Virtual care and health technology assessment considerations.

The COVID-19 pandemic resulted in a rapid adoption of virtual care. Virtual care existed before the pandemic for specific conditions and circumstances. Health Technology Assessment (HTA) of virtual care evaluated clinical and cost-effectiveness to inform decisions about the optimal use prior to the pandemic but the necessary implementation of virtual care during the pandemic meant HTA was not feasible prior to adoption. The questions for HTA no longer focused on clinical or cost-effectiveness and focused on implementation considerations. Health technology assessment post-adoption of virtual care included questions such as the appropriate medical conditions for virtual care, training, billing, patient and clinician perspectives and experiences, and equity of access. Moving forward, it is important for HTA organizations to identify new and emerging virtual care technologies, explore early and other types of evidence, assess the potential impact on the healthcare system, and explore the operational considerations.

Nanoscopic and photonic ultrastructural characterization of two distinct insulin amyloid states.

Two different conformational isoforms or amyloid strains of insulin with different cytotoxic capacity have been described previously. Herein these filamentous and fibrillar amyloid states of insulin were investigated using biophysical and spectroscopic techniques in combination with luminescent conjugated oligothiophenes (LCO). This new class of fluorescent probes has a well defined molecular structure with a distinct number of thiophene units that can adopt different dihedral angles depending on its binding site to an amyloid structure. Based on data from surface charge, hydrophobicity, fluorescence spectroscopy and imaging, along with atomic force microscopy (AFM), we deduce the ultrastructure and fluorescent properties of LCO stained insulin fibrils and filaments. Combined total internal reflection fluorescence microscopy (TIRFM) and AFM revealed rigid linear fibrous assemblies of fibrils whereas filaments showed a short curvilinear morphology which assemble into cloudy deposits. All studied LCOs bound to the filaments afforded more blue-shifted excitation and emission spectra in contrast to those corresponding to the fibril indicating a different LCO binding site, which was also supported by less efficient hydrophobic probe binding. Taken together, the multi-tool approach used here indicates the power of ultrastructure identification applying AFM together with LCO fluorescence interrogation, including TIRFM, to resolve structural differences between amyloid states.

A versatile synthetic approach toward diversity libraries using monosaccharide scaffolds.

The pyranose scaffold is unique in its ability to position pharmacophore substituents in various ways in 3D space, and unique pharmacophore scanning libraries could be envisaged that focus on scanning topography rather than diversity in the type of substituents. Approaches have been described that make use of amine and acid functionalities on the pyranose scaffolds to append substituents, and this has enabled the generation of libraries of significant structural diversity. Our general aim was to generate libraries of pyranose-based drug-like mimetics, where the substituents are held close to the scaffold, in order to obtain molecules with better defined positions for the pharmacophore substituents. Here we describe the development of a versatile synthetic route toward peptide mimetics build on 2-amino pyranose scaffolds. The method allows introduction of a wide range of substituent types, it is regio- and stereospecific, and the later diversity steps are performed on solid phase. Further, the same process was applied on glucose and allose scaffolds, in the exemplified cases, and is likely adaptable to other pyranose building blocks. The methods developed in this work give access to molecules that position the three selected binding elements in various 3D orientations on a pyranose scaffold and have been applied for the production of a systematically diverse library of several hundred monosaccharide-based mimetics.

Promotion of central nervous system remyelination by induced differentiation of oligodendrocyte precursor cells.

OBJECTIVE: Repair of demyelinated axons in diseases such as multiple sclerosis requires activation of the myelination program in existing or newly recruited oligodendrocyte precursor cells (OPCs). The control of OPC differentiation and initiation of myelination during repair is poorly understood. In this study, we test the ability of anti-LINGO-1 reagents to promote myelination in vitro and remyelination in the rodent adult central nervous system in vivo. METHODS: The effects of LINGO-1 antagonists on the differentiation of OPCs and the promotion of myelination has been assayed using a combination of coculture and slice culture preparations. Using three different animal models of demyelination and remyelination, we morphologically and functionally assessed the effects of LINGO-1 antagonists on OPC differentiation and myelin repair. RESULTS: The data indicate that in vitro treatment with antagonists of LINGO-1 promote OPC differentiation and myelination, whereas in vivo remyelination is accelerated in lysophosphatidylcholine- or cuprizone-induced demyelination. This remyelination is associated with enhanced OPC differentiation and functional recovery of conduction velocities in demyelinated axons. INTERPRETATION: Our studies demonstrate that LINGO-1 antagonism promotes OPC differentiation and remyelination, and suggest LINGO-1 functions as an inhibitor of OPC differentiation to retard central nervous system remyelination.

On-line coupling of high temperature GPC and 1H NMR for the analysis of polymers.

The on-line coupling of gel permeation chromatography (GPC) and 1H NMR operating at temperatures up to 130 degrees C is presented. A NMR flow probe with a cell volume of 120 microL and a stop-flow valve are developed for on-flow and stop-flow NMR measurements at high temperatures. To maintain high and constant temperatures through the whole probe, the flow probe contains two separate heating circuits. A modified stop-flow valve is developed as a control device for enabling on-flow and stop-flow experiments at high temperature conditions. Heated transfer lines connect the flow probe with the high temperature GPC system. Due to their semicrystalline nature, polyolefins can be studied by liquid chromatography only at temperatures above 100 degrees C. The novel high temperature GPC-NMR system is used for the separation of complex polyolefins regarding their molar mass and for the analysis of different chemical structures. Blends of polyethylene, poly(methyl methacrylate), and ethylene-methyl methacrylate copolymers are separated according to the molar masses of the components. The compositions of the components are directly studied by on-line NMR. Moreover, the chemical composition distribution of an ethylene-methyl methacrylate copolymer sample is analysed. Differences between results of on-flow and stop-flow measurements are discussed.