Thrombectomy and stenting of pseudoaneurysm from transcarotid artery revascularization.

Background: Transcarotid artery revascularization (TCAR) is becoming an increasingly popular treatment of carotid stenosis. Despite this rapid adoption, little in the literature describes the associated complications of this procedure. Case Description: We report a case of a left M1 large-vessel occlusion following treatment of symptomatic, high-grade carotid stenosis with a TCAR procedure approximately three weeks earlier. The initial angiography demonstrated a pseudoaneurysm in the left common carotid artery at the site of TCAR access with a distal clot in the carotid stent. The clot within the stent was aspirated, and a mechanical thrombectomy was performed with a combination of a stent-retriever and aspiration catheter for thrombolysis in cerebral infarction 2B revascularization. Conclusion: The TCAR procedure offers a novel method for revascularization of carotid lesions; it does include its complications. While generally safe, access site complications such as pseudoaneurysms can always occur. Knowledge of this risk allows for appropriate surveillance and management should it occur.

A case series of eight amateur athletes: exercise-induced pre-/syncope during the Zurich Marathon 2023.

Background: Marathon running poses unique cardiovascular challenges, sometimes leading to syncopal episodes. We present a case series of athletes who experienced pre-/syncope during the Zurich Marathon 2023, accompanied by elevated cardiac biomarkers. Case summary: Eight athletes (2 females, 6 males) aged 21-35 years, with pre-/syncope and various additional diverse symptoms such as dizziness and palpitations during the (half-)marathon, were admitted to two emergency departments in Zurich, Switzerland. Clinical evaluations included electrocardiogram, echocardiography, telemetry, coronary computed tomography (CT) scans, and cardiac biomarker assessments. High-sensitive troponin T (hs-cTnT) was elevated in all cases at initial assessment and returned to normal at follow-up. All athletes who received CT scans had normal coronary and brain CT results. None of the eight athletes had underlying cardiovascular disease. Renal function normalized post-admission, and neurological symptoms resolved within hours. Creatinine levels indicated transient acute kidney injury. A common feature was inexperience in running, inadequate race preparation, particularly regarding fluid, electrolyte, and carbohydrate intake, along with pacing issues and lack of coping strategies with heat. Discussion: From a clinician perspective, the case series highlights the challenge in the management of patients with a pre-/syncopal event during strenuous exercise and elevated cardiac biomarkers. Diverse initial symptoms prompted tailored investigations. Adequate training, medical assessments, and awareness of syncope triggers are essential for marathon participants. Caution and pacing strategies are crucial, especially among novices in competitive running. This information is pertinent given the growing popularity of marathon events and prompts a standardized diagnostic approach after these events.

Edge Contacts to Atomically Precise Graphene Nanoribbons.

Bottom-up-synthesized graphene nanoribbons (GNRs) are an emerging class of designer quantum materials that possess superior properties, including atomically controlled uniformity and chemically tunable electronic properties. GNR-based devices are promising candidates for next-generation electronic, spintronic, and thermoelectric applications. However, due to their extremely small size, making electrical contact with GNRs remains a major challenge. Currently, the most commonly used methods are top metallic electrodes and bottom graphene electrodes, but for both, the contact resistance is expected to scale with overlap area. Here, we develop metallic edge contacts to contact nine-atom-wide armchair GNRs (9-AGNRs) after encapsulation in hexagonal boron-nitride (h-BN), resulting in ultrashort contact lengths. We find that charge transport in our devices occurs via two different mechanisms: at low temperatures (9 K), charges flow through single GNRs, resulting in quantum dot (QD) behavior with well-defined Coulomb diamonds (CDs), with addition energies in the range of 16 to 400 meV. For temperatures above 100 K, a combination of temperature-activated hopping and polaron-assisted tunneling takes over, with charges being able to flow through a network of 9-AGNRs across distances significantly exceeding the length of individual GNRs. At room temperature, our short-channel field-effect transistor devices exhibit on/off ratios as high as 3 × 105 with on-state current up to 50 nA at 0.2 V. Moreover, we find that the contact performance of our edge-contact devices is comparable to that of top/bottom contact geometries but with a significantly reduced footprint. Overall, our work demonstrates that 9-AGNRs can be contacted at their ends in ultra-short-channel FET devices while being encapsulated in h-BN.

Field and Thermal Emission Limited Charge Injection in Au-C60-Graphene van der Waals Vertical Heterostructures for Organic Electronics.

Among the family of 2D materials, graphene is the ideal candidate as top or interlayer electrode for hybrid van der Waals heterostructures made of organic thin films and 2D materials due to its high conductivity and mobility and its inherent ability of forming neat interfaces without diffusing in the adjacent organic layer. Understanding the charge injection mechanism at graphene/organic semiconductor interfaces is therefore crucial to develop organic electronic devices. In particular, Gr/C60 interfaces are promising building blocks for future n-type vertical organic transistors exploiting graphene as tunneling base electrode in a two back-to-back Gr/C60 Schottky diode configuration. This work delves into the charge transport mechanism across Au/C60/Gr vertical heterostructures fabricated on Si/SiO2 using a combination of techniques commonly used in the semiconductor industry, where a resist-free CVD graphene layer functions as a top electrode. Temperature-dependent electrical measurements show that the transport mechanism is injection limited and occurs via Fowler-Nordheim tunneling at low temperature, while it is dominated by a nonideal thermionic emission at room and high temperatures, with energy barriers at room temperature of ca. 0.58 and 0.65 eV at the Gr/C60 and Au/C60 interfaces, respectively. Impedance spectroscopy confirms that the organic semiconductor is depleted, and the energy band diagram results in two electron blocking interfaces. The resulting rectifying nature of the Gr/C60 interface could be exploited in organic hot electron transistors and vertical organic permeable-base transistors.

Nanoscale electronic transport at graphene/pentacene van der Waals interfaces.

We report a study on the relationship between the structure and electron transport properties of nanoscale graphene/pentacene interfaces. We fabricated graphene/pentacene interfaces from 10 to 30 nm thick needle-like pentacene nanostructures down to two-three layer (2L-3L) dendritic pentacene islands, and we measured their electron transport properties by conductive atomic force microscopy (C-AFM). The energy barrier at the interfaces, i.e., the energy position of the pentacene highest occupied molecular orbital (HOMO) with respect to the Fermi energy of graphene and the C-AFM metal tip was determined and discussed with an appropriate electron transport model (a double Schottky diode model and a Landauer-Buttiker model, respectively) taking into account the voltage-dependent charge doping of graphene. In both types of samples, the energy barrier at the graphene/pentacene interface is slightly larger than that at the pentacene/metal tip interface, resulting in 0.47-0.55 eV and 0.21-0.34 eV, respectively, for the 10-30 nm thick needle-like pentacene islands, and 0.92-1.44 eV and 0.67-1.05 eV, respectively, for the 2L-3L thick dendritic pentacene nanostructures. We attribute this difference to the molecular organization details of the pentacene/graphene heterostructures, with pentacene molecules lying flat on graphene in the needle-like pentacene nanostructures, while standing upright in the 2L-3L dendritic islands, as observed from Raman spectroscopy.

The Effect of C60 and Pentacene Adsorbates on the Electrical Properties of CVD Graphene on SiO2.

Graphene is an excellent 2D material for vertical organic transistors electrodes due to its weak electrostatic screening and field-tunable work function, in addition to its high conductivity, flexibility and optical transparency. Nevertheless, the interaction between graphene and other carbon-based materials, including small organic molecules, can affect the graphene electrical properties and therefore, the device performances. This work investigates the effects of thermally evaporated C60 (n-type) and Pentacene (p-type) thin films on the in-plane charge transport properties of large area CVD graphene under vacuum. This study was performed on a population of 300 graphene field effect transistors. The output characteristic of the transistors revealed that a C60 thin film adsorbate increased the graphene hole density by (1.65 ± 0.36) × 1012 cm-2, whereas a Pentacene thin film increased the graphene electron density by (0.55 ± 0.54) × 1012 cm-2. Hence, C60 induced a graphene Fermi energy downshift of about 100 meV, while Pentacene induced a Fermi energy upshift of about 120 meV. In both cases, the increase in charge carriers was accompanied by a reduced charge mobility, which resulted in a larger graphene sheet resistance of about 3 kΩ at the Dirac point. Interestingly, the contact resistance, which varied in the range 200 Ω-1 kΩ, was not significantly affected by the deposition of the organic molecules.

Charge Transport Across Au-P3HT-Graphene van der Waals Vertical Heterostructures.

Hybrid van der Waals heterostructures based on 2D materials and/or organic thin films are being evaluated as potential functional devices for a variety of applications. In this context, the graphene/organic semiconductor (Gr/OSC) heterostructure could represent the core element to build future vertical organic transistors based on two back-to-back Gr/OSC diodes sharing a common graphene sheet, which functions as the base electrode. However, the assessment of the Gr/OSC potential still requires a deeper understanding of the charge carrier transport across the interface as well as the development of wafer-scale fabrication methods. This work investigates the charge injection and transport across Au/OSC/Gr vertical heterostructures, focusing on poly(3-hexylthiophen-2,5-diyl) as the OSC, where the PMMA-free graphene layer functions as the top electrode. The structures are fabricated using a combination of processes widely exploited in semiconductor manufacturing and therefore are suited for industrial upscaling. Temperature-dependent current-voltage measurements and impedance spectroscopy show that the charge transport across both device interfaces is injection-limited by thermionic emission at high bias, while it is space charge limited at low bias, and that the P3HT can be assumed fully depleted in the high bias regime. From the space charge limited model, the out-of-plane charge carrier mobility in P3HT is found to be equal to µ ≈ 2.8 × 10-4 cm2 V-1 s-1, similar to the in-plane mobility reported in previous works, while the charge carrier density is N0 ≈ 1.16 × 1015 cm-3, also in agreement with previously reported values. From the thermionic emission model, the energy barriers at the Gr/P3HT and Au/P3HT interfaces result in 0.30 eV and 0.25 eV, respectively. Based on the measured barriers heights, the energy band diagram of the vertical heterostructure is proposed under the hypothesis that P3HT is fully depleted.

Correlative Cathodoluminescence Electron Microscopy: Immunolabeling Using Rare-Earth Element Doped Nanoparticles.

The understanding of living systems and their building blocks relies on the assessment of structure-function relationships at the nanoscale. Although electron microscopy (EM) gives access to ultrastructural imaging with nanometric resolution, the unambiguous localization of specific molecules is challenging. An EM approach capable of localizing biomolecules with respect to the cellular ultrastructure will offer a direct route to the molecular blueprints of biological systems. In an approach departing from conventional correlative imaging, an electron beam may be used as excitation source to generate optical emission with nanometric resolution, that is, cathodoluminescence (CL). Once suitable luminescent labels become available, CL may be harnessed to enable identification of biomolecule labels based on spectral signatures rather than electron density and size. This work presents CL-enabled immunolabeling based on rare-earth element doped nanoparticle-labels allowing specific molecules to be visualized at nanoscale resolution in the context of the cellular ultrastructure. Folic acid decorated nanoparticles exhibiting single particle CL emission are employed to specifically label receptors and identify characteristic receptor clustering on the surface of cancer cells. This demonstration of CL immunotargeting gives access to protein localization in the context of the cellular ultrastructure and paves the way for immunolabeling of multiple proteins in EM.

In Vivo Shaping of Inorganic Functional Devices using Microalgae.

The usage of biomineralization processes performed by living microalgae to create 3D nanostructured materials are advantageous compared to conventional synthesis routes. Exploitation of in vivo shaping using living cells leads to inorganic intricate biominerals, produced with low environmental impact. Since biomineralization processes are genetically controlled, the formation of nanostructured materials is highly reproducible. The shells of microalgae, like coccoliths, are particularly of great interest. This study shows the generation of mesoporous highly structured functional materials with induced optoelectronical properties using in vivo processes of the microalga species Emiliania huxleyi. It demonstrates the metabolically driven incorporation of the lanthanide terbium into the coccoliths of E. huxleyi as a route for the synthesis of finely patterned photoluminescent particles by feeding the microalgae with this luminescent element. The resulting green luminescent particles have hierarchical ordered pores on the nano- and microscale and may act as powerful tools for many applications; they may serve as imaging probes for biomedical applications, or in microoptics. The luminescent coccoliths combine a unique hierarchical structure with a characteristic luminescence pattern, which make them superior to conventional produced Tb doted material. With this study, the possibility of the further exploitation of coccoliths as advanced functional materials for nanotechnological applications is given.

Ultrabright and Stable Luminescent Labels for Correlative Cathodoluminescence Electron Microscopy Bioimaging.

The mechanistic understanding of structure-function relationships in biological systems heavily relies on imaging. While fluorescence microscopy allows the study of specific proteins following their labeling with fluorophores, electron microscopy enables holistic ultrastructural analysis based on differences in electron density. To identify specific proteins in electron microscopy, immunogold labeling has become the method of choice. However, the distinction of immunogold-based protein labels from naturally occurring electron dense granules and the identification of several different proteins in the same sample remain challenging. Correlative cathodoluminescence electron microscopy (CCLEM) bioimaging has recently been suggested to provide an attractive alternative based on labels emitting characteristic light. While luminescence excitation by an electron beam enables subdiffraction imaging, structural damage to the sample by high-energy electrons has been identified as a potential obstacle. Here, we investigate the feasibility of various commonly used luminescent labels for CCLEM bioimaging. We demonstrate that organic fluorophores and semiconductor quantum dots suffer from a considerable loss of emission intensity, even when using moderate beam voltages (2 kV) and currents (0.4 nA). Rare-earth element-doped nanocrystals, in particular Y2O3:Tb3+ and YVO4:Bi3+,Eu3+ nanoparticles with green and orange-red emission, respectively, feature remarkably high brightness and stability in the CCLEM bioimaging setting. We further illustrate how these nanocrystals can be readily differentiated from morphologically similar naturally occurring dense granules based on optical emission, making them attractive nanoparticle core materials for molecular labeling and (multi)color CCLEM.

Corrosion fatigue in DLC-coated articulating implants: an accelerated methodology to predict realistic interface lifetime.

We present a methodology to accelerate and estimate the lifetime of an interlayer under dynamic loading in body-like media. It is based on accelerating corrosion fatigue processes taking place at the buried interface of a Si-based adhesion-promoting interlayer in articulating implants on a CoCrMo biomedical alloy; the implants are coated with diamond-like carbon (DLC). The number of interface loading cycles to delamination is determined by reciprocal loading in corrosive fluid. Its dependence on the load is summarized in a Wöhler-like curve of a DLC/DLC-Si/CoCrMo system in body working conditions: cyclic stresses at 37 °C in phosphate buffered saline (PBS). The presence of oxygen as a contaminant strongly affects the lifetime of the interface under corrosion fatigue. The main parameters acting on the prediction, with a special emphasis on simulated in vivo conditions, are analyzed and discussed: the media (PBS, Milli-Q water, NaCl, Ringers' solution and bovine calf serum), the load, the frequency and the composition of the interface determined by X-ray photoelectron spectroscopy.

Epitaxial Thin Films as a Model System for Li-Ion Conductivity in Li4Ti5O12.

Using an epitaxial thin-film model system deposited by pulsed laser deposition (PLD), we study the Li-ion conductivity in Li4Ti5O12, a common anode material for Li-ion batteries. Epitaxy, phase purity, and film composition across the film thickness are verified employing out-of-plane and in-plane X-ray diffraction, transmission electron microscopy, time-of-flight mass spectrometry, and elastic recoil detection analysis. We find that epitaxial Li4Ti5O12 behaves like an ideal ionic conductor that is well described by a parallel RC equivalent circuit, with an ionic conductivity of 2.5 × 10-5 S/cm at 230 °C and an activation energy of 0.79 eV in the measured temperature range of 205 to 350 °C. Differently, in a co-deposited polycrystalline Li4Ti5O12 thin film with an average in-plane grain size of <10 nm, a more complex behavior with contributions from two distinct processes is observed. Ultimately, epitaxial Li4Ti5O12 thin films can be grown by PLD and reveal suitable transport properties for further implementation as zero-strain and grain boundary free anodes in future solid-state microbattery designs.

DRAGON score predicts functional outcomes in acute ischemic stroke patients receiving both intravenous tissue plasminogen activator and endovascular therapy.

BACKGROUND: The DRAGON score, which includes clinical and computed tomographic (CT) scan parameters, predicts functional outcomes in ischemic stroke patients treated with intravenous tissue plasminogen activator (IV tPA). We assessed the utility of the DRAGON score in predicting functional outcome in stroke patients receiving both IV tPA and endovascular therapy. METHODS: A retrospective chart review of patients treated at our institution from February 2009 to October 2015 was conducted. All patients with computed tomography angiography (CTA) proven large vessel occlusions (LVO) who underwent intravenous thrombolysis and endovascular therapy were included. Baseline DRAGON scores and modified Rankin Score (mRS) at the time of hospital discharge was calculated. Good outcome was defined as mRS ≤3. RESULTS: Fifty-eight patients with LVO of the anterior circulation were studied. The mean DRAGON score of patients on admission was 5.3 (range, 3-8). All patients received IV tPA and endovascular therapy. Multivariate analysis demonstrated that DRAGON scores ≥7 was associated with higher mRS (P < 0.006) and higher mortality (P < 0.0001) compared with DRAGON scores ≤6. Patients with DRAGON scores of 7 and 8 on admission had a mortality rate of 3.8% and 40%, respectively. CONCLUSIONS: The DRAGON score can help predict better functional outcomes in ischemic stroke patients receiving both IV tPA and endovascular therapy. This data supports the use of the DRAGON score in selecting patients who could potentially benefit from more invasive therapies such as endovascular treatment. Larger prospective studies are warranted to further validate these results.

Ion beam profiling from the interaction with a freestanding 2D layer.

Recent years have seen a great potential of the focused ion beam (FIB) technology for the nanometer-scale patterning of a freestanding two-dimensional (2D) layer. Experimentally determined sputtering yields of the perforation process can be quantitatively explained using the binary collision theory. The main peculiarity of the interaction between the ion beams and the suspended 2D material lies in the absence of collision cascades, featured by no interaction volume. Thus, the patterning resolution is directly set by the beam diameters. Here, we demonstrate pattern resolution beyond the beam size and precise profiling of the focused ion beams. We find out that FIB exposure time of individual pixels can influence the resultant pore diameter. In return, the pore dimension as a function of the exposure dose brings out the ion beam profiles. Using this method of determining an ion-beam point spread function, we verify a Gaussian profile of focused gallium ion beams. Graphene sputtering yield is extracted from the normalization of the measured Gaussian profiles, given a total beam current. Interestingly, profiling of unbeknown helium ion beams in this way results in asymmetry of the profile. Even triangular beam shapes are observed at certain helium FIB conditions, possibly attributable to the trimer nature of the beam source. Our method of profiling ion beams with 2D-layer perforation provides more information on ion beam profiles than the conventional sharp-edge scan method does.

Pipeline embolization device as primary treatment for cervical internal carotid artery pseudoaneurysms.

BACKGROUND: Limited data exists on the durability and occlusion rate of treating extracranial cervical internal carotid artery pseudoaneurysms using the pipeline embolization device (PED) flow-diverting stent. METHODS: Three patients presenting with dissecting cervical internal carotid artery pseudoaneurysms were treated with the PED as the sole treatment modality. RESULTS: In all three patients, successful aneurysmal occlusion and parent vessel reconstruction occurred on immediate angiography and continued on 6-month follow-up. No immediate or delayed complications were seen, and all patients remained neurologically intact. CONCLUSION: Complete aneurysmal occlusion and long-term angiographic occlusion can occur after PED treatment of cervical carotid pseudoaneurysms. In select patients, the PED can be a suitable primary treatment modality with good neurological outcome for cervical carotid pseudoaneurysms.

General Anesthesia During Endovascular Stroke Therapy Does Not Negatively Impact Outcome.

OBJECTIVE: Recent randomized trials have demonstrated that endovascular therapy improves outcomes in patients with an acute ischemic stroke from a large vessel occlusion. Subgroup analysis of the Multicenter Randomized CLinical trial of Endovascular treatment for Acute ischemic stroke in the Netherlands (MR CLEAN) study found that patients undergoing general anesthesia (GA) for the procedure did worse than those with nongeneral anesthesia (non-GA). Current guidelines now suggest that we consider non-GA over GA, without large, randomized trials specifically designed to address this issue. We sought to review our experience and outcomes in a program where we routinely use GA in patients undergoing mechanical thrombectomy with similar techniques. METHODS: Patients with anterior circulation strokes who received intravenous tissue plasminogen activator (IV-tPA) and endovascular stroke therapy were included in the analysis. The National Institutes of Health Stroke Scale (NIHSS) on admission and discharge and modified Rankin scale scores at discharge were recorded and compared with the outcome measurements of MR CLEAN. RESULTS: Sixty patients were identified: 39 males and 21 females with a mean age of 62 (range of 29-88). Forty-seven patients were transferred from outside primary stroke centers, while 13 patients presented directly to our institution. Median NIHSS on admission was 15. The median time of symptom onset to endovascular therapy was 265 minutes, with an interquartile range of 81 minutes. Using the thrombolysis in cerebral infarction (TICI) scale, recanalization of TICI 2b-3 was achieved in 76.4% of recorded patients (42/55 recorded). At discharge, mortality was 16.7% (10/60), median NIHSS was 5, and 38.3% (23/60) of patients had a modified Rankin Scale score of 0-2. CONCLUSIONS: General anesthesia does not worsen outcome in patients undergoing mechanical thrombectomy when compared to historical subgroups. Despite a longer time from symptom onset to treatment, our outcomes for patients receiving GA compare favorably to the GA and non-GA groups in MR CLEAN.

Successful treatment of ibrutinib-associated central nervous system hemorrhage with platelet transfusion support.

Ibrutinib is a novel targeted therapy for B-cell malignancies. Hemorrhagic events were reported in the original trials, however the mechanism of bleeding is just being elucidated. Recent studies have demonstrated platelet dysfunction as a mechanism of bleeding. Currently we report two patients who developed life-threatening central nervous system hemorrhage while receiving ibrutinib for chronic lymphoid leukemia (CLL) and mantle cell lymphoma, respectively. Both patients improved rapidly after platelet transfusions even though their platelet counts were normal or only mildly reduced at the time of hemorrhage. We suggest that platelet transfusions can ameliorate the platelet dysfunction defect of ibrutinib and can support the patient through the critical period until new platelet production occurs.