Three-Dimensional Printed Patient-Specific Vestibular Augmentation: A Case Report

Background: The anterior maxilla is challenging regarding aesthetic rehabilitation. Current bone augmentation techniques are complex and 3D-printed bioceramic bone grafts can simplify the intervention. Aim: A four-teeth defect in the anterior maxilla was reconstructed with a 3D-printed synthetic patient-specific bone graft in a staged approach for dental implant delivery. Methods: The bone graft was designed using Cone-Beam Computed Tomography (CBCT) images. The bone graft was immobilized with fixation screws. Bone augmentation was measured on CBCT images at 11 days and 8 and 13 months post-surgery. A biopsy sample was retrieved at reentry (10 months post-augmentation) and evaluated by histological and micro-computed tomography assessments. The definitive prosthesis was delivered 5 months post-reentry and the patient attended a visit 1-year post-loading. Results: A total bone width of 8 mm was achieved (3.7 mm horizontal bone gain). The reconstructed bone remained stable during the healing period and was sufficient for placing two dental implants (with an insertion torque > 35 N·cm). The fractions of new bone, bone graft, and soft tissue in the biopsy were 40.77%, 41.51%, and 17.72%, respectively. The histological assessment showed no signs of encapsulation, and mature bone was found in close contact with the graft, indicating adequate biocompatibility and suggesting osteoconductive properties of the graft. At 1-year post-loading, the soft tissues were healthy, and the dental implants were stable. Conclusions: The anterior maxilla's horizontal ridge can be reconstructed using a synthetic patient-specific 3D-printed bone graft in a staged approach for implant placement. The dental implants were stable and successful 1-year post-loading.

Natural and Synthetic Polymers for Biomedical and Environmental Applications

Natural and synthetic polymers are a versatile platform for developing biomaterials in the biomedical and environmental fields. Natural polymers are organic compounds that are found in nature. The most common natural polymers include polysaccharides, such as alginate, hyaluronic acid, and starch, proteins, e.g., collagen, silk, and fibrin, and bacterial polyesters. Natural polymers have already been applied in numerous sectors, such as carriers for drug delivery, tissue engineering, stem cell morphogenesis, wound healing, regenerative medicine, food packaging, etc. Various synthetic polymers, including poly(lactic acid), poly(acrylic acid), poly(vinyl alcohol), polyethylene glycol, etc., are biocompatible and biodegradable; therefore, they are studied and applied in controlled drug release systems, nano-carriers, tissue engineering, dispersion of bacterial biofilms, gene delivery systems, bio-ink in 3D-printing, textiles in medicine, agriculture, heavy metals removal, and food packaging. In the following review, recent advancements in polymer chemistry, which enable the imparting of specific biomedical functions of polymers, will be discussed in detail, including antiviral, anticancer, and antimicrobial activities. This work contains the authors' experimental contributions to biomedical and environmental polymer applications. This review is a vast overview of natural and synthetic polymers used in biomedical and environmental fields, polymer synthesis, and isolation methods, critically assessessing their advantages, limitations, and prospects.

Comprehensive analysis of synthetic learning applied to neonatal brain MRI segmentation

Brain segmentation from neonatal MRI images is a very challenging task due to large changes in the shape of cerebral structures and variations in signal intensities reflecting the gestational process. In this context, there is a clear need for segmentation techniques that are robust to variations in image contrast and to the spatial configuration of anatomical structures. In this work, we evaluate the potential of synthetic learning, a contrast-independent model trained using synthetic images generated from the ground truth labels of very few subjects. We base our experiments on the dataset released by the developmental Human Connectome Project, for which high-quality images are available for more than 700 babies aged between 26 and 45 weeks postconception. First, we confirm the impressive performance of a standard UNet trained on a few volumes, but also confirm that such models learn intensity-related features specific to the training domain. We then confirm the robustness of the synthetic learning approach to variations in image contrast. However, we observe a clear influence of the age of the baby on the predictions. We improve the performance of this model by enriching the synthetic training set with realistic motion artifacts and over-segmentation of the white matter. Based on extensive visual assessment, we argue that the better performance of the model trained on real T2w data may be due to systematic errors in the ground truth. We propose an original experiment allowing us to show that learning from real data will reproduce any systematic bias affecting the training set, while synthetic models can avoid this limitation. Overall, our experiments confirm that synthetic learning is an effective solution for segmenting neonatal brain MRI. Our adapted synthetic learning approach combines key features that will be instrumental for large multisite studies and clinical applications.

Synthetic versus non-synthetic slings for female stress and mixed urinary incontinence: A systematic review and meta-analysis

OBJECTIVE

To systematically review objective and subjective success, and surgical outcomes of sub-urethral sling surgery for female patients with stress or mixed urinary incontinence (SUI, MUI) using synthetic vs. non-synthetic material with corresponding surgical approach (retropubic, RP or transobturator, TO).

DATA SOURCES

We systematically searched Medline, Embase, EBM Reviews, ClinicalTrials.gov and Web of Science Core Collection using standardized medical subject headings, no date restrictions (Prospero registered). We double-screened studies and used backward citation chaining.

STUDY ELIGIBILITY

We included peer-reviewed randomized controlled trials and prospective or retrospective comparative studies examining outcomes of RP or TO synthetic vs non-synthetic (autologous, allograft, xenograft) slings for female SUI or MUI, with available English or French full text. We excluded minislings (single insertion point). We allowed slings for recurrent SUI or MUI, and slings concomitant with prolapse surgery, with at least 6 weeks of postoperative follow-up. We excluded systematic reviews, meta-analyses, review studies, case-control studies, case reports, studies that did not describe surgical approach or material, and studies of combination slings.

STUDY APPRAISAL

We evaluated study quality using the Cochrane Risk of Bias Tool for randomized controlled trials and the Newcastle-Ottawa Scale for observational studies. We used pooled relative risk (RR) with 95% confidence intervals (CI) to estimate effect of sling material type on each outcome through meta-analysis and meta-regression as appropriate.

RESULTS

We screened 4341 abstracts, assessed 104 full-texts and retained 35 manuscripts (30 separate studies). For RP synthetic vs non-synthetic, there was no difference in number of objectively or subjectively continent patients. Reoperation for SUI and overall was higher for non-autologous RP slings compared to synthetic. RP synthetic vs autologous slings were associated with higher subjective continence in populations with ≥ 25% recurrent SUI (RR 1.27, 95% CI 1.12-1.43). For TO synthetic vs non-synthetic, there were no differences in continence. Subjective satisfaction was better in the TO synthetic group compared to autologous (RR 1.42, 95% CI 1.03;1.94).

CONCLUSIONS

Synthetic and non-synthetic slings have comparable objective and subjective success, with differences in operative outcomes and complications generally in favour of synthetic material.

Evaluating Novel SP-B and SP-C Synthetic Analogues for Pulmonary Surfactant Efficacy

Pulmonary surfactants, a complex assembly of phospholipids and surfactant proteins such as SP-B and SP-C, are critical for maintaining respiratory system functionality by lowering surface tension (ST) and preventing alveolar collapse. Our study introduced five synthetic SP-B peptides and one SP-C peptide, leading to the synthesis of CHAsurf candidates (CHAsurf-1 to CHAsurf-5) for evaluation. We utilized a modified Wilhelmy balance test to assess the surface tension properties of the surfactants, measuring spreading rate, surface adsorption, and ST-area diagrams to comprehensively evaluate their performance. Animal experiments were performed on New Zealand white rabbits to test the efficacy of CHAsurf-4B, a variant chosen for its economic viability and promising ST reduction properties, comparable to Curosurf®. The study confirmed that higher doses of SP-B in CHAsurf-4 are associated with improved ST reduction. However, due to cost constraints, CHAsurf-4B was selected for in vivo assessment. The animal model revealed that CHAsurf-4B could restore alveolar structure and improve lung elasticity, akin to Curosurf®. Our research highlights the significance of cysteine residues and disulfide bonds in the structural integrity and function of synthetic SP-B analogues, offering a foundation for future surfactant therapy in respiratory disorders. This study's findings support the potential of CHAsurf-4B as a therapeutic agent, meriting further investigation to solidify its role in clinical applications.

Trends in the synthetic polymer delivery of RNA

Ribonucleic acid (RNA) has emerged as one of the most promising therapeutic payloads in the field of gene therapy. There are many unique types of RNA that allow for a range of applications including vaccination, protein replacement therapy, autoimmune disease treatment, gene knockdown and gene editing. However, RNA triggers the host immune system, is vulnerable to degradation and has a low proclivity to enter cells spontaneously. Therefore, a delivery vehicle is required to facilitate the protection and uptake of RNA therapeutics into the desired host cells. Lipid nanoparticles have emerged as one of the only clinically approved vehicles for genetic payloads, including in the COVID-19 messenger RNA vaccines. While lipid nanoparticles have distinct advantages, they also have drawbacks, including strong immune stimulation, complex manufacturing and formulation heterogeneity. In contrast, synthetic polymers are a widely studied group of gene delivery vehicles and boast distinct advantages, including biocompatibility, tunability, inexpensiveness, simple formulation and ease of modification. Some classes of polymers enhance efficient transfection efficiency, and lead to lower stimulation of the host immune system, making them more viable candidates for non-vaccine-related applications of RNA medicines. This review aims to identify the most promising classes of synthetic polymers, summarize recent research aimed at moving them into the clinic and postulate the future steps required for unlocking their full potential.

Deep learning-based synthetic dose-weighted LET map generation for intensity modulated proton therapy

The advantage of proton therapy as compared to photon therapy stems from the Bragg peak effect, which allows protons to deposit most of their energy directly at the tumor while sparing healthy tissue. However, even with such benefits, proton therapy does present certain challenges. The biological effectiveness differences between protons and photons are not fully incorporated into clinical treatment planning processes. In current clinical practice, the relative biological effectiveness (RBE) between protons and photons is set as constant 1.1. Numerous studies have suggested that the RBE of protons can exhibit significant variability. Given these findings, there is a substantial interest in refining proton therapy treatment planning to better account for the variable RBE. Dose-average linear energy transfer (LETd) is a key physical parameter for evaluating the RBE of proton therapy and aids in optimizing proton treatment plans. Calculating precise LETddistributions necessitates the use of intricate physical models and the execution of specialized Monte-Carlo simulation software, which is a computationally intensive and time-consuming progress. In response to these challenges, we propose a deep learning based framework designed to predict the LETddistribution map using the dose distribution map. This approach aims to simplify the process and increase the speed of LETdmap generation in clinical settings. The proposed CycleGAN model has demonstrated superior performance over other GAN-based models. The mean absolute error (MAE), peak signal-to-noise ratio and normalized cross correlation of the LETdmaps generated by the proposed method are 0.096 ± 0.019 keVμm-1, 24.203 ± 2.683 dB, and 0.997 ± 0.002, respectively. The MAE of the proposed method in the clinical target volume, bladder, and rectum are 0.193 ± 0.103, 0.277 ± 0.112, and 0.211 ± 0.086 keVμm-1, respectively. The proposed framework has demonstrated the feasibility of generating synthetic LETdmaps from dose maps and has the potential to improve proton therapy planning by providing accurate LETdinformation.

Advances in Synthetic Grafts in Spinal Fusion Surgery

Degenerative spine disease is increasing in prevalence as the global population ages, indicating a need for targeted therapies and continued innovations. While autograft and allograft have historically demonstrated robust results in spine fusion surgery, they have significant limitations and associated complications such as infection, donor site morbidity and pain, and neurovascular injury. Synthetic grafts may provide similar success while mitigating negative outcomes. A narrative literature review was performed to review available synthetic materials that aim to optimize spinal fusion. The authors specifically address the evolution of synthetics and comment on future trends. Novel synthetic materials currently in use include ceramics, synthetic polymers and peptides, bioactive glasses, and peptide amphiphiles, and the authors focus on their success in both human and animal models, physical properties, advantages, and disadvantages. Advantages include properties of osteoinduction, osteoconduction, and osteogenesis, whereas disadvantages encompass a lack of these properties or growth factor-induced complications. Typically, the use of synthetic materials results in fewer complications and lower costs. While the development and tuning of synthetic materials are ongoing, there are many beneficial alternatives to autografts and allografts with promising fusion results.

A native phosphoglycolate salvage pathway of the synthetic autotrophic yeast Komagataella phaffii

Synthetic autotrophs can serve as chassis strains for bioproduction from CO2 as a feedstock to take measures against the climate crisis. Integration of the Calvin-Benson-Bassham (CBB) cycle into the methylotrophic yeast Komagataella phaffii (Pichia pastoris) enabled it to use CO2 as the sole carbon source. The key enzyme in this cycle is ribulose-1,5-bisphosphate carboxylase/oxygenase (RuBisCO) catalyzing the carboxylation step. However, this enzyme is error prone to perform an oxygenation reaction leading to the production of toxic 2-phosphoglycolate. Native autotrophs have evolved different recycling pathways for 2-phosphoglycolate. However, for synthetic autotrophs, no information is available for the existence of such pathways. Deletion of CYB2 in the autotrophic K. phaffii strain led to the accumulation of glycolate, an intermediate in phosphoglycolate salvage pathways, suggesting that such a pathway is enabled by native K. phaffii enzymes. 13C tracer analysis with labeled glycolate indicated that the yeast pathway recycling phosphoglycolate is similar to the plant salvage pathway. This orthogonal yeast pathway may serve as a sensor for RuBisCO oxygenation, and as an engineering target to boost autotrophic growth rates in K. phaffii.

Antimicrobial effects of a borate-based bioactive glass wound matrix on wound-relevant pathogens

OBJECTIVE

The antimicrobial effects of a borate-based bioactive glass matrix (BBBGM) on clinically relevant microorganisms was investigated for up to seven days in vitro.

METHOD

A total of 19 wound-relevant pathogens were studied using the in vitro AATCC 100 test method.

RESULTS

The reduction of viable Gram-negative and Gram-positive bacteria and yeasts at days 4 and 7 post-culture on the BBBGM was significant (> 4log10) in most cases. Mould counts were reduced (<2log10) during the seven-day assessment, indicating that mould viability and reproduction was inhibited. The cell count of each organism was reduced at seven days indicating that the BBBGM not only reduced the viable cell count, but that the cell count did not recover during the seven-day period, indicating a sustained reduction in pathogenic activity.

CONCLUSION

Based on the present results, the use of a BBBGM as a pathogenic barrier should be considered as a tool for combating pathogenic colonisation and infection in acute and hard-to-heal (chronic) wounds.

The Use of a Synthetic Hybrid-Scale Fiber Matrix to Treat Difficult-to-Heal Wounds

INTRODUCTION

Complex and chronic wounds are often difficult to treat, and current advanced therapies have their limitations. A synthetic hybrid-scale fiber matrix could be a viable option in treating these wounds, as previous clinical studies utilizing the matrix have shown positive results in treating chronic ulcers and surgical wounds.

METHODS

Patients with difficult-to-treat wounds of varying etiologies were treated with a synthetic hybrid-scale fiber matrix (Restrata®, Acera Surgical, Inc., St. Louis, Missouri). The wound bed was debrided and prepared, and the synthetic matrix was prepared and applied to the wound. Wounds were monitored for healing progress. Additional applications of the synthetic matrix were used based on clinician discretion.

RESULTS

Six patients with wounds of varying etiologies were assessed, including a 30-year recalcitrant wound. All wounds achieved significant healing, with four of the six wounds (67%) achieving complete closure in an average of 57.8 ± 27.0 days (8.3 ± 3.9 weeks).

CONCLUSIONS

The study found that the synthetic matrix was effective, resulting in improved healing across various etiologies, including cancer resection and amputation. The clinical results presented here suggest that the synthetic hybrid-scale fiber matrix may be an optimal alternative in treating difficult-to-heal wounds.

Synthetic MRI plus FSE-PROPELLER DWI for differentiating malignant from benign head and neck tumors: a preliminary study

Background

Preoperative classification of head and neck (HN) tumors remains challenging, especially distinguishing early cancerogenic masses from benign lesions. Synthetic MRI offers a new way for quantitative analysis of tumors. The present study investigated the application of synthetic MRI and stimulus and fast spin echo diffusion-weighted imaging with periodically rotated overlapping parallel lines with enhanced reconstruction (FSE-PROPELLER DWI) to differentiate malignant from benign HN tumors.

Materials and methods

Forty-eight patients with pathologically confirmed HN tumors were retrospectively recruited between August 2022 and October 2022. The patients were divided into malignant (n = 28) and benign (n = 20) groups. All patients were scanned using synthetic MRI and FSE-PROPELLER DWI. T1, T2, and proton density (PD) values were acquired on the synthetic MRI and ADC values on the FSE-PROPELLER DWI.

Results

Benign tumors (ADC: 2.03 ± 0.31 × 10-3 mm2/s, T1: 1741.13 ± 662.64 ms, T2: 157.43 ± 72.23 ms) showed higher ADC, T1, and T2 values compared to malignant tumors (ADC: 1.46 ± 0.37 × 10-3 mm2/s, T1: 1390.06 ± 241.09 ms, T2: 97.64 ± 14.91 ms) (all P<0.05), while no differences were seen for PD values. ROC analysis showed that T2+ADC (cut-off value, > 0.55; AUC, 0.950) had optimal diagnostic performance vs. T1 (cut-off value, ≤ 1675.84 ms; AUC, 0.698), T2 (cut-off value, ≤ 113.24 ms; AUC, 0.855) and PD (cut off value, > 80.67 pu; AUC, 0.568) alone in differentiating malignant from benign lesions (all P<0.05); yet, the difference in AUC between ADC and T2+ADC or T2 did not reach statistical significance.

Conclusion

Synthetic MRI and FSE-PROPELLER DWI can quantitatively differentiate malignant from benign HN tumors. T2 value is comparable to ADC value, and T2+ADC values could improve diagnostic efficacy., apparent diffusion coeffificient, head and neck tumors.

Indole-Based Compounds as Potential Drug Candidates for SARS-CoV-2

The COVID-19 pandemic has posed a significant threat to society in recent times, endangering human health, life, and economic well-being. The disease quickly spreads due to the highly infectious SARS-CoV-2 virus, which has undergone numerous mutations. Despite intense research efforts by the scientific community since its emergence in 2019, no effective therapeutics have been discovered yet. While some repurposed drugs have been used to control the global outbreak and save lives, none have proven universally effective, particularly for severely infected patients. Although the spread of the disease is generally under control, anti-SARS-CoV-2 agents are still needed to combat current and future infections. This study reviews some of the most promising repurposed drugs containing indolyl heterocycle, which is an essential scaffold of many alkaloids with diverse bio-properties in various biological fields. The study also discusses natural and synthetic indole-containing compounds with anti-SARS-CoV-2 properties and computer-aided drug design (in silico studies) for optimizing anti-SARS-CoV-2 hits/leads.

Back to Nature: Medicinal Plants as Promising Sources for Antibacterial Drugs in the Post-Antibiotic Era

Undoubtedly, the advent of antibiotics in the 19th century had a substantial impact, increasing human life expectancy. However, a multitude of scientific investigations now indicate that we are currently experiencing a phase known as the post-antibiotic era. There is a genuine concern that we might regress to a time before antibiotics and confront widespread outbreaks of severe epidemic diseases, particularly those caused by bacterial infections. These investigations have demonstrated that epidemics thrive under environmental stressors such as climate change, the depletion of natural resources, and detrimental human activities such as wars, conflicts, antibiotic overuse, and pollution. Moreover, bacteria possess a remarkable ability to adapt and mutate. Unfortunately, the current development of antibiotics is insufficient, and the future appears grim unless we abandon our current approach of generating synthetic antibiotics that rapidly lose their effectiveness against multidrug-resistant bacteria. Despite their vital role in modern medicine, medicinal plants have served as the primary source of curative drugs since ancient times. Numerous scientific reports published over the past three decades suggest that medicinal plants could serve as a promising alternative to ineffective antibiotics in combating infectious diseases. Over the past few years, phenolic compounds, alkaloids, saponins, and terpenoids have exhibited noteworthy antibacterial potential, primarily through membrane-disruption mechanisms, protein binding, interference with intermediary metabolism, anti-quorum sensing, and anti-biofilm activity. However, to optimize their utilization as effective antibacterial drugs, further advancements in omics technologies and network pharmacology will be required in order to identify optimal combinations among these compounds or in conjunction with antibiotics.

Nanoemulsions of synthetic rhamnolipids act as plant resistance inducers without damaging plant tissues or affecting soil microbiota

Plant pathogens and pests can cause significant losses in crop yields, affecting food security and the global economy. Many traditional chemical pesticides are used to combat these organisms. This can lead to the development of pesticide-resistant strains of pathogens/insects and negatively impact the environment. The development of new bioprotectants, which are less harmful to the environment and less likely to lead to pesticide-resistance, appears as a sustainable strategy to increase plant immunity. Natural Rhamnolipids (RL-Nat) are a class of biosurfactants with bioprotectant properties that are produced by an opportunistic human pathogen bacterium. RL-Nat can act as plant resistance inducers against a wide variety of pathogens. Recently, a series of bioinspired synthetic mono-RLs produced by green chemistry were also reported as phytoprotectants. Here, we explored their capacity to generate novel colloidal systems that might be used to encapsulate bioactive hydrophobic compounds to enhance their performance as plant bioprotectants. The synthetic mono-RLs showed good surfactant properties and emulsification power providing stable nanoemulsions capable of acting as bio-carriers with good wettability. Synthetic RLs-stabilized nanoemulsions were more effective than RLs suspensions at inducing plant immunity, without causing deleterious effects. These nanoemulsions were innocuous to native substrate microbiota and beneficial soil-borne microbes, making them promising safe bio-carriers for crop protection.

Effects of Temperature on the Physicochemical Properties of Bioinspired, Synthetic, and Biogenic Hydroxyapatites Calcinated under the Same Thermal Conditions

The paper studies the changes in physicochemical properties of three types of hydroxyapatite (HAp): HAp-HB (from bovine sources), HAp-SC (chemically synthesized), and bioinspired HAp-SE (synthesized using eggshells) calcined under identical thermally controlled conditions from room temperature to 400, 500, 600, 650, 680, 700, 720, 750, 800, and 900 °C in furnace air. The thermogravimetric analysis (TGA) indicated distinct thermal transitions and coalescence phenomena at different temperatures for these samples due to their sources and mineral composition differences. Inductively coupled plasma (ICP) showed that HAp-H (human), HAp-HB (bovine), and HAp-SE (bioinspired) have similar Ca, P, and Mg contents. Scanning electron microscopy (SEM) and transmission electron microscopy (TEM) revealed that the coalescence phenomena increased in the crystallite size as the temperature increased. X-Ray diffraction (XRD) patterns revealed partial phase changes in the bioinspired sample (HAp-SE) and crystallite growth in all samples, resulting in full width at the half maximum (FWHM) and peak position alterations. Fourier-transform infrared spectroscopy (FTIR) showed that HAp-SE exhibited a partial phase change due to dehydroxylation and the presence of functional groups (PO43-, OH, and CO32-) with varying vibrational modes influenced by the obtained method and calcination temperature. Raman spectra of the HAp-SE samples exhibited fluorescence at 400 °C and revealed vibrational modes of surface P-O. It observed the bands of the internal phosphates of the crystal lattice and shifts in the band positions at higher temperatures indicated phosphorus interacting with carbon and oxygen, triggering dehydroxylation.

Current Market Potential and Prospects of Copper-based Pyridine Derivatives: A Review

Nicotine, minodronic acid, nicotinamide (niacin), zolpidem, zolimidine, and other pyridine-based chemicals play vital roles in medicine and biology. Pyridine-containing drugs are widely available on the market to treat a wide range of human ailments. As a result of these advances, pyridine research is continually expanding, and there are now higher expectations for how it may aid in the treatment of numerous ailments. This evaluation incorporates data acquired from sources, like PubMed, to provide a thorough summary of the approved drugs and bioactivity data for compounds containing pyridine. Most of the reactions discussed in this article will provide readers with a deeper understanding of various pyridine-related examples, which is necessary for the creation of copper catalysis-based synthetic processes that are more accessible, secure, environmentally friendly, and practical, and that also have higher accuracy and selectivity. This paper also discusses significant innovations in the multi-component copper-catalyzed synthesis of N-heterocycles (pyridine), with the aim of developing precise, cost-effective, and environmentally friendly oxygenation and oxidation synthetic methods for the future synthesis of additional novel pyridine base analogs. Therefore, the review article will serve as a novel platform for researchers investigating copper-based pyridine compounds.

Exploring the landscape of synthetic IL-6-type cytokines

Interleukin-6 (IL-6)-type cytokines not only have key immunomodulatory functions that affect the pathogenesis of diseases such as autoimmune diseases, chronic inflammatory conditions and cancer, but also fulfill important homeostatic tasks. Even though the pro-inflammatory arm has hindered the development of therapeutics based on natural-like IL-6-type cytokines to date, current synthetic trends might pave the way to overcome these limitations and eventually lead to immune-inert designer cytokines to aid type 2 diabetes and brain injuries. Those synthetic biology approaches include mutations, fusion proteins and inter-cytokine swapping, and resulted in IL-6-type cytokines with altered receptor affinities, extended target cell profiles, and targeting of non-natural cytokine-receptor complexes. Here, we survey synthetic cytokine developments within the IL-6-type cytokine family and discuss potential clinical applications.

Nanocarriers significantly augment the absorption of ocular-delivered drugs: A comparative meta-analysis study

This study presents a meta-analysis that compiles information collected from several studies aiming to prove, by evidence, that nanocarriers out-perform conventional formulations in augmenting the bioavailability of ocular topically administered drugs. Data was further categorized into two subgroups; polymeric-based nanocarriers versus their lipid-based counterparts, as well as, naturally-driven carriers versus synthetically-fabricated ones. After normalization, the pharmacokinetic factor, area under the curve (AUC), was denoted as the "effect" in the conducted study, and the corresponding Forest plots were obtained. Our meta-analysis study confirmed the absorption enhancement effect of loading drugs into nanocarriers as compared to conventional topical ocular dosage forms. Interestingly, no significant differences were recorded between the polymeric and lipidic nanocarriers included in the study, while naturally-driven nanoplatforms were proven superior to the synthetic alternatives.

The rise and fall of the Synthetic: The mediatization of Canada's oil sands

The concept of the Synthetic is developed to trace and trouble the prevailing popular mythology of Alberta's oil sands and place the omnipresence of petro-hegemony into focus in a time of crisis and transition. The Synthetic is theorized as a period of petroculture beginning in the late 1960s with the rise of Alberta's oil sands industry together with a rise in oil sands narratives, docudrama, and the emergence of mediated or synthetic politics reliant upon processed images. Attention focuses on three mediated moments within the Synthetic beginning with the banned 1977 CBC docudrama The Tar Sands and the reaction of Premier Peter Lougheed. This signals the power and grip of oil's hegemony. Second, the short film Synergy produced for Expo 86 captures the thickening of synthetic culture and oil's saturation of the public imagination. Finally, the controversy manufactured by Alberta's Canadian Energy Centre over the animated film Bigfoot Family suggests petro-hegemony's loosening grip.

Design and computational optimization of compliance-matching aortic grafts

Introduction: Synthetic vascular grafts have been widely used in clinical practice for aortic replacement surgery. Despite their high rates of surgical success, they remain significantly less compliant than the native aorta, resulting in a phenomenon called compliance mismatch. This incompatibility of elastic properties may cause serious post-operative complications, including hypertension and myocardial hypertrophy. Methods: To mitigate the risk for these complications, we designed a multi-layer compliance-matching stent-graft, that we optimized computationally using finite element analysis, and subsequently evaluated in vitro. Results: We found that our compliance-matching grafts attained the distensibility of healthy human aortas, including those of young adults, thereby significantly exceeding the distensibility of gold-standard grafts. The compliant grafts maintained their properties in a wide range of conditions that are expected after the implantation. Furthermore, the computational model predicted the graft radius with enough accuracy to allow computational optimization to be performed effectively. Conclusion: Compliance-matching grafts may offer a valuable improvement over existing prostheses and they could potentially mitigate the risk for post-operative complications attributed to excessive graft stiffness.

Role of Natural and Synthetic Compounds in Modulating NRF2/KEAP1 Signaling Pathway in Prostate Cancer

Prostate cancer is the second most common cancer in men worldwide. Prostate cancer can be treated by surgery or active surveillance when early diagnosed but, when diagnosed at an advanced or metastatic stage, radiation therapy or androgen-deprivation therapy is needed to reduce cancer progression. However, both of these therapies can cause prostate cancer resistance to treatment. Several studies demonstrated that oxidative stress is involved in cancer occurrence, development, progression and treatment resistance. The nuclear factor erythroid 2-related factor 2 (NRF2)/KEAP1 (Kelch-Like ECH-Associated Protein 1) pathway plays an important role in protecting cells against oxidative damage. Reactive oxygen species (ROS) levels and NRF2 activation can determine cell fate. In particular, toxic levels of ROS lead physiological cell death and cell tumor suppression, while lower ROS levels are associated with carcinogenesis and cancer progression. On the contrary, a high level of NRF2 promotes cell survival related to cancer progression activating an adaptive antioxidant response. In this review, we analyzed the current literature regarding the role of natural and synthetic compounds in modulating NRF2/KEAP1 signaling pathway in prostate cancer.

A review of nanomaterials from synthetic and natural molecules for prospective breast cancer nanotherapy

Breast cancer being one of the most frequent cancers in women accounts for almost a quarter of all cancer cases. Early and late-stage breast cancer outcomes have improved dramatically, with considerable gains in overall survival rate and disease-free state. However, the current therapy of breast cancer suffers from drug resistance leading to relapse and recurrence of the disease. Also, the currently used synthetic and natural agents have bioavailability issues which limit their use. Recently, nanocarriers-assisted delivery of synthetic and natural anticancer drugs has been introduced to the breast cancer therapy which alienates the limitations associated with the current therapy to a great extent. Significant progress has lately been made in the realm of nanotechnology, which proved to be vital in the fight against drug resistance. Nanotechnology has been successfully applied in the effective and improved therapy of different forms of breast cancer including invasive, non-invasive as well as triple negative breast cancer (TNBC), etc. This review presents a comprehensive overview of various nanoformulations prepared for the improved delivery of synthetic and natural anticancer drugs alone or in combination showing better efficacy and pharmacokinetics. In addition to this, various ongoing and completed clinical studies and patents granted on nanotechnology-based breast cancer drug delivery are also reviewed.

The Role of NQO1 in Ovarian Cancer

Ovarian cancer is one of the most dangerous gynecologic malignancies showing a high fatality rate because of late diagnosis and relapse occurrence due to chemoresistance onset. Several researchers reported that oxidative stress plays a key role in ovarian cancer occurrence, growth and development. The NAD(P)H:quinone oxidoreductase 1 (NQO1) is an antioxidant enzyme that, using NADH or NADPH as substrates to reduce quinones to hydroquinones, avoids the formation of the highly reactive semiquinones, then protecting cells against oxidative stress. In this review, we report evidence from the literature describing the effect of NQO1 on ovarian cancer onset and progression.

Reliability of a Novel Preoperative Protocol for Determining Graft Sizes for Superior Capsular Reconstruction Using Plain Film Radiography

BACKGROUND

Superior capsular reconstruction (SCR) for massive, irreparable rotator cuff tears involves anchoring a graft between the superior glenoid and the greater tuberosity of the humerus. Optimizing the graft size is important. We aimed (1) to evaluate the reliability of plain film radiography in determining graft size for SCR and (2) to create a database to help predict future graft sizes.

METHODS

An inter- and intra-rater reliability trial was conducted on 10 and 6 subjects with healthy shoulders, respectively, using plain film radiography to measure the distance between the superior glenoid and the supraspinatus footprint. The subjects were positioned upright with an abduction pillow modified to hold the shoulder at 30° abduction and 45° external rotation, afterwhich a true antero-posterior shoulder radiograph was captured. Thirty subjects were recruited for the database and grouped using the aforementioned protocol.

RESULTS

The inter-rater and intra-rater trial agreement was excellent, with intraclass correlation coefficients of 0.94 (95% CI) and 0.76 (95% CI), respectively. Three medio-lateral patch sizes, of 33 mm, 38 mm, and 47 mm, were proposed based on the protocol in 30 subjects.

CONCLUSIONS

Plain film radiography demonstrated excellent reliability in measuring the distance between the superior glenoid and the supraspinatus footprint. Three ordinal patch sizes are proposed.

Biomechanical and morphological comparison of two interposition graft rotator cuff repair techniques

BACKGROUND

Interposition graft rotator cuff repair is one option for the treatment of massive, otherwise irreparable rotator cuff tears. It is undetermined how different suturing techniques influence morphology at the patch-tendon interface in interposition rotator cuff repairs, particularly with respect to increased cross-sectional area at the repair site post-exposure to cyclic loading, which may influence healing. We aimed to analyze how the morphology of the grafts used in polytetrafluoroethylene (PTFE) interposition rotator cuff repairs differed according to whether the graft was secured using the multiple mattress technique or the weave technique respectively.

METHODS

Twelve PTFE interposition rotator cuff repairs (two groups, n = 6) were cyclically loaded. The thickness, width, cross-sectional area at the individual patches and at the repair site, and patch elongation were compared between repairs using the 'multiple mattress' technique and repairs that used the 'weave' technique.

RESULTS

At all loads, repair site cross-sectional area and thickness was greater in the weave group than in the multiple mattress group (P<0.05), despite repair site width being greater in the multiple mattress group (P<0.05). No significant differences in elongation were found between the multiple mattress and weave groups.

CONCLUSION

Greater repair site cross-sectional area under cyclic loading was observed in polytetrafluoroethylene interposition rotator repairs that used the weave technique than in those that used the multiple mattress technique. Increased repair site cross-sectional area in the weave group occurred due to increased thickness and decreased width relative to the multiple mattress group. No differences in cross-sectional area were found between groups at the individual patches.

Neurodegenerative disorders: Assessing the impact of natural vs drug-induced treatment options

Neurodegenerative illnesses refer to the gradual, cumulative loss of neural activity. Neurological conditions are considered to be the second leading cause of mortality in the modern world and the two most prevalent ones are Parkinson's disease and Alzheimer's disease. The negative side effects of pharmaceutical use are a major global concern, despite the availability of many different treatments for therapy. We concentrated on different types of neurological problems and their influence on targets, in vitro, in vivo, and in silico methods toward neurological disorders, as well as the molecular approaches influencing the same, in the first half of the review. The bulk of the second half of the review focuses on the many categories of treatment possibilities, including natural and artificial. Nevertheless, herbal treatment solutions are piquing scholarly attention due to their anti-oxidative properties and accessibility. However, more quality investigations and innovations are undoubtedly needed to back up these conclusions.

Stable Isotope Ratio Analysis for the Authentication of Natural Antioxidant Curcuminoids from Curcuma longa (Turmeric)

Curcuminoid complex, a mixture of curcumin, demethoxycurcumin and didemethoxycurcumin, is one of the most popular antioxidants of natural origin, and it has a multitude of other health benefits. It is threatened by the proliferation of counterfeit products on the market containing synthetic curcuminoids whose addition is difficult to identify as they present the three curcuminoid forms in the correct ratios. Consequently, the necessity to detect this fraudulent practice is escalating. Carbon-14 analysis is the most effective available method, but it is also expensive and difficult to implement. This paper describes the first attempt to characterize natural curcuminoids and their synthetic form, used as an adulterant, through the analysis of stable isotope ratios of carbon and hydrogen (expressed as δ¹³C and δ²H). Carbon values greater than -28.6‱ and hydrogen values greater than -71‱ may indicate the addition of synthetic curcuminoids to the natural ones.

Vaccines on demand, part II: future reality

INTRODUCTION

Prior to the emergence of SARS-CoV-2, the potential use of mRNA vaccines for a rapid pandemic response had been well described in the scientific literature, however during the SARS-CoV-2 outbreak we witnessed the large-scale deployment of the platform in a real pandemic setting. Of the three RNA platforms evaluated in clinical trials, including 1) conventional, non-amplifying mRNA (mRNA), 2) base-modified, non-amplifying mRNA (bmRNA), which incorporate chemically modified nucleotides, and 3) self-amplifying RNA (saRNA), the bmRNA technology emerged with superior clinical efficacy.

AREAS COVERED

This review describes the current state of these mRNA vaccine technologies, evaluates their strengths and limitations, and argues that saRNA may have significant advantages if the limitations of stability and complexities of manufacturing can be overcome.

EXPERT OPINION

The success of the SARS-CoV-2 mRNA vaccines has been remarkable. However, several challenges remain to be addressed before this technology can successfully be applied broadly to other disease targets. Innovation in the areas of mRNA engineering, novel delivery systems, antigen design, and high-quality manufacturing will be required to achieve the full potential of this disruptive technology.

Rates of operative intervention for infection after synthetic or autologous cranioplasty: a National Readmissions Database analysis

OBJECTIVE

The aim of this study was to characterize the clinical utilization and associated charges of autologous bone flap (ABF) versus synthetic flap (SF) cranioplasty and to characterize the postoperative infection risk of SF versus ABF using the National Readmissions Database (NRD).

METHODS

The authors used the publicly available NRD to identify index hospitalizations from October 2015 to December 2018 involving elective ABF or SF cranioplasty after traumatic brain injury (TBI) or stroke. Subsequent readmissions were further characterized if patients underwent neurosurgical intervention for treatment of infection or suspected infection. Survey Cox proportional hazards models were used to assess risk of readmission.

RESULTS

An estimated 2295 SF and 2072 ABF cranioplasties were performed from October 2015 to December 2018 in the United States. While the total number of cranioplasty operations decreased during the study period, the proportion of cranioplasties utilizing SF increased (p < 0.001), particularly in male patients (p = 0.011) and those with TBI (vs stroke, p = 0.012). The median total hospital charge for SF cranioplasty was $31,200 more costly than ABF cranioplasty (p < 0.001). Of all first-time readmissions, 20% involved surgical treatment for infectious reasons. Overall, 122 SF patients (5.3%) underwent surgical treatment of infection compared with 70 ABF patients (3.4%) on readmission. After accounting for confounders using a multivariable Cox model, female patients (vs male, p = 0.003), those discharged nonroutinely (vs discharge to home or self-care, p < 0.001), and patients who underwent SF cranioplasty (vs ABF, p = 0.011) were more likely to be readmitted for reoperation. Patients undergoing cranioplasty during more recent years (e.g., 2018 vs 2015) were less likely to be readmitted for reoperation because of infection (p = 0.024).

CONCLUSIONS

SFs are increasingly replacing ABFs as the material of choice for cranioplasty, despite their association with increased hospital charges. Female sex, nonroutine discharge, and SF cranioplasty are associated with increased risk for reoperation after cranioplasty.

Biomechanical Comparison of Synthetic Polytetrafluoroethylene (PTFE) vs Human Dermal Allograft (HDA), 2 vs 3 Glenoid Anchors, and Suture vs Minitape in Superior Capsule Reconstruction

Background: Superior capsule reconstruction (SCR) is an option for the treatment of massive, irreparable rotator cuff tears. However, which materials yield the strongest constructs remains undetermined. Purposes: We sought to investigate whether SCR with polytetrafluoroethylene (PTFE) or human dermal allograft (HDA), 2 or 3 glenoid anchors, and suture or minitape resulted in better failure load properties at the patch-glenoid interface. Methods: We conducted a biomechanical study in 30 glenoid-sided SCR repairs in Sawbones models divided into 5 groups. Each was pulled to failure to assess mode of failure, peak load (N), stiffness (N/mm), yield load (N), peak energy (N m), and ultimate energy (N m). The 5 groups were as follows: group 1-PTFE, 2 anchors, and suture; group 2-PTFE, 2 anchors, and minitape; group 3-HDA, 2 anchors, and suture; group 4-HDA, 2 anchors, and minitape; group 5-PTFE, 3 anchors, and minitape. Results: Repairs failed by button-holing of suture/minitape. Group 5 had greater peak load, stiffness, yield load, and peak energy (384 ± 62 N; 24 ± 3 N/mm; 343 ± 42 N; 4 ± 2 N m) than group 3 (226 ± 67 N; 16 ± 4 N/mm; 194 ± 74 N; 2 ± 1 N m) or group 4 (274 ± 62 N; 17 ± 4 N/mm; 244 ± 50 N; 2 ± 1 N m) and greater ultimate energy (8 ± 3 N m) than all other groups. Conclusions: This biomechanical study of SCR repairs in Sawbones models found that yield load was greater in PTFE than HDA, 3 anchors were better than 2, and minitape was no better than suture.

From ancient Egypt to the dermatologic office: An overview of skin substitutes and modern-day applications in dermatologic surgery

Skin grafting (specifically xenografting) dates back to as early as 1500 before Christ (BC) in the Ebers papyrus, an Egyptian medical papyrus. In 1503, the use of human skin allograft was described in the manuscript of Branca of Sicily, and among the Hindu Tilemaker Caste approximately 2500-3000 years ago, surgeons repaired defects secondary to nose amputations of those who committed adultery and thievery. Over the years, many advancements in skin grafts/substitutes and their applications have propelled the field to focus on better graft survival, contracture prevention, cosmesis, and quality of life. We provide a general overview of skin substitutes (SS) with a particular focus on placental SS and their current applications in dermatologic surgery.

Whole transcriptomic analysis of mesenchymal stem cells cultured in Nichoid micro-scaffolds

Mesenchymal stem cells (MSCs) are known to be ideal candidates for clinical applications where not only regenerative potential but also immunomodulation ability is fundamental. Over the last years, increasing efforts have been put into the design and fabrication of 3D synthetic niches, conceived to emulate the native tissue microenvironment and aiming at efficiently controlling the MSC phenotype in vitro. In this panorama, our group patented an engineered microstructured scaffold, called Nichoid. It is fabricated through two-photon polymerization, a technique enabling the creation of 3D structures with control of scaffold geometry at the cell level and spatial resolution beyond the diffraction limit, down to 100 nm. The Nichoid's capacity to maintain higher levels of stemness as compared to 2D substrates, with no need for adding exogenous soluble factors, has already been demonstrated in MSCs, neural precursors, and murine embryonic stem cells. In this work, we evaluated how three-dimensionality can influence the whole gene expression profile in rat MSCs. Our results show that at only 4 days from cell seeding, gene activation is affected in a significant way, since 654 genes appear to be differentially expressed (392 upregulated and 262 downregulated) between cells cultured in 3D Nichoids and in 2D controls. The functional enrichment analysis shows that differentially expressed genes are mainly enriched in pathways related to the actin cytoskeleton, extracellular matrix (ECM), and, in particular, cell adhesion molecules (CAMs), thus confirming the important role of cell morphology and adhesions in determining the MSC phenotype. In conclusion, our results suggest that the Nichoid, thanks to its exclusive architecture and 3D cell adhesion properties, is not only a useful tool for governing cell stemness but could also be a means for controlling immune-related MSC features specifically involved in cell migration.

Quantitative evaluation of the spinal cord compression in patients with cervical spondylotic myelopathy using synthetic MRI

Objectives: This work aimed to investigate the feasibility and diagnostic value of synthetic MRI, including T1, T2 and PD values in determining the severity of cervical spondylotic myelopathy (CSM). Methods: All subjects (51 CSM patients and 9 healthy controls) underwent synthetic MRI scan on a 3.0T GE MR scanner. The cervical canal stenosis degree of subjects was graded 0-III based on the method of a MRI grading system. Regions of interest (ROIs) were manually drawn at the maximal compression level (MCL) by covering the whole spinal cord to generate T1_MCL, T2_MCL, and PD_MCL values in grade I-III groups. Besides, anteroposterior (AP) and transverse (Trans) diameters of the spinal cord at MCL were measured in grade II and grade III groups, and relative values were calculated as follows: rAP = AP_MCL/AP_normal, rTrans = Trans_MCL/Trans_normal. rMIN = rAP/rTrans. Results: T1_MCL value showed a decreasing trend with severity of grades (from grade 0 to grade II, p < 0.05), while it increased dramatically at grade III. T2_MCL value showed no significant difference among grade groups (from grade 0 to grade II), while it increased dramatically at grade III compared to grade II (p < 0.05). PD_MCL value showed no statistical difference among all grade groups. rMIN of grade III was significantly lower than that of grade II (p < 0.05). T2_MCL value was negatively correlated with rMIN, whereas positively correlated with rTrans. Conclusion: Synthetic MRI can provide not only multiple contrast images but also quantitative mapping, which is showed promisingly to be a reliable and efficient method in the quantitative diagnosis of CSM.

Synthetic biodegradable polymer materials in the repair of tumor-associated bone defects

The repair and reconstruction of bone defects and the inhibition of local tumor recurrence are two common problems in bone surgery. The rapid development of biomedicine, clinical medicine, and material science has promoted the research and development of synthetic degradable polymer anti-tumor bone repair materials. Compared with natural polymer materials, synthetic polymer materials have machinable mechanical properties, highly controllable degradation properties, and uniform structure, which has attracted more attention from researchers. In addition, adopting new technologies is an effective strategy for developing new bone repair materials. The application of nanotechnology, 3D printing technology, and genetic engineering technology is beneficial to modify the performance of materials. Photothermal therapy, magnetothermal therapy, and anti-tumor drug delivery may provide new directions for the research and development of anti-tumor bone repair materials. This review focuses on recent advances in synthetic biodegradable polymer bone repair materials and their antitumor properties.

Decompressive hemicraniectomy and cranioplasty using subcutaneously preserved autologous bone flaps versus synthetic implants: perioperative outcomes and cost analysis

OBJECTIVE

It has not been well-elucidated whether there are advantages to preserving bone flaps in abdominal subcutaneous (SQ) tissue after decompressive hemicraniectomy (DHC), compared to discarding bone flaps. The authors aimed to compare perioperative outcomes and costs for patients undergoing autologous cranioplasty (AC) after DHC with the bone flap preserved in abdominal SQ tissue, and for patients undergoing synthetic cranioplasty (SC).

METHODS

A retrospective review was performed of all patients undergoing DHC procedures between January 2017 and July 2021 at two tertiary care institutions. Patients were divided into two groups: those with flaps preserved in SQ tissue (SQ group), and those with the flap discarded (discarded group). Additional analysis was performed between patients undergoing AC versus SC. Primary end points included postoperative and surgical site complications. Secondary endpoints included operative costs, length of stay, and blood loss.

RESULTS

A total of 248 patients who underwent DHC were included in the study, with 155 patients (62.5%) in the SQ group and 93 (37.5%) in the discarded group. Patients in the discarded group were more likely to have a diagnosis of severe TBI (57.0%), while the most prevalent diagnosis in the SQ group was malignant stroke (35.5%, p < 0.05). There were 8 (5.2%) abdominal surgical site infections and 9 (5.8%) abdominal hematomas. The AC group had a significantly higher reoperation rate (23.2% vs 12.9%, p = 0.046), with 11% attributable to abdominal reoperations. The average cost of a reoperation for an abdominal complication was $40,408.75 ± $2273. When comparing the AC group to the SC group after cranioplasty, there were no significant differences in complications or surgical site infections. There were 6 cases of significant bone resorption requiring cement supplementation or discarding of the bone flap. Increased mean operative charges were found for the SC group compared to the AC group ($72,362 vs $59,726, p < 0.001).

CONCLUSIONS

Autologous bone flaps may offer a cost-effective option compared to synthetic flaps. However, when preserved in abdominal SQ tissue, they pose the risk of resorption over time as well as abdominal surgical site complications with increased reoperation rates. Further studies and methodologies such as cryopreservation of the bone flap may be beneficial to reduce costs and eliminate complications associated with abdominal SQ storage.

Antiviral Polymers: A Review

Polymers, due to their high molecular weight, tunable architecture, functionality, and buffering effect for endosomal escape, possess unique properties as a carrier or prophylactic agent in preventing pandemic outbreak of new viruses. Polymers are used as a carrier to reduce the minimum required dose, bioavailability, and therapeutic effectiveness of antiviral agents. Polymers are also used as multifunctional nanomaterials to, directly or indirectly, inhibit viral infections. Multifunctional polymers can interact directly with envelope glycoproteins on the viral surface to block fusion and entry of the virus in the host cell. Polymers can indirectly mobilize the immune system by activating macrophages and natural killer cells against the invading virus. This review covers natural and synthetic polymers that possess antiviral activity, their mechanism of action, and the effect of material properties like chemical composition, molecular weight, functional groups, and charge density on antiviral activity. Natural polymers like carrageenan, chitosan, fucoidan, and phosphorothioate oligonucleotides, and synthetic polymers like dendrimers and sialylated polymers are reviewed. This review discusses the steps in the viral replication cycle from binding to cell surface receptors to viral-cell fusion, replication, assembly, and release of the virus from the host cell that antiviral polymers interfere with to block viral infections.

Synthetic Extracellular Volume in Cardiac Magnetic Resonance Without Blood Sampling: a Reliable Tool to Replace Conventional Extracellular Volume

Background:

The calculation of extracellular volume (ECV) in cardiac magnetic resonance requires hematocrit, limiting its applicability in clinical practice. Based on the linear relationship between hematocrit and blood T1 relaxivity, a synthetic ECV could be estimated without a blood sample. We aim to develop and test regression models for synthetic ECV without blood sampling in 1.5-T and 3.0-T scanners.

Methods:

A total of 1101 subjects who underwent cardiac magnetic resonance scanning with native and postcontrast T1 mapping and venous hematocrit within 24 hours were retrospectively enrolled. Subjects were randomly split into derivation (n=550) and validation (n=551) subgroups for each scanner. Different regression models were derived controlling for sex, field strength, and left ventricle/right ventricle blood pool and validated in the validation group. We performed additional validation analyses in subgroups of patients with histological validation (n=17), amyloidosis (n=29), anemia (n=185), and reduced ejection fraction (n=322).

Results:

In the derivation group, 8 specific models and 2 common estimate models were derived. In the validation group, using specific models, synthetic ECV had high agreement with conventional ECV (R², 0.87; P<0.0001 and R², 0.88, P<0.0001; −0.16% and −0.10%, left ventricle and right ventricle model, respectively). Common models also performed well (R², 0.88; P<0.0001 and R², 0.89, P<0.0001; −0.21% and −0.18%, left ventricle and right ventricle model, respectively). Histological validation demonstrated equal performance of synthetic and measured ECV. Synthetic ECV as calculated by the common model showed a bias in the anemia cohort significantly reduced by the specific model (−2.45 to −1.28, right ventricle common and specific model, respectively).

Conclusions:

Synthetic ECV provided a promising way to calculate ECV without blood sampling. Specific models could provide the most accurate value, while common models could be more suitable in routine clinical practice because of their simplicity while maintaining adequate accuracy.

Field Testing of Synthetic Growth Charts in 1-60-Month-Old Indian Children

BACKGROUND

Malnutrition among under-five children (U5C) in India is a major public health problem due to double burden caused by nutritional transition. WHO cut-offs are adopted as global growth standards which define how children should grow in condition of optimal nutrition and health. Growth references which are representative of population-specific existing growth patterns need to be updated regularly which is cumbersome; hence, the author's group published 'synthetic growth references' for Indian children of age 0-18 years.

OBJECTIVES

The objective of this study is to field test the new synthetic growth references in U5C for height-for-age, weight-for-age and body mass index (BMI)-for-age against WHO charts in urban and rural Indian children to estimate prevalence of various indices of malnutrition.

METHODS

A cross-sectional anthropometric assessment of apparently healthy rural and urban Indian U5C attending vaccination centre was performed using standard protocols. They were converted to Z-scores using WHO and Indian synthetic growth references. The equality of proportion of parameters of malnutrition was tested by McNemar's test and P value <0.05 was considered significant.

RESULTS

WHO charts significantly overestimated stunting and malnutrition as compared to synthetic references with difference in sensitivity of 7.2% and 8.5%, respectively, and converse for over-nutrition by 2.1%. The most commonly affected parameter of malnutrition was underweight. Stunting was significantly higher in rural population using both cut-offs (P < 0.05).

CONCLUSION

The synthetic references limit the spread of weight and BMI and do not overestimate stunting and wasting. They may be more useful for identification of malnutrition and may thus be recommended for routine screening in Indian U5C.

Emerging Anthelmintic Resistance in Poultry: Can Ethnopharmacological Approaches Offer a Solution?

Limited pharmacological studies have been conducted on plant species used against poultry helminths. The objective of this study was to provide a basis for plant based anthelmintics as possible alternatives against poultry anthelmintic resistance. The study justified the need for alternative anthelmintics. The study places emphasis on the increasing anthelmintic resistance, mechanism of resistance, and preparational protocols for plant anthelmintics and their associated mechanism of action. Pharmaceutical studies on plants as alternative therapies for the control of helminth parasites have not been fully explored especially in several developing countries. Plants from a broad range of species produce a wide variety of compounds that are potential anthelmintics candidates. Important phenolic acids have been found in Brassica rapa L. and Terminalia avicenniodes Guill. and Perri that affect the cell signaling pathways and gene expression. Benzo (c) phenanthridine and isoquinoline alkaloids are neurotoxic to helminths. Steroidal saponins (polyphyllin D and dioscin) interact with helminthic mitochondrial activity, alter cell membrane permeability, vacuolation and membrane damage. Benzyl isothiocyanate glucosinolates interfere with DNA replication and protein expression, while isoflavones from Acacia oxyphylla cause helminth flaccid paralysis, inhibit energy generation, and affect calcium utilization. Condensed tannins have been shown to cause the death of nematodes and paralysis leading to expulsion from the gastro-intestinal tract. Flavonoids from Chenopodium album L and Mangifera indica L act through the action of phosphodiesterase and Ca2+-ATPase, and flavonoids and tannins have been shown to act synergistically and are complementary to praziquantel. Artemisinins from Artemisia cina O. Berg are known to disrupt mitochondrial ATP production. Terpenoids from Cucurbita moschata L disrupt neurotransmission leading to paralysis as well as disruption of egg hatching. Yeast particle encapsulated terpenes are effective for the control of albendazole-resistant helminths.

Off-target pharmacological profiling of synthetic cannabinoid receptor agonists including AMB-FUBINACA, CUMYL-PINACA, PB-22, and XLR-11

INTRODUCTION

Synthetic cannabinoid receptor agonists (SCRAs) are a diverse class of new psychoactive substances that have been associated with multiple instances and types of toxicity. Some SCRAs appear to carry a greater toxicological burden than others, or compared to the prototypical cannabis-derived agonist Δ⁹-tetrahydrocannabinol (Δ⁹-THC), despite a common primary mechanism of action via cannabinoid 1 (CB1) receptors. "Off-target" (i.e., non-CB1 receptor) effects could underpin this differential toxicity, although there are limited data around the activity of SCRAs at such targets.

METHODS

A selection of 7 SCRAs (AMB-FUBINACA, XLR11, PB-22, AKB-48, AB-CHMINICA, CUMYL-PINACA, and 4F-MDMB-BUTINACA), representing several distinct chemotypes and toxicological profiles, underwent a 30 μM single-point screen against 241 G protein-coupled receptor (GPCR) targets in antagonist and agonist mode using a cellular β-arrestin recruitment assay. Strong screening "hits" at specific GPCRs were followed up in detail using concentration-response assays with AMB-FUBINACA, a SCRA with a particularly notable history of toxicological liability.

RESULTS

The single-point screen yielded few hits in agonist mode for any compound aside from CB1 and CB2 receptors, but many hits in antagonist mode, including a range of chemokine receptors, the oxytocin receptor, and histamine receptors. Concentration-response experiments showed that AMB-FUBINACA inhibited most off-targets only at the highest 30 μM concentration, with inhibition of only a small subset of targets, including H₁ histamine and α_2B adrenergic receptors, at lower concentrations (≥1 μM). AMB-FUBINACA also produced concentration-dependent CB1 receptor signaling disruption at concentrations higher than 1 μM, but did not produce overt cytotoxicity beyond CP55,940 or Δ⁹-THC in CB1 expressing cells.

DISCUSSION

These results suggest that while some "off-targets" could possibly contribute to the SCRA toxidrome, particularly at high concentrations, CB1-mediated cellular dysfunction provides support for hypotheses concerning on-target, rather than off-target, toxicity. Further investigation of non-GPCR off-targets is warranted.

Synthetic Cannabinoids in Prisons: Content Analysis of TikToks

Background

Synthetic cannabinoids are a significant public health concern, especially among incarcerated populations due to increased reports of abuse. Recent news reports have highlighted the severe consequences of K2/Spice, a synthetic cannabinoid, among the prison population in the United States. Despite regulations against cell phone use, inmates use TikTok to post K2/Spice-related content.

Objective

This study aimed to examine TikTok posts for use and illicit distribution of psychoactive substances (eg, K2/Spice) among incarcerated populations.

Methods

The study collected TikTok videos associated with the #k2spice hashtag and used a data collection approach similar to snowball sampling. Inductive coding was used to conduct content analysis of video characteristics. Videos were manually annotated to generate binary classifications related to the use of K2/Spice as well as selling and buying activities associated with it. Statistical analysis was used to determine associations between a video's user engagement and an intent to buy or sell K2/Spice.

Results

A total of 89 TikTok videos with the hashtag #k2spice were manually coded, with 40% (n=36) identified as displaying the use, solicitation, or adverse effects of K2/Spice among the prison population. Of them, 44.44% (n=16) were in a prison-based setting documenting adverse effects including possible overdose. Videos with higher user engagement were positively correlated with comments indicating an intent to buy or sell K2/Spice.

Conclusions

K2/Spice is a drug subject to abuse among prison inmates in the United States, including depictions of its harmful effects being recorded and shared on TikTok. Lack of policy enforcement on TikTok and the need for better access to treatment services within the prison system may be exacerbating substance use among this highly vulnerable population. Minimizing the potential individual harm of this content on the incarcerated population should be a priority for social media platforms and the criminal justice system alike.

Novel strategies to oral delivery of insulin: Current progress of nanocarriers for diabetes management

Diabetes mellitus is one of the most serious public health problems in the world. Repeated daily injections of subcutaneous insulin is the standard treatment for patients with type 1 diabetes mellitus; however, subcutaneous insulin injections can potentially cause local discomfort, patient noncompliance, hypoglycemia, failure to regulate glucose homeostasis, infections, and fat deposits at the injection sites. In recent years, numerous attempts have been made to produce safe and efficient nanoparticles for oral insulin delivery. Oral administration is considered the most effective alternative route to insulin injection, but it is accompanied by several challenges related to enzymatic proteolysis, digestive breakdown, and absorption barriers. A number of natural and synthetic polymeric, lipid-based, and inorganic nanoparticles have been investigated for use. Although improvements have recently been made in potential oral insulin delivery systems, these require further investigation before clinical trials are conducted. In this review, new approaches to oral insulin delivery for diabetes treatment are discussed, including polymeric, lipid-based, and inorganic nanoparticles, as well as the clinical trials performed for this purpose.

Improved accuracy and reduced uncertainty in greenhouse gas inventories by refining the IPCC emission factor for direct N2 O emissions from nitrogen inputs to managed soils

Most national GHG inventories estimating direct N₂ O emissions from managed soils rely on a default Tier 1 emission factor (EF₁ ) amounting to 1% of nitrogen inputs. Recent research has, however, demonstrated the potential for refining the EF₁ considering variables that are readily available at national scales. Building on existing reviews, we produced a large dataset (n = 848) enriched in dry and low latitude tropical climate observations as compared to former global efforts and disaggregated the EF₁ according to most meaningful controlling factors. Using spatially explicit N fertilizer and manure inputs, we also investigated the implications of using the EF₁ developed as part of this research and adopted by the 2019 IPCC refinement report. Our results demonstrated that climate is a major driver of emission, with an EF₁ three times higher in wet climates (0.014, 95% CI 0.011-0.017) than in dry climates (0.005, 95% CI 0.000-0.011). Likewise, the form of the fertilizer markedly modulated the EF₁ in wet climates, where the EF₁ for synthetic and mixed forms (0.016, 95% CI 0.013-0.019) was also almost three times larger than the EF₁ for organic forms (0.006; 95% CI 0.001-0.011). Other factors such as land cover and soil texture, C content, and pH were also important regulators of the EF₁ . The uncertainty associated with the disaggregated EF₁ was considerably reduced as compared to the range in the 2006 IPCC guidelines. Compared to estimates from the 2006 IPCC EF₁ , emissions based on the 2019 IPCC EF₁ range from 15% to 46% lower in countries dominated by dry climates to 7%-37% higher in countries with wet climates and high synthetic N fertilizer consumption. The adoption of the 2019 IPCC EF₁ will allow parties to improve the accuracy of emissions' inventories and to better target areas for implementing mitigation strategies.

Effect of UVC and UVA Photocatalytic Processes on Tetracycline Removal Using CuS-Coated Magnetic Activated Carbon Nanocomposite: A Comparative Study

In this study, we synthesized a novel MAC nanocomposite using almond’s green hull coated with CuS. The whole set of experiments have been conducted inside a batch (discontinuous reactor system) at room temperature. The effectiveness of different parameters in tetracycline removal pH (3, 5, 7, and 9), pollutant concentration (5–100 mg/L), nanocomposite dosage (0.025–1 g/L), and contact time (5–60 min) using newly synthesized nanocomposite were investigated. Based on the results, in the optimal conditions of pH = 9, nanocomposite dosage of 1 g/L, pollutant concentration of 20 mg/L, contact time of 60 min, and room temperature, 95% removal efficiency was obtained. In MAC/CuS/UV_C process, the removal of COD and TOC were 76.89% and 566.84% respectively meanwhile, these values in MAC/CuS/UV_A process were 74.19% and 62.11%, respectively. The results of nanocomposite stability and magnetic recovery illustrated that the removal efficiency was reduced by 1.5% in the presence of UV_C and 5% in the presence of UV_A lights during all six cycles. Therefore, this nanocomposite was highly capable of recycling and reuse. It can be concluded that considering the high potential of the synthesized nanocomposite, the photocatalytic efficiency of the MAC/CuS/UV_C process in tetracycline synthesis was higher than MAC/CuS/UV_A process.

Synthetic Material for Bone, Periodontal, and Dental Tissue Regeneration: Where Are We Now, and Where Are We Heading Next?

Alloplasts are synthetic, inorganic, biocompatible bone substitutes that function as defect fillers to repair skeletal defects. The acceptance of these substitutes by host tissues is determined by the pore diameter and the porosity and inter-connectivity. This narrative review appraises recent developments, characterization, and biological performance of different synthetic materials for bone, periodontal, and dental tissue regeneration. They include calcium phosphate cements and their variants β-tricalcium phosphate (β-TCP) ceramics and biphasic calcium phosphates (hydroxyapatite (HA) and β-TCP ceramics), calcium sulfate, bioactive glasses and polymer-based bone substitutes which include variants of polycaprolactone. In summary, the search for synthetic bone substitutes remains elusive with calcium compounds providing the best synthetic substitute. The combination of calcium sulphate and β-TCP provides improved handling of the materials, dispensing with the need for a traditional membrane in guided bone regeneration. Evidence is supportive of improved angiogenesis at the recipient sites. One such product, (EthOss^® Regeneration, Silesden, UK) has won numerous awards internationally as a commercial success. Bioglasses and polymers, which have been used as medical devices, are still in the experimental stage for dental application. Polycaprolactone-TCP, one of the products in this category is currently undergoing further randomized clinical trials as a 3D socket preservation filler. These aforementioned products may have vast potential for substituting human/animal-based bone grafts.

Bilirubin as a Therapeutic Molecule: Challenges and Opportunities

There is strong evidence that serum free bilirubin concentration has significant effects on morbidity and mortality in the most significant health conditions of our times, including cardiovascular disease, diabetes, and obesity/metabolic syndrome. Supplementation of bilirubin in animal and experimental models has reproduced these protective effects, but several factors have slowed the application bilirubin as a therapeutic agent in human patients. Bilirubin is poorly soluble in water, and is a complex molecule that is difficult to synthesize. Current sources of this molecule are animal-derived, creating concerns regarding the risk of virus or prion transmission. However, recent developments in nanoparticle drug delivery, biosynthetic strategies, and drug synthesis have opened new avenues for applying bilirubin as a pharmaceutical agent. This article reviews the chemistry and physiology of bilirubin, potential clinical applications and summarizes current strategies for safe and efficient drug delivery.

Tetravalent SARS-CoV-2 Neutralizing Antibodies Show Enhanced Potency and Resistance to Escape Mutations

Neutralizing antibodies (nAbs) hold promise as therapeutics against COVID-19. Here, we describe protein engineering and modular design principles that have led to the development of synthetic bivalent and tetravalent nAbs against SARS-CoV-2. The best nAb targets the host receptor binding site of the viral S-protein and tetravalent versions block entry with a potency exceeding bivalent nAbs by an order of magnitude. Structural studies show that both the bivalent and tetravalent nAbs can make multivalent interactions with a single S-protein trimer, consistent with the avidity and potency of these molecules. Significantly, we show that the tetravalent nAbs show increased tolerance to potential virus escape mutants and an emerging variant of concern. Bivalent and tetravalent nAbs can be produced at large-scale and are as stable and specific as approved antibody drugs. Our results provide a general framework for enhancing antiviral therapies against COVID-19 and related viral threats, and our strategy can be applied to virtually any antibody drug.

A Novel Technique for the Treatment of a Case of Verneuil's Disease of Perineum and Axillary Regions

Hidradenitis suppurativa (HS) is a chronic inflammatory disease involving apocrine glands of the skin. It carries out an important burden on the daily life of the patient. Unfortunately, it presents a major concern for medical care management in the absence of clear guidelines for proper medical and surgical treatment. Hence, we report a case of concomitant axillary and perianal HS. We opted for surgical management using a novel technique, which proved efficacy for a year of follow-up recurrence free.

The Impact of Osteobiologic Subtype Selection on Perioperative Complications and Hospital-Reported Charges in Single- and Multi-Level Lumbar Spinal Fusion

BACKGROUND

Over the last several decades, various osteobiologics including allograft, synthetics, and growth factors have been used for lumbar spinal fusion surgery. However, the data on these osteobiologic products remain controversial with conflicting evidence in the literature. This study evaluates the influence of osteobiologic type selection on perioperative complications and hospital-reported charges in single-level and multilevel lumbar fusion.

METHODS

Using the 2016 and 2017 Nationwide Readmission Database, we conducted a retrospective cohort analysis of 125,143 patients who received lumbar fusion with either autologous tissue substitute, nonautologous tissue substitute, or synthetic substitute. This cohort was split into single-level and multilevel fusion procedures, and one-to-one age and sex propensity score matching was implemented. This resulted in cohorts each consisting of 1967 patients for single-level fusion, and cohorts each consisting of 1657 patients for multilevel fusion. Statistical analysis included one-way analysis of variance and Tukey multiple comparisons of means.

RESULTS

Autologous single-level fusion resulted in significantly more postoperative pain at 30-, 90-, and 180-day follow-up compared to fusion with nonautologous graft (P < .05). Multilevel fusion with autologous graft had higher rates of acute postsurgical anemia compared with synthetic (P = .021) and nonautologous (P = .016) alternatives, and less postsurgical infection when compared with nonautologous fusion (P = .0020). In addition, procedures using autologous osteobiologics were associated with significantly more neurological complications at 30 days (P = .049) and 90 days (P = .048) for multi-level fusion and at 30 days (P = .044) for single-level fusion compared with the nonautologous group. Lastly, for both cohorts, the total accrued inpatient hospital charges during admission for patients receiving nonautologous grafts were the most expensive and those for patients receiving autologous grafts were the least expensive.

CONCLUSION

Significant differences were found between the groups with respect to rates of complications, including infection, postoperative pain, and neurologic injury. Furthermore, the hospital-reported charges of each procedure varied significantly. As the field of biologics continues to expand, it is important to continually evaluate the safety, efficacy, and cost-effectiveness of these novel materials and techniques.

LEVEL OF EVIDENCE

3 CLINICAL RELEVANCE: With increased utilization of osteobiologics and spinal fusion being a common procedure, longitudinal data on readmissions, and post-operative complications are critical in guiding evidence-based practice.