3D printed PEDOT:PSS-based conducting and patternable eutectogel electrodes for machine learning on textiles.

The proliferation of medical wearables necessitates the development of novel electrodes for cutaneous electrophysiology. In this work, poly(3,4-ethylenedioxythiophene) polystyrene sulfonate (PEDOT:PSS) is combined with a deep eutectic solvent (DES) and polyethylene glycol diacrylate (PEGDA) to develop printable and biocompatible electrodes for long-term cutaneous electrophysiology recordings. The impact of printing parameters on the conducting properties, morphological characteristics, mechanical stability and biocompatibility of the material were investigated. The optimised eutectogel formulations were fabricated in four different patterns -flat, pyramidal, striped and wavy- to explore the influence of electrode geometry on skin conformability and mechanical contact. These electrodes were employed for impedance and forearm EMG measurements. Furthermore, arrays of twenty electrodes were embedded into a textile and used to generate body surface potential maps (BSPMs) of the forearm, where different finger movements were recorded and analysed. Finally, BSPMs for three different letters (B, I, O) in sign-language were recorded and used to train a logistic regressor classifier able to reliably identify each letter. This novel cutaneous electrode fabrication approach offers new opportunities for long-term electrophysiological recordings, online sign-language translation and brain-machine interfaces.

Direct ink writing of PEDOT eutectogels as substrate-free dry electrodes for electromyography.

Deep Eutectic Solvents (DES) are a new class of ionic conductive compounds attracting significant attention as greener alternatives to costly ionic liquids. Herein, we developed novel mixed ionic-electronic conducting materials by simple mixing of poly(3,4-ethylenedioxythiophene)/poly(styrenesulfonate) (PEDOT:PSS) and various DES as additives. The DES addition induces the supramolecular assembly and gelification of PEDOT:PSS forming eutectogels triggered by extensive hydrogen bonding and charge stabilization. The eutectogels feature boosts the mixed ionic-electronic conductivity of PEDOT:PSS up to 368 S cm-1, unveiling great potential as flexible bioelectronics. All the PEDOT:PSS/DES gels showed shear-thinning behavior and viscosity values ranging from 100 to 1000 Pa s. The eutectogels show good injectability with almost instantaneous elastic recovery, making them ideal materials for direct ink writing (DIW). As proof of that, PEDOT:PSS/DES (choline chloride:lactic acid) was 3D printed in different patterns, annealed at high temperature, and assembled into adhesive electrodes. This way tattoos-like electrodes, denoted as Eutecta2 were fabricated and placed in vivo on the forearm and the thumb of human volunteers for electromyography measurements. Eutecta2 hexagonal patterns showed excellent conformability, and their signal-to-noise ratio (SNR) was higher than Ag/AgCl commercial electrodes for thumb motion measurements. Furthermore, forearm motion was measured after 14 days with similar values of SNR, demonstrating long-term stability and reusability. All in all, our findings revealed that DES could be used as inexpensive and safe additives to direct the self-assembly of PEDOT:PSS into supramolecular eutectogels inks for flexible bioelectronics.

Polyphenol Iongel Patches with Antimicrobial, Antioxidant and Anti-Inflammatory Properties.

There is an actual need for developing materials for wound healing applications with anti-inflammatory, antioxidant, or antibacterial properties in order to improve the healing performance. In this work, we report the preparation and characterization of soft and bioactive iongel materials for patches, based on polymeric poly(vinyl alcohol) (PVA) and four ionic liquids containing the cholinium cation and different phenolic acid anions, namely cholinium salicylate ([Ch][Sal]), cholinium gallate ([Ch][Ga]), cholinium vanillate ([Ch][Van]), and cholinium caffeate ([Ch][Caff]). Within the iongels, the phenolic motif in the ionic liquids plays a dual role, acting as a PVA crosslinker and a bioactive compound. The obtained iongels are flexible, elastic, ionic conducting, and thermoreversible materials. Moreover, the iongels demonstrated high biocompatibility, non-hemolytic activity, and non-agglutination in mice blood, which are key-sought material specifications in wound healing applications. All the iongels have shown antibacterial properties, being PVA-[Ch][Sal], the one with higher inhibition halo for Escherichia Coli. The iongels also revealed high values of antioxidant activity due to the presence of the polyphenol, with the PVA-[Ch][Van] iongel having the highest activity. Finally, the iongels show a decrease in NO production in LPS-stimulated macrophages, with the PVA-[Ch][Sal] iongel displaying the best anti-inflammatory activity (>63% at 200 µg/mL).

Ascidian-Inspired Supramolecular Cellulose Nanocomposite Hydrogels with Antibacterial Activity.

The design of ultratough hydrogels has recently emerged as a topic of great interest in the scientific community due to their ability to mimic the features of biological tissues. An outstanding strategy for preparing these materials relies on reversible and dynamic cross-links within the hydrogel matrix. In this work, inspired by the composition of ascidians' tunic, stretchable supramolecular hydrogels combining poly(vinyl alcohol), green tea-derived gallic acid, and rigid tannic acid-coated cellulose nanocrystals (TA@CNC) were designed. The addition of TA@CNC nanofillers in concentrations up to 1.2 wt % significantly impacted the mechanical and viscoelastic properties of the hydrogels due to the promotion of hydrogen bonding with the polymer matrix and polyphenols π-π stacking interactions. These supramolecular associations endow the hydrogels with excellent stretchability and strength (>340%, 540 kPa), low thermoreversible gel-sol transition (60 °C), and remolding ability, while the natural polyphenols provided potential antibacterial properties. These versatile materials can be anticipated to open up new prospects for the rational design of polyphenol-based cellulosic hydrogels for different biomedical applications.

Natural Deep Eutectic Solvents Based on Choline Chloride and Phenolic Compounds as Efficient Bioadhesives and Corrosion Protectors.

Natural deep eutectics solvents (NADES), owing to their high solvation capacity and nontoxicity, are actively being sought for many technological applications. Herein, we report a series of novel NADES based on choline chloride and plant-derived polyphenols. Most of the obtained phenolic NADES have a wide liquid range and high thermal stability above 150 °C. Among them, small-sized polyphenols, like pyrogallol, vanillyl alcohol, or gentisic acid, lead to low-viscosity liquids with ionic conductivities in the order of 10-3 S cm-1 at room temperature. Interestingly, polyphenols possess valuable properties as therapeutic agents, antioxidants, adhesives, or redox-active compounds, among others. Thus, we evaluated the potential of these novel NADES for two applications: bioadhesives and corrosion protection. The mixture of choline chloride-vanillyl alcohol (2:3 mol ratio) and gelatin resulted in a highly adhesive viscoelastic liquid (adhesive stress ≈ 135 kPa), affording shear thinning behavior. Furthermore, choline chloride-tannic acid (20:1) showed an extraordinary ability to coordinate iron ions, reaching excellent corrosion inhibitive efficiencies in mild steel protection.

Gelatin and Tannic Acid Based Iongels for Muscle Activity Recording and Stimulation Electrodes.

Iongels are soft ionic conducting materials, usually composed of polymer networks swollen with ionic liquids (ILs), which are being investigated for applications ranging from energy to bioelectronics. The employment of iongels in bioelectronic devices such as bioelectrodes or body sensors has been limited by the lack of biocompatibility of the ILs and/or polymer matrices. In this work, we present iongels prepared from solely biocompatible materials: (i) a biobased polymer network containing tannic acid as a cross-linker in a gelatin matrix and (ii) three different biocompatible cholinium carboxylate ionic liquids. The resulting iongels are flexible and elastic with Young's modulus between 11.3 and 28.9 kPa. The morphology of the iongels is based on a dual polymer network system formed by both chemical bonding due to the reaction of the gelatin's amines with the polyphenol units and physical interactions between the tannic acid and the gelatin. These biocompatible iongels presented high ionic conductivity values, from 0.003 and up to 0.015 S·cm-1 at room temperature. Furthermore, they showed excellent performance as a conducting gel in electrodes for electromyography and electrocardiogram recording as well as muscle stimulation.

Study of the Evolution of the Plastic Zone and Residual Stress in a Notched T-6061 Aluminum Sample.

Using experimental measurements and numerical computations, this paper focuses on studying the evolution of the plastic zone and how the residual stresses change in a notched T-6061 aluminum sample. Before the crack initiation, digital image measurements were taken to visualize the evolution of the plastic zone. After the sample was fractured, the material microstructure and the residual stresses around the cracked zone were characterized through optical microscopy and X-ray diffractometry. This article describes in detail how the plastic zone evolved around the notch before the crack initiation and shows the close agreement between experimental and numerical data during the load increment. The surface residual stress values around the tip of the notched sample were also measured and computed to give a better understanding of the affected region during the fracture process.

Exploiting cyanine dye J-aggregates/monomer equilibrium in hydrophobic protein pockets for efficient multi-step phototherapy: an innovative concept for smart nanotheranostics.

After several decades of development in the field of near-infrared (NIR) dyes for photothermal therapy (PTT), indocyanine green (ICG) still remains the only FDA-approved NIR contrast agent. However, upon NIR light irradiation ICG can react with molecular oxygen to form reactive oxygen species and degrade the ICG core, losing the convenient dye properties. In this work, we introduce a new approach for expanding the application of ICG in nanotheranostics, which relies on the confinement of self-organized J-type aggregates in hydrophobic protein domains acting as monomer depots. Upon the fast photobleaching, while the dye is irradiated, this strategy permits the equilibrium-driven monomer replacement after each irradiation cycle that radically increases the systems' effectivity and applicability. Gadolinium-doped casein micelles were designed to prove this novel concept at the same time as endowing the nanosystems with further magnetic resonance imaging (MRI) ability for dual-modal imaging-guided PTT. By teaching a new trick to a very old dog, the clinical prospect of ICG will undoubtedly be boosted laying the foundation for novel therapeutics. It is anticipated that future research could be expanded to other relevant J-aggregates-forming cyanine dyes or nanocrystal formulations of poorly water-soluble photosensitizers.

Elastic and Thermoreversible Iongels by Supramolecular PVA/Phenol Interactions.

Iongels have attracted much attention over the years as ion-conducting soft materials for applications in several technologies including stimuli-responsive drug release and flexible (bio)electronics. Nowadays, iongels with additional functionalities such as electronic conductivity, self-healing, thermo-responsiveness, or biocompatibility are actively being searched for high demanding applications. In this work, a simple and rapid synthetic pathway to prepare elastic and thermoreversible iongels is presented. These iongels are prepared by supramolecular crosslinking between polyphenols biomolecules with a hydroxyl-rich biocompatible polymer such as poly(vinyl alcohol) (PVA) in the presence of ionic liquids. Using this strategy, a variety of iongels are obtained by combining different plant-derived polyphenol compounds (PhC) such as gallic acid, pyrogallol, and tannic acid with imidazolium-based ionic liquids, namely 1-ethyl-3-methylimidazolium dicyanamide and 1-ethyl-3-methylimidazolium bromide. A suite of characterization tools is used to study the structural, morphological, mechanical, rheological, and thermal properties of the supramolecular iongels. These iongels can withstand large deformations (40% under compression) with full recovery, revealing reversible transitions from solid to liquid state between 87 and 125 °C. Finally, the polyphenol-based thermoreversible iongels show appropriated properties for their potential application as printable electrolytes for bioelectronics.

Thermally self-assembled biodegradable poly(casein-g-N-isopropylacrylamide) unimers and their application in drug delivery for cancer therapy.

In this work, we report the synthesis of graft copolymers based on casein and N-isopropylacrylamide, which can self-assemble into biodegradable micelles of approximately 80 nm at physiological conditions. The obtained copolymers were degraded by trypsin, an enzyme that is overexpressed in several malignant tumors. Moreover, graft copolymers were able to load doxorubicin (Dox) by ionic interaction with the casein component. In vitro release experiments showed that the in situ assembled micelles can maintain the cargo at plasma conditions but release Dox immediately after their exposition at pH 5.0 and trypsin. Cellular uptake and cytotoxicity assays revealed the efficient delivery to the nucleus and antiproliferative efficacy of Dox in the breast cancer cell line MDA231. Both delivery and therapeutic activity were enhanced in presence of trypsin. Overall, the prepared micelles hold a great potential for their utilization as dual responsive trypsin/pH drug delivery system.

Real-world data from the Portuguese Nivolumab Expanded Access Program (EAP) in previously treated Non Small Cell Lung Cancer (NSCLC).

OBJECTIVE: The main aim of the study was to evaluate the efficacy and safety profile of Nivolumab, an immune-checkpoint-inhibitor antibody, in advanced, previously treated, Non-Small Cell Lung Cancer (NSCLC) patients, in a real world setting. METHODS: We performed a retrospective, multicentre data analysis of patients who were included in the Portuguese Nivolumab Expanded Access Program (EAP). Eligibility criteria included histologically or citologically confirmed NSCLC, stage IIIB and IV, evaluable disease, sufficient organ function and at least one prior line of chemotherapy. The endpoints included Overall Response Rate (ORR), Disease Control Rate (DCR), Progression Free Survival (PFS) and Overall Survival (OS). Safety analysis was performed with the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE), version 4.0, and immune-related Adverse Events (irAEs) were treated according to protocol treatment guidelines. Tumour response was assessed using the Response Evaluation Criteria in Solid Tumours (RECIST) version 1.1. Data was analysed using SPSS, version 21.0 (IBM Statistics). RESULTS: From June 2015 to December 2016, a total of 229 patients with advanced NSCLC were enrolled at 30 Portuguese centres. Clinical data were collected up to the end of July 2018. The baseline median age was 64 years (range 37-83) and the majority of patients were males (70.3%) and former/current smokers (69.4%). Patients with non-squamous histology predominated (88.1%), and 67.6% of the patients had received 2 or more prior lines of chemotherapy. Out of 229 patients, data was available for 219 patients (3 patients did not start treatment, while data was unavailable in 7 patients); of the 219 patients, 15.5% were not evaluated for radiological tumour assessment, 1.4% had complete response (CR), 21% partial response (PR), 31% stable disease (SD) and 31.1% progressive disease (PD). Thus, the ORR was 22.4% and DCR was 53.4% in this population. At the time of survival analysis the median PFS was 4.91 months (95% CI, 3.89-6.11) and median OS was 13.21 months (95% CI, 9.89-16.53). The safety profile was in line with clinical trial data. CONCLUSIONS: Efficacy and safety results observed in this retrospective analysis were consistent with observations reported in clinical trials and from other centres.

Controlled Thermoreversible Formation of Supramolecular Hydrogels Based on Poly(vinyl alcohol) and Natural Phenolic Compounds.

Supramolecular hydrogels have promising applications in a wide variety of fields including 3D bioprinting, sensors and actuators, biomedicine, and controlled drug delivery. This communication reports the facile reversible thermotriggered formation of novel pH-responsive supramolecular hydrogels based on poly(vinyl alcohol) (PVA) bonded via dynamic H-bridge with small phenolic biomolecules. PVA and phenolic compounds form a clear solution when they are physically mixed in water at high temperature, but a fast gelation is produced at room temperature through multiple strong H-bonding interactions. The structure and type of functional groups of different phenolic molecules allow preparing hydrogels with tailor-made viscoelastic properties, controlled low phase transition temperature, and pH-dependent swelling behavior. This combination makes these supramolecular networks very interesting candidates to be used in 3D bioprinting and topical drug delivery of thermolabile biomolecules.

Effect of Delivery Platforms Structure on the Epidermal Antigen Transport for Topical Vaccination.

Transdermal immunization is highly attractive because of the skin's accessibility and unique immunological characteristics. However, it remains a relatively unexplored route of administration because of the great difficulty of transporting antigens past the outermost layer of skin, the stratum corneum. In this article, the abilities of three poly( N-vinylcaprolactam) (PVCL)-based thermoresponsive assemblies-PVCL hydrogels and nanogels plus novel film forming PVCL/acrylic nanogels-to act as protein delivery systems were investigated. Similar thermal responses were observed in all systems, with transition temperatures close to 32 °C, close to that of the skin surface. The investigated dermal delivery systems showed no evidence of cytotoxicity in human fibroblasts and were able to load and release ovalbumin (OVA), a well-studied antigen, in a temperature-dependent manner in vitro. The penetration of OVA into ex vivo human skin following topical application was evaluated, where enhanced skin delivery was seen for the OVA-loaded PVCL systems relative to administration of the protein alone. The distinct protein release and skin penetration profiles observed for the different PVCL assemblies were here discussed on the basis of their structural differences.

Photo-curable poly-(ethylene glycol)-fumarate elastomers with controlled structural composition and their evaluation as eluting systems.

Elastomeric poly-ester materials have extraordinary potential for soft tissue engineering applications. In connection, in the last 10 years, cross-linkable oligo-(polyethylene glycol fumarate)s emerged as promising materials for obtaining hydrogels for bone tissue engineering applications. In this work we prepared a new family of photo-curable poly-(ethylene glycol)-fumarate elastomers with controlled structural composition. These novel elastomers were obtained by photo-curing of fumarate pre-polymers based on diethylene glycol and oligo-ethylene glycols (PEGs 200 and 400), under extremely mild experimental conditions using a low power UV source. The synthesis of fumarate pre-polymers, which were obtained by thermal poly-condensation, and the photo-curing process, were both here discussed on the basis of their structural differences and proposed operating mechanisms. Finally, the photo-radical cross-linking reactions were performed in the presence of anti-cancer drugs (doxorubicin and paclitaxel), in order to evaluate the potential application of the elastomers as new eluting systems. Thus, different release profiles were obtained for hydrophilic (doxorubicin) and hydrophobic (paclitaxel) anticancer drugs, and these differences are discussed on the basis of the structure of the elastomers.

Genotype-phenotype correlation of contiguous gene deletions of SLC6A8, BCAP31 and ABCD1.

The BCAP31 gene is located between SLC6A8, associated with X-linked creatine transporter deficiency, and ABCD1, associated with X-linked adrenoleukodystrophy. Recently, loss-of-function mutations in BCAP31 were reported in association with severe developmental delay, deafness and dystonia. We characterized the break points in eight patients with deletions of SLC6A8, BCAP31 and/or ABCD1 and studied the genotype-phenotype correlations. The phenotype in patients with contiguous gene deletions involving BCAP31 overlaps with the phenotype of isolated BCAP31 deficiency. Only deletions involving both BCAP31 and ABCD1 were associated with hepatic cholestasis and death before 1 year, which might be explained by a synergistic effect. Remarkably, a patient with an isolated deletion at the 3'-end of SLC6A8 had a similar severe phenotype as seen in BCAP31 deficiency but without deafness. This might be caused by the disturbance of a regulatory element between SLC6A8 and BCAP31.

Guía retenida y anudada extravascular durante un cateterismo venoso central: reporte de un caso

El cateterismo venoso central (CVC) es un procedimiento común en la práctica médica de especialistas en salas de emergencia, cuidado intensivo y salas de cirugía. Su uso no está libre de complicaciones estas pueden ser de tipo mecánica, infecciosa y trombóticas. Dentro de las complicaciones mecánicas las asociadas con la guía tipo atrapamiento vascular es la más común, pero el anudamiento y el atrapamiento extravascular son muy infrecuentes. Presentamos el caso de una mujer con atrapamiento extravascular de la guía y neumotórax como complicaciones de un CVC subclavio.

Central venous catheterization is a common procedure in the medical practice of specialists of emergency rooms, critical care and surgery rooms. The use of central venous catheters is associated with mechanical infectious and thrombotic complications. Within the mechanical complications, those associated with the guidewire, especially extravascular entrapments are very infrequent. This work presents a case of a female patient with extravascular entrapment of the guidewire and pneumothorax as complications of right subclavian venous catheterization.

[Characteristics of drug interactions in a pediatric intensive care unit]. / Características de las interacciones farmacológicas en una unidad de cuidados intensivos de pediatría.

INTRODUCTION: The aim of this study is to calculate the theoretical frequency of potential drug interactions (PDI) and their characteristics in the therapeutic plan of hospitalized patients in a Pediatric Intensive Care Unit (PICU). PATIENTS AND METHODS: An observational study was conducted which analyzed PICU prescriptions between September and November 2011. The inclusion criteria included to be hospitalized in a PICU, requirements of at least 3 drugs, except those topically applied, either gender, no age limit, no hospital stay required. The Micromedex® 2.0 program was used to detect and classify PDI. RESULTS: Of 223 patients, 100 met inclusion criteria, 610 prescriptions were analyzed and 815 drugs were prescribed. 1,240 PDI were detected in 44 patients; 12 patients received more than 10 drugs each, presenting 1,162 PDI (93.7% of total PDI). 8 patients were hospitalized for more than 10 days, presenting 1,035 PDI (83.5% of total PDI). According to PDI theoretical severity, 37.5% were high, 51.7% moderate, 6.7% low and 4.1% contraindicated. The therapeutic group most involved was antimicrobials (17.6%) and the most frequently involved individual drugs were chloral hydrate (15.9%), midazolam (14.1%) and vecuronium (13.4%). CONCLUSION: PDI were more frequent in patients associated with major polypharmacy and longer hospital stay.