Direct Visualization of the Self-Alignment Process for Nanostructured Block Copolymer Thin Films by Transmission Electron Microscopy.

Herein, this work aims to directly visualize the morphological evolution of the controlled self-assembly of star-block polystyrene-block-polydimethylsiloxane (PS-b-PDMS) thin films via in situ transmission electron microscopy (TEM) observations. With an environmental chip, possessing a built-in metal wire-based microheater fabricated by the microelectromechanical system (MEMS) technique, in situ TEM observations can be conducted under low-dose conditions to investigate the development of film-spanning perpendicular cylinders in the block copolymer (BCP) thin films via a self-alignment process. Owing to the free-standing condition, a symmetric condition of the BCP thin films can be formed for thermal annealing under vacuum with neutral air surface, whereas an asymmetric condition can be formed by an air plasma treatment on one side of the thin film that creates an end-capped neutral layer. A systematic comparison of the time-resolved self-alignment process in the symmetric and asymmetric conditions can be carried out, giving comprehensive insights for the self-alignment process via the nucleation and growth mechanism.

Controlled Self-Assembly of Polystyrene-block-Polydimethylsiloxane for Fabrication of Nanonetwork Silica Monoliths.

Herein, this work aims to carry out controlled self-assembly of single-composition block copolymer for the fabrication of various nanonetwork silica monoliths. With the use of lamellae-forming polystyrene-block-polydimethylsiloxane (PS-b-PDMS), nanonetwork-structured films could be fabricated by solvent annealing using a PS-selective solvent (chloroform). By simply tuning the flow rate of nitrogen purge to the PS-selective solvent for the controlled self-assembly of the PS-b-PDMS, gyroid- and diamond-structured monoliths can be formed due to the difference in the effective volume of PS in the PS-b-PDMS during solvent annealing. As a result, well-ordered nanonetwork SiO2 (silica) monoliths can be fabricated by templated sol-gel reaction using hydrofluoric acid etched PS-b-PDMS film as a template followed by the removal of the PS. This bottom-up approach for the fabrication of nanonetwork materials through templated synthesis is appealing to create nanonetwork materials for various applications.

An Innovative Thread-looping Method for Facial Rejuvenation: Minimal Access Multiple Plane Suspension.

BACKGROUND: Management of facial rejuvenation has evolved over past decades. Facelift with barbed suture is a minimally invasive surgical technique for facial rejuvenation. This study examined the efficacy and associated complications of a new thread-looping procedure called minimal access multiple plane suspension. METHODS: A total of 103 thread lifts were performed between 2014 and 2017. Patient satisfaction and adverse effects were evaluated. RESULTS: In the majority of patients (88/103, 85.4%), the results obtained were considered satisfactory 3 months after the procedure. The incidence of complications was low. Only 5.8% of the patients had slight postoperation asymmetry that was easily corrected. Minor complications experienced by patients included palpable suture knots (12.6%), persistent facial swelling (7.88%), and facial dimpling (2.9%). The causes of procedure-related complications were reviewed and discussed. CONCLUSION: Reinforced by select anchoring points, "minimal access multiple plane suspension" suspends ptotic anatomic tissues, serving as an effective facial rejuvenation procedure with minimal downtime and satisfactory cosmetic results.

Directed Self-Assembly of Star-Block Copolymers by Topographic Nanopatterns through Nucleation and Growth Mechanism.

Exploring the ordering mechanism and dynamics of self-assembled block copolymer (BCP) thin films under confined conditions are highly essential in the application of BCP lithography. In this study, it is aimed to examine the self-assembling mechanism and kinetics of silicon-containing 3-arm star-block copolymer composed of polystyrene (PS) and poly(dimethylsiloxane) blocks as nanostructured thin films with perpendicular cylinders and controlled lateral ordering by directed self-assembly using topographically patterned substrates. The ordering process of the star-block copolymer within fabricated topographic patterns with PS-functionalized sidewall can be carried out through the type of secondary (i.e., heterogeneous) nucleation for microphase separation initiated from the edge and/or corner of the topographic patterns, and directed to grow as well-ordered hexagonally packed perpendicular cylinders. The growth rate for the confined microphase separation is highly dependent upon the dimension and also the geometric texture of the preformed pattern. Fast self-assembly for ordering of BCP thin film can be achieved by lowering the confinement dimension and also increasing the concern number of the preformed pattern, providing a new strategy for the design of BCP lithography from the integration of top-down and bottom-up approaches.

Effects of calcium channel blockers comparing to angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in patients with hypertension and chronic kidney disease stage 3 to 5 and dialysis: A systematic review and meta-analysis.

BACKGROUND: Calcium channel blocker (CCB) or two renin angiotensin aldosterone system blockades (RAAS), angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), are major potent and prevalently used as initial antihypertensive agents for mild to moderate hypertension, but no uniform agreement as to which antihypertensive drugs should be given for initial therapy, especially among chronic kidney disease (CKD) patients. DESIGN: A systematic review and meta-analysis comparing CCBs and the two RAAS blockades for hypertensive patients with CKD stage 3 to 5D. The inclusion criteria for this systematic review was RCT that compared the effects of CCBs and the two RAAS blockades in patients with hypertension and CKD. The exclusion criteria were (1) renal transplantation, (2) CKD stage 1 or 2, (3) combined therapy (data cannot be extracted separately). Outcomes were blood pressure change, mortality, heart failure, stroke or cerebrovascular events, and renal outcomes. RESULTS: 21 randomized controlled trials randomized 9,492 patients with hypertensive and CKD into CCBs and the two RAAS blockades treatments. The evidence showed no significant differences in blood presser change, mortality, heart failure, stroke or cerebrovascular events, and renal outcomes between CCBs group and the two RAAS blockades group. The publication bias of pooled mean blood presser change that was detected by Egger's test was non-significant. CONCLUSIONS: CCBs has similar effects on long term blood pressure, mortality, heart failure, stroke or cerebrovascular events, and renal function to RAAS blockades in patients CKD stage 3 to 5D and hypertension.

Generalized bullous fixed drug eruption is distinct from Stevens-Johnson syndrome/toxic epidermal necrolysis by immunohistopathological features.

BACKGROUND: Generalized bullous fixed drug eruption (GBFDE), a particular form of fixed drug eruption (FDE), is characterized by widespread blisters and erosions and can be confused with Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). OBJECTIVE: We sought to analyze specific features of GBFDE and differentiate it from SJS/TEN. METHODS: We retrospectively studied patients with GBFDE and SJS/TEN during a period of 10 years. GBFDE was defined as typical FDE lesions with blisters involving at least 10% body surface area on at least 3 of 6 different anatomic sites. Clinical presentations; histopathological features; immunohistochemical patterns of cluster-of-differentiation (CD)3, CD4, CD8, CD56, Fas, Fas ligand, granzyme B, perforin, granulysin, and forkhead box P3 (Foxp3); and serum granulysin levels were compared. RESULTS: Twenty-three cases of GBFDE were collected. Patients with GBFDE had shorter latent periods, less mucosal involvement, more eosinophil infiltration, and dermal melanophages. Lesional infiltrates in GBFDE had more dermal CD4(+) cells including Foxp3(+) regulatory T cells, fewer intraepidermal CD56(+) cells, and fewer intraepidermal granulysin(+) cells. The serum level of granulysin in GBFDE was also significantly lower than in SJS/TEN. LIMITATIONS: The number of cases in this study is small. CONCLUSION: GBFDE is a distinct disease distinguishable from SJS/TEN by particular features such as granulysin, CD56, and Foxp3 expressions.

Clinicopathologic analysis of coxsackievirus a6 new variant induced widespread mucocutaneous bullous reactions mimicking severe cutaneous adverse reactions.

BACKGROUND: The cutaneous manifestations of human enterovirus (HEV) infection are usually limited, such as hand-foot-mouth disease. By comparison, Stevens-Johnson syndrome (SJS) is a life-threatening severe cutaneous adverse reaction (SCAR), mainly caused by drugs. During the HEV outbreaks in 2010-2012 in Taiwan, we identified 21 patients who developed widespread blistering mucocutaneous reactions without any suspected drug causality. METHODS: We screened possible pathogen(s) for detecting human herpes virus (HHV1-HHV7), HEV, or Mycoplasma pneumoniae infections using throat swab virus cultures, real-time PCR, DNA sequencing, immunochemistry and electron microscopy analyses. RESULTS: Coxsackievirus A6 (CVA6) DNA was identified in the blistering skin lesions in 6 of 21 patients. Cytotoxic T lymphocytes and natural killer cells expressing granulysin predominantly infiltrated into the skin lesions, sharing the histopathological features with SJS. Intact CVA6 viral particles were identified in the blister fluids and skin lesions by electron microscopy. The phylogenetic analysis of the viral genome showed the CVA6 DNA sequence sharing higher similarity (97.6%-98.1%) to CVA6 strains reported from Finland at 2008. CONCLUSIONS: This study identifies a new variant of CVA6 as the causative agent for severe mucocutaneous blistering reactions mimicking SCAR. An awareness of this unusual presentation of HEV infection is needed in the epidemic area.

Acute pulmonary embolism in a patient with hypereosinophilia and psoriasis.

Peripheral blood hypereosinophilia reflects various underlying disorders. However, its thromboembolic consequences are not often highlighted. We report a case of acute pulmonary embolism in a 42 year-old male prisoner hospitalized for erythrodermic psoriasis who presented with generalized edema and shortness of breath. Severe eosinophilia (absolute eosinophil count 6232/ΜL) was also noted. Although severe psoriasis can be associated with eosinophilia and metabolic syndrome, acute pulmonary embolism is very rare in these patients. Immobilization secondary to severe psoriatic arthritis and prolonged use of leg cuffs can exacerbate the formation of thromboembolism. Although investigating the underlying causes of eosinophilia is important, we would like to highlight the importance of being aware of thromboembolic events, especially in patients with other thrombotic risk factors.