Comparing the Efficacy of Foot Reflexology and Benson's Relaxation on Anxiety and Physiologic Parameters After Cesarean Surgery.

OBJECTIVE: To compare the efficacy of foot reflexology and Benson's relaxation on anxiety and physiologic parameters after cesarean surgery. DESIGN: Randomized controlled trial with three parallel arms. SETTING: Gynecologic ward of the Persian Gulf Martyrs Hospital in Bushehr, Iran, in 2020. PARTICIPANTS AND INTERVENTIONS: Women undergoing cesarean surgery (n = 135) were selected by convenience sampling and divided via block randomization into three groups of foot reflexology, Benson's relaxation interventions, and control group (n = 45 in each group). Interventions were performed 2 hours after cesarean surgery. MEASUREMENTS: Spielberger's State-Trait Anxiety Inventory, mercury sphygmomanometer, and pulse oximeter were used to collect the data. Anxiety was measured before and 30 minutes after the intervention. Physiologic parameters were measured before the intervention and immediately, 30 minutes, and 60 minutes after the intervention. Data were analyzed using inferential statistics. RESULTS: The mean score of situational anxiety after the intervention was significantly lower than before the intervention in the reflexology (t = 6.171; 95% confidence interval [CI] [5.66, 11.14]) and Benson's relaxation groups (t = 7.362; 95% CI [5.91, 9.85]). However, changes in the control group were not significant (t = 1.674; 95% CI [-0.24, 2.55]). Decreases in anxiety scores were similar in the two intervention groups. After intervention, in most measurement times, respiratory rate and pulse rate decreased in the two intervention groups compared to the control group, and arterial oxygen saturation and systolic blood pressure increased. CONCLUSION: Considering the effect of both interventions on decreasing anxiety and improving most physiologic parameters, it seems that foot reflexology and Benson's relaxation can be recommended after cesarean surgery.

Safety and feasibility of pulmonary vein isolation utilizing pulsed field ablation in patients with symptomatic atrial fibrillation and implanted Watchman devices.

BACKGROUND: Pulsed field ablation (PFA) is a novel method of non-thermal cardiac ablation for atrial fibrillation (AF). Its use on patients with pre-existing Watchman devices has not been studied. METHODS: Pulmonary vein isolation (PVI) utilizing PFA was performed in 7 patients with symptomatic AF and implanted Watchman devices. All cases were conducted at a single academic center. RESULTS: Successful PVI in patients with Watchman devices implanted at a median time of 534 days prior to the index ablation procedure (IQR 365 days) was achieved in all cases. No major adverse events (intraprocedural CVA, post-procedural CVA, major or minor bleeding events, device embolization, or cardiac tamponade) were observed. In 6 of 7 patients, a low-dose direct oral anticoagulant (DOAC) strategy was implemented post-PFA. CONCLUSION: We present the first reported case series of PFA in patients with AF and implanted Watchman devices. This study highlights the safety and feasibility of the FARAPULSE PFA system in this patient population.

Fontan Circulation and Aortic Stiffness: Insights into Vascular Dynamics and Haemodynamic Interplay.

Increased aortic stiffness predisposes cardiac afterload and influences cardiac function. Congenital heart diseases involving aortic arch malformation and extended cardiovascular surgery, i.e. univentricular heart diseases, can lead to increased aortic stiffness. This study aimed to investigate whether Fontan patients (FO) have increased aortic stiffness within distinct aortic segments, and whether these parameters relate to Fontan-specific haemodynamics. In a prospective case-control study, 20 FO and 49 heart-transplanted control subjects with biventricular circulation underwent invasive cardiac catheterisation. We invasively measured pulse wave velocity (PWV) in the ascending aorta and along the entire aorta. Haemodynamic parameters, including end-diastolic pressure, pulmonary artery pressure, the cardiac index and systemic vascular resistance index were also assessed. FO exhibited significantly higher ascending aorta PWV (aPWV) than controls (FO: 7.2 ± 2.4 m/s|Controls: 4.9 ± 0.7 m/s, p < 0.001) and compared to the inner group central aorta PWV (cPWV; FO: 5.5 ± 1.2 m/s|Controls: 5.3 ± 1.0 m/s). Multivariate analysis confirmed this aPWV elevation in FO even after adjusting for age and BMI. aPWV and cPWV were almost identical within the control group. Correlation analyses revealed associations between cPWV and blood pressure in controls, while correlations were less apparent in FO. We detected no significant association between the aPWV and other haemodynamic parameters in any of our groups. FO exhibit increased aPWV, indicating specific vascular stiffness in the ascending aorta, while their overall aortic stiffness remains comparable to controls. Further research is needed to understand the implications of these findings on Fontan circulation and long-term cardiovascular health. CENTRAL MESSAGE: Fontan patients show increased aortic arch pulse wave velocity, suggesting specific vascular stiffness. PERSPECTIVE STATEMENT: Our study offers rare insights into pulse wave velocity in Fontan patients, highlighting increased arterial stiffness in the aortic arch. Vascular stiffness was particularly increased in the area of surgical reconstruction. This indicates the need for further research on vascular stiffness in Fontan circulation to understand its impact on cardiovascular health. CLINICAL TRIAL REGISTRATION: German clinical trial registration, DRKS00015066.

Flow Analysis of Central Venous Outflow Tract: A New Approach to Understanding Pulse-Synchronous Tinnitus.

OBJECTIVE: Pulse-synchronous tinnitus (PST) has been linked to multiple anatomical variants of the central venous outflow tract (CVOT) including sigmoid sinus (SS) dehiscence and diverticulum. This study investigates flow turbulence, pressure, and wall shear stress along the CVOT and proposes a mechanism that results in SS dehiscence and PST. STUDY DESIGN: Case series. SETTING: Tertiary Academic Center. METHODS: Venous models were reconstructed from computed tomography scans of 3 patients with unilateral PST. Two models for each patient are obtained: a symptomatic and contralateral asymptomatic side. A turbulent model-enabled commercial flow solver was used to simulate the pulsatile blood flow over the cardiac cycle through the models. Fluid flow through the transverse and SS junction was analyzed to observe the velocity, pressure, turbulent kinetic energy (TKE), and shear stress over a simulated cardiac cycle. RESULTS: Fluid flow on the symptomatic side showed increased vorticity in the presence of an SS diverticulum. Higher TKE with periodicity following the cardiac cycle was observed on the symptomatic side, and a sharp increase was observed if SS diverticulum was present. Shear stress was highest near the narrowest segments of the vessel. Pressure was observed to be lower on the symptomatic side at the transverse-SS junction for all 3 patients. CONCLUSION: Computational fluid dynamics modeling of blood flow through the CVOT in PST suggests that low pressure may be the cause of dehiscence, and tinnitus may result from periodic increases in TKE.

Intermittent pulses of methylprednisolone with low-dose prednisone attenuate lupus symptoms in B6.MRL-Faslpr/J mice with fewer glucocorticoid side effects.

Glucocorticoids (GCs) are potent anti-inflammatory and immunosuppressant medications and remain the cornerstone of systemic lupus erythematosus (SLE) therapy. However, ongoing exposure to GCs has the potential to elicit multiple adverse effects. Considering the irreplaceability of GCs in SLE therapy, it is important to explore the optimal regimen of GCs. Here, we compared the long-term efficacy and safety of pulsed and oral GC therapy in a lupus-prone mouse model. Mice were grouped using a randomized block design. We monitored survival rates, proteinuria, serum autoantibodies, and complement 3 (C3) levels up to 28 weeks of age, and assessed renal damage, bone quality, lipid deposition in the liver and marrow, glucose metabolic parameters, and levels of hormones of the hypothalamic-pituitary-adrenal (HPA) axis. Finally, we explored the mechanisms underlying the superior efficacy of the pulse regimen over oral prednisone regimen. We found that both GC regimens alleviated the poor survival rate, proteinuria, and glomerulonephritis, while also reducing serum autoantibodies and increasing the level of C3. The pulsed GC regimen showed less resistance to insulin, less suppression of the HPA axis, less bone loss, and less bone marrow fat deposition than the oral GC regimen. Additionally, GC-induced leucine zipper (GILZ) was significantly overexpressed in the GC pulse group. These results suggest that the GC pulse regimen ameliorated symptoms in lupus-prone mice, with fewer side effects, which may be related to GILZ overexpression. Our findings offer a potentially promising GC treatment option for SLE.

Estimated Pulse-Wave Velocity and Magnetic Resonance Imaging Markers of Cerebral Small-Vessel Disease in the NOMAS.

BACKGROUND: Pulse-wave velocity is a measure of arterial stiffness and a risk factor for cardiovascular disease. Recently, an estimated pulse-wave velocity (ePWV) was introduced that was predictive of increased risk of cardiovascular disease. Our objective was to determine whether ePWV was associated with cerebral small-vessel disease on magnetic resonance imaging. METHODS AND RESULTS: We included 1257 participants from the NOMAS (Northern Manhattan Study). The ePWV values were calculated using a nonlinear function of age and mean arterial blood pressure. The association between ePWV and white matter hyperintensity volume was assessed. Modification by race and ethnicity was evaluated. Associations between ePWV and other cerebral small-vessel disease markers, covert brain infarcts, cerebral microbleeds, and enlarged perivascular spaces, were explored as secondary outcomes. Mean±SD age of the cohort was 64±8 years; 61% were women; 18% self-identified as non-Hispanic Black, 67% as Hispanic, and 15% as non-Hispanic White individuals. Mean±SD ePWV was 11±2 m/s in the total NOMAS population and was similar across race and ethnic groups. The ePWV was significantly associated with white matter hyperintensity volume (ß=0.23 [95% CI, 0.20-0.26]) after adjustment. Race and ethnicity modified the association between ePWV and white matter hyperintensity volume, with stronger associations in Hispanic and non-Hispanic Black individuals. Significant associations were found between ePWV and covert brain infarcts, cerebral microbleeds, and perivascular spaces after adjustment. CONCLUSIONS: The ePWV function may provide a vascular mechanism for deleterious cerebrovascular outcomes in individuals with cerebral small-vessel disease and is particularly apparent in the racial and ethnic minorities represented in the NOMAS cohort.

Regulating the Distribution and Accumulation of Charged Molecules by Progressive Electroporation for Improved Intracellular Delivery.

The cell membrane separates the intracellular compartment from the extracellular environment, constraining exogenous molecules to enter the cell. Conventional electroporation typically employs high-voltage and short-duration pulses to facilitate the transmembrane transport of molecules impermeable to the membrane under natural conditions by creating temporary hydrophilic pores on the membrane. Electroporation not only enables the entry of exogenous molecules but also directs the intracellular distribution of the electric field. Recent advancements have markedly enhanced the efficiency of intracellular molecule delivery, achieved through the utilization of microstructures, microelectrodes, and surface modifications. However, little attention is paid to regulating the motion of molecules during and after passing through the membrane to improve delivery efficiency, resulting in an unsatisfactory delivery efficiency and high dose demand. Here, we proposed the strategy of regulating the motion of charged molecules during the delivery process by progressive electroporation (PEP), utilizing modulated electric fields. Efficient delivery of charged molecules with an expanded distribution and increased accumulation by PEP was demonstrated through numerical simulations and experimental results. The dose demand can be reduced by 10-40% depending on the size and charge of the molecules. We confirmed the safety of PEP for intracellular delivery in both short and long terms through cytotoxicity assays and transcriptome analysis. Overall, this work not only reveals the mechanism and effectiveness of PEP-enhanced intracellular delivery of charged molecules but also suggests the potential integration of field manipulation of molecular motion with surface modification techniques for biomedical applications such as cell engineering and sensitive cellular monitoring.

Electric Field Generated at the Millisecond Pulse-Polarized Interface Facilitates the Electrolytic Conversion of SO2 into H2S.

Interfacial electric field holds significant importance in determining both the polar molecular configuration and surface coverage during electrocatalysis. This study introduces a methodology leveraging the varying electric dipole moment of SO2 under distinct interfacial electric field strengths to enhance the selectivity of the SO2 electroreduction process. This approach presented the first attempt to utilize pulsed voltage application to the Au/PTFE membrane electrode for the control of the molecular configuration and coverage of SO2 on the electrode surface. Remarkably, the modulation of pulse duration resulted in a substantial inhibition of the hydrogen evolution reaction (HER) (FEH2 < 3%) under millisecond pulse conditions (ta = 10 ms, tc = 300 ms, Ea = -0.8 V (vs Hg/Hg2SO4), Ec = -1.8 V (vs Hg/Hg2SO4)), concomitant with a noteworthy enhancement in H2S selectivity (FEH2S > 97%). A comprehensive analysis, incorporating in situ Raman spectroscopy, electrochemical quartz crystal microbalance, COMSOL simulations, and DFT calculations, corroborated the increased selectivity of H2S products was primarily associated with the inherently large dipole moment of the SO2 molecule. The enhancement of the interfacial electric field induced by millisecond pulses was instrumental in amplifying SO2 coverage, activating SO2, facilitating the formation of the pivotal intermediate product *SOH, and effectively reducing the reaction energy barrier in the SO2 reduction process. These findings provide novel insights into the influences of ion and molecular transport dynamics, as well as the temporal intricacies of competitive pathways during the SO2 electroreduction process. Moreover, it underscores the intrinsic correlation between the electric dipole moment and surface-molecule interaction of the catalyst.

Artificial intelligence-based evaluation of carotid artery compressibility via point-of-care ultrasound in determining the return of spontaneous circulation during cardiopulmonary resuscitation.

AIM: This study introduces RealCAC-Net, an artificial intelligence (AI) system, to quantify carotid artery compressibility (CAC) and determine the return of spontaneous circulation (ROSC) during cardiopulmonary resuscitation. METHODS: A prospective study based on data from a South Korean emergency department from 2022 to 2023 investigated carotid artery compressibility in adult patients with cardiac arrest using a novel AI model, RealCAC-Net. The data comprised 11,958 training images from 161 cases and 15,080 test images from 134 cases. RealCAC-Net processes images in three steps: TransUNet-based segmentation, the carotid artery compressibility measurement algorithm for improved segmentation and CAC calculation, and CAC-based classification from 0 (indicating a circular shape) to 1 (indicating high compression). The accuracy of the ROSC classification model was tested using metrics such as the dice similarity coefficient, intersection-over-union, precision, recall, and F1 score. RESULTS: RealCAC-Net, which applied the carotid artery compressibility measurement algorithm, performed better than the baseline model in cross-validation, with an average dice similarity coefficient of 0.90, an intersection-over-union of 0.84, and a classification accuracy of 0.96. The test set achieved a classification accuracy of 0.96 and an F1 score of 0.97, demonstrating its efficacy in accurately identifying ROSC in cardiac arrest situations. CONCLUSIONS: RealCAC-Net enabled precise CAC quantification for ROSC determination during cardiopulmonary resuscitation. Future research should integrate this AI-enhanced ultrasound approach to revolutionize emergency care.

The role of non-invasive oscillometric method to detect aortic stiffness in patients with subclinical hypothyroidism.

INTRODUCTION: Subclinical hypothyroidism (SCH) is a biochemical condition that is diagnosed when peripheral free thyroid hormone levels are within normal reference laboratory range but serum thyroid-stimulating hormone (TSH) levels are mildly elevated. The aim of this study was to investigate the relationship between SCH and arterial stiffness using two different non-invasive methods, including echocardiography and oscillometric arteriography. MATERIAL AND METHODS: The study included 33 newly diagnosed SCH patients and 34 age- and gender-matched healthy controls. Systolic and diastolic diameters and elastic parameters of the aorta were calculated by 2D Transthoracic echocardiography (TTE). Central blood pressure and aortic stiffness values of patient groups were measured noninvasively from the brachial artery using Mobil-O-Graph arteriography. Pulse wave velocity (PWV) and augmentation index (AIx) were used as arterial stiffness indicators. RESULTS: There was no significant difference between SCH and control groups with regard to age, gender, and body mass index (BMI). Aortic strain and aortic distensibility, were significantly lower in the SCH group than in the control group (p < 0.001). PWV and AIx which measured by Mobil-O-Graph arteriography were found to be significantly higher in the subclinical hypothyroid group compared to the control group (p < 0.05). CONCLUSION: Aortic stiffness assessed by TTE and Mobil-O-Graph arteriography deteriorated in patients with SCH after excluding other cardiovascular risk factors. The assessment of aortic stiffness by the oscillometric method was easy and useful for widespread clinical use.

Thickness Measurements with EMAT Based on Fuzzy Logic.

Metal thickness measurements are essential in various industrial applications, yet current non-contact ultrasonic methods face limitations in range and accuracy, hindering the widespread adoption of electromagnetic ultrasonics. This study introduces a novel combined thickness measurement method employing fuzzy logic, with the aim of broadening the applicational scope of the EMAT. Leveraging minimal hardware, this method utilizes the short pulse time-of-flight (TOF) technique for initial thickness estimation, followed by secondary measurements guided by fuzzy logic principles. The integration of measurements from the resonance, short pulse echo, and linear frequency modulation echo extends the measurement range while enhancing accuracy. Rigorous experimental validation validates the method's effectiveness, demonstrating a measurement range of 0.3-1000.0 mm with a median error within ±0.5 mm. Outperforming traditional methods like short pulse echoes, this approach holds significant industrial potential.

High Power Pulsed LED Driver for Vibration Measurements.

Vibration measurements pose specific experimental challenges to be faced. In particular, optical methods can be used to obtain full-field vibration information. In this scenario, stereo-camera systems can be developed to obtain 3D displacement measurements. As vibration frequency increases, the common approach is to reduce camera exposure time to avoid blurred images, which can lead to under-exposed images and data loss, as well as issues with the synchronization of the stereo pair. Both of these problems can be solved by using high-intensity light pulses, which can produce high-quality images and guarantee camera synchronization since data is saved by both cameras only during the short-time light pulse. To this extent, high-power Light-Emitting Diodes (LEDs) can be used, but even if the LED itself can have a fast response time, specific electronic drivers are needed to ensure the desired timing of the light pulse. In this paper, a circuit is specifically designed to achieve high-intensity short-time light pulses in the range of 1 µs. A prototype of the designed board was assembled and tested to check its capability to respect the specification. Three different measurement methods are proposed and validated to achieve short-time light pulse measurements: shunt voltage measurement, direct photodiode measurement with a low-cost sensor, and indirect pulse measurement through a low-frame-rate digital camera.

Temporal Convolutional Neural Network-Based Prediction of Vascular Health in Elderly Women Using Photoplethysmography-Derived Pulse Wave during Exercise.

(1) Background: The objective of this study was to predict the vascular health status of elderly women during exercise using pulse wave data and Temporal Convolutional Neural Networks (TCN); (2) Methods: A total of 492 healthy elderly women aged 60-75 years were recruited for the study. The study utilized a cross-sectional design. Vascular endothelial function was assessed non-invasively using Flow-Mediated Dilation (FMD). Pulse wave characteristics were quantified using photoplethysmography (PPG) sensors, and motion-induced noise in the PPG signals was mitigated through the application of a recursive least squares (RLS) adaptive filtering algorithm. A fixed-load cycling exercise protocol was employed. A TCN was constructed to classify flow-mediated dilation (FMD) into "optimal", "impaired", and "at risk" levels; (3) Results: TCN achieved an average accuracy of 79.3%, 84.8%, and 83.2% in predicting FMD at the "optimal", "impaired", and "at risk" levels, respectively. The results of the analysis of variance (ANOVA) comparison demonstrated that the accuracy of the TCN in predicting FMD at the impaired and at-risk levels was significantly higher than that of Long Short-Term Memory (LSTM) networks and Random Forest algorithms; (4) Conclusions: The use of pulse wave data during exercise combined with the TCN for predicting the vascular health status of elderly women demonstrated high accuracy, particularly in predicting impaired and at-risk FMD levels. This indicates that the integration of exercise pulse wave data with TCN can serve as an effective tool for the assessment and monitoring of the vascular health of elderly women.

Geomagnetic Disturbances and Pulse Amplitude Anomalies Preceding M > 6 Earthquakes from 2021 to 2022 in Sichuan-Yunnan, China.

Compelling evidence has shown that geomagnetic disturbances in vertical intensity polarization before great earthquakes are promising precursors across diverse rupture conditions. However, the geomagnetic vertical intensity polarization method uses the spectrum of smooth signals, and the anomalous waveforms of seismic electromagnetic radiation, which are basically nonstationary, have not been adequately considered. By combining pulse amplitude analysis and an experimental study of the cumulative frequency of anomalies, we found that the pulse amplitudes before the 2022 Luding M6.8 earthquake show characteristics of multiple synchronous anomalies, with the highest (or higher) values occurring during the analyzed period. Similar synchronous anomalies were observed before the 2021 Yangbi M6.4 earthquake, the 2022 Lushan M6.1 earthquake and the 2022 Malcolm M6.0 earthquake, and these anomalies indicate migration from the periphery toward the epicenters over time. The synchronous changes are in line with the recognition of previous geomagnetic anomalies with characteristics of high values before an earthquake and gradual recovery after the earthquake. Our study suggests that the pulse amplitude is effective for extracting anomalies in geomagnetic vertical intensity polarization, especially in the presence of nonstationary signals when utilizing observations from multiple station arrays. Our findings highlight the importance of incorporating pulse amplitude analysis into earthquake prediction research on geomagnetic disturbances.

Use of Non-Destructive Ultrasonic Techniques as Characterization Tools for Different Varieties of Wine.

In this work, we have verified how non-destructive ultrasonic evaluation allows for acoustically characterizing different varieties of wine. For this, a 3.5 MHz transducer has been used by means of an immersion technique in pulse-echo mode. The tests were performed at various temperatures in the range 14-18 °C. The evaluation has been carried out studying, on the one hand, conventional analysis parameters (velocity and attenuation) and, on the other, less conventional parameters (frequency components). The experimental study comprised two stages. In the first, the feasibility of the study was checked by inspecting twelve samples belonging to six varieties of red and white wine. The results showed clearly higher ultrasonic propagation velocity values in the red wine samples. In the second, nine samples of different monovarietal wine varieties (Grenache, Tempranillo and Cabernet Sauvignon) were analyzed. The results show how ultrasonic velocity makes it possible to unequivocally classify the grape variety used in winemaking with the Cabernet Sauvignon variety having the highest values and the Grenache the lowest. In addition, the wines of the Tempranillo variety are those that present higher values of the attenuation coefficient, and those from the Grenache variety transmit higher frequency waves.

A new stress measurement strategy based on time-frequency characteristics of Lamb waves.

Existing stress evaluation methods based on the Lamb waves mainly use the time of flight (TOF) or velocity as the means of stress measurement. However, these two features used for stress measurement are sometimes insensitive to stress changes. Therefore, it is essential to explore other features that are potentially more sensitive to stress changes. The time-frequency spectrums of signals containing stress information have not yet been fully studied for stress evaluation. This paper proposes a uniaxial stress measurement method based on two time-frequency characteristics of Lamb waves, i.e., the slope of time-frequency spectrum distribution (TFSD) and pulse width impact factor. Theoretical expressions of the slope of TFSD are derived. The impacts of excitation signal parameters (i.e., bandwidth and center frequency) and noise on two time-frequency characteristics were discussed. Then, the fitting results of the finite element simulation are consistent with the results predicted by theory. To experimentally validate the proposed theory, aluminum plate specimens with two different types of adhesives were used for the experiment. According to the experimental stress measurement expression, three uniaxial tensile tests in the range of 35-95 MPa were conducted on the identical batch of specimens. The maximum standard deviation of multiple measured stress based on pulse width impact factor is 3.76433 MPa, demonstrating excellent measurement stability. The maximum standard deviation of multiple measured stress based on the slope of TFSD is 9.12492 MPa. It shows that the proposed methodology is a promising alternative for stress measurement.

Inspection of defects in composite structures using long pulse thermography and shearography.

Long pulse thermography (LPT) and shearography have been developed as primary methods for detecting debonding or delamination defects in composites due to their full-field imaging, non-contact operation, and high detection efficiency. Both methods utilize halogen lamps as the excitation source for thermal loading. However, the defects detected by the two techniques differ due to their distinct inspection mechanisms. In this study, LPT and shearography are employed to evaluate internal damage in various composite structures. The experimental results demonstrate that LPT, when combined with thermal signal processing algorithms, can clearly detect debonding defects in rubber-to-metal bonded plates, whereas excessive adhesive defects can only be identified by shearography. Flat-bottom holes in the CFRP panel can only be detected by LPT, and shearography is particularly effective for detecting composite materials with a metal skin. For the quantitative measurement of defect sizes, the average errors of the rubber-to-metal bonded plate and CFRP panel using LPT are 4.9 % and 2.2 %, respectively, whereas the average errors of the rubber-to-metal bonded plate and aluminum honeycomb panel using shearography are 15.12 % and 95.4 %, respectively. This indicates that LPT is superior to shearography in quantitatively measuring defect sizes. These two nondestructive testing methods, based on different principles, each have their own advantages and disadvantages. Employing a multi-modal inspection method can leverage their complementary advantages, preventing misdetection and leakage of internal defects in composites.

How Long Does Deep Brain Stimulation Give Patients Benefit?

INTRODUCTION: One of the most common questions patients ask when they are contemplating deep brain stimulation (DBS) is how long it will last. To guide physicians in answering this query, we performed a scoping review to assess the current state of the literature and to identify the gaps that need to be addressed. MATERIALS AND METHODS: The authors performed a MEDLINE search inclusive of articles from January 1987 (advent of DBS literature) to June 2023 including human and modeling studies written in English. For longevity of therapy data, only studies with a mean follow-up of ≥three years were included. Using the Rayyan platform, two reviewers (JP and RM) performed a title screen. Of the 734 articles, 205 were selected by title screen and 109 from abstract review. Ultimately, a total of 122 articles were reviewed. The research questions we explored were 1) how long can the different components of the DBS system maintain functionality? and 2) how long can DBS remain efficacious in treating Parkinson's disease (PD), essential tremor (ET), dystonia, and other disorders? RESULTS: We showed that patients with PD, ET, and dystonia maintain a considerable long-term benefit in motor scores seven to ten years after implant, although the percentage improvement decreases over time. Stimulation off scores in PD and ET show worsening, consistent with disease progression. Battery life varies by the disease treated and the programming settings used. There remains a paucity of literature after ten years, and the impact of new device technology has not been classified to date. CONCLUSION: We reviewed existing data on DBS longevity. Overall, outcomes data after ten years of therapy are substantially limited in the current literature. We recommend that physicians who have data for patients with DBS exceeding this duration publish their results.

Preoperative Counseling in Spinal Cord Stimulation: A Designated Driver in Implantable Pulse Generator-Related Inconveniences?

BACKGROUND: Spinal cord stimulation (SCS) has been reported to cause substantial pain relief and improved quality of life (QoL) in patients with persistent spinal pain syndrome (PSPS). Despite implantable pulse generator (IPG)-related inconveniences such as pain, shame, and discomfort affecting QoL and patient satisfaction, these are often neglected. Hence, the current study aims to determine the associations between patient satisfaction, IPG-related inconveniences, and preoperative counseling in a homogeneous group of patients with PSPS receiving SCS with IPG implantation in the gluteal or abdominal area. MATERIALS AND METHODS: Retrospective data on sample characteristics were gathered from the EPIC (electronic health record software) digital patient data base. Prospective data on patient satisfaction were obtained with a questionnaire that covered various topics such as shame, pain, disturbances in daily/intense activities, night rest and/or sleep, discomfort caused by clothing, and preoperative counseling. The exact location of the IPG and its scar were determined with photo analysis. Thereafter, the site of IPG placement was classified into separate quadrants within the gluteal and abdominal area. Patient satisfaction was defined as accepting the current location of the IPG without having the wish to undergo revision surgery. RESULTS: In total, 81 participants (50.9 ± 10 years) were included in this analysis, with patient satisfaction observed in 61 patients (75.3%). Among satisfied patients, more extensive preoperative counseling concerning IPG pain and discomfort was reported compared with patients who were not satisfied (p < 0.001). When comparing the two groups, significant differences were found in shame (8/81, 9.9%), IPG site pain (21/81, 25.9%), disturbance of activities (42/81, 51.9%), and clothing-related discomfort (42/81, 51.9%). CONCLUSIONS: On the basis of the current results, shared decision-making and comprehensive preoperative provision of information are recommended to optimize patient satisfaction regarding IPG pain, discomfort, and inconveniences. Although many patients experience these disadvantages despite successful SCS for pain related to PSPS, most of them accept this if they have received adequate preoperative information about expectations.

Effect of Discharge Energy on Micro-Arc Oxidation Coating of Zirconium Alloy.

The micro-arc oxidation (MAO) technique was used to grow in situ oxidation coating on the surface of R60705 zirconium alloy in Na2SiO3, Na2EDTA, and NaOH electrolytes. The thickness, surface morphology, cross-section morphology, wear resistance, composition, and structure of the micro-arc oxidation coating were analyzed by an eddy current thickness measuring instrument, XPS, XRD, scanning electron microscopy, energy spectrometer, and wear testing machine. The corrosion resistance of the coating was characterized by a polarization curve and electrochemical impedance spectroscopy (EIS). The results show that, with the increase in frequency, the single-pulse discharge energy decreases continuously, and the coating thickness shows a decreasing trend, from the highest value of 152 µm at 400 Hz to the lowest value of 87.5 µm at 1000 Hz. The discharge pore size on the surface of the coating gradually decreases, and the wear resistance and corrosion resistance of the coating first increase and then decrease. The corrosion resistance is the best when the frequency is 400 Hz. At this time, the corrosion potential is -0.215 V, and the corrosion current density is 2.546 × 10-8 A·cm-2. The micro-arc oxidation coating of zirconium alloy is mainly composed of monoclinic zirconia (m-ZrO2) and tetragonal zirconia (t-ZrO2), in which the content of monoclinic zirconia is significantly more than that of tetragonal zirconia.