Tissue-mimetic hybrid bioadhesives for intervertebral disc repair.

Intervertebral disc (IVD) degeneration and herniation often necessitate surgical interventions including a discectomy with or without a nucleotomy, which results in a loss of the normal nucleus pulposus (NP) and a defect in the annulus fibrosus (AF). Due to the limited regenerative capacity of the IVD tissue, the annular tear may remain a persistent defect and result in recurrent herniation post-surgery. Bioadhesives are promising alternatives but show limited adhesion performance, low regenerative capacity, and inability to prevent re-herniation. Here, we report hybrid bioadhesives that combine an injectable glue and a tough sealant to simultaneously repair and regenerate IVD post-nucleotomy. The glue fills the NP cavity while the sealant seals the AF defect. Strong adhesion occurs with the IVD tissues and survives extreme disc loading. Furthermore, the glue can match native NP mechanically, and support the viability and matrix deposition of encapsulated cells, serving as a suitable cell delivery vehicle to promote NP regeneration. Besides, biomechanical tests with bovine IVD motion segments demonstrate the capacity of the hybrid bioadhesives to restore the biomechanics of bovine discs under cyclic loading and to prevent permanent herniation under extreme loading. This work highlights the synergy of bioadhesive and tissue-engineering approaches. Future works are expected to further improve the tissue specificity of bioadhesives and prove their efficacy for tissue repair and regeneration.

Combined central retinal artery and medial posterior ciliary artery occlusion: Localizing the lesion.

Purpose: To report a rare case of a combined central retinal artery (CRA) and medial posterior ciliary artery (MPCA) occlusion due to an atherosclerotic lesion in the common trunk supplying both arteries. Observations: A 75-year-old man presented with acute vision loss associated with elevated intraocular pressure in the right eye. Multi-modal imaging revealed a combined retinal and choroidal infarction in the distribution of the CRA and MPCA, localizing the lesion to the common trunk of the ophthalmic artery supplying both the CRA and MPCA. Neurovascular imaging provided supportive evidence for the diagnosis. Conclusions and importance: A simultaneous retinal and choroidal vascular occlusion is an uncommon presentation. Familiarity with the anatomy of the ophthalmic arteries and its branches facilitates localizing the lesion.

New era of medical education: asynchronous and synchronous online teaching during and post COVID-19.

Importance: Covid-19 struck the world suddenly and unexpectedly. Since traditional education requires face to face communication, to avoid further spreading of the virus, a majority part of that education has moved online. Objective: Our study attempts to compare the differences between online medical education with a unique course design and traditional face-to-face education. Design: We conducted a retrospectively analysis of a total of 4,098 medical students between 2019 and 2020, including two groups of students who received online education and classroom education of same subjects, respectively. Participants: Freshmen enrolled in September 2018 received traditional classroom physiology and pharmacology education in the spring semester of 2019. Due to the impact of the COVID-19 pandemic, freshmen who were enrolled in September 2019 received online physiology and pharmacology education in the spring semester of 2020. Assessments: The final marks of the two groups of students were recorded and compared. Data on students participating in online discussions, learning, homework, and watching instructional videos were also recorded. Results: There was no significant difference in the final academic performance between the two groups (average mark: 55.93 (online education) vs. 56.27 (classroom education), p=0.488). Further analysis showed that student participation rates in online discussions, online learning, and online viewing of instructional videos were closely correlated with final grades in online courses (p<0.01). Conclusions and Relevance: In conclusion, our results suggested that the pedagogical effects of online education during COVID-19 were promising and we provided a well-designed medical online course to inspire further improvements in online education.

Study on properties of sewage sludge cemented paste backfill and leaching mechanism of heavy metals.

In order to achieve sustainable development and control environmental pollution, this paper proposes sewage sludge (SS) as an auxiliary cementitious material, which is mixed with ordinary Portland cement (OPC), fly ash (FA), and gangue to produce sewage sludge cemented paste backfill (SS-CPB) material. The fluidity and mechanical properties of backfill materials with different SS contents and the heavy metal leaching mechanism of SS-CPB are investigated. The results reveal that (1) with the increase of SS content from 10 to 30%, the slump of fresh SS-CPB mortar decreased from 21.7 to 18.2 cm, the initial setting time decreased from 2.83 to 0.58 h, and the final setting time decreased from 4.92 to 0.83 h. (2) Compared with the control group, the 3-day unconfined compressive strength (UCS) of the SS-CPB mixed with 10% SS increased by 49.5%, and the UCS decreased slightly in the later stage, but it also met the actual needs of coal mines. (3) Scanning electron microscopy (SEM), X-ray diffraction (XRD), and Fourier transform infrared (FTIR) spectroscopy were used to study the SS-CPB samples. It was found that the free Al3+ in SS promoted the formation of ettringite (AFt), provided part of the early UCS, and accelerated the setting time. (4) The leaching rule of heavy metal ions was analyzed in combination with leaching kinetics, and the change of heavy metal ion mass concentration in the rising stage was in line with the contraction core model controlled by diffusion.

A general averaging method for count data with overdispersion and/or excess zeros in biomedicine.

With the aim of providing better estimation for count data with overdispersion and/or excess zeros, we develop a novel estimation method-optimal weighting based on cross-validation-for the zero-inflated negative binomial model, where the Poisson, negative binomial, and zero-inflated Poisson models are all included as its special cases. To facilitate the selection of the optimal weight vector, a K-fold cross-validation technique is adopted. Unlike the jackknife model averaging discussed in Hansen and Racine (2012), the proposed method deletes one group of observations rather than only one observation to enhance the computational efficiency. Furthermore, we also theoretically prove the asymptotic optimality of the newly developed optimal weighting based on cross-validation method. Simulation studies and three empirical applications indicate the superiority of the presented optimal weighting based on cross-validation method when compared with the three commonly used information-based model selection methods and their model averaging counterparts.

The prediction value of platelet-derived growth factor for major adverse cardiovascular events in patients with acute non-ST-segment elevation myocardial infarction.

BACKGROUND: The value of plasma Platelet-Derived Growth Factor (PDGF) as a biomarker in predicting major adverse cardiovascular events (MACEs) in patients with acute non-ST-segment elevation myocardial infarction (NSTEMI) remains unclear. METHODS: A total of 242 patients with NSTEMI were enrolled in this observational cohort study. The correlation between PDGF and MACEs was evaluated during a five-year follow-up. Kaplan-Meier survival analysis with Cox proportional-hazards regression was used to identify predictive values of PDGF. RESULTS: The mean follow-up of NSTEMI patients was 1334 days. It was found that as the PDGF level increased, a significant uptrend in the incidence of MACEs and all-cause death, including the MACEs of 30 days, 180 days, 1 year, 5 years and the death of 1 year and 5 years (All Log-rank p < .05). Subgroup analysis further showed that PDGF had better predictive value for patients with age >65 years, GRACE score ≥140 and platelet count (PLT) >200 × 109/L. CONCLUSION: PDGF levels can predict short-term and long-term MACEs in NSTEMI patients after discharge, especially for patients with older age, higher GRACE score and baseline PLT > 200 × 109/L.Key messagesPDGF is a risk factor for short- and long-term MACEs in patients with STEMI.PDGF has a better prognostic value in patients with older age and PLT > 200 × 109/L.Baseline plasma PDGF levels were positively correlated with GRACE score.

Development of an immune-related gene prognostic risk model and identification of an immune infiltration signature in the tumor microenvironment of colon cancer.

BACKGROUND: Colon cancer is a common and highly malignant tumor. Its incidence is increasing rapidly with poor prognosis. At present, immunotherapy is a rapidly developing treatment for colon cancer. The aim of this study was to construct a prognostic risk model based on immune genes for early diagnosis and accurate prognostic prediction of colon cancer. METHODS: Transcriptome data and clinical data were downloaded from the cancer Genome Atlas database. Immunity genes were obtained from ImmPort database. The differentially expressed transcription factors (TFs) were obtained from Cistrome database. Differentially expressed (DE) immune genes were identified in 473 cases of colon cancer and 41 cases of normal adjacent tissues. An immune-related prognostic model of colon cancer was established and its clinical applicability was verified. Among 318 tumor-related transcription factors, differentially expressed transcription factors were finally obtained, and a regulatory network was constructed according to the up-down regulatory relationship. RESULTS: A total of 477 DE immune genes (180 up-regulated and 297 down-regulated) were detected. We developed and validated twelve immune gene models for colon cancer, including SLC10A2, FABP4, FGF2, CCL28, IGKV1-6, IGLV6-57, ESM1, UCN, UTS2, VIP, IL1RL2, NGFR. The model was proved to be an independent prognostic variable with good prognostic ability. A total of 68 DE TFs (40 up-regulated and 23 down-regulated) were obtained. The regulation network between TF and immune genes was plotted by using TF as source node and immune genes as target node. In addition, Macrophage, Myeloid Dendritic cell and CD4+ T cell increased with the increase of risk score. CONCLUSION: We developed and validated twelve immune gene models for colon cancer, including SLC10A2, FABP4, FGF2, CCL28, IGKV1-6, IGLV6-57, ESM1, UCN, UTS2, VIP, IL1RL2, NGFR. This model can be used as a tool variable to predict the prognosis of colon cancer.

Impact of off-hour admission on the MACEs of patients with acute myocardial infarction.

BACKGROUND: In China, on more than 100 weekends or holidays, only on-duty cardiologists are available during admissions. This study aimed to analyze the impact of admission time on major adverse cardiovascular events (MACEs) in patients with acute myocardial infarction (AMI). METHODS: This prospective observational study enrolled patients with AMI between October 2018 and July 2019. The patients were assorted into off-hour (admitted on weekends or national holidays) and on-hour groups. The outcome was MACEs at admission and 1 year after discharge. RESULTS: A total of 485 patients with AMI were enrolled in this study. The occurrence of MACEs was significantly higher in the off-hour group compared with the on-hour group (P < .05). Multivariate regression analysis showed that age (HR = 1.047, 95% CI: 1.021-1.073), blood glucose level (HR = 1.029, 95% CI: 1.009-1.050), multivessel disease (HR = 1.904, 95% CI: 1.074-3.375), and off-hour hospital admission (HR = 1.849, 95% CI: 1.125-3.039) were all independent risk factors for in-hospital MACEs, while percutaneous coronary intervention (HR = 0.210, 95% CI: 0.147-0.300) and on-hour admission (HR = 0.723, 95% CI: 0.532-0.984) were protective factors for MACEs 1 year after discharge. CONCLUSION: The "off-hour effect" still existed in patients with AMI, and the risk of MACEs in the hospital and 1 year after discharge was higher for off-hour admission.

Functional-structural large-scale brain networks are correlated with neurocognitive impairment in acute mild traumatic brain injury.

Background: This study was conducted to investigate topological changes in large-scale functional connectivity (FC) and structural connectivity (SC) networks in acute mild traumatic brain injury (mTBI) and determine their potential relevance to cognitive impairment. Methods: Seventy-one patients with acute mTBI (29 males, 42 females, mean age 43.54 years) from Nanjing First Hospital and 57 matched healthy controls (HC) (33 males, 24 females, mean age 46.16 years) from the local community were recruited in this prospective study. Resting-state functional magnetic resonance imaging (rs-fMRI) and diffusion tensor imaging (DTI) were acquired within 14 days (mean 3.29 days) after the onset of mTBI. Then, large-scale FC and SC networks with 116 regions from the automated anatomical labeling (AAL) brain atlas were constructed. Graph theory analysis was used to analyze global and nodal metrics. Finally, correlations were assessed between topological properties and neurocognitive performances evaluated by the Montreal Cognitive Assessment (MoCA). Bonferroni correction was performed out for multiple comparisons in all involved analyses. Results: Compared with HC, acute mTBI patients had a higher normalized clustering coefficient (γ) for FC (Cohen's d=4.076), and higher γ and small worldness (σ) for SC (Cohen's d=0.390 and Cohen's d=0.395). The mTBI group showed aberrant nodal degree (Dc), nodal efficiency (Ne), and nodal local efficiency (Nloc) for FC and aberrant Dc, nodal betweenness (Bc), nodal clustering coefficient (NCp) and Ne for SC mainly in the frontal and temporal, cerebellum, and subcortical areas. Acute mTBI patients also had higher functional-structural coupling strength at both the group and individual levels (Cohen's d=0.415). These aberrant global and nodal topological properties at functional and structural levels were associated with attention, orientation, memory, and naming performances (all P<0.05). Conclusions: Our findings suggested that large-scale FC and SC network changes, higher correlation between FC and SC and cognitive impairment can be detected in the acute stage of mTBI. These network aberrances may be a compensatory mechanism for cognitive impairment in acute mTBI patients.

DNA Nano Trihedron Exhibits an Inhibitory Effect on Breast Cancer Cells.

As a new type of nanomaterial, DNA nanomaterials show great potential in biomedical applications because of their high precision, high controllability, and high biocompatibility among other characteristics. Therapeutic drugs based on DNA nanomaterials have been shown to have beneficial therapeutic effects on a variety of diseases. The application of DNA nanomedicines in the treatment of diseases has become a rapidly developing area of study. However, the instability of DNA nanomaterials greatly limits their clinical application. Therefore, we designed and synthesized a stable topological DNA nanostructure: DNA Nano Trihedron (DNT). We demonstrated that DNT could enter MCF-7 cells without the transfection agent. In addition, DNT could induce dramatic changes in gene expression and produce significant inhibitory effects on MCF-7 cells. DNT after two months of storage still had an inhibitory effect on MCF-7 cells.

Meticulous Graded and Early Warning System of Coal Spontaneous Combustion Based on Index Gases and Characteristic Temperature.

The accurate prediction of coal spontaneous combustion (CSC) in the goaf areas of coal mines is a vital aspect of the migration from passive to active fire prevention and control. However, CSC is highly complicated and existing technologies cannot accurately monitor coal temperatures over wide expanses. Thus, it may be beneficial to assess CSC based on various index gases produced by the reactions of coal. In the present study, the CSC process was simulated by temperature-programmed experiments, and the relationships between index gas concentrations with the coal temperature were determined using logistic fitting functions. CSC was divided into seven stages, and a coal seam spontaneous ignition early warning system involving six criteria was established. Field trials demonstrated that this system is a viable approach to predicting coal seam fires and meets the requirements for the active prevention and control of coal combustion. This work establishes an early warning system based on specific theoretical guidelines that permits the identification of CSC and the implementation of active fire prevention and extinguishing measures.

Co-Gasification Synergistic Characteristics of Sewage Sludge and High-Sodium Coal.

A comprehensive study was conducted to assess the co-gasification characteristics of sewage sludge and high-sodium coal. As the gasification temperature increased, the CO2 concentration was decreased, and the concentrations of CO and H2 were increased, while the change of CH4 concentration was not obvious. As the coal blending ratio increased, the H2 and CO concentrations initially increased and then decreased, while the CO2 concentration initially decreased and then increased. The mixture of sewage sludge and high-sodium coal shows the synergistic effect of co-gasification, and the synergistic effect was to promote the gasification reaction positively. The average activation energies of co-gasification reactions were calculated by the OFW method, and the average activation energy initially decreases and then increases as the coal blending ratio increases. Both fluidized-bed gasification and thermogravimetric analyzer gasification show that the optimum coal blending ratio is 0.6. Overall, these results provide a theoretical basis for the industrial application of sewage sludge and high-sodium coal co-gasification.

Effects of Omega-3 Fatty Acids Supplementation on Serum Lipid Profile and Blood Pressure in Patients with Metabolic Syndrome: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

The purpose of this study was to explore the effect of omega-3 polyunsaturated fatty acids (n-3 PUFAs) supplementation on serum lipid profile and blood pressure in patients with metabolic syndrome. We searched PubMed, Web of Science, Embase, and the Cochrane library from database inception to 30 April 2022. This meta-analysis included eight trials with 387 participants. We found that supplementation of n-3 PUFAs has no significant reduction in TC level (SMD = -0.02; 95% CI: -0.22 ~ 0.18, I2 = 23.7%) and LDL-c level in serum (SMD = 0.18; 95% CI: -0.18 ~ 0.53, I2 = 54.9%) of patients with metabolic syndrome. Moreover, we found no significant increase in serum high-density lipoprotein cholesterol level (SMD = 0.02; 95% CI: -0.21 ~ 0.25, I2 = 0%) in patients with metabolic syndrome after consuming n-3 PUFAs. In addition, we found that n-3 PUFAs can significantly decrease serum triglyceride levels (SMD= -0.39; 95% CI: -0.59 ~ -0.18, I2 = 17.2%), systolic blood pressure (SMD = -0.54; 95% CI: -0.86 ~ -0.22, I2 = 48.6%), and diastolic blood pressure (SMD = -0.56; 95% CI: -0.79 ~ 0.33, I2 = 14.0%) in patients with metabolic syndrome. The results from the sensitivity analysis confirmed that our results were robust. These findings suggest that n-3 PUFA supplementation may serve as a potential dietary supplement for improving lipids and blood pressure in metabolic syndrome. Given the quality of the included studies, further studies are still needed to verify our findings.

Effect of Health Intervention via Web-Based Education on Improving Information-Motivation-Behavioral Skills Related to HPV Vaccination Among Chinese Female College Students.

Objectives: The human papillomavirus (HPV) vaccination rate is generally low in China. This study aimed to assess the effect of web-based education on improving information-motivation-behavior skills related to HPV vaccination among Chinese female college students. Methods: From February to May 2020, female students were recruited from a university and divided into intervention and control groups. The intervention group received 7 days of HPV-related web-based education. Related information were collected using questionnaires in the baseline, 7 days, 1 month, and 3 months after the intervention. Chi-square test and repeated ANOVA were used to compare the differences between the two groups in the four surveys. Results: A total of 449 students (235 in the intervention and 214 in the control group) were included in the analysis. There were no statistical differences in demographic information between the two groups. Compared with the control group, students in the intervention group showed a richer knowledge and subjective norms of HPV vaccination (p < 0.05). Conclusion: The study provides preliminary support for a health intervention via web-based education in increasing HPV vaccination information among female college students.

Computer-aided discovery of potent broad-spectrum vaccine adjuvants.

Adjuvants stimulate the immune system to vigorously respond to a vaccine. While current adjuvants such as aluminum salts and oil-in-water emulsions have been used for decades, they do not generate broad and long-lasting responses in many vaccines. Consequently, more potent adjuvants are needed. Here, using computer-aided molecule design and machine learning, we discovered 2 new, broad-spectrum adjuvants that can boost vaccine responses. Our library containing 46 toll-like receptor (TLR)-targeting agonist ligands were assembled on Au nanoparticles. Comprehensive in vitro, ex vivo and in vivo studies showed both leads promoted dendritic cell activation via multiple TLRs and enhanced antigen presentation to T cells. When used together with tumor-specific antigens to immunize mice against B16-OVA melanoma and 4T1-PD1 breast cancer, both adjuvants unleashed strong immune responses that suppressed tumor growth and lung metastases. Our results show computer-aided design and screening can rapidly uncover potent adjuvants for tackling waning immunity in current vaccines.

Efficient removal of hexavalent chromium from water by Bacillus sp. Y2-7 with production of extracellular polymeric substances.

Bioremediation is an environmentally friendly technology for the treatment of chromium-contaminated sites. Here, a hexavalent chromium [Cr(VI)]-resistant strain was isolated from oil-contaminated soil and designated as Bacillus sp. Y2-7 based on 16S rDNA sequence characterization. The effects of various factors including inoculation dose, pH value, glucose concentration, and temperature on Cr(VI) removal rates were then evaluated. Based on the response surface methodology, optimal Cr(VI) removal efficiency (above 90%) could be achieved at an initial Cr(VI) concentration of 155.0 mg·L-1, glucose concentration of 11.479 g·L-1, and pH of 7.1. The potential removal mechanisms of Cr(VI) by strain Y2-7 were also supposed. The contents of polysaccharide and protein in extracellular polymer (EPS) of strain Y2-7 decreased slowly after cultured with Cr(VI) of 15 mg·L-1 from 1 to 7 days. We thus inferred that EPS bonded with Cr(VI) and underwent morphological changes in water. Molecular operating environment (MOE) analysis suggested that macromolecular protein complexes in Bacillus sp. Y2-7 and hexavalent chromium could establish hydrogen bonds. Collectively, our findings indicate that Bacillus sp. Y2-7 is an excellent bacterial candidate for chromium bioremediation.

Increased serum levels of sCD40L were associated with rapidly progressive interstitial lung disease in idiopathic inflammatory myopathies.

OBJECTIVES: Whether coagulopathy exists in development of idiopathic inflammatory myopathies associated rapidly progressive interstitial lung disease (IIMs-RPILD) is unclear. In this study, we aimed to investigate soluble CD40 ligand and D-dimer levels in RPILD patients. METHODS: Patients with IIMs-ILD were enrolled and classified as RPILD and stable-ILD group. Clinical data, laboratory examinations including coagulation-associated parameters and the myositis antibodies status, chest high-resolution computed tomography (HRCT) findings and treatment regimens were collected and serum levels of sCD40L were detected by ELISA. Univariable and adjusted multivariable cox regression were performed to identify risk factors for 6-month mortality, and further to select predictors for establishing predictive model for RPILD. RESULTS: Eighty patients with IIMs-ILD were enrolled and 34 of them were diagnosed as RPILD while 46 as stable-ILD. Multivariable cox regression showed that albumin<32.4 g/L and sCD40L<1658.55 pg/ml were independent risk factors of short-term mortality in RPILD. A SMAD model consisting of serum sCD40L>1054 pg/ml, anti-MDA5 positivity, albumin<32.4 g/L and D-dimer>0.865 mg/L were generated. The odds for RPILD with SMAD score of 0, 1, 2, 3 and 4 were 0, 26.9%, 66.7%, 91.7% and 100%. The 6-month survival stratified by mild (SMAD score 0), moderate (SMAD score 1 and 2) and severe group (SMAD score 3 and 4) were 100%, 79.5% and 20%, respectively. CONCLUSIONS: We established a predictive model for IIMs-RPILD, which provided a clue that coagulopathy might exist in IIMs-RPILD and could help to better treat patients with RPILD. This model awaits further validations.

Application of Machine Learning to Metabolomic Profile Characterization in Glioblastoma Patients Undergoing Concurrent Chemoradiation.

We here characterize changes in metabolite patterns in glioblastoma patients undergoing surgery and concurrent chemoradiation using machine learning (ML) algorithms to characterize metabolic changes during different stages of the treatment protocol. We examined 105 plasma specimens (before surgery, 2 days after surgical resection, before starting concurrent chemoradiation, and immediately after chemoradiation) from 36 patients with isocitrate dehydrogenase (IDH) wildtype glioblastoma. Untargeted GC-TOF mass spectrometry-based metabolomics was used given its superiority in identifying and quantitating small metabolites; this yielded 157 structurally identified metabolites. Using Multinomial Logistic Regression (MLR) and GradientBoostingClassifier (GB Classifier), ML models classified specimens based on metabolic changes. The classification performance of these models was evaluated using performance metrics and area under the curve (AUC) scores. Comparing post-radiation to pre-radiation showed increased levels of 15 metabolites: glycine, serine, threonine, oxoproline, 6-deoxyglucose, gluconic acid, glycerol-alpha-phosphate, ethanolamine, propyleneglycol, triethanolamine, xylitol, succinic acid, arachidonic acid, linoleic acid, and fumaric acid. After chemoradiation, a significant decrease was detected in 3-aminopiperidine 2,6-dione. An MLR classification of the treatment phases was performed with 78% accuracy and 75% precision (AUC = 0.89). The alternative GB Classifier algorithm achieved 75% accuracy and 77% precision (AUC = 0.91). Finally, we investigated specific patterns for metabolite changes in highly correlated metabolites. We identified metabolites with characteristic changing patterns between pre-surgery and post-surgery and post-radiation samples. To the best of our knowledge, this is the first study to describe blood metabolic signatures using ML algorithms during different treatment phases in patients with glioblastoma. A larger study is needed to validate the results and the potential application of this algorithm for the characterization of treatment responses.

Size-Induced Ferroelectricity in Antiferroelectric Oxide Membranes.

Despite extensive studies on size effects in ferroelectrics, how structures and properties evolve in antiferroelectrics with reduced dimensions still remains elusive. Given the enormous potential of utilizing antiferroelectrics for high-energy-density storage applications, understanding their size effects will provide key information for optimizing device performances at small scales. Here, the fundamental intrinsic size dependence of antiferroelectricity in lead-free NaNbO3 membranes is investigated. Via a wide range of experimental and theoretical approaches, an intriguing antiferroelectric-to-ferroelectric transition upon reducing membrane thickness is probed. This size effect leads to a ferroelectric single-phase below 40 nm, as well as a mixed-phase state with ferroelectric and antiferroelectric orders coexisting above this critical thickness. Furthermore, it is shown that the antiferroelectric and ferroelectric orders are electrically switchable. First-principle calculations further reveal that the observed transition is driven by the structural distortion arising from the membrane surface. This work provides direct experimental evidence for intrinsic size-driven scaling in antiferroelectrics and demonstrates enormous potential of utilizing size effects to drive emergent properties in environmentally benign lead-free oxides with the membrane platform.