Evolving Therapeutic Landscape of Intracerebral Hemorrhage: Emerging Cutting-Edge Advancements in Surgical Robots, Regenerative Medicine, and Neurorehabilitation Techniques.

Intracerebral hemorrhage (ICH) is the most serious form of stroke and has limited available therapeutic options. As knowledge on ICH rapidly develops, cutting-edge techniques in the fields of surgical robots, regenerative medicine, and neurorehabilitation may revolutionize ICH treatment. However, these new advances still must be translated into clinical practice. In this review, we examined several emerging therapeutic strategies and their major challenges in managing ICH, with a particular focus on innovative therapies involving robot-assisted minimally invasive surgery, stem cell transplantation, in situ neuronal reprogramming, and brain-computer interfaces. Despite the limited expansion of the drug armamentarium for ICH over the past few decades, the judicious selection of more efficacious therapeutic modalities and the exploration of multimodal combination therapies represent opportunities to improve patient prognoses after ICH.

The Role of ICP Monitoring in Minimally Invasive Surgery for the Management of Intracerebral Hemorrhage.

Intracerebral hemorrhage (ICH) is the second major stroke type, with high incidence, high disability rate, and high mortality. At present, there is no effective and reliable treatment for ICH. As a result, most patients have a poor prognosis. Minimally invasive surgery (MIS) is the fastest treatment method to remove hematoma, which is characterized by less trauma and easy operation. Some studies have confirmed the safety of MIS, but there are still no reports showing that it can significantly improve the functional outcome of ICH patients. Intracranial pressure (ICP) monitoring is considered to be an important part of successful treatment in traumatic brain diseases. By monitoring ICP in real time, keeping stable ICP could help patients with craniocerebral injury get a good prognosis. In the course of MIS treatment of ICH patients, keeping ICP stable may also promote patient recovery. In this review, we will take ICP monitoring as the starting point for an in-depth discussion.

Surgical Robotics for Intracerebral Hemorrhage Treatment: State of the Art and Future Directions.

Intracerebral hemorrhage (ICH) is a stroke subtype with high mortality and disability, and there are no proven medical treatments that can improve the functional outcome of ICH patients. Robot-assisted neurosurgery is a significant advancement in the development of minimally invasive surgery for ICH. This review encompasses the latest advances and future directions of surgical robots for ICH. First, three robotic systems for neurosurgery applied to ICH are illustrated. Second, the key technologies of robot-assisted surgery for ICH are introduced in aspects of stereotactic technique and navigation, the puncture instrument, and hematoma evacuation. Finally, the limitations of current surgical robots are summarized, and the possible development direction is discussed, which is named "multisensor fusion and intelligent aspiration control of minimally invasive surgical robot for ICH". It is expected that the new generation of surgical robots for ICH will facilitate quantitative, precise, individualized, standardized treatment strategies for ICH.

The Regulatory Effect of Braided Silk Fiber Skeletons with Differential Porosities on In Vivo Vascular Tissue Regeneration and Long-Term Patency.

The development of small-diameter vascular grafts that can meet the long-term patency required for implementation in clinical practice presents a key challenge to the research field. Although techniques such as the braiding of scaffolds can offer a tunable platform for fabricating vascular grafts, the effects of braided silk fiber skeletons on the porosity, remodeling, and patency in vivo have not been thoroughly investigated. Here, we used finite element analysis of simulated deformation and compliance to design vascular grafts comprised of braided silk fiber skeletons with three different degrees of porosity. Following the synthesis of low-, medium-, and high-porosity silk fiber skeletons, we coated them with hemocompatible sulfated silk fibroin sponges and then evaluated the mechanical and biological functions of the resultant silk tubes with different porosities. Our data showed that high-porosity grafts exhibited higher elastic moduli and compliance but lower suture retention strength, which contrasted with low-porosity grafts. Medium-porosity grafts offered a favorable balance of mechanical properties. Short-term in vivo implantation in rats indicated that porosity served as an effective means to regulate blood leakage, cell infiltration, and neointima formation. High-porosity grafts were susceptible to blood leakage, while low-porosity grafts hindered graft cellularization and tended to induce intimal hyperplasia. Medium-porosity grafts closely mimicked the biomechanical behaviors of native blood vessels and facilitated vascular smooth muscle layer regeneration and polarization of infiltrated macrophages to the M2 phenotype. Due to their superior performance and lack of occlusion, the medium-porosity vascular grafts were evaluated in long-term (24-months) in vivo implantation. The medium-porosity grafts regenerated the vascular smooth muscle cell layers and collagen extracellular matrix, which were circumferentially aligned and resembled the native artery. Furthermore, the formed neoarteries pulsed synchronously with the adjacent native artery and demonstrated contractile function. Overall, our study underscores the importance of braided silk fiber skeleton porosity on long-term vascular graft performance and will help to guide the design of next-generation vascular grafts.

A warm hug from a robot: A dual-mode e-skin with programming compliance.

Recent achievements in the field of electronic skin (e-skin) have provided promising technology for service robots. However, the development of a bionic perception system that exhibits superior performance in terms of safety and interaction quality remains a challenge. Here, we demonstrate a biomimetic soft e-skin that is composed of an array of capacitors and air pouches. It is a single platform that shows dual-mode sensing capabilities of tactile sensing and proximity perception. We optimized the shape and area of the electrode via simulation of the approach of a robot to an object. Moreover, the compliance and temperature of the e-skin can be actively adjusted by tuning the pressure and heat of the air inside the pouches. The e-skin provided dual-mode sensing feedback and soft touch for humanoid service robots, for example, when a robot hugged a man, which illustrated the potential of this e-skin for applications in human-robot interactions.

Three-dimensional silk fibroin scaffolds incorporated with graphene for bone regeneration.

Porous three-dimensional (3D) silk fibroin (SF) scaffolds were widely applied for bone regeneration and showed excellent biocompatibility and biodegradability. Recently graphene was developed for bone scaffolds due to its osteogenic properties. Thus, we combine the SF and graphene to improve the osteogenic properties of SF scaffolds. In our study, we explored the incorporation of SF scaffolds with graphene to develop osteogenic scaffolds capable of accelerating bone formation. The 3D SF scaffolds were fabricated with different contents of graphene (0, 0.5, and 2%). Fluorescence images showed that the graphene nanosheets were homogeneously dispersed in the SF scaffolds. The addition of graphene affected the microarchitecture of the scaffolds. The G/SF scaffolds were cocultured with rat bone marrow-derived mesenchymal stem cells (rBMSCs) for 21 days. The cell morphology and cell proliferation study suggested that 0 and 0.5% G/SF scaffolds displayed good cell proliferation. In addition, immunofluorescent staining (e.g., osteonectin, osteopontin, and osteocalcin) and ALP activities indicated that the osteogenic properties was more actively exhibited on 0.5% G/SF scaffolds compared with the other groups. Our results indicated that SF scaffolds incorporated with graphene could be an appropriate scaffold for bone tissue engineering.

Pre-Impact Fall Detection with CNN-Based Class Activation Mapping Method.

In this paper, we report our improvement on the prediction accuracy of pre-impact fall detection by applying a learning-based method on the real-time data from an IMU (inertial measurement unit)-sensor mounted on the waist, making it possible to achieve a high accuracy on a wearable device with the extracted features. Using the fixed threshold method is difficult for achieving satisfactory detection accuracy, due to various characteristics and behaviors in the movement of different individuals. In contrast, one could realize high-accuracy detection with machine learning-based methods, but it is difficult to apply them in the wearable devices due to the high hardware requirement. Our method merges the two methods above. We build a convolutional neural network (CNN) with a class activation mapping (CAM) method, which could highlight the class-specific region in the data and obtain a hot map of the fall data. After training on the MobiAct dataset, the model could achieve high-accuracy detection (95.55%) and obtain the region with high contributions to the classification. Then, we manually extract effective features and characteristics of this region and form our special threshold method, achieving pre-impact fall detection in real-world data. Consequently, our method achieves accuracy of 95.33% and a detection time of within 400 ms.

Multimodal pipe-climbing robot with origami clutches and soft modular legs.

In nature, climbing trees and pipes of varying diameters or even navigating inside of hollow pipes and tree holes is easy for some climbing animals and insects. However, today's pipe-climbing robots, which are important for automatically conducting periodic inspections and maintenance of pipelines to save time and keep humans away from hazardous environments, are designed mainly for a specific task, limiting their adaptability to different working scenarios and further implementation in real-life. In this paper, we propose a pipe-climbing robot with a soft linear actuator for bioinspired propulsion, two origami clutches to realize multi-degrees-of-freedom (DoF) motion and two pairs of soft modular legs for multimodal climbing. Design, modeling and experimental validation of the origami clutch are introduced in detail. Preliminary experimental results show that we can achieve a stroke of up to 289.6% and a maximum 45° bending angle on the soft linear actuator by regulating the air pressure inside the soft actuator and origami clutches. Additionally, by choosing the leg-type, three climbing modes, including out-pipe versatile mode, out-pipe high-force mode and in-pipe mode can be realized for particular working scenarios. A prototype climbing robot demonstrates that in out-pipe versatile mode, the robot can climb on the exterior of pipes made of various materials including PVC, rubber and metal with diameters ranging from 105 to 117 mm. In the out-pipe high-force mode, the climber can navigate along a specific pipe carrying maximum 675 g external load at the top or 200 g hanging from the bottom, as well as keeping functional without failure under static loads as high as 1968 g. In the in-pipe mode, the robot is able to travel inside pipes. This research might bridge the design gap between in-pipe and out-pipe climbing robots while offering an alternative option for soft robots to execute multi-DoF motion.

Evaluation and Prediction of Mass Transport Properties for Porous Implant with Different Unit Cells: A Numerical Study.

Efficient exchange of nutrients and wastes required for cell proliferation and differentiation plays a pivotal role in improving the service life of porous implants. In this study, mass transport properties for porous implant with different unit cells were evaluated and predicted when the porosities are kept the same. To this end, three typical unit cells (diamond (DO), rhombic dodecahedron (RD), and octet truss (OT)) were selected, in which DO displayed diagonal-symmetrical shape, while RD and OT share midline-symmetrical structure. Then, single unit cells were designed quantitatively, and its shape parameters were measured and calculated. Moreover, corresponding porous scaffolds with same outline size were created, respectively. Furthermore, using computational fluid dynamics (CFD) methodology, flow performances with Dulbecco's Modified Eagle's Medium (DMEM) in vitro were simulated for three different porous implants, and flow trajectory, velocity, and wall shear stress which could reflect the properties of mass transfer and tissue regeneration were compared and predicted numerically. Results demonstrated that different unit cell could directly lead to different mass transport properties for porous implant, in spite of same porosity, scaffold size, and service environment. Additionally, by the results, DO displayed greater tortuosity, more appropriate areas, and smoother shear stress distribution than RD and OT, which would provide better surroundings for implant fixation and tissue regeneration. However, RD and OT showed better mass transport properties because of bigger maximum velocity (5.177 mm/s, 4.381 mm/s) than DO (3.941 mm/s). This study would provide great helps for unit cell selection and biological performance optimization for 3D printed bone implants.

Chain-Like Granular Jamming: A Novel Stiffness-Programmable Mechanism for Soft Robotics.

The ability to regulate the mechanical stiffness in a large range could be extremely important for soft robots to interact with the environment more effectively. In this article, we propose a novel chain-like granular jamming mechanism to achieve a large range of stiffness variation instantly, based on a method that is totally different from existing vacuum-based granular jamming systems. Theoretical modeling is introduced to find the best combination of granules to form the chain-like structure (CLS) and experiments are conducted to demonstrate it. The experimental results indicate that the novel jamming structure is able to achieve a stiffness variation range as large as 50.7 folds. To further validate the effectiveness of the CLS, a soft-rigid hybrid actuator based on the jamming structure is proposed and an integrated fabrication method is provided. Furthermore, an anthropomorphic hand based on the hybrid actuators is developed and the experimental results show that the hand is not only versatile enough to manipulate various objects with different weights, material properties, shapes, and surface characteristics at the soft state, like existing soft grippers, but also can lift heavy objects (1.5 kg in a cylindrical grasping gesture and 3.52 kg in a hook gesture) at the rigid state, which could be difficult for other soft grippers. Finally, the hand is integrated into our homemade service robot, significantly improving the practicability and safety of the robot when serving humans.

Numerical Evaluation and Prediction of Porous Implant Design and Flow Performance.

Porous structure has been widely acknowledged as important factor for mass transfer and tissue regeneration. This study investigates effect of aimed-control design on mass transfer and tissue regeneration of porous implant with regular unit cell. Two shapes of unit cells (Octet truss, and Rhombic dodecahedron) were selected, which have similar symmetrical structure and are commonly used in practice. Through parametric design, porous scaffolds with the strut sizes of φ 0.5, 0.7, 0.9, and 1.1mm were created, respectively. Then using fluid flow simulation method, flow velocity, permeability, and shear stress which could reflect the properties of mass transfer and tissue regeneration were compared and evaluated, and the relationships between porous structure's physical parameters and flow performance were studied. Results demonstrated that unit cell shape and strut size greatly determine and influence other physical parameters and flow performances of porous implant. With the increasing of strut size, pore size and porosity linearly decrease, but the volume, surface area, and specific surface area increased. Importantly, implant with smaller strut size resulted in smaller flow velocity directly but greater permeability and more appropriate shear stress, which should be beneficial to cell attachment and proliferation. This study confirmed that porous implant with different unit cell shows different performances of mass transfer and tissue regeneration, and unit cell shape and strut size play vital roles in the control design. These findings could facilitate the quantitative assessment and optimization of the porous implant.

An Open-Structure Treadmill Gait Trainer: From Research to Application.

Lower limb rehabilitation robots are designed to enhance gait function in individuals with motor impairments. Although numerous rehabilitation robots have been developed, only few of these robots have been used in practical health care, particularly in China. The objective of this study is to construct a lower limb rehabilitation robot and bridge the gap between research and application. Open structure to facilitate practical application was created for the whole robot. Three typical movement patterns of a single leg were adopted in designing the exoskeletons, and force models for patient training were established and analyzed under three different conditions, respectively, and then a control system and security strategy were introduced. After establishing the robot, a preliminary experiment on the actual use of a prototype by patients was conducted to validate the functionality of the robot. The experiment showed that different patients and stages displayed different performances, and results on the trend variations across patients and across stages confirmed the validity of the robot and suggested that the design may lead to a system that could be successful in the treatment of patients with walking disorders in China. Furthermore, this study could provide a reference for a similar application design.

A Survey of Bioinspired Jumping Robot: Takeoff, Air Posture Adjustment, and Landing Buffer.

A bioinspired jumping robot has a strong ability to overcome obstacles. It can be applied to the occasion with complex and changeable environment, such as detection of planet surface, postdisaster relief, and military reconnaissance. So the bioinspired jumping robot has broad application prospect. The jumping process of the robot can be divided into three stages: takeoff, air posture adjustment, and landing buffer. The motivation of this review is to investigate the research results of the most published bioinspired jumping robots for these three stages. Then, the movement performance of the bioinspired jumping robots is analyzed and compared quantitatively. Then, the limitation of the research on bioinspired jumping robots is discussed, such as the research on the mechanism of biological motion is not thorough enough, the research method about structural design, material applications, and control are still traditional, and energy utilization is low, which make the robots far from practical applications. Finally, the development trend is summarized. This review provides a reference for further research of bioinspired jumping robots.