studies have examined individual risk factors separately,but integrated predictive models are lacking.We compared the predictive performance and interpretability of artificial neural network(ANN)and logistic regression models to evaluate their respective strengths in clinical risk assessment.Methods:This retrospective study analyzed data from 180 patients who underwent cardiac implantable electronic device(CIED)implantation in Taiwan between 2017 and 2018.To address class imbalance and enhance model training,the dataset was augmented to 540 records using the Synthetic Minority Oversampling Technique(SMOTE).A total of 13 clinical risk factors were evaluated(e.g.,age,body mass index(BMI),platelet count,left ventricular ejection fraction(LVEF),prothrombin time/international normalized ratio(PT/INR),hemoglobin(Hb),comorbidities,and antithrombotic use).Results:The most influential risk factors identified by the ANN model were platelet count,PT/INR,LVEF,Hb,and age.In the logistic regression analysis,reduced LVEF,lower hemoglobin levels,prolonged PT/INR,and lower BMI were significantly associated with an increased risk of complications.ANN model achieved a higher area under the curve(AUC=0.952)compared to the logistic regression model(AUC=0.802),indicating superior predictive performance.Additionally,the overall model quality was also higher for the ANN model(0.93)than for logistic regression(0.76).Conclusions:This study demonstrates that ANN models can effectively predict complications associated CIED procedures and identify critical preoperative risk factors.These findings support the use of ANN-based models for individualized risk stratification,enhancing procedural safety,improving patient outcomes,and potentially reducing healthcare costs associated with postoperative complications.
基金Key Research and Development Projects of Zhejiang Science and Technology Plan(No.2021C03103)Research and Development Plan of Zhejiang Science and Technology Department(No.2023C03089)Scientific Research Project of Zhejiang Provincial Department of Education(No.Y202456401)。
文摘Phakic intraocular lens implantation has become one of the important means of correcting refractive errors today.Among them,the implantable collamer lens(ICL)is favored for its wide range of correction,excellent optical quality,and high safety,but the risks of postoperative complications such as glaucoma and anterior subcapsular opacification still exist.Vault is an important indicator for evaluating the safety after ICL implantation,and its ideal state is crucial for preventing complications.Studies have shown that iris morphology has a significant impact on vault.In order to further optimize surgical outcomes and improve surgical safety,this review comprehensively reviews the research progress of iris-related parameters in ICL implantation and discusses the importance of various parameters in preoperative evaluation and postoperative follow-up.
基金sponsored by the National Key R&D Program of China(Grant Nos.2022YFC2402500 and 2022YFB3205602)the National Natural Science Foundation of China(Grant Nos.62121003,T2293730,T2293731,62333020,62171434,62471291)+2 种基金the Major Program of Scientific and Technical Innovation 2030(Grant No.2021ZD02016030)the Joint Foundation Program of the Chinese Academy of Sciences(Grant No.8091A170201)the Scientific Instrument Developing Project of the Chinese Academy of Sciences(Grant No.PTYQ2024BJ0009).
文摘Anesthesia plays a crucial role in regulating physiological states during medical procedures,but its effects on neural activity remain incompletely understood,particularly at the prefrontal cortical level.The prefrontal cortex is essential for various cognitive and motor functions,yet high-spatiotemporal-resolution electrodes at the cellular level remain challenging to develop,which has hindered the acquisition of detailed electrophysiological data from anesthetized subjects.Here,we design a 16-channel silicon-based microelectrode array(MEA),which,after modification with platinum black nanoparticles,exhibits significantly reduced impedance(22.5 kΩ)and increased phase(−33.5°),enhancing its electrical performance and electrophysiological signal detection capabilities.Using this modified MEA,we have recorded cellular-level neural activity during the recovery process of a rhesus macaque following prolonged anesthesia.Over a 660 s period,we observed a gradual increase in the neuronal firing rate in the F7 area,along with distinctive patterns in local field potentials across different frequency bands.Notably,power in the δ and θ bands increased continuously during recovery,highlighting their potential role in the transition from anesthesia to wakefulness.Our findings provide new insights into the dynamic recovery process of cortical neurons and offer a powerful tool for high-spatiotemporal-resolution neural monitoring in nonhuman primates.
文摘Background:Ventricular arrhythmia is a common cause of mortality in adult congenital heart disease(ACHD).The beneficial effects of implantable cardioverter-defibrillators(ICD)in patients with ACHD have been demonstrated;however,evidence on this topic remains insufficient.This study aimed to assess the long-term outcomes after ICD implantation in the ACHD population.Methods:We retrospectively reviewed 35 consecutive patients with ACHD who underwent ICD implantation between December 2012 and August 2022.ICD implantation was classified as primary or secondary prevention.The long-term outcomes,including all-cause mortality,appropriate and inappropriate ICD therapy,and complications related to ICD implantation,were evaluated.Results:Among the 35 patients,18 patients underwent ICD implantation for primary prevention.During a median follow-up period of 1484 days,3 patients in the primary prevention group and 1 patient in the secondary prevention group died.The 2-and 5-year all-cause mortality rates were 6.2%and 13.6%,respectively.Two(11.1%)and 4(23.5%)patients in the primary and secondary prevention groups,respectively,received appropriate therapy.Six patients(17%)were administered inappropriate therapy,and 2 patients(5.7%)experienced device-related complications.Kaplan-Meier analysis revealed no significant differences in the all-cause mortality or the rates of appropriate and inappropriate therapy between the primary and secondary prevention groups(p=0.297,p=0.427,and p=0.490,respectively).Conclusions:The incidence of appropriate ICD therapy in patients with ACHD was considerably high and comparable to that observed in patients with acquired heart disease,both in primary and secondary prevention.ICD implantation for primary prevention as well as for secondary prevention may be important in patients with ACHD.
文摘As cardiac implantable electronic devices(CIED)become more prevalent,it is important to acknowledge potential electromagnetic interference(EMI)from other sources,such as internal and external electronic devices and procedures and its effect on these devices.EMI from other sources can potentially inhibit pacing and trigger shocks in permanent pacemakers(PPM)and implantable cardioverter defibrillators(ICD),respectively.This review analyzes potential EMI amongst CIED and left ventricular assist device,deep brain stimulators,spinal cord stimulators,transcutaneous electrical nerve stimulators,and throughout an array of procedures,such as endoscopy,bronchoscopy,and procedures involving electrocautery.Although there is evidence to support EMI from internal and external devices and during procedures,there is a lack of large multicenter studies,and,as a result,current management guidelines are based primarily on expert opinion and anecdotal experience.We aim to provide a general overview of PPM/ICD function,review documented EMI effect on these devices,and acknowledge current management of CIED interference.
文摘AIM To test of the implantable-cardioverter-defibrillator is done at the time of implantation. We investigate if any testing should be performed.METHODS All consecutive patients between January 2006 and December 2008 undergoing implantable cardioverterdefibrillator(ICD) implantation/replacement(a total of 634 patients) were included in the retrospective study.RESULTS Sixteen patients(2.5%) were not tested(9 with LA/LVthrombus, 7 due to operator's decision). Analyzed were 618 patients [76% men, 66.4 + 11 years, 24% secondary prevention(SP), 46% with left ventricular ejection fraction(LVEF) < 20%, 56% had coronary artery disease(CAD)] undergoing defibrillation safety testing(SMT) with an energy of 21 + 2.3 J. In 22/618 patients(3.6%) induced ventricular fibrillation(VF) could not be terminated with maximum energy of the ICD. Six of those(27%) had successful SMT after system modification or shock lead repositioning, 14 patients(64%) received a subcutaneous electrode array. Younger age(P = 0.0003), non-CAD(P = 0.007) and VF as index event for SP(P = 0.05) were associated with a higher incidence of ineffective SMT. LVEF < 20% and incomplete revascularisation in patients with CAD had no impact on SMT.CONCLUSION Defibrillation testing is well-tolerated. An ineffective SMT occurred in 4% and two third of those needed implantation of a subcutaneous electrode array to passa SMT > 10 J.
文摘BACKGROUND Cardiovascular implantable electronic devices(CIEDs)are implanted in an increasing number of patients each year,which has led to an increase in the risk of CIED infection.Antibacterial CIED envelopes locally deliver antibiotics to the implant site over a short-term period and have been shown to reduce the risk of implant site infection.These envelopes are derived from either biologic or nonbiologic materials.There is a paucity of data examining patient risk profiles and outcomes from using these envelope materials in the clinical setting and comparing these results to patients receiving no envelope with their CIED implantation.AIM To evaluate risk profiles and outcomes of patients who underwent CIED procedures with an antibacterial envelope or no envelope.METHODS After obtaining Internal Review Board approval,the records of consecutive patients who underwent a CIED implantation procedure by a single physician between March 2017 and December 2019 were retrospectively collected from our hospital.A total of 248 patients within this period were identified and reviewed through 12 mo of follow up.The CIED procedures used either no envelope(n=57),a biologic envelope(CanGaroo®,Aziyo Biologics)that was pre-hydrated by the physician with vancomycin and gentamicin(n=89),or a non-biologic envelope(Tyrx^(TM),Medtronic)that was coated with a resorbable polymer containing the drug substances rifampin and minocycline by the manufacturer(n=102).Patient selection for receiving either no envelope or an envelope(and which envelope to use)was determined by the treating physician.Statistical analyses were performed between the 3 groups(CanGaroo,Tyrx,and no envelope),and also between the No Envelope and Any Envelope groups by an independent,experienced biostatistician.RESULTS On average,patients who received any envelope(biologic or non-biologic)were younger(70.7±14.0 vs 74.9±10.6,P=0.017),had a greater number of infection risk factors(81.2%vs 49.1%,P<0.001),received more high-powered devices(37.2%vs 5.8%,P=0.004),and were undergoing more reoperative procedures(47.1%vs 0.0%,P<0.001)than patients who received no envelope.Between the two envelopes,biologic envelopes tended to be used more often in higher risk patients(84.3%vs 78.4%)and reoperative procedures(62.9%vs 33.3%)than non-biologic envelopes.The rate of CIED implant site pocket infection was low(any envelope 0.5%vs no envelope 0.0%)and was statistically equivalent between the two envelope groups.Other reported adverse events(lead dislodgement,lead or pocket revision,device migration or erosion,twiddler’s syndrome,and erythema/fever)were low and statistically equivalent between groups(biologic 2.2%,non-biologic 3.9%,no envelope 1.8%).CONCLUSION CIED infection rates for biologic and non-biologic antibacterial envelopes are similar.Antibacterial envelopes may benefit patients who are higher risk for infection,however additional studies are warranted to confirm this.
基金supported by the National Natural Science Foundation of China (11674048)the Fundamental Research Funds for the Central Universities (N160502002)Liaoning BaiQianWan Talents Program (2014921017)
文摘Implantable bioelectronics for analyzing physiological biomarkers has recently been recognized as a promising technique in medical treatment or diagnostics. In this study, we developed a self-powered implantable skinlike glucometer for real-time detection of blood glucose level in vivo. Based on the piezo-enzymatic-reaction coupling effect of GOx@ZnO nanowire, the device under an applied deformation can actively output piezoelectric signal containing the glucose-detecting information. No external electricity power source or battery is needed for this device, and the outputting piezoelectric voltage acts as both the biosensing signal and electricity power. A practical application of the skin-like glucometer implanted in mouse body for detecting blood glucose level has been simply demonstrated. These results provide a new technique path for diabetes prophylaxis and treatment.
