Reversible Snapping of Constrained Anisotropic Hydrogels Upon Light Stimulations.

Creatures, such as Venus flytrap and hummingbirds, capable of rapid predation through snap-through transition, provide paradigms for the design of soft actuators and robots with fast actions. However, these artificial "snappers" usually need contact stimulations to trigger the flipping. Reported here is a constrained anisotropic poly(N-isopropylacrylamide) hydrogel showing fast snapping upon light stimulation. This hydrogel is prepared by flow-induced orientation of nanosheets (NSs) within a rectangular tube. The precursor containing gold nanoparticles is immediately exposed to UV light for photopolymerization to fix the ordered structure of NSs. Two ends of the slender gel are clamped to form a buckle with bistability nature, which snaps to the other side upon laser irradiation. Systematic experiments are conducted to investigate the influences of power intensity and irradiation angle of the laser, as well as thickness and buckle height of the gel, on the snapping behaviors. The fast snapping is further used to kick a plastic bead and control the switch state. Furthermore, synergetic or oscillated snapping of the gel with two buckles of opposite directions is realized by inclined irradiation of a laser or horizontal irradiation with two lasers, respectively. Such light-steered snapping of hydrogels should merit designing soft robots, energy harvests, etc.

Impact of Microbubble Degradation and Flow Velocity on Subharmonic-aided Pressure Estimation (SHAPE): An Experimental Investigation.

OBJECTIVE: This study aimed to investigate the impact of microbubble degradation and flow velocity on Sub-Harmonic Aided Pressure Estimation (SHAPE), and to explore the correlation between subharmonic amplitude and pressure as a single factor. METHODS: We develop an open-loop vascular phantom platform system and utilize a commercial ultrasound machine and microbubbles for subharmonic imaging. Subharmonic amplitude was measured continuously at constant pressure and flow velocity to assess the impact of microbubble degradation. Flow velocity was varied within a range of 4-14 cm/s at constant pressure to investigate its relationship to subharmonic amplitude. Furthermore, pressure was varied within a range of 10-110 mm Hg at constant flow velocity to assess its isolated effect on subharmonic amplitude. RESULTS: Under constant pressure and flow velocity, subharmonic amplitude exhibited a continuous decrease at an average rate of 0.221 dB/min, signifying ongoing microbubble degradation during the experimental procedures. Subharmonic amplitude demonstrated a positive correlation with flow velocity, with a variation ratio of 0.423 dB/(cm/s). Under controlled conditions of microbubble degradation and flow velocity, a strong negative linear correlation was observed between pressure and subharmonic amplitude across different Mechanical Index (MI) settings (all R2 > 0.90). The sensitivity of SHAPE was determined to be 0.025 dB/mmHg at an MI of 0.04. CONCLUSION: The assessment of SHAPE sensitivity is affected by microbubble degradation and flow velocity. Excluding the aforementioned influencing factors, a strong linear negative correlation between pressure and subharmonic amplitude was still evident, albeit with a sensitivity coefficient lower than previously reported values.

Closed Twisted Hydrogel Ribbons with Self-Sustained Motions under Static Light Irradiation.

Self-sustained motions are widespread in biological systems by harvesting energy from surrounding environments, which inspire scientists to develop autonomous soft robots. However, most-existing soft robots require dynamic heterogeneous stimuli or complex fabrication with different components. Recently, control of topological geometry has been promising to afford soft robots with physical intelligence and thus life-like motions. Reported here are a series of closed twisted ribbon robots, which exhibit self-sustained flipping and rotation under constant light irradiation. Both Möbius strip and Seifert ribbon robots are devised for the first time by using an identical hydrogel, which responds to light irradiation on either side. Experiment and simulation results indicate that the self-regulated motions of the hydrogel robots are related to fast and reversible response of muscle-like gel, self-shadowing effect, and topology-facilitated refresh of light-exposed regions. The motion speeds and directions of the hydrogel robots can be tuned over a wide range. These closed twisted ribbon hydrogels are further applied to execute specific tasks in aqueous environments, such as collecting plastic balls, climbing a vertical rod, and transporting objects. This work presents new design principle for autonomous hydrogel robots by benefiting from material response and topology geometry, which may be inspirative for the robotics community.

Photo-steered rapid and multimodal locomotion of 3D-printed tough hydrogel robots.

Hydrogels are an ideal material to develop soft robots. However, it remains a grand challenge to develop miniaturized hydrogel robots with mechanical robustness, rapid actuation, and multi-gait motions. Reported here is a facile strategy to fabricate hydrogel-based soft robots by three-dimensional (3D) printing of responsive and nonresponsive tough gels for programmed morphing and locomotion upon stimulations. Highly viscoelastic poly(acrylic acid-co-acrylamide) and poly(acrylic acid-co-N-isopropyl acrylamide) aqueous solutions, as well as their mixtures, are printed with multiple nozzles into 3D constructs followed by incubation in a solution of zirconium ions to form robust carboxyl-Zr4+ coordination complexes, to produce tough metallo-supramolecular hydrogel fibers. Gold nanorods are incorporated into ink to afford printed gels with response to light. Owing to the mechanical excellence and small diameter of gel fibers, the printed hydrogel robots exhibit high robustness, fast response, and agile motions when remotely steered by dynamic light. The design of printed constructs and steering with spatiotemporal light allow for multimodal motions with programmable trajectories of the gel robots. The hydrogel robots can walk, turn, flip, and transport cargos upon light stimulations. Such printed hydrogels with good mechanical performances, fast response, and agile locomotion may open opportunities for soft robots in biomedical and engineering fields.

Animating hydrogel knotbots with topology-invoked self-regulation.

Steering soft robots in a self-regulated manner remains a grand challenge, which often requires continuous symmetry breaking and recovery steps for persistent motion. Although structural morphology is found significant for robotic functions, geometric topology has rarely been considered and appreciated. Here we demonstrate a series of knotbots, namely hydrogel-based robots with knotted structures, capable of autonomous rolling and spinning/rotating motions. With symmetry broken by external stimuli and restored by self-regulation, the coupling between self-constraint-induced prestress and photothermal strain animates the knotbots continuously. Experiments and simulations reveal that nonequilibrium processes are regulated dynamically and cooperatively by self-constraints, active deformations, and self-shadowing effect of the photo-responsive gel. The active motions enable the knotbots to execute tasks including gear rotation and rod climbing. This work paves the way to devise advanced soft robots with self-regulated sustainable motions by harnessing the topology.

Localization of Ectopic Hyperparathyroidism: Ultrasound Versus 99mTc-sestamibi, 4-Dimensional Computed Tomography, and 11C-choline Positron Emission Tomography/Computed Tomography.

OBJECTIVE: To investigate the usefulness of ultrasound (US) for the localization of ectopic hyperparathyroidism and compare it with 99mTc-sestamibi (99mTc-MIBI), 4-dimensional computed tomography (4D-CT), and 11C-choline positron emission tomography/ computed tomography (PET/CT). METHODS: Of the 527 patients with surgically confirmed primary hyperparathyroidism, 79 patients with ectopic hyperparathyroidism were enrolled. The diagnostic performance of US, 99mTc-MIBI, US + MIBI, 4D-CT, and 11C-choline PET/CT was calculated, and the factors affecting the sensitivity of US and 99mTc-MIBI were analyzed. RESULTS: Eighty-three ectopic parathyroid lesions were found in 79 patients. The sensitivity was 75.9%, 81.7%, 95.1%, 83.3%, and 100% for US, 99mTc-MIBI, US + MIBI, 4D-CT, and 11C-choline PET/CT, respectively. The difference in sensitivity among these different modalities did not achieve statistical significance (P > .05). The US sensitivity was significantly higher for ectopic lesions in the neck region than for those in the anterior mediastinum/chest wall (85.9% vs. 42.1%, P < .001). The 99mTc-MIBI and 4D-CT sensitivity was not significantly different between these two groups (84.1% vs. 94.6%, P = .193 and 81.3% vs. 85.7%, P = 1). The 11C-choline PET/CT sensitivity was 100% in both groups. CONCLUSIONS: US is a valuable tool for the localization of ectopic hyperparathyroidism, especially for ectopic lesions in the neck region.

Toughening Hydrogels by Forming Robust Hydrazide-Transition Metal Coordination Complexes.

Energy dissipation based on dynamic fracture of metal ligands is an effective way to toughen hydrogels for specific applications in biomedical and engineering fields. Exploration of new kinds of metal-ligand coordinates with robust bonding strength is crucial for the facile synthesis of tough gels. Here a hydrogel toughening strategy based on the formation of robust coordination complexes between the hydrazide ligands and zinc ions is reported. The resultant hydrogels exhibit high strength and toughness at room temperature. Their mechanical properties show temperature dependence due to the dynamic nature of coordination bonds. In addition, the amine group of hydrazides in the gel matrix provides a reactive site for Schiff's base reaction, enabling surface modification without influence on overall mechanical performances of the gel. The hydrazide ligands are easy to synthesize and can coordinate very well with several transition metals. Such a metal-ligand coordination should be suitable to develop tough soft materials with versatile applications.

A novel nomogram for the preoperative prediction of sentinel lymph node metastasis in breast cancer.

BACKGROUND OR PURPOSE: A practical noninvasive method to identify sentinel lymph node (SLN) status in breast cancer patients, who had a suspicious axillary lymph node (ALN) at ultrasound (US), but a negative clinical physical examination is needed. To predict SLN metastasis using a nomogram based on US and biopsy-based pathological features, this retrospective study investigated associations between clinicopathological features and SLN status. METHODS: Patients treated with SLN dissection at four centers were apportioned to training, internal, or external validation sets (n = 472, 175, and 81). Lymph node ultrasound and pathological characteristics were compared using chi-squared and t-tests. A nomogram predicting SLN metastasis was constructed using multivariate logistic regression models. RESULTS: In the training set, statistically significant factors associated with SLN+ were as follows: histology type (p < 0.001); progesterone receptor (PR: p = 0.003); Her-2 status (p = 0.049); and ALN-US shape (p = 0.034), corticomedullary demarcation (CMD: p < 0.001), and blood flow (p = 0.001). With multivariate analysis, five independent variables (histological type, PR status, ALN-US shape, CMD, and blood flow) were integrated into the nomogram (C-statistic 0.714 [95% CI: 0.688-0.740]) and validated internally (0.816 [95% CI: 0.784-0.849]) and externally (0.942 [95% CI: 0.918-0.966]), with good predictive accuracy and clinical applicability. CONCLUSION: This nomogram could be a direct and reliable tool for individual preoperative evaluation of SLN status, and therefore aids decisions concerning ALN dissection and adjuvant treatment.

The value of dermoscopy and high-frequency ultrasound in staging morphea.

Morphea is an autoimmune disease characterized by skin sclerosis. According to the disease progression, morphea can be divided into inflammatory, sclerotic, and atrophic stages. Dermoscopy and high-frequency ultrasound (HF-US) have been applied in the noninvasive evaluation of many inflammatory diseases, but studies on the skin imaging features of the different stages of morphea are limited. To analyze the dermoscopic and HF-US features of the different stages of morphea and explore their auxiliary value in staging the disease, we followed 34 patients with histopathology-confirmed morphea between April 2018 and July 2021 who underwent dermoscopy and 50 and 20 MHz HF-US. Fisher's exact test was used to assess the differences in dermoscopic and HF-US features among patients with different stages of morphea. Seven patients were classified as the inflammatory stage, 20 as the sclerotic stage, and seven as the atrophic stage by histopathology. The most common dermoscopic features of inflammatory lesions were red structureless areas (100%) and linear curved vessels (85.7%). White clouds and shiny white streaks could be seen in 100% and 90% of sclerotic lesions, respectively. Among atrophic lesions, pigmentary structures (100%) and red structureless areas (85.7%) were the main features. In the HF-US examination, inflammatory lesions showed hypoechogenicity around the appendages (85.7%), a hypoechogenic dermis (71.4%), and an unclear boundary between the dermis and the subcutaneous fat (71.4%). Among lesions of the sclerotic stage, the main HF-US characteristics included a hyperechogenic dermis (85.0%), acoustic attenuation of the dermis (70.0%), and an unclear boundary between the dermis and the subcutaneous fat (85.0%). All atrophic lesions showed a hyperechogenic dermis, and 28.6% showed an unclear boundary between the dermis and the subcutaneous fat. Dermoscopy and HF-US can reveal the characteristic features of the different stages of morphea and show good correspondence with the histopathology. Dermoscopy and HF-US can provide important information for the staging of morphea.

High-frequency ultrasound features in vulvar lichen sclerosus and correlation with histopathology.

BACKGROUND: Vulvar lichen sclerosus (VLS) is a chronic inflammatory disease initially involving anogenital areas. Noninvasive assessment is essential for precise management in VLS. We aim to analyze high-frequency ultrasound (HFUS) features and correlate HFUS with histopathological changes. MATERIALS AND METHODS: Forty patients with histopathologically confirmed VLS lesions were retrospectively identified from August 2020 to September 2021. The clinical manifestations, dermoscopic images as well as both 20 and 50 MHz HFUS images were assessed. HFUS assessment included epidermal morphology, hypoechoic dermal band thickness, and hypoechoic dermal band internal echo. We compared HFUS images with histopathology, and Pearson's correlation coefficient was used to assess the relationship between hypoechoic dermal band thickness and histopathological depth. RESULTS: Hypoechoic dermal band was present in 100% (40/40) VLS lesions. There was a significant linear positive correlation between the histopathological depth and corresponding hypoechoic dermal band thickness, with a Pearson correlation coefficient of 0.685 (p < 0.001). Besides, 95% (38/40) lesions revealed smooth epidermis, and the internal echo of hypoechoic dermal band was assessed as homogeneous in 60% (24/40) and inhomogeneous in 40% (16/40) lesions. CONCLUSION: HFUS characteristics, as well as measurable hypoechoic dermal band thickness, may provide valuable information in the precise diagnosis and the treatment monitoring of VLS.

[Imaging in the Diagnosis of Breast Cancer in Elderly Women].

The breast cancer diagnosed in the women at or above age 70 is defined as breast cancer in the elderly.As the population keeps aging,breast cancer in the elderly presents increasing incidence and high mortality.Early detection,early diagnosis,and early treatment might improve the prognosis of these patients. Comprehensively evaluating the functional age of elderly patients is essential for the individualized treatment. Medical imaging plays a key role in the screening,early diagnosis,therapy selection,evaluation of neoadjuvant therapy efficacy,and postoperative follow-up.We reviewed the current literature and focused on the role of medical imaging in the diagnosis and treatment recommendations for breast cancer in the elderly.

Magneto-Orientation of Magnetic Double Stacks for Patterned Anisotropic Hydrogels with Multiple Responses and Modulable Motions.

Reported here is a multi-response anisotropic poly(N-isopropylacrylamide) hydrogel developed by using a rotating magnetic field to align magnetic double stacks (MDSs) that are fixed by polymerization. The magneto-orientation of MDSs originates from the unique structure with γ-Fe2 O3 nanoparticles sandwiched by two silicate nanosheets. The resultant gels not only exhibit anisotropic optical and mechanical properties but also show anisotropic responses to temperature and light. Gels with complex ordered structures of MDSs are further devised by multi-step magnetic orientation and photolithographic polymerization. These gels show varied birefringence patterns with potentials as information materials, and can deform into specific configurations upon stimulations. Multi-gait motions are further realized in the patterned gel through dynamic deformation under spatiotemporal light and friction regulation by imposed magnetic force. The magneto-orientation assisted fabrication of hydrogels with anisotropic structures and additional functions should bring opportunities for gel materials in biomedical devices, soft actuators/robots, etc.

Programmable Morphing Hydrogels for Soft Actuators and Robots: From Structure Designs to Active Functions.

Nature provides abundant inspiration and elegant paradigms for the development of smart materials that can actuate, morph, and move on demand. One remarkable capacity of living organisms is to adapt their shapes or positions in response to stimuli. Programmed deformations or movements in plant organs are mainly driven by water absorption/dehydration of cells, while versatile motions of mollusks are based on contraction/extension of muscles. Understanding the general principles of these morphing and motion behaviors can give rise to disruptive technologies for soft robotics, flexible electronics, biomedical devices, etc. As one kind of intelligent material, hydrogels with high similarity to soft biotissues and diverse responses to external stimuli are an ideal candidate to construct soft actuators and robots.The objective of this Account is to give an overview of the fundamental principles for controllable deformations and motions of hydrogels, with a focus on the structure designs and responsive functions of the corresponding soft actuators and robots. This field has been rapidly developed in recent years with a growing understanding of working principles in natural organisms and a substantial revolution of manufacturing technologies to devise bioinspired hydrogel systems with desired structures. Diverse morphing hydrogels and soft actuators/robots have been developed on the basis of several pioneering works, ranging from bending and folding deformations of bilayer hydrogels to self-shaping of non-Euclidean hydrogel surfaces, and from thermoactuated bilayer gel "hands" to electrodriven polyelectrolyte gel "worms". These morphing hydrogels have demonstrated active functions and versatile applications in biomedical and engineering fields.In this Account, we discuss recent progress in morphing hydrogels and highlight the design principles and relevant applications. First, we introduce the fundamentals of basic deformation modes, together with generic structure features, actuation strategies, and morphing mechanisms. The advantages of in-plane gradient structures are highlighted for programmable deformations by harnessing the out-of-plane buckling with bistability nature to obtain sophisticated three-dimensional configurations. Next, we give an overview of soft actuators and robots based on morphing hydrogels and focus on the working principles of the active systems with different structure designs. We discuss the advancements of hydrogel-based soft robots capable of swift locomotion with different gaits and emphasize the significances of structure control and dynamic actuation. Then we summarize versatile applications of hydrogel-based actuators and robots in biomedicines, cargo delivery, soft electronics, information encryption, and so forth. Some hydrogel robots with a built-in feedback loop and self-sensing system exhibit collaborative functions and advanced intelligence that are informative for the design of next-generation hydrogel machines. Finally, concluding remarks are given to discuss future opportunities and remaining challenges in this field. For example, miniature hydrogel-based actuators/robots with therapeutic or diagnostic functions are highly desired for biomedical applications. The morphing mechanisms summarized in this Account should be applicable to other responsive materials. We hope that this Account will inspire more scientists to be involved in this emerging area and make contributions to reveal novel working principles, design multifunctional soft machines, and explore applications in diverse fields.

Association Between Vascular Index Measured via Superb Microvascular Imaging and Molecular Subtype of Breast Cancer.

Background: To determine whether vascular index (VI; defined as the ratio of Doppler signal pixels to pixels in the total lesion) measured via superb microvascular imaging in breast cancer correlates with immunohistochemically defined subtype and is able to predict molecular subtypes. Methods: This prospective study involved 225 patients with 225 mass-type invasive breast cancers (mean size 2.6 ± 1.4 cm, range 0.4~5.9 cm) who underwent ultrasound and superb microvascular imaging (SMI) at Peking Union Medical College Hospital before breast surgery from December 2016 to June 2018. The correlations between primary tumor VI measured via SMI, clinicopathological findings, and molecular subtype were analyzed. The performance of VI for prediction of molecular subtypes in invasive breast cancer was investigated. Results: The median VI of the 225 tumors was 7.3% (4.2%~11.8%) (range 0%~54.4%). Among the subtypes of the 225 tumors, 41 (18.2%) were luminal A, 91 (40.4%) were luminal B human epidermal growth factor receptor-2 (HER-2)-negative, 26 (11.6%) were luminal B HER-2-positive, 17 (7.6%) were HER-2-positive, and 50 (22.2%) were triple-negative, and the corresponding median VI values were 5.9% (2.6%~11.6%) (range 0%~47.1%), 7.3 (4.4%~10.5%) (range 0%~29.5%), 6.3% (3.9%~11.3%) (range 0.6%~22.2%), 8.2% (4.9%~15.6%) (range 0.9%~54.4%), and 9.2% (5.1%~15.3%) (range 0.7%~32.9%), respectively. Estrogen receptor (ER) negativity, higher tumor grade, and higher Ki-67 index (≥20%) were significantly associated with a higher VI value. Tumor size, ER status, and Ki-67 index were shown to independently influence VI. A cutoff value of 4.1% yielded 79.9% sensitivity and 41.5% specificity with an area under the receiver operating characteristic curve (AUC) of 0.58 for predicting that a tumor was of the luminal A subtype. A cutoff value of 16.4% yielded 30.0% sensitivity and 90.3% specificity with an AUC of 0.60 for predicting a triple-negative subtype. Conclusions: VI, as a quantitative index obtained by SMI examination, could reflect histologic vascular changes in invasive breast cancer and was found to be higher in more biologically aggressive breast tumors. VI shows a certain degree of correlation with the molecular subtype of invasive breast cancer and plays a limited role in predicting the luminal A with high sensitivity and triple-negative subtype with high specificity.

A comparative study of melanocytic nevi classification with dermoscopy and high-frequency ultrasound.

BACKGROUND: Melanocytic nevi (MN) can be classified into three subtypes according to the depth of the nests of nevus cells which is important for management. High-frequency ultrasound (HF-US) can clearly reveal the lesion size, contour, depth, and internal structures. However, the HF-US studies of MN according to subtypes are limited. We aimed to describe the HF-US features of MN and explore its value in accurate classification. MATERIALS AND METHODS: This retrospective study was conducted from January 2018 to November 2019. Eighty-five patients with MN were included and examined by 50 and 20 MHz HF-US. The HF-US features were recorded including morphological flatness, depth, shape, boundary, internal echogenicity, hyperechoic spots, lateral acoustic shadow, posterior echoic patterns, mushroom signs, and straw-hat signs. Each image was evaluated by two physicians independently, and the consistency was tested. RESULTS: Eleven lesions could not be detected by HF-US. The rest 74 lesions underwent ultrasonic analysis. MN appeared as strip-shaped or oval, hypoechoic areas localized in the epidermis and dermis under ultrasonography. A strong consistency between HF-US and dermoscopy of determining the lesion depth was achieved (κ = 0.935, p < 0.001). The hyperechoic spots were found in 57.6% intradermal nevi. The mushroom signs were seen in 34.8% intradermal nevi, and the straw-hat signs were seen in all the compound nevi. CONCLUSION: MN can be correctly classified using HF-US, and it had a strong correlation with dermoscopic and clinical classification. HF-US could further reveal the internal morphological features of MN, which may support more precise classification and management.

Patterned Electrode Assisted One-Step Fabrication of Biomimetic Morphing Hydrogels with Sophisticated Anisotropic Structures.

Anisotropic structures are ubiquitous in nature, affording fascinating morphing behaviors. Biomimetic morphing materials can be developed by spatially controlling the orientations of molecules or nanofillers that produce anisotropic responses and internal stresses under external stimuli. However, it remains a serious challenge to fabricate materials with sophisticated anisotropic architectures. Here, a facile strategy to fabricate morphing hydrogels with elaborately ordered structures of nanosheets, which are oriented under distributed electric field and immobilized by polymerization to form a poly(N-isopropylacrylamide) matrix, is proposed. Diverse sophisticated anisotropic structures are obtained by engineering the electric field through the patterns and relative locations of the electrodes. Upon heating, the monolithic hydrogels with through-thickness and/or in-plane gradients in orientation of the nanosheets deform into various three-dimensional configurations. After incorporating gold nanoparticles, the hydrogels become photoresponsive and capable of programmable motions, for example, dynamic twisting and flipping under spatiotemporal stimuli. Such a strategy of using patterned electrodes to generate distributed electric field should be applicable to systems of liquid crystals or charged particles/molecules to direct orientation or electrophoresis and form functional structures. The biomimetically architectured hydrogels would be ideal materials to develop artificial muscles, soft actuators/robots, and biomedical devices with versatile applications.

Light-steered locomotion of muscle-like hydrogel by self-coordinated shape change and friction modulation.

Many creatures have the ability to traverse challenging environments by using their active muscles with anisotropic structures as the motors in a highly coordinated fashion. However, most artificial robots require multiple independently activated actuators to achieve similar purposes. Here we report a hydrogel-based, biomimetic soft robot capable of multimodal locomotion fueled and steered by light irradiation. A muscle-like poly(N-isopropylacrylamide) nanocomposite hydrogel is prepared by electrical orientation of nanosheets and subsequent gelation. Patterned anisotropic hydrogels are fabricated by multi-step electrical orientation and photolithographic polymerization, affording programmed deformations. Under light irradiation, the gold-nanoparticle-incorporated hydrogels undergo concurrent fast isochoric deformation and rapid increase in friction against a hydrophobic substrate. Versatile motion gaits including crawling, walking, and turning with controllable directions are realized in the soft robots by dynamic synergy of localized shape-changing and friction manipulation under spatiotemporal light stimuli. The principle and strategy should merit designing of continuum soft robots with biomimetic mechanisms.

Distributed Electric Field Induces Orientations of Nanosheets to Prepare Hydrogels with Elaborate Ordered Structures and Programmed Deformations.

Living organisms use musculatures with spatially distributed anisotropic structures to actuate deformations and locomotion with fascinating functions. Replicating such structural features in artificial materials is of great significance yet remains a big challenge. Here, a facile strategy is reported to fabricate hydrogels with elaborate ordered structures of nanosheets (NSs) oriented under a distributed electric field. Multiple electrodes are distributed with various arrangements in the precursor solution containing NSs and gold nanoparticles. A complex electric field induces sophisticated orientations of the NSs that are permanently inscribed by subsequent photo-polymerization. The resultant anisotropic nanocomposite poly(N-isopropylacrylamide) hydrogels exhibit rapid deformation upon heating or photoirradiation, owing to the fast switching of permittivity of the media and electric repulsion between the NSs. The complex alignments of NSs and anisotropic shape change of discrete regions result in programmed deformation of the hydrogels into various configurations. Furthermore, locomotion is realized by a spatiotemporal light stimulation that locally triggers time-variant shape change of the composite hydrogel with complex anisotropic structures. Such a strategy on the basis of the distributed electric-field-generated ordered structures should be applicable to gels, elastomers, and thermosets loaded with other anisotropic particles or liquid crystals, for the design of biomimetic/bioinspired materials with specific functionalities.

The Vascular Index of Superb Microvascular Imaging Can Improve the Diagnostic Accuracy for Breast Imaging Reporting and Data System Category 4 Breast Lesions.

PURPOSE: To investigate whether the vascular index (VI) of superb microvascular imaging (SMI) could improve the diagnostic efficiency for BI-RADS 4 breast lesions and reduce the number of unnecessary biopsies. PATIENTS AND METHODS: For this study, we selected 222 consecutive BI-RADS 4 breast lesions detected by ultrasound and confirmed by pathology from January 2016 to October 2018. A VI of 4.0 was set as the cutoff value to degrade BI-RADS classification. We calculated the accuracy, sensitivity and PPV of a BI-RADS diagnosis alone and the combination of BI-RADS and the VI. RESULTS: Pathologically, of the 222 lesions, 129 were confirmed to be benign, and 93 were found to be malignant. A VI of 4.0 was set as the cutoff value; when the VI≤4.0, those BI-RADS 4 masses were downgraded one level (4C-4B, 4B-4A, 4A-3) to an integral BI-RADS grade, while the others maintained the conventional grade. A total of 54 BI-RADS 4 lesions were degraded to BI-RADS 3, including 53 benign lesions and 1 malignant lesion. The diagnostic accuracy (65.3% vs 41.9%) and PPV (54.8% vs 41.9%) were significantly improved. The sensitivity decreased slightly (98.9% vs 100%) because 1 of the 54 downgraded BI-RADS 4 lesions, which had a pathological type of invasive ductal carcinoma, was incorrectly downgraded. CONCLUSION: SMI is a noninvasive tool for visualizing the vascular structure with high-resolution microvascular images. As a quantitative index, the VI can be used to appropriately downgrade benign lesions classified as BI-RADS 4, which can improve the diagnostic accuracy and PPV and reduce unnecessary biopsies.