Passive Fingerprinting of Same-Model Electrical Devices by Current Consumption.

One possible device authentication method is based on device fingerprints, such as software- or hardware-based unique characteristics. In this paper, we propose a fingerprinting technique based on passive externally measured information, i.e., current consumption from the electrical network. The key insight is that small hardware discrepancies naturally exist even between same-electrical-circuit devices, making it feasible to identify slight variations in the consumed current under steady-state conditions. An experimental database of current consumption signals of two similar groups containing 20 same-model computer displays was collected. The resulting signals were classified using various state-of-the-art time-series classification (TSC) methods. We successfully identified 40 similar (same-model) electrical devices with about 94% precision, while most errors were concentrated in confusion between a small number of devices. A simplified empirical wavelet transform (EWT) paired with a linear discriminant analysis (LDA) classifier was shown to be the recommended classification method.

Two-Dimensional Conjugated Metal-Organic Frameworks with Large Pore Apertures and High Surface Areas for NO2 Selective Chemiresistive Sensing.

The emergence of two-dimensional conjugated metal-organic frameworks (2D c-MOFs) with pronounced electrical properties (e.g., high conductivity) has provided a novel platform for efficient energy storage, sensing, and electrocatalysis. Nevertheless, the limited availability of suitable ligands restricts the number of available types of 2D c-MOFs, especially those with large pore apertures and high surface areas are rare. Herein, we develop two new 2D c-MOFs (HIOTP-M, M=Ni, Cu) employing a large p-π conjugated ligand of hexaamino-triphenyleno[2,3-b:6,7-b':10,11-b'']tris[1,4]benzodioxin (HAOTP). Among the reported 2D c-MOFs, HIOTP-Ni exhibits the largest pore size of 3.3 nm and one of the highest surface areas (up to 1300 m2 g-1 ). As an exemplary application, HIOTP-Ni has been used as a chemiresistive sensing material and displays high selective response (405 %) and a rapid response (1.69 min) towards 10 ppm NO2 gas. This work demonstrates significant correlation linking the pore aperture of 2D c-MOFs to their sensing performance.

Permanent His bundle pacing using a new tridimensional delivery sheath and a standard active fixation pacing lead: The telescopic technique.

INTRODUCTION: Permanent His bundle pacing (PHBP) preserves physiological ventricular activation but technical difficulties have limited its widespread use. We report the first experience of PHBP performed with a new specific delivery sheath (Selectra 3D, Biotronik, Berlin, Germany) and an extendable-retractable active screw, stylet-driven pacing lead (Solia S 60, Biotronik). METHODS AND RESULTS: Clinical, procedural, ECG, and electrical data from consecutive patients undergoing PHBP with this system were collected at implantation, and follow-up was performed after 1 month. Our cohort included 17 patients (71% males; mean age 76 ± 8 years) undergoing permanent pacing for sick sinus syndrome (59%) or atrioventricular block (41%). PHBP was successful in 15 (88%) procedures with mean procedure and fluoroscopy times of 63 ± 14 and 13 ± 5 min, respectively. The pacing threshold was 2.1 ± 1.1 V @1 ms and the sensed R-wave amplitude was 5.6 ± 3.5 mV; bipolar and unipolar pacing impedances were 526 ± 115 and 369 ± 109 Ω, respectively. At discharge, neither procedure-related complications nor lead dislodgement or pacing capture failures was reported. After 1 month, 14 (93%) patients still demonstrated His bundle stimulation and one (7%) lost His bundle capture but the lead revision was not necessary because the myocardial pacing threshold was stable. Follow-up threshold (2 ± 1.1 vs. 2.3 ± 1.2 V@1 ms, p = .239) and sensed R-wave amplitude (5.6 ± 3.4 vs. 6.4 ± 2.5, p = .403) was unchanged compared to the acute phase. CONCLUSION: PHBP performed with a standard active fixation pacing lead and a new delivery sheath for His pacing is feasible, safe and demonstrates clinically acceptable electric performance both at implantation and after 1 month.

MOF Nanosheet Reconstructed Two-Dimensional Bionic Nanochannel for Protonic Field-Effect Transistors.

The construction of hydrophobic nanochannel with hydrophilic sites for bionic devices to proximally mimick real bio-system is still challenging. Taking the advantages of MOF chemistry, a highly oriented CuTCPP thin film has been successfully reconstructed with ultra-thin nanosheets to produce abundant two-dimensional interstitial hydrophobic nanochannels with hydrophilic sites. Different from the classical active-layer material with proton transport in bulk, CuTCPP thin film represents a new type of active-layer with proton transport in nanochannel for bionic proton field-effect transistor (H+ -FETs). The resultant device can reversibly modulate the proton transport by varying the voltage on its gate electrode. Meanwhile, it shows the highest proton mobility of ≈9.5×10-3  cm2 V-1 s-1 and highest on-off ratio of 4.1 among all of the reported H+ -FETs. Our result demonstrates a powerful material design strategy for proximally mimicking the structure and properties of bio-systems and constructing bionic electrical devices.

Electrical Characterization of the Backside Interface on BSI Global Shutter Pixels with Tungsten-Shield Test Structures on CDTI Process.

A new methodology is presented using well known electrical characterization techniques on dedicated single devices in order to investigate backside interface contribution to the measured pixel dark current in BSI CMOS image sensors technologies. Extractions of interface states and charges within the dielectric densities are achieved. The results show that, in our case, the density of state is not directly the source of dark current excursions. The quality of the passivation of the backside interface appears to be the key factor. Thanks to the presented new test structures, it has been demonstrated that the backside interface contribution to dark current can be investigated separately from other sources of dark current, such as the frontside interface, DTI (deep trench isolation), etc.

Back to Fundamentals: Radiographic Evaluation of Thoracic Lines and Tubes in Children.

OBJECTIVE. The purpose of this article is to provide an up-to-date review of the radiographic appearance of the most commonly used thoracic lines and tubes in pediatric patients in daily clinical practice. CONCLUSION. Thoracic support lines and tubes are frequently used in children receiving hospital care. Evaluation of these devices is a fundamental skill in radiology. Many different devices are currently used, and new devices are regularly introduced. It is essential for radiologists to maintain a clear understanding of all devices currently in use.

The Contribution of Secondary Particles Following Carbon Ion Radiotherapy to Soft Errors in CIEDs.

Introduction: While carbon ion radiotherapy is highly effective in cancer treatment, it has a high risk of causing soft error, which leads to malfunctions in cardiac implantable electrical devices (CIEDs). To predict the risk of malfunction prior to treatment, it is necessary to measure the reaction cross-sections and contributions to the soft error of secondary particles generated during treatments. Methods: A field-programmable gate array was used instead of CIEDs to measure soft errors by varying the energy spectrum of secondary particles. Results and discussion: The reaction cross-sections measured for each secondary particle were 3.0 × 10-9, 2.0 × 10-9, 1.3 × 10-8, and 1.5 × 10-8 [cm2/Mb] for thermal neutrons, intermediate-energy neutrons, high-energy neutrons above 10 MeV, and protons, respectively. The contribution of high-energy neutrons was the largest among them. Our study indicates that to reduce the risk of soft errors, secure distance and appropriate irradiation directions are necessary.

A leadless pacemaker implantation for a patient with systemic right ventricle under ventricular assist device support.

Patients with congenitally corrected transposition of the great arteries (ccTGA) often develop complete atrioventricular block and heart failure due to the abnormal disposition of atrioventricular node and disadvantage of systemic right ventricle. These issues are managed with a pacing system and a ventricular assist device (VAD), respectively. While technological advances offer new treatment strategies, the simultaneous deployment of a leadless pacemaker and a VAD in cases of ccTGA remains unexplored. Here, we present a case of leadless pacemaker implantation for a VAD-supported ccTGA patient. The safety of a leadless pacemaker for a subpulmonary left ventricle and electromagnetic interference between devices are major concerns when implanting a leadless pacemaker; however, the current case overcomes these obstacles. There were no perioperative complications, and both devices were functioning without problems during a one-year follow up. We expect that, even in patients with cardiac complexity such as systemic right ventricle under VAD support, a leadless pacemaker could become the treatment of choice if the indication is appropriate, although careful and close follow up is needed. Learning objective: Technological advances expand treatment strategies and provide significant benefits to patients with adult congenital heart disease (ACHD). However, discussion of the combination of a leadless pacemaker and a ventricular assist device (VAD) is rare. We demonstrated the efficacy of a leadless pacemaker for a subpulmonary left ventricle in a patient with systemic right ventricle on VAD. This approach could be an option even for ACHD patients.

Working on the dirty side-the ipsilateral subclavian access for temporary pacing after lead extraction.

Background: Temporary pacing is necessary in pacemaker-dependent patients after transvenous lead extraction (TLE) for cardiac implantable electronic device infection. In case of unavailability of other accesses, we propose to use the ipsilateral subclavian access (ISA) combined with a standard permanent active fixation lead for the temporary pacemaker and present preliminary data. Methods: We consecutively enrolled patients undergoing TLE who received a temporary pacemaker using the ISA between August 2016 and April 2020 at our centre. Results: During the observation period, 36 patients undergoing TLE for pocket infection (72.2%), endocarditis (25.0%) or other causes received a temporary pacemaker over the ISA. Their mean age was 77.0 ± 10.7 years, and 13.9% were female. Complete TLE was achieved in 94.4%. There were no major periprocedural complications. Intra-hospital mortality was 11.1%. Pocket revision was performed in 19.4%. During long-term follow-up (23 ± 13 months), 8.3% had a relapse of local pocket infection and 2.8% needed rehospitalization for reintervention. Conclusions: Temporary pacing using a standard permanent active fixation lead using the ISA is a convenient alternative to conventional venous accesses. However, risks of implanting a lead into a previously infected area have to be taken into account.

G-Optrode Bio-Interfaces for Non-Invasive Optical Cell Stimulation: Design and Evaluation.

Biocompatibility and potential efficacy in biological applications rely on the bio-interactions of graphene nanoparticles with biological tissues. Analyzing and modulating cellular and device-level activity requires non-invasive electrical stimulation of cells. To address these needs, G-optrodes, bio-interfaces based on graphene, have been developed. These devices use light to stimulate cells without modifying their genetic code. Optoelectronic capabilities, in particular the capacity to transform light energy into electrical energy, will be maintained throughout the procedures of neural stimulation. G-optrodes have also been studied as thin films on a range of substrates, and they have been designed to function at a very small scale. This study examines the impact of G-optrode-based substrate designs on the optical stimulation of pheochromocytoma (PC-12). Graphene electrodes, known as G-optrodes, are responsible for converting light into electrical pulses with stimulating effects. G-optrode bio-interfaces provide a stimulus that is independent of wavelength range but is sensitive to changes in illuminance. The authors have performed a comprehensive investigation based on the correct effects of the medication in vitro, employing substrate-based G-optrode biointerfaces. In substrate-based systems, the authors have proven that graphene is biocompatible. PC-12 cells were cultured on graphene for 7 days. Based on the findings, 20-nm and 50-nm thick G-optrodes are being studied for possible use in biological and artificial retinal applications. The findings of this study highlight the significance of biocompatibility in the selection and use of G-optrodes for biomedical purposes.

FDG PET/CT in Cardiac Infection: Does It Matter? A Narrative Review.

The limited performance of echocardiography in specific infectious processes involving the heart led to the search for additional diagnostic tools. Fluorodeoxyglucose positron emission tomography computed tomography (FDG PET/CT) has been proposed for its diagnostic abilities in several infectious diseases including cardiac infections. A literature review of studies evaluating FDG PET/CT in native valve infective endocarditis (IE), prosthetic valve IE, cardiac implantable electrical device (CIED) infection, and left ventricular assist device (LVAD) infection is presented, focusing on studies published in recent years. Overall, in prosthetic valve endocarditis (PVE), FDG PET/CT demonstrate high sensitivity (73-93%) and specificity (80-95%), while in native valve endocarditis (NVE) the sensitivity is very low (22-68%), with high specificity (97-100%) similar to PVE. For CIED, LVAD infection, and transcatheter aortic valve implantation associated endocarditis, data come from small studies and show good diagnostic performance of FDG PET/CT. International guidelines are increasingly recommending FDG PET/CT for the diagnosis of specific conditions of cardiac infections. Beyond the diagnostic performance ability, few studies have evaluated the added benefit of FDG PET/CT in terms of clinical outcomes of patients with suspected cardiac infection. This should be the focus in future studies.

Robust Photoelectric Biomolecular Switch at a Microcavity-Supported Lipid Bilayer.

Biomolecular devices based on photo-responsive proteins have been widely proposed for medical, electrical, and energy storage and production applications. Also, bacteriorhodopsin (bR) has been extensively applied in such prospective devices as a robust photo addressable proton pump. As it is a membrane protein, in principle, it should function most efficiently when reconstituted into a fully fluid lipid bilayer, but in many model membranes, lateral fluidity of the membrane and protein is sacrificed for electrochemical addressability because of the need for an electroactive surface. Here, we reported a biomolecular photoactive device based on light-activated proton pump, bR, reconstituted into highly fluidic microcavity-supported lipid bilayers (MSLBs) on functionalized gold and polydimethylsiloxane cavity array substrates. The integrity of reconstituted bR at the MSLBs along with the lipid bilayer formation was evaluated by fluorescence lifetime correlation spectroscopy, yielding a protein lateral diffusion coefficient that was dependent on the bR concentration and consistent with the Saffman-Delbrück model. The photoelectrical properties of bR-MSLBs were evaluated from the photocurrent signal generated by bR under continuous and transient light illumination. The optimal conditions for a self-sustaining photoelectrical switch were determined in terms of protein concentration, pH, and light switch frequency of activation. Overall, a significant increase in the transient current was observed for lipid bilayers containing approximately 0.3 mol % bR with a measured photo-current of 250 nA/cm2. These results demonstrate that the platforms provide an appropriate lipid environment to support the proton pump, enabling its efficient operation. The bR-reconstituted MSLB model serves both as a platform to study the protein in a highly addressable biomimetic environment and as a demonstration of reconstitution of seven-helix receptors into MSLBs, opening the prospect of reconstitution of related membrane proteins including G-protein-coupled receptors on these versatile biomimetic substrates.

Radiotherapy-induced malfunctions of cardiac implantable electronic devices in cancer patients.

The number of patients with cardiac implantable electronic devices (CIEDs) requiring radiation therapy (RT) for cancer treatment is increasing. The purpose of this study is to estimate the prevalence, possible predictors, and clinical impact of RT-related CIEDs malfunctions. We retrospectively reviewed the medical records of all pacemaker (PM)/implantable cardioverter-defibrillator (ICD) patients who underwent RT in the last 14 years. One hundred and twenty-seven patients who underwent 150 separate RT courses were analysed (99 with a PM and 27 with an ICD). Of note, 21/127 (16.6%) patients were PM-dependent. Neutron-producing RT was used in 37/139 (26.6%) courses, whereas non-neutron-producing RT was used in 102/139 (73.4%) courses. The cumulative dose (Dmax) delivered to the CIED exceeded 5 Gy only in 2/132 (1.5%) cases. Device malfunctions were observed in 3/150 (2%) RT courses, but none was life-threatening or led to a major clinical event and all were resolved by CIED reprogramming. In all cases, the Dmax delivered to the CIED was < 2 Gy. Two malfunctions occurred in the 37 patients treated with neutron-producing RT (5.4%), and 1 malfunction occurred in the 102 patients treated with non-neutron-producing RT (1%) (p = 0.17). Device relocation from the RT field was performed in 2/127 (1.6%) patients. RT in patients with CIED is substantially safe if performed in an appropriately organized environment, with uncommon CIEDs malfunctions and no major clinical events. Neutron-producing energies, rather than Dmax, seem to increase the risk of malfunctions. Device interrogation on a regular basis is advised to promptly manage CIED malfunctions.

Growth of High-Quality Hexagonal Boron Nitride Single-Layer Films on Carburized Ni Substrates for Metal-Insulator-Metal Tunneling Devices.

Two-dimensional (2D) hexagonal boron nitride (h-BN) plays a significant role in nanoscale electrical and optical devices because of its superior properties. However, the difficulties in the controllable growth of high-quality films hinder its applications. One of the crucial factors that influence the quality of the films obtained via epitaxy is the substrate property. Here, we report a study of 2D h-BN growth on carburized Ni substrates using molecular beam epitaxy. It was found that the carburization of Ni substrates with different surface orientations leads to different kinetics of h-BN growth. While the carburization of Ni(100) enhances the h-BN growth, the speed of the h-BN growth on carburized Ni(111) reduces. As-grown continuous single-layer h-BN films are used to fabricate Ni/h-BN/Ni metal-insulator-metal (MIM) devices, which demonstrate a high breakdown electric field of 12.9 MV/cm.

Contemporary use of devices in chronic heart failure in the Netherlands.

AIMS: Despite previous surveys regarding device implantation rates in heart failure (HF), insight into the real-world management with devices is scarce. Therefore, we investigated device implantation rates in HF with reduced left ventricular ejection fraction (LVEF) in 34 Dutch centres. METHODS AND RESULTS: A cross-sectional outpatient registry was conducted in 6666 patients with LVEF < 50% and with information about device implantation available [74 (66-81) years of age; 64% male]. Patients were classified into conventional pacemakers (PM, n = 562), implantable cardioverter defibrillators (ICD, n = 1165), and cardiac resynchronization therapy with defibrillator function (CRT-D, n = 885) or pacemaker function only (CRT-P, n = 248), or no device (n = 3806). Centres were divided into ICD-implanting and CRT-implanting and referral centres. Overall, 17.5% had an ICD, 13.3% CRT-D, 3.7% CRT-P, and 8.4% PM. Of those with LVEF ≤ 30%, 42.5% had ICD or CRT-D therapy. A large variation in implantation rates existed between centres: 3-51% for ICD therapy, 0.3-44% for CRT-D therapy, 0-11% for CRT-P therapy, and 0-25% PM therapy. Implantation centres showed higher implantation rates of ICD, CRT-D, and CRT-P compared with referral centres [36% vs. 25% for defibrillators (ICD or CRT-D) and 17% vs. 9% for CRT devices (CRT-D or CRT-P), respectively, P < 0.001], independently of other factors. A large number of clinical factors were predictive for device usage. Among other, LVEF < 40% and male sex were independent positive predictors for ICD/CRT-D use [odds ratio (OR) = 3.33, P < 0.001; OR = 1.87, P = 0.019, respectively]. Older age was independently associated with less ICD/CRT-D (OR = 0.96 per year, P < 0.001) and more CRT-P/PM use (OR = 1.03 per year, P = 0.006). CONCLUSIONS: In this large Dutch HF registry, less than half of the patients with reduced LVEF received an ICD or CRT, even if LVEF was ≤30%, and a large variation between centres existed. Patients from implantation centres had more often ICD or CRT. More uniformity regarding guideline-based use of device therapy in clinical practice is needed.

Thoracic surgery in patients with an implanted neurostimulator device.

Movement disorders such as Parkinson's disease are increasingly treated with deep brain stimulators. Being implanted in a subcutaneous pocket in the chest region, thoracic surgical procedures can interfere with such devices, as they are sensible to external electromagnetic forces. Monopolar electrocautery can lead to dysfunction of the device or damage of the brain tissue caused by heat. We report a series of 3 patients with deep brain stimulators who underwent thoracic surgery. By turning off the deep brain stimulators before surgery and avoiding the use of monopolar cautery, electromagnetic interactions were avoided in all patients.

MRI for patients with cardiac implantable electrical devices.

MRI has become an invaluable tool in the evaluation of soft tissue and bony abnormalities. The presence of a cardiac implantable electrical device (CIED) may complicate matters, however, because these devices are considered a contraindication to MRI scanning. When MRI is performed in patients with a CIED, risks include reed switch activation in older devices, lead heating, system malfunction, and significant radiofrequency noise resulting in inappropriate inhibition of demand pacing, tachycardia therapies, or programming changes. This report reviews indications and risk-benefit evaluation of MRI in patients with CIED and provides a clinical algorithm for performing MRI in patients with implanted devices.

Cardiac implantable electrical devices: bioethics and management issues near the end of life.

Cardiac implantable electrical devices (CIEDs) are extremely sophisticated modern devices that provide patients with many beneficial effects, including increased survival and enhanced quality of life. CIEDs, however, may complicate and unnecessarily prolong the process of dying from terminal illnesses. A rational plan for CIED deactivation near the end of life should therefore be carefully drawn up well in advance by the patient in concert with loved ones and treating physicians.