Can thoraco-abdominal organ boundaries be accurately determined from X-ray and anthropometric surface scans? Implications for body armour system coverage and design

To optimise soldier protection within body armour systems, knowledge of the boundaries of essential thoraco-abdominal organs is necessary to inform coverage requirements. However, existing methods of organ boundary identification are costly and time consuming, limiting widespread adoption for use on soldier populations. The aim of this study was to evaluate a novel method of using 3D organ models to identify essential organ boundaries from low dose planar X-rays and 3D external surface scans of the human torso. The results revealed that, while possible to reconstruct 3D organs using template 3D organ models placed over X-ray images, the boundary data (relating to the size and position of each organ) obtained from the reconstructed organs differed significantly from MRI organ data. The magnitude of difference varied between organs. The most accurate anatomical boundaries were the left, right, and inferior boundaries of the heart, and lateral boundaries for the liver and spleen. Visual inspection of the data demonstrated that 11 of 18 organ models were successfully integrated within the 3D space of the participant's surface scan. These results suggest that, if this method is further refined and evaluated, it has potential to be used as a tool for estimating body armour coverage requirements.

Low-intensity ultrasound-assisted adaptive laboratory evolution of Bacillus velezensis for enhanced production of peptides

This work aimed to explore low-intensity ultrasound-assisted adaptive laboratory evolution (US-ALE) of Bacillus velezensis and fermentation performance of mutant strains were investigated by nitrogen transformation metabolism. Results showed ultrasound accelerated the process of adaptive evolution and enhanced cell dry weight, amylase and protease activity of mutant strains, accompanied with the improved transformation abilities of NO-3-N to NH4+-N. Compared with original strain, the total peptide-N, peptide-N (<3 kDa) and autolytic peptide-N of mutant strains increased by the maximum 23.17%, 66.07% and 30.30%, respectively, based on ideal fermentation medium. According to the actual liquid-state fermentation of soybean meal and corn gluten meal with mutant strains, the highest peptide yields of 50.63% and 23.67% were noticed in mutant strain US-ALE-BV3, accompanied with the improved amino acid composition by bacterial autolysis technology. Thus, this study showed that low-intensity ultrasound could accelerate the process of adaptive evolution and US-ALE will provide more possibilities for modifying fermentation strains.

Development and atomic structure of a new fluorescence-based sensor to probe heme transfer in bacterial pathogens

Heme is the most abundant source of iron in the human body and is actively scavenged by bacterial pathogens during infections. Corynebacterium diphtheriae and other species of actinobacteria scavenge heme using cell wall associated and secreted proteins that contain Conserved Region (CR) domains. Here we report the development of a fluorescent sensor to measure heme transfer from the C-terminal CR domain within the HtaA protein (CR2) to other hemoproteins within the heme-uptake system. The sensor contains the CR2 domain inserted into the β2 to β3 turn of the Enhanced Green Fluorescent Protein (EGFP). A 2.45 Å crystal structure reveals the basis of heme binding to the CR2 domain via iron-tyrosyl coordination and shares conserved structural features with CR domains present in Corynebacterium glutamicum. The structure and small angle X-ray scattering experiments are consistent with the sensor adopting a V-shaped structure that exhibits only small fluctuations in inter-domain positioning. We demonstrate heme transfer from the sensor to the CR domains located within the HtaA or HtaB proteins in the heme-uptake system as measured by a ∼ 60% increase in sensor fluorescence and native mass spectrometry.

Development of a novel virus-like particle-based vaccine for preventing tick-borne encephalitis virus infection

Tick-borne encephalitis virus (TBEV) is an important tick-borne pathogen that poses as a serious public health concern. The coverage and immunogenicity of the currently available vaccines against TBEV are relatively low; therefore, it is crucial to develop novel and effective vaccines against TBEV. The present study describes a novel strategy for the assembly of virus-like particles (VLPs) by co-expressing the structural (core/prM/E) and non-structural (NS2B/NS3Pro) proteins of TBEV. The efficacy of the VLPs was subsequently evaluated in C57BL/6 mice, and the resultant IgG serum could neutralize both Far-Eastern and European subtypes of TBEV. These findings indicated that the VLP-based vaccine elicited the production of cross-subtype reactive antibodies. The VLPs provided protection to mice lacking the type I interferon receptor (IFNAR-/-) against lethal TBEV challenge, with undetectable viral load in brain and intestinal tissues. Furthermore, the group that received the VLP vaccine did not exhibit significant pathological changes and the inflammatory factors were significantly suppressed compared to the control group. Immunization with the VLP vaccine induced the production of multiple-cytokine-producing antiviral CD4+ T cells in vivo, including TNF-α+, IL-2+, and IFN-γ+ T cells. Altogether, the findings suggest that noninfectious VLPs can serve as a potentially safe and effective vaccine candidate against diverse subtypes of TBEV.

Ubiquitin specific peptidase 47 contributes to liver regeneration

AIMS

Hepatocytes resume proliferation following liver injuries to compensate for the loss of liver mass. Robust liver regeneration is an intrinsic and pivotal process that facilitates restoration of liver anatomy and function. In the present study we investigated the role of ubiquitin-specific peptidase 47 (USP47) in liver regeneration.

METHODS AND MATERIALS

Proliferation of hepatocytes was evaluated by Ki67 staining in vivo and EdU incorporation in vitro. DNA-protein interaction was evaluated by chromatin immunoprecipitation (ChIP).

RESULTS

USP47 expression was up-regulated in hepatocytes isolated from mice subjected to partial hepatectomy (PHx) or exposed to HGF treatment. Ingenuity pathway analysis revealed E2F1 as a primary regulator of USP47 transcription. Reporter assay and ChIP assay confirmed that E2F1 directly bound to the USP47 promoter and activated USP47 transcription. Consistently, E2F1 knockdown abrogated USP47 induction by HGF. Compared to the wild type littermates, USP47 knockout mice displayed compromised liver regeneration following PHx. In addition, USP47 inhibition by a small-molecule compound impaired liver regeneration in mice. On the contrary, USP47 over-expression enhanced proliferation of hepatocytes in vitro and promoted liver regeneration in mice. Importantly, a positive correlation between USP47 expression and hepatocyte proliferation was identified in patients with acute liver failure (ALF).

SIGNIFICANCE

Our data suggest that USP47, transcriptionally activated by E2F1, plays an essential role in liver regeneration.

Ultrasound-assisted enzyme extraction and properties of Shatian pomelo peel polysaccharide

In this study, Shatian pomelo peel was used as the raw material for extracting polysaccharides using hot water extraction (HW) and ultrasonic-assisted enzyme (UVE) methods, respectively. The optimal parameters for extractingShatian pomelo peel polysaccharides (StPP) using the ultrasound-assisted enzymatic method were determined using response surface methodology (RSM). The optimal conditions for the extraction of StPP were as follows: ultrasound power 350 W, ultrasound time 50 min, enzymatic digestion time 50 min, compound enzyme addition 1.5%, and enzymatic digestion temperature 55 °C. The yield of StPP was found to be 30.1310% under these conditions. Comparing the physicochemical properties and antioxidant activity of StPP extracted using different methods, it was observed that ultrasound-assisted enzyme extraction resulted in higher yield, sugar content and glucuronic acid content of StPP compared to traditional hot water extraction. Additionally, StPP extracted by ultrasound-assisted enzyme extraction showed better antioxidant activity. These results suggest that ultrasound-assisted enzymatic extraction is an effective method to enhance the activity of natural polysaccharides.

[Feasibility and safety of one-stage bilateral video-assisted thoracic surgery for resection of bilateral multiple pulmonary nodules]

OBJECTIVE

To evaluate the feasibility and safety of one- stage bilateral video-assisted thoracic surgery (VATS) for resection of bilateral multiple pulmonary nodules (BMPNs).

METHODS

We analyzed the clinical characteristics, pathological features, perioperative outcomes and follow-up data of 41 patients with BMPNs undergoing one-stage bilateral VATS from July, 2011 to August, 2021.

RESULTS

One-stage bilateral VATS was performed uneventfully in 40 of the patients, and conversion to open surgery occurred in 1 case. The surgical approaches included bilateral lobectomy (4.9%), lobar-sublobar resection (36.6%) and sublobar-sublobar resection (58.5%) with a mean operative time of 196.3±54.5 min, a mean blood loss of 224.6±139.5 mL, a mean thoracic drainage duration of 4.7±1.1 days and a mean hospital stay of 14±3.8 days. Pathological examination revealed bilateral primary lung cancer in 15 cases, unilateral primary lung cancer in 21 cases and bilateral benign lesions in 5 cases. A total of 112 pulmonary nodules were resected, including 67 malignant and 45 benign lesions. Postoperative complications included pulmonary infection (5 cases), respiratory failure (2 cases), asthma attack (2 cases), atrial fibrillation (2 cases), and drug-induced liver injury (1 case). No perioperative death occurred in these patients, who had a 1-year survival rate of 97.6%.

CONCLUSION

With appropriate preoperative screening and perioperative management, one-stage bilateral VATS is feasible and safe for resection of BMPNs.

TRIB1 regulates liver regeneration by antagonizing the NRF2-mediated antioxidant response

Robust regenerative response post liver injuries facilitates the architectural and functional recovery of the liver. Intrahepatic redox homeostasis plays a key role in liver regeneration. In the present study, we investigated the contributory role of Tribbles homolog 1 (Trib1), a pseudokinase, in liver regeneration and the underlying mechanism. We report that Trib1 expression was transiently down-regulated in animal and cell models of liver regeneration. Further analysis revealed that hepatocyte growth factor (HGF) repressed Trib1 transcription by evicting liver X receptor (LXRα) from the Trib1 promoter. Knockdown of Trib1 enhanced whereas over-expression of Trib1 suppressed liver regeneration after partial hepatectomy in mice. Of interest, regulation of liver regenerative response by Trib1 coincided with alterations of intracellular ROS levels, GSH levels, and antioxidant genes. Transcriptional assays suggested that Trib1 influenced cellular redox status by attenuating nuclear factor erythroid 2-related factor 2 (Nrf2) activity. Mechanistically, Trib1 interacted with the C-terminus of Nrf2 thus masking a potential nuclear localization signal (NLS) and blocking nuclear accumulation of Nrf2. Finally, correlation between Trib1 expression, Nrf2 nuclear localization, and cell proliferation was identified in liver specimens taken from patients with acute liver failure. In conclusion, our data unveil a novel pathway that depicts Trib1 as a critical link between intracellular redox homeostasis and cell proliferation in liver regeneration.

Identification of a Prunus MAX1 homolog as a unique strigol synthase

Strigol is the first identified and one of the most important strigolactones (SLs), but the biosynthetic pathway remains elusive. We functionally identified a strigol synthase (cytochrome P450 711A enzyme) in the Prunus genus through rapid gene screening in a set of SL-producing microbial consortia, and confirmed its unique catalytic activity (catalyzing multistep oxidation) through substrate feeding experiments and mutant analysis. We also reconstructed the biosynthetic pathway of strigol in Nicotiana benthamiana and reported the total biosynthesis of strigol in the Escherichia coli-yeast consortium, from the simple sugar xylose, which paves the way for large-scale production of strigol. As proof of concept, strigol and orobanchol were detected in Prunus persica root extrudes. This demonstrated a successful prediction of metabolites produced in plants through gene function identification, highlighting the importance of deciphering the sequence-function correlation of plant biosynthetic enzymes to more accurately predicate plant metabolites without metabolic analysis. This finding revealed the evolutionary and functional diversity of CYP711A (MAX1) in SL biosynthesis, which can synthesize different stereo-configurations of SLs (strigol- or orobanchol-type). This work again emphasizes the importance of microbial bioproduction platform as an efficient and handy tool to functionally identify plant metabolism.

Zinc finger transcription factor Egf1 promotes non-alcoholic fatty liver disease

Background & Aims

Non-alcoholic fatty liver disease (NAFLD) contributes to the global epidemic of metabolic syndrome and is considered a prelude to end-stage liver diseases such as cirrhosis and hepatocellular carcinoma. During NAFLD pathogenesis, hepatic parenchymal cells (hepatocytes) undergo both morphological and functional changes owing to a rewired transcriptome. The underlying mechanism is not entirely clear. In the present study, we investigated the involvement of early growth response 1 (Egr1) in NAFLD.

Methods

Quantitative PCR, Western blotting, and histochemical staining were used to assess gene expression levels. Chromatin immunoprecipitation was used to evaluate protein binding to DNA. NAFLD was evaluated in leptin receptor-deficient (db/db) mice.

Results

We report here that Egr1 was upregulated by pro-NAFLD stimuli in vitro and in vivo. Further analysis revealed that serum response factor (SRF) was recruited to the Egr1 promoter and mediated Egr1 transactivation. Importantly, Egr1 depletion markedly mitigated NAFLD in db/db mice. RNA sequencing revealed that Egr1 knockdown in hepatocytes, on the one hand, boosted fatty acid oxidation (FAO) and, on the other hand, suppressed the synthesis of chemoattractants. Mechanistically, Egr1 interacted with peroxisome proliferator-activated receptor α (PPARα) to repress PPARα-dependent transcription of FAO genes by recruiting its co-repressor NGFI-A binding protein 1 (Nab1), which potentially led to promoter deacetylation of FAO genes.

Conclusions

Our data identify Egr1 as a novel modulator of NAFLD and a potential target for NAFLD intervention.

Impact and Implications

Non-alcoholic fatty liver disease (NAFLD) precedes cirrhosis and hepatocellular carcinoma. In this paper, we describe a novel mechanism whereby early growth response 1 (Egr1), a transcription factor, contributes to NAFLD pathogenesis by regulating fatty acid oxidation. Our data provide novel insights and translational potential for NAFLD intervention.

Serum response factor activates peroxidasin transcription to block senescence of hepatic stellate cells

AIMS

Aberrant liver fibrosis is a hallmark event in end-stage liver diseases. Hepatic stellate cells (HSCs) are considered the major source of myofibroblasts in the liver that produce extracellular matrix proteins to promote liver fibrosis. HSCs undergo senescence in response to various stimuli, a process that can be exploited to dampen liver fibrosis. We investigated the role of serum response factor (SRF) in this process.

METHODS AND MATERIALS

Senescence was induced HSCs by serum withdrawal or progressive passage. DNA-protein interaction was evaluated by chromatin immunoprecipitation (ChIP).

RESULTS

SRF expression was down-regulated in HSCs entering into senescence. Coincidently, SRF depletion by RNAi accelerated HSC senescence. Of note, treatment of an anti-oxidant (N-acetylcysteine or NAC) blocked HSC senescence by SRF deficiency suggesting that SRF may antagonize HSC senescence by eliminating excessive reactive oxygen species (ROS). PCR-array based screening identified peroxidasin (PXDN) as a potential target for SRF in HSCs. PXDN expression was inversely correlated with HSC senescence whereas PXDN knockdown accelerated HSC senescence. Further analysis reveals that SRF directly bound to the PXDN promoter and activated PXDN transcription. Consistently, PXDN over-expression protected whereas PXDN depletion amplified HSC senescence. Finally, PXDN knockout mice displayed diminished liver fibrosis compared to wild type mice when subjected to bile duct ligation (BDL).

SIGNIFICANCE

Our data suggest that SRF, via its downstream target PXDN, plays a key role in regulating HSC senescence.

Central nervous system efficacy of rezivertinib (BPI-7711) in advanced NSCLC patients with EGFR T790M mutation: A pooled analysis of two clinical studies

BACKGROUND

Rezivertinib (BPI-7711) is a novel third-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) which revealed the systematic and central nervous system (CNS) antitumor activities for EGFR T790M-mutated advanced NSCLC in previous clinical studies and is further analyzed here.

METHODS

Eligible patients from the previous phase I and phase IIb studies of rezivertinib were included for pooled analysis. Post-progressive patients who received a prescribed dosage (≥180 mg) of rezivertinib orally once daily were included in full analysis set (FAS), while those with stable, asymptomatic CNS lesions, including measurable and non-measurable ones at baseline were included in CNS full analysis set (cFAS). Patients with measurable CNS lesions were included in CNS evaluable for response set (cEFR). BICR-assessed CNS objective response rate (CNS-ORR), CNS disease control rate (CNS-DCR), CNS duration of response (CNS-DoR), CNS progression-free survival (CNS-PFS), and CNS depth of response (CNS-DepOR) were evaluated.

RESULTS

355 patients were included in FAS, among whom 150 and 45 patients were included in cFAS and cEFR. This pooled analysis showed the CNS-ORR was 32.0% (48/150; 95% CI: 24.6-40.1%) and the CNS-DCR was 42.0% (63/150; 95% CI: 34.0-50.3%) in cFAS, while that in cEFR were 68.9% (31/45; 95% CI: 53.4-81.8%) and 100% (45/45; 95% CI: 92.1-100.0%). In cEFR, the median CNS-DepOR and the mean of CNS-DepOR were -52.0% (range: -100.0 to 16.1%) and -46.8% (95% CI: -55.5 to -38.1%). In cFAS, the median CNS-DoR and CNS-PFS were 13.8 (95% CI: 9.6-not calculable [NC]) and 16.5 (95% CI: 13.7-NC) months.

CONCLUSIONS

Rezivertinib demonstrated encouraging clinical CNS efficacy among advanced NSCLC patients with EGFR T790M mutation and CNS metastases.

Novel Alcohol-Soluble Nitroxide Radical Conjugated Polymer for Cathode Modifier of Efficient Organic Solar Cells with Enhanced Stability

Alcohol-soluble conjugated polymers with polar side-chain components have been regarded as one of the most promising cathode interfacial modifers (CIMs) to achieve high-performance organic solar cells (OSCs). Herein, a novel alcohol-soluble nitrogen oxide radical conjugated polymer (PBN-NO) containing dimethylamine groups for regulating metal work function and the dangling of 2,2,6, 6-tetramethylpiperidine 1-oxy (TEMPO) radical side-chain groups for theoretically improving the conductivity, was prepared and characterized. As compared to the OSCs from PM6:Y6 blends with the most common CIMs of PFN, PDINO, and PDINN, the OSCs with PBN-NO as CIMs provide better or comparable power conversion efficiencies (PCEs) (16.19% vs 13.10%, 15.60%, and 16.15%), enhanced photostability, and thermal stability. Besides that, the reasons for the improving PCEs of the OSCs with PBN-NO modifier are systematically investigated and supported by a set of comparative experiments such as exciton dissociation, charge recombination, capacitance-voltage (C-V), etc. To the best of our knowledge, this is the first report of an alcohol-soluble nitroxide radical conjugated polymer that successfully integrates the interfacial modification of polar groups and improves conductivity by dangling radicals, therefore contributing to efficient OSCs with enhanced stability.

Circ_0124055 promotes the progression of thyroid cancer cells through the miR-486-3p/MTA1 axis

BACKGROUND

Thyroid cancer is one of the malignancy cancers. CircRNA, a non-coding RNA, plays an important role in the development of cancer. The relationship and roles of circ_0124055, miR-486-3p and MTA1 in thyroid cancer have not been reported.

METHODS

Real-time quantitative polymerase chain reaction (RT-qPCR) was performed to analyze the RNA levels of circ_0124055, miR-486-3p and MTA1. Western blot was conducted to analyze the protein levels of MTA1, Epithelial cadherin (E-cadherin) and Neuro cadherin (N-cadherin). Subcellular localization assay was used to analyze circ_0124055 location in thyroid cancer cells. Colony formation assay and 5-Ethynyl-2'-deoxyuridine (EdU) assay were carried out to analyze cell proliferation. Cell migration and invasion were analyzed by wound-healing assay and transwell assay. Flow cytometry assay was performed to investigate cell apoptosis. Dual-luciferase reporter assay and RIP assay were employed to analyze the interactions among circ_0124055, miR-486-3p and MTA1. Immunohistochemical (IHC) assay was performed to assess the expression of Ki67, MTA1 and E-cadherin in tumor tissues. Thyroid cancer tumor growth in vivo was evaluated by tumor xenograft mouse model assay.

RESULTS

The expression of circ_0124055 was up-regulated in tumor tissues and cells. Knockdown of circ_0124055 could inhibit thyroid cancer cell proliferation, migration and invasion and promote cell apoptosis, accompanied by the dysregulation of E-cadherin and N-cadherin expression. Circ_0124055 could target miR-486-3p, and miR-486-3p could target MTA1. MiR-486-3p inhibitor could restore the effect of circ_0124055 knockdown in the progression of thyroid cancer. Moreover, MTA1 overexpression weakened the inhibitory effects of miR-486-3p mimics on the progression of thyroid cancer. Further, circ_0124055 could influence tumor growth in vivo.

CONCLUSION

Circ_0124055 promoted the progression of thyroid cancer cells through the miR-486-3p /MTA1 axis.

SARS-CoV-2 infection activates CREB/CBP in cellular cyclic AMP-dependent pathways

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused a global coronavirus disease 2019 (COVID-19) pandemic that has affected the lives of billions of individuals. However, the host-virus interactions still need further investigation to reveal the underling mechanism of SARS-CoV-2 pathogenesis. Here, transcriptomics analysis of SARS-CoV-2 infection highlighted possible correlation between host-associated signaling pathway and virus. In detail, cAMP-protein kinase (PKA) pathway has an essential role in SARS-CoV-2 infection, followed by the interaction between cyclic AMP response element binding protein (CREB) and CREB-binding protein (CBP) could be induced and leading to the enhancement of CREB/CBP transcriptional activity. The replication of Delta and Omicron BA.5 were inhibited by about 49.4% and 44.7% after knockdown of CREB and CBP with small interfering RNAs, respectively. Furthermore, a small organic molecule naphthol AS-E (nAS-E), which targets on the interaction between CREB and CBP, potently inhibited SARS-CoV-2 wild-type (WT) infection with comparable the half-maximal effective concentration (EC₅₀ ) 1.04 μM to Remdesivir 0.57 μM. Compared with WT virus, EC₅₀ in Calu-3 cells against Delta, Omicron BA.2, and Omicron BA.5 were, on average, 1.5-fold, 1.1-fold, and 1.5-fold higher, respectively, nAS-E had a satisfied antiviral effect against Omicron variants. Taken together, our study demonstrated the importance of CREB/CBP induced by cAMP-PKA pathway during SARS-CoV-2 infection, and further provided a novel CREB/CBP interaction therapeutic drug targets for COVID-19.

Do thoracoabdominal organ boundaries differ between males and females? Implications for body armour coverage and design

To optimise fit and protection of body armour systems, knowledge of the location of thoracoabdominal organ boundaries is required. The aims of this study were (i) determine the effect of sex on essential and desirable thoracoabdominal organ boundaries, and (ii) compare essential thoracoabdominal organ boundaries with small and large hard ballistic plate sizes from the National Institute of Justice (NIJ) and determine if coverage requirements differ between sexes. 33 males and 33 females underwent supine magnetic resonance imaging of their thoracoabdominal organs. Male participants on average displayed more laterally and inferiorly positioned essential and desirable organ boundaries than females. Based on NIJ plate sizes, insufficient coverage of essential organs was identified for male and female participants. A greater range of body armour sizes and designs that better cater to the diverse anatomy of soldier populations is warranted, but must be considered in the context of ergonomic and performance implications.

Outcomes of patients after repeat heart transplantation – insights from the UNOS database

Background

Cardiac graft failure may require repeat heart transplantation (HTx). Outcomes of patients that undergo repeat HTx have not been well described.

Methods

We compared patients that received repeat HTx with patients that received initial HTx by inquiring the United Network for Organ Sharing database between 2015–2021. The primary endpoint was all-cause mortality.

Results

A total of 19,805 HTx patients were included in the study. Patients that underwent repeat HTx (n=578, 3%) were younger (43.8±15.3 vs. 53.7±12.7 years, p&lt;0.001) with lower body mass index (26.8±5.3 vs. 27.6±4.9 kg/m2, p&lt;0.001) and worse renal function (Cr 1.8±1.4 vs. 1.4±0.9 mg/dl). Patients with repeat HTx had increased risk for 1-year mortality (hazard ratio 1.49 [1.16–1.90], p=0.002) compared to patients with initial HTx after adjusting for age, ethnicity, use of left ventricular assist device, UNOS recipient status, diabetes, ischemic time, donor age and predicted heart mass mismatch (Figure 1). Results did not change with the new allocation system (10/2018).

Conclusion

Repeat HTx occurred in 3% of a contemporary UNOS cohort and carried an increased and independent risk for mortality.

Funding Acknowledgement

Type of funding sources: None.

876 Veriset Haemostatic Patch, Indications, Benefits and Complications: A Systematic Review

Aim

Achieving haemostasis intraoperatively is important for minimising blood loss, complications, and operation time. Suturing, cauterisation, fibrin glues and patches are used for this purpose. We explore Veriset, a patch consisting of polyethylene glycol and oxidised cellulose, to determine and compare its safety and effectiveness.

Method

Medline, Embase, Web of Science, Scopus, Cinahl and Cochrane databases were searched. Data points collected were Study/subject characteristics/demographics, surgery/specialty, time to haemostasis, proportion of haemostasis achieved, intraoperative adverse events, post operative complications, follow up time, and biochemical/histological analysis. Risk of Bias was assessed by Newcastle-Ottawa Scale

Results

Six studies were included; four human trials (3 RCTs, 1 case series) and two animal trials.

The human trials combined had 250 patients, with 147 using Veriset. In two RCTs, Veriset showed faster time to haemostasis and higher proportion of haemostasis achieved vs suturing and Tachosil haemostatic patch. In all three RCTs, no significant differences in adverse events and complications were seen between Veriset and suturing/Tachosil. Vascular, nephrectomy and hepatic surgery were investigated.

In the animal studies, the pig trial showed similar effectiveness and safety as the human trials. The rat study compared novel experimental patches to Veriset, and showed similar effectiveness to Veriset, at reduced costs.

Conclusions

Although current literature is scarce, Veriset is more effective than alternatives for haemostasis, with similar safety, although there are now other experimental patches that could have better health economic implications. Further clinical trials would be necessary to determine the breadth of applicable surgical fields for Veriset.

180 Retrograde Hindfoot Nailing for the Treatment of Acute Ankle Fractures in the Elderly - a Systematic Review and Meta-Analysis

Aim

Fragility ankle fractures are traditionally managed conservatively or with open reduction internal fixation (ORIF). Tibiotalocalcaneal (TTC) nailing is an alternative option for the geriatric patient. This meta-analysis provides the most detailed analysis of hindfoot nailing for fragility ankle fractures.

Method

A systematic search was performed on MEDLINE, EMBASE, Cochrane Library, Scopus, Web of Science, identifying fourteen studies for inclusion. Studies including patients over 60 with a fragility ankle fracture, treated with TTC nail were included. Patients with a previous fracture of the ipsilateral limb, fibular nails, and pathological fractures were excluded.

Meta-regression analyses were performed to explore sources of heterogeneity, and publication bias was assessed using Egger's test.

Results

312 ankle fractures were included. The mean age was 77.3 (32–101) years. 26.9% were male, and 41.9% were diabetics. The pooled proportion of superficial infection, deep infection, implant failure, malunion, and all-cause mortality was 0.10 (95%CI:0.06–0.16; I2=44%), 0.08 (95%CI:0.06–0.11, I2=0%), 0.11 (95%CI:0.07–0.15,I2=0%), 0.11 (95%CI:0.06–0.18; I2=51%), and 0.27 (95%CI:0.20–0.34; I2=11%), respectively. The pooled mean post-operative OMAS score was 54.07 (95%CI:48.98–59.16; I2=85%). The best-fitting meta-regression model included age and percentage of male patients as covariates (p=0.0263), and were inversely correlated with higher OMAS scores. Egger's test (p=0.56) showed no significant publication bias.

Conclusions

TTC nailing is an adequate alternative option for fragility ankle fracture management. However, current evidence includes mainly case series with inconsistent outcome measures reported and post-operative rehabilitation protocols. Prospective RCTs with long follow-up times and large cohort sizes are needed to clearly guide the use of TTC nailing for ankle fractures.

893 Predictors for Infection Severity in Open Tibial Fractures

Aim

Open tibial fractures can be difficult to manage - many factors could affect treatment and outcome, including being complicated by infection. We present a cohort of 244 patients and analyse which factors are significantly associated with infection outcome.

Method

Open tibia fractures treated at a major trauma centre between 2015–2021 were included.

Infection status was categorized into no infection, superficial infection, osteomyelitis. Data collected were Age, mode of injury, polytrauma, fibula status, Gustilo-Anderson (GA) classification, wound contamination, time to first procedure. time to definitive plastics procedure, time to definitive fixation, type of definitive fixation, smoking/diabetic status, and BMI.

Multicollinearity was calculated, with highly correlated factors removed. Multinomial logistic regression was performed. Chi-Squared test, with Post-Hoc Bonferroni correction was performed for complex categorical factors.

Results

244 patients were included. Polytrauma and fibula status, and type of definitive fixation were excluded from the multivariate model due to strong multicollinearity. Compared to non-infected outcome, patients with superficial infection had higher BMI (p&lt;0.01), higher GA grade (p&lt;0.01), and osteomyelitis patients had longer time to definitive fixation (p=0.049) and longer time to definitive plastics procedure (p=0.013), higher GA grade, and wound contamination.

Post-hoc analysis showed “no infection” was positively associated with GA-I (p=0.029) and GA-II (p&lt;0.01), and negatively associated with GA-IIIC (p&lt;0.01). Osteomyelitis was positively associated with GA-IIIc (p&lt;0.01)

Conclusions

This study investigated associations between injury and presentation factors that may have been associated with infection. We suggest clinicians should give extra consideration to the factors highlighted during management and take preventative measures to mitigate the infection risk.

245 Ankle Fusion with Tibiotalocalcaneal Retrograde Nail for Fragility Ankle Fractures: Outcomes at a Major Trauma Centre

Aim

Fragility ankles fractures in the geriatric population are challenging to manage, due to fracture instability, soft tissue compromise, and patient co-morbidities. Traditional management options include open reduction internal fixation, or conservative treatment, both of which are fraught with high complication rates. We aimed to present functional outcomes of elderly patients with fragility ankle fractures treated with retrograde ankle fusion nails.

Method

171 patients received a tibiotalocalcaneal nail over a six-year period, but only twenty met the inclusion criteria of being over sixty and having poor bone stock. Primary outcome was mortality risk from co-morbidities according to Charlson co-morbidity index (CCI), and patients’ post-operative mobility status compared to pre-operative mobility. Secondary outcomes include intra-operative and post-operative complications, six-month mortality rate, time to mobilisation and union.

Results

Mean age was 77.82 years old. The average CCI was 5.05. Thirteen patients returned to their pre-operative mobility state. Patients with low CCI are more likely to return to pre-operative mobility status (p=0.16;OR=4.00).

Average time to bone union and mobilisation were 92.5 days and 7.63 days, respectively. Mean post-operative AOFAS ankle-hindfoot and Olerud-Molander scores were 53.0 and 50.9, respectively. There were four cases of superficial infection. Patients with high CCI were more likely to acquire superficial infections (p=0.264,OR=3.857). There were no deep infections, periprosthetic fractures, nail breakages, non-unions. Average follow-up time was 499.3 days.

Conclusions

Tibiotalocalcaneal nailing is an effective and safe option for managing fragility ankle fractures in the elderly. This technique leads to lower complication rates and earlier mobilisation than traditional fixation methods.

The structure of the Clostridium thermocellum RsgI9 ectodomain provides insight into the mechanism of biomass sensing

Clostridium thermocellum is actively being developed as a microbial platform to produce biofuels and chemicals from renewable plant biomass. An attractive feature of this bacterium is its ability to efficiently degrade lignocellulose using surface-displayed cellulosomes, large multi-protein complexes that house different types of cellulase enzymes. Clostridium thermocellum tailors the enzyme composition of its cellulosome using nine membrane-embedded anti-σ factors (RsgI1-9), which are thought to sense different types of extracellular carbohydrates and then elicit distinct gene expression programs via cytoplasmic σ factors. Here we show that the RsgI9 anti-σ factor interacts with cellulose via a C-terminal bi-domain unit. A 2.0 Å crystal structure reveals that the unit is constructed from S1C peptidase and NTF2-like protein domains that contain a potential binding site for cellulose. Small-angle X-ray scattering experiments of the intact ectodomain indicate that it adopts a bi-lobed, elongated conformation. In the structure, a conserved RsgI extracellular (CRE) domain is connected to the bi-domain via a proline-rich linker, which is expected to project the carbohydrate-binding unit ~160 Å from the cell surface. The CRE and proline-rich elements are conserved in several other C. thermocellum anti-σ factors, suggesting that they will also form extended structures that sense carbohydrates.

Application of coal fly ash in pavement subgrade stabilisation: A review

Expansive clays are found in many countries worldwide, and they exhibit inherent volume change during the seasonal moisture variation causing cracks, heaves, and damages to the overlying pavements. Chemical stabilisation is one of the most used approaches to treat the expansive clay subgrades. Cement, Lime and Fly ash are the most commonly used stabilisers, in which fly is cheaper and a by-product obtained from the coal power plant. This paper reviews fly ash stabilisation on various clay types, including low plasticity clays, high plasticity clays, silty clays, organic clays, and peats. The review begins with the properties of fly ash, followed by the characteristics of fly ash stabilised subgrades. The micro-level mechanism, physical, mechanical, and hydraulic characteristics of stabilised pavements are presented graphically for the Class C, and F fly ashes. The micro-level studies reveal that the pozzolanic reaction is stronger than the cation exchange during the fly ash stabilisation. The unconfined compressive strength (UCS), California bearing ratio (CBR) and resilient modulus (M_r) increased with the fly ash addition and curing time for most soft soils except peat clays. Based on the mechanical and hydraulic characteristics, using 15% class C fly ash with 7 days of curing is recommended for optimum performance. Although few research studies confirm that the leachate limit of stabilised soil is within the acceptable limit, further studies are required to investigate the uptake of heavy metals and other certain carcinogenic contaminants. This study will provide key information for researchers and Engineers on the selection of fly ash stabilisation measures for expansive subgrades.

High-Efficiency Fast-Radiative Blue-Emitting Perovskite Nanoplatelets and Their Formation Mechanisms

High-efficiency blue perovskite emitters with fast fluorescence radiation are not only crucial to achieving high-quality displays but also highly desired for optical wireless communications and quantum information technologies. Here, we demonstrate the preparation of blue-emitting Eu³⁺-, Sb³⁺-, and Ba²⁺-induced CsPbBr₃ nanoplatelets with narrow spectral widths. Among them, Sb³⁺-doped CsPbBr₃ NPLs can reach a photoluminescence quantum yield of 95%, with a very short fluorescence lifetime of 1.48 ns and greatly reduced ligand dosage. Through nuclear magnetic resonance analysis and density functional theory calculations, we find that the dopant-ligand interaction and dopant-induced growth energy barrier decide the growth kinetics of doped nanoplatelets. These mechanisms offer a fresh route to controlling the dimension of nanoscale perovskite emitters and benefit the development of fast-radiative perovskite emitters.

Flexible triboelectric nanogenerator based on polyester conductive cloth for biomechanical energy harvesting and self-powered sensors

As a new nanotechnology of mechanical energy harvesting and self-powered sensing, triboelectric nanogenerators (TENGs) have been explored as a new path of using various low-frequency disordered mechanical energies in the surrounding environment to provide power and/or sensing. However, the research of TENGs that provide full flexibility and environmental friendliness is still limited. Herein, a flexible single-electrode TENG (S-TENG) based on polyester conductive cloth as the working electrode is developed to harvest human motion energy for powering light emitting diodes (LEDs) and portable electronics. The flat conductive cloth was wrapped in a flexible elastomer. Defatted cowhide was firstly selected as a friction positive charge material for TENGs. When the size of the fabricated S-TENG is 40 × 100 mm², high output performance has been achieved and it can generate an open-circuit voltage of 534 V and a power density of 230 mW m^-2 at an operation frequency of 3.0 Hz. After integrating with a rectifier, the S-TENG can power 240 LEDs, charge various capacitors, and drive an electronic watch or a calculator. Moreover, the S-TENG can harvest the biomechanical energy of wrist movement, hand tapping, and human walking. Meanwhile, the S-TENG as a self-powered sensor can be employed to monitor subtle signals of human physiological activities, such as finger motion, facial masseter activity, and diaphragmatic breathing. Additionally, the S-TENG can be attached to clothes (such as wool coats, polyamide sweaters) to harvest the energy of cuff movement. Therefore, this work provides new insights for clean power sources of skin-mounted electronics and promotes the development of a sustainable energy supply for wearable and portable electronics.

[Treatment response to Conbercept of different types of diabetic macular edema classified based on optical coherence tomography]

OBJECTIVE

To compare different types of diabetic macular edema (DME) classified based on optical coherence tomography (OCT) for their responses to Conbercept injection and analyze the factors that affect the treatment responses.

METHODS

We retrospectively analyzed the clinical data of 65 patients (76 eyes) with DME diagnosed and treated with intravitreal injection of Conbercept (1+PRN) in our hospital from February, 2019 to February, 2021. According to OCT findings, DME in these patients was classified into cystic macular edema (CME; 28 eyes), serous retinal detachment (SRD; 33 eyes), and diffuse retinal thickening (DRT; 15 eyes). The best corrected visual acuity (BCVA) and central retinal thickness (CRT) were measured before and at 3 months after the first treatment. The baseline OCT characteristics of different types of DME were compared, and the correlation of these OCT characteristics with the treatment response to Conbercept was analyzed.

RESULTS

All the patients showed significant improvement of the BCVA 3 months after the treatment (P < 0.05). For all the 3 types of DME, the CRT at 3 months after the first treatment was significantly reduced as compared to the baseline (P < 0.05). The number of hyperreflective foci (HF) in the outer retina and the proportion of ellipsoid zone (EZ) interruption were the greatest in SRD group (P < 0.05). The baseline outer retinal HF was significantly correlated with the baseline CRT, CRT changes and CRT after treatment (all P < 0.05). The patients with baseline outer limiting membrane (ELM)/ EZ disruption had poorer baseline BCVA, greater baseline CRT, greater variation of CRT and poorer BCVA at 3 months after treatment (all P < 0.05).

CONCLUSION

For all the 3 types of DME, treatment with intravitreal injection of Conbercept can significantly improve the BCVA and CRT of the patients. DME of the SRD type has the best morphological response to Conbercept, while the DRT type has a relatively poor response. A greater number of HF at baseline may indicate a better morphological response to Conbercept treatment, and baseline ELM/EZ disruption may suggest a poor visual prognosis at 3 months after treatment.

33 Impact of Disruption of Tibio-Fibular Joints During Distraction Osteogenesis on Knee and Ankle Joint Function

Aim

The aim of this study is to investigate whether a disruption of proximal and/or distal tibio-fibular joint correlates to patient’s function and osteoarthritis.

Method

Retrospective analysis of 44 patients with lower limb bone defects treated by tibial corticotomy and distraction osteogenesis was conducted. Analysis of lower limb x-rays before surgery, immediately post-surgery and after frame removal permitted calculations of changes in tibial length and changes in fibula position relative to the tibia at the proximal and distal tibio-fibular joints. X-rays before and after treatment were also graded for osteoarthritis severity using Alhbäck's classification. Functional ability was scored using the American Orthopaedic Foot & Ankle Society (AOFAS) score and the Knee society score (KSS).

Results

15 patients showed a decrease in the distance between fibular tip and distal tibia, 5 showed no change and 12 showed an increase at the end of the treatment. No statistical significant association was noted with KSS or AOFAS score (p &gt; 0.05), however one patient with a large distance increase exhibited severe radiological exacerbation of knee osteoarthritis. The distal corticotomy group achieved significantly higher length of new bone (p &lt; 0.001) and were more likely to have exacerbation of knee osteoarthritis (p &lt; 0.05). Conversely, proximal corticotomy group were significantly more likely to show an exacerbation of ankle osteoarthritis (p &lt; 0.05).

Conclusions

Attempts should be made not to disrupt the tibio-fibular joints during bone transport, but disruption does not necessarily correlate to poorer outcomes. Our results show that lengthening index reduces with larger bone defects, suggesting that radical debridement/resection may not negatively affect the healing index.

Establishment of strigolactone-producing bacterium-yeast consortium

Strigolactones (SLs) are a class of phytohormones playing diverse roles in plant growth and development, yet the limited access to SLs is largely impeding SL-based foundational investigations and applications. Here, we developed Escherichia coli–Saccharomyces cerevisiae consortia to establish a microbial biosynthetic platform for the synthesis of various SLs, including carlactone, carlactonoic acid, 5-deoxystrigol (5DS; 6.65 ± 1.71 μg/liter), 4-deoxyorobanchol (3.46 ± 0.28 μg/liter), and orobanchol (OB; 19.36 ± 5.20 μg/liter). The SL-producing platform enabled us to conduct functional identification of CYP722Cs from various plants as either OB or 5DS synthase. It also allowed us to quantitatively compare known variants of plant SL biosynthetic enzymes in the microbial system. The titer of 5DS was further enhanced through pathway engineering to 47.3 μg/liter. This work provides a unique platform for investigating SL biosynthesis and evolution and lays the foundation for developing SL microbial production process.

Current Understanding of Osteoimmunology in Certain Osteoimmune Diseases

The skeletal system and immune system seem to be two independent systems. However, there in fact are extensive and multiple crosstalk between them. The concept of osteoimmunology was created to describe those interdisciplinary events, but it has been constantly updated over time. In this review, we summarize the interactions between the skeletal and immune systems in the co-development of the two systems and the progress of certain typical bone abnormalities and bone regeneration on the cellular and molecular levels according to the mainstream novel study. At the end of the review, we also highlighted the possibility of extending the research scope of osteoimmunology to other systemic diseases. In conclusion, we propose that osteoimmunology is a promising perspective to uncover the mechanism of related diseases; meanwhile, a study from the point of view of osteoimmunology may also provide innovative ideas and resolutions to achieve the balance of internal homeostasis.

Circulating trophoblast cell clusters for early detection of placenta accreta spectrum disorders

Placenta accreta spectrum (PAS) is a high-risk obstetrical condition associated with significant morbidity and mortality. Current clinical screening modalities for PAS are not always conclusive. Here, we report a nanostructure-embedded microchip that efficiently enriches both single and clustered circulating trophoblasts (cTBs) from maternal blood for detecting PAS. We discover a uniquely high prevalence of cTB-clusters in PAS and subsequently optimize the device to preserve the intactness of these clusters. Our feasibility study on the enumeration of cTBs and cTB-clusters from 168 pregnant women demonstrates excellent diagnostic performance for distinguishing PAS from non-PAS. A logistic regression model is constructed using a training cohort and then cross-validated and tested using an independent cohort. The combined cTB assay achieves an Area Under ROC Curve of 0.942 (throughout gestation) and 0.924 (early gestation) for distinguishing PAS from non-PAS. Our assay holds the potential to improve current diagnostic modalities for the early detection of PAS.

Placenta accreta spectrum (PAS) is a high-risk obstetrical complication associated with significant morbidity and mortality. Here the authors discover a uniquely high prevalence of circulating trophoblasts clusters in PAS and explore their diagnostic potential to augment current diagnostic modalities for the early detection of PAS.

Circadian rhythms driving a fast-paced root clock implicate species-specific regulation in Medicago truncatula

Plants have a hierarchical circadian structure comprising multiple tissue-specific oscillators that operate at different speeds and regulate the expression of distinct sets of genes in different organs. However, the identity of the genes differentially regulated by the circadian clock in different organs, such as roots, and how their oscillations create functional specialization remain unclear. Here, we profiled the diurnal and circadian landscapes of the shoots and roots of Medicago truncatula and identified the conserved regulatory sequences contributing to transcriptome oscillations in each organ. We found that the light-dark cycles strongly affect the global transcriptome oscillation in roots, and many clock genes oscillate only in shoots. Moreover, many key genes involved in nitrogen fixation are regulated by circadian rhythms. Surprisingly, the root clock runs faster than the shoot clock, which is contrary to the hierarchical circadian structure showing a slow-paced root clock in both detached and intact Arabidopsis thaliana (L.) Heynh. roots. Our result provides important clues about the species-specific circadian regulatory mechanism, which is often overlooked, and possibly coordinates the timing between shoots and roots independent of the current prevailing model.

Management of systemic risk factors ahead of dental implant therapy: A beard well lathered is half shaved

As the most successful therapy for missing teeth, dental implant has become increasingly prevalent around the world. A lot of papers have reported diverse local risk factors affecting the success and survival rate of dental implants, either for a short or a long period. However, there are also many types of systemic disorders or relatively administrated medicine that may jeopardize the security and success of dental implant treatment. Additionally, the coronavirus disease 2019 pandemic also poses a challenge to dental implant clinicians. Some of these risk factors are clinically common but to some extent unfamiliar to dentists, thus optimal measurements are often lacking when they occur in dental clinics. In this review, we analyze potential systemic risk factors that may affect the success rate of dental implants. Some of them may affect bone mineral density or enhance the likelihood of local infection, thus impeding osseointegration. Others may even systemically increase the risk of the surgery and threaten patients' life. In order to help novices receive high-risk patients who need to get dental implant treatment in a more reasonable way, we accordingly review recent research results and clinical experiments to discuss promising precautions, such as stopping drugs that impact bone mineral density or the operation, and addressing any perturbations on vital signs.

Rational design strategies for functional reconstitution of plant cytochrome P450s in microbial systems

Plant natural products (NPs) are of pharmaceutical and agricultural significance, yet the low abundance is largely impeding the broad investigation and utilization. Microbial bioproduction is a promising alternative sourcing to plant NPs. Cytochrome P450s (CYPs) play an essential role in plant secondary metabolism, and functional reconstitution of plant CYPs in the microbial system is one of the major challenges in establishing efficient microbial plant NP bioproduction. In this review, we briefly summarized the recent progress in rational engineering strategies for enhanced activity of plant CYPs in Escherichia coli and Saccharomyces cerevisiae, two commonly used microbial hosts. We believe that in-depth foundational investigations on the native microenvironment of plant CYPs are necessary to adapt the microbial systems for more efficient functional reconstitution of plant CYPs.

Plasma-induced black bismuth tungstate as a photon harvester for photocatalytic carbon dioxide conversion

The Bi QDs are reduced in situ on the surface of black Bi₂WO₆ nanosheets using a novel plasma treatment, which shows a superior CO₂ conversion performance.

Coupling Nanostructured Microchips with Covalent Chemistry Enables Purification of Sarcoma-Derived Extracellular Vesicles for Downstream Functional Studies

Tumor-derived extracellular vesicles (EVs) play essential roles in intercellular communication during tumor growth and metastatic evolution. Currently, little is known about the possible roles of tumor-derived EVs in sarcoma because the lack of specific surface markers makes it technically challenging to purify sarcoma-derived EVs. In this study, a specific purification system is developed for Ewing sarcoma (ES)-derived EVs by coupling covalent chemistry-mediated EV capture/ release within a nanostructure-embedded microchip. The purification platform-ES-EV Click Chip-takes advantage of specific anti-LINGO-1 recognition and sensitive click chemistry-mediated EV capture, followed by disulfide cleavage-driven EV release. Since the device is capable of specific and efficient purification of intact ES EVs with high purity, ES-EV Click Chip is ideal for conducting downstream functional studies of ES EVs. Absolute quantification of the molecular hallmark of ES (i.e., EWS rearrangements) using reverse transcription Droplet Digital PCR enables specific quantification of ES EVs. The purified ES EVs can be internalized by recipient cells and transfer their mRNA cargoes, exhibiting their biological intactness and potential role as biological shuttles in intercellular communication.