Characteristics of Neutrophil Migration and Function in Acute Inflammation Induced by Zymosan and Carrageenan in the Mice Air Pouch Model.

Deciphering the complex and redundant process of acute inflammation remains challenging. The failure of numerous clinical trials assessing anti-inflammation agents which had promising preclinical effects inevitably questions the validity of current animal models of inflammation. This study aimed to better understand the process of immune inflammatory response and to select more suitable models to evaluate the effect of potential anti-inflammatory drugs. Zymosan and λ-carrageenan are the most used representatives of particulate and soluble irritants that trigger acute inflammation in the air pouch inflammation model. When zymosan was used, the number of exudate cells first increased at 4 h-8 h, followed by a drop at 12 h-24 h. While, the changes in number of leukocytes in peripheral blood and proportion of neutrophils in bone marrow have the opposite trend. Meanwhile, neutrophils released neutrophil extracellular traps (NETs) to clean zymosan particles. In contrast, the cell migration response to carrageenan increased during 4 h to 24 h, no obvious NETs were observed, and the number of leukocytes in peripheral blood increased and the proportion of neutrophils in bone marrow decreased slightly. This study indicated that although both zymosan and carrageenan are sterile irritants, the characteristics of the inflammatory response induced by each other were different. In the acute phase of inflammation, zymosan-stimulated neutrophils were mobilized, recruited, and engulfed, and then died by NETs. Carrageenan stimulated the production of cytokines/chemokines by neutrophils or macrophages, but did not lead to an obvious death by releasing NETs.

Nonlinear effects of dual-frequency focused ultrasound on the on-demand regulation of acoustic droplet vaporization.

Dual-frequency ultrasound has been widely employed to enhance and regulate acoustic droplet vaporization (ADV) but the role of ultrasonic nonlinear effects on it remains unclear. The main objective of this study is to investigate the influence of nonlinear effects on the control of ADV nucleation under different dual-frequency focused ultrasound conditions. ADV nucleation of PFC nanodroplets activated by nonlinear dual-frequency ultrasound was modeled and parametric studies were conducted to investigate the influence of dual-frequency ultrasound frequency and acoustic power on the degree of nonlinearity (DoN), nucleation rates and dimensions of the nucleation region in a wide parameter range. The results showed that the ultrasonic nonlinearity caused a significant decrease in peak negative pressure due to waveform distortion, which leads to a lower nucleation rate in the nonlinear model compared to that in the linear model. Furthermore, the distributions of nucleation regions were also affected by the interaction between waves of different frequencies and cloud-like spatial distributions were produced, which could be modulated by the dual-frequency ultrasound parameters and have great potentials in the spatial regulation of the ADV and customized treatment protocols in clinical applications. In addition, represented by 1.5 MHz + 3 MHz, such a dual-frequency combination of fundamental and second harmonic could effectively enhance ultrasonic nonlinear effects with relatively lower peak negative pressure and higher DoN. Therefore, nonlinear effect of the dual-frequency ultrasound plays an important role in the ADV regulation, which should be considered in the numerical model and practical applications.

Combined effects of high-intensity ultrasound treatment and hydrogen peroxide addition on the thermal stabilities of myofibrillar protein emulsions at low ionic strengths.

In this study, the effects of high-intensity ultrasound (HIU) treatment combined with hydrogen peroxide (H2O2) addition on the thermal stability of myofibrillar protein (MP)-stabilized emulsions in low-salt conditions were investigated. Results showed that compared to using either HIU or H2O2 treatment alone, HIU treatment combined with H2O2 was most effective in enhancing the physical stability of emulsions. Moreover, the emulsion stabilized by MPs co-treated with HIU and H2O2 exhibited the most uniform distribution, highest absolute zeta potential, and optimal rheological properties upon heating. This combination effect during heating was caused by the inhibition of disulfide bond cross-linking of myosin heads by H2O2 and the dissociation of filamentous myosin structures using the HIU treatment. In addition, the results of oxidative stability analysis indicated that the addition of H2O2 increased the content of oxidation products; however, the overall influence on the oxidative stability of emulsions was not significant. In conclusion, the combination of HIU and H2O2 treatment is a promising approach to suppress heat-induced MP aggregation and improve the thermal stability of corresponding emulsions.

A Novel Homoconjugated Propellane Triimide: Synthesis, Structural Analyses, and Gas Separation.

Rigid three-dimensional (3D) polycyclic propellanes have garnered interest due to their unique conformational spaces, which display great potential use in selectivity, separation and as models to study through-space electronic interactions. Herein we report the synthesis of a novel rigid propellane, trinaphtho[3.3.3]propellane triimide, which comprises three imide groups embedded on a trinaphtho[3.3.3]propellane. This propellane triimide exhibits large bathochromic shift, amplified molar absorptivity, enhanced fluorescence, and lower reduction potential when compared to the subunits. Computational and experimental studies reveal that the effective through-space π-orbitals interacting (homoconjugation) occurs between the subunits. Single-crystal XRD analysis reveals that the propellane triimide has a highly quasi-D3h symmetric skeleton and readily crystallizes into different superstructures by changing alkyl chains at the imide positions. In particular, the porous 3D superstructure with S-shaped channels is promising for taking up ethane (C2H6) with very good selectivity over ethylene (C2H4), which can purify C2H4 from C2H6/C2H4 in a single separation step. This work showcases a new class of rare 3D polycyclic propellane with intriguing electronic and supramolecular properties.

Functional Electrospun Nanofibrous Hybrid Materials for Colorimetric Sensors: A Review.

Electrospun nanofibrous hybrid materials have several advantageous characteristics, including easy preparation, high porosity, and a large specific surface area. Meanwhile, they can be more suitable for colorimetric detection in environmental and food areas than organic materials due to the advantages of inorganic nanomaterials, i.e., stability, low toxicity, and durability. In addition to being able to immobilize nanomaterials to avoid particle aggregation, electrospinning hybrid materials also have the advantages of high specific surface area and high porosity, which is beneficial for constructing colorimetric sensors. This review mainly summarizes the fabrication methods of electrospun nanofibrous hybrid materials and the application of electrospun nanofibrous hybrid material based colorimetric sensors. First, the preparation strategies of electrospun nanofibrous hybrid materials were discussed. Then, the applications of the obtained electrospun nanofibrous hybrid materials in the colorimetric sensors for environmental molecules in the gas and liquid phase were further investigated. Finally, this review looks forward to the development prospects and challenges of electrospun hybrid materials in practical applications of colorimetric sensors in order to support the application of colorimetric sensors in practical detection.

Soy protein isolate-sodium alginate colloidal particles for improving the stability of high internal phase Pickering emulsions: Effects of mass ratios.

The potential of sodium alginate (SA) at different mass ratios to improve the emulsifying ability of soy protein isolate (SPI) in high internal phase Pickering emulsions (HIPPEs) was evaluated in this work. SPI-SA particles were used as a natural particle stabilizer of HIPPEs with 80 % oil phase. The properties of particles with varying SPI to SA ratios (10:0, 10:1, 10:3, 10:5, 10:10, and 10:15 w/w) were evaluated. HIPPEs with a 10:10 SPI to SA ratio exhibited the smallest droplet sizes. Both the storage modulus and loss modulus of the HIPPEs increased with increasing SA addition ratios, implying that HIPPEs with higher SA addition have stronger gel characteristics. In addition, super-resolution microscopy and cryogenic scanning electron microscopy indicated that SA addition strengthened the compactness of the interface film and increased the distribution uniformity of HIPPEs. In conclusion, the combination of SPI and SA is beneficial for improving the performance of HIPPEs.

Coordination-Polymer-Derived Cu-CoO/C Nanocomposite Used in Fenton-like Reaction to Achieve Efficient Degradation of Organic Compounds.

In this paper, carbon-matrix-supported copper (Cu) and cobaltous oxide (CoO) nanoparticles were obtained by using coordination polymers (CPs) as a precursor. The aqueous solutions of copper methacrylate (CuMA) and cobalt methacrylate (CoMA) were preferentially prepared, which were then mixed with anhydrous ethanol to fabricate dual metal ion coordination polymers (CuMA/CoMA). After calcination under an argon atmosphere, the Cu-CoO/C nanocomposite was obtained. Scanning electron microscope (SEM) and transmission electron microscope (TEM) showed that the material has banded morphology, and the dual functional nanoparticles were highly dispersed in the carbon matrix. The prepared material was used in a heterogeneous Fenton-like reaction, with the aim of replacing traditional ferric catalysts to solve pH constraints and the mass production of ferric slime. The obtained nanocomposite showed excellent catalytic performance on the degradation of methylene blue (MB) at near-neutral conditions; the discoloration efficiency is about 98.5% within 50 min in the presence of 0.15 mmol/mL H2O2 and 0.5 mg/mL catalyst. And good reusability was verified via eight cycles. The plausible pathway for MB discoloration and the possible catalytic mechanism was also proposed.

Investigating the effect of catechin on the emulsification and oxidation stability of myofibrillar protein-diacylglycerol emulsions.

The effects of catechin on the emulsification and oxidation stability of myofibrillar protein-diacylglycerol (MP-DAG) emulsions were investigated. Lard samples, namely, lard, unpurified glycerolytic lard (UGL), and purified glycerolytic lard (PGL), were used as oil phases. The emulsifying effects of UGL- and PGL-based emulsions were superior to those of lard-based emulsions (P < 0.05). The emulsifying properties of MP-DAG emulsions increased initially and then decreased with a rise in the catechin concentration, with 20-µmol/g catechin exhibiting optimal emulsification activity and stability (P < 0.05). The droplets were tinier and evenly distributed, and the absolute ξ-potential values and rheological characteristics reached their maximum at a catechin concentration of 20 µmol/g. The formation of thiobarbituric acid-reactive substances and carbonyls declined significantly with the growth of catechin levels (P < 0.05), which confirmed that the oxidation of MPs and lipids was reduced efficiently by catechin. This study provides an idea for improving the emulsification and oxidation stability of MP-DAG emulsions, which offers a theoretical basis for the application of MP-DAG emulsions in meat products.

Evaluation of the Emulsifying Property and Oxidative Stability of Myofibrillar Protein-Diacylglycerol Emulsions Containing Catechin Subjected to Different pH Values.

Myofibrillar protein-diacylglycerol emulsions containing catechin (MP-DAG-C) possess outstanding emulsifying property and oxidative stability. However, the effect of pH on MP-DAG-C emulsions should be revealed to provide possibilities for their application in practical meat products. Therefore, MP-DAG-C emulsions at different pH values were used in this study, in which lard, unpurified glycerolytic lard (UGL), and purified glycerolytic lard (PGL) were used as the oil phases. The results indicated that the emulsifying property of the UGL- and PGL-based emulsions increased compared to those of the lard-based emulsions (p < 0.05). The emulsifying activity and stability indices, absolute value of ζ-potential, and rheological characteristics increased with the increase in pH values (p < 0.05), with the droplets were smallest and distributed most uniformly at a pH of 6.5 compared to the other acidic environment (p < 0.05). The thiobarbituric acid substance and carbonyl content increased (p < 0.05), while the total sulfydryl content decreased (p < 0.05) during storage. However, there was no statistical difference between the oxidative stability of the MP-DAG-C emulsions with different pH values (p > 0.05). The results implied that the emulsifying property of MP-DAG-C emulsions increased with an increase in pH values. The oxidative stability of the MP-DAG-C emulsions at high pH values was improved by catechin.

Engineering Nanosensitizer to Remodel the TME for Hypoimmunogenic "Cold"-"Hot" Tumor Transformations.

α-PD-L1 therapy has shown encouraging results at harnessing the immune system to combat cancer. However, the treatment effect is relatively low due to the dense extracellular matrix (ECM) and tumor immunosuppressive microenvironment (TIME). Therefore, an ultrasound (US)-responsive nanosensitizer (URNS) is engineered to deliver losartan (LST) and polyethylenimine (PEI) to remolde the TME, driving "cold"-"hot" tumor transformation and enhancing the sensitivity of α-PD-L1 therapy. In the tumor site, noninvasive US can make MTNP generate ROS, which cleave ROS-sensitive bonds to dissociate MTNPtK@LST-PEI, shedding PEI and releasing LST from mesoporous spheres. The results demonstrated that URNS combined with α-PD-L1 therapy effectively inhibited tumor growth with an inhibition rate as high as 90%, which was 1.7-fold higher than that of the α-PD-L1 treatment in vivo. In summary, the URNS improves the sensitivity of α-PD-L1 therapy by remodeling the TME, which provides promising insights for optimizing cancer immunotherapy.

Recombinant duck enteritis virus bearing the hemagglutinin genes of H5 and H7 influenza viruses is an ideal multivalent live vaccine in ducks.

Due to the fact that many avian influenza viruses that kill chickens are not lethal to ducks, farmers are reluctant to use avian influenza inactivated vaccines on ducks. Large numbers of unvaccinated ducks play an important role in the transmission of avian influenza viruses from wild birds to domestic poultry, creating a substantial challenge to vaccination strategies for avian influenza control. To solve this problem, we constructed a recombinant duck enteritis virus (DEV), rDEV-dH5/H7, using a live attenuated DEV vaccine strain (vDEV) as a vector. rDEV-dH5/H7 carries the hemagglutinin gene of two H5 viruses [GZ/S4184/17 (H5N6) (clade 2.3.4.4 h) and LN/SD007/17 (H5N1) (clade 2.3.2.1d)] and an H7 virus [GX/SD098/17 (H7N9)]. These three hemagglutinin genes were stably inherited in rDEV-dH5/H7 and expressed in rDEV-dH5/H7-infected cells. Animal studies revealed that rDEV-dH5/H7 and vDEV induced similar neutralizing antibody responses and protection against lethal DEV challenge. Importantly, rDEV-dH5/H7 induced strong and long-lasting hemagglutinin inhibition antibodies against different H5 and H7 viruses and provided complete protection against challenges with homologous and heterologous highly pathogenic H5 and H7 influenza viruses in ducks. Our study shows that rDEV-dH5/H7 could serve as an ideal live attenuated vaccine to protect ducks against infection with lethal DEV and highly pathogenic avian influenza viruses.

Investigating the rheological properties and 3D printability of tomato-starch paste with different levels of xanthan gum.

Tomato is an inexpensive vegetable with high nutritional value，but it does not have the suitable self-supporting ability for 3D printing. Xanthan gum (XG) is a common thickener that may improve 3D printability of tomatoes paste. This study evaluated the printability of tomato-starch paste (TSP) by examining its rheological and textural properties and microstructure of 3D samples. The rheological results showed that apparent viscosity, recovery rate, storage modulus, loss modulus, initial and average rheological forces, and shear stress increased significantly (P < 0.05) with increase of XG levels in tomato-starch paste. The low-field NMR results showed that T21 and T22 of the TSP decreased with increase of XG levels (P < 0.05). With increase of XG levels, a dense network structure in the TSP was formed as observed in the microstructural images. The TSP with 5 g/kg XG had the highest printing accuracy, and the textural property showed that the addition of 5 g/kg of XG significantly improved the hardness, elasticity, and chewability of TSP (P < 0.05). Overall, with increase of XG levels the fluidity of the pseudoplastic gel formed by the tomato-starch system and increased the density of the structure, resulting in improved extrudability, shape stability, and self-supporting property.

Pathogenicity of duck circovirus 1 in experimentally infected specific pathogen-free ducks.

Ducks infected with duck circovirus (DuCV) show symptoms such as feather loss, growth retardation and low body weight in the flock. The virus induces immunosuppression and increases the prevalence of infection with other pathogens. However, most studies on duck circovirus were focused on coinfection, and fewer studies had been conducted on the pathogenicity of duck circovirus alone. The aim of the present study was to investigate the pathogenesis of DuCV-1 in experimentally infected specific pathogen-free ducks. In this study, we sequenced the whole genome of a strain of duck circovirus and identified the virus genotype as DuCV-1b. This strain of duck circovirus was named SDLH(OR567883). Animal pathogenicity experiments were then conducted, wherein specific pathogen-free ducks were infected by mucosal injection and abdominal injection. Infected ducks were sampled for 4 consecutive weeks after infection and showed symptoms of dwarfism. We further examined the replication of DuCV-1 in the ducks. The highest virus titers in the 2 infection groups were found in the liver and spleen, with different results for the different routes of infection. Pathological sections of duck organs were made and it was found that organs such as the liver and spleen were damaged by DuCV-1. In conclusion, our experimental results indicate that DuCV-1 can infect ducks individually and cause widespread organ damage in infected ducks.

Bespoke Tailoring of Graphenoid Sheets: A Rippled Molecular Carbon Comprising Cyclically Fused Nonbenzenoid Rings.

The incorporation of nonbenzenoid rings into the hexagonal networks of graphenoid nanostructures is of immense importance for electronic, magnetic, and mechanical properties, but the underlying mechanisms of nonbenzenoid ring fusion are rather unexplored. Here, we report the synthesis and characterization of a rippled C84 molecular carbon, which contains 10 nonbenzenoid rings (five-, seven-, and eight-membered rings) that are contiguously fused to give a cyclic geometry. The fused nonbenzenoid rings impart high solubility, configurational stability, multiple reversible redox behaviors, unique aromaticity, and a narrow band gap to the system. Moreover, this carbon nanostructure allows for further functionalization via electrophilic substitution and metalation reactions, enabling access to finely tuned derivatives. Interestingly, both the bowl-shaped and planar conformations of the core in molecular carbon are observed in the solid state. Additionally, this molecular carbon displays ambipolar transport characteristics.

RBMS3-induced circHECTD1 encoded a novel protein to suppress the vasculogenic mimicry formation in glioblastoma multiforme.

Glioblastoma multiforme (GBM) is a highly vascularized malignant cancer of the central nervous system, and the presence of vasculogenic mimicry (VM) severely limits the effectiveness of anti-vascular therapy. In this study, we identified downregulated circHECTD1, which acted as a key VM-suppressed factor in GBM. circHECTD1 elevation significantly inhibited cell proliferation, migration, invasion and tube-like structure formation in GBM. RIP assay was used to demonstrate that the flanking intron sequence of circHECTD1 can be specifically bound by RBMS3, thereby inducing circHECTD1 formation to regulate VM formation in GBM. circHECTD1 was confirmed to possess a strong protein-encoding capacity and the encoded functional peptide 463aa was identified by LC-MS/MS. Both circHECTD1 and 463aa significantly inhibited GBM VM formation in vivo and in vitro. Analysis of the 463aa protein sequence revealed that it contained a ubiquitination-related domain and promoted NR2F1 degradation by regulating the ubiquitination of the NR2F1 at K396. ChIP assay verified that NR2F1 could directly bind to the promoter region of MMP2, MMP9 and VE-cadherin, transcriptionally promoting the expression of VM-related proteins, which in turn enhanced VM formation in GBM. In summary, we clarified a novel pathway for RBMS3-induced circHECTD1 encoding functional peptide 463aa to mediate the ubiquitination of NR2F1, which inhibited VM formation in GBM. This study aimed to reveal new mechanisms of GBM progression in order to provide novel approaches and strategies for the anti-vascular therapy of GBM. The schematic illustration showed the inhibitory effect of circHECTD1-463aa in the VM formation in GBM.

Pseudogene MAPK6P4-encoded functional peptide promotes glioblastoma vasculogenic mimicry development.

Glioma is the most common primary malignancy of the central nervous system. Glioblastoma (GBM) has the highest degree of malignancy among the gliomas and the strongest resistance to chemotherapy and radiotherapy. Vasculogenic mimicry (VM) provides tumor cells with a blood supply independent of endothelial cells and greatly restricts the therapeutic effect of anti-angiogenic tumor therapy for glioma patients. Vascular endothelial growth factor receptor 2 (VEGFR2) and vascular endothelial cadherin (VE-cadherin) are currently recognized molecular markers of VM in tumors. In the present study, we show that pseudogene MAPK6P4 deficiency represses VEGFR2 and VE-cadherin protein expression levels, as well as inhibits the proliferation, migration, invasion, and VM development of GBM cells. The MAPK6P4-encoded functional peptide P4-135aa phosphorylates KLF15 at the S238 site, promoting KLF15 protein stability and nuclear entry to promote GBM VM formation. KLF15 was further confirmed as a transcriptional activator of LDHA, where LDHA binds and promotes VEGFR2 and VE-cadherin lactylation, thereby increasing their protein expression. Finally, we used orthotopic and subcutaneous xenografted nude mouse models of GBM to verify the inhibitory effect of the above factors on GBM VM development. In summary, this study may represent new targets for the comprehensive treatment of glioma.

The Application of a Topology Optimization Algorithm Based on the Kriging Surrogate Model in the Mirror Design and Optimization of an Aerial Camera.

In a Cassegrain optical system, the surface precision of the primary mirror is an important factor in the quality of the image. The design of a lightweight primary mirror with a high-quality optical surface is crucial. In this thesis, an integrated mirror light engine design optimization process is proposed for an aviation optoelectronic device. It is based on the Kriging surrogate model and nests the topology optimization algorithm, which constructs the mirror RMS value response surface and obtains the dominant relationship between mirror structure and surface accuracy. The optimal surface figure lightweight structure of the mirror is obtained by optimizing the surrogate model with an additive criterion and multi-objective optimization analysis. The root mean square value (RMS) of the corresponding primary mirror is 10.41 nm, which is better than 1/40 λ (λ = 632.8 nm). This meets the optical design specifications. The optimal primary mirror structure is analyzed by using the finite element method, which verifies the precision of the Kriging surrogate model. It has an error of 0.28%. The kinetic analysis of the primary mirror shows that the primary mirror does not yield to plastic deformation or even failure under a three-way 20 g acceleration load. This meets the environmental suitability requirements.

Mechanism of Dcp2/RNCR3/Dkc1/Snora62 axis regulating neuronal apoptosis in chronic cerebral ischemia.

RNA-binding proteins (RBPs), long non-coding RNAs (lncRNAs), and small nucleolar RNAs (snoRNAs) were found to play crucial regulatory roles in ischemic injury. Based on GEO databases and our experimental results, we selected Dcp2, lncRNA-RNCR3, Dkc1, and Snora62 and Foxh1 as research candidates. We found that expression levels of Dcp2, RNCR3, Dkc1, Snora62, and Foxh1 were upregulated in oxygen glucose deprivation-treated HT22 cells and hippocampal tissues subject to chronic cerebral ischemia (CCI). Silencing of Dcp2, RNCR3, Dkc1, Snora62, and Foxh1 all inhibited apoptosis of oxygen glucose deprivation-treated HT22 cells. Moreover, Dcp2 promoted RNCR3 expression by increasing its stability. Importantly, RNCR3 may act as a molecular skeleton to bind to Dkc1 and recruit Dck1 to promote snoRNP assembly. Snora62 was responsible for pseudouridylation at 28S rRNA U3507 and U3509 sites. Pseudouridylation levels of 28S rRNA were reduced after knockdown of Snora62. Decreased pseudouridylation levels inhibited the translational activity of its downstream target, Foxh1. Our study further confirmed that Foxh1 transcriptionally promoted the expression of Bax and Fam162a. Notably, experiments in vivo showed that Dcp2 knockdown combined with RNCR3 knockdown and Snora62 knockdown resulted in an anti-apoptosis effect. In conclusion, this study suggests that the axis Dcp2/RNCR3/Dkc1/Snora621 is important for the regulation of neuronal apoptosis induced by CCI.

Effects of Long-Term Intervention with Losartan, Aspirin and Atorvastatin on Vascular Remodeling in Juvenile Spontaneously Hypertensive Rats.

Hypertension in adolescents is associated with adverse cardiac and vascular events. In addition to lowering blood pressure, it is not clear whether pharmacological therapy in early life can improve vascular remodeling. This study aimed to evaluate the effects of long-term administration of losartan, aspirin, and atorvastatin on vascular remodeling in juvenile spontaneously hypertensive rats (SHRs). Losartan, aspirin, and atorvastatin were administered via gavage at doses of 20, 10, and 10 mg/kg/day, respectively, on SHRs aged 6-22 weeks. Paraffin sections of the blood vessels were stained with hematoxylin-eosin (H&E) and Sirius Red to evaluate the changes in the vascular structure and the accumulation of different types of collagen. The plasma levels of renin, angiotensin II (Ang II), aldosterone (ALD), endothelin-1 (ET-1), interleukin-6 (IL-6), and neutrophil elastase (NE) were determined using ELISA kits. After the 16-week treatment with losartan, aspirin, and atorvastatin, the wall thickness of the thoracic aorta and carotid artery decreased. The integrity of the elastic fibers in the tunica media was maintained in an orderly manner, and collagen deposition in the adventitia was retarded. The plasma levels of renin, ALD, ET-1, IL-6, and NE in the SHRs also decreased. These findings suggest that losartan, aspirin, and atorvastatin could improve vascular remodeling beyond their antihypertensive, anti-inflammatory, and lipid-lowering effects. Many aspects of the protection provided by pharmacological therapy are important for the prevention of cardiovascular diseases in adults and older adults.