Clinical efficacy of robotic spine surgery: an updated systematic review of 20 randomized controlled trials.

Purpose: To determine whether using robots in spine surgery results in more clinical advantages and fewer adverse consequences. Methods: Between October 1990 and October 2022, a computer-based search was conducted through the databases of PubMed, Cochrane Library, Embase, Web of Science, China National Knowledge Infrastructure, China Biology Medicine, VIP databases, and WAN FANG. The study only included randomized controlled trials (RCTs) comparing the clinical efficacy and safety of robot-assisted surgery with those of conventional spine surgery. The review was conducted following PRISMA 2020, and AMSTAR-2 was used to evaluate the methodological quality. R version 4.2.1 was used in the meta-analysis. The Cochrane Collaboration Tool was used for evaluating the risk of bias. Results: This study analyzed 954 participants from 20 RCTs involving cervical spondylosis, lumbar degenerative disease, scoliosis, etc. The robot-assisted group outperformed the freehand group in terms of intraoperative blood loss, number of screws in grade A position, grade A + B position, radiation dose, and hospital stay. Operation duration, visual analog scale scores of low back pain, Oswestry disability index, and radiation exposure time did not significantly differ between the two groups. Conclusions: Although robotic spine surgery is more accurate in pedicle screw placement than conventional methods, the robot group did not demonstrate an advantage in terms of clinical efficacy. Studies of complications and cost-effectiveness are still very rare.

Machine Learning-Based Risk Model for Predicting Early Mortality After Surgery for Infective Endocarditis.

Background The early mortality after surgery for infective endocarditis is high. Although risk models help identify patients at high risk, most current scoring systems are inaccurate or inconvenient. The objective of this study was to construct an accurate and easy-to-use prediction model to identify patients at high risk of early mortality after surgery for infective endocarditis. Methods and Results A total of 476 consecutive patients with infective endocarditis who underwent surgery at 2 centers were included. The development cohort consisted of 276 patients. Eight variables were selected from 89 potential predictors as input of the XGBoost model to train the prediction model, including platelet count, serum albumin, current heart failure, urine occult blood ≥(++), diastolic dysfunction, multiple valve involvement, tricuspid valve involvement, and vegetation >10 mm. The completed prediction model was tested in 2 separate cohorts for internal and external validation. The internal test cohort consisted of 125 patients independent of the development cohort, and the external test cohort consisted of 75 patients from another center. In the internal test cohort, the area under the curve was 0.813 (95% CI, 0.670-0.933) and in the external test cohort the area under the curve was 0.812 (95% CI, 0.606-0.956). The area under the curve was significantly higher than that of other ensemble learning models, logistic regression model, and European System for Cardiac Operative Risk Evaluation II (all, P<0.01). This model was used to develop an online, open-access calculator (http://42.240.140.58:1808/). Conclusions We constructed and validated an accurate and robust machine learning-based risk model to predict early mortality after surgery for infective endocarditis, which may help clinical decision-making and improve outcomes.

Belumosudil, ROCK2-specific inhibitor, alleviates cardiac fibrosis by inhibiting cardiac fibroblasts activation.

Cardiac fibrosis is thought to be the hallmark of pathological hypertrophic remodeling, of which the myofibroblast transdifferentiation is the key cell biological event. However, there is still no specific and effective therapeutic agent approved for cardiac fibrosis. To investigate the effects of belumosudil, the first ρ-associated kinase-2 (ROCK2)-specific inhibitor, on cardiac hypertrophy, fibrosis, and dysfunction induced by pressure overload, the transverse aortic constriction (TAC) or sham operation was carried out on wild-type C57BL/6 mice (male, 6-8 wk old) under pentobarbital anesthesia. After that, mice were randomly divided into three groups: sham operation + vehicle, TAC + vehicle, TAC + 50 mg·kg-1·day-1 belumosudil. We found that belumosudil effectively ameliorated cardiac hypertrophy, fibrosis, and dysfunction in TAC mice. To elucidate the underlying mechanism, we inhibited the expression of ROCK2 in vitro by either belumosudil or siRNA. We showed that the inhibition of ROCK2 by either belumosudil or knockdown suppressed cardiac fibroblasts activation and proliferation significantly induced by transforming growth factor-ß1 (TGF-ß1). Furthermore, our study confirmed ROCK2 mediates cardiac fibrosis by interacting with TGF-ß1/mothers against decapentaplegic homolog 2 (Smad2) pathway. Taken together, we demonstrated that belumosudil ameliorates cardiac hypertrophy and fibrosis induced by TAC via inhibiting cardiac fibroblasts activation. In conclusion, belumosudil may be a promising therapeutic drug for cardiac hypertrophy and fibrosis induced by myocardial pressure overload.NEW & NOTEWORTHY Although ρ-associated kinase-2 (ROCK2) is the main isoform of ρ-associated kinases (ROCKs) in the heart and more important in cardiac hypertrophy and fibrosis than ρ-associated kinase-1 (ROCK1), there has not been any pharmacological approach to inhibit ROCK2 selectively. Our study demonstrates for the first time that belumosudil, the first ROCK2-specific inhibitor, effectively ameliorates cardiac hypertrophy, fibrosis, and dysfunction induced by TAC via inhibiting cardiac fibroblasts activation.

A Flexible and Ultra-Highly Sensitive Tactile Sensor through a Parallel Circuit by a Magnetic Aligned Conductive Composite.

The development of flexible electronic skins with high performance and multifunctional sensing capabilities is of great significance for applications ranging from healthcare monitoring to artificial intelligence. To mimic and surpass the high-gauge-factor sensing properties of human skin, structure design and appropriate material selection of sensors are both essentially required. Here, we present an efficient, low-cost fabrication strategy to construct an ultra-highly sensitive, flexible pressure sensor by embedding the aligned nickel-coated carbon fibers (NICFs) in a polydimethylsiloxane (PDMS) substrate. Our design substantially contributes to ultrahigh sensitivity through the parallel circuit formed by aligned NICFs as well as surface spinosum microstructure molded by sandpaper. As a result, the sensor exhibits excellent sensitivity (15 525 kPa-1), a fast response time (30 ms), and good stability over 3000 loading-unloading cycles. Furthermore, these superior sensing properties trigger applications in water quality and wave monitoring in conjunction with mechanical flexibility and robustness. As a precedent for adjusting the sensitivities of the sensor, the NICFs/PDMS sensor provides a promising method for multiscenario healthcare monitoring, multiscale pressure spatial distribution, and human-machine interfacing.

Facile Fabrication of Flexible Pressure Sensor with Programmable Lattice Structure.

Flexible pressure sensors have attracted intense attention because of their widespread applications in electronic skin, human-machine interfaces, and healthcare monitoring. Conductive porous structures are always utilized as active layers to improve the sensor sensitivities. However, flexible pressure sensors derived from traditional foaming techniques have limited structure designability. Besides, random pore distribution causes difference in structure and signal repeatability between different samples even in one batch, therefore limiting the batch production capabilities. Herein, we introduce a structure designable lattice structure pressure sensor (LPS) produced by bottom-up digital light processing (DLP) 3D printing technique, which is capable of efficiently producing 55 high fidelity lattice structure models in 30 min. The LPS shows high sensitivity (1.02 kPa-1) with superior linearity over a wide pressure range (0.7 Pa to 160 kPa). By adjusting the design parameters such as lattice type and layer thickness, the electrical sensitivities and mechanical properties of LPS can be accurately controlled. In addition, the LPS endures up to 60000 compression cycles (at 10 kPa) without any obvious electrical signal degradation. This benefits from the firm carbon nanotubes (CNTs) coating derived from high-energy ultrasonic probe and the subsequent thermal curing process of UV-heat dual-curing photocurable resin. For practical applications, the LPS is used for real time pulse monitoring, voice recognition and Morse code communication. Furthermore, the LPS is also integrated to make a flexible 4 × 4 sensor arrays for detecting spatial pressure distribution and a flexible insole for foot pressure monitoring.

Ultracomfortable Hierarchical Nanonetwork for Highly Sensitive Pressure Sensor.

Skin sensors are of paramount importance for flexible wearable electronics, which are active in medical diagnosis and healthcare monitoring. Ultrahigh sensitivity, large measuring range, and high skin conformability are highly desirable for skin sensors. Here, an ultrathin flexible piezoresistive sensor with high sensitivity and wide detection range is reported based on hierarchical nanonetwork structured pressure-sensitive material and nanonetwork electrodes. The hierarchical nanonetwork material is composed of silver nanowires (Ag NWs), graphene (GR), and polyamide nanofibers (PANFs). Among them, Ag NWs are evenly interspersed in a PANFs network, forming conductive pathways. Also, GR acts as bridges of crossed Ag NWs. The hierarchical nanonetwork structure and GR bridges of the pressure-sensitive material enable the ultrahigh sensitivity for the pressure sensor. More specifically, the sensitivity of 134 kPa-1 (0-1.5 kPa) and the low detection of 3.7 Pa are achieved for the pressure sensor. Besides, the nanofibers act as a backbone, which provides effective protection for Ag NWs and GR as pressure is applied. Hence, the pressure sensor possesses an excellent durability (>8000 cycles) and wide detection range (>75 kPa). Additionally, ultrathin property (7 µm) and nanonetwork structure provide high skin conformability for the pressure sensor. These superior performances lay a foundation for the application of pressure sensors in physiological signal monitoring and pressure spatial distribution detection.

Highly conductive, stretchable, and breathable epidermal electrode based on hierarchically interactive nano-network.

Stretchable electrodes have a crucial impact on the development of flexible electronic systems. Most conventionally blended nanocomposite electrodes are incapable of achieving high stretchability, breathability, or durability. In this work, a highly conductive, breathable, and stretchable epidermal electrode (SEE) is demonstrated by designing a hierarchically interactive nano-network that is composed of elastic polymer nano-fibers and multi-level silver nano-wires (AgNWs). The elastic polymer nano-fibers act as a continuous scaffold, and multi-level AgNWs embedded in the nano-fibers form branched conductive pathways. This structure enables high conductivity of the SEE at 4800 S cm-1 (at a significantly low AgNW content of 1.59 vt%), with high stretchability and excellent durability. For example, the SEE remained conductive even at a high strain of 500%, and it also maintained its initial resistance even after 30 000 cycles of strain at 50% or being washed with water for 100 000 cycles. The SEE was prepared by a facile in situ nonequilibrium fabrication process, and can easily be produced into an elastic circuit on a large scale, which provides a foundation for integrated and multifunctional electronic skins. The SEE possesses superior mechanical conformability and permeability of gas and liquid, and therefore, it was successfully applied in measuring electrocardiogram signals and thermal therapy, and exhibited highly robust and comfortable performances even while being washed with water or undergoing complex deformations.

Large-Area Integrated Triboelectric Sensor Array for Wireless Static and Dynamic Pressure Detection and Mapping.

Large-area flexible pressure sensors are of paramount importance for various future applications, such as electronic skin, human-machine interfacing, and health-monitoring devices. Here, a self-powered and large-area integrated triboelectric sensor array (ITSA) based on coupling a triboelectric sensor array and an array chip of CD4066 through a traditional connection is reported. Enabled by a simple and cost-effective fabrication process, the size of the ITSA can be scaled up to 38 × 38 cm2 . In addition, unlike previously proposed triboelectric sensors arrays, which can only react to the dynamic interaction, this ITSA is able to detect static and dynamic pressure. Moreover, through integrating the ITSA with a signal processing circuit, a complete wireless sensing system is present. Diverse applications of the system are demonstrated in detail, including detecting pressure, identifying position, tracking trajectory, and recognizing the profile of external contact objects. Thus, the ITSA in this work opens a new route in the direction of large-area, self-powered, and wireless triboelectric sensing systems.

Small-Sized, Lightweight, and Flexible Triboelectric Nanogenerator Enhanced by PTFE/PDMS Nanocomposite Electret.

The rapid development of flexible and wearable electronics calls for a sustainable solution of the power supply. In recent years, the energy-harvesting triboelectric nanogenerator (TENG) has attracted increasing attentions due to its sustainability, flexibility, and versatility. However, achieving both high electric output and flexibility at the same time remains to be a challenge. In this work, we reported a corona charging enhanced flexible triboelectric nanogenerator (EF-TENG) to harvest mechanical energy from human motions. The EF-TENG relied on the repeated contacts between a poly(tetrafluoroethylene)/poly(dimethylsiloxane) nanocomposite electret and a nanofibers/AgNWs electrode on arrayed silicone pyramids. When the EF-TENG (3.5 × 3.5 cm2) was pressed, the open-circuit voltage ( Voc), the short-circuit current ( Isc), and the power density could reach 275 V, 9.5 µA, and 802.31 mW/m2, respectively. The Voc of the EF-TENG was improved by 244% compared to the device of which the electret was not corona charged. Major factors that affected the electric output of the EF-TENG were discussed, including the height of the pyramids, the configuration of the pyramids array, and the properties of the electret nanocomposite. The EF-TENG only had an overall thickness of 1.3 mm and a weight of 1.7 g, making it especially suitable to be attached onto human body for harvesting mechanical energy from biomechanical motions.

Nanofiber-Reinforced Silver Nanowires Network as a Robust, Ultrathin, and Conformable Epidermal Electrode for Ambulatory Monitoring of Physiological Signals.

Extremely soft and thin electrodes with high skin conformability have potential applications in wearable devices for personal healthcare. Here, a submicrometer thick, highly robust, and conformable nanonetwork epidermal electrode (NEE) is reported. Electrospinning of polyamide nanofibers and electrospraying of silver nanowires are simultaneously performed to form a homogeneously convoluted network in a nonwoven way. For a 125 nm thick NEE, a low sheet resistance of ≈4 Ω sq-1 with an optical transmittance of ≈82% is achieved. Due to the nanofiber-based scaffold that undertakes most of the stress during deformation, the electric resistance of the NEE shows very little variation; less than 1.2% after 50 000 bending cycles. The NEE can form a fully conformal contact to human skin without additional adhesives, and the NEE shows a contact impedance that is over 50% lower than what is found in commercial gel electrodes. Due to conformal contact even under deformation, the NEE proves to be a stable, robust, and comfortable approach for measuring electrocardiogram signals, especially when a subject is in motion. These features make the NEE promising for use in the ambulatory measurement of physiological signals for healthcare applications.

Enhanced High-Resolution Triboelectrification-Induced Electroluminescence for Self-Powered Visualized Interactive Sensing.

Transforming dynamic mechanical interactions into visualized luminescence represents a research frontier in the detection of tactile stimuli. Here, we report a self-powered high-resolution triboelectrification-induced electroluminescence (HR-TIEL) sensor for visualizing the contact profile and dynamic trajectory of a contact object. As dynamic interactions occur, triboelectric charges at the contact interface generate a transient electric field that excites the phosphor. From the numerical simulation, a conductive layer based on transparent silver nanowires (AgNWs) guides the direction of the electric field and confines it within the profile boundary of the connect object. As a result, a sharp change of the electric field at the profile boundary greatly promotes the luminescence intensity as well as the lateral spatial resolution. Compared to a triboelectrification-induced electroluminescence (TIEL) sensor without the conductive layer, the luminescence intensity is enhanced by 90%, and the lateral spatial resolution of ∼500 µm is achieved. The HR-TIEL sensor is then demonstrated to reveal the surface texture on a nitrile glove. It relies on neither additional power supplies nor complex wiring/circuit design. This work paves the way for the feasible detection of tactile stimuli such as touch and slipping, which will be potentially used in robotics, human-machine interface, flexible and wearable electronics, and so forth.

Dehydroepiandrosterone attenuates pulmonary artery and right ventricular remodeling in a rat model of pulmonary hypertension due to left heart failure.

AIM: Pulmonary hypertension due to left heart failure (PH-LHF) is the most common cause of pulmonary hypertension. However, therapies for PH-LHF are lacking. Therefore, we investigated the effects and potential mechanism of dehydroepiandrosterone (DHEA) treatment in an experimental model of PH-LHF. MAIN METHOD: PH-LHF was induced in rats via ascending aortic banding. The rats then received daily DHEA from Day 1 to Day 63 for the prevention protocol or from Day 49 to Day 63 for the reversal protocol. Other ascending aortic banding rats were left untreated to allow development of PH and right ventricular (RV) failure. Sham ascending aortic banding rats served as controls. KEY FINDING: Significant increases in mean pulmonary arterial pressure (mPAP) and right ventricular end-diastolic diameter (RVEDD) were observed in the PH-LHF group. Therapy with DHEA prevented LHF-induced PH and RV failure by preserving mPAP and preventing RV hypertrophy and pulmonary artery remodeling. In preexisting severe PH, DHEA attenuated most lung and RV abnormalities. The beneficial effects of DHEA in PH-LHF seem to result from depression of the STAT3 signaling pathway in the lung. SIGNIFICANT: DHEA not only prevents the development of PH-LHF and RV failure but also rescues severe preexisting PH-LHF.

Flexible Porous Polydimethylsiloxane/Lead Zirconate Titanate-Based Nanogenerator Enabled by the Dual Effect of Ferroelectricity and Piezoelectricity.

Flexible piezoelectric nanogenerators have drawn considerable attention for their wide applications in harvesting ambient mechanical energy. Here, we report a flexible porous nanogenerator (FPNG) based on the dual effect of ferroelectricity and piezoelectricity. The electric output originated from the combination of the above two effects can be constructively added up, resulting in an enhancement of the electric output. With dimensions of 2 × 2 × 0.3 cm3, the FPNG can generate an open-circuit voltage ( Voc) of 29 V and a short-circuit current ( Isc) of 116 nA under a compressive force of 30 N. Besides, the FPNG is applicable to other forms of mechanical stimuli, including twisting and bending. Harvesting energy from a rowing bicycle tire is demonstrated in this report. This work provides a new route to promoting the electric output of piezoelectric nanogenerators.

Triboelectrification-Induced Self-Assembly of Macro-Sized Polymer Beads on a Nanostructured Surface for Self-Powered Patterning.

Here we report an electrostatic-templated self-assembly (ETSA) method for arbitrarily patterning millimeter-sized polymer beads on a nanostructured surface without using an extra voltage source. A patterned electrode underneath an electrification layer generates "potential wells" of the corresponding pattern at predefined window sites, which capture and anchor the beads within the window sites by electrostatic force. Analytical calculation is combined with numerical modeling to derive the electrostatic force acting on the beads, which is in great agreement with experimentally measured values. The generated pattern is solely determined by the predefined underlying electrode, making it arbitrarily switchable by using different electrode patterns. By transferring the assembled beads into an elastomer matrix, possible applications of the ETSA in fabricating optical and flexible displays are demonstrated.

Stretchable Porous Carbon Nanotube-Elastomer Hybrid Nanocomposite for Harvesting Mechanical Energy.

A stretchable porous nanocomposite (PNC) is reported based on a hybrid of a multiwalled carbon nanotubes network and a poly(dimethylsiloxane) matrix for harvesting energy from mechanical interactions. The deformation-enabled energy-generating process makes the PNC applicable to various mechanical interactions, including pressing, stretching, bending, and twisting. It can be potentially used as an energy solution for wearable electronics.

Dynamic Triboelectrification-Induced Electroluminescence and its Use in Visualized Sensing.

Triboelectrification-induced electroluminescence converts dynamic motion into light emission. Tribocharges resulting from the relative mechanical interactions between two dissimilar materials can abruptly and significantly alter the surrounding electric potential, exciting the electroluminescence of phosphor along the motion trajectory. The position, trajectory, and contour profile of a moving object can be visualized in high resolution, demonstrating applications in sensing.

High-Performance Organolead Halide Perovskite-Based Self-Powered Triboelectric Photodetector.

We report a MAPbI3-based self-powered photodetector (SPPD). It has a dual sensing mechanism that relies on the joint properties of a photoelectric effect and a triboelectric effect of the perovskite material. Both the photoconductivity and the surface triboelectric density of the MAPbI3-based composite thin film are significantly altered upon solar illumination, which results in considerable reduction of the output voltage. The SPPD exhibits excellent responsivity (7.5 V W(-1)), rapid response time (<80 ms), great repeatability, and broad detection range that extends from UV to visible regions. This work presents a route to designing high-performance self-powered photodetectors from the aspect of materials.

Interface-Free Area-Scalable Self-Powered Electroluminescent System Driven by Triboelectric Generator.

Self-powered system that is interface-free is greatly desired for area-scalable application. Here we report a self-powered electroluminescent system that consists of a triboelectric generator (TEG) and a thin-film electroluminescent (TFEL) lamp. The TEG provides high-voltage alternating electric output, which fits in well with the needs of the TFEL lamp. Induced charges pumped onto the lamp by the TEG generate an electric field that is sufficient to excite luminescence without an electrical interface circuit. Through rational serial connection of multiple TFEL lamps, effective and area-scalable luminescence is realized. It is demonstrated that multiple types of TEGs are applicable to the self-powered system, indicating that the system can make use of diverse mechanical sources and thus has potentially broad applications in illumination, display, entertainment, indication, surveillance and many others.

Triboelectric Charging at the Nanostructured Solid/Liquid Interface for Area-Scalable Wave Energy Conversion and Its Use in Corrosion Protection.

We report a flexible and area-scalable energy-harvesting technique for converting kinetic wave energy. Triboelectrification as a result of direct interaction between a dynamic wave and a large-area nanostructured solid surface produces an induced current among an array of electrodes. An integration method ensures that the induced current between any pair of electrodes can be constructively added up, which enables significant enhancement in output power and realizes area-scalable integration of electrode arrays. Internal and external factors that affect the electric output are comprehensively discussed. The produced electricity not only drives small electronics but also achieves effective impressed current cathodic protection. This type of thin-film-based device is a potentially practical solution of on-site sustained power supply at either coastal or off-shore sites wherever a dynamic wave is available. Potential applications include corrosion protection, pollution degradation, water desalination, and wireless sensing for marine surveillance.