Preliminary study of improving immune tolerance in vivo of bioprosthetic heart valves through a novel antigenic removal method.

The durability of bioprosthetic heart valves is always compromised by the inherent antigenicity of biomaterials. Decellularization has been a promising approach to reducing the immunogenicity of biological valves. However, current methods are insufficient in eliminating all immunogenicity from the biomaterials, necessitating the exploration of novel techniques. In this study, we investigated using a novel detergent, fatty alcohol polyoxyethylene ether sodium sulfate (AES), to remove antigens from bovine pericardium. Our results demonstrated that AES treatment achieved a higher pericardial antigen removal rate than traditional detergent treatments while preserving the mechanical properties and biocompatibility of the biomaterials. Moreover, we observed excellent immune tolerance in the in vivo rat model. Overall, our findings suggest that AES treatment is a promising method for preparing biological valves with ideal clinical application prospects.

Multi-strand Fibers with Hierarchical Helical Structures Driven by Water or Moisture for Soft Actuators.

Smart actuators that combine excellent mechanical properties and responsive actuating performance like biological muscles have attracted considerable attention. In this study, a water/humidity responsive actuator, consisting of multi-strand carboxyl methyl cellulose (CMC) fibers with helical structures, was prepared using wet-spinning and twisting methods. The results showed that owing to the multi-strand structure, the actuator consisted of one-, two-, three-, and four-strand helical fibers, thus achieving a combination of high strength (∼27 MPa), high toughness (>10.34 MJ/m3), and large load limit (>0.30 N), which enable the actuator to theoretically withstand a weight that is at least 20,000 times its weight. Meanwhile, owing to the excellent moisture-responsive ability of CMC, the actuator, with a 5 g load, could achieve untwisting motion. Additionally, its maximum speed was approximately 2158 ± 233 rpm/m under water stimulation, whereas the recovery speed could reach 804 ± 44 rpm/m. Moreover, this untwisting-recovery reversible process was cyclic, whereas the shape and the actuating speed of the actuator remained stable after more than 150 cycles. The actuator improved the load limit that the fiber could withstand when driving under stimulation, thereby enabling the actuator to lift or move heavy objects like human muscles when executing spontaneously under external stimuli. This result shows considerable potential applications in artificial muscles and biomimetic robots.

The hybrid crosslinking method improved the stability and anti-calcification properties of the bioprosthetic heart valves.

The bioprosthetic heart valves (BHVs) are the best option for the treatment of valvular heart disease. Glutaraldehyde (Glut) is commonly used as the golden standard reagent for the crosslinking of BHVs. However, the obvious defects of Glut, including residual aldehyde toxicity, degradation and calcification, increase the probability of valve failure in vivo and motivated the exploration of alternatives. Thus, the aim of this study is to develop a non-glutaraldehyde hybrid cross-linking method composed of Neomycin Trisulfate, Polyethylene glycol diglycidyl ether and Tannic acid as a substitute for Glut, which was proven to reduce calcification, degradation, inflammation of the biomaterial. Evaluations of the crosslinked bovine pericardial included histological and ultrastructural characterization, biomechanical performance, biocompatibility and structural stability test, and in vivo anti-inflammation and anti-calcification assay by subcutaneous implantation in juvenile Sprague Dawley rats. The results revealed that the hybrid crosslinked bovine pericardial were superior to Glut crosslinked biomaterial in terms of better hydrophilicity, thermodynamics stability, hemocompatibility and cytocompatibility, higher Young's Modulus, better stability and resistance to enzymatic hydrolysis, and lower inflammation, degradation and calcification levels in subcutaneous implants. Considering all above performances, it indicates that the hybrid cross-linking method is appropriate to replace Glut as the method for BHV preparation, and particularly this hybrid crosslinked biomaterials may be a promising candidate for next-generation BHVs.

A Novel Crosslinking Method for Improving the Anti-Calcification Ability and Extracellular Matrix Stability in Transcatheter Heart Valves.

More than 200,000 patients with aortic diseases worldwide undergo surgical valve replacement each year, and transcatheter heart valves (THV) have been more widely used than ever before. However, THV made by the glutaraldehyde (Glut) crosslinking method has the disadvantage of being prone to calcification, which significantly reduces the durability of biomaterials. In this study, we applied a novel crosslinking method using ribose in THV for the first time, which can decrease calcification and increase the stability of the extracellular matrix (ECM). We incubated the bovine pericardium (BP) in ribose solution at 37°C by shaking for 12 days and confirmed that the structure of the BP was more compact than that of the Glut group. Moreover, the ribose method remarkably enhanced the biomechanical properties and provided reliable resistance to enzymatic degradation and satisfactory cellular compatibility in THV. When the BP was implanted subcutaneously in vivo, we demonstrated that ECM components were preserved more completely, especially in elastin, and the immune-inflammatory response was more moderate than that in the Glut treatment group. Finally, the ribose-cross-linked materials showed better anti-calcification potential and improved durability of THV than Glut-cross-linked materials.

Improved Cytocompatibility and Reduced Calcification of Glutaraldehyde-Crosslinked Bovine Pericardium by Modification With Glutathione.

Bioprosthetic heart valves (BHVs) used in clinics are fabricated via glutaraldehyde (GLUT) crosslinking, which results in cytotoxicity and causes eventual valve calcification after implantation into the human body; therefore, the average lifetime and application of BHVs are limited. To address these issues, the most commonly used method is modification with amino acids, such as glycine (GLY), which is proven to effectively reduce toxicity and calcification. In this study, we used the l-glutathione (GSH) in a new modification treatment based on GLUT-crosslinked bovine pericardium (BP) as the GLUT + GSH group, BPs crosslinked with GLUT as GLUT-BP (control group), and GLY modification based on GLUT-BP as the GLUT + GLY group. We evaluated the characteristics of BPs in different treatment groups in terms of biomechanical properties, cell compatibility, aldehyde group content detection, and the calcification content. Aldehyde group detection tests showed that the GSH can completely neutralize the residual aldehyde group of GLUT-BP. Compared with that of GLUT-BP, the endothelial cell proliferation rate of the GLUT + GSH group increased, while its hemolysis rate and the inflammatory response after implantation into the SD rat were reduced. The results show that GSH can effectively improve the cytocompatibility of the GLUT-BP tissue. In addition, the results of the uniaxial tensile test, thermal shrinkage temperature, histological and SEM evaluation, and enzyme digestion experiments proved that GSH did not affect the ECM stability and biomechanics of the GLUT-BP. The calcification level of GLUT-BP modified using GSH technology decreased by 80%, indicating that GSH can improve the anti-calcification performance of GLUT-BP. Compared with GLUT-GLY, GLUT + GSH yielded a higher cell proliferation rate and lower inflammatory response and calcification level. GSH can be used as a new type of anti-calcification agent in GLUT crosslinking biomaterials and is expected to expand the application domain for BHVs in the future.

Vascular endothelial growth factor attenuates neointimal hyperplasia of decellularized small-diameter vascular grafts by modulating the local inflammatory response.

Small-diameter vascular grafts (diameter <6 mm) are in high demand in clinical practice. Neointimal hyperplasia, a common complication after implantation of small-diameter vascular grafts, is one of the common causes of graft failure. Modulation of local inflammatory responses is a promising strategy to attenuates neointimal hyperplasia. Vascular endothelial growth factor (VEGF) is an angiogenesis stimulator that also induces macrophage polarization and modulates inflammatory responses. In the present study, we evaluated the effect of VEGF on the neointima hyperplasia and local inflammatory responses of decellularized vascular grafts. In the presence of rhVEGF-165 in RAW264.6 macrophage culture, rhVEGF-165 induces RAW264.6 macrophage polarization to M2 phenotype. Decellularized bovine internal mammary arteries were implanted into the subcutaneous and infrarenal abdominal aorta of New Zealand rabbits, with rhVEGF-165 applied locally to the adventitial of the grafts. The vascular grafts were removed en-bloc and submitted to histological and immunofluorescence analyses on days 7 and 28 following implantation. The thickness of the fibrous capsule and neointima was thinner in the VEGF group than that in the control group. In the immunofluorescence analysis, the number of M2 macrophages and the ratio of M2/M1 macrophages in vascular grafts in the VEGF group were higher than those in the control group, and the proinflammatory factor IL-1 was expressed less than in the control group, but the anti-inflammatory factor IL-10 was expressed more. In conclusion, local VEGF administration attenuates neointimal hyperplasia in decellularized small-diameter vascular grafts by inducing macrophage M2 polarization and modulating the inflammatory response.

Preparation and Mechanism of Bio-Based Sodium Alginate Fibers with Flame Retardant and Antibacterial Properties.

Flame retardant and antibacterial sodium alginate (SA) fiber were fabricated using the bio-based flame retardant of phytic acid and DL-arginine successively, and then the morphological structures, combustion behavior, thermal stability, and mechanical as well as antibacterial properties of SA fiber were investigated carefully. It is found that when the additional amount of PADL (reaction products of phytic acid and DL-arginine) in SA composite fiber is 20 wt%, its limiting oxygen index (LOI) is 40.0 ± 0.3%, and UL-94 is V-0 grade. The combustion behavior of composite fiber shows that PADL can effectively reduce combustion heat and promote carbon formation. Its peak of HRR (pkHRR) is 5.9% of pure SA fiber, and the residual carbon increases from 23.0 ± 0.1% to 44.2 ± 0.2%. At the same time, the density of the residual carbon increases gradually. PADL can promote SA to form expanded carbon with increasing density, and isolate the heat and volatilization of combustible gases. The guanidine group of DL-arginine can interact with the cell membrane to kill bacteria, and the antibacterial property of SA composite fiber is increased by 30%. This study provides a very ecological, safe, environmentally friendly and simple method to prepare flame retardant and antibacterial SA composite fiber with bio-based materials.

Yak Pericardium as an Alternative Biomaterial for Transcatheter Heart Valves.

Transcatheter aortic valve implantation (TAVI) has received much attention and development in the past decade due to its lower risk of complication and infections compared to a traditional open thoracotomy. However, the current commercial transcatheter heart valve does not fully meet clinical needs; therefore, new biological materials must be found in order to meet these requirements. We have discovered a new type of biological material, the yak pericardium. This current research studied its extracellular matrix structure, composition, mechanical properties, and amino acid content. Folding experiment was carried out to analyze the structure and mechanics after folding. We also conducted a subcutaneous embedding experiment to analyze the inflammatory response and calcification after implantation. Australian bovine pericardium, local bovine pericardium, and porcine pericardium were used as controls. The overall structure of the yak pericardium is flat, the collagen runs regularly, it has superior mechanical properties, and the average thickness is significantly lower than that of the Australian bovine and the local bovine pericardium control groups. The yak pericardium has a higher content of elastic fibers, showing that it has a better compression resistance effect during the folding experiment as well as having less expression of transplantation-related antigens. We conducted in vivo experiments and found that the yak pericardium has less inflammation and a lower degree of calcification. In summary, the yak pericardium, which is thin and strong, has lower immunogenicity and outstanding anti-calcification effects may be an excellent candidate valve leaflet material for TAVI.

Smart Actuators Based on External Stimulus Response.

Smart actuators refer to integrated devices that are composed of smart and artificial materials, and can provide actuation and dampening capabilities in response to single/multi external stimuli (such as light, heat, magnetism, electricity, humidity, and chemical reactions). Due to their capability of dynamically sensing and interaction with complex surroundings, smart actuators have attracted increasing attention in different application fields, such as artificial muscles, smart textiles, smart sensors, and soft robots. Among these intelligent material, functional hydrogels with fiber structure are of great value in the manufacture of smart actuators. In this review, we summarized the recent advances in stimuli-responsive actuators based on functional materials. We emphasized the important role of functional nano-material-based additives in the preparation of the stimulus response materials, then analyzed the driving response medium, the preparation method, and the performance of different stimuli responses in detail. In addition, some challenges and future prospects of smart actuators are reported.

Preparation and thermal cross-linking mechanism of co-polyester fiber with flame retardancy and anti-dripping by in situ polymerization.

Extensive research has been conducted on polyester flame retardants and anti-droplet modifications in recent years. The conventional methods used to improve the effectiveness of the anti-droplet modifications usually involve improving the melt fluidity and the combustion char formation through reactive cross-linking. However, these methods, while reducing the droplets, may produce more smoke. This study proposes a combustion cross-linking method which avoids the droplet and flame retardancy synergistic modification problem. Based on the flame retardancy of polyester, anti-droplet properties were realized using a collaborative cross - linking structure formed by a phosphorus - containing flame - retardant group and acid silicon solvent to achieve a flame retardant and anti-droplets result. The results show that the phosphorus-silicon copolyester presents an enhancement effect for flame retardancy, confirmed by obvious reductions in the peak value of heat release rate (78.4%) and total heat release (44.2%). Meanwhile, the total smoke release and smoke product rate of phosphorus-silicon copolyester are decreased by 45.1% and 41.5%, respectively. And the phosphorus-silicon copolyester has a high LOI value of 34.8 ± 0.1% and UL-94 is V-0 rating with superior anti-dripping performance. Flame retardancy index (FRI) of the copolyesters containing phosphorus-silica are up to 4.3093 (good flame retardancy). Nonisothermal differential scanning calorimetry (DSC) was performed for qualitative analysis of network formation by the aid of Cure Index (CI) dimensionless criterion. It was observed that the acidic silica led to Excellent cure situation. The TG-DSC, XPS, and FTIR results validate the thermal cross-linking ability of the copolymer due to the synergistic cross-linking effect between the self-cross-linking characteristic of the catalysed acidic silica sol containing the phosphorus flame retardant. The SEM-EDX and Raman results further verify the effectiveness of the condensed-phase flame-retardant mechanism. Phosphorus-silicon copolyester has good spinnability, flame retardancy and anti-droplets properties. Which provides a simple method for preparing polyester by using this combustion synergistic crosslinking effect to achieve flame retardant and anti-dripping modification of copolymers.

Preparation, filtration, and photocatalytic properties of PAN@g-C3N4 fibrous membranes by electrospinning.

Particulate matter and formaldehyde (HCHO) in closed indoor environments are seriously harmful to human health; hence, techniques for the improvement of air quality have attracted significant attention. PAN@g-C3N4 fibrous membranes with high efficiency, low resistance, and photocatalytic activity were prepared by electrospinning with polyacrylonitrile (PAN) and graphite carbon nitride (g-C3N4), followed by the high-temperature polycondensation of melamine. The addition of g-C3N4 to the nanofibrous membrane effectively improved the filtration efficiency of PM2.5. When the amount of added g-C3N4 was 3 wt%, the filtration efficiency of PM2.5 was 99.76 ± 0.3%, the filtration efficiency was stable for 24 hours at a continuous high concentration, and the filtration cycle stability was good. As a photocatalytic material, g-C3N4 causes the photocatalytic degradation of HCHO, and thus, significantly improves the filtration efficiency of the nanofibrous membrane to HCHO. When the amount of added g-C3N4 was 3 wt%, the filtration efficiency of the nanofibrous membrane to HCHO reached 78.0 ± 1.8%. The mechanism of catalytic degradation showed that the PAN fibres first adsorbed and intercepted the HCHO molecules. Under simulated sunlight irradiation, the photogenerated holes generated by the g-C3N4 nanosheets in the fibres oxidised and decomposed the adsorbed HCHO molecules. This study has broad application potential for high-efficiency filters to improve indoor air quality.

Prenatal counseling in cardiac surgery: A report of 225 fetuses with congenital heart disease. / 心外科产前咨询225ä¾‹å ˆå¤©æ€§å¿ƒè„ç— èƒŽå„¿.

OBJECTIVES: To explore the method and significance of prenatal counseling in cardiac surgery for fetal congenital heart disease (CHD). METHODS: The prenatal counseling should be provided by experienced CHD experts. The preliminary clinical diagnosis based on relevant data was carried out, the prognosis risk for fetal CHD was graded, and the pathophysiological process and potential hazards of the disease were analyzed. The current condition of CHD in the treatment plan, the long-term quality of life, and the special requirements of parturition in place, period and mode were described. A reliable follow-up system of the fetuses was established, the diagnosis after delivery was verified, and surgical treatment was carried out timely. RESULTS: From January 2016 to December 2018, 225 parents with fetal CHD received prenatal counseling, including 60 fetuses (26.7%) with simple CHD and 165 (73.3%) with complex CHD, among which 59 cases (98.3%) and 93 cases (56.4%) decided to continue the pregnancy, respectively. During the follow-up, 118 fetuses were born, of which 66 infants received surgical treatment within 6 months after birth, 63 infants (95.5%) recovered and 3 infants (4.5%) died. The rest 52 infants continued to be followed up. CONCLUSIONS: The prenatal counseling for fetal CHD can provide the parents a comprehensive medical information about CHD, which is beneficial to making appropriate pregnancy decisions, and can turn the fetuses from unreasonable birth and passive treatment to selective birth and active treatment in CHD.

Flexible conductive polypyrrole nanocomposite membranes based on bacterial cellulose with amphiphobicity.

Flexible conductive polypyrrole nanocomposite membranes based on bacterial cellulose (BC) with amphiphobicity have been successfully prepared through in situ chemical synthesis and then infiltrated with polysiloxane solution. The results suggested that polypyrrole (PPy) nanoparticles deposited on the surface of BC formed a continuous core-shell structure by taking along the BC template. After modification with polysiloxane, the surface characteristics of the conductive BC membranes changed from highly hydrophilic to hydrophobic. The AFM images revealed that the roughness of samples after polysiloxane treatment increased along with the increase of pyrrole concentration. The contact angles (CAs) data revealed that the highest water contact angle and highest oil contact angle are 160.3° and 136.7°, respectively. The conductivity of the amphiphobic membranes with excellent flexibility reached 0.32 S/cm and demonstrated a good electromagnetic shielding effectiveness with an SE of 15 dB which could be applied in electromagnetic shielding materials with self-cleaning properties. It opened a new field of potential applications of BC materials.