Recent advancements in the measurement of pathogenic airborne viruses.

Air-transmissible pathogenic viruses, such as influenza viruses and coronaviruses, are some of the most fatal strains and spread rapidly by air, necessitating quick and stable measurements from sample air volumes to prevent further spread of diseases and to take appropriate steps rapidly. Measurements of airborne viruses generally require their collection into liquids or onto solid surfaces, with subsequent hydrosolization and then analysis using the growth method, nucleic-acid-based techniques, or immunoassays. Measurements can also be performed in real time without sampling, where species-specific determination is generally disabled. In this review, we introduce some recent advancements in the measurement of pathogenic airborne viruses. Air sampling and measurement technologies for viral aerosols are reviewed, with special focus on the effects of air sampling on damage to the sampled viruses and their measurements. Measurement of pathogenic airborne viruses is an interdisciplinary research area that requires understanding of both aerosol technology and biotechnology to effectively address the issues. Hence, this review is expected to provide some useful guidelines regarding appropriate air sampling and virus detection methods for particular applications.

Integrated microfluidic platform with electrohydrodynamic focusing and a carbon-nanotube-based field-effect transistor immunosensor for continuous, selective, and label-free quantification of bacteria.

Electrokinetic technologies such as AC electro-osmosis (EO) and dielectrophoresis (DEP) have been used for effective manipulation of bacteria to enhance the sensitivity of an assay, and many previously reported electrokinetics-enhanced biosensors are based on stagnant fluids. An effective region for positive DEP for particle capture is usually too close to the electrode for the flowing particles to move toward the detection zone of a biosensor against the flow direction; this poses a technical challenge for electrokinetics-assisted biosensors implemented within pressure-driven flows, especially if the particles flow with high speed and if the detection zone is small. Here, we present a microfluidic single-walled carbon nanotube (SWCNT)-based field-effect transistor immunosensor with electrohydrodynamic (EHD) focusing and DEP concentration for continuous and label-free detection of flowing Staphylococcus aureus in a 0.01× phosphate buffered saline (PBS) solution. The EHD focusing involved AC EO and negative DEP to align the flowing particles along lines close to the bottom surface of a microfluidic channel for facilitating particle capture downstream at the detection zone. For feasibility, 380 nm-diameter fluorescent beads suspended in 0.001× PBS were tested, and 14.6 times more beads were observed to be concentrated in the detection area with EHD focusing. Moreover, label-free, continuous, and selective measurement of S. aureus in 0.01× PBS was demonstrated, showing good linearity between the relative changes in electrical conductance of the SWCNTs and logarithmic S. aureus concentrations, a capture/detection time of 35 min, and a limit of detection of 150 CFU mL-1, as well as high specificity through electrical manipulation and biological interaction.

Current status of the spontaneous reporting and classification/coding system for herbal and traditional medicine in pharmacovigilance.

BACKGROUND: While the use of herbal and traditional medicine (H&TM) has been extensive worldwide, the current status of H&TM management in pharmacovigilance remains to be investigated. To date, there is little information regarding the use of the classification/coding system (CCS) to detect signals for certain drugs within databases built on the basis of the spontaneous reporting system (SRS). The purpose of this study is to investigate the status of the SRS and CCS for H&TM in the pharmacovigilance systems of various countries around the world. METHODS: An e-mail survey was performed from late December 2018 to early January 2019 with 54 experts in pharmacovigilance. The results based on the information provided by the respondents were summarized. RESULTS: Fourteen experts from 13 countries responded to the survey. Eleven countries/regions were found to already include H&TM in their SRSs, managing only limited range of H&TM. Of the 9 countries/regions that provided the information on the status of CCS for H&TM in their domestic pharmacovigilance systems, only China had a separate CCS for H&TM. CONCLUSION: Revising the current pharmacovigilance systems to include or expand the range of H&TM, and developing an internationally harmonized system to classify and code H&TM suitable to the unique characteristics of H&TM are critical and overall beneficial.

Electroacupuncture for post-stroke dysphagia: A protocol for systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Post-stroke dysphagia (PSD) requires effective treatment as it may cause aspiration pneumonia, dehydration, or malnutritution, which can increase the length of hospital stay as well as mortality. In the field of stroke, electroacupuncture (EA) has been widely used, and a number of clinical research papers have been published regarding its effects. This systematic review aims to evaluate the effectiveness of EA for the treatment of PSD. METHODS: Randomized controlled trials evaluating the use of EA in PSD will be included in this meta-analysis. The following electronic databases will be searched from inception to July 31, 2020, using terms relating to EA and PSD: PubMed, the Cochrane Library, the Excerpta Medica Database, China National Knowledge Infrastructure, the Korean Medical Database, KoreaMed, the National Digital Science Library, and the Oriental Medicine Advanced Searching Integrated System. Two reviewers will independently search these databases, select studies for inclusion, and evaluate the quality of the studies. Methodological quality will be assessed using the Cochrane Handbook for Systematic Reviews of Interventions (version 6.0). The primary outcome will be the total effective rate; secondary outcomes will include results of other assessments of dysphagia such as the water drinking test scale and videofluoroscopic swallowing study. We will also investigate the number and severity of adverse events. The Cochrane Review Manager (RevMan) software (version 5.3.5) will be employed to assess bias risk, data integration risk, and meta-analysis risk. Mean difference and standardized mean difference will be used to represent continuous data, while risk ratios will be used for pooled binary data. RESULTS: This study will provide a comprehensive review and evaluation of the available evidence regarding the efficacy and safety of EA as a treatment for PSD. CONCLUSION: This study will clarify whether EA could be an effective and safe treatment for PSD.

Pharmacopuncture for stroke survivors: A systematic review of randomized controlled trials in South Korea.

BACKGROUND AND PURPOSE: Pharmacopuncture is one of the widely used interventions for stroke in Korea, but there is a lack of such evidence. This study was aimed to summarize the currently available evidence on the use of pharmacopuncture for stroke in the clinical practice of Korean medicine. METHODS: A systematic review of randomized controlled trials (RCTs) to evaluate the efficacy and safety of pharmacopuncture for stroke in Korea was conducted. RESULTS: Pharmacopuncture using bee venom was significantly beneficial for improving motor function and relieving the post-stroke shoulder pain. No serious adverse events were reported. The overall risk of bias of the included studies indicated a certain degree of concern and the level of evidence was low. CONCLUSION: The majority of RCTs have focused on the pain relief effects of bee venom injection. However, the quantity and quality of the evidence are not sufficiently high to draw definitive conclusions on this topic.

Discovering hidden information in biosignals from patients using artificial intelligence.

Biosignals such as electrocardiogram or photoplethysmogram are widely used for determining and monitoring the medical condition of patients. It was recently discovered that more information could be gathered from biosignals by applying artificial intelligence (AI). At present, one of the most impactful advancements in AI is deep learning. Deep learning-based models can extract important features from raw data without feature engineering by humans, provided the amount of data is sufficient. This AI-enabled feature presents opportunities to obtain latent information that may be used as a digital biomarker for detecting or predicting a clinical outcome or event without further invasive evaluation. However, the black box model of deep learning is difficult to understand for clinicians familiar with a conventional method of analysis of biosignals. A basic knowledge of AI and machine learning is required for the clinicians to properly interpret the extracted information and to adopt it in clinical practice. This review covers the basics of AI and machine learning, and the feasibility of their application to real-life situations by clinicians in the near future.

Two-dimensional computational method for generating planar electrode patterns with enhanced volumetric electric fields and its application to continuous dielectrophoretic bacterial capture.

An array of microfabricated interdigitated electrodes (IDEs) is one of the most commonly used forms of electrode geometry for dielectrophoretic manipulation of biological particles in microfluidic biochips owing to simplicity of fabrication and ease of analysis. However, the dielectrophoretic force dramatically reduces as the distance from the electrode surface increases; therefore, the effective region is usually close to the electrode surface for a given electric potential difference. Here, we present a novel two-dimensional computational method for generating planar electrode patterns with enhanced volumetric electric fields, which we call the "microelectrode discretization (MED)" method. It involves discretization and reconstruction of planar electrodes followed by selection of the electrode pattern that maximizes a novel objective function, factor S, which is determined by the electric potentials on the electrode surface alone. In this study, IDEs were used as test planar electrodes. Two arrays of IDEs and respective MED-optimized electrodes were implemented in microfluidic devices for the selective capture of Escherichia coli against 1 µm-diameter polystyrene beads, and we experimentally observed that 1.4 to 35.8 times more bacteria were captured using the MED-optimized electrodes than the IDEs (p < 0.0016), with a bacterial purity against the beads of more than 99.8%. This simple design method offered simplicity of fabrication, highly enhanced electric field, and uniformity of particle capture, and can be used for many dielectrophoresis-based sensors and microfluidic systems.

Adjunctive herbal medicine treatment for patients with acute ischemic stroke: A systematic review and meta-analysis.

BACKGROUND AND PURPOSE: In the East-Asian countries, the combined treatment of Western medicine and herbal medicine has been widely administered. The purpose of this study was to evaluate the efficacy and safety of herbal medicine in the treatment of acute ischemic stroke. METHODS: We searched the PubMed, Cochrane Central Register of Controlled Trials, EMBASE, and CNKI up to January 2017. Randomized Controlled Trials evaluating the effect of adjunctive herbal medicine on acute ischemic stroke were included. RESULTS: A total of 80 studies (8057 patients) were collected. The overall methodological quality was low. In the herbal group, meta-analysis indicated a statistically significant improvement in the neurologic deficits and activity of daily living compared with the non-herbal group. Furthermore, herbal treatments were relatively safe. CONCLUSION: The treatment can induce neurological improvements without side effects. However, concrete conclusions cannot be made due to the methodological problems of the included studies.

Rapid and selective concentration of bacteria, viruses, and proteins using alternating current signal superimposition on two coplanar electrodes.

Dielectrophoresis (DEP) is usually effective close to the electrode surface. Several techniques have been developed to overcome its drawbacks and to enhance dielectrophoretic particle capture. Here we present a simple technique of superimposing alternating current DEP (high-frequency signals) and electroosmosis (EO; low-frequency signals) between two coplanar electrodes (gap: 25 µm) using a lab-made voltage adder for rapid and selective concentration of bacteria, viruses, and proteins, where we controlled the voltages and frequencies of DEP and EO separately. This signal superimposition technique enhanced bacterial capture (Escherichia coli K-12 against 1-µm-diameter polystyrene beads) more selectively (>99%) and rapidly (~30 s) at lower DEP (5 Vpp) and EO (1.2 Vpp) potentials than those used in the conventional DEP capture studies. Nanometer-sized MS2 viruses and troponin I antibody proteins were also concentrated using the superimposed signals, and significantly more MS2 and cTnI-Ab were captured using the superimposed signals than the DEP (10 Vpp) or EO (2 Vpp) signals alone (p < 0.035) between the two coplanar electrodes and at a short exposure time (1 min). This technique has several advantages, such as simplicity and low cost of electrode fabrication, rapid and large collection without electrolysis.

Gentle Sampling of Submicrometer Airborne Virus Particles using a Personal Electrostatic Particle Concentrator.

Measurements of airborne viruses via sampling have been critical issues. Most electrostatic samplers have been assessed for bacterial aerosols or micrometer-sized viral particles; however, sampling of submicrometer-sized airborne viruses is necessary, especially because of the high probability of their staying airborne and their deposition in the lower respiratory tract. Here, we present a novel personal electrostatic particle concentrator (EPC) for gentle sampling of submicrometer airborne virus particles. Owing to the enhanced electric field designed in this EPC, the collection efficiencies reached values as high as 99.3-99.8% for 0.05-2 µm diameter polystyrene particles at a flow rate of 1.2 L/min. Submicrometer-sized MS2 and T3 virus particles were also collected in the EPC, and the concentrations relative to their respective initial suspensions were more than 10 times higher than those in the SKC BioSampler. Moreover, the recovery rate of T3 was 982 times higher in the EPC (-2 kV) than in the BioSampler at 12.5 L/min because of the gentle sampling of the EPC. Gentle sampling is desirable because many bioaerosols suffer from significant viability losses during sampling. The influence of ozone generated, applied electrostatic field, and the flow rate on the viability of the viruses will also be discussed.

Rapid electrical immunoassay of the cardiac biomarker troponin I through dielectrophoretic concentration using imbedded electrodes.

Rapidity and high sensitivity are critical factors for the diagnoses of heart attacks, and cardiac troponin I (cTnI) is at present a clinical standard for its diagnosis. Here we report a rapid, label-free, and highly sensitive single-walled carbon nanotube (SWCNT) electrical immunosensor, featuring two pairs of electrodes. Two concentration electrodes (gaps: 25 and 80µm) and two detection electrodes (source and drain; gap: 20µm; width: 50µm) were used for dielectrophoretic concentration of cTnI on the SWCNT channels and resistance measurements of the dielectrophoresis (DEP)-concentrated cTnI, respectively. The two concentration electrodes were imbedded between upper and lower dielectric layers, facing each other, underneath the -COOH-functionalized SWCNT channels deposited between the detection electrodes. Therefore, the gap between these imbedded concentration electrodes can be reduced to maximize the electric field intensity for DEP-mediated concentration of cTnI, thereby greatly reducing the detection time (1min) and enhancing the limit of detection (0.7-0.8pgmL(-)(1)). Relative resistance changes of the SWCNTs were measured as cTnI concentration in Tris-Borate-EDTA (TBE; 0.0025×) and human serum diluted 500-fold with 0.0025× TBE decreased from 100ngmL(-)(1) to 1pgmL(-1), and they were shown to be linear with the logarithm of cTnI concentration (R(2)=0.99 and 0.97, respectively). These immunosensors also showed high specificity over another cardiac biomarker, myoglobin, TBE medium (0.0025×), and 500-fold diluted human serum. The DEP-capture of cTnI depended on the frequency of the applied electric field, demonstrating the qualitative nature of the real part of the Clausius-Mossotti factor for cTnI.

The neuritogenic and synaptogenic effects of the ethanolic extract of radix Puerariae in cultured rat hippocampal neurons.

ETHNOPHARMACOLOGICAL RELEVANCE: Radix Puerariae, the root of Pueraria montana var. lobata (Willd.) Sanjappa & Pradeep, is used in Korean traditional medicine to treat neuronal disorders including Parkinson's disease, and its active constituent, puerarin has been reported to have a neuroprotective effect in experimental models of Parkinson's and Alzheimer's disease. AIMS OF THE STUDY: To investigate the neurotrophic effects of these ethnomedicines on the development of central nervous system neurons and the molecular bases of these activities. MATERIALS AND METHODS: Rat embryonic (E19) brain neurons were cultured in the absence or presence of the ethanolic extract of Radix Puerariae (RPE) or puerarin. At predetermined times, cells were fixed and immunostained to visualize neuronal morphologies, or lysed for protein harvesting. Morphometric analyses of neurite outgrowths and synaptogenesis were performed using Image J software. RPE or puerarin-mediated changes in the protein profiles of cultured neurons were assessed by MALDI-TOF-MS/PMF and measuring immunofluorescent intensities. RESULTS: RPE and puerarin alone promoted maximum neurite outgrowths at concentrations of 1µg/ml and 5µM, respectively. At these optimal concentrations, RPE and puerarin provided neurotrophic support by promoting axo-dendritic arbors and synapse formation in cultured neurons. Proteomic study revealed that RPE and puerarin both up-regulated a number of proteins, including dynein light chain 2 (DLC2) and elongation factor 2 (EF2), which are associated with neuritogenesis and synaptic potentiation, respectively. Immunofluorescence intensity measurements confirmed the expressions of the DLC2 and Dync1h1 subunits of dynein in RPE or puerarin treated hippocampal neurons were up-regulated when RPE or puerarin induced changes in neuronal cytoarchitecture. CONCLUSIONS: Our study demonstrates that RPE and puerarin should be considered potentially valuable preventative therapeutics for brain disorders due to their abilities to promote the neuronal cytoarchitecture and the synaptic functionality, which are possibly associated with dynein-dependent regulation of cytoskeletal structures and up-regulation of translation machinery.

NADPH oxidase and the cardiovascular toxicity associated with smoking.

Smoking is one of the most serious but preventable causes of cardiovascular disease (CVD). Key aspects of pathological process associated with smoking include endothelial dysfunction, a prothrombotic state, inflammation, altered lipid metabolism, and hypoxia. Multiple molecular events are involved in smokinginduced CVD. However, the dysregulations of reactive oxygen species (ROS) generation and metabolism mainly contribute to the development of diverse CVDs, and NADPH oxidase (NOX) has been established as a source of ROS responsible for the pathogenesis of CVD. NOX activation and resultant ROS production by cigarette smoke (CS) treatment have been widely observed in isolated blood vessels and cultured vascular cells, including endothelial and smooth muscle cells. NOX-mediated oxidative stress has also been demonstrated in animal studies. Of the various NOX isoforms, NOX2 has been reported to mediate ROS generation by CS, but other isoforms were not tested thoroughly. Of the many CS constituents, nicotine, methyl vinyl ketone, and α,ß-unsaturated aldehydes, such as, acrolein and crotonaldehyde, appear to be primarily responsible for NOX-mediated cytotoxicity, but additional validation will be needed. Human epidemiological studies have reported relationships between polymorphisms in the CYBA gene encoding p22phox, a catalytic subunit of NOX and susceptibility to smoking-related CVDs. In particular, G allele carriers of A640G and -930(A/G) polymorphisms were found to be vulnerable to smoking-induced cardiovascular toxicity, but results for C242T studies are conflicting. On the whole, evidence implicates the etiological role of NOX in smoking-induced CVD, but the clinical relevance of NOX activation by smoking and its contribution to CVD require further validation in human studies. A detailed understanding of the role of NOX would be helpful to assess the risk of smoking to human health, to define high-risk subgroups, and to develop strategies to prevent or treat smoking-induced CVD.

Enhancement of platelet aggregation by ursolic Acid and oleanolic Acid.

The pentacyclic triterpenoid ursolic acid (UA) and its isomer oleanolic acid (OA) are ubiquitous in food and plant medicine, and thus are easily exposed to the population through natural contact or intentional use. Although they have diverse health benefits, reported cardiovascular protective activity is contentious. In this study, the effect of UA and OA on platelet aggregation was examined on the basis that alteration of platelet activity is a potential process contributing to cardiovascular events. Treatment of UA enhanced platelet aggregation induced by thrombin or ADP, which was concentration-dependent in a range of 5-50 µM. Quite comparable results were obtained with OA, in which OA-treated platelets also exhibited an exaggerated response to either thrombin or ADP. UA treatment potentiated aggregation of whole blood, while OA failed to increase aggregation by thrombin. UA and OA did not affect plasma coagulation assessed by measuring prothrombin time and activated partial thromboplastin time. These results indicate that both UA and OA are capable of making platelets susceptible to aggregatory stimuli, and platelets rather than clotting factors are the primary target of them in proaggregatory activity. These compounds need to be used with caution, especially in the population with a predisposition to cardiovascular events.

Joongpoongtang 05 (JP05) confers neuroprotection via anti-apoptotic activities in Neuro-2a cells during oxygen-glucose deprivation and reperfusion.

To evaluate the anti-apoptotic effects of Joongpoongtang 05 (JP05), a mixture of plant extracts, on a Neuro-2a (N2a) cell model of oxygen and glucose deprivation (OGD)/reperfusion (OGDR), a neuroblastoma cell injury model was induced by OGDR. This model allowed us to investigate cerebral ischemic changes and the protective effects of JP05. JP05 treatment significantly enhanced cell viability and reduced the levels of lactate dehydrogenase, nitric oxide, reactive oxygen species and the oxidants/antioxidants balance in neuronal cells as compared to the untreated OGDR group. Here, JP05 reduced OGDR-induced expressions of heme oxygenase-1 and nitric oxide synthase, which may contribute to the neuroprotection. JP05 also partially reversed the effects of OGDR on NF-κB and activated Akt production. Our findings suggest that JP05 confers neuroprotective effects via anti-apoptotic property against OGDR-induced free radical injury in N2a cells.

Contralateral acupuncture versus ipsilateral acupuncture in the rehabilitation of post-stroke hemiplegic patients: a systematic review.

BACKGROUND: Contralateral acupuncture (CAT) involves inserting needles in the meridian on the side opposite the disease location and is often used in post-stroke rehabilitation. The aim of this systematic review is to summarize and critically evaluate the evidence for and against the effectiveness of CAT for post-stroke rehabilitation as compared to ipsilateral acupuncture (IAT). METHODS: Seventeen databases were searched from their inceptions through June 2010. Prospective clinical trials were included if CAT was tested as the sole treatment or as an adjunct to other treatments for post-stroke rehabilitation and compared to IAT. RESULTS: Eight randomized clinical trials (RCTs) met our inclusion criteria. Four of them reported favorable effects of CAT compared to IAT for at least one outcome. A meta-analysis showed superior effects of CAT compared to IAT on recovery rate (n = 361; risk ratio (RR), 1.12; 95% confidence intervals (CIs), 1.04 to 1.22, P = 0.005). Subgroup analysis also showed favorable effects of using CAT on patients with cerebral infarction (n = 261; RR, 1.15; 95% CIs, 1.04 to 1.27, P = 0.006). Further analysis including patients with cerebral infarction and intracranial hemorrhage, however, failed to show these advantages (n = 100; RR, 1.11; 95% CIs, 0.85 to 1.46, P = 0.43). CONCLUSION: The results of our systematic review and meta-analysis suggest that there is limited evidence for CAT being superior to IAT in the treatment of cerebral infarction. The total number of RCTs included in our analysis was low, however, and the RCTs included had a high risk of bias. Future RCTs appear to be warranted.

Cupping for stroke rehabilitation: a systematic review.

Cupping is often used for stroke rehabilitation in Asian countries. Currently, no systematic review of this topic is available. The aim of this systematic review is to summarize and critically evaluate the evidence for and against the effectiveness of cupping for stroke rehabilitation. Thirteen databases were searched from their inception through March of 2010 without language restrictions. Prospective clinical trials were included if cupping was tested as the sole treatment or as an adjunct to other conventional treatments for stroke rehabilitation. We found 43 potentially relevant articles, of which 5 studies including 3 randomized clinical trials (RCTs) and 2 uncontrolled observational studies (UOSs) met our inclusion criteria. Cupping was compared with acupuncture, electro-acupuncture and warm needling. Some superior effects of cupping were found in two of the RCTs when compared to acupuncture in hemiplegic shoulder pain and high upper-limb myodynamia after stroke. The other RCT failed to show favorable effects of cupping when compared to acupuncture and warm needling in patients with hemiplegic hand edema. The two UOSs reported favorable effects of cupping on aphasia and intractable hiccup after stroke. There are not enough trials to provide evidence for the effectiveness of cupping for stroke rehabilitation because most of the included trials compared the effects with unproven evidence and were not informative. Future RCTs seem warranted but must overcome the methodological shortcomings of the existing evidence.

Moxibustion for stroke rehabilitation: systematic review.

BACKGROUND AND PURPOSE: Positive effects of moxibustion for stroke rehabilitation may be seen in real clinical practice. Currently, no systematic reviews are available. The aim of this systematic review was to analyze the trial data on the effectiveness of moxibustion for stroke rehabilitation. METHODS: Fourteen databases were searched without language restriction. Randomized clinical trials were included if moxibustion was tested as the sole treatment or as an adjunct to other treatments for stroke rehabilitation. RESULTS: Nine randomized clinical trials met our inclusion criteria. Three randomized clinical trials reported favorable effects of moxibustion plus standard care on motor function versus standard care alone (N=142; standardized mean difference=0.72; 95% confidence interval, 0.37 to 1.08; P<0.0001). Three randomized clinical trials compared the effects of moxibustion on activities of daily living alone but failed to show favorable effects of moxibustion. CONCLUSION: This systematic review found limited effectiveness of moxibustion as an adjunct to standard care in stroke rehabilitation.