A modular platform to generate functional sympathetic neuron-innervated heart assembloids.

The technology of human pluripotent stem cell (hPSC)-based 3D organoid/assembloid cultures has become a powerful tool for the study of human embryonic development, disease modeling and drug discovery in recent years. The autonomic sympathetic nervous system innervates and regulates almost all organs in the body, including the heart. Yet, most reported organoids to date are not innervated, thus lacking proper neural regulation, and hindering reciprocal tissue maturation. Here, we developed a simple and versatile sympathetic neuron (symN)-innervated cardiac assembloid without the need for bioengineering. Our human sympathetic cardiac assembloids (hSCAs) showed mature muscle structures, atrial to ventricular patterning, and spontaneous beating. hSCA-innervating symNs displayed neurotransmitter synthesis and functional regulation of the cardiac beating rate, which could be manipulated pharmacologically or optogenetically. We modeled symN-mediated cardiac development and myocardial infarction. This hSCAs provides a tool for future neurocardiotoxicity screening approaches and is highly versatile and modular, where the types of neuron (symN or parasympathetic or sensory neuron) and organoid (heart, lung, kidney) to be innervated may be interchanged.

A novel technique using long segment patch angioplasty maturation to increase the maturation rate of arteriovenous fistulas.

OBJECTIVE: Given the superior patency of arteriovenous fistulas (AVFs) and the decreased risk of infection compared with arteriovenous grafts, the Kidney Disease Outcomes Quality Initiative guidelines have recommended the fistula-first approach. However, ∼20% to 60% of all fistulas will fail to mature. We have described our experience with a novel technique using bovine pericardial patch angioplasty to increase the rate of AVF maturation. METHODS: We used 2-cm × 9-cm-long or 2.5-cm × 15-cm-long segment pericardial patch angioplasty to assist in the maturation of AVFs. A single-center, retrospective cohort study was conducted of all patients who had undergone patch angioplasty maturation (PAM) for AVFs that had failed to mature. The outcomes of interest were maturation status and patency, censored by the death and last known follow-up dates. RESULTS: From March 2007 to October 2019, 139 patients had undergone PAM. Follow-up data were available for 137 of the 139 patients (98.6%), with 126 AVFs (92.0%) progressing to maturation. Of the 126 patients with AVFs that had progressed to maturity, the previous hemodialysis (HD) method was known for 88 patients (69.8%). Of these 88 patients, 70 (79.5%) had previously been receiving HD via an HD catheter. Using a Kaplan-Meier estimator censored for death and loss to follow-up, the assisted primary patency rates at 1, 2, and 3 years were 87.3%, 78.1%, and 68.0%, respectively. Of the 137 patients, 69 (54.8%) had required no additional interventions after patch angioplasty. The complications requiring intervention were stenosis (n = 45; 32.8%), thrombosis (n = 10; 7.3%), infection (n = 3; 2.2%), steal syndrome (n = 3; 2.2%), noninfected wound complications (n = 1; 0.8%), and pseudoaneurysm (n = 1; 0.8%). The average interval to intervention after patch angioplasty was 4.56 months. CONCLUSIONS: Long-segment bovine pericardial PAM can be performed safely to treat nonmaturing AVFs, with a 92.0% successful maturation rate and patency rates comparable to those for AVFs. PAM should be a consideration for patients with nonmaturing AVFs.

Global Warming Impacts of Residential Electricity Consumption: Agent-Based Modeling of Rooftop Solar Panel Adoption in Los Angeles County, California.

Solar photovoltaics (PV) are a renewable electricity technology with lower carbon dioxide equivalent (CO2 e) impacts compared to fossil electricity, making it a technology of interest with respect to combatting global climate change. This paper combines agent-based modeling (ABM) with life cycle assessment (LCA) to simulate rooftop solar PV adoption in Los Angeles (LA) County from 2018-2050 and generate CO2 e impact data at the societal level to compare PV and grid electricity. With respect to solar PV panels, consumer adoption is the "pull" that moves the system and corresponding life cycle CO2 e impacts forward. ABM is used to evaluate the impact of policies and evolutions in technology regarding the adoption of solar PV. Life cycle assessment is used to quantify the life cycle CO2 e impacts of solar PV (including raw materials, manufacturing, and use). The results show that scenarios that increase PV adoption also increase the CO2 e impacts from solar PV use in the short term, due to the raw materials and manufacturing portions of the life cycle. Yet, in the long term, adoption of solar PV may provide CO2 e impact savings from offsetting grid electricity (although this is dependent on the carbon intensity of the electricity sources). The CO2 e impacts of solar panels are dominated by the raw materials and manufacturing phases on a product level basis, but the use phase contributes to the majority of environmental impact savings from an adoption and societal-level perspective. Future work may apply the methodology to other locations in the United States to evaluate if solar panels are an advantageous electricity source compared to the environmental impacts of the electricity grid. Integr Environ Assess Manag 2020;16:1008-1018. © 2020 SETAC.

Advances in the Management of Peripheral Artery Disease.

PURPOSE OF REVIEW: This paper provides a concise update on the management of peripheral artery disease (PAD). RECENT FINDINGS: PAD continues to denote a population at high risk for mortality but represents a threat for limb loss only when associated with foot ulcers, gangrene, or infections. Performing either angiogram or non-invasive testing for all patients with foot ulcers, gangrene, or foot infections will help increase the detection of PAD, and refined revascularization strategies may help optimize wound healing in this patient group. Structured exercise programs are becoming available to more patients with claudication as methods to improve adherence to community-based exercise programs will improve. Finally, ensuring more patients with PAD receive aspirin therapy and statins may improve long-term survival, while further research will help determine if adding newer antiplatelet or anticoagulant medications may reduce leg amputations in selected patients. Clinicians should have a low threshold to obtain an angiogram and to pursue revascularization in patients with foot ulcers, gangrene, or foot infections. In patients with claudication, clinicians should maximize the benefits derived from exercise therapy and medical management before offering percutaneous or surgical revascularization.

Core Team Members' Impact on Outcomes and Process Improvement in the Initial Resuscitation of Trauma Patients.

Genesis Trauma Center is an American College of Surgeons-The Committee on Trauma-verified Level III facility located in Southeastern Ohio. Process improvement and patient safety showed inconsistencies in trauma documentation and comfort level of the nursing staff. In February 2014, Genesis implemented a trauma nurse leader program to provide a core team of trauma nurses for the initial resuscitation. The overall goal of implementing a trauma nurse leader (TNL) program was to focus education on a core team, providing an increased level of skill of experience to oversee trauma patient care. The TNL program has shown promise in the pilot phase by decreasing emergency department length of stay and improving trauma documentation.