Cascade Mesophase Transitions of Multi-enzyme Responsive Polymeric Formulations.

Studying how synthetic polymer assemblies respond to sequential enzymatic stimuli can uncover intricate interactions in biological systems. Using amidase- and esterase-responsive PEG-based diblock (DBA) and triblock amphiphiles (TBAs), we created two distinct formulations: amidase-responsive DBA with esterase-responsive TBA and vice versa. We studied their cascade responses to the two enzymes and the sequence of their introduction. These formulations underwent cascade mesophase transitions upon the addition of the DBA-degrading enzyme, transitioning from (i) coassembled micelles to (ii) triblock-based hydrogel, and ultimately to (iii) dissolved polymers when exposed to the TBA hydrolyzing enzyme. The specific pathway of the two mesophase transitions depended on the compositions of the formulations and the enzyme introduction sequence. The results highlight the potential for designing polymeric formulations with programmable multistep enzymatic responses, mimicking the complex behavior of biological macromolecules.

Directional actuation and phase transition-like behavior in anisotropic networks of responsive microfibers.

Two-dimensional shape-morphing networks are common in biological systems and have garnered attention due to their nontrivial physical properties that emanate from their cellular nature. Here, we present the fabrication and characterization of anisotropic shape-morphing networks composed of thermoresponsive polymeric microfibers. By strategically positioning fibers with varying responses, we construct networks that exhibit directional actuation. The individual segments within the network display either a linear extension or buckling upon swelling, depending on their radius and length, and the transition between these morphing behaviors resembles Landau's second-order phase transition. The microscale variations in morphing behaviors are translated into observable macroscopic effects, wherein regions undergoing linear expansion retain their shape upon swelling, whereas buckled regions demonstrate negative compressibility and shrink. Manipulating the macroscale morphing by adjusting the properties of the fibrous microsegments offers a means to modulate and program morphing with mesoscale precision and unlocks novel opportunities for developing programmable microscale soft robotics and actuators.

Hydrogel Microneedles with Programmed Mesophase Transitions for Controlled Drug Delivery.

Microneedle-based drug delivery offers an attractive and minimally invasive administration route to deliver therapeutic agents through the skin by bypassing the stratum corneum, the main skin barrier. Recently, hydrogel-based microneedles have gained prominence for their exceptional ability to precisely control the release of their drug cargo. In this study, we investigated the feasibility of fabricating microneedles from triblock amphiphiles with linear poly(ethylene glycol) (PEG) as the hydrophilic middle block and two dendritic side-blocks with enzyme-cleavable hydrophobic end-groups. Due to the poor formation and brittleness of microneedles made from the neat amphiphile, we added a sodium alginate base layer and tested different polymeric excipients to enhance the mechanical strength of the microneedles. Following optimization, microneedles based on triblock amphiphiles were successfully fabricated and exhibited favorable insertion efficiency and low height reduction percentage when tested in Parafilm as a skin-simulant model. When tested against static forces ranging from 50 to 1000 g (4.9-98 mN/needle), the microneedles showed adequate mechanical strength with no fractures or broken segments. In buffer solution, the solid microneedles swelled into a hydrogel within about 30 s, followed by their rapid disintegration into small hydrogel particles. These hydrogel particles could undergo slow enzymatic degradation to soluble polymers. In vitro release study of dexamethasone (DEX), as a steroid model drug, showed first-order drug release, with 90% released within 6 days. Eventually, DEX-loaded MNs were subjected to an insertion test using chicken skin and showed full penetration. This study demonstrates the feasibility of programming hydrogel-forming microneedles to undergo several mesophase transitions and their potential application as a delivery system for self-administration, increased patient compliance, improved efficacy, and sustained drug release.

Contextual Factors and Adoption of Strategies Related to Opioid Prescribing Practices in Healthcare Settings: Cross-Sectional Study.

This study aimed to examine the association between different contextual factors (e.g., facility size, rurality, and perceived needs) and the adoption of a policy or strategy related to opioid prescribing practices in healthcare settings. Cross-sectional survey data was collected from a convenience sample of physicians (N = 68). Logistic regression models were used to examine the effects of contextual factors on the dependent variables. Less than half reported having a policy restricting opioid prescribing practices, and 81% reported having one or more strategies for the safe use of chronic opioid therapy. After adjusting for other contextual factors, small practice size was positively associated with having a policy restricting opioid prescribing practices. This exploratory study provides insights for further investigation of how various contextual factors can influence policy adoption in different healthcare settings and practices to address major public health threats.

Architecture-Based Programming of Polymeric Micelles to Undergo Sequential Mesophase Transitions.

Di- and triblock amphiphiles can form different mesophases ranging from micelles to hydrogels depending on their chemical structures, hydrophilic to hydrophobic ratios, and their ratio in the mixture. In addition, their different architectures dictate their exchange rate between the assembled and unimer states and consequently affect their responsiveness toward enzymatic degradation. Here we report the utilization of the different reactivities of di- and triblock amphiphiles, having exactly the same hydrophilic to lipophilic balance, toward enzymatic degradation as a tool for programming formulations to undergo sequential enzymatically induced transitions from (i) micelles to (ii) hydrogel and finally to (iii) dissolved polymers. We show that the rate of transition between the mesophases can be programmed by changing the ratio of the amphiphiles in the formulation, and that the hydrogels can maintain encapsulated cargo, which was loaded into the micelles. The reported results demonstrate the ability of molecular architecture to serve as a tool for programming smart formulations to adopt different structures and functions.

Controlling Nano-to-Microscale Multilevel Architecture in Polymeric Microfibers through Polymerization-Induced Spontaneous Phase Separation.

Hierarchically structured polymeric fibers, composed of structural nanoscale motifs that assemble into a microscale fiber are frequently found in natural fibers including cellulose and silk. The creation of synthetic fibers with nano-to-microscale hierarchical structures represents a promising avenue for the development of novel fabrics with distinctive physical, chemical, and mechanical characteristics. In this work, we introduce a novel approach for creating polyamine-based core-sheath microfibers with controlled hierarchical architectures. This approach involves a polymerization-induced spontaneous phase separation and subsequent chemical fixation. Through the use of various polyamines, the phase separation process can be manipulated to produce fibers with diverse porous core architectures, ranging from densely packed nanospheres to segmented "bamboo-stem" morphology. Moreover, the nitrogen-rich surface of the core enables both the chemisorption of heavy metals and the physisorption of proteins and enzymes. Our method offers a new set of tools for the production of polymeric fibers with novel hierarchical morphologies, which has a high potential for a wide range of applications such as filtering, separation, and catalysis.

Physicians' interest in different strategies for supporting pain -management and opioid prescribing: A cross-sectional study.

OBJECTIVE: The purpose of this study was to explore physicians' attitudes toward different strategies for supporting pain management and opioid prescribing and to identify factors related to their attitudes toward the support strategies. Design/setting/participants/measures: This preliminary cross-sectional study collected and analyzed online survey responses from physicians in Texas and Minnesota (N = 69) between December 2017 and February 2018. Primary outcomes were physicians' interest in online continuing medical education (CME), mHealth patient monitoring system, and short, non-CME YouTube informational briefs about pain management and opioid prescribing. Multiple logistic regression models were used to examine the associations between physicians' characteristics, attitudes, training, experience, practice setting, and their interest in three different support strategies. RESULTS: About 51-58 percent of physicians indicated moderate-to-extreme interest in online CME (54 percent), mHealth monitoring (58 percent), and short, non-CME YouTube informational briefs (51 percent). Physicians, who practiced in a medium or large practice setting, were less likely to be interested in online CME or short, non-CME YouTube informational briefs. Physicians who prescribed a small number of Schedule II opioids were more likely to be interested in short, non-CME YouTube informational briefs and mHealth monitoring. CONCLUSIONS: Findings suggest that physicians may have different preferences in strategies for supporting their pain management and opioid prescribing practices. Future studies are needed to better understand the mechanisms underlying physicians' interest in different support strategies.

A Cross-Sectional Examination of Patients' Perspectives About Their Pain, Pain Management, and Satisfaction with Pain Treatment.

OBJECTIVE: Empirical studies show conflicting findings about the relationship between pain relief and patient satisfaction. To address this research gap, this study examines the differential effects of pain relief on patient satisfaction based on patients' perceptions about pain management. METHODS: Cross-sectional survey data were collected from 178 adults with self-reported chronic noncancer pain (i.e., pain that typically lasts >12 weeks that is not due to cancer). Participants rated their satisfaction with pain care, pain relief, and perceptions about participation in their treatment decisions and confidence in their physicians. Multiple linear regression models were used to examine whether patients' perceptions moderated the effects of pain on patient satisfaction. All models were adjusted for age, education, and frequency of chronic pain. Based on the preliminary analyses, separate models were performed for participants who reported low (median or lower) and high (greater than median) pain relief. RESULTS: On average, patients reported moderate patient satisfaction with their pain care (score of 5.54 out of 10, with a higher score indicating greater patient satisfaction). Among patients who reported low pain relief, the level of pain relief (P < 0.001) and confidence in their physicians (P = 0.031) were positively associated with satisfaction after adjusting for other covariates and control variables. Among patients who reported high pain relief, the level of pain relief (P = 0.002) positively predicted satisfaction after adjusting for other covariates and control variables. Patients' confidence in their physicians positively moderated the effects of pain relief on satisfaction among patients who reported low pain relief (P = 0.006), but not among patients who reported high pain relief (P = 0.275). CONCLUSIONS: Interventions to improve patients' confidence in their physician's pain management may enhance the effects of pain relief on patient satisfaction, particularly among patients who experience low levels of pain alleviation during their pain treatment.

Differential effects of methylmercury on gamma-aminobutyric acid type A receptor currents in rat cerebellar granule and cerebral cortical neurons in culture.

Cerebellar granule cells are particularly sensitive to inhibition by methylmercury (MeHg) on GABA(A) receptor function. This is manifested as a more rapid block of inhibitory postsynaptic currents/inhibitory postsynaptic potentials than for Purkinje cells. The underlying mechanism(s) for differential sensitivity of GABAergic transmission to MeHg in cerebellar neurons is unknown. Differential expression of alpha(6) subunit-containing GABA(A) receptors in cerebellar granule and Purkinje neurons could partially explain this. GABA-evoked currents (I(GABA)) were recorded in response to MeHg in alpha(6) subunit-containing cerebellar granule cells and alpha(6) subunit-deficient cerebral cortical cells in culture. Cortical cells were substituted for Purkinje cells, which do not express alpha(6) subunits. They express the same alpha(1)-containing GABA(A) receptor as Purkinje cells but lack characteristics that enhance Purkinje cell resistance to MeHg. I(GABA) were obtained using whole-cell recording and symmetrical [Cl(-)]. MeHg reduced I(GABA) to complete block in both cell types in a time- and concentration-dependent manner. This effect was faster in granule cells than cortical cells. Effects of MeHg on I(GABA) were recorded in granule cells at various developmental stages (days in vitro 4, 6, and 8) to alter the expression level of alpha(6) subunit-containing GABA(A) receptors. Effects of MeHg on I(GABA) were similar in cells at all days. In human embryonic kidney 293 cells expressing either alpha(6) or alpha(1) subunit-containing GABA(A) receptors, time to block of I(GABA) by MeHg was comparable. Thus, the presence of the alpha(6) subunit alone may not underlie the differential effects of MeHg on I(GABA) observed in cerebellar granule and cortical neurons; other factors are likely to be involved as well.

Acetylcholine release at neuromuscular junctions of adult tottering mice is controlled by N-(cav2.2) and R-type (cav2.3) but not L-type (cav1.2) Ca2+ channels.

The mutation in the alpha(1A) subunit gene of the P/Q-type (Ca(v)2.1) Ca(2+) channel present in tottering (tg) mice causes ataxia and motor seizures that resemble absence epilepsy in humans. P/Q-type Ca(2+)channels are primarily involved in acetylcholine (ACh) release at mammalian neuromuscular junctions. Unmasking of L-type (Ca(v)1.1-1.2) Ca(2+) channels occurs in cerebellar Purkinje cells of tg mice. However, whether L-type Ca(2+) channels are also up-regulated at neuromuscular junctions of tg mice is unknown. We characterized thoroughly the pharmacological sensitivity of the Ca(2+) channels, which control ACh release at adult tg neuromuscular junctions. Block of N- and R-type (Ca(v)2.2-2.3), but not L-type Ca(2+) channels, significantly reduced quantal content of end-plate potentials in tg preparations. Neither resting nor KCl-evoked miniature end-plate potential frequency differed significantly between tg and wild type (WT). Immunolabeling of Ca(2+) channel subunits alpha(1A), alpha(1B), alpha(1C), and alpha(1E) revealed an apparent increase of alpha(1B), and alpha(1E) staining, at tg but not WT neuromuscular junctions. This presumably compensates for the deficit of P/Q-type Ca(2+)channels, which localized presynaptically at WT neuromuscular junctions. No alpha(1C) subunits juxtaposed with pre- or postsynaptic markers at either WT or tg neuromuscular junctions. Thus, in adult tg mice, immunocytochemical and electrophysiological data indicate that N- and R-type channels both assume control of ACh release at motor nerve terminals. Recruitment of alternate subtypes of Ca(2+) channels to control transmitter release seems to represent a commonly occurring method of neuronal plasticity. However, it is unclear which conditions underlie recruitment of Ca(v)2 as opposed to Ca(v)1-type Ca(2+) channels.