Mechanical activation opens a lipid-lined pore in OSCA ion channels.

OSCA/TMEM63 channels are the largest known family of mechanosensitive channels1-3, playing critical roles in plant4-7 and mammalian8,9 mechanotransduction. Here we determined 44 cryogenic electron microscopy structures of OSCA/TMEM63 channels in different environments to investigate the molecular basis of OSCA/TMEM63 channel mechanosensitivity. In nanodiscs, we mimicked increased membrane tension and observed a dilated pore with membrane access in one of the OSCA1.2 subunits. In liposomes, we captured the fully open structure of OSCA1.2 in the inside-in orientation, in which the pore shows a large lateral opening to the membrane. Unusually for ion channels, structural, functional and computational evidence supports the existence of a 'proteo-lipidic pore' in which lipids act as a wall of the ion permeation pathway. In the less tension-sensitive homologue OSCA3.1, we identified an 'interlocking' lipid tightly bound in the central cleft, keeping the channel closed. Mutation of the lipid-coordinating residues induced OSCA3.1 activation, revealing a conserved open conformation of OSCA channels. Our structures provide a global picture of the OSCA channel gating cycle, uncover the importance of bound lipids and show that each subunit can open independently. This expands both our understanding of channel-mediated mechanotransduction and channel pore formation, with important mechanistic implications for the TMEM16 and TMC protein families.

Site-specific crosslinking and assembly of tetrameric ß-glucuronidase improve glycyrrhizin hydrolysis.

In this study, eight nonconserved residues with exposed surfaces and flexible conformations of the homotetrameric PGUS (ß-glucuronidase from Aspergillus oryzae Li-3) were identified. Single-point mutation into cysteine enabled the thiol-maleimide reaction and site-specific protein assembly using a two-arm polyethylene glycol (PEG)-maleimide crosslinker (Mal2 ). The Mal2 (1k) (with 1 kDa PEG spacer)-crosslinked PGUS assemblies showed low crosslinking efficiency and unimproved thermostability except for G194C-Mal2 (1k). To improve the crosslinking efficiency, a lengthened crosslinker Mal2 (2k) (with 2 kDa PEG spacer) was used to produce PGUS assembly and a highly improved thermostability was achieved with a half-life of 47.2-169.2 min at 70°C, which is 1.04-3.74 times that of wild type PGUS. It is found that the thermostability of PGUS assembly was closely associated with the formation of inter-tetramer assembly and intratetramer crosslinking, rather than the PEGylation of the enzyme. Therefore, the four-arm PEG-maleimide crosslinker Mal4 (2k) (with 2 kDa PEG spacer) was employed to simultaneously increase the inter-tetramer assembly and intratetramer crosslinking, and the resulting PGUS assemblies showed further improved thermostabilities compared with Mal2 (2k)-crosslinked assemblies. Finally, the application of PGUS assemblies with significantly improved thermostability to the bioconversion of GL proved that the PGUS assembly is a strong catalyst for glycyrrhizin (GL) hydrolysis in industrial applications.

Monitoring the Opening of Rapid Palatal Expansion (RPE) in a 3D-Printed Skull Model Using Fiber Optic F-P Sensors.

We present a novel method for the online measurement of multi-point opening distances of midpalatal sutures during a rapid palatal expansion (RPE) using fiber optic Fabry-Perot (F-P) sensors. The sensor consists of an optical fiber with a cut flat end face and an optical reflector, which are implanted into the palatal base structure of an expander and is capable of measuring the precise distance between two optical reflective surfaces. As a demonstration, a 3D-printed skull model containing the maxilla and zygomaticomaxillary complex (ZMC) was produced and a miniscrew-assisted rapid palatal expander (MARPE) with two guide rods was used to generate the midpalatal suture expansion. The reflected spectrums of the sensors were used to dynamically extract cavity length information for full process monitoring of expansion. The dynamic opening of the midpalatal suture during the gradual activation of the expander was measured, and a displacement resolution of 2.5 µm was demonstrated. The angle of expansion was derived and the results suggested that the midpalatal suture was opened with a slight V-type expansion of 0.03 rad at the first loading and subsequently expanded in parallel. This finding might be useful for understanding the mechanical mechanisms that lead to different types of expansion. The use of a fiber optic sensor for mounting the rapid palatal expander facilitates biomechanical studies and experimental and clinical evaluation of the effects of RPE.

Derivation of the toxicological threshold of silicon element in the extractables and leachables from the pharmaceutical packaging and process components.

Silicon is one of the most monitored elements in extractables and leachables studies of pharmaceutical packaging systems and related components. There is a need to review and evaluate toxicological thresholds of silicon because of its direct contact with drug products (DP) especially a liquid form of DP with the widely used pharmaceutical packaging systems made of silicon materials like glass and silicone. It is required by regulatory authorities to test silicon content in DP; however, there are no official guidelines on the toxicology of silicon that are currently available, yet the knowledge of toxicological thresholds of silicon is critical to justify the analytical limit of quantification (LOQ). Therefore, we reviewed the toxicity of silicon to derive a toxicological threshold by literature review of toxicity studies of both inorganic and organic silicon compounds. Oral toxicity is low for inorganic silicon like silicon dioxide or organic silicon polymers such as silicone tube/silicone oil (polydimethylsiloxane, or namely, PDMS as the major ingredient). In comparison, inhalational toxicity of silicon dioxide leads to pulmonary silicosis or even lung cancer. When orally administered, the toxicity of silicon dioxide, glass, polymers, or PDMS oligomers varies depending on their morphology, molecular weight (MW), and degrees of polymerization. PDMS with high MW has minimal toxic symptoms with non-detectable degradation/elimination by both intraperitoneal and subcutaneous administration routes, while exposure to either PDMS or small molecule dimethyl silicone compounds by the intravenous administration route may lead to death. We here determined a general parenteral permitted daily exposure (PDE) of 93 µg/day for inorganic silicon element and 100 µg/day for organic silicon element by reviewing toxicological data of both forms of silicon. In conclusion, this work provides evidence for pharmaceutical companies and regulatory agencies on the PDEs of silicon elements in pharmaceutical packaging and process components through a variety of administration routes.

Sodium alginate/collagen hydrogel loaded with human umbilical cord mesenchymal stem cells promotes wound healing and skin remodeling.

Stem cell transplantation is a promising therapy for wound healing, but the low retention and survival of transplanted stem cells limit their application. Injectable hydrogels exert beneficial effects in skin tissue engineering. In this study, an injectable hydrogel composed of sodium alginate (SA) and collagen type I (Col) was synthesized as a tissue scaffold to improve the efficacy of stem cells in a full-thickness excision wound model. Our results showed that SA/Col hydrogel was injectable, biodegradable, and exhibited low immunogenicity, which could promote the retention and survival of hUC-MSCs in vivo. SA/Col loaded with hUC-MSCs showed reduced wound size (p < 0.05). Histological and immunofluorescence results confirmed that SA/Col loaded with hUC-MSCs significantly promoted the formation of granulation, enhanced collagen deposition and angiogenesis, increased VEGF and TGF-ß1 expression (p < 0.05), and mitigated inflammation evidenced by lower production of TNF-α and IL-1ß and higher release of IL-4 and IL-10 (p < 0.05). Furthermore, SA/Col loaded with hUC-MSCs significantly lowered the expression of NLRP3 inflammasome-related proteins (p < 0.05). Taken together, our results suggest that SA/Col loaded with hUC-MSCs promotes skin wound healing via partly inhibiting NLRP3 pathway, which has potential to the treatment of skin wounds.

Evaluation of influence factors on the width, length, and width to length ratio of the maxillary central incisor: A systematic review and meta-analysis.

OBJECTIVES: The aim of this study was to analyze whether symmetry of left and right sides, gender, measuring method, and ethnicity have influences on width (W), length (L), and width to length ratio (W/L) of the maxillary central incisor (MCI) and provide a reference for dental treatment planning in the esthetic zone. MATERIALS AND METHODS: An electronic search was conduct of the dental literature. Studies reporting data about measurements were included. Data were extracted and analyzed for the differences between left and right, male and female, different measuring methods, and ethnicities by Review Manager and Stata statistical software. RESULTS: Seventeen studies were included. There were no differences between measurement of the left and right groups, perceived and actual measuring groups. However, differences were found between genders in MCI's W and L but no difference in W/L. Differences were also found between Asians and Caucasian subjects in MCI's W, L, and W/L. CONCLUSIONS: The results of this meta-analysis suggest that symmetry of left and right sides and measuring method do not influence MCI dimension. Gender and ethnicity are found as influence factors for MCI dimension. We believe these findings can be helpful for dentists to decide and design the dimensions of the restorations for maxillary anterior teeth in clinical practices. CLINICAL SIGNIFICANCE: In the process of designing maxillary anterior teeth for implantation, the contralateral MCI can be helpful to create a symmetrical esthetic restoration. For patients with maxillary anterior tooth loss or diastemas, dentists should divide the left and right space equally and keep the MCI contact area aligned with the midline. Dentists should take face size and gender into consideration when making treatment plans for the MCI. Facial parameters as well as the size ratios of the previous teeth can be evaluated and may influence the size and shape of the teeth. When measuring anterior teeth or facial dimensions for esthetic evaluation, the recommended method is to measure the perceived sizes of a facial view image created by a digital camera. Slight discrepancies may exist between the actual and measured values due to the curvature of the arch and the angle in which the photograph was taken.

The application of individualized abutment-crown integrated provisional restoration in optimizing the peri-implant soft tissue contour in the esthetic zone.

OBJECTIVE: This article introduced a modified method to fabricate an individualized abutment-crown integrated provisional restoration for single-tooth implant restoration in the esthetic zone, which created a satisfactory peri-implant soft tissue architecture. CLINICAL CONSIDERATIONS: Three months after the implant placement, the individualized abutment-crown integrated provisional restoration was designed and fabricated in the laboratory, by referring to the profile of natural contra-lateral tooth digitally, and seated on the implant afterwards. The peri-implant soft tissue architecture was evaluated and the Pink Esthetic Score (PES) was recorded. The provisional restoration stayed on the implant for 3 months until the individualized definitive ceramic abutment and crown were fixed on the implant. CONCLUSIONS: This protocol provided an alternative solution for shaping the peri-implant soft tissue morphology in the esthetic zone by using an individualized abutment-crown integrated provisional restoration and showed promising effect on the esthetics of anterior single-tooth implant restoration. CLINICAL SIGNIFICANCE: The individualized abutment-crown integrated provisional restoration whose emergence profile mirroring that of the natural contra-lateral tooth, was designed with the help of computer-aided design-manufacture (CAD/CAM). It may help shaping the peri-implant soft tissue in the esthetic zone with merits of saving amount of hand labor of technicians as well as clinicians, and reducing the visits of patients.

Study on Synergistic Corrosion Inhibition Effect between Calcium Lignosulfonate (CLS) and Inorganic Inhibitors on Q235 Carbon Steel in Alkaline Environment with Cl.

The synergistic corrosion inhibition effect between calcium lignosulfonate (CLS) and three kinds of inorganic inhibitors (Na2MoO4, Na2SnO3, and NaWO4) with various molar ratios on Q235 carbon steel in alkaline solution (pH 11.5) with 0.02 mol/L NaCl was investigated by cyclic potentiodynamic polarization, electrochemical impedance spectroscopy, linear polarization, scanning electron microscopy, and X-ray photoelectron spectroscopy. Molybdate and stannate in hybrid inhibitor could promote the passivation of steel and form a complex film, which could suppress the corrosion effectively. Moreover, the insoluble metal oxides in the complex film formed by three kinds of inorganic inhibitor could help the adsorption of CLS onto the steel surface. The CLS molecules could adsorb onto the steel surface and metal oxides to form an adsorption film to protect the steel from corrosion. A three-layer protection film formed by a hybrid inhibitor, including passivation film, deposition film, and adsorption film, would effectively inhibit the corrosion reactions on the steel surface. The CLS compound with molybdate with the ratio of 2:3 shows the best inhibition effect on both general corrosion and localized corrosion.

Multiplexing microelectrodes for dielectrophoretic manipulation and electrical impedance measurement of single particles and cells in a microfluidic device.

This work presents a microfluidic device, which was patterned with (i) microstructures for hydrodynamic capture of single particles and cells, and (ii) multiplexing microelectrodes for selective release via negative dielectrophoretic (nDEP) forces and electrical impedance measurements of immobilized samples. Computational fluid dynamics (CFD) simulations were performed to investigate the fluidic profiles within the microchannels during the hydrodynamic capture of particles and evaluate the performance of single-cell immobilization. Results showed uniform distributions of velocities and pressure differences across all eight trapping sites. The hydrodynamic net force and the nDEP force acting on a 6 µm sphere were calculated in a 3D model. Polystyrene beads with difference diameters (6, 8, and 10 µm) and budding yeast cells were employed to verify multiple functions of the microfluidic device, including reliable capture and selective nDEP-release of particles or cells and sensitive electrical impedance measurements of immobilized samples. The size of immobilized beads and the number of captured yeast cells can be discriminated by analyzing impedance signals at 1 MHz. Results also demonstrated that yeast cells can be immobilized at single-cell resolution by combining the hydrodynamic capture with impedance measurements and nDEP-release of unwanted samples. Therefore, the microfluidic device integrated with multiplexing microelectrodes potentially offers a versatile, reliable, and precise platform for single-cell analysis.

Graphene Oxide and Lysozyme Ultrathin Films with Strong Antibacterial and Enhanced Osteogenesis.

There is a great demand worldwide for bone-related implant materials. The drawbacks of chronic infections and poor bone healing of current implant materials have limited their clinical applications. Functionalizing the implant surfaces with antibacterial and osteogenic films on implant materials provides new opportunities for fabricating novel implant materials. In the present study, an ultrathin (GO/Lys)8 film of several tens of nanometers was fabricated using a layer-by-layer (LBL) technique with alternative deposition of graphene oxide (GO) and lysozyme (Lys). The deposition of the (GO/Lys) n film exhibited a successive growth as supported by ellipsometry, UV-vis, and Fourier transform infrared data, and the physical properties (morphology, roughness, and stiffness) of this film were characterized with an atomic force microscope. The ultrathin films exhibited a great effect on bacterium sterilization of Gram-positive Staphylococcus aureus and Gram-negative Escherichia coli and enhanced osteogenic differentiation efficiency, showing the potential application in bone implant coatings. We believe that this LBL assembling strategy will pave the way for fabricating dual-functional surfaces and guide the design of the implanted surfaces in the future.

Experimental and Theoretical Study on the Synergistic Inhibition Effect of Pyridine Derivatives and Sulfur-Containing Compounds on the Corrosion of Carbon Steel in CO2-Saturated 3.5 wt.% NaCl Solution.

The corrosion inhibition performance of pyridine derivatives (4-methylpyridine and its quaternary ammonium salts) and sulfur-containing compounds (thiourea and mercaptoethanol) with different molar ratios on carbon steel in CO2-saturated 3.5 wt.% NaCl solution was investigated by weight loss, potentiodynamic polarization, electrochemical impedance spectroscopy, and scanning electron microscopy. The synergistic corrosion inhibition mechanism of mixed inhibitors was elucidated by the theoretical calculation and simulation. The molecules of pyridine derivative compounds with a larger volume has priority to adsorb on the metal surface, while the molecules of sulfur-containing compounds with a smaller volume fill in vacancies. A dense adsorption film would be formed when 4-PQ and sulfur-containing compounds are added at a proper mole ratio.

Pretreatment of human cervicovaginal mucus with pluronic F127 enhances nanoparticle penetration without compromising mucus barrier properties to herpes simplex virus.

Mucosal drug delivery nanotechnologies are limited by the mucus barrier that protects nearly all epithelial surfaces not covered with skin. Most polymeric nanoparticles, including polystyrene nanoparticles (PS), strongly adhere to mucus, thereby limiting penetration and facilitating rapid clearance from the body. Here, we demonstrate that PS rapidly penetrate human cervicovaginal mucus (CVM), if the CVM has been pretreated with sufficient concentrations of Pluronic F127. Importantly, the diffusion rate of large polyethylene glycol (PEG)-coated, nonmucoadhesive nanoparticles (PS-PEG) did not change in F127-pretreated CVM, implying that F127 did not significantly alter the native pore structure of CVM. Additionally, herpes simplex virus type 1 (HSV-1) remains adherent in F127-pretreated CVM, indicating that the presence of F127 did not reduce adhesive interactions between CVM and the virions. In contrast to treatment with a surfactant that has been approved for vaginal use as a spermicide (nonoxynol-9 or N9), there was no increase in inflammatory cytokine release in the vaginal tract of mice after daily application of 1% F127 for 1 week. Pluronic F127 pretreatment holds potential as a method to safely improve the distribution, retention, and efficacy of nanoparticle formulations without compromising CVM barrier properties to pathogens.

Effect of Maillard reaction products on the physical and antimicrobial properties of edible films based on ε-polylysine and chitosan.

BACKGROUND: Edible films based on Maillard reaction products (MRPs) of ε-polylysine and chitosan, without the use of any plasticiser, were prepared by solution casting. The effect of Maillard reaction parameters (reaction time and the ratio of polylysine/chitosan) of ε-polylysine and chitosan on the structure, moisture content, water solubility, total colour difference and mechanical properties of edible films formed by MRPs were systematically evaluated. RESULTS: Scanning electron microscopy confirmed that edible films prepared by the MRPs of ε-polylysine and chitosan through the Maillard reaction exhibited a more compact and dense structure than those from the mixture of biopolymers without the presence of MRPs. The tensile strength and % elongation values of films from the mixture were decreased significantly with the rise of ε-polylysine (P < 0.05). The moisture content of the films was not significantly affected by Maillard reaction, whereas water solubility was decreased and total colour difference was increased significantly (P < 0.05) with the extension of Maillard reaction time. In addition, antimicrobial activity of chitosan films against E. coli and S. aureus. could be achieved by incorporating ε-polylysine into chitosan. CONCLUSION: These films can ensure food quality and safety, especially for coating highly perishable foods, such as meat products. © 2014 Society of Chemical Industry.

Preparation and characterization of bacterial cellulose synthesized by kombucha from vinegar residue.

Bacterial cellulose (BC) has been widely applied in various fields due to its excellent physicochemical properties, but its high production cost remains a challenge. Herein, the present study aimed to utilize the hydrolysate of vinegar residue (VR) as the only medium to realize the cost-effective production of BC. The BC production was optimized by the single-factor test. The treatment of 6 % VR concentration with 3 % acid concentration at 100 °C for 1.5 h and 96 U/mL of cellulase for 4 h at 50 °C obtained a maximum reducing sugar concentration of about 32 g/L. Additionally, the VR hydrolysate treated with 3 % active carbon (AC) at 40 °C for 0.5 h achieved a total phenol removal ratio of 86 %. The yield of BC reached 2.1 g/L under the optimum conditions, which was twice compared to the standard medium. The produced BC was characterized by SEM, FT-IR, XRD, and TGA analyses, and the results indicated that the BC prepared by AC-treated VR hydrolysate had higher fiber density, higher crystallinity, and good thermal stability. Furthermore, the regenerated BC (RBC) fibers with a tensile stress of 400 MPa were prepared successfully using AmimCl solution as a solvent by dry-wet-spinning method. Overall, the VR waste could be used as an alternative carbon source for the sustainable production of BC, which could be further applied to RBC fibers preparation.

Polystyrene nanoparticles induce biofilm formation in Pseudomonas aeruginosa.

In recent years, micro/nanoplastics have garnered widespread attention due to their ecological risks. In this study, we investigated the effects of polystyrene nanoparticles (PS-NPs) of different sizes on the growth and biofilm formation of Pseudomonas aeruginosa PAO1. The results demonstrated that exposure to certain concentrations of PS-NPs significantly promoted bacterial biofilm formation. Meanwhile, we comprehensively revealed its mechanism whereby PS-NPs induced oxidative stress and altered bacterial membrane permeability by contacting or penetrating bacterial membranes. To counteract the stimulation by PS-NPs and reduce their toxicity, bacteria enhanced biofilm formation by upregulating the expression of biofilm-related genes, increasing EPS and virulence factors secretion, and enhancing bacterial motility through the participation of the quorum sensing (QS) system. Additionally, we also found that exposure to PS-NPs enhanced bacterial antibiotic resistance, posing a challenge to antimicrobial therapy. Our study reveals the toxic effects of nanoplastics and the defense mechanisms of bacteria, which has important implications for the risk assessment and management of environmental nanoplastics.

Osteogenic effect of low-intensity pulsed ultrasound on peri-implant bone: A systematic review and meta-analysis.

Purpose This study aimed to evaluate the effect of low-intensity pulsed ultrasound (LIPUS) on promoting osseointegration around dental implants.Study selection A comprehensive search was performed on two databases, including MEDLINE (PubMed) and Web of Science to identify relevant studies published before June 1, 2022. Randomized controlled trials that met the inclusion criteria were selected for the study. The year of publication, study design, animal species, number of animals, number of implants, implant position, implant size, intervention, follow-up time, bone volume ratio (BV/TV), bone-implant contact ratio (BIC), and implant removal torque value (RTV) measurements, including mean and SD, were extracted.Results Ten randomized trials were included in this meta-analysis. The results showed that LIPUS significantly promoted osteogenesis around dental implants. Furthermore, in animal models of pre-existing diseases such as osteoporosis and diabetes, LIPUS had the same effect. The included data were divided into subgroups to explore the effects of different follow-up time, acoustic intensities, and frequencies. Results showed that higher acoustic intensities and frequencies significantly improve the osteogenic effects of LIPUS. There was some degree of heterogeneity owing to bias in the included studies. More high-quality randomized controlled trials are necessary in the future.Conclusions LIPUS can promote bone healing around dental implants and is an attractive option for edentulous patients, especially those with pre-existing diseases. Further clinical trials on the use of LIPUS in implant dentistry are warranted. Furthermore, future studies must pay more attention to acoustic intensity and frequency.

Evaluate the effects of low-intensity pulsed ultrasound on dental implant osseointegration under type II diabetes.

Objective: The objective of this study is to assess the impact of low-intensity pulsed ultrasound (LIPUS) therapy on the peri-implant osteogenesis in a Type II diabetes mellitus (T2DM) rat model. Methods: A total of twenty male Sprague-Dawley (SD) rats were randomly allocated into four groups: Control group, T2DM group, Control-LIPUS group, and T2DM-LIPUS group. Implants were placed at the rats' bilateral maxillary first molar sites. The LIPUS treatment was carried out on the rats in Control-LIPUS group and T2DM-LIPUS group, immediately after the placement of the implants, over three consecutive weeks. Three weeks after implantation, the rats' maxillae were extracted for micro-CT, removal torque value (RTV), and histologic analysis. Results: Micro-CT analysis showed that T2DM rats experienced more bone loss around implant cervical margins compared with the non-T2DM rats, while the LIPUS treated T2DM rats showed similar bone heights to the non-T2DM rats. Bone-implant contact ratio (BIC) were lower in T2DM rats but significantly improved in the LIPUS treated T2DM rats. Bone formation parameters including bone volume fraction (BV/TV), trabecular thickness (Tb.Th), bone mineral density (BMD) and RTV were all positively influenced by LIPUS treatment. Histological staining further confirmed LIPUS's positive effects on peri-implant new bone formation in T2DM rats. Conclusion: As an effective and safe treatment in promoting osteogenesis, LIPUS has a great potential for T2DM patients to attain improved peri-implant osteogenesis. To confirm its clinical efficacy and to explore the underlying mechanism, further prospective cohort studies or randomized controlled trials are needed in the future.

Cone-beam CT evaluation of post-extraction alveolar bone changes at the maxillary incisor sites in an East Asian population: A cross-sectional study.

Objective: Understanding the characteristics of alveolar bone resorption in an East Asian population after maxillary incisor extraction and providing a reference for implant treatment plans. Study design: Cone-beam computerized tomography (CBCT) data of 125 East Asian patients with unilateral extraction of maxillary incisors for 3 months were collected. The alveolar bone width and height in the extraction sites were measured and compared with the corresponding contralateral sites. Results: The differences in alveolar bone width between the extraction site and contralateral site were as follows: 4.11 mm, 2.68 mm, and 2.09 mm (3 mm, 5 mm, 7 mm apical from CEJ of the contralateral tooth). Data are expressed as the median. The horizontal resorption ratio of alveolar bone was 49.94 %, 31.5 %, and 24.46 %. The difference in alveolar bone height was 0.78 mm. The vertical resorption ratio was 7.78 %. The resorption did not differ significantly between sexes and was not significantly affected by tooth positions. Conclusions: In the studied East Asian population, significant horizontal and vertical alveolar bone resorption occurs after natural healing of maxillary incisor extraction for 3 months. The closer to the alveolar ridge crest, the more significant the horizontal resorption, resulting in an "inverted triangle" shape residual alveolar bone.

Efficacy of Electronic Cigarettes vs Varenicline and Nicotine Chewing Gum as an Aid to Stop Smoking: A Randomized Clinical Trial.

Importance: Electronic cigarettes (ECs) are often used by smokers as an aid to stopping smoking, but evidence is limited regarding their efficacy compared with nicotine replacement therapy (NRT), and no evidence is available on how their efficacy compares with that of varenicline. Objective: To evaluate whether ECs are superior to NRT and noninferior to varenicline in helping smokers quit. Design, Setting, and Participants: This was a randomized clinical trial conducted at 7 sites in China and including participants who were smoking at least 10 cigarettes per day and motivated to quit, not using stop-smoking medications or EC, and willing to use any of the study products. Participants were first recruited in May 2021, and data analysis was conducted in December 2022. Interventions: A cartridge-based EC (30 mg/mL nicotine salt for 2 weeks and 50 mg/mL after that), varenicline (0.5 mg, once a day for 3 days; 0.5 mg, twice a day for 4 days; and 1 mg, twice a day, after that), and 2 mg (for smokers of ≤20 cigarettes per day) or 4 mg (>20 cigarettes per day) nicotine chewing gum, all provided for 12 weeks and accompanied by minimal behavioral support (an invitation to join a self-help internet forum). Main Outcomes and Measures: The primary outcome was sustained abstinence from smoking at 6 months as validated by an expired-air carbon monoxide reading (<8 parts per million). Participants lost to follow-up were included as nonabstainers. Results: Of 1068 participants, 357 (33.5%) were female, and the mean (SD) age was 33.9 (3.1) years. A total of 409 (38.3%), 409 (38.3%), and 250 (23.4%) participants were randomized to the EC, varenicline, and NRT arms, respectively. The 6-month biochemically validated abstinence rates were 15.7% (n = 64), 14.2% (n = 58), and 8.8% (n = 22) in the EC, varenicline, and NRT study arms, respectively. The quit rate in the EC arm was noninferior to the varenicline arm (absolute risk reduction, 1.47%; 95% CI, -1.41% to 4.34%) and higher than in the NRT arm (odds ratio, 1.92; 95% CI, 1.15-3.21). Treatment adherence was similar in all study arms during the initial 3 months, but 257 participants (62.8%) in the EC arm were still using ECs at 6 months, with no further use in the 2 other study arms. The most common adverse reactions were throat irritation (32 [7.8%]) and mouth irritation (28 [6.9%]) in the EC arm, nausea (36 [8.8%]) in the varenicline arm, and throat irritation (20 [8.0%]) and mouth irritation (22 [8.8%]) in the NRT arm. No serious adverse events were recorded. Conclusions and Relevance: The results of this randomized clinical trial found that when all treatments were provided with minimal behavior support, the efficacy of EC was noninferior to varenicline and superior to nicotine chewing gum. Trial Registration: Chinese Clinical Trial Registry: ChiCTR2100048156.

The microstructure and bulk rheology of human cervicovaginal mucus are remarkably resistant to changes in pH.

The protective barrier, lubricant, and clearance functions of mucus are intimately coupled to its microstructure and bulk rheology. Mucus gels consist of a network of mucin biopolymers along with lipids, salts, and other proteins and exhibit similar biochemical and physical properties across diverse mucosal surfaces. Nevertheless, mucus is exposed to a broad range of pH values throughout the human body. Protein functions are typically sensitive to small changes in pH, and prior investigations using reconstituted, purified mucin gels suggested mucus undergoes a transition from a low-viscosity liquid at neutral pH to a highly viscoelastic solid at low pH. We sought to determine whether those observations hold for fresh, minimally perturbed human mucus ex vivo by using different-sized muco-inert nanoparticles to probe microstructure and cone-and-plate rheometry to measure bulk rheology. We demonstrate that both the microstructure and bulk rheology of fresh, undiluted, and minimally perturbed cervicovaginal mucus exhibit relatively minor changes from pH 1-2 to 8-9, in marked contrast with the pH sensitivity of purified mucin gels. Our work also suggests additional components in mucus secretions, typically eliminated during mucin purification and reconstitution, may play an important role in maintaining the protective properties of mucus.