International Journal of Artificial Organs最新文献

Lung cancer (LC) is one of the leading causes of cancer related deaths worldwide and early recognition is critical for enhancing patient outcomes. However, existing LC detection techniques face challenges such as high computational demands, complex data integration, scalability limitations, and difficulties in achieving rigorous clinical validation. This research proposes an Enhanced Hyper Tuning Deep Learning (EHTDL) model utilizing bioinspired algorithms to overcome these limitations and improve accuracy and efficiency of LC detection and classification. The methodology begins with the Smooth Edge Enhancement (SEE) technique for preprocessing CT images, followed by feature extraction using GLCM-based Texture Analysis. To refine the features and reduce dimensionality, a Hybrid Feature Selection approach combining Grey Wolf optimization (GWO) and Differential Evolution (DE) is employed. Precise lung segmentation is performed using Mask R-CNN to ensure accurate delineation of lung regions. A Deep Fractal Edge Classifier (DFEC) is introduced, consisting of five fractal blocks with convolutional layers and pooling to progressively learn LC characteristics. The proposed EHTDL model achieves remarkable performance metrics, including 99% accuracy, 100% precision, 98% recall, and 99% F1-score, demonstrating its robustness and effectiveness. The model's scalability and efficiency make it suitable for real-time clinical application offering a promising solution for early LC detection and significantly enhancing patient care.

Platelet derived prothrombotic microparticles (MP) have been associated with hemocompatibility related adverse events in patients with continuous flow left ventricular assist devices; little is known with the contemporary Impella platform micro-axial flow pumps. Indeed, the extended duration of support provided by the Impella 5.5 calls for a specific evaluation. We report for the first time two patients in whom MP have been assessed during Impella 5.5 and concomitant dual antiplatelet and direct thrombin inhibitor therapy. Interestingly, the patients showed significantly different profile in overall MP release (peak: 78.1% vs 2.7%), which was not correlated to lactate dehydrogenase nor platelet count. The patient with the higher values suffered from minor stroke 4 days after pump removal, when systemic anticoagulation with Bivalirudin had been stopped. These preliminary data might envision a new predictor of hemocompatibility related adverse events in patients with Impella, and a rethinking on the post support antithrombotic strategy.

Background: Wound healing is a complex process that involves a sequential interplay of inflammation, cell proliferation, and migration. Natural rubber extracts have been explored in cell migration and proliferation, playing a pivotal role in tissue regeneration.

Objectives: This study identified and fractionated bioactive elements in natural rubber serum and investigated their effect on wound healing capacity.

Methods: The fractions were obtained through anion exchange chromatography, acetone precipitation, and ammonium sulfate precipitation. Wound healing effects were studied in vitro through fibroblast cell proliferation, scratch assay, and fibroblast cytotoxicity by live-dead cell staining.

Results: Specific fractions R10k0.2, R10k0.4, R1k1, R1k0.6, and R1k0.8 were obtained through anion chromatography. Only the R1k-unbound, R1k0.6, and R1k0.8 promoted fibroblast proliferation, and those fractions were further extracted by acetone precipitation and ammonium sulfate. These fractions expedited wound gap closure in migration assays. Sugar compounds and carbohydrates were primarily identified in the fractions from anion exchange chromatography, while protein constituents were found from ammonium sulfate precipitation.

Conclusions: The bioactive fractions from natural rubber serum primarily consisted of sugar compounds with trace amounts of proteins. The carbohydrates extracted enhanced fibroblast proliferation and migration with no toxicity to the cells. These compounds possessed potential applications in wound healing and tissue regeneration.

Introduction: This study aimed to investigate the association of exposure below various thresholds of mean arterial pressure (MAP), pump flow rates, and hemoglobin levels during cardiopulmonary bypass (CPB) with cardiac surgery-associated acute kidney injury (CSA-AKI).

Methods: Adult patients undergoing cardiac surgery with CPB at a university hospital between April 2015 and August 2023 were included. The primary outcome was CSA-AKI within 7 days postoperatively. The primary exposures were the area under the threshold (AUT) of MAP, pump flow rate, and Hb during CPB. A multivariable logistic regression using covariates selected via Lasso regularization estimated the adjusted odds ratios (aORs) and 95% confidence intervals (CIs).

Results: We finally analyzed 333 patients, of which 156 patients (46.8%) developed CSA-AKI. The AUT of hemoglobin, but not those of MAP and pump flow rate, was associated with CSA-AKI. The lower the threshold, the stronger the association (<8 g/dL, aOR = 1.132 per 10 g/dL × min, 95% CI = 1.036-1.243, p = 0.007; <9 g/dL, aOR = 1.048, 95% CI = 1.013-1.086, p = 0.007; and <10 g/dL, aOR = 1.027, 95% CI = 1.007-1.048, p = 0.010).

Conclusion: Hemoglobin levels during CPB below 8.0 g/dL were associated with CSA-AKI, while MAP and pump flow rates indicated no such association.

Enhancing information security via reliable user authentication in wireless body area network (WBAN)-based Internet of Things (IoT) applications has garnered increasing attention. Traditional biometric methods, like fingerprint recognition, carry significant privacy risks because they cannot be cancelled or changed. Once a biometric template is exposed, it cannot be replaced, leading to potential privacy violations. Addressing these challenges, this study proposes a novel Secure EMG Framework, a cancellable biometric modality using surface electromyogram (sEMG) signals encoded by hand gesture passwords for user authentication. sEMG signals are collected from the forearm muscles, specifically the flexor carpi ulnaris (FCU), during hand gestures, forming a unique and secure biometric token. This proposed method enhances security and reliability through a multi-stage process that involves data capture, pre-processing, feature extraction, and machine learning-based computation of matching scores. A cancellable biometric token is generated through the collection of sEMG data during 16 static wrist and hand movements, increasing authentication diversity and security. To ensure signal clarity within the critical frequency range of 5-500 Hz, a Pure Frequency Hamming Filter is used to reduce noise and artifacts in the raw sEMG data. Key time-domain parameters are then extracted to form a 16-length feature vector, enhancing gesture discrimination. To further improve classification accuracy, a Tuned Boost Perfect Classifier is implemented, addressing overfitting and minimizing errors. The matching score computation enables the evaluation of input and registered signal similarity, allowing users to reset compromised biometric tokens. Experimental results validate the method, achieving an accuracy of 99.72%, an F1-score of 96.0%, and an Equal Error Rate (EER) of 0.0037.

Background: The combination of VA-ECMO and Impella^®, known as "ECpella" offers an alternative to the method of left ventricle unloading with intra-aortic balloon pump (IABP). Limited information is available to inform anticoagulation management in cases of concomitant use of Mechanical Circulatory Support (MCS) devices.

Methods: This retrospective study included 34 patients receiving hemodynamic support through concomitant MCS for cardiogenic shock for a duration exceeding 24 h. Data collection included patients' demographics, comorbidities, transfusion requirements, anticoagulation protocol, time within therapeutic anticoagulation range, and incidence of bleeding or ischemic events.

Results: Survival to discharge was 32.4% (11 out of 34). Of the 34 patients, 28 patients were treated with a combination of VA-ECMO and IABP (82.4%), while 6 patients (17.6%) were supported with the ECpella. Patients in the VA-ECMO with IABP group had a longer hospital stay (median = 30 days, IQR = 20-43.5) when compared to the ECpella group (median = 21.5 days, IQR = 6-63). Bleeding was documented in a similar proportion in both arms of the investigation (89% in the VA-ECMO with IABP group and 83% in the ECpella group). Thrombosis was more common in the VA-ECMO with IABP group (17.9%) as compared to the ECpella group (16.7%).

Conclusion: Cardiogenic shock requiring concomitant MCS which includes VA-ECMO presents a challenging clinical scenario where the risks of bleeding and thrombosis have to be balanced. Our experience, and review of the literature, highlight the need for further investigation via large retrospective registry analysis as well as randomized controlled trials.

Introduction: One goal of therapeutic efforts in sepsis/septic shock is rapid shock reversal that might be enhanced by adjunctive hemoadsorption by CytoSorb^®. We hypothesized that shortening the time the adsorbers are used, reduces the time to shock reversal.

Methods: In a retrospective study, we compared two groups of 16 and 17 patients with sepsis/septic shock treated with short change interval (sci) of 14.2 (12.9, 15.2) h/adsorber or long change interval (lci) of 21.7 (17.6, 24.0) h/adsorber.

Results: Time to shock reversal, defined as the time from hemoadsorption start to the end of norepinephrine treatment, was similar between groups (sci: 5 (3.8, 12.7), lci: 10.8 (6.5, 18.5) days; p = 0.210) and did not correlate with the change interval. At baseline, the change interval correlated inversely with interleukin-6 (IL-6; p < 0.001). From baseline to day 5 the significant decrease of thrombocytes was more pronounced in the sci group.

Discussion: Shortening the CytoSorb^® change interval did not promote faster shock reversal, but imbalances in baseline imply patients in the sci group to have been sicker. Hemodynamic instability and high IL-6 levels prompted intensivists to use shorter change intervals. Possibly the increased number of adsorber binding sites was too low to be effective, or the observed spread between the short and lci was ineffective, or shortening of the change interval improved the outcomes of patients with higher risk profiles at baseline. The calculation of an effective hemoadsorption dose, be it by the amount of blood purified, or binding sites, or a combination hereof, remains speculative.

Trial registration: Not applicable.