El implante de dispositivos de electroestimulación cardiaca (DECI) constituye una terapia útil para el tratamiento de diferentes cardiopatías. Sin embargo, su utilización no está exenta de ...complicaciones. La infección relacionada con los dispositivos de electroestimulación es una de las más frecuentes y serias que pueden producirse. La extracción intravenosa del sistema de electroestimulación es un procedimiento seguro y eficaz, dirigido al tratamiento de múltiples situaciones relacionadas con los dispositivos.
En el presente artículo abarcamos las complicaciones relacionadas con los procedimientos de extracción, identificamos los factores de riesgo asociados a la morbimortalidad de los pacientes, y establecemos una guía de prevención y tratamiento de las complicaciones cardiovasculares mayores.
A pesar del crecimiento del número de procedimientos de extracción y del desarrollo de nuevos instrumentos, su práctica implica un riesgo potencial de complicaciones mayores y de morbimortalidad asociada. La realización de la técnica presentada, la correcta evaluación del riesgo quirúrgico del paciente y la estandarización del tratamiento completo como proceso asistencial son los 3 pilares básicos del tratamiento seguro y eficaz de las complicaciones relacionadas con los DECI.
El procedimiento de extracción de los DECI que presentamos es eficaz y debe realizarse en un entorno seguro, implicando necesariamente un quirófano de cirugía cardiovascular, monitorización completa, ecocardiografía transesofágica y posibilidad de realizar esternotomía y cirugía de forma inmediata. Es necesario evaluar las posibles complicaciones y elaborar un proceso asistencial completo, teniendo en cuenta que las decisiones tomadas durante el implante inciden directamente en el potencial riesgo de la extracción.
Implantation of cardiac electrostimulation devices (CIED) is a useful therapy for the treatment of various heart diseases. However, its use is not free of complications. Infection related to electrostimulation devices is one of the most common and serious complications. Intravenous removal of the electrostimulation system is a safe and effective procedure, aimed at the treatment of multiple pathological situations related to the devices.
In the present article, we cover complications related to extraction procedures, identify risk factors associated with patient morbidity and mortality, and establish a guideline for the prevention and treatment of major cardiovascular complications.
Despite the growth in the number of extraction procedures and the development of new instruments, its practice involves a potential risk of major complications and morbi-mortality associated with the treatment. The performance of the technique presented here, the correct assessment of the patient's surgical risk, and the standardization of the entire process are the three basic pillars for a safe and effective treatment of complications related to CIED.
The extraction procedure for CIED that we present is effective and should be performed in a safe environment, necessarily involving a cardiovascular surgery operating room, complete monitoring, transesophageal echocardiography, and the possibility of an immediate sternotomy and surgery. It is necessary to evaluate possible complications and develop a complete care process, considering that the decisions made during implantation have a direct impact on the potential risk of extraction.
Integrating the advantages of multiple therapies into one therapeutic platform is highly desired for augmented treatment effects. Herein, by modifying MLS and PEG on ZnO-nanorods/AuNPs nanoassemblies ...and coating with C6 cell membrane (MP-Au/ZnO@CCM), we construct a novel ultrasound-activatable Au/ZnO-based tumor therapeutic platform (Trojan nanogenerators) and exploit it for effective tumor therapy. The developed MP-Au/ZnO@CCM nanogenerators worked well in multiple ways to achieve targeted electrostimulation and enhanced catalytic therapy of tumor, under ultrasound excitation. Firstly, the ZnO-nanogenerators will generate a piezoelectric potential difference of about 140 mV by ultrasonic excitation when targeted (by MLS moiety) to the mitochondria, disrupting the mitochondrial membrane potential for electrostimulation. Secondly, the nanogenerators enhances greatly multiple enzyme-like activities of Au nano-components for enhanced tumor catalytic therapy. Among them, the affinity and maximum reaction rate of peroxidase-like are increased by 34.99% and 53.36% respectively through kinetic analysis. Simulations and calculations revealed the roles of piezoelectric polarization electric field and displacement current in enhancing catalytic activity. The superior tumor suppressive effect of the MP-Au/ZnO@CCM was confirmed by in-vitro cell study and in-vivo C6 tumor-bearing mouse models. The developed ultrasound-activated nanogenerators will provide a unique electrostimulation tumor therapy strategy and opens a new way for improving the therapeutic efficacy of nanozymes.
By combined use of nanogenerators and nanozymes, a novel ultrasound-activated Au/ZnO-based tumor therapeutic platform (Trojan nanogenerators) was constructed for effective tumor therapy. The developed Trojan nanogenerator can simultaneously perform mitochondrial targeted electrostimulation and enhanced catalytic therapy of tumor, under ultrasound excitation. The superior antitumor effect was confirmed through in vitro and in vivo experiments. Display omitted
•A novel ultrasound-activatable Au/ZnO-based Trojan nanogenerators was developed and employed for effective tumor therapy.•Targeted electrostimulation at the subcellular level using ZnO nanogenerators was realized for the first time.•Multiple enzyme-like activities of Au nano-components was boosted greatly for enhanced tumor catalytic therapy.•The vital roles of polarization electric field and displacement current on catalytic activity enhancement were revealed.
Abstract
The efficiency with which the brain reorganizes following injury not only depends on the extent and the severity of the lesion, but also on its temporal features. It is established that ...diffuse low-grade gliomas (DLGG), brain tumours with a slow-growth rate, induce a compensatory modulation of the anatomo-functional architecture, making this kind of tumours an ideal lesion model to study the dynamics of neuroplasticity. Direct electrostimulation (DES) mapping is a well-tried procedure used during awake resection surgeries to identify and spare cortical epicentres which are critical for a range of functions. Because DLGG is a chronic disease, it inevitably relapses years after the initial surgery, and thus requires a second surgery to reduce tumour volume again. In this context, contrasting the cortical mappings obtained during two sequential neurosurgeries offers a unique opportunity to both identify and characterize the dynamic (i.e. re-evolving) patterns of cortical re-arrangements.
Here, we capitalized on an unprecedented series of 101 DLGG patients who benefited from two DES-guided neurosurgeries usually spaced several years apart, resulting in a large DES dataset of 2082 cortical sites. All sites (either non-functional or associated with language, speech, motor, somatosensory and semantic processing) were recorded in Montreal Neurological Institute (MNI) space. Next, we used a multi-step approach to generate probabilistic neuroplasticity maps that reflected the dynamic rearrangements of cortical mappings from one surgery to another, both at the population and individual level.
Voxel-wise neuroplasticity maps revealed regions with a relatively high potential of evolving reorganizations at the population level, including the supplementary motor area (SMA, Pmax = 0.63), the dorsolateral prefrontal cortex (dlPFC, Pmax = 0.61), the anterior ventral premotor cortex (vPMC, Pmax = 0.43) and the middle superior temporal gyrus (STG Pmax = 0.36). Parcel-wise neuroplasticity maps confirmed this potential for the dlPFC (Fisher's exact test, PFDR-corrected = 6.6 × 10−5), the anterior (PFDR-corrected = 0.0039) and the ventral precentral gyrus (PFDR-corrected = 0.0058). A series of clustering analyses revealed a topological migration of clusters, especially within the left dlPFC and STG (language sites); the left vPMC (speech arrest/dysarthria sites) and the right SMA (negative motor response sites). At the individual level, these dynamic changes were confirmed for the dlPFC (bilateral), the left vPMC and the anterior left STG (threshold free cluster enhancement, 5000 permutations, family-wise error-corrected).
Taken as a whole, our results provide a critical insight into the dynamic potential of DLGG-induced continuing rearrangements of the cerebral cortex, with considerable implications for re-operations.
Ng et al. describe the rearrangement of functions across the cerebral cortex in patients who each underwent two electrostimulation mapping sessions during sequential awake tumour surgeries months or years apart. The results reveal the continuing potential of the cortex to remodel over time, with implications for re-operations.
See Viganó and Bello (https://doi.org/10.1093/brain/awad190) for a scientific commentary on this article.
Ibuprofen (IBU) and naproxen (NPX) are commonly used non-steroidal anti-inflammatory drugs (NSAIDs) with high-risk quotients and are frequently detected in various aquatic environments. A weak ...electrostimulated biofilm not only had improved removal efficiencies to IBU and NPX, but also transformed different enantiomers with comparable efficiency and without configuration inversion. IBU was transformed mainly by oxidation (hydroxyl-IBU, carboxy-IBU), while NPX was mainly detoxified. The microbial analysis of IBU and NPX biofilm showed that the shared core consortia (> 1%) contained typical electro-active bacteria (Geobacter, Desulfovibrio), fermenters (Petrimonas, Acetobacterium) and potential degraders (Pandoraea, Nocardiaceae), which exhibited synergistic interactions by exchanging the additional electrons, H+, coenzyme NAD(H) or NAD(P) (H) and energy. The fungal community has a significant correlation to those core bacteria and they may also play transformation roles with their diverse enzymes. Plenty of nonspecific oxidoreductase, decarboxylase, hydrolase, cytochrome P450, and other enzymes relating to xenobiotic degradation were high-abundance encoded by the core consortia and could potentially participate in IBU and NPX biotransformation. This study offers new insights into the functional microbes and enzymes working on complex NSAIDs biotransformation and provided a feasible strategy for the enhanced removal of NSAIDs (especially IBU and NPX).
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•Ibuprofen and (S)-naproxen were effectively transformed with weak electrostimulation.•The biotransformation pathways of ibuprofen (IBU) and naproxen (NPX) were proposed.•The core consortia contained electro-active, fermentative, and degradative bacteria.•The core bacteria and fungi had synergistical interaction in the biotransformation.•The potential genera/genes participating in the IBU/NPX transformation were disclosed.
Electrogenetics, the combination of electronics and genetics, is an emerging field of mammalian synthetic biology in which electrostimulation is used to remotely program user-designed genetic ...elements within designer cells to generate desired outputs. Here, we describe recent advances in electro-induced therapeutic gene expression and therapeutic protein secretion in engineered mammalian cells. We also review available tools and strategies to engineer electro-sensitive therapeutic designer cells that are able to sense electrical pulses and produce appropriate clinically relevant outputs in response. We highlight current limitations facing mammalian electrogenetics and suggest potential future directions for research.
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•In electrogenetics, electrical fields are used to control engineered cell behavior.•Electrostimulation offers safe, precise, efficient remote control of designer cells.•Bioelectronic implants have huge potential for next-generation precision medicine.
The organization of basic functions of the human brain, particularly in the right hemisphere, remains poorly understood. Recent advances in functional neuroimaging have improved our understanding of ...cortical organization but do not allow for direct interrogation or determination of essential (versus participatory) cortical regions. Direct cortical stimulation represents a unique opportunity to provide novel insights into the functional distribution of critical epicentres. Direct cortical stimulation (bipolar, 60 Hz, 1-ms pulse) was performed in 165 consecutive patients undergoing awake mapping for resection of low-grade gliomas. Tasks included motor, sensory, counting, and picture naming. Stimulation sites eliciting positive (sensory/motor) or negative (speech arrest, dysarthria, anomia, phonological and semantic paraphasias) findings were recorded and mapped onto a standard Montreal Neurological Institute brain atlas. Montreal Neurological Institute-space functional data were subjected to cluster analysis algorithms (K-means, partition around medioids, hierarchical Ward) to elucidate crucial network epicentres. Sensorimotor function was observed in the pre/post-central gyri as expected. Articulation epicentres were also found within the pre/post-central gyri. However, speech arrest localized to ventral premotor cortex, not the classical Broca's area. Anomia/paraphasia data demonstrated foci not only within classical Wernicke's area but also within the middle and inferior frontal gyri. We report the first bilateral probabilistic map for crucial cortical epicentres of human brain functions in the right and left hemispheres, including sensory, motor, and language (speech, articulation, phonology and semantics). These data challenge classical theories of brain organization (e.g. Broca's area as speech output region) and provide a distributed framework for future studies of neural networks.
•RONCs transformation and ammonification is the key step for total nitrogen removal.•The cleavage of C-N bond limited the transformation of electrophilic RONCs to NH4+.•Electrostimulation enhances ...the anaerobic reduction of RONCs into aromatic amines.•Micro-aeration enhances the aerobic oxidation of amine products into NH4+.•Regulating microbial redox reactions facilitates the transformation of RONCs.
Biotechnology for wastewater treatment is mainstream and effective depending upon microbial redox reactions to eliminate diverse contaminants and ensure aquatic ecological health. However, refractory organic nitrogen compounds (RONCs, e.g., nitro-, azo-, amide-, and N-heterocyclic compounds) with complex structures and high toxicity inhibit microbial metabolic activity and limit the transformation of organic nitrogen to inorganic nitrogen. This will eventually result in non-compliance with nitrogen discharge standards. Numerous efforts suggested that applying exogenous electron donors or acceptors, such as solid electrodes (electrostimulation) and limited oxygen (micro-aeration), could potentially regulate microbial redox reactions and catabolic pathways, and facilitate the biotransformation of RONCs. This review provides comprehensive insights into the microbial regulation mechanisms and applications of electrostimulation and micro-aeration strategies to accelerate the biotransformation of RONCs to organic amine (amination) and inorganic ammonia (ammonification), respectively. Furthermore, a promising approach involving in-situ hybrid anaerobic biological units, coupled with electrostimulation and micro-aeration, is proposed towards engineering applications. Finally, employing cutting-edge methods including multi-omics analysis, data science driven machine learning, technology-economic analysis, and life-cycle assessment would contribute to optimizing the process design and engineering implementation. This review offers a fundamental understanding and inspiration for novel research in the enhanced biotechnology towards RONCs elimination.
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Direct electrical stimulation, the transient 'lesional' method probing brain function, has been utilized in identifying the language cortex and preserving language function during epilepsy and ...neuro-oncological surgeries for about a century. However, comparison of functional maps of the language cortex across languages/continents based on cortical stimulation remains unclear. We conducted a retrospective multicentre study including four cohorts of direct electrical stimulation mapping from four centres across three continents, where three indigenous languages (English, French and Mandarin) are spoken. All subjects performed the two most common language tasks: number counting and picture naming during stimulation. All language sites were recorded and normalized to the same brain template. Next, Spearman's correlation analysis was performed to explore the consistency of the distributions of the language cortex across centres, a kernel density estimation to localize the peak coordinates, and a hierarchical cluster analysis was performed to detect the crucial epicenters. A total of 598 subjects with 917 speech arrest sites (complete interruption of ongoing counting) and 423 anomia sites (inability to name or misnaming) were included. Different centres presented highly consistent distribution patterns for speech arrest (Spearman's coefficient r ranged from 0.60 to 0.85, all pair-wise correlations P < 0.05), and similar patterns for anomia (Spearman's coefficient r ranged from 0.37 to 0.80). The combinational speech arrest map was divided into four clusters: cluster 1 mainly located in the ventral precentral gyrus and pars opercularis, which contained the peak of speech arrest in the ventral precentral gyrus; cluster 2 in the ventral and dorsal precentral gyrus; cluster 3 in the supplementary motor area; cluster 4 in the posterior superior temporal gyrus and supramarginal gyrus. The anomia map revealed two clusters: one was in the posterior part of the superior and middle temporal gyri, which peaked at the posterior superior temporal gyrus; and the other within the inferior frontal gyrus, peaked at the pars triangularis. This study constitutes the largest series to date of language maps generated from direct electrical stimulation mapping. The consistency of data provides evidence for common language networks across languages, in the context of both speech and naming circuit. Our results not only clinically offer an atlas for language mapping and protection, but also scientifically provide better insight into the functional organization of language networks.
Mechanism of microbiome assembly and function driven by cathode potential in electro-stimulated microbial reductive dechlorination system remain poorly understood. Here, core microbiome structure, ...interaction, function and assembly regulating by cathode potential were investigated in a 2,4,6-trichlorophenol bio-dechlorination system. The highest dechlorination rate (24.30 μM/d) was observed under − 0.36 V with phenol as a major end metabolite, while, lower (−0.56 V) or higher (0.04 V or −0.16 V) potentials resulted in 1.3–3.8 times decreased of dechlorination kinetic constant. The lower the cathode potential, the higher the generated CH4, revealing cathode participated in hydrogenotrophic methanogenesis. Taxonomic and functional structure of core microbiome significantly shifted within groups of − 0.36 V and − 0.56 V, with dechlorinators (Desulfitobacterium, Dehalobacter), fermenters (norank_f_Propionibacteriaceae, Dysgonomonas) and methanogen (Methanosarcina) highly enriched, and the more positive interactions between functional genera were found. The lowest number of nodes and links and the highest positive correlations were observed among constructed sub-networks classified by function, revealing simplified and strengthened cooperation of functional genera driven by group of − 0.36 V. Cathode potential plays one important driver controlling core microbiome assembly, and the low potentials drove the assembly of major dechlorinating, methanogenic and electro-active genera to be more deterministic, while, the major fermenting genera were mostly governed by stochastic processes.
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•Cathode potential regulation lead to the differed dechlorination performance.•Low potential stimulated cathode participated hydrogenotrophic methanogenesis.•Microbiome structure shifted and more positive interactions under low potential.•Simplified and strengthened microbial cooperation by cathode potential assembly.•Group of − 0.36 V drove assembly of major functional genera more deterministic.
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