Targeting HSP47 for cancer treatment.

Heat shock protein 47 (HSP47) serves as an endoplasmic reticulum residing collagen-specific chaperone and plays an important role in collagen biosynthesis and structural assembly. HSP47 is encoded by the SERPINH1 gene, which is located on chromosome 11q13.5, one of the most frequently amplified regions in human cancers. The expression of HSP47 is regulated by multiple cellular factors, including cytokines, transcription factors, microRNAs, and circular RNAs. HSP47 is frequently upregulated in a variety of cancers and plays an important role in tumor progression. HSP47 promotes tumor stemness, angiogenesis, growth, epithelial-mesenchymal transition, and metastatic capacity. HSP47 also regulates the efficacy of tumor therapies, such as chemotherapy, radiotherapy, and immunotherapy. Inhibition of HSP47 expression has antitumor effects, suggesting that targeting HSP47 is a feasible strategy for cancer treatment. In this review, we highlight the function and expression of regulatory mechanisms of HSP47 in cancer progression and point out the potential development of therapeutic strategies in targeting HSP47 in the future.

When transition-metal catalysis meets electrosynthesis: a recent update.

While aiming at sustainable synthesis, organic electrosynthesis has attracted increasing attention in the past few years. In parallel, with a deeper understanding of catalyst and ligand design, 3d transition-metal catalysis allows the conception of more straightforward synthetic routes in a cost-effective fashion. Owing to their intrinsic advantages, the merger of organic electrosynthesis with 3d transition-metal catalysis has offered huge opportunities for conceptually novel transformations while limiting ecological footprint. This review summarizes the key advancements in this direction published in the recent two years, with specific focus placed on strategy design and mechanistic aspects.

Exposure Order to Photoaging and Humic Acids Significantly Modifies the Aggregation and Transformation of Nanoplastics in Aqueous Solutions.

The colloidal stability of nanoplastics in aqueous solutions is greatly regulated by photoaging and dissolved organic matter (DOM). However, how the exposure order to sunlight and DOM modifies the environmental behavior of nanoplastics is seldomly determined. Here, with two different exposure orders, we investigated the impact of molecular-weight (MW)-fractionated humic acids (HAs) derived from biochar and the Suwannee River, respectively, on the aggregation of poly(ethylene terephthalate) nanoplastics (PET-NPs) in mono- and divalent electrolyte solutions. For exposure pattern (i) (photoaging followed by HA coating), photoaged PET-NPs had more oxidized surfaces and exhibited 22-320% higher binding affinity to HAs (especially the higher MW fractions) than the pristine counterparts, which greatly improved the dispersion of PET-NPs. For exposure pattern (ii) (HA coating followed by photoaging), HA-PET assemblies were formed, the dispersion of which increased with increasing irradiation time and was significantly higher than that of the samples in the exposure pattern (i) at the end of the experiment. This high dispersion of photoaged HA-PET assemblies was ascribed to the extra oxidation of PET by reactive oxygen species generated in the PET-HA interfaces during photoaging. These findings highlight the "active nature" of HA-PET assemblies, which provide new insight into the reaction of HA with nanoplastics beyond adsorption in the natural environment.

Unraveling the critical role of iron-enriched sludge hydrochar in mediating the Fenton-like oxidation of triclosan.

The traditional Fenton system is subject to the low efficiency of the Fe(III)/Fe(II) conversion cycle, with significant attempts made to improve the oxidation efficiency by overcoming this hurdle. In support of this goal, iron-enriched sludge-derived hydrochar was prepared as a high-efficiency catalyst by one-step hydrothermal carbonization and its performance and mechanisms in mediating the oxidation of triclosan were explored in the present study. The hydrochar prepared at 240 °C for 4 h (HC240-4) had the highest removal of triclosan (97.0%). The removal of triclosan in the HC240-4/H2O2 system was greater than 90% in both acidic and near-neutral environments and remained as high as 83.5% after three cycles, indicating the broad pH applicability and great recycling stability of sludge-derived hydrochar in Fenton-like systems. H2O2 was activated by both persistent free radicals (PFRs; 19.7%) and iron (80.3%). The binding of Fe(III) to carboxyl decreased the electron transfer energy from H2O2 to Fe(III), making its degradation efficiency 2.6 times greater than that of the conventional Fenton reaction. The study provides a way for iron-enriched sludge utilization and reveals a role for hydrochar in promoting iron cycling and electron transfer in the Fenton reaction.

Particle size of biochar significantly regulates the chemical speciation, transformation, and ecotoxicity of cadmium in biochar.

The pyrolysis of biomass containing excessive heavy metals is likely to produce heavy metal contaminated biochar (BC). Although multiple lines of evidence indicate that higher charring temperature leads to enhanced immobilization of heavy metals in BC, we find that particle size could also play a critical role in the content of heavy metals in BC and BC ecotoxicity. Here, BC derived from cadmium (Cd) enriched rice straw was prepared at different temperatures (300-600 °C) and divided into macro-, colloidal-, and nano-sized fractions, respectively. The content and chemical forms of Cd in BC fractions as well as related algal toxicity were examined. The results show that for the same temperature BC the content of Cd followed an order of colloidal-BC > macro-BC > nano-BC; and the residual fractions of Cd significantly decreased (3.47-16.08%) while that of acid soluble and reducible fractions significantly increased (4.13-16.51% and 0.24-1.71%, respectively) with decreasing particle size of BC. Consistently, colloidal-BC exhibited the highest ecotoxicity for Scenedesmus obliquus. The acid soluble fractions of Cd in macro- and colloidal-BC played a dominating role in their algal toxicity (p < 0.05). However, the ecotoxicity of nano-BC was more dependent on the total content of Cd than specific fractions probably due to the phagocytosis by algal cells. These results indicate that the chemical forms and ecotoxicity of Cd in BC could be remarkably modified by its particle size, which has profound implications for understanding the behavior and potential risk of heavy metal contaminated BC in the environment.

Pneumomediastinum and subcutaneous emphysema secondary to dental extraction: Two case reports.

BACKGROUND: Dental extraction is a common operation in oral surgery and is usually accompanied by pain, swelling, and local infection. The application of high-speed air turbines increases the comfort of alveolar surgery and makes it more minimally-invasive. However, high-speed gas can enter the subcutaneous tissue of the face and neck or even the chest and mediastinum, which is a serious iatrogenic complication. CASE SUMMARY: We describe two cases of severe subcutaneous and mediastinal emphysema caused by high-speed turbine splitting during dental extraction. The first case involved a 34-year-old man who complained of swelling of the face, mild chest tightness, and chest pain after dental extraction. Computed tomography (CT) scan showed a large amount of gas in the neck, chest wall, and mediastinum. The second case involved a 54-year-old woman who complained of swelling and pain of the neck after dental extraction. CT showed a large amount of gas collected in the neck and mediastinum. Both of them used high-speed turbine splitting during dental extraction. CONCLUSION: High-speed turbine splitting during dental extraction may lead to severe subcutaneous and mediastinal emphysema. Dentists should carefully operate to avoid emphysema. If emphysema occurs, CT can be used to improve the diagnosis. The patient should be informed, and the complications dealt with carefully.

Nanoscale Iron trioxide catalyzes the synthesis of auxins analogs in artificial humic acids to enhance rice growth.

Humic acids (HAs), kinds of valuable active carbon, are critical for improving soil fertility. However, the majority of soils are poor in HAs, arousing the development of artificial HAs. In this study, two iron-based catalysts (nanoscale iron trioxide (nFe2O3) and FeCl3) were used to catalyze the hydrothermal humification of waste corn straw. With the help of ultra-performance liquid chromatography-mass spectrometry, we proposed the specific humification process with the action of catalysis for the first time, which is of great significance for the design, synthesis and application of artificial HAs in the future. Moreover, the growth-promoting effect and mechanisms of the artificial HAs were determined by rice planting in a greenhouse. Results showed that compared to no catalyst treatment, the FeCl3 and nFe2O3 catalysts increased the decomposition rate of macromolecular biomass by 39 and 14 %, respectively, increasing the yield of artificial HAs. During the humification process, nFe2O3 catalysts benefit the formation of many aromatic structure monomers including furfural and hydroxycaproic acids. These monomers were condensed into growth hormone analogs such as vanillin and methionine sulfoxide and were further built in the artificial HAs. Therefore, the artificial HAs from nFe2O3 catalytic treatment promoted the rice growth the best, showing that the resultant germination rate, root activity, and photosynthetic rate of rice increased by 50, 167, and 72 %, respectively; moreover, the uptake and accumulation of water and nutrient by roots as well as the contents of soluble protein and sugar of rice are also significantly increased. This could be ascribed to the upregulated expression of functional genes including OsRHL1, OsZPT5-07, OsSHR2 and OsDCL. Considering both the economic and environmental benefits, we suggested that the artificial HAs, especially that produced with the action of nFe2O3 catalysis, are promising in alleviating environmental stress from waste biomass and sustainably improving agricultural production.

Effect of root exudates on the release, surface property, colloidal stability, and phytotoxicity of dissolved black carbon.

In this study, the release of dissolved black carbon (DBC) from bulk-BC, its surface properties, colloidal stability, and oxidative stress to rice seedlings in the presence and absence of rice root exudates were compared. The bulk-BCs were prepared at 550 °C and derived from wood chips and pig manure, respectively. The release of DBC from bulk-BC was significantly enhanced (20.19-23.63%) by the introduction of root exudates, where low molecular weight organic acids played a dominating role in the dissociation of DBC from carbon skeleton. The surface properties of DBC were greatly modified by root exudates including decreases in the surface area (18.13%) and mineral contents (43.90-69.57%). The O-containing groups and graphitization were also enhanced by 11.46% and 18.65%, respectively. Meanwhile, the presence of root exudates not only reduced the colloidal stability of DBC but also lowered the intensity of free radicals (19.44-22.22%) in DBC. Consequently, the oxidative stress of DBC to rice seedlings was significantly (p < 0.05) alleviated, evidenced by reduced antioxidative enzyme activities (5.67-29.25%) and soluble protein content (15.75-46.79%) in rice plants. These results indicate that the interaction between DBC and root exudates could remarkably modify the surface properties and reactivity of DBC, which has profound implications for understanding the behavior and functions of DBC in the environment.

Early-phase insulin hypersecretion associated with weight loss outcome after LSG: a prospective cohort study in Asian patients with BMI ≥28 kg/m2.

BACKGROUND: Obesity has become a global problem that poses a serious threat to human health. Laparoscopic sleeve gastrectomy (LSG) is an effective long-term treatment. However, the weight loss of some patients after LSG is still insufficient. It is necessary to investigate the factors associated with inadequate weight loss after LSG. OBJECTIVE: The objective of this study was to explore whether preoperative insulin secretion could be associated with weight loss after LSG in patients with obesity. SETTING: This is a single-center prospective cohort study conducted in a university hospital. METHODS: Patients from a prospective database who underwent LSG were analyzed. All 178 participants underwent a 75-g oral glucose tolerance test (OGTT) to assess preoperative insulin and c-peptide secretion before LSG. The areas under the curve (AUCs) for glucose, insulin, and c-peptide were determined in the OGTT. The percentage of excess weight loss (%EWL) and the percentage of total weight loss (%TWL) were used to estimate the effect of weight loss after LSG. Regression models were used to assess the correlation between preoperative insulin and c-peptide secretion with %EWL ≥75% and TWL ≥35% at 12 months after LSG. RESULTS: The AUCs of insulin and c-peptide were significantly lower in the %EWL ≥75% and %TWL ≥35% groups at 0-30 minutes, 0-60 minutes, and 0-120 minutes during the OGTT. At 30, 60, and 120 minutes during the OGTT, c-peptide levels were significantly lower in the %EWL ≥75% group and %TWL ≥35% group. The preoperative c-peptide level at 30 minutes during the OGTT (C30) was significantly negatively correlated with %EWL (ß = -.37, P < .001) and %TWL (ß = -.28, P = .011). Univariate logistic regression analysis showed that preoperative C30 was associated with %EWL ≥75% and %TWL ≥35% after LSG. According to multiple logistic regression analysis, patients with a low preoperative C30 had an 8-fold higher %TWL ≥35% after LSG than those with a high C30 (odds ratio: 8.41 [95% confidence interval: 1.46-48.58], P = .017). Similarly, patients with a low preoperative C30 had a 7-fold higher EWL% ≥75% after LSG than patients with a high C30 (odds ratio: 7.25 [95% confidence interval: 1.11-47.50], P = .039). CONCLUSIONS: The rate of weight loss after LSG is low among patients with preoperative hyperinsulinemia. The preoperative c-peptide level at 30 minutes during the OGTT is associated with weight loss after LSG.

Novel Insights into the Impact of Nano-Biochar on Composition and Structural Transformation of Mineral/Nano-Biochar Heteroaggregates in the Presence of Root Exudates.

Multiple lines of existing evidence indicate that natural organic matter (NOM) could protect poorly crystalline Fe(III) (oxyhydr)oxides from Fe(II)-catalyzed mineral transformation. Conversely, we find that nano-sized biochar (nano-BC), a pyrogenic form of NOM, promotes the phase transformation of ferrihydrite (Fh) in nano-BC/Fh heteroaggregates in the presence of aqueous Fe(II) and rice root exudates. The nano-BC/Fh heteroaggregates are composed of a core-shell like structure where the inner-layered nano-BC is more compacted and plays the dominant role in accelerating the phase transformation of Fh relative to that in the outer sphere. The extent of phase transformation is more regulated by the reversible redox reactions between quinone and hydroquinone in nano-BC than the electron transfer via its condensed aromatic structures. Furthermore, the reductive organic acids in root exudates contribute to the mineral transformation of nano-BC/Fh associations by donating electrons to Fe(III) through nano-BC. Our results suggest that heteroaggregates between nano-BC and Fe minerals are subjected to partial dissociation during their co-transport, and the stably attached nano-BC is favorable to the phase transformation of poorly crystalline Fe minerals (e.g., Fh), which might have profound implications on biogeochemical cycles of carbon and Fe in the prevailing redox environments.

Systematic Research on the Transport of Ball-Milled Biochar in Saturated Porous Media: Effect of Humic Acid, Ionic Strength, and Cation Types.

Ball-milled biochar (BMBC) is a typical engineering material that has promising application prospects in remediating contaminated soil and water. It is fundamental to rate the transport behaviors of BMBC in the underground environment before extensive use. In this study, the effects of the ubiquitous cations (Na+, Mg2+, and Al3+) and model organic matter (humic acid) on the transport of BMBC were investigated using laboratory column experiments. The results demonstrated the facilitated effect of HA on the transport of BMBC due to the negatively charged surface and steric effect under neutral conditions. HA and ionic strength manifested an antagonistic effect on the transport of BMBC, where the presence of one could weaken the effect from the other. We also found the charge reversal of the BMBC surface in the presence of Mg2+, thus enhancing the deposition of BMBC onto the medium surface. On the other hand, the charge reversal from Al3+-coupled acid conditions led to the restabilization and transport of BMBC in porous media. Therefore, the rational usage of BMBC is indispensable and more attention should be paid to the composition and change in underground water that might facilitate the transport of BMBC and thus lead to negative environmental implications.

Potential toxicity of nanoplastics to fish and aquatic invertebrates: Current understanding, mechanistic interpretation, and meta-analysis.

Nanoplastics (NPs) are widely detected in aquatic ecosystems and attracting considerable attention. Although ecotoxicological impacts of NPs on aquatic biota are increasingly identified, the extent and magnitude of these detrimental effects on fish and aquatic invertebrates still lack systematic quantification and mechanistic interpretation. Here, the toxicity, influencing factors, and related mechanisms of NPs to fish and aquatic invertebrates are critically reviewed and summarized based on a total of 634 biological endpoints through a meta-analysis, where five vital response categories including growth, consumption, reproduction, survival, and behavior were emphasized to elucidate the negative impacts of NPs to fish and aquatic invertebrates from physiological to molecular levels. Our results revealed that NPs significantly decreased the survival, behavior, and reproduction of fish and/or aquatic invertebrates by 56.1%, 24.2%, and 36.0%, respectively. NPs exposure increased the oxidative stress and oxidative damage by 72.0% and 9.6%, respectively; while significantly decreased antioxidant prevention system and neurotransmission by 24.4% and 15.9%, respectively. Also, the effects of particle size, functional group, and concentration range of NPs on the physiological and biochemical reactions in the living organisms were discussed. This information is helpful to more accurately understanding the underlying toxic mechanisms of NPs to aquatic biota and guiding future studies.

PAI-1 induction during kidney injury promotes fibrotic epithelial dysfunction via deregulation of klotho, p53, and TGF-ß1-receptor signaling.

Renal fibrosis leads to chronic kidney disease, which affects over 15% of the U.S. population. PAI-1 is highly upregulated in the tubulointerstitial compartment in several common nephropathies and PAI-1 global ablation affords protection from fibrogenesis in mice. The precise contribution of renal tubular PAI-1 induction to disease progression, however, is unknown and surprisingly, appears to be independent of uPA inhibition. Human renal epithelial (HK-2) cells engineered to stably overexpress PAI-1 underwent dedifferentiation (E-cadherin loss, gain of vimentin), G2/M growth arrest (increased p-Histone3, p21), and robust induction of fibronectin, collagen-1, and CCN2. These cells are also susceptible to apoptosis (elevated cleaved caspase-3, annexin-V positivity) compared to vector controls, demonstrating a previously unknown role for PAI-1 in tubular dysfunction. Persistent PAI-1 expression results in a loss of klotho expression, p53 upregulation, and increases in TGF-ßRI/II levels and SMAD3 phosphorylation. Ectopic restoration of klotho in PAI-1-transductants attenuated fibrogenesis and reversed the proliferative defects, implicating PAI-1 in klotho loss in renal disease. Genetic suppression of p53 reversed the PA1-1-driven maladaptive repair, moreover, confirming a pathogenic role for p53 upregulation in this context and uncovering a novel role for PAI-1 in promoting renal p53 signaling. TGF-ßRI inhibition also attenuated PAI-1-initiated epithelial dysfunction, independent of TGF-ß1 ligand synthesis. Thus, PAI-1 promotes tubular dysfunction via klotho reduction, p53 upregulation, and activation of the TGF-ßRI-SMAD3 axis. Since klotho is an upstream regulator of both PAI-1-mediated p53 induction and SMAD3 signaling, targeting tubular PAI-1 expression may provide a novel, multi-level approach to the therapy of CKD.

Photochemical Transformation and Catalytic Activity of Dissolved Black Nitrogen Released from Environmental Black Carbon.

Biomass combustion results in the formation and wide distribution of black carbon (BC) in soils, wherein the dissolved fractions are among the most active components. Although the presence of dissolved black nitrogen (DBN) in BC has been identified, its environmental behavior and implication are not understood. This study investigated the photochemical transformation and catalytic activity of DBN under simulated solar irradiation. DBN is more easily transformed than dissolved BC due to its photoactive heteroaromatic N structure, and the half-life of DBN produced at 500 °C (8.6 h) is two times shorter than that of the dissolved BC counterpart (23 h). Meanwhile, solar irradiation is favorable for the homoaggregation of DBN. During irradiation, DBN generates not only reactive oxygen species (e.g., 1O2, O2-, and •OH) but also reactive nitrogen species (mainly •ON), which account for its higher photocatalytic degradation of bisphenol A than dissolved BC. These findings shed new light on the impact of heteroatoms on the phototransformation and activity of BC as well as cycling of N in terrestrial systems.

Silicon combined with foliar melatonin for reducing the absorption and translocation of Cd and As by Oryza sativa L. in two contaminated soils.

Potentially toxic elements (PTE) toxicity has serious effects for human health. Si has been tested to investigate their ability to mitigate Cd and As contamination of rice. In this study, the combined effect of Si and melatonin (MT) on Cd and As uptake and transport in rice plants is tested in two contaminated soils via controlled pot experiments. Results showed that a combined Si and MT treatment (Si + MT) was more effective at reducing Cd and As uptake and transport than Si alone. The treatment had the strongest effect on Cd concentrations in rice grains from high-polluted soil (HP) when treated at the flowering stage (81.8% reduction) and from low-polluted soil (LP) at the tillering stage (TS, 64.9%). The greatest reduction of grain As was found when treated at TS in both soils, by 58.2% and 39.2% in HP and LP soil, respectively. The significant upregulation of CAT, SOD, and POD activities, and downregulation of MDA by Si + MT was more effective than that of Si alone; Si + MT significantly decreased expressions of Nramp1, HMA2, and IRT2 in roots in both soils, and also Nramp5, HMA3, and IRT1 in LP soil, which might result in Si+MT effect on Cd and As accumulation. However, Si + MT had little effect on the amino acid content of grains compared to Si alone. Overall, the combination of Si and MT was substantially more effective at reducing Cd and As uptake and transport than Si alone, especially in HP soil. This effect might result from the regulation of antioxidant potential and gene expression relating Cd uptake and transport.

Indirect Electrosynthesis with Halogen Ions as Mediators.

Organic electrosynthesis has gained increasing research interest as it harvests electric current as redox regents, thereby providing a sustainable alternative to conventional approaches. Compared with direct electrosynthesis, indirect electrosynthesis employs mediator(s) to lower the overpotentials for substrate activation, and enhance the reaction efficiency and functional group compatibility by shifting the heterogenous electron transfer process to be homogenous. As one of the most versatile and cost-efficient mediators, halogen mediators are always combined with an irreversible halogenation reaction. Thus, the electrochemical reaction between halogen mediators and substrates doesn't directly controlled by the two standard potentials difference. In this account, our recent developments in the area of halogen-mediated indirect electrosynthesis are summarized. The anodically generated halogen species from halogenide salts have the abilities to undergo electron-transfer (ET) or hydrogen-atom- transfer (HAT) processes. The reaction features, scopes, limitations, and mechanistic rationalisations are discussed in this account. We hope our studies will contribute to the future developments to broaden the scope of halogen-mediated electrosynthesis.

A Case of Ewing Sarcoma of the Bladder Presenting in Early Infancy.

A 6-week-old female presented with gross hematuria and was diagnosed with Ewing sarcoma of the bladder through ultrasound and cystoscopic biopsies, along with a negative metastatic workup. She was treated with transurethral resection, chemotherapy consisting of with vincristine, cycolphosphamide, doxorubicin, ifosfamide and etoposide, and partial cystectomy. After completing chemotherapy, the patient has been doing well with no evidence of disease. There have been 14 other cases, 4 pediatric, of Ewing sarcoma of the bladder reported. To our knowledge, our case is the youngest patient reported with this disease.

CuO nanoparticles doping recovered the photocatalytic antialgal activity of graphitic carbon nitride.

In this work, graphitic carbon nitride (g-C3N4) and CuO nanoparticles doped g-C3N4 (Cu-g-C3N4) was synthesized, and the mechanisms of humic acid (HA) impact on the photocatalytic antialgal activities of g-C3N4 and Cu-g-C3N4 to harmful algae were investigated. The 72 h median effective concentrations of g-C3N4 and Cu-g-C3N4 to two algae (Microcystis aeruginosa, Chlorella vulgaris) were (56.4, 89.6 mg/L) and (12.5, 20.6 mg/L), respectively. Cu-g-C3N4 exhibited higher photocatalytic antialgal activity than g-C3N4 because that: I) Cu-g-C3N4 was easier to aggregate with algal cells due to its lower surface potential and higher hydrophobicity than g-C3N4; II) Cu-g-C3N4 generated more O2-, OH*, and h+ due to its higher full-wavelength light utilization efficiency and higher electron-hole pairs separation efficiency than g-C3N4. HA (10 mg/L) inhibited the photocatalytic antialgal activity of g-C3N4, however, HA had no effect on that of Cu-g-C3N4. The mechanisms were that: I) doped CuO nanoparticles occupied the adsorption sites of HA on g-C3N4, which alleviated the inhibition of HA on the g-C3N4-algae heteroaggregation; II) HA adsorbed on CuO nanoparticles enhanced the oxygen reduction rate of Cu-g-C3N4. This work provides new insight into the inhibition mechanisms of NOM on g-C3N4 photocatalytic antialgal activity and addresses the optimization of g-C3N4 for environmental application.

Readability Metrics of Provider Postoperative Handouts in Urology.

OBJECTIVE: To examine the readability of postoperative urology handouts and assess for areas of improvement. We hypothesize that the majority of provider handouts exceed the National Institutes of Health recommendation of writing at a sixth-grade reading level. METHODS: We reviewed 238 postoperative patient handouts in the public domain representing United States academic and private practices. All handouts were categorized and re-formatted into text-only using Microsoft Word. A median reading grade was calculated using the Readability.io web application using Flesch-Kincaid Grade Level, Gunning Fog index, Coleman-Liau index, Simple Measure of Gobbledygook, and Automated-Reading Index. Word count was also assessed. RESULTS: Provider handouts were written at a median 9.3 grade reading level (range 5.8-14, IQR 8.45-10). A total of 15 (6.8%) handouts were written at a sixth-grade reading level, with only 1 (0.4%) handout written below the target. Six (2.7%) handouts were written at college-level. There were no significant differences between different subspecialties. Median word count was 509 (range 90-3796, IQR 361-738). Although a high word count may make it more difficult for patients to follow suggestions, the readability of each handout did not correlate with word count. CONCLUSIONS: Our data show that over 93% of analyzed handouts failed to meet National Institutes of Health recommendations for grade level. Longer word counts did not correlate with higher reading levels. It will be important to assess patient satisfaction with handouts and to correlate the complexity of postoperative handouts with outcome, such as unplanned phone calls and unscheduled visits.

Size Matters: Nano-Biochar Triggers Decomposition and Transformation Inhibition of Antibiotic Resistance Genes in Aqueous Environments.

Antibiotic resistance genes (ARGs) are considered to be a type of emerging contaminant; their interaction with biochar (BC) could affect their dissemination and fate in the environment. Although adsorption of ARGs onto bulk-BC has been reported, the interaction with nanosized BC (nano-BC) is largely unknown. In this study, the interactions of a model extracellular DNA (eDNA, calf thymus DNA) and two typical ARGs (ampC and ermB) extracted from a natural river with bulk- and nano-BCs from two pyrolysis temperatures (400 and 700 °C) were investigated. Only adsorption was observed on bulk-BCs, while not only adsorption but also fragmentation of these eDNA molecules was found to occur on nano-BCs. Also, their replication was greatly inhibited by nano-BCs. The electron paramagnetic resonance results indicated that hydroxyl radicals produced from persistent free radicals (PFRs) on nano-BCs played a major role in the damage of eDNA. Moreover, the direct contact with nonradical reacting sites and PFRs on nano-BCs also contributed to the decay of eDNA. Comparatively, PFRs in bulk-BCs were difficult to be reached by eDNA because of steric hindrance and played a negligible role in destroying eDNA. These findings highlight the importance of the size effect in evaluating the reactivity and related environmental risks of PFRs on BC and improve our understanding on the interaction between ARGs and BC.