Enhanced Recovery after Surgery in patients undergoing total joint arthroplasty: A retrospective study.

Objective: Enhanced Recovery after Surgery (ERAS) protocol has been developed and practiced for various surgical procedures to improve outcomes in the postoperative period. We hereby present our experience of ERAS for a large cohort of patients undergoing total joint arthroplasty (TJA). Methods: We implemented the ERAS program at The Third Affiliated Hospital of Shanghai University from January 2020 and retrospectively compared outcomes of patients undergoing total knee or hip arthroplasty before and after the implementation of the program. ERAS protocol consisted of the use of patient education, blood management, multimodal analgesia, antiemetics, shorter fasting time, no patient-controlled analgesia, early physical therapy, and reduced use of catheters and drains. Results: There were 94 patients in the study group (ERAS) and 113 patients in the control group (non-ERAS). We noted a statistically significant reduction in the incidence of postoperative nausea/vomiting, lowered pain scores, reduced length of hospital stay and better functional outcomes with both total knee and hip arthroplasties in our study cohort. Conclusion: ERAS protocol can bae effectively implemented for patients undergoing TJA. The use of ERAS leads to better postoperative outcomes and shortened hospital stay.

Highly Sensitive and Reliable Internal-Standard Surface-Enhanced Raman Scattering Microneedles for Determination of Bacterial Metabolites as Infection Biomarkers in Skin Interstitial Fluid.

Microneedles (MNs) are currently one of the most promising tools for skin interstitial fluid (ISF)-based biosensing, while it is still a challenge to expand the detectable biomarkers in ISF due to limited MNs types and detection techniques. Herein, highly sensitive internal-standard surface-enhanced Raman scattering microneedles (IS-SERS-MNs) were developed, which enabled the reliable detection of bacterial metabolites in ISF as new detectable biomarkers for infection diagnosis. The developed IS-SERS-MNs can not only directly detect pyocyanin (a representative bacterial metabolite) present in mouse dermal ISF but also indirectly detect pyocyanin in the hypodermis via its diffusion into the dermis, revealing a new possible pathway for the source of biomarkers in dermal ISF. Moreover, the SERS signal of pyocyanin was also clearly detected at real mouse wounds, indicating that the developed IS-SERS-MNs have great potential in minimally invasive and painless diagnosis of bacterial infection via a new ISF route. This work not only develops IS-SERS-MNs as a powerful tool for expanding the application of SERS-based MNs but also provides a new chance for ISF-related infection diagnosis.

Near-Infrared Light-Responsive SERS Tags Enable Positioning and Monitoring of the Drug Release of Photothermal Nanomedicines In Vivo.

Understanding the in vivo behavior of photothermal nanomedicines (PTNMs) is important for drug development and evaluation. However, it is still very challenging. Herein, two key parameters, i.e., the depth of PTNMs under biological tissue and the drug release ratio of PTNMs in vivo, can be revealed by a near-infrared (NIR) light-responsive surface-enhanced Raman scattering (SERS) strategy. The fabricated PTNMs were composed of waxberry-like gold nanoparticles, model drug curcumin, and an elaborately selected NIR light-responsive Raman reporter (3,3'-diethylthiatricarbocyanine iodide, DTTC). The response mechanism of DTTC to NIR light was investigated as photodegradation. NIR light irradiation heated the gold nanoparticles, triggered the release of a model drug, and simultaneously decreased the SERS intensity of the PTNMs. In vitro experiment results revealed that the SERS intensity decrease could well reflect the depth of PTNMs with a correlation coefficient of more than 0.99. On this basis, after in situ SERS detection, the depth of PTNMs in a tumor could be revealed with satisfactory accuracy. Moreover, the decrease in the SERS intensity of PTNMs showed a highly similar trend to the increase in the drug release, suggesting that it could be used for real-time monitoring of drug release of PTNMs. This study not only opens a new avenue for the release study of many inactive fluorescent and Raman drugs of PTNMs but also provides an effective way for reporting the depth, which greatly promotes the application of PTNMs in vivo.

Silica-Coated, Waxberry-like Surface-Enhanced Raman Resonant Scattering Tag-Pair with Near-Infrared Raman Dye Encoding: Toward In Vivo Duplexing Detection.

Surface-enhanced Raman resonant scattering (SERRS) tags encoded with near-infrared (NIR) Raman reporters showed great potential for in vivo detection owing to their ultrasensitivity. However, in vivo signal stability of such tags is a remaining problem due to the lack of suitable silica coating method because the weakly adsorbed NIR reporters tend to detach from traditional gold nanosubstrates in the ethanol-rich and high pH conditions, which are commonly used for silica coating. Herein, we propose a silica coating method for NIR SERRS tags by using waxberry-like gold nanoparticles (NPs) as substrates. The lipid bilayer of the NPs played a crucial role in the coating, which can encapsulate the NIR Raman reporter via hydrophobic interactions and prevent the interference from a harsh medium. Thus, the silica-coated tags well preserved ultrasensitivity of bare tags and simultaneously gained satisfactory signal stability in vivo. Moreover, the coating method is compatible for the encapsulation of a variety of thiol group-free NIR reporters (as exemplified by DTTC, Cy7, IR792, and DIR), relying on which a tag-pair with distinguishable peaks can be screened (labeling with DTTC and Cy7, respectively). In vivo duplexing detection revealed that the tag-pair-labeled liposome was cleared faster in the liver than polydopamine NPs within one mouse. The developed method paves an easy way for gaining high-quality SERRS tags and will promote their in vivo multiplex analysis and diagnostics applications.

Knocking-down long non-coding RNA LINC01094 prohibits chondrocyte apoptosis via regulating microRNA-577/metal-regulatory transcription factor 1 axis.

PURPOSE: The abnormal function and survival of chondrocytes result in articular cartilage failure, which may accelerate the onset and development of osteoarthritis (OA). This study is aimed to investigate the role of LINC01094 in chondrocyte apoptosis. METHODS: The viability and apoptosis of lipopolysaccharide (LPS)-induced chondrocytes were evaluated through CCK-8 assay and flow cytometry analysis, respectively. The expression levels of LINC01094, miR-577 and MTF1 were detected by qRT-PCR. Dual luciferase reporter tests were implemented for the verification of targeted relationships among them. Western blotting was employed to measure the levels of pro-apoptotic proteins (Caspase3 and Caspase9). RESULTS: The viability of LPS-induced chondrocytes was overtly promoted by loss of LINC01094 or miR-577 upregulation, but could be repressed via MTF1 overexpression. The opposite results were observed in apoptosis rate and the levels of Caspase3 and Caspase9. LINC01094 directly bound to miR-577, while MTF1 was verified to be modulated by miR-577. Both LINC01094 and MTF1 were at high levels, whereas miR-577 was at low level in OA synovial fluid and LPS-induced chondrocytes. Furthermore, the highly expressed miR-577 abolished the influences of MTF1 overexpression on LPS-induced chondrocytes. CONCLUSIONS: Silencing of LINC01094 represses the apoptosis of chondrocytes through upregulating miR-577 expression and downregulating MTF1 levels, providing a preliminary insight for the treatment of OA in the future.

Hydrogel-Coated SERS Microneedles for Drug Monitoring in Dermal Interstitial Fluid.

In vivo drug monitoring is crucial for evaluating the effectiveness and safety of drug treatment. Blood sampling and analysis is the current gold standard but needs professional skills and cannot meet the requirements of point-of-care testing. Dermal interstitial fluid (ISF) showed great potential to replace blood for in vivo drug monitoring; however, the detection was challenging, and the drug distribution behavior in ISF was still unclear until now. In this study, we proposed surface-enhanced Raman spectroscopy (SERS) microneedles (MNs) for the painless and real-time analysis of drugs in ISF after intravenous injection. Using methylene blue (MB) and mitoxantrone (MTO) as model drugs, the innovative core-satellite structured Au@Ag SERS substrate, hydrogel coating over the MNs, rendered sensitive and quantitative drug detection in ISF of mice within 10 min. Based on this technique, the pharmacokinetics of the two drugs in ISF was investigated and compared with those in blood, where the drugs were analyzed via liquid chromatography-mass spectrometry. It was found that the MB concentration in ISF and blood was comparable, whereas the concentration of MTO in ISF was 2-3 orders of magnitude lower than in blood. This work proposed an efficient tool for ISF drug monitoring. More importantly, it experimentally proved that the penetration ratio of blood to ISF was drug-dependent, providing insightful information into the potential of ISF as a blood alternative for in vivo drug detection.

Inflammatory bowel disease alters in vivo distribution of orally administrated nanoparticles: Revealing via SERS tag labeling technique.

Nanoparticles (NPs) could be uptake orally and exposed to digestive tract through various sources such as particulate pollutant, nanomedicine and food additive. Inflammatory bowel disease (IBD), as a global disease, induced disruption of the intestinal mucosal barrier and thus altered in vivo distribution of NPs as a possible consequence. However, related information was relatively scarce. Herein, in vivo distribution of typical silica (SiO2) and titania (TiO2) NPs was investigated in healthy and IBD models at cell and animal levels via a surface-enhanced Raman scattering (SERS) tag labeling technique. The labeled NPs were composed of gold SERS tag core and SiO2 (or TiO2) shell, demonstrating sensitive and characteristic SERS signals ideal to trace the NPs in vivo. Cell SERS mapping revealed that protein corona from IBD intestinal fluid decreased uptake of NPs by lipopolysaccharide-induced RAW264.7 cells compared with normal intestinal fluid protein corona. SERS signal detection combined with inductively coupled plasma mass spectrometry (ICP-MS) analysis of mouse tissues (heart, liver, spleen, lung and kidney) indicated that both NPs tended to accumulate in lung specifically after oral administration for IBD mouse (6 out of 20 mice for SiO2 and 4 out of 16 mice for TiO2 were detected in lung). Comparatively, no NP signals were detected in all tissues from healthy mice. These findings suggested that there might be a greater risk associated with the oral uptake of NPs in IBD patients due to altered in vivo distribution of NPs.

Revealing drug release and diffusion behavior in skin interstitial fluid by surface-enhanced Raman scattering microneedles.

Microneedle (MNs), as a novel dermal drug delivery formulation, have drawn a lot of attention in recent years. Drug release and diffusion behavior in dermal interstitial fluid (ISF) determines the pharmacokinetics and effectiveness of MNs, which have not been clearly elucidated until now. Herein, we develop surface-enhanced Raman scattering (SERS)-based detection MNs (D-MNs) for the sensitive analysis of model drugs in ISF. The surface of the D-MNs was deposited with a high density of hotspot-rich core-satellite gold nanoparticles, which would generate a sensitive SERS signal of a model drug (3,3'-diethylthiatricarbocyanine, DTTC) released by therapeutic MNs (T-MNs). Furthermore, the D-MNs produced an internal-standard signal for drug signal calibration, increasing the accuracy of detection. Taking advantage of the D-MNs, the release and diffusion behavior of the drug from T-MNs in the ISF of living mice was systematically studied. It was found that DTTC diffused without directional preference in ISF up to a distance of 1.5 cm. The intensities at diffusion sites decreased sharply with increasing distance from the release site (less than 0.3% at 1.5 cm). These results indicated that drug concentration gradient rather than ISF fluidity was a major driving force for the diffusion. Moreover, the application of water-soluble MN polymers, hydrophilic model drugs in T-MNs, as well as a heating or cupping treatment of mouse skin, enhanced drug diffusion in ISF. This work provides a new tool for in situ and real-time detection of molecules in ISF, which would be beneficial for the development and evaluation of MN-based therapeutic systems.

Downregulation of lncRNA NEAT1 interacts with miR-374b-5p/PGAP1 axis to aggravate the development of osteoarthritis.

BACKGROUND: Osteoarthritis (OA), characterized by inflammation and articular cartilage degradation, is a prevalent arthritis among geriatric population. This paper was to scrutinize the novel mechanism of long noncoding RNA (lncRNA) NEAT1 in OA etiology. METHODS: A total of 10 OA patients and 10 normal individuals was included in this study. Cell model of OA was built in human normal chondrocytes induced by lipopolysaccharide (LPS). An OA Wistar rat model was established through intra-articular injection of L-cysteine and papain mixtures (proportion at 1:2) into the right knee. Quantitative reverse transcription-polymerase chain reaction was employed to ascertain the expression levels of NEAT1, microRNA (miR)-374b-5p and post-GPI attachment to protein 1 (PGAP1), while dual-luciferase reporter experiments were used for the validation of target relationship among them. Cell cycle and apoptosis were calculated by flow cytometry analysis. CCK-8 assay was done to evaluate the proliferative potentials of chondrocytes. The levels of cell cycle-related proteins (Cyclin A1, Cyclin B1 and Cyclin D2) and pro-apoptotic proteins (Caspase3 and Caspase9) were measured by western blotting. Tumor necrosis factor-alpha (TNF-α), interleukin-1beta (IL-1ß) and IL-6 levels were determined via ELISA. Hematoxylin & eosin (HE) Staining was used for pathological examination in OA rats. RESULTS: Pronounced downregulation of NEAT1 and PGAP1 and high amounts of miR-374b-5p were identified in OA patients, LPS-induced chondrocytes and OA rats. NEAT1 targeted miR-374b-5p to control PGAP1 expression. Loss of NEAT1 or upregulation of miR-374b-5p dramatically accelerated apoptosis, led to the G1/S arrest and promoted the secretion of inflammatory cytokines in LPS-induced chondrocytes, while ectopic expression of PGAP1 exhibited the opposite influences on chondrocytes. Additionally, we further indicated that upregulation of miR-374b-5p attenuated the effects of PGAP1 overexpression on LPS-induced chondrocytes. CONCLUSIONS: Reduced NEAT1 induces the development of OA via miR-374b-5p/PGAP1 pathway. This suggests that the regulatory axis NEAT1/miR-374b-5p/PGAP1 is a novel and prospective target for OA treatment.

Skin Interstitial Fluid-Based SERS Tags Labeled Microneedles for Tracking of Peritonitis Progression and Treatment Effect.

Skin interstitial fluid (ISF)-based microneedle (MN) sensing has recently exhibited wide promise for the minimally invasive and painless diagnosis of diseases. However, it is still a great challenge to diagnose more disease types due to the limited in situ sensing techniques and insufficient ISF biomarker sources. Herein, ISF is employed to pioneer the tracking of acute peritonitis progression via surface-enhanced Raman scattering (SERS) tags labeled MNs patch technique. Densely deposited core-satellite gold nanoparticles and 3-mercaptophenylboronic acid as a Raman reporter enable the developed MNs patch with high sensitivity and selectivity in the determination of H2O2, an indicator of peritonitis development. Importantly, the MNs patch not only reliably tracks the different states of peritonitis but also evaluates the efficacy of drugs in the treatment of peritonitis, as evidenced by the altered SERS signal consistent with plasma pro-inflammatory factor (TNF-α) and peritoneum pathological manifestations. Interestingly, the major source of H2O2 in ISF of acute peritonitis investigated may not be through conventional blood capillary filtration pathway. This work provides a new route and technique for the early diagnosis of acute peritonitis and the evaluation of drug therapy effects. The developed MNs patch is promising to serve as a universal sensing tool to greatly enrich the variety and prospect of ISF-based disease diagnosis.

Polystyrene nanoplastics demonstrate high structural stability in vivo: A comparative study with silica nanoparticles via SERS tag labeling.

Nanoplastics are regarded as inert particulate pollutants pose potential threat to organisms. It has been verified that they can penetrate biological barriers and accumulate in organisms; however, there is still a knowledge gap on the in vivo stability and degradation behaviors due to the lack of ideal analytical methods. Herein, a surface-enhanced Raman scattering (SERS) tag labeling technique was developed to study the in vivo behaviors of polystyrene (PS) nanoplastics by comparison with silica (SiO2) nanoparticles (NPs). The labeled NPs were composed of gold NP core, attached Raman reporters as well as PS and silica shell, respectively, demonstrating strong SERS signals which were responsive to the compactness of the shells. The labeled NPs enabled the probing of in vivo structural stability of PS and silica in the liver, spleen and lung of mice after intravenous injection via the time-dependent evolution of SERS signal intensity and gold element content in the organs. The results indicated that both PS and silica model NPs retained in these organs without apparent excretion within 28 d. However, the structural stabilities of PS and silica differed dramatically as reflected by the SERS signal and tissue slice characterization. The silica shell completely degraded whereas the PS shell was still compact. Our results verified the long-term accumulation and in vivo inert property of nanoplastics, hinting that they were distinct from natural NPs and probably induce higher health risks from the aspect of the non-degradation property.

Tracking of realistic nanoplastics in complicated matrices by iridium element labeling and inductively coupled plasma mass spectroscopy.

Herein, we proposed a protocol to track realistic nanoplastics (NPs) by labeling them with an iridium-containing organic molecular agent (denoted as Ir) followed by inductively coupled plasma mass spectroscopy detection, as exemplified by polyethylene terephthalate (PET) NPs prepared from water bottles. The Ir showed satisfactory labeling stability in typical environmental and biological matrices. After 3d's incubation, the leaching ratios were less than 3% in water, phosphate buffered saline, sea water, cell culture medium, artificial gastric juice, artificial intestinal fluid, sediment resuspension, and around 5% in fetal bovine serum. On this basis, in vivo distribution of PET NPs in mice was analyzed. The intravenously injected NPs widely distributed in liver, spleen, lung and kidney. Comparatively, NPs could hardly be detected in these organs after intragastric administration, suggesting that they could not penetrate the intestinal barriers. The temporal and spatial distribution of the NPs in an intertidal zone sediment resuspension model was also investigated. The NPs mostly deposited at the overlying deposit, implying the absorption-driven sinking behavior of NPs with natural organic matters. This work provided an effective way to quantitatively track realistic NPs, which could promote the understanding of the fate and effect of NPs in natural environments and organisms.

Quantitative assessment of in vivo distribution of nanoplastics in bivalve Ruditapes philippinarum using reliable SERS tag-labeled nanoplastic models.

Nanoplastics (NPs) as emerging marine pollutants can be taken up by seafood organisms. It is crucial to quantitatively assess NP's distribution behavior in organisms to elucidate concentration dependent biological effects. Such a knowledge gap has remained due to the lack of reliable NP models and analytical methods. Herein, surface enhanced Raman scattering (SERS)-labeled NP models were developed and their bioavailability, distribution and accumulation in Ruditapes philippinarum, a typical marine bivalve, were quantitatively studied. Taking advantage of the sensitive and characteristic SERS signals of the NP models, distribution could be quickly and accurately obtained by the Raman imaging technique. Moreover, quantitative analysis of NPs could be performed by the detection of gold element contents via inductively coupled plasma mass spectroscopy (ICP-MS) detection. ICP-MS results revealed that after 3 days exposure of monodispersed NPs (100 nm, 0.2 mg L-1), the digestive gland accumulated 86.7% of whole-body NPs followed by gill (5.2%), mantle (5.1%), foot (1.3%), exhalant siphon (1.1%), and adductor (0.6%). Upon 11 days depuration, 98.7% of NPs in the digestive gland were excreted, whereas the clearance ratios in other organs were much lower. NP aggregates (around 1.5 µm) demonstrated similar distribution and clearance trends to the monodispersed ones. However, the accumulation amount in each organ was 15.2% to 77.6% lower. Surface adherence and passive ingestion routes resulted in NP accumulation, which contributed to the comparable NP abundance in these organs. Additionally, boiling treatment (mimicking a cooking process) did not decrease the NP amount in these organs. This work provided a dual-mode and quantitative analysis protocol for NPs for the first time, and suggested the risk of NP uptake by humans via bivalve seafood diets.

Surface-enhanced Raman scattering labeled nanoplastic models for reliable bio-nano interaction investigations.

Nanoplastics (NPs) have attracted great attention as an emerging pollution. To date, their interaction with biological systems has been studied mostly by using fluorescent-labeled NPs, which suffered from serious drawbacks such as biological autofluorescence interference and false-positive results. Reliable optically labeled NP models are eagerly desired until now. Herein, a novel near-infrared (NIR) surface-enhanced Raman scattering (SERS) labeled NP model was proposed, which gained single-particle ultra-sensitivity, deep tissue detection, multiplex labeling ability, and anti-interference property. More importantly, the NP demonstrated satisfactory in vivo signal stability which completely prevented the positive-false problems. The advantages of the NPs enabled direct, dynamic in vivo behavior imaging study in living zebrafish embryo, adult zebrafish and green vegetable Brassica rapa. It was found for the first time that NPs entered blood circulation system of zebrafish larva via dermal uptake route, which only occurred in a short 48 h-window post-hatch. NPs widely distributed in roots, shoots and leaves of Brassica rapa seedlings germinating and growing in the NP-containing hydroponic culture. Different depths of one root showed varied adsorption capabilities towards NPs with fulvic acid, lipid and sodium dodecyl sulfate eco-coronas. This work provided an ideal tool for reliable bio-NP interaction study for a variety of organisms, which could promote the research of NPs.

The combined toxic effects of polyvinyl chloride microplastics and di(2-ethylhexyl) phthalate on the juvenile zebrafish (Danio rerio).

Microplastics (MPs) have the characteristics of large specific surface area, high hydrophobicity and surface charge, so they are easy to combine with other pollutants and cause toxic effects on aquatic organisms. Here, we prepared a polyvinyl chloride-microplastics (PVC-MPs) fragmentation model to simulate the real microplastic state, and characterized its composition, morphology, particle size and zeta potential. On this basis, we used single and compound exposure of PVC and di(2-ethylhexyl) phthalate (DEHP) to explore their effects on hatchability and mortality of zebrafish (Danio rerio) embryos and toxicity to oxidative stress and cardiac development in zebrafish larvae. Herein, PVC-MPs slowed down the hatching rate of zebrafish embryos and induced the death of zebrafish, while DEHP could slow down the induced of death, it had no effect on hatching rate. The PVC-MPs/DEHP single pollution could induce the reactive oxygen species (ROS) and activated the antioxidant defense signaling pathway, while the compound group showed the level of feedback autoregulation of NF-E2-related factor 2 (Nrf2) signaling pathway. The single pollution also could inhibit the expression of genes related to cardiac development, while the combined pollution showed an antagonistic effect. This study provided a theoretical basis for the ecotoxicology and biomonitoring of MPs in the natural state.

[Relationship between transforming growth factor beta-1 gene-509C/T polymorphism and severe chronic periodontitis].

OBJECTIVE: To investigate the relationship between transforming growth factor beta-1 (TGF-ß(1)) gene-509C/T polymorphism and severe chronic periodontitis in Chinese Hans population. METHODS: TGF-ß(1)-509C/T genotype polymorphism was analyzed in 102 patients with severe chronic periodontitis (periodontitis group) and 102 healthy controls (control group) by polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP) method. RESULTS: The distributions of TGF-ß(1)-509C/T genotype and allele were significantly different between severe chronic periodontitis group and control group (P < 0.05). TGF-ß(1)-509CC, CT and TT genotype frequency were 44.1% (45/102), 47.1% (48/102), 8.8% (9/102) in periodontitis group and 29.4% (30/102), 51.0% (52/102), 19.6% (20/102) in control group, respectively. The relative risk analysis found that C allele carriers had higher risk of suffering from severe chronic periodontitis compared with T allele carriers (OR = 1.718, 95%CI: 1.148-2.569). CONCLUSIONS: TGF-ß(1)-509C/T polymorphism is associated with severe chronic periodontitis in Chinese Hans population, and C allele may be an important genetic susceptibility gene for severe chronic periodontitis.