Camrelizumab plus apatinib in patients with advanced or recurrent endometrial cancer after failure of at least one prior systemic therapy (CAP 04): a single-arm phase II trial.

BACKGROUND: The combination of anti-programmed death 1 (PD-1) inhibitors and tyrosine kinase inhibitors is an effective treatment strategy in endometrial cancer. We aimed to explore the efficacy and safety of camrelizumab plus apatinib as an alternative therapeutic option in patients with previously treated endometrial cancer. METHODS: This single-arm Simon's two-stage phase II trial was conducted at the Fudan University Shanghai Cancer Center. Patients with advanced or recurrent endometrial cancer who had failed at least one prior systemic therapy were screened for potential participation. Eligible patients were treated with intravenous camrelizumab (200 mg d1 q2w) and oral apatinib (250 mg qd) every 4 weeks. The primary end point was the objective response rate (ORR) per RECIST v1.1 in the intention-to-treat principle. RESULTS: Between January 20, 2020, and October 14, 2022, 36 patients (29 with microsatellite stability/mismatch repair proficient [MSS/pMMR] tumors; two with microsatellite instability-high/mismatch repair deficient [MSI-H/dMMR] tumors) were enrolled and treated. The confirmed ORR was 44.4% (95% CI: 27.9, 61.9) and the disease control rate was 91.7% (95% CI: 77.5, 98.2). The median duration of response was 9.3 (95% CI: 4.3, not reached) months, the median progression-free survival was 6.2 (95% CI: 5.3, 11.1) months, and the median overall survival was 21.0 (95% CI: 13.4, not reached) months during a median follow-up of 14.2 (interquartile range: 10.3, 27.6) months. Treatment-related adverse events of grade 3 or 4 occurred in 20 (55.6%) patients, with the most common being increased γ-glutamyl transferase (27.8%), alanine aminotransferase (16.7%) and aspartate aminotransferase (13.9%), and hypertension (11.1%). No treatment-related death occurred. CONCLUSIONS: Camrelizumab plus apatinib showed promising antitumor activity with manageable toxicity in patients with advanced or recurrent endometrial cancer who had failed at least one prior systemic therapy. The findings of this study support further investigation of camrelizumab plus apatinib as an alternative therapeutic option, especially for patients with MSS/pMMR tumors. TRIAL REGISTRATION: This trial was retrospectively registered with ChiCTR.org.cn, number ChiCTR2000031932.

Regioselective synthesis of 2-aminophenols from N-arylhydroxylamines.

A novel strategy for the synthesis of 2-aminophenols in the absence of metals and oxidants was described. The 2-aminophenols were efficiently obtained through a cascade [3,3]-sigmatropic rearrangement and in situ hydrolysis process by using readily available N-arylhydroxylamines and the in situ-generated methyl chlorosulfonate from commercially available sulfuryl chloride and methanol under mild conditions. This method could be scaled up and has a wide substrate scope with great functional group tolerance and high regioselectivity. The 2-aminophenol products could be readily converted into structurally diverse functional molecules in good yields under various conditions.

Dipole Moment Dictates the Preferential Immobilization in Gel Electrolytes for Ah-level Aqueous Zinc-Metal Batteries.

Aqueous Zn-metal batteries are of great interest due to their high material abundance, low production cost, and excellent safety. However, they suffer from severe side reactions and notorious dendrite growth closely related to electrolytes. Here, in-situ generated zwitterionic polymers are used as gel electrolytes to overcome these problems. It is shown that anions and H2O, but not anions and cations, are preferentially immobilized at different sites of zwitterionic polymers, facilitating the free migration of Zn2+ and reducing the side reactions. This immobilization can be associated with the dipole moment of zwitterionic polymers. As a result, poly[3-dimethyl(methacryloyl oxyethyl) ammonium propane sulfonate] (PDMAPS) stands out from a series of zwitterionic polymers and outperforms the other candidates in electrochemical performance. The symmetric cells using PDMAPS smoothly operate ~9000 h at 0.5 mA cm-2 for 0.5 mAh cm-2, much better than the controls. Moreover, PDMAPS enables an Ah-level pouch cell for continuous cycling. These results not only benefit the rational molecular design of advanced electrolytes, but also demonstrate the promising potential of zwitterionic polymers in aqueous Zn-metal batteries.

Se-dopant Modulated Selective Co-Insertion of H+ and Zn2+ in MnO2 for High-Capacity and Durable Aqueous Zn-Ion Batteries.

MnO2 is commonly used as the cathode material for aqueous zinc-ion batteries (AZIBs). The strong Coulombic interaction between Zn ions and the MnO2 lattice causes significant lattice distortion and, combined with the Jahn-Teller effect, results in Mn2+ dissolution and structural collapse. While proton intercalation can reduce lattice distortion, it changes the electrolyte pH, producing chemically inert byproducts. These issues greatly affect the reversibility of Zn2+ intercalation/extraction, leading to significant capacity degradation of MnO2. Herein, we propose a novel method to enhance the cycling stability of δ-MnO2 through selenium doping (Se-MnO2). Our work indicates that varying the selenium doping content can regulate the intercalation ratio of H+ in MnO2, thereby suppressing the formation of ZnMn2O4 by-products. Se doping mitigates the lattice strain of MnO2 during Zn2+ intercalation/deintercalation by reducing Mn-O octahedral distortion, modifying Mn-O bond length upon Zn2+ insertion, and alleviating Mn dissolution caused by the Jahn-Teller effect. The optimized Se-MnO2 (Se concentration of 0.8 at.%) deposited on carbon nanotube demonstrates a notable capacity of 386 mAh g-1 at 0.1 A g-1, with exceptional long-term cycle stability, retaining 102 mAh g-1 capacity after 5000 cycles at 3.0 A g-1.

Safety and efficacy of apatinib in patients with advanced gastric or gastroesophageal junction adenocarcinoma after the failure of two or more lines of chemotherapy (AHEAD): a prospective, single-arm, multicenter, phase IV study.

BACKGROUND: Apatinib, a highly selective VEGFR2 inhibitor, significantly improved efficacy versus placebo as a third- and later-line treatment for advanced gastric cancer in phase 2 and 3 trials. This prospective, single-arm, multicenter phase IV AHEAD study was conducted to verify the safety and efficacy of apatinib in patients with advanced or metastatic gastric or gastroesophageal adenocarcinoma after at least two lines of systematic therapy in clinical practice settings. METHODS: Patients with advanced gastric cancer who had previously failed at least two lines of chemotherapy received oral apatinib until disease progression, death or unacceptable toxicity. The primary endpoint was safety. The secondary endpoints included objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS) and overall survival (OS). Adverse events were summarized by the incidence rate. Median OS and PFS were estimated using the Kaplan-Meier method. ORR, DCR, OS at 3 and 6 months, and PFS at 3 and 6 months were calculated, and their 95% CIs were estimated according to the Clopper-Pearson method. RESULTS: Between May 2015 and November 2019, a total of 2004 patients were enrolled, and 1999 patients who received at least one dose of apatinib were assessed for safety. In the safety population, 87.9% of patients experienced treatment-related adverse events (TRAEs), with the most common hypertension (45.2%), proteinuria (26.5%), and white blood cell count decreased (25.3%). Additionally, 51% of patients experienced grade ≥ 3 TRAEs. Fatal TRAEs occurred in 57 (2.9%) patients. No new safety concerns were reported. Among the 2004 patients included in the intention-to-treat population, the ORR was 4.4% (95% CI, 3.6-5.4%), and DCR was 35.8% (95% CI, 33.7-38.0%). The median PFS was 2.7 months (95% CI 2.2-2.8), and the median OS was 5.8 months (95% CI 5.4-6.1). CONCLUSIONS: The findings in the AHEAD study confirmed the acceptable and manageable safety profile and clinical benefit of apatinib in patients with advanced gastric cancer as a third- or later-line of treatment. TRIAL REGISTRATION: This study was registered with ClinicalTrials.gov NCT02426034. Registration date was April 24, 2015.

A Thermal-Ball-Valve Structure Separator for Highly Safe Lithium-Ion Batteries.

The separator located between the positive and negative electrodes not only provides a lithium-ion transmission channel but also prevents short circuits for direct contact of electrodes. The inferior dimension thermostability of commercial polyolefin separators intensifies the thermal runaway of batteries under abuse such as short circuits, overcharge, and so on. a polyvinylidene fluoride/polyether imide (PVDF/PEI) separator with high thermal stability in which the high thermostable PEI microspheres are evenly dispersed in the PVDF film matrix and also located in the micro holes of the PVDF film is developed. They not only function as strong skeleton that enables the rare shrink of the separator at 200 °C avoiding short circuit but also act as ball valve that blocks the lithium ion transmission channel at 150 °C interrupting the further heat aggregation. Thus, the LiNi0.6 Co0.2 Mn0.2 O2 /Li batteries exhibit high cycle stability of 96.5% capacity retention after 100 cycles at 0.2C and 80°C. Further, the LiNi0.6 Co0.2 Mn0.2 O2 /graphite pouch cells are constructed and deliver good safety performance without smoke release and catching fire after the nail penetration test.

On-Demand Removable Self-Healing and pH-Responsive Europium-Releasing Adhesive Dressing Enables Inflammatory Microenvironment Modulation and Angiogenesis for Diabetic Wound Healing.

Current diabetic wound treatments remain unsatisfactory due to the lack of a comprehensive strategy that can integrate strong applicability (tissue adhesiveness, shape adaptability, fast self-healability, and facile dressing change) with the initiation and smooth connection of the cascade wound healing processes. Herein, benefiting from the multifaceted bonding ability of tannic acid to metal ions and various polymers, a family of tannin-europium coordination complex crosslinked citrate-based mussel-inspired bioadhesives (TE-CMBAs) are specially developed for diabetic wound healing. TE-CMBAs can gel instantly (< 60 s), possess favorable shape-adaptability, considerable mechanical strengths, high elasticity, considerable wet tissue adhesiveness (≈40 kPa), favorable photothermal antimicrobial activity, excellent anti-oxidant activity, biocompatibility, and angiogenetic property. The reversible hydrogen bond crosslinking and sensitive metal-phenolic coordination also confers TE-CMBAs with self-healability, pH-responsive europium ion and TA releasing properties and on-demand removability upon mixing with borax solution, enabling convenient painless dressing change and the smooth connection of inflammatory microenvironment modulation, angiogenesis promotion, and effective extracellular matrix production leveraging the acidic pH condition of diabetic wounds. This adhesive dressing provides a comprehensive regenerative strategy for diabetic wound management and can be extended to other complicated tissue healing scenarios.

Synergistic Chaotropic Effect and Cathode Interface Thermal Release Effect Enabling Ultralow Temperature Aqueous Zinc Battery.

Although rechargeable zinc-ion batteries are promising candidates for next-generation energy storage devices, their inferior performance at subzero temperatures limits their practical application. Here, a strategy to destroy the H-bond network by adding synergistic chaotropic regents is reported, thus reducing the freezing point of the aqueous electrolyte below -90 °C. Owing to the synergistic chaotropic effect between urea and Zn(ClO4 )2 and the thermal release effect on the cathode interface during charging, Zn//VO2 batteries feature a specific capacity of 111.4 mAh g-1 and stability after ≈1000 cycles with 81.9% capacity retention at -40 °C. This work demonstrates that the synergistic chaotropic effect and the thermal effect on the interface can effectively widen the operation range of temperature of aqueous electrolytes and maintain fast kinetics, which provides a new design strategy for all-weather aqueous zinc batteries.

Aqueous Rechargeable Li+ /Na+ Hybrid Ion Battery with High Energy Density and Long Cycle Life.

The practical application of aqueous rechargeable batteries is hampered by the low energy density and poor cycle stability, which mostly arises from the corrosion of cathode current collector, exfoliation of active material, and narrow electrochemical stability window of aqueous electrolyte. A light-weight and low-cost cathode current collector composed of graphite and carbon nanotube coated on nylon membrane exhibiting corrosion resistance and strong adhesion is developed. Also, a modified aqueous electrolyte with the addition of urea whose window is expanded to ≈3.2 V is developed that contributes to the formation of solid-electrolyte interphase on surfaces of electrodes. LiMn2 O4 /NaTi2 (PO4 )3 Li+ /Na+ hybrid ion battery using such aqueous electrolyte and current collector is demonstrated to cycle up to 10 000 times with low cost (60 dollars per kWh) and high energy density (100 Wh kg-1 ) for stationary energy storage and electronic vehicles applications.

A High-Energy and Long-Life Aqueous Zn/Birnessite Battery via Reversible Water and Zn2+ Coinsertion.

Aqueous rechargeable Zn/birnessite batteries have recently attracted extensive attention for energy storage system because of their low cost and high safety. However, the reaction mechanism of the birnessite cathode in aqueous electrolytes and the cathode structure degradation mechanics still remain elusive and controversial. In this work, it is found that solvation water molecules coordinated to Zn2+ are coinserted into birnessite lattice structure contributing to Zn2+ diffusion. However, the birnessite will suffer from hydroxylation and Mn dissolution with too much solvated water coinsertion. Through engineering Zn2+ primary solvation sheath with strong-field ligand in aqueous electrolyte, highly reversible [Zn(H2 O)2 ]2+ complex intercalation/extraction into/from birnessite cathode is obtained. Cathode-electrolyte interface suppressing the Mn dissolution also forms. The Zn metal anode also shows high reversibility without formation of "death-zinc" and detrimental dendrite. A full cell coupled with birnessite cathode and Zn metal anode delivers a discharge capacity of 270 mAh g-1 , a high energy density of 280 Wh kg-1 (based on total mass of cathode and anode active materials), and capacity retention of 90% over 5000 cycles.

Sulfur-Rich Phosphorus Sulfide Molecules for Use in Rechargeable Lithium Batteries.

A new family of sulfur-rich phosphorus sulfide molecules (P4 S10+n ) and their electrochemical reaction mechanism with metallic Li has been explored. These P4 S10+n molecules are synthesized by the reaction between P4 S10 and S. For Li batteries, the P4 S40 molecule in the series of P4 S10+n molecules provides the highest capacity, which has a first discharge capacity of 1223 mAh g-1 at 100 mA g-1 and stabilizes at approximately 720 mAh g-1 at 500 mA g-1 after 100 cycles. This new class of sulfur-rich P4 S10+n molecules and its electrochemical behavior for room-temperature Li+ storage could provide novel insights for phosphorus sulfide molecules and high-energy batteries.

A genome-wide association study identifies susceptibility loci of silica-related pneumoconiosis in Han Chinese.

Pneumoconiosis is the most serious occupational disease in China and its leading cause is occupational silica exposure. Pneumoconiosis takes several years to develop depending on the exposure level of silica. However, individual variation in the susceptibility to pneumoconiosis has been observed among the subjects with similar exposure. We conducted a genome-wide screening with 710,999 single nucleotide polymorphisms (SNPs) in a cohort of 400 coal workers (202 cases and 198 exposed controls) for pneumoconiosis susceptible loci. Seven promising variants were evaluated in an independent cohort of 568 coal workers (323 cases and 245 exposed controls), followed by a second replication on 463 iron ore workers (167 cases and 296 exposed controls). By pooling all of the genome-wide association studies and replication stages together, we found a genome-wide significant (P < 5.0 × 10(-8)) association for rs73329476 (P = 1.74 × 10(-8), OR = 2.17, 95% CI = 1.66-2.85) and two additional replicated associations for rs4320486 (P < 0.05) and rs117626015 (P < 0.05) with combined P-values of 4.29 × 10(-6) and 5.05 × 10(-6), respectively. In addition, the risk allele T of rs73329476 was significantly associated with lower mRNA expression levels of carboxypeptidase M (CPM) in total cellular RNA from whole blood of 156 healthy individuals (P = 0.0252). The identified pneumoconiosis susceptibility loci may provide new insights into the pathogenesis of pneumoconiosis, and may also have some clinical utility for risk prediction for pneumoconiosis and high-risk population screening for workers with occupational silica exposure.

A Composite Structure of Cu3 Ge/Ge/C Anode Promise Better Rate Property for Lithium Battery.

Much effort has been made to search for high energy and high power density electrode materials for lithium ion batteries. Here, a composite structure among Ge, C and Cu3Ge in Cu3Ge/Ge/C materials with a high rate performance of lithium batteries has been reported. Such Cu3Ge/Ge/C composite is synthesized through the in-situ formation of Ge, C and Cu3Ge by one-pot reaction. Density function theory (DFT) calculations and electrochemical impedance spectroscopy (EIS) suggest a higher electron mobility of the hibrid Cu3Ge/Ge/C composites through the in-situ preparation. As a result, remarkable charge rate over 300 C (fast delithiated capability) and outstanding cycling stability (≈0.02% capacity decay per cycle for 500 cycles at 0.5 C) are achieved for the Cu3Ge/Ge/C composites anode. These Cu3Ge/Ge/C composites demonstrate another perspective to explore the energy storage materials and should provide a new pathway for the design of advanced electrode materials.

Research on the Relationships between Endogenous Biomarkers and Exogenous Toxic Substances of Acute Toxicity in Radix Aconiti.

Radix Aconiti, a classic traditional Chinese medicine (TCM), has been widely used throughout China for disease treatment due to its various pharmacological activities, such as anti-inflammatory, cardiotonic, and analgesic effects. However, improper use of Radix Aconiti often generated severe acute toxicity. Currently, research on the toxic substances of Radix Aconiti is not rare. In our previous study, acute toxic biomarkers of Radix Aconiti have been found. However, few studies were available to find the relationships between these endogenous biomarkers and exogenous toxic substances. Therefore, in this study, toxic substances of Radix Aconiti have been found using UPLC-Q-TOF-MS technology. Then, we used biochemical indicators as a bridge to find the relationships between biomarkers and toxic substances of Radix Aconiti through Pearson correlation analysis and canonical correlation analysis (CCA). Finally, the CCA results showed that LysoPC(22:5) is related to 14-acetyl-talatisamine, mesaconitine, talatisamine and deoxyaconitine in varying degrees; l-acetylcarnitine is negatively correlated with deoxyaconitine and demethyl-14-acetylkaracoline; shikimic acid has a good correlation with karacoline, demethyl-14-acetylkaracoline and deoxyaconitine; and valine is correlated with talatisamine and deoxyaconitine. Research on these relationships provides an innovative way to interpret the toxic mechanism of traditional Chinese medicine, and plays a positive role in the overall study of TCM toxicity.

Screening, verification, and optimization of biomarkers for early prediction of cardiotoxicity based on metabolomics.

Drug-induced cardiotoxicity seriously affects human health and drug development. However, many conventional detection indicators of cardiotoxicity exhibit significant changes only after the occurrence of severe heart injuries. Therefore, we investigated more sensitive and reliable indicators for the evaluation and prediction of cardiotoxicity. We created rat cardiotoxicity models in which the toxicity was caused by doxorubicin (20 mg/kg), isoproterenol (5 mg/kg), and 5-fluorouracil (125 mg/kg). We collected data from rat plasma samples based on metabolomics using ultra-performance liquid chromatography quadrupole time-of-flight mass spectrometry. Following multivariate statistical and integration analyses, we selected 39 biomarker ions of cardiotoxicity that predict cardiotoxicity earlier than biochemical analysis and histopathological assessment. Because drugs with different toxicities may cause similar metabolic changes compared with other noncardiotoxic models (hepatotoxic and nephrotoxic models), we obtained 10 highly specific biomarkers of cardiotoxicity. We subsequently used a support vector machine (SVM) to develop a predictive model to verify and optimize the exclusive biomarkers. l-Carnitine, 19-hydroxydeoxycorticosterone, LPC (14:0), and LPC (20:2) exhibited the strongest specificities. The prediction rate of the SVM model is as high as 90.0%. This research provides a better understanding of drug-induced cardiotoxicity in drug safety evaluations and secondary development and demonstrates novel ideas for verification and optimization of biomarkers via metabolomics.

A GC-MS Based Metabonomics Study of Rheumatoid Arthritis and the Interventional Effects of the Simiaowan in Rats.

Simiaowan (SMW) is a famous Chinese prescription widely used in clinical treatment of rheumatoid arthritis (RA). The aim of the present study is to determine novel biomarkers to increase the current understanding of RA mechanisms, as well as the underlying therapeutic mechanism of SMW, in RA-model rats. Plasma extracts from control, RA model, and SMW-treated rats were analyzed by gas chromatography coupled with mass spectrometry (GC-MS). An orthogonal partial least-square discriminant analysis (OPLS-DA) model was created to detect metabolites that were expressed in significantly different amounts between the RA model and the control rats and investigate the therapeutic effect of SMW. Metabonomics may prove to be a valuable tool for determining the efficacy of complex traditional prescriptions.

MUC5B promoter polymorphisms and risk of coal workers' pneumoconiosis in a Chinese population.

Coal workers' pneumoconiosis (CWP) is characterized by fibrosing nodular lesions that eventually develop into progressive pulmonary fibrosis. Genetic variations have been recognized to be involved in the multi-factorial susceptibility to CWP, and MUC5B is a candidate lung fibrosis susceptibility gene. In the present study, we investigated possible genetic associations between three single nucleotide polymorphisms in MUC5B promoter region and CWP in a case-control study including 686 CWP patients and 680 controls. Genotyping was carried out by TaqMan method. Only rs2672794 allele and genotype frequencies distributions were significantly different between CWP patients and controls (P = 0.017 and 0.046 for allele and genotype, respectively). The MUC5B rs2672794 CC genotype was associated with a significantly increased risk of CWP, compared with the TT genotype. Moreover, individuals with TC/CC genotype had an obviously increased risk of CWP than those with TT genotype, particularly among subgroups of dust exposure <27 years and smokers. This is the first report showing an association between the MUC5B rs2672794 polymorphism and CWP, and our results suggest that MUC5B rs2672794 CC genotype could increase the risk of CWP. Further studies are warranted to confirm our findings.

Reversible Deposition/Dissolution of Double Hydroxides to Modulate Electrolyte pH Enabling High-Performance Aqueous Zinc-Ion Batteries.

Vanadium oxide has been extensively studied as a host of zinc ion intercalation but still suffers from low conductivity, dissolution, and byproduct accumulation during cycling. Here, we hydrothermally synthesize the VO2@MXene Ti3C2 (MV) composite and find that in the MV//3 M Zn(CF3SO3)2//Zn system, the double hydroxide Zn12(CF3SO3)9(OH)15·nH2O (ZCOH) uniformly covers VO2 during the charging process and dissolves reversibly during the discharge process. In situ X-ray diffraction of the MV combined with in situ pH measurements reveals that ZCOH acts as a pH buffer during cycling, which is beneficial to the cycling stability of batteries. And the theoretical calculation indicates that the decomposition energy required by ZCOH on the MV surface is lower than that on pure VO2, which is more conducive to ZCOH dissolution. The coin battery exhibits high-rate performance of 65.1% capacity retention at a current density of 15 A g-1 (compared to 0.6 A g-1) and a long cycling life of 20,000 cycles with a capacity retention of 80.7%. For a 22.4 mA h soft-packaged battery, its capacity remains at 72.1% after 2000 cycles. This work demonstrates the active role of ZCOH in the electrochemical process of VO2 and provides a new perspective for exploiting this mechanism to develop high-performance aqueous zinc-ion battery vanadium oxide cathode materials.

Ion-Anchored Strategy for MnO2/Mn2+ Chemistry without "Dead Mn" and Corrosion.

The utilization of MnO2/Mn2+ chemistry in near-neutral pH acetate aqueous electrolytes provides an opportunity to achieve a higher energy density (theoretical capacity 616 mA h/g, discharge platform >1.5 V). However, this Zn-MnO2 aqueous battery suffers from inevitable "dead Mn" and proton corrosion. In this study, we discover that the diffusion of the cathode reaction intermediate Mn3+ is intrinsic for the generation of "dead Mn", and the accumulation of "dead Mn" increases the H+ which shuttles to the anode, inducing serious corrosion. A pH-neutral hydrogel ion-anchored strategy is proposed here not only to restrict the diffusion of Mn3+ but also to suppress the proton transference. This hydrogel ion anchor is designed by deprotonating a series of monomers undergoing in situ free radical polymerization at the cathode interface. The anionic monomer with a moderate binding energy to manganese ions is screened to anchor Mn3+, which enhances the reversibility of the MnO2/Mn2+ reaction. Simultaneously, a substantial amount of anionic groups and hydrophilic functional groups in the hydrogel effectively constrains the proton shuttle to corrode the anode. Consequently, the Zn/MnO2 battery achieves exceptional cyclic stability of the MnO2/Mn2+ reaction, sustaining 8500 cycles even at a relatively low current density and discharge current density of 1 mA/cm2. Our findings highlight the importance of anchoring Mn3+ at the cathode interface and offer valuable insights for advancing practical applications of MnO2/Mn2+ reactions.

Injectable citrate-based polyurethane-urea as a tug-of-war-inspired bioactive self-expansive and planar-fixing screw augmented bone-tendon healing.

Inspired by tug-of-war, a game-changing bone-tendon fixation paradigm was developed. Specifically, injectable citrate-based bioactive self-expansive and planar-fixing screw (iCSP-Scr) consisting of reactive isocyanate (NCO) terminalized citrate-based polyurethane, proanthocyanidin modified hydroxyapatite (HAp) and water (with/without porogen) was developed and administrated in the bone-tendon gap. Instead of the "point to point" tendon fixation by traditional interface screws, along with the moisture-induced crosslinking and expansion of iCSP-Scr within the confined space of the irregularly shaped bone-tendon gap, the tendon graft was evenly squeezed into the bone tunnel in a "surface to surface" manner to realize strong and stable bone-tendon fixation via physical expansion, mechanical interlocking and chemical bonding (between -NCO and the -NH2, -SH groups on bone matrix). The optimized iCSP-Scr exhibited rapid crosslinking, moderate expansion rate, high porosity after crosslinking, as well as tunable elasticity and toughness. The iCSP-Scr possessed favorable biodegradability, biocompatibility, and osteoinductivity derived from citrate, PC and HAp, it was able to promote osteogenesis and new bone growth inward of bone tunnel thus further enhanced the bone/iCSP-Scr mechanical interlock, ultimately leading to stronger tendon fixation (pull-out force 106.15 ± 23.15 N) comparing to titanium screws (93.76 ± 17.89 N) after 14 weeks' ACL reconstruction in a rabbit model. The iCSP-Scr not only can be used as a self-expansive screw facilitating bone-tendon healing, but also can be expanded into other osteogenic application scenarios.