Kidney machine perfusion (MP) prevents delayed graft function (DGF). Whether this benefit translates into improved long-term graft survival (LGS) remains uncertain. We evaluated the association between MP and LGS and its potential mediation by DGF. UNOS analysis of adult deceased donor kidney transplant recipients (KTRs) from January 2010 to June 2019. We selected KTRs with cold ischemia time (CIT) > 12 h and on tacrolimus maintenance. We included KTRs from dual-kidney donors and compared outcomes where one mate kidney received MP and the other did not. The primary endpoint was all-cause graft failure (GF) analyzed using a stratified multivariable Cox proportional hazards model. We assessed the association of MP and DGF with conditional logistic regression. We evaluated the mediation effect of DGF by combining the predictor and outcome models and bootstrapping with 1000 iterations to calculate 95% confidence intervals (CI). We included 2355 mate-kidney pairs with 5.8 years (IQR 4-8) median follow-up. MP was associated with lower GF risk (aHR 0.86, 95% CI 0.75-0.98) and DGF odds (aOR 0.41, 95% CI 0.34-0.51) than no MP. DGF fully mediated the association between MP and GF, as the effect was no longer statistically significant after adjusting for DGF (aHR 0.89, 95% CI 0.78-1.03). DGF explained 76.8% of the association between MP and GF. In mate-kidney pairs with discordant MP use and CIT > 12 h, MP was associated with decreased GF risk, mediated by decreased DGF likelihood. MP both mate kidneys with CIT > 12 h should be considered to potentially improve LGS.

Adult neurogenesis is the biological process whereby neural stem cells (NSCs) differentiate into neurons and glial cells in specific areas of the adult brain. Impairments in neurogenesis may lead to many complications, including neurodegenerative illnesses and psychiatric problems. In the adult brain, new neurons are generated from neural stem or progenitor cells (NPCs) through a meticulously controlled process that governs both cell proliferation and the specification of neuronal identity. This review discusses how artificial intelligence (AI) can be applied to analyze the effects of exercise on neural stem cell proliferation, focusing on data collection, AI model training, and the prediction of outcomes such as neural regeneration and recovery. AI-based models, including machine learning algorithms and deep learning techniques, offer promising tools for understanding and predicting the mechanisms underlying neurogenesis, potentially guiding personalized interventions for individuals with neurological conditions. Adult neurogenesis is fundamentally impacted by several physiological, pathological, and pharmacological variables. These factors encompass exercise, age, severe brain injury, epilepsy, and antidepressant therapies. Recent studies indicate that physical exercise is a vital external element that significantly promotes adult neurogenesis in the hippocampus.

Total artificial hearts (TAH) are sparsely implanted, and new configurations may help reduce complication rates and improve quality of life.In the native heart, the interventricular septum is responsible for 40% of the native myocardial work.Arfaee et al. from the Netherlands recently reported a new soft robotic TAH which produces contraction with a septal embedded pneumatic actuator.The device consists of two 140 cc chambers, that is, ventricles, separated by a pneumatic muscle that can distend to 160 cc.The pneumatic muscle is connected to fixed-length wires that wrap around both chambers in order to equally pressurize the chambers.The inflation of the septal muscle during systole results in centripetal movement of the ventricular free walls, creating systolic contractile movement.The chambers are lined with a newly developed durable material consisting of nylon coated with thermoplastic polyurethane.This fabrication incorporates redundancy in the ventricular lining, creating "origami folds" that stretch only at higher filling pressures, mimicking the Frank-Starling mechanism of the native myocardium.Similar to other TAHs, the chambers require attachment of inlet and outlet valves, followed by attachment to their respective atrial and great vessel arteries.In in vitro testing, the soft robotic ventricles were able to generate a maximum cardiac output of 5.7 L at a heart rate of 60 bpm.However, in goat experiments, the TAH was able to produce about 2.3 L/min at 65 beats per minute.While the current experiments were performed with a pneumatic system requiring an external driveline, investigators note efforts for the development of a fully implantable closed-circuit pneumatic system coupled with a transcutaneous power transmitter.Overall, this proof-of-concept study describes the feasibility of soft robotic applications for the development of the next-generation total artificial heart that could change the landscape of advanced heart failure therapy.-ADG

In vitro thrombosis tests for mechanical circulatory support systems lack standardized ISO guidelines. A major limitation of current approaches is the absence of continuous thrombus monitoring, as terminated experiments at a single time point fail to capture the dynamic nature of thrombus formation. However, spatially resolved thrombus formation and its underlying dynamics are crucial for the optimization of mechanical circulatory support systems. In this study, we present a high-resolution thrombus monitoring approach using particle image velocimetry with a thrombogenic, two-phase blood analog fluid, designated as "ghost blood". Ghost blood consists of plasma and ghost cells, which are hemoglobin-depleted erythrocytes. We validate and quantify the particle image velocimetry with ghost blood and use this combination to monitor thrombus growth. The validation demonstrated velocity fields in the FDA-pump are consistent with existing literature, confirming the usability of ghost blood in particle image velocimetry. The use range of ghost blood is quantified as a formula to determine the maximum possible optical penetration depth. Finally, thrombus growth was successfully monitored in the FDA-pump. In this proof of principle study, we grew a thrombus in the FDA-pump and were able to monitor its growth from a first thrombus thread to a complete obstruction of the flow. This approach enables both the localization and the temporal growth of the thrombus to be visualized and thereby provides a foundation for future advancements in thrombosis assessment and the optimization of mechanical circulatory support systems.

Glucose absorption into the bloodstream and body tissues poses a significant challenge in peritoneal dialysis, resulting in a reduced ultrafiltration rate and requiring the use of a dialysate with a high initial glucose concentration. The goal of the presented study is to develop a system for controlling glucose concentration and ultrafiltration rate. The paper proposes a method for the automatic control of glucose infusion to maintain a given glucose concentration and ultrafiltration rate. This method utilizes an optical glucose monitor and a control strategy that combines feedback with prediction of peritoneal volume. Computer simulations were conducted to evaluate the efficiency of the method under various conditions, including errors in the glucose monitor, inaccuracies in parameter determination, and drift in patient parameters. Additionally, the method was compared to an open loop. Our results demonstrate the feasibility of using noninvasive glucose monitoring systems and the proposed control strategy to maintain a given dialysate glucose concentration. The proposed closed loop provides more stable maintenance of glucose concentration and ultrafiltration rate for at least 12 h, even in the presence of significant glucometer errors, compared to continuous glucose infusion.

Normothermic machine perfusion for deceased donor kidney transplantation p. 749Extracorporeal liver support systems in patients with acute-on-chronic liver failure p. 762Glucagon-like peptide-1 receptor agonists in patients with durable left ventricular assist devices p. 864

Functional Electrical Stimulation Assisted Cycling (FES-cycling) is a rehabilitation intervention for individuals with Spinal Cord Injury (SCI), offering benefits like increased muscle trophism, improved cardiopulmonary function, and reduced bone demineralization. Despite numerous studies on its physical advantages, few have focused on user experience. This study evaluates the user experience, usability, acceptability, and human-device interaction of two FES-cycling systems: a recumbent FES-bike prototype from Politecnico di Milano and the commercial BerkelBike Pro. We recruited 15 participants with SCI, aged 18-65, with varying injury levels. The user experience (primary outcome), acceptability, usability, human-device interaction, and ergonomics of both systems were investigated by means of 4 questionnaires: the User Experience Questionnaire (UEQ), the Technological Acceptance Measure 3 (TAM-3), the System Usability Scale (SUS), and a customized questionnaire to evaluate human-device interaction both in terms of ergonomic aspects and psychological factors. The user experience received positive evaluations across all dimensions (scores ≥ 1.5 on a scale from -3 to 3), with slightly higher, though not statistically significant, scores for the FB. Secondary outcomes indicated strong acceptability (global TAM-3 scores > 5.5/7 for both devices), high usability ratings (SUS scores ≥ 75/100 for both devices), and favorable interaction and ergonomics, emphasizing ease of use, comfort, and alignment with user expectations. The study underscores the positive user experience as the primary outcome, along with strong acceptance and usability of both devices, emphasizing their potential to enhance Sport-Therapy and the value of integrating user perspectives in future development.

The authors declare no conflicts of interest.

Neurological impairments seriously affect the quality of life in patients with venoarterial extracorporeal membrane oxygenation (VA-ECMO). However, the underlying mechanisms have been restricted to a satisfactory animal model with determined support and recovery time. This study aimed to establish a rodent VA-ECMO model with different durations, assessing the feasibility of a long-term surviving model with determined recovery time. Thirty-six Sprague-Dawley rats were divided into five groups: sham group (n = 10), ECMO-2 h group (n = 5), ECMO-3 h group (n = 5), ECMO-4 h group (n = 11) and ECMO-6 h group (n = 5). The ECMO-4 h group was further assigned to the surviving time of postoperative day 7 (n = 6) to perform the Morris water maze. VA-ECMO was established through the right external jugular vein-right atrium for venous drainage and tail artery for arterial infusion. The branch of the left femoral artery was cannulated for arterial blood pressure monitoring and blood gas analyses. Thereafter, the brains were fixed for histopathological assessment. All VA-ECMO processes were successfully achieved, and one rat in the ECMO-4 h group died 2 h after ECMO. The physiologic variables of all rats were stable. Histologic deficits (pathological score, surviving neurons, and loss of dendritic spines) were detectable after more than 3 h of support, and functional deficits were observed after 4 h of exposure, which persisted for 3 days. We established a reproducible and long-term recovery model of VA-ECMO in rats with cerebral histologic deficits depending on support duration. The neurocognitive performance was impaired after 4-h VA-ECMO exposure with the 3-day recovery time frame.