Shock indices are associated with in-hospital mortality among patients with septic shock and normal left ventricular ejection fraction.

BACKGROUND: The understanding of shock indices in patients with septic shock is limited, and their values may vary depending on cardiac function. METHODS: This prospective cohort study was conducted across 20 university-affiliated hospitals (21 intensive care units [ICUs]). Adult patients (≥19 years) with septic shock admitted to the ICUs during a 29-month period were included. The shock index (SI), diastolic shock index (DSI), modified shock index (MSI), and age shock index (Age-SI) were calculated at sepsis recognition (time zero) and ICU admission. Left ventricular (LV) function was categorized as either normal LV ejection fraction (LVEF ≥ 50%) or decreased LVEF (<50%). RESULTS: Among the 1,194 patients with septic shock, 392 (32.8%) who underwent echocardiography within 24 h of time zero were included in the final analysis (normal LVEF: n = 246; decreased LVEF: n = 146). In patients with normal LVEF, only survivors demonstrated significant improvement in SI, DSI, MSI, and Age-SI values from time zero to ICU admission; however, no notable improvements were found in all patients with decreased LVEF. The completion of vasopressor or fluid bundle components was significantly associated with improved indices in patients with normal LVEF, but not in those with decreased LVEF. In multivariable analysis, each of the four indices at ICU admission was significantly associated with in-hospital mortality (P < 0.05) among patients with normal LVEF; however, discrimination power was better in the indices for patients with lower lactate levels (≤ 4.0 mmol/L), compared to those with higher lactate levels. CONCLUSIONS: The SI, DSI, MSI, and Age-SI at ICU admission were significantly associated with in-hospital mortality in patients with septic shock and normal LVEF, which was not found in those with decreased LVEF. Our study emphasizes the importance of interpreting shock indices in the context of LV function in septic shock.

Impact of sepsis on Eastern Cooperative Oncology Group performance status among fully ambulatory patients: a prospective nationwide multicenter cohort.

Background: Investigations of the impact of sepsis on the Eastern Cooperative Oncology Group performance status (ECOG PS) of fully ambulatory patients are scarce. Methods: This is a retrospective analysis of prospectively collected nationwide data on septic patients recruited from 19 hospitals of the Korean Sepsis Alliance between August 2019 and December 2020. Adult septic patients with good ECOG PS (i.e., 0 or 1) before sepsis were enrolled in this study. The change in ECOG PS and the prevalence of disability (ECOG PS ≥2) at hospital discharge were recorded. Results: Of the 4,145 septic patients, 1,735 (41.9%) patients who had ECOG PS of 0 or 1 before sepsis and eventually survived to discharge were selected. After treatment for sepsis, the ECOG PS deteriorated in 514 (29.6%) patients; 376 (21.7%) patients had poor ECOG PS (i.e., ≥2) at hospital discharge. The proportion of patients with poor ECOG PS at hospital discharge increased with increases in the initial sequential organ failure assessment (SOFA) score and lactate level. Furthermore, poor ECOG PS at hospital discharge was found in young patients (aged <65 years, 17.4%), those with no history of cancer (18.2%) or with low comorbidities [Charlson comorbidity index (CCI) ≤2; 13.6%], and those without septic shock (19.9%). In multivariable analysis, age, solid cancer, immunocompromised condition, SOFA score, mechanical ventilation, and use of inappropriate empirical antibiotics (odds ratio: 1.786; 95% confidence interval: 1.151-2.771) were significant risk factors for poor ECOG PS. Conclusions: One in five septic patients who were fully ambulatory before sepsis were not functionally independent at hospital discharge. Incomplete functional recovery was also seen in a substantial proportion of younger patients, those with low comorbidities, and those without septic shock. However, the adequacy of empirical antibiotics may improve the functional status in such patients.

Recent Increases in Influenza-Related Hospitalizations, Critical Care Resource Use, and In-Hospital Mortality: A 10-Year Population-Based Study in South Korea.

Background: Long-term trends in influenza-related hospitalizations, critical care resource use, and hospital outcomes since the 2009 H1N1 influenza pandemic season have been rarely studied for adult populations. Materials and Methods: Adult patients from the Korean Health Insurance Review and Assessment Service who were hospitalized with influenza over a 10-year period (2009−2019) were analyzed. The incidence rates of hospitalization, critical care resource use, and in-hospital death were calculated using mid-year population census data. Results: In total, 300,152 hospitalized patients with influenza were identified (men, 35.7%; admission to tertiary hospitals, 9.4%). Although the age-adjusted hospitalization rate initially decreased since the 2009 H1N1 pandemic (52.61/100,000 population in 2009/2010), it began to increase again in 2013/2014 and reached a peak of 169.86/100,000 population in 2017/2018 (p < 0.001). The in-hospital mortality rate showed a similar increasing trend as the hospitalization, with a peak of 1.44/100,000 population in 2017/2018 (vs. 0.35/100,000 population in 2009/2010; p < 0.001). The high incidence rates of both hospitalization and in-hospital mortality were mainly attributable to patients aged ≥60 years. The rate of intensive care unit admission and the use of mechanical ventilation, continuous renal replacement therapy and vasopressors have also increased from the 2013/2014 season. The incidence of heart failure was the most frequent complication investigated, with a three-fold increase in the last two seasons since 2009/2010. In multivariate analysis adjusted for covariates, among hospitalized patients, type of hospitals and 2009 H1N1 pandemic season were associated with in-hospital mortality. Conclusions: We confirmed that the rates of hospitalization, critical care resource use, and in-hospital mortality by influenza have increased again in recent years. Therefore, strategies are needed to reduce infections and optimize resource use with a greater focus on older people.

JAK2 regulates paclitaxel resistance in triple negative breast cancers.

We investigated the molecular mechanisms of paclitaxel resistance in TNBC using seven patient-derived xenograft (PDX) models and TNBC cell lines. Among the seven PDX models, four models showed resistance to paclitaxel. Dysregulation of JAK/STAT pathways and JAK2 copy number gains were observed in the four paclitaxel-resistant PDX tumors. In TNBC cell lines, silencing the JAK2 gene showed a significant but mild synergistic effect when combined with paclitaxel in vitro. However, JAK1/2 inhibitor treatment resulted in restoration of paclitaxel sensitivity in two out of four paclitaxel-resistant PDX models and JAK1/2 inhibitor alone significantly suppressed the tumor growth in one out of the two remaining PDX models. Transcriptome data derived from the murine microenvironmental cells revealed an enrichment of genes involved in the cell cycle processes among the four paclitaxel-resistant PDX tumors. Histologic examination of those PDX tumor tissues showed increased Ki67-positive fibroblasts in the tumor microenvironment. Among the four different cancer-associated fibroblast (CAF) subtypes, cycling CAF exhibiting features of active cell cycle was enriched in the paclitaxel-resistant PDX tumors. Additionally, fibroblasts treated with the conditioned media from the JAK2-silenced breast cancer cells showed downregulation of cell cycle-related genes. Our data suggest that the JAK2 gene may play a critical role in determining responses of TNBC to paclitaxel by modulating the intrinsic susceptibility of cancer cells against paclitaxel and also by eliciting functional transitions of CAF subtypes in the tumor microenvironment. KEY MESSAGES : We investigated the molecular mechanisms of paclitaxel resistance in TNBC. JAK2 signaling was associated with paclitaxel resistance in TNBC PDX models. Paclitaxel-resistant PDX tumors were enriched with microenvironment cCAF subpopulation. JAK2 regulated paclitaxel-resistant CAF phenotype transition.

Therapeutic Prognosis System for Root Coverage Procedures.

Although several techniques and materials have been adopted to treat gingival recession, the therapeutic prognosis of various treatment modalities is not well established. This article proposes a multidimensional therapeutic prognosis system for the treatment of gingival recession based on the currently available literature. Gingival defect characteristics, patient behavioral habits, and surgical- and anatomical-related factors that may affect the outcome of root coverage procedures are reviewed. A therapeutic prognosis system is provided to enable clinicians to analyze these factors prior to the root coverage procedures. Three clinical cases are also discussed to demonstrate the assessment and validation of this therapeutic prognosis system.

Brain natriuretic peptide levels predict 6-month mortality in patients with cardiogenic shock who were weaned off extracorporeal membrane oxygenation.

There are limited data regarding the association between brain natriuretic peptide (BNP) levels obtained after weaning from extracorporeal membrane oxygenation (ECMO) and the outcomes of patients with acute coronary syndrome (ACS)-associated cardiogenic shock.We prospectively obtained data regarding patients (aged ≥ 19 years) with ACS-associated cardiogenic shock who received ECMO and were subsequently weaned off the treatment. BNP levels were collected at 5 time points: pre-ECMO implantation, post-ECMO implantation, pre-ECMO weaning, day 1 after ECMO weaning, and day 5 after ECMO weaning.Of 48 patients with ACS-related cardiogenic shock, 33 were included in this analysis. Mean patient age was 59.0 (50.0-66.5) years, and 5 patients (15.2%) were women. Eight patients had asystole/pulseless electrical activity before ECMO and 14 (42.4%) had 3-vessel disease on coronary angiography. During the 6-month follow up, 12 (36.4%) patients died. BNP levels after ECMO weaning were significantly different between 6-month survivors and non-survivors. Cox proportional hazards model revealed that BNP levels (tertiles) on days 1 and 5 after ECMO weaning were significantly associated with 6-month mortality (hazard ratio, 7.872; 95% confidence interval, 1.870-32.756; 8.658 and 1.904-39.365, respectively). According to the Kaplan-Meier curves, the first tertile had significantly longer survival compared to the third tertile for both days 1 and 5 after ECMO weaning.Post-ECMO weaning BNP levels (days 1 and 5) were significantly associated with increased 6-month mortality in patients with ACS complicated by refractory cardiogenic shock who were weaned off ECMO.

Rapid large-scale fabrication of multipart unit cell metasurfaces.

Periodic diffractive elements known as metasurfaces constitute platform technology whereby exceptional optical properties, not attainable by conventional means, are attained. Generally, with increasing unit-cell complexity, there emerges a wider design space and bolstered functional capability. Advanced devices deploying elaborate unit cells are typically generated by electron-beam patterning which is a tedious, slow process not suitable for large surfaces and quick turnaround. Ameliorating this condition, we present a novel route towards facile fabrication of complex periodic metasurfaces based on sequential exposures by laser interference lithography. Our method is fast, cost-effective, and can be applied to large surface areas. It is enabled by precise control over periodicity and exposure energy. With it we have successfully patterned and fabricated one-dimensional (1D) and two-dimensional (2D) multipart unit cell devices as demonstrated here. Thus, zero-order transmission spectra of an etched four-part 1D grating device are simulated and measured for both transverse-electric (TE) and transverse-magnetic (TM) polarization states of normally incident light. We confirm non-resonant wideband antireflection (∼800 nm) for TM-polarized light and resonance response for TE-polarized light in the near-IR band spanning 1400-2200 nm in a ∼100 mm2 device. Furthermore, it is shown that this method of fabrication can be implemented not only to pattern periodic symmetric/asymmetric designs but also to realize non-periodic metasurfaces. The method will be useful in production of large-area photonic devices in the realm of nanophotonics and microphotonics.

Development of a pressure sensor system for unobtrusive monitoring of abdominal muscle activities.

Surface electromyogram (sEMG) is often used by to objectively measure muscular activity during rehabilitation exercises. sEMG is accurate, but it is unsuitable for uses outside the clinic, and patients can benefit from an unobtrusive device which can be readily used to ubiquitously measure abdominal muscle activation. In this study, we present a pressure sensor system which can be latched onto a belt to measure abdominal muscle activation. sEMG and pressure sensor output were measured in 15 healthy young males during isometric trunk flexion exercise (public trials registration number, KCT0002351), and the results were highly correlated (median R > 0.939). As initial contact force can change the pressure sensor sensitivity, the experiment was performed at two different levels of belt tightness, but the correlations did not significantly improve after tightening the belt, suggesting that the system can be used to ubiquitously and unobtrusively monitor abdominal muscle activity with minimal discomfort.

Flat-top narrowband filters enabled by guided-mode resonance in two-level waveguides.

Resonant nanogratings and periodic metasurfaces express diverse spectral and polarization properties on broadside illumination by incident light. Cooperative resonance interactions may yield shaped spectra for particular applications, in contrast to a multilayer dielectric mirror. Here, we provide guided-mode resonance filters with flat-top spectra suitable for wavelength division multiplexing systems. Applying a single one-dimensional grating layer sandwiched by two waveguides, we theoretically achieve high-efficiency flat-top spectra in the near-infrared region. This result is obtained by inducing simultaneous nearly degenerate resonant modes. The resonance separation under this condition controls the width of the flat-top spectrum. This means we can implement spectral widths ranging from a sub-nanometer to several nanometers applying fundamentally the same device architecture.

Kalopanacis Cortex extract-capped gold nanoparticles activate NRF2 signaling and ameliorate damage in human neuronal SH-SY5Y cells exposed to oxygen-glucose deprivation and reoxygenation.

Recently, environment-friendly synthesis of gold nanoparticles (GNPs) has been extensively explored by biologists and chemists. However, significant research is still required to determine whether "eco-friendly" GNPs are beneficial to human health and to elucidate the molecular mechanisms of their effects on human cells. We used human neuronal SH-SY5Y cells to show that treatment with Kalopanacis Cortex extract-capped GNPs (KC-GNs), prepared via an eco-friendly, fast, one-pot synthetic route, protected neuronal cells against oxygen-glucose deprivation/reoxygenation (OGD/R)-induced damage. To prepare GNPs, Kalopanacis Cortex was used without any chemical reducing and stabilizing agents. Ultraviolet-visible spectroscopy showed maximum absorbance at 526 nm owing to KC-GN surface plasmon resonance. Hydrodynamic size (54.02±2.19 nm) and zeta potential (-20.3±0.04 mV) were determined by dynamic light scattering. The average diameter (41.07±3.05 nm) was determined by high-resolution transmission electron microscopy. Energy-dispersive X-ray diffraction spectroscopy and X-ray diffraction confirmed the presence of assembled GNPs. Fourier transform infrared analysis suggested that functional groups such as O-H, C-C, and C-N participated in KC-GN formation. Cell viability assays indicated that KC-GNs restored the viability of OGD/R-treated SH-SY5Y cells. Flow cytometry demonstrated that KC-GNs inhibited the OGD/R-induced reactive oxygen species production and mitochondrial membrane potential disruption. KC-GNs also inhibited the apoptosis of OGD/R-exposed cells. Western blot analysis indicated that the OGD/R-induced cellular apoptosis and simultaneous increases in the expression of cleaved caspase-3, p53, p21, and B-cell lymphoma 2-associated X protein were reversed by KC-GNs. The KC-GN-mediated protection against OGD/R-induced neurotoxicity was diminished by NRF2 and heme oxygenase-1 gene knockdowns. Collectively, these results suggested that KC-GNs exerted strong neuroprotective effects on human neuronal cells, which might be attributed to the attenuation of OGD/R-induced neuronal cell injury through the NRF2 signaling pathway.

Experimental demonstration of wideband multimodule serial reflectors.

We demonstrate unpolarized wideband reflectors fashioned with orthogonal serial resonant reflectors. Unpolarized incident light generates internal TM- and TE-polarized reflections that are made to cooperate to extend the bandwidth of the composite spectral reflectance. The experimental results presented show ~42% band extension by a two-grating module. In addition, good angular tolerance is found because the orthogonal arrangement simultaneously supports classical and fully conic mountings at oblique angles. The resulting spectra form contiguous zero-order reflectance across wide spectral/angular regions. Furthermore, using a multimodule device with serial reflectors fabricated with silicon-on-quartz wafers with different device layer thicknesses, extreme band extension is achieved providing ~56% fractional bandwidth with reflectance exceeding 98%. These results imply potential for developing lossless unpolarized mirrors operating in diverse spectral regions of practical interest.

Gardenia jasminoides extract-capped gold nanoparticles reverse hydrogen peroxide-induced premature senescence.

This study reports a green approach for synthesis of gold nanoparticles using Gardenia jasminoides extract, and specifically, can potentially enhance anti senescence activity. Biological synthesis of gold nanoparticles is ecofriendly and effective for the development of environmentally sustainable nanoparticles compared with existing methods. Here, we developed a simple, fast, efficient, and ecofriendly approach to the synthesis of gold nanoparticles by means of a Gardenia jasminoides extract. These G. jasminoides extract-capped gold nanoparticles (GJ-GNPs) were characterized by UV-vis, high resolution transmission electron microscopy (HR-TEM), X-ray diffraction (XRD), and Furrier transform infrared spectroscopy (FT-IR). The synthesized GJ-GNPs turned red and showed maximal absorbance at 540nm. Thus, GJ-GNPs were synthesized successfully. We hypothesized that GJ-GNPs would protect ARPE19 cells from hydrogen peroxide-induced premature senescence. SA-ß-gal activity was elevated in hydrogen peroxide-treated cells, however, this effect was attenuated by GJ-GNP treatment. Moreover, compared with the normal control, hydrogen peroxide treatment significantly increased lysosome content of the cells and production of reactive oxygen species (ROS). GJ-GNPs effectively attenuated the increase in lysosome content and ROS production in these senescent cells. According to cell cycle analysis, G2/M arrest was promoted by hydrogen peroxide treatment in ARPE19 cells, however, this change was reversed by GJ-GNPs. Western blot analysis showed that treatment with GJ-GNPs increased the expression of p53, p21, SIRT3, HO-1, and NQO1 in senescent cells. Our findings should advance the understanding of premature senescence and may lead to therapeutic use of GJ-GNPs in retina-related regenerative medicine.

Usefulness of anterior uveitis as an additional tool for diagnosing incomplete Kawasaki disease.

PURPOSE: There are no specific tests for diagnosing Kawasaki disease (KD). Additional diagnostic criteria are needed to prevent the delayed diagnosis of incomplete Kawasaki disease (IKD). This study compared the frequency of coronary artery lesions (CALs) in IKD patients with and without anterior uveitis (AU) and elucidated whether the finding of AU supported the diagnosis of IKD. METHODS: This study enrolled patients diagnosed with IKD at The Catholic University of Korea, Uijeongbu St. Mary's Hospital from January 2010 to December 2014. The patients were divided into 2 groups: group 1 included patients with IKD having AU; and group 2 included patients with IKD without AU. We analyzed the demographic and clinical data (age, gender, duration of fever, and the number of diagnostic criteria), laboratory results, and echocardiographic findings. RESULTS: Of 111 patients with IKD, 41 had uveitis (36.98%, group 1) and 70 did not (63.02%, group 2). Patients in group 1 had received a diagnosis and treatment earlier, and had fewer CALs (3 of 41, 1.7%) than those in group 2 (20 of 70, 28.5%) (P=0.008). All 3 patients with CALs in group 1 had coronary dilatation, while patients with CALs in group 2 had CALs ranging from coronary dilatation to giant aneurysm. CONCLUSION: The diagnosis of IKD is challenging but can be supported by the presence of features such as AU. Group 1 had a lower risk of coronary artery disease than group 2. Therefore, the presence of AU is helpful in the early diagnosis and treatment of IKD and can be used as an additional diagnostic tool.

Prediction of nonresponsiveness to medium-dose intravenous immunoglobulin (1 g/kg) treatment: an effective and safe schedule of acute treatment for Kawasaki disease.

PURPOSE: Medium-dose (1 g/kg) intravenous immunoglobulin (IVIG) is effective in the majority of patients with Kawasaki disease (KD) but some patients who do not respond to medium-dose IVIG are at high risk for the development of coronary artery lesions (CALs). The purpose of this study was to identify the clinical predictors associated with unresponsiveness to medium-dose IVIG and the development of CALs. METHODS: A retrospective study was performed in 91 children with KD who were treated with medium-dose IVIG at our institution from January 2004 to December 2013. We classified the patients into responders (group 1; n=68) and nonresponders (group 2; n=23). We compared demographic, laboratory, and echocardiographic data between the 2 groups. RESULTS: Multivariate logistic regression analysis identified 6 variables as predictors for resistance to medium-dose IVIG. We generated a predictive scoring system assigning 1 point each for percentage of neutrophils ≥65%, C-reactive protein≥100 mg/L, aspartate aminotransferase≥100 IU/L, and alanine aminotransferase≥100 IU/L, as well as 2 points for less than 5 days of illness, and serum sodium level≤136 mmol/L. Using a cutoff point of ≥4 with this scoring system, we could predict nonresponsiveness to medium-dose IVIG with 74% sensitivity and 71% specificity. CONCLUSION: If a patient has a low-risk score in this system, medium-dose IVIG can be recommended as the initial treatment. Through this process, we can minimize the adverse effects of high-dose IVIG and incidence of CALs.

Robust snapshot interferometric spectropolarimetry.

This Letter describes a Stokes vector measurement method based on a snapshot interferometric common-path spectropolarimeter. The proposed scheme, which employs an interferometric polarization-modulation module, can extract the spectral polarimetric parameters Ψ(k) and Δ(k) of a transmissive anisotropic object by which an accurate Stokes vector can be calculated in the spectral domain. It is inherently strongly robust to the object 3D pose variation, since it is designed distinctly so that the measured object can be placed outside of the interferometric module. Experiments are conducted to verify the feasibility of the proposed system. The proposed snapshot scheme enables us to extract the spectral Stokes vector of a transmissive anisotropic object within tens of msec with high accuracy.

Relationships of physical fitness and obesity with metabolic risk factors in children and adolescents: Chungju city cohort study.

PURPOSE: The purpose of this study was to investigate the relationships of physical fitness and obesity with metabolic risk factors in children and adolescents. METHODS: This cohort study was conducted in Chungju city, South Korea. Total 843 subjects were enrolled, including 193 elementary school 4th grade male (E4M), 189 elementary school 4th grade female (E4F) and 461 male-middle school students (M1M). The subjects were also classified into 2 groups by body mass index; normal weight (NW) group and overweight included obesity (OW/OB) group. Physical fitness was measured by shuttle run (cardiorespiratory fitness, CRF), sit and reach (flexibility), handgrip strength (muscular strength) and stand long jump (agility). RESULTS: The prevalence of OW/OB was respectively 33.7% (65 of 193) among E4M, 28.6% (54 of 189) among E4F, and 28.0% (129 of 461) among M1M. Hematocrit, white blood cell, triglyceride, low-density lipoprotein, insulin, homeostasis model assessment of insulin resistance, systolic and diastolic blood pressure were higher, while high-density lipoprotein were lower in the OW/OB group than in the NW group. The OW/OB group presented significantly lower CRF (P<0.01) and lower agility, but higher muscular strength compared with NW group. CRF was negatively correlated with obesity indices and metabolic risk factors. After adjustments for potential confounders, odds ratios for 4th-5th grade CRF of OW/OB compared NW in the E4M, E4F, M1M, were 7.38 (95 % CI, 3.24-16.83), 4.10 (95% CI, 1.83-9.18), 16.06 (95% CI, 8.23-31.00) (P<0.01). CONCLUSION: Our study has shown that CRF has negative correlation with OW/OB in children and adolescents of Chungju city. We suggest that improvement of CRF through regular physical activity would be an important method for reducing the metabolic risks of childhood obesity.

Gold-conjugated resveratrol nanoparticles attenuate the invasion and MMP-9 and COX-2 expression in breast cancer cells.

Gold nanoparticles (AuNPs) with antitumorigenic effects obstruct the initiation, development and progression of tumors via the regulation of various processes, such as proliferation and apoptosis. However, the effects of AuNPs on breast cancer metastasis have not been well studied, and their response to 12-O-tetradecanoylphorbol-13-acetate (TPA) stimulation remains unclear. Therefore, we synthesized resveratrol-capped gold nanoparticles (Rev-AuNPs) using green nanotechnology and investigated their potential anti-invasive properties in human breast cancer cells in response to TPA stimulation. The Rev-AuNPs formed spherical nanoparticles of 22.28±2.98 nm in diameter. Next, we found that non-cytotoxic concentrations of Rev-AuNPs significantly suppressed the TPA-induced migration and invasion abilities of breast cancer cells. Rev-AuNPs suppressed TPA-induced enzymatic activity and the expression of matrix metalloproteinase (MMP)-9 and cyclooxygenase-2 (COX-2). Furthermore, Rev-AuNP treatment remarkably downregulated TPA-induced nuclear translocation and transcriptional activation of nuclear transcription factor-κB (NF-κB) and activator protein-1 (AP-1). Rev-AuNPs reduced the phosphorylation of phosphoinositide 3-kinase/Akt (PI3K/Akt) and extracellular signal-regulated kinase (ERK)1/2 signaling, but did not affect the phosphorylation of Jun N-terminal kinase (JNK) or p38 MAPK in the TPA-stimulated breast cancer cells. Notably, Rev-AuNPs generally showed better anti-invasive activity than resveratrol without cytotoxicity. The inhibitory effect of Rev-AuNPs on MMP-9, COX-2, NF-κB, AP-1, PI3K/Akt and ERK activation was stronger than that of resveratrol for the same concentrations. We also demonstrated that Rev-AuNPs induced heme oxygenase-1 (HO-1) expression and that the inhibition of MMP-9 and COX-2 expression and MMP-9 enzymatic activity of Rev-AuNPs were abrogated by siRNA knockdown of HO-1 expression. Our findings revealed that the anti-invasive effects of Rev-AuNPs in response to TPA-stimulation were mediated by the suppression of MMP-9, COX-2, NF-κB, AP-1, PI3K/Akt and ERK and/or the activation of HO-1 signaling cascades. This novel finding emphasizes the pharmacological ability of Rev-AuNPs to treat breast cancer metastasis.

High-Pressure Balloon-Assisted Stretching of the Coracohumeral Ligament to Determine the Optimal Stretching Positions: A Cadaveric Study.

BACKGROUND: The coracohumeral ligament (CHL) is a thick capsular structure and markedly thickened when affected by adhesive capsulitis. Therapeutic stretching is the most commonly applied treatment for adhesive capsulitis, but optimal stretching postures for maximal therapeutic effects on the CHL have not been fully investigated. OBJECTIVE: To investigate the most effective stretching direction for the CHL by measuring the stretching intensity in 5 different directions and to determine whether the stretching intervention resulted in loosening of the ligament by comparing the changes of CHL tightness before and after stretching. DESIGN: Biomechanical cadaver study. SETTING: Academic institution cadaver laboratory. PARTICIPANTS: Nine fresh frozen cadaveric shoulders. METHODS: A high-pressure balloon catheter inserted under the CHL and intraballoon pressure was measured, to evaluate CHL tightness without ligament damage as well as to augment and monitor stretching intensity. To find the optimal stretching direction, the glenohumeral joint was stretched from the neutral position into 5 directions sequentially under pressure-monitoring: flexion, extension [EX], external rotation [ER], EX+ER, and EX+ER+adduction [AD] directions. MAIN OUTCOME MEASUREMENTS: CHL tightness was determined by a surrogate parameter, the additional pressure created by the overlying CHL. The pressure increase (ΔPstr) by a specific directional stretch was considered as the stretching intensity. RESULTS: ΔPstr by the 5 directions were mean (standard deviation) values of 0.03 ± 0.07 atm, 0.87 ± 1.31 atm, 1.13 ± 1.36 atm, 1.49 ± 1.32 atm, and 2.10 ± 1.70 atm, respectively, revealing the highest ΔPstr by the EX+ER+AD stretch (P < .05). The balloon pressure by the overlying CHL was decreased from 0.45 ± 0.35 atm to 0.18 ± 0.14 atm (P = .012) before and after the stretching manipulation. CONCLUSIONS: EX+ER+AD of the glenohumeral joint resulted in the greatest increase in balloon pressure, implying that it could be the most effective stretching direction. A series of stretching manipulations assisted with an underlying pressure balloon were capable of decreasing CHL tightness. With further development and modification, high-pressure balloon-assisted stretching can be a potential therapeutic option to release tight CHL, including the advantage of augmenting and monitoring stretching intensity. LEVEL OF EVIDENCE: II.

Properties of wideband resonant reflectors under fully conical light incidence.

Applying numerical modeling coupled with experiments, we investigate the properties of wideband resonant reflectors under fully conical light incidence. We show that the wave vectors pertinent to resonant first-order diffraction under fully conical mounting vary less with incident angle than those associated with reflectors in classical mounting. Therefore, as the evanescent diffracted waves drive the leaky modes responsible for the resonance effects, fully-conical mounting imbues reflectors with larger angular tolerance than their classical counterparts. We quantify the angular-spectral performance of representative resonant wideband reflectors in conic and classic mounts by numerical calculations with improved spectra found for fully conic incidence. Moreover, these predictions are verified experimentally for wideband reflectors fashioned in crystalline and amorphous silicon in distinct spectral regions spanning the 1200-1600-nm and 1600-2400-nm spectral bands. These results will be useful in various applications demanding wideband reflectors that are efficient and materially sparse.

Ultra-sparse dielectric nanowire grids as wideband reflectors and polarizers.

Engaging both theory and experiment, we investigate resonant photonic lattices in which the duty cycle tends to zero. Corresponding dielectric nanowire grids are mostly empty space if operated as membranes in vacuum or air. These grids are shown to be effective wideband reflectors with impressive polarizing properties. We provide computed results predicting nearly complete reflection and attendant polarization extinction in multiple spectral regions. Experimental results with Si nanowire arrays with 10% duty cycle show ~200-nm-wide band of high reflection for one polarization state and free transmission for the orthogonal state. These results agree quantitatively with theoretical predictions. It is fundamentally extremely significant that the wideband spectral expressions presented can be generated in these minimal systems.