Thrombotic microenvironment responsive crosslinking cyclodextrin metal-organic framework nanocarriers for precise targeting and thrombolysis

Global public health is seriously threatened by thrombotic disorders because of their high rates of mortality and disability. Most thrombolytic agents, especially protein-based pharmaceuticals, have a short half-life in circulation, reducing their effectiveness in thrombolysis. The creation of an intelligent drug delivery system that delivers medication precisely and releases it under regulated conditions at nearby thrombus sites is essential for effective thrombolysis. In this article, we present a unique medication delivery system (MCRUA) that selectively targets platelets and releases drugs by stimulation from the thrombus' microenvironment. The thrombolytic enzyme urokinase-type plasminogen-activator (uPA) and the anti-inflammatory medication Aspirin (acetylsalicylic acid, ASA) are both loaded onto pH-sensitive CaCO3/cyclodextrin crosslinking metal-organic frameworks (MC) that make up the MCRUA system. c(RGD) is functionalized on the surface of MC, which is functionalized by RGD to an esterification reaction. Additionally, the thrombus site's acidic microenvironment causes MCRUA to disintegrate to release uPA for thrombolysis and aiding in vessel recanalization. Moreover, cyclodextrin-encapsulated ASA enables the treatment of the inflammatory environment within the thrombus, enhancing the antiplatelet aggregation effects and promoting cooperative thrombolysis therapy. When used for thrombotic disorders, our drug delivery system (MCRUA) promotes thrombolysis, suppresses rethrombosis, and enhances biosafety with fewer hemorrhagic side effects.

Activation Mechanism of Fe2+ in Pyrrhotite Flotation: Microflotation and DFT Calculations

In industrial manufacturing, pyrrhotite(Fe1-xS), once depressed, is commonly activated for flotation. However, the replacement of CuSO4 is necessary due to the need for exact control over the dosage during the activation of pyrrhotite, which can pose challenges in industrial settings. This research introduces the use of FeSO4 for the first time to efficiently activate pyrrhotite. The impact of two different activators on pyrrhotite was examined through microflotation experiments and density functional theory (DFT) calculations. Microflotation experiments confirmed that as the CuSO4 dosage increased from 0 to 8 × 10-4 mol/L, the recovery of pyrrhotite initially increased slightly from 71.27% to 87.65% but then sharply decreased to 16.47%. Conversely, when the FeSO4 dosage was increased from 0 to 8 × 10-4 mol/L, pyrrhotite's recovery rose from 71.27% to 82.37%. These results indicate a higher sensitivity of CuSO4 to dosage variations, suggesting that minor alterations in dosage can significantly impact its efficacy under certain experimental conditions. In contrast, FeSO4 might demonstrate reduced sensitivity to changes in dosage, leading to more consistent performance. Fe ions can chemically adsorb onto the surface of pyrrhotite (001), creating a stable chemical bond, thereby markedly activating pyrrhotite. The addition of butyl xanthate (BX), coupled with the action of Fe2+ on activated pyrrhotite, results in the formation of four Fe-S bonds on Fe2+. The proximity of their atomic distances contributes to the development of a stable double-chelate structure. The S 3p orbital on BX hybridizes with the Fe 3d orbital on pyrrhotite, but the hybrid effect of Fe2+ activation is stronger than that of nonactivation. In addition, the Fe-S bond formed by the addition of activated Fe2+ has a higher Mulliken population, more charge overlap, and stronger covalent bonds. Therefore, Fe2+ is an excellent, efficient, and stable pyrrhotite activator.

Dual-targeting fucoidan-based microvesicle for arterial thrombolysis and re-occlusion inhibition

Arterial thrombosis is a critical thrombotic disease that poses a significant threat to human health. However, the existing clinical treatment of arterial thrombosis lacks effective targeting and precise drug release capability. In this study, we developed a system for targeted delivery and on-demand release in arterial thrombosis treatment. The carrier was constructed using chitosan (CS) and fucoidan (Fu) through layer-by-layer assembly, with subsequent surface modification using cRGD peptide. Upon encapsulation of urokinase-type plasminogen activator (uPA), the resulting therapeutic drug delivery system, uPA-CS/Fu@cRGD, demonstrated dual-targeting abilities towards P-selectin and αIIbβ3, as well as pH and platelet-responsive release properties. Importantly, we have demonstrated that the dual targeting effect exhibits higher targeting efficiency at shear rates simulating thrombosed arterial conditions (1800 s-1) compared to single targeting for the first time. In the mouse common iliac artery model, uPA-CS/Fu@cRGD exhibited great thrombolytic capability while promoting the down-regulation of coagulation factors (FXa and PAI-1) and inflammatory factors (TNF-α and IL-6), thus improving the thrombus microenvironment and exerting potential in preventing re-occlusion. Our dual-target and dual-responsive, fucoidan-based macrovesicle represent a promising platform for advanced drug target delivery applications, with potential to prevent coagulation tendencies as well as improving thrombolytic and reducing the risk of re-occlusion.

[Application of super-resolution and ultrafast ultrasound to reveal the characteristics of vascular blood flow changes after rat spinal cord injury at different segments]

Objective: To investigate the changes of spinal vascular blood flow in SD rats after cervical, thoracic and lumbar spinal cord injury (SCI) using super-resolution ultrafast ultrasound technology. Methods: A total of 9 SD rats were used to construct SCI models at different segments using a 50 g aneurysm clip. Super-resolution ultrafast ultrasound technology was used to perform vascular blood flow imaging on the spinal cord of rats before and after injury at 6 hours, obtaining quantitative information such as spinal cord vascular density and blood flow velocity. Results: Ultrasound imaging showed that after SCI, the vascular density in the thoracic segment decreased (18.16%±1.04%) more than in the cervical segment (11.42%±1.39%) and lumbar segment (13.88%±1.43%, both P<0.05). The length of the spinal cord with decreased vascular density in the thoracic segment [(4.80±0.34)mm] was longer than that in the cervical segment [(2.80±0.57)mm] and lumbar segment [(3.10±0.36)mm, both P<0.05]. After injury, the decrease of blood flow in the thoracic segment [(8.87±0.85)ml/min] was higher than that in the cervical segment [(4.88±0.56)ml/min] and lumbar segment [(6.19±0.71)ml/min, both P<0.05]. HE staining and Nissl staining showed that the proportion of cavity area after thoracic SCI (11.53%±0.93%) was higher than that in the cervical segment (4.90%±1.72%) and lumbar segment (7.64%±0.84%, both P<0.05). The number of Nissl bodies in the thoracic segment (18.0±5.3) was also lower than that in the cervical segment (32.3±5.1) and lumbar segment (37.0±5.6) (both P<0.05). Conclusions: There are different changes in vascular blood flow after SCI in different segments of rats. The same injury causes the most severe damage to blood vessels in the thoracic spinal cord, followed by the lumbar spinal cord, and the cervical spinal cord has the least damage.

Flotation Separation of Fluorite from Calcite using an Efficient Depressant Nitrilotriacetic Acid in the NaOL System

Fluorite and calcite were separated with nitrilotriacetic acid (NTA) as a depressant. The single mineral flotation experiment confirmed that with 40 mg/L NaOL and 80 mg/L NTA, the fluorite recovery and calcite recovery were 24.37 and 94.13%, respectively, at pH 9. Meanwhile, in the fluorite-calcite binary mixed ore flotation experiment, the calcite recovery and fluorite recovery were 75.50 and 26.84%, respectively, and the CaCO3 and CaF2 grade in concentrate was 74.32 and 25.61%, respectively. The results confirmed that NTA could be used as a depressant to selectively inhibit fluorite flotation. The mechanism study illustrated that NTA was selectively reacted with fluorite by chemical interaction between O of NTA and Ca of fluorite. The adsorption of NTA on fluorite will impede the interaction between fluorite and NaOL. NTA could adsorb on fluorite in three ways, while the dominant two ways were the complex between double O of NTA and Ca of fluorite in a vertical model and the complex between double O of NTA and Ca of fluorite in a horizontal model.

Efficacy and Safety of First-line Therapies for Advanced Unresectable Oesophageal Squamous Cell Cancer: a Systematic Review and Network Meta-analysis

AIM

To compare the clinical efficacy and safety of first-line treatments for advanced unresectable oesophageal squamous cell cancer.

MATERIALS AND METHODS

A systematic review and network meta-analysis was carried out by retrieving and retaining relevant literature from databases. The studies were randomised controlled trials comparing first-line treatments for advanced unresectable oesophageal squamous cell cancer. A Bayesian network meta-analysis was used to assess clinical outcomes.

RESULTS

Nine studies including 4499 patients receiving first-line treatments were analysed. For all populations, toripalimab plus chemotherapy tended to provide the best overall survival (hazard ratio 0.58, 95% confidence intervals 0.43-0.78) and sintilimab plus chemotherapy provided the best progression-free survival (0.56, 0.46-0.68). Nivolumab plus chemotherapy presented the best objective response rate (odds ratio 2.45, 1.78-3.42) and camrelizumab plus chemotherapy (0.47, 0.29-0.74) appeared to be the safest. Sintilimab plus chemotherapy (0.55, 0.40-0.75) and nivolumab (0.54, 0.37-0.80) plus chemotherapy had the best overall survival in programmed death ligand 1 (PD-L1) tumour proportion score <1% and ≥1% subgroups. Toripalimab plus chemotherapy (0.61, 0.40-0.93) and pembrolizumab (0.57, 0.43-0.75) were the best in overall survival in combined positive score <10 and ≥10 subgroups, respectively. Toripalimab plus chemotherapy showed the best overall survival in the Asian group; pembrolizumab presented better overall survival in the Asian population than the non-Asian group.

CONCLUSION

Most immunotherapy combined with chemotherapy showed superior clinical benefits and sintilimab plus chemotherapy, toripalimab plus chemotherapy and tislelizumab plus chemotherapy had better comprehensive clinical efficacy. PD-L1 expression detection and ethnicity differences are still of great significance and most suitable regimens varied from each subgroup.

A sandwich-like silk fibroin/polysaccharide composite dressing with continual biofluid draining for wound exudate management

Optimal wound healing requires a wet microenvironment without over-hydration. Inspired by capillarity and transpiration, we have developed a sandwich-like fibers/sponge dressing with continuous exudate drainage to maintain appropriate wound moisture. This dressing is prepared by integrating a three-layer structure using the freeze-drying method. Layer I, as the side that contacts with the skin directly, consists of a hydrophobic silk fibroin membrane; Layer II, providing the pumping action, is made of superabsorbent chitosan-konjac glucomannan sponge; Layer III, accelerating evaporation sixfold compared to natural evaporation, is constructed with a graphene oxide soaked hydrophilic cellulose acetate membrane. Animal experiments showed that the composite dressing had superior wound-healing characteristics, with wounds decreasing to 24.8% of their original size compared to 28.5% for the commercial dressing and 43.2% for the control. The enhanced wound healing can be ascribed to the hierarchical porous structure serves as the fluid-driving factor in this effort; the hydrophilicity of a membrane composed of silk fibroin nanofibers is adjustable to regulate fluid-transporting capacity; and the photothermal effect of graphene oxide guarantees exudates that have migrated to the top layer to evaporate continuously. These findings indicate the unidirectional wicking dressing has the potential to become the next generation of clinical dressings.

Chitosan/silk fibroin nanofibers-based hierarchical sponges accelerate infected diabetic wound healing via a HClO self-producing cascade catalytic reaction

The diabetic chronic wound healing is extremely restricted by issues such as hyperglycemia, excessive exudate and reactive oxygen species (ROS), and bacterial infection, causing significant disability and fatality rate. Herein, the chitosan/silk fibroin nanofibers-based hierarchical 3D sponge (CSSF-P/AuGCs) with effective exudate transfer and wound microenvironment modulation are produced by integrating cascade reactor (AuGC) into sponge substrates with parallel-arranged microchannels. When applied to diabetic wounds, the uniformly parallel-arranged microchannels endow CSSF-P/AuGCs with exceptional exudate absorption capacity, keeping the wound clean and moist; additionally, AuGCs efficiently depletes glucose in wounds to generate H2O2, which is then converted into HClO via cascade catalytic reaction to eliminate bacterial infection and reduce inflammation. Experiments in vitro demonstrated that the antibacterial activity of CSSF-P/AuGCs against S. aureus and E. coli was 92.7 and 94.27 %, respectively. Experiments on animals indicated that CSSF-P/AuGC could cure wounds in 11 days, displaying superior wound-healing abilities when compared to the commercial medication Tegaderm™. This versatile CSSF-P/AuGCs dressing may be an attractive choice for expediting diabetic wound healing with little cytotoxicity, providing a novel therapeutic method for establishing a favorable pathological microenvironment for tissue repair.

Facilely Prepared Thirsty Granules Arouse Tough Wet Adhesion on Overmoist Wounds for Hemostasis and Tissue Repair

Bioadhesives have been widely used in hemostasis and tissue repair, but the overmoist and wet nature of wound surface (due to the presence of blood and/or wound exudate) has led to poor wet adhesion of bioadhesives, which interrupts the continuous care of wounds. Here, a thirsty polyphenolic silk granule (Tan@SF-pwd-hydro), which absorbs blood and exudate to self-convert to robust bioadhesives (Tan@SF-gel-hydro) in situ, was facilely developed in this study for enhanced wet adhesion toward hemostasis and tissue repair. Tan@SF-pwd-hydro could shield wounds' wetness and immediately convert itself to Tan@SF-gel-hydro to seal wounds for hemorrhage control and wound healing. The maximum adhesiveness of Tan@SF-gel-hydro over wet pigskin was as high as 59.8 ± 2.1 kPa. Tan@SF-pwd-hydro is a promising transformative dressing for hemostasis and tissue repair since its hemostatic time was approximately half of that of the commercial hemostatic product, CeloxTM, and its healing period was much shorter than that of the commercial bioadhesive product, TegadermTM. This pioneering study utilized adverse wetness over wounds to arouse robust adhesiveness by converting thirsty granules to bioadhesives in situ, creatively turning adversity into opportunities. The facile fabrication approach also offers new perspectives for manufacturing sustainability of biomaterials.

In situ generation of bioadhesives using dry tannic silk particles: a wet-adhesion strategy relying on removal of hydraulic layer over wet tissues for wound care

Tissue adhesives have been widely used in biomedical applications. However, the presence of a hydrated layer on the surface of wet tissue severely hinders their adhesion capacities, resulting in ineffective wound treatment. To address this issue, a dry particle dressing (plas@SF/tann-hydro-pwd) capable of removing the hydrated layer and converting in situ to bioadhesives (plas@SF/tann-hydro-gel) was fabricated via simple physical mixing based on the hydrophobic-hydrogen bonding synergistic effect and Schiff-base reaction. It was found that the plas@SF/tann-hydro-gel bioadhesive, which was changed from plas@SF/tann-hydro-pwd dressing by adsorption of water, exhibited good wet adhesion to diverse biological tissues. In addition, the wet adhesion qualities of the plas@SF/tann-hydro-gel adhesive was studied under a variety of demanding conditions, including a wide range of temperatures, varying pH levels, highly concentrated salt solutions, and simulated fluids. Experiments on animals had showed that the adhesive plas@SF/tann-hydro-gel has superior wet adhesion qualities and superior wound healing properties compared to the commercial product Tegaderm™. This study develops a new wet-adhesion technique employing dry particle dressing to eliminate the hydrated layer over wet tissues for the in situ creation of gel bioadhesives for wound healing.

The Incidence and Prognosis Value of Perineural Invasion in Rectal Carcinoma: From Meta-Analyses and Real-World Clinical Pathological Features

AIMS

Perineural invasion (PNI) is a special type of metastasis of several cancers and has been reported as being a factor for poor prognosis in colorectal carcinoma. However, investigations of PNI in only rectal cancer and a comprehensive analysis combining meta-analyses with real-world case studies remain lacking.

MATERIALS AND METHODS

First, articles from 2000 to 2020 concerning the relationship between PNI and rectal cancer prognoses and clinical features were meta-analysed. Subsequently, we carried out a retrospective analysis of 312 rectal cancer cases that underwent radical surgery in the real world. The incidence of PNI and the relationship between PNI and prognosis, as well as clinicopathological factors, were investigated.

RESULTS

The incidence of PNI was 23.09% and 33.01% in the meta-analysis and clinical cases, respectively. PNI occurred as early as stage I (2.94%). Moreover, neoadjuvant therapy significantly reduced the PNI-positive rate (20.34% versus 26.54%). Both meta-analysis and real-world clinical case studies suggested that PNI-positive patients had poorer prognoses than PNI-negative patients. We established an effective risk model consisting of T stage, differentiation and lymphovascular invasion to predict PNI in rectal cancer.

CONCLUSION

PNI is a poor prognostic factor for rectal cancer and could occur even in stage I. Additionally, neoadjuvant therapy could sufficiently reduce the PNI-positive rate. T stage, lymphovascular invasion and differentiation grade were independent risk factors for PNI and the risk model that included these factors could predict the probability of PNI.

Catechol-chitosan/carboxymethylated cotton-based Janus hemostatic patch for rapid hemostasis in coagulopathy

Uncontrolled bleeding is the leading cause of death, and the death risk of bleeding from coagulopathy is even higher. By infusing the relevant coagulation factors, bleeding in patients with coagulopathy can be clinically treated. However, there are not many emergency hemostatic products accessible for coagulopathy patients. In response, a Janus hemostatic patch (PCMC/CCS) with a two-layer structure of partly carboxymethylated cotton (PCMC) and catechol-grafted chitosan (CCS) was developed. Ultra-high blood absorption (4000 %) and excellent tissue adhesion (60 kPa) were both displayed by PCMC/CCS. The proteomic analysis revealed that PCMC/CCS has significantly contributed to the creative generation of FV, FIX, and FX, as well as to the substantial enrichment of FVII and FXIII, re-paving the initially blocked coagulation pathway of coagulopathy to promote hemostasis. The in vivo bleeding model of coagulopathy demonstrated that PCMC/CCS was substantially more effective than gauze and commercial gelatin sponge at achieving hemostasis in just 1 min. The study provides one of the first investigations on procoagulant mechanisms in anticoagulant blood conditions. Rapid hemostasis in coagulopathy will be significantly affected by the results of this experiment.

Attenuation of NLRP3 Inflammasome by Cigarette Smoke is Correlated with Decreased Defense Response of Oral Epithelial Cells to Candida albicans

BACKGROUND

It is well recognized that both smoke and Candida infection are crucial risk factors for oral mucosal diseases. The nucleotide-binding domain-like receptor family pyrin domain containing 3 (NLRP3) inflammasome and its downstream effectors, interleukin (IL)-1β and IL-18, are pivotal to the host defense against Candida and other pathogens.

METHODS

The present study was designed to explore the effects of cigarette smoke and C. albicans on the NLRP3 inflammasome and its downstream signal pathway via in vitro cell model. Oral epithelial cells (Leuk-1 cells) were exposed to cigarette smoke extract (CSE) for 3 days and/or challenged with C. albicans.

RESULTS

Microscopically, Leuk-1 cells exerted a defense response to C. albicans by markedly limiting the formation of germ tubes and microcolonies. CSE clearly eliminated the defense response of Leuk-1 cells. Functionally, CSE repressed NLRP3 inflammasome, and IL-1β and IL-18 activation induced by C. albicans in Leuk-1 cells.

CONCLUSION

Our results suggested that in oral epithelial cells, the NLRP3 inflammasome might be one of the target pathways by which CSE attenuates innate immunity and leads to oral disorders.

Dual modes reinforced silk adhesives for tissue repair: Integration of textiles and inorganic particles in silk gel for enhanced mechanical and adhesive strength

Skin wound healing in dynamic environments remains challenging. Conventional gels are not ideal dressing materials for wound healing due to difficulties in completely sealing wounds and the inability to deliver drugs quickly and precisely to the injury. To tackle these issues, we propose a multifunctional silk gel that rapidly forms strong adhesions to tissue, has excellent mechanical properties, and delivers growth factors to the wound. Specifically, the presence of Ca²⁺ in the silk protein leads to a solid adhesion to the wet tissue through a chelation reaction with water-trapping behavior; the integrated chitosan fabric and CaCO₃ particles ensure enhanced mechanical strength of the silk gel for better adhesion and robustness during wound repair; and the preloaded growth factor further promoted wound healing. The results showed the adhesion and tensile breaking strength were as high as 93.79 kPa and 47.20 kPa, respectively. MSCCA@CaCO₃-aFGF could remedy the wound model in 13 days, with 99.41 % wound shrinkage without severe inflammatory responses. Due to strong adhesion properties and mechanical strength, MSCCA@CaCO₃-aFGF can be a promising alternative to conventional sutures and tissue closure staples for wound closure and healing. Therefore, MSCCA@CaCO₃-aFGF is expected to be a strong candidate for the next generation of adhesives.

Bioinspired Hemostatic Strategy via Pulse Ejections for Severe Bleeding Wounds

Efficient hemostasis during emergency trauma with massive bleeding remains a critical challenge in prehospital settings. Thus, multiple hemostatic strategies are critical for treating large bleeding wounds. In this study, inspired by bombardier beetles to eject toxic spray for defense, a shape-memory aerogel with an aligned microchannel structure was proposed, employing thrombin-carrying microparticles loaded as a built-in engine to generate pulse ejections for enhanced drug permeation. Bioinspired aerogels, after contact with blood, can rapidly expand inside the wound, offering robust physical barrier blocking, sealing the bleeding wound, and generating a spontaneous local chemical reaction causing an explosive-like generation of CO₂ microbubbles, which provide propulsion thrust to accelerate burst ejection from arrays of microchannels for deeper and faster drug diffusion. The ejection behavior, drug release kinetics, and permeation capacity were evaluated using a theoretical model and experimentally demonstrated. This novel aerogel showed remarkable hemostatic performance in severely bleeding wounds in a swine model and demonstrated good degradability and biocompatibility, displaying great potential for clinical application in humans.

Oral squamous cell carcinoma-derived EVs promote tumor progression by regulating inflammatory cytokines and the IL-17A-induced signaling pathway

BACKGROUND

Inflammatory cytokines in the tumor microenvironment (TME) contribute to tumor growth, proliferation, and invasion, and tumor-derived extracellular vesicles (EVs) act as critical "messengers" of communication in the tumor microenvironment. The effects of EVs derived from oral squamous cell carcinoma (OSCC) cells on tumor progression and the inflammatory microenvironment are still unclear. Our study aims to investigate the role of OSCC-derived EVs in tumor progression, the imbalanced TME, and immunosuppression and their effect on the IL-17A-induced signaling pathway.

METHODS

EVs were isolated from the supernatant of a mouse OSCC cell line, SCC7. The effects of SCC7-EVs and the EV release-specific inhibitor GW4869 on the proliferation and migration of SCC7 cells were investigated in vitro by using CCK-8 and scratch wound healing assays. RT-qPCR and ELISA were performed to examine the alterations in cytokine levels. Then, a mouse xenograft model of OSCC was established by submucosal injection of SCC7 cells with or without SCC7-EV and GW4869 treatment. The effects of GW4869 and SCC7-EVs on xenograft tumor proliferation and invasion were investigated by tumor volume determination and histopathological examination. ELISA was used to investigate the changes in serum cytokine levels. Immunohistochemistry was adopted to analyze the alterations in the levels of inflammatory cytokines, immune factors, and crucial molecules in the IL-17A signaling pathway.

RESULTS

SCC7-derived EVs increased the supernatant and serum levels of IL-17A, IL-10, IL-1β, and PD-L1, while GW4869 decreased those of TNF-α and IFN-γ. SCC7-EV treatment significantly increased xenograft tumor growth and invasion in mice but resulted in little liquefactive necrosis in tumors. However, GW4869 treatment significantly inhibited xenograft tumor growth but resulted in more liquefactive necrosis. SCC7-derived EVs decreased the expression level of PTPN2, suppressing the immune responses of CD8 + T cells in vivo. Moreover, SCC7-EV treatment significantly enhanced the tumor expression levels of crucial molecules in the IL-17A pathway, including IL-17A, TRAF6 and c-FOS, whereas GW4869 treatment significantly reduced those levels in tumor tissues.

CONCLUSION

Our results indicated that OSCC-derived EVs can promote tumor progression by altering the TME, causing an inflammatory cytokine imbalance, inducing immunosuppression, and contributing to overactivation of the IL-17A-induced signaling pathway. Our study might provide novel insights into the role of OSCC-derived EVs in tumor biological behavior and immune dysregulation.

[Research progress on the epidemiology and risk factors of dry eye in children]

The prevalence of dry eye in children is increasing with changes in the environment and the widespread use of electronic products. However, due to poor ability to express themselves and hidden symptoms of children, lack of understanding of dry eye in children, children with dry eye are likely to be misdiagnosed. Dry eye can seriously affect the quality of children's learning, life, vision and visual development. Therefore, it is urgent to raise awareness of clinical workers about dry eye in children, prevent the occurrence of related complications of dry eye, and avoid permanent visual damage to children. This review discusses and summarizes the epidemiology and common risk factors of children with dry eye, with the aim of improving doctors' understanding of dry eye in children.

[Exploration of making removable partial denture by digital technology]

To explore the digital manufacturing process of distal extension removable partial denture. From November 2021 to December 2022, 12 patients (7 males and 5 females) with free-ending situation were selected from the Department of Prosthodontics, School of Stomatology, The Fourth Military Medical University. Three-dimensional model of the relationship between alveolar ridge and jaw position was obtained by intraoral scanning technique. After routine design, manufacturing and try-in of metal framework for removable partial denture, the metal framework was located in the mouth and scanned again to obtain the composite model of dentition, alveolar ridge and metal framework. The free-end modified model is obtained by merging the digital model of free-end alveolar ridge with the virtual model with the metal framework. The three-dimensional model of artificial dentition, and base plate was designed on the free-end modified model, and the resin model were made by digital milling technology. The removable partial denture was made by accurately positioning the artificial dentition and base plate, bonding metal framework with injection resin, grinding and polishing the artificial dentition and resin base. Compared with the design data after clinical trial, the results showed that there was an error of 0.4-1.0 mm and an error of 0.03-0.10 mm in the connection between the resin base of artificial dentition and the connecting rod of the in-place bolt and the connection between artificial dentition and resin base. After denturen delivery, only 2 patients needed grinding adjustment in follow-up visit due to tenderness, and the rest patients did not find any discomfort. The digital fabrication process of removable partial denture used in this study can basically solve the problems of digital fabrication of free-end modified model and assembly of artificial dentition with resin base and metal framework.

Gas-jet propelled hemostats for targeted hemostasis in wounds with irregular shape and incompressibility

Since hemostats are likely to be flushed off a wound by a massive gushing of blood, achieving rapid and effective hemostasis in complex bleeding wounds with powder hemostats continues to be a significant therapeutic challenge. In order to counter the flushing effect of gushing blood, a gas-jet propelled powder hemostat ((COL/PS)₄@CaCO₃-T-TXA⁺) has been developed. (COL/PS)₄@CaCO₃-T-TXA⁺ dives into the deep bleeding sites of complex wounds for targeted hemostasis. In preparation, protamine sulfate and collagen are first electrostatically deposited on CaCO₃, which is then loaded with thrombin, and finally doped with protonated tranexamic acid (TXA-NH₃⁺) to produce the final therapeutic medicine (COL/PS)₄@CaCO₃-T-TXA⁺. When applied to bleeding tissues, CaCO₃ and TXA-NH₃⁺ from (COL/PS)₄@CaCO₃-T-TXA⁺ immediately react with each other in blood to release countless CO₂ macro-bubbles, which direct the hemostatic powder, (COL/PS)₄@CaCO₃-T-TXA⁺, precisely towards deep bleeding sites from complex wounds. Then the carried thrombin is released to accomplish targeted hemostasis. According to animal studies, (COL/PS)₄@CaCO₃-T-TXA⁺ has better effects in rabbit hepatic hemorrhage models; the hemorrhage quickly stops within 30 s, which is roughly 20% less than with the commercial product Celox^TM. The present study provides a new strategy for using powder hemostats to quickly and effectively stop bleeding in complex bleeding wounds.

UArch: A Super-Resolution Processor With Heterogeneous Triple-Core Architecture for Workloads of U-Net Networks

High-resolution medical images are of critical significance to improve disease diagnosis. Limited by the camera and power of medical devices, medical images often have very low resolution. For example, wireless capsule endoscopes, often used to diagnose diseases of the small bowel, can only capture low-resolution endoscopic images. The existing super-resolution (SR) networks perform exceptionally well in recovering high-resolution images, but they are computationally expensive and require high bandwidth, which can result in unacceptable latency and bandwidth requirements for embedded medical devices. In this paper, we propose a U-Net-based SR (USR) network structure and an SR processor named UArch. The USR-s, which is the lightweight version of USR, has an SR performance of 42.68 dB for ×2 scale SR. The USR-s has 0.3 dB higher PSNR (peak signal-to-noise ratio) than the SR algorithm, which is often used in recent SR hardware. Based on well-designed strategies, including heterogeneous triple-core architecture, fine-grained on-chip memory allocation, out-of-order execution, and sub- tensor-based processing flow, the UArch, designed for U-Net networks, can fulfill ×2, ×3, and ×4 scale SR by deploying USR-s, achieving high throughput of 60 fps and low latency of 25 ms for ×2 scale 1920 × 1080 output image SR at 156 MHz. The UArch achieves high energy efficiency which is 2264.5 GOPS/W when synthesized and evaluated under the TSMC 28 nm process and which is 199.3 GOPS/W when implemented on Xilinx ZCU111. Our SR processor is capable of reconstructing high-quality endoscopic images and is more efficient than the previous state-of-the-art SR processors.

The Promotional Effect of GW4869 on C. albicans Invasion and Cellular Damage in a Murine Model of Oral Candidiasis

Candida albicans (C. albicans) is one of the most common fungi in the human body; it is an opportunistic pathogen and can cause candidiasis. Extracellular vesicles (EVs) derived from the host cells have a potentially protective effect against pathogens and can be developed as vaccine formulations. GW4869 can inhibit the production and release of EVs. Previous studies have indicated that GW4869 can alter the immune and inflammatory responses of the host. However, the effect of GW4869 on Candida infection and the anti-Candida response of the host has not been investigated. We evaluated the effect of GW4869 on C. albicans invasion, biofilm formation, and cellular damage in a murine model of oral candidiasis. In this study, C. albicans-infected mice were injected with or without GW4869. The results proven by macroscopic, microscopic, and ultramicroscopic methods showed that GW4869 treatment exacerbated the oral candidiasis of mice, promoted C. albicans invasion and biofilm formation, and aggravated oral mucosal inflammation and cellular ultrastructural damage. The results are beneficial in the further exploration of the immune mechanism of C. albicans infection.

The Value of Preoperative Phase-Contrast MRI in Predicting the Clinical Outcome of Moyamoya Disease after Encephalo-Duro-Arterial Synangiosis Surgery

BACKGROUND AND PURPOSE

In patients with Moyamoya disease, the relationship between preoperative hemodynamic status and prognosis after encephalo-duro-arterial synangiosis (EDAS) surgery was unclear. We aimed to explore the value of the preoperative hemodynamic status acquired by cine phase-contrast MR imaging in predicting collateral formation and clinical outcomes after EDAS surgery in patients with Moyamoya disease.

MATERIALS AND METHODS

Participants with Moyamoya disease were prospectively recruited and underwent preoperative phase-contrast MR imaging. All participants were classified into good and poor groups according to the collateral formation after EDAS surgery. On the basis of the change in the mRS system, participants were classified into the improved mRS group and the poor response group. Hemodynamic status including mean velocity, peak velocity, and blood volume flow of the superficial temporal artery was compared between groups. Logistic regression was performed to relate the phase-contrast MR imaging parameters to collateral formation and clinical outcomes.

RESULTS

A total of 45 patients with Moyamoya disease with unilateral EDAS surgery were finally included. Mean velocity, peak velocity, and blood volume flow of the ipsilateral superficial temporal artery were significantly greater in patients with good collateral formation compared with those with poor collateral formation (P = .011, .004, and .013, respectively). The mean velocity, peak velocity, and blood volume flow were independently associated with postoperative collateral formation after adjusting for confounding factors. Furthermore, the peak velocity of the ipsilateral superficial temporal artery was also significantly associated with improvement of the mRS score.

CONCLUSIONS

Good hemodynamic status of the ipsilateral superficial temporal artery as a donor artery evaluated by phase-contrast MR imaging was significantly associated with better collateral formation and improved mRS after EDAS surgery in patients with Moyamoya disease.

Microcluster colloidosomes for hemostat delivery into complex wounds: A platform inspired by the attack action of torpedoes

Complex yet lethal wounds with uncontrollable bleeding hinder conventional hemostats from clotting blood at the source or deep sites of injury vasculature, thereby causing massive blood loss and significantly increased mortality. Inspired by the attack action of torpedoes, we synthesized microcluster (MC) colloidosomes equipped with magnetic-mediated navigation and "blast" systems to deliver hemostats into the cavity of vase-type wounds. CaCO₃/Fe₂O₃ (CF) microparticles functionalized with Arg-Gly-Asp (RGD) modified polyelectrolyte multilayers were co-assembled with oppositely charged zwitterionic carbon dots (CDs) to form MC colloidosomes, which were loaded with thrombin and protonated tranexamic acid (TXA-NH₃ ⁺). The composite microparticles moved against blood flow under magnetic mediation and simultaneously disassembled for the burst release of thrombin stimulated by TXA-NH₃ ⁺. The CO₂ bubbles generated during disassembly produced a "blast" that propelled thrombin into the wound cavity. Severe bleeding in a vase-type hemorrhage model in the rabbit liver was rapidly controlled within ∼60 s. Furthermore, in vivo subcutaneous muscle and liver implantation models demonstrated excellent biodegradability of MC colloidosomes. This study is the first to propose a novel strategy based on the principle of torpedoes for transporting hemostats into vase-type wounds to achieve rapid hemostasis, creating a new paradigm for combating trauma treatment.

[Association between postpartum depression and concentrations of transforming growth factor-β in human colostrum: a nested cohort study]

OBJECTIVE

To explore the association between postpartum depression (PPD) and transforming growth factor-β (TGF-β) concentrations in human colostrum.

METHODS

Participants were recruited from a maternal and infant cohort established in a tertiary general hospital in Guangdong Province between December, 2020 and September, 2021. In the afternoon of the second postpartum day, the women were evaluated with Edinburgh Postnatal Depression Scale (EPDS) for screening PPD (defined as a score of 10 or higher). The women with PPD were matched at a 1:1 ratio with women without PPD with maternal age difference within 5 years and the same mode of delivery. Colostrum samples were collected in morning on the third postpartum day for measurement of TGF-β concentrations using enzyme-linked immunosorbent assay (ELISA), and the association between EPDS scores and TGF-β concentrations was analyzed in the two groups.

RESULTS

A total of 90 women were included in the final analysis. The mean concentrations of TGF-β1, TGF-β2 and TGF-β3 in the colostrum were 684.03 (321.22-859.25) pg/mL, 5116.50±1747.04 pg/mL and 147.84±48.68 pg/mL in women with PPD, respectively, as compared with 745.67 (596.00-964.22) pg/mL, 4912.40±1516.80 pg/mL, and 168.21±48.15 pg/mL in women without PPD, respectively. Compared with women without PPD, the women with PPD had significantly lower concentrations of TGF-β1 (P=0.026) and TGF-β3 (P=0.049) in the colostrum. Spearman correlation analysis revealed that the EPDS scores were negatively associated with the concentrations of TGF-β1 (r=-0.23, P=0.03) and TGF-β3 (r=-0.25, P=0.02) in the colostrum.

CONCLUSION

PPD is associated with decreased concentrations of TGF-β1 and TGF-β3 in human colostrum, suggesting the need of early PPD screening and interventions during pregnancy and the perinatal period to minimize the impact of PPD on human milk compositions.

JS08.6.A A connectivity signature for glioblastoma

Background

Tumor cell extensions called tumor microtubes (TMs) in glioma resemble neurites during neurodevelopment and connect glioma cells to a network that has considerable relevance for tumor progression and therapy resistance. The determination of interconnectivity in individual tumors has been challenging and the impact of tumor cell connectivity on patient survival remained unresolved so far.

Material and Methods

A connectivity signature was derived by single-cell RNA-sequencing (scRNA-Seq) of highly and lowly connected cells obtained from an SR101 dye transfer xenograft model of primary glioblastoma (GB). The signature was validated in different in vitro models of cell-to-cell connectivity and could be translated to GB clinical specimens.

Results

34 of 40 connectivity genes were related to neurogenesis, neural tube development or glioma progression, including the TM-network-relevant GAP43 gene. Astrocytic-like and mesenchymal-like GB cells had the highest connectivity signature scores in scRNA-Seq data of patient-derived xenografts and patient samples. In 230 human GBs, high connectivity correlated with the mesenchymal expression subtype, TP53 wildtype, and with dismal patient survival. CHI3L1 was identified and validated as a robust molecular marker of connectivity with a functional relevance.

Conclusion

The connectivity signature gives novel insights into brain tumor biology, provides a proof-of-principle that tumor cell connectivity is relevant for patients’ prognosis, and serves as a robust biomarker that can be used for future clinical trials

Antimicrobial Effect of Extracellular Vesicles Derived From Human Oral Mucosal Epithelial Cells on Candida albicans

Candida albicans (C. albicans) is a commensal microorganism that colonizes the mucosal surfaces of healthy individuals. Changes in the host or environment can lead to overgrowth of C. albicans and infection of the host. Extracellular vesicles (EVs) are released by almost all cell types and play an increasingly recognized role in fighting microbial infection. The aim of the present study was to assess whether EVs derived from human oral mucosal epithelial (Leuk-1) cells can suppress the growth and invasion of C. albicans. The in vitro efficacy of Leuk-1-EVs against C. albicans was assessed by optical microscopy, laser scanning confocal microscopy, scanning electron microscopy, and transmission electron microscopy. The germ tube formation rate, the percentage of hyphae and the microcolony optical density were also used to analyze the growth of C. albicans in a coculture model with Leuk-1 cells and EVs or after inhibition of the secretion of EVs. A mouse model of oral candidiasis was established and submucosal injection of Leuk-1-EVs in the tongue was performed. Macroscopic observation, H&E staining, PAS staining, and scanning electron microscopy were used to assess antifungal effects of Leuk-1-EVs in vivo. The in vitro results showed that the growth of C. albicans was inhibited and that the morphology and ultrastructure were changed following Leuk-1-EVs treatment. The in vivo results exhibited that white lesions of the tongue, C. albicans infection, and oral mucosal inflammation of the infected mice were significantly alleviated after Leuk-1-EVs treatment. We thus reveal an antifungal capability of EVs derived from oral epithelial cells against C. albicans that is mediated by direct damage effects and potential synergy between EVs and human oral mucosal epithelial cells. This finding offers an intriguing, previously overlooked method of antifungal defense against C. albicans.

POS1569-PARE TESTING A NEW APPROACH TO IDENTIFY AND ASSESS PATIENT-VALUED TREATMENT GOALS IN RHEUMATOID ARTHRITIS (RA): A PATIENT-ENGAGED HEALTHCARE VALUATION STRATEGY

Background

Common approaches to valuing health technologies often fail to capture outcomes that matter to patients and families. The treatment goals of people living with rheumatoid arthritis (RA) include common trial endpoints but also include other facets of disease impact. Identifying a feasible and rigorous approach to inclusion of the patient perspective is needed as trialists increasingly seek to incorporate patient-important outcomes in trial design and as varied patient-centered value assessment frameworks emerge. No standard approach is available to systemically identify and quantify patient-important outcomes, nor to include those outcomes in deliberative decision-making. We developed the Patient-Engaged Healthcare Valuation strategy, using principles of goal attainment scaling to frame survey-based goal collection directly from adults.

Objectives

To develop and test a goal-based method for collecting RA patient input for use in clinical trials and value assessment and evaluating the feasibility of this approach in people with RA.

Methods

Patient goals and domains were identified from (1) a literature review (2010-2020) of patient outcomes, goals, and preferences in RA, and (2) discussions with patients and clinicians during two meetings with a steering committee (SC) consisting of clinicians, outcomes researchers, patients/advocates, and health economists. These goals informed the development of a draft survey. Adults with RA were recruited from online patient networks to rate goal importance and suggest additional goals. SC members reviewed the survey findings and assessed feasibility of scaling up goal collection for HTA.

Results

Of 135 articles identified, 17 were retained. An inductive and iterative approach was used to identify and thematically group the final set of 36 goals into 4 domains. The draft survey was cognitively debriefed with 4 adults with RA. The first survey was administered to 20 participants; results informed item revisions and additions for the second round of data collection (n=27).

The 47 respondents were mostly White (87%), college-educated (72%) women (93%) living with RA for an average of 15 years; 75% rated their RA as moderate to severe. Free-text goals added in round 1 include: 1) finding specialists who listen to patient input on symptoms; 2) addressing loneliness or isolation; and 3) finding support from or helping others with RA. All Symptom and Life Impact goals were rated as Important or Very Important by ≥85% of participants; endorsement for Management and Treatment goals was somewhat more variable, with ≥85% endorsing these as Somewhat to Very Important. Results suggested that domains match key goals. Steering committee ratings supported the feasibility of this method.

Conclusion

Goals relevant for RA treatment evaluation can be efficiently identified and rated for importance by patients. Patient-important goals can be incorporated into deliberative healthcare valuation using this method to permit “crowd-sourced” input from people living with RA and to capture heterogeneous patient perspectives in healthcare valuation.

Table 1.

Top Goals based on rating as “Very Important” by >70% of subjects, from set of 36. “My goals for living with RA are to…”

GoalsNot ImportantSomewhat ImportantImportantVery ImportantSymptom Managementimprove the quality of my life with RA0% (0)0% (0)23% (11)77% (36)manage my RA pain0% (0)2% (1)11% (5)87% (41)reduce how my RA pain interferes with my life0% (0)9% (4)17% (8)74% (35)Life Impactreduce the ways in which RA interferes with my life0% (0)2% (1)21% (10)77% (36)be independent in my daily functioning0% (0)4% (1)15% (4)81% (22)Managing my RAfeel like I can manage my RA0% (0)2% (1)26% (12)72% (34)Treatment Featuresunderstand my RA treatment options0% (0)4% (2)21% (10)74% (35)have the information I need to make treatment decisions0% (0)0% (0)19% (9)81% (38)know what to expect with my RA treatment0% (0)2% (1)23% (11)74% (35)find treatments that are effective0% (0)0% (0)6% (3)94% (44)

Acknowledgements

I have no acknowledgements to declare.

Disclosure of Interests

None declared

Dual-Driven Hemostats Featured with Puncturing Erythrocytes for Severe Bleeding in Complex Wounds

Achieving rapid hemostasis in complex and deep wounds with secluded hemorrhagic sites is still a challenge because of the difficulty in delivering hemostats to these sites. In this study, a Janus particle, SEC-Fe@CaT with dual-driven forces, bubble-driving, and magnetic field– (MF–) mediated driving, was prepared via in situ loading of Fe₃O₄ on a sunflower sporopollenin exine capsule (SEC), and followed by growth of flower-shaped CaCO₃ clusters. The bubble-driving forces enabled SEC-Fe@CaT to self-diffuse in the blood to eliminate agglomeration, and the MF-mediated driving force facilitated the SEC-Fe@CaT countercurrent against blood to access deep bleeding sites in the wounds. During the movement in blood flow, the meteor hammer-like SEC from SEC-Fe@CaT can puncture red blood cells (RBCs) to release procoagulants, thus promoting activation of platelet and rapid hemostasis. Animal tests suggested that SEC-Fe@CaT stopped bleeding in as short as 30 and 45 s in femoral artery and liver hemorrhage models, respectively. In contrast, the similar commercial product Celox™ required approximately 70 s to stop the bleeding in both bleeding modes. This study demonstrates a new hemostat platform for rapid hemostasis in deep and complex wounds. It was the first attempt integrating geometric structure of sunflower pollen with dual-driven movement in hemostasis.

[Differential expression profile of miRNAs in amniotic fluid exosomes from fetuses with Down syndrome]

OBJECTIVE

To investigate the role of miRNAs in amniotic fluid exosomes in growth and development of fetuses with Down syndrome (DS).

METHODS

Amniotic fluid were collected from 20 fetuses with DS and 20 normal fetuses (control) to extract amniotic exosome miRNA. MicroRNA sequencing technique was used to identify the differentially expressed miRNAs between the two groups, for which gene ontology (GO) and pathway analysis was performed. Three differentially expressed miRNAs with the strongest correlation with DS phenotype were selected for qPCR verification. Dual luciferase reporter assay was used to verify the activity of let-7d-5p for targeted regulation of BACH1.

RESULTS

We identified 15 differentially expressed miRNAs in DS as compared with the control group, among which 7 miRNAs were up-regulated and 8 were down-regulated. Target gene prediction results showed that the differentially expressed miRNAs targeted 17 DS-related genes. GO analysis revealed that the main functions of the target genes involved protein binding, protein transport, ATP binding, transferase activity and synapses. Pathway analysis revealed that the functional pathways were closely related with the development of the nervous system. qPCR results showed that the expression levels of miR-140-3p and let-7d-5p were significantly lower in DS group than in the control group (P < 0.05), as was consistent with miRNA sequencing results; the expression level of miR-4512 was significantly higher in DS group than in control group (P < 0.05), which was contrary to miRNA sequencing results. The results of double luciferase reporter gene assay confirmed that let-7d-5p was capable of targeted regulation of BACH1 expression.

CONCLUSION

Let-7d-5p in amniotic fluid exosomes may promote oxidative stress events in the brain of fetuses with DS by regulating BACH1 expression.

Polarization conversion in the caviton driven by linearly polarized lasers

In one-dimensional particle-in-cell simulations of a plasma irradiated by linearly polarized lasers from both sides of boundaries, it is found that there is an appreciable growth of the electromagnetic field in cavitons in the transverse direction perpendicular to the direction of polarization, which indicates the polarization conversion of the electromagnetic field in cavitons. This paper demonstrates the mechanism of this phenomenon based on parametric resonance induced by ponderomotive force with twice the frequency of the electromagnetic radiation in the caviton. We develop a theoretical model and verify it with simulation results. This phenomenon contributes to the heating and acceleration of particles and traps more EM energy in cavitons.

Recent advances in materials for hemostatic management

Traumatic hemorrhage can be a fatal event, particularly when large quantities of blood are lost in a short period of time. Therefore, hemostasis has become a crucial part of emergency treatment. For small wounds, hemostasis can be achieved intrinsically depending on the body's own blood coagulation mechanism; however, for large-area wounds, particularly battlefield and complex wounds, materials delivering rapid and effective hemostasis are required. In parallel with the constant progress in science, technology, and society, advances in hemostatic materials have also undergone various iterations by integrating new ideas with old concepts. There are various natural and synthetic hemostatic materials, including hemostatic powders, adhesives, hydrogels, and tourniquets, for the treatment of severe external trauma. This review covers the differences among the currently available hemostatic materials and comprehensively describes the hemostatic effects of different materials based on the underlying mechanisms. Finally, solutions for current issues related to trauma bleeding are discussed, and the prospects of hemostatic materials are proposed.

Association between coronary artery vitamin D receptor expression and select systemic risks factors for coronary artery atherosclerosis

OBJECTIVE

The aim of this study is to analyze the association between coronary artery vitamin D receptor (VDR) expression and systemic coronary artery atherosclerosis (CAA) risk factors.

METHODS

Female cynomolgus monkeys (n = 39) consumed atherogenic diets containing the women's equivalent of 1000 IU/day of vitamin D₃. After 32 months consuming the diets, each monkey underwent surgical menopause. After 32 postmenopausal months, CAA and VDR expression were quantified in the left anterior descending coronary artery. Plasma 25OHD_3, lipid profiles and serum monocyte chemotactic protein-1 (MCP-1) were measured.

RESULTS

In postmenopausal monkeys receiving atherogenic diets, serum MCP-1 was significantly elevated compared with baseline (482.2 ± 174.2 pg/ml vs. 349.1 ± 163.2 pg/ml, respectively; p < 0.001; d = 0.79) and at the start of menopause (363.4 ± 117.2 pg/ml; p < 0.001; d = 0.80). Coronary VDR expression was inversely correlated with serum MCP-1 (p = 0.042). Additionally, the change of postmenopausal MCP-1 (from baseline to necropsy) was significantly reduced in the group with higher, compared to below the median, VDR expression (p = 0.038). The combination of plasma 25OHD₃ and total plasma cholesterol/high-density lipoprotein cholesterol was subsequently broken into low-risk, moderate-risk and high-risk groups; as the risk increased, the VDR quantity decreased (p = 0.04). CAA was not associated with various atherogenic diets.

CONCLUSION

Coronary artery VDR expression was inversely correlated with markers of CAA risk and inflammation, including MCP-1, suggesting that systemic and perhaps local inflammation in the artery may be associated with reduced arterial VDR expression.

[Aryl hydrocarbon receptor modulates airway inflammation in mice with cockroach allergen-induced asthma by regulating Th17/Treg differentiation]

OBJECTIVE

To investigate whether aryl hydrocarbon receptor (AhR) modulates cockroach allergen (CRE)-induced asthma by regulating Th17/Treg differentiation.

OBJECTIVE

Mouse models of CRE-induced asthma established by sensitizing and challenging the mice with CRE were randomized into asthma model group, AhR agonist group treated with TCDD (10 μg/ kg), and AhR antagonist group treated with TCDD and CH223191 (10 mg/kg) (n=5), with 5 mice without CRE challenge as the control group. The expressions of AhR, Cyp1a1 and Cyp1b1 mRNA in the lung tissues of the mice were detected using RT-PCR, and pulmonary inflammation was evaluated with immumohistochemical staining. The expressions of inflammatory cytokines in the lungs were detected using ELISA, and the expression of Treg in the lung tissues and pulmonary lymph nodes was analyzed with flow cytometry.

OBJECTIVE

Both TCDD and CH223191 were capable of modulating pulmonary expressions of AhR and its downstream genes Cyp1a1 and Cyp1b1 in asthmatic mice (P < 0.002). TCDD treatment significantly decreased inflammatory cells and mucus production in the lungs of asthmatic mice, and BALFs from TCDD-treated mice with CRE challenge contained lowered levels of the proinflammatory factors including IL-4, IL-13 and IL-17A (P < 0.001) but increased anti-inflammatory factors including IL-10, IL-22 and TGF-β1 (P < 0.001). All these changes were significantly reversed by treatment with CH223191 to the levels comparable with those in the asthma model group (P>0.05). More importantly, TCDD treatment significantly increased the number of Tregs cells and FOXP3 expression and lowered RORγt mRNA expression in the lungs and pulmonary lymph nodes in asthmatic mice (P < 0.001); inhibition of AhR with CH223191, as compared with TCDD, significantly decreased the expression of CD4⁺CD25⁺Foxp3⁺Treg cells in the lungs and pulmonary lymph nodes and the expression of FOXP3 mRNA in lymphocytes and increased RORγt mRNA expression (P < 0.001) to the levels comparable with those in asthma model group (P>0.05).

OBJECTIVE

AhR activation modulates airway inflammation in mice with CRE-induced asthma by modulating the differentiation of Th17/Treg.

Chestnut-like macro-acanthosphere triggered hemostasis: a featured mechanism based on puncturing red blood cells

Acute hemorrhage that occurs after trauma is a life-threatening condition. Hence, to halt massive bleeding, there is a critical need to develop a suitable therapy. In this study, we developed self-propelling chestnut-like particles (Pro-MAS) comprising a macro-acanthosphere (MAS) coated with calcium carbonate and protonated tranexamic acid to puncture red blood cells (RBCs) and thus activate hemostasis. In vitro assessments revealed that Pro-MAS was biocompatible, biodegradable, and nontoxic; furthermore, it was capable of puncturing RBCs to release procoagulants and activate platelet aggregation for hemostasis. Animal tests showed that self-propelling Pro-MAS effectively traveled through blood flow to the deep ends of wounds; hemorrhage was controlled within 90 s and 4 min in the injured liver and bleeding femoral artery, respectively. Compared with a commercial hemostat, superior hemostasis was achieved with Pro-MAS, which could be ascribed to its functional and structural features. Overall, traveling Pro-MAS possessed sufficient impact force to puncture RBCs and sufficient momentum to reach the targeted bleeding sites. The present study demonstrated the ability of a novel platform, self-propelling MAS particles, to trigger hemostasis by puncturing RBCs. To the best of our knowledge, this is the first trial in which the release of endogenous procoagulants is promoted without the addition of exogenous procoagulants for severe hemorrhage control.

Magnetically Guided Nanoworms for Precise Delivery to Enhance In Situ Production of Nitric Oxide to Combat Focal Bacterial Infection In Vivo

Overexploitation of antibiotics increases the emergence of multidrug-resistant agents (MDRAs), which may potentially cause a global crisis with severe health consequences. Hence, there is great demand for next-generation antibacterial platforms based on antibiotic-free strategies or targeted therapies to mitigate the emergence of MDRAs. Herein, an all-in-one hollow nanoworm (A-Fe/AuAg@PDA) is developed with a core comprising citrate-capped Au-Ag nanoparticles (Cit-AuAg NPs) loaded with Fe₂O₃ and an l-arginine (L-Arg)-modified polydopamine (PDA) outer shell, possessing exceptional magnetic-targeting ability and a photothermal therapeutic effect. Following intravenous injection, A-Fe/AuAg@PDA can be precisely delivered to the targeted infection sites by an externally applied magnetic field. The in situ produced NO, together with Ag ions and reactive oxygen species, synergistically results in the highly effective elimination of in vivo bacterial infection. With the aid of functional worm-like A-Fe/AuAg@PDA nanocarriers possessing superior biocompatibility, the combination of magnetic guidance therapy and near-infrared-triggered in situ generation of NO may provide a novel approach for eradicating abscesses in the body. To our knowledge, this is the first study highlighting the magnetically guided delivery of worm-like nanocarriers for the antibiotic-free therapy of bacterial infections using in situ generated NO gas, which demonstrates high potential for application in clinical gas therapy.

Magnetic field-mediated Janus particles with sustained driving capability for severe bleeding control in perforating and inflected wounds

Severe bleeding in perforating and inflected wounds with forky cavities or fine voids encountered during prehospital treatments and surgical procedures is a complex challenge. Therefore, we present a novel hemostatic strategy based on magnetic field-mediated guidance. The biphasic Janus magnetic particle (MSS@Fe₂O₃-T) comprised aggregates of α-Fe₂O₃ nanoparticles (Fe₂O₃ NPs) as the motion actuator, negatively modified microporous starch (MSS) as the base hemostatic substrate, and thrombin as the loaded hemostatic drug. Before application, the particles were first wrapped using NaHCO₃ and then doped with protonated tranexamic acid (TXA-NH₃⁺), which ensured their high self-dispersibility in liquids. During application, the particles promptly self-diffused in blood by bubble propulsion and travelled to deep bleeding sites against reverse rushing blood flow under magnetic guidance. In vivo tests confirmed the superior hemostatic performance of the particles in perforating and inflected wounds (“V”-shaped femoral artery and “J”-shaped liver bleeding models). The present strategy, for the first time, extends the range of magnetically guided drug carriers to address the challenges in the hemorrhage control of perforating and inflected wounds.

•

A new Janus hemostat was developed for treating severe bleeding.

•

The “J” shape bleeding model was proposed for hemostatic test.

•

Magnetic field-mediated driving capacity was employed for hemostasis.

•

Explosive self-dispersibility endowed to the hemostat largely enhanced the bleeding control capacity.

Biogenetic Acellular Dermal Matrix Maintaining Rich Interconnected Microchannels for Accelerated Tissue Amendment

Given that many people suffer from extensive skin damage, wound repair has drawn tremendous attention in research. Among the various assistant dressing materials that promote healing, a porcine acellular dermal matrix (PADM), as a skin substitute, can efficiently accelerate healing by promoting cell migration and proliferation. However, a simple, low-cost preparation process remains a challenge facing PADM development, particularly because of the inferior elasticity. To overcome these drawbacks, a CaCl₂-ethanol-H₂O solution (ternary solution) combined with an additional enzyme treatment was used to obtain a transparent, porous, and elastic PADM that retained the major extracellular matrix composition of the dermis. Our results indicated that alterations in the fiber organization and secondary structural changes in the collagen occurred after treatment. Furthermore, the in vivo wound healing and histological analyses clearly revealed an extremely expedited wound repair process following the application of the biocompatible PADM. In conclusion, this study provides new insights into the development of a transparent PADM with a porous structure and good elasticity that can be used as a skin substitute to accelerate the wound healing process. Moreover, this effective technique could potentially be used to extrapolate other decellularized materials in the future.

MC-LSTM: Real-Time 3D Human Action Detection System for Intelligent Healthcare Applications

Due to the movement expressiveness and privacy assurance of human skeleton data, 3D skeleton-based action inference is becoming popular in healthcare applications. These scenarios call for more advanced performance in application-specific algorithms and efficient hardware support. Warnings on health emergencies sensitive to response speed require low latency output and action early detection capabilities. Medical monitoring that works in an always-on edge platform needs the system processor to have extreme energy efficiency. Therefore, in this paper, we propose the MC-LSTM, a functional and versatile 3D skeleton-based action detection system, for the above demands. Our system achieves state-of-the-art accuracy on trimmed and untrimmed cases of general-purpose and medical-specific datasets with early-detection features. Further, the MC-LSTM accelerator supports parallel inference on up to 64 input channels. The implementation on Xilinx ZCU104 reaches a throughput of 18 658 Frames-Per-Second (FPS) and an inference latency of 3.5 ms with the batch size of 64. Accordingly, the power consumption is 3.6 W for the whole FPGA+ARM system, which is 37.8x and 10.4x more energy-efficient than the high-end Titan X GPU and i7-9700 CPU, respectively. Meanwhile, our accelerator also keeps a 4  ∼ 5x energy efficiency advantage against the low-power high-performance Firefly-RK3399 board carrying an ARM Cortex-A72+A53 CPU. We further synthesize an 8-bit quantized version on the same hardware, providing a 48.8% increase in energy efficiency under the same throughput.

Active control of electron cyclotron emission radiometer channel frequencies for improved electron temperature measurements

As advanced scenarios are developed for tokamak operations, the demand for flexibility of the electron cyclotron emission (ECE) channels' locations has increased. The tunable feature of yttrium iron garnet (YIG) filters provides this spatial flexibility. Here, we present a method of performing ECE measurements on fixed flux surfaces instead of fixed frequencies. This is achieved by adjusting YIG filters utilized in the intermediate frequency section to frequencies associated with flux surfaces in regions of interest during the discharge. The key components are the application of tunable YIG filters and a control program that calculates the filter settings using flux information from real-time reconstruction equilibria (EFIT). This fast procedure facilitates T_e measurements in regions of interest to investigate plasma dynamic behaviors.

Preoperative anthropomorphic radiographic measurements can predict postoperative pancreatic fistula formation following pancreatoduodenectomy

BACKGROUND

Postoperative pancreatic fistulae (POPF) are a major contributing factor to pancreatoduodenectomy-associated morbidity. Established risk calculators mostly rely on subjective or intraoperative assessments. We hypothesized that various objective preoperatively determined computed tomography (CT) measurements could predict POPF as well as validated models and allow for more informed operative consent in high-risk patients.

METHODS

Patients undergoing elective pancreatoduodenectomies between January 2013 and April 2018 were identified in a prospective database. Comparative statistical analyses and multivariable logistic regression models were generated to predict POPF development. Model performance was tested with receiver operating characteristics (ROC) curves. Pancreatic neck attenuation (Hounsfield units) was measured in triplicate by pancreatic protocol CT (venous phase, coronal plane) anterior to the portal vein. A pancreatic density index (PDI) was created to adjust for differences in contrast timing by dividing the mean of these measurements by the portal vein attenuation. Total areas of subcutaneous fat and skeletal muscle were calculated at the L3 vertebral level on axial CT. Pancreatic duct (PD) diameter was determined by CT.

RESULTS

In the study period 220 patients had elective pancreatoduodenectomies with 35 (16%) developing a POPF of any grade. Multivariable regression analysis revealed that demographics (age, sex, and race) were not associated with POPF, yet patients resected for pancreatic adenocarcinoma or chronic pancreatitis were less likely to develop a POPF (10 vs. 24%; p = 0.004). ROC curves were created using various combinations of gland texture, body mass index, skeletal muscle index, sarcopenia, PDI, PD diameter, and subcutaneous fat area indexed for height (SFI). A model replacing gland texture with SFI and PDI (AUC 0.844) had similar predictive performance as the established model (p = 0.169).

CONCLUSION

A combination of preoperative objective CT measurements can adequately predict POPF and is comparable to established models relying on subjective intraoperative variables. Validation in a larger dataset would allow for better preoperative stratification of high-risk patients and improve informed consent among this patient population.