Treatment for wide-neck bifurcation cerebral aneurysms (WNBAs) is widely performed by endovascular treatment as well as open surgical clipping. However, due to factors such as the shape and size of the aneurysms, as well as the anatomical features of surrounding branch vessels, there are some cases in which simple coiling or conventional adjunctive techniques, such as balloon-assisted or neck bridge stent-assisted coiling, are not sufficient to achieve a satisfactory cure. Against this backdrop, the device known as the Woven EndoBridge (WEB) (MicroVention, Aliso Viejo, CA, USA) was developed and can be deployed directly into the aneurysm for treatment. Over a decade has passed since its development, and it is now used in many countries worldwide. This review provides insights into the evolution of the WEB device from its development to the date of this writing, highlighting the unique features of the device and its treatment indications. Additionally, it discusses the posttreatment course, perspectives on recurrence and retreatment, imaging assessments, and potential off-label use based on numerous studies primarily conducted in Europe and the USA.
Polar topological structures such as skyrmions and merons have become an emerging research field due to their rich functionalities and promising applications in information storage. Up to now, the obtained polar topological structures are restricted to a few limited ferroelectrics with complex heterostructures, limiting their large-scale practical applications. Here, we circumvent this limitation by utilizing a nanoscale ripple-generated flexoelectric field as a universal means to create rich polar topological configurations in nonpolar nanofilms in a controllable fashion. Our extensive phase-field simulations show that a rippled SrTiO_{3} nanofilm with a single bulge activates polarizations that are stabilized in meron configurations, which further undergo topological transitions to Néel-type and Bloch-type skyrmions upon varying the geometries. The formation of these topologies originates from the curvature-dependent flexoelectric field, which extends beyond the common mechanism of geometric confinement that requires harsh energy conditions and strict temperature ranges. We further demonstrate that the rippled nanofilm with three-dimensional ripple patterns can accommodate other unreported modulated phases of ferroelectric topologies, which provide ferroelectric analogs to the complex spin topologies in magnets. The present study not only unveils the intriguing nanoscale electromechanical properties but also opens exciting opportunities to design various functional topological phenomena in flexible materials.
INTRODUCTION: Glycemic control is essential for improving the prognosis of cardiac surgery, although precise recommendations have not yet been established. Under a constant blood glucose level, the insulin infusion rate correlates with insulin resistance during glycemic control using an artificial pancreas (AP). We conducted this retrospective study to elucidate changes in intraoperative insulin sensitivity as a first step to creating glycemic control guidelines. METHODS: Fifty-five cardiac surgery patients at our hospital who underwent intraoperative glycemic control using an AP were enrolled. Twenty-three patients undergoing surgical procedures requiring cardiac arrest under hypothermic cardiopulmonary bypass (CPB) with minimum rectal temperatures lower than 32°C, 13 patients undergoing surgical procedures requiring cardiac arrest under hypothermic CPB with minimum rectal temperatures of 32°C, eight patients undergoing on-pump beating coronary artery bypass grafting and 11 patients undergoing off-pump coronary artery bypass were assigned to groups A, B, C and D, respectively. We analyzed the time course of changes in the data derived from glycemic control using the AP. RESULTS: Significant time course changes were observed in groups A and B, but not in groups C and D. Insulin resistance was induced after the start of hypothermic CPB in groups A and B, and the induced change was not resolved by the rewarming procedure, remaining sustained until the end of surgery. CONCLUSIONS: Hypothermia is the predominant factor of the induced insulin resistance during cardiac surgery. Thus, careful glycemic management during hypothermic CPB is important. Prospective clinical studies are required to confirm the findings of this study.
Coronary Artery Bypass, Off-Pump , Heart Arrest , Hypothermia, Induced , Insulin Resistance , Pancreas, Artificial , Humans , Retrospective Studies , Prospective Studies , Cardiopulmonary Bypass/methods
PURPOSE: Recently, a novel device, the Woven Endo Bridge (WEB), was developed for wide-neck bifurcation intracranial aneurysms (WNBAs). The aim of this study is to investigate factors that contribute to adequate occlusion (AO) after the operation using detailed radiological images. METHODS: The subjects were 29 patients with 29 aneurysms who received WEB implantation for WNBAs between December 2020 and April 2022. We assessed the contributing factors to AO by retrospectively comparing the AO group and non-AO group. RESULTS: The mean age was 64.6 ± 13.1 years, and 18 were female (62.1%). The mean aneurysm dome width, aneurysm height, and aneurysm neck diameter were 4.8 ± 0.6 mm, 5.1 ± 0.6 mm, and 3.7 ± 0.6 mm, respectively. After about 6 months, 22 of 29 patients (75.9%) had AO. Complications were observed in 2 patients (6.9%), renal artery injury in one, and minor cerebral infarction in another, but the modified Rankin scale scores of both patients remained unchanged. Multivariate analysis extracted only WEB shape modification (WSM) as a contributing factor to AO (odds ratio: 0.912, p = 0.0287). CONCLUSION: WEB implantation for WNBAs was a treatment modality with acceptable efficacy and safety. WSM was the only significant factor contributing to non-AO after the treatment. We should clarify the mechanisms or causes of WSM to achieve AO after WEB implantation in future.
Embolization, Therapeutic , Endovascular Procedures , Intracranial Aneurysm , Humans , Female , Middle Aged , Aged , Male , Treatment Outcome , Intracranial Aneurysm/diagnostic imaging , Intracranial Aneurysm/surgery , Retrospective Studies , Embolization, Therapeutic/methods
Ultimately small multiferroics with coupled ferroelectric and ferromagnetic order parameters have drawn considerable attention for their tremendous technological potential. Nevertheless, these ferroic orders inevitably disappear below the critical size of several nanometers in conventional ferroelectrics or multiferroics. Here, based on first-principles calculations, we propose a new strategy to overcome this limitation and create ultrasmall multiferroic elements in otherwise nonferroelectric CaTiO3 by engineering the interplay of oxygen octahedral rotations and hole polarons, though both of them are generally believed to be detrimental to ferroelectricity. It is found that the hole doped in CaTiO3 spontaneously forms a localized polaronic state. The lattice distortions associated with a hole polaron interacting with the intrinsic oxygen octahedral rotations in CaTiO3 effectively break the inversion symmetry and create atomic-scale ferroelectricity beyond the critical size limitation. The hole polaron also causes highly localized magnetism attributed to the associated spin-polarized electric state and thus manifests as a multiferroic polaron. Moreover, the hole polaron exhibits high hopping mobility accompanied by rich switching of polarization and magnetic directions, indicating strong magnetoelectric coupling with a mechanism dissimilar from that of conventional multiferroics. The present work provides a new mechanism to engineer inversion symmetry and opens avenues for designing unusual multifunctional materials.
Background: The pipeline embolization device (PED) is the most common flow diverter device in the world. To date, there have been no reports of treatment outcomes specific to intradural internal carotid artery (ICA) aneurysms. The safety and efficacy of the PED treatments for intradural ICA aneurysms are reported. Methods: 131 patients with 133 aneurysms underwent PED treatments for intradural ICA aneurysms. The mean aneurysm dome size and neck length were 12.7 ± 4.3 mm and 6.1 ± 2.2 mm, respectively. We used adjunctive endosaccular coil embolization for 88 aneurysms (66.2%). A total of 113 aneurysms (85%) were angiographically followed up 6 months following the procedure, and 93 aneurysms (69.9%) were followed up for 1 year. Results: The angiographic outcome at 6 months showed that 94 (83.2%) aneurysms had O'Kelly-Marotta (OKM) grade D, 6 (5.3%) had C, 10 (8.8%) had B, and 3 (2.7%) had A. At 1 year, 82 (88.2%) aneurysms had OKM grade D, 6 (6.5%) had C, 3 (3.2%) had B, and 2 (2.2%) had A. Multivariate analysis showed that aneurysm neck size and adjunctive coiling were statistically significant in aneurysm occlusion status. Major morbidity modified Rankin Scale >2 and mortality rates related to procedures were 3.0% and 0%, respectively. Delayed aneurysm ruptures were not observed. Conclusion: These results reveal that PED treatment of intradural ICA aneurysms is safe and efficacious. The combined use of adjunctive coil embolization not only prevents delayed aneurysm ruptures but also contributes to an increase in the rate of complete occlusion.
The flow diverter has been shown to be a safe and effective device for large cerebral aneurysms in the proximal internal carotid artery (ICA). Recently, its indication has been expanded to small- and medium-sized cerebral aneurysms in the distal segment of the ICA. In this study, we report a single-center, retrospective investigation of the safety and efficacy of the Pipeline Flex device to treat these aneurysms. Of the patients who underwent Pipeline implantation for small- and medium-sized ICA aneurysms (≤12 mm) at our hospital between July 2013 and October 2021, 102 patients with 104 aneurysms were included in this study. The mean age of the patients was 57.7 ± 12.1 years, and 94 (90.4%) were female. The mean aneurysmal dome diameter was 9.2 ± 2.3 mm, the mean neck diameter was 5.3 ± 1.6 mm, and the mean dome-to-neck ratio was 1.8 ± 0.5. Twenty-five patients (24.0%) had incorporated vessels from the aneurysm. Complete occlusion of the aneurysms was obtained in 96 patients (92.3%). There were no cases of parent artery stenosis or major stroke after the procedure. Absence of incorporated vessel from the aneurysm dome and adjunctive coil embolization are statistically significant factors indicating complete occlusion in multivariate analysis. The time to complete occlusion was determined earlier with the use of the Pipeline Shield (p = 0.0386) and with adjunctive coils (p = 0.0025). We showed that Pipeline implantation for small- and medium-sized aneurysms was safe and highly effective.
Embolization, Therapeutic , Intracranial Aneurysm , Humans , Female , Middle Aged , Aged , Male , Intracranial Aneurysm/diagnostic imaging , Intracranial Aneurysm/surgery , Treatment Outcome , Retrospective Studies , Prospective Studies , Stents , Cerebral Angiography/methods
As of January 2021, the Surpass Streamline (SS) is the most recently approved flow diverter in Japan. A total of 28 Japanese patients, including 9 clinical trial patients, with 28 large or giant unruptured internal carotid artery (ICA) aneurysms, underwent SS embolization at Juntendo University Hospital. Procedural failure occurred in two patients due to the difficulty to navigate the device in the tortuous parent artery. Therefore, 26 patients with 26 aneurysms were available for clinical and anatomical assessments. Patients' mean age was 62.6 years (range 46-86), and 24 patients (92.3%) were female. Mean aneurysm size and neck width were 15.4 mm and 7.7 mm, respectively, with 20 saccular and 6 fusiform aneurysms. Seven aneurysms were symptomatic due to the aneurysmal mass effect. Twenty patients underwent a 6-month follow-up angiography to evaluate the degree of occlusion. Anatomical outcomes were 12 (60%) complete occlusion (CO), 4 (20%) residual neck (RN), and 4 (20%) residual aneurysm. Favorable aneurysm occlusion consisted of CO, and RN was achieved in 16 (80.0%). There were no significant device stenoses. Aneurysmal mass effect improved in one and was unchanged in eight patients. There were three device-related complications, namely, delayed aneurysm rupture, minor ischemic stroke, and device occlusion (11.5%). One patient with minor ischemic stroke fully recovered before 30 days, and our series showed 7.7% risk of major ipsilateral stroke and neurological death at 30 days. The SS embolization for large and giant unruptured ICA aneurysms offers satisfactory anatomical and clinical outcomes with a low risk of device-related complications.
Carotid Artery Diseases , Embolization, Therapeutic , Endovascular Procedures , Intracranial Aneurysm , Ischemic Stroke , Stroke , Aged , Aged, 80 and over , Carotid Artery Diseases/etiology , Carotid Artery, Internal/diagnostic imaging , Carotid Artery, Internal/surgery , Clinical Trials as Topic , Female , Humans , Intracranial Aneurysm/diagnostic imaging , Intracranial Aneurysm/etiology , Intracranial Aneurysm/therapy , Male , Middle Aged , Stroke/etiology , Treatment Outcome
Crystal defects often lead to an intriguing variety of catastrophic failures of materials and determine the mechanical properties. Here we discover that a dislocation, which was believed to be a source of plasticity, leads to brittle fracture in SrTiO3. The fracture mechanism, i.e., bond breaking at the dislocation core triggers crack initiation and subsequent fracture, is elucidated from an atomic view by hybrid quantum and molecular simulations and in situ nanomechanical experiments. The fracture strength of the dislocation-included SrTiO3 was theoretically evaluated to be 8.8-10.7 GPa, which was eminently lower than that of the pristine one (21.7 GPa). The experimental results agree well with the simulated ones. Moreover, the fracture toughness of the ultrasmall crack initiating from the dislocation is quantitatively evaluated. This study reveals not only the role of dislocations in brittle fracture but also provides an in-depth understanding of the fracture mechanism of dislocations at the atomic scale.
BACKGROUND: Most patients with congenital tracheal stenosis (CTS) develop respiratory symptoms early in life. CTS remaining undiagnosed until adulthood is rare. CASE PRESENTATION: A 51-year-old female was scheduled for cardiovascular surgery. She had undergone laparoscopic surgery 3 years earlier and was found to have a difficult airway. Postoperatively, she was diagnosed with CTS. For the current cardiovascular surgery, combined use of a McGRATHTM MAC videolaryngoscope and fiberoptic bronchoscope allowed sufficient visualization of the glottis and trachea, resulting in successful intubation. CONCLUSIONS: CTS patients have a high probability of difficult intubation. Our experience suggests the efficacy of combined use of a videolaryngoscope and fiberoptic bronchoscope for airway management in CTS patients.
Current synthetic elastomers suffer from the well-known trade-off between toughness and stiffness. By a combination of multiscale experiments and atomistic simulations, a transparent unfilled elastomer with simultaneously enhanced toughness and stiffness is demonstrated. The designed elastomer comprises homogeneous networks with ultrastrong, reversible, and sacrificial octuple hydrogen bonding (HB), which evenly distribute the stress to each polymer chain during loading, thus enhancing stretchability and delaying fracture. Strong HBs and corresponding nanodomains enhance the stiffness by restricting the network mobility, and at the same time improve the toughness by dissipating energy during the transformation between different configurations. In addition, the stiffness mismatch between the hard HB domain and the soft poly(dimethylsiloxane)-rich phase promotes crack deflection and branching, which can further dissipate energy and alleviate local stress. These cooperative mechanisms endow the elastomer with both high fracture toughness (17016 J m-2 ) and high Young's modulus (14.7 MPa), circumventing the trade-off between toughness and stiffness. This work is expected to impact many fields of engineering requiring elastomers with unprecedented mechanical performance.
Correction for 'Two-dimensional polar metal of a PbTe monolayer by electrostatic doping' by Tao Xu et al., Nanoscale Horiz., 2020, 5, 1400-1406, DOI: .
Owing to a finite and single-atom-thick two-dimensional structure, graphene nanostructures such as nanoribbons possess outstanding physical properties and unique size-dependent characteristics due to nanoscale defects, especially for mechanical properties. Graphene nanostructures characteristically exhibit strong nonlinearity in deformation and the defect brings about an extremely localized singular stress field of only a few nanometers, which might lead to unique fracture properties. Fundamental understanding of their fracture properties and criteria is, however, seriously underdeveloped and limited to the level of continuum mechanics and linear elasticity. Here, we demonstrate the breakdown of continuum-based fracture criteria for graphene nanoribbons due to the strong nonlinearity and discreteness of atoms emerging with decreasing size and identify the critical sizes for these conventional criteria. We further propose an energy-based criterion considering atomic discrete nature, and show that it can successfully describe the fracture beyond the critical sizes. The complete clarification of fracture criterion for nonlinear graphene with nanoscale singularity contributes not only to the reliable design of graphene-based nanodevices but also to the elucidation of the extreme dimensional limit in fracture mechanics.
Polar metals characterized by the simultaneous coexistence of a polar structure and metallicity have been a long-sought goal due to the promise of novel electronic devices. Developing such materials at low dimensions remains challenging since both conducting electrons and reduced dimensions are supposed to quench the polar state. Here, based on first-principles calculations, we report the discovery of a non-centrosymmetric polar structure in two-dimensional (2D) metallic materials with electrostatic doping, even though ferroelectricity is unconventional at the atomic scale. We revealed that the PbTe monolayer is intrinsically ferroelectric with pronounced out-of-plane electric polarization originating from its non-centrosymmetric buckled structure. Moreover, the polar distortions can be preserved with carrier doping in the monolayer, which further enables the doped PbTe monolayer to act as a 2D polar metal. With an effective Hamiltonian extracted from the parametrized energy space, we found that the special elastic-polar mode interaction is of great importance for the existence of robust polar instability (i.e., soft phonon mode associated with polar distortion) in the doped system. The application of this doping strategy is not specific to the present crystal, but is rather general to other 2D ferroelectrics to bring about the fascinating non-centrosymmetric metallic state. Our findings thus change the conventional knowledge in 2D materials and will facilitate the development of multifunctional materials in low dimensions.
Beyond a ferroelectric critical thickness of several nanometers existed in conventional ferroelectric perovskite oxides, ferroelectricity in ultimately thin dimensions was recently discovered in SnTe monolayers. This discovery suggests the possibility that SnTe can sustain ferroelectricity during further low-dimensional miniaturization. Here, we investigate a ferroelectric critical size of low-dimensional SnTe nanostructures such as nanoribbons (1D) and nanoflakes (0D) using first-principle density-functional theory calculations. We demonstrate that the smallest (one-unit-cell width) SnTe nanoribbon can sustain ferroelectricity and there is no ferroelectric critical size in the SnTe nanoribbons. On the other hand, the SnTe nanoflakes form a vortex of polarization and lose their toroidal ferroelectricity below the surface area of 4 × 4 unit cells (about 25 Å on one side). We also reveal the atomic and electronic mechanism of the absence or presence of critical size in SnTe low-dimensional nanostructures. Our result provides an insight into intrinsic ferroelectric critical size for low-dimensional chalcogenide layered materials.
There have recently been reports of patients who developed postprocedural symptoms or alterations due to delayed foreign body embolisms observed in imaging findings. Polymer coating of devices have been described as a possible cause of foreign body embolisms, manifesting in delayed granulomatous responses and exhibiting characteristic imaging findings. In four of 4,025 patients who underwent coil embolization in our hospital or its affiliated facilities, similar findings were observed. Delayed lesions appeared between 1 month and 1 year after the procedures. There was extensive edema in the perfusion area of the treated vessels. In two cases examined by contrast-enhanced magnetic resonance imaging, multiple solid enhancing lesions within vasogenic edema were observed. Biopsy revealed a membranous foreign body in a blood vessel with surrounding foreign body granuloma formation in 1 case. Because these findings are similar to those of cases reported previously, they were considered as a foreign body embolism due to coating separations from the devices. Polymer coating separation occurs most frequently from guidewires. Especially if a metal introducer is used, the risk of separation increases. Surgeons should carefully follow the manufacturers' instructions when they use these devices and should acknowledge and report any events that may occur. Although these complications are extremely rare, further studies are warranted of similar cases; and we should prepare and share information on these intravascular devices for wide-scale dissemination in the industry.
The control of topological defects in ferroelectrics, in particular by a homogeneous electric field, has emerged as an active research direction. A polarization vortex, which is a fundamental topological defect formed in ferroelectric nanodots, has recently been demonstrated to be switchable by a homogeneous electric field through the control of the built-in electrical distribution using low-symmetry nanodots. Such electrotoroidic switching is investigated for nearly ideal systems, e.g., free-standing nanodots. However, the electrotoroidic switching may be impacted by several factors, for instance, the nanoscale effect of flexoelectricity (intrinsic effect), epitaxial strain and the frequency of the applied field (extrinsic effects). In the present study, the switching of the polarization vortex in a notched nanodot under a homogeneous electric field is investigated. The emphasis is put on a comparison between intrinsic and extrinsic effects on the vortex switching. The results show that the vortex switching takes place through alternate vortex-to-polar and polar-to-vortex transformations due to the appearance of the notch. Although the flexoelectricity breaks the symmetry of the polarization field in the notched nanodot during the polarization transformation and gives rise to an unusual behavior of the vortex core, which departs from the symmetry axis of the notched nanodot, this intrinsic effect plays a relatively insignificant role in the switching behavior of the polarization vortex. In comparison to the intrinsic effect, interestingly, the extrinsic effects strongly influence the vortex switching behavior. Specifically, the frequency of the applied electric field can alter both the shape of the toroidal hysteresis loop and the domain transformation process of the vortex switching. In addition, under substrate constraints, the magnitude of the coercive electric fields at which the vortex-to-polar and polar-to-vortex transformations occur linearly decreases with the increase of strain. The present study provides instructive information on the efficient control of a polarization vortex, which is dominated by extrinsic factors rather than intrinsic ones.
Ferroelectric materials exhibit novel topological polarization configurations due to geometric confinements originating from the material shapes and interfaces at the nanoscale. In this study, we demonstrate that those nontrivial topological ferroelectric nanostructures can be tailored in paraelectric nanoporous materials by mechanical loads using phase-field modeling. That is, in nanoporous strontium titanate, periodically-arrayed ferroelectric nanostructures in the shape of networks are formed due to strain concentrations by mechanical loads, and topological polarization configurations, such as hierarchical vortices, woven fabrics and nested structures of spiral like Hopf fibration, are stabilized in the structures strongly affected by the pore arrangements. Our work indicates that various ferroelectric nanostructures with novel shapes and topologies can be designed by controlling the pore arrangements and strain conditions in nanoporous SrTiO3, and thus provides a new pathway to realize novel topological ferroelectric nanostructures, which are essential for future nanodevices.
A dislocation induces ferroelectricity around it in incipient ferroelectric SrTiO3 due to some reasons such as electro-mechanical coupling and it being a one-dimensional ferroelectric nanostructure. Furthermore, this microstructure is arrayed periodically in the material and dislocation structures such as a dislocation wall are formed. Due to these facts, periodically-arrayed ferroelectric nanostructures, which show various intriguing polarization configurations and functionalities depending on the internal periodic structure, may be fabricated by dislocations. The phase-field simulation exhibits that a ferroelectric nano-region induced by the strain concentration and incidental electric field around a dislocation connects with each other in a dislocation wall. As a result, a periodic ferroelectric nano-region, which is a periodically-arrayed ferroelectric nanostructure embedded in paraelectric matrices, is formed. Our findings provide a new pathway for the fabrication of novel functional nanodevices in ferroelectric systems.
