Citations

AbstractPatients with thrombophilia remain concerned about venous thromboembolism (VTE) risk with COVID‐19 vaccinations. The aim of this study was to examine VTE outcomes in patients with inherited or acquired thrombophilia who were vaccinated for COVID‐19. Vaccinated patients ≥18 years between November 1, 2020 and November 1, 2021 were analyzed using electronic medical records across the Mayo Clinic enterprise. The primary outcome was imaging confirmed acute VTE occurring 90 days before and after the date of the first vaccine dose. Thrombophilia patients were identified through laboratory testing results and ICD‐10 codes. A total of 792 010 patients with at least one COVID‐19 vaccination were identified. Six thousand sixty‐seven of these patients were found to have a thrombophilia, among whom there was a total of 39 VTE events after compared to 51 VTE events before vaccination (0.64% vs. 0.84%, p = .20). In patients with Factor V Leiden or prothrombin gene mutation, VTE occurred in 27 patients before and in 29 patients after vaccination (0.61 vs. 0.65%, p = .79). In patients with antiphospholipid syndrome, VTE occurred in six patients before and four patients after vaccination (0.59% vs. 0.39%, p = .40). No difference was observed in the overall VTE rate when comparing the postvaccination 90 days to the prevaccination 90 days, adjusted hazard ratio 0.81 (95% confidence interval: 0.53–1.23). In this subgroup of COVID‐19 vaccinated patients with thrombophilia, there was no increased risk for acute VTE postvaccination compared to the prevaccination timeframe. These results are consistent with prior studies and should offer additional reassurance to patients with inherited or acquired thrombophilia.

Abstract Advancements in the design of knitted Shape Memory Alloy (SMA) actuators have produced highly functional and easy-to-wear advanced textiles with variable fit/stiffness properties. Annealing SMA at high temperatures can alter their thermomechanical properties; however, heat treatments of SMA knitted actuators have yet to be systematically studied. This study investigates the relationship between annealing temperatures and the resultant SMA knit thermomechanical behavior (maximum force and actuator transformation temperature). Twelve SMA knitted samples were manufactured using Dynalloy Flexinol® 70°C (0.012″). Nine samples were annealed at three different temperatures (350°C, 450°C, 550°C), with the remaining samples acting as controls. The blocked force mechanical performance was characterized by varying the thermal load across various applied structural strains. The samples were thermally cycled between 20°C and 90°C at each strain level. The results indicate that samples annealed while stretched along the knit-course direction enabled large-force actuation at smaller displacements than the control samples. Annealed samples showed higher peak force than control samples as annealing temperature increased until the 450°C condition; however, the 550° samples showed a dip in force. The actuator transformation temperatures showed reduced Austenite start (As) temperature compared to the control sample, enabling actuation at a lower temperature while also reducing the Martensite Finish (Mf) temperatures. This work allows for greater tuning of knitted SMA actuators to meet the needs of researchers and product developers.

ImportanceCytokine storm due to COVID-19 can cause high morbidity and mortality and may be more common in patients with cancer treated with immunotherapy (IO) due to immune system activation.ObjectiveTo determine the association of baseline immunosuppression and/or IO-based therapies with COVID-19 severity and cytokine storm in patients with cancer.Design, Setting, and ParticipantsThis registry-based retrospective cohort study included 12 046 patients reported to the COVID-19 and Cancer Consortium (CCC19) registry from March 2020 to May 2022. The CCC19 registry is a centralized international multi-institutional registry of patients with COVID-19 with a current or past diagnosis of cancer. Records analyzed included patients with active or previous cancer who had a laboratory-confirmed infection with SARS-CoV-2 by polymerase chain reaction and/or serologic findings.ExposuresImmunosuppression due to therapy; systemic anticancer therapy (IO or non-IO).Main Outcomes and MeasuresThe primary outcome was a 5-level ordinal scale of COVID-19 severity: no complications; hospitalized without requiring oxygen; hospitalized and required oxygen; intensive care unit admission and/or mechanical ventilation; death. The secondary outcome was the occurrence of cytokine storm.ResultsThe median age of the entire cohort was 65 years (interquartile range [IQR], 54-74) years and 6359 patients were female (52.8%) and 6598 (54.8%) were non-Hispanic White. A total of 599 (5.0%) patients received IO, whereas 4327 (35.9%) received non-IO systemic anticancer therapies, and 7120 (59.1%) did not receive any antineoplastic regimen within 3 months prior to COVID-19 diagnosis. Although no difference in COVID-19 severity and cytokine storm was found in the IO group compared with the untreated group in the total cohort (adjusted odds ratio [aOR], 0.80; 95% CI, 0.56-1.13, and aOR, 0.89; 95% CI, 0.41-1.93, respectively), patients with baseline immunosuppression treated with IO (vs untreated) had worse COVID-19 severity and cytokine storm (aOR, 3.33; 95% CI, 1.38-8.01, and aOR, 4.41; 95% CI, 1.71-11.38, respectively). Patients with immunosuppression receiving non-IO therapies (vs untreated) also had worse COVID-19 severity (aOR, 1.79; 95% CI, 1.36-2.35) and cytokine storm (aOR, 2.32; 95% CI, 1.42-3.79).Conclusions and RelevanceThis cohort study found that in patients with cancer and COVID-19, administration of systemic anticancer therapies, especially IO, in the context of baseline immunosuppression was associated with severe clinical outcomes and the development of cytokine storm.Trial RegistrationClinicalTrials.gov Identifier: NCT04354701

AbstractNew medical compression technologies that are simultaneously low‐profile, facile to don, and dynamic—applying medical compression only when needed—can expand the use of wearable compression, increase patient compliance, and lead to better medical outcomes. Dynamic and conformal wearable compression devices are presented that can be donned in a low‐stiffness state and transition into a high‐stiffness and, consequently, high‐compression state, on‐demand. These devices are enabled by active textiles developed from custom NiTi filaments that remain inactive at room temperature and accomplish actuation proximal to the human body surface. Further, these compression devices exploit NiTi material hysteresis to sustain a high‐compression state post‐heating and upon equilibrium with the body surface temperature for thermally‐comfortable, on‐body performance. Two case study examples—1) a consumer medical compression device and 2) a custom astronaut compression device—demonstrate the generalizability and flexibility of the engineering and design methods to develop a range of dynamic, tunable, and conformal compression devices with different goals and requirements. Further, this work demonstrates a roadmap for developing wearable systems that can accommodate a range of users without sacrificing system performance. This research opens doors for new NiTi‐based medical and consumer applications that interface with the body surface.