Amphibious Hybrid Laser Tweezers for Fluid and Solid Domains.

Optical trapping is a potent tool for achieving precise and noninvasive manipulation of small objects in a vacuum and liquids. However, due to the substantial disparity between optical forces and interfacial adhesion, target objects should be suspended in fluid environments, rendering solid contact surfaces a restricted area for conventional optical tweezers. In this work, by relying on a single continuous wave (CW) laser, we demonstrate an optical manipulation system applicable for both fluid and solid domains, namely, amphibious hybrid laser tweezers. The key to our system lies in modulating the intensity of the CW laser with duration shorter than the dynamic thermal equilibrium time within objects, wherein strong thermal gradient forces with ∼6 orders of magnitude higher than the forces in optical tweezers are produced, enabling moving and trapping micro/nano-objects on solid interfaces. Thereby, CW laser-based optical tweezers and pulsed laser-based photothermal shock tweezers are seamlessly fused with the advantages of cost-effectiveness and simplicity. Our concept breaks the stereotype that CW lasers are limited to generating tiny forces and instead achieve ultrawide force generation spanning from femto-newtons (10-15 N) to (10-6 N). Our work expands the horizon of optical manipulation by seamlessly bridging its applications in fluid and solid environments and holds promise for inspiring optical manipulation techniques to perform more challenging tasks, which may unearth application scenarios in diverse fields such as fundamental physical research, nanofabrication, micro/nanorobotics, biomedicine, and cytology.

Autonomous nanorobots with powerful thrust under dry solid-contact conditions by photothermal shock.

Nanorobotic motion on solid substrates is greatly hindered by strong nanofriction, and powerful nanomotors‒the core components for nanorobotic motion‒are still lacking. Optical actuation addresses power and motion control issues simultaneously, while conventional technologies with small thrust usually apply to fluid environments. Here, we demonstrate micronewton-thrust nanomotors that enable the autonomous nanorobots working like conventional robots with precise motion control on dry surfaces by a photothermal-shock technique. We build a pulsed laser-based actuation and trapping platform, termed photothermal-shock tweezers, for general motion control of metallic nanomaterials and assembled nanorobots with nanoscale precision. The thrust-to-weight ratios up to 107 enable nanomotors output forces to interact with external micro/nano-objects. Leveraging machine vision and deep learning technologies, we assemble the nanomotors into autonomous nanorobots with complex structures, and demonstrate multi-degree-of-freedom motion and sophisticated functions. Our photothermal shock-actuation concept fundamentally addresses the nanotribology challenges and expands the nanorobotic horizon from fluids to dry solid surfaces.

Clopidogrel as a Distinctive Cause of Insulin Autoimmune Syndrome: A Systematic Case Review.

The sulfhydryl group of clopidogrel metabolite could induce insulin autoimmune syndrome (IAS) with hypoglycemia as the major symptom. For patients with cardiovascular disease taking clopidogrel for vascular protection, this adverse event hypoglycemia increases the risk of cardiovascular events. However, discontinuing clopidogrel leaves patients without appropriate antiplatelet therapy. Treating IAS with glucocorticoids is also risky for these patients' primary cardiovascular diseases. Early recognition and appropriate treatment of clopidogrel-induced IAS (CIAS) would be beneficial for patients. This research aimed to discover the clinical features and investigate optimal therapeutic management of CIAS. We systematically searched for cases of CIAS in PubMed and Embase and performed data mining in Food and Drug Administration Adverse Event Reporting System (FAERS). In the CIAS series, clinical features were summarized and compared to 287 IAS cases, including demographic information, HLA alleles, onset, and symptoms. The therapeutic effect of glucocorticoids was compared between the receiving group and the not-receiving group. The possibilities of common antiplatelet drugs to induce hypoglycemia/IAS were investigated with chemical structure and FAERS reports. A CIAS series of 51 patients was established. CIAS had an onset age of 74.8±8.6 years old, 92.2% male, and a balanced proportion of East Asians and non-East Asians. Confusion occurred more frequently in CIAS than in IAS from various causes, while the other symptoms and hypoglycemia types were similar. The recovery time was approximately the same whether using glucocorticoids/immunotherapy in CIAS or not. Among common antiplatelet drugs, ticagrelor and rivaroxaban were unlikely to induce hypoglycemia/IAS. Clopidogrel is a distinctive cause of IAS featuring an elderly male presenting confusion as the symptom of hypoglycemia. Glucocorticoids/immunotherapy might not be necessary for the long-term recovery of CIAS. To balance the risks of hypoglycemia and cardiovascular events, substituting clopidogrel with ticagrelor and rivaroxaban might be considered.

Thermal-mechanical-photo-activation effect on silica micro/nanofiber surfaces: origination, reparation and utilization.

The exploration relevant to the surface changes on optical micro- and nanofibers (MNFs) is still in infancy, and the reported original mechanisms remain long-standing puzzles. Here, by recognizing the combined interactions between fiber heating, mechanically tapering, and high-power pulsed laser guiding processes in MNFs, we establish a general thermal-mechanical-photo-activation mechanism that can explain the surface changes on MNFs. Our proposed activation mechanism can be well supported by the systematical experimental results using high-intensity nanosecond/femtosecond pulsed lasers. Especially we find large bump-like nanoscale cavities on the fracture ends of thin MNFs. Theoretically, on the basis of greatly increased bond energy activated by the fiber heating and mechanically tapering processes, the energy needed to break the silicon-oxygen bond into dangling bonds is significantly reduced from its intrinsic bandgap of ∼9 eV to as low as ∼4.0 eV, thus high-power pulsed lasers with much smaller photon energy can induce obvious surface changes on MNFs via multi-photon absorption. Finally, we demonstrate that using surfactants can repair the MNF surfaces and exploit them in promising applications ranging from sensing and optoelectronics to nonlinear optics. Our results pave the way for future preventing the performances from degradation and enabling the practical MNF-based device applications.

Plasmon-driven nanowire actuators for on-chip manipulation.

Chemically synthesized metal nanowires are promising building blocks for next-generation photonic integrated circuits, but technological implementation in monolithic integration will be severely hampered by the lack of controllable and precise manipulation approaches, due to the strong adhesion of nanowires to substrates in non-liquid environments. Here, we demonstrate this obstacle can be removed by our proposed earthworm-like peristaltic crawling motion mechanism, based on the synergistic expansion, friction, and contraction in plasmon-driven metal nanowires in non-liquid environments. The evanescently excited surface plasmon greatly enhances the heating effect in metal nanowires, thereby generating surface acoustic waves to drive the nanowires crawling along silica microfibres. Advantages include sub-nanometer positioning accuracy, low actuation power, and self-parallel parking. We further demonstrate on-chip manipulations including transporting, positioning, orientation, and sorting, with on-situ operation, high selectivity, and great versatility. Our work paves the way to realize full co-integration of various functionalized photonic components on single chips.

Disease activity in patients with synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome: the utility of the SPARCC MRI scoring system for assessment of axial spine involvement.

OBJECTIVES: The aim of this study is to investigate the relationship between spinal MRI findings with disease activity and other clinical and serological parameters, and to determine the importance of MRI scoring system in evaluating disease activity of SAPHO syndrome. METHODS: Thirty patients with SAPHO syndrome underwent clinical, laboratory and MRI evaluation at baseline, 3 months, 6 months and 1 year. Magnetic resonance images were analysed using modified Spondyloarthritis Research Consortium of Canada (SPARCC) scoring system. Correlations between MRI score and clinical and laboratory parameters were analysed using Spearman's rank correlation test. RESULTS: Persistent improvement was observed after 12 months in terms of total modified SPARCC scores (37(12,59) vs. 23(5,45) at baseline and 12 months, p<0.05). Total modified SPARCC scores showed Spearman correlations with hypersensitive C-reaction protein (hs-CRP), ankylosing spondylitis disease activity score (ASDAS) and bath ankylosing spondylitis metroloty index (BASMI) at baseline, 3 months, 6 months and 12 months (p varied from <0.001 to <0.05, and r varied from 0.418 to 0.601). Modified SPARCC scores of spine joint, as the largest contribution to the total scores with the mean score of 12(5,30) after 12 months vs. 26 (12,40) at baseline. CONCLUSIONS: The modified SPARCC score proposed in this study exhibits promising potential in the evaluation of extensive radiographic damage in SAPHO and the reflection the disease activity. Our study suggests that MRI could be used together with other parameters of disease activity in the assessment of symptomatic SAPHO patients with spine involvement.

Intensity-modulated Radiotherapy for Pituitary Somatotroph Adenomas.

OBJECTIVE: To summarize our experience in the treatment of pituitary somatotroph adenomas by fractionated intensity-modulated radiotherapy (IMRT), describe the treatment outcomes, and determine predictors. METHODS AND MATERIALS: Patients with pituitary somatotroph adenoma treated by IMRT in our institution from August 2009 to January 2019 were reviewed. A total of 113 patients (37 male) were included in this study. The median age was 33 years (range 12-67 years). A total of 112 patients had not achieved complete remission after surgery, and 1 patient was treated by radiotherapy (RT) alone because she refused to surgery. The median growth hormone level was 8.6 ng/mL (range 2-186 ng/mL) and the median insulin-like growth factor (IGF)-1 level was 732 ng/mL (range 314-1485 ng/mL) pre-RT. The radiation doses to clinical target volume were usually 50-56 Gy in 25 to 30 fractions and to gross tumor volume were 60.2 Gy in 28 fractions while simultaneous integrated boost-IMRT used. After RT, the patients were followed up with endocrine testing every 6 to 12 months and magnetic resonance imaging annually. Endocrine complete remission was defined as a normal sex- and age-adjusted IGF-1 level without any pituitary suppressive medications. The outcomes including endocrine remission and new hypopituitarism after RT were recorded. The median follow-up time was 36 months (range 6-105.5 months). RESULTS: The endocrine complete remission rates of IGF-1 at 1, 2, 3, and 5 years were 6%, 22.8%, 48.6%, and 74.3%, respectively. The median time to complete remission was 36.2 ±â€…3.8 months. The tumor control rate was 99% during the follow-up. The overall incidence of RT-induced hypopituitarism was 28.3% at the last follow-up. Univariate and multivariate analysis demonstrated that tumor sizes before RT, pre-RT IGF-1 level, and age significant predicted the endocrine remission. CONCLUSIONS: IMRT is a highly effective treatment for pituitary somatotroph adenoma. Endocrine remission rate, tumor control rate, the median time to remission and hypopituitarism incidence are similar to stereotactic radiosurgery. Age and IGF-1 level before RT were significant predictive factors in endocrine remission.

Predictive effect of five hepatitis B virus markers on re-vaccination time of hepatitis B vaccine.

Examination of predictive effect of five hepatitis B virus (HBV) markers on the re-vaccination time of hepatitis B vaccine was assessed. A total of 3,243 patients examined by five HBV markers in Women and Children's Health Care Hospital of Linyi from January 2015 to December 2017 were selected as the subjects and analyzed retrospectively. According to the previous time of hepatitis B antibody vaccination, subjects were divided into three groups: Short-term group (previous time of hepatitis B vaccination <5 years, n=798); medium-term group (>5 years - ≤10 years, n=1,242); long-term group (>10 years, n=1,203). The enzyme linked immunosorbent assay was used to qualitatively analyze the five HBV markers, and chemiluminescence immunoassay was used to quantitatively analyze the five HBV markers. Hepatitis B surface antigen (HBsAg) in the long-term group and the medium-term group was significantly lower than that in the short-term group (P<0.001). HBsAg, hepatitis B e antigen, hepatitis B e antibody, hepatitis B core antibody in the long-term group was significantly higher than that in the medium-term and short-term group (P<0.050). The hepatitis B surface antibody in the long-term group was significantly lower than that in the other two groups (P<0.050). According to the previous time of the hepatitis B antibody vaccination, the patients in the long-term group were subdivided into three groups: Group A (vaccination time: 10-13 years, n=420); group B (13-15 years, n=377) and group C (>15 years, n=406). Geometric mean titer in group A was significantly lower than that in the other two groups (P<0.050). In conclusion, the protective effect of hepatitis B antibody vaccine is satisfactory for 10 years after vaccination, and re-vaccination is recommended after more than 13 years of vaccination when the virus begins to increase significantly, in order to prevent the occurrence of hepatitis B.

Enhancing monolayer photoluminescence on optical micro/nanofibers for low-threshold lasing.

Although monolayer transition metal dichalcogenides (TMDs) have direct bandgaps, the low room-temperature photoluminescence quantum yields (QYs), especially under high pump intensity, limit their practical applications. Here, we use a simple photoactivation method to enhance the room-temperature QYs of monolayer MoS2 grown on to silica micro/nanofibers by more than two orders of magnitude in a wide pump dynamic range. The high-density oxygen dangling bonds released from the tapered micro/nanofiber surface are the key to this strong enhancement of QYs. As the pump intensity increases from 10-1 to 104 W cm-2, our photoactivated monolayer MoS2 exhibits QYs from ~30 to 1% while maintaining high environmental stability, allowing direct lasing with greatly reduced thresholds down to 5 W cm-2. Our strategy can be extended to other TMDs and offers a solution to the most challenging problem toward the realization of efficient and stable light emitters at room temperature based on these atomically thin materials.

Spinal and sacroiliac involvement in SAPHO syndrome: A single center study of a cohort of 354 patients.

OBJECTIVE: SAPHO syndrome is a highly heterogeneous disease with distinct treatment response. We report the largest cohort of SAPHO syndrome and explore its clinical classification with special interest in spinal and sacroiliac involvement. METHODS: A total of 354 patients with SAPHO syndrome were recruited in Peking Union Medical College Hospital. The demographic, clinical and imaging data were collected at baseline. Spinal and sacroiliac involvement was determined by the co-existence of related symptoms and imaging evidence of lesions in the spine or sacroiliac joints on either bone scintigraphy, CT or MRI. RESULTS: A total of 197 (55.6%) patients were identified to have spinal or sacroiliac involvement. Compared to those without spinal or sacroiliac lesions, these patients were significantly older at onset (38 ±â€¯12 vs 35 ±â€¯10 years old, p = 0.019) but had comparable duration of disease. Therapeutically, patients with spinal or sacroiliac involvement had been treated more aggressively with more frequently prescribed NSAIDs, glucocorticoids, DMARDs, TNF-α inhibitors, and bisphosphonates (all p ≤ 0.001). Nonetheless, greater disease activity was observed for these patients at baseline, supported by both inflammatory markers (ESR and hs-CRP) and visual analog scale (VAS) for pain (all p < 0.001). CONCLUSIONS: SAPHO patients with spinal or sacroiliac involvement are older at onset and have greater disease activity despite of more aggressive treatments compared to those without. Stratified management is in urgent need for this rare disease.

Efficacy of bisphosphonates in patients with synovitis, acne, pustulosis, hyperostosis, and osteitis syndrome: a prospective open study.

OBJECTIVES: To evaluate the clinical efficacy of bisphosphonates treatment for spinal bone marrow oedema (BME) in patients with synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome. METHODS: SAPHO syndrome patients presenting to Peking Union Medical College Hospital from 2015 to 2016 were recruited. Patients were administered pamidronate disodium 1 mg/kg/d intravenously, for 3 days, at baseline and 3 months later. The symptoms were evaluated using the Visual Analog Score (VAS) for pain, and other clinical measures including, spinal BME scores, ß-crosslaps, osteocalcin, and inflammatory factors, were collected. RESULTS: A total of 30 patients (20 women and 10 men) with a median age of 47.2 (interquartile range 8.8) years were recruited. In a short time, the patients showed a significant decrease in VAS (before vs. after; first treatment: 5.70±1.62 vs. 2.30±1.29 cm, second treatment: 4.03±1.88 vs. 2.17±1.23 cm) and ß-crosslaps (first treatment: 0.4441±0.1923 vs. 0.0859±0.0374 pg/ml, second treatment: 0.2891±0.1983 vs. 0.0962±0.0324 pg/ml) (all p<0.05). At 12-month follow-up, compared with the baseline, we noticed a significant drop in the VAS (5.70±1.62 vs. 2.43±1.25 cm), erythrocyte sedimentation rate (28.87±25.26 vs. 18.00±18.65 mm/h), high-sensitivity C-reactive protein level (11.76±10.19 vs. 5.84±5.88 mg/L), osteocalcin (2.30±1.27 vs. 1.65±0.80 ng/ml), and BME (30.50±24.09 vs. 22.13±27.79) (all p<0.05). No one had serious adverse events. CONCLUSIONS: Bisphosphonates can significantly and rapidly relieve symptoms in patients with SAPHO syndrome and have a long-term effect on inflammation and spinal BME. We suggest that bisphosphonates could be used as the first-line therapeutic drug for SAPHO syndrome, especially in patients with spinal BME.

Three patterns of osteoarticular involvement in SAPHO syndrome: a cluster analysis based on whole body bone scintigraphy of 157 patients.

OBJECTIVES: To explore the patterns of osteoarticular involvement in SAPHO syndrome. METHODS: Baseline clinical characteristics and imaging data of 99mTc-MDP whole-body bone scintigraphy (WBBS) were collected from 157 out of 164 patients diagnosed with SAPHO syndrome. The twelve most frequently involved osteoarticular sites were analysed by hierarchical cluster analysis with the Ward minimum-variance method. RESULTS: Three distinctive patterns of osteoarticular involvement were identified: the spinal type (70 patients, 44.6%), with predominantly thoracic, lumbar or sacral vertebral lesions; the costal type (52 patients, 33.1%), with lesions of anterior ribs, particularly the first ribs; and the sternoclavicular type (35 patients, 22.3%), with predominantly sternal and bilateral sternoclavicular lesions, characterized by the typical bullhead sign. Notably, a total of 77 (49%) patients exhibited lesions of ribs on WBBS, of which 61.3% involved the first ribs. Interestingly, patients of spinal type were older at onset of cutaneous manifestations than those of sternoclavicular type (P = 0.036) and costal type (P = 0.035). The disease course was remarkably longer in sternoclavicular type than costal type (P = 0.001) and spinal type (P < 0.001). CONCLUSION: The osteoarticular involvement in SAPHO syndrome can be categorized as three distinct patterns with different corresponding clinical features. The costal involvement in SAPHO syndrome, which was under-recognized previously, may define a distinct sub-type of the disease.

Efficient higher-order nonlinear optical effects in CdSe nanowaveguides.

Stimulating higher-order nonlinear optical (HO-NLO) response from individual semiconductor nanostructures is challenging due to the low nonlinear coefficients and the small number of molecules within the nanostructures. In this work, we demonstrate efficient third harmonic generation and multi-photon luminescence in CdSe nanowaveguides by means of evanescent wave coupling technique. Under appropriate conditions, a coupling efficiency of 70% can be achieved from an optical microfiber to a single CdSe nanowaveguide, leading to the enhanced HO-NLO effects. Provided a high signal-to-noise ratio, we thus observe a fourth order excitation power dependence of 3-photon luminescence, and we attribute it to surface defect mechanism based on the recombination of free carriers. This work provides an alternative for efficient excitation for HO-NLO, which also makes these hard-to-produce signals more feasible in the applications of nonlinear optical devices.

Comprehensive analysis of circRNA expression profiles in humans by RAISE.

Circular RNAs (circRNAs) are pervasively expressed circles of non­coding RNAs. Even though many circRNAs have been reported in humans, their expression patterns and functions remain poorly understood. In this study, we employed a pipeline named RAISE to detect circRNAs in RNA­seq data. RAISE can fully characterize circRNA structure and abundance. We evaluated inter-individual variations in circRNA expression in humans by applying this pipeline to numerous non­poly(A)-selected RNA­seq data. We identified 59,128 circRNA candidates in 61 human liver samples, with almost no overlap in the circRNA of the recruited samples. Approximately 89% of the circRNAs were detected in one or two samples. In comparison, 10% of the linear mRNAs and non­coding RNAs were detected in each sample. We estimated the variation in other tissues, especially the circRNA high-abundance tissues, in advance. Only 0.5% of the 50,631 brain circRNA candidates were shared among the 30 recruited brain samples, which is similar to the proportion in liver. Moreover, we found inter- and intra-individual diversity in circRNAs expression in the granulocyte RNA­seq data from seven individuals sampled 3 times at one-month intervals. Our findings suggest that careful consideration of inter-individual diversity is required when extensively identifying human circRNAs or proposing their use as potential biomarkers and therapeutic targets in disease.

The role of three-dimensional printed models of skull in anatomy education: a randomized controlled trail.

Three-dimensional (3D) printed models represent educational tools of high quality compared with traditional teaching aids. Colored skull models were produced by 3D printing technology. A randomized controlled trial (RCT) was conducted to compare the learning efficiency of 3D printed skulls with that of cadaveric skulls and atlas. Seventy-nine medical students, who never studied anatomy, were randomized into three groups by drawing lots, using 3D printed skulls, cadaveric skulls, and atlas, respectively, to study the anatomical structures in skull through an introductory lecture and small group discussions. All students completed identical tests, which composed of a theory test and a lab test, before and after a lecture. Pre-test scores showed no differences between the three groups. In post-test, the 3D group was better than the other two groups in total score (cadaver: 29.5 [IQR: 25-33], 3D: 31.5 [IQR: 29-36], atlas: 27.75 [IQR: 24.125-32]; p = 0.044) and scores of lab test (cadaver: 14 [IQR: 10.5-18], 3D: 16.5 [IQR: 14.375-21.625], atlas: 14.5 [IQR: 10-18.125]; p = 0.049). Scores involving theory test, however, showed no difference between the three groups. In this RCT, an inexpensive, precise and rapidly-produced skull model had advantages in assisting anatomy study, especially in structure recognition, compared with traditional education materials.