Development of Inkjet-Printed PEDOT:PSS-Based Organic Electrochemical Transistor (OECT) for Biopotential Amplification.

With the ever-increasing need for miniaturized and biocompatible devices for physiological recordings, high signal fidelity and ease of fabrication are key to achieve reliable data collection. This calls for the development of active recording devices such as Organic Electrochemical Transistors (OECTs) which, compared to passive electrodes, offer local amplification. In this work, we built PEDOT:PSS based OECTs using novel inkjet printing technology, achieving a transconductance of 75 mS. The device was later used to amplify arbitrary signals simulating in vivo recordings. Gate voltage offset manipulation offered a range of current peak-to-peak amplitudes. Additionally, we demonstrate a simple circuit for voltage readings, where another resistor-dependent characterization involving voltage source and drain voltage is performed. At ideal operating point and when using a 220 Ω resistor, a gain of 14.5 is achieved.Clinical Relevance- 1This work demonstrates the ability to rapidly and easily develop OECT-based technology for potential signal sensing for more accurate diagnosis of pathologies and diseases.

Novel Coronavirus Infection (COVID-19) Related Thrombotic and Bleeding Complications in Critically Ill Patients: Experience from an Academic Medical Center.

INTRODUCTION: Thrombosis and bleeding are recognized complications of the novel coronavirus infection (COVID-19), with a higher incidence described particularly in the critically ill. METHODS: A retrospective review of COVID-19 patients admitted to our intensive care units (ICU) between 1 January 2020 and 31 December 2020 was performed. Primary outcomes included clinically significant thrombotic and bleeding events (according to the ISTH definition) in the ICU. Secondary outcomes included mortality vis-a-vis the type of anticoagulation. RESULTS: The cohort included 144 consecutive COVID-19 patients with a median age of 64 years (IQR 54.5-75). The majority were male (85 (59.0%)) and Caucasian (90 (62.5%)) with a median BMI of 30.5 kg/m2 (IQR 25.7-36.1). The median APACHE score at admission to the ICU was 12.5 (IQR 9.5-22). The coagulation parameters at admission were a d-dimer level of 109.2 mg/mL, a platelet count of 217.5 k/mcl, and an INR of 1.4. The anticoagulation strategy at admission included prophylactic anticoagulation for 97 (67.4%) patients and therapeutic anticoagulation for 35 (24.3%) patients, while 12 (8.3%) patients received no anticoagulation. A total of 29 patients (20.1%) suffered from thrombotic or major bleeding complications. These included 17 thrombus events (11.8%)-8 while on prophylactic anticoagulation (7 regular dose and 1 intermediate dose) and 9 while on therapeutic anticoagulation (p-value = 0.02)-and 19 major bleeding events (13.2%) (4 on no anticoagulation, 7 on prophylactic (6 regular dose and 1 intermediate dose), and 8 on therapeutic anticoagulation (p-value = 0.02)). A higher thrombosis risk among patients who received remdesivir (18.8% vs. 5.3% (p-value = 0.01)) and convalescent serum (17.3% vs. 5.8% (p-value = 0.03%)) was noted, but no association with baseline characteristics (age, sex, race, comorbidity), coagulation parameters, or treatments (steroids, mechanical ventilation) could be identified. There were 10 pulmonary embolism cases (6.9%). A total of 99 (68.8%) patients were intubated, and 66 patients (45.8%) died. Mortality was higher, but not statistically significant, in patients with thrombotic or bleeding complications-58.6% vs. 42.6% (p-value = 0.12)-and higher in the bleeding (21.2%) vs. thrombus group (12.1%), p-value = 0.06. It did not significantly differ according to the type of anticoagulation used or the coagulation parameters. CONCLUSIONS: This study describes a high incidence of thrombotic and bleeding complications among critically ill COVID-19 patients. The findings of thrombotic events in patients on anticoagulation and major bleeding events in patients on no or prophylactic anticoagulation pose a challenging clinical dilemma in the issue of anticoagulation for COVID-19 patients. The questions raised by this study and previous literature on this subject demonstrate that the role of anticoagulation in COVID-19 patients is worthy of further investigation.

Incidence of Post-Heart Transplant Chronic Thyroiditis and Its Association With Pretransplant Amiodarone Use.

BACKGROUND: Chronic thyroiditis (CT) is a common cause of thyroid dysfunction and could therefore adversely affect outcomes in patients undergoing heart transplant (HT). The incidence of post-HT CT and whether amiodarone, a commonly used anti-arrhythmic drug in patients with heart failure during pre-HT period, is associated with the development of post-HT CT are unknown. METHODS: A retrospective review of HT recipients from February 2, 2010 to October 16, 2018 was performed. Patients who lacked relevant pre-/post-HT records, underwent thyroidectomy, had pre-HT thyroid dysfunction or thyroiditis within 15 days post-HT, and those on amiodarone during the post-HT period were excluded, yielding a final cohort of 75 patients. RESULTS: Patients had a mean age of 63.3 ± 1.4 years and were predominantly male (90.7%) and white (80%). The incidence of post-HT CT was 32% with the majority (83.3%) manifesting as hypothyroidism. Median time to diagnosis of CT after transplant was 10.2 months (interquartile range, 4-27.4). Additionally, the CT group had higher pre-HT use of amiodarone (non-CT vs CT: 21.6% vs 50%, P = .01), higher prevalence of atrial fibrillation (non-CT vs CT: 23.5% vs 45.8%; P = .05), and more stage IV/V chronic kidney disease (non-CT vs CT: 2% vs 16.7%, P = .02). On multivariate analysis, pre-HT amiodarone use was associated with the development of post-HT CT after adjustment for age, sex, and chronic kidney disease (odds ratio, 3.65; 95% CI, 1.17-11.44; P = .03). CONCLUSION: The incidence of post-HT CT is high and is strongly associated with pre-HT amiodarone use underpinning the importance of closely following the post-HT thyroid profile in these patients.

Local Mechanical Perturbation Provides an Effective Means to Regulate the Growth and Assembly of Functional Peptide Fibrils.

Mucin 1 (MUC1) peptide fused with Q11 (MUC1-Q11) having 35 residues has previously been shown to form amyloid fibrils. Using time-dependent and high-resolution atomic force microscopy (AFM) imaging, it is revealed that the formation of individual MUC1-Q11 fibrils entails nucleation and extension at both ends. This process can be altered by local mechanical perturbations using AFM probes. This work reports two specific perturbations and outcomes. First, by increasing load while maintaining tip-surface contact, the fibrils are cut during the scan due to shearing. Growth of fibrils occurs at the newly exposed termini, following similar mechanism of the MUC1-Q11 nucleation growth. As a result, branched fibrils are seen on the surface whose orientation and length can be controlled by the nuclei orientation and reaction time. In contrast to the "one-time-cut", fibrils can be continuously fragmented by modulation at sufficiently high amplitude. As a result, short and highly branched fibrils accumulate and pile on surfaces. Since the fibril formation and assembly of MUC1-Q11 can be impacted by local mechanical force, this approach offers a nonchemical and label-free means to control the presentation of MUC1 epitopes, and has promising application in MUC1 fibril-based immunotherapy.

Catheter ablation of supraventricular tachycardia without fluoroscopy during pregnancy.

BACKGROUND: Although uncommon, supraventricular tachycardia is difficult to manage during pregnancy. Catheter ablation traditionally has been deferred owing to radiation exposure risks. Three-dimensional mapping is a new tool in cardiac electrophysiology, which is being utilized to eliminate fluoroscopy during catheter ablation. We report a case of ablation of supraventricular tachycardia during pregnancy without using fluoroscopy. CASE: A 27-year-old woman with a 22-week twin gestation was referred for incessant supraventricular tachycardia. Medical management with propranolol and flecainide was unsuccessful. An electrophysiology study was performed with catheter navigation guided by a three-dimensional mapping system instead of fluoroscopy. The patient underwent successful cryoablation. The procedure was performed without fluoroscopy or sedation. The patient delivered healthy twins at 35 weeks of gestation without complications. On follow-up at 26 months, she showed no evidence of recurrence. CONCLUSION: New tools in electrophysiology now make curative procedures more readily available to pregnant women and safer for the fetus.

Peripartum robotic-assisted laparoscopic hysterectomy after second-trimester pregnancy loss with placenta increta.

BACKGROUND: Peripartum hysterectomy is performed for a variety of indications, including abnormal placentation, retained placenta, uterine rupture, and uterine atony. Most cases are emergent and performed through open laparotomy. CASE: At 20 weeks of gestation, a patient with previous endometrial ablation had ruptured membranes and delivered her fetus but not her placenta. She was hemodynamically stable and underwent robotic hysterectomy. Surgical pathology confirmed placenta increta. CONCLUSION: In appropriate patients, a minimally invasive approach may be considered for peripartum hysterectomy to potentially decrease maternal morbidity.

Pregnancy and acromegaly: a review.

To review the literature regarding the diagnosis and management of acromegaly during pregnancy. A systematic literature search was performed using MEDLINE including hand-searching reference lists from original articles. The diagnosis of acromegaly during pregnancy is made difficult due to the physiologic changes in pituitary GH secretion and IGF-1 production resulting from placental GH secretion and the inability of commercial assays to discriminate between pituitary and placental GH. Most patients with acromegaly during pregnancy do not have an increase in tumor size, metabolic complications are uncommon, and neonatal outcome is largely unaffected. IGF-1 levels tend to be stable in such patients possibly due to the high estrogen levels causing GH resistance. Dopamine agonists, somatostatin analogues, and a GH receptor antagonist have been reported to be safe during pregnancy. Patients with visual field defects should be considered for surgery, but in most cases this can be safely postponed until after delivery. Overall, pregnancy in acromegaly is uneventful and newborns unaffected. Dopamine agonists and somatostatin analogues have not been associated with major adverse effects to the fetus; however, more data are needed to validate their safety.

Comparison of estimated fetal weights using volume and 2-dimensional sonography and their relationship to neonatal markers of fat.

OBJECTIVE: The purpose of this study was to compare the accuracy of traditional 2-dimensional sonographically estimated fetal weight (EW2D) with 3-dimensional volume-based estimated fetal weight (EW3D) and to evaluate the relationship between fetal limb volume, birth weight, and markers of neonatal adiposity. METHODS: Fifty singleton pregnancies at 32 to 42 weeks' gestation underwent sonographic evaluation within 48 hours of delivery. We compared the accuracy of the EW2D and EW3D in the prediction of birth weight. The Ponderal index, sum of all skin fold measurements, estimated neonatal fat mass, and percent body fat were calculated. Paired t tests, simple regression analyses, a chi(2) test, and the Steiger z test were used where appropriate. P< .05 was considered significant. RESULTS: The mean birth weight+/-SD was 3130+/-589 g at 38.8+/-2.1 weeks. The EW2D (r(2)=0.66) and EW3D (r(2)=0.76) estimates were both correlated with birth weight. The birth weight and neonatal fat mass were more highly correlated with the sonographically based thigh volume (r(2)=0.67 and 0.61) than femur length (r(2)=0.41 and 0.37). The mean percent error between EW2D and birth weight was larger (-3.3%+/-11.6%) than the mean percent error of EW3D (0.7%+/-9.2%; P= .0004). CONCLUSIONS: Sonographically based fetal limb volumes, especially the fractional thigh volume, reflect neonatal fat mass and are better correlated with birth weight.

The impact of maternal obesity on satisfactory detailed anatomic ultrasound image acquisition.

OBJECTIVE: To assess the impact of maternal body mass index (BMI) on ultrasound visualisation of fetal morphology. STUDY DESIGN: Singleton pregnancies undergoing targeted ultrasound fetal anatomic evaluation at 18- to 25-weeks gestation from 1/05 to 12/05 were included. Ultrasound reports and maternal medical records were reviewed for maternal characteristics and documentation of adequatecy of ultrasound visualisation for each organ system was obtained by individual chart review. BMI was divided into normal (18.5-24.9 kg/m2) and obese (>30 kg/m2) groups. Overweight women (BMI 25-29.9 kg/m2) were excluded. Suboptimal visualisation for each organ system was compared between BMI groups. Multivariable analysis controlled for sonographer, physician, US equipment, race, parity, fetal lie, weight and gestational age. RESULTS: Eight hundred fourteen patients were included (Normal = 148, Obese = 666). The frequency of suboptimal visualisation was significantly increased in the obese group for the cardiovascular system SV (50.9% vs. 26.9%, p < 0.0001), facial soft tissue SV (39.1% vs. 19.3%p < 0.0001) and abdominal wall SV (2.7% vs. 0%, p < 0.0001). Suboptimal visualisation declined with advancing gestational age. CONCLUSIONS: Suboptimal fetal anatomic visualisation is increased with maternal obesity, but declines with advancing gestational age in both normal weight and obese populations.

Late presentation of retained intracardiac ice pick with papillary muscle injury.

An unusual case of a penetrating intracardiac injury is described in a 16-year-old boy who presented with a retained 14-cm segment of an ice pick that went unnoticed by the patient for 4 days. The ice pick had lacerated the anterior papillary muscle of the left ventricle causing avulsion of its tip and prolapse of the anterior leaflet of the mitral valve resulting in severe mitral regurgitation. The urgency for surgical correction of the traumatic mitral valve injury at the time of extraction of the intracardiac foreign body through a single-stage approach versus a two-stage approach is discussed.