Femtosecond Laser Fabrication of Three-Dimensional Bubble-Propelled Microrotors for Multicomponent Mechanical Transmission

Inspired by the reverse thrust generated by fuel injection, micromachines that are self-propelled by bubble ejection are developed, such as microrods, microtubes, and microspheres. However, controlling bubble ejection sites to build micromachines with programmable actuation and further enabling mechanical transmission remain challenging. Here, bubble-propelled mechanical microsystems are constructed by proposing a multimaterial femtosecond laser processing method, consisting of direct laser writing and selective laser metal reduction. The polymer frame of the microsystems is first printed, followed by the deposition of catalytic platinum into the desired local site of the microsystems by laser reduction. With this method, a variety of designable microrotors with selective bubble ejection sites are realized, which enable excellent mechanical transmission systems composed of single and multiple mechanical components, including a coupler, a crank slider, and a crank rocker system. We believe the presented bubble-propelled mechanical microsystems could be extended to applications in microrobotics, microfluidics, and microsensors.

Insect-Scale Biped Robots Based on Asymmetrical Friction Effect Induced by Magnetic Torque

Multimodal and controllable locomotion in complex terrain is of great importance for practical applications of insect-scale robots. Robust locomotion plays a particularly critical role. In this study, a locomotion mechanism for magnetic robots based on asymmetrical friction effect induced by magnetic torque is revealed and defined. The defined mechanism overcomes the design constraints imposed by both robot and substrate structures, enabling the realization of multimodal locomotion on complex terrains. Drawing inspiration from human walking and running locomotion, a biped robot based on the mechanism is proposed, which not only exhibits rapid locomotion across substrates with varying friction coefficients but also achieves precise locomotion along patterned trajectories through programmed controlling. Furthermore, apart from its exceptional locomotive capabilities, the biped robot demonstrates remarkable robustness in terms of load-carrying and weight-bearing performance. The presented locomotion and mechanism herein introduce a novel concept for designing magnetic robots while offering extensive possibilities for practical applications in insect-scale robotics.

Retrospective analysis of antimicrobial resistance in bacterial pathogens from pet rabbits in Hong Kong, 2019-2022

Antimicrobial resistance (AMR) is a growing threat to human and animal health. Data are limited on the prevalence of resistant bacteria in pet rabbits. Therefore, we aimed to identify prevalent bacterial infections and AMR profiles among pet rabbits in Hong Kong (HK). Our search of the CityU Veterinary Diagnostic Laboratory (VDL) database found 301 cases of pet rabbits submitted for bacteriologic and antimicrobial susceptibility testing by veterinarians at 20 exotic veterinary clinics across HK between 2019 and 2022. The rabbits were of 8 different breeds and had a median age of 6.5 y, with 54.8% males, 40.2% females, and 5% unspecified. Of the 301 samples received, 168 (55.8%) had positive bacterial growth; 125 (74.4%) had single bacterial isolates, and 43 (25.6%) had mixed cultures. Cultures included Enterococcus faecalis (21.3%) as the most frequently isolated gram-positive bacterium, followed by Streptococcus intermedius (12.5%), and Staphylococcus aureus (11.3%). The most frequently isolated gram-negative bacteria were Pseudomonas aeruginosa (18.1%), followed by Escherichia coli (8.3%), Pasteurella multocida (6.9%), and Klebsiella pneumoniae (4.2%). Approximately 83% of the isolates had acquired resistance to at least one antimicrobial agent, and 49.4% were multidrug-resistant. The isolated bacteria had high levels of resistance to penicillin (69.8%), clindamycin (47.4%), and doxycycline (46.9%). Our findings highlight the high levels of AMR in bacteria isolated from pet rabbit clinical samples in HK; many of these bacteria are zoonotic and pose a public health threat.

Framework of humanistic care for patients in the ICU: A preliminary study

BACKGROUND

Humanistic care involves caring, concern, paying attention to people's individuality, meeting their needs and respecting their rights, which is the core concept and central task of nursing. Effective care can enhance patients' ability to deal with stress and promote patient recovery. Implementing humanistic care in the intensive care unit (ICU) is particularly important for health care providers.

AIM

This study aims to develop a framework of the humanistic care in the ICU.

STUDY DESIGN

The qualitative research followed Strauss' procedural grounded theory approach. Purposive sampling and theoretical sampling were used to select 12 nurses in the Department of Critical Medicine, 16 patients, and eight family members for semi-structured interviews from October 2020 to April 2021. Results were summarized and analysed through three-level coding based on grounded principles.

RESULTS

Sixteen subcategories and six main categories were extracted after three-level coding, and the final ICU humanistic care framework was formed with home, activity, visit, environment, nursing and safety ("HAVENS") as the core.

CONCLUSIONS

This study provides an explanatory theory of humanistic care in the ICU that can guide nurses' practice in ICU clinical work.

RELEVANCE TO CLINICAL PRACTICE

This theory provides guidance for nurses to implement humanistic care in critical care practice to improve the ICU stay experience of critically ill patients.

Effect of Different Postures on Intraocular Pressure in Open-Angle Glaucoma

INTRODUCTION

This study aims to investigate the pattern of intraocular pressure (IOP) changes in different postures among patients with open-angle glaucoma (OAG).

METHODS

A observational study was conducted on a total of 74 patients with OAG (148 eyes). IOP measurements were taken in a variety of positions, including supine, left lateral decubitus, right lateral decubitus, head tilted downwards position with immediate head-up (transient head tilted downwards), seated, seated with head tilted downwards, standing, and walking. Each position was held for 5 min before measurement. In all positions, the patient maintains both eyes looking forward and remains alert. In the head tilted downwards position, the angle of head tilt with respect to the sagittal plane was 30°.

RESULTS

The overall trend of IOP changes showed a significant decrease with an increase in the position height (r = 0.037, p < 0.001). The IOP was significantly higher in the supine, left lateral decubitus, right lateral decubitus, and head tilted downwards positions than in the seated position (p < 0.001). Compared with the seated position with eyes at primary gaze, IOP decreased significantly when standing (p = 0.008) or walking (p < 0.001). The IOP in the left lateral decubitus and right lateral decubitus was significantly higher than in the supine position (p = 0.008, p = 0.001, respectively). The IOP decreased significantly during walking compared with standing (p < 0.001).

CONCLUSIONS

The magnitude of IOP strongly correlates with the body position during IOP measurement. The head tilted downwards, supine, left lateral decubitus, and right lateral decubitus positions result in a higher IOP than IOP at the seated position. Patients with OAG can potentially reduce IOP fluctuations by adjusting their daily postures.

Leisure crafting and work engagement among Chinese ICU nurses: The multiple mediation effect of recovery experience and humanistic care ability

AIMS

Based on the conservation of resources theory, this study explored the intermediary role of intensive care unit (ICU) nurses' recovery experience and humanistic care ability between leisure crafting and work engagement.

BACKGROUND

As the ICU is an important life-saving department, the level of work engagement of nurses directly affect the quality of life and health outcomes of patients. Actively seeking countermeasures to improve the work engagement level of ICU nurses is of great significance to enhancing the nursing quality of the ICU. According to the theory of resource conservation, the resources owned by individuals are limited and must be replenished promptly and effectively to maintain relatively stable physical, mental, and working states. Therefore, determining ways for ICU nurses to supplement the consumed resources effectively and efficiently in a limited time to maintain a high level of work engagement is the main concern of this study.

METHODS

In this cross-sectional study from January 2023 to March 2023, 478 ICU nurses were recruited by convenience sampling. The survey tools included the Leisure Crafting Scale, the Utrecht Work Engagement Scale-9, the Caring Ability Inventory, and the Recovery Experience Questionnaire. Descriptive data and Pearson correlation coefficients were analyzed via SPSS 26.0 (IBM Corp.). PROCESS v4.0 (by Andrew F. Hayes) Macro Model 6 was applied to analyze the serial multiple mediator models. We used the STROBE checklist to report the results.

RESULTS

First, the results showed that leisure crafting, humanistic care ability, and recovery experience were positively correlated with work engagement. Second, recovery experience and humanistic care ability played a partially mediating role between leisure crafting and work engagement, respectively. Third, recovery experience and humanistic care ability also had a serial mediation effect between leisure crafting and work engagement.

CONCLUSION

The findings of the study indicated that improving nurses' active control of leisure time may have particularly positive effects on ICU nurses' work engagement through increasing recovery experience and humanistic care ability.

IMPLICATIONS FOR NURSING AND NURSING POLICY

Administrators can formulate intervention measures to improve the leisure crafting level of ICU nurses, promote work-life balance, which enhances recovery and supports engagement with patient-focused humanistic care, and have a positive impact on the work engagement of ICU nurses.

Effects of Schlemm's Canal Suture Implantation Surgery and Pilocarpine Eye Drops on Trabecular Meshwork Pulsatile Motion

The trabecular meshwork is an important structure in the outflow pathway of aqueous humor, and its movement ability directly affects the resistance of aqueous humor outflow, thereby affecting the steady state of intraocular pressure (IOP). (1) Objective: The purpose of this study was to preliminarily estimate the effects of pilocarpine eye drops and trabeculotomy tunneling trabeculoplasty (3T) on trabecular meshwork (TM) pulsatile motion via phase-sensitive optical coherence tomography (Phs-OCT). (2) Method: In a prospective single-arm study, we mainly recruited patients with primary open-angle glaucoma who did not have a history of glaucoma surgery, and mainly excluded angle closure glaucoma and other diseases that may cause visual field damage. The maximum velocity (MV) and cumulative displacement (CDisp) of the TM were quantified via Phs-OCT. All subjects underwent Phs-OCT examinations before and after the use of pilocarpine eye drops. Then, all subjects received 3T surgery and examinations of IOP at baseline, 1 day, 1 week, 1 month, 3 months, and 6 months post-surgery. Phaco-OCT examinations were performed at 3 and 6 months post-surgery, and the measurements were compared and analyzed. (3) Results: The MV of TM before and after the use of pilocarpine eye drops was 21.32 ± 2.63 μm/s and 17.00 ± 2.43 μm/s. The CDisp of TM before and after the use of pilocarpine eye drops was 0.204 ± 0.034 μm and 0.184 ± 0.035 μm. After the use of pilocarpine eye drops, both the MV and CDisp significantly decreased compared to those before use (p < 0.001 and 0.013, respectively). The IOP decreased from baseline at 22.16 ± 5.23 mmHg to 15.85 ± 3.71 mmHg after 3 months post-surgery and from 16.33 ± 2.51 mmHg at 6 months post-surgery, showing statistically significant differences (p < 0.001). The use of glaucoma medication decreased from baseline at 3.63 ± 0.65 to 1.17 ± 1.75 at 3 months and 1.00 ± 1.51 at 6 months post-surgery; the differences were statistically significant (p < 0.001). Additionally, there was no statistically significant difference in the MV between 3 and 6 months after surgery compared to baseline (p = 0.404 and 0.139, respectively). Further, there was no statistically significant difference in the CDisp between 3 and 6 months after surgery compared to baseline (p = 0.560 and 0.576, respectively) (4) Conclusions: After the preliminary study, we found that pilocarpine eye drops can attenuate TM pulsatile motion, and that 3T surgery may reduce IOP without affecting the pulsatile motion status of the TM.

Trabecular Meshwork Movement Controls Distal Valves and Chambers: New Glaucoma Medical and Surgical Targets

Herein, we provide evidence that human regulation of aqueous outflow is by a pump-conduit system similar to that of the lymphatics. Direct observation documents pulsatile aqueous flow into Schlemm's canal and from the canal into collector channels, intrascleral channels, aqueous veins, and episcleral veins. Pulsatile flow in vessels requires a driving force, a chamber with mobile walls and valves. We demonstrate that the trabecular meshwork acts as a deformable, mobile wall of a chamber: Schlemm's canal. A tight linkage between the driving force of intraocular pressure and meshwork deformation causes tissue responses in milliseconds. The link provides a sensory-motor baroreceptor-like function, providing maintenance of a homeostatic setpoint. The ocular pulse causes meshwork motion oscillations around the setpoint. We document valves entering and exiting the canal using real-time direct observation with a microscope and multiple additional modalities. Our laboratory-based high-resolution SD-OCT platform quantifies valve lumen opening and closing within milliseconds synchronously with meshwork motion; meshwork tissue stiffens, and movement slows in glaucoma tissue. Our novel PhS-OCT system measures nanometer-level motion synchronous with the ocular pulse in human subjects. Movement decreases in glaucoma patients. Our model is robust because it anchors laboratory studies to direct observation of physical reality in humans with glaucoma.

[A preliminary study on the efficacy and safety of a new type of trabeculotome tunnelling trabeculoplasty for open-angle glaucoma]

Objective: To compare the efficacy and safety of trabeculotome tunnelling trabeculoplasty and gonioscopy-assisted transluminal trabeculotomy (GATT) in the treatment of open-angle glaucoma. Methods: A prospective randomized controlled study. The patients with open-angle glaucoma diagnosed in the ophthalmology center of Beijing Tongren Hospital affiliated to Capital Medical University from January to July 2022 were collected and divided into GATT group (undergoing GATT) and 3T group (undergoing 3T operation) using a random number table. Intraocular pressure (IOP) was recorded for both groups at 1 day, 1 week, 1 month, and 3 months after the operation, and the types and quantities of anti-glaucoma drugs used, postoperative complications, and surgical success rate were compared. Normal distribution measurement data were analyzed using independent sample t-tests, non-normal distribution measurement data were analyzed using non-parametric tests, and counting data were analyzed using chi-square tests. Results: This study included 35 patients (43 eyes), consisting of 27 males and 8 females, with an average age of (43.0±14.3) years. There were 21 patients (23 eyes) in the GATT group and 19 patients (20 eyes) in the 3T group. The maximum IOP without anti-glaucoma drugs before surgery, the highest IOP with the maximum number of anti-glaucoma drugs, and the IOP at 3 months after surgery in the GATT group were (33.5±9.1), (22.2±6.1), and (16.0±3.1) mmHg (1 mmHg=0.133 kPa), respectively. The corresponding values for the 3T group were (35.2±7.8), (21.5±6.8), and (16.1±2.0) mmHg. After surgery, the IOP in both groups was lower than before surgery, with a statistically significant difference (P<0.05) and no significant difference between the two groups (P>0.05). In the 3 months following surgery, 13 eyes in the GATT group and 11 eyes in the 3T group received more than two types of anti-glaucoma drugs, with no significant difference between the two groups (P>0.05). Three months after surgery, the complete and conditional success rates of the GATT group were 14/18 and 16/18, respectively, and those of the 3T group were 12/15 and 13/15, respectively, with no significant difference between the two groups (P>0.05). The incidence of hyphema, ciliary detachment, and shallow anterior chamber 1 day after surgery was 91%(21/23), 35%(8/23), and 30%(7/23), respectively, in the GATT group and 55%(11/20), 5%(1/20), and 0 in the 3T group, with a statistically significant difference between the two groups (P<0.05). Conclusion: 3T and GATT have similar success rates in the treatment of open-angle glaucoma. However, compared with GATT, 3T has fewer complications and is considered to be safer. (This article was published ahead of print on the Online-First Publishing Platform for Excellent Scientific Researches of Chinese Medical Association Publishing House on February 28, 2023).

[Mechanism of melatonin-mediated antihyperglycemic effect of transcutaneous auricular vagus nerve stimulation]

OBJECTIVE

To observe the effects of transcutaneous auricular vagus nerve stimulation （taVNS） on plasma melatonin （MLT） content and insulin receptor expression in the liver, the skeletal muscles, and the pancreas of Zucker diabetic fatty （ZDF） rats, so as to explore the hypoglycemic mechanism of taVNS.

METHODS

Thirty male ZDF rats were randomly divided into model group, taVNS group and sham-taVNS group, with 10 rats in each group； besides, 10 male Zucker lean rats of the same strain were collected for the blank control group. ZDF rats were fed with high-fat diet to induce type 2 diabetes mellitus （T2DM） rat model. In the taVNS group, HANS-100A electroacupuncture instrument was used to stimulate the cavum conchae of both sides. The stimulation sites of rats in the sham-taVNS were the same as the taVNS group, but without electricity delivered. The above interventions were performed 30 min each time, once daily, lasting for 6 weeks. Fasting blood glucose （FBG） was measured weekly in each group, the plasma metatonin （MLT） content was detected by ELISA, and the insulin receptor expression level in the liver, the skeletal muscle and the pancreas was determined by Western blot.

RESULTS

Compared with the blank control group, the level of FBG of rats were increased （P<0.01）, the plasma MLT content was decreased （P<0.01） and the insulin receptor expression level in the pancreatic tissue was decreased （P<0.01） in the model group. In the taVNS gruop, FBG was decreased （P<0.05, P<0.01）, the plasma MLT content was increased （P<0.01）, and the insulin receptor expression level in the liver, the skeletal muscle and the pancreas was increased （P<0.05, P<0.01, P<0.001） when compared with the model group. Compared with the taVNS group, FBG was increased （P<0.05, P<0.01）, the plasma MLT content was decreased （P<0.01）, and the expression level of insulin receptors in the skeletal muscle and the pancreas was decreased （P<0.01, P<0.001） in the sham-taVNS group.

CONCLUSION

The taVNS can improve the insulin resistance and ultimately obtain the antihyperglycemic effect through regulating MLT concentration.

Light-triggered multi-joint microactuator fabricated by two-in-one femtosecond laser writing

Inspired by the flexible joints of humans, actuators containing soft joints have been developed for various applications, including soft grippers, artificial muscles, and wearable devices. However, integrating multiple microjoints into soft robots at the micrometer scale to achieve multi-deformation modalities remains challenging. Here, we propose a two-in-one femtosecond laser writing strategy to fabricate microjoints composed of hydrogel and metal nanoparticles, and develop multi-joint microactuators with multi-deformation modalities (>10), requiring short response time (30 ms) and low actuation power (<10 mW) to achieve deformation. Besides, independent joint deformation control and linkage of multi-joint deformation, including co-planar and spatial linkage, enables the microactuator to reconstruct a variety of complex human-like modalities. Finally, as a proof of concept, the collection of multiple microcargos at different locations is achieved by a double-joint micro robotic arm. Our microactuators with multiple modalities will bring many potential application opportunities in microcargo collection, microfluid operation, and cell manipulation.

Deep learning for the rapid automatic segmentation of forearm muscle boundaries from ultrasound datasets

Ultrasound (US) is widely used in the clinical diagnosis and treatment of musculoskeletal diseases. However, the low efficiency and non-uniformity of artificial recognition hinder the application and popularization of US for this purpose. Herein, we developed an automatic muscle boundary segmentation tool for US image recognition and tested its accuracy and clinical applicability. Our dataset was constructed from a total of 465 US images of the flexor digitorum superficialis (FDS) from 19 participants (10 men and 9 women, age 27.4 ± 6.3 years). We used the U-net model for US image segmentation. The U-net output often includes several disconnected regions. Anatomically, the target muscle usually only has one connected region. Based on this principle, we designed an algorithm written in C++ to eliminate redundantly connected regions of outputs. The muscle boundary images generated by the tool were compared with those obtained by professionals and junior physicians to analyze their accuracy and clinical applicability. The dataset was divided into five groups for experimentation, and the average Dice coefficient, recall, and accuracy, as well as the intersection over union (IoU) of the prediction set in each group were all about 90%. Furthermore, we propose a new standard to judge the segmentation results. Under this standard, 99% of the total 150 predicted images by U-net are excellent, which is very close to the segmentation result obtained by professional doctors. In this study, we developed an automatic muscle segmentation tool for US-guided muscle injections. The accuracy of the recognition of the muscle boundary was similar to that of manual labeling by a specialist sonographer, providing a reliable auxiliary tool for clinicians to shorten the US learning cycle, reduce the clinical workload, and improve injection safety.

Temperature-Regulated Bidirectional Capillary Force Self-Assembly of Femtosecond Laser Printed Micropillars for Switchable Chiral Microstructures

Bottom-up self-assembly is regarded as an alternative way to manufacture series of microstructures in many fields, especially chiral microstructures, which attract tremendous attention because of their optical micromanipulations and chiroptical spectroscopies. However, most of the self-assembled microstructures cannot be tuned after processing, which largely hinders their broad applications. Here, we demonstrate a promising manufacturing strategy for switchable microstructures by combining the flexibility of femtosecond laser printing induced capillary force self-assembly and the temperature-responsive characteristics of smart hydrogels. Through designing asymmetric cross-link density, the printed microarchitectures can be deformed in the opposite direction and assembled into switchable ordered microstructures driven by capillary forces under different temperatures. Finally, the assembled chiral microstructures with switchable opposite handedness are realized, which shows tunable vortical dichroism. The proposed strategy holds potential applications in the fields of chiral photonics, chiral sensing, and so on.

Ab interno canaloplasty versus gonioscopy-assisted transluminal trabeculotomy in open-angle glaucoma: a randomised controlled trial

OBJECTIVE

To compare the efficacy and safety of ab interno canaloplasty (ABiC) with gonioscopy-assisted transluminal trabeculotomy (GATT) in patients with open-angle glaucoma (OAG).

METHOD

This randomised clinical trial recruited eyes with OAG and no previous incisional ocular surgery, among which 38 were randomised to ABiC and 39 to GATT. Follow-ups were performed at 1, 3, 6 and 12 months postoperatively. The primary outcome measures were intraocular pressure (IOP) and use of glaucoma medication at 12 months postoperatively. The secondary outcome measure was complete surgical success (not requiring glaucoma surgery, IOP ≤21 mm Hg and non-use of glaucoma medications).

RESULTS

Both groups had similar demographic and ocular characteristics. A total of 71 of the 77 subjects (92.2%) completed 12-month follow-up. At 12 months, mean IOP was 19.0±5.2 mm Hg in the ABiC group and 16.0±3.1 mm Hg in the GATT group (p=0.003). Overall, 57.2% of ABiC patients and 77.8% of GATT patients were medication free (p=0.06). The number of glaucoma medications was 0.9±1.3 in the ABiC group and 0.6±1.2 in the GATT group (p=0.27). The 12-month cumulative rate of complete surgical success was 56% in the ABiC group and 75% in the GATT group (p=0.09). Three eyes in the ABiC group and one eye in the GATT group required additional glaucoma surgery. Hyphema (87% vs 47%) and supraciliary effusion (92% vs 71%) were noted more often in the GATT group than in the ABiC group.

CONCLUSIONS

The preliminary result showed that GATT had an advantage over ABiC in IOP reduction for OAG patients, accompanied by favourable safety at 12-month postoperatively.

TRIAL REGISTRATION NUMBER

ChiCTR1800016933.

Removal of BTEX from water system by synergistic flocculation of biosurfactant and iron salt

The adsorption micelle flocculation (AMF) effect of biosurfactants (rhamnolipids, RL) and polymerized ferric sulfate (PFS) on the removal of low molecular weight benzoic acid (benzoic acid and p-methyl benzoic acid) and phenol (2,4-dichlorophenol and bisphenol A) organics was investigated. The coexistence system of RL and organic matter was constructed, and the effects of pH, Fe concentration, RL concentration and initial concentration of organic matter on the removal effect were discussed. For benzoic acid and p-methyl benzoic acid, the increase of Fe and RL concentrations was beneficial to their removal rates under weak acidic conditions, and the removal rate of the coexistence system was higher for methyl benzoic acid (87.7 %) than for benzoic acid (78.6 %), which might be attributed to the stronger hydrophobicity of the coexistence system for methyl benzoic acid; while for 2,4-dichlorophenol and bisphenol A, pH and Fe concentration changes had less effect on the removal rate, but the increase in RL concentration was favorable to the removal rate, which was 93.1 % and 86.7 % for BPA and 2,4-dichlorophenol, respectively. These findings provide feasible ideas and directions for the removal of organics by AMF using biosurfactants.

Anti-neuroinflammation effects of transcutaneous auricular vagus nerve stimulation against depression-like behaviors via hypothalamic α7nAchR/JAK2/STAT3/NF-κB pathway in rats exposed to chronic unpredictable mild stress

BACKGROUND

Transcutaneous auricular vagus nerve stimulation (taVNS) is a vital neuromodulation for the treatment of depression, but its antidepressant molecular mechanism is unclear. The α7 nicotinic acetylcholine receptor (α7nAchR) is a key mediator of the vagus nerve that mediates its anti-inflammatory efficacy. Here, we investigated whether the antidepressant effect of taVNS in chronic unpredicted mild stress (CUMS)-exposed rats works through the α7nAchR/JAK2/STAT3/NF-κB pathway.

METHODS

The depression model was established by CUMS for continuous 6 weeks in rats. From the 4th week of the experiment, CUMS-exposed rats were subjected to taVNS for 3 weeks. To clarify the role of α7nAchR in the antidepressant effect of taVNS, we used α7nAchR^-/- gene knockout rats. The sucrose preference test (SPT), open field test (OFT), and forced swimming test (FST) were used to evaluate depression-like behaviors of rats. Immunofluorescent staining was used to observe the morphology of microglia in the hypothalamus. Western blot was used to examine the protein expression of α7nAchR, p-JAK2, p-STAT3, IL-1β, NF-κB p65, and p-NF-κB p65 in the hypothalamus.

RESULTS

Depression-like behaviors in CUMS-exposed rats were manifested by decreased SPT ratio, increased FST immobility time, decreased total distance, vertical movement score, and activity time of OFT. Hypothalamic neuroinflammation in CUMS-exposed rats was manifested by an amoebic-like activated state of microglia, downregulated expression of α7nAchR, p-JAK2, p-STAT3, and upregulated expression of NF-κB p65, p-NF-κB p65, and IL-1β. TaVNS could significantly reverse the above-mentioned phenomena, but had a poor improvement effect for CUMS-exposed α7nAchR^-/- rats.

CONCLUSION

The hypothalamic α7nAchR/JAK2/STAT3/NF-κB signaling pathway may play an important role in the antidepressant-like behavior of taVNS.

[Silencing SIRT1 reduces 5-fluorouracil resistance of cholangiocarcinoma cells by inhibiting the FOXO1/Rab7 autophagy pathway]

OBJECTIVE

To investigate the mechanism by which SIRT1 silencing reduces 5-fluorouracil (5-FU) resistance of cholangiocarcinoma cells and the role of FOXO1/Rab7 autophagy pathway in mediating this effect.

METHODS

Human cholangiocarcinoma HCCC-9810 cells were treated with 50, 100, 150, and 200 μg/mL 5-FU to construct a 5-FU-resistant cell model, whose expressions of SIRT1, FOXO1 and Rab7 were detected with immunofluorescence assay, Western blotting and RTqPCR, and the expression levels of autophagy related proteins (Beclin1, LC3, and p62) were detected with Western blotting. The 5-FU resistant cells were transfected with a SIRT1 siRNA, and the changes in 5-Fu resistance and migration ability of the cells were evaluated using CCK-8 assay and wound healing assay; The changes in FOXO1 and Rab7 mRNA levels and protein expressions of SIRT1, FOXO1, Rab7, Beclin1, LC3 and P62 were detected with RT-qPCR and Western blotting.

RESULTS

Treatments with 5-FU at 50, 100, 150, and 200 μg/mL all inhibited the proliferation of HCCC-9810 cells. Immunofluorescence assay revealed significantly enhanced SIRT1 expression in 5-FU-resistant HCC-9810 cells, and Western blotting also showed significantly up-regulated protein expressions of SIRT1, Rab7, P62, FOXO1 and Beclin 1 (P < 0.001) and an increased LC3II/LC3I ratio in the cells (P < 0.001). The mRNA levels of SIRT1, Rab7 and FOXO1 were also up-regulated in 5-Fu-resistant cells (P < 0.05). SIRT1 silencing significantly attenuated 5-FU resistance and migration ability of HCCC-9810 cells, and obviously decreased the protein expressions of SIRT1, Rab7, P62, FOXO1 and Beclin1 and the LC3II/LC3I ratio as well (P < 0.001). FOXO1 and Rab7 mRNA levels were significantly decreased in 5-FU-resistant HCC-9810 cells after SIRT1 silencing (P < 0.05).

CONCLUSION

Silencing SIRT1 attenuates 5-FU resistance in HCC-9810 cells by inhibiting the activation of the FOXO1/Rab7 autophagy pathway.

Factors associated with delayed reporting for surgical care among patients with surgical acute abdomen attended at Muhimbili National Hospital: Tanzania

BACKGROUND

Surgical acute abdomen is a sudden onset of severe abdominal symptoms (pain, vomiting, constipation etc.) indicative of a possible life-threatening intra-abdominal pathology, with most cases requiring immediate surgical intervention. Most studies from developing countries have focused on complications related to delayed diagnosis of specific abdominal problems like intestinal obstruction or acute appendicitis and only a few studies have assessed factors related to the delay in patients with acute abdomen. This study focused on the time from the onset of a surgical acute abdomen to presentation to determine factors that led to delayed reporting among these patients at the Muhimbili National Hospital (MNH) and aimed to close the knowledge gap on the incidence, presentation, etiology, and death rates for acute abdomen in Tanzania.

METHODS

We conducted a descriptive cross-sectional study at MNH, Tanzania. Patients with a clinical diagnosis of the surgical acute abdomen were consecutively enrolled in the study over a period of 6 months and data on the onset of symptoms, time of presentation to the hospital, and events during the illness were collected.

RESULTS

Age was significantly associated with delayed hospital presentation, with older groups presenting later than younger ones. Informal education and being uneducated were factors contributing to delayed presentation, while educated groups presented early, albeit the difference was statistically insignificant (p = 0.121). Patients working in the government sector had the lowest percentage of delayed presentation compared to those in the private sector and self-employed individuals, however, the difference was statistically insignificant. Family and cohabiting individuals showed late presentation (p = 0.03). Deficiencies in health care staff on duty, unfamiliarity with the medical facilities, and low experience in dealing with emergency cases were associated with the factors for delayed surgical care among patients. Delays in the presentation to the hospital increased mortality and morbidity, especially among patients who needed emergency surgical care.

CONCLUSION

Delayed reporting for surgical care among patients with surgical acute abdomen in underdeveloped countries like Tanzania is often not due to a single reason. The causes are distributed across several levels including the patient's age and family, deficiency in medical staff on duty and lack of experience in dealing with emergency cases, educational level, working sectors, socioeconomic and sociocultural status of the country.

Gonioscopy-assisted transluminal trabeculotomy for open-angle glaucoma with failed incisional glaucoma surgery: two-year results

BACKGROUND

To evaluate the safety and efficacy of gonioscopy-assisted transluminal trabeculotomy (GATT) in treating patients with open-angle glaucoma (OAG) who had failed prior incisional glaucoma surgery.

METHODS

A consecutive case series of OAG patients aged ≥ 18 who underwent GATT with previous failed glaucoma incision surgery was retrospectively analyzed. Main outcome measures included intraocular pressure (IOP), the number of glaucoma medications, surgical success rate, and occurrence of complications. Success was defined as an IOP of ≤ 21 mmHg and a reduction of IOP by 20% or more from baseline with (qualified success) or without (complete success) glaucoma medications. For eyes with preoperative IOP of < 21 mmHg on 3 or 4 glaucoma medications, postoperative IOP of ≤ 18 mmHg without any glaucoma medications was also defined as complete success.

RESULTS

Forty-four eyes of 35 patients (21 with juvenile-onset open-angle glaucoma and 14 with adult-onset primary open-angle glaucoma) with a median age of 38 years were included in this study. The proportion of eyes with 1 prior incisional glaucoma surgery was 79.5%, and the others had 2 prior surgeries. IOP decreased from 27.4 ± 8.8 mm Hg on 3.6 ± 0.7 medications preoperatively to 15.3 ± 2.7 mm Hg on 0.5 ± 0.9 medications at the 24-month visit (P < 0.001). The mean IOP and the number of glaucoma medications at each follow-up visit were lower than the baseline (all P < 0.001). At 24 months postoperatively, 82.1% of the eyes had IOP ≤ 18 mmHg (versus 15.9% preoperatively, P < 0.001), 56.4% reached IOP ≤ 15 mmHg (versus 4.6% preoperatively, P < 0.001), and 15.4% achieved IOP ≤ 12 mmHg (compared to none preoperatively, P = 0.009). While 95.5% of eyes took 3 or more medications preoperatively, 66.7% did not take glaucoma medication 24 months after GATT. Thirty-four (77.3%) eyes achieved IOP reduction greater than 20% on fewer medications. The complete and qualified success rates were 60.9% and 84.1%, respectively. No vision-threatening complications occurred.

CONCLUSIONS

GATT was safe and effective in treating refractory OAG patients who failed prior incisional glaucoma surgery.

Screening Key Pathogenic Genes and Small Molecule Compounds for PNET

Primitive neuroectodermal tumors (PNET) are rare malignant tumors, but the mortality rate of the patients is extremely high. The aim of this study was to identify the hub genes and pathways involved in the pathogenesis of PNET and to screen the potential small molecule drugs for PNET. We extracted gene expression profiles from the Gene Expression Omnibus database and identified differentially expressed genes (DEGs) through Limma package in R. Two expression profiles (GSE14295 and GSE74195) were downloaded, including 33 and 5 cases separately. Four hundred sixty-eight DEGs (161 upregulated; 307 downregulated) were identified. Functional annotation and KEGG pathway enrichment of the DEGs were performed using DAVID and Kobas. Gene Ontology analysis showed the significantly enriched Gene Ontology terms included but not limited to mitosis, nuclear division, cytoskeleton, synaptic vesicle, syntaxin binding, and GABA A receptor activity. Cancer-related signaling pathways, such as DNA replication, cell cycle, and synaptic vesicle cycle, were found to be associated with these genes. Subsequently, the STRING database and Cytoscape were utilized to construct a protein-protein interaction and screen the hub genes, and we identified 5 hub genes (including CCNB1, CDC20, KIF11, KIF2C, and MAD2L1) as the key biomarkers for PNET. Finally, we identified potential small molecule drugs through CMap. Seven small molecule compounds, including trichostatin A, luteolin, repaglinide, clomipramine, lorglumide, vorinostat, and resveratrol may become potential candidates for PNET drugs.

Research on knowledge representation and modeling of health management based on fuzzy ontology

The long-term maintenance of good condition for equipment is the basis of carrying out combat missions under the high technology and fast pace of modern war. However, the knowledge in the health management field at present has the characteristics of distribution, multi-source, heterogeneity and uncertainty, which seriously affects the efficiency of knowledge sharing and reuse. In order to improve the utilization of health management knowledge, an ontology-based knowledge representation method is proposed to describe knowledge in a unified and standardized way, and the classical ontology is extended to express the uncertain knowledge in the field of health management. In addition, to improve the maintenance and knowledge updating efficiency, a global ontology model and a hierarchy, time and activity (HTA) ontology model are constructed. This paper takes the guidance subsystem of a missile as an example to illustrate the process of knowledge modeling. The results show this method realizes knowledge sharing in the health management field and can provide decision support for health management of equipment.

Effect of cervical suspensory traction in the treatment of severe cervical kyphotic deformity

Objective

This study aimed to investigate a new noninvasive traction method on the treatment of severe cervical kyphotic deformity.

Methods

The clinical data of patients with severe cervical kyphosis (Cobb > 40°) treated in Peking University Third Hospital from March 2004 to March 2020 were retrospectively summarized. 46 cases were enrolled, comprising 27 males and 19 females. Fifteen patients underwent skull traction, and 31 patients underwent suspensory traction. Among them, seven used combined traction after one week of suspensory traction. Bedside lateral radiographs were taken every two or three days during traction. The cervical kyphosis angle was measured on lateral radiographs in and extended position at each point in time. The correction rate and evaluated Japanese Orthopedic Association (JOA) scoring for the function of the spinal cord were also measured. The data before and after the operation were compared with paired sample t-test or Wilcoxon signed-rank test.

Results

No neurological deterioration occurred during the skull traction and the cervical suspensory traction. There were 12 patients with normal neurological function, and the JOA score of the other 34 patients improved from 11.5 ± 2.8 to 15.4 ± 1.8 at the end of follow up (P < 0.05). The average kyphotic Cobb angle was 66.1° ± 25.2, 28.7° ± 20.1 and 17.4° ± 25.7 pre-traction, pre-operative, and at the final follow-up, respectively (P < 0.05). The average correction rate of skull traction and suspensory traction was 34.2% and 60.6% respectively. Among these, the correction rate of patients with simple suspensory traction was 69.3%. For patients with a correction rate of less than 40% by suspensory traction, combined traction was continued, and the correction rates after suspensory traction and combined traction were 30.7% and 67.1% respectively.

Conclusions

Pre-correction by cervical suspensory traction can achieve good results for severe cervical kyphotic deformity, with no wound and an easy process. Combined traction is effective for supplemental traction after suspensory traction.

High-performance Marangoni hydrogel rotors with asymmetric porosity and drag reduction profile

Miniaturized rotors based on Marangoni effect have attracted great attentions due to their promising applications in propulsion and power generation. Despite intensive studies, the development of Marangoni rotors with high rotation output and fuel economy remains challenging. To address this challenge, we introduce an asymmetric porosity strategy to fabricate Marangoni rotor composed of thermoresponsive hydrogel and low surface tension anesthetic metabolite. Combining enhanced Marangoni propulsion of asymmetric porosity with drag reduction of well-designed profile, our rotor precedes previous studies in rotation output (~15 times) and fuel economy (~34% higher). Utilizing thermoresponsive hydrogel, the rotor realizes rapid refueling within 33 s. Moreover, iron-powder dopant further imparts the rotors with individual-specific locomotion in group under magnetic stimuli. Significantly, diverse functionalities including kinetic energy transmission, mini-generator and environmental remediation are demonstrated, which open new perspectives for designing miniaturized rotating machineries and inspire researchers in robotics, energy, and environment.

4D Direct Laser Writing of Submerged Structural Colors at the Microscale

Biomimetic stimuli-responsive structure colors (SCs) can improve the visualization and identification in the micro functional structure field such as information encryption/decryption and smart actuators. However, it is still challenging to develop the ability to 4D print arbitrary submerged colorful patterns with stimuli-responsive materials at the microscale. Herein, a hydrogel photoresist with feature resolution (98 nm) for the fabrication of 4D microscopic SCs by the femtosecond direct laser writing method is developed. The 4D printed woodpile SCs are grouped as pixel palettes with various laser parameters and they spanned almost the entire color space. The coloring mechanism of diffraction gratings is not only investigated by optics microscopy and spectroscopy but also supported by simulation. Moreover, the 4D printed hydrogel-integrated amphichromatic fish constructions and pixelated painting can visually discolor reversibly by regulating the solution pH. This finding promises an ideal coloring method for sensors, anti-counterfeiting labels, and transformable photonic devices.

A bibliometric analysis of 100 top-cited journal articles related to acupuncture regulation of the autonomic nervous system

Purpose

Research on the effects of acupuncture on autonomic function has been conducted for several decades, and a few notable studies have emerged in recent years. This study used bibliometric analysis to assess 100 top-cited articles to characterize the current status and research trends over the last three decades.

Methods

The 100 top-cited publications were identified from the Web of Science Core Collection database. The bibliometrix package in R was used for quantitative and qualitative analyses of the publication patterns and the country/region, institution, and author contributions. VOSviewer was used to construct networks based on co-citation analysis of the journals and the keyword co-occurrence.

Results

The 100 top-cited articles were identified with a total of 8,123 citations (range: 37-345). The majority of the articles came from the USA (n = 42), followed by Japan (n = 14) and mainland China (n = 13). Articles from the USA exhibited the largest number of citations (3,582 citations), followed by articles from Japan (1,189 citations), then articles from mainland China (755 citations). Neurosciences/Neurology was the most studied research area (n = 41). The Autonomic Neuroscience: Basic and Clinical published the largest number of papers (n = 14), while Brain Research received the largest number of citations (205 citations). Longhurst JC was the most productive author (10 publications), and Sato A was first among the cited authors (87 citations). The most frequently cited articles that focused on gastrointestinal, cardiovascular, or gynecologic responses to acupuncture regulation of the autonomic nervous system first appeared in the 1990s, peaked in the 2000s, then decreased after 2010. Publication of articles focused on the anti-inflammatory effects of acupuncture associated with autonomic function demonstrated an increasing trend over the last three decades.

Conclusion

From the initial studies focusing on the autonomic mechanism of visceral responses to acupuncture, researchers concentrated on exploring the autonomic mechanism of acupuncture in the control of systemic inflammation. Non-invasive electrical methods that activate somato-autonomic reflexes are current translational directions in clinical practice. Additional investigation of the underlying neuroanatomical basis of somato-autonomic reflexes also is needed.

Intraocular Pressure Fluctuation in Primary Open-Angle Glaucoma with Canaloplasty and Microcatheter Assisted Trabeculotomy

Background: Schlemm’s canal (SC) targeted procedures constitute a promising therapy for open angle glaucoma (POAG), safer and less invasive. However, little attention was paid to the intraocular pressure (IOP) variation in patients receiving these procedures, which is the risk factor for POAG progression. This study is to evaluate the IOP variation in eyes with POAG after modified canaloplasty (MC) and microcatheter assisted trabeculotomy (MAT). (2) Methods: POAG with good IOP in office hours after MC or MAT and age-matched normal subjects were recruited in this prospective coherent study. IOP in sitting and supine positions and 24-h IOP was measured. Aqueous vein and blood reflux into the SC were examined. (3) Results: Among 20 normal subjects, 25 eyes with MC eyes and 30 eyes with MAT were recruited in this study. Aqueous veins are frequently located in the inferior nasal quadrants in all groups. No pulsatile signs were observed in an aqueous vein in the MAT group but they were observed in 68% of the MC group. Blood reflux in the SC could be seen in all the operated eyes. The IOP in the sitting position was not significant different among groups (p = 0.419). Compared to normal, the IOP increased dramatically after lying down for 5 min in the MC and MAT groups (PMC vs. normal = 0.003, PMAT vs. normal = 0.004), which is similar for IOP change after lying down for 60 min (PMC vs. normal < 0.001, PMAT vs. normal < 0.001). In terms of diurnal IOP, subjects were stable in the MAT group (p < 0.01), variable in the normal group (p = 0.002), and most fluctuant in MC group (p < 0.001). (4) Conclusions: MC and MAT reduce the IOP but present aberrant short-term IOP regulation, which should be paid attention to in clinical settings.

A deubiquitination module essential for Treg fitness in the tumor microenvironment

The tumor microenvironment (TME) enhances regulatory T (T_reg) cell stability and immunosuppressive functions through up-regulation of lineage transcription factor Foxp3, a phenomenon known as T_reg fitness or adaptation. Here, we characterize previously unknown TME-specific cellular and molecular mechanisms underlying T_reg fitness. We demonstrate that TME-specific stressors including transforming growth factor-β (TGF-β), hypoxia, and nutrient deprivation selectively induce two Foxp3-specific deubiquitinases, ubiquitin-specific peptidase 22 (Usp22) and Usp21, by regulating TGF-β, HIF, and mTOR signaling, respectively, to maintain T_reg fitness. Simultaneous deletion of both USPs in T_reg cells largely diminishes TME-induced Foxp3 up-regulation, alters T_reg metabolic signatures, impairs T_reg-suppressive function, and alleviates T_reg suppression on cytotoxic CD8⁺ T cells. Furthermore, we developed the first Usp22-specific small-molecule inhibitor, which dramatically reduced intratumoral T_reg Foxp3 expression and consequently enhanced antitumor immunity. Our findings unveil previously unappreciated mechanisms underlying T_reg fitness and identify Usp22 as an antitumor therapeutic target that inhibits T_reg adaptability in the TME.

On-Demand Maneuver of Millirobots with Reprogrammable Motility by a Hard-Magnetic Coating

Millirobots that can be actuated and accurately steered by external magnetic fields, are highly desirable for bioengineering and wearable devices. However, existing designs of millirobots are limited by their specific material composition, hindering their wider application due to a lack of scalability. Here, we present a method for the generation of heterogeneous magnetic millirobots based on magnetic coatings. The coatings, composed of hard-magnetic CrO₂ particles dispersed in an adhesive solution, impart magnetic actuation to diverse substrates with planar sheets or 3D structures. Millirobots constructed from the coatings can be readily reprogrammed with intricate magnetization profiles using laser localized heating, enabling reconfigurable shape changes under magnetic actuation. Using this approach, we demonstrate on-demand maneuvering capability of reconfiguring locomotion involving crawling, overturning and rolling with a single millirobot. Various functions, including the ability to catch a fast-moving ball, object transportation, and targeted assembly, have been achieved. This adhesive strategy facilitates the design of millirobots and may open avenues to the creation of complex millirobots for broad applications.

Does acupuncture therapy affect peripheral inflammatory cytokines of major depressive disorder? A protocol for the systematic review and meta-analysis

Background

Acupuncture is widely used as adjuvant therapy for major depressive disorder (MDD). There is robust evidence that inflammation is closely associated with MDD. To date, only a few numbers of studies have investigated the potential relationship between acupuncture and the change of inflammatory biomarkers in patients with MDD. Additionally, the results are inconsistent among studies. The current study aims to provide a comprehensive, systematic review of the association between acupuncture and changes in peripheral inflammation of patients with MDD, and clarify the alterations of inflammatory cytokines before and after acupuncture treatment by meta-analysis.

Methods and analysis

This study will be conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Eligible randomized controlled trials (RCTs) reporting acupuncture, with inflammatory cytokines as the outcome measured before and after intervention in patients with MDD, were searched in electronic databases, such as PubMed, Embase, Cochrane, SINOMED, Wanfang, China national knowledge infrastructure (CNKI), and Chongqing VIP (CQVIP). Primary outcomes of interest will be validated to measure the levels of inflammatory cytokines before and after acupuncture treatment in patients with MDD.

Discussion

Acupuncture can drive anti-inflammatory effects, as well as symptom changes in MDD, which may represent a viable, multi-faceted treatment approach in MDD.

Systematic review registration

[PROSPERO], identifier [CRD42021289207 on 04 December 2021].

Effect of Hypoxic-Ischemic Brain Injury in Neonatal Rats on Behavioral Parameters and Expression of CDK8 in the Brain Tissue

Behavioral changes in newborn 3-day-old rats (n=44) with modeled hypoxic-ischemic brain injury (HIBI) were observed, and the expression of CDK8 in brain tissues was detected to clarify the significance of CDK8. In 30 min, 3 h, and 3 days after HIBI, the left (ischemic) hemisphere was taken for examination. In 3 days after HIBI, the rat pups were examined in the behavioral tests. In rat pups with HIBI, changes of CDK8 expression were detected by Western blotting and real-time PCR and changes in the righting reflex and forelimb grip strength test (p<0.05) were revealed in comparison with sham-operated animals. The expression of CDK8 increased 30 min after HIBI and decreased in 3 h and 3 days. Hypoxia and ischemia of the left brain may affect locomotion, but not sensation. Since CDK8 is involved in the immune response after cerebral hypoxia and ischemia, this kinase can be used as an early diagnostic index.

Magnetically encoded 3D mesostructure with high-order shape morphing and high-frequency actuation

Inspired by origami/kirigami, three-dimensional (3D) mesostructures assembled via a mechanics-guided approach, with reversible and maneuverable shape-morphing capabilities, have attracted great interest with regard to a broad range of applications. Despite intensive studies, the development of morphable 3D mesostructures with high-order (multi-degree-of-freedom) deformation and untethered high-frequency actuation remains challenging. This work introduces a scheme for a magnetically encoded transferable 3D mesostructure, with polyethylene terephthalate (PET) film as the skeleton and discrete magnetic domains as actuation units, to address this challenge. The high-order deformation, including hierarchical, multidirectional and blending shape morphing, is realized by encoding 3D discrete magnetization profiles on the architecture through ultraviolet curing. Reconfigurable 3D mesostructures with a modest structural modulus (∼3 GPa) enable both high-frequency (∼55 Hz) and large-deformation (∼66.8%) actuation under an alternating magnetic field. Additionally, combined with the shape-retention and adhesion property of PET, these 3D mesostructures can be readily transferred and attached to many solid substrates. On this basis, diverse functional devices, including a switchable colour letter display, liquid mixer, sequential flashlight and biomimetic sliding robot, are demonstrated to offer new perspectives for robotics and microelectronics.

Analysis of Drug Clinical Trials for Eye Diseases in China

Purpose: We systematically retrospected and analyzed the general characteristics of ophthalmic drug clinical trials (CTs) registered in China from January 2014 to December 2021. Methods: Data were retrieved from the Drug Trial Registration and Information Publication Platform and then standardized and statistically classified using bibliometric analysis. Results: We identified 201 drug CTs for eye diseases, including 24 international multicenter trials. The number of drug CTs for eye diseases has considerably increased since 2017 in parallel with new policies to encourage innovation in drugs and medical devices in China. The drug types consist of biologicals (48.26%), chemicals (45.77%), and traditional Chinese medicine/natural medicines (5.97%). The main indications were age-related macular degeneration (AMD; n = 47, 23.38%), macular edema (n = 32, 15.92%), and diabetic retinopathy (n = 19, 9.45%). The trials included those in phase I (n = 67, 33.33%), phase II (n = 33, 16.42%), and phase III (n = 72, 35.82%). The phase I trials comprised 24 innovative drug treatments for AMD and 6 novel drug treatments for neuromyelitis optica spectrum disorders, with 39 biologicals and 27 chemicals. The trials mostly followed a randomized (84.08%) or masked (67.16%) design, with 90.37% of the latter being double-masked trials. Conclusion: Research and development of ophthalmic drugs have substantially increased in recent years and are influenced by regulatory policies. Among these drugs, biologicals for AMD are the most prevalent, followed by biologicals for macular edema. Randomized double-masked research designs are often used and represent high-quality evidence.

[Evidence summary of early rehabilitation of adults with veno-venous extracorporeal membrane oxygenation]

OBJECTIVE

To evaluate and summarize the best evidence for early rehabilitation of adults with veno-venous extracorporeal membrane oxygenation (VV-ECMO).

METHODS

Evidence on early rehabilitation of adult VV-ECMO patients was searched by computer from 7 English literature databases [PubMed database, cumulative index to nursing and allied health literature (CINAHL), Embase database, Cochrane library database, UpToDate clinical consultant, BMJ best clinical practice, JBI database], 5 Chinese literature databases (China biomedical literature database, China Yimai Tong, China national knowledge infrastructure, Wanfang data, VIP database), 5 guideline networks [National Institute for Health and Care Excellence (NICE), Scottish Intercollegiate Guidelines Network (SIGN), National Guideline Clearinghouse (NGC), Guidelines International Network (GIN), China Guide Network] and 2 professional association websites [Extracorporeal Life Support Organization (ELSO), Chinese Association of Rehabilitation Medicine]. The search period is from January 2011 to December 2021. The appraisal of guidelines for research and evaluation II (AGREE ) and JBI 2014 quality assessment tools were used to evaluate the quality of inclusion guidelines, systematic reviews, expert consensus and original studies, respectively, and to extract and summarize the best evidence for early rehabilitation of adults with VV-ECMO.

RESULTS

A total of 2 guidelines, 2 expert consensuses, 2 systematic reviews and 8 original studies [including 1 randomized controlled trial (RCT), 1 non-randomized controlled study, 3 cohort studies and 3 case reports] were included. The evidence was summarized from 9 aspects including the necessity of early rehabilitation, rehabilitation initiation time, rehabilitation location, pre-rehabilitation preparation, pre-rehabilitation assessment, rehabilitation method, rehabilitation frequency and duration, rehabilitation process monitoring and effect evaluation,and finally 24 pieces of the best evidence were summarized.

CONCLUSIONS

Early rehabilitation of adults with VV-ECMO is safe and feasible. The summary of the best evidence can provide evidence-based guidance for clinical medical staff to reasonably carry out early rehabilitation.

A meta-analysis of clinical effects of microscopic unilateral laminectomy bilateral decompression (ULBD) versus biportal endoscopic ULBD for lumbar canal stenosis

Osbjective

Several studies have shown that both microscopic unilateral laminotomy bilateral decompression (ULBD) and unilateral biportal endoscopic (UBE) ULBD are effective for treating lumbar canal stenosis (LCS). However, there are different viewpoints as to which surgical technique is superior. Therefore, this meta-analysis investigated the clinical efficacy and side effects of microscopic ULBD and UBE ULBD for treating LCS.

Methods

To identify relevant studies describing the clinical outcomes and complication rates of microscopic ULBD and UBE ULBD for LCS, several databases were systematically searched in the Internet. The visual analog scale score for back and leg pain and the Oswestry Disability Index were used to assess clinical outcomes. Furthermore, data about perioperative outcomes and complications were documented.

Results

In total, six studies with 450 participants were included in this meta-analysis. The UBE ULBD was found to be superior to microscopic ULBD in terms of efficacy against early postoperative back and leg pain. However, there was no significant difference between the two procedures in terms of final clinical outcomes and complications. In addition, compared with microscopic ULBD, UBE ULBD was associated with a significant reduction in the length of hospital stay and C-reactive protein levels 2 days after surgery.

Conclusion

UBE ULBD and microscopic ULBD for the treatment of LCS were similar in terms of final clinical outcomes and complications. However, UBE ULBD has several advantages over microscopic ULBE, including a shorter hospital stay and faster alleviation of postoperative back and leg pain.

Association of serum retinol concentration with normal-tension glaucoma

OBJECTIVES

To evaluate the association between serum retinol concentration and normal-tension glaucoma (NTG).

METHODS

A total of 345 study subjects were recruited in a prospective cross-sectional study: 101 patients with NTG, 106 patients with high-pressure primary open-angle glaucoma (POAG) and 138 healthy control subjects. Serum retinol concentration in fasting blood samples was determined by ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS). All study subjects were given complete ophthalmic examinations and diagnosed by two glaucoma sub-specialists.

RESULTS

Serum retinol concentrations in NTG, POAG, and controls were 338.90 ± 103.23 ng/mL, 405.22 ± 114.12 ng/mL, and 408.84 ± 122.36 ng/mL respectively. NTG patients had lower serum retinol concentrations than POAG (p < 0.001) or healthy controls (p < 0.001). There was no statistical difference between the POAG and healthy controls (p = 0.780). Higher proportion of NTG patients (37.6%) than POAG (17.9%) or controls (21.7%) had serum retinol concentrations lower than 300 ng/mL. Serum retinol was positively correlated with optic nerve sheath diameter (ONSD) (r = 0.349, p = 0.001) in glaucoma patients and not associated with any other demographic features or ophthalmic biometric parameters in the NTG patients. Multivariate logistic regression showed that serum retinol (OR = 0.898, 95CI%: 0.851-0.947) was associated with incident NTG.

CONCLUSIONS

NTG patients had lower serum retinol concentrations. Serum retinol uniquely associated with NTG makes it a new potential option for the diagnosis and treatment of the disease.

Rapid and Multimaterial 4D Printing of Shape-Morphing Micromachines for Narrow Micronetworks Traversing

Micromachines with high environmental adaptability have the potential to deliver targeted drugs in complex biological networks, such as digestive, neural, and vascular networks. However, the low processing efficiency and single processing material of current 4D printing methods often limit the development and application of shape-morphing micromachines (SMMs). Here, two 4D printing strategies are proposed to fabricate SMMs with pH-responsive hydrogels for complex micro-networks traversing. On the one hand, the 3D vortex light single exposure technique can rapidly fabricate a tubular SMM with controllable size and geometry within 0.1 s. On the other hand, the asymmetric multimaterial direct laser writing (DLW) method is used to fabricate SMMs with designable 3D structures composed of hydrogel and platinum nanoparticles (Pt NPs). Based on the presence of ferroferric oxide (Fe₃ O₄ ) and Pt NPs in the SMMs, efficient magnetic, bubble, and hybrid propulsion modes are achieved. Finally, it is demonstrated that the spatial shape conversion capabilities of these SMMs can be used for narrow micronetworks traversing, which will find potential applications in targeted cargo delivery in microcapillaries.

Functional Shape-Morphing Microarchitectures Fabricated by Dynamic Holographically Shifted Femtosecond Multifoci

Functional microdevices based on responsive hydrogel show great promise in targeted delivery and biomedical analysis. Among state-of-the-art techniques for manufacturing hydrogel-based microarchitectures, femtosecond laser two-photon polymerization distinguishes itself by high designability and precision, but the point-by-point writing scheme requires mechanical apparatuses to support focus scanning. In this work, by predesigning holograms combined with lens phase modulation, multiple femtosecond laser spots are holographically generated and shifted for prototyping of three-dimensional shape-morphing structures without any moving equipment in the construction process. The microcage array is rapidly fabricated for high-performance target capturing enabled by switching environmental pH. Moreover, the built scaffolds can serve as arrayed analytical platforms for observing cell behaviors in normal or changeable living spaces or revealing the anticancer effects of loaded drugs. The proposed approach opens a new path for facile and flexible manufacturing of hydrogel-based functional microstructures with great versatility in micro-object manipulation.

Factors influencing intentions to use library social media marketing accounts: taking the example of WeChat

Purpose

This study aims to explore the factors influencing intentions to use library social media marketing accounts from users’ perspectives to help libraries use social media to provide targeted information services to users to meet their information needs.

Design/methodology/approach

This study is based on the technology acceptance model and theory of planned behaviour and uses WeChat as an example to build the model of factors influencing intentions to use library social media marketing accounts. It takes college students as the research object, performing empirical research through questionnaire surveys and structural equation modeling.

Findings

The results show that attitude, subjective norm and perceived behaviour control have a significant positive impact on library social media marketing – attitude exerts the most significant effect while the impact of perceived usefulness is nonsignificant. Notably, attitude completely mediates perceived usefulness and use intention, while perceived usefulness partially mediates perceived ease of use and attitude. However, birthplace plays a negative moderating role between attitudes and use intention.

Originality/value

This study integrates the theory of planned behaviour and technology acceptance model, discusses the factors influencing intentions to use library social media marketing accounts from the users’ perspectives and proposes strategies and methods for the optimization of library social media marketing. The study helps enhance the effects of library social media marketing by improving the comprehension of current circumstances and influencing factors relevant to this issue.

Pulsatile Trabecular Meshwork Motion: An Indicator of Intraocular Pressure Control in Primary Open-Angle Glaucoma

(1) Background: To investigate the value of pulsatile trabecular meshwork (TM) motion in predicting the diurnal intraocular pressure (IOP) fluctuation of primary open-angle glaucoma (POAG). (2) Methods: This cross-sectional study recruited 20 normal patients and 30 patients with POAG. Of the POAG group, 20 had stable diurnal IOP and 10 had high IOP fluctuation. A clinical prototype phase-sensitive optical coherence tomography (PhS-OCT) model was used to measure TM pulsatile motion with maximum velocity (MV) and cumulative displacement (CDisp). (3) Results: MV and CDisp were higher in the external region in both normal and POAG patients. All MV and CDisp reduced significantly in the POAG group (p < 0.001). In the POAG group, except MV in the external region (p = 0.085), MV and CDisp in the nasal area were significantly higher than those in the temporal area (p < 0.05). The MV and CDisp in the external region in the nasal area of POAG patients with high IOP fluctuation were much lower than those with stable IOP (pEMV3 = 0.031, pECDisp3 < 0.001); (4) Conclusions: Pulsatile TM motion reduced in POAG patients relevant to the level of diurnal IOP fluctuation. This study presents the segmental variance of TM stiffness in human living eyes and suggests the clinical potential of the measurement of pulsatile TM motion with PhS-OCT for the evaluation of diurnal IOP fluctuation.

Valve-Like Outflow System Behavior With Motion Slowing in Glaucoma Eyes: Findings Using a Minimally Invasive Glaucoma Surgery–MIGS-Like Platform and Optical Coherence Tomography Imaging

Purpose

This study aimed to investigate anatomic relationships and biomechanics of pressure-dependent trabecular meshwork and distal valve-like structure deformation in normal and glaucoma eyes using high-resolution optical coherence tomography (HR-OCT).

Methods

We controlled Schlemm’s canal (SC) pressure during imaging with HR-OCT in segments of three normal (NL) and five glaucomatous (GL) ex vivo eyes. The dissected limbal wedges were studied from 15 locations (5 NL and 10 GL). A minimally invasive glaucoma surgery (MIGS)-like cannula was inserted into the SC lumen, whereas the other end was attached to a switch between two reservoirs, one at 0, the other at 30 mm Hg. A steady-state pressure of 30 mm Hg was maintained to dilate SC and collector channels (CC) during 3D volume imaging. The resulting 3D lumen surface relationships were correlated with internal structural features using an image mask that excluded tissues surrounding SC and CC. While imaging with HR-OCT, real-time motion responses in SC and CC areas were captured by switching pressure from 0 to 30 or 30 to 0 mm Hg. NL vs. GL motion differences were compared.

Results

Lumen surface and internal relationships were successfully imaged. We identified SC inlet and outlet valve-like structures. In NL and GL, the mean SC areas measured at the steady-state of 0 and 30 mm Hg were each significantly different (p &lt; 0.0001). Synchronous changes in SC and CC lumen areas occurred in &lt;200 ms. Measured SC area differences at the steady-state 0 and 30 mmHg, respectively, were larger in NL than GL eyes (p &lt; 0.0001). The SC motion curves rose significantly more slowly in GL than NL (p &lt; 0.001). Pressure waves traveled from the cannula end along the SC lumen to CC and deep intrascleral channels.

Conclusion

HR-OCT provided simultaneous measurements of outflow pathway lumen surfaces, internal structures, and biomechanics of real-time pressure-dependent dimension changes. We identified SC inlet and outlet valve-like structures. GL tissues underwent less motion and responded more slowly than NL, consistent with increased tissue stiffness. A MIGS-like shunt to SC permitted pulse waves to travel distally along SC lumen and into CC.

Prelithiation Reagents and Strategies on High Energy Lithium-Ion Batteries

Lithium-ion batteries (LIBs) have been widely employed in energy-storage applications owing to the relatively higher energy density and longer cycling life. However, they still need further improvement especially on the energy density to satisfy the increasing demands on the market. In this respect, the irreversible capacity loss (ICL) in the initial cycle is a critical challenge due to the lithium loss during the formation of solid electrolyte interphase (SEI) layer on the anode surface. The strategy of prelithiation was then proposed to compensate for the ICL in the anode and recover the energy density. Here, various methods of the prelithiation are summarized and classified according to the basic working mechanism. Further, considering the critical importance and promising progress of prelithiation in both fundamental research and real applications, this Review article is intended to discuss the considerations involved in the selection of prelithiation reagents/strategies and the electrochemical performance in full-cells. Moreover, insights are provided regarding the practical application prospects and the challenges that still need to be addressed.

Refractive Lens Exchange Surgery in Early-Onset High Myopia Patients With Partial Cataract

Purpose

By reporting clinical characteristics and retinal image quality before and after refractive lens replacement surgery in early-onset high myopia (eoHM) patients presenting with partial cataract, we emphasized the need for an objective way to grade the severity of partial cataracts.

Methods

This retrospective, consecutive case series included six Chinese patients (nine eyes). Analysis of previous medical records, visual acuity, optometry, retinal image quality, and axial length (AXL) before surgery and after surgery was performed.

Results

Five females and one male (nine eyes) with a mean (± SD) age of 11.6 ± 7.9 years (range: 4–25 years) were included in this study. The preoperative spherical power ranged from −7.5 to −42 D. The mean follow-up time was 36 months (range: 24–48 months). Phacoemulsification was followed by in-the-bag implantation of intraocular lens. For patients who were under 6 years old, posterior capsulotomy + anterior vitrectomy were performed simultaneously. All surgeries were uneventful and no postoperative complications occurred during the entire follow-up period. All patients’ uncorrected visual acuity improved by ≥2 lines postoperatively(Snellen acuity). LogMAR best-corrected visual acuity was improved at 24-month (P = 0.042) and endpoint (P = 0.046) follow-ups. Modulation transfer function cutoff frequency (MTF_cutoff) and objective scatter index (OSI) was significantly improved at 12-month (P = 0.025, P = 0.038), 24-month (P = 0.005, P = 0.007) and endpoint (P = 0.005, P = 0.008) follow-ups. Postoperative AXL remained stable during 2–4 year follow-ups (P > 0.05).

Conclusion

Refractive lens replacement surgery is safe and effective for improving functional vision in eoHM patients presenting with partial cataract. Retinal image quality could provide a useful and objective way to facilitate partial cataract severity evaluation and surgery decision making.

A Prospective Study of Intraocular Pressure Spike and Failure After Gonioscopy-Assisted Transluminal Trabeculotomy in Juvenile Open-Angle Glaucoma: A Prospective Study of GATT in JOAG

PURPOSE

To identify risk factors for surgical failure after gonioscopy-assisted transluminal trabeculotomy (GATT) in juvenile open-angle glaucoma (JOAG).

DESIGN

Prospective, interventional case series.

METHODS

GATT was the initial surgery in 70 eyes of 70 patients with JOAG. Surgical success was defined as a postoperative intraocular pressure (IOP) of ≤21 mm Hg with at least a 20% reduction from preoperative IOP, with or without the use of antiglaucoma medication (qualified and complete success, respectively) at each postoperative visit. IOP spike was defined as IOP >30 mm Hg and an increase of at least 10 mm Hg from IOP before the spike, and then reduced to ≤21 mm Hg.

RESULTS

The median age at the time of surgery was 19.3 years (range, 4.9-37.5 years) with a visual field mean deviation of -17.4 ± 10.6 dB. Mean IOP decreased from 31.3 ± 9.5 mm Hg preoperatively to 15.8 ± 2.7 at 12 months postoperatively. The complete and qualified success rates were 74.3% and 91.4%, respectively. An IOP spike occurred in 52 eyes (74%), with a median spike duration of 3.5 days (range, 1-21 days). Longer duration of IOP spike (P = .009) and older age at the time of surgery (P = .025) were both associated with worse surgical outcomes. Advanced disease was associated with prolonged IOP spike (P = .007).

CONCLUSIONS

GATT provided excellent outcomes in patients with severe JOAG. Older age and longer duration of postoperative IOP spike are risk factors for failure. Severe cases are more likely to have longer durations of IOP spike. Frequent IOP monitoring during the early postoperative period is needed to detect IOP spikes in these patients.

Retracted “Effect of bifidobacteria on intestinal injury and flora in a mouse model of ulcerative colitis”

No Abstract.

Consensus Recommendation for Mouse Models of Ocular Hypertension to Study Aqueous Humor Outflow and Its Mechanisms

Due to their similarities in anatomy, physiology, and pharmacology to humans, mice are a valuable model system to study the generation and mechanisms modulating conventional outflow resistance and thus intraocular pressure. In addition, mouse models are critical for understanding the complex nature of conventional outflow homeostasis and dysfunction that results in ocular hypertension. In this review, we describe a set of minimum acceptable standards for developing, characterizing, and utilizing mouse models of open-angle ocular hypertension. We expect that this set of standard practices will increase scientific rigor when using mouse models and will better enable researchers to replicate and build upon previous findings.

Development of a Clinical Decision Support System to Predict Unplanned Cancer Readmissions

Unplanned 30-day cancer readmissions are an important outcome of cancer hospitalization and can significantly raise mortality rates and costs for both the patient and the hospital. This paper aimed to develop a predictive model using machine learning and electronic health records to predict unplanned 30-day cancer readmissions and further develop it as a clinical decision support system. The three-stage study design followed the 2022 AMIA Artificial Intelligence Evaluation Showcase. In the first stage, the technical performance of the model was determined (81% of AUROC) and contributing factors were identified. In the second stage, the technical feasibility and workflow considerations of using such a predictive model were explored through semi-structured interviews. In the third stage, a decision tree analysis and a cost estimation showed that the model can reduce unplanned readmissions significantly if timely action is taken and that preventing a single readmission may significantly reduce costs.