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Wearable and implantable devices require conductive, stretchable and biocompatible materials. However, obtaining composites that simultaneously fulfil these requirements is challenging due to a trade-off between conductivity and stretchability. Here, we report on Ag–Au nanocomposites composed of ultralong gold-coated silver nanowires in an elastomeric block-copolymer matrix. Owing to the high aspect ratio and percolation network of the Ag–Au nanowires, the nanocomposites exhibit an optimized conductivity of 41,850 S cm−1 (maximum of 72,600 S cm−1). Phase separation in the Ag–Au nanocomposite during the solvent-drying process generates a microstructure that yields an optimized stretchability of 266% (maximum of 840%). The thick gold sheath deposited on the silver nanowire surface prevents oxidation and silver ion leaching, making the composite biocompatible and highly conductive. Using the nanocomposite, we successfully fabricate wearable and implantable soft bioelectronic devices that can be conformally integrated with human skin and swine heart for continuous electrophysiological recording, and electrical and thermal stimulation.

Tissue adhesives have emerged as an alternative to sutures and staples for wound closure and reconnection of injured tissues after surgery or trauma. Owing to their convenience and effectiveness, these adhesives have received growing attention particularly in minimally invasive procedures. For safe and accurate applications, tissue adhesives should be detectable via clinical imaging modalities and be highly biocompatible for intracorporeal procedures. However, few adhesives meet all these requirements. Herein, we show that biocompatible tantalum oxide/silica core/shell nanoparticles (TSNs) exhibit not only high contrast effects for real-time imaging but also strong adhesive properties. Furthermore, the biocompatible TSNs cause much less cellular toxicity and less inflammation than a clinically used, imageable tissue adhesive (that is, a mixture of cyanoacrylate and Lipiodol). Because of their multifunctional imaging and adhesive property, the TSNs are successfully applied as a hemostatic adhesive for minimally invasive procedures and as an immobilized marker for image-guided procedures. The use of tissue adhesives for the closure of wounds is of growing interest for surgery and trauma management. Here, the authors develop an adhesive that is biocompatible, enables tissue adhesion and also permits real-time imaging due to the presence of contrast agents for multiple modalities.

The motions of the heart are regulated by electrophysiological signals, which can be monitored and altered by bioelectronic devices for the diagnosis and treatment of cardiovascular diseases. In particular, soft bioelectronic devices, composed of deformable and conductive materials, can be implanted or designed as wearable devices to enable conformal contact with heart tissue or the skin for real-time and precise diagnosis and treatment. In this Review, we discuss the design and materials of soft bioelectronic devices, highlighting their advantages, as compared with rigid bioelectronic devices, in cardiovascular disease management. We examine the engineering and applications of soft implantable bioelectronics, including cardiac mapping devices, cardiac stimulation devices and mechanically assisting devices, as well as wearable soft bioelectronics, such as blood oxygen saturation sensors, heart monitoring devices and transdermal drug delivery systems. Finally, we outline technical challenges and future opportunities for the clinical application of soft bioelectronic devices, such as a wireless power supply, optogenetic control of cardiac motion, bioadhesives for device–tissue interfaces and artificial intelligence-assisted data analysis.Flexible and stretchable materials and devices can be applied for the design of soft bioelectronics. This Review discusses soft electronic materials that can be engineered into implantable and wearable devices for the monitoring and treatment of cardiovascular diseases.

Abstract Context Thyrotoxicosis requires accurate and expeditious differentiation between Graves’ disease (GD) and thyroiditis to ensure effective treatment decisions. Objective This study aimed to develop a machine learning algorithm using ultrasonography and Doppler images to differentiate thyrotoxicosis subtypes, with a focus on GD. Methods This study included patients who initially presented with thyrotoxicosis and underwent thyroid ultrasonography at a single tertiary hospital. A total of 7719 ultrasonography images from 351 patients with GD and 2980 images from 136 patients with thyroiditis were used. Data augmentation techniques were applied to enhance the algorithm's performance. Two deep learning models, Xception and EfficientNetB0_2, were employed. Performance metrics such as accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and F1 score were calculated for both models. Image preprocessing, neural network model generation, and neural network training results verification were performed using DEEP:PHI® platform. Results The Xception model achieved 84.94% accuracy, 89.26% sensitivity, 73.17% specificity, 90.06% PPV, 71.43% NPV, and an F1 score of 89.66 for the diagnosis of GD. The EfficientNetB0_2 model exhibited 85.31% accuracy, 90.28% sensitivity, 71.78% specificity, 89.71% PPV, 73.05% NPV, and an F1 score of 89.99. Conclusion Machine learning models based on ultrasound and Doppler images showed promising results with high accuracy and sensitivity in differentiating GD from thyroiditis.

Although various oral pathogens are inactivated by non-thermal atmospheric pressure plasma (NTAPP), the in vivo effects of NTAPP are poorly understood. The first aim of this study was to examine the antibacterial activity of microwave-pulsed NTAPP against Staphylococcus aureus in artificial saliva to mimic oral environmental conditions. The second aim was to determine the influence of microwave-pulsed NTAPP on human gingival fibroblasts (HGFs). The microwave-pulsed NTAPP reduced bacterial viability (as measured by colony forming units [CFU]) to a greater extent in artificial saliva than in saline. Extending the post-treatment incubation time increased bacterial inactivation in artificial saliva compared to saline. HGFs viability was unaffected by microwave-pulsed NTAPP for bacterial inactivation. Rather, HGFs proliferation increased after a 5-min microwave-pulsed NTAPP. Less tumor necrosis factor alpha was released by microwave-pulsed NTAPP-treated HGFs stimulated with lipopolysaccharide (LPS) than by untreated, LPS-stimulated HGFs; thus, plasma appeared to suppress the inflammatory response. Our study suggests that microwave-pulsed NTAPP may have stronger in vivo antibacterial activity than in vitro activity, and that microwave-pulsed NTAPP may have the additional advantage of suppressing gingival inflammatory responses.

Plant-derived substances exhibit antioxidant and antibacterial activities and have been proven to have beneficial effects in wound healing and skin regeneration. Plant stem cells have recently received much attention as research materials in cosmetic development because they promote regeneration after damage. In this paper, we demonstrate for the first time that the plasma treatment of stem cells obtained from rice-seed embryos can be effective in enhancing antioxidant activity and in regenerating human skin. We investigated this potential utilizing micro-DBD (Dielectric Barrier Discharge) plasma as a pretreatment technique to enhance the vitality and functional activity of rice stem cells. The results of the cell culture experiments show that plasma-treated rice stem cell extracts (RSCE) have promising antioxidant and anti-skin aging activities. The results of quantitative real-time PCR (qRT-PCR) for major antioxidant enzymes and anti-aging genes confirm that the plasma technique used in the pretreatment of RSCE was able to enhance cell activities in skin regeneration, including cell survival, proliferation, and collagen enhancement for Human Fibroblast (HFB) degraded by oxidative stress. These results show that the relatively low energy of less than 300 W and an amount of NOx-based reactive nitrogen species (RNS) from plasma discharge of about 3 μL/L were the key factors and that RSCE, of which the antioxidant activity was enhanced by plasma treatment, appeared to be a major contributor to the protective effect of HFB against oxidative stress. Plasma-treated RSCE induced excellent anti-aging properties by stimulating HFB to promote collagen synthesis, thereby promoting skin regeneration. These properties can protect the skin from various oxidative stresses. This study demonstrates that plasma-treated extracts of stem cells derived from rice-seed embryos have an excellent regenerative effect on aging-treated HFB. Our results demonstrate the potential utility of plasma-treated RSCE as a skin anti-aging agent in cosmeceutical formulations for the first time.

To compare the diagnostic performance of high-resolution ultrasound (HRUS) with contrast-enhanced CT and contrast-enhanced magnetic resonance imaging (MRI) with MR cholangiopancreatography (MRCP) to differentiate between adenomyomatosis (ADM) and gallbladder cancer (GBCA). Forty patients with surgically proven ADM (n = 13) or GBCA at stage T2 or lower (n = 27) who previously underwent preoperative HRUS, contrast-enhanced CT, and contrast-enhanced MRI with MRCP were retrospectively included in this study. According to the well-known diagnostic criteria, two reviewers independently analyzed the images from each modality separately with a five-point confidence scale. The interobserver agreement was calculated using weighted κ statistics. A receiver operating characteristic curve analysis was performed and the sensitivity, specificity, and accuracy were calculated for each modality when scores of 1 or 2 indicated ADM. The interobserver agreement between the two reviewers was good to excellent. The mean Az values for HRUS, multidetector CT (MDCT), and MRI were 0.959, 0.898, and 0.935, respectively, without any statistically significant differences between any of the modalities (p > 0.05). The mean sensitivity of MRI with MRCP (80.8%) was significantly higher than that of MDCT (50.0%) (p = 0.0215). However, the mean sensitivity of MRI with MRCP (80.8%) was not significantly different from that of HRUS (73.1%) (p > 0.05). The mean specificities and accuracies among the three modalities were not significantly different (p > 0.05). High-resolution ultrasound and MRI with MRCP have comparable sensitivity and accuracy and MDCT has the lowest sensitivity and accuracy for the differentiation of ADM and GBCA.

Isolating actively proliferating cardioblasts is the first crucial step for cardiac regeneration through cell implantation. However, the origin and identity of putative cardioblasts are still unclear. Here, we uncover a novel class of cardiac lineage cells, PDGFRα + Flk1 − cardioblasts (PCBs), from mouse and human pluripotent stem cells induced using CsAYTE, a combination of the small molecules Cyclosporin A, the rho-associated coiled-coil kinase inhibitor Y27632, the antioxidant Trolox, and the ALK5 inhibitor EW7197. This novel population of actively proliferating cells is cardiac lineage–committed but in a morphologically and functionally immature state compared to mature cardiomyocytes. Most important, most of CsAYTE-induced PCBs spontaneously differentiated into functional αMHC + cardiomyocytes (M + CMs) and could be a potential cellular resource for cardiac regeneration.

Background and Aims: The feasibility of incidental cholecystectomy during colorectal cancer (CRC) surgery has not been determined as yet. We aimed to investigate the feasibility of incidental cholecystectomy during CRC surgery. Methods: The clinicopathologic data of patients who underwent CRC surgery between January 2004 and May 2011 were assessed. Patients with asymptomatic cholelithiasis were divided into groups that did and did not undergo incidental cholecystectomy. Their in-hospital morbidity and long-term biliary complications were compared. Results: Of the 282 patients identified, 143 (50.7%) underwent incidental cholecystectomy and 139 (49.3%) were observed without cholecystectomy. The two groups were similar in clinical characteristics, except for gender and operation time. Only one patient (0.7%) in the cholecystectomy group experienced an intraoperative biliary complication. There was no significant difference in overall in-hospital morbidity between the two groups. After a median follow-up period of 33 months, long-term biliary complications developed in 12 patients (8.6%) in the observation group, with 9 undergoing cholecystectomy. Conclusions: Incidental cholecystectomy was not associated with increased postoperative morbidity, whereas previously asymptomatic patients were at substantial long-term risk of becoming symptomatic. Thus, in the absence of clear contraindications, concomitant cholecystectomy might be a desirable treatment option during CRC surgery in patients with asymptomatic gallstones.

Objective To compare the performance of computer-aided detection (CAD) for CT colonography (CTC) with and without electronic cleansing (EC) in a high-risk population tagged with a faecal tagging (FT) protocol. Methods Thirty-two patients underwent CTC followed by same-day colonoscopy. All patients underwent bowel preparation and FT with barium and gastrografin. Each CTC dataset was processed with colon CAD with and without EC. Per-polyp sensitivity was calculated. The average number of false-positive (FP) results and their causes were also analysed and compared. Results Eighty-six polyps were detected in 29 patients. Per-polyp sensitivities of CAD with EC (93.8% and 100%) were higher than those without EC (84.4% and 87.5%) for polyps ≥6 mm and ≥10 mm, respectively. However, the differences were not significant. The average number (6.3) of FPs of CAD with EC was significantly larger than that (3.1) without EC. The distribution of FPs in both CAD settings was also significantly different. The most common cause of FPs was the ileocaecal valve in both datasets. However, untagged faeces was a significantly less common cause of FPs with EC, EC-related artefacts being more common. Conclusion Electronic cleansing has the potential to improve per-polyp sensitivity of CTC CAD, although the significantly larger number of FPs with EC remains to be improved.