Utilization of Spontaneous Alkyne-Gold Self-Assembly Chemistry as an Alternative Method for Fabricating Electrochemical Aptamer-Based Sensors.

Electrochemical aptamer-based (E-AB) sensors are a promising class of biosensors which use structure-switching redox-labeled oligonucleotides (aptamers) codeposited with passivating alkanethiol monolayers on electrode surfaces to specifically bind and detect target analytes. Signaling in E-AB sensors is an outcome of aptamer conformational changes upon target binding, with the sequence of the aptamer imparting specificity toward the analyte of interest. The change in conformation translates to a change in electron transfer between the redox label attached to the aptamer and the underlying electrode and is related to analyte concentration, allowing specific electrochemical detection of nonelectroactive analytes. E-AB sensor measurements are reagentless with time resolutions of seconds or less and may be miniaturized into the submicron range. Traditionally these sensors are fabricated using thiol-on-gold chemistry. Here we present an alternate immobilization chemistry, gold-alkyne binding, which results in an increase in sensor lifetimes under ideal conditions by up to ∼100%. We find that gold-alkyne binding is spontaneous and supports efficient E-AB sensor signaling with analytical performance characteristics similar to those of thiol generated monolayers. The surface modification differs from gold-thiol binding only in the time and aptamer concentration required to achieve similar aptamer surface coverages. In addition, alkynated aptamers differ from their thiolated analogues only by their chemical handle for surface attachment, so any existing aptamers can be easily adapted to utilize this attachment strategy.

DrugMap: A quantitative pan-cancer analysis of cysteine ligandability.

Cysteine-focused chemical proteomic platforms have accelerated the clinical development of covalent inhibitors for a wide range of targets in cancer. However, how different oncogenic contexts influence cysteine targeting remains unknown. To address this question, we have developed "DrugMap," an atlas of cysteine ligandability compiled across 416 cancer cell lines. We unexpectedly find that cysteine ligandability varies across cancer cell lines, and we attribute this to differences in cellular redox states, protein conformational changes, and genetic mutations. Leveraging these findings, we identify actionable cysteines in NF-κB1 and SOX10 and develop corresponding covalent ligands that block the activity of these transcription factors. We demonstrate that the NF-κB1 probe blocks DNA binding, whereas the SOX10 ligand increases SOX10-SOX10 interactions and disrupts melanoma transcriptional signaling. Our findings reveal heterogeneity in cysteine ligandability across cancers, pinpoint cell-intrinsic features driving cysteine targeting, and illustrate the use of covalent probes to disrupt oncogenic transcription-factor activity.

Single Voltammetric Sweep Calibration-Free Interrogation of Electrochemical Aptamer-Based Sensors Employing Continuous Square Wave Voltammetry.

Continuous square wave voltammetry (cSWV) is a technique that enables the continuous collection of current data (at 100 kHz) to maximize the information content obtainable from a single voltammetric sweep. This data collection procedure results in the generation of multiple voltammograms corresponding to different effective square wave frequencies. The application of cSWV brings significant benefits to electrochemical aptamer-based (E-AB) sensors. The E-AB sensor platform permits continuous real-time monitoring of small biological molecules. Traditionally, E-AB sensors report only on changes in analyte concentration rather than absolute quantification in matrices when basal concentrations are not known a priori. This is because they exhibit a voltammetric peak current even in the absence of a target. However, using a dual-frequency approach, calibration-free sensing can be performed effectively, eliminating the sensor-to-sensor variation by taking ratiometric current responses obtained at two different frequencies from two different voltammetric sweeps. In employing our approach, cSWV provides a great advantage over the conventionally used square wave voltammetry since the required voltammograms are collected with a single sweep, which improves the temporal resolution of the measurement when considering the current at multiple frequencies for improved accuracy and reduced surface interrogation. Moreover, we show here that using cSWV provides significantly improved concentration predictions. E-AB sensors sensitive to ATP and tobramycin were interrogated across a wide range of concentrations. With this approach, cSWV allowed us to estimate the target concentration, retaining up to an ±5% error of the expected concentration when tested in buffer and complex media.

A rare case of taper junction corrosion in semi-constrained total knee arthroplasty.

Metallosis is a known yet rare late complication of unicompartmental and total knee arthroplasty (TKA), usually secondary to either metal-backed patellar component failure, mobile-bearing polyethylene dislocation, or catastrophic polyethylene failure and wear through. The majority of literature surrounding metallosis has been published in relation to total hip arthroplasty (THA) metal on metal bearing wear or mechanically assisted crevice corrosion.This case report describes the development of metallosis in a 77-year-old male patient with advanced (Kellgren-Lawrence Grade 4) osteoarthritis with associated valgus deformity, who underwent index TKA with a semiconstrained revision knee system due to intraoperative medial collateral ligament laxity. The taper junction between the titanium alloy stem and cobalt chromium femoral component was the source of diffuse intra-articular metallosis.

Tuning the Probe-Bilayer Architecture of Silver Nanoneedle-based Ion Channel Probes.

Ion channel probes, as one of the ion channel platforms, provide an appealing opportunity to perform localized detection with a high precision level. These probes come basically in two classes: glass and metal. While the glass-based probes showed the potential to be employed for molecular sensing and chemical imaging, these probes still suffer from limited resolution and lack of control over protein insertion. On the other hand, metal-based nanoneedle probes (gold and silver) have been recently developed to allow reducing probe dimensions to the nanoscale geometry. More specifically, silver probes are preferable owing to their ability to mitigate the channel current decay observed with gold probes and provide a stable DC channel current. However, there are still some challenges related to the probe design and bilayer curvature that render such probes insensitive to small changes in the tip-substrate distance. Herein, we introduce two main pathways to control the probe-bilayer architecture; the first is by altering the probe shape and geometry during the fabrication process of silver probes. The second pathway is by altering the surface characteristics of the silver probe via an electrophoretic deposition process. Our findings reveal that varying the electrochemical etching parameters results in different probe geometries and producing sharper tips with a 2-fold diameter reduction. In addition, the electrophoretic deposition of a cathodic paint on the silver nanoneedle surface led to a miniaturized exposed silver tip that enables the formation of a confined bilayer. We further investigated the characteristics of bilayers supported on both the sharper nanoneedles and the HSR-coated silver probes produced by controlling the etching conditions and electrodeposition process, respectively. We believe this work paves the way to rationally design silver nanoneedle ion channel probes, which are well suited for localized molecular sensing and chemical imaging.

Controlling the Collision Type and Frequency of Single Pt Nanoparticles at Chemically Modified Gold Electrodes.

Studying the electrochemical response of single nanoparticles at an electrode surface gives insight into the dynamic and stochastic processes that occur at the electrode interface. Herein, we investigated single platinum nanoparticle collision dynamics and type (elastic vs inelastic) at gold electrode surfaces modified with self-assembled monolayers (SAMs) of varying terminal chemistries. Collision events are measured via the faradaic current from catalytic reactions at the Pt surface. By changing the terminal, solution-facing group of a thiolate monolayer, we observed the effect of hydrophobicity at the solution-electrode interface on single-particle collisions by employing either a hydrophobic -CH3 terminal group (1-hexanethiol), a hydrophilic -OH terminal group (6-mercaptohexanol), or an equimolar mixture of the two. Changes in the terminal group lead to alterations in collision-induced current magnitude, collisional frequency, and the distinct shape of the collision event current transient. The effects of the terminal group of the SAM were probed by measuring quantitative differences in the events monitored through both the hydrogen evolution reaction (HER) and hydrazine oxidation. In both cases, a platinum nanoparticle (PtNP) favors adsorption to bare and hydrophilic surfaces but demonstrates elastic collision behavior when it collides with a hydrophobic surface. In the case of a mixed monolayer, distinct characteristics of hydrophobic and hydrophilic surfaces are observed. We report how single nanoparticle collisions can reveal nanoscale surface heterogeneity and can be used to manipulate the nature of single-particle interactions on an electrode surface by functionalized self-assembled monolayers.

Hip, knee, and shoulder arthroplasty in patients with a history of solid organ transplant: A review.

Solid organ transplants (SOT) have evolved into life-saving interventions for end-stage diseases affecting vital organs. Advances in transplantation techniques, donor selection, and immunosuppressive therapies have enhanced outcomes, leading to a growing demand for SOT. Patients with a solid organ transplant are living long enough to develop the same pathologies which are indicated for joint replacement surgery in the general population. SOT patients who undergo a total hip, knee, or shoulder arthroplasty do similarly in the context of clinical outcomes and implant survival when compared to the general population. These immunosuppressed patients tend to have higher complication rates in the short-term following surgery. Prudent management of these patients in the short-term may be necessary, but patients can expect to do well otherwise.

promSEMBLE: Hard Pattern Mining and Ensemble Learning for Detecting DNA Promoter Sequences.

Accurate identification of DNA promoter sequences is of crucial importance in unraveling the underlying mechanisms that regulate gene transcription. Initiation of transcription is controlled through regulatory transcription factors binding to promoter core regions in the DNA sequence. Detection of promoter regions is necessary if we are to build genetic regulatory networks for biomedical and clinical applications, and for identification of rarely expressed genes. We propose a novel ensemble learning technique using deep recurrent neural networks with convolutional feature extraction and hard negative pattern mining to detect several types of promoter sequences, including promoter sequences with the TATA-box and without the TATA-box, within DNA sequences of four different species. Using extensive independent tests and previously published results, we demonstrate that our method sets a new state-of-the-art of over 98% Matthews correlation coefficient in all eight organism categories for recognizing the stretch of base pairs that code for the promoter region within DNA sequences.

Perspective-Assessing Electrochemical, Aptamer-Based Sensors for Dynamic Monitoring of Cellular Signaling.

Electrochemical, aptamer-based (E-AB) sensors provide a generalizable strategy to quantitatively detect a variety of targets including small molecules and proteins. The key signaling attributes of E-AB sensors (sensitivity, selectivity, specificity, and reagentless and dynamic sensing ability) make them well suited to monitor dynamic processes in complex environments. A key bioanalytical challenge that could benefit from the detection capabilities of E-AB sensors is that of cell signaling, which involves the release of molecular messengers into the extracellular space. Here, we provide a perspective on why E-AB sensors are suited for this measurement, sensor requirements, and pioneering examples of cellular signaling measurements.

Microscale, Electrochemical, Aptamer-Based Sensors for Enhanced Small-Molecule Detection at Millisecond Time Scales.

Microscale electrodes offer the advantages of increased mass transport rates, high sensitivity, and rapid measurement capabilities. Fabricating electrochemical aptamer-based (E-AB) sensors on these electrode platforms opens new applications to chemical and biological sensing but has remained challenging due to low signal-to-noise ratios and monolayer instability. In this article, we report the development and characterization of E-AB sensors on a gold microelectrode platform (∼500 nm radius). To overcome the small current response, we modified the electrodes by growing nanostructures via electrodeposition. We interrogated the sensors with two different electroanalytical techniques, square wave voltammetry (SWV) and intermittent pulse voltammetry (IPA), to measure the representative response of an ATP sensor and determine aptamer-target binding and dissociation time scales. We find robust and stable sensor performance with an increased response rate over sensors fabricated on macroscale electrodes. These results demonstrate that sensors developed on this microelectrode platform can be employed for enhanced spatiotemporal resolution measurements in chemical and biological environments.

DrugMap: A quantitative pan-cancer analysis of cysteine ligandability.

Cysteine-focused chemical proteomic platforms have accelerated the clinical development of covalent inhibitors of a wide-range of targets in cancer. However, how different oncogenic contexts influence cysteine targeting remains unknown. To address this question, we have developed DrugMap , an atlas of cysteine ligandability compiled across 416 cancer cell lines. We unexpectedly find that cysteine ligandability varies across cancer cell lines, and we attribute this to differences in cellular redox states, protein conformational changes, and genetic mutations. Leveraging these findings, we identify actionable cysteines in NFκB1 and SOX10 and develop corresponding covalent ligands that block the activity of these transcription factors. We demonstrate that the NFκB1 probe blocks DNA binding, whereas the SOX10 ligand increases SOX10-SOX10 interactions and disrupts melanoma transcriptional signaling. Our findings reveal heterogeneity in cysteine ligandability across cancers, pinpoint cell-intrinsic features driving cysteine targeting, and illustrate the use of covalent probes to disrupt oncogenic transcription factor activity.

Development of an Electrochemical, Aptamer-Based Sensor for Dynamic Detection of Neuropeptide Y.

The ability to monitor dynamic changes in neuropeptide Y (NPY) levels in complex environments can have an impact on many fields, including neuroscience and immunology. Here, we describe the development of an electrochemical, aptamer-based (E-AB) sensor for the dynamic (reversible) measurement of physiologically relevant (nanomolar) concentrations of neuropeptide Y. The E-AB sensors are fabricated using a previously described 80 nucleotide aptamer1 reported to specifically bind NPY with a binding affinity Kd = 0.3 ± 0.2 uM. We investigated two redox tag placement locations on the aptamer sequence (terminal vs internal) and various sensor fabrication and interrogation parameters to tune the performance of the resulting sensor. The best-performing sensor architecture displayed a physiologically relevant dynamic range (nM) and low limit of detection and is selective among competitors and similar molecules. The development of this sensor accomplishes two breakthroughs: first, the development of a nonmicrofluidic aptamer-based electrochemical sensor that can detect NPY on a physiologically relevant (seconds to minutes) time scale and across a relevant concentration range; second, the expansion of the range of molecules for which an electrochemical, aptamer-based sensor can be used.

Code status orders in hospitalized patients with COVID-19.

Background: The COVID-19 pandemic created complex challenges regarding the timing and appropriateness of do-not-attempt cardiopulmonary resuscitation (DNACPR) and/or Do Not Intubate (DNI) code status orders. This paper sought to determine differences in utilization of DNACPR and/or DNI orders during different time periods of the COVID-19 pandemic, including prevalence, predictors, timing, and outcomes associated with having a documented DNACPR and/or DNI order in hospitalized patients with COVID-19. Methods: A cohort study of hospitalized patients with COVID-19 at two hospitals located in the Midwest. DNACPR code status orders including, DNI orders, demographics, labs, COVID-19 treatments, clinical interventions during hospitalization, and outcome measures including mortality, discharge disposition, and hospice utilization were collected. Patients were divided into two time periods (early and late) by timing of hospitalization during the first wave of the pandemic (March-October 2020). Results: Among 1375 hospitalized patients with COVID-19, 19% (n = 258) of all patients had a documented DNACPR and/or DNI order. In multivariable analysis, age (older) p =< 0.01, OR 1.12 and hospitalization early in the pandemic p = 0.01, OR 2.08, were associated with having a DNACPR order. Median day from DNACPR order to death varied between cohorts p => 0.01 (early cohort 5 days versus late cohort 2 days). In-hospital mortality did not differ between cohorts among patients with DNACPR orders, p = 0.80. Conclusions: There was a higher prevalence of DNACPR and/or DNI orders and these orders were written earlier in the hospital course for patients hospitalized early in the pandemic versus later despite similarities in clinical characteristics and medical interventions. Changes in clinical care between cohorts may be due to fear of resource shortages and changes in knowledge about COVID-19.

Examining the Influence of Physician Assistant/Associate Scope of Practice Reforms and Individual Characteristics on Wages.

High labor demand for physician assistants/associates (PA) has led to substantial PA workforce and wage growth. During this growth period, states have adopted reforms to reduce PA scope of practice restrictions and reports of significant gender and race wage disparities have emerged. This study examined data from the American Community Survey to investigate the influence of demographic characteristics, human capital, and scope of practice reforms on PA wages from 2008 to 2017. Using an ordinary least squares two-way fixed effects estimator, a significant association between reforms and PA wages could not be established. Rather, wages were found to be strongly associated with human capital and demographic characteristics. Gender and race wage disparities persist, with female PAs earning 7.5% lower wages than male PAs and White PAs earning 9.1% to 14.5% higher wages than racial and ethnic minority PAs. These findings suggest a minimal influence of prior scope of practice reforms on PA wages.

Week-Long Operation of Electrochemical Aptamer Sensors: New Insights into Self-Assembled Monolayer Degradation Mechanisms and Solutions for Stability in Serum at Body Temperature.

Conventional wisdom suggests that widely utilized self-assembled alkylthiolate monolayers on gold are too unstable to last more than several days when exposed to complex fluids such as raw serum at body temperature. Demonstrated here is that these monolayers can not only last at least 1 week under such harsh conditions but that significant applied value can be captured for continuous electrochemical aptamer biosensors. Electrochemical aptamer biosensors provide an ideal tool to investigate monolayer degradation, as aptamer sensors require a tightly packed monolayer to preserve sensor signal vs background current and readily reveal fouling by albumin and other solutes when operating in biofluids. Week-long operation in serum at 37 °C is achieved by (1) increasing van der Waals interactions between adjacent monolayer molecules to increase the activation energy required for desorption, (2) optimizing electrochemical measurement to decrease both alkylthiolate oxidation and electric-field-induced desorption, and (3) mitigating fouling using protective zwitterionic membranes and zwitterion-based blocking layers with antifouling properties. This work further proposes origins and mechanisms of monolayer degradation in a logical stepwise manner that was previously unobservable over multiday time scales. Several of the observed results are surprising, revealing that short-term improvements to sensor longevity (i.e., hours) actually increase sensor degradation in the longer term (i.e., days). The results and underlying insights on mechanisms not only push forward fundamental understanding of stability for self-assembled monolayers but also demonstrate an important milestone for continuous electrochemical aptamer biosensors.

Continuous Square Wave Voltammetry for High Information Content Interrogation of Conformation Switching Sensors.

Square wave voltammetry (SWV) is a voltammetric technique for measuring Faradaic current while minimizing contributions from non-Faradaic processes. In square wave voltammetry, the potential waveform applied to a working electrode and the current sampling protocols followed are designed to minimize contributions from non-Faradaic processes (i.e., double layer charging) to improve voltammetric sensitivity. To achieve this, the current is measured at the end of each forward and reverse potential pulse after allowing time for non-Faradaic currents to decay exponentially. A consequence of sampling current at the end of a potential pulse is that the current data from the preceding time of the potential pulse are discarded. These discarded data can provide information about the non-Faradaic contributions as well as information about the redox system including charge transfer rates. In this paper, we introduce continuous square wave voltammetry (cSWV), which utilizes the continuous collection of current to maximize the information content obtainable from a single voltammetry sweep eliminating the need for multiple scans. cSWV enables acquiring a multitude of voltammograms corresponding to various frequencies and, thus, different scan rates from a single sweep. An application that benefits significantly from cSWV is conformation switching, functional nucleic acid sensors. We demonstrate the utility of cSWV on two representative small molecules targeting electrochemical, aptamer-based sensors. Moreover, we show that cSWV provides comparable results to those obtained from traditional square wave voltammetry, but with cSWV, we are able to acquire dynamic information about the sensor surfaces enabling rapid calibration and optimization of sensing performance. We also demonstrate cSWV on soluble redox markers. cSWV can potentially become a mainstay technique in the field of conformation switching sensors.

Moving beyond velocity derivatives; using global positioning system data to extract sequential movement patterns at different levels of rugby league match-play.

This study aims to (a) quantify the movement patterns during rugby league match-play and (b) identify if differences exist by levels of competition within the movement patterns and units through the sequential movement pattern (SMP) algorithm. Global Positioning System data were analysed from three competition levels; four Super League regular (regular-SL), three Super League (semi-)Finals (final-SL) and four international rugby league (international) matches. The SMP framework extracted movement pattern data for each athlete within the dataset. Between competition levels, differences were analysed using linear discriminant analysis (LDA). Movement patterns were decomposed into their composite movement units; then Kruskal-Wallis rank-sum and Dunn post-hoc were used to show differences. The SMP algorithm found 121 movement patterns comprised mainly of "walk" and "jog" based movement units. The LDA had an accuracy score of 0.81, showing good separation between competition levels. Linear discriminant 1 and 2 explained 86% and 14% of the variance. The Kruskal-Wallis found differences between competition levels for 9 of 17 movement units. Differences were primarily present between regular-SL and international with other combinations showing less differences. Movement units which showed significant differences between competition levels were mainly composed of low velocities with mixed acceleration and turning angles. The SMP algorithm found 121 movement patterns across all levels of rugby league match-play, of which, 9 were found to show significant differences between competition levels. Of these nine, all showed significant differences present between international and domestic, whereas only four found differences present within the domestic levels. This study shows the SMP algorithm can be used to differentiate between levels of rugby league and that higher levels of competition may have greater velocity demands.Highlights This study shows that movement patterns and movement units can be used to investigate team sports through the application of the SMP frameworkOne hundred and twenty-one movement patterns were found to be present within rugby league match-play, with the walk- and jog-based movement units most prevalent. No movement pattern was unique to a single competition level.Further analysis revealed that the majority of movement units analysed had significant differences between international and domestic rugby league, whereas only four movement units (i.e. f,m,n,q) had significant differences within the two domestic rugby league levels.International rugby league had higher occurrences of the movement patterns consisting of higher velocity movement units (ie. T,S,y). This suggests that international rugby league players may need greater high velocity exposure in training.

Solution-Phase Electrochemical Aptamer-Based Sensors.

Electrochemical aptamer-based sensors (EABs) using self-assembled monolayers on gold working-electrodes have now been in-vivo demonstrated for multiple-analytes, demonstrating their sensitivity and specificity even in a continuous sensing format. However, longevity has been demonstrated for only 24 hours and sensitivity has been challenging for highly dilute analytes (nM regime). A novel approach is reported here using electrochemical aptamer-based sensing that is not covalently-bound to a gold-working electrode but where aptamers are freely mobile in solution. This alternative approach has the potential to improve longevity by reducing electrode surface degradation and improving sensitivity using aptamer binding constructs that are not available for aptamers when covalently bound to the electrode. Specifically, a molecular-beacon (fluorescent) cortisol aptamer was adapted into an amperometry solution-phase cortisol EAB sensor, demonstrating ∼5% signal gain starting at only 10 nM and a saturated signal gain of ∼70% at several µM. A robust signal was achieved due to use of methylene-blue redox-tagged aptamer that was measured through amperometry with interdigitated electrodes. While this result demonstrates the basic feasibility of solution-phase EAB sensors, the result also required a self-assembled monolayer alkylthiolate blocking-layer on the gold working electrode which restricts potential device longevity. These results cumulatively suggest that initial significance of solution-phase EAB sensors may be strongest for point-of-care type testing applications and further development would be required for long-lasting continuous sensing applications.

The invisible gap: Older adults' communication with health care providers about concomitant use of alcohol and medications.

The purpose of this study was to assess the impact of a new educational intervention, Communicating with your Health Care Providers, which was designed to assist older adults in communicating with their physicians and other health care providers and improving their knowledge about concomitant alcohol and medication risks. A randomized control trial was conducted in older adult centers in an urban community. Participants were assigned to either the intervention group or a control group that received traditional services. The intervention group received educational material about health, physical and other aging changes, medication use and possible adverse interactions between alcohol and medications, as well as strategies to initiate communication with physicians and other health care providers. The outcomes measured were: (1) interest in communicating with physicians and health care providers; (2) perception of the importance of communication; and (3) knowledge about concomitant alcohol and medication use. MANCOVA tests indicated that the intervention group had greater knowledge about the risks of combining alcohol with prescription medications than the control group, as well as greater interest in having health care discussions with their physicians and other health care providers. These findings may be translated into future educational programming for community centers.