Digital health integration for noncommunicable diseases: Comprehensive process mapping for full-life-cycle management.

AIM: To create a systematic digital health process mapping framework for full-life-cycle noncommunicable disease management grounded in key stakeholder engagement. METHODS: A triphasic, qualitative methodology was employed to construct a process mapping framework for digital noncommunicable disease management in Shanghai, China. The first phase involved desk research to examine current guidance and practices. In the second phase, pivotal stakeholders participated in focus group discussions to identify prevalent digital touchpoints across lifetime noncommunicable disease management. In the final phase, the Delphi technique was used to refine the framework based on expert insights and obtain consensus. RESULTS: We identified 60 digital touchpoints across five essential stages of full-life-cycle noncommunicable disease management. Most experts acknowledged the rationality and feasibility of these touchpoints. CONCLUSIONS: This study led to the creation of a comprehensive digital health process mapping framework that encompasses the entire life cycle of noncommunicable disease management. The insights gained emphasize the importance of a systemic strategic, person-centered approach over a fragmented, purely technocentric approach. We recommend that healthcare professionals use this framework as a linchpin for efficient disease management and seamless technology incorporation in clinical practice.

MicroRNA Profiling in the Aqueous Humor of Keratoconus Eyes.

Purpose: To identify differentially expressed (DE) microRNAs (miRNAs) in the aqueous humor (AH) of keratoconus (KC) eyes using next-generation sequencing and to explore whether DE miRNAs might play roles in KC pathophysiology. Methods: The small RNAs in the AH of 15 KC eyes and 15 myopia eyes (the control group) were sequenced on an Illumina NovaSeq 6000 platform. Gene Oncology and Kyoto Encyclopedia of Genes and Genome enrichment analyses were performed. Receiver operating characteristic curves were used to identify potential KC biomarkers. Results: We identified 204 miRNAs in the AH of the KC group and 200 in the AH of the control group. Fourteen miRNAs were differentially expressed between the two groups; four miRNAs were upregulated and 10 downregulated in KC AH. The possible pathways regulated by the DE miRNAs included antigen processing and presentation, endocytosis, mismatch repair, and Hippo signaling. The AH concentrations of miR-222-3p, miR-363-3p, and miR-423-5p exhibited areas under the curves of 1. Conclusions: We profiled the DE miRNAs of the AH of KC eyes. These miRNAs may be associated with KC pathogenesis and could serve as KC biomarkers. Translational Relevance: Data on aberrantly expressed miRNAs in KC combined with bioinformatics analyses suggest possible roles for specific miRNAs. The DE miRNAs may serve as diagnostic KC biomarkers.

Optical Quality of Highly Myopic Eyes under Different Lighting Conditions and Other Relevant Parameters.

Purpose: To evaluate the optical quality of highly myopic eyes under light and dark conditions and correlate it with other relevant parameters. Materials and Methods: A cross-sectional, observational study was performed on 180 eyes of 90 highly myopic patients (29 males and 61 females; mean age: 27.833 ± 0.364 years [range: 18-45 years]). The modulation transfer function (MTF) cutoff frequency, Strehl ratio, objective scattering index (OSI), and predicted visual acuity (PVA; 100%, 20%, and 9%) under different lighting conditions were measured to evaluate the optical quality, which was correlated with probable relevant factors, including, axis length, spherical equivalent (SE), uncorrected distance visual acuity (UDVA), best-corrected distance visual acuity (BDVA), astigmatism, and corneal curvature. The relationship between these visual parameters and optical quality was analyzed using a generalized linear model. Results: The OSIs were 1.241 ± 0.068 and 1.515 ± 0.076; the MTF cutoff frequencies were 37.725 ± 0.559 and 30.238 ± 0.550 cpd; the Strehl ratios were 0.219 ± 0.004 and 0.175 ± 0.003; and the PVAs at 100%, 20%, and 9% were 1.257 ± 0.019 and 1.001 ± 0.018, 0.949 ± 0.017 and 0.719 ± 0.015, and 0.579 ± 0.011 and 0.439 ± 0.010, under bright and dark conditions respectively. The optical quality parameters were correlated with age, SE, BDVA, corneal astigmatism, and curvature to different degrees under different lighting conditions. Conclusions: The optical quality declined in highly myopic eyes under both bright and dark lighting conditions. SE, BDVA, corneal astigmatism, and curvature were correlated with optical quality to different degrees under different lighting conditions.

Optical quality after posterior chamber Phakic implantation of an intraocular Lens with a central hole (V4c implantable Collamer Lens) under different lighting conditions.

BACKGROUND: The current study compared optical quality before and after implantation of a posterior chamber phakic intraocular lens with a central hole [V4c implantable collamer lens (ICL)] under bright and dark lighting conditions by means of the Optical Quality Analysis System™ (OQAS; Visiometrics, Terrassa, Spain). METHODS: This prospective study involved 91 eyes of 46 consecutive high myopia patients (15 males and 31 females, average spherical equivalent - 10.50 ± 0.33D) undergoing implantation of a V4c ICL. The modulation transfer function (MTF) cutoff frequency, Strehl ratio, objective scattering index (OSI), and predicted visual acuities (PVAs; 100, 20, and 9%), under different lighting conditions, were measured before and 1 week, 1 month, and 3 months after surgery. RESULTS: All optical parameters showed significant improvements, at all time points, under dark condition after surgery. We observed no significant changes in PVA 9% at 1 week (mean value 0.539, P = 0.12) or 1 month after surgery (mean value 0.573, P = 0.08) under bright condition; but all other postoperative parameters improved significantly. Comparing the two lighting conditions, the OSI decreased more under dark conditions at 1 week (P = 0.02), 1 month (P = 0.004), and 3 months (P = 0.002), but there was no significant difference in any other parameter. In addition, patients were divided into super high myopia (group S, spherical equivalent greater than - 10 D) and high myopia (group H, spherical equivalent from - 6 D to - 10 D), the group S improved significantly more than group H in all parameters, under both bright and dark conditions. CONCLUSIONS: V4c ICL implantation improved optical quality under both bright and dark lighting conditions, and had a better ability to reduce the extent of scattering in the dark. Furthermore, group S achieved greater improvement in visual quality, which should be considered by physicians before surgery.

Static and dynamic pupillary characteristics in high myopic eyes with two implantable collamer lenses.

PURPOSE: To determine static and dynamic pupillometry characteristics before and after implantable collamer lens (ICL) (V4 and V4c) implantation. SETTING: Shanghai, China. DESIGN: Prospective consecutive observational case series. METHODS: Patients who had either V4 or V4c ICL implantation were included in this observational study. An automatic quantitative pupillometry system (MonCv3) was used for pupillometry preoperatively and 1 week, 1 month, and 3 months after surgery. Static pupillometry measurements (pupil diameters [PDs] at 4 standardized illumination levels) and dynamic parameters (including initial PD, amplitude of contraction, latency of contraction, duration of contraction, velocity of contraction, latency of dilation, duration of dilation, and velocity of dilation) were measured. RESULTS: The study comprised 98 eyes (50 patients). Mesopic and low photopic PDs declined by 0.32 mm and 0.27 mm, respectively, at 3 months after ICL implantation; scotopic PD declined at 1 week and recovered to preoperative levels at 3 months; and high photopic PD remained unchanged. Regarding the pupil light reflex, contraction amplitude and velocity declined after surgery, whereas other dynamic parameters remained unchanged. The static and dynamic pupillary characteristics were similar between the V4 and V4c ICL groups. CONCLUSIONS: The V4 and V4c ICLs had similar influences on iris motility. ICL implantation had a miotic effect under mesopic and low photopic illumination conditions, resulting in decreases in pupil contraction amplitude and velocity in light reflexes.

Polydopamine-Assisted Immobilization of Copper Ions onto Hemodialysis Membranes for Antimicrobial.

The hemodialysis therapy is the primary treatment for the end-stage renal disease (ESRD) patients to extend their lives. To reduce the pathogenic infection during hemodialysis treatment, mussel-inspired polydopamine (PDA) was self-polymerized onto poly(ether sulfone) (PES) membranes to immobilize copper ions, because PDA coating could firmly adhere to the PES membranes and immobilize antimicrobial metal ions with its functional groups. The immobilized copper ions through PDA can penetrate deeply into the inner surface of the pores of PES membrane. Water permeability test further indicates PDA coating can obviously enhance the hydrophilicity of PES membranes. And copper ion immobilized PES membranes showed effective antibacterial activity with a relative safe release amount of copper ions (below 1 ppm). Furthermore, hemolysis test results revealed that PDA-assisted antibacterial PES membranes can relieve red blood cells damage compared to the pure PES membranes. To sum up, PES hemodialysis membranes obtained the antibacterial ability by the PDA-assisted copper ion immobilization, which can reduce the abuse of antibiotics and is beneficial to the patient suffering from kidney disease.

Polarization of an electroactive functional film on titanium for inducing osteogenic differentiation.

To enhance the surface bioactivity of titanium (Ti) prostheses, an electroactive polyvinylidene fluoride (PVDF) film was prepared on a Ti substrate to provide a mimetic of the electrical microenvironment, which facilitated the performance of cell functions. The results of cell proliferation and differentiation assays indicated that polarization of the PVDF-Ti (PTi) altered its surface charge, thus inducing adhesion, proliferation and osteogenic differentiation of cells. The polarized PVDF-Ti (PPTi) may therefore find applications in bone regeneration.

Surface-Selective Preferential Production of Reactive Oxygen Species on Piezoelectric Ceramics for Bacterial Killing.

Reactive oxygen species (ROS) can be used to kill bacterial cells, and thus the selective generation of ROS from material surfaces is an emerging direction in antibacterial material discovery. We found the polarization of piezoelectric ceramic causes the two sides of the disk to become positively and negatively charged, which translate into cathode and anode surfaces in an aqueous solution. Because of the microelectrolysis of water, ROS are preferentially formed on the cathode surface. Consequently, the bacteria are selectively killed on the cathode surface. However, the cell experiment suggested that the level of ROS is safe for normal mammalian cells.

Ti nanorod arrays with a medium density significantly promote osteogenesis and osteointegration.

Ti implants are good candidates in bone repair. However, how to promote bone formation on their surface and their consequent perfect integration with the surrounding tissue is still a challenge. To overcome such challenge, we propose to form Ti nanorods on their surface to promote the new bone formation around the implants. Here Ti nanorod arrays (TNrs) with different densities were produced on pure Ti surfaces using an anodizing method. The influence of TNr density on the protein adsorption as well as on the adhesion, proliferation, and osteogenic differentiation of MC3T3-E1 pre-osteoblastic cells were assessed. The TNrs were also implanted into the bone defects in rabbits to test their application in promoting bone formation and osteointegration at the implant-bone interface. TNrs with the medium density were found to show the best capability in promoting the protein adsorption from surrounding medium, which in turn efficiently enhanced osteogenic differentiation in vitro and osteointegration in vivo. Our work suggests that growing TNrs with a medium density on the surface of traditional Ti implants is an efficient and facile method for promoting bone formation and osteointegration in bone repair.

Influence of Surrounding Cations on the Surface Degradation of Magnesium Alloy Implants under a Compressive Pressure.

The effect of cations in the surrounding solutions on the surface degradation of magnesium alloys, a well-recognized biodegradable biomaterial, has been neglected compared with the effect of anions in the past. To better simulate the compressive environment where magnesium alloys are implanted into the body as a cardiovascular stent, a device is designed and employed in the test so that a pressure, equivalent to the vascular pressure, can be directly applied to the magnesium alloy implants when the alloys are immersed in a medium containing one of the cations (K(+), Na(+), Ca(2+), and Mg(2+)) found in blood plasma. The surface degradation behaviors of the magnesium alloys in the immersion test are then investigated using hydrogen evolution, mass loss determination, electron microscopy, pH value, and potentiodynamic measurements. The cations are found to promote the surface degradation of the magnesium alloys with the degree decreased in the order of K(+) > Na(+) > Ca(2+) > Mg(2+). The possible mechanism of the effects of the cations on the surface degradation is also discussed. This study will allow us to predict the surface degradation of magnesium alloys in the physiological environment and to promote the further development of magnesium alloys as biodegradable biomaterials.

Cancer Associated Fibroblast-Derived Hepatocyte Growth Factor Inhibits the Paclitaxel-Induced Apoptosis of Lung Cancer A549 Cells by Up-Regulating the PI3K/Akt and GRP78 Signaling on a Microfluidic Platform.

Tumor stroma and growth factors provide a survival environment to tumor cells and can modulate their chemoresistance by dysregulating several signal pathways. In this study, we fabricated a three-dimensional (3D) microfluidic chip using polydimethylsiloxane (PDMS) to investigate the impact of hepatocyte growth factor (HGF) from cancer-associated fibroblasts (CAF) on the Met/PI3K/AKT activation, glucose regulatory protein (GRP78) expression and the paclitaxel-induced A549 cell apoptosis. With a concentration gradient generator, the assembled chip was able to reconstruct a tumor microenvironment in vitro. We found high levels of HGF in the supernatants of CAF and the CAF matrix from the supernatants of activated HFL1 fibroblasts or HGF enhanced the levels of Met, PI3K and AKT phosphorylation and GRP78 expression in A549 cells cultured in a 3D cell chamber, which was abrogated by anti-HGF. Inhibition of Met attenuated the CAF matrix-enhanced PI3K/AKT phosphorylation and GRP78 expression while inhibition of PI3K reduced GRP78 expression, but not Met phosphorylation in A549 cells. Inhibition of GRP78 failed to modulate the CAF matrix-enhanced Met/PI3K/AKT phosphorylation in A549 cells. Furthermore, inhibition of PI3K or GRP78 enhanced spontaneous and paclitaxel-induced A549 cell apoptosis. Moreover, treatment with the CAF matrix inhibited spontaneous and medium or high dose of paclitaxel-induced A549 cell apoptosis. Inhibition of PI3K or GRP78 attenuated the CAF matrix-mediated inhibition on paclitaxel-induced A549 cell apoptosis. Our data indicated that HGF in the CAF matrix activated the Met/PI3K/AKT and up-regulated GRP78 expression, promoting chemoresistance to paclitaxel-mediated apoptosis in A549 cells. Our findings suggest that the microfluidic system may represent an ideal platform for signaling research and drug screening.

Chondroitin sulphate-guided construction of polypyrrole nanoarchitectures.

Nanospheres, nanocones, and nanowires are three typical polypyrrole (PPy) nanoarchitectures and electrochemically polymerized with the dope of chondroitin sulphate (CS) in this study. CS, a functional biomacromolecule, guides the formation of PPy nanoarchitectures as the dopant and morphology-directing agent. Combined with our previous reported other PPy nanoarchitectures (such as nanotube arrays and nanowires), this work further proposed the novel mechanism of the construction of PPy/CS nanoarchitectures with the synergistic effect of CS molecular chains structure and the steric hindrance. Compared to the undoped PPy, MC3T3-E1 cells with PPy/CS nanoarchitectures possessed stronger proliferation and osteogenic differentiation capability. This suggests that PPy/CS nanoarchitectures have appropriate biocompatibility. Altogether, the nanoarchitectured PPy/CS may find application in the regeneration of bone defect.