Multilayer fabrication of durable catheter-deployable soft robotic sensor arrays for efficient left atrial mapping.

Devices that perform cardiac mapping and ablation to treat atrial fibrillation provide an effective means of treatment. Current devices, however, have limitations that either require tedious point-by-point mapping of a cardiac chamber or have limited ability to conform to the complex anatomy of a patient's cardiac chamber. In this work, a detailed, scalable, and manufacturable technique is reported for fabrication of a multielectrode, soft robotic sensor array. These devices exhibit high conformability (~85 to 90%) and are equipped with an array of stretchable electronic sensors for voltage mapping. The form factor of the device is intended to match that of the entire left atrium and has a hydraulically actuated soft robotic structure whose profile facilitates deployment from a 13.5-Fr catheter. We anticipate that the methods described in this paper will serve a new generation of conformable medical devices that leverage the unique characteristics of stretchable electronics and soft robotics.

Microneedle Patterning of 3D Nonplanar Surfaces on Implantable Medical Devices Using Soft Lithography.

Micropatterning is often used to engineer the surface properties of objects because it allows the enhancement or modification of specific functionalities without modification of the bulk material properties. Microneedle arrays have been explored in the past for drug delivery and enhancement of tissue anchoring; however, conventional methods are primarily limited to thick, planar substrates. Here, we demonstrate a method for the fabrication of microneedle arrays on thin flexible polyurethane substrates. These thin-film microneedle arrays can be used to fabricate balloons and other inflatable objects. In addition, these thin-filmed microneedles can be transferred, using thermal forming processes, to more complex 3D objects on which it would otherwise be difficult to directly pattern microneedles. This function is especially useful for medical devices, which require effective tissue anchorage but are a challenging target for micropatterning due to their 3D nonplanar shape, large size, and the complexity of the required micropatterns. Ultrathin flexible thermoplastic polyurethane microneedle arrays were fabricated from a polydimethylsiloxane (PDMS) mold. The technique was applied onto the nonplanar surface of rapidly prototyped soft robotic implantable polyurethane devices. We found that a microneedle-patterned surface can increase the anchorage of the device to a tissue by more than twofold. In summary, our soft lithographic patterning method can rapidly and inexpensively generate thin-film microneedle surfaces that can be used to produce balloons or enhance the properties of other 3D objects and devices.

Socioeconomic Status and Cardiovascular Risk Control in Adults With Diabetes.

OBJECTIVE: To examine the association between subjective social status (SSS) and objective social status (OSS) and cardiovascular disease (CVD) risk factors in adults with type 2 diabetes. METHODS: Adult study participants (N = 358) were recruited from 2 primary care settings. The CVD risk factors included hemoglobin A1c (HbA1c), systolic blood pressure and diastolic blood pressure (DBP) and low-density lipoprotein cholesterol (LDL-C). The OSS was assessed by income, education and employment. The SSS was measured using the validated MacArthur Scales of Subjective Social Status to demarcate self-reported perceptions of having the most money, education and respected job using a ladder scale (1 = rung 1, 10 = rung 10). Multiple linear regression was used to examine associations between CVD risk factors and SSC and OSS controlling for age, sex, race or ethnicity, marital status, employment status, income, study site, comorbidity, education and insurance status. RESULTS: Fully adjusted models showed that rung 2 (P = 0.029), rung 3 (P = 0.032), rung 8 (P = 0.049) and rung 9 (P = 0.032) of the SSS to be significantly associated with poorer DBP. Annual income ≥ $75,000 was significantly associated with lower LDL-C (P = 0.021). Employment was associated with lower HbA1c (P = 0.036), but higher LDL-C (P = 0.002). CONCLUSIONS: The SSS and OSSS levels are differentially associated with HbA1c, DBP and LDL-C. Findings provide new information about patients' perspectives of the relationship between social status and diabetes-related outcomes.