Progression of Bone Marrow Lesions and the Development of Knee Osteoarthritis: Osteoarthritis Initiative Data.

Background Bone marrow lesions (BMLs) are a known risk factor for incident knee osteoarthritis (OA), and deep learning (DL) methods can assist in automated segmentation and risk prediction. Purpose To develop and validate a DL model for quantifying tibiofemoral BML volume on MRI scans in knees without radiographic OA and to assess the association between longitudinal BML changes and incident knee OA. Materials and Methods This retrospective study included knee MRI scans from the Osteoarthritis Initiative prospective cohort (February 2004-October 2015). The DL model, developed between August and October 2023, segmented the tibiofemoral joint into 10 subregions and measured BML volume in each subregion. Baseline and 4-year follow-up MRI scans were analyzed. Knees without OA at baseline were categorized into three groups based on 4-year BML volume changes: BML-free, BML regression, and BML progression. The risk of developing radiographic and symptomatic OA over 9 years was compared among these groups. Results Included were 3869 non-OA knees in 2430 participants (mean age, 59.5 years ± 9.0 [SD]; female-to-male ratio, 1.3:1). At 4-year follow-up, 2216 knees remained BML-free, 1106 showed an increase in BML volume, and 547 showed a decrease in BML volume. BML progression was associated with a higher risk of developing radiographic knee OA compared with remaining BML-free (hazard ratio [HR] = 3.0; P < .001) or BML regression (HR = 2.0; P < .001). Knees with BML progression also had a higher risk of developing symptomatic OA compared with BML-free knees (HR = 1.3; P < .001). Larger volume changes in BML progression were associated with a higher risk of developing both radiographic OA (HR = 2.0; P < .001) and symptomatic OA (HR = 1.7; P < .001). In almost all subchondral plates, especially the medial femur and tibia, BML progression was associated with a higher risk of developing both radiographic and symptomatic OA compared with remaining BML-free. Conclusion Knees with BML progression, according to subregion and extent of volume changes, were associated with an increased risk of OA compared with BML-free knees and knees with BML regression, highlighting the potential utility of monitoring BML volume changes in evaluating interventions to prevent OA development. ClinicalTrials.gov Identifier: NCT00080171 © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Said and Sakly in this issue.

Erosive hand osteoarthritis and sarcopenia: data from Osteoarthritis Initiative cohort.

OBJECTIVES: There is no evidence linking specific osteoarthritis (OA) types, such as erosive hand OA (EHOA), with distant generalised changes in muscle composition (sarcopenia), which can potentially be modified. This study pioneers the exploration of the association between EHOA and sarcopenia, both of which are predominantly observed in the older adults. METHODS: Using the Osteoarthritis Initiative cohort, we selected hand OA (modified Kellgren and Lawrence (grade ≥2 in ≥1 hand joint) participants with radiographic central erosions in ≥1 joints (EHOA group) and propensity score-matched hand OA participants with no erosion (non-EHOA group). MRI biomarkers of thigh muscles were measured at baseline, year 2 and year 4 using a validated deep-learning algorithm. To adjust for 'local' effects of coexisting knee OA (KOA), participants were further stratified according to presence of radiographic KOA. The outcomes were the differences between EHOA and non-EHOA groups in the 4-year rate of change for both intramuscular adipose tissue (intra-MAT) deposition and contractile (non-fat) area of thigh muscles. RESULTS: After adjusting for potential confounders, 844 thighs were included (211 EHOA:633 non-EHOA; 67.1±7.5 years, female/male:2.9). Multilevel mixed-effect regression models showed that EHOA is associated a different 4-year rate of change in intra-MAT deposition (estimate, 95% CI: 71.5 mm2/4 years, 27.9 to 115.1) and contractile area (estimate, 95% CI: -1.8%/4 years, -2.6 to -1.0) of the Quadriceps. Stratified analyses showed that EHOA presence is associated with adverse changes in thigh muscle quality only in participants without KOA. CONCLUSIONS: EHOA is associated with longitudinal worsening of thigh muscle composition only in participants without concomitant KOA. Further research is needed to understand the systemic factors linking EHOA and sarcopenia, which unlike EHOA is modifiable through specific interventions.

Thigh muscle composition changes in knee osteoarthritis patients during weight loss: Sex-specific analysis using data from osteoarthritis initiative.

OBJECTIVES: Sex of patients with knee osteoarthritis (KOA) may impact changes in thigh muscle composition during weight loss, the most well-known disease-modifying intervention. We investigated longitudinal sex-based changes in thigh muscle quality during weight loss in participants with KOA. METHODS: Using Osteoarthritis Initiative (OAI) cohort data, we included females and males with baseline radiographic KOA who experienced > 5 % reduction in Body Mass Index (BMI) over four years. Using a previously validated deep-learning algorithm, we measured Magnetic Resonance Imaging (MRI)-derived biomarkers of thigh muscles at baseline and year-4. Outcomes were the intra- and inter-muscular adipose tissue (Intra-MAT and Inter-MAT) and contractile percentage of thigh muscles between females and males. The analysis adjusted for potential confounders, such as demographics, risk factors, BMI change, physical activity, diet, and KOA status. RESULTS: A retrospective selection of available thigh MRIs from KOA participants who also had a 4-year weight loss (>5 % of BMI) yielded a sample comprising 313 thighs (192 females and 121 males). Female and male participants exhibited a comparable degree of weight loss (females: -9.72 ± 4.38, males: -8.83 ± 3.64, P-value=0.060). However, the changes in thigh muscle quality were less beneficial for females compared to males, as shown by a less degree of longitudinal decrease in Intra-MAT (change difference,95 %CI: 783.44 mm2/4-year, 505.70 to 1061.19, P-value<0.001) and longitudinal increase in contractile percentage (change difference,95 %CI: -3.9 %/4-year, -6.5 to -1.4, P-value=0.019). CONCLUSIONS: In participants with KOA and 4-year weight loss, the longitudinal changes in thigh muscle quality were overall beneficial but to a less degree in females compared to males. Further research is warranted to investigate the underlying mechanisms and develop sex-specific interventions to optimize muscle quality during weight loss.

3D printed microfluidic valve on PCB for flow control applications using liquid metal.

Direct 3D printing of active microfluidic elements on PCB substrates enables high-speed fabrication of stand-alone microdevices for a variety of health and energy applications. Microvalves are key components of microfluidic devices and liquid metal (LM) microvalves exhibit promising flow control in microsystems integrated with PCBs. In this paper, we demonstrate LM microvalves directly 3D printed on PCB using advanced digital light processing (DLP). Electrodes on PCB are coated by carbon ink to prevent alloying between gallium-based LM plug and copper electrodes. We used DLP 3D printers with in-house developed acrylic-based resins, Isobornyl Acrylate, and Diurethane Dimethacrylate (DUDMA) and functionalized PCB surface with acrylic-based resin for strong bonding. Valving seats are printed in a 3D caterpillar geometry with chamber diameter of 700 µm. We successfully printed channels and nozzles down to 90 µm. Aiming for microvalves for low-power applications, we applied square-wave voltage of 2 Vpp at a range of frequencies between 5 to 35 Hz. The results show precise control of the bistable valving mechanism based on electrochemical actuation of LMs.

Tungsten Oxide Coated Liquid Metal Electrodes via Galvanic Replacement as Heavy Metal Ion Sensors.

Gallium liquid metals (LMs) like Galinstan and eutectic Gallium-Indium (EGaIn) have seen increasing applications in heavy metal ion (HMI) sensing, because of their ability to amalgamate with HMIs like lead, their high hydrogen potential, and their stable electrochemical window. Furthermore, coating LM droplets with nanopowders of tungsten oxide (WO) has shown enhancement in HMI sensing owing to intense electrical fields at the nanopowder-liquid-metal interface. However, most LM HMI sensors are droplet based, which show limitations in scalability and the homogeneity of the surface. A scalable approach that can be extended to LM electrodes is therefore highly desirable. In this work, we present, for the first time, WO-Galinstan HMI sensors fabricated via photolithography of a negative cavity, Galinstan brushing inside the cavity, lift-off, and galvanic replacement (GR) in a tungsten salt solution. Successful GR of Galinstan was verified using optical microscopy, SEM, EDX, XPS, and surface roughness measurements of the Galinstan electrodes. The fabricated WO-Galinstan electrodes demonstrated enhanced sensitivity in comparison with electrodes structured from pure Galinstan and detected lead at concentrations down to 0.1 mmol·L-1. This work paves the way for a new class of HMI sensors using GR of WO-Galinstan electrodes, with applications in microfluidics and MEMS for a toxic-free environment.

Musculoskeletal CT Imaging: State-of-the-Art Advancements and Future Directions.

CT is one of the most widely used modalities for musculoskeletal imaging. Recent advancements in the field include the introduction of four-dimensional CT, which captures a CT image during motion; cone-beam CT, which uses flat-panel detectors to capture the lower extremities in weight-bearing mode; and dual-energy CT, which operates at two different x-ray potentials to improve the contrast resolution to facilitate the assessment of tissue material compositions such as tophaceous gout deposits and bone marrow edema. Most recently, photon-counting CT (PCCT) has been introduced. PCCT is a technique that uses photon-counting detectors to produce an image with higher spatial and contrast resolution than conventional multidetector CT systems. In addition, postprocessing techniques such as three-dimensional printing and cinematic rendering have used CT data to improve the generation of both physical and digital anatomic models. Last, advancements in the application of artificial intelligence to CT imaging have enabled the automatic evaluation of musculoskeletal pathologies. In this review, the authors discuss the current state of the above CT technologies, their respective advantages and disadvantages, and their projected future directions for various musculoskeletal applications.

Immunomodulatory effects of Isochrysis galbana incorporated diet on Oreochromis sp. (red hybrid tilapia) via Sera-1H NMR metabolomics study.

Tilapia is one of the most common fish species that is intensively produced all over the world. However, significant measures at improving aquaculture health must be taken since disease outbreaks are often encountered in the rapidly developing aquaculture industry. Therefore, the objective of the study was designed to evaluate the metabolite changes in tilapia' sera through 1H NMR metabolomics in identifying the potential biomarkers responsible for immunomodulatory effect by the indigenous species of Malaysian microalgae Isochrysis galbana (IG). The results showed that IG-incorporated diet mainly at 5.0% has improved the immune response of innate immunity as observed in serum bactericidal activity (SBA) and serum lysozyme activity (SLA). The orthogonal partial least squares (OPLS) analysis indicated 5 important metabolites significantly upregulated namely as ethanol, lipoprotein, lipid, α-glucose and unsaturated fatty acid (UFA) in the 5.0% IG-incorporated diet compared to control. In conclusion, this study had successfully determined IG in improving aquaculture health through its potential use as an immune modulator. This work also demonstrated the effective use of metabolomics approach in the development of alternative nutritious diet from microalgae species to boost fish health in fulfilling the aquaculture's long-term goals.

Echocardiography- versus intracardiac electrocardiogram-based optimization of cardiac resynchronization therapy: A systematic review.

OBJECTIVE: This systematic review aimed to evaluate the performance of echocardiography-based programming in comparison with the intracardiac electrocardiogram (IEGM)-based method for the optimization of cardiac resynchronization therapy (CRT). METHODS: A literature review was conducted using digital databases to systematically identify the studies reporting CRT optimization through echocardiography compared with IEGM. Detailed patient-level study characteristics including the type of study, sample size, therapy, the New York Heart Classification (NYHA) status, lead placement, and other parameters were abstracted. Finally, postprogramming outcomes were extracted for each article. RESULTS: In a total of 11 studies, 919 patients were recruited for the final analysis. Overall, 692 (75.29%) were males. The mean duration of the QRS complex in our study population ranged from 145.2 ± 21.8 ms to 183 ± 19.9 ms. There was an equal improvement in the NYHA class between the two methods while the left ventricular ejection fraction (LVEF) demonstrated an improvement by IEGM. Many studies supported IEGM to increase the 6-minute walk test and left ventricular outflow tract velocity time interval (LVOT VTI) when compared to echocardiography. The mean time for echocardiography-based optimization was 60.15 min while that of IEGM-based optimization was 6.65 min. CONCLUSION: IEGM is an alternative method for CRT optimization in improving the NYHA class, LVEF, and LVOT VTI, and is less time-consuming when compared to the echocardiography-based methods.

Subchondral bone in knee osteoarthritis: bystander or treatment target?

The subchondral bone is an important structural component of the knee joint relevant for osteoarthritis (OA) incidence and progression once disease is established. Experimental studies have demonstrated that subchondral bone changes are not simply the result of altered biomechanics, i.e., pathologic loading. In fact, subchondral bone alterations have an impact on joint homeostasis leading to articular cartilage loss already early in the disease process. This narrative review aims to summarize the available and emerging imaging techniques used to evaluate knee OA-related subchondral bone changes and their potential role in clinical trials of disease-modifying OA drugs (DMOADs). Radiographic fractal signature analysis has been used to quantify OA-associated changes in subchondral texture and integrity. Cross-sectional modalities such as cone-beam computed tomography (CT), contrast-enhanced cone beam CT, and micro-CT can also provide high-resolution imaging of the subchondral trabecular morphometry. Magnetic resonance imaging (MRI) has been the most commonly used advanced imaging modality to evaluate OA-related subchondral bone changes such as bone marrow lesions and altered trabecular bone texture. Dual-energy X-ray absorptiometry can provide insight into OA-related changes in periarticular subchondral bone mineral density. Positron emission tomography, using physiological biomarkers of subchondral bone regeneration, has provided additional insight into OA pathogenesis. Finally, artificial intelligence algorithms have been developed to automate some of the above subchondral bone measurements. This paper will particularly focus on semiquantitative methods for assessing bone marrow lesions and their utility in identifying subjects at risk of symptomatic and structural OA progression, and evaluating treatment responses in DMOAD clinical trials.

Impact of immune status on the clinical characteristics, treatment outcomes and mortality of pulmonary nocardiosis: a retrospective analysis in a tertiary care hospital from a low to middle-income country.

Nocardiosis is an opportunistic infection that primarily targets the immunosuppressed. We investigate the differences in demographics and characteristics between immunosuppressed and immunocompetent patients with nocardiosis in a tertiary care hospital in Pakistan. Retrospective records were reviewed for patients diagnosed with pulmonary nocardiosis between 2010 and 2020. Immunosuppressed individuals were identified as those with autoimmune diseases, hematologic diseases and malignancies, HIV, immunosuppressant therapy, etc. Data collected included basic demographics, comorbid conditions, medication history, clinical presentation, radiological and microbiological data, and nocardiosis outcomes and complications. A total of 66 patients with nocardiosis were included in this study out of which 48 were immunosuppressed while 18 were immunocompetent. Both groups were compared for a number of variables including patient characteristics, underlying conditions, radiological findings, treatment regimen and outcomes. Immunosuppressed individuals were younger, and had higher rates of diabetes, chronic renal disease, chronic liver disease, higher platelet counts, surgical intervention, and longer hospital stays. Fever, dyspnea, and sputum production were the most common presentations. Nocardia asteroides was found to be the most common species of Nocardia overall. Nocardiosis presents differently in patients with immunosuppressed and immunocompetent patients consistent with previous studies. Nocardiosis should be considered in any patient presenting with treatment-resistant pulmonary or neurological symptoms.

Nutritional value of commercial broiler feed supplemented with olive mill waste fermented with probiotic Rhizopus oryzae strains.

AIMS: The changes in chemical composition and metabolizable energy (ME) of both olive mill waste (OMW) upon fermentation by three potential probiotic Rhizopus oryzae strains and commercial feed (CF) upon its supplementation by fermented olive mill waste (FOMW) were investigated. The objective was to test whether there will be an enhancement in the nutritional value of OMW after fermentation and/or commercial broiler feed upon supplementation by potentially probiotic filamentous fungi. METHODS AND RESULTS: A three Rhizopus oryzae strains (92/1, 236/2 and 284) isolated from agricultural soil that were proven to have good probiotic properties (non-toxic, antimicrobial activity, antioxidant capacity and gastrointestinal tolerance) were used to ferment OMW, then the chemical composition was analysed after 7 and 14 days of fermentation. The FOMW with the R. oryzae 284 strain, which gave the best results, was added to a commercial broiler feed at 20%, 30% and 40% supplementation ratios. Then proximal analyses were done to compare non-supplemented with supplemented CF. Chemical analyses included dry weight, crude protein, crude fats, crude fibres, crude ash, sugars and starch, and then ME was calculated from the given values. CONCLUSIONS: Compared to non-fermented OMW, the best results were obtained by the R. oryzae 284 strain allowing an increase in crude protein content by 23.4% after 7 days of fermentation, a decrease in crude fibre content by 9.8% after 14 days of fermentation and an increase in ME by 3.6% after 7 days of fermentation. Compared to non-supplemented CF, the ME changes of 20%, 30% and 40% supplementation increased by 8.38%, 2.83% and decreased by 4.27%, respectively. SIGNIFICANCE AND IMPACT OF THE STUDY: FOMW can be incorporated into broiler feed rations until 30% without causing any decrease in metabolizable energy. It can be a cheaper alternative with promising productivity and chicken health improvements.

Functional properties of Rhizopus oryzae strains isolated from agricultural soils as a potential probiotic for broiler feed fermentation.

The most crucial and expensive fragment in the broiler chicken production industry is the feed. Because of the rising demand, finding a cheap and effective feed is an urgent necessity. Fermentation of broiler feed by probiotic fungal starters can enhance the nutrient's availability and digestibility while preventing pathogenic growth. In this study different Rhizopus spp. have been isolated from agricultural soils around Izmir, Turkey, and tested for their probiotic potential and fermentative capacity. The isolated Rhizopus strains first underwent microscopical fluorescent investigation to exclude endofungal bacterial presence, then, those without endofungal bacteria (totally 82) were tested for antimicrobial activity counter bacterial and fungal pathogens. The ones with wide-spectrum antimicrobial activity (totally 10) were tested for gastrointestinal tolerance and antioxidant ability. Upon phenotypic and genotypic identification, the 10 isolates were found to belong to Rhizopus oryzae species. While all 10 strains showed variable gastrointestinal tolerance and antioxidant activities, three of them (92/1, 236/2, and 284) had relatively high antioxidant activity. Upon fermentative capacity assay, compared to unfermented commercial feed, there was a general decrease in crude fiber content by 56% after fermentation by 92/1 isolate for 4 days and 236/2 isolate for 2 days. The highest increase in crude protein content (by 14.5%) occurred after a 4-day fermentation period by 236/2 isolate. The highest increase in metabolizable energy was 8.64%, by the 284 isolate after 2 days of fermentation. In conclusion, the three strains showed good probiotic properties and fermentative capacities hence can be beneficial for the poultry industry.

Sarcoidosis: An experience from a tertiary care center in Karachi Pakistan.

OBJECTIVE: To assess the demographic and clinical characteristics and treatment of patients with sarcoidosis in tertiary care settings. METHODS: The descriptive retrospective study was conducted at the Aga Khan University Hospital, Karachi, and comprised data from 2017 to 2019 of patients with established diagnosis of sarcoidosis. Data was collected on a predesigned proforma and it was analysed using SPSS 23. RESULTS: Of the 974 patients evaluated, sarcoidosis was established in 108(11.1%); 58(53.7%) of them being females. The overall mean age was 50.9±12.9 years. Hypertension 49(45.4%) and diabetes mellitus 37(34.3%) were the most frequent co-morbidities. Extra-pulmonary manifestations were found in 27(25%) patients; ophthalmic 9(33.3%), musculoskeletal 8(29.6%) and skin 7(25.9%). Prednisolone was the mainstay of treatment in 93(86.1%) patients. CONCLUSIONS: Sarcoidosis was not found to be rare in Pakistan.

Complementary Analytical Platforms of NMR Spectroscopy and LCMS Analysis in the Metabolite Profiling of Isochrysis galbana.

This study was designed to profile the metabolites of Isochrysis galbana, an indigenous and less explored microalgae species. 1H Nuclear Magnetic Resonance (NMR) spectroscopy and Liquid Chromatography-Mass Spectrometry (LCMS) were used to establish the metabolite profiles of five different extracts of this microalga, which are hexane (Hex), ethyl acetate (EtOAc), absolute ethanol (EtOH), EtOH:water 1:1 (AqE), and 100% water (Aq). Partial least square discriminant analysis (PLS-DA) of the generated profiles revealed that EtOAc and Aq extracts contain a diverse range of metabolites as compared to the other extracts with a total of twenty-one metabolites, comprising carotenoids, polyunsaturated fatty acids, and amino acids, that were putatively identified from the NMR spectra. Meanwhile, thirty-two metabolites were successfully annotated from the LCMS/MS data, ten of which (palmitic acid, oleic acid, α-linolenic acid, arachidic acid, cholesterol, DHA, DPA, fucoxanthin, astaxanthin, and pheophytin) were similar to those present in the NMR profile. Another eleven glycerophospholipids were discovered using MS/MS-based molecular network (MN) platform. The results of this study, besides providing a better understanding of I.galbana's chemical make-up, will be of importance in exploring this species potential as a feed ingredient in the aquaculture industry.

Comprehensive GCMS and LC-MS/MS Metabolite Profiling of Chlorella vulgaris.

The commercial cultivation of microalgae began in the 1960s and Chlorella was one of the first target organisms. The species has long been considered a potential source of renewable energy, an alternative for phytoremediation, and more recently, as a growth and immune stimulant. However, Chlorella vulgaris, which is one of the most studied microalga, has never been comprehensively profiled chemically. In the present study, comprehensive profiling of the Chlorella vulgaris metabolome grown under normal culture conditions was carried out, employing tandem LC-MS/MS to profile the ethanolic extract and GC-MS for fatty acid analysis. The fatty acid profile of C. vulgaris was shown to be rich in omega-6, -7, -9, and -13 fatty acids, with omega-6 being the highest, representing more than sixty percent (>60%) of the total fatty acids. This is a clear indication that this species of Chlorella could serve as a good source of nutrition when incorporated in diets. The profile also showed that the main fatty acid composition was that of C16-C18 (>92%), suggesting that it might be a potential candidate for biodiesel production. LC-MS/MS analysis revealed carotenoid constituents comprising violaxanthin, neoxanthin, lutein, ß-carotene, vulgaxanthin I, astaxanthin, and antheraxanthin, along with other pigments such as the chlorophylls. In addition to these, amino acids, vitamins, and simple sugars were also profiled, and through mass spectrometry-based molecular networking, 48 phospholipids were putatively identified.

Islam and Motivation to Quit Smoking: Public Health Policy Implications.

In the WHO Eastern Mediterranean Regional Office some 14 years ago, a 'religiously inspired approach' was proposed to combat tobacco use. This promoted a useful debate in the region. The purpose of this paper is to argue the need to identify the role which Islamic beliefs and teachings play (1) in influencing individual motivation to quit smoking and (2) in gaining support for public policies to reduce smoking. Ramadan and Hajj are taken as key points. These, it is argued, are times when Muslim religious motivation to abstain from smoking is strongest. This paper concludes that there is an insufficient evidence base on which to adopt a religiously inspired approach. All of civil society, including religious Muslim authorities, should rather supplement the efforts of health professionals to encourage smoking cessation.

Evolutionary analysis of seasonal influenza A viruses in Pakistan 2020-2023.

INTRODUCTION: Influenza A viruses cause global health concerns due to their high amino acid substitution rates. They are linked to yearly seasonal epidemics and occasional pandemics. This study focused on sequencing influenza A virus strains in Pakistan. MATERIALS AND METHODS: We analyzed the genetic characteristics of influenza A(H1N1)pdm09 and A(H3N2) viruses circulating in Pakistan from January 2020 to January 2023. Whole genome sequences from influenza A (n = 126) virus isolates were amplified and sequenced by the Oxford Nanopore (MinION) platform. RESULTS: The HA genes of influenza A(H1N1)pdm09 underwent amino acid substitutions at positions K54Q, A186T, Q189E, E224A, R259K, and K308R in sequenced samples. The HA genes of influenza A(H3N2) had amino acid substitutions at G53D, E83K, D104G, I140M, S205F, A212T, and K276R in the sequenced samples. Furthermore, the HA gene sequences of influenza A(H1N1)pdm09 in this study belonged to subclade 6B.1A.5a.2a. Similarly, the HA gene sequences of influenza A(H3N2) were classified under six subclades (3C.3a.1 and 3C.2a1b.2a [2, 2a.1, 2b, 2c, and 2a.3b]). Notably, amino acid substitutions in other gene segments of influenza A(H1N1)pdm09 and A(H3N2) were also found. CONCLUSION: These findings indicate influenza A(H1N1)pdm09 and A(H3N2) viruses co-circulated during the 2020-2023 influenza season in Pakistan. Continued surveillance is crucial for real-time monitoring of possible high-virulence variation and their relevance to existing vaccine strains.

External Quality Assessment Program for SARS-COV-2 Molecular Detection in Pakistan.

INTRODUCTION: Amid coronavirus disease 2019 (COVID-19) pandemic, accurate detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is critical for diagnosis management and breaking down transmission chains. We designed a national external quality assessment panel (EQAP) for SARS-CoV-2 molecular detection comprising working laboratories nationwide. METHODS: A molecular diagnostic EQA panel that consists of five samples for SARS CoV-2 testing was distributed to 141 public and private sector laboratories across country. These samples contain different concentrations of SARS-CoV-2 to evaluate the sensitivity of commercial kits available. RESULTS: Sensitivity among public and private sector laboratories was variable, particularly lower SARS-CoV-2 concentrations significantly increased the risk of false-negative tests, whereas Ct values of accurately tested SARS-CoV-2 specimens increased as concentration decreased. These findings highlighted that performance of used commercial kits was not significantly correlated to various extraction or PCR methods. CONCLUSION: This study highlights the need for a national external quality assessment panel (EQAP) in the country to improve the quality of the healthcare system while ensuring the accuracy and reliability of results. Furthermore, EQAPs can help laboratories meet accreditation and regulatory requirements. However, continued participation in EQAP is recommended for quality enhancement of laboratories.

In Situ Actuators with Gallium Liquid Metal Alloys and Polypyrrole-Coated Electrodes.

Gallium liquid metal alloys (GLMAs) such as Galinstan and gallium-indium eutectic (EGaIn) are interesting materials due to their high surface tensions, low viscosities, and electrical conductivities comparable to classical solid metals. They have been used for applications in microelectromechanical systems (MEMS) and, more recently, liquid metal microfluidics (LMMF) for setting up devices like actuators. However, their high tendency to alloy with the most common metals used for electrodes such as gold (Au), platinum (Pt), titanium (Ti), nickel (Ni), and tungsten-titanium (WTi) is a major problem limiting the scaleup and applicability, e.g., liquid metal actuators. Stable electrodes are key elements for many applications and thus, the lack of an electrode material compatible with GLMAs is detrimental for many potential application scenarios. In this work, we study the effect of actuating Galinstan on various solid metal electrodes and present an electrode protection methodology that, first, prevents alloying and, second, prevents electrode corrosion. We demonstrate reproducible actuation of GLMA segments in LMMF, showcasing the stability of the proposed protective coating. We investigated a range of electrode materials including Au, Pt, Ti, Ni, and WTi, all in aqueous environments, and present the resulting corrosion/alloying effects by studying the interface morphology. Our proposed protective coating is based on a simple method to electrodeposit electrically conductive polypyrrole (PPy) on the electrodes to provide a conductive alloying-barrier layer for applications involving direct contact between GLMAs and electrodes. We demonstrate the versatility of this approach by direct three-dimensional (3D) printing of a 500 µm microfluidic chip on a set of electrodes onto which PPy is electrodeposited in situ for actuation of Galinstan plugs. The developed protection protocol will provide a generic, widely applicable strategy to protect a wide range of electrodes from alloying and corrosion and thus form a key element in future applications of GLMAs.

4D Printed Shape-Memory Elastomer for Thermally Programmable Soft Actuators.

Polymeric shape-memory elastomers can recover to a permeant shape from any programmed deformation under external stimuli. They are mostly cross-linked polymeric materials and can be shaped by three-dimensional (3D) printing. However, 3D printed shape-memory polymers so far only exhibit elasticity above their transition temperature, which results in their programmed shape being inelastic or brittle at lower temperatures. To date, 3D printed shape-memory elastomers with elasticity both below and above their transition temperature remain an elusive goal, which limits the application of shape-memory materials as elastic materials at low temperatures. In this paper, we printed, for the first time, a custom-developed shape-memory elastomer based on polyethylene glycol using digital light processing, which possesses elasticity and stretchability in a wide temperature range, below and above the transition temperature. Young's modulus in these two states can vary significantly, with a difference of up to 2 orders of magnitude. This marked difference in Young's modulus imparts excellent shape-memory properties to the material. The difference in Young's modulus at different temperatures allows for the programming of the pneumatic actuators by heating and softening specific areas. Consequently, a single actuator can exhibit distinct movement modes based on the programming process it undergoes.