Skeletal muscle regeneration with 3D bioprinted hyaluronate/gelatin hydrogels incorporating MXene nanoparticles

There has been significant progress in the field of three-dimensional (3D) bioprinting technology, leading to active research on creating bioinks capable of producing structurally and functionally tissue-mimetic constructs. Ti3C2Tx MXene nanoparticles (NPs), promising two-dimensional nanomaterials, are being investigated for their potential in muscle regeneration due to their unique physicochemical properties. In this study, we integrated MXene NPs into composite hydrogels made of gelatin methacryloyl (GelMA) and hyaluronic acid methacryloyl (HAMA) to develop bioinks (namely, GHM bioink) that promote myogenesis. The prepared GHM bioinks were found to offer excellent printability with structural integrity, cytocompatibility, and microporosity. Additionally, MXene NPs within the 3D bioprinted constructs encouraged the differentiation of C2C12 cells into skeletal muscle cells without additional support of myogenic agents. Genetic analysis indicated that representative myogenic markers both for early and late myogenesis were significantly up-regulated. Moreover, animal studies demonstrated that GHM bioinks contributed to enhanced regeneration of skeletal muscle while reducing immune responses in mice models with volumetric muscle loss (VML). Our results suggest that the GHM hydrogel can be exploited to craft a range of strategies for the development of a novel bioink to facilitate skeletal muscle regeneration because these MXene-incorporated composite materials have the potential to promote myogenesis.

Regulated Behavior in Living Cells with Highly Aligned Configurations on Nanowrinkled Graphene Oxide Substrates: Deep Learning Based on Interplay of Cellular Contact Guidance

Micro-/nanotopographical cues have emerged as a practical and promising strategy for controlling cell fate and reprogramming, which play a key role as biophysical regulators in diverse cellular processes and behaviors. Extracellular biophysical factors can trigger intracellular physiological signaling via mechanotransduction and promote cellular responses such as cell adhesion, migration, proliferation, gene/protein expression, and differentiation. Here, we engineered a highly ordered nanowrinkled graphene oxide (GO) surface via the mechanical deformation of an ultrathin GO film on an elastomeric substrate to observe specific cellular responses based on surface-mediated topographical cues. The ultrathin GO film on the uniaxially prestrained elastomeric substrate through self-assembly and subsequent compressive force produced GO nanowrinkles with periodic amplitude. To examine the acute cellular behaviors on the GO-based cell interface with nanostructured arrays of wrinkles, we cultured L929 fibroblasts and HT22 hippocampal neuronal cells. As a result, our developed cell-culture substrate obviously provided a directional guidance effect. In addition, based on the observed results, we adapted a deep learning (DL)-based data processing technique to precisely interpret the cell behaviors on the nanowrinkled GO surfaces. According to the learning/transfer learning protocol of the DL network, we detected cell boundaries, elongation, and orientation and quantitatively evaluated cell velocity, traveling distance, displacement, and orientation. The presented experimental results have intriguing implications such that the nanotopographical microenvironment could engineer the living cells' morphological polarization to assemble them into useful tissue chips consisting of multiple cell types.

Highly Aligned Ternary Nanofiber Matrices Loaded with MXene Expedite Regeneration of Volumetric Muscle Loss

Current therapeutic approaches for volumetric muscle loss (VML) face challenges due to limited graft availability and insufficient bioactivities. To overcome these limitations, tissue-engineered scaffolds have emerged as a promising alternative. In this study, we developed aligned ternary nanofibrous matrices comprised of poly(lactide-co-ε-caprolactone) integrated with collagen and Ti3C2Tx MXene nanoparticles (NPs) (PCM matrices), and explored their myogenic potential for skeletal muscle tissue regeneration. The PCM matrices demonstrated favorable physicochemical properties, including structural uniformity, alignment, microporosity, and hydrophilicity. In vitro assays revealed that the PCM matrices promoted cellular behaviors and myogenic differentiation of C2C12 myoblasts. Moreover, in vivo experiments demonstrated enhanced muscle remodeling and recovery in mice treated with PCM matrices following VML injury. Mechanistic insights from next-generation sequencing revealed that MXene NPs facilitated protein and ion availability within PCM matrices, leading to elevated intracellular Ca2+ levels in myoblasts through the activation of inducible nitric oxide synthase (iNOS) and serum/glucocorticoid regulated kinase 1 (SGK1), ultimately promoting myogenic differentiation via the mTOR-AKT pathway. Additionally, upregulated iNOS and increased NO- contributed to myoblast proliferation and fiber fusion, thereby facilitating overall myoblast maturation. These findings underscore the potential of MXene NPs loaded within highly aligned matrices as therapeutic agents to promote skeletal muscle tissue recovery.

Laser-Assisted Structuring of Graphene Films with Biocompatible Liquid Crystal Polymer for Skin/Brain-Interfaced Electrodes

The work presented here introduces a facile strategy for the development of flexible and stretchable electrodes that harness the robust characteristics of carbon nanomaterials through laser processing techniques on a liquid crystal polymer (LCP) film. By utilizing LCP film as a biocompatible electronic substrate, control is demonstrated over the laser irradiation parameters to achieve efficient pattern generation and transfer printing processes, thereby yielding highly conductive laser-induced graphene (LIG) bioelectrodes. To enhance the resolution of the patterned LIG film, shadow masks are employed during laser scanning on the LCP film surface. This approach is compatible with surface-mounted device integration, enabling the circuit writing of LIG/LCP materials in a flexible format. Moreover, kirigami-inspired on-skin bioelectrodes are introduced that exhibit reasonable stretchability, enabling independent connections to healthcare hardware platforms for electrocardiogram (ECG) and electromyography (EMG) measurements. Additionally, a brain-interfaced LIG microelectrode array is proposed that combines mechanically compliant architectures with LCP encapsulation for stimulation and recording purposes, leveraging their advantageous structural features and superior electrochemical properties. This developed approach offers a cost-effective and scalable route for producing patterned arrays of laser-converted graphene as bioelectrodes. These bioelectrodes serve as ideal circuit-enabled flexible substrates with long-term reliability in the ionic environment of the human body.

Mobile Point-of-Care Device Using Molecularly Imprinted Polymer-Based Chemosensors Targeting Interleukin-1β Biomarker

Molecularly imprinted polymers (MIPs) have garnered significant attention as a promising material for engineering specific biological receptors with superior chemical complementarity to target molecules. In this study, we present an electrochemical biosensing platform incorporating MIP films for the selective detection of the interleukin-1β (IL-1β) biomarker, particularly suitable for mobile point-of-care testing (POCT) applications. The IL-1β-imprinted biosensors were composed of poly(eriochrome black T (EBT)), including an interlayer of poly(3,4-ethylene dioxythiophene) and a 4-aminothiophenol monolayer, which were electrochemically polymerized simultaneously with template proteins (i.e., IL-1β) on custom flexible screen-printed carbon electrodes (SPCEs). The architecture of the MIP films was designed to enhance the sensor sensitivity and signal stability. This approach involved a straightforward sequential-electropolymerization process and extraction for leaving behind cavities (i.e., rebinding sites), resulting in the efficient production of MIP-based biosensors capable of molecular recognition for selective IL-1β detection. The electrochemical behaviors were comprehensively investigated using cyclic voltammograms and electrochemical impedance spectroscopy responses to assess the imprinting effect on the MIP films formed on the SPCEs. In line with the current trend in in vitro diagnostic medical devices, our simple and effective MIP-based analytical system integrated with mobile POCT devices offers a promising route to the rapid detection of biomarkers, with particular potential for periodontitis screening.

Spontaneous Osteogenic Differentiation of Human Mesenchymal Stem Cells by Tuna-Bone-Derived Hydroxyapatite Composites with Green Tea Polyphenol-Reduced Graphene Oxide

In recent years, bone tissue engineering (BTE) has made significant progress in promoting the direct and functional connection between bone and graft, including osseointegration and osteoconduction, to facilitate the healing of damaged bone tissues. Herein, we introduce a new, environmentally friendly, and cost-effective method for synthesizing reduced graphene oxide (rGO) and hydroxyapatite (HAp). The method uses epigallocatechin-3-O-gallate (EGCG) as a reducing agent to synthesize rGO (E-rGO), and HAp powder is obtained from Atlantic bluefin tuna (Thunnus thynnus). The physicochemical analysis indicated that the E-rGO/HAp composites had exceptional properties for use as BTE scaffolds, as well as high purity. Moreover, we discovered that E-rGO/HAp composites facilitated not only the proliferation, but also early and late osteogenic differentiation of human mesenchymal stem cells (hMSCs). Our work suggests that E-rGO/HAp composites may play a significant role in promoting the spontaneous osteogenic differentiation of hMSCs, and we envision that E-rGO/HAp composites could serve as promising candidates for BTE scaffolds, stem-cell differentiation stimulators, and implantable device components because of their biocompatible and bioactive properties. Overall, we suggest a new approach for developing cost-effective and environmentally friendly E-rGO/HAp composite materials for BTE application.

Strain-tunable optical microlens arrays with deformable wrinkles for spatially coordinated image projection on a security substrate

As a new concept in materials design, a variety of strategies have been developed to fabricate optical microlens arrays (MLAs) that enable the miniaturization of optical systems on the micro/nanoscale to improve their characteristic performance with unique optical functionality. In this paper, we introduce a cost-effective and facile fabrication process on a large scale up to ~15 inches via sequential lithographic methods to produce thin and deformable hexagonally arranged MLAs consisting of polydimethylsiloxane (PDMS). Simple employment of oxygen plasma treatment on the prestrained MLAs effectively harnessed the spontaneous formation of highly uniform nanowrinkled structures all over the surface of the elastomeric microlenses. With strain-controlled tunability, unexpected optical diffraction patterns were characterized by the interference combination effect of the microlens and deformable nanowrinkles. Consequently, the hierarchically structured MLAs presented here have the potential to produce desirable spatial arrangements, which may provide easily accessible opportunities to realize microlens-based technology by tunable focal lengths for more advanced micro-optical devices and imaging projection elements on unconventional security substrates.

Surface-mediated high antioxidant and anti-inflammatory effects of astaxanthin-loaded ultrathin graphene oxide film that inhibits the overproduction of intracellular reactive oxygen species

Background

Astaxanthin (AST) is known as a powerful antioxidant that affects the removal of active oxygen and inhibits the production of lipid peroxide caused by ultraviolet light. However, it is easily decomposed by heat or light during production and storage because of the unsaturated compound nature with a structural double bond. The activity of AST can be reduced and lose its antioxidant capability. Graphene oxide (GO) is an ultrathin nanomaterial produced by oxidizing layered graphite. The chemical combination of AST with GO can improve the dispersion properties to maintain structural stability and antioxidant activity because of the tightly bonded functionalized GO surface.

Methods

Layered GO films were used as nanocarriers for the AST molecule, which was produced via flow-enabled self-assembly and subsequent controlled solution deposition of RGD peptide and AST molecules. Synthesis of the GO-AST complex was also carried out for the optimized concentration. The characterization of prepared materials was analyzed through transmission electron microscopy (TEM), scanning electron microscope (SEM), Fourier-transform infrared spectroscopy (FT-IR), atomic force microscope (AFM), and Raman spectroscopy. Antioxidant activity was tested by 2,2′-azino-bis(3-ethylbenzothiazoline-6-sulfonic acid) (ABTS) and 2.2-diphenyl-1-picrylhydrazyl (DPPH) assays. The antibacterial effect and antioxidant effects were monitored for the ultrathin GO/RGD/AST Film. Further, reactive oxygen species (ROS) assay was used to evaluate the anti-inflammatory effects on L-929 fibroblasts.

Results

Cotreatment of GO-AST solution demonstrated a high antioxidant combined effect with a high ABTS and DPPH radicals scavenging activity. The GO/RGD/AST film was produced by the self-assembly process exhibited excellent antibacterial effects based on physicochemical damage against E. coli and S. aureus. In addition, the GO/RGD/AST film inhibited H₂O₂-induced intracellular ROS, suppressed the toxicity of lipopolysaccharide (LPS)-induced cells, and restored it, thereby exhibiting strong antioxidant and anti-inflammatory effects.

Conclusion

As GO nanocarrier-assisted AST exerted promising antioxidant and antibacterial reactions, presented a new concept to expand basic research into the field of tissue engineering.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40824-022-00276-4.

Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

BACKGROUND

Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications.

METHODS

We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC).

FINDINGS

In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]).

INTERPRETATION

In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required.

FUNDING

British Journal of Surgery Society.

Recent Advances of Point-of-Care Devices Integrated with Molecularly Imprinted Polymers-Based Biosensors: From Biomolecule Sensing Design to Intraoral Fluid Testing

Recent developments of point-of-care testing (POCT) and in vitro diagnostic medical devices have provided analytical capabilities and reliable diagnostic results for rapid access at or near the patient's location. Nevertheless, the challenges of reliable diagnosis still remain an important factor in actual clinical trials before on-site medical treatment and making clinical decisions. New classes of POCT devices depict precise diagnostic technologies that can detect biomarkers in biofluids such as sweat, tears, saliva or urine. The introduction of a novel molecularly imprinted polymer (MIP) system as an artificial bioreceptor for the POCT devices could be one of the emerging candidates to improve the analytical performance along with physicochemical stability when used in harsh environments. Here, we review the potential availability of MIP-based biorecognition systems as custom artificial receptors with high selectivity and chemical affinity for specific molecules. Further developments to the progress of advanced MIP technology for biomolecule recognition are introduced. Finally, to improve the POCT-based diagnostic system, we summarized the perspectives for high expandability to MIP-based periodontal diagnosis and the future directions of MIP-based biosensors as a wearable format.

Phenotypic change of mesenchymal stem cells into smooth muscle cells regulated by dynamic cell-surface interactions on patterned arrays of ultrathin graphene oxide substrates

The topographical interface of the extracellular environment has been appreciated as a principal biophysical regulator for modulating cell functions, such as adhesion, migration, proliferation, and differentiation. Despite the existed approaches that use two-dimensional nanomaterials to provide beneficial effects, opportunities evaluating their impact on stem cells remain open to elicit unprecedented cellular responses. Herein, we report an ultrathin cell-culture platform with potential-responsive nanoscale biointerfaces for monitoring mesenchymal stem cells (MSCs). We designed an intriguing nanostructured array through self-assembly of graphene oxide sheets and subsequent lithographical patterning method to produce chemophysically defined regions. MSCs cultured on anisotropic micro/nanoscale patterned substrate were spontaneously organized in a highly ordered configuration mainly due to the cell-repellent interactions. Moreover, the spatially aligned MSCs were spontaneously differentiated into smooth muscle cells upon the specific crosstalk between cells. This work provides a robust strategy for directing stem cells and differentiation, which can be utilized as a potential cell culture platform to understand cell-substrate or cell-cell interactions, further developing tissue repair and stem cell-based therapies.

Rotating Cylinder-Assisted Nanoimprint Lithography for Enhanced Chemisorbable Filtration Complemented by Molecularly Imprinted Polymers

Rotating cylindrical stamp-based nanoimprint technique has many advantages, including the continuous fabrication of intriguing micro/nanostructures and rapid pattern transfer on a large scale. Despite these advantages, the previous nanoimprint lithography has rarely been used for producing sophisticated nanoscale patterns on a non-planar substrate that has many extended applications. Here, the simple integration of nanoimprinting process with a help of a transparent stamp wrapped on the cylindrical roll and UV optical source in the core to enable high-throughput pattern transfer, particularly on a fabric substrate is demonstrated. Moreover, as a functional resin material, this innovative strategy involves a synergistic approach on the synthesis of molecularly imprinted polymer, which are spatially organized free-standing perforated nanostructures such as nano/microscale lines, posts, and holes patterns on various woven or nonwoven blank substrates. The proposed materials can serve as a self-encoded filtration medium for selective separation of formaldehyde molecules. It is envisioned that the combinatorial fabrication process and attractive material paves the way for designing next-generation separation systems in use to capture industrial or household toxic substances.

Role for colorectal teams to support non-colorectal teams to improve clinical outcomes and adherence to ERAS guidelines for segmental colectomy: a cohort study

Background

To identify whether compliance with Enhanced Recovery After Surgery (ERAS) Society recommendations is associated with length of stay (LOS) in a New Zealand hospital for patients undergoing segmental colectomy in mixed acute and elective general surgery wards.

Methods

Consecutive elective colorectal surgeries (n = 770) between October 2012 and February 2019 were audited. Patients with non-segmental colectomies, multi-organ surgeries, LOS > 14 days, and those who died were excluded. Logistic regression was used to determine the relationship between patient demographics, compliance with ERAS guidelines, and suboptimal LOS (> 4 days).

Results

Analysis included 376 patients. Age, surgery prior to 2014, surgical approach, non-colorectal surgical team, operation type, and complications were significantly associated with suboptimal LOS. Non-compliance with ERAS recommendations for laparoscopy [OR 8.9, 95% CI (4.52, 19.67)], removal of indwelling catheters (IDC) [OR 3.14, 95% CI (1.85, 5.51)], use of abdominal drains [OR 4.27, 95% CI (0.99, 18.35)], and removal of PCA [OR 8.71, 95% CI (1.78, 157.27)], were associated with suboptimal LOS (univariable analysis). Multivariable analysis showed that age, surgical team, late removal of IDC, and open approach were independent predictors of suboptimal LOS.

Conclusions

Non-compliance with ERAS guidelines for laparoscopic approach and early removal of IDC was higher among procedures performed by non-colorectal surgery teams, and was also associated with adverse postoperative events and suboptimal LOS. This study demonstrates the importance of the surgical team’s expertise in affecting surgical outcomes, and did not find significant independent associations between most individual ERAS guidelines and suboptimal LOS once adjusting for other factors.

Cutaneous paraneoplastic syndrome associated with anal squamous cell carcinoma: a rare presentation of an uncommon cancer

Paraneoplastic syndromes associated with anal squamous cell carcinoma (scc) are rare. Erythema gyratum repens (egr) is a cutaneous paraneoplastic syndrome with distinctive characteristics. Here, we report the rare case of a 73-year-old woman with a chronic erythematous rash for 11 months associated with intense pruritus. She was treated with prednisone and antihistamines by dermatologists, but did not respond. The patient was subsequently seen in our clinic for unintentional weight loss and anorexia with intermittent nausea and vomiting. During further evaluation with imaging studies, upper endoscopy, and colonoscopy with biopsy, poorly differentiated anal scc was identified. Biopsies of the skin rash were characteristic of egr. She was treated using concurrent chemotherapy with 5-fluorouracil and mitomycin C and pelvic radiation (50.4 Gy in 28 fractions) for anal scc. She tolerated the treatment, and her rash faded, with resolution of the pruritus.

AB0598 THE INCREASING USE OF IMMUNOSUPPRESSANTS IN EARLY SYSTEMIC SCLEROSIS

Background:

Immunosuppression (IS) remains the main treatment for progressing skin involvement, active interstitial lung disease (ILD) and underlying inflammatory joint (IJ) or muscle disease in systemic sclerosis (SSc).

Objectives:

This study investigated the pattern and trends in immunosuppressive agent use in patients with early SSc diagnosed before and after 2007 to determine whether the changes in the preferred type and combination of IS, timing and predictors of administration took place over the past decade.

Methods:

397 SSc patients from Canadian Scleroderma Research Group (CSRG) database (183dcSSc, 214 lcSSc) who had baseline and follow-up visits within 3 years (1.8±0.8) after disease onset were included: 82% females, age at diagnosis 53±13 years, disease duration 1.6±0.8 years. Organ involvement was assessed by modified Rodnan skin score, Medsger Disease Severity Score (DSS) and CSRG definitions using bivariate, chi-squared, ANOVA, and adjusted regression analyses.

Results:

115 dcSSc patients (63%) and 62 lcSSc (29%) received IS, most commonly methotrexate (MTX) (72% dcSSc and 52% lcSSc), followed by mycophenylate mofetil (MMF) and cyclophosphamide (CYC). Within the patients receiving IS, monotherapy prevailed (77% dcSSc and 68% lcSSc); CYC and azathioprine were the preferred choice of IS more frequently in lcSSc compared to dcSSc (p<0.006 and p<0.02, respectively). In dcSSc, IS were predominantly prescribed at years 2 and 3 after the onset of first non-Raynaud’s phenomenon (RP) manifestation, when about half of the patients received IS. The proportion of lcSSc patients receiving IS was significantly lower and distributed more equally through the first three years. After 2007, dcSSc patients received IS more often (74% vs 50%, p=0.001), especially MTX (p=0.02) and MMF (p<0.05), and earlier (peaked at 2 years after disease onset)(Table 1).

Table 1.

Proportion of patients receiving immunosuppressive treatment at each year after disease onset in SSc diagnosed before and after 2007.

Years after the first non-RP symptomlcSScBefore 2007After 2007Total N of pts seen at each year% receiving immune suppressivesTotal N of pts seen at each year% receiving immune suppressivesP-value113154717>0.92242182180.7723491410714>0.9dcSSc1242940430.2862512665650.00013624563540.325

IS administration was associated with male gender, ILD, a-Scl-70 positivity, ACA-negativity and IJ disease in lcSSc, and with ACA-negativity and a higher mRSS in dcSSc. Multivariate logistic regression analysis showed that IS treatment could be predicted by ACA-negativity in lcSSc patients (Exp(B) 0.317, p=0.012) and younger age in dcSSc patients (Exp(B) 0.974, p=0.002).

Conclusion:

Over the past decade, there has been a trend to prescribe IS more often, especially MTX, and earlier in dcSSc patients. MMF has gained favour over CYC. Autoantibody status was the most consistent predictor whether a patient is likely to take IS over the course of the disease.

Disclosure of Interests:

Ryan Park: None declared, Tatiana Nevskaya: None declared, Murray Baron: None declared, Janet Pope Grant/research support from: AbbVie, Bristol-Myers Squibb, Eli Lilly & Company, Merck, Roche, Seattle Genetics, UCB, Consultant of: AbbVie, Actelion, Amgen, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Eicos Sciences, Eli Lilly & Company, Emerald, Gilead Sciences, Inc., Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, UCB, Speakers bureau: UCB

One-Step Laser Patterned Highly Uniform Reduced Graphene Oxide Thin Films for Circuit-Enabled Tattoo and Flexible Humidity Sensor Application

The conversion of graphene oxide (GO) into reduced graphene oxide (rGO) is imperative for the electronic device applications of graphene-based materials. Efficient and cost-effective fabrication of highly uniform GO films and the successive reduction into rGO on a large area is still a cumbersome task through conventional protocols. Improved film casting of GO sheets on a polymeric substrate with quick and green reduction processes has a potential that may establish a path to the practical flexible electronics. Herein, we report a facile deposition process of GO on flexible polymer substrates to create highly uniform thin films over a large area by a flow-enabled self-assembly approach. The self-assembly of GO sheets was successfully performed by dragging the trapped solution of GO in confined geometry, which consisted of an upper stationary blade and a lower moving substrate on a motorized translational stage. The prepared GO thin films could be selectively reduced and facilitated from the simple laser direct writing process for programmable circuit printing with the desired configuration and less sample damage due to the non-contact mode operation without the use of photolithography, toxic chemistry, or high-temperature reduction methods. Furthermore, two different modes of the laser operating system for the reduction of GO films turned out to be valuable for the construction of novel graphene-based high-throughput electrical circuit boards compatible with integrating electronic module chips and flexible humidity sensors.

Abdominoplasty in Prune Belly Syndrome

INTRODUCTION

Many patients with Prune Belly Syndrome (PBS) require abdominoplasty alone or in combination with correction of any urogenital abnormalities. This video presents a simplified technique with which to treat the abdominal flaccidity in PBS.

METHODS

A longitudinal xypho-pubic fusiform figure is drawn on the abdomen, based on the area of skin and subcutaneous tissue to be removed. This is performed with preservation of the musculo-fascial layer and the umbilicus. A lateral elliptical single xypho-pubic line is drawn in the most lax side of the fascia, which is incised along this line. After urinary tract reconstruction and orchidopexy, closure is initiated by suturing the medial edge of the wider fascial flap laterally to the peritoneal side of the contralateral flap. Next, the now outer fascial flap is laid over the inner flap, and a buttonhole is made to expose the umbilicus. The subcutaneous tissue of the inner flap is laterally undermined to gain extra distance for the suture of the outer flap over the inner flap. The subcutaneous tissue and skin are sutured in the midline, incorporating the umbilicus.

RESULTS

In a 30-year period, 43 PBS patients underwent this procedure with good cosmetic and long-term functional results.

CONCLUSION

This abdominoplasty technique is simple and presents good functional and cosmetic results in PBS patients.

Rubi Fructus (Rubus coreanus) activates the expression of thermogenic genes in vivo and in vitro

OBJECTIVE

To investigate the anti-obesity effect of Rubi Fructus (RF) extract using brown adipose tissue (BAT) and primary brown preadipocytes in vivo and in vitro.

METHODS

Male C57BL/6 J mice (n=5 per group) were fed a high-fat diet (HFD) for 10 weeks with or without RF. Brown preadipocytes from the interscapular BAT of mice (age, post-natal days 1-3) were cultured with differentiation media (DM) including isobutylmethylxanthine, dexamethasone, T3, indomethacin and insulin with or without RF.

RESULTS

In HFD-induced obese C57BL/6 J mice, long-term RF treatment significantly reduced weight gain as well as the weights of the white adipose tissue, liver and spleen. Serum levels of total cholesterol and low-density lipoprotein cholesterol were also reduced in the HFD group which received RF treatment. Furthermore, RF induced thermogenic-, adipogenic- and mitochondria-related gene expressions in BAT. In primary brown adipocytes, RF effectively stimulated the expressions of thermogenic- and mitochondria-related genes. In addition, to examine whether LIPIN1, a regulator of adipocyte differentiation, is regulated by RF, Lipin1 small interfering RNA (siRNA) and RF were pretreated in primary brown adipocytes. Pretreatment with Lipin1 siRNA and RF downregulated the DM-induced expression levels of thermogenic- and mitochondria-related genes. Moreover, RF markedly upregulated AMP-activated protein kinase. Our study shows that RF is capable of stimulating the differentiation of brown adipocytes through the modulation of thermogenic genes.

CONCLUSIONS

This study demonstrates that RF prevents the development of obesity in mice fed with a HFD and that it is also capable of stimulating the differentiation of brown adipocytes through the modulation of thermogenic genes, which suggests that RF has potential as a therapeutic application for the treatment or prevention of obesity.

Augmentation of NAD(+) by NQO1 attenuates cisplatin-mediated hearing impairment

Cisplatin (cis-diaminedichloroplatinum-II) is an extensively used chemotherapeutic agent, and one of its most adverse effects is ototoxicity. A number of studies have demonstrated that these effects are related to oxidative stress and DNA damage. However, the precise mechanism underlying cisplatin-associated ototoxicity is still unclear. The cofactor nicotinamide adenine dinucleotide (NAD(+)) has emerged as a key regulator of cellular energy metabolism and homeostasis. Here, we demonstrate for the first time that, in cisplatin-mediated ototoxicity, the levels and activities of SIRT1 are suppressed by the reduction of intracellular NAD(+) levels. We provide evidence that the decrease in SIRT1 activity and expression facilitated by increasing poly(ADP-ribose) transferase (PARP)-1 activation and microRNA-34a through p53 activation aggravates cisplatin-mediated ototoxicity. Moreover, we show that the induction of cellular NAD(+) levels using β-lapachone (β-Lap), whose intracellular target is NQO1, prevents the toxic effects of cisplatin through the regulation of PARP-1 and SIRT1 activity. These results suggest that direct modulation of cellular NAD(+) levels by pharmacological agents could be a promising therapeutic approach for protection from cisplatin-induced ototoxicity.

Crucial role of calbindin-D28k in the pathogenesis of Alzheimer's disease mouse model

Calbindin-D_28k (CB), one of the major calcium-binding and buffering proteins, has a critical role in preventing a neuronal death as well as maintaining calcium homeostasis. Although marked reductions of CB expression have been observed in the brains of mice and humans with Alzheimer disease (AD), it is unknown whether these changes contribute to AD-related dysfunction. To determine the pathogenic importance of CB depletions in AD models, we crossed 5 familial AD mutations (5XFAD; Tg) mice with CB knock-out (CBKO) mice and generated a novel line CBKO·5XFAD (CBKOTg) mice. We first identified the change of signaling pathways and differentially expressed proteins globally by removing CB in Tg mice using mass spectrometry and antibody microarray. Immunohistochemistry showed that CBKOTg mice had significant neuronal loss in the subiculum area without changing the magnitude (number) of amyloid β-peptide (Aβ) plaques deposition and elicited significant apoptotic features and mitochondrial dysfunction compared with Tg mice. Moreover, CBKOTg mice reduced levels of phosphorylated mitogen-activated protein kinase (extracellular signal-regulated kinase) 1/2 and cAMP response element-binding protein at Ser-133 and synaptic molecules such as N-methyl-D-aspartate receptor 1 (NMDA receptor 1), NMDA receptor 2A, PSD-95 and synaptophysin in the subiculum compared with Tg mice. Importantly, this is the first experimental evidence that removal of CB from amyloid precursor protein/presenilin transgenic mice aggravates AD pathogenesis, suggesting that CB has a critical role in AD pathogenesis.

In-patient discharge rates for the irritable bowel syndrome - an analysis of national trends in the United States from 1997 to 2010

BACKGROUND

Irritable bowel syndrome (IBS) is one of the most common out-patient diagnoses in primary care and gastroenterology. There are limited data on the rate and costs associated with in-patient discharges for IBS.

AIM

To estimate the incidence and costs of hospital discharges for IBS in the United States.

METHODS

We analysed the National Inpatient Sample database for all subjects in which IBS (ICD-9 code: 564.1) was the principal discharge diagnosis from 1997 to 2010. The National Inpatient Sample contains data from approximately 8 million hospital stays each year. Our findings reflected patient and hospital characteristics like geographical region and bed size.

RESULTS

In 1997, there were 11 433 patients with a principal discharge diagnosis of IBS as compared to 12 842 in 2010 (P > 0.9, GoF test). The mean length of stay for IBS also remained the same between 1997 and 2010 at 3.7 ± 0.1 days. However, during this period, the mean hospital charges per hospitalization increased by 207.8% from $6873 ± 198 in 1997 to $21 153 ± 598 in 2010 (P < 0.01). The aggregate charges (i.e., 'national bill') for IBS increased by 245.5% from $78 524 129 ± 3 781 316 in 1997 to $271 311 405 ± 14 023 289 in 2010 (P < 0.01).

CONCLUSIONS

The number of in-patient discharges and length of stay for IBS have remained relatively stable between 1997 and 2010, whereas the cost associated with these discharges has increased significantly. In-patient costs associated with IBS contribute significantly to the total healthcare bill. Further research on the cost-effectiveness of diagnostic procedures and therapies in IBS is required.

Kinetic quantification of protein polymer nanoparticles using non-invasive imaging

Protein polymers are repetitive amino acid sequences that can assemble monodisperse nanoparticles with potential applications as cancer nanomedicines. Of the currently available molecular imaging methods, positron emission tomography (PET) is the most sensitive and quantitative; therefore, this work explores microPET imaging to track protein polymer nanoparticles over several days. To achieve reliable imaging, the polypeptides were modified by site-specific conjugation using a heterobifunctional sarcophagine chelator, AmBaSar, which was subsequently complexed with (64)Cu. AmBaSar/(64)Cu was selected because it can label particles in vivo over periods of days, which is consistent with the timescales required to follow long-circulating nanotherapeutics. Using an orthotopic model of breast cancer, we observed four elastin-like polypeptides (ELPs)-based protein polymers of varying molecular weight, amino acid sequence, and nanostructure. To analyze this data, we developed a six-compartment image-driven pharmacokinetic model capable of describing their distribution within individual subjects. Surprisingly, the assembly of an ELP block copolymer (78 kD) into nanoparticles (R(h) = 37.5 nm) minimally influences pharmacokinetics or tumor accumulation compared to a free ELP of similar length (74 kD). Instead, ELP molecular weight is the most important factor controlling the fate of these polymers, whereby long ELPs (74 kD) have a heart activity half-life of 8.7 hours and short ELPs (37 kD) have a half-life of 2.1 hours. These results suggest that ELP-based protein polymers may be a viable platform for the development of multifunctional therapeutic nanoparticles that can be imaged using clinical PET scanners.

Apolipoprotein M can discriminate HNF1A-MODY from Type 1 diabetes

AIMS

Missed diagnosis of maturity-onset diabetes of the young (MODY) has led to an interest in biomarkers that enable efficient prioritization of patients for definitive molecular testing. Apolipoprotein M (apoM) was suggested as a biomarker for hepatocyte nuclear factor 1 alpha (HNF1A)-MODY because of its reduced expression in Hnf1a(-/-) mice. However, subsequent human studies examining apoM as a biomarker have yielded conflicting results. We aimed to evaluate apoM as a biomarker for HNF1A-MODY using a highly specific and sensitive ELISA.

METHODS

ApoM concentration was measured in subjects with HNF1A-MODY (n = 69), Type 1 diabetes (n = 50), Type 2 diabetes (n = 120) and healthy control subjects (n = 100). The discriminative accuracy of apoM and of the apoM/HDL ratio for diabetes aetiology was evaluated.

RESULTS

Mean (standard deviation) serum apoM concentration (μmol/l) was significantly lower for subjects with HNF1A-MODY [0.86 (0.29)], than for those with Type 1 diabetes [1.37 (0.26), P = 3.1 × 10(-18) ) and control subjects [1.34 (0.22), P = 7.2 × 10(-19) ). There was no significant difference in apoM concentration between subjects with HNF1A-MODY and Type 2 diabetes [0.89 (0.28), P = 0.13]. The C-statistic measure of discriminative accuracy for apoM was 0.91 for HNF1A-MODY vs. Type 1 diabetes, indicating high discriminative accuracy. The apoM/HDL ratio was significantly lower in HNF1A-MODY than other study groups. However, this ratio did not perform well in discriminating HNF1A-MODY from either Type 1 diabetes (C-statistic = 0.79) or Type 2 diabetes (C-statistic = 0.68).

CONCLUSIONS

We confirm an earlier report that serum apoM levels are lower in HNF1A-MODY than in controls. Serum apoM provides good discrimination between HNF1A-MODY and Type 1 diabetes and warrants further investigation for clinical utility in diabetes diagnostics.

Integrated Cancer System: a perspective on developing an integrated system for cancer services in London

This article explores the potential for integrated cancer systems to improve the quality of care and deliver cost efficiencies and improve outcomes for cancer patients. Currently, patients in the UK still have poorer survival rates than comparable countries such as Canada, Sweden, Norway and Australia. Improving the quality of cancer services is a key policy objective and cancer is a priority outcome measure in both the NHS and Public Health Outcomes Framework. Evidence suggests that better integrated delivery has the potential to improve the quality and reduce the cost of healthcare, and ultimately improve health outcomes. One of the key themes from the Model of Care for Cancer Services (1) was that cancer services should be commissioned along pathways and that provider networks should be established to deliver care. London has two integrated cancer systems; one covering north central and east London (London Cancer) and the other covering west and south London (London Cancer Alliance). There a number of areas in cancer care that the current model of service provision has failed to adequately address and which have the potential to improve significantly though implementation of integrated services. These include improving early diagnosis, reducing inequalities in access to treatment and outcomes and maximising research and training across the system. Important drivers for the integration of cancer services are strong clinical leadership, shared informatics systems, focusing on quality of services and improving patient experience. Emerging needs of integrated cancer in London are around strengthening the involvement of primary care, public health and the third sector; working to develop sufficient capacity and expertise in primary care and collaborating more closely with commissioners to develop integrated systems.

Association of CHRM2 polymorphisms with severity of alcohol dependence

The cholinergic muscarinic 2 receptor (CHRM2) gene has been considered a candidate gene for the alcohol dependence in that it might underpin certain risk factors for this condition. This study examined variations in the CHRM2 between the patients with alcohol dependence and population controls in Korean and explored the associations between CHRM2 polymorphisms and severity of symptoms in the patients with alcohol dependence. One hundred and fifty-five patients with alcohol dependence, defined by the Alcohol Use Disorders Identification Test (AUDIT) and the Alcohol Dependence Scale (ADS) to measure the severity of symptoms, and one hundred and ninety-five population controls were drawn in the study. Three single nucleotide polymorphisms (SNPs) of CHRM2 were genotyped using the TaqMan assay and analyzed with the severity of symptoms of alcohol dependence. We found that although SNP rs324650 showed marginal association with the risk of alcohol dependence (P = 0.03), the significance of the result was not sustained after multiple corrections. SNP rs1824024 was significantly associated with the AUDIT and ADS scores in patients (P = 0.005 and 0.003, respectively). These findings suggested that the muscarinic acetylcholine function might be related not with alcohol dependence itself but with the severity of alcohol dependence in Korean population.

Investigation of low 5-year relative survival for breast cancer in a London cancer network

BACKGROUND

Breast cancer 5-year relative survival is low in the North East London Cancer Network (NELCN).

METHODS

We compared breast cancer that was diagnosed during 2001-2005 with that in the rest of London.

RESULTS

North East London Cancer Network women more often lived in socioeconomic quintile 5 (42 vs 21%) and presented with advanced disease (11 vs 7%). Cox regression analysis showed the survival difference (hazard ratio: 1.27, 95% confidence interval (CI): 1.15-1.41) reduced to 1.00 (95% CI: 0.89-1.11) after adjustment for age, stage, socioeconomic deprivation, ethnicity and treatment. Major drivers were stage and deprivation. Excess mortality was in the first year.

CONCLUSION

Late diagnosis occurs in NELCN.

Lack of relationship between either specific weight or presence of the 1B1R gene and nutritive value of wheat in broiler diets

1. A study of the relationship between specific weight (SW) and nutritive value of wheat in diets offered to broilers up to 4 weeks of age was carried out using 10 varieties of wheat grown at three different locations; this gave rise to a range of specific weights from 59 to 76 kg/hl. 2. Because five varieties contained the 1B1R translocation and 5 did not, this allowed the effects of 1B1R on the performance of birds given high concentrations of dietary wheat to be further investigated. 3. The diets, which contained wheat at 744 g/kg with casein (142 g/kg) as the sole protein supplement, were heat-treated and pelleted. They were fed ad libitum to male, Ross broiler chicks from 7 to 28 d, in individual cages in a controlled environment room. 4. A 7 d excreta collection was made from 14 to 21 d for determination of apparent metabolisable energy (AME) content and wheat AME was calculated from the diet values. A separate determination of true metabolisable energy (TME) was undertaken using the method of McNab and Blair (British Poultry Science, 29: 697-707, 1988). 5. Wheat samples were analysed for proximate constituents, starch, total and soluble non-starch polysaccharides (NSP), amino acid content and gross energy and specific weight, thousand grain weight and in vitro viscosity were recorded. They were also subjected to near infrared reflectance spectroscopy (NIRS) with a view to establishing relationships with chemical constituents and performance parameters. 6. At 28 d the birds were humanely killed and in vivo viscosity was determined on the jejunal digesta supernatant. 7. There was quite a narrow range of crude protein content (N x 5.83) across the 30 wheat samples, the means for the three locations (Crossnacreevy, Downpatrick and Limavady, respectively) being 112, 121 and 122 g/kg. Starch contents of individual samples ranged from 604 to 679 g/kg, total NSP from 92.1 to 122.6 g/kg, soluble NSP from 17.6 to 32.6 g/kg and in vitro viscosity from 10.6 to 26.3 cps. 8. There were no significant varietal effects for dry matter intake (DMI), live weight gain (LWG) or gain:feed ratio. Apparent metabolisability of energy (ME:GE) for the diets ranged from 0.738 (Hussar) to 0.778 (Harrier) the effect being significant (P < 0.05) and there was a significant (P < 0.001) relationship (r(2) = 0.46) between ME:GE and gain:feed ratios. Calculated wheat AME for individual varieties ranged from 14.1 to 15.0 MJ/kg DM (P > 0.05). TME values ranged from 16.3 to 16.6 MJ/kg DM (NS). 9. In vivo viscosity ranged from 12.3 (Ritmo) to 23.7 cps (Hussar), the varietal effects being significant (P < 0.001). Viscosity was significantly higher for the 1B1R varieties than for the non-1B1R (22.7 vs 16.3 cps) but there were no significant effects on mean DM intake, LWG, gain:feed, ME:GE, calculated wheat AME, ME:gain (MJ AME per kg gain) or TME. 10. Wheat AME was negatively correlated (P < 0.05) with total NSP (slope -0.035) but was significantly affected by variety, constants ranging from 16.74 to 17.79. For wheat TME there were significant variety*total NSP interactions with slopes ranging from 0.29 to -0.07. There was no significant relationship between wheat AME and soluble NSP and there were significant variety*soluble NSP interactions for TME with slopes ranging from 0.09 to -0.14. 11. Despite the relatively wide range of in vitro viscosity there was no significant correlation of either calculated wheat AME or wheat TME with in vitro viscosity. For TME there were significant variety*viscosity interactions with slopes ranging from 0.21 to -0.13 (P < 0.001). There was also no significant correlation between soluble NSP and in vivo viscosity. 12. AME values for the NIRS calibration set varied from 13.7 to 15.6 MJ/kg and averaged 14.6 MJ/kg, whereas for the validation set, the values ranged from 14.0 to 16.1 MJ/kg with the mean value being 14.7 MJ/kg. The best correlation coefficient (r(2)) of 0.90 was obtained when the calibration sample set was subjected to SMLR using the second-order derivatised data. However, moving to validation, the outcome was extremely poor with 1-VR values being 0.12 and 0.09, respectively, for the external validation and an internal validation subset. 13. In summary, none of the production characteristics showed a good correlation with specific weight. Using the linear estimates for wheat AME and TME the effect of a 10 kg/hl change in SW equates to a 3 or 1.4% change, respectively. The estimate for AME is likely to be a worst-case value due to the high inclusion level of wheat. The range of calculated wheat AME (approximately 1 MJ) across the 30 wheat samples is similar to that seen in previous studies for wheat grown in Northern Ireland and much lower than in some other studies. 14. None of the other parameters examined gave any better relationship with nutritive value (assessed as AME or TME) than SW. This is a disappointing outcome, particularly in view of some previous studies which suggested that in vitro viscosity provides a good prediction of nutritive value.

Exploratory laparoscopy for recurrent right lower quadrant pain in a pediatric population

Recurrent or chronic abdominal pain can be a challenging problem when conventional diagnostic studies fail to identify the cause. It is estimated that up to one-third of children suffer from abdominal pain, and in this population recurrent pain can be even more challenging. Although recurrent right lower quadrant (RLQ) or periumbilical pain may be attributed to chronic appendicitis, this diagnosis remains controversial. Our aim was to evaluate pediatric patients who had undergone laparoscopic exploration for chronic RLQ abdominal pain to determine their histologic diagnosis, etiology of pain, and contributing factors that may predict a positive outcome. Patients with abdominal pain greater than 1 month in duration who ultimately underwent laparoscopic exploration and appendectomy were included in the study. Patients were excluded if an identified source of pain was discovered during preoperative workup, or if postoperative follow-up was less than 2 years. Intraoperative findings were noted, and all specimens were histologically examined with additional, subsequent independent review. Pertinent findings from preoperative diagnostic tests, mental health history, and pre and postoperative symptomatology were noted. Patient outcomes were recorded at the time of follow-up and after 2 years to assess resolution of their symptoms. Of the 44 patients studied, 31 (70.5%) had partial or complete resolution of symptoms at 2 years. Thirteen (29.5%) continued to have pain. Twenty-eight patients (63.6%) had abnormal histology identified on appendiceal examination, and 14 had other abnormalities found at laparoscopy (31.8%). Eighteen patients were being treated for psychiatric diagnosis, and 21 suffered from chronic headaches. There were no long-term complications from surgery. Long-term follow-up revealed that 70% reported complete or partial relief of their RLQ pain at 2 years. No factors were identified that may be helpful in predicating outcome in this population. While exploration was beneficial for a majority of this population, patients and parents should be warned that this intervention might not provide the relief of symptoms or provide the diagnostic answer to their pain.