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Chronic pancreatitis represents the result of a continuous, prolonged, inflammatory, and fibrosing process that affects the pancreas. Pseudocysts are common sequelae of acute pancreatitis or chronic pancreatitis and the most common cystic lesion of the pancreas. Abdominal ultrasonography is limited in detecting pancreatic disease, especially that located in the pancreatic tail. A 60-year-old woman presented to our institute with upper abdominal discomfort. We visualized pancreatic calcification and pseudocyst after filling the stomach with water by drinking and changing her body position. The patient was diagnosed with chronic pancreatitis and pseudocyst of the pancreatic tail.

Splenic lymphoma can occur as a primary or secondary malignancy, but the latter form is more common. Primary splenic lymphoma is defined as lymphomatous involvement of the spleen with or without splenic hilar lymphadenopathy. It can present as splenomegaly with homogenous echogenicity without a focal lesion, a diffuse infiltrative lesion with miliary lesions, multiple focal nodular lesions, or as a large solitary mass. A 71-year-old woman presented with mild upper abdominal pain and a splenic mass. We visualized a hypoechoic splenic mass with splenic hilar lymphadenopathy on abdominal ultrasound. The patient underwent surgery and was diagnosed with splenic diffuse large B-cell lymphoma.

Chronic wounds, particularly those associated with diabetes mellitus, represent a growing threat to public health, with additional notable economic impacts. Inflammation associated with these wounds leads to abnormalities in endogenous electrical signals that impede the migration of keratinocytes needed to support the healing process. This observation motivates the treatment of chronic wounds with electrical stimulation therapy, but practical engineering challenges, difficulties in removing stimulation hardware from the wound site, and absence of means to monitor the healing process create barriers to widespread clinical use. Here, we demonstrate a miniaturized wireless, battery-free bioresorbable electrotherapy system that overcomes these challenges. Studies based on a splinted diabetic mouse wound model confirm the efficacy for accelerated wound closure by guiding epithelial migration, modulating inflammation, and promoting vasculogenesis. Changes in the impedance provide means for tracking the healing process. The results demonstrate a simple and effective platform for wound site electrotherapy.

Acute liver failure due to malignant melanoma is uncommon. We presents a case of acute liver failure secondary to hepatic infiltration of a malignant melanoma. An 86-year-old man was admitted with elevated liver enzymes and an increased lactate dehydrogenase level. His condition progressed to acute liver failure, but the etiology of liver failure was unclear. Esophagogastroduodenoscopy was performed to evaluate dyspepsia, which showed signs indicative of malignant melanoma. Based on the endoscopy findings and elevated liver enzyme levels, liver biopsy was performed to confirm the presence of malignant melanoma. Hepatic infiltration of malignant melanoma was observed histologically. However, massive and diffuse liver metastasis is very rare and difficult to identify on imaging studies. If the etiology of liver failure is unclear, diffuse metastatic melanoma infiltration should be considered as differential diagnosis. Early liver biopsy can help to clarify the diagnosis.

Most pancreatic neuroendocrine tumors (NETs) are detected incidentally and arise in the endocrine tissues. NETs can secrete hormones and result in clinical syndromes. However, between 50 and 75 percent of pancreatic NETs are nonfunctioning. Ultrasonography shows a well-circumscribed mass with a smooth margin and round or oval hypoechoic shape. A 38-year-old woman visited our hospital with mild upper abdominal discomfort. We visualized an oval hypoechoic mass with inner hyperechogenicity after water intake in the stomach and position change. The patient underwent surgery, and the mass was diagnosed as pancreatic NET.

Recently reported winged microelectronic systems offer passive flight mechanisms as a dispersal strategy for purposes in environmental monitoring, population surveillance, pathogen tracking, and other applications. Initial studies indicate potential for technologies of this type, but advances in structural and responsive materials and in aerodynamically optimized geometries are necessary to improve the functionality and expand the modes of operation. Here, we introduce environmentally degradable materials as the basis of 3D fliers that allow remote, colorimetric assessments of multiple environmental parameters—pH, heavy metal concentrations, and ultraviolet exposure, along with humidity levels and temperature. Experimental and theoretical investigations of the aerodynamics of these systems reveal design considerations that include not only the geometries of the structures but also their mass distributions across a range of bioinspired designs. Preliminary field studies that rely on drones for deployment and for remote colorimetric analysis by machine learning interpretation of digital images illustrate scenarios for practical use.

Local electrical stimulation of peripheral nerves can block the propagation of action potentials, as an attractive alternative to pharmacological agents for the treatment of acute pain. Traditional hardware for such purposes, however, involves interfaces that can damage nerve tissue and, when used for temporary pain relief, that impose costs and risks due to requirements for surgical extraction after a period of need. Here, we introduce a bioresorbable nerve stimulator that enables electrical nerve block and associated pain mitigation without these drawbacks. This platform combines a collection of bioresorbable materials in architectures that support stable blocking with minimal adverse mechanical, electrical, or biochemical effects. Optimized designs ensure that the device disappears harmlessly in the body after a desired period of use. Studies in live animal models illustrate capabilities for complete nerve block and other key features of the technology. In certain clinically relevant scenarios, such approaches may reduce or eliminate the need for use of highly addictive drugs such as opioids.

Self-powered implantable devices have the potential to extend device operation time inside the body and reduce the necessity for high-risk repeated surgery. Without the technological innovation of in vivo energy harvesters driven by biomechanical energy, energy harvesters are insufficient and inconvenient to power titanium-packaged implantable medical devices. Here, we report on a commercial coin battery-sized high-performance inertia-driven triboelectric nanogenerator (I-TENG) based on body motion and gravity. We demonstrate that the enclosed five-stacked I-TENG converts mechanical energy into electricity at 4.9 μW/cm3 (root-mean-square output). In a preclinical test, we show that the device successfully harvests energy using real-time output voltage data monitored via Bluetooth and demonstrate the ability to charge a lithium-ion battery. Furthermore, we successfully integrate a cardiac pacemaker with the I-TENG, and confirm the ventricle pacing and sensing operation mode of the self-rechargeable cardiac pacemaker system. This proof-of-concept device may lead to the development of new self-rechargeable implantable medical devices., Self-powered implantable devices have the potential to extend device operation, though current energy harvesters are both insufficient and inconvenient. Here the authors report on a commercial coin battery-sized high-performance inertia-driven triboelectric nanogenerator based on body motion and gravity that can be used to charge a lithium-ion battery and integrated into a cardiac pacemaker.

On 11 February, 2020, the World Health Organization announced that COVID-19 was a novel coronavirus disease first detected in Wuhan, Hubei Province, China. COVID-19 is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The complete clinical picture is not fully known. Illness ranges from mild to fatal. The common symptoms include fever, cough, and dyspnea usually developing 2-14 days after exposure. However, diarrhea was present in a few patients with COVID-19. We report a case of COVID-19 mimicking acute colitis.

Angiolipoma is a benign fatty neoplasm that has components of proliferating blood vessels. These types of lesions commonly occur in the subcutaneous tissue of the limbs and trunk. Angiolipoma in the gastrointestinal tract is extremely rare, and the final diagnosis generally depends on histological examination of the excised biopsy. In most previously reported cases, the lesions were diagnosed and treated with surgical management. In this study, we report a case of gastric angiolipoma of approximately 4 cm in size that was diagnosed and treated with endoscopic submucosal dissection.

Capabilities for continuous monitoring of pressures and temperatures at critical skin interfaces can help to guide care strategies that minimize the potential for pressure injuries in hospitalized patients or in individuals confined to the bed. This paper introduces a soft, skin-mountable class of sensor system for this purpose. The design includes a pressure-responsive element based on membrane deflection and a battery-free, wireless mode of operation capable of multi-site measurements at strategic locations across the body. Such devices yield continuous, simultaneous readings of pressure and temperature in a sequential readout scheme from a pair of primary antennas mounted under the bedding and connected to a wireless reader and a multiplexer located at the bedside. Experimental evaluation of the sensor and the complete system includes benchtop measurements and numerical simulations of the key features. Clinical trials involving two hemiplegic patients and a tetraplegic patient demonstrate the feasibility, functionality and long-term stability of this technology in operating hospital settings.

Nutrients play critical roles in maintaining core physiological functions and in preventing diseases. Technologies for delivering these nutrients and for monitoring their concentrations can help to ensure proper nutritional balance. Eccrine sweat is a potentially attractive class of biofluid for monitoring purposes due to the ability to capture sweat easily and noninvasively from nearly any region of the body using skin‐integrated microfluidic technologies. Here, a miniaturized system of this type is presented that allows simple, rapid colorimetric assessments of the concentrations of multiple essential nutrients in sweat, simultaneously and without any supporting electronics – vitamin C, calcium, zinc, and iron. A transdermal patch integrated directly with the microfluidics supports passive, sustained delivery of these species to the body throughout a period of wear. Comparisons of measurement results to those from traditional lab analysis methods demonstrate the accuracy and reliability of this platform. On‐body tests with human subjects reveal correlations between the time dynamics of concentrations of these nutrients in sweat and those of the corresponding concentrations in blood. Studies conducted before and after consuming certain foods and beverages highlight practical capabilities in monitoring nutritional balance, with strong potential to serve as a basis for guiding personalized dietary choices., This paper introduces a soft, skin‐interfaced microfluidic system that enables nutrient analysis in sweat and delivery of vitamins to the body. Accurate colorimetric sensors can quantify the concentrations of nutrients in sweat, and a transdermal patch integrated directly with the microfluidics supports passive, sustained delivery of nutrients to the body throughout a period of wear.

Traditionally, tissue biopsies of kidney lesions are usually performed with CT or percutaneous ultrasound guidance, but biopsies using EUS have rarely been reported. In this report, we describe a case of renal cell carcinoma (RCC) diagnosed using EUS-guided fine-needle aspiration biopsy. A 75-year-old woman taking aspirin due to stable angina continued to exhibit weight loss and anemia and visited the gastroenterology department. No bleeding was observed on upper and lower gastrointestinal endoscopy. A contrast-enhanced mass was observed in the left kidney, accompanied by 8.9×10.8 cm-sized necrosis suggesting RCC on abdominal CT. Chest CT showed masses in both lungs. We planned to administer targeted therapy after pathological confirmation using EUS. Aspirin was continued, and we performed fine-needle biopsy using a 22-gauge needle three times. No adverse events were observed after the procedure. Pathological examination confirmed RCC, clear cell type, and the patient is currently undergoing treatment with sunitinib. EUS-guided fine-needle aspiration biopsy is safe for liver, pancreatic, or other tumors accessible from the upper gastrointestinal tract. This technique shows fewer adverse events. To the best of our knowledge, there have been no other reports on EUS-guided fine-needle aspiration biopsy to identify RCC in Korea.

Capabilities for continuous monitoring of pressures and temperatures at critical skin interfaces can help to guide care strategies that minimize the potential for pressure injuries in hospitalized patients or in individuals confined to the bed. This paper introduces a soft, skin-mountable class of sensor system for this purpose. The design includes a pressure-responsive element based on membrane deflection and a battery-free, wireless mode of operation capable of multi-site measurements at strategic locations across the body. Such devices yield continuous, simultaneous readings of pressure and temperature in a sequential readout scheme from a pair of primary antennas mounted under the bedding and connected to a wireless reader and a multiplexer located at the bedside. Experimental evaluation of the sensor and the complete system includes benchtop measurements and numerical simulations of the key features. Clinical trials involving two hemiplegic patients and a tetraplegic patient demonstrate the feasibility, functionality and long-term stability of this technology in operating hospital settings., Uninterrupted monitoring of pressure and temperature at skin interfaces can help to minimize the potential for pressure injuries in hospitalized or bedridden patients. Here, the authors introduce a soft, skin-mountable sensor that can continuously provide readings via antennas mounted under bedding, and demonstrate the functionality and robustness of the devices on patients.

Continuous monitoring of vital signs is an essential aspect of operations in neonatal and pediatric intensive care units (NICUs and PICUs), of particular importance to extremely premature and/or critically ill patients. Current approaches require multiple sensors taped to the skin and connected via hard-wired interfaces to external data acquisition electronics. The adhesives can cause iatrogenic injuries to fragile, underdeveloped skin, and the wires can complicate even the most routine tasks in patient care. Here, materials strategies and design concepts are introduced that significantly improve these platforms through the use of optimized materials, open (i.e., "holey") layouts and precurved designs. These schemes 1) reduce the stresses at the skin interface, 2) facilitate release of interfacial moisture from transepidermal water loss, 3) allow visual inspection of the skin for rashes or other forms of irritation, 4) enable triggered reduction of adhesion to reduce the probability for injuries that can result from device removal. A combination of systematic benchtop testing and computational modeling identifies the essential mechanisms and key considerations. Demonstrations on adult volunteers and on a neonate in an operating NICUs illustrate a broad range of capabilities in continuous, clinical-grade monitoring of conventional vital signs, and unconventional indicators of health status.

Wearable electronics with dual-sensing modalities enable artifact-free health monitoring through differential detection., Soft, skin-integrated electronic sensors can provide continuous measurements of diverse physiological parameters, with broad relevance to the future of human health care. Motion artifacts can, however, corrupt the recorded signals, particularly those associated with mechanical signatures of cardiopulmonary processes. Design strategies introduced here address this limitation through differential operation of a matched, time-synchronized pair of high-bandwidth accelerometers located on parts of the anatomy that exhibit strong spatial gradients in motion characteristics. When mounted at a location that spans the suprasternal notch and the sternal manubrium, these dual-sensing devices allow measurements of heart rate and sounds, respiratory activities, body temperature, body orientation, and activity level, along with swallowing, coughing, talking, and related processes, without sensitivity to ambient conditions during routine daily activities, vigorous exercises, intense manual labor, and even swimming. Deployments on patients with COVID-19 allow clinical-grade ambulatory monitoring of the key symptoms of the disease even during rehabilitation protocols.

3D multifunctional frameworks, as flexible as a single strand of silk, modulate and measure neural activity of brain spheroids., Three-dimensional (3D), submillimeter-scale constructs of neural cells, known as cortical spheroids, are of rapidly growing importance in biological research because these systems reproduce complex features of the brain in vitro. Despite their great potential for studies of neurodevelopment and neurological disease modeling, 3D living objects cannot be studied easily using conventional approaches to neuromodulation, sensing, and manipulation. Here, we introduce classes of microfabricated 3D frameworks as compliant, multifunctional neural interfaces to spheroids and to assembloids. Electrical, optical, chemical, and thermal interfaces to cortical spheroids demonstrate some of the capabilities. Complex architectures and high-resolution features highlight the design versatility. Detailed studies of the spreading of coordinated bursting events across the surface of an isolated cortical spheroid and of the cascade of processes associated with formation and regrowth of bridging tissues across a pair of such spheroids represent two of the many opportunities in basic neuroscience research enabled by these platforms.

A sound way to deliver power Implanted medical devices, such as pacemakers and neurological stimulators, require a source of power, usually in the form of a battery. If a battery is implanted with the device, replacing it would require additional surgery. On the other hand, external power packs are prone to lead to infections where their wires enter the body. Hinchet et al. describe a triboelectric generator that can convert externally applied ultrasound into an internal electricity source capable of delivering sufficient energy to recharge a battery on a daily basis. Science , this issue p. 491

Mechanical durability and the triboelectric property of the friction layer are crucial for obtaining stable high power output from triboelectric nanogenerators (TENGs). Here, we introduce butylated melamine formaldehyde (BMF) as a promising triboelectric material because of both its mechanical durability and its highly positive triboelectric property. These unique characteristics originate from its functional group, which contains hydrogen atoms. Kelvin probe force microscopy measurements and density functional theory calculations confirm that BMF is triboelectrically more positive than are pristine MF and methylated MF. In addition, the Young's modulus, calculated by molecular dynamics simulations, of BMF is six times higher than that of polytetrafluoroethylene (PTFE). Additionally, BMF has demonstrated a lower wear rate than PTFE in an abrasion test with Cu as the counter friction material. Because of the superior mechanical and triboelectric characteristics, the root-mean-square output of a rotation-type BMF based TENG [210 V and 125 μA (24 mA m−2)] is higher than that of the one with PTFE [90 V and 31 μA (5.9 mA m−2)] and remained stable over extended operation of 27 000 cycles. BMF thus offers an opportunity for fabricating high-performance TENGs with applications in self-powered smart systems.

Objective and Impact Statement . Real-time monitoring of the temperatures of regional tissue microenvironments can serve as the diagnostic basis for treating various health conditions and diseases. Introduction . Traditional thermal sensors allow measurements at surfaces or at near-surface regions of the skin or of certain body cavities. Evaluations at depth require implanted devices connected to external readout electronics via physical interfaces that lead to risks for infection and movement constraints for the patient. Also, surgical extraction procedures after a period of need can introduce additional risks and costs. Methods . Here, we report a wireless, bioresorbable class of temperature sensor that exploits multilayer photonic cavities, for continuous optical measurements of regional, deep-tissue microenvironments over a timeframe of interest followed by complete clearance via natural body processes. Results . The designs decouple the influence of detection angle from temperature on the reflection spectra, to enable high accuracy in sensing, as supported by in vitro experiments and optical simulations. Studies with devices implanted into subcutaneous tissues of both awake, freely moving and asleep animal models illustrate the applicability of this technology for in vivo measurements. Conclusion . The results demonstrate the use of bioresorbable materials in advanced photonic structures with unique capabilities in tracking of thermal signatures of tissue microenvironments, with potential relevance to human healthcare.

Soft, wireless sensors monitor the temperature and interface pressure of the patient’s skin for compression therapy., Therapeutic compression garments (TCGs) are key tools for the management of a wide range of vascular lower extremity conditions. Proper use of TCGs involves application of a minimum and consistent pressure across the lower extremities for extended periods of time. Slight changes in the characteristics of the fabric and the mechanical properties of the tissues lead to requirements for frequent measurements and corresponding adjustments of the applied pressure. Existing sensors are not sufficiently small, thin, or flexible for practical use in this context, and they also demand cumbersome, hard-wired interfaces for data acquisition. Here, we introduce a flexible, wireless monitoring system for tracking both temperature and pressure at the interface between the skin and the TCGs. Detailed studies of the materials and engineering aspects of these devices, together with clinical pilot trials on a range of patients with different pathologies, establish the technical foundations and measurement capabilities.

Triboelectric nanogenerators (TENGs), which have demonstrated that all moving things in the universe can generate electricity in a sustainable way are currently being developed to be integrated with electronics, and to improve user convenience. The electrically charged surface upon a contact electrification phenomenon caused by contact of the materials determines the output performance of TENGs. This review focuses on the electrification and surface charge density characteristics of various fluoropolymer-based materials as active materials that have been investigated to realize high performance TENGs, and the results of the study of their applications. Furthermore, the characteristics of electrification with differently polymerized P(VDF-TrFE) as TENGs’ active materials and their applications are reviewed. The boosted output performance characteristics when used as a matrix material and integrated with a composite system with a high dielectric constant material are also reviewed. Finally, the paper presents three perspectives on the direction of TENG research for future improvement, namely material, structure, and circuitry.

Triboelectric nanogenerators (TENGs) typically have very low outputs in terms of root-mean-square (RMS) values as the outputs are in the form of short duration pulses. In order to overcome this limitation, here we introduce multi-phase rotation-type TENGs (MP-TENGs). The rotator of the MP-TENGs consists of alternating components of PTFE and mono cast nylon, whereas the stator consists of PTFE with multiple back electrodes. Each electrode produces an output of the same frequency and amplitude, but of different regularly shifted phases. Consequently, the outputs from all the electrodes are full-wave rectified and superimposed, and the total output of the MP-TENGs is almost constant direct current (DC), unlike typical TENGs, with much higher RMS values. A 5-phase TENG has produced 380 V, 3.6 mA m−2, and 4.9 W m−2, and the current crest factor is dramatically decreased to 1.26. Finally, due to the almost constant DC output, the MP-TENGs successfully operate electronic devices and charge a battery.

Despite their high power density, aqueous-based electric double-layer capacitors (EDLCs) possess relatively low energy density due to the limitation of potential window (~1.0 V) and low specific capacitance of active materials. To increase the energy density without sacrificing the power density, it is highly desired to achieve a simultaneous improvement of both specific capacitance and potential window of EDLCs. However, this remains a major challenge that is not been solved up to date. This work demonstrates that by inserting a polarized-polyvinylidene fluoride (PVDF) ferroelectric layer underneath the graphene, a simultaneous enhancement of both areal capacitance and potential window is achieved, in which the areal capacitance increases from 5.5 to 7.5 μF/cm2 (i.e., 36%) (or 55 F/cm3 to 75 F/cm3 in terms of volumetric capacitance), and the potential window expands from 1.0 V to 1.5 V. This results in a threefold increase in the areal energy density of the capacitor. The enhancement in capacitance can be explained by the Gouy–Chapman–Stern model. The widening of potential window is due to the shift of the Fermi level of graphene caused by the doping effect of the polarized-PVDF layer.

Recently developed methods for transforming 2D patterns of thin-film materials into 3D mesostructures create many interesting opportunities in microsystems design. A growing area of interest is in multifunctional thermal, electrical, chemical, and optical interfaces to biological tissues, particularly 3D multicellular, millimeter-scale constructs, such as spheroids, assembloids, and organoids. Herein, examples of 3D mechanical interfaces are presented, in which thin ribbons of parylene-C form the basis of transparent, highly compliant frameworks that can be reversibly opened and closed to capture, envelop, and mechanically restrain fragile 3D tissues in a gentle, nondestructive manner, for precise measurements of viscoelastic properties using techniques in nanoindentation. Finite element analysis serves as a design tool to guide selection of geometries and material parameters for shape-matching 3D architectures tailored to organoids of interest. These computational approaches also quantitate all aspects of deformations during the processes of opening and closing the structures and of forces imparted by them onto the surfaces of enclosed soft tissues. Studies of cerebral organoids by nanoindentation show effective Young's moduli in the range from 1.5 to 2.5 kPa depending on the age of the organoid. This collection of results suggests broad utility of compliant 3D mesostructures in noninvasive mechanical measurements of millimeter-scale, soft biological tissues.