Clinical management and outcome of adult patients with extracorporeal life support device–associated intracerebral hemorrhage—a neurocritical perspective and grading

Intracerebral hemorrhage (ICH) is a devastating complication in patients treated with extracorporeal membrane oxygenation (ECMO) due to respiratory or cardiac issues. Neurosurgical evaluation and management of such cases has only insufficiently been studied. We conducted a retrospective, cohort study of adult patients treated with ECMO between January 2007 and January 2017 in a tertiary healthcare center. Demographics, clinical data, coagulation status, ICH characteristics, and treatment modalities were analyzed. The primary outcome parameter was defined as mortality caused by ICH during ECMO. 525 patients with ECMO therapy were eligible for analysis. An overall incidence for any type of intracranial bleeding of 12.3% was found. Small hemorrhages accounted for 6.4% and acute subdural and epidural hematoma for 1.2%. Twenty-four (4.6%) patients developed ICH, and 11 patients (46%) died due to the ICH. Mortality was significantly higher in patients with larger ICH volumes (86.8 +/- 34.8 ml vs 9.9 +/- 20.3 ml, p < 0.001), intraventricular hemorrhage (83% vs 8%, p = 0.01), and a fluid level inside the ICH (75% vs 31%, p = 0.04). All patients were classified according to the bleeding pattern on the initial CT scan into 3 types. Patients with type 1 bleeding were statistically more likely to die (p < 0.001). In 15 out of 24 patients (63%), correction of the coagulation status was possible within 12 h after ICH onset. Seven out of 9 patients (78%) without early coagulation correction died compared to 2 out of 15 patients (13%), in whom early coagulation correction was successful (p = 0.01). This is the first study evaluating the course and management of patients experiencing an ICH under ECMO therapy and establishing an ICH classification based on the bleeding patterns. Early correction of the coagulation is of paramount importance in the treatment of these patients

Size-dependent long-term tissue response to biostable nanowires in the brain

AbstractNanostructured neural interfaces, comprising nanotubes or nanowires, have the potential to overcome the present hurdles of achieving stable communication with neuronal networks for long periods of time. This would have a strong impact on brain research. However, little information is available on the brain response to implanted high-aspect-ratio nanoparticles, which share morphological similarities with asbestos fibres. Here, we investigated the glial response and neuronal loss in the rat brain after implantation of biostable and structurally controlled nanowires of different lengths for a period up to one year post-surgery. Our results show that, as for lung and abdominal tissue, the brain is subject to a sustained, local inflammation when biostable and high-aspect-ratio nanoparticles of 5 μm or longer are present in the brain tissue. In addition, a significant loss of neurons was observed adjacent to the 10 μm nanowires after one year. Notably, the inflammatory response was restricted to a narrow zone around the nanowires and did not escalate between 12 weeks and one year. Furthermore, 2 μm nanowires did not cause significant inflammatory response nor significant loss of neurons nearby. The present results provide key information for the design of future neural implants based on nanomaterials

Proposing a novel classification of growth periods based on biomechanical properties and seasonal changes of Spartina anglica

Salt marshes are a valuable ecosystem with coastal protection potential, for example by absorbing hydrodynamic energy, increasing sedimentation and stabilizing the soil. This study investigated biomechanical properties of Spartina anglica to improve future models of wave-vegetation interaction. To fully understand the correlations between hydro- and biomechanics, the biomechanical vegetation properties from December 2021 to July 2022 are investigated with specimens collected from the field monthly. 551 specimens were used to determine the vegetation properties during storm surge season with high hydrodynamic forces. Additional geometrical properties were determined for 1265 specimens. Three-point bending tests measured the stiffness S (N/mm) and maximum forces Fmax (N). Different phenological states were observed over time and separated for analysis. These states provide a novel classification of growth periods for evaluating the coastal protection potential of Spartina anglica. Especially during storm season, most specimen were identified as broken shoots with a mean stiffness of 1.92N/mm (using 304 samples) compared to the bottom part of flowering shoots in December and January with a mean stiffness of 2.98N/mm (using 61 samples). The classification of plant properties recognizing phenological differences, based on plant state and seasonality, can be used to explain and reduce variability of biomechanical properties obtained during field campaigns. Additionally, this study shows that March to April is recommended for future investigations focusing on shoot properties during storm surge season, which is the important season for coastal engineers considering vegetation state

Navigation accuracy and assessability of carbon fiber-reinforced PEEK instrumentation with multimodal intraoperative imaging in spinal oncology

Radiolucent carbon-fiber reinforced PEEK (CFRP) implants have helped improve oncological follow-up and radiation therapy. Here, we investigated the performance of 3D intraoperative imaging and navigation systems for instrumentation and precision assessment of CFRP pedicle screws across the thoraco-lumbar spine. Thirty-three patients with spinal tumors underwent navigated CFRP instrumentation with intraoperative CT (iCT), robotic cone-beam CT (rCBCT) or cone-beam CT (CBCT) imaging. Two different navigation systems were used for iCT-/rCBCT- and CBCT-based navigation. Demographic, clinical and outcome data was assessed. Four blinded observers rated image quality, assessability and accuracy of CFRP pedicle screws. Inter-observer reliability was determined with Fleiss` Kappa analysis. Between 2018 and 2021, 243 CFRP screws were implanted (iCT:93, rCBCT: 99, CBCT: 51), of which 13 were non-assessable (iCT: 1, rCBCT: 9, CBCT: 3; *p = 0.0475; iCT vs. rCBCT). Navigation accuracy was highest using iCT (74%), followed by rCBCT (69%) and CBCT (49%) (*p = 0.0064; iCT vs. CBCT and rCBCT vs. CBCT). All observers rated iCT image quality higher than rCBCT/CBCT image quality (*p < 0.01) but relevant pedicle breaches were reliably identified with substantial agreement between all observers regardless of the imaging modality. Navigation accuracy for CFRP pedicle screws was considerably lower than expected from reports on titanium implants and CT may be best for reliable assessment of CFRP materials

Clinical implementation of a 3D4K-exoscope (Orbeye) in microneurosurgery

Exoscopic surgery promises alleviation of physical strain, improved intraoperative visualization and facilitation of the clinical workflow. In this prospective observational study, we investigate the clinical usability of a novel 3D4K-exoscope in routine neurosurgical interventions. Questionnaires on the use of the exoscope were carried out. Exemplary cases were additionally video-documented. All participating neurosurgeons (n = 10) received initial device training. Changing to a conventional microscope was possible at all times. A linear mixed model was used to analyse the impact of time on the switchover rate. For further analysis, we dichotomized the surgeons in a frequent (n = 1) and an infrequent (n = 9) user group. A one-sample Wilcoxon signed rank test was used to evaluate, if the number of surgeries differed between the two groups. Thirty-nine operations were included. No intraoperative complications occurred. In 69.2% of the procedures, the surgeon switched to the conventional microscope. While during the first half of the study the conversion rate was 90%, it decreased to 52.6% in the second half (p = 0.003). The number of interventions between the frequent and the infrequent user group differed significantly (p = 0.007). Main reasons for switching to ocular-based surgery were impaired hand-eye coordination and poor depth perception. The exoscope investigated in this study can be easily integrated in established neurosurgical workflows. Surgical ergonomics improved compared to standard microsurgical setups. Excellent image quality and precise control of the camera added to overall user satisfaction. For experienced surgeons, the incentive to switch from ocular-based to exoscopic surgery greatly varies

Digitization in Catalysis Research: Towards a Holistic Description of a Ni/Al2O3 Reference Catalyst for CO2 Methanation

There is considerable motivation in the catalysis community and chemical industry to envision a future where rational catalyst design and targeted chemical process optimization become standard. Achieving this goal for heterogeneous catalysis requires a cultural shift centered around effective research data management. The core elements of modern catalysis research are synthesis, characterization, and testing, while all can be elevated by effective collection, correlation, interoperation, and exploitation of data between disciplines and stakeholders. Here, first steps are made towards a holistic picture of an industrial Ni/Al$_2$O$_3$ reference catalyst for CO$_2$ methanation. A range of conventional and advanced characterization tools are applied to probe metal particle size and pore characteristics of the support, selected as crucial parameters for catalyst performance. Challenges are shown with respect to current reporting of characterization data and metadata, which ultimately influences the development and reliability of digital twins in catalysis research. Furthermore, the cooperation and combined expertise of diverse research groups from different fields is recognized as essential to deliver meaningful progress towards the digital future of catalysis research

Opportunities and Challenges of DLT (Blockchain) in Mobility and Logistics

This report presents the economic potential, legal framework, and technical foundations required to understand distributed ledger (DL) / blockchain technology and llustrates the opportunities and challenges they present, especially in the mobility and logistics sectors. It was compiled by the blockchain laboratory at Fraunhofer FIT on behalf of the German Federal Ministry of Transport and Digital Infrastructure (BMVI). Its intended audience comprises young companies seeking, for example, a legal assessment of data protection issues related to DL and blockchain technologies, decisionmakers in the private sector wishing concrete examples to help them understand how this technology can impact existing and emerging markets and which measures might be sensible from a business perspective, public policymakers and politicians wishing to familiarize themselves with this topic in order to take a position, particularly in the mobility and logistics sectors, and members of the general public interested in the technology and its potential. The report does not specifically address those with a purely academic or scientific interest in these topics, although parts of it definitely reflect the current state of academic discussion

Chancen und Herausforderungen von DLT (Blockchain) in Mobilität und Logistik

This basic report presents the economic potential e, the legal framework and the technical fundamentals of distributed ledger or blockchain technology necessary for understanding in order to exploit the opportunities and challenges of these technologies, especially in the mobility and logistics sector. clear. The basic report was prepared on behalf of the Federal Ministry of Transport and Digital Infrastructure (BMVI) by the blockchain laboratory of Fraunhofer FIT

DNA methylation-based classification of central nervous system tumours.

Accurate pathological diagnosis is crucial for optimal management of patients with cancer. For the approximately 100 known tumour types of the central nervous system, standardization of the diagnostic process has been shown to be particularly challenging-with substantial inter-observer variability in the histopathological diagnosis of many tumour types. Here we present a comprehensive approach for the DNA methylation-based classification of central nervous system tumours across all entities and age groups, and demonstrate its application in a routine diagnostic setting. We show that the availability of this method may have a substantial impact on diagnostic precision compared to standard methods, resulting in a change of diagnosis in up to 12% of prospective cases. For broader accessibility, we have designed a free online classifier tool, the use of which does not require any additional onsite data processing. Our results provide a blueprint for the generation of machine-learning-based tumour classifiers across other cancer entities, with the potential to fundamentally transform tumour pathology

Comparison of Saccharomyces cerevisiae strains of clinical and nonclinical origin by molecular typing and determination of putative virulence traits

Saccharomyces cerevisiae strains of clinical and nonclinical origin were compared by pulse field gel electrophoresis. Complete separation between strains of clinical origin and food strains by their chromosome length polymorphism was not obtained even though there was a tendency for the clinical and food strains to cluster separately. All the investigated strains, except for one food strain, were able to grow at temperatures ≥37 °C but not at 42 °C. Great strain variations were observed in pseudohyphal growth and invasiveness, but the characters were not linked to strains of clinical origin. The adhesion capacities of the yeast strains to a human intestinal epithelial cell line (Caco-2) in response to different nutritional availabilities were determined, as were the effects of the strains on the transepithelial electrical resistance (TER) across polarized monolayers of Caco-2 cells. The yeast strains displayed very low adhesion capacities to Caco-2 cells (0.6–6.2%), and no significant difference was observed between the strains of clinical and nonclinical origin. Both S. cerevisiae strains of clinical and non-clinical origin increased the TER of polarized monolayers of Caco-2 cells. Based on the results obtained in this study, no specific virulence factor was found that clearly separated the strains of clinical origin from the strains of nonclinical origin. On the contrary, all investigated strains of S. cerevisiae were found to strengthen the epithelial barrier function