Drowning prevention challenges and opportunities: An exploratory study of perspectives of delegates from ASEAN nations.

The South East Asian region has the world's second highest fatal drowning burden. This study reports analysis of survey data from representatives from nations within the Association of South East Asian Nations regarding current efforts, challenges and future opportunities for drowning prevention. Twenty-two responses were received from respondents from all ASEAN nations excepting Cambodia and Myanmar. Drowning prevention initiatives varied across ASEAN nations, with most efforts focused on public education and raising awareness, including the provision of drowning data to the media. The lack of comprehensive, national level data collection was identified as a challenge, necessitating strengthened data collection capacity. Governmental involvement spanned one to six different ministries, highlighting the multi-sectoral nature of drowning prevention. However, a lead ministry could be identified in only two countries. Despite the challenges identified, there remain many opportunities to strengthen drowning prevention across ASEAN nations, addressing a significant regional public health threat.

Boosting Urea-Assisted Natural Seawater Electrolysis in 3D Leaf-Like Metal-Organic Framework Nanosheet Arrays Using Metal Node Engineering.

Metal node engineering, which can optimize the electronic structure and modulate the composition of poor electrically conductive metal-organic frameworks, is of great interest for electrochemical natural seawater splitting. However, the mechanism underlying the influence of mixed-metal nodes on electrocatalytic activities is still ambiguous. Herein, a strategic design is comprehensively demonstrated in which mixed Ni and Co metal redox-active centers are uniformly distributed within NH2-Fe-MIL-101 to obtain a synergistic effect for the overall enhancement of electrocatalytic activities. Three-dimensional mixed metallic MOF nanosheet arrays, consisting of three different metal nodes, were in situ grown on Ni foam as a highly active and stable bifunctional catalyst for urea-assisted natural seawater splitting. A well-defined NH2-NiCoFe-MIL-101 reaches 1.5 A cm-2 at 360 mV for the oxygen evolution reaction (OER) and 0.6 A cm-2 at 295 mV for the hydrogen evolution reaction (HER) in freshwater, substantially higher than its bimetallic and monometallic counterparts. Moreover, the bifunctional NH2-NiCoFe-MIL-101 electrode exhibits eminent catalytic activity and stability in natural seawater-based electrolytes. Impressively, the two-electrode urea-assisted alkaline natural seawater electrolysis cell based on NH2-NiCoFe-MIL-101 needs only 1.56 mV to yield 100 mA cm-2, much lower than 1.78 V for alkaline natural seawater electrolysis cells and exhibits superior long-term stability at a current density of 80 mA cm-2 for 80 h.

Arsenic removal adsorbent using limonite-polyethersulfone composite fiber via continuous flow column process.

This research introduces an enhanced limonite-based composite fiber adsorbent for arsenic (As) removal. The modification involves creating polyethersulfone (PES)-limonite composite fibers loaded with 60 wt% limonite powders, designed to be applicable in water flow environments. The fibers were prepared using a wet-spinning process based on phase inversion, with varying concentrations (10, 20, and 30 wt%) of PES in NMP solution. The composite fiber with 10 wt% NMP exhibited a porous structure and demonstrated efficient absorption of both As(III) and As(V). Adsorption followed the Langmuir model, with qm values of 1.5 mg/g for As(III) and 3.2 mg/g for As(V) at pH 6. In column experiments, As removal rates increased with contact time, attributed to decreased flow rates (1 mL/min). Moreover, increasing fiber column height led to enhanced removal rates, as indicated by the Adams-Bohart model. The mechanism for As(V) removal involved the formation of an inner-sphere complex through ion exchange between α-FeOOH and HAsO4 - and H2 AsO4 2- in an aqueous solution at pH 6.8. PRACTITIONER POINTS: Changing the polyethersulfone ratio in the composite leads to variations in the appearance of limonite within each composite fiber. Limonite composite fibers effectively remove As(III) and As(V) at neutral pH. The adsorption behavior follows Langmuir kinetic model, the qm of 1.5 mg/g for As(III) and 3.2 mg/g for As(V). Longer columns and contact times enhance arsenic (As) removal in practical water treatment systems. Adam-Bohart model aids in predicting breakthrough and saturation time in As adsorption column design.

Suppression of Hydrogen Sulfide Generation via the Coexistence of Anaerobic Sludge and Goethite-Rich Limonite/Polyethersulfone Composite Fibers.

Limonite-polyethersulfone (PES) composite fibers were prepared by the wet spinning method to suppress hydrogen sulfide (H2S) generation from anaerobic microbial sludge. The H2S adsorption of the prepared limonite composite fibers followed the Langmuir type, with a maximum adsorption capacity of 3.7-4.4 g H2S/g, indicating mesopore adsorption. The in vitro H2S fermentation environment with anaerobic microbial sludge with the coexistence of limonite composite fibers exhibited suppression of H2S generation. The coexistence of limonite composite fibers also suppressed the amount of CO generation produced by microbial fermentation, so the fibers also affected the metabolism of anaerobic microorganisms. During the anaerobic digestion process, particularly at 672-840 h (28-35 days), the mesopores of limonite in the composite fibers disappeared and changed to macropore adsorption, and the reaction of limonite with hydrogen sulfide produced pyrite (FeS2) and iron sulfate (Fe2(SO4)3) as products, which remained in the fiber with conversion efficiencies of 6.8 and 32.4%, respectively. The in vitro hydrogen disulfide action of limonite composite fibers was found to be able to suppress the generated environment of about 300 ppm to about 0.4 ppm.

Clinical Diagnosis and Early Medical Management for Endometriosis: Consensus from Asian Expert Group.

This work provides consensus guidance regarding clinical diagnosis and early medical management of endometriosis within Asia. Clinicians with expertise in endometriosis critically evaluated available evidence on clinical diagnosis and early medical management and their applicability to current clinical practices. Clinical diagnosis should focus on symptom recognition, which can be presumed to be endometriosis without laparoscopic confirmation. Transvaginal sonography can be appropriate for diagnosing pelvic endometriosis in select patients. For early empiric treatment, management of women with clinical presentation suggestive of endometriosis should be individualized and consider presentation and therapeutic need. Medical treatment is recommended to reduce endometriosis-associated pelvic pain for patients with no immediate pregnancy desires. Hormonal treatment can be considered for pelvic pain with a clinical endometriosis diagnosis; progestins are a first-line management option for early medical treatment, with oral progestin-based therapies generally a better option compared with combined oral contraceptives because of their safety profile. Dienogest can be used long-term if needed and a larger evidence base supports dienogest use compared with gonadotropin-releasing hormone agonists (GnRHa) as first-line medical therapy. GnRHa may be considered for first-line therapy in some specific situations or as short-term therapy before dienogest and non-steroidal anti-inflammatory drugs as add-on therapy for endometriosis-associated pelvic pain.

Promoter hypomethylation and overexpression of TSTD1 mediate poor treatment response in breast cancer.

Epigenetic alterations play a pivotal role in cancer treatment outcomes. Using the methylation array data and The Cancer Genome Atlas (TCGA) dataset, we observed the hypomethylation and upregulation of thiosulfate sulfurtransferase-like domain containing 1 (TSTD1) in patients with breast cancer. We examined paired tissues from Taiwanese patients and observed that 65.09% and 68.25% of patients exhibited TSTD1 hypomethylation and overexpression, respectively. A significant correlation was found between TSTD1 hypomethylation and overexpression in Taiwanese (74.2%, p = 0.040) and Western (88.0%, p < 0.001) cohorts. High expression of TSTD1 protein was observed in 68.8% of Taiwanese and Korean breast cancer patients. Overexpression of TSTD1 in tumors of breast cancer patients was significantly associated with poor 5-year overall survival (p = 0.021) and poor chemotherapy response (p = 0.008). T47D cells treated with TSTD1 siRNA exhibited lower proliferation than the control group, and transfection of TSTD1 in MDA-MB-231 induced the growth of MDA-MB-231 cells compared to the vector control. Additionally, overexpression of TSTD1 in MCF7 cells mediated a poor response to chemotherapy by epirubicin (p < 0.001) and docetaxel (p < 0.001) and hormone therapy by tamoxifen (p =0.025). Circulating cell-free hypomethylated TSTD1 was detected in plasma of Taiwanese breast cancer patients with disease progression and poor chemotherapy efficacy. Our results indicate that promoter hypomethylation and overexpression of TSTD1 in patients with breast cancer are potential biomarkers for poor 5-year overall survival and poor treatment response.

Determination of enantiomeric impurity of tenofovir disoproxil fumarate on a cellulose tris(3,5-dichlorophenyl-carbamate) chiral stationary phase and the characterization of its related substances.

A simple and reliable high-performance liquid chromatography method was developed to determine the enantiomeric impurity of tenofovir disoproxil fumarate, an orally bioavailable prodrug of tenofovir, commonly used for the treatment of human immunodeficiency virus and hepatitis B. Tenofovir disoproxil and its enantiomer, were completely separated on a Chiralpak IC column (3 µm, 100 × 4.6 mm, i.d.). The chiral separation was achieved using a mobile phase containing n-hexane, ethanol, methanol, and triethylamine 65/25/10/0.1 (v/v/v/v) at a flow rate of 0.6 mL/min. Ideally, the reversal of enantiomer elution order was achieved on the Chiralpak IC column, to allow the elution of the minor enantiomeric impurity before the major component. Moreover, the proposed method was able to discriminate the active ingredient from the related substances available in the tenofovir disoproxil fumarate raw materials. These compounds were isolated and structurally elucidated by MS and nuclear magnetic resonance. Based on the spectral data, the structures of related substances were confirmed as tenofovir isoproxil monoester and fumaric acid. The high-performance liquid chromatography method was optimized by the design of experiment approach and successfully validated following the International Conference on Harmonization guideline. Proposed method was effectively applied for the quantification of enantiomeric impurity in tenofovir disoproxil fumarate raw materials.

Unveiling surface charge on chalcogen atoms toward the high aspect-ratio colloidal growth of two-dimensional transition metal chalcogenides.

Controlling surface energies of each facet is essential for the anisotropic growth of two-dimensional transition metal chalcogenides (TMCs). However, it is a challenge due to stronger binding energies of ligand head groups to the edge facets compared to the planar facets. Herein, we demonstrate that the adsorption of ligands on metal positions can induce partial electron localization on the chalcogen sites, and then accelerate metal-chalcogen bond formation for enhanced anisotropic growth of nanosheets. And only in the case of trioctylphosphine oxide (TOPO)-adsorbed nanosheets, surface polarization can be unveiled on the surface of the colloidal nanosheets due to restricted development of nonpolar ligand shells by the steric effects of the ligands. Moreover, density functional theory (DFT) calculation results reveal that the decrease of surface energy on the (100) edge facets as well as the increase on the (001) basal facets by the adsorption of triorganylphosphine oxide also contribute to the preferentially lateral growth. As a result, various 2D TMCs, including MoSe2, WSe2, and SnSe2 synthesized with TOPO, show enhanced anisotropic growth.

A capillary electrophoresis method for the determination of the linagliptin enantiomeric impurity.

Linagliptin is a highly specific, long-acting inhibitor that is used as an orally administrable agent for type-2 diabetes treatment. Because only the R-enantiomer is of clinical use, we developed a capillary electrophoresis method for the determination of the enantiomeric impurity of this compound. Carboxymethyl-ß-cyclodextrin was selected as the chiral selector for the separation of linagliptin enantiomers. Design of experiments and desirability functions were used for the analytical optimization, which was focused on understanding and improving the electrophoretic process. The effects of significant parameters (background electrolyte concentration and pH, cyclodextrin concentration, temperature, and voltage) were thoroughly investigated. The complete separation of linagliptin and its enantiomeric impurity with baseline resolution was achieved within 10 min on an uncoated fused-silica capillary (50 µm inner diameter, 365 µm outer diameter, 64.5/56 cm in total/ effective length) maintained at 25°C, under an applied voltage of 28.0 kV. The background electrolyte contained 70 mM sodium acetate and 4.7 mM carboxymethyl-ß-cyclodextrin, and the pH was adjusted to 6.10. The method was validated, and a limit of quantitation of 0.05% for the impurity was estimated.

Understanding Surface Modulation to Improve the Photo/Electrocatalysts for Water Oxidation/Reduction.

Water oxidation and reduction reactions play vital roles in highly efficient hydrogen production conducted by an electrolyzer, in which the enhanced efficiency of the system is apparently accompanied by the development of active electrocatalysts. Solar energy, a sustainable and clean energy source, can supply the kinetic energy to increase the rates of catalytic reactions. In this regard, understanding of the underlying fundamental mechanisms of the photo/electrochemical process is critical for future development. Combining light-absorbing materials with catalysts has become essential to maximizing the efficiency of hydrogen production. To fabricate an efficient absorber-catalysts system, it is imperative to fully understand the vital role of surface/interface modulation for enhanced charge transfer/separation and catalytic activity for a specific reaction. The electronic and chemical structures at the interface are directly correlated to charge carrier movements and subsequent chemical adsorption and reaction of the reactants. Therefore, rational surface modulation can indeed enhance the catalytic efficiency by preventing charge recombination and prompting transfer, increasing the reactant concentration, and ultimately boosting the catalytic reaction. Herein, the authors review recent progress on the surface modification of nanomaterials as photo/electrochemical catalysts for water reduction and oxidation, considering two successive photogenerated charge transfer/separation and catalytic chemical reactions. It is expected that this review paper will be helpful for the future development of photo/electrocatalysts.

Earth-Abundant Transition-Metal-Based Bifunctional Electrocatalysts for Overall Water Splitting in Alkaline Media.

The depletion of fossil fuels has accelerated the search for clean, sustainable, scalable, and environmentally friendly alternative energy sources. Hydrogen is a potential energy carrier because of its advantageous properties, and the electrolysis of water is considered as an efficient method for its industrial production. However, the high-energy conversion efficiency of electrochemical water splitting requires cost-effective and highly active electrocatalysts. Therefore, researchers have aimed to develop high-performance electrode materials based on non-precious and abundant transition metals for conversion devices. Moreover, to further reduce the cost and complexity in real-world applications, bifunctional catalysts that can be simultaneously active on both the anodic (i.e., oxygen evolution reaction, OER) and cathodic (i.e., hydrogen evolution reaction, HER) sides are economically and technically desirable. This Minireview focuses on the recent progress in transition-metal-based materials as bifunctional electrocatalysts, including several promising strategies to promote electrocatalytic activities for overall water splitting in alkaline media, such as chemical doping, defect (vacancy) engineering, phase engineering, facet engineering, and structure engineering. Finally, the potential for further developments in rational electrode materials design is also discussed.

Porosity-Engineering of MXene as a Support Material for a Highly Efficient Electrocatalyst toward Overall Water Splitting.

The use of 2 D transition metal carbide MXenes as support materials to incorporate catalytically active compounds is of interest because of their unique properties. However, the preparation of well-dispersed catalytic phases on the inter-connected porous MXene network is challenging and has been rarely explored. This work focuses on the synthesis of basal-plane-porous titanium carbide MXene (ac-Ti3 C2 ) that is used subsequently as an effective host for the incorporation of a known catalytically active phase (IrCo) as an effective bifunctional electrocatalyst toward water splitting. The porous ac-Ti3 C2 with abundant macro/meso/micropores is prepared by a wet chemical method at room temperature and provides ideal anchor sites for intimate chemical bonding with alien compounds. The resulting IrCo@ac-Ti3 C2 electrocatalyst exhibits an excellent reactivity (220 mV at 10 mA cm-2 ) towards the oxygen evolution reaction in 1.0 m KOH, which surpasses that of the benchmark RuO2 , a low voltage cell of 1.57 V (@ 10 mA cm-2 ) and good long-term durability. Our work demonstrates the effectiveness of porosity engineering in MXene nanosheets as a support material to shorten ion migration pathways, to increase electrolyte accessibility between inter-sheets and to overcome inherited re-stacking and aggregation issues.

Phase-Selective Disordered Anatase/Ordered Rutile Interface System for Visible-Light-Driven, Metal-Free CO2 Reduction.

Visible-light-driven photocatalytic CO2 reduction using TiO2 that can absorb light of all wavelengths has been sought for over half a century. Herein, we report a phase-selective disordered anatase/ordered rutile interface system for visible-light-driven, metal-free CO2 reduction using a narrow band structure, whose conduction band position matches well with the reduction potential of CO2 to CH4 and CO. A mixed disordered anatase/ordered rutile (Ad/Ro) TiO2 was prepared from anatase and rutile phase-mixed P25 TiO2 at room temperature and under an ambient atmosphere in sodium alkyl amine solutions. The Ad/Ro TiO2 showed a narrow band structure due to multi-internal energy band gaps of Ti3+ defect sites in the disordered anatase phase, leading to high visible light absorption and simultaneously providing fast charge separation through the crystalline rutile phase, which was faster than that of pristine P25 TiO2. The band gap of Ad/Ro TiO2 is 2.62 eV with a conduction band of -0.27 eV, which matches well with the reduction potential of -0.24 VNHE of CO2/CH4, leading to effective electron transfer to CO2. As a result, the Ad/Ro TiO2 provided the highest CH4 production (3.983 µmol/(g h)), which is higher than that of even metal (W, Ru, Ag, and Pt)-doped P25, for CO2 reduction under visible light.

Effect of carbapenem resistance on outcomes of bloodstream infection caused by Enterobacteriaceae in low-income and middle-income countries (PANORAMA): a multinational prospective cohort study.

BACKGROUND: Low-income and middle-income countries (LMICs) are under-represented in reports on the burden of antimicrobial resistance. We aimed to quantify the clinical effect of carbapenem resistance on mortality and length of hospital stay among inpatients in LMICs with a bloodstream infection due to Enterobacteriaceae. METHODS: The PANORAMA study was a multinational prospective cohort study at tertiary hospitals in Bangladesh, Colombia, Egypt, Ghana, India, Lebanon, Nepal, Nigeria, Pakistan, and Vietnam, recruiting consecutively diagnosed patients with carbapenem-susceptible Enterobacteriaceae (CSE) and carbapenem-resistant Entero-bacteriaceae (CRE) bloodstream infections. We excluded patients who had previously been enrolled in the study and those not treated with curative intent at the time of bloodstream infection onset. There were no age restrictions. Central laboratories in India and the UK did confirmatory testing and molecular characterisation, including strain typing. We applied proportional subdistribution hazard models with inverse probability weighting to estimate the effect of carbapenem resistance on probability of discharge alive and in-hospital death, and multistate modelling for excess length of stay in hospital. All patients were included in the analysis. FINDINGS: Between Aug 1, 2014, and June 30, 2015, we recruited 297 patients from 16 sites in ten countries: 174 with CSE bloodstream infection and 123 with CRE bloodstream infection. Median age was 46 years (IQR 15-61). Crude mortality was 20% (35 of 174 patients) for patients with CSE bloodstream infection and 35% (43 of 123 patients) for patients with CRE bloodstream infection. Carbapenem resistance was associated with an increased length of hospital stay (3·7 days, 95% CI 0·3-6·9), increased probability of in-hospital mortality (adjusted subdistribution hazard ratio 1·75, 95% CI 1·04-2·94), and decreased probability of discharge alive (0·61, 0·45-0·83). Multilocus sequence typing showed various clades, with marginal overlap between strains in the CRE and CSE clades. INTERPRETATION: Carbapenem resistance is associated with increased length of hospital stay and mortality in patients with bloodstream infections in LMICs. These data will inform global estimates of the burden of antimicrobial resistance and reinforce the need for better strategies to prevent, diagnose, and treat CRE infections in LMICs. FUNDING: bioMérieux.

Intertwined Titanium Carbide MXene within a 3 D Tangled Polypyrrole Nanowires Matrix for Enhanced Supercapacitor Performances.

The exploration of the rational design and synthesis of unique and robust architectured electrodes for the high capacitance, rate capability, and stability of supercapacitors is crucial to the future of energy storage technology. Herein, an in situ synthesis of multilayered titanium carbide MXene tightly caging within a 3 D conducting tangled polypyrrole (PPy) nanowire (NW) network is proposed as an effective strategy to prevent the aggregation of MXene, profoundly enhancing the electrochemical performance of the supercapacitor. Owing to the beneficial effects of an ideal 3 D interconnected porous structure and high electrical conductivity, the obtained electrode exhibits fast charge and ion transport kinetics as well as full usage of active material. As expected, the 3 D Ti3 C2 Tx @PPY NW exhibits a specific capacitance five times higher than that of pristine MXene (610 F g-1 ), a good rate capability up to a current density of 25 A g-1 , and excellent stability with 100 % retention after 14 000 cycles at 4 A g-1 , outperforming the known state-of-the-art MXene-based supercapacitor. Our work provides a facile method for enhancing the performance of MXene-based energy storage devices.

Low temperature solution synthesis of reduced two dimensional Ti3C2 MXenes with paramagnetic behaviour.

MXenes - two dimensional, 2D, early transition metal, M, carbides and nitrides, X - are the latest addition to the 2D materials' world. Herein, we report on a facile low temperature solution chemical synthesis method to reduce Ti3C2Tx multilayered, ML, MXenes. Using X-ray photoelectron spectroscopy, electron spin resonance, magnetization measurements and other techniques, we concluded that immersing Ti3C2Tx MLs in the reducing agent Li-ethylenediamine (Li-EDA) - held at temperatures varying from room to 120 °C - reduces the 2D layers creating Ti3+ ions and oxygen vacancies. Above a temperature (T) of ≈10 K, the magnetic susceptibilities, χ, are temperature independent, implying that the resulting powders are Pauli paramagnetic. The loss of the magnetic signal upon intercalation of Li+ or EDA, together with a Curie-like increase in χ at T < 10 K, is consistent with that of a disordered metal that is close to a metallic to insulator transition and proves that the magnetism is associated with the 2D flakes. This result is the first evidence of any magnetism of any MXene.

Antimicrobial stewardship for acute-care hospitals: An Asian perspective.

Inappropriate use of antibiotics is contributing to a serious antimicrobial resistance problem in Asian hospitals. Despite resource constraints in the region, all Asian hospitals should implement antimicrobial stewardship (AMS) programs to optimize antibiotic treatment, improve patient outcomes, and minimize antimicrobial resistance. This document describes a consensus statement from a panel of regional experts to help multidisciplinary AMS teams design programs that suit the needs and resources of their hospitals. In general, AMS teams must decide on appropriate interventions (eg, prospective audit and/or formulary restriction) for their hospital, focusing on the most misused antibiotics and problematic multidrug-resistant organisms. This focus is likely to include carbapenem use with the goal to reduce carbapenem-resistant gram-negative bacteria. Rather than initially trying to introduce a comprehensive, hospital-wide AMS program, it would be practical to begin by pilot testing a simple program based on 1 achievable core intervention for the hospital. AMS team members must work together to determine the most suitable AMS interventions to implement in their hospitals and how best to put them into practice. Continuous monitoring and feedback of outcomes to the AMS teams, hospital administration, and prescribers will enhance sustainability of the AMS programs.

APSIC guidelines for disinfection and sterilization of instruments in health care facilities.

Background: The Asia Pacific Society of Infection Control launched its revised Guidelines for Disinfection and Sterilization of Instruments in Health Care Facilities in February 2017. This document describes the guidelines and recommendations for the reprocessing of instruments in healthcare setting. It aims to highlight practical recommendations in a concise format designed to assist healthcare facilities at Asia Pacific region in achieving high standards in sterilization and disinfection. Method: The guidelines were revised by an appointed workgroup comprising experts in the Asia Pacific region, following reviews of previously published guidelines and recommendations relevant to each section. Results: It recommends the centralization of reprocessing, training of all staff with annual competency assessment, verification of cleaning, continual monitoring of reprocessing procedures to ensure their quality and a corporate strategy for dealing with single-use and single-patient use medical equipment/devices. Detailed recommendations are also given with respect to reprocessing of endoscopes. Close working with the Infection Prevention & Control department is also recommended where decisions related to reprocessing medical equipment/devices are to be made. Conclusions: Sterilization facilities should aim for excellence in practices as this is part of patient safety. The guidelines that come with a checklist help service providers identify gaps for improvement to reach this goal.

Analysis of the cause of recurrent pregnancy loss in Vietnam: A cross-sectional study.

Recurrent pregnancy loss (RPL) is a physical and mental burden for women. In Vietnam, exploring the cause of miscarriages is still a challenge to clinical physicians. We aimed to investigate the etiology of RPL in the National Hospital of Obstetrics and Gynecology in Vietnam from 2012 to 2014. The cross-sectional study included 301 pregnant women with a history of RPL. The patients were examined and offered medical testing to determine the cause(s). Based on the testing, we determined causation for (11.29%) patients who had positive scores on an antiphospholipid antibody test and who were subsequently successfully treated for their problem.

An injectable hydrogel enhances tissue repair after spinal cord injury by promoting extracellular matrix remodeling.

The cystic cavity that develops following injuries to brain or spinal cord is a major obstacle for tissue repair in central nervous system (CNS). Here we report that injection of imidazole-poly(organophosphazenes) (I-5), a hydrogel with thermosensitive sol-gel transition behavior, almost completely eliminates cystic cavities in a clinically relevant rat spinal cord injury model. Cystic cavities are bridged by fibronectin-rich extracellular matrix. The fibrotic extracellular matrix remodeling is mediated by matrix metalloproteinase-9 expressed in macrophages within the fibrotic extracellular matrix. A poly(organophosphazenes) hydrogel lacking the imidazole moiety, which physically interacts with macrophages via histamine receptors, exhibits substantially diminished bridging effects. I-5 injection improves coordinated locomotion, and this functional recovery is accompanied by preservation of myelinated white matter and motor neurons and an increase in axonal reinnervation of the lumbar motor neurons. Our study demonstrates that dynamic interactions between inflammatory cells and injectable biomaterials can induce beneficial extracellular matrix remodeling to stimulate tissue repair following CNS injuries.The cystic cavity that develops following injuries to brain or spinal cord is a major obstacle. Here the authors show an injection of imidazole poly(organophosphazenes), a hydrogel with thermosensitive sol-gel transition behavior, almost completely eliminates cystic cavities in a clinically relevant rat spinal cord injury model.